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.

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

Obstructive sleep apnea-hypopnea syndrome ( OSAHS) is a prevalent disorder often associated with multisystem dys-function.Available therapies are limited by either lack of long-term adherence or low response rates .Two emerging therapies hold promise in providing alternatives to patients with OSA .The first stems from the importance of the upperairway dilator muscles in main-taining pharyngeal stability .Electrical stimulation of the genioglossus muscle improves both upper-airway diameter and ameliorates pha-ryngeal obstruction .The results of phase ⅠandⅡclinical trials hold promise , but the reported improvements in the apnea-hypopnea index vary between subjects and long-term safety needs further studies .The second technology relies on creating an increased expiratory nasal resistance via a bidirectional valve designed to be worn just inside the nostrils .Initial findings of clinical trials suggest reduction in severity of sleep apnea and subjective daytime sleepiness .Considerable heterogeneity in response to the nasal device was noted de-spite the high adherence rates .It remains unclear which patients will likely benefit from these devices .

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.

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 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.