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.

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.

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 explore the clinical application value of blood uric acid(SUA),beta 2 microglobulin(β2-MG),lipopro-tein(a)[LP(a)]and C-reactive protein(CRP)in the early renal damage caused by elderly hypertension.Methods According to the clinical diagnosis,210 elderly patients with primary hypertension were selected as the research subjects and 50 healthy elderly per-sons as the healthy control.The SUA,β2-MG,LP(a)and CRP levels were detected.The differences were compared between the groups with the different severity degrees of hypertension and the healthy control group;Furthermore,these 210 cases of hyperten-sion were divided into the simple hypertension group and the hypertensive renal group according to the creatinine clearance rate (Ccr)for observing the changes of the four indicators.Results The blood SUA,β2-MG,LP(a)and CRP levels in the hypertension group were significantly increased,which were higher than those in the normal control group,the differences had statistical signifi-cance(P <0.01);In the study by grouping according to the increase degree of blood pressure:the blood SUA,β2-MG,LP(a)and CRP levels in the three groups of the grade 1,2,3 hypertension were significantly increased,the statistical analysis showed the sig-nificant difference between groups(P <0.05);Compared with the simple hypertension group,the SUA,β2-MG,LP(a)and CRP lev-els were significantly increased compared with the hypertensive renal group,the difference showed the statistical significance(P <0.05).Conclusion Monitoring blood SUA,beta 2-MG,LP(a)and CRP levels in elderly patients with hypertension can effectively monitor the early renal function damage in the patients with senile hypertension,can find the renal lesions more rapidly and effec-tively and is conducive to early diagnosis and treatment in clinic.

Objective To explore the effects of the different doses of propofol for preventing postoperative agitation in chil-dren.Methods 60 children cases undergoing elective indirect inguinal hernia hernioplasty were selected in the Affiliated Hospital of Traditional Chinese Medicine,Luzhou Medical College from June 2011 to April 2011 and randomly divided into the group Ⅰ,Ⅱ andⅢ.The three groups were performed the general anesthesia with sevoflurane and postoperatively given 0.90% sodium chloride in-jection 0.10 mL/kg by intravenous injection,propofol 1.00 mg/kg by once intravenous injection and propofol 1.00 mg/kg by twice intravenous injection,respectively.The occurrence rate of postoperative agitation within 30 min was compared among 3 groups.The anesthesia recovery agitation score,improved Aldrete score,awakening time and time out of the operation room were also compared. Results The occurrence rates of agitation within postoperative 30 min in the group Ⅰ,Ⅱ and Ⅲ were 65.00%,65.00% and 15.00% respectively,the difference among three groups was statistically significant (P <0.05);the anesthesia recovery agitation score,improved Aldrete score and awakening time had statistically significant differences among 3 groups (P <0.05),the time out of the operation room had no statistical difference(P > 0.05).Conclusion Postoperative twice intravenous injection of propofol 1.00 mg/kg has obvious effect and good safety for preventing the postoperative agitation in children,which has important clinical reference value.

To investigate the effect of herbal drugs for clearing away heat, removing dampness and killing parasites,which are used for washing on tinea pedis. Two hundred and eight cases confirmed as tinea pedis were randomized to two groups: group A (n=108) and group B (n=100). Group A was treated with Xiaoxuan Lotion (mainly composed of Radix et Rhizoma Rhei, Herba Artemisiae Scopariae, Cortex Phellodendri, Radix Sophorae Flavescentis, Radix Stemonae, etc.) and group B with miconazole nitrate cream. Two treatment courses were carried out. After one treatment course, 65 (60.2%) cases were cured in group A and 45 (45%) in group B, the difference being significant (P

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 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.