Objective To investigate the effects of alpha-melanocyte-stimulating hormone (alpha-MSH) on the production of tumor necrosis factor-alpha (TNF-alpha) and intedeukin-10 (IL-10) by peri-pheral blood monohuclear cells (PBMCs) from patients with psoriasis vulgaris. Methods Heparinized peri-pheral blood was obtained from 20 patients with psoriasis vulgaris and 10 healthy human controls. PBMCs were isolated, cultured in complete medium, and stimulated with phytohemagglutinin (PHA) alone, the com-bination of PHA and various concentrations of alpha-MSH, or nothing. After another 48-hour culture, ELISA and real-time PCR were performed to measure the secretion levels of TNF-alpha and IL-10 in the super-natants of cultured PBMCs as well as the mRNA expression levels of TNF-alpha and IL-10 in PBMCs. Results The secretion level of TNF-alpha in the supematants of patient-derived PBMCs stimulated by nothing or PHA alone was significantly higher than that from normal control-derived PBMCs (329.87 ± 99.33 ng/L vs 116.95 ± 37.15 ng/L, 1756.01 ± 183.60 ng/L vs 1287.30 ± 152.36 ng/L, both P<0.01). alpha-MSH of all tested concentrations (10-13, 10-11, 10-7,mol/L) could inhibit the secretion of TNF-alpha by PBMCs com-pared with PHA alone (all P < 0.01), and the maximum effective concentration was 10-13 mol/L. On the con-Wary, a significant decrease was observed in the secretion level of IL-10 in the supematants of patient-derived PBMCs stimulated by nothing or PHA alone compared with normal control-derived PBMCs (P <0.05 or 0.01). Moreover, the secretion of IL-10 by PBMCs was promoted by alpha-MSH of all tested con-centrations (P < 0.01 or 0.05), with the maximum effective concentration being 10-13 mol/L (P < 0.01). The alpha-MSH of 10-13 mol/L down-regulated the mRNA expression of TNF-alpha (P < 0.001), but up-regnlated that of IL-10 (P < 0.001) in PHA-stimulated PBMCs from patients. Conclusion alpha-MSH can regulate the production of TNF-alpha and IL-10 by PHA-stimulated PBMCs from patients with psoriasis vulgaris.

Tutorial System is beneficial to improving the general disposition of undergraduate students,forming better learning atmosphere,enhancing the scientific research ability,broadening the pathway of contacting society,developing students' cognitive ability,and strengthening employment instructive work.Tutorial system for undergraduate students has been carried out for 4 years in our military medical university.After finding some problems of the work,making a summary of the beneficial experience and analyzing the cause of problems,we try to put forward some suggestions and take some optimization measures.

AIM:To observe the clinical curative effect of different duration of retinal vein occlusion ( RVO ) by laser photocoagulation treatment, discuss the timing of the RVO laser photocoagulation treatment, provide the basis for clinical choice of RVO photocoagulation treatment time.
METHODS: Retrospective analysis. Line selection retinal laser photocoagulation treatment for 103 cases (103 eyes) with RVO, patients were divided into three groups according to the onset time. In group A (46 eyes), course≤ 1mo, 28 eyes with branch retinal vein occlusion ( BRVO ) , 18 eyes with central retinal vein occlusion ( CRVO);30 eyes were ischemic RVO, 16 eyes were non-ischemic RVO. In group B (38 eyes), 1mo RESULTS: The best corrected visual acuity improved rate, retinal hemorrhage, macular edema, absorption, macular center concave thickness decreased of patients with different course after RVO photocoagulation treatment, the early group was better than that of the late, non-ischemic RVO was better than that of ischemic RVO, laser photocoagulation treatment effect BRVO was better than that of CRVO and the difference was statistically significant (P<0. 05).
CONCLUSION:RVO laser photocoagulation in the early intervention treatment can accelerate the retinal hemorrhage, macular edema, absorption, effectively protect the patient's existing vision, improve the long-term vision, and has a certain clinical practical significance.

AIM:To introduce a new method of guiding by using 3D-OCT to treatment central serous chorioretinopathy ( CSCR) with multiwavelength laser.
METHODS:Twenty-three cases ( 23 eyes ) typicality central serous chorioretinopathy were collected in July 2010 to July 2013 in Changchun Aier Eye Hospital, using 3D-OCT model locate central serous chorioretinopathy leakage point and photocoagulation treatment with multiwavelength laser. Postoperative follow-up of 24wk, the postoperative vision and macular area retina neuroepithelial layer detachment height were observed.RESULTS: Twenty-three cases ( 23 eyes ) of central serous chorioretinopathy patients by the 3D-OCT guided multiwavelength laser treatment vision after 24wk of follow-up compared with before treatment. there was statistically significant ( P < 0.05 ) . Visual improved obviously after treatment. OCT macular area before and after the treatment on macular area retina neuroepithelial layer detachment height ( P<0.05 ) . OCT macular area before and after the treatment of macular area retina neuroepithelial layer detachment height significantly decreased, slurry apparent absorption. Except 1 case lost visitors, 23 cases ( 23 eyes ) with central serous chorioretinopathy did not see the whole body or eye local adverse reactions occur.
CONCLUSION: 3D- OCT guided by multiwavelength laser treatment of central serous chorioretinopathy and under the guidance of FFA in the central serous chorioretinopathy laser treatment have the same curative ratio, has certain clinical value.

Objective To prospectively investigate the neurological complications(NC)after offpump coronary artery bypass grafting(OPCABG),including the kinds of NC and their mobility,risk factors.prevetion and treatment.Methods A total of 55 consecutive patients with undergoing OPCABG were evaluated from March to June 2006 at the Department of Cardiosurgery in Beijing Anzhen Hospital.Risk factors of NC were collected before operation.Nervous system physical examination,The NIH Stroke Scale(NIHSS)score evaluation,cognitive tests,imaging examination(MRI,MRA and f-MRI),anxious and depression scale were performed before and after OPCABG.NC and their kinds were identified after surgery.According to the presence or absence of NC after the operation,the patients were divided into two groups,and univariate analysis was used between the two groups.P＜0.05 was considered of statistically significant difference.Results (1)2 cases of ischemic stroke developed after surgery(2/55),but there no case of mortality.The risk factors were not statistically different between the two groups(P＞0.05):(2)For all the patients,cognitive evaluation was normal and unchanged before and after surgery(P＞0.05),including Mini-Mental State Examination(MMSE),Clinical dementia rating(CDR)and Global Deterioration Scale (GDS);(3)Except the 2 cases of stroke,the others were normal and had no change on MRI,MRA,and f-MRI(P＞0.05)before and after surgery;(4)7 patients with slight anxiety and one with sight depression before operation recovered completely after surerty without treatment.Both the Self-rating Anxiety Scale (SAS)and Self-rating Depression Scale(SDS)were normal and unchanged before and after surgery (P＞0.05).Conclusions 2 cases of ischemic stroke were found among 55 patients undergoing OPCABG (2/55)and there was no mortality.There was no obvious change of cognitive function,imaging finding,anxiety and depression before and after the operation(P＞0.05).OPCABG is relatively safe for nervous system,but more exploratory work andclinical data are needed.

Objective To explore the influence of coal-arsenic exposure on human T cells proliferation and its mechanism.Methods Blood samples colleoted from individuals which lived in arsenism area of coal-burning type and non-arsenism area in Guizhou Province were divided into exposed group(17),mild(35),moderate(38) and severe arsenism group(19)and control group(35)according to Diagnosis Smndard for Endemic Arsenism (WS/T 211-2001).T cell stimulation index wag determined by methyl thiazolyl tetrazolium(MTT)colorimetric method.The intracellular Ca2+ exponential(IECa2+)in peripheral blood mononuclear cell(PBMC)was analyzed by Fho-3/AM dye and flow cytometry.DNA binding activity of actively T cells nuclear factor(NF-AT)in PBMC was evaluated by electrophoretie mobility shift assay(EMSA).Results Concanavalin A(ConA)stimulation decreased the T cells stimulation indexes in exposed group,mild,moderate and severe arsenism groups(1.315±0.962, 1.611±1.224,1.114±0.545,1.289±0.875)compared with control group(2.322±1.241),all the differences being statistically significant(P＜0.01).After stimulated by anti-CD3 monoclonal antibody(McAb),the T cells stimulation index in exposed group,mild,moderate and severe arsenism group(0.997±0.177,1.103±0.291,1.007±0.221, 0.957±0.205) were lower than that of control group(1.842±0.429,P ＜ 0.01 ). IECa2+ of PBMC after treated by anti-CD3 McAb in mild,moderate and severe arsenism group( 110.130±49.637,92.429±31.191,77.640± 35.372) were lower compared with control group(145.986±59.450,P ＜0.01 ). Moreover,IECa2+ in moderat and severe arsenism group were lower than exposed group(121.337±46.410,P ＜ 0.05). DNA binding activity of PBMC NF-AT in mild,moderate and severe arsenism group(1.354±0.446,1.290±0.291,1.159±0.411 ) were lowered than that of control group(1.722±0.291,P ＜ 0.01) and exposed group(1.611±0.294,P ＜ 0.05). Conclusions The coal-arsenic exposure can reduce the human T cells stimulation indexes,IECa2+ in PBMC and the DNA binding activity of NF-AT. It suggest that arsenic may suppress the proliferation ability of human T cells,which may be partly related to the influence of arsenic on T cell receptor(TCR)/CD3 signal transduetion pathway.

Objective To investigate the activation of T lymphocytes in human peripheral blood and the signaling molecules in protein kinase C/nuclear factor KB(PKC/NF-κB) pathway expressivity or activity changes in human peripheral blood mononuclear cells(PBMCs) exposed to coal-arsenic,to explore the role of PKC/NF-κB signal pathway in activation of T cells in human exposed to coal-arsenic. Methods Blood samples were collected from individuals who lived in arsenism area of coal-burning in Guizhou province, and were divided into asymptomatically exposed group (12),mild arsenism group (33),moderate arsenism group (34) and severe arscnism group (15) according to Diagnosis Standard for Endemic Arsenism (WS/T 211-2001). The individuals who lived in non-arsenism area were control group(27). The ratio of activated T ceils was analyzed by flow cytometry. DNA binding activity of NF-κB in PBMCs was evaluated by electrophoretic mobility shift assay(EMSA). The expression of PKCθ and phospho-PKCθ(pPKCθ) in PBMCs were detected with western blotting analysis. Results The ratio of activating T cells in asymptomatically exposed group[(21.76±15.31)%],mild arsenism group[(18.41±11.36)%],moderate arsenism group[(17.78±11.93)%]and severe arsenism group[(18.79±13.38)%]were all higher than that of control group[(3.19±2.12)%],the difference among all groups being statistically significant(F = 7.893,P < 0.05). DNA binding activity of PBMCs NF-κB in asymptomatically exposed group,mild arsenism group,moderate arsenism group and severe arsenism group(1.49±0.24,1.58±0.30,1.57±0.34,1.51±0.16) were higher than that of the control group(1.30±0.17),the difference being statistically sign/ficant(P < 0.05 or < 0.01). The expression of PBMCs pPKCθ in mild arsenism group,moderate arsenism group and severe arsenism group(0.64± 0.14,0.64±0.27,0.62±0.12) were all lower than that of the control group(0.93±0.20),the difference being statistically significant(P < 0.05). There were significant negative correlations between the expression of pPKCθ and the activity of NF-κB(r =-0.565,P < 0.01). There were significant positive correlations between the activity of NF-κB and the ratio of activating T cells(r = 0.546,P < 0.01). Conclusion Coal-arsenic enhances the DNA binding activity of NF-κB,reduces the expression of PBMCs pPKCθ in human PBMCs and up-regulates the activity of T cells. It suggests that the PKC/NF-κB signal might be one of transduction pathway via activating of T cells by coal-arsenic.

Objective To explore the relationship between K-ras gene and cholangiocarcinoma by detecting the K-ras gene mutation of bile duct tissues.Method We studied all the patients who presented to our hospital from June 2010 to June 2012 with stenosis of the bile duct.There were 17 cases of cholangiocarcinoma and 17 cases of benign stenosis.From the DNA extracted from the paraffin tissues,we used the HRM assay for K-ras gene mutation.Result We found that the HRM method and the DNA typing had exactly the same result for the DNA content which confirmed the effectiveness of the HRM assay.Of note,the K-ras mutation rate was found to be significantly higher in the cholangiocarcinoma cases (11/17) when compared with the benign cases (3/17).Conclusion The mutation of the K-ras gene was closely related to cholangiocarcinoma.Our results suggest a new way to diagnosis cholangiocarcinoma.

Objective To compare the curative effect of 360° arthroscopic denervation and routine arthroscopic debridement in treatment of knee osteoarthritis.Methods A total of 85 patients were included in the study after excluding the 5 follow-up dropout among the 90 patients with knee osteoarthritis treated between May 2006 and May 2011.Subsequently,the odd and even quality of the mantissa of admission number was used to determine the groups:Group A,42 patients underwent routine arthroscopic debridement; Group B,43 patients underwent arthroscopic debridement plus 360 degree denervation.Traumatic and degenerative arthritis occurred in 30 and 55 patients respectively.There were 34 male and 51 female patients whose mean age was 63 years (range,52-73 years).Western Ontario and McMaster University Osteoarthritis Index (WOMAC),MOS item short from health survey (SF-36),and visual analogue score (VAS) were compared between the two groups before and after operation.Results WOMAC score and SF-36 score of the two groups improved after surgery.At postoperative 6 months,12 months,and 24 months,WOMAC in Group B scored 81.0,78.5,and 82.4 respectively,lower than 86.8,83.8,and 91.7 in Group A (P ＜ 0.05) ; SF-36 in group B scored 47.4,46.3,and 44.4 respectively,higher than 43.9,41.4,and 39.5 in group A (P ＜ 0.05).At postoperative 1 week,VAS of group B was 1.6 points,lower than 2.6 points in group A (P ＜ 0.05).There was no statistical difference between the two groups in postoperative swelling of joint (P ＞ 0.05).Conclusions According to the area involved in knee osteoarthritis and characteristics of innervation of knee joint synovium,arthroscopic 360° denervation provides thorough debridement and removes as many innervation of knee joint synovium.Arthroscopic 360° denervation is superior to the routine arthroscopic debridement in improvement and duration of the symptoms.

Objective To investigate the efficacy and safety of butenafine hydrochloride 1% aerosol in the treatment of tinea pedis,tinea cruris or tinea corporis.Methods A randomized,double-blind,multi-center clinical trial was conducted.Efficacy was assessed in terms of mycological cure,total clinical sign and symptom scores,and clinical response,at baseline,mid-term,end of study,and 2 weeks after treatment.Results One hundred and seventeen patients with tinea cruris or tinea corporis were randomly allocated to individual groups treated with either butenafine 1% aerosol (n = 58,male 53,female 5,age 29.45 ? 11.80,course of disease 3.0 ? 5.0 months) or bifonazole 1% aerosol (n = 59,male 49,female 10,age 34.12 ? 12.98,course of disease 3.0 ? 11.0 months).One hundred and nineteen patients with tinea pedis were also allocated to two groups treated with either butenafine (n = 59,male 59,age 22.97 ? 3.97,course of disease 24.0 ? 36.0 months) or bifonazole (n = 60,male 60,age 23.77 ? 4.12,course of disease 36.0 ? 48.0 months).The cure rates and total response rates were 25.86% vs.40.68%,and 86.21% vs.91.53%,in the study group and the control group,respectively,at the end of study,and 58.62% vs.74.58%,and 96.55% vs.96.61% in 2 weeks following-up,for the patients with tinea cruris or tinea corporis.Also,the cure rates and total response rates were 23.73% vs.25.00%,81.36% vs.78.33%,in the study group and the control group,respectively,at the end of study,and 37.29% vs.41.57% and 81.36% vs.90.00% in 2 weeks following-up,for the patients with tinea pedis.Local adverse reactions were recorded in 13 of butenafine group,and 20 of bifonazole group.The differences of above data between two groups were not statistically significant.Conclusion Butenafine hydrochloride 1% aerosol is effective and well tolerated for the treatment of tinea pedis,tinea cruris or tinea corporis.