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.

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.

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.

Seven cases exhibited segmental bile duct dilation with filling defects. One case only showed dilatation of lobar bile ducts. Conclusion MRI features of IPNB are helpful for distinguishing IPNB from other hepatic lesions.

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.

Background Corneal transplantation faces a great challenge because of the shortage of corneal donors and difficulty of human corneal endothelial cells (HCECs) regeneration in vitro.So the study on tissue engineering cornea is still a main topic.Previous research showed that mouse embryonic stem cell conditioned medium (ESC-CM) improved the proliferative capacity of HCECs in vitro,and acellular porcine corneal stroma (APCS) was a good saffold material.However,whether HECEs cultured by mouse ESC-CM can form cell sheet in vitro were rarely studied.Objective This study was to investigate the potential that HCECs cultured by mouse ESC-CM form a monolayer cell sheet.Methods The supernatant of ESC-CM was collected after mouse ES-E14 cells were cultured,and the cultured medium was centrifuged and mixed with 75％ human corneal endothelium medium (CEM)at a proportion of 1 ∶ 3 to prepare the 25％ ESC-CM system.Primary cultures of HCECs were established from explants of corneal limbal with Descemet's membrane,and the cells were identified by using reverse-transcription PCR to determine the expressions of collagen Ⅷ (Col Ⅷ) mRNA and neuron-specific enolase (NSE) mRNA in the cells.APCS was prepared by decellularization with phospholipase A2 and bicarbonate solution,and the second generation of HCECs were inoculated on the sterilized APCS at a 800/mm2 density.The morphology of the cells was observed by hematoxylin-eosin staining under the phase-contrast microscope.The expressions of zona occludens protein-1 (ZO-1)and Na+-K+-ATPase in the cell sheet were detected by immunofluorescence staining.Results The second generation of HCECs cultured with 25％ ESC-CM in vitro showed the hexagon in shape with positive expressions for Col Ⅷ mRNA and NSE mRNA.Decellularization APCS was transparent,and no corneal cells were seen,the structures of corneal collagenous fibres were regular.HCECs attached closely to APCS and formed monolayer sheet 7 days after culture on the APCS with the cell density of (2 694±143)/mm2.ZO-1 and Na+-K+-ATPase were positively expressed on the HCECs sheet.Conclusions Twenty-five percent ESC-CM promotes the proliferation and maintains the normal morphology of HCECs.APCS provide a good scoffold and microenvironment for the formation of HCEC sheet.The HCEC sheet Possesses the pump function of HCECs and is a good corneal donor for transplantation.

Objective To observe clinical effects of Zhenzhumingmu eye drops combing with antibiotic in treatment of chronic conjunctivitis.Methods 96 patients with chronic conjunctivitis from ophthalmology department from January 2015 to October 2016 were grouped two groups by draw method,each with 48 cases.The control group was treated with ofloxacin eye drops,and observation group was treated with Zhenzhumingmu eye drops combing with ofloxacin eye drops.Related indicators are analyzed in two groups.Results ①Effective rate of observation group was 87.50%,higher than control group with 66.67%(P<0.05).②Dry eye, eye itching, eye fatigue and foreign body sensation score of observation group were (1.01±0.24),(0.93±0.22),(0.85±0.18),(0.81±0.25)points,lower than control group(1.46±0.30),(1.39±0.25),(1.16±0.21),(1.22±0.29)(all P<0.05).③Eye discomfort proportion of observation group was 12.50%, higher than control group 8.33%,but the difference was not statistically significant.Conclusion Zhenzhumingmu eye drops has exact curative effect in treatment of chronic conjunctivitis,can improve the symptoms and has high security.

OBJECTIVE:To observe clinical efficacy and safety of Xinmailong injection combined with trimetazidine in the treatment of chronic heart failure of coronary heart disease(CHD)(Qi Yang deficiency ). METHODS:A total of 80 patients with Qi Yang deficiency chronic heart failure of CHD were selected from our hospital during Jan. 2011-Dec. 2105 were divided into ob-servation group and control group according to random number table,with 40 cases in each group. Both groups received routine treatment. Control group was additionally given Trimetazidine dihydrochloride tablets 20 mg,tid,for consecutive 6 months,on the basis of routine treatment. Observation group was additionally given Xinmailong injection 5 mg/kg added into 0.9％ Sodium chlo-ride injection 500 mL,ivgtt,at speed of 30 drops/min,bid,medication interval>6 h,for consecutive 5 days,on the basis of con-trol group. Efficacies of cardiac function improvement,TCM symptom efficacies as well as LVEF before and after treatment were observed in 2 groups. The occurrence of ADR was compared between 2 groups. RESULTS:Total response rates of cardiac function and TCM symptom were 90.00％ and 95.00％ in observation group,which were significantly higher than 62.50％ and 55.00％ of control group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in LVEF between 2 groups (P>0.05). After treatment,LEVF levels of 2 groups were increased significantly,and the observation group was signifi-cantly higher than the control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Xinmailong injection combined with trimetazidine in the treatment of Qi Yang deficiency chronic heart failure of CHD show significant therapeutic efficacy and improve LEVF level with good safety.