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.

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.

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.

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.

This paper analyzed some policies of new health care reform from the perspective of doctor -patient trust.The implementation of the policy of income and expenses in two lines has changed the management mode of township hospitals , eliminated some factors harming the doctor -patient relationship .The policy of equalization of public healthand other policies have guided the hospitals to change the way of service , service and health man-agement into the village increased the degree of doctor -patient trust .But at the same time , to ensure the new health care reform run smoothly , township hospitals introduced various ways of prescribing restraints .In addition , the policy of zero profit for basic drugs also brought some restrictions and regulations , resulting in a decline of satis-faction of patients , who have a tendency to blame the hospitals and doctors for these inconveniences .This misun-derstanding has becomed the new difficulties for doctor -patient trust as policy running .

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.

Due to the advance of CT equipment, combined with the current intensifying doctor-patient conflict, the indication of CT examination is relaxed, even expanded to the examination of benign lesions, which contributes to the blind diagnosis using CT or the so-called“Casting a big net”. However, X-rays bring two kinds of risks. One of them is the risk of the accumulated X-rays, the other one is the missed diagnosis resulting from the poor image quality, which is caused by the low amount of radiation. Therefore, how to strike a balance between these two not only becomes the focus of academic circles, but sparks the whole society’s attention. This article elaborates X-rays hazards, CT radiation does, application of Multiple Detector Spiral CT, purpose and principles of radiological protection and optimization of CT scanning technology. The author believes “exposure does individualization” can be achieved under the principle of ALARA (as low as reasonably achievable), or we can even minimize the exposure does according to the requirements of diagnosis and accept the image with appropriate noise.

Subacromial impingement is an important cause of shoulder pain,which is common in orthopedic diseases. Clinicians have different views on the diagnosis and therapies. This article summarizes research advances of subacromial impingement syndrome in pathogenesis,types,clinical manifestation,ima-ging findings and treatment,hoping to standardize the diagnosis and treatment.

T-cell lymphoma is a rare form of non-Hodgkin lymphoma with high heterogeneity. The basic and clinical research of T cell lymphoma is lagged than B cell lymphoma. Recently, with the development of pathology and molecular biology, the level of diagnose has been raised, novel therapies such as targeted therapy and immunotherapy have been developed, these will make it possible to improve the prognosis of patients.