Objective To analyze the clinical characteristics of brucellosis presenting as fever of unknown origin in non-endemic area.Methods Clinical data of 11 patients with fever of unknown origin,who were admitted in a general hospital of non-endemic area from Jan 2013 to Jan 2017 and diagnosed as brucellosis by blood culture,were retrospectively analyzed.Results There were 8 males and 3 females aged 40-70 years.The patients were admitted with or without accompanied symptoms.The patients were initially presented in rheumatology (1 case),neurology (1 case),emergency (4 cases),hematology (1 case),orthopedics (2 cases) and pneumology (2 cases) departments,respectively.The time from onset to presentation was 0.5-7.0 months.The clinical manifestations were nonspecific,and blood cultures of Brucella were positive between 2 to 5 weeks with a mean of 3 weeks.Time to diagnosis was 1 to 9 months with a mean of 4 months.All patients were transferred to infectious hospital when the diagnosis was confirmed.The telephone follow-up showed that none of the patients had fever after discharged.Conclusion Brucellosis should not be neglected in the differential diagnosis of FUO in non-endemic area,and blood culture is important for a definitive diagnosis.

Objective To assess the effective of helicobacter pylori in gallbladder malignant disease ,cholelithiasis ,cholecysti‐tis .Methods The literature about helicobacter pylori and gallbladder disease were collected in EMbase ,Pubmed ,VIP and CBM from inception to May ,2015 .Two reviewers independently screened the literature according to the inclusion and exclusion criteria , extracted the data ,and assessed the quality ,and then the meta‐analysis were performed by using Stata11 software .Results A total of 24 case control study were included .The results of meta‐analysis showed that ,helicobacter pylori had a higher incidence rate in gallbladder maliganant disease and cholelithiasis(OR=5 .31 ,95% CI:2 .34 -12 .05 ,P= 0 .000)and (OR=1 .84 ,95% CI:1 .13-2 .98 ,P=0 .014) compared with control group .Also it have influence on cholecystitis (OR= 9 .92 ,95% CI:4 .04 -24 .39 ,P=0 .000) .Conclusion Helicobacter pylori is a risk factor of inducing cholelithiasis and gallbladder malignancy disease ,cholecystitis .

Objective To analyze the dose‐effects of different doses of dexmedetomidine for sedation and sleep of the patients under epidural nerve block anesthesia .Methods A total of 82 patients undergoing elective lower limbs surgery(ASA grade Ⅰ - Ⅱ) were randomly divided into 4 different doses of dexmedetomidine groups(group 1 ,n=19 ;group 2 ,n=22 ;group 3 ,n=20;group 4 , n=21) ,under continuous epidural nerve block ,the loading dose of dexmedetomidine 0 .7 ,0 .8 ,0 .9 ,1 .0μg · kg -1 · h-1 was intrave‐nously pumped for 30 min ,then pumped at a rate of 0 .7 ,0 .8 ,0 .9 ,1 .0 μg · kg -1 · h-1 in the group 1 ,2 ,3 and 4 respectively .If any patient in 4 groups fell asleep at less than half an hour ,the loading dose was stopped and the continuous dose was changed to pump , the drug administration was discontinued at wound dressing after operation .Whether the patient falling asleep was recorded ,and the mean arterial blood pressure ,heart rate at 4 time points of 10 ,30 ,60 ,90 min after infusion of dexmedetomidine were also recorded . The 50% effective dose(ED50 ) ,ED95 and 95% confidence interval(CI) were calculated by using the Probit method .Results ED50 and ED95 of dexmedetomidine were 0 .65μg/kg(95% CI:0 .36-0 .73μg/kg)and 1 .00 μg /kg(95% CI:0 .90-1 .74μg/kg) ,which could decrease the heart rate and increase the arterial blood pressure .Conclusion Although dexmedetomidine can decrease the heart rate and increase the arterial blood pressure ,but the patients quietly fall asleep without discomfort and pain occurrence by the intra‐venous administration under continuous epidural nerve block .

Objective:To investigate the prognostic values of tumor–stroma ratio and tumor-infiltrating lymphocytes in colorec-tal cancer. Methods:A total of 218 stageⅡorⅢprimary colorectal cancer patients were analyzed for the tumor–stroma ratio (TSR) and tumor-infiltrating lymphocytes (TIL) by using HE stained histological sections. The relationship between TSR and clinicopatholog-ic variables and the difference in clinical outcomes of different groups were also analyzed. Results:Overall survival rates for the stro-ma-low group were significantly higher than the stroma-high group in stagesⅡandⅢcolorectal cancer (P＜0.05). However, the differ-ences in TSR were not correlated with clinicopathologic features such as gender and age (P>0.05). Overall survival rates of patients with high TIL were significantly higher than patients with low TIL (P＜0.05). Patients with high TIL had notable better prognosis than patients with low TIL (P＜0.05) in the stroma-low group. Conclusion:TSR and TIL are independent prognostic factors for stagesⅡandⅢcolorectal cancer. The combined estimates of TSR and TIL in routine pathology diagnoses may provide more evidence to predict the prognosis of stagesⅡandⅢcolorectal cancer.

Objective To investigate the effects of neoadjuvant chemotherapy on the hepatic function and histology of liver in patients with hepatic metastasis of colorectal cancer.Methods The clinical data of 65 patients with hepatic metastasis of colorectal cancer who received hepatectomy at the First People's Hospital of Foshan from January 2010 to September 2012 were retrospectively analyzed.Thirty-nine patients were in the experimental group,and they received partial hepatectomy 1 month after receiving a 6-month continous FOLFOX7 chemotherapy (5-fluorouracil + calcium leucovorin + oxaloplatin) ; 39 patients were in the control group,and they received partial hepatectomy without adjuvant chemotherapy.The perioperative condition,pre-and postoperative hepatic function,postoperative complications and the histopathological changes of the hepatic tissues of the 2 groups were compared by t test or chi-square test,data repeated measured were analyzed using the repeated measure analysis of variance.Results The operation time of the experimental group and the control group were (195 ± 37)minutes and (190 ±41) minutes,respectively,with no significant difference (t =0.1,P＞0.05).The operative blood loss of the experimental group was (410 ± 75)ml,which was significantly greater than (348 ± 44) ml of the control group (t =6.3,P ＜ 0.05).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 3 were (328 ± 121)U/L and (330 ± 120)U/L in the experimental group,which were significantly higher than (160 ±22) U/L and (168 ±26) U/L of the control group (t =13.4,12.8,P ＜ 0.05).There were no significant differences in the levels of prothrombin time,AST,ALT,total bilirubin and albumin between the experimental group and the control group (t =1.0,0.0,1.4,1.3,0.4,P ＞ 0.05).The levels of AST and ALT at postoperative day 7 were (243 ± 132) U/L and (253 ± 147)U/L in the experimental group,which were significantly higher than (90 ± 17)U/L and (99 ± 16)U/L of the control group (t=12.5,12.0,P＜0.05).The incidence of congestion and edema of the liver was 71.8％ (28/39) in the experimental group,which was significantly higher than 0 (0/26) of the control group (x2 =90.0,P ＜ 0.05).The incidence of hepatic sinusoid expansion with liver cellular altrophy and necrosis was 48.7％ (19/39),which was significantly higher than 15.4％ (4/26) of the control group (x2=89.2,P ＜ 0.05).Conclusion There is no effect of long-time FOLFOX7 chemotherapy on the hepatic function of the patients with hepatic metastasis of colorectal cancer who received hepatectomy 1 month later,but the postoperative hepatic function is affected.The hepatic parenchyma is changed after adjuvant chemotherapy,which might have adverse effect on hepatectomy.

Objective To investigate the duration for silicon gastric tube to indwell in stomach of aged patients.Methods One hundred elderly patients needing long-term nutrition support were equally randomized into two groups: control group and observation group.The former had the gastric tubes indwelled in the stomach for 4 weeks and the latter for 3 weeks.The two groups were compared about the used tubes in terms of the color of tube at the length of the first 10cm,the indentation by reflection for 10 seconds at the tube of first 10 cm,the hardness of the tube at the length of the first 10 cm and the springback angle of tube at the first 10cm after reflection.Results The tubes in the observation group were significantly better than those in the control group in terms of color,indentation,hardness and springback angle(all P<0?01).Conclusion The duration of indwelling silicon gastric tubes in stomach can be three weeks for old patients needing long-term nutrition support via indwelling silicon tubes in their stomach.

Associating liver partition and portal vein ligation for two-staged hepatectomy(ALPPS) is a novel approach for hepatectomy.The case we reported was a 68 years old male patient diagnosed with hilar cholangiocellular carcinoma and obstructive jaundice.ALPPS surgery was operated.Since the patient's left lateral lobe volume was less than 40％ of the whole liver volume (merely 33.91％),the ligation of the right portal vein,plus in situ split of the junction zone between left medial and left lateral liver lobe and the dissection of portal lymph nodes as the first stage operation was conducted.Abdominal CT on the 8th day after the operation reported an increase on the volume of left lateral lobe by 32％ to 41.5％ of the whole liver volume.On the 12th day after the first stage operation,an extended right trilobate hepatectomy combined with left hepatic duct intra-jejunum drainage was performed as the second operation.The patient completely recovered and was discharged three weeks after the second stage operation.

Objective To study the effect of sodium ferulate (SF) on the expressions of nuclear factor-?B (NF-?B) and inhibitory ?B? (I?B?) in rat brain microvascular endothelial cells (BMEC) injured by hypoxia. Methods Brain microvascular endothelial cells from Wistar rat cerebral cortex were isolated and cultured, and then cultivated in 95%N_2 and 5% CO_2 for 12 h to induce hypoxia injury. The cells were divided into normal group, hypoxia group, and SF group. BMEC activity was assayed by MTT assay. Endothelin-1(ET-1) concentration was evaluated by radioimmunoassay.The expression of NF-?B and I?B? of BMEC were assessed by immunocytochemistry. Results The content of ET-1 in BMEC media was increased after hypoxia, while sodium ferulate (100 ?g/ml) significantly decreased the content compared with hypoxia group. Immunocytochemistry indicated I?B? expression were significantly decreased in hypoxia BMEC in consistent with NF-?B expression. Conclusion Sodium ferulate may significantly reduce NF-?B of hypoxia BMEC and nuclear translocation, and increase I?B? expression and BMEC activity. It is a potent inhibitor of NF-?B in endothelial cells, which might explain its beneficial effect on injured BMEC by hypoxia.

Objective Comparing the effects of steam sterilization on cyclic fatigue of stainless steel files. Meth-ods Fifty instruments of 25# stainless steel K files were randomly divided into 5 groups, which include 10 in each group. Group 1 was the blank control group, group 2 to 5 were subjected to 1, 3, 4, 5 steam sterilization cycles, then the files were tested by a custom-made device to assess cyclic fatigue and the number of cycles of failure (NCF) was calculated. Microstruc-ture of each file’s fracture surface was analyzed by Scanning Electron microscope (SEM). Results NCF in the 5 groups were 4 345.2 ± 384.2,3 937.9 ± 645.4,3 812.9 ± 532.5,3 626.2 ± 380.0,3 625.9 ± 565.6 respectively, and the differences among 5 groups were significantly different(F=2.598, P<0.05). After 4 or 5 times of steam sterilization, cyclic fatigue de-creased if compared with that in control group (P<0.05). Fracture surface in group 1 and group 2 was tough dimple structure and large numbers of regular, deep dimples were distributed on the surface. You could also see micro cavities clearly formed by fracture;Fracture surface in group 4 was dimple structure in brittle intergranular morphology. It is characterized by the presence of thin brittle precipitates, clean and smooth crystal interface, and a great sense of polyhedral stereo. Conclusion After 4 times of steam sterilization, cyclic fatigue strength of 25# stainless steel K files declined, which possessed the poten-tial risk of fracture.