Objective   To compare the treatment outcome in patients with acute proximal deep vein thrombosis（DVT）between the two groups，whether pharmacomechanical thrombectomy（PMT）is suitable for patients with trauma for its’ safety and efficacy.Method  45 patients underwent AngioJet rheolytic thrombectomy with/without conjunctive stent implantation or catheterdirected thrombolysis（CDT）and staged stenting were divided into the control group and trauma group.Comparing the complications between two groups，and the risk of postthrombotic syndrome（PTS）was evaluated according to the Villalta scale.A venogram was performed to assess patency follow to 1 year.Results  The CDT time of the control group[（2.23±0.60）d] was noted longer compared with that [（1.60±0.52）d] in the trauma group（P<0.05）.There was no difference of postoperative complication between the two groups（P>0.05），but 2 patients had new PE in the control group after procedure.Comparing the both group with immediate（24 hour）clinical improvement（70.83% vs 76.19%），preoperative VRI scores [（12.71±1.73）vs（12.52±1.33）]，postoperative VRI scores[（2.71±2.29）vs（3.14±1.56）]，Villalta score at one year[（2.39±1.31）vs（2.90±1.55）]，and the primary patency rate at 1 year （83.33% vs 95.24%） reveal no statistical differences（P>0.05）.Conclusion  PMT maybe a safe and efficient treatment for the DVT patients with trauma as contraindication of CDT.

Objective To investigate the clinical effect of high ligation of great saphenous vein combined with endovenous laser closure and foam sclerotherapy in the treatment of chronic varicose veins of lower extremities.Methods  80 patients with varicose veins of lower extremities in our department were selected and divided into two groups（40 cases）according to different surgical methods.Among them，the study group was treated with high saphenous vein ligation plus foam sclerotherapy plus endovenous laser closure，and the control group（treated by high saphenous vein ligation plus endovenous laser closure）.The clinical effects of the 2 groups were compared.Results  The operation time，intraoperative bleeding volume，incision number，hospitalization time，〖JP2〗visual analogue score，hospitalization expenses and complications in the study group were （57.8±13.3）min，（9.6±2.5）ml，（3.6±1.2），（4.2±1.2）d，（6.4±1.4），（6820.4±610.4）yuan，5.0%，respectively.They were significantly less than those in the control group which were （44.5±14.5）min，（15.3±4.2） ml，（7.9±2.0），（6.4±2.1） d，（8.2±1.6），（7381.2±731.6）yuan，20.0%，respectively.After treatment，FIB，tPA，PAI1，PAI1，PAI1，IL10，IL10，IL10 and IL2 of study group were （3.0±0.2）g/L，（24.2±3.1）ng/L，（35.9±4.2）ng/L，（157.2±23.3）pg/ml and（125.3±15.2）pg/ml，respectively.Which were better than control group[（3.4±0.3）g/L，（20.5±3.0）ng/L，（42.4±3.6）ng/L，（131.5±17.0）pg/ml，（142.8±17.0）pg/ml）]，there were significantly improved（P<0.05）.Multivariate logistic regression analysis showed that the risk factors associated with recurrence after operation included saphenous vein diameter >1cm，left iliac vein pressure，elastic socks wearing time <3months，varicose vein diameter >2cm，venous mass treatment >2 times 〖LM〗and location.Closed small saphenous vein.Conclusion Foam sclerotherapy combined with EVLT is effective in the treatment of varicose veins of lower extremities，and can improve coagulation function and reduce inflammatory reaction.

Objective    To investigate and analysis the treatment of Guide wirecapture technique in the endovascular stent repair for Stanford B aortic dissection.Method  67 consecutive patients with complex Stanford B aortic dissection.Our patients cohort were divided into those applied with retrograde technique endovascular stent repair(group A,n=57) and anterograde Guide wirecapture technique(group B,n=10).Compared the general characteristics,true and false lumen diameter,Xray exposure time,total surgical time and analysis the correlation between intimal rupture number and Xray exposure time.Result  There was no significant difference in success rate between group A and B(85.1% vs 100.0%,P>0.05).The intimal rupture number(Group A:1.9±0.8,Group B:3.4±0.8,P<0.05）,tissue or organ poor perfusion case of group B(60.0%) was higher than that of group A(15.8%,P<0.05).The false lumen diameter of group B[（29.6±9.1）mm] was wider than that of group A[（21.7±7.4）mm,P<0.05)].3 patients of group A suffer from the left upper limb poor perfusion syndrome and conducted with rightleft axillary artery bypass.1 patient of group B suffered reversely tore after operation and progressed to A type aortic dissection,then conducted with Sun’ surgery and been completely reversed.The operation time and Xray exposure time of group B[（174.2±26.2）min and（522.9±67.4）s] was longer than that of groupA[（147.8±22.6）min and（267.1±29.1）s,P<0.05)].We conclude that the Xray exposure time may positively correlated with the intimal rupture number(R2=0.47,95%CI： 0.1051～0.9197,P<0.05).In most cases,followup was maintained and no obvious leakage occurred. Conclusion  We concluded that the increased intimal rupture number may increase the degree of surgical difficulty and the Xray exposure time.Guide wirecapture technique in the endovascular stent repair for complicated Stanford B aortic dissection  may be a safe  and reliable manner.

  Objective     To analyse the clinical efficacy of ProUK and catheterdirected thrombolysis for acute lower extremity arterial thrombosis.Methods sixtyfive patients with acute lower extremity arterial thrombosis were selected in our department.35 cases were enrolled with catheterdirected thrombolysis（ProUK group），and the remaining 30 were treated with urokinase（control group）.Observe the change before and after thrombolysis.Among the ProUK group，there were 22 cases as experimental group，and compared with 30 cases of urokinase control group，the arterial patency and adverse reactions after thrombolysis were evaluated.Results  Among the 35 patients in the ProUK group，thirtythree cases were effective，two were ineffective and the effective rate was 94.3%.Among the 30 patients in the control group，twentyone cases were effective，nine were ineffective and the effective rate was 70%.Postoperative ABI was increased in most patients（P<0.05）.Compared with the control group，the recanalization rate was higher in the experimental group and the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of adverse reactions between the two groups（P＞0.05）.All patients were followed up had different degrees of improvement in symptoms.Conclusion  The efficacy of ProUK and catheterdirected thrombolysis for acute lower extremity arterial thrombosis is superior to that of urokinase.

Objective   To summarize the clinical efficacy of endovascular treatment for vertebral dissecting aneurysms and explore the treatment strategies for different aneurysms.Methods  The clinical data and treatment effect of 10 patients with vertebral dissecting aneurysms were retrospectively analyzed.  Results    The 10 patients were vertebral dissecting aneurysms，including 9 cases with hemorrhage and 1 case without rupture.All aneurysms were successfully treated by endovascular method：6 cases were treated by single stentassisted coiling embolization in vertebral artery，3 cases were treated by double stentassisted coiling embolization in Vertebral artery and posterior inferior cerebellar artery，and 1 case was treated with covered stent implantation.Postoperatively 1 patient died due to delayed cerebral hemorrhage and subdural hematoma，Cerebral infarction occurred in 1 patient.  Conclusion    Satisfactory therapeutic effect can be achieved by fully analyzing the imaging characteristics of each aneurysm and adopting individualized endovascular treatment. 

  Objective     The purpose of this study was to examine the effect of clinical pathway of rehabilitation on perioperative VTE in older patients with THA of hip fractures.   Methods  139 older patients with THA of hip fractures were randomly divided into the conventional therapy group and the rehabilitation clinical pathway group.Conventional therapy group（n=75）receive conventional exercise therapy to preventing thrombosis.Rehabilitation clinical pathway group（n=64）receive motility rehabilitation therapy on admission.Ddimer level and whole blood viscosity were compared when the treatment is over.Moreover，the risks of bleeding and the morbidity of deep vein thrombosis（DVT）and pulmonary embolism（PE）after surgery were evaluated.  Results  Compared with conventional therapy group[（326.11±93.05）μg/L and（4.42±0.65）mPa〖DK〗·s]，Ddimer level[（300.25±90.28）μg/L] and whole blood viscosity[（3.33±0.45）mPa〖DK〗·s] in rehabilitation clinical pathway group were significantly decreased（P＜0.05）.The incidence of DVT within one month after surgery in the clinical pathway of rehabilitation group was significantly lower（10.9%）than in the conventional group（25.3%）（P＜0.05）.There was no significant difference in PE incidence between the two groups（P＞0.05）.  Conclusion  Clinical pathway of rehabilitation combined with anticoagulant drugs can significantly reduce the risk of VTE with in 1 month after the THA of hip fractures in highrisk population over 65 years of age.

Objective    To analyze outcomes and effect of endoscopic endonasal transsphenoidal surgery for 52 patients with prolactinsecrecting pituitary adenoma. Methods  52 patients treated with endoscopic transsphenoidal surgery were collected and postoperative efficacy and related influencing factors were analyzed.Results The clinical symptoms and levels of prolactin were significantly improved in the 52 patients after operation.The total removal rate of 52 patients was 61.5%（32），and compared with the giant adenomas（35.7%），the total removal rate of microadenomas （100%）and large adenomas（68.6%） was significantly higher（P<0.05）.The total resection rate between invasive（29.2%） and noninvasive prolactin adenomas（89.3%） was significantly different（P<0.05）.The total remission rate of 52 patients was 65.4%（34），and there was no significant difference in the remission rate（76.9%，62.5%，40.0%） of preoperative prolactin levels groups（P>0.05）.There was no significant difference in the postoperative remission rate among patients of different ethnic groups（P>0.05）.Taking bromocriptine before surgery had no significant effect on the surgical outcome，the difference was not statistically significant（P>0.05）.There were no complications such as cerebrospinal fluid rhinorrhea，visual field defects，or decreased visual acuity after surgery.No patient died.Conclusion  The tumor size and invasiveness were important factors for influencing the surgery effect.Taking bromocriptine before surgery had little effect on the surgical outcome.There was no significant difference for postoperative efficacy in different ethnic group，and the total cut rate and the decrease degree of postoperative PRL are closely related with the recurrence of tumor.

  Objective    To investigate the expression of FOXM1 and Ecadherin in breast cancer tissues and their relationship with clinicopathological parameters.Methods  The expression of FOXM1 and Ecadherin in breast cancer and surrounding normal tissues were detected by immunohistochemical method（IHC）.Then we analyzed the data with the SPSS statistical software.Results  The positive rate of FOXM1 protein was 48.5%（33/68）in 68 cases of invasive ductal carcinoma of breast，and the positive rate of Ecadherin protein was 41.2%（28/68）.The expression of FOXM1 protein in tumor tissues was higher than that in normal breast tissues.The expression of FOXM1 and Ecadherin was unrelated with age，location，histological grading and molecular typing.The expression rate of FOXM1 in axillary lymph node metastasis group was higher than that in nonlymph node metastasis group（P<0.05），and correlated with tumor size tumor TNM staging and estrogen receptor status（P<0.05）.The expression of Ecadherin protein was also correlated with lymph node metastasis and tumor TNM staging（P<0.05）.The expression of FOXM1 and Ecadherin protein was negatively correlated（r=-0.324，P<0.05）. Conclusion  FOXM1 and Ecadherin are important biomarkers of breast cancer.

Objective   To explore the clinical significant on protection of parathyroid and recurrent laryngeal nerve（RLN）by meticulous capsular dissection in thyroid lobectomy.Methods  Clinical date of 211 patients who underwent thyroid lobectomy by meticulous capsular dissection were retrospectively analyzed.  Results  All of the 211cases underwent thyroid lobectomy successfully without death,and the operative time was 85 min.The pathological results showed that there were thyroid papillary carcinoma in 48 cases,thyroid medullary carcinoma in one case,thyroid adenoma in 21 cases and nodular goiter in 141cases.After operation,12 cases suffered transient hypocalcemia whose symptom disappeared witnin one week to one month after therapy;3 cases suffered hoarseness whose symptom disappeared after one month,there was no case suffering permanent hypocalcemia and laryngeal nerve injury.There was no recurrence happened during the followed up period.No recurrence was found during the followup period. Conclusion  Meticulous capsular dissection can effectively protect function of parathyroid and reduce or stop the injury of RLN，so meticulous capsular dissection is worth using in the clinical practice.

Objective   Summarize the clinical experiences and features of performing redoCoronary artery bypass grafting（redoCABG）through a modified left posterolateral thoracotomy pathway.Methods  From July 2014 to Mar 2016，two cases of patients were underwent redoCABG operation through the left fifth intercostal incision.
Using a common rib spreader,enter the chest through the left fifth rib.Gradually dissociate from the apex of the heart into the pericardium and separate the original adhesive surface.The target vessels were reasonably exposed and identified as the distal anastomosis area.The great saphenous vein or small saphenous vein were used as the vascular bridge,the lower pulmonary ligaments were dissociated,and the descending aorta was taken by the lateral wall forceps as the proximal anastomosis,so as to conduct the redoCABG.Results  Offpump redoCABG was performed on these two patients successfully.The mean operative time was 182 min，distal anastomotic sites were 2～3.No 30day mortality was reported and no operation related death or complications were reported during follow up.Conclusion  Offpump redoCABG through a modified left posterolateral thoracotomy pathway was safe and available method for patients who need to receive reoperation therapy.

Objective    To investigate the feasibility of placing single chest tube drainage after total thoracoscopic lobectomy in patients with NSCLC greater than 5cm in diameter. Methods Take a prospective controlled study,selected 120 patients with NSCLC greater than 5cm in diameter who underwent thoracoscopic lobectomy in our hospital.According to the order of hospitalization,then check the random number table into two groups:sixty patients in the control group received double chest tube drainage after operation,the observation group consisted of 60 patients and a single chest tube drainage was placed after the operation.Comparing the two groups of chest drainage,chest drainage time,number of chest punctures after extubation,postoperative hospital stay,visual analogue scale/score(VAS) scores,lung expansion on the 1st and 30th postoperative,reintubation rate,incision complication rate,chest infection rate,pleural effusion rate,and postoperative mortality at 30 days after operation on the 1st and 3rd postoperative day.Results  There were no significant differences in chest drainage,chest drainage time and chest puncture drainage after extubation(P>0.05).The postoperative hospital stay(5.12±0.24)d in the observation group was significantly shorter than that in the control group(5.73±0.57)d,and the difference was statistically significant(P<0.05).The VAS scores of the observation group on the 1st and 30th day after surgery were(3.96±0.07) points and(1.27±0.02) points,respectively,and the control group were(4.51±0.04) points and(1.69±0.02) points,respectively.Tthe VAS scores of the two groups on the 1st and 30th day after operation were statistically significant(P<0.05).There was no significant difference in lung dilatation between the two groups on the 1st and 3rd postoperative(P>0.05).In the observation group,the rate of reintubation was 0,the incidence of incision complications was 3.33%,the rate of chest infection was 1.67%,the rate of pleural effusion was 1.67%,and the mortality rate was 0 after 30 days.The control group was 0,6.67%,3.33%,0,0,respectively.There was no significant difference in the rate of reintubation and related complications between the two groups(P>0.05).〖WTHZ〗Conclusion〖WTBZ〗〓It is feasible to perform single chest tube drainage after thoracoscopic lobectomy in patients with NSCLC greater than 5cm in diameter,drainage effect and safety should be worthy of recognition.Compared with double thoracic drainage,it is superior in reducing postoperative pain.

  Objective   To analyze the difference of efficacy between laparotomy and laparoscopic gastroscopy in elderly patients with gastrointestinal perforation.Methods  90 cases of elderly patients with digestive tract perforation，according to the method of random numbers are divided into research group and the control group，45 cases each.Control group were treated by routine treatment procedure，application of combined gastroscope laparoscopic treatment group patients.To observe the therapeutic effect of the two groups，the differences of various indicators in the operation，the occurrence of complications and the changes in the quality of life before and after treatment.  Results  The effective rate of treatment in the study group was 93.3%，the effective rate of the control group was 68.9%，the effective rate of the study group was significantly higher than that of the control group（P<0.05）.The hospitalization time of the study group was(4.9±1.3)d，the amount of bleeding in the operation was(14.6±2.2)ml;the time of hospitalization of the control group was(7.6±1.4)d，and the amount of bleeding during the operation was(31.2±4.1)ml，the level of each index was significantly lower than that of the control group（P<0.05）.The complication rate of the study group was 4.4%，the incidence of complications in the control group was 26.7%（P＜0.05）.Quality of life aspect，the two groups before treatment patients quality of life in all aspects has no obvious difference（P>0.05），after treatment the team to improve the quality of life of patients with significantly higher than the control group patients（P<0.05）.Conclusion  The elderly digestive tract perforation application of combined gastroscope thoracoscope treatment effect is more ideal，fast postoperative recovery，reduce the incidence of postoperative complications，significantly improve patients clinical indicators，improve the quality of life of patients.

  Objective  To study the effect of short course glucocorticoid on postoperative complications and inflammatory cytokines in patients with primary gastric cancer.Methods  A total of 96 patients who underwent laparoscopic partial gectomy for gastric cancer were concluded in this study.The patients were randomly divided into control group and treatment group，the patients of the control group received routine treatment in our department before and after the surgery，the treatment group were further treated with Glucocorticoid（methylprednisolone）intravenously based on the routine treatment，the dose of methylprednisolone were at 1mg/kg weight /d for continual 3 days，followed by half the dose for another 2 days.The chi square test or t test were used as the methods for analysis of the data，including the postoperative complications and the time of hospitalization，the changes of serum levels of interleukin 6（IL6），tumor necrosis factor alpha（TNF a）and hypersensitivity C reaction protein（hsCRP）in 1d，3d and 7d before and after the operation.〖WTHZ〗Results〖WTBZ〗〓Postoperative complications occurred in the two groups，including gastric emptying disorder（12.5% vs 2.1%），intestinal obstruction（14.6% vs 2.1%），anastomotic fistula（8.3% ratio 0）and hospitalization time [（15.52±3.00）d vs（13.27±1.54）d].The serum levels of IL6 [（109.40±14.48）pg/ml vs（81.59±12.61）pg/ml]，〖JP2〗TNF alpha（TNFα）[（52.92 ±11.67）pg/ml vs（39.16±11.67）pg/ml]，hsCRP [（29.56±4.12）mg/ml vs（22.27±4.61）mg/ml] all had statistically〖JP〗 significant at the first day（P<0.05）.The serum levels of IL6 [（93.34±14.19）pg/ml vs（70.19±12.00）pg/ml）]，TNFα [（44.95 ± 1.55）pg/ml vs（29.99±1.29）pg/ml] and hsCRP [（25.58±1.04）mg/ml vs（18.11±0.47）mg/ml] all had statistically significant at the third day（P<0.05）.The serum levels of IL6 [（83.52±13.99）pg/ml vs（55.74±11.80）pg/ml]，TNFα [（34.65±5.44）pg/ml vs（21.85±4.15）pg/ml]，hsCRP[（21.11±3.84）mg/ml vs（14.81±3.38）mg/ml]had statistically significant at the seventh day（P<0.05）.Conclusion  Short course glucocorticoids can reduce the〖JP〗 〖LM〗hospitalization time and complications of patients with primary gastric cancer，and the mechanism may be due to reducing the inflammatory cytokines such as IL6，TNF as well as hsCRP in blood.

  Objective   To study on the related factors of postoperative complications of duodenal injury.Methods A retrospective review of 72 cases of duodenal injury treated，the patients were divided into early treatment group(39 cases） and control group(33 cases） according to whether the intervention occurred within 24 hours after onset of disease.The patients were divided into the DCS group(35 cases） and the nonDCS group(37 cases） according to whether the operation was planned according to the concept of damage control surgery.The incidence and mortality of postoperative complications like celiac infection，intraperitoneal hemorrhage，multiple organ dysfunction syndrome（MODS） were compared between the two groups.Rusults  The incidence of postoperative complications in the early treatment group was 41.02% and the mortality was 5.12%.In the control group，the incidence of postoperative complications was 75.75% and the mortality was 24.24%.The incidence and mortality of postoperative complications in the early treatment group were lower than those in the control group.The difference between the two groups was statistically significant（P<0.05）.The incidence of postoperative complications in DCS group was 37.14%，the mortality rate was 2.85%.The incidence of postoperative complications in non DCS group was 75.67%，and the mortality rate of 24.32%.The data of DCS group was lower than that of non DCS group（P< 0.05）.Conclusion  Early diagnosis and early surgical intervention and treatment with the concept of injury control surgery can reduce the incidence of postoperative complications and mortality of duodenal injury.

   Objective    To compare the safety and efficacy of single pointsuturing fixation and free airbags free fixation in laparoscopic totally extraperitoneal inguinal hernia repair.Methods  82 patients diagnosed with inguinal hernia who underwent TEP were collected.Among them，35 patients underwent singlepointsuturing fixation as group A，47 patients underwent free airbags and free fixation as group B.The operation conditions，postoperative complications and recurrence of the two groups were compared.The quality of life was evaluated by the MOS item short from health survey（SF36）at 3 months after surgery.Results  The operation time of group A was（68.95±12.71）min，which was significantly shorter than（83.04±15.82）min of group B（P<0.05）.There were no significant differences of intraoperative blood loss [（8.96±2.45）ml vs（8.25±2.23）ml]，postoperative anal ventilatory time[（15.68±4.61）h vs（14.45±4.25）h]，ambulation activity time[（21.12±4.25）h vs（22.45±4.61）h]，length of stay[（3.72±1.13）d vs（3.96±1.33）d]，the incidence of postoperative complications（11.76% vs 21.88%）between group A and B（P>0.05）;There was no significant difference of recurrence rate between group A and group B（1.47% vs 6.25%，P>0.05）.The SF36 scores at 3 months after surgery were significantly increased than before surgery in the two groups（P<0.05），but there were no significant differences between the two groups（P>0.05）.Conclusion  The singlepointsuturing fixation in TEP is safe and feasible，which can reduce the difficulty of operation and shorten the operation time when compare4d with free airbags and free fixation.It is worthy of clinical application.

Objective   To analyze recent efficacy and safety of laparoscopic totally extraperitoneal implantation in treatment of inguinal hernias.Methods  62 cases of inguinal hernia who received therapy，according to random table method，those patients was divided into control group and research group，31 cases in each group.The control group was treated with tensionfree hernia repair，and the research group was treated with laparoscopic totally extraperitoneal repair.Compared the surgical effect，complications and recurrence rates between the two group.Results  Operation time between control group and reaearch group was no difference [（48.90±7.12）min vs（51.04±6.79）min，P>0.05]，intraoperative blood loss[（7.60±1.03）ml vs（11.83±1.90）ml]，postoperative autonomous team of bed activity time[（1.25±0.15）vs（2.11±0.24）]，postoperative pain score[（1.59±0.23）vs（3.10±0.42）] in research group was lower than the control group(all P<0.05).There was hematoma，urinary retention and surgical field nerve sensation in both groups，but the complication rate was no difference between two group(16.13% vs 19.35%，P>0.05).During the followup，the recurrence rate in the control group and the research group was 6.45%（2/31）and 3.23%（1/31），respectively.The difference was not statistically significant（P>0.05）.conclusion  Recent effect of laparoscopic totally extraperitoneal repair in the treatment of inguinal hernia is certain，postoperative recurrence rate is low，postoperative recurrence rate was low，it has the advantages of small trauma，quick recovery and less complication.

  Objective    To study the Cajal interstitial cells of gallbladder tissue in patients with cholecystolithiasis.Methods  The subjects were 103 patients with indirect cholecystectomy were divided into gallstone group（54 cases）and nongallstone group（49 cases）according to the existence of gallstone.The gallbladder contraction rate was calculated at 45min.The gallbladder tissue was excised as a specimen during the operation，and the neck，body and bottom tissues were sectioned respectively，the length was 0.2cm，0.5cm，0.8cm，respectively.The number of ICC was determined by immunofluorescence method.Results  The rate of gallbladder contraction and the number of ICC in gallstone group were significantly lower than those in noncholelithiasis group（P<0.05）.The rate of gallbladder contraction was positively correlated with the number of ICC in gallbladder tissue（r=0.137，P>0.05）.Conclusion  The number of ICC in gallbladder tissue of patients with gallstone was significantly decreased and the contraction function of gallbladder was decreased.However，there is not a simple linear relationship between the two factors，and there are other reasons for the effect of gallbladder contraction function，which can be used as a new direction in the treatment of cholecystolithiasis.

  Objective  To explore the diagnosis and treatment of NPPE during general anesthesia recovery period.Methods  A retrospective investigation of clinical manifestation，imageology，clinical course and outcome of 16 cases with NPPE.  Results  All these cases presented with tachypnea，dyspnea，oxygen desaturation，rales and frothy sputum in few minute after upper airway obstruction.12 cases was performed endotracheal intubation and were admitted to the ICU,four patients had no intubation.The duration of mechanical ventilation was less than 8 hours in 10 cases and 12 hours in two.Four patients were treated with oxygen inhalation，whose symptoms were obviously improved in 6 to 8 hours.In 12 cases chest radiography was performed and showed bilateral diffuse infiltrates.4 cases displayed diffuse infiltrates in right lung.〖WTHZ〗Conclusion〖WTBZ〗〓NPPE is easily occurred in male，ASAI yong patients.The severity of NPPE is depended on obstruction of time.The main treatment of NPPE are symptomatic treatment，oxygen therapy timely with or without mechanical ventilation.Airway obstruction during general anesthesia recovery should be vigilant NPPE.

   Objective    To investigate the effect of sevoflurane inhalation anesthesia on postoperative serum cTnI and myocardial enzyme levels in patients undergoing thoracotomy.Methods  62 cases of patients undergoing thoracotomy were selected for this study.The patients were randomly divided into the observation group and the control group.In the observation group，the patients were treated with sevoflurane inhalation anesthesia.In the control group，patients received propofol intravenous anesthesia.The Cardiac troponin I（cTn I）levels and myocardial enzyme levels at 7 time points of before induction of anesthesia，10 minutes after the start of CPB（T1），aortic opening immediately（T2），30 minutes after the opening of the aorta（T3），1 hour after the opening of the aorta（T4），and 6 hours after CPB shutdown（T5）and 24 hours after CPB shutdown were recorded and compared between the two groups of patients.Results  The cTnI concentrations of the two groups of patients showed an increasing trend at seven time points.The cTnI concentration of the observation group at the time points of T4 and T5 was higher than those of the control group.The levels of CKMB and LDH of the observation group at the time point of T3 were lower than those of the control group，and the difference was statistically significant（P<0.05）.Conclusion  The cTnI concentration of inhaled anesthesia patients is generally lower than that of intravenous anesthesia patients.Compared with intravenous anesthesia patients，the recovery time of inhalation anesthesia patients is short，and the postoperative pain perception is relatively lower and the myocardial damage is relatively lighter，which is worthy of clinical recommendation.

   Children and adolescents are increasingly suffering from articular cartilage and osteochondral deficiencies Traumatic incidents often result in damage to the joint surfaces,Surgery is indicated in young patients when conservative measures fail.The operative techniques for articular cartilage injuries traditionally performed in adults may be performed in children,while an individualized approach must be tailored according to patient and defect characteristics.Autologous chondrocyte transplantation has good biological potential,especially for large cartilage defects on the joint surface.In recent years,emerging PRP and tissue engineering technologies have not been reported in children and adolescents.Clear guidelines for defect dimensionassociated techniques have not been reported.Knee joint dimensions must be considered and correlated with respect to the cartilage defect size.In addition,the damage of the subchondral bone can not be ignored.Articular cartilage repair techniques appear to be safe in this cohort of patients,and no differences in complication rates have been reported when compared with adult patients.

  Objective  Clinical analysis of the effect of internal fixation combined with postoperative rehabilitation training on tibial plateau fractures.Methods  Fifty patients with tibial plateau fractures were randomly divided into observation group and control group，25 cases in each group.Patients in control group were treated with internal fixation combined with independent rehabilitation.Patients in observation group Internal fixation combined with postoperative rehabilitation training.The knee joint function was assessed by knee function scoring system（HSS）at 3，6，and 12 months after operation.The degree and clinical efficacy of tibial plateau varus（TPA）and rake angle（PA）.Results  Both groups were followed up for 3，6 and 12 months after operation，and the improvement rate of HSS score in observation group was significantly higher than that in control group（P<0.05）;the TPA of the observation group and the control group had a decreasing trend at 3，6 and 12 months after operation，although there was no significant difference between the two groups（P>0.05），but the decrease of the observation group was higher than that of the control group[ the two groups of patients showed an upward trend in PA，the increase in the age group was higher than that in the control group，but the difference was not statistically significant（P>0.05）;the total effective rate in the observation group was significantly higher than that of the control group，the result was statistically significant（P<0.05）.Conclusion  HSS score，TPA，PA were significantly better than traditional open surgery combined with independent rehabilitation treatment after internal fixation operation combined with postoperative rehabilitation training，internal fixation combined with postoperative rehabilitation effective in improving patient's joint function，the prognosis of patients with good.