Medicine is a practicing and experiencing subject.The most important study method for medical students is to practice during clinic.With the development of society,patients' consciousness of sticking up for their rights is stronger and stronger.During their receiving medical treatment,they are not satisfied with the teaching behavior provided by physician,and even to make medical conflicts.To resolve these conflicts,it is necessary to rule the clinical practicing teaching,harmonize the relationship between clinical teachers,medical practicing students,and patients.Medical education should be based on humanity and should be behaved by law.

The author reviewed papers on Evaluation on Teaching Hospitals in China from 1997 to now.Teaching hospitals were evaluated by educational and health administrator of local government since 1997.The methods the roles of evaluation,advantage and disadvantage of evaluation on teaching hospitals were described in this paper.

Objective To study and observe the application effect of debridement adhesive combined with comfeel silver ion dressing in the treatment of wound after the total cystectomy.Methods 90 patients with total cystectomy in Cixi People's Hospital from July 2014 to June 2016 were selected as the research object, and all the patients were randomly divided into control group 45 cases and observation group 45 cases, the control group were treated with conventional treatment of postoperative wound, the observation group were treated with debridement adhesive combined with comfeel silver ion dressing on the treatment of control group, then the infection rates, degree of edema and local comfort, life quality and local microcirculation state before and after the intervention of two groups were respectively analyzed and compared .Results The infection rates of observation group were higher than those of control group, the degree of edema and local comfort, life quality and local microcirculation state after the intervention were all significantly better than those of control group, the difference was all statistically significant ( P <0.05 ).Conclusion The application effect of debridement adhesive combined with comfeel silver ion dressing in the treatment of wound after the total cystectomy is better , and it has active role for the improvement of discomfortableness and microcirculation state.

[Objective] To explore the clinical effect of Buyang Huangwu Decoction and Guipi Decoction together on BTS. [Method] Select 48 cases of BTS in accordance of diagnosis standard, divide them into treatment group 48 cases(take revised Buyang Huangwu Decoction and Guipi Decoction ) and control one 20(routine western medicine), judge their cure effect after 2~4 courses. [Result] The cure rate and total effective rate were respectively 60.42%and 87.50% for treament group, for control one, they were respectively 30.00% and 65.00%; with χ2 test, their differences were respectively of marked statistical meaning and statistical meaning. [Conclusion] Buyang Huangwu Decoction and Guipi Decoction together had definite cure effect on BTS.

ObjectiveTo study the mastery, acquiring ways and need of studying the knowl-edge and skill of emergency treatment in non- medical junior college and technical secondary school students. MethodsThe survey was carried out in 600 non-medical junior college and technical sec-ondary school students to investigate their mastery and need of emergency knowledge, the results underwent analysis. ResultsThe mastery of the emergency knowledge was uneven in non- medical junior college and technical secondary school students. 100.0% of them can call 120 correcdy, 58.5% of them mastered the e-mergency treatment of carbon monoxide poisoning, and 25.0% mastered cardiac pulmonary resuscitation. All the students desired to hold the knowledge and skill of emergency treatment. Television, broadcast and internet were the main ways for them to master emergency knowledge. ConclusionsThe mastery of the knowledge and skill of emergency treatment is not good. It is urgent to educate and train them with the knowledge and skill of emergency treatment, and to improve knowledge and skill of emergency treatment.

Objective To summarize the nursing experience in prehospital first-aid of patients with cardiac traumas in order to improve the cooperation capability of prehospital first-aid. Methods The nursing cooperation of prehospital first-aid of 33 patients with cardiac trauma was analyzed retrospec-tively. Results 24 cases of them were rescued successfully, and were completely recovered without se-quelas. 4 cases complicated with severe multiple trauma, died after arriving at hospital, and 3 cases com-plicated with multiple trauma died of complications, while 2 cases with injury of thoracic aorta died during the surgery. Conclusions Early emergency treatment and judgment of traumatic condition could pro-vide valuable chance for inhospital first-aid.

Objective To discuss the influence of respiratory training and prompting effective discharging of sputum for chronic obstructive pulmonary disease (COPD) patients in acute aggravation period. Methods 50 patients were randomized into the intervention group and the control group with 25 cases in each group.The intervention group received respiratory training and prompting effective discharging of sputum while the control was only given routine treatment and nursing.The ratio of first second expiration volume to forced vital capacity, oxygen partial pressure (PaO2),carben dioxide partial pressure (PaCO2) ,blood oxygen saturation (SpO2)and the in-hospital days were compared between the two groups. Results The clinical effect in the intervention group was superior to that of the control group with shorter in-hospital days (P<0.01).Conclusion Better results could be obtained by application of respiratory training and prompting effective discharging of sputum for COPD patients in acute aggravation period.

Objective To explore the effect of anti-TNF rcMAb in the treatment of patients with rheumatoid arthritis (RA) and its effect on peripheral blood Th1,Th17 and Treg cells.Methods Fifty rigorously screened RA patients were randomly divided to the therapy group (n=40) who received the combined treatment of anti-TNF rcMAb and MTX,and control group (n=10) who were given MTX along with placebo,both at week 0,2,6,and 14.The clinical data of the two groups were observed and accessed respectively at week 0 and 18.In addition,the percentage of Th1,Th17,Treg cells in the peripheral blood and the relative gene expressions of transcription factors T-bet,RORC,Foxp3 in these patients were also observed respectively before and after treatment.We used t inspection and x2 inspection as the statistical analysis methods in conducting this study.Results Comparing with the control group,more patients achieved ACR20,ACR50 and ACR70 response in the combined therapy group (Z=1.671,P=0.000 94).The percentage of peripheral blood Th1 cells decreased [week 0:(7.1±3.9)％; week 18:(4.2±2.8)％] and the percentage of Treg cells obviously increased [week 0:(1.5±0.8)％; week 18:(3.0±0.6)％,t=2.301,P=0.048] in the combined therapy recipients,while the percentage of Th1 cells fell [week 0:(9.1±3.1)％; week 18:(5.8±2.6)％] and that of Treg cells slightly increased [week 0:(1.2±0.6)％; week 18:(2.2±0.6)％] in the controls.The mRNA expressions of RORC and T-bet,the transcription factors of Th17 and Th1,were decreased respectively and that of Foxp3,the transcription factor of Treg,were elevated in both groups.Conclusion The combined therapy of anti-TNF rcMAb and MTX is very effective in RA patients.Good outcome is likely achieved by modifying the peripheral blood Th cell subsets in patients with RA.

Objective To study the change of Yes-associated protein (YAP) expression in rectal cancer and to explore the significance of YAP in rectal cancer.Methods Reverse transcriptase polymerase chain reaction(PT-PCR) and Western bloting technology were used to detect mRNA and protein expression of YAP in 30 patients with rectal cancer and 10 cases of normal rectal mucosa tissue.Results The expressions of mRNA and protein of YAP in rectal cancer were significantly higher than those in normal rectal mucosa tissue (73.2 ± 1 1.1 vs.10.4 ± 4.1,65.7 ± 9.5 vs.9.2 ± 4.3,P ＜ 0.05).Conclusion YAP high expression is related to the occurrence of rectal cancer.

Objective To assess the value of endoscopic submucosal dissection(ESD)for the treatment of early tumors located at the esophagogastric junction.Methods The clinical data of 57 patients with early tumors located at the esophagogastric junction who received ESD at the Zhongshan Hospital from November 2006to March 2011 were retrospectively analyzed.The operation time,blood loss,resection of tumor and perioperative complications were observed.The pre-and postoperative pathological findings were analyzed.Results ESD was successfully completed on the 57 patients.The median operation time was 55 minutes(range,25-95 minutes),and the median volume of blood loss was 74 ml(range,20-300 ml).En-bloc and piecemeal resections were carried out on 39 and 18 patients,respectively.The operative complication rate was 25%(14/57),including 5 patients complicated with perforation and 9 with bleeding.The postoperative complication rate was 16%(9/57),including 6 patients complicated with delayed hemorrhage and 3 with stricture of the esophagogastric junction.Of the 39 patients who were diagnosed as with high-level intraepithelial neoplasia preoperatively.3 were confirmed as with intramucosal carcinoma;of the 18 patients who were diagnosed as with intramucosal carcinoma preoperatively,4 were confirmed ag with adenocarcinoma.All patients were followed up for 9-27 months,no recurrence or metastasis was found.Conclusion ESD is effective and safe for the treatment of early tumors located at the esopha gogastric junction.