2018年·第98卷第27期

The overall prevalence of knee osteoarthritis (KOA) in the population was about 3.8%, higher in women than in men (4.8% vs. 2.8%), and the prevalence was positively correlated with age increasing, reaching a peak at 50 years old^[1]。 The prevalence of KOA in people over 50 years old is 25% ~80%^[2,3]。 Knee and hip osteoarthritis ranks 11th among the causes of disability in the world, and the years of loss of health life and disability-adjusted life years caused by disability are increasing year by year, most of which are caused by KOA. KOA imposes great suffering and heavy medical burden on patients and families. Symptomatic KOA is necessary for surgical treatment. At present, the commonly used surgical protocols can be divided into knee-preserving surgery [high tibial osteotomy (HTO), proximal fibular osteotomy, proximal tibiofibular osteotomy combined with absorbable spacer implantation, distal femoral osteotomy (DFO), etc.] and knee replacement surgery [unicondylar knee replacement (UKA) and total knee replacement (TKA)].

The so-called precision medicine refers to the application of modern genetics, molecular imaging and bioinformation technology, combined with patients' living environment and clinical data, to achieve accurate disease classification and diagnosis, and to formulate personalized disease prevention and diagnosis and treatment plans, including accurate prediction of disease risk, accurate diagnosis and classification of diseases, accurate application of drugs, accurate evaluation of curative effect, and accurate prediction of prognosis. With the precision medicine plan entering China's 13th Five-Year Plan major scientific research project, the experts of the project team have reached some consensus on the early foundation of China's current precision medicine, including biological therapy and personalized diagnosis and treatment technology becoming an important direction of modern medicine, medical devices becoming a new industry that goes hand in hand with drugs, and big data and bioinformatics play an important role in the development of biomedicine. In this context, China's joint surgery has also put forward the concept of precise development.

osteoarthritis (OA) is the most common joint disease. The United Nations and the World Health Organization named the period from 2000 to 2010 "Bone and Joint Decade" to increase academic and public attention to OA. As a surgeon in the front line of clinical practice, although relieving patients' pain through surgery can bring a sense of achievement and professional happiness, after all, only a minority of patients need surgical treatment, and most patients can get their disease control through conservative treatment. In other words, in the face of a large number of OA patients, only one "scalpel" is far from enough.

In the past few decades, total knee arthroplasty (TKA) has achieved great success, which has also prompted scholars to discuss the surgical technique and prosthesis design concept of TKA. Undoubtedly, the designs of posterior cruciate ligament (PCL) preserving (CR) and posterior stable (PS) prostheses have been the focus of debate. We have been carrying out CR-TKA surgery since 2000 and have accumulated some experience in CR-TKA surgery and have our own insights. This paper discusses the application of CR-TKA.

The prevalence of Alzheimer's disease (AD) is increasing year over year, and the prevalence of AD is expected to increase by approximately 50% by 2050. The main clinical manifestations are cognitive dysfunction, memory impairment, language impairment and personality change^[1]。 Because the onset of AD is relatively hidden, it is difficult to diagnose it early. At present, it mainly relies on the detection of clinical symptoms and neuropsychological scales of patients to diagnose it, which has certain subjectivity and limitations. Although cerebrospinal fluid examination is helpful for early diagnosis of AD, it has shortcomings such as difficulty in sampling and high detection cost, so it can't be used in clinic on a large scale. Therefore, finding an objective, accurate and simple diagnostic method for AD is a hot topic in AD research. Recent experimental studies have found that inflammatory oxidation reaction is closely related to the occurrence and development of AD. high-mobility group box 1 (HMGB1) as an inflammatory factor is involved in the occurrence of AD and plays an important role in the evolution of AD disease^[2,3]。 This study investigated the correlation between serum HMGB1 and AD in order to find a new and convenient biomarker for early diagnosis of AD.

The 15-year-old male came to the Third Affiliated Hospital of Sun Yat-sen University in January 2017. More than 4 years ago, the patient developed episodic numbness and inflexibility of the right limb without obvious trigger, and could barely hold the object, which lasted for about 40 minutes and then relieved by itself. After relief, it is accompanied by headache, nausea, and occasionally vomiting a small amount of stomach content, which lasts for several minutes to tens of minutes before relief. Since then, numbness and inflexibility of the right limb have occurred repeatedly 3 to 4 times a year, which are easily induced when tired and nervous. In the past, when the patient was 3 years old, he went to the local hospital due to "abnormal skin on the left forehead". After skin biopsy, he was diagnosed with scleroderma. He was treated with "hormone" for about half a year, and so far the skin lesions on the left forehead have not enlarged. There is no special personal history and family history.

A 51-year-old male was admitted to Jiaxing No.2 Hospital on March 28, 2017 due to "cough and expectoration for half a month, accompanied by chest tightness and shortness of breath for 3 days". He had a history of "rectal cancer" in the past, underwent "radical rectal cancer surgery", reported that he had been cured, had a history of "tachycardia" in the past, did not take drug treatment, and denied a history of "hypertension, heart failure, and coronary heart disease". History of hereditary heart disease denied. Physical examination at admission: body temperature 36.2℃, pulse 110 beats/min, breathing 18 beats/min, blood pressure 152/96 mmHg (1 mmHg =0.133 kPa), clear mind, soft spirit, bilateral pupils of equal size and round, 3 mm in diameter, sensitive to light reflection, soft strength, pharyngeal congestion, tonsil I ° enlargement, bilateral breathing sound coarse, no rales, harmonic heart rhythm, heart rate: 110 beats/min, no pathological murmur, soft abdomen, no tenderness, no rebound pain, and no edema in both lower limbs. Auxiliary examination: Chest CT showed scattered inflammation in both lungs and a small amount of pleural effusion on both sides. Preliminary diagnosis: pulmonary infection, pleural effusion, lymphoma, postoperative rectal cancer. After admission, he was treated with anti-infection and phlegm resolution. Echocardiography after admission showed (Figure 1，Figure 2): (1) Left atrial enlargement (61 mm ×42 mm), diffuse reduction of interventricular septal and left ventricular wall movement; (2) The myocardium at the left ventricular apex was slightly thinner, the trabeculae were thickened, the gap was deepened, and the ratio of non-dense myocardial layer to dense myocardial layer at the end of systole was>2; (3) Mild to moderate aortic valve regurgitation and severe mitral valve regurgitation (regurgitation area 10.3 cm²), mild tricuspid regurgitation; (4) Systolic pulmonary artery pressure 40 mmHg, right atrial probe and anechoic area 4 mm, posterior pericardial probe and anechoic area 5 mm, LVEF 42%, considering myocardial insufficiency. Chest CT showed slight inflammation in the lower lobes of both lungs, increased bilateral pleural effusion, enlarged heart shadow, and thickened pericardium. ECG shows: (1) Sinus rhythm-tachycardia (heart rate 124 beats/min), (2) ECG axis left deviation-34° (please consider clinical). Type B natriuretic peptide: 658.94 pg/ml. This patient's supplementary diagnosis: myocardial insufficiency, heart failure. The patient was treated with furosemide injection, spironolactone diuresis, and metoprolol tartrate to slow down heart rate. The chest tightness and shortness of breath improved. The reexamination of B-type natriuretic peptide was 218.67 pg/ml, and the patient was followed up regularly after discharge.

The pathogenesis of systemic lupus erythematosus (SLE) is currently unknown. In a narrow sense, it may be attributed to the dysfunction of T, B lymphocytes, dendritic cells, macrophages and neutrophils caused by genetic or environmental factors^[1]。 Broadly speaking, the pathogenesis of SLE is related to molecular mimicry, modification and abnormal exposure of endogenous antigens, and expression of SLE autoantibodies, which lead to the formation of pathogenic immune complexes and cause tissue damage^[2]。 Recent studies have found that oxidative stress interacts with the immune system and may be a prevalent pathological condition in SLE^[3]。 Then, how oxidative stress is involved in the development of SLE is not clear. Therefore, the research status and progress of oxidative stress in the pathogenesis of SLE will be reviewed as follows, in order to find new targets for the diagnosis and treatment of SLE.