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.

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.

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.

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.

Objective To investigate the value of the multiple short tandem repeat (STR)amplification by fluorescence labeling polymerase chain reaction (PCR) combined with fusion gene bcr-abl mRNA expression for quantitative determination of chimerism and qualitative detection of bcr-abl transcripts,and to evaluate the status of engraftment and predict the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods 5 relapse patients with CML after alIo-HSCT were dynamically investigated. Quantitative analysis of donor chimerism was performed by multiplex PCR amplification of STR markers and capillary electrophoresis with fluorescence detection, qualitative detection of bcr-abl transcripts was performed by RT-PCR. Results The donors alleles appeared in all of 5 patients on day 28 post transplant, and bcr-abl expression was negative. But 5 patients had unstable mixed ehimerism. (DC: 0～80.4 %) at the different time points after aIIo-HSCT and bcr-abl was positive. One of them kept eontinuely the mixed chimerism in the relapse of disease, and died after one year, and the other changed from MC to CC by intervention of clinical treatment. Reduction of donor chimerism were detected prior to the occurrence of graft rejection and disease relapse, while bcr-abl gene expression was positive. Conclusion The results of STR-PCR in the range of its sensitivity fully correspond with bcr-abl tests in patients with CML. The combination of STR-PCR with RT-PCR provides a highly sensitive and valuable tool for engraftment evaluation, graft rejection, relapse and predicting GVHD. Furthermore it can provide a basis for early intervention of clinical treatment, and can identify these patients at high risk with molecular or cytogenetic relapse after allo-HSCT.

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.

AlM: To evaluate the application of phacoemulsification of different nucleus density using ozil and traditional mode.METHODS: A total of 89 eyes (72 patients ) ( visual acuity was of 0. 6 and above after 1mo follow - up) of different nucleus density level (LOCS Ⅱ criteria grade Ⅲ 46 eyes, grade Ⅳ and more 43 eyes ) were randomly assigned into 2 groups: ozil group (group A), grade Ⅲ 22 eyes (torsional energy 80% lP on);grade Ⅳ and more 17 eyes (torsional energy 100% lP on); Traditional mode group(group B), grade Ⅲ 24 eyes (energy 50% ), grade Ⅳ and more 26 eyes (energy 60% ~ 70% ) . All surgeries were performed by the same experienced surgeon,who use the chop to split the nucleus in the application of phacoemulsification. lntraoperative parameters were total equivalent pawer ( TEP ), cumulative dissipated energy ( CDE ) and effective phaco time ( EPT ) and surgical complications. The effectiveness of the two modes in dealing with hard - core cataract phacoemulsification were compared.RESULTS: GradeⅢ nucleus dealing: TEP of ozil group was significantly higher than that of the traditional mode group [(24.58±7.78)% vs (13.84±1.97) %]and EPT of ozil group was significantly lower than that of the traditional mode group (50. 59±14. 73 s vs 60. 19±9. 04 s, P<0. 05). CDE showed no difference between two groups [(13.12±6.03)% vs (13.38±2.85)]. Grade Ⅳ and more nucleus dealing: CDE [( 34. 10 ± 13. 48 )%] and EPT (104. 64±32. 4s) of the ozil group was higher than CDE [(30. 31 ± 13. 48)%] and EPT (93. 01 ± 41. 01s) of the traditional mode group, but there were no difference between two groups. Obstacles in the needle of phacoemulsification surgery: ozil group 4/17, traditional mode group 2/26 (χ2=2. 16, P=0. 14).CONCLUSlON: Bothozil and traditional mode can deal with all kinds of nucleus effectively and safely. Ozil mode is more efficacy and quick deal in gradeⅢnucleus. With the increase of nucleus hardness, the traditional mode still have the advantage of high efficiency and no obstacle to dealing patients with grade Ⅳ and more nucleus. Choose according to different nuclear hardness ultrasonic model can improve the operation efficiency and security.

Objective To investigate the variation and correlation between tumor necrosis factor-?(TNF-?)and transforming growth factor-?1(TGF-?1)in children with Henoch-Schonlein purpura nephritis(HSPN)in plasma and explore their effects on kidney lesion in children with Henoch-Schonlein purpura(HSP).Methods Plasma TNF-? and TGF-?1 were determined with enzyme-linked immunosorbent assay(ELISA)in 30 cases with HSP,38 cases with HSPN and 30 normal controls,urinary protein excretion with urinary analyze method in these children.Renal biopsies were performed and renal biopsy specimens were observed by light,immunofluorescence and electron microscopy in 32 out of 38 cases with HSPN.The SPSS 11.0 software was used to analyze the data.Results 1.Comparing with normal controls,the plasma level of TNF-? and TGF-?1 in children with HSP increased with significant difference in statistics(Pa