Volume 92  ·   Issue 35  ·  2012

Knee joint is the largest synovial joint in human body. Its anatomical structure is complicated, and its motor function is important. Knee joint diseases have a great influence on the quality of life of patients. Compared with artificial hip replacement, knee replacement surgery started slightly later, but it progressed rapidly. Since Verneil proposed to form joints with inserts to restore the articular surface, artificial knee replacement has gone through the development course of more than 100 years.

Objective To examine the feasibility of autologous uncultured bone-marrow-derived mononuclear cells (BM-MNCs) in combination with microfracture in a full-thickness articular cartilage defect model so as to provide experimental rationales for clinical applications.Methods A total of 40 rabbits were divided randomly into groups A,B,C and D (n =10 each).In groups A and C,5 ml marrow samples were harvested from left femur and then autologous BM-MNCs isolated.The full-thickness articular cartilage defects were made on femoral intercondylar fossa in right knees of rabbits.Group A:micro-fracture was made on cartilage defect and then autologous uncultured BM-MNCs-autologous fibrin gel complex implanted; Group B:the same micro-fracture was made on cartilage defect and autologous fibrin gel implanted; Group C:the cartilage defect was implanted with autologous uncultured BM-MNCs-autologous fibrin gel complex; Group D:the cartilage defect was implanted with autologous fibrin gel.Five rabbits were sacrificed at Weeks 8 and 12 post-transplantation in each group.And the reparative tissue samples evaluated grossly,histologically and immunohistochemically were graded according to the gross and histological scales.Results The statistical analyses of histological gradings at Weeks 8 and 12 showed that group A was significantly better than groups B,C and D (P＜0.05),groups B and C were better than group D (P ＜0.05) and each group at Week 12 was better than itself at Week 6 ( P ＜ 0.05 ).Conclusion Both of micro-fracture and transplantation of uncultured autologous BM-MNCs plus autologous fiber gel can promote the repair of cartilage defects.The combined use of micro-fracture and autologous uncultured BM-MNCs promotes the regeneration of articular cartilage so that it may provide theoretical rationales for clinical applications.

Objective To evaluate the effects of anterior cruciate ligament reconstruction with peroneus longus tendon and observe the clinical outcomes of ankle joint after the resection of peroneus longus tendon.Methods From January 2006 to December 2009,35 patients with anterior cruciate ligament injuries were recruited to undergo surgical procedures.There were 30 males and 5 females with an average age of 31.8 years (range:21-56).All anterior cruciate ligament reconstructions underwent arthrosocopy.All ligaments were reconstructed with peroneus longus tendon and fixed with absorb screw.The post-operative assessments included the followings:clinical evaluations,Lysholm knee score,KT-3000 arthrometer evaluation and the American Orthopedic Foot and Ankle Society ankle-hindfoot scale(AOFAS).Results All cases were followed up for an average follow-up period of 15 months (range:12-24).The healing time was 6-15 weeks.according to the Lysholm knee score,their outcomes were excellent ( n =25 ),good ( n =6),fair ( n =3 ) and poor ( n =1 ).The average score was 97.2 ( range:60-100).The rate of excellent and good was 88.6％ ; according to the KT-3000 arthrometer evaluations,the outcomes were normal (n =28 ),nearly normal ( n =4),abnormal ( n =2) and poor ( n =1 ).Preoperatively,the average anterior displacement was 11.59 ± 1.25 mm and the average anterior displacement at final follow-up 1.76 ± 1.83 mm.The average AOFAS score was 96.3 (range:84-100).Lysholm knee score and KT-3000 arthrometer evaluation had statistical differences (P ＜ 0.05 ) while AOFAS score showed no difference ( P ＞ 0.05).Conclusion Peroneus longus tendon can be a good substitute of anterior cruciate ligament reconstruction.And its resection has no major influence for ankle joint.

Objective The question of whether a total joint arthroplasty should be attempted in a patient with a current or previous infection of tuberculosis continues to arouse controversy.The aim of this report was to evaluate the clinical outcomes of cementless total hip arthroplasty for the treatment of advanced tuberculosis of hip.Methods A total of 14 patients with advanced tuberculosis of hip treated by cementless total hip arthroplasty were retrospectively analyzed.For the patients with a definite diagnosis of tuberculosis and elevated levels of CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) before surgery,preoperative antituberculous medications were prescribed for at least 2 weeks.The inflamed soft tissues and destroyed bones were completely curetted out at the time of operation.Twelve of 14 patients received onestage cementless total hip arthroplasty after a thorough debridement.For the remaining 2 patients,two-stage strategy was taken with cement articulating spacer implanted after a thorough debridement and followed by cementless total hip arthroplasty at 6-8 months later.All patients were prescribed antituberculous medications postoperatively for the first 6 months.Results The mean Harris Hip Score ( HHS ) was 36 preoperatively and 87 at the last follow-up.Within an average follow-up period of 49 months ( range:27-77 ),only one patient had reactivation of tuberculosis 7 months after primary THA ( total hip arthroplasty)and received resection arthroplasty.Another 13 patients had no reactivation of tuberculosis and revealed stability by bone ingrowth on both socket and femoral stem.Conclusion Cementless total hip arthroplasty is a safe and effective procedure for advanced tuberculosis of hip.With a thorough debridement followed by a conplete course of antituberculous chemotherapy,active tuberculous infection should not be considered a contraindication for THA.In patients whose diagnosis of tuberculosis is confirmed intraoperatively and with no preoperative antituberculous chemotherapy,or in those a thorough debridement can not be achieved,a two-stage surgery may be considered.

Objective To analyze various clinical parameters of elderly hip fractures so as to improve the management of eider hip fractures in China.Methods The data of elder patients with hipfracture (primary diagnosis was fracture of femoral neck or intertrochanter) admitted into our department between 2002 to 2010 were collected.And the relevant clinical parameters included case number,age,ratio of concurrent chronic disease and duration and cost of hospitalization.The software of SAS was used for statistical analysis.Results A total of 1626 patients (M/F =547/1079 ) ≥ 65 yr old with femoral neck fracture were admitted.Average age was 74.7 ±6.4 yr (65 -99) and annual average increasing rate 0.5％ (-0.1％-1.8％ ).The ratio of concurrent chronic disease was 53.3％.Average duration of hospitalization was 18.3±10.9 days (1-114) and annual average increasing rate was-6.3％ (-19.2％-8.4％).Average cost of hospitalization was 38 758.04 ± 24 558.15 yuan (76.8-339 987.49) and annual average increasing rate 6.4％ (-8.7％-40.0％ ).A total of 892 patients (M/F =362/530) ≥65 yr with femoral intertrochanteric fracture were admitted.Average age was 76.7 ± 6.8 yr ( 65-105 ) and annual average increasing rate 1.3％ (-1.8％-4.3％ ).The ratio of concurrent chronic disease was 55.8％.Average duration of hospitalization was 15.7 ± 8.7 days ( 1-78 ) and annual average increasing rate-4.5％ (-22.1％-8.0％).Average cost of hospitalization was 35 183.45 ± 21 427.47 yuan (75.3-148 150.41 ) and annual average increasing rate 18.3％ (-3.7％-79.9％ ).Conclusion The number,age and therapeutic cost of elder patients with hip fracture are increasing continuously.Elderly hip fracture is becoming a serious problem of public health.

Objective To explore the intraoperative oculomotor nerve monitoring during skull base tumor surgery for injury avoidance.Methods The study was conducted from January 2006 to January 2012.Monitoring group:35 skull base tumor operations were monitored by neurophysiology (22 males and 13 females).Control group:26 skull base tumor operations without intraoperative monitoring were treated with microsurgery alone (16 males and 10 females).The prognoses of different groups were evaluated.Results Monitoring group:2 cases had injury of oculomotor nerve.One of them suffered mild diplopia and recovered one months later.Another one had blepharoptosis and mydriasis,reaction to light was absent and recovered six months later.Control group:6 cases had injury of oculomotor nerve.Five of 6 cases recovered six months later.And one showed no recovery after a 1-year follow-up.Conclusion Intraoperative monitoring of oculomotor is essential for the protection of oculomotor nerve during skull base tumor surgery.

Objective To evaluate the clinical significance of combined detection of TCT and HR-HPV-HC2 assay in the screening and recurrence prediction of CIN.Methods A total of 725 patients with suspected cervical abnormalities received TCT plus HR-HPV-HC2 detection and histopathological examinations.203 CIN Ⅱ-Ⅲ patients received TCT and HC2 detection and histopathological examinations after treated with loop electrosurgical excision procedure or cold knife conization operation.The results of pathological examinations were gold standard.The sensitivity and specificity of TCT,HR-HPV-HC2 and TCT plus HR-HPV-HC2 were analyzed.Results The missed diagnosis and misdiagnosis rate of TCT and HC2 alone were 19.23％,12.50％ and 48.15％,74.07％ and sensitivity and specificity 90.02％,97.01％and 51.85％,17.76％ respectively.The sensitivity,missed diagnosis rate and negative predictive value were 98.25％,1.75％ and 89.70％ when TCT or HR-HPV-HC2 met the CIN diagnostic criteria.The specificity and positive predictive value were 58.95％ and 72.80％ when TCT and HR-HPV-HC2 met the CIN diagnostic criteria.The specificity of TCT or HR-HPV-HC2 alone was 80％ for the prediction of recurrence at Month 6 postoperation.The specificity of TCT plus HR-HPV-HC2 was 98.27％ for the prediction of recurrence at Month 3 postoperation and the negative predictive value was 98.75％ at Month 6 postoperation.The sensitivity of TCT or HR-HPV-HC2 was 97.22％ for the prediction of recurrence at Month 3/6.And the negative predictive value was 99.17％ at Month 6 postoperation.Conclusion The combined detection of TCT and HR-HPV-HC2 may improve the sensitivity and specificity of CIN and the predication of its postoperative recurrence.

Objective To explore the reproducibility and stability of brain functional area in the response of language tasks during Chinese word processing with functional magnetic resonance imaging (fMRI) by follow-up scanning so as to provide rationales for clinical preoperative localization and the mechanisms of recovery from aphasia.Methods The fMRI data were collected by scanning semantic and phonologic judgments in 15 healthy volunteers.Each subject was scanned twice by the same fMRI procedure of both language tasks with an interval of 1 month.By analyzing the effective overlapping average activation maps,the reproducibility of inter-subject imaging result for two language tasks were estimated by selecting the main language areas,such as Broca's area and Wernicke's area as the region of interest (ROI).By individually calculating the spatial distance of ROI centroid coordinates in the same activating range before and after test,the inter-subject stability in between-session was calculated quantitatively.Results Both language tasks activated more than one language-related brain areas in cerebral hemispheres.Both language tasks induced significant BOLD response in Broca's and Wernicke's areas with a tendency of left lateralization.The number of subjects in terms of the activation of both language tasks in Broca' s and Wernicke's areas accounted over a half of the total subjects.As compared with the phonologic judgment task,the semantic judgment task showed better reproducibility in Broca's area.In the same spatial distance of ROI centroid coordinates,the stability of Broca's area was higher than that of Wernicke's area while the stability of semantic judgment in Broca' s area higher than that of phonologic judgment.Conclusion Such main language domains as Broca's and Wernicke's areas can be effectively activated by both semantic and phonologic judgments.By comparison,semantic judgment in Broca' s area shows a higher level of reproducibility and stability.Thus it is applicable for clinical preoperative localization and the mechanisms of recovery from aphasia.

Objective To evaluate the diagnostic values of 18F-sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) imaging in the detection of bone metastases of lung cancer.Methods A total of 107 lung cancer patients were diagnosed by histopathology and undergone 18F-NaF PET-CT imaging.Results Among them,the histopathologically diagnosed tumors included adenocarcinoma (n =47),squamous cell carcinoma ( n =19),small cell lung cancer ( n =4) and other malignant types ( n =34 ).Bone metastases occurred in adenocarcinoma ( n =19 ) and squamous cell carcinoma (n =4).18 F-NaF PET/CT imaging had a high sensitivity of 100％ in the diagnosis of bone metastases with malignant lung tumors.And its specificity was 98.7％,accuracy 99％ and positive predictive value 97.0％.Conclusion 18 F-NaF PET-CT imaging can detect the bone metastases of lung cancer preoperatively with a high level of sensitivity and accuracy.

Objective To explore the application values of high-field intraoperative magnetic resonance imaging (MRI) in stereotactic aspiration and drainage of hypertensive hematomas.Methods During a period of August 2011 to January 2012,11 patients with hypertensive hemorrhage were examined preoperatively by conventional MRI and diffusion tensor imaging (DTI) with 1.5T intraoperative MRI system (Signa HDi,GE,USA ) at Tianjin Medical University General Hospital.The anatomic relationship of corticospinal tract (CST) and hematoma was used for the operative planning with the neuronavigation planning workstation (iPlan Cranial 3.0 software,BrainLab,Germany) for 3D reconstruction.During stereotactic surgery,intraoperative MRI scan was performed.According to the clearance rate of hematomas,the operators decided to finish the operation or update the operative planning to continue hematoma removal.All patients were reexamined by conventional MRI and DTI at Week 3 postoperation.Then comparative analysis was performed for the preoperative and postoperative integrity of CST.Results No death or severe complications occurred.All patients showed improvement of motor function and the postoperative integrity of CST.Conclusion The intracranial condition may be monitored effectively by intraoperative MRI throughout surgery so as to increase the rate of hematoma removal and reduce the postoperative complications.

Objective To explore the influencing factors of bleeding in the patients with cerebral arteriovenous malformation (AVM) through observing its angioarchitecture with cerebral digital subtraction angiography (DSA) so as to decipher its hemorrhagic risks.Methods A total of 87 cases of cerebral AVM during the period of 2004-2010 underwent cerebral angiography by digital subtraction angiography.The relationships between bleeding and such factors as the site and size of masses of AVM,the type and site of supplying arteries,the number and pathway of venous drainage,the relationships between AVM and aneurysm in terms of location and venous tumor were determined by univariate analyses and binary Logistic regression with SPSS 18.0.Results Univariate analysis indicated that such factors as the site and size of masses,the type and site of supplying arteries,the number venous drainage,the relationships between AVM and aneurysm were positively correlated with hemorrhagic presentation.When stepwise multiple Logistic regression analysis was employed,only the size of AVM,the number of venous drainage and aneurysm were the independent predictors of hemorrhagic presentation.Conclusion The size of masses of AVM,the number of venous drainage and aneurysm are the strong risk predictors for AVM hemorrhage.

Objective To explore the perioperative airway management for transoral surgical lysis in patients with irreducible atlantoaxial dislocation and posterior atlantoaxial or occipitocervical fixation.Methods Thirty patients undergoing surgical lysis through transoral approach with oral endotracheal intubation (OEI group) between September 2009 and June 2010 were recruited.And another 31 patients underwent transoral surgical lysis from December 2008 to August 2009 with percutaneous dilatational tracheostomy (PDT group).The time interval from artificial airway establishment to start of operation,the duration of nasogastric feeding,the incidence of respiratory complications and the postoperative length of hospital stay were compared between two groups.Results The time interval from artificial airway establishment to the start of operation in the OEI group was significantly shorter than that in the PDT group [ (39±15) vs (58 ± 16) min,P ＜ 0.01 ].The duration for nasogastric feeding in the OEI group was significantly shorter than that in the PDT group [ (6.0 ± 1.2 ) vs ( 7.9 ± 0.3 ) days,P ＜ 0.01 ].And the postoperative length of hospital stay was also shorter in the OEI group than that in the PDT group [ (9.5 ±1.7) vs ( 11.8 ± 3.4 ) days,P ＜ 0.01 ].Conclusion The management of perioperative airway with oral endotracheal intubation may avoid the complications of PDT,improve the utilizing efficiency of operating rooms and shorten the postoperative length of hospital stay.

Objective To compare the effectiveness of lung isolation among double-lumen endotracheal tube,Univent blocker and bronchial blocker during thoracic surgical anesthesia.Methods A total of 120 patients undergoing elective thoracic surgery were enrolled.They were intubated with Mallinckrodt DLT ( DLT group,n =40 ),Univent blocker ( UNI group,n =40 ) and Coopdech bronchial blocker (BB group,n =40) after intravenous anesthesia induction.The following paraneters were recorded:(1) tine to initially position the assigned tube; (2) changes of mean arterial pressure (MAP) and heart rate (HR) at 5 min post-intubation ; ( 3 ) lung collapse scores ; (4) frequency of malpositions ; (5) airway press and blood gas change during one lung ventilation ( OLV ) ; ( 6 ) postoperative sore throat at 24 h postoperation.Results No statistical difference existed in positioning three types of endotracheal tubes.But MAP and HR were higher at post-intubation in DLT group compared with the other 2 groups.No difference existed among the lung isolation devices in lung collapse scores at 5/10 min after pleural opening.As compared with the UNI and BB groups,Ppeak and Pplat increased while compliance decreased in DLT group during OLV.Statistical differences existed in tube malpositions among three groups ( n =4,DLT; n =5,UNI; n =8,BB).The incidence of postoperative sore throat was significantly higher in DLT group (70％)than the other two groups (37.5％,UNI; 22.5％,BB).Conclusion As compared with DLT,Univent and Coopdech bronchial blocker may reduce the airway injury and improve the compliance during OLV.But there is a higher intraoperative incidence of tube malposition.

Objective To explore the impact of lacrimal obstruction type on the efficacy of lacrimal probing in the treatment of congenital nasolacrimal duct obstruction.Methods We conducted a retrospective study in which 872 eyes of 741 children with congenital nasolacrinal duct obstruction underwent nasolacrimal duct probing under superficial anesthesia.Two types of obstructions were encountered during probing,i.e.simple and complex.They were divided into early (4-12 months) and late ( 1-4 years) groups based upon the age at the time of initial probing.Those refractory to the first probing underwent a second probing 4 weeks later.The main observation criterion was the success rate of probing.Results The success rate was 90.0％in early group versus 70.4％ in late group (x2 =38.527,P ＜0.01 ).No significant difference existed in the cure rate of simple or complex obstruction between two groups (x2 simple =0.054,P =0.815,x2 complex =1.705,P =0.192).The proportion of simple obstruction was 94.4％ in early group versus 62.2％ in late group.Difference was statistically significant (x2 =125.471,P ＜ 0.01 ).The success rate of a second probing of simple obstruction was 61.9％ in early group versus 68.2％ in late group (x2 =0.324,P =0.569 ).The success rate of a second probing of complex obstruction was 19.2％ in early group versus 5.7％in late group (Fisher's exact test,P =0.125).For either group,the success rate of a second probing of simple obstruction was higher than that of complex obstruction (x2 early group =16.100,P ＜ 0.01 ; x2 late group =25.186,P ＜ 0.01 ).Conclusion Unsuccessful probing may result from the selection of complex obstructions.Probing should remain the first-line treatment in children above 1 year of age.The success rate with a second probing was significantly lower in patients of complex obstruction.Other surgical interventions,such as silicone tube intubation or balloon dacryocystoplasty,should be recommended instead of repeated probing for the patients of complex obstruction if an initial probing fails.

Objective To evaluate the efficacy and safety of middle-dose cyclophosphamide plus methylprednisolone for myasthenia gravis (MG) patients in crisis.Methods For this prospective,open,parallel,randomized controlled trial,we recruited a total of 156 MG patients in crisis from January 1999 to October 2011 at Department of Neurology,First Affiliated Hospital,Sun Yat-sen University.They were divided into two groups of cyclophosphamide and control ( n =78 each).In the cyclophosphamide group,each received methylprednisolone 500 mg/d for 3 days,then tapered to 250 mg/d and tapered half every 3 days until 62.5 mg/d.Afterward an oral dose of prednisone was prescribed at 30 mg/d until the end of the trial.At the same time,an intravenous injection of cyclophosphamide was offered at 0.4 g/d for 3 days and then 0.4 g/d every 3 days.In the control group,each received methylprednisolone alone.And the efficacies were assessed by absolute and relative MG scores.Results ( 1 ) There were 54 ( 69.2％ ) patients offventilation in 3 days in the cyclophosphamide group versus 36 (46.2％ ) patients in 8-14 days in the control group.Notable statistical significance existed between two groups (P =0.000).(2) More than half of the patients in cyclophosphamide group with extremity weakness ( n =44,56％ ) and dysphagia ( n =47,60.3％ ) significantly improved in 10-14 days versus 28 days in the control group.Notable statistical significance existed between two groups ( P =0.000 ).( 3 ) In the cyclophosphamide group,dyspnea disappeared in 54 (69.2％ ) patients when the dose reached 1.2 g.The recovery of dysphagia ( n =47,60.3％ ) and extremity weakness (n =44,56.4％ ) occurred in more than half of the patients when the dose reached 2.8 g.Notable statistical significance existed among three groups ( P =0.000 ).( 4 ) During the treatment period,there were 17 cases (21.8％) with pulmonary infection in the cyclophosphamide group versus 53 cases (67.9％) in the control group.Notable statistical significance existed between two groups (P=0.000).(5) Brief and minor side effects appeared in the patients of the cyclophosphamide group.Conclusion ( 1 ) The combined treatment of middle-dose cyclophosphamide and methylrednisolone for MG patients in crisis is both effective and safe.(2) When combined with methylrednisolone,90％ of patients with MG crisis are successfully off-ventilation when the dose of cyclophosphamide reaches 1.6 g.

Objective To explore the net power and net energy of a cooled antenna radiator in ex vivo and in vivo porcine livers.Methods All animal experiments complied with the guidelines of our animal use committee.Microwave ablation (MWA) was performed in ex vivo and in vivo porcine livers with a cooled-shaft antenna in different microwave ablation parameter groups (50,80 and 110 W for 10 min).The energy losses from the microwave antenna or cables were calculated.And the net power,net energy and the relationship between net power and power readout were determined.Results When the power displayed by the machine indicated 50 W,80 W and 110 W,the net power during MWA was 31.3 ±0.6,47.3 ±0.8and 62.1 ±0.9 W ex vivo and 31.8 ± 0.8,47.4 ± 0.3 and 61.7 ± 1.5 W in vivo.For the same power readout,the ex vivo or in vivo effective power was the same (P =0.841,P =0.133,P =0.551 ).For both ex vivo and in vivo experiments,the ratio of microwave antenna energy loss to microwave antenna input energy was relatively constant (P =0.613,0.326).For the same treatment time and net power,the difference was significant between ex vivo and in vivo ablation volumes (P =0.001,0.006,0.001 ).Conclusion Using net power as a reference during MWA is more accurate compared to the traditional power readout.And net energy offers a more realistic reflection of MWA energy in tissues.

Objective To study the differential in vitro motor and invasion capacities of methotrexate (MTX) enantiomer-resistant tumor cells.Methods The incremental concentrations and successive low-dose induction were employed to acquire the cell series resistant to 15 μmol/L MTX enantiomer,namely L-( + )-MTX/A549 and D-(-)-MTX/A549.Their drug-resistant indices were determined by MTT assay and their migration capacities by wound healing assay.Double soft-agar clone formation was used to detect the colony efficiency and size.And Transwell was employed to detect the in vitro movement and invasion capacity of three cell types.Results The resistance indices of L-( + )-MTX/A549 and D-(-)-MTX/A549 were (6.1 ± 1.0)and (20.3 ± 1.8) respectively.At 72 hours after wound healing assay,the number of L-( + )-MTX/A549 entering scratch zone was fewer than that of D-(-)-MTX/A549 ;The numbers of colony formation in D-(-)-MTX/A549,L-( + )-MTX/A549 and parental cells were (50 ±7),(44 ±6),(52 ±7)and the rates of colony formation(1.68％ ±0.23％ ),(1.49％ ±0.18％ ),(1.73％ ± 0.23％ )respectively.And there was no significant significance among three groups (P ＞ 0.05 ).But the size of D-(-)-MTX/A549 was larger than that of L-( + )-MTX/A549.Transwell detected infiltration and invasion through artificial basement membrane Matrigel.The numbers of D-(-)-MTX/A549,L-( + )-MTX/A549 and parent cells were (267 ± 30),(106 ± 16) and (134 ± 16)respectively.The data were significant between D-(-)-MTX/A549 cells and L-( + )-MTX/A549 or parent cells (P ＜0.05) but not significant between L-( + )-MTX/A549 and parent cells (P ＞0.05 ).Conclusion The D-(-)-MTX-induced NSCLC A549 cells have greater motor and invasion capacities than those of L-( + )-MTX-induced ones.It suggests that MTX enantiomer has different capacities of tumor invasion and metastasis after acquiring resistance.

Multiple sclerosis is a common neurological immune-related disease, with more than 1.3 million patients worldwide. The immune system (especially T cells) may play a key role in the development of cancer and multiple sclerosis, so is the risk of cancer in patients with multiple sclerosis the same as that in other populations?

The patient was a 75-year-old female who was admitted to Peking Union Medical College Hospital on January 17, 2011 due to "low back pain for 3 months". In October 2010, the patient developed persistent low back pain without obvious trigger, which was not severe, sometimes accompanied by abdominal distension and pain, irrelevant to body position, accompanied by anorexia, nausea, no vomiting and no diarrhea. In December 2010, she developed fever, with a maximum body temperature of 39℃, accompanied by increased sputum, white sticky sputum, and no fear of cold and chills.