Brucellosis is a zoonosis with worldwide distribution.There is an upward trend in the incidence of this disease in recent years,and multiple systems and organs are affected.Complication of bone and joint is the most commonly seen of Brucellosis.Although cardiovascular complication is rare,it is the major reason for Brucellosis-related mortality.The author summarized domestic and foreign studies on Brucella endocarditis.

Objective To investigate the expression of vascular endothelial growth factor C(VEGF-C ) in tissue, serum and lymph fluid in esophageal cancer patients, and the relationship between its expression and tumor lymphatic metastasis. Methods Expressions of VEGF-C in 76 cases of ESC was detected by immunohisto-chemical SP method and VEGF-C levels in lymph fluid and serum were assessed by enzyme-linked immunosorbent assay. Results Positive immunostaining of VEGF-C in esophageal cancer tissue was 63.1%,The expression of VEGF-C in tissue was significantly associated with lymph node metastasis and TNM stage ( P<0.01, P<0.05 respectively), but not to patient age, tumor length or differentiation; VEGF-C in lymph fluid is significantly higher than in serum( P<0.05) ; The expression of VEGF-C in lymph fluid end serum were significantly associated with lymph node metastasis( P<0.05). Conclusion There are cliuical significance between VEGF-C expression and lymph node metastasis、TNM stage in tissue of esophageal cancer. The level of VFGF-C in lymph fluid is higher than that in serum, both associate with lymph-node metastasis closely.

OBJECTIVE Approach the cause of esophageal perforation and the analysis of diagnosis, therapy and its outcome in this disease. METHODS We retrospectively review 11 patients of esophageal perforation between1997 and 2004 in our department. There were 9 cases were taken out foreign bodies from their esophageal, another 2 cases haven't been found any foreignbodies and 1 of 2 was caused by iatrogenic reasons. Perforation occurred in the cervical esophagus was 4, and in the thoracic esophagus was 7. Their symptoms were dysphagia or pain, retrosternal-pain, dyspnea, subcutaneous emphysema, fever, hematemesis or melena. RESULTS 7/11 cases visited the clinic during 24 hours after foreign-body occured, 4/11 cases visited after 24 hours and the last visited clinic on 27th day late. Dysphagia was the most common presenting symptom specially with pain in eating, noted in 9 cases (81.8 %); retrosternal-pain and fever were noted in 8 cases (72.7 %), subcutaneous emphysema in 5 (45.5 %), dyspnea in 2 (18.2 %), hematemesis and melena.in 1 (9.1 %). 5 cases were died and the common mortality was 45.45 % (5/11). The mortality in primary repair with surgery treatment was 66.7 % (2/3); the mortality in conservative management was 37.5 % (3/8). The mortality of the perforation in cervical esophagus was 25 % (1/4), in thoracic esophagus was 57.14 % (4/7). The mortality of the visit time in 24 hours was 28.57 % (2/7),and out of 24 hour was 75% (3/4). CONCLUSION Sophageal perforation is usually caused by foreign body or iatrogenic in ENT-Head&Neck surgery. The esophageal perforation will been cured that decided in early visiting, taking away of foreign-boby, the right choice of antibiotic, nutritional support, primary healthy statement of esophagus. We regard that should perform non-operational conservative therapy in the patients who resulted in esophageal perforation except abscess or remain causing by foreign body. And the high risks in mortality of the repairing in surgery should been noticed.

Objective To investigate the expression of vascular endothelial growth factorC(VEGF-C),its receptor3(VEGFR-3) and podoplanin in tissue of esophageal cancer,and the relationship between their expression and tumor lymphatic metastasis.Methods Expression of VEGF-C,VEGFR-3 and podoplanin in 76 cases of ESC was detected by immunohistochemical SP method and lymphatic vessel density(LVD) was calculated.Results Positive immunostaining of VEGF-C in esophageal cancer tissue was 63.1%;the expression of VEGF-C was significantly associated with the depth of lymph node metastasis and tumor invasion(P

Objective:To summarize the ultrasound features of renal arteriovenous fistula(RAVF)under various ultrasound imaging modes,so as to avoid missed diagnosis of RAVF on initial ultrasound examination.Methods:The clinical data of 6 patients with RAVF,including the ultrasound evidence,the timing of ultrasound diagnosis,the modes of ultrasound diagnosis, and the agreement between ultrasound diagnosis and selective renal arterial angiography,were retrospectively analyzed.Results: 2D ultrasound had 1 case of correct diagnosis,1 case of misdiagnosis and 4 cases of missed diagnosis.Color Doppler and spectral Doppler both had all the 6 cases correctly diagnosed.Ultrasound angiography in 3 cases demonstrated that the contrast agent reached the renal veins earlier than reached the renal parenchyma;large fistula lumen was associated with ischemia of downstream areas.3D ultrasound vividly reflected the structure of fistula lumen volume,and provided us with the profiles of blood signal in fistula at different planes and angles,improving our knowledge of blood flow on the fistula.Conclusion: Ultrasound is the first line screening method for RAVF.Color Doppler plays a decisive role in the diagnosis of RAVF and pulsed spectral Doppler plays a synergetic role and contributes to differential diagnosis.Contrast-enhanced ultrasound may help to discover the abnormality of venous circulation and the ischemic parenehyma area due to shunting.2D ultrasound has a poor diagnostic value and is liable to lead to misdiagnosis and missed diagnosis.

Objective:To explore the protective effect of sodium channels antagonists HOE642 on lung ischemia reperfusion and the role of the p38 mitogen activated protein kinase (p38MAPK) signaling pathway in this process.Methods:A total of 36 mice were randomly divided into a sham operation group (SHAM group),a lung ischemia reperfusion group (I/R group) and a lung ischemia reperfusion+HOE642 group (HOE group).The water content was detected by electronic scales,and the lung tissue pathological changes were observed under optical microscope.The inflammatory cytokines including IL-6 and TNF-α were examined by ELISA.The intracellular calcium fluorescence intensity was examined and observed under fluorescence microscope,and the protein expression of p38MAPK was detected by Western blot.Results:Lung water content in the HOE group was lower than that in the I/R group,but higher than that in the SHAM group (both P＜0.05).Lung interstitial edema,hemorrhage,lung tissue inflammatory cells infiltration were significantly alleviated in the HOE group than those in the I/R group,while the injury in the HOE group was aggravated than those in the SHAM group (both P＜0.05).T he IL-6 and TNF-α in lung tissues in the HOE group were lower than those in the I/R group,but higher than those in the SHAM group (both P＜0.05).Intracellular calcium fluorescence intensity in the HOE group was lower than that in the I/R group,but higher than that in the SHAM group (both P＜0.05).The protein expression of p38MAPK in lung tissues in the HOE group was lower than that in the I/R group,but higher than that in the SHAM group (both P＜0.05).Conclusion:HOE642 may exert protective effect on pulmonary I/R injury through regulation of the p38MAPK signaling pathway,resulting in reduction of intracellular calcium ion concentration and calcium overload,and decrease of inflammatory response.

Clinical teaching is an important link in cultivating clinician,Heuristic teaching can stimulate students'activeness of learning,enlighten their thoughts,arouse their positivity and creativity,find out their inner potential,and increase teaching effect.Intractable case discussion is an important method of heuristic clinical teaching,which can help strengthening theory knowledge,exercising correct clinical thinking,creating scrupulous scientism and satisfactory medical ethics.

Objective To summarize the characteristics of liver injury due to brucellosis to provide reference for clinical diagnosis and treatment of brucellosis.Methods A total of 359 patients with brucellosis at the First affiliated Hospital of Xinjiang Medical University during 2010-2016 were enrolled, among them 113 (31.5%) developed liver injury.Alanine aminotransferase (ALT), aspartate transaminase (AST), γ-glutamyl transferase (γ-GT), serum albumin (Alb), alkaline phosphatase (ALP) and total bilirubin (TBil) were obtained before and after treatment.Ultrasound of upper abdomen was performed to observe the morphological changes of liver and spleen at admission.The routine blood test, erythrocyte sedimentation rate, C-reactive protein and other laboratory examinations were also performed.The data of patients before and after therapy were analyzed by t test.Results A total of 113 patients were included in this study.Eighty-eight (77.9%) were male.The mean age was (43.2±15.8) years old, among whom 81(71.7%) cases were between 31 and 60 years old.Seventy-one cases (62.8%) was in acute phase, and 42(37.2%) in chronic phase.The Han, Uighurs and Kazak nationalities accounted for 41.6%(47 patients),31.0%(35 patients) and 18.6%(21 cases), respectively.At admission, ALT level was (98.54±59.32) U/L before treatment, and decreased to (38.18±17.13) U/L after treatment, with statistically significant difference (t=6.627, P<0.05).AST levels before and after treatment were (93.17±59.19) U/L and (30.67±12.56) U/L, respectively, with significant difference (t=8.042, P<0.05).γ-GT levels before and after treatment were (162.27±48.19) U/L and (69.53±32.17) U/L, respectively, with statistically significant difference (t=8.271, P<0.05).Alb was (32.31±5.29) g/L before therapy, and increased to (38.00±4.27) g/L after therapy, with statistically significant difference (t=4.429, P<0.05).Conclusions Liver injury is common in patients with brucellosis.Elevation of transaminase is usually mild to moderate, accompanied by reduced ALB.For brucellosis patients with liver injury, antimicrobial treatment combined with liver protecting drugs could improve liver function effectively, and even within the normal range.

Objective:The clinical factors of single-port video-assisted thoracoscopic surgery (SP-VATS) were compared with those of multi-port video-assisted thoracoscopic surgery (MP-VATS). The differences between the two surgical methods and their respective postoperative recoveries were also discussed. Methods:A total of 522 patients who underwent surgical treatment for lung cancer in Tianjin Medical University Cancer Institate and Hospital from January, 2014 to December, 2015 were retrospectively reviewed. Of these cases, 83 underwent SP-VATS and 439 underwent MP-VATS. The two surgical methods were then compared in terms of opera-tive time, operative bleeding, number of lymph node and lymph node cleaning station, pain degree, 24 h postoperative chest drain-age, and in-hospital time after operation. Results:The differences between the patients who underwent SP-VATs and those who under-went MP-VATS in term of gender, age, smoking, tumor diameter, TNM stage, pathological type, and tumor location were not statistical-ly significant. The operative time in SP-VATS group was longer than that in the MP-VATS group (P<0.01), whereas in-hospital time after operation in the former group was shorter than that in the latter (P=0.011). Furthermore, pain degree in the SP-VATS group is lower than that in the MP-VATS group (P=0.041). The differences between the two groups in terms of operative bleeding, number of lymph node and lymph node cleaning station, and 24 h postoperative chest drainage were not statistically significant. Conclusion:SP-VATS can achieve a surgical effect similar to that of MP-VATS but has a prolonged operation time. SP-VATS is beneficial to postoperative re-covery and reduces the degree of pain. Thus, it has great potential for development.

Objective:To analyze the benefit incidence and evaluate the implementation effects on catastrophic disease insurance under the New Rural Cooperative Medical System ( NRCMS) in Jilin Province and put forward sug-gestions to perfect the catastrophic disease insurance under NRCMS. Method: In-depth interviews with related staff were conducted to gain an understanding of the operating status of catastrophic disease insurance under NRCMS;cat-astrophic disease patient data of Jilin Province from 2013 were collected, with a comparative analysis of implementa-tion effects among nine districts;the benefit incidence was analyzed by means of the Sperman rank correlation analy-sis; Results: The policy of catastrophic disease insurance under the NRCMS exhibited sound implementation effects and played an important role in reducing the economic burden of catastrophic disease patients. The average individual expenditure decreased by 4336. 52 yuan, while the reimbursement rate increased by 11. 15% after NRCMS cata-strophic disease insurance reimbursements. Additionally, statistical analysis results showed that there was a weak cor-relation between benefit incidence and economic level, the benefit equality of catastrophic disease insurance under NRCMS was relatively good, but the benefit level of rich patients was slightly higher. Conclusion:The reimbursement scheme of catastrophic disease insurance under NRCMS should be refined and improved, and the benefit fairness of different districts must be ensured, thus achieving the goal of relieving the“poverty caused by illness” phenomenon.