It is found in clinical practice that decisions made by agents on hehalf of the patients without capability of independent choice may sometimes conflict interests of the patient in question. The author summarized by categories common dilemmas faced by clinicians, and came up with the ethical principles to resolve the problems, as proven in case studies. Doctors should fully respect reasonable decisions of agents of such patients. Furthermore, to make a reasonable decision on their behalf, the agent is expected to make medical decisions in the interests of the life and health of the patient, with adequate knowledge of the disease, therapeutic measures and outcomes, and without any damage to interests of the patient they represent. Such a reasonable decision should neither violate laws of the state, nor infringe on interests of other individuals, collectives and the society at large for benefits of the patient in question. In addition, it should conform to the medical ethics of fair distribution of health resources.

Objective To study the clinical,pathological features and therapeutic method of metastatic triple negative breast cancer (TNBC) and its relationship with disease-free survival.Methods One hundred and thirty-six cases of metastatic TNBC patients who were treated from January 2007 to January 2012 in the Third People''s Hospital of Dalian were selected as research objects.All patients received operation and radiochemotherapy,the clinical,pathological features,therapeutic method,the survival rate within 3,5 years,and the metastasis and survival situation of the patients were analyzed.Results For the patients in clinical stage Ⅲ period,the survival rate within 3,5 years were 45.9%(17/37),37.8%(14/37),respectively,significantly lower than those in stageⅡperiod (89.9%(89/99),73.7%(73/99)),and the differences were statistically significant (χ2=18.459,12.681,P<0.01).The 3-year survival rate of the patients in pathological grade Ⅲ was 64.9%(37/57),5-year survival rate was 43.9%(25/57),significantly lower than those of gradeⅠ(91.7%(22/24),83.3%(20/24)) and grade Ⅱ(85.5%(47/55),76.4%(42/55)),the differences were statistically significant (χ2=14.728,12.450,P<0.05).The 3-year survival rate of radiotherapy group was 81.8%(27/33),significantly higher than that of the non-radiotherapy group (59.1%(13/22)),the difference was statistically significant (χ2=5.468,P<0.05).Lung,liver,brain,bone and supraclavicular lymph nodes were main distant metastasis,the survival time of patients with metastasis was less than 2 years.Conclusion Metastatic TNBC is a special type of breast cancer that is difficult to treat.Breast conserving surgery has certain application value,radiotherapy can only increase the 3 year survival rate.Pathological grade and clinical staging are the main prognostic factors.

Objective To find out the best orientations and sections in diagnosing tetralogy of Fallot using multiplane transesophageal echocardiography(TEE).Methods The visible heart was compared with the images of multiplane TEE to determine the best orientations and sections in the multiplane TEE for tetralogy of Fallot.Results The best orientation and section of pulmonary artery and its branches in multiplane TEE was the pulmonary artery viewed at 0? from the upper part of esophagus;that of ventricular septal defect and aortic overriding were five chambers viewed at 0? from the middle part of esophagus or the left ventricle long-axis view at 135? from the middle and end parts of the esophagus;that of the right ventricular outflow tract stenosis and the right ventricular hypertrophy was the right ventricular outflow tract long-axis viewed at 45? from the middle part of esophagus.Conclusion The best orientations and sections in TEE based on the visible heart are helpful to simplify the operation procedure of multiplane TEE and to shorten the examination time.

The effects of high erucic acid rapeseed oil (HER) on fatty acid oxidation in rat livers compared with low erucic acid rapeseed oil (LER) were studied. Weanling male SD rats were fed on 20% (% by weight, similarly hereinbelow) HER or LER diet for a week or 4 weeks, or 5% HER diet for 4 weeks. The hepatic capacity for oxidation of butyric acid and palmitic acid was determined by titrating the acetone produced by the fatty acid oxidation. The results showed that feeding HER to rats led to an increse in weight of liver and the extent of this increase was positively correlated to the intake of erucic acid (C22:1, n-9 cis). Feeding HER reduced the hepatic oxidation capacity for palmitic acid, notably in 20% HER (1 wk) group. Feeding LER had not shown this effect,indicating that erucic acid plays an important role in the toxicity of rapeseed oil. In the present study it was not found that the hepatic oxidation capacity for butyric acid was influenced by the intake of HER. Therefore, we considered that the inhibitory effect of HER on oxidation of long-chain fatty acids probably resulted from that the incorporation of erucic acid into mitocho-ndrial membranes interfered with the fatty acyl-CoA transfering system on the membranes, leading the fatty acyl-CoA to be unable to enter the mitochondria and to be oxidized there, but not from that the B-oxidation system in mitochondria was directly inhibited.

Objective To identify the effect of blood pool 18F-FDG activity on liver SUV and to investigate the optimal normalization method.Methods PET/CT and common serological examination items from 1 018 subjects were retrospectively collected.Mean SUV of liver and blood were recorded as SUVmean(L) and SUVmean (B),respectively.The difference and quotient of SUVmean(L) and SUV mean (B) were calculated as SUVmean (L-B) and SUVmean (L/B),respectively.CV of SUVmean (L),SUVmean (L-B) and SUVmean(L/B) were calculated to assess their inter-individual variations.Pearson correlation analysis was used to evaluate the relationship of SUVmean(L),SUVmean(L-B),SUVmean(L/B) with SUVmean(B).Multiple linear stepwise regression was performed to identify their vulnerability to common serological examination items.Results CV of SUVmean(L/B) (15.1％) was less than that of SUmean(L) (23.2％) and SUVmean(L-B) (40.6％).Correlation between SUVmean(L) and SUVmean(B) (r =0.820,P＜0.001) was more significant than that between SUVmean(L-B) and SUVmean(B) (r =0.205,P＜0.001) as well as between SUVmean (L/B) and SUVmean (B) (r=-0.376,P＜0.001).Blood glucose and BMI correlated with SUVmean(L) and SUVmean(L/B),but not with SUV (B).Age and HDL correlated with SUVmean(L) and SUVmean(B),but not with SUV (L/B).Fatty liver was significantly associated with SUV mean (L/B) (β =-0.047,P ＜0.001),but not with SUVmean(L) and SUVmean (B).Conclusions 18 F-FDG activity of blood pool affects liver SUV.SUV mean (L/B) is a simple and reliable normalization method since its inter-individual variation and vulnerability to common serological examination items are relatively lower than liver SUV.

Objective To study the sectional anatomy of the heart with esophagus to provide the sectional anatomic data for transesophageal echocardiography(TEE). Methods Hearts with esophaguses were sectioned at the angles of 0?, 45?, 90? and 135? relative to the human cross section by frozen section technique. The sectional anatomic structures were observed and analyzed. Results A total of 140, 130, 44 and 130 slices were obtained at the angles of 0?, 45?, 90? and 135?, respectively. The anatomic structures of the key slices were described. Conclusion The thin sections of the heart can clearly display the anatomical details of the inner structures of the heart, which may play an important role in the clinical application of TEE.

Objective To find out the best orientation and section for diagnosing rheumatic heart disease using multiplane transesophageal echocardiography (TEE). Methods The visible heart was compared with the images by multiplane TEE for the establishment of the best orientation and section for multiplane TEE for the diagnosis of rheumatic heart disease. Results The best orientation and section of mitral valve detected by multiplane TEE were the four chamber view at 0? orientation at the end part of esophagus. The best orientation and section of aorta valve were short axis section of the heart at 45? orientation and long axis section of the heart at 135? orientation at the middle part of the esophagus. The best orientation and section were the short axis section at 45? orientation and the oblique short axis section at 0? orientation of the aorta valve at the middle and the upper part of esophagus. Conclusion The best orientation and section of TEE based on the study of the visible heart are helpful to simplify the operation procedure of multiplane TEE and to shorten the examining time.

Objective To study the apllication value of cerebraspinal fluid minimal residual leukemia cells(MRLCs) combined with lactate dehydrogenase(LDH) detection in early diagnosis of central nervous system leukemia(CNSL) to provide a laboratory basis for clinical diagnosis and evaluation of disease progression and therapeutic effect.Methods Thirty inpatiernts without blood disease and central nervous system(CNS) organic diseases,and normal CSF routine and detected biochemical indexes were selected as the control group and 96 cases of acute leukemia (AL) diagnosed by bone marrow puncture FAB morphology and flow cytometry typing served as the disease group.Flow cytometry was used to detect the MRLCs in CSF,the activity of LDH in CSF was detected by the rate method,and the detection results were performed the comparative analysis.Results Among 96 cases of AL,30 patients with CNSL had 13 cases of positive MRLCs in CSF,the positive rate was 43.33%,among 66 cases of non-MRLCs,MRLCs was not detected detected.Among 96 cases of AL,CSF LDH level in 30 cases of CNSL was (30.54±10.29)U/L,which was significantly higher (16.16±7.12)U/L in the patients without CNSL,the difference between the two groups was statistically significant (P<0.05).Conclusion The detection of MRLCs and LDH in CSF of AL can be used as a laboratory diagnostic index for early diagnosis of CNSL,and MRLCs combined with LDH detection can improve the positive diagnosis rate of CNSL.

Learning guidance in pathology teaching can help to improve the students' learning ability. Learning guidance can be mainly done in two aspects:developing and fostering the students' learning ability on their own and guiding the students to review scientifically.

Objective To analyze the genetic polymorphism of GSTM1 to lung cancer patients in north Sichuan of China and compare with race from other district.Methods PCR-based technique was used to detect the genotypes of GSTM1 in lung cancer patients.Results In local lung cancer patients,the frequency of homozygous deletions(null genotype) for GSTM1 was 58.4 % (73/125).Among the patients,the frequencys of null genotype for GSTM1 were 62.5 % (20/32) in female,56.9 % (53/93) in male,56.1% (32/57)in patients with squamous cell carcinoma and 54.8 % (17/31) in patients with adenocarcinoma,respectively.The frequency of deletions of GSTM1 in lung cancer patients from north Sichuan of China is slightly exceeding those of Europe and Americas (P ＜0.05) and similar to the domestic result (P ＞0.05).Conclusion The genetic polymorphism of GSTM1 to lung cancer patients in north Sichuan of China dosen' t show distinguished feature for this district and race.