Aiming at the unstable moral relationship between doctor and patient,the in-depth analysis and consideration were performed to factors influencing the harmonious relationship between doctor and patient,indicating that it was of great significance to the establishment of harmonious moral relationship between doctor and patient by taking the opportunity of new medical reform and making the best of antiseismic spirit.

Purpose To explore the clinicopathological features,immunophenotype,differential diagnosis and prognosis of the composite pheochromocytoma (CP)-ganglioneuroma.Methods 3 cases of CP-ganglioneuroma were stained by immunohistochemical SP method,and the related literatures were reviewed.Results 3 cases of CP-ganglioneuroma were one male and 2 females,the age were 37-64.Case 3 were of primary mediastinal.Microscopically,the tumor tissues were composed of two components:one type of tumor cells were arranged in nests with a predominant Zellballen pattern,round or oval nuclei,fine granular cytoplasm and rare mitotic,another part of the neoplasm showed scattered and aggregated distributed ganglion cells in the background of neurofibromatosis which aligned bundles and interwoven,the edge of the tumor was still residual adrenal tissue.Immunohistochemically,components of pheochromocytoma were positive for CD56,CgA,Syn,vimentin and negative for SMA,Melan-A,α-inhibin NF with low Ki-67 proliferation index.S-100 was positive in supporting cells,ganglioneuroma components were positive for NF,S-100 with low Ki-67 proliferation index.CgA and Syn were weakly positive or negative in the ganglion cells.Conclusion CP is a relatively rare tumor,which can not be distinguished from pheochromocytoma in clinical and radiological diagnosis.The corresponding clinical treatment and follow-up management should be taken according to the different ingredients (benign or malignant).

Histological classification system ( HCS) is an important system in judging and predicting ma-lignant behaviors of breast cancer .This study is aimed to analyze research progress and development direction of HCS by perusing literatures ,including the origin and development progress of HCS ,contents and deficiencies of Nottingham classification system(NCS),and introduction of novel classification system .HCS of breast cancer has a history of more than one hundred years ,among which NCS is the most widely used ,based on morphological fea-tures of cancer cells .However,there are still some shortcomings about NCS ,such as few indexes incorporation , great evaluation variation and low evaluation efficiency .Recently ,many newly evaluation systems have been devel-oped,including“nucleus+proliferation”classification system ,computer assisted classification system and compre-hensive prognostic classification model .Therefore,the future development directions of HCS on breast cancer is to use high throughput analysis technology to extract and analyze the hidden molecular information in cancer cells and the surrounding tumor microenvironment ,so as to better guide personalized therapy and predict clinical prog-nosis.

According to teaching outline and clinical training characteristic of psychophy-laxis speciality(including Psychiatry and Medicopsychology),we explored how to strengthen the clinical thinking ability and clinical skill training for clinical medicine students based on cultiva-tion of elementary knowledge and theory,and we also established a set of more appropriate item system of clinical skills assessment so as to improve the practice quality in psychiatry and medical psychology departments.

Objective To investigate the clinical and pathological features of anorectal malignant melanoma ( AMM) .Methods The clinical pathological and follow-up data of 7 cases of anorectal malignant melanoma were collected.The clinical and histopathological features and immunophenotype were analyzed .Results Among the 7 cases, 5 cases were female, 2 cases were male, aged 50-68 years, the average was 61 years.The tumors located in the lower rectum in 1 cases, 2 cases of teeth near the line , 4 cases of anal anus .The structure and morphology of the cancer cells were diverse .The organizational structures were mainly diffuse , focal and acinar .The cellular morphologies were mainly epithelioid , spindle and lymphocyte like .And the results of IHC showed the expression of the following three markers, vimentin, S-100 and HMB45, were strongly positive in cancer cells.However, the expression of CK , EMA and LCA were negative .And 2 cases of CEA expression were positive , LI Ki-67 was 20%-50%.Conclusions Anorectal malignant melanoma is one kind of rare malignant tumor and its characteristic morphology , immunophenotype could be helpful for diagnosis and differential diagnosis .

Objective To observe the efficacy of high-energy red light combined with human-like collagen dressing in treatment of facial corticosteroid addictive dermatitis.Methods Eighty-three patients with facial corticosteroid addictive dermatitis were divided into treatment group (42 cases) and control group (41 cases) by random digits table method.All patients in 2 groups were treated with ebastine 10 mg,once a day,and vitamin E cream,twice a day.At the same time,the patients in control group were given human-like collagen dressing,once a day in the first week,then 3 times/week.On the basis of control treatment,the patients in treatment group were irradiated with high-energy red light 10 min in face,2-3 times/week.The treatment of both groups lasted for 12 weeks.The symptoms,skin lesions and untoward reaction were observed after treatment of 4,8 and 12 weeks.Results After treatment of 4 weeks,there was no statistical difference in the effective rate between 2 groups (P ＞ 0.05).After treatment of 8 and 12 weeks,the effective rates in treatment group were significantly higher than those in control group [83.3％(35/42) vs.58.5％ (24/41),90.5％ (38/42) vs.65.9％ (27/41)],there were statistical differences (P ＜ 0.05).No untoward reaction was found in 2 groups.Conclusion High-energy red light combined with human-like collagen dressing is effective and safe in treatment of facial corticosteroid addictive dermatitis.

Objective To analyze the endoscopic and pathological characteristics of rectum neuroendocrine neoplasm (NEN).Methods From January 2005 to May 2012,the endoscopic and pathological data of 66 patients with rectum NEN were collected and graded according to historistic grade of gastroenteropancreatic-neuroendocrine neoplasm (GEP-NEN) by World Health Organization (WHO).The factors related with the metastasis of neuroendocrine tumor (NET) and neuroendocrine cancer (NEC) were analyzed by Chi square test and Fisher exact probability method.Results The locations of 66 NEN cases were between three and 15 cm from the anus.The diameters of 54 cases were less than 1 cm and under endoscopy the appearance of most tumors was submucosal hemispherical polypoid bulge.The diameters of nine cases were over 1 cm but less than 2 cm,of which the appearance of five cases was submucosal thickening or sessile polypoid bulge.The diameter of three cases was over 2 cm and the appearance was cauliflower-like or polypoid tumor which caused annular lumen stenosis.Sixty-one cases were NET (grade G1),three cases were NEC (grade G3) and two cases were mixed adenoendocrine carcinoma with both NEC and adenocarcinoma components.The metastasis of NET and NEC was not related with gender (x2 =0.158,P＞0.05) and age (Fisher exact probability method,P＞ 0.05),however was related with the diameter of tumor (Fisher exact probability method,P＜0.05).Conclusions NEN is a tumor with variety endoscopic characteristics and pathological features.The metastasis of NET and NEC seems not related with gender and age,but related with diameter.

Objective To investigate the significance of sonographic patterns of thyroid calcification in diagnosis of thyroid nodule.Methods 235 patients with 355 thyroid nodules were retrospectively analyzed.Nodule calcification size,distribution and pattern were observed.Results The incidence of calcification in benign and malignant nodules was 30.3％ (89/294)and 73.7％ (45/61) respectively.The difference had statistical significance(x2 =24.3,P ＜0.01).The rate of microcalcification in cancer was 47.5％ (29/61),higher than that in benign one 3.1％ (9/294)(x2 =99.1,P ＜ 0.01).Coarse calcification in benign nodules and malignant lesion was 27.2％ (80/294)and 26.2％ (16/61)respectively.The difference had no statistical significance(x2 =0.42,P ＞0.05).Conclusions Microcalcification of thyroid nodules is a specific index for thyroid carcinoma.Any type of sonographically detected calcification represents risk of malignancy.Not only microcalcification,these cases should raise the suspicion of malignancy in coarse calcification,especially involving a solitary nodule and irregular shape.

Objective To investigate the clinical and pathological characteristics of carcinoid tumor in rectum and its treatment. Methods The clinical and pathological data of 38 rectal carcinoid patients from Wuhan Center Hospital and Wuhan the Eighth Hospital from January 2005 to December 2009 and reviewed were analyzed retrospectively. Results All 38 cases were typical carcinoid, located in the rectum within 10 centimeters to the lower border of the anal canal.The classic characters were submuscosal tumor with yellow color and rigid or tough texture and always were lack of mobility. Carcinoid tumor of rectum often expressed markers of neuroendocrine differentiation on immunohistochemical staining.Among 38 cases, 34 cases were less than or equal to 2.0 cm in diameter and located in lamina propria (n=30) or invased submucosal layer (n=4), these patients were cured by endoscopic mucosal resection (EMR).Four cases were larger than 2.0 cm in diameter with muscularis externa invasion, treated by curative resection.All tumors <2.0 cm in diameter had a very lower Ki-67 labeling index (<3% ).34 patients survived at the latest follow-up. Conclusions The diagnosis of rectal carcinoid relies on histopathology and immunohistochemistry. The behavior of the rectal carcinoid shows low degree of malignant potentia. They rarely invade the muscularis externa or metastases. Most of them can be cured by endoscopic mucosal resection(EMR).