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.

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.

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.

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 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).

In this study, authors observed and compared the clearances of different molecule weight substances between different dialysis membranes and different hemopurification methods. The results showed that the clearances of BUN by hemodialysis (HD) with cuprophan membrane, hemodiafiltration (HDF) with polysulfone and high flux dialysis (HFD) with polysulfone were all satisfactory. TACurea were all below 50 mg. Hemodialysis with cuprophan could clean out some middle molecule substances (MMS), but not ?2-microglobulin (?2m). Hemodiafiltration with polysulfone had the best clearances of MMS and ?2m. Hemofiltration (HF) with polysulfone had fair clearances of MMS and ?2m, but the clearances of BUN and Cr by HF were not so good. The clearances of MMS and ?2m by high flux dialysis were lower than those of HDF and HF. The clearances of MMS and ?2m by continuous ambulatory peritoneal dialysis (CAPD) at a single time were lower than those of HF, HDF and HFD, but the general clearances of MMS and ?2m by CAPD per week were two to four times higher than those by hemodialysis with cuprophan. CAPD is a choice method for those hospitals where HF or HDF can not be performed.

AIM To investigate the role of ERK/AP-1 pathway in the differentiation induced by diallyl disulfide (DADS) on human gastric cancer MGC803 cell. METHODS Immunocytochemical staining and morphometric quantitative analysis detected the expression of c-fos and c-jun;Western Blot which measured the activation of ERK was analyzed to elucidate the possible mechanism of DADS-induced human gastric cancer cell differentiation. RESULTS Immunocytochemical staining and morphometric quantitative analysis indicated that expression of c-fos and c-jun reduced(P