Volume 98  ·  Issue 27  ·  2018

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.

To evaluate the effect of patient education and tailored exercise in the knee osteoarthritis (OA) patients.

One hundred and eighty-five patients with knee OA were enrolled in this ongoing prospective cohort study at Arthritis Clinic and Research Center, Peking University People′s Hospital since May, 2016.The treatment consisted of two one-hour sessions of patient education and six weeks of supervised, in-group, tailored exercise.The contents of the patient education were evidence-based and its overall focus was to increase the knowledge of the participants regarding OA and how to treat it.The exercise program was a neuromuscular exercise based on biomechanical and neuromuscular principles that aimed at restoring a neutral functional alignment of the lower extremities by improving sensorimotor control and obtaining compensatory functional stability.The outcomes were evaluated at baseline, 3 and 6 months, which included pain on the visual analogue scale (VAS, 0-100), quality of life on the Euro-quality of life-5 Dimensional (EQ-5D) VAS form, Knee Injury and Osteoarthritis Outcome Score (KOOS), 30-second chair stand test, 40-meter walk test and use of analgesics.The participants were also asked to rate their opinion of this program on a five-point scale (very satisfactory, satisfactory, neither satisfactory nor dissatisfactory, dissatisfactory, very dissatisfactory). One way analysis of variance was applied to compare the outcomes at baseline and 3 and 6 months follow-up.

One hundred and forty-two participants completed the 6-month follow-up.There were significant improvements in pain VAS, EQ-5D-VAS, 30-second chair stand test and 40-meter walk test at the follow-up at 3 and 6 months when compared with those at baseline (F=22.9, 8.4, 3.4, 4.1, 3.8, all P<0.05). The rate of analgesics use in the past two week at baseline was 43.2%, and it decreased to 18.9% at 6-month follow-up (P<0.001). Most participants (71.1%, 101 out of 142) rated the program as 'Very Satisfactory’ and the rest (28.9%, 41 out of 142) rated the program as 'Satisfactory’.

This program comprising the group patient education and tailored exercise therapy is effective in relieving pain, improving the function and quality of life in patients with knee OA.

To compare the surgical time and postoperative coronal mechanical axis alignment in patients with osteoarthritis who were treated with three different total knee arthroplasty (TKA) techniques: computer-assisted navigation surgery (CAS), patient specific instrumentation(PSI) and traditional instrumentation.

A total of 96 patients with severe knee osteoarthritis who underwent unilateral primary TKA by the same surgeon were included in this retrospective study.The patients were divided into CAS-TKA group (34 patients), PSI-TKA group (29 patients) and control group (33 patients) based on surgical techniques used in the operations.The surgical time and postoperative coronal mechanical axis alignment were compared between the three groups.One-way ANOVA was used to detect the differences between three groups, and LSD test was used for the post-hoc test.

The overall mean surgical time of the patients was (79±16) min.CAS-TKA group had significantly longer surgical time when compared with those in the other two groups [CAS-TKA vs PSI-TKA: (90±10) min vs (80±14) min, LSD-t=3.458, P<0.05; CAS-TKA vs control: (90±10) min vs (66±11) min, LSD-t=8.350, P<0.05; PSI-TKA vs control: (80±14) min vs (66±11) min, LSD-t=4.582, P<0.05]. The overall mean postoperative coronal mechanical alignment varus/valgus deformity was 2.4° and 2.0°, respectively.The overall outliers (varus/valgus>3°) represented 22.9% of cases and were distributed as followed: 11.8% in CAS-TKA group, 27.6% in PSI-TKA group, 30.3% in control group; and no significant differences was found among the three groups (χ²=3.771, P=0.151).

The use of CAS or PSI in TKA costs a significant longer surgical time.These two techniques results in acceptable postoperative coronal alignment and both demonstrated a potential benefit in reducing outliers when compared with the traditional instruments.

To investigate the association between high-sensitivity C-reactive protein (hs-CRP) and long-term outcomes in Chinese patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after drug-eluting stent (DES) implantation.

A total of 4 815 consecutive NSTE-ACS patients who treated with DESs were included.Patients were divided into three groups: <1.00 mg/L, 1.00 to 2.99 mg/L and ≥3.00 mg/L, based on the level of hs-CRP on admission.Major adverse cardiovascular and cerebrovascular events (MACCE, including all-cause death, myocardial infarction, revascularization, in-stent thrombosis and stroke) were compared among groups during 2-year follow-up.

Patients with higher hs-CRP had more risk factors of cardiovascular events such as concomitant morbidities and multi-vessel lesions(68.5% vs 73.6% vs 76.2%, P<0.001). Higher hs-CRP value was associated with increased rates of MACCE (8.8% vs 11.2% vs 12.6%,P=0.003) and revascularization (6.5% vs 8.5% vs 9.8%, P=0.003). However, the rates of all-cause death, myocardial infarction, stroke, and stent thrombosis were comparable among groups(all P>0.05). Ongoing divergences in MACCE and revascularization among three groups were significant on Kaplan-Meier curves (both Log-rankP=0.003). Multivariable Cox regression analysis indicated that compared to hs-CRP<1.00 mg/L group, MACCE in the >3.00 mg/L group was increased by 42% [HR 1.42 (1.13-1.78), P=0.002]. Meanwhile, multivessel leisions, ejection fraction<50%, elevated white blood cell counts were also independent risk factors.CRP≥3.00 mg/L(HR 1.56, 95%CI 1.16-2.08, P=0.003, compared to <1.00 mg/L) and multivessel leisions were independent predictors of revascularization.

(1)Patients with higher hs-CRP on admission have more risk factors of cardiovascular events.(2)Higher hs-CRP value is associated with increased rates of MACCE and revascularization.(3)Pre-procedural hs-CRP is an independent predictor of 2-year outcomes for Chinese NSTE-ACS patients treated with DESs.

To investigate the effects ofepicardial adipose tissue volume (EATV) and inflammatory factors on left ventricular diastolic function in patients with coronary heart disease(CHD).

The clinical data of patients with coronary heart disease receiving coronary artery intervention therapy from January 2014 to October 2015 in TEDA international cardiovascular hospital were preoperatively collected.We measured the indexes of EATV and left ventricular diastolic function.

The difference of age (F=7.76, P=0.01), IL-6 (F=14.34, P<0.01), Hs-CRP (F=4.08, P=0.04), adiponect-in (F=4.50, P=0.04) and EATV (F=71.29, P<0.01) between the diastolicdysfunction group (n=156) and the normal group (n=76) was statistically significant.Multivariate logistic regression analysis showed that EATV was a risk factor for left ventricular diastolic dysfunction in patients with coronary artery disease (P<0.05),OR=1.05, 95%CI (1.03-1.06). The AUC value of EATV in the diagnosis of left ventriculardiastolic function in patients with coronary heart disease was 0.79, 95%CI (0.73-0.85) P<0.01.

EATV can be used as an independent risk factor for left ventricular diastolic dysfunction.It has some non-invasive diagnosis and predictive value, and it can be used as a new therapeutic target.

To investigate the association between serum lipid level and depression in patients with chronic heart failure (CHF).

A total of 348 patients with CHF from the First department of Cardiology of the people′s hospital of Shaanxi province from September 2016 to June 2017 were included.The Hamilton Depression Scale (HAMD) was used to evaluate the degree of depression and some related clinical data were tested.The serum lipid level and depression scores in the patients were analyzed using Pearson correlation analysis, and Logistic regression analysis was used to analyze the confounding factors of depression.

There was significant difference in the proportion of depression between normal serum lipid group and dyslipidemia group (P=0.044). Pearson correlation analysis showed that depression score was linearly related to total cholesterol (r=0.326, P<0.001) and low density lipoprotein cholesterol (r=0.354, P<0.001), and Logistic regression analysis showed that after adjusting for age, BMI, triglyceride, low density lipoprotein cholesterol, creatinine, total bilirubin, albumin, B type natriuretic peptide, total cholesterol (OR=3.523, P=0.007) and high density lipoprotein cholesterol (OR=0.205, P=0.041) were associated with depression in CHF patients.

Total cholesterol can increase the risk of depression, and high density lipoprotein cholesterol can reduce the risk of depression in CHF patients.

To analyze the clinical characteristics, clinical effect and follow-up outcome of the different endovascular treatment techniques in the treatment of unruptured vertebrobasilar dissecting aneurysms (VBDAs).

The clinical data of 160 consecutive patients (175VBDAs) from January 2012 to December 2016 in Beijing Tiantan hospital were retrospectively analyzed.All of the 175 aneurysms were treated with endovascular embolization, including 115 stent-assisted coils, 27 simple stents, 21 blood flow diverting devices, and 12 parent arteries occlusion.The imaging and clinical follow-up were performed after the operation.

Headache including cervical-occipital pain(43.1%)was the most common clinical manifestation.The incidence of perioperative complications was 3.75%, no intraoperative bleeding and no deaths.The imaging findings of 113 aneurysms were followed up for (9.9±7.3) months.Of the 71 stent-assisted coils, 62 recovered well and 9 relapsed; of the 19 aneurysms treated with simple stent, 4 recovered well, 11 improved, 2 stable and 2 relapsed; of the 15 aneurysms treated by the blood flow diverting devices, 4 recovered and 11 improved; all of the 8 aneurysms with parent arteries occlusion recovered well.A total of 144 patients were follow-up (17.3±16.6) months by the Modified Rankin Scale(mRS) score: 140 patients were 0-2 score and 4 patients were 3-6 score.

The clinical manifestations of the unruptured VBDAs are complex, and the headache is the most common clinical symptom.Endovascular treatment for the treatment of unruptured VBDAs is safe and feasible.The principle of individualization should be followed during embolization.

To summarize the safety and efficacy of Pipeline embolization device in the treatment of large and giant intracranial aneurysms (maximum diameter ≥ 10 mm).

The clinical and imaging data of 22 patients with intracranial aneurysms treated by Pipeline Embolization Device (PED) from February 2015 to July 2016 in the Zhengzhou University People′s Hospital were retrospectively analyzed. The results about postoperative clinical and imaging follow-up and complications were evaluated.

The PED were successfully implanted in 22 patients with 22 intracranial aneurysms. Two aneurysms were treated with PED alone, and 20 aneurysms were treated with PED assisted coil embolization. Perioperative complications occurred in 3 patients (13.6%), and 1 patient died because aneurysm ruptured 3 days after operation. Nineteen patients (19 aneurysms) obtain imaging follow-up visit 3-17 months after operation, 13 of the 19 aneurysms (68.4%) received complete and subtotal occlusion, with no aneurysm recurrence. Eighteen patients obtain clinical follow-up visit 16-32 months after operation, with mRS (modified Rankin scale) score 1 in 5 patients, mRS score 0 in 13 patients, none developed new neurologic symptoms.

PED has showed the high rate of obliteration for the treatment of large and giant intracranial aneurysms. But the complications needs to be further studied.

To evaluate the correlation of CT small airway measurement with clinical and inflammatory factors in asthma patients.

From November 2014 to December 2015, a total of 20 patients with asthma were recruited in outpatient department of Peking University Third Hospital. All underwent asthma control test (ACT), CT and pulmonary function test. Serum leptin, immunoglobulin E(IgE) and transforming growth factor-β1(TGF-β1), induced sputum eosinophil percentage(Eos%) and matrix metalloproteinase(MMP-9) results were collected.Using GE airway analysis software and adjusted by body surface area, luminal diameter(LD_adjusted), luminal area(Ai_adjusted), wall thickness(WT_adjusted) and wall area%(WA%)at the end of 6th generation airway were recorded.

In asthma patients with smoking history, both LD_adjusted and Ai_adjusted were significantly lower than patients without smoking history(LD_adjutsed (1.19±0.14)vs(1.34±0.11) mm, Ai_adjusted (1.13±0.32) vs (1.43±0.24) mm^2,t=-2.459, -2.267, all P<0.05); in asthma patients with induced sputum Eos%≥3%, both LD_adjusted and Ai_adjusted were significantly lower but WA% significantly higher than patients with induced sputum Eos%<3% (LD_adjutsed (1.26±0.05) vs (1.44±0.09) mm, Ai_adjusted(1.27±0.11) vs (1.66±0.17) mm^2, WA%(83.96%±1.26%) vs (81.20%±2.26%), t=-3.935, -4.492, 2.448, all P<0.05). LD_adjutsed and Ai_adjusted had negative correlation with course of disease and induced sputum Eos%(LD_adjutsedr=-0.512, -0.841, Ai_adjustedr=-0.489, -0.841, all P<0.05), and positive correlation with FEV₁/FVC and serum leptin(LD_adjutsedr=0.669, 0.533, Ai_adjustedr=0.681, 0.552, all P<0.05). Ai_adjusted also showed positive correlation with FEV₁%(r=0.452, P<0.05). WT_adjusted and WA% were significantly negative correlated with FEV₁/FVC and FEV₁%(WT_adjustedr=-0.621, -0.483, WA% r=-0.729, -0.548, all P<0.05). WA% also showed positive correlation with serum IgE and induced sputum MMP-9(r=0.509, 0.636, all P<0.05). CT airway indexes showed no significantly correlation with age, ACT scores and serum TGF-β1.

CT airway indexes are found partially associated with course of disease, smoking history, serum leptin and IgE, induced sputum Eos% and MMP-9. CT airway indexes show correlation with FEV₁/FVC and FEV₁%.

To investigate the therapeutic efficacy and safety of CT-guided radiofrequency ablation(RFA)combined with biopsy synchronously to multiple small nodules of metastatic tumors in lung.

From January 2016 to December 2016, a total of 86 patients in the General Hospital of People′s Liberation Army with 144 lesions were divide into two groups(all the lesions were less than 1 cm). Group A with 51 cases located in the lung periphery underwent biopsy prior to RFA.Group B with 35 cases located in the middle and inner side of lung adjacent to the vasculatures contrarily underwent RFA first.The changes of these lesions during the 1 to 12-month were followed up.

All the procedures were completed successfully.The intra operative CT scanning showed the ablation zones were completely covered by the indicative "halo sign" respectively.The P value was 0.818, 0.155 and 0.452 respectively, in the number of nodules, pathological results positive rate and complications in the rank and inspection for A, B two groups, which were all higher than 0.05.Though different strategies according to different location of the nodes, the two groups can achieve safe and effective treatments.All patients in two groups had high density ablation zones on their 1-month post operative CT without enhancement.3-and 6-post operative CT illustrated a decrease of lesions, 12-month post operative CT showed the lesions turned to fibrous stripes.

The CT-guided RFA combined with biopsy synchronously to multiple small nodules of metastatic tumors in lung is safe and effective, for the lesions located in the middle or inner side of lung, RFA prior to the biopsy can avoid the massive hemoptysis.

To investigate the reproductive outcomes after the previous cesarean scar pregnancy (CSP).

The clinical data of 138 patients with CSP in Tianjin Medical University General Hospital from January 2011 to March 2016 were collected and analyzed.Fifty-four cases underwent uterine artery embolization+ dilation & curettage (UAE+ D&C) surgery, 41 cases underwent D&C surgery, and 43 cases underwent laparoscopic surgery.Reproductive outcomes were followed up and analyzed.

All women were followed up for (46±17) months.It was encouraging that 37 women got 42 spontaneous pregnancies among 50 women with fertility plan, and the subsequent spontaneous pregnancy rate was 74.0%(37/50). Unfortunately, 6 women experienced recurrence of CSP (RCSP) in the subsequent pregnancies, and the RCSP rate was 14.3%(6/42). There were no significant differences with regard to spontaneous pregnancy rate and RCSP rate among the 3 groups (P>0.05). Nineteen women had led to a live delivery indeed without the presence of placenta previa, placenta accrete, uterine rupture and postpartum hemorrhage in the perinatal period.

The reproductive outcomes following the previous CSP include the intrauterine pregnancy, spontaneous abortion and RCSP.The individualized treatments on CSP had no significant differences to the subsequent spontaneous pregnancy rate which was favorable in the future fertility plan.The incidence of RCSP was not significantly reduced by laparoscopic uterine scar repair.The risk of RCSP appeared to be increased in the subsequent pregnancies, and early diagnosis and treatment were needed to exclude the abnormal CSP.The overall perinatal outcomes were favorable.

To investigate the impact of TGF-β3 on the chondrogenesis of bone marrow mesenchymal stem cells (BM-MSCs) under hypoxia environment.

BM-MSCs were obtained from SD rat tibias and femora and cultured with whole bone marrow adherent method. Cell surface antigens were analyzed by flow cytometry and the multiple-directional differentiation capabilities were detected with special differentiation agents to affirm the reality of BM-MSCs. Under normoxia or hypoxia condition, BM-MSCs were induced with TGF-β3 or not. Then, alcian blue and immunofluorescence staining were performed to evaluate the expression level of aggrecan, collagen Ⅱ. qRT-PCR analysis were performed to analyze the expression of aggrecan, collagen Ⅱ and collagen Ⅹ. qRT-PCR and Western blot analysis was performed to detect the mRNA and protein level of HIF-1α, collagenⅡ and β-catenin.

BM-MSCs were fibroblast-like shape and had ablities of osteogeic, adipogenic and chondrogenic differentiation, with the expression of CD_29,CD₄₄ and CD₉₀ but not CD₄₅. Alcian blue and immunofluorescence staining showed that BM-MSCs strongly expressed the aggrecan and collagen Ⅱ with the presence of TGF-β3 under hypoxia condition. qRT-PCR analysis showed the mRNA expression levels of collagen Ⅱ, aggrecan and collagen Ⅹ were up-regulated at 2.46, 2.20 and 1.80 folds, comparing with control group (allP<0.05). Western blot analysis showed that the protein levels of HIF-1α, collagenⅡ in BM-MSCs were up-regulated with the presence of TGF-β3 under hypoxia condition, but β-catenin level was down-regulated.

TGF-β3 promotes the chondrogenic differentiation ability of BM-MSCs under hypoxia condition, which may be relative with the inhibition of Wnt/β-catenin signaling pathway.

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.