Volume 88  ·   Issue 27  ·  2008

Mesenchymal stem cells (MSCs) have a class of pluripotent stem cells that differentiate into osteoblasts, chondrocytes, adipocytes, muscle cells, bone marrow stromal cells, liver cells and nerve cells [1].

Rheumatic diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), polymyositis, Takayasu arteritis and primary Sjogren's syndrome (pSS) are more common in female patients, especially women of childbearing age.

It is human nature to "like new drugs", and it is reasonable that new drugs are easily favored by doctors and patients. However, in clinical practice, expensive new drugs may not be superior to classic old drugs with low price in all directions, and the most important thing is to use the drugs just right.

Objective To investigate the related factors of systemic 1upus erythematosus(SLE)and the situatjon of diagnosis and treatment after onset.Methods 203 SLE patients,11 males and 192 females,with a male/femaIe ratio of 1:17,average onset age of(32±14),and average course of 3 years,were followed up and the related flactors such as risk factors,family history and the situation of diagnosis and treatment were studied.Results 63 patients(31%)had the history of overworking before falling ill;47 patients(23.2%)had suffered from infection before SLE onset Other risk factors,such as solarization,emotional nuctuation, menstmal disorder,abortion,dyeing, and chemical drug contacting accounted for14.3%,14.3%,9.4%,6.9%,4.9%,and 1.5%respectively.16 patients(7.9%)had positive family history. 120 patients got the correct diagnosis at the first visit 83 patients had been misdiagnosed for less than 1 year to 14 years.47 of the 83 patients(23.2%)failed to get the correct diagnosis for more than one year 140 of the 203 patiens(69.0%)were given glucocorticoid and/or immunosuppressant as the first choice treatment measures after the diagnosis was confirmed. 39 of the 203 patjents (19.2%) chose traditional Chinese medicine or folk prescription as the first choice. And 24 of the 203 patients(11.8%)used anti-innarnmatory, and antipyretic drugs. 128 patients (63.1%) failed to continue to work.ConcIusion overworking,infection,solarization,and emotional fluctuation may be related to the onset of SLE.A great part of SLE patients can not be diagnosed early and treated promply.SLE brings bad influence on the life quality of patients.

Objective To investigate the effects of alendronate(Alen)on the prevention of systemic glueocortieoid-induced osteopomsis in patients with rheumatic diseases.Methods 140 patients suffering from rheumatic diseases,including systemic lupus erythematosus,polymyositis,dermatomyositis,and Sj(o)gren's syndrome,with normal boRe mineral density(BMD)and treated with oral glucocorticoids Were randomly divided into 2 groups:Alen+calcium group(n=74)receiving Aten 10 mg once a day and caltrate D 600 0.6 g once a day for 24 weeks and control group(n=66)receiving eahrate D 600 0.6 g once a day for 24 weeks.The BMD and biomarkers of bone turnover were measured at baseline and 24 weeks afterinitiating glucocorticoid therapy.Results After 24 weeks.the BMD Values at lumbar spine,femoral neck,major troehanter,and Ward's triangle increased by 6.1%,6.3%,3.3%,and 2.2% respectively compared with those at baseline(all P＜0.05),however,those of the control group decreased by 8.7%,9.1%,7.7%,and 6.4%respectively(P＜0.01,P＜0.05),and the BMD levels at lumbar spine and femoral neck 24 weeks Iater of the Alen+calcium group were both higher than those of the control group (P＜0.01,P＜0.05).24 weeks later the level of urine cross linked N-telopeptides of type Ⅰ collagen (NTX)of the Alert+calcium group decreased(P＜0.05),and the blood osteocalcin(BGP)of the Alen+calcium group increased,however,not significantly(P＞0.05).There were no significant differences in scram AKP and BGP and urine NTX 24 weeks later between these 2 groups.Conclusion Improving BMD,alendronate plays an important role in the prevention of glueocorticoid-induced osteoporosis.However,calcium treatment alone fails to prevent the loss of bone.

Objective To observe the clinical feature of rheumatoid arthritis associated interstitial lung disease(RA.ILD)patients and changes of serum cytokines tumor growth factor(TGF)-β1,tumor necrosis factor(TNF)-α,insulin-like growth factor(IGF)-1,and platelet derived growth factor(PDGF)-AB.Methods The clinical manifestations,lung high resolution CT(HRCT),lung functions,blood gasand other relative laboratory findings of 30 RA-ILD patients and 35 RA patients were observed.ELASA Was used to detect the levels of TGF-β1,TNF-α,IGF-l,and PDGF-AB.Thirty healthy volunteers were observed too as controls.Results The clinical manifestations of RA-ILD patients were more serious than those of the RA patients.The ESR Was faster,the serum C-reactive protein,rheumatoid factor(RF),and globulin levels hisher,and pulmonary arterial pressure higher too in the RA-ILD patients than in the RA patients(all P＜0.01).The main respiratory manifestations of the RA-ILD patients were cough,expectoration,chest distress,short breath,chest pain,change of breath sounds,Velcro rales,and dyspnea.The main lung HRCT findings included thickening of interlobular septum and bronchial wall,pachynsis pleurae,mosaic sign,bronchieetasis,emphysema,patching shadow,honeycombing,fibrous seal,etc.Pulmonary funetion test showed that the levels of vital capacity.forced vital capacity,maximam mid-expiratory flow.and diffusing capacity of the lung for carbon monoxide of the RA-ILD patients were all significantly lower than those of the RA patients(all P＜0.01).Arterial gas test showed that the PO,of the RA-ILD patients Was significantly lower than that of the RA patients(P＜0.01).The TGF-β1;TNF-α,IGF-1,and PDGF-AB of both the RA-ILD and RA patients were all significantly higher than those of the healthy volunteers(all P＜0.01).and the levels of these cytokines of the RA-ILD patients were all higher than those of the RA patients(all P＜0.01).Conclusion The symptoms and signs of the RA-ILD patients are more serious,the lung HRCT changes more obvious,lung function decreases,and the levels of TGF-β1,TNF-α.IGF-1.and PDGF-AB increase.

Objective To investigate the relationship between HLA-DR4/1 subtypes and T cell response to influenza virus hemagglutinin(HA)as well as anti-HA308-317 antibodies in rheumatoid arthritis (RA).Methods The peripheral blood mononuclear cells(PBMCs)from 70 RA patients were cultured with HA308-317 for 5 days.T cell proliferative responses to HA308-317 were evaluated by[3H]thymidine incorporation assay.ELISA was used to detect the antibodies to HA308-317.HLA-DR4/1 subtypes were analyzed by PCR with sequence-specific primers.Results Twenty-seven of the 70 RA patients(38.6%)were positive for HLA-DR4/1 subtypes and 43 patients(61.4%)were negative for HLA.DR4/1 subtypes.In the HLA-DR4/1 positive group,T cell proliferative response to HA308-317 was observed in 17(62.9%)RA patients and anti-HA308-3 17 antibodies were present in 15 RA patients(55.6%).In the HLA-DR4/1 negative group,T cell proliferative response to HA308-317 was observed in 10(23.3%)patients and anti-HA308-317 antibodies were present in 25(58.1%)patients.T cell proliferative response to HA308-317 in the HLA-DR4/1 positive group was higher than in the negative group(P＜0.01).However,there was no significant difference in production of antibodies to HA308-317 between the HLA-DR4/1 positive and negative groups(P＞0.05).Conclusion There is a relationship between HLA.DR4/1 subtypes and T cell response to HA308-317.Antibodies to HA308-317 are not associated with HLA-DR4/1 phenotype.HA308-317 peptide may be involved in the pathogenesis of RA through activating HLA-DR4/1 specific T cells.

Objective To evaluate the the therapeutic efficacy of interposition of graft meso-cavo-atrial shunt(MCAS)for the treatment of Budd-Chiari syndrome(BCS)with occlusion of both inferior cava vena (ICV)and hepatic veins(HVs).Methods 51 BCS patients with combined occlusion of ICV and HVs,30 males and 20 females,aged 18-45.underwent MCAS.A 16-18 mm ring-reinforced graft(main graft) was anastomesed firstly to the side of ICV with continuous 5/0 Vascular suture,then to the side of the right atrium with continuous 5/0 vascular suture.A 10-12 mm graft(secondary graft) Was anastomosed to the side of the superior mesenteric vein(SMV)with continuous 5/0 vascular suture,then to the side of the main graft with continuous 5/0 vascular suture.The pressure and blood flow of ICV and portal vein(PV)were examinedbefore and after operation.The patients were followed up for 6 months to 16 years.Results There Was no perioperative death.During the follow-up no thrombosis of the main graft Was found but thrombosis of the secondary graft occurred in two cases.The patency rates of the main and secondary grafts were 100%and 96.1%respectively.The total patency rate of graft was 96.1%.After operation the pressure of IVC and PV decreased by 17.4±5.7 cm H2O and 17.0±7.0 cm H2O respectively compared with those before operation.Conclusion MCAS is very effective in decompression of PC and IVC.MCAS may be a Valuable surgical procedure for treatment of BCS with occlusion of both ICV and HVs.

Objective To investigate the pathology,diagnosis,treatment,and prognosis of primary appendieeal tumors.Methods The clinical data of 37 patients with primary tumors of the appendix,16males and 21 females,aged 56±13(35-87)hospitalized Jan 1977 to Feb.2007 were analyzed retrospectively.Results Appendicitis and abdominal mass were the major clinical manifestations.All 37 cases received surgical operation with the diagnosis confirmed by pathology.The pathological types included carcinoid tumor(n=12),mucinous tumor(n=17),and adenocarcinoma(n=8).Only 4 cases were diagnosed pathologically by biopay before operation,28 cases were diagnosed by intra.operative frozen section,and 5 cases were diagnosed after operation Single appendectomy were performed in 17 cases,ileocecalectomy in 9 eases,right hemicoleetomy in 8 cases,and other operation patterns in 3 cases.The 1,3,and 5-year survival rates of the primary appendix earcinoid tumor,mucinous tumor,and adenocarcinoma were 100.0%,100.0%,and 91.7%,100.0%,86.7%,and 71.5%,and 75.0%,50.0%.and 50.0% respectively.Conclusion A rare disease,appendiceal tumors lack specific clinical features.Intra-operative exploration and frozen section are very important for diagnosis and operation choice.The prognosis of primary appendix carcinoid tumors is better.

Objective To evaluate the efficacy and Bafety of spinal navigation with intra-operative 3D-imasing madality in lumbar pedicle screw fixation.Methods 401 patients with lumbar degenerativedisorders or fracture were randomly divided into 2 groups:Group A,undergoing pedicle screw fixation by spinal navigation with inca-operative 3D-imaging system,and Group B undergoing pedicle screw fixation by traditional method.The position of pedicle screw was assessed by intr-operative 3D-imaging system.Theexcellent rate of pedicle screw position,mean time of pedicle Screw implantation,operating time,blood loss,and post-operative complication were compared.Results The excellent rate of pedicle screw position was higher Group A wag 95.3%,significantly higher than that of Group B(84.1%,P＜0.001).The mean time of pedicle screw implantation and operating time of Group A were(3.70±0.65)min,significantly shorter than that of Group B[(7.83±2.32)min,P＜0.1301].The blood loss amount ofGroup A was(272±153) ml,significantly less than that of Group B[(455±289)ml,P＜0.05].However,the total operating time of Group A Was(134±48)min,not significantly different from that of Group B[(179 ±62)min,P＞0.05].Conclusion With spinal navigation combined with the intra-operative 3D-imaging modality,implantation of lumbar pedicle screw is more simplified,more accurate,safer,and with shorter operating time.

Objective To establish a new imaging protocol to acquire the most appropriate fluoro-images for fluoro-navigated percutaneous fixation of acetabular fracture and to evaluate the safety and effieiency of the procedures.Methods Guide needles were inserted into the bilateral anterior and posterior columns of the acetabula of 4 dry human cadaver pelvic skeletons and 4 plastic pelvic models.Then the pelvis skeletons were fixed to imaging guided surgery mimic operation modules.Dynamic fluoroscopy Was conducted with C-arm X-ray machine vertically on the 4 virtual planes of the acetabulum,inner,outer,anterior,and posterior from multiple angles.The fluoroscopic images clearly showing the guide needles,anterior and posterior columns,and acetabulum were selected as registration images,and the relative space positions between the C-arm X-ray fluoroscope and pelvis and operation table.Guided by the navigation system.totally 16 titanium hollow screws were inserted into bilateral anterior and posterior columns of acetabula of the 4 pelvis skeletons.The screw positions were estimated by visual method.The time needed to position the C-arm so as to obtain the standard registration image,time needed for fluoroscopy,and operation time,including establishment of navigation system,software interface operation,and screw insertion,were recorded.Results All the screws were inserted to the satisfying positions:placed within the desired bony corridor of the column and none of then were inserted into the joint.While inserting the screw into the anterior column fluoroscopy should be conducted with obturated oblique view.obturated inlet view,obturated oblique outlet view,or pelvic AP view.While inserting the screw into the posterior column fluoroscopy should be conducted with iliac-oblique view,obturated oblique view,pelvic inlet view,or obturated oblique outlet view.The total surgical time required for screw insertion was 11.7 min for anterior column,and Was 9.2 min for posterior column.9.5 and 7.3 minutes were needed to position the C-arm X-ray machine so as to obtain the images of the anterior and posterior columns respectively.2.9 and 1.7 seconds were needed for the actual fluoroscopy during insertion of the screws into the anterior and posterior columns respectively.Conclusion The standard registered fluoro-images are different from the conventional standard Judet-Letournel oblique views.How to get appmpriate fluoro-images is the key point for fluoro-navigated percutancous fixation of acetabular fractures.

Objective To investigate the changes of CCR7 and CD45 RA expression after blocking of the potassium channel Kv1.3 in myelin specific CD4+T lymphocytes and the relation thereof with multiple sclerosis(MS).Methods Peripheral blood mononuclear cells were isolated from 15 activated MS patients.15 INF-B-1b treated MS patients,and 15 normal controls,CIM+T lymphocytes were isolated using positive selection method with anti-CD4-coated magnetic beads.To establish culturing MBP special CD4+Tlymphocyte lines,the different groups of T cell were labeled with CD3,CD4,CCR7,and CD45RA fluorescence-antibody or homotype controls and analyzed by four-color flow cytometer.Results The most part of phenotype in the activated MS patients was CD4+CCR7-CD45 RA-T cells and the percentage was increaged after myelin antigen stimulation(P＜0.05),whereas the percentage of CCR7+CD45 RA+T cells was decreased(P＜0.05).SHK greatly inhibited CCR7-CD45RA-in activated MS(P＜0.05).CCR7-CD45 RA-and CCR7+CD45 RA-were in correlation with expanded disability status scale (EDSS)score (r=0.73,r=0.705.P＜0.05)in the peripheral blood of activated MS.Conclusion There is a strong correlation between TEM phenotype and severity of MS,which may suggest Tem phenotype as the marker to estimate the state of illness.Kv1.3 potassium channel may be the new target in treatment of MS.

Objective To analyze the differential expression proteins of rat ischemia/reperfusion (I/R)lung tissues in vivo and normal lung tissues by comparative proteome analysis,and to study the mechanism of donor lung I/R injury.Methotis Forty male SD rats were randomly divided into 2 equal groups:I/R group undergoing mimic orthotopic left lung auto-grafting and harvesting of the left lung five hours after the operation,and control group undergoing isolation of the left hilus of lung and then harvesting of the left lung.The ditierential proteins in the left ventricle of transplanted heart were separated by means of immobilized pH gradient-based two-dimensional gel electrophoresis(2-DE),identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF-MS),and searched through Matrix Science software system. Western blotting was used to veilfy part of the differentially expressed proteins.Resuits Well-resolved and reproducible 2-DE profile of rat L/R lung tissues and normal lung tissues were obtained.In the I/R lung tissue profile,the average spot number from 3 gels was 489±52 spots (P＞0.05)with all average matching rate of 89.28%(P＞0.05),and in the control group,the average spot number from 3 gels was 511±83 spots(P＞0.05)with an average matching rate of 91.22%(P＞0.05).Fourteen differential proteins were identified by peptide mass fingerprinting(PMF)searched in Matrix Science(P＜0.05).Western blotting confirmed that the protein expression of selenium binding protein 1(SBP-1)and heat shock protein 25(HSP25)increased at the early stage of I/R group.Conclusion The protein expression of HSP25 and SBP-1 with stress protection function is up-regulated in the early stage of lung I/R injury.Other differentially expressed proteins identified may have important functions in energy metabolism,tissue stress,cell apoptosis,and signal transduction.

Objective To investigate the role of gap-junction in suspended animation for hemorrhagic shock with brain injury.Methods Twenty-four SD rats were made into models of uncontrolled hemorrhagic shock and occlusion of bilateral common carotid arteries and randomly divided into 3 equal groups:traditional resuscitation group(Group Ⅰ)undergoing traditional resuscitation,hypothermy resuscitation group(Group Ⅱ)undergoing temperature lowering by ice-cap,and carbenoxolone resuscitation group(Group Ⅲ)undergoing injection of carbenoxolone 50μg/200 g.The process was divided into 3 periods:traumatic hemorrhagic period(30 min),pre-hospital treatment period(60 min),and in-hospital cardiopulmonary resuscitation period(60 min).The levels of left ventfieular systolic pressure(LVSP),maximum change rate of left ventricular pressure rise and fall(±dp/dtmax),mean arterial pressure (MAP),heart rate(HR),and respiratory rate(RR)were recorded at the beginning and t11e end of traumatic hemorrhagic period(T1 and T2),the end of pre-hospital treatment period(T3),and the end of in-hospital cardiopulmonary resuscitation period(T4).The survival time was recorded after in-hospital cardiopulmonary resuscitation period.Then the left brain wag taken out and the hippocampal neurons apoptosis was observed by flow cytometry,chemiluminescence was used to detect the ATP.and IL-6 and tumor necrosis fatetor(TNF)-α were detected by enzyme linked immunosorbent assay(ELISA).Results The survival time ofGroupsⅡ andⅢwere(2.9±0.6)h and(2.6 ±1.0)h respectively,both significantly longer than that of Group Ⅰ[(1.4±0.3)h,both P＜0.01].The apoptotic rates of hippocampal neurons of GroupsⅡand Ⅲ were(72±6)%and(75±9)% respectively,both significantly lower than that of Group[(83±5)%,P＜0.05].The ATP levels in hippocampus of GroupsⅡandⅢ were(2.0±0.3)and (1.9±0.4)pg/g respectively,both significantly higher than that of Group Ⅰ[(1.4±0.5 Pg/g,beth P＜0.05).The TNF-αand IL-6 levels of Groups Ⅱwere (1.7±0.3)pg/g and(19±3)Pg/g respectively,beth significantly lower than those of Group Ⅰ[(2.2±0.6)and(24±3)pg/g respectively,beth P＜O.05].The IL-6 level of GroupⅢwas(26±4)pg/g,significantly higher than that of Group Ⅱ(P＜0.01).There were no significant difference between Groups ⅡandⅢin the values of survival time,hippocampal neuron apoptosis,dissipation of ATP,and liberation of TNF-α(all P＞0.05),but there was significant difference in IL-6(P＜0.01).Conclusion Both hypothermy resuscitation and carbenoxolone resuscitation protect the brain of cerebral ischemia on hemorrhagic shock with brain injury,and suggest that Gap junctions play an important role in suspended animation to treat hemorrhagic shock with brain injury.

Objective To evaluate the efficacy of in vivo magnetic resonance imaging(MRI) of mesenchymal stem cells(MSCs)injected intravascularly in treatment of acute renal failure(ARF),and to investigate the changes of renal functian and pathology of ARF after MSC transplantation.Methods Rat MSCs were isolated and labeled with Fe2O3-PLL in vitro.Thirty SD rats underwent intramuscular injeetion of glycerol so as to establish ARF models and then randomly divided into 3 equal groups:Group I undergoing injection of labeled MSCs jnto abdominal aorta via transcatheter,GroupⅡinjected with unlabelled MSCs,and Group Ⅲ injected with normal saline as controls.MRI of kidney was conducted before injection,and O.5 h,and 1,2,and 5 days after injection.One and 2 days after the transplantation 3 rats from each group underwent MRI and extraction of blood samples from the abdominal aorta and then killed with their kidneystaken out,and 5 days after the rest rats were all killed after MRl with their kidneys taken out Serum creatinine(Scr)and blood urea nitrogen(BUN)were examined so as to evaluate the renal function.Microscopy was conducted to observe the pathological changes.Prussian blue+CD68 antibody staining was performed to identify the labeled MSCs.Results MRI showed decrease of signal intensity in renal cortex on the T2*-weighted MR images up to 5 days after transplantation.Histological analysis showed that most Prussian blue-positive cells were in the glomerular capillaries.corresponding to the areas where signal intcnsity decrease was observed by MRI.The Scr and BUN levels 2 and 5 days after the implantation of Group Ⅰ were both lower than those of the control group,and there were not significant differences in the Scr and BUN levels between Groups Ⅰ andⅡ.Renal tubular injury scoring showed that the renal tubular injury was significantly lishter than that of the control group.Conclusion 1.5-T MRI seems a good in vivo technique to monitor the magnetically labeled MSCs administered into the abdominal aorta of ARF animals.which are distributed in the glomerular capillaries in the early stage after transplantation.MSCs may promote the recovery of ARF.

Objective To investigate whether posteonditoning with sevoflurane could alleviate spinal cord ischemia reperfusion injury in rabbits,and whether the beneficial effect is dependent on oxygen free radicals.Methods In Experiment 1.48 male New Zealand white rabbits were randomly assigned to six groups(n=8 each).Animals in the sham group only underwent sham-operation.Animals in the control group underwent spinal cord ischemia for 20 min without postconditioning.Animals in O2 postconditioning group(Group O2)inhaled 100%O2 from 5 min before reperfusion and lasted 13 min. Animals in sevoflurane postconditioning groups(Group Sevo0.5,Sevo1.0 and Sevo1.5)inhaled 0.5,1.0,1.5minimum alveolar concentration(MAC)sevoffurane in 100%O2,from 5 min before reperfusion and lasted 10min,then inhaled 100% O2 for 3 min to wash out the remaining sevoflurane.In Experiment 2.36 male New Zealand White rabbits were randomly assigned to four groups(n=9 each).Animals in O2 and Sevo groups received normal saline(5 ml/kg intravenously)1 h before postconditioning with 100% O2 and 1.0 MAC sevoflurane,respectively.In the DMTU+Sevo and DMTU+O2 groups,5 mL/kg of 10%dimethylthiourea (DMTU,a potent oxygen free radical scavenger.dissolved in saline)was administered intravenously at the same time.Spinal cord ischemia was induced by an infrarenaI aorta clamping for 20 min.Forty-eight hours after reperfusion,hind-1imb motor funetion and histopathology of the spinal cord were examined in a blinded fashion.Results (1)The neurologic and histopathologic outcomes in the sevoflurane postconditioning groups were better than those in the control group(P＜0.05),the histopathologic outcomes in Sevo1.0 group were better than that in Sevo0.5 and Sevo1.5 groups(P＜0.05).(2)The neurologic and histopathologic outcomes in Sevo.DMTU+Sevo and DMTU+O2,groups were better than those in the O2 group(P＜0.05).the histopathologic outcomes in Sevo group were better than that in the DMTU+Sevo and DMTU+O2 groups(P＜0.05).Conclusions Our study demonstrates that sevoflurane postconditioning against spinal cord ischemia injury via the release of oxygen free radicals in rabbits.

A 38-year-old male patient was admitted to the Department of Nephrology, Peking University People's Hospital on January 27, 2007, mainly due to intermittent fever for 1 month, vomiting and blood in the stool for 4 days. The patient had fever with chills after drinking heavily one month before admission, and the maximum body temperature was 40℃, which dropped to normal after 1 day.

The aetiology, pathogenesis and therapeutic strategies of rheumatoid arthritis (RA) have always been a hot topic at home and abroad. Because the aetiology and pathogenesis of RA are unclear, it has not been cured.

By Cancer Prevention and Treatment Center of Sun Yat-sen University, Royal College of Surgeons of Australia and New Zealand (RACS), Esophageal Cancer Professional Committee of China Anti-Cancer Association,<Chinese Medical Journal>Editorial Department,<Cancer>Magazine Editorial Department,<The 5th China-Australia-New Zealand Cancer Surgery Conference and the New Advances in Diagnosis and Treatment of Esophageal Cancer in Umbrella Countries jointly sponsored by the editorial department of Chinese Journal of Gastrointestinal Surgery were held at the Cancer Prevention and Treatment Center of Sun Yat-sen University in Guangzhou from May 16 to 18, 2008.

A 63-year-old male was admitted to hospital for 20 days due to fever. On August 25, 2005, the patient developed chills and fever, with a body temperature of 38.5℃ and occasional cough. Blood routine: white blood cells 14.5×106/L, neutral 0.847. Blood culture: Salmonella bacteria. After 7 days of anti-infective treatment with meropenem + vancomycin, the peak body temperature dropped to 37.8℃, and he was transferred to our hospital for further diagnosis and treatment.

A 46-year-old male was admitted to Huashan Hospital affiliated to Fudan University for more than 2 months due to fever, headache and yellow urine. The patient had low fever at first, accompanied by persistent head pain, paroxysmal exacerbation, without nausea and vomiting.

A 37-year-old male suffered from a sprained left ankle while playing ball a month ago. X-ray film showed one osteolytic lesion in the left calcaneus and was admitted to the hospital. Previously, there was no discomfort such as heel pain, soreness and swelling. Physical examination showed that there was no obvious abnormality in gait, no redness, swelling, varicose veins in the left foot, low skin temperature, no tenderness or longitudinal buckling pain.

A 29-year-old woman was found to have stopped embryonic development at 20 weeks of pregnancy. She underwent induction of labor in a local hospital on 14 May 2007. On 30 May 2007, she was re-admitted due to persistent postoperative vaginal bleeding. Routine blood test showed that red blood cells were 2.35×1012/L, hemoglobin 79 g/L, and B-ultrasound showed residual intrauterine placenta.