双侧中耳炎引起寰枕关节感染和神经症状

Bilateral Otitis Media Causing Atlanto-Occipital Joint Infection and Neurologic Signs

翻译 By @宠物神经科医生高健

原文网址:

Bilateral Otitis Media Causing Atlanto-Occipital Joint Infection and Neurologic Signs

Because otitis media and interna can be hard to diagnose without advanced imaging, it is important to take even subtle clinical signs seriously.

由于中耳炎和内耳炎在没有高阶影像学检查的情况下很难诊断,
所以即使是细微的临床症状也要认真对待。


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Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘5744796c7d21161…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘5744796c7d21161…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘5744796c7d21161…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘5744796c7d21161…’)
#22 {main}” width=”100″ height=”129″>
Kathleen R. Hipple CVT

Kathleen graduated in 2007 from the Vet Tech Institute in Pittsburgh, Pennsylvania, with a degree in Veterinary Specialized Technology. In 2015, she received a Bachelor of Science degree from the University of Pittsburgh with a focus on chemistry, biology, and psychology. She has worked for 7 years in general practice and 7 years in specialty practice, primarily neurology.

Kathleen于2007年毕业于宾夕法尼亚州匹兹堡的兽医技术学院,获得兽医专业技术学位。2015年,她获得了匹兹堡大学(University of Pittsburgh)的化学、生物学和心理学学士学位。她在全科医生临床工作了7年,在专科医生临床工作了7年,主要是神经病学。

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GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d43739cb20eed30…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d43739cb20eed30…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d43739cb20eed30…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d43739cb20eed30…’)
#22 {main}” width=”1198″ height=”44″>

On March 26, 2019, “Sam,” a 9-year-old, 4.7-kg, intact male domestic short-haired cat, underwent dental cleaning and extractions of teeth 308, 309, 408, and 409. During the procedure, a mass was found and determined to be a bony prominence from a broken tooth. He was discharged the same day but returned on March 29 due to hiding at home. Dental radiographs showed roots that remained from teeth 308 and 309, so they were extracted. Sam was then hospitalized for medication (clindamycin at 0.27 mg/kg PO q12h) and observation and was discharged on April 5.

2019年3月26日,9岁、体重4.7公斤的未绝育雄性家养短毛猫“Sam”接受了牙齿清洁和拔牙手术,拔牙为308、309、408和409号牙齿。在手术过程中,发现了一个肿物,并确定是一颗断裂牙齿的骨突起。它当天出院,但由于在家里躲藏,于3月29日回到了医院。牙科X光片显示308号和309号牙齿的牙根还在,所以进行了牙根清除手术。随后Sam住院用药治疗(克林霉素0.27 mg/kg PO q12h)并观察,4月5日出院。

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GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘59382767885a61f…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘59382767885a61f…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘59382767885a61f…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘59382767885a61f…’)
#22 {main}” width=”1198″ height=”44″>

Presentation 动物病况

On April 8, Sam was presented to the emergency department of our hospital for difficulty walking and a 2-week history of hiding, pawing at his face, decreased appetite, and “not being himself.” A complete blood count was within normal limits, and blood chemistry showed increased total protein (9.6 g/dL, reference range 6.5 to 8.4 g/dL), decreased albumin (2.3 g/dL, reference 2.8 to 4 g/dL), increased globulin (7.3 g/dL, reference 2 to 5 g/dL), and increased glucose (236 mg/dL, reference 70 to 160 g/dL).

4月8日,Sam被送到我们医院的急诊科,原因是行走困难,并且有两周的躲藏史,用爪子抓自己的脸,食欲下降,“不能正常表现自己应有的行为”。全血细胞计数在正常范围内,血液生化显示总蛋白升高(9.6 g/dL,参考范围6.5至8.4 g/dL),白蛋白降低(2.3 g/dL,参考范围2.8至4 g/dL),球蛋白升高(7.3 g/dL,参考2至5 g/dL),葡萄糖升高(236 mg/dL,参考70至160 g/dL)。

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘6e71108af4667b1…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘6e71108af4667b1…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘6e71108af4667b1…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘6e71108af4667b1…’)
#22 {main}” width=”1198″ height=”44″>


At the time, the increased total protein and hypoalbuminemia were attributed to dehydration and inappetence.1,2 Hypoalbuminemia can be caused by malnutrition, liver disease, kidney disease, or sepsis.3 Elevated globulin indicates infection or inflammation.3 Hyperglycemia was correlated with the patient’s acute stress.2

当时,总蛋白的增加和低白蛋白血症归因于脱水和食欲不振。1,2 低白蛋白血症可由营养不良、肝脏疾病、肾脏疾病或败血症。3 引起球蛋白升高表明感染或炎症。3 高血糖与病患的急性应激相关。2


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ada79a49a1b95e4…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ada79a49a1b95e4…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ada79a49a1b95e4…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ada79a49a1b95e4…’)
#22 {main}” width=”1198″ height=”44″>

During physical examination, Sam was bright, alert, and responsive. He was ambulatory but tetraparetic and knuckling on his forelimbs. The remainder of the examination was unremarkable. Thoracic, cervical, and skull radiographs were taken. The skull radiographs indicated some bony lysis of the cranial mandible, consistent with his recent dental extractions. No other abnormalities were noted. The patient was given fluids (lactated Ringer’s solution at 2.8 mL/kg and a rate of 13 mL/hr) along with clindamycin (22.34 mg/kg IV).

在体检时,Sam 活泼,警觉,反应灵敏。它可以走动,但四肢轻瘫,前肢掌背贴地。检查的其余部分无明显异常。拍摄胸片、颈椎片和颅骨片。颅骨X光片显示颅骨下颌骨有些骨溶解,与它最近拔牙的情况相符。没有发现其他异常。给予它补充液体(乳酸林格氏液,2.8 mL/kg,速率13 mL/hr)和克林霉素(22.34 mg/kg IV)。

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘4da013010036f43…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘4da013010036f43…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘4da013010036f43…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘4da013010036f43…’)
#22 {main}” width=”1198″ height=”44″>

The next day, Sam was transferred to the neurology service, where his examination indicated spastic tetraparesis, generalized ataxia, and decreased motor function of all limbs. His postural reactions, which help determine lesion location,4 were abnormal: 0 to 1 (absent to weak) in the thoracic limbs and 1 (weak) in the pelvic limbs. No cranial nerve deficits were noted. Spinal reflexes were normal. Palpation elicited no clear signs of spinal pain. Cranial nerve examination, used to evaluate various nerve pathways to the brain and help with lesion localization,4 revealed no deficits. Because Sam’s cranial nerve examination revealed no abnormalities and because his tetraparesis and abnormal postural reactions were more pronounced in the thoracic than in the pelvic limbs, the neuroanatomic disorder was determined to be localized to the cervical (C1 to C5) spinal cord segment.

第二天,Sam被转诊到神经科,检查显示它患有痉挛性四肢轻瘫、全身性共济失调和四肢运动功能减退。它的姿势反应有助于确定病变位置,其中有4项异常:前肢 0到1(无到减弱),后肢 1(减弱)。未发现脑神经缺陷。脊髓反射正常。触诊未发现明显的脊柱疼痛迹象。脑神经检查用于评估通往大脑的各种神经通路并帮助定位病变,4 未发现缺陷。由于Sam的脑神经检查未发现异常,并且由于它的四肢轻瘫和异常姿势反应在前肢比在后肢更明显,因此神经解剖学上的疾病被定位于颈(C1至C5)脊髓节段。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘787ad30c37b60d5…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘787ad30c37b60d5…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘787ad30c37b60d5…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘787ad30c37b60d5…’)
#22 {main}” width=”1198″ height=”44″>

Diagnostics, Results, and Diagnosis 诊断方式,结果和诊断

Magnetic resonance imaging (MRI) of Sam’s brain and cranial cervical region was performed by using contrast (gadolinium at 100 mg/kg IV). He was premedicated with buprenorphine (0.4 mg/kg IV), and anesthesia was induced with midazolam (0.2 mg/kg IV) and propofol (4 mg/kg IV).

采用造影剂(钆gadolinium剂量为100 mg/kg IV)对Sam的大脑和颅颈区进行磁共振成像(MRI)检查,麻醉前用药为丁丙诺啡buprenorphine(0.4 mg/kg IV),咪达唑仑midazolam(0.2 mg/kg IV)和丙泊酚propofol(4 mg/kg IV)诱导麻醉。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘b28abf551e8bddc…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘b28abf551e8bddc…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘b28abf551e8bddc…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘b28abf551e8bddc…’)
#22 {main}” width=”1198″ height=”44″>

After induction, a fluid bolus (4.26 mg/kg IV) was given to remedy bradycardia (120 beats/min) and hypotension (76/57 mm Hg, mean 65 mm Hg, measured indirectly). Sam’s heart rate increased to 138 beats/min, but his blood pressure did not respond. Atropine (0.04 mg/kg IV) was then given, after which his blood pressure increased to 88/56 mm Hg (mean 68 mm Hg) and remained stable for 25 minutes. Anesthesia was maintained with isoflurane at 1.5 L/min and oxygen at 1 L/min. When heart rate and blood pressure again decreased, to 133 beats/minute and 65/44 mm Hg (mean 59 mm Hg), respectively, a second dose of atropine was given. Isoflurane was turned down to 1 L/min and 2 doses of hetastarch (hydroxyethyl starch) at 2.1 mL/kg IV were administered 5 minutes apart. Hetastarch causes an increase in plasma volume, which in turn increases and maintains appropriate blood pressure. Sam’s blood pressure increased and stayed in the mid-80s (mm Hg) for systolic and the mid-40s (mm Hg) for diastolic (approximate mean 65 mm Hg).

诱导后,给予4.26 mg/kg液体团注(译者注:可能是 mL/kg),以纠正心动过缓(120次/分)和低血压(76/57 mm Hg,平均65 mm Hg,间接测量法)。Sam的心率增加到每分钟138次,但它的血压没有反应。给予阿托品(0.04 mg/kg IV)后,病患血压升高至88/56 mm Hg(平均68 mm Hg),并稳定25分钟。维持1.5 L/min异氟烷麻醉,1L/min供氧。当心率和血压再次下降至133次/分钟和65/44mm Hg(平均59mm Hg)时,给予第二次剂量的阿托品。异氟烷降至1 L/min,并以2.1 mL/kg IV给药2剂羟乙基淀粉,间隔5分钟。羟乙基淀粉引起血浆容量增加,从而使血压升高并维持在适当水平。Sam的血压升高,收缩压保持在80 mmHg左右,舒张压保持在40左右(大约平均65mmHg)。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘792d0a6ea2f0ea3…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘792d0a6ea2f0ea3…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘792d0a6ea2f0ea3…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘792d0a6ea2f0ea3…’)
#22 {main}” width=”1198″ height=”44″>

The MRIs showed hyperintense material in both tympanic bullae, more pronounced in the right but more expansive in the left (FIGURES 1–5). The atlanto-occipital (AO) joint showed increased fluid accumulation, which was causing extradural compression of the caudal brain stem and the spinal cord at C1, tapering over the C2 vertebra. The increased fluid and the stronger peripheral contrast enhancement of the AO joint were consistent with septic arthritis. Bilateral otitis media and interna were diagnosed and deemed the most likely source of the joint infection.

MRI显示两个鼓泡存在(T2WI)高强度信号物质,右侧更明显,左侧更具有扩张性(图1-5)。寰枕关节显示积液增多,导致后侧脑干和C1处脊髓的硬膜外压迫,在C2椎体上方逐渐变细。寰枕关节积液增多和外周显著增强,提示化脓性关节炎。双侧中耳炎和内耳炎被诊断为最可能的关节感染来源。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d91e521b151ea4d…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d91e521b151ea4d…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d91e521b151ea4d…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d91e521b151ea4d…’)
#22 {main}” width=”1198″ height=”44″>

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ad1ef149565a67b…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ad1ef149565a67b…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ad1ef149565a67b…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ad1ef149565a67b…’)
#22 {main}” width=”840″ height=”832″>
Figure 1. MRI axial T1-weighted scan, before contrast. Both tympanic bullae are filled with material, the right more than the left (arrow). 图1。增强前MRI横断面 T1加权扫描。两个鼓泡内均充满物质,右侧鼓泡内比左侧鼓泡内多(箭头)。

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ’37f2a57dcd3b9d6…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ’37f2a57dcd3b9d6…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ’37f2a57dcd3b9d6…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ’37f2a57dcd3b9d6…’)
#22 {main}” width=”960″ height=”715″>
Figure 2. MRI axial T2-weighted scan, before contrast. Both tympanic bullae are filled with material, but the material in the right ear (arrow) can be better visualized. 图2。MRI横断面 T2加权扫描,增强前。两个鼓泡内都充满了物质,但右耳内(箭头)的物质可以更清楚地看到。

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘c1d80e8c315fe44…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘c1d80e8c315fe44…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘c1d80e8c315fe44…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘c1d80e8c315fe44…’)
#22 {main}” width=”1078″ height=”637″>
Figure 3. MRI sagittal T2-weighted scan, before contrast, showing the abnormal atlanto-occipital joint (arrow). 图3。增强前的MRI矢状面T2加权扫描显示异常的寰枕关节(箭头)。

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘360f2bc324cdab8…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘360f2bc324cdab8…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘360f2bc324cdab8…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘360f2bc324cdab8…’)
#22 {main}” width=”1008″ height=”684″>
Figure 4. MRI sagittal T1-weighted scan, with contrast, showing increased contrast enhancement around the margins of the atlanto-occipital joint space, which can be seen protruding dorsally (arrow) and causing compression of the brain stem.
图4。MRI矢状面T1加权扫描,增强后显示寰枕关节间隙边缘增强,可见背侧突出(箭头),导致脑干受压。(译者注,此图的箭头位置错误,见下图蓝色箭头)
<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘e86fc4fbf7f1034…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘e86fc4fbf7f1034…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘e86fc4fbf7f1034…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘e86fc4fbf7f1034…’)
#22 {main}” width=”646″ height=”440″>
<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘b4d975e7f7820ac…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘b4d975e7f7820ac…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘b4d975e7f7820ac…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘b4d975e7f7820ac…’)
#22 {main}” width=”900″ height=”772″>
Figure 5. MRI axial T1-weighted scan, with contrast, showing the variable hyperintense material in the right middle ear (arrow), much more than in the left middle ear. 图5。MRI横断面T1加权扫描,增强后显示右侧中耳(箭头)不同程度高强度信号物质,远多于左侧中耳。

After the MRI, ultrasonography was performed to better visualize the AO joint. The joint was deemed accessible and was aspirated, with 2 to 3 mL of translucent fluid removed for cytology, culture, and sensitivity.

MRI后进行超声检查以更好地观察寰枕关节。此关节可以够得到并进行穿刺抽吸,取到了2 – 3ml半透明的液体进行细胞学、培养和药物敏感性检查。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ff4bd8cb121886a…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ff4bd8cb121886a…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ff4bd8cb121886a…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ff4bd8cb121886a…’)
#22 {main}” width=”1198″ height=”44″>

After the aspiration, bilateral myringotomy was performed. An otoscope was used to visualize the eardrum. A 12-mL syringe with a 22-gauge spinal needle attached was then gently guided through the eardrum into the internal ear canal, and 4 mL of saline was flushed into each bulla and aspirated back. The aspirated fluid was placed in a culturette. With the needle remaining in place, the syringe was switched out 4 times to flush out the debris and aspirate it back. With the eardrum pierced, any remaining trapped fluid could drain into the external ear canal.5 Myringotomies are performed to obtain specimens for cytology, culture, and antibiotic sensitivity; they can also immediately relieve pain caused by pressure associated with otitis media and interna.5

抽吸后行双侧鼓膜切开术。用耳镜观察鼓膜。接有22号脊髓针的12ml注射器通过鼓膜轻轻引导进入内耳道,将4ml生理盐水注入鼓泡内并抽吸回去。将抽吸的液体放入培养器中。针头留在原位,切换了4次注射器,反复冲洗掉碎片并将其抽吸回去。鼓膜穿孔后,任何残留的液体都可能流入外耳道。5 进行鼓膜切开术以获得细胞学、培养和抗生素敏感性的样本;它们还能立即缓解由中耳炎和内耳炎引起的压力升高而引起的疼痛。5


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘3c5224e4adf2729…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘3c5224e4adf2729…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘3c5224e4adf2729…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘3c5224e4adf2729…’)
#22 {main}” width=”1198″ height=”44″>

Sam was extubated and recovered with heat support. Lactated Ringer’s solution was restarted at 13 mL/hr. Cefazolin was given at 30 mg/kg IV q8h. Enrofloxacin (15 mg/kg IV), dexamethasone SP (0.15 mg/kg IV), and cefovecin (8.5 mg/kg SQ) were each given 1 time.

(停止麻醉)拔掉Sam的气管插管并保暖恢复。乳酸林格氏液以13mL/小时再次输注。头孢唑林(Cefazolin)给药 30 mg/kg IV q8h。恩诺沙星(Enrofloxacin)(15 mg/kg IV)、地塞米松磷酸钠(dexamethasone SP) (0.15 mg/kg IV)、头孢维星(cefovecin)(8.5 mg/kg SQ)各1次。



<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘65883e653364f75…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘65883e653364f75…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘65883e653364f75…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘65883e653364f75…’)
#22 {main}” width=”1198″ height=”44″>

Sam’s vital signs returned to within normal limits, and his demeanor during the night was unremarkable. After much of the fluid in the AO joint had been aspirated, along with steroid treatment, his condition greatly improved within the next few hours. This improvement was presumed to be because the AO joint was no longer as swollen and no longer compressing the brain stem, thereby relieving his symptoms.

Sam的生命体征恢复到正常范围内,它在夜间的举止也变得很平常了。在抽吸了寰枕关节内的大部分液体后,加上类固醇治疗,它的病情在接下来的几个小时内得到了极大的改善。这种改善被认为是因为寰枕关节不再肿胀,不再压迫脑干,从而造成了病患的症状的减轻。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘415e4650a5279a9…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘415e4650a5279a9…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘415e4650a5279a9…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘415e4650a5279a9…’)
#22 {main}” width=”1198″ height=”44″>

The cytology of the AO joint indicated that the aspirate was highly cellular, consisting of 97% neutrophils, 2% macrophages, and 1% small lymphocytes. No infectious organisms were seen and no growth occurred on culture, presumably the result of antibiotic treatment before hospitalization. The myringotomy aspirate was not sent out for culture because the treatment for the septic AO joint would also treat otitis media and interna.

寰枕关节的细胞学检查表明,抽吸液是富含细胞的,由97%的中性粒细胞、2%的巨噬细胞和1%的小淋巴细胞组成。未见感染性微生物,培养未出现生长,可能是住院前抗生素治疗的结果。由于化脓性寰枕关节的治疗同时也会治疗中耳炎和内耳炎,因此没有将鼓膜切开术的抽吸液送出进行培养。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ’72ae87756eb5889…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ’72ae87756eb5889…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ’72ae87756eb5889…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ’72ae87756eb5889…’)
#22 {main}” width=”1198″ height=”44″>

Treatment and Outcome 治疗和结果

By the day after surgery, Sam’s condition had improved markedly, and his medications were transitioned from intravenous to oral. He was given pradofloxacin (7.4 mg/kg PO q24h) and gabapentin (10.6 mg/kg PO q12h) to prevent nerve pain that may be associated with the infected AO joint.

手术后的第二天,Sam的病情明显好转,它的药物治疗也从静脉注射转为口服。给予普拉氟沙星(pradofloxacin)(7.4 mg/kg PO q24h)和加巴喷丁(gabapentin)(10.6 mg/kg PO q12h)预防可能与寰枕关节感染相关的神经疼痛。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d0e6f3d5b8782c3…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d0e6f3d5b8782c3…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d0e6f3d5b8782c3…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d0e6f3d5b8782c3…’)
#22 {main}” width=”1198″ height=”44″>

Physical examination revealed a small amount of dried blood in the left ear canal and some serous ocular discharge. Neurologically, the patient was ambulatory with marginal ataxia. The rest of the examination was unremarkable. Sam was discharged home the next day. The gabapentin was continued for 1 week, pradofloxacin for 1 month, and cefovecin for 2 months (an injection every 2 weeks).

体检发现左侧耳道有少量干血,眼角有浆液性分泌物。神经学方面,病患可走动,伴有边缘性共济失调。检查的其余方面无明显异常。Sam第二天出院回家了。加巴喷丁(gabapentin)治疗1周,普拉氟沙星(pradofloxacin)治疗1个月,头孢维星(cefovecin)治疗2个月(每2周注射一次)。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d4f9899e25e96e0…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d4f9899e25e96e0…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘d4f9899e25e96e0…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘d4f9899e25e96e0…’)
#22 {main}” width=”1198″ height=”44″>

At the 6-week recheck, the client reported that Sam was doing well, eating and drinking normally, and back to “his old self.” Physical and neurologic examinations revealed no abnormalities, and no recurrence has been reported.

6 周后复查,宠主报告说Sam一切正常,饮食正常,恢复了“本性”。体格和神经检查未见异常,无复发报道。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘9900a6eae20a981…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘9900a6eae20a981…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘9900a6eae20a981…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘9900a6eae20a981…’)
#22 {main}” width=”1198″ height=”44″>

Discussion 讨论

Otitis media and interna are somewhat common in cats. It is hypothesized that if left untreated, otitis externa can progress to otitis media and interna, damaging ear structures over time.5 The exact mechanism of otitis media is unknown, but it is theorized that an infection (such as a respiratory pathogen) ascends through the eustachian tube.5 It is also possible for an infection to build up in the external ear canal and rupture the eardrum, causing infection to travel from the external ear canal to the middle ear.5 If left untreated, otitis media and interna can lead to infection in nearby structures, including the brain.5 Only exceedingly rarely does otitis lead to an AO joint infection. Common clinical signs of otitis media and interna include head shaking, pain on palpation of the ear pinna or canal, and reluctance to open the mouth because of swelling within the bulla affecting the temporomandibular joint.5 Otitis media and interna can affect the sympathetic nerves that travel through the middle ear, such as the facial and trigeminal nerves. When they do, Horner’s syndrome, head tilt, or facial nerve palsy can result.5 Even after a thorough ear examination, otitis media and interna can be difficult to diagnose, especially if the eardrum is intact. A classic clinical sign is purulent mucoid exudate along the floor of the horizontal canal, but it is not necessarily diagnostic nor is radiographic assessment always conclusive.5 Otitis media and interna can be diagnosed with MRI or computed tomography.

中耳炎和中耳炎在猫身上比较常见。据推测,如果不及时治疗,外耳炎会发展为中耳炎和内耳炎,随着时间的推移会损害耳朵结构。5 中耳炎的确切机制尚不清楚,但理论上认为感染(如呼吸道病原体)通过咽鼓管逆行感染。也有可能在外耳道积聚,使鼓膜破裂,导致感染从外耳道传播到中耳。如果不及时治疗,中耳炎和内耳炎会导致附近结构的感染,包括大脑。中耳炎导致寰枕关节感染的情况极为罕见。中耳炎和内耳炎的常见临床症状包括摇头、耳廓或耳道触诊疼痛、因影响颞下颌关节的鼓泡内肿胀而不愿张开嘴巴。中耳炎和内耳炎可影响穿过中耳的交感神经,如面神经和三叉神经。当影响这些神经时时,就会导致霍纳综合症、头部倾斜或面神经麻痹。即使经过彻底的耳部检查,中耳炎和内耳炎也很难诊断,特别是如果鼓膜是完好无损的时候。一个典型的临床征象是沿水平耳道底有脓性粘液渗出,但这并不一定是诊断性的,影像学检查也不总是有结论性的。中耳炎和内耳炎可通过MRI或计算机断层扫描诊断。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘408ad84295b1b5b…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘408ad84295b1b5b…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘408ad84295b1b5b…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘408ad84295b1b5b…’)
#22 {main}” width=”1198″ height=”44″>

Sam’s infection most likely traveled from the middle ear to the AO joint via the vertebral artery, which runs anterior to the AO joint and enters the foramen magnum (FIGURE 6).5 However, other pathways could have been involved, including the carotid artery and jugular vein.4 Sam’s sympathetic nerves were not affected. His clinical signs were initially assumed to have resulted from a tooth abscess. It was not until Sam became tetraparetic that his diagnosis was investigated further. In retrospect, it was determined that his clinical signs were caused by the otitis. The brain stem compression also contributed to Sam’s clinical signs. This type of compression can lead to tetraparesis, generalized ataxia, abnormal postural reactions, weakness, dizziness, impaired vision, neck pain, weakness in the limbs, and proprioceptive deficits.6

Sam的感染极有可能通过椎动脉从中耳传播到寰枕关节,该椎动脉在寰枕关节前方并进入枕骨大孔(图6) 5。然而,其他途径也可能参与其中,包括颈动脉和颈静脉。Sam的交感神经没有受到影响。它的临床症状最初被认为是由牙齿脓肿引起的。直到Sam逐渐发展为四肢轻瘫,它的诊断才得到进一步的调查。经过回顾,确定它的临床症状是由中耳炎引起的。脑干压迫也导致了Sam的临床症状。这种类型的压迫可导致四肢轻瘫、全身性共济失调、异常姿势反应、虚弱 无力、头晕、视力受损、颈部疼痛、四肢无力和本体感觉缺陷。6


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘1cc013087b92aad…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘1cc013087b92aad…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘1cc013087b92aad…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘1cc013087b92aad…’)
#22 {main}” width=”1198″ height=”44″>

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘c8a30c2697ff637…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘c8a30c2697ff637…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘c8a30c2697ff637…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘c8a30c2697ff637…’)
#22 {main}” width=”1008″ height=”682″>
Figure 6. Potential route for infection travel from the middle ear to the atlanto-occipital joint via the vertebral artery. Illustration: Kip Carter

<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘23873c2e79d4c76…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘23873c2e79d4c76…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘23873c2e79d4c76…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘23873c2e79d4c76…’)
#22 {main}” width=”642″ height=”434″>
图6。潜在的感染途径,从中耳经椎动脉进入寰枕关节。插图:基普·卡特

Otitis media and interna can be hard to diagnose without access to advanced imaging such as MRI or computed tomography. Therefore, it is important to take even subtle clinical signs seriously. If an outgoing cat suddenly starts to hide in abnormal places, becomes head shy, or exhibits a darker shade of red on its ears, these signs should be cause for concern. Had Sam’s otitis externa been found and treated sooner, the infection might not have progressed. However, as with Sam, some cats do not show many clinical signs until otitis externa progresses.

中耳炎和内耳炎在没有MRI或计算机断层扫描等高阶成像技术的情况下很难诊断。因此,即使是细微的临床症状也要重视。如果一只外向的猫突然开始躲在不正常的地方,变得害羞,或者耳朵上出现更深的红色斑块,这些迹象应该引起关注。如果Sam的外耳炎能早点被发现并治疗,感染可能就不会恶化了。然而,和Sam一样,有些猫在外耳炎渐进性发展之前没有表现出很多临床症状。


<img data-src="
Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ba0c02282f33b72…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ba0c02282f33b72…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘ba0c02282f33b72…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘ba0c02282f33b72…’)
#22 {main}” width=”1210″ height=”42″>

参考文献 References

1. Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med. 2012;7 Suppl 3:S193–199. doi: 10.1007/s11739-012-0802-0

2. Jain NC. Essentials of veterinary hematology. 1993 Jan 1. archive.org/details/essentialsofvete0000jain/page/n11/mode/2up?view=theater. Accessed January 2021.

3. Medline Plus. Globulin test. 2020 July 31. medlineplus.gov/lab-tests/globulin-test. Accessed January 2021.

4. Dewey CW, da Costa RC, Ducoté JM. Chapter 5: Neurodiagnostics. In: Dewey CW, da Costa RC, eds. Practical Guide to Canine and Feline Neurology. Hoboken, NJ: Wiley-Blackwell; 2016:61–86.

5. Gotthelf LN. Diagnosis and treatment of otitis media in dogs and cats. Vet Clin North Am Small Anim Pract. 2004;34(2):469–487. doi:10.1016/j.cvsm.2003.10.007

6. Rubin M. Craniocervical junction disorders. Merck Manual. merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/craniocervical-junction-disorders/craniocervical-junction-disorders. Accessed December 2020.

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Warning: curl_setopt_array(): Unable to create temporary file. in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php on line 59
GuzzleHttp\Exception\RequestException: cURL error 0: The connection unexpectedly failed without providing an error. The request would have been retried, but attempting to rewind the request body failed. Exception: RuntimeException: Stream is not seekable in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php:204
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\psr7\src\Stream.php(193): GuzzleHttp\Psr7\Stream->seek(0)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(517): GuzzleHttp\Psr7\Stream->rewind()
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#18 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘4aa545dccf7de8d…’, Object(GuzzleHttp\Psr7\Stream))
#22 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘4aa545dccf7de8d…’)
#23 {main} (see https://curl.haxx.se/libcurl/c/libcurl-errors.html) in C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php:201
Stack trace:
#0 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(524): GuzzleHttp\Handler\CurlFactory::createRejection(Object(GuzzleHttp\Handler\EasyHandle), Array)
#1 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(152): GuzzleHttp\Handler\CurlFactory::retryFailedRewind(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Array)
#2 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlFactory.php(105): GuzzleHttp\Handler\CurlFactory::finishError(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#3 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(201): GuzzleHttp\Handler\CurlFactory::finish(Object(GuzzleHttp\Handler\CurlMultiHandler), Object(GuzzleHttp\Handler\EasyHandle), Object(GuzzleHttp\Handler\CurlFactory))
#4 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(130): GuzzleHttp\Handler\CurlMultiHandler->processMessages()
#5 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\guzzle\src\Handler\CurlMultiHandler.php(145): GuzzleHttp\Handler\CurlMultiHandler->tick()
#6 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Handler\CurlMultiHandler->execute(true)
#7 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#8 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(269): GuzzleHttp\Promise\Promise->waitIfPending()
#9 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(226): GuzzleHttp\Promise\Promise->invokeWaitList()
#10 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#11 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(67): GuzzleHttp\Promise\Promise->wait()
#12 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(248): GuzzleHttp\Promise\Coroutine->GuzzleHttp\Promise\{closure}(true)
#13 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(224): GuzzleHttp\Promise\Promise->invokeWaitFn()
#14 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Promise.php(62): GuzzleHttp\Promise\Promise->waitIfPending()
#15 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\promises\src\Coroutine.php(103): GuzzleHttp\Promise\Promise->wait(true)
#16 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(77): GuzzleHttp\Promise\Coroutine->wait()
#17 C:\wwwroot\upimg.chonwuleyuan.com\vendor\guzzlehttp\command\src\ServiceClient.php(153): GuzzleHttp\Command\ServiceClient->execute(Object(GuzzleHttp\Command\Command))
#18 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(269): GuzzleHttp\Command\ServiceClient->__call(‘PutObject’, Array)
#19 C:\wwwroot\upimg.chonwuleyuan.com\src\Client.php(321): Qcloud\Cos\Client->__call(‘putObject’, Array)
#20 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(36): Qcloud\Cos\Client->upload(‘chonwuleyuan-12…’, ‘4aa545dccf7de8d…’, Object(GuzzleHttp\Psr7\Stream))
#21 C:\wwwroot\upimg.chonwuleyuan.com\getcos.php(10): upload(‘http://i0.hdslb…’, ‘4aa545dccf7de8d…’)
#22 {main}” class=”cut-off-2″>

END

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