This paper analyzes ethical issues to be concerned in the nursing process for patients' with severe degree burn,and comes up with countermeasures including building up comfortable environment of medical service,showing enough respect for patients,improving mutual communication between doctors and patients,applying flexible regulations of visiting and accompany,strengthening health propaganda,and making best efforts to maintain the original appearance and function of the burnt organs.

Objective: To study the relationship between different patterns of invasion and extracapsular spread in lymph node metastasis from squamous cell carcinoma of tongue. Methods: Pattern of invasion described by Anneroth was used to evaluate the malignance grade of tongue cancer and immunohistochemical and HE staining were used to detect the extracapsular spread in successive cases of tongue cancer with radical neck dissection. Results: Lymph node metastasis was observed in 0/5 of the cases with pattern I invasion,3/8 pattern II,5/6 pattern III and 1/1 pattern Ⅳ. Extracapsular spread occurred as totally or partly replacement of the lymph node by the tumourcells. The tumour cells infiltrated between lymph nodes, perinodal fibroadipose tissue or sternocleidmastoid muscle in the form of cell cluster or isolated cell. Conclusion: Pattern of invasion is a significant factor for evaluating the malignance grading of tongue cancer. Radical neck dissection should be used to treat the tongue cancer with pattern III or IV invasion.

Since the first reported case of swine influenza A in Mexico,a total of 15 510 cases have been confirmed in 53 countries by May 29,2009.On April 29,2009,the World Health Organization(WHO)raised its pandemic alert from grade 4 to grade 5.The virus is described as a new subtype of A/H1N1 and is not detected in pigs or humans previously.The virus is sensitive to oseltamivir and zanamivir,but resistant to amantadine and rimantadine.The genetics of the virus are so novel that humans are unlikely to have much immunity to it.The virus can transmit from human to human;therefore it is necessary to enforce quarantine measure for close contactors because the virus transmits during latency.Precaution methods like covering noses and mouths with a tissue when coughing or sneezing can reduce the transmission opportunity.Hands should be washed frequently with soap,especially after coughing or sneezing.Public places with ventilation conditions,personal health behavior and health condition are critical for the prevention and control of this epidemic.

Office blood pressure has been regarded as a gold standard of blood pressure measurements.It is an important indicator of ensurement of correct diagnosis,management of condition and evaluation of prognosis.But limitations of office blood pressure have led to the increasing use of out-of-office blood pressure.Many evidence show that out-of-office blood pressure could more accurately reflex variability of blood pressure and rhythm of blood pressure.Out-of-office blood pressure could diagnose white-coat hypertensives or masked hypertensives without delay,properly determine the need for antihypertensive treatment and decrease risk of developing blood pressure-related complications.

This paper presents a description about training of post-graduate students majoring in rheumatology.The essential knowledge and theory are highly stressed,and the clinical skill,comprehensive ability are also emphasized to encouraging students to bring forth new ideas.Besides cooperation and team spirit are encouraged through group and pair work.

From the perspectives of social equitable exchange theory, contents and features of exchange between medical staff and patients in the doctor-patient relationship as well as their evalua-tion on social equitable exchange theory were analyzed according to basic features of doctor-patient relationship. Suggestions were proposed from government, industry, hospital and medical staff.

Objective To analyze the clinical effects of small needle -knife therapy with movement exercise on knee osteoarthritis (KOA).Methods The clinical data collected from all the patients with hospital care and other 60 patients with KOA treated in the outpatient department in People's Hospital of Changzhi from February 201 4 to August 201 4.The patients were divided into needle -knife group and hyaluronan group,30cases in each group.The needle -knife group was given small needle -knife therapy to each patient one or two times.The hyaluronan group was given weekly intra -articular hyaluronan treatment,once a week,5times in total.But all the patients must do the same exercise movement as treatment.The clinical efficacy evaluation went on 6 months to follow up the patients.The evaluation for each patient was made at 0.5,1 st,2nd,4th,and 6th months using the following measures:WOMAC (Western Ontario and McMaster University Osteoarthritis Index)global assessment and SF -36 (short form 36). Make a contrast to the efficacy of both therapies on the osteoarthritis of knee joint from pain -easing and functional recovery.And the results were synthetically analyzed.Results In terms of pain assessment,the outcomes obtained by WOMAC on the two groups was statistically effective in the phase of 1 -6 months (t =-5.952,P <0.001 ),while those by SF -36 showed differences between the first 0.5 month and 6th month (t =3.1 21 ,P <0.001 ,t =4.091 , P =0.01 1 ).In terms of the functional assessment,the figures obtained by the WOMAC manifested that the needle -knife group was significantly superior to the hyaluronan group at the second and sixth months (t =-8.579,P <0.001 ,t =-3.993,P =0.003),and SF -36 also displayed that after treatment,the objects from the two groups per-formed distinctively in the first half,first,and sixth month respectively.(t =6.1 32,P <0.001 ,t =5.063,P =0.0068, t =8.1 09,P =0.003).Conclusion Small needle knife with movement exercise can obviously improve activity -related function of knee joint and relief the pain for the patients with KOA.

ObjectiveTo explore the relationship between the expression of Dishevelled2 and Vangl2 and the embryonic neural tube defects (NTDs) induced by all-trans retinoic acid (RA)in Kunming mouse. Methods Fifty pregnant mice were randomly divided into control and RA-treated groups.RA-treated mice were fed with 30mg/kg RA dissolved with peanut oil on embryo 7.75 days, while the mice of control group were administrated with an equal volume of peanut oil on the same time. Then all the embryos were sampled from pregnant mice at the 4th, 18th, 42nd, 66th and 90th hour after treatment. In situ hybridization and immunohistochemical staining technique were used to detect the expression of Dishevelled2 and Vangl2 in embryonic neural tube. Results The two proteins both existed in the epithelial tissue of the mouse embryonic neural tube and displayed different expression modes at various developmental stages.Compared with the control group, the RA treated group showed a significant decrease (P≤0.05) at the 18th and 42nd hour and a significant increase (P≤0.05) at the 66th hour in Dishevelled2 protein after maternal treatment, and no significant difference was found at the 90th hour. Compared with the control group, the Vangl2 mRNA expression in the RA treated group displayed a significant decrease (P≤0.05) at the 4th and 18th hour and a significant increase (P≤0.05) at the 66th hour after RA treatment, and no difference was found at the 42nd hour. Compared with the control group, the expression of Vangl2 protein in the RA treated group decreased (P≤0.05) at the 18th and 42nd hour, and increased (P≤0.05) at the 90th hour after RA treatment, no difference was found at the 66th hour. Conclusion Excessive RA may interfere with the normal embryonic neural tube closure by regulating the expression of Dishevelled2 and Vangl2.

ObjectiveIn order to confirm the value of high resolution frequency(HFUS) ultrasonography in the early diagnosis of psoriatic arthritis(PsA).MethodsTwenty-nine patients with psoriatic arthritis reporting sixty-nine finger pain and 30 patients with rheumatoid arthritis reporting seventy finger pain and 20 healthy volunteers underwent X-ray and US evaluation.The ultrasonographic characteristics and blood flows in the joints were checked with high resolution ultrasonography.Bilateraljoints were compared each other in every patient.Comparisons between groups were tested by x2 test.ResultsSonographic positive signs were found in all the involved joints in 29 PsA patients,joint effusion in 42 fingers (61％).Synovial thickening was found in 38 fingers (55％).Bone erosions were found in 28 fingers(41％),tenosynovitis were found in 40 fingers (58％),soft tissue inflammation was revealed in 29 fingers (42％).Enthesitis were foundin 30 fingers (43％).In RA patients,joint effusion was found in 52 fingers (74％) and synovial thickening in 48 fingers (69％).Bone erosions were found in 33 fingers (47％).Tenosynovitis,soft tissue inflammation and enthesitis were not found in RA patients.ConclusionHigh resolution ultrasonography is an easy,safe and effective method for the early diagnosis of pathological changes of small joints in psoriatic arthritis.