As the doctor - patient relation becomes more and more strained, the former study on the relation between these two parts, done only from the perspective of medical ethics, has been found far from enough. Many -sided factors, in fact, contribute to it. The government reduces investment into medical field; the medical insurance coverage shrinks; welfare sense in state - run medical organizations decreases; doctors focus on medical procedures, ignore humane care to patients; the cost for treatment is increasing and the sense of self - protection of the patients is growing and so on. Therefore, it is of critical importance to study the relation from multi -perspective for the reconstruction of harmonious doctor - patient relation in the future.

Objective To investigate the expression and clinical significance of ubiquitin-like with PHD and ringfinger domains 1(UHRF1) in benign and malignant pleural effusion.Methods From November,2015 to February,2017,130 cases of pleural effusion were collected in Jiangning hospital of Nanjing,including 54 cases of malignant pleural effusion caused by lung cancer and 76 cases of lung benign pleural effusion.And the latter contained 36 cases of tuberculous pleural effusion and 40 cases of inflammatory pleural effusion.Enzyme-linked immunosorbent assay (ELISA) were used to detect the level of UHRF1 in each group,and the relationship between UHRF1 and clinical pathology was analyzed.Results The level of UHRF1 437.28± 140.05 ng/L in patients with lung cancer was higher than that 338.47± 163.72 ng/L in patients with benign lung diseases,and the differences were statistically significant (t=3.596,P=0.0005).The level of UHRF1 470.59 ± 127.74 ng/L in patients with non-adenocarcinoma was higher than that 377.78± 145.81 ng/L in patients with adenocarcinoma,and the differences were statistically significant(t=2.329,P=0.023).In group with benign lesion,there were no sig nificant differences (t =1.374,P =0.174) between the level of U HRF1 365.51 ± 167.54 ng/L in tuberculous pleura l effusion and the level of UHRF1 314.13± 158.34 ng/L in inflammatory pleural effusion.And the level of UHRF1 in benign and ma lignant pleural effusion was not related to age,sexuality and smoking history.Conclusion UHRF1 is a potential marker in the differential diagnosis of benign and malignant pleural effusion.

The medical development in the 21th century will present a very societal and synthetical trend. The medical education in 21th century is sure to comply with the needs of medical development.We must change idea, regulate education content, expand education intension and renew education goal to train high-quality medicine personnel with comprehensive ability.

The research on the problem of subjectivity education which inherits and surmounts the traditional education is an important orientation in the development of the education reform theories.Subjectivity education follows the objective law governing the development of education and the inherent requirements of the comprehensive development of man.Subjectivity education which has become the theme of contemporary education is to be the main melody in the 21st century.

At present,most of the physiological teachers of medical university in our country have graduated from medical universities,and have never been trained by special teachers.Because of the influence of medical education training mode and cultural environment factors,teachers' teaching ability and teaching level are different.This paper proposed the full range of skills training for teachers through microteaching.To enhance the in-service teachers' teaching ability and professional level of development,the design procedures of the microteaching training should include the establishment of tutor teaching system,training teachers preparing lessons,after-school peer experts review,self-evaluation and improvement of the video after watching video and questionnaire evaluation,etc.

OBJECTIVE:To investigate the effects,prognosis and safery of recombinant human brain natriuretic peptide on the treatment of patients with acute decompensated heart failure. METHODS:90 inpatients with acute decompensated heart failure were divided into observation group and control group according to the use of recombinant human brain natriuretic peptide or not,with 45 cases in each group. Control group received rountine anti-heart failure therapy and intravenous dripping of Nitroglycerin injection at 20 μg/min continuously for 72 h. Observation group was additionally given Lyohilized recombinant human brain natriuretic peptide with initial loading amount of 1.5 μg/kg,iv,then intravenous dropping at 0.007 5 μg/(kg·min)continuously for 72 h,on the basis of control group. Hemodynamic parameters,brain natriuretic peptide level,the difference of liquid intake and output,dyspnea,lung rales,systemic edema,the improvement of cardiac function were observed and compared between 2 groups before and after treat-ment as well as re-hospitalization rate and surriral rate 30 d after medication,the occarrence of ADR. RESULTS:After treatment, left ventricular ejection fraction of observation group was significantly higher than that of control group,and central venous pressure and brain natriuretic peptide level were lower than those of control group,with statistically significance (P<0.05). The difference of liquid intake and output after treatment was (1 171.60 ± 444.80)ml in observation group and (822.30 ± 268.40)ml in control group,with statistical significance between 2 groups(P<0.05). After treatment,the scores of dyspnea,lung rales and systemic ede-ma were decreased in 2 groups;the improvement of observation group was significantly better than that of control group,with statis-tical significance(P<0.05). Total effective rates of observation group and control group were 95.56% and 82.22%;re-hospitaliza-tion rates 30 d after medication were 17.78%and 26.67%;survival rates 30 d after medication were 88.89%and 75.56%,with sta-tistical significance between 2 groups (P<0.05). There was no statistical significanse in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Recombinant human brain natriuretic peptide can significantly improve hemodynamic parameters and heart function of patients with acute decompensated heart failure,and effectively relieve dyspnea,lung rales and systemic edema. It is better than routine treatment in prognosis with good safety.

Objective To investigate the influence of negative emotion on patients with peptic ulcer and their cognition about self-management knowledge. Methods Zung self-rating depression scale (SDS), self-rating anxiety scale(S/IS) and self-designed survey questionnaire of peptic deer patients' gen-end knowledge were used to examine 105 peptic ulcer patients in outpatient and inpatient in the digestive department and the data were compared with those of 106 healthy people. Results The peptic ulcer pa-tients' total score of SDS and SAS, and the occurrence rate of positive symptom were obviously higher than those of healthy people. In the group of ulcer patients, we compared the data of SDS one by one, the emo-tion of patients was different when their profession was different. The difference between patients with and without anxiety in keeping emotion steady and appropriate diet was significant. 45.8%～78.1% of patients with negative emotions didn't understand the cycle of treatment, regular consultation with a doctor or com-plication. Conclusions Nurses should evaluate the emotional state of patients, establish nursing plan based on individual patients, give different nursing and education to different patient. Thus patients' general self-management knowledge and compliance can be improved, their spirit health level can be alleviated. It can also reduce incidence of the disease and prevent relapse.

Medical humanistic education becomes “remarkable leaning” because many problems arise from the development of contemporary medicine such as the meaning of life,the medical aim,the medical model and doctor-patient relationship etc.Multi-channel and multi-modal development of medical humanistic education has become a must to understand medicine and makes it develope soundly,and all-directional resultant force and the environment of medical humanistic education,striving for studies,is an exploration and even a mission and responsibility

Objective To investigate uncertainty in illness of family members of patients with malignant tumor,to explore the factors that affect uncertainty in illness of family members of patients with malignant tumor,and to provide clinical basis for clinical doctors and nurses implementing effective interventions for their patients.Methods Questionnaires were conduted to investigate uncertainty in illness of family members of patients with malignant tumor and explore the related factors.The measurements included three parts,Chinese version of Mishel uncertainty in illness scale for family member,self-designed questionnaire about family general condition,patients disease information.Results The total score of uncertainty in illness was 82.71±9.93,more than 50 ％ (75 score) of the highest PPUS-FM score.There were statistical significances of uncertainty in illness in education (F =8.06,P ＜ 0.05),family income (F=3.14,P ＜ 0.05),residence place (F =3.99,P ＜ 0.05) and frequency of hospitalization (F =4.85,P ＜ 0.05).Conclusion Family members of patients with malignant tumor have a higher level of uncertainty in illness.Education,family income,residence place and frequency of hospitalization have a certain effect on uncertainty in illness of family members of patients with malignant tumor.

Objective To investigate the changes in the detection rate of gastric ulcer,duodenal ulcer and gastric cancer by gastroscopy after 10 years' eradicative treatment of Helicobacter pylori,in order to learn the characteristic alternations of these diseases and the significance of eradicative treatment of Helicobacter pylori.Methods The clinical and endoscopic data of gastric ulcer,duodenal ulcer and gastric cancer at our hospital in January 1994 to December 1995 and January 2004 to December 2005 were collected and analyzed.Results The detection rate of gastric ulcer,duodenal ulcer,and gastric cancer by gastroscopy during the period of January 2004 to December 2005(5.53%,10.07% and 4.03%,respectively) was significantly lower than that during the period of January 1994 to December 1995(8.17%,11.21% and 6.21%,respectively,P