Clinical Clerkship is the necessary stage from theory to clinical practice,As teaching hospital of Nanjing Medical University.we explore various kinds of methods of clinical practice quality improvement by emphasizing practice training,developing multiform teaching activities,highhghting autonomic learning and strengthening intemship management.

Objective To explore the characteristics and clinical significance of CD+4 CD+25 Regulatory T lymphocytes and T cell subsets in peripheral blood and malignant pleural effusion from lung cancer patients. Methods Flow cytometry was used to detect the percentage of CD+4 CD+25 regulatory T cells and T cell subsets in peripheral blood from 68 lung cancer patients and 56 healthy persons, and in pleural effusion from 32 lung cancer patients with malignant effusion. Results T lymphocyte subsets in peripheral blood of lung cancer patients in different periods were expressed differently. The percentage of CD+4 CD+25 regulatory T cells in peripheral blood were (19.52±3.32)%, (27.28±8.26)% and (32.31±15.60)% in Ⅰ+Ⅱ, Ⅲ and Ⅳ period lung cancer patients, respectively, and were higher than that of healthy volunteers (11.12±3.32) % (t =31.0040, -7.9688, -4.9770, P ＜0.05). In the lung cancer patients with malignant effusion, the percentage of CD+4 CD+25 regulatory T cells in the pleural effusion was higher than that in the peripheral blood [(34.12±18.63) % vs (26.36± 16.25)%, t =21.164, P＜0.05]. In the lung cancer patients with malignant effusion ,the percentages of CD+4 in peripheral blood and pleural effusion were (25.32±13.45) % and (34.68±12.34) %, were lower than that in healthy volunteers (t =7.3104, 4.8818, P＜0.05), the percentages of CD+56 were (8.24±7.38) % and(11.23± 7.65) %, CD+4/CD+8 were (1.02±0.56) % and (1.32±0.82)%, were lower than (18.23±9.23) % and (1.89± 0.32) % in healthy volunteers, respectively, (CD+56: t =-14.7549, -11.7216; CD+4/CD+8: t =-24.78,-4.4564, P＜0.05). Conclusion The relative increase of CD+4 CD+25 Regulatory T cells may be related to immunosuppression and tumor progression in patients with lung cancer. Conclusion The relative increase of CD+4 CD+25 regulatory T cells may be related to immunosuppression and tumor progression in patients with lung cancer.

BACKGROUND:With unique structure and physicochemical property, carbon nanotubes have promising application prospects in the fields of drug delivery, biosensor and biomaterials. However, carbon nanotubes are highly hydrophobic and trend to aggregate, and thus carbon nanotubes are hard to be dispersed in solution. Furthermore, carbon nanotubes induce blood coagulation and have cytotoxicity, which greatly limit the application of carbon nanotubes. OBJECTIVE:To prepare heparinized single-wal ed carbon nanotubes and to study the effects of heparin-immobilization on the water solubility, stability as wel as biocompatibility of carbon nanotubes. METHODS:By the method of covalent grafting, heparinized single-wal ed carbon nanotubes was fabricated and characterized by Fourier transform infrared spectroscopy and carbazole assay. Transmission electron microscopy was used to investigate the dispersing performance and suspension stability of heparinized single-wal ed carbon nanotubes in aqueous solution. Anti-Xa activity and activated partial thromboplastin time assays were used to measure the anticoagulation activity of heparinized single-wal ed carbon nanotubes. MTT assay was used to evaluate the cytocompatibility of heparinized single-wal ed carbon nanotubes.
RESULTS AND CONCLUSION:Heparin was covalently linked to the surface of single-wal ed carbon nanotubes successful y. The amount of heparin on single-wal ed carbon nanotubes was measured to be 257.53 mg/g. Heparinized single-wal ed carbon nanotubes were wel dispersed and stable in an aqueous solution without aggregation. The anti-Xa activity of heparinized single-wal ed carbon nanotubes was measured to be 36.53 U/mg, suggesting a significant anticoagulant activity. Further study of activated partial thromboplastin time assay found that the anticoagulant effect of heparinized single-wal ed carbon nanotubes could be prolonged. MTT assay revealed that heparinized single-wal ed carbon nanotubes had no cytotoxicity and showed good cytocompatibility. Taken together, the immobilization of heparin on single-wal ed carbon nanotubes wil not only improve its solubility and stability in water, but also endow it with excellent biocompatibility.

Objective:To investigate the effect of short single reverse-α fixation of nasobiliary tube after endoscopic nasobiliary drainage.Methods:From January 2019 to October 2019, the patients who performed with endoscopic nasolbiliary drainage in Tongji University Affiliated Shanghai East Hospital were randomly divided into experimental group (short single reverse-α fixation, 155 cases) and control group (routine reverse-α fixation, 137 cases). The incidences of the fixation time, prolapse rate, nursing time, scores of nasal comfort and bile flow rate of nasobiliary duct were evaluated between the two groups.Results:The average time of nasobiliary duct fixation was (18.31±1.67) s, the prolapse rate was 5.2% (8/155) and the time of nursing was (35.03±2.68) s, which were lower than those of the control group (46.50±5.50) s, 13.9% (19/137) and (72.07±7.63) s. The difference was statistically significant ( t or χ 2 values were 60.795, 6.570, 56.629, P<0.01 or 0.05). The comfort score of the experimental group was (4.61±1.06) points, the bile flow rate was (241.52±53.95) ml/days, which were higher than (5.76±0.76) points and (174.09±47.55) ml/days of the control group, the difference was statistically significant ( t values were 10.448, 11.265, P<0.01). Conclusions:Shortening the length of nasobiliary duct combined with single reaction "α" method has the advantages of simper operation and nursing, low prolapse rate, high comfort and good drainage effect. It is worthy of clinical application.

Objective:To build the three different risk prediction models for peripherally inserted central catheter (PICC) -associated thrombosis based on machine learning algorithm, and compare the performance of the models, so as to provide a basis for evaluating and preventing PICC-associated thrombosis.Methods:The PICC-associated Thrombasis Risk Factor Questionnaire was developed based on the best evidence and expert consultation. From January 2016 to October 2020, convenience sampling was used to select 626 patients with PICC in the Affiliated Hospital of Jiangsu University as the research object to collect clinical data. Based on machine learning algorithms, Support Vector Machine (SVM) , XGBoost and Logistic regression methods were used to construct three different PICC-associated thrombosis risk prediction models, which were evaluated and compared.. Model evaluation indicators included Matthews correlation coefficient ( MCC) , F1 value, area under the receiver operating characteristic curve ( AUC) and Brier score. Results:A total of 30 variables were included, and the predictors included four aspects, namely, demographic data of patients, patient condition, treatment factors, and catheter-related factors. For the model verified on the test set, the Logistic regression prediction model had lower scores than the XGBoost and SVM prediction models in terms of MCC and F1 values. On AUC, the Logistic regression prediction model score was equal to SVM and smaller than XGBoost. On Brier, the Logistic regression prediction model scored higher than the XGBoost and SVM prediction models. Conclusions:The performance of the prediction model based on the machine learning algorithm XGBoost and SVM is superior to the traditional Logistic regression model in terms of sensitivity and accuracy. Thrombotic predictors can help guide medical and nursing staff to identify high-risk patients and reduce the incidence of PICC-associated thrombosis.

Objective To explore the feasibility of low concentration contrast medium and low-voltage combined with adaptive statistical iterative reconstruction(ASRI)technique in enhanced CT imaging of solitary pulmonary nodules. Methods A total of 40 patients with solitary pulmonary nodules who underwent routine exam-inations and were pathologically confirmed from February 2015 to February 2017 were collected and divided into conventional group(conventional dose,high osmolar contrast,using filtered back projection reconstruction)and low dose group(low voltage,low concentration isotonic contrast,iterative reconstruction). Results Subjective scoring of conventional group(3.97 ± 0.57)and low dose group(4.01 ± 0.54)indicated no statistical significance (P > 0.05). No significant difference was found regarding to reconstructed image quality,SNR and CNR in both two groups.The dose length product(DLP)and effective dose(ED)in low dose group were lower than those in the conventional group[(283.52 ± 11.50)mGy/cm vs(370.74 ± 29.56)mGy/cm;(3.65 ± 0.32)mSV vs(5.11±0.25) mSV],and the difference was statistically significant(P < 0.05). Conclusions Low concentration isotonic con-trast agent(iodixanol 270 mgI/L)and low voltage(100 kV)combined with ASIR technology could satisfy the clini-cal need in enhanced CT imaging of solitary pulmonary nodule.

OBJECTIVE To explore the efficacy of autologous fat injection of eustachian tube pharyngeal orifice in the treatment of Patulous eustachian tube (PET). METHODS We selected 18 patients who had no obvious improvement after medical treatment of PET over 1 months. They were treated with autologous fat injections to narrow the pharyngeal ostium of the eustachian tube. The treatment results were documented, including the patient's supervisory feeling and visual analogue scale (VAS). RESULTS The total effective rate was 83.3％ after 12 months of follow-up (symptoms significantly reduced in 27.8％ of patients and partial improvement is 55.6％), 16.7％ the symptoms remain unchanged, no one worsened. No patients had any complications. CONCLUSION Autologous fat injection of the eustachian tube is a effective and safe treatment for PET with the percentage of significant or partial relief of 83.3％, It is easy to conduct in clinical practice which could potentially serve as an alternative treatment for PET.

Objective To explore the demand of peer support in tumor patients, to provide the basis for the construction and improvement of peer support systems for cancer patients. Methods Self-designed questionnaire was used to investigate the demand of peer support in 94 tumor patients.Results Results showed that among the 94 patients surveyed, 46. 8% of them had received peer support; up to 77. 6% of the patients were willing to accept peer support; three aspects of patients′ demand for peer support in a descending order were emotional demand ( 72. 34%) , information demand ( 68. 9%) and evaluation requirements ( 56. 6%) . Conclusions Tumor patients need peer support, and peer support development has a broader space.

0.05). Conclusion After heated, the physical stability of UAE and UAS is reduced, the viscosity become lower, ADM releasing rate is fell. The heated Lipiodol-Adriamycin pharmaceutics had advantage in the interventional embolization chemotherapy of the neoplasm.