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 .

The authors study the character of properties,micro-organization and general physical and chemical identification of Radix Tetrastigmae from Zhejiang and Guangxi,that provides an experimental basis for identification and establishing quality specifica- tions of Radix Tetrastigmae.

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.

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 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 .

AIM: To evaluate the efficacy and safety of orbital decompression in the treatment of Graves ophthalmopathy. ·METHODS: Totally 55 patients 77 eyes with Graves eye disease were selected in our hospital from February 2011 to February 2016. All eyes underwent orbital decompression, the visual acuity, exophthalmos and complications of the patients were followed up for 6mo. · RESULTS: Postoperatively 6mo, the best corrected visual acuity were 0. 23±0. 09, which were better than that of preoperative 0. 46±0. 07(P<0. 05). Postoperatively 6mo, the degree of exophthalmos of the patients were 16. 20 ± 1. 99mm, which was significantly lower than that preoperative 20. 13±1. 87mm (P<0. 05). Postoperative CAS score was ≤3 points in 56 eyes ( 73%) , significantly increased compared with preoperative 15 eyes (19%), the difference was statistically significant (P<0. 05). There were 50 eyes ( 65%) with color vision disorder before operation;after operation, 42 eyes (55%) had significant improvement in visual impairment, and there was no change in the eye in 8 eyes (10%). Postoperatively 6mo, the average decreased degree of exophthalmos were 3. 87±1. 03mm;5 cases were found postoperative diplopia, new diplopia rate was 10%;followed up for 3mo, diplopia disappeared. ·CONCLUSION:Orbital decompression is an effective method for the treatment of Graves ophthalmopathy, but attention should be paid to postoperative complications such as diplopia.

Objective To observe the changes in levels of plasma leukocyte cell-derived chemnotaxin 2 (LECT2) in patients with newly diagnosed type 2 diabetes (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD),and to investigate the clinical significance.Methods A total of 137 subjects were enrolled in the study,including 50 patients with newly diagnosed T2DM complicated with NAFLD,47 patients with newly diagnosed T2DM with non-NAFLD and 40 healthy subjects.The level of plasma LECT2 was determined by ELISA.Anthropometric data and other biochemical indicators were measured in three groups.The body mass index (BMI) and waist-to-hip ratio (WHR) were calculated.Insulin resistance and pancreas β-cell function were determined by homeostasis model assessment (HOMA-IR,HOMA-％β).Results Plasma concentration of LECT2 in patients with newly diagnosed T2DM complicated with non-NAFLD was higher than that in type 2 diabetic patients with non-NAFLD [(32.95 ± 10.11 vs 29.08 ± 7.54) ng/mL,P ＜ 0.01].Plasma LECT2 levels in both groups were significantly higher than that in normal control group [(22.38 ± 4.40) ng/mL,P ＜ 0.01].Plasma LECT2 level was positively correlated with BMI,FPG,FINS,C peptide,HbA1c,GGT,TG and HOMA-IR,while negatively with HDL-C and HOMA-％ β (all P ＜ 0.01).Multivariate regression analysis showed that levels of BMI,FPG and HDL-C were important factors affecting plasma LECT2 level.Conclusions Plasma LECT2 concentration significantly elevates in patients with newly diagnosed T2DM complicated with non-NAFLD.Plasma level of LECT2 is closely correlated with insulin resistance and glycolipid metabolism.LECT2 may play an important role in the patho genesis of insulin resistance and T2DM.

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.