Volume 91  ·   Issue 05  ·  2011

Parkinson's disease (PD) is a dyskinesia with tremor, myotonia, hypokinesia and abnormal posture as its main manifestations. After the application of levodopa in the treatment of PD in the 1960s, it has been the "gold standard" for the treatment of Parkinson's disease. However, it was found in the clinical process that after the "honeymoon period" of about 3~5 years, 50% ~75% of patients will have motor complications such as abnormal movement and symptom fluctuation.

Objective To study the effects of memantine on cognitive and motor impairment in patients with Parkinson's disease (PD). Methods A total of 55 PD patients omplicated by varying degrees of cognitive impairment were randomly divided into two groups. The patients of experimental group ( n = 28 )received memantine (20 mg/d) while those in the control group (n = 27 ) conventional antiparkinsonian drug therapy alone. The cognitive and motor evaluations were assessed at pre-treatment and 12, 24 weeks posttreatment by clinical assessment, rating scales and neuropsychological tests. Results At week 24 the patients m the memantine group had better MMSE (22.8 ±1.8), ADAS-cog (18.6 ±2.3), and UPDRS-Ⅲ (34.6 ±4.2) scales scores than those taking placebo MMSE (18.5 ±1.7), ADAS-cog (21.9 ±2.4), and UPDRS-Ⅲ (41.2 ±4.0). Patients treated with memantine had better improvement on the MMSE (P ＜ 0.05), ADAScog (P＜ 0.05), and UPDRS-Ⅲ (P＜ 0.05) scales compared with the control group by the end of study week 24. Conclusion Memantine may improve the cognitive and motor impairments of PD. And it is both safe and well-tolerated.

Objective To investigate whether there is an association of PARK 16 locus with Parkinson's disease (PD) in Han population of Suzhou area. Methods Polymerase chain reaction (PCR), sequencing analysis, allele-specific PCR mediated by pfu DNA polymerases and real-time PGR were employed to determine the genotype of each subject. The PARK16 representative SNP rs947211 was analyzed in 160 PD patients and 200 age-matched healthy controls. Results The results of pfu-mediated allelespecific PGR were 100% concordant with the direct-sequencing analysis. All genotypes were found in this study. A significant distinction occurred in the allelic frequency of rs947211. There was a higher expression of G allele in PD patients versus the controls (60. 63% vs 51.00%; χ2 =6. 662, P =0. 010, OR =0. 676,95% CI0. 502 - 0. 911 ). There were remarkable differences between G/G genotype and A/G + A/A genotype of two groups(χ2 =8. 401, P = 0. 004, OR = 1. 951, 95% CI 1. 238 - 3. 076). In addition, a significant distinction also existed in different genotypes through H&Y stage (P ＜ 0.05). For example, the stage of G/G was higher than A/A genotype ( P = 0. 025,95% CI 0. 059 - 0. 851 ) or A/G genotype ( P =0. 020,95% CI 0. 058 -0. 654 ). Conclusion We have established a simple and reliable rs947211genotyping method mediated by pfu DNA polymerases. The results confirmed the existence of PARK16 in Han population of Suzhou area, rs947211 G/G genotype maybe a risk factor for PD and G/G genotype carriers perhaps obtain higher illness severity.

Objective To study the effects of deep brain stimulation (DBS) of bilateral subthalamic nucleus (STN) on the motor and non-motor symptoms in moderate or advanced Parkinson's disease (PD) patients. Methods From August 2006 to January 2010, 21 consecutive PD patients with refractory motor fluctuations or dyskinesia underwent operations at our hospital. All patients were evaluated by unified Parkinson's disease rating scale (UPDRS), Hoehn & Yahr (H&Y) stage, Parkinson's disease questionnaire (PDQ-39), mini mental state examination (MMSE), Parkinson's disease sleep scale-Chinese vision( PDSS-CV), Pittsburgh sleep quality index ( PSQI), Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA). And the daily dosage of dopaminergic agents was recorded at 1week pre-operation and 3, 6 and 12 months post-operation. Results Ten patients finished a 12-month follow-up. Their motor functions showed significant improvement. And the scores of UPDRS-motor, tremor,rigidity, bradykinesia and axial symptoms reduced significantly in the on-stimulation-off-medication condition and the on-stimulation-on-medication condition vs the on-medication condition pre-operation. And the improvement of tremor was the most pronounced ( 52. 1% and 77.7% respectively ) . The H&Y stage decreased significantly from 3.2 ± 0. 7 to 2. 5 ± 0. 4 post-operation. The activities of daily living improved while PDQ-39 declined significantly from 56 ±9 pre-operation to 32 ± 13 at 12 months follow-up. The score changes of MMSE, PDSS-CV, PSQI, HAMA and HAMD were statistically insignificant. The levo-dopa equivalent dose of 1-year post-operation decreased significantly by 49.2% versus that of pre-operation ( P ＜0.05). Conclusion Bilateral STN-DBS can significant ameliorate the motor symptoms of moderate or advanced PD patients, reduce the dosage of anti-PD medications and improve the quality of life. This procedure has the advantages of a greater safety, minor side effects and an easy controllability.

Objective To evaluate the efficacy of sternoclidomastoideus radiofrequency carburation with local anesthesia under arthroscope for the treatment of congenital muscular torticollis in adults. Methods Twenty-six cases of congenital muscular torticollis were treated by radiofrequency carburetion with local anesthesia under arthroscope. The right side was in 14 patients and left in 12. There were 11 males and 15 females with an average age of 22 years old. Sternoclidomastoideus and clavicula were pre-operatively marked. Through an artificial lacouna, arthroscope and radiofrequency probe were inserted. Results The mean follow-up period was 25 months (range: 15-71 ). According to the motion deficits, craniofacial asymmetry, head tilt and subjective assessment,there were 19 excellent and 7 fair outcomes. Most patients showed a marked improvement in neck motion and head tilt with satisfactory functional and cosmetic outcomes. There was no nerve or vascular injury, no recurrence, infection and scar. The overall efficacy was satisfactory. Conclusion The radiofrequncy therapy for torticollis with local anesthesia under arthroscopy has a satisfactory efficacy. The advantages are minimal trauma, simple procedure, less pain and better cosmetics.

Objective To evaluate the operative outcome of associated acetabular fractures through single Kocher-Langenbeck (K-L) approach and investigate the relationship between the quality of fracture reduction and long-term joint function. Methods A total of 116 associated acetabular fractures were treated through single K-L approach at our department from October 1993 to December 2004. All cases were evaluated retrospectively. And 80 cases (81 hips) were followed up, including 5 hips of T-shaped fractures,53 hips of associated transverse and posterior wall factures, 18 hips of associated posterior column and posterior wall fractures, 4 hips of both column fractures and 1 hip of the associated anterior and posterior hemitransverse fractures. The quality of fracture reduction was evaluated. And the functional results and complications were tracked. Results The average duration of follow-up was 51.7 months. Anatomical reduction was achieved in 39, satisfactory in 31 and unsatisfactory reduction in 11 hips. The clinical outcome was excellent and good in 62 ( 76. 5% ) hips. All fractures were healed without infection. And 24 hips showed post-operative heterotopic ossification. The incidence of post-traumatic osteoarthritis was 22. 5% ( 18hips). There were 5 hips with the palsies of sciatic nerve. And the avascular necrosis of femoral head was found in 6 hips. Conclusion Associated posterior column and posterior wall fractures, most transverse and posterior wall fractures, certain T shape fractures and both column fractures may be treated through a single K-L approach. Excellent reductions and satisfactory functional outcome can be achieved. The satisfactory joint function is based on a perfect fracture reduction.

Objective To investigate the key microanatomic and radiological structures of optic canal comprehensively so as to provide anatomic parameters and procedural flows for the decompression of optic canal. Methods Gross observations and microscopic measurements were applied on 10 (20 sides)formalin-treated cadaveric specimens and 15 (30 sides) adult skulls. Using multislice helical CT( computed tomography)-aided three-dimensional reconstruction in combination with direct anatomic measurement, the investigators dissected, photographed, measured and analyzed the shape of optic canal and analyze its anatomic relationship with the adjoining structures. Results Optic canal was formed by the superior,inferior, medial and external walls and distal proximal opening. The lateral wall of optic canal was formed by anterior clinoid process with a length of ( 9. 87 ± 1.34 ) mm, a width of ( 11.66 ± 2. 35 ) mm, a base thickness of (5. 35 ± 1.07) mm and a middle thickness of ( 4. 50 ± 1.06) mm. Optic strut separating the optic canal from the superior orbital fissure was located inferiorly. And the distance between the apex of anterior clinoid process and the middle of ICA (internal carotid artery) groove was (4. 25 ±2. 30) mm. The CSF (cerebrospinal fluid) leakage and secondary injury of optic nerve and injury of ICA, ophthalmic artery might occur during the surgical procedures due to the variation of anterior clinoid process. The microanatomic figures and radiological measurements had a mean difference very close to each other at (0. 08 -0. 48) mm.No statistical difference was found ( P ＞ 0. 05 ). Conclusion Optic nerve, ophthalmic artery and ICA may be exposed by a high-speed drilling of the lateral wall of optic canal. The drilling dissection of lateral wall plays a vital role during a successful optic canal decompression. Radiological measurement and threedimensional reconstruction of skull base may be of great clinical significance in lesion visualization. And it helps to make a better choice of surgical approaches. The measurements provide valuable references for surgeons and researchers.

Objective To investigate the isolation and expansion of mesenchymal stem cells (MSCS) from human umibilical cord Wharton's jelly and their biological identities , and explore the possibility of inducing human umbilical cord-derived MSCS to differentiate into chondrogenic and osteogenic cells. Methods The hUCMSCs were isolated form human umbilical cord by tissue adherence and digested with collagenaseNB4, dispase Ⅱ and hyaluronidase. The morphology, proliferation and immunophenotype of the 3rd passage cells were analyzed, and then the chondrogenic and osteogenic differentiation was tested and evaluated by specific staining methods. cells were induced to chondrogenic and osteogenic differentiation in vitro. Results The isolation of hUCMSCs by digestion with collagenaseNB4, dispase Ⅱ and hyaluronidase was efficient. After seeded for 24 hours, the adherent cells showed spindle shape and fibroblast cell-like shape and the size of hUCMSCs was homogeneous. Flow cytometry analysis revealed that the hUCMSCs were positive for CD44,CD105, CD90, CD73, but were negative for CD45, CD34, CD14, CD19 and HLA-DR.These cells could be induced to differentiate into chondrogenic and osteogenic cells under proper inducing conditions. The hUCMSCs retained the appearance and phenotype even after being expanded more than 40 passages in vitro. Conclusions The human MSCs could be isolated from human umbilical cord Wharton's jelly ,and it was easy to propagate these MSCs. An in vitro method for isolation and purification of hUCMSCs from human umbilical cord has been established. The cultured cells were composed of only undifferentiated cells and their biological properties were stable. The hUCMSCs are expected to be a new type of stem cells of tissue engineering.

Objective To investigate the prevalence of infertility and its risk factors in the fertileage couples of Beijing, China. Methods A cross-sectional survey on the prevalence and risk factors was conducted from July 2007 to May 2008 in 7 Beijing districts. The districts were subdivided into the administrative units of "communities". A total of 33 communities were sampled and households selected randomly within each community. Of 5862 couples (women aged 20 -49 years) who were eligible for an interview, 5632 (96. 07% ) provided information in relation to all the questionnaire questions. The other couples did not participate because they were not at home for the interview, or became incapacitated, refused or others. The trained interviewers administered a detailed questionnaire to each study couple at their home,collecting the relevant information about contraception, sexual practices, marriage and a complete pregnancy history. The definition of infertility in the study was "a noncontracepting couple who want another child or a child if childless tried to conceive for at least 2 years" following the WHO recommendation[c2]. The study protocol was approved by the ethics committee of National Research Institute for Family Planning (NRIFP).Results A total of 97 couples were classified as infertile. And the total prevalence of infertility in 7 Beijing districts was 1.72%. The standardized prevalence of infertility was 2. 1%. 57 (58. 76% ) couples were classified as of primary infertility and 40 (41.24%) of secondary infertility. So the prevalence of primary and secondary infertilities were 1.01% and 0. 71% respectively. In women, the prevalence of infertility was the highest in the age group of 20 -29 (3.13%) and the lowest in the age group of 40 -49 (1.38%). The prevalence rate of infertility in the women whose marriage age were younger than 20 years or elder than 29 years of age was apparently higher than those of the 20 - 29 years old. The risk factors of infertility were tuberculosis ( TB), endometriosis (EM) and pelvic infection disease (PID). Conclusion The prevalence rate of infertility declines with age in women. Both EM and PID are the risk factors for infertility.

Objective To evaluate five screening methods of cervical cancer so as to popularize an effective screening strategy for cervical cancer in Zhejiang province. Methods A total of 1005 women aged 25 -65 years old were selected from Lishui where cervical cancer was highly prevalent. And 859 subjects were ultimately enrolled between June 2009 and December 2009. Each subject was subjected to five screening methods, including Pap smear, liquid-based cytology (LBC), human papillomavirus DNA with a second-generation hybridization assay( HC2 ), visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). CIN (cervical intraepithelial neoplasia) 2 + on biopsy was used as the reference standard for disease positivity. Negative colposcopy was accepted as a negative outcome. Results The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV)were 25%, 90%, 26.7% and 98.6% for Pap smear; 81.3%, 97.3%, 35. 1% and 99.6% for LBC;68.9%, 82. 8%, 7. 1% and 99. 3% for VIA; 81.3%, 84. 6%, 9. 1% and 99.3% for VILI; 87. 5%,77.3% and 6. 8% for HPV-DNA test respectively. Conclusions LBC is associated with a better profile of sensitivity, specificity and predictive value for five screening methods. It has the potential of optimizing the effectiveness of primary cervical cancer screening. Due to a low cost and an easy operation, VIA screening is an effective method of screening cervical cancer in the underdeveloped areas.

Objective To summarize the morbidity, mortality, clinical manifestations and risk factors for IRIS (immune reconstruction inflammatory syndrome) during HAART (highly active antiretroviral therapy) in China. Methods From October 2007 to September 2009, a prospective cohort of 238 AIDS (acquired immunodeficiency syndrome) patients on HAART from Hunan and Jianxi provinces was recruited for a follow-up of 24 weeks. And 47 and 191 patients were assigned into the IRIS and non-IRIS groups respectively. The data of general information, clinical manifestations and treatment of two groups were collected and compared. Blood samples were collected in both groups at pre-and post-HAART 12 weeks, 24weeks for HIV viral load and CD4 + cell count examinations. A statistical analysis was performed. Results A total of 47 ( 19. 7% ) IRIS cases was analyzed. The median onset of IRIS was 28 (9 -36) days. And 29(61.7%) cases of tuberculosis IRIS were found. There was no significant difference in age, gender, route of transmission and antiretroviral regimens between the IRIS and non-IRIS groups. At baseline, Weeks 12 and 24, both groups showed a significant decline of viral load. And there was no significant difference between them. Both groups showed a significant increase of CD4 + cell count. But there was no significant difference between two groups. However, the baseline CD4+ cell count was markedly lower in the IRIS group than that in the non-IRIS group. In 85. 1% (40/47)of cases, the CD4+ cell count was ＜ 100 × 106/L in the IRIS group at the baseline of HAART. Conclusion IRIS mostly occurs during 3 months of HAART initiation.The age, gender, route of transmission and antiretroviral treatment regimens of patients on HAART are not risk factors for the development of IRIS. The HIV RNA viral load decreases in both IRIS and non-IRIS groups without any significant difference. The patients with a CD4 + cell count ＜ 100/μl are more vulnerable to develop IRIS.

Objective To investigate the effects of nimodipine on symptomatic cerebral vasospasm in rabbits. Methods Twenty four japanese white rabbits which ligation of bilateral common carotid arteries and no neurological deficits were randomized to sham-operation, subarachnoid hemorrhage (SAH) and nimodipine which injected of nimodipine 0.1 mg/kg, continuous vein administration 5 day. The behavior scores, neurological scores were observed everyday and cerebral angiography changes were measured twice by 3D-CTA,and basilar artery was removed for pathological examination after last CTA examination. Results In SAH group , The basilar artery were significantly vasoconstrictive on 5 days, neurological scores were increased, and the basilar artery was found apoptosis-like changes under light microscopic and electron microscope. Nimodipine group could not dilated the basilar artery arteriospasm after SAH, but it could attenuate neurological deficit,and obviously alleviate the pathological changes of basilar artery. Conclusion Nimodipine could not vasodilation of basilar artery in SCVS, but obviously could alleviate neurological changes and pathological changes of basilar artery. in rabbits with symptomatic cerebral vasospasm.

Objective To explore the effects of recombinant human Elafin gene transfection on lipopolysaccharide (LPS)-induced airway mucous hypersecretion. Methods An eukaryotic expression vector pEGFP-C1-Elafin was first constructed and then transfected into NCI-H292 cell. After co-incubation with polymorphonuclear granulocyte (PMN) plus LPS stimulation for 24 hour, the vital force unit of neutrophil elastase (NE) and the content of mucin (MUC) protein in culture media and the level of MUC 5AC mRNA in culture cells were detected with substrate detection technique, enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) respectively. Results All parameters in control group showed a low level(0. 13 ±0. 03, 0. 28 ±0. 06, 0. 29 ±0. 04 respectively). And transfectiing NCI-H292 cell with pEGFP-C1 at different levels of LPS, all parameters were obviously different (all P ＜0. 01 ) and they all showed a dose-dependent relationship. After LPS stimulation (0. 5, 5 mg/L),as compared with the transfection of NCI-H292 cell with pEGFP-C1-Elafin, the vital force unit of NE and the content of MUC5AC protein in culture media and the level of MUC 5AC mRNA in transfecting pEGFP-C1NCI-H292 cell decreased obviously (all P ＜ 0. 05 ). But after LPS stimulation (25 mg/L), as compared with the transfection of NCI-H292 cell with pEGFP-C1-Elafin, no parameter of transfecting pEGFP-C1 NCI-H292 cell had any obvious alteration (0. 67 ±0. 06, 0. 64 ±0. 08, 0. 67 ±0. 07 respectively, all P ＞0. 05).Conclusion The transfection of recombinant human elafin gene into NCI-H292 cell may inhibit the force of inflammatory telo-effective factor NE induced by a certain level of LPS and airway mucous hypersecretion.But it can not inhibit the effects induced by a high level of LPS.

Objective To investigate the effects of EMPs on HUVECs permeability in vitro,then evaluate the effect on the Avascular Necrosis of Femoral Head. Methods Incubate HUVECs with EMPs which is released by HUVECs in vitro,then estimate the endothelial permeability. Results Flowcytometry analysis showed that EMPs were released at maximum concentration (7. 66 × 104/ml ) after 24 hours stimulated by 10 mmol DEX And 7.66 × 104, 7.66 × 103/ml concentration (moderate and high concentrations) of EMPs caused injury to the permeability of HUVECs ( P values are 0. 002 and 0. 031respectively, ＜0. 05 ), while 7.66 × 102/ml concentration ( low concentration ) of EMPs didn't ( P =0. 425 ＞ 0. 05). Conclusion Dexamethasone can induce HUVECs to release EMPs in vitro. EMPs caused collapse of connections of HUVECs, and increase the HUVECs permeability, decrease vascular stability,finally lead to Avascular Necrosis of Femoral Head.

Objective To study the anesthetic effect of brachial plexus block by adding buprenorphine in local anesthetics and patients with intramuscular injection , and observe the anesthesia effects, the anesthesia maintenance time, postoperative analgesia effects. Methods 60 cases of upper limb to line, hand surgery patients from Sep. 2009 to Dec. 2009 in Tianjin Hospital were randomly divided into 3groups. A (local anesthetics without buprenorphine, n = 20); B group (plus 2 μg/kg buprenorphine in local anesthetics, n = 20); C group ( intramuscular injection 2 μg/kg buprenorphine before anesthesia ,n =20). With B/ BRAMN-STIMMPLEX-DIG nerve stimulator guided positioning of brachial plexus block of axillary line. 3 groups of patients recorded ( 1 )the onset time of narcotic; (2) the duration of anesthesia;(3)the surgery time; (4)the pain score of postoperative 4, 8, 12, 24, 36, 48, 72 h; (5)the incidence of nausea and vomiting; (6)observed other side effects. Results the patients' age, weight, sex, operation time of the 3 groups had no significant difference between the comparison ( P ＞ 0. 05 ); anesthesia onset time between the 3 groups showed no significant difference ( P ＞ 0. 05). Duration of anesthesia: A, C group was significantly shorter than the B group (P ＜0. 01 ); pain score at 4 h, A and B, C no significant difference between groups ( P ＞0.05 ); 8、12、24 h, when group A was significantly higher than the B, C group ( P ＜0. 01 ), 36、48、72 h when the A group and B, C no significant difference between groups ( P ＞ 0. 05 ); the incidence of nausea A group 10%, B group 20% , C group 20%. Vomiting, the incidence of A, B group was 0, C group 30%. Conclusion Buprenorphine adding local anesthetics in brachial plexus block or intramuscular injection buprenorphine before a block can be to achieve a satisfactory effect of postoperative analgesia, buprenorphine adding local anesthetics in brachial plexus block Narcotic maintenance of anesthesia time can be extended and have a significant effect and fewer adverse reactions.

extensively drug resistant tuberculosis (XDR-TB) refers to the in vitro tests confirming that Mycobacterium tuberculosis infected by tuberculosis patients is resistant to at least isoniazid and rifampicin among the first-line anti-tuberculosis drugs, but also to any of the injectable drugs of kanamycin, amikacin and capreomycin and any of the fluoroquinolones of ofloxacin, levofloxacin and moxifloxacin.

Objective To study the regulation effects of CR (caloric restriction) and SIRT3 in the H2O2-induced oxidative stress injury of PC12 cell. Methods The cells were divided into four groups:H2O2, H2O2+CR, CR and control (high glucose). For control and H2O2 group, cells were cultured in DMEM containing 0.45% glucose; for group in CR condition, cells were treated with the medium containing 0.1% glucose. For groups with H2O2, the H2O2 was diluted in EMEM medium to obtain the final concentration containing 60 μmol/L. Viability of PC12 cells were measured by MTT assay. The medium was refreshed with different concentration of H2O2 (from 10 to 120 μmol/L). The absorbance of the samples was measured at 492 nm using a microtiter plate reader. We detected TUNEL-positive cells using the In Situ Cell Apoptosis Detection kit pretreated with CR and H2O2. Immunofluorescence double staining detected the expression and localization of SIRT3. RT-PCR and Western-blot mehtods detected the expression of SIRT3,Caspase-3. Results After pretreating with 60 μmol/L H2O2 for 6 h, the viability of PC12 cells in H2O2 group (74.01±2.21)% retained above 70%, and have statistical significance contrasted with control group (P＜0.05); After pretreating with 120μmol/L H2O2, the viability of PC12 cells declined significantly (38.22±3.34)%. So 60μmol/L H2O2 is our experiment concentration . The viability of H2O2 group (74.01±2.21)% was much lower than CR + H2O2 group (97.26±1.92)% (P＜0.05). After pretreating with H2O2, TUNEL staining showed the apoptosis cells of CR+H2O2 group decreased significantly contrasted with H2O2 group. The immunofluorescence double staining results showed that SIRT3was a mitochondria protein. Western-blot showed the expression of SIRT3 in CR group (6857±157) (P＜0.05) increased and decreased in H2O2 group (3786±160) (P＜0.05) contrasted with control group (5256±143). The expression of SIRT3 in CR + H2O2 group(5056±121)(P＜0.05)increased contrasted with H2O2 group(3786±160). We also detected that Caspase-3 in H2O2 group(8499±426)(P＜0.001 )was much higher than control group than (5342±420), but in the CR + H2O2 group (5750±438 ) theexpression of Caspase-3 was much lower than H2O2 group(8499±426) (P＜0.001). RT-PCR also showed that the expression of SIRT3 in CR group (7214±148) increased and decreased in H2O2 group (4807±143 ) (P＜0.05) contrasted with control group (6204 ± 134 ). The expression of SIRT3 in CR + H2O2 group (6195 ± 166) increased contrasted with H2O2 group (4807 ± 143 ) ( P＜0.05). Conclusion CR causes anti-oxidative injury and has apoptotic effects in PC12 cell. It up-regulates the expression of SIRT3 and the effects of CR-SIRT3 can prevent PC12 cell from H2O2-induced apoptosis. And SIRT3 may be a novel molecule of regulating target in the delay of neuronal senescence.

Case 1: A 39-year-old male was admitted to Peking Union Medical College Hospital on Nov. 30, 2009 due to fever, joint pain for 1 year, unclear speech and unsteady walking for 1 month. The patient developed fever, joint pain with morning stiffness and proximal limb muscle weakness 1 year ago, and the symptoms were relieved after taking methylprednisolone 16 mg/d orally.