After-department examination palys an important role in clinical teaching.The level of clinical teaching is one of the most important markers to evaluate the whole quality of the hospital.To improve the ability of teaching and teaching concept,we summarized the problem of after-department examination and put forward a series of reformation methods.

Objective To observe the variations of the functional states of T helper cells(Th) in peripheral blood of children with mycoplasma pneumoniae pneumonia(MPP) in acute phase,and to explore their roles in the pathogenesis of MPP.Methods Peripheral blood mononuclear cells(PBMC) of 40 MPP children were stimulated with PMA and ionomycin and cultured in vitro for 48 hours.The levels of IL-4,IFN-?,and TGF-?1 in the supernatants of PBMC were detected by ELISA.Results The levels of IFN-? and the ratio of IFN-?/IL-4 of MPP children in acute phase were significantly lower than those of the controls(P0.05).Conclusions The function of Th2 relatively prevails over Th1 in MPP children.The protective or regulative function of Th3 in vivo increases,but the protective regulation of TGF-?1 is insufficient,so the imbalance of Th1/Th2 can not be corrected.The variation of the functional states of T helper cells in acute phase has no relationship with or without the extrapulmonary damage.

The response of murine lymphoreticular tissue with Special reference to regional lymph node after implantation of Ehrlich ascites carcinoma cells was investigated histologically and ultrastructurally. The tumor induced a vigorous histological response in both regional and nonregional lymph nodes that was proliferation of immunoblasts with enlargement of paracortical area in early stage and enlargement, fusion of germinal centers with an increased number of plasma cells in the medullary cords during the late stage of tumor growth.The results suggested that the response of lymph nodes might be mainly related to cell-mediated immune mechanism in the early stage and humoral immunity during the late stage of tumor growth. Regional lymph node gave reaction earlier and more vigorously in participating cell-mediated immunity, nonregional lymph node might be more significantly involved in humoral immunity. It was observed ultrastructurally that sinus histiocyte engulfed tumor cell in which the cooperation with lymphocyte might be necessary. The experimental results indicated that the increased number of immunoblast in paracortex may be considered as an indicator for antitumor cellmediated immunity with an important prognostic significance for host bearing tumor.

Objective To investigate the clinical characteristics of colorectal cancer and its trend in Guangdong province.Methods The data from 6501 patients with pathologically confirmed colorectal cancer of 5 hospitals from 1990 to 2004 was analyzed.Results The mean age of 6501 patients with colo- rectal cancer was 59 years old,with the predominant age ranged from 61 to 70 years old.The proportion of young patients decreased from 7.1% to 3.5%.and the ratio between male and female was 1.47:1, which was gradually increased with increasing of age.The prevelence reached a high peak(60 years old) and dropped after that as a single peak curve.The ratio between rectal cancer and colon cancer was 1.1: 1,and the descending colon cancer accounted for 27.6%.With ageing,the rectal cancers decreased while the right hemi colon cancer increased gradually.Tubular adenocarinoma was predominant with his- tological typing,which accounted for 76.0%.The progressing stage(Dukes B,C,and D)was found in 93.9% of all cases.Conclusions The onset age of patients with colorectal cancer become close to west- ern country.The proportion of young patients are decreasing.The ratio between male and female dis- plays a single peak curve from rising to dropping.A tendency of decreasing percentage in rectal cancer and the gradual increasing in right hemi colon cancer emphasize the importance of colonoscopy in colorec- tal caner screening.

s Objective: To investigate the comorbidity of depression and anxiety in primary school students. Methods:565 pupils ranged from 2 to 6 grade in a primary school were tested by The Screen for Child Anxiety Related Emotional Disorders (SCARED) and Depression Self-Rating Scale for Children (DSRSC). Results: There were 140 pupils with a total score higher than cut-off point of SCARED; 97 pupils with a total score higher than cut-off point of DSRSC; 43 pupils with total scores higher than cut-off point of both SCARED and DSRSC, and the positive rate of comorbidity of anxiety and depression was 7.61%. 30.71 percent of children with anxiety disorder was considered co-morbiding depression; 44.33 percent of children with depressive disorder was considered comorbiding anxiety. Chil-dren with comorbidities had higher scores in Withdrawn(mean rank 297.7 ) than Anxiety group(220.8) and Depressive group(202.2);Somatic Complaints(268.2)than Anxiety group (232.2 ) and Depressive group(206.2 ) , Anxious/Depressed (277.2 )than Anxiety group (227.7 ) and Depressive group(219.2 )of CBCL(?~2 =16.72～22.71,P

Objective To investigate the efficacy of monotherapy or combination of ACEI and ARB in treating diabetic nephropathy(DN). Methods 183 patients with DN were randomly allocated into three treatment groups: benazepril,losartan or the combination of these two drugs for 12 weeks.The changes of blood pressure, proteinuria, serum potassium and creatinine, creatinine clearance(Ccr)were observed before and after treatment. Results Both of benazepril and losartan reduced blood pressure and proteinuria efficiently.And their effects were similar.In contrast, the reduction in proteinuria was greater in the combination therapy than in treatments of either drug alone(P<0.05), but their reductions in blood pressure were achieved to the same level(P>0.05).There were not significant differences in serum levels of potassium, creatinine and Ccr before and after treatment(P>0.05). Conclusion A combination of ACEI and ARB in patients with DN produces a better anti-proteinuric effect than either of the monotherapies.This protection is not dependent on changes in blood pressure.

Aiming at status of training the rural order directed free medical educational talents, we should improve the understanding of training the free medical students, perfect the relevant management system, strengthen medical ethics education of students, pay attention to humanistic care of students,strengthen the continuing education of students, standardize the access system of students, reform the medical distribution system, to ensure the quality of training free medical students.

Objective To evaluate the potential association of CD4+CD25+ T cells with alopecia areata.Methods Totally,this study enrolled 23 patients with progressive alopecia areata,25 patients with stable alopecia areata,and 25 healthy controls.Peripheral blood was isolated from these subjects followed by isolation of CD4+ CD25+ regulatory T cells,which were then cuhured with the presence of anti-CD3 and-CD28 monoclonal antibodies for four days.Subsequently,enzyme-linked immunosorbent assay was performed to measure the levels of interleukin (IL)-10 and transforming growth factor (TGF)-β1 in the culture supematant of these T cells.Results The levels of IL-10 and TGF-β1 were (31.68 ± 6.78) pg/ml and (32.29 ± 6.8) pg/ml respectively in the culture supernatant of CD4+CD25+ regulatory T cells from patients with progressive alopecia areata,significantly lower than those from the healthy controls ((57.34 ± 14.15) pg/ml and (57.43 ± 15.16) pg/ml,both P ＜ 0.05) and patients with stable alopecia areata ((52.56 ± 13.02) pg/ml and (61.75 ± 14.10) pg/ml,both P ＜ 0.05).However,no significant difference was observed in the supernatant levels of IL-10 or TGF-β1 between the healthy controls and patients with stable alopecia areata.Conclusions The secretion of IL-10 and TGF-β1 by CD4+CD25+ T cells is decreased in patients with progressive alopecia areata,which may contribute to the pathogenesis of alopecia areata.

Objective　To investigate the importance of CT diagnosis and differential diagnosis in Wilms′ tumors of children.Methods　45 cases of Wilms′ tumors confirmed by clinical and pathology were retrospectively analyzed,CT characteristics of Wilms′ tumor,renal carcinoma(2 cases),renal rhabdomyosarcoma(1 case)in children were discussed.Results　Wilms' tumors appeared in solid masses in 34 cases (76%),cysticsolid masses in 9 cases(20%),cystic masses in 2 cases (4%),7 cases (15.6%)had thrombosis in renal vein or IVC.Renal carcinoma shared the same appearance with Wilms′ tumor in image.Rhabdoid tumor of kidney appeard as cystic-solid mass with lineal calcification and subcapsular fluid accumulation.Conclusion　Wilms′ tumor is the most popular malignant renal tumors in children.It is originate from renal parenchyma,and likely to invade renal pelvis.Hemorrhhage,necrosis or cystic formation in tumor is common.They are difficult to be distinguished from renal cell carcinomas in radiology.Rhabdoid tumor of kidney is rare and has characteristic features on CT.

Objective To investigate the clinical feature, treatment and prognosis of severe hand-footmouth disease without typical skin lesions. Methods Clinical data from 24 patients with severe hand-footmouth disease without typical skin lesions collected from January 2010 to May 2010 were retrospectively analyzed.Results There were 17 males and 7 females among the 24 patients. Of them, 3 patients with positive EV71 showed no skin lesions at the first visit, 2 presented with only herpes of mouth, 3 with only skin rashes in gluteal regions, 5 with only skin rashes on the palms, 2 with only skin rashes of the knees, 9 with skin rashes in hands, feet and gluteal regions simultaneously. The skin rashes were sparse with an atypical distribution.Fever occurred in all the 24 patients and lasted 6 - 7 days. Nervous system was involved in all the patients,and pulmonary hemorrhage occurred in 4 patients. RT-PCR and real-time PCR showed that the pharyngeal swab was positive for EV71 in 13 patients, for CoxA16 in 2, for other enterovirus in 3, and feces samples were positive for EV71 in 9 patients, for CoxA16 in 1, for other enterovirus in 2. Five patients were positive for EV71 in both pharyngeal swab and feces samples. Four patients died of multiple organ failure, the other 20 patients were cured and discharged from hospital. Conclusions The major pathogen causing severe hand-footmouth disease is EV71 in the 24 patients; children under 2 years are liable to this disease; high fever is common with various rashes. Early recognition of atypical skin lesions and timely management are most important for the control of severe hand-foot-mouth disease and improvement in overall survival of patients with this entity.