Objective〖WTBZ〗〓To investigate diagnosis and treatment methods of the statininduced rhabdomyolysis in renal transplant recipients.〖WTHZ〗Methods〖WTBZ〗〓A retrospective study was performed on the clinical date of a case of atorvastatininduced rhabdomyolysis and acute renal failure triggered by addition of cyclosporine A（CsA）to a kidney transplant recipient.Given his diabetes，the recipient received CsAcontaining immunosuppressive regimens，and he had been continually treated with atorvastatin（20 mg/d）owing to hyperlipidemia for the preceding 2 years.〖WTHZ〗Results〖WTBZ〗〓The patient got a delayed graft function until the 22nd day after the operation.Then the patient developed severe rhabdomyolysis on the 29th day after the surgery，followed by acute kidney failure in 33 days.Finally，he showed gradual recovery in renal function and overall clinical status on the 75th day after the surgery.The serum creatinine remained stable at about 80 μmol/L at the time of the followup to March 29，2018.〖WTHZ〗Conclusion〖WTBZ〗〓It is advisable to start with small dosage of lipidlowering agent and pay more attention to the possible muscle toxicity when the CsAtreated renal transplant recipient took statins metabolized by CYP3A4 for hyperlipidemia.

Objective〖WTBZ〗〓To compare ligation and Hemolok in securing of appendix stump in laparoscopic  appendectomy.〖WTHZ〗Methods〖WTBZ〗〓There were 105 patients undergoing  laparoscopic appendectomy.They were treated by two different methods in securing of the base of the appendix：silk ligation of the stump was performed in 53 cases（ligation group）； while stump ligation by using Hemolok clips was performed in 52 cases（Hemlock group）.Two groups were compared in operation time and postoperative patient recovery.〖WTHZ〗Results〖WTBZ〗〓Between the both groups，postoperative complications and postoperative hospital stay had no significant differences（P>0.05）.The operation time of the ligation group was （55.5±7.8）min，which was significantly longer than that of the Hemolok group[（46.1±5.6）min，（P<0.05）].The cost of appendix root treatment in the ligation group was 0.3 yuan，while the cost in Hemolok group was 560 yuan.The difference between the two groups was statistically significant（P<0.05）.〖WTHZ〗Conclusion〖WTBZ〗〓Both methods are safe and effective in securing of the base of the appendix in laparoscopic appendectomy.Pursestring suture is more in line with traditional appendectomy requirements and cost effective，but requiring more skilled laparoscopic manipulation.Hemolok clipping of the appendix saves operation time and is easy to perform，which is more suitable for beginners.

〗[Abstract]〓Objective〖WTBZ〗〓To investigate the effect and safety of Lichtenstein，Rutkow and Kugel in treatment of adult inguinal hernia.〖WTHZ〗Methods〖WTBZ〗〓The clinical data of 155 adult inguinal hernia patients were retrospectively analyzed.All of the patients were divided into Lichtenstein group（n=61），Rutkow group（n=43）and Kugel group（n=51），according to the different surgical methods.The perioperative period，postoperative complications，postoperative pain，postoperative foreign body sensation and recurrence rate between the three groups were compared.〖WTHZ〗Results〖WTBZ〗〓There was no significant difference in operation time，offbed time and hospitalization time between the three groups（P>0.05）.Postoperative urinary retention occurred in 2 cases，scrotal edema in 1 cases，incisional infection in 1 cases，and there was no significant difference in the total incidence of postoperative complications between the three groups（P>0.05）.The VAS scores of Rutkow group were significantly higher than those in Lichtenstein group and Kugel group at 1 month and 3 months after operation，and the differences were statistically significant（P<0.05）.In Rutkow group，8 cases（18.60%）had obvious foreign body sensation，which was significantly higher than that in Lichtenstein group and Kugel group，and the difference was statistically significant（P<0.05）.There was no significant difference in recurrence rate between the three groups（P>0.05）.〖WTHZ〗Conclusion〖WTBZ〗〓Lichtenstein，Rutkow and Kugel have equal effect in treatment of adult inguinal hernia.The Rutkow group have obvious postoperative pain and postoperative foreign body sensation.Lichtenstein has curative effect in treatment of adult inguinal hernia，with fewer complications，low recurrence rate，convenient operation and low cost.

[Abstract]〓Objective〖WTBZ〗〓To explore the risk factor of cognitive function after coronary artery bypass grafting（CABG）.〖WTHZ〗Methods〖WTBZ〗〓According to the inclusive criteria setted before the research，we gathered relevant data of preoperation，postoperation，and recovery condition after operation of 80 patients with CABG in our hospital from March 2012 to March 2013 before operation.Delirium one day before operation and the first to the third day after operation were assessed with CAMICU.Cognitive function one day before operation and the seventh day after operation were assessed with MMSE.〖WTHZ〗Results〖WTBZ〗〓There were 17 patients（21.25%）developed postoperative delirium during 3 days after operation.Univariate analysis showed that age，stroke history，time to stop jumping，visual analogue score（VAS），hypocardia syndrome and preoperative MMSE were risk factors for postoperative delirium.Multivariate Logistic regression analysis showed that older than 65 years old，stroke history，too long time of cardiac arrest，higher postoperative VAS score，low cardiac output syndrome and lower preoperative MMSE score were independent risk factors in patients undergoing CABG surgery developed delirium.On the seventh day after operation，there were 25 patients（31.25%）developed cognitive dysfunction.Univariate analysis showed that age，history of hypertension，history of diabetes，duration of arrest，intraoperative oxygen saturation，postoperative VAS score，hypocardia syndrome and preoperative MMSE were risk factors for postoperative cognitive dysfunction.Multivariate Logistic regression analysis showed that older than 65 years old，too long time for cardiac arrest，diabetes，higher postoperative VAS score，low cardiac output syndrome and lower preoperative MMSE score were independent risk factors for patients undergoing CABG developed cognitive disorders.〖WTHZ〗Conclusion〖WTBZ〗〓Older than 65 years old，history 〖JP+1〗of stroke，too long time of cardiac arrest，diabetes，higher〖JP〗〖LM〗postoperative VAS score，low cardiac output syndrome and lower preoperative MMSE score were risk factors for patients with CABG developed delirium and cognitive impairment.

[Abstract]〓Objective〖WTBZ〗〓To explore the application value of the threedimensional（3D）imaging system in the diagnosis and treatment of complex hepatolithiasis.〖WTHZ〗Methods〖WTBZ〗〓The clinical data of 40 cases of complex hepatolithiasis were analyzed retrospectively.3D evaluation，surgical planning and simulated operation were conducted on the basis of MDCT and MRCP to guide the actual operation.Statistical analysis was performed to compare the consistency between the intraoperative and the preoperative evaluation，the actual surgical protocols and its compliance with the preoperative surgical planning，the operative time，the intraoperative blood loss，the incidence of complications and the perioperative mortality.〖WTHZ〗Results〖WTBZ〗〓The 3Dimages of all 40 cases were successfully obtained.The intraoperative findings were consistent with the preoperative 3D images，and the consistency between the actual surgical plan and the surgical planning was 97.5%（39/40）.1 patient refused to undergo lobectomy and 3 patients had extensive choledocholithiasis.36 cases were confirmed to be free of stone remnants by cholangiography or Bultrasonography after operation.The recurrence rate of stones in 1 year was 8.3%（3/36）.〖WTHZ〗Conclusion〖WTBZ〗〓The 3D evaluation system can clearly show the distribution of intrahepatic stones and the spatial relationship with the biliary system，adjacent liver tissue and blood vessels，which is conducive to the preoperative accurate evaluation of complex hepatolithiasis and the formulation of individualized and reasonable surgical plans.

[Abstract]〓Objective〖WTBZ〗〓To study the expression and clinical significance of p53，Ki67，Ecadherin and CD34 in gallbladder carcinoma.〖WTHZ〗Methods〖WTBZ〗〓We collected a total of 120 cases of cholecystectomy，which were divided into 3 groups：40 cases of gallbladder carcinoma（gallbladder cancer group），40 cases of paracancerous tissue（paracancer group），and 40 cases of normal gallbladder tissue（normal group）.Immunohistochemistry was used to detect the expression of p53，Ki67，Ecadherin and CD34 in the tissues.〖WTHZ〗Results〖WTBZ〗〓The positive expression rates of p53 in the normal group，paracancer group，and gallbladder cancer group were 0，12.5% and 72.5%，respectively.The difference between the three groups was statistically significant（P<0.05）.The positive expression rates of Ki67 were 2.5%，17.5% and 80%，respectively（P<0.05）.The positive expression rates of Ecadherin were 95.0%，85.0% and 30.0%，respectively（P<0.05）.The expression of CD34（MVD mean）in gallbladder carcinoma tissue（57.43±5.21）was higher than that in normal group（30.68±4.59）and paracancer group（32.66±4.28），the difference was statistically significant（P<0.05）.The results of immunohistochemistry showed that the positive expression of p53，Ki67，Ecadherin and CD34 were significantly correlated with the degree of differentiation and lymph node metastasis of gallbladder carcinoma.There was no correlation with the patient's age，gender，tumor diameter and tumor location，and the difference was not statistically significant（P>0.05）.In the TNM stage，only CD34（MVD mean）showed significant difference（P<0.05），p53，Ki67，Ecadherin and TNM staging were not correlated（P>0.05）.〖WTHZ〗Conclusion〖WTBZ〗〓p53，Ki67，Ecadherin and CD34 are closely related to the invasion and metastasis of gallbladder cancer cells，but further validation by clinical big data research is still needed.

[Abstract]〓Objective〖WTBZ〗〓To analyze differences in clinical efficacy of central pancreatectomy（CP）and distal pancreatectomy（DP）in the treatment of benign or borderline tumors of the pancreas.〖WTHZ〗Method〖WTBZ〗〓A retrospective study was used to analyze 39 cases of central pancreatectomy（CP group）and 52 cases of distal pancreatectomy（DP group）.The basic clinical features，intraoperative condition，postoperative complications and follow-up of the patients were observed.〖WTHZ〗Result〖WTBZ〗〓In the CP group，the operation time[（220.96±90.69）min] and diet start time[（4.29±1.05）d] were significantly longer than DP group[（275.52±88.78）min and（5.28±2.22）d]（P＜0.05）.There was no significant difference in serious complications including clinically significant pancreatic fistula（B+C），delayed gastric emptying，reoperative，and mortality（P＞0.05）.Compared with DP group，CP group patients could benefit from longterm postoperative exocrine and endocrine function（P＜0.05）.〖WTHZ〗Conclusion〖WTBZ〗〓These findings provide a rationale for CP could as an acceptable and reliable procedure，especially in improving the quality of life of patients.

[Abstract] Objective：To investigate the clinical efficacy of splenectomy combined with splenic graft transplantation in treatment of Ⅲ～Ⅳ degree traumatic splenic rupture patients and its effect on immune function and risk of thrombosis.Methods：80 cases of Ⅲ～Ⅳ degree traumatic splenic rupture patients were regarded as research subjects，which were divided into study group with 40 cases and control group with 40 cases.Patients in control group were given routine splenectomy and patients in study group were given implantation of autologous spleen segments after splenectomy.The two groups were compared in terms of clinical efficacy.Results：The study group[（91.2±18.5）min] takes more time than control group[（76.6±15.0）min，P<0.05].The operative blood loss，postoperative hospital stay and postoperative complications were no significant difference（P＞0.05）.There was no significance in postoperative complications rate between study group（20.0%）and control group（12.5%，P＞0.05）.The immune function indexes were all better in study group than in the control group after the treatment（P＜0.05）.The platelets level at 1，2 weeks and 1 month after surgery in the study group was significantly lower than in the control group（P＜0.05）.The Tuftsin level in the study group was significantly higher than in the control group（P＜0.05）.Conclusion：The implantation of autologous spleen segments after splenectomy in the treatment of Ⅲ～Ⅳ degree traumatic splenic rupture patients is significant，which can accelerate the recovery of the patient's immune function and reduce the risk of thrombosis，but the indications should be strictly controlled.

[Abstract] Objective:To investigate the advantages of the modified transforaminal endoscopic spine system（TESSYS）technique united interlaminar and posterolateral approach of endoscopic in treatment of degenerative spinal stenosis decompression.Methods:41 patients with degenerative spinal stenosis were decompressed by modified TESSYS technique united posterolateral approachs.The NRS scores，the ODI index and the JOA scores were evaluated before and after the operation，the sagittal diameter of the spinal canal，the space between intervertebral disc and ligamentum flavum，the area of the vertebral canal，and the anterior and posterior diameter of the intervertebral foramen.Results:The operation time was 82～114min，with an average of（91.31±10.64）min.The intraoperative bleeding was 130～210ml，with an average of（174.38±31.18）ml.1 cases with limb in the lower extremities，2 cases of cerebrospinal fluid leakage.The followup time was 12～15weeks，with the average of（13.37±2.38）weeks.There was statistical significance difference between before and after operation NRS score，ODI index，JOA score（P<0.05）.The sagittal diameter of the spinal canal，the space between intervertebral disc and ligamentum flavum，the area of the vertebral canal，and the anterior and posterior diameter of the intervertebral foramen were increased after operation 24.05%，53.99%，45.35%，21.34% separately，there was statistical significance compared with that before operation（P<0.05）.Conclusion:The combined interlaminar and transforaminal approach approachs of endoscopic could significantly expand the effective space of lumbar spinal canal and improve the clinical symptoms of patients with degenerative lumbar spinal stenosis，and without affecting the stability of lumbar.

[Abstract]Objective:To compare the curative effect of minimally invasive bilateral decompression fixation via unilateral approach and open bilateral decompression fixation in the treatment of single level lumbar spinal stenosis.Methods:86 patients with single level lumbar spinal stenosis treated in our hospital during the period were selected as the subjects，and they were divided into the observation group and the control group with 43 cases in each group by the random number table method.The two groups were treated by minimally invasive bilateral decompression fixation via unilateral approach and open bilateral decompression fixation respectively.The situation of operation and postoperative recovery were compared between the two groups，and the incidence of postoperative complications in the two groups was statistically analyzed.The operation effect was evaluated with modified Macnab criteria.The pain degree and improvement of lumbar function were evaluated by the visual analogue scale（VAS）and Oswestry disability index（ODI）before and after operation.A followup survey of 1 year was performed，and changes in intervertebral height index at different time after operation were determined.Results:The length of incision，intraoperative blood loss，postoperative ambulation time and hospitalization time in the observation group were shorter or less than those in the control group [（1.90±0.34）cm vs（12.81±2.41）cm，（98.25±16.74）ml vs（180.45±20.26）ml，（1.72±0.36）d and（6.32±1.07）d vs（2.81±0.52）d and（8.90±0.96）d ]（P<0.05）.There was no significant difference in the incidence of postoperative complications or the curative effect of operation between the observation group and the control group（2.33% vs 9.30%，90.70% vs 86.05%）（P>0.05）.VAS scores of the two groups were decreased at 1 day and 3 months after operation，and the VAS score of observation group at 1 day after operation was lower than that of control group [（3.04±1.26）points vs（3.91±1.75）points]（P<0.05）.ODI scores of two groups were decreased at 6 months and 12 months after operation [（13.51±2.26）points and（10.79±3.52）points in the observation group，（14.11±3.23）points and（10.94±2.47 points）in the control group].Compared with those before operation [（32.14±5.15）points in the observation group，（33.31±4.98）points in the control group]，there were statistically significant difference（P<0.05），but there was no significant difference between the two groups（P>0.05）.There was no significant difference in the intervertebral space height index between the observation group and the control group at different time after operation（P>0.05）.Conclusion:The curative effect of minimally invasive bilateral decompression fixation via unilateral approach is similar to that of open bilateral decompression fixation in treatment of single level lumbar spinal stenosis.However，the trauma of the former is smaller and pain is milder，which can shorten the recovery time after operation，and it has little effect on the longterm stability of the spine.

[Abstract] Objective：To investigate the application of the concept of fast track surgery in the perioperative period of total hip arthroplasty.Methods：100 cases of total hip arthroplasty in our hospital were retrospectively analyzed.The patients were divided into observation group and control group，50 cases in each group，according to the perioperative intervention measures.The control group received routine intervention，and the observation group adopted enhanced recovery after surgery intervention mode on the basis of the control group.The blood loss and blood transfusion were compared between the 2 groups.The hip joint function，pain and selfcare ability of the 2 groups were detected and compared before and 3 months after operation.The hemorrheology indexes of the 2 groups were detected and compared before and 7 d after operation.The incidence of postoperative complications and nursing satisfaction in the 2 groups were statistically analysed.Results：Compared with the control group，the nursing satisfaction of the observation group was significantly higher（P<0.05）.The total blood loss，blood transfusion rate，the 1st d hemoglobin reduction of the observation group decreased significantly（P<0.05），the time of ambulation and the time of postoperative hospitalization of the observation group shortened significantly（P<0.05）.The daily activity and gait，joint activity and Harris total scores of the 2 groups after 3 months operation were significantly higher than those before the operation，the scores of pain and joint deformity were significantly lower than those before operation，the score of Visual analogue scale（VAS）in the 2 groups after 3 months operation was significantly lower than that before the operation，the Barthel index was significantly higher than that before the operation，the plasma levels of Ddimer in 7d of the 2 group were significantly higher than those before the operation，there were significant differences between the two groups in the above indexes（P<0.05）.The high viscosity of whole blood，low shear viscosity，blood sedimentation and plasma viscosity of the observation group after 7 d operation were significantly lower than those before the operation，and that were significantly lower than those in the control group（P<0.05）.There was no significant difference in the incidence of complications between the two groups（P>0.05）.Conclusion：The fast track surgery intervention model for patients with total hip arthroplasty can effectively improve hip joint function and selfcare ability，help to speed up the blood flow speed and reduce the pain of the body.

[Abstract] Objective：To investigate the effect of deep subfascial noncontact locking plate in treatment of occult infective femoral fracture.Methods：32 patients with occult infective refracture after femoral shaft fracture were analyzed retrospectively.Deep subfascial non contact locking plate fixation combined with cancellous bone granule transplantation was used.The occult infection，postoperative recovery and the difference of blood biochemical indexes of the patients before and after treatment were observed and analyzed.Results：32 cases confirmed the existence of chronic bone infection by pathological examination，21 cases of bacterial culture were positive，all were different types of staphylococcal infection，the postoperative drainage time was 7～14d，the average drainage time was（8.5±3.1）d.The healing time was 15～24w after operation，the average healing time was（17.8±4.3）w.The white blood cell count，erythrocyte sedimentation rate and C reactive protein at 2 months after the operation after fracture healing were significantly lower than those before the treatment（all P<0.05）.The leukocyte count and erythrocyte sedimentation rate did not continue to decrease after 2 months，while C reactive protein continued to decline（P<0.05）.Conclusion：The noncontact locking plate under fascia for the treatment of the infection of the patients after the fracture of the femur is beneficial to control the infection and promote the healing of the fracture.

[Abstract] Objective：To investigate the clinical analysis of the proximal femoral nail in treatment of unstable femoral intertrochanteric fracture with elderly patients.Methods：The clinical data of 100 elderly patients with femoral intertrochanteric fracture were analyzed retrospectively.Patients were divided into two groups according to the different treatment methods.51 patients in the control group received the locking compression plate（LCP），and 49 patients in the observation group received the PFNA.Then the postoperative general conditions，hip function，complications，and quality of life scores were compared between the two groups.Results：The operative time，intraoperative blood loss，first walking time，hospital stay，and fracture healing time were significantly shorter in the observation group[（48.59±5.54）min，（96.58±3.55）ml，（6.54±1.55）d，（7.26±01.22）d，（11.23±2.44）w]than in the control group[（78.59±5.56）min，（117.89±3.58）ml，（10.59±1.54）d，（15.59±1.24）d，（13.59±2.47）w]（P<0.05）.The observation group had higher rate of the excellent（57.14%）and good（30.61%）as well as lower rate of the fair（10.20%）and poor（2.04%）than those of the control group（39.22%，27.45%，23.51%，9.80%，respectively）（P<0.05）.The hip function between the two groups had significant difference（P<0.05）； The incidence of complications in the observation group（2.04%）was significantly lower than that in the control group（P<0.05）.The scores of patients in the observation group were higher than those in the control group（P<0.05）.Conclusion：The application of the PFNA can significantly shorten the operation time，intraoperative blood loss，improve hip function and postoperative patient quality of life for elderly patients with femoral intertrochanteric fracture.

[Abstract] Objective：To compare the clinical efficacy of olecranon osteotomy and trochanter lingual petal approach in treatment of adult AOC humerus fractures.Methods：70 cases of adult AOC humerus fractures patients were divided into two groups by random number table method（n=35）.Group Ⅰ was treated with olecranon osteotomy approach fixation，and group Ⅱ was treated with triceps by passage into the tongueshaped flap fixation.Then compared the incidence of postoperative complications，elbow joint function recovery situation and so on.Results：There was no significant difference between the two groups in operation time，blood loss，fracture healing time and hospitalization time（P>0.05）.After operation 1 year，the elbow joint function recovery rate was 88.57% in group Ⅰ，which was significantly higher than 60.00% in group Ⅱ（P<0.05）.The total complication rate was 17.14% in group Ⅰ and 20.00% in group Ⅱ，there was no significant difference between the two groups（P>0.05）.Conclusion：The two approaches can be used to treat AOC humeral fractures with satisfactory results.However，the elbow joint function of AOC humerus fracture treated by olecranon osteotomy approach is better.

[Abstract] Objective：To evaluate the efficacy of total hip replacement（THA）in the treatment of developmental dysplasia of hip（DDH）associated with osteoarthritis in adults.Methods：THA was used to treat 28 adult DDH patients with 30 hips，among them，Crowe Ⅰ type 4 hips，Crowe type Ⅱ10 hips，Crowe type Ⅲ 8 hips，Crowe type Ⅳ 8 hips，the modified posterolateral，intraoperative periprosthetic soft tissue release，restore the true acetabular reconstruction，prolong objective limb length.Follow up was 6 to 60 months，with an average of 33 months.Harris scoring system（including pain，function，etc.）was used for preoperative and postoperative follow up.Results：Preoperative Harris score of 23～57 points，with an average of（42.37±2.51）points，postoperative score of 79～95 points，with an average of（88.13±3.27）points，significantly improved than before（P＜0.05）.The pain was relieved，the activity and function were satisfactory，the quality of life was greatly improved，and the prosthesis position was better and no looseness occurred.Conclusion：THA is an effective method in the treatment of adult DDH，which can greatly relieve the pain and improve the function of the patients.

[Abstract] The tolerance of allograft has been considered the ultimate goal in organ transplantation.Although numerous protocols of allograft tolerance induction have been reported in mice，thus far，chimerism based on hematopoietic stem cell transplantation is the only reproducible scheme for inducing immune tolerance in human kidney transplantation.Transient immune chimerism or stable chimerism could induce renal allograft tolerance.Although persistent complete chimerism may reduce the risk of rejection，the development of graftversushost disease（GVHD）has limited its wide clinical application.In contrast，shortterm mixed chimerism does not lead to GVHD，but it is difficult to predict the risk of graft rejection after the disappearance of hematopoietic stem cell chimerism.Current efforts are aimed at developing clinically more feasible and reliable methods to induce persistent mixed chimeras in order to expand the clinical applicability of these treatment regimens.

[Abstract] The rapid changes of tissuetyping technology，including the widely used of highly specific molecular typing methods and solid phase analysis technology for detection of alleles specific antiHLA antibodies，promoted the selection of organ transplant recipients to a more accurate level and promoted the scientific development of organ transplant matching.At present，the graft survival rate has been greatly improved through the prevention and treatment of Tcellmediated rejection（TCMR），but the humoral immune response，the main cause of late graft loss，is still not effectively controlled.Describing HLA antigens as a series of antibody targets，or epitopes，relative to serological response patterns or precise amino acid sequences，may provide a better HLA matching system，combined with clinical practice to help avoid antibodymediated rejection（AMR），reduce sensitization after transplantation，and select the most appropriate organs to avoid preexisting antibodies in the case of persisting HLA antibody positive recipients choosing.The following contents，in the background of the study of tissue matching，describe the HLA epitopes system and its potential role in transplantation，and explore the potential significance of HLA epitope matching in the clinical practice of renal transplantation.

[Abstract] Kidney transplantation is the optimal treatment of endstage renal disease.In order to offset the shortage of donors，the proportion of marginal donor kidneys have increased significantly and the higher requirements have been put forward on preservation and evaluation.Normothermic machine perfusion is a potential way to objectively evaluate the quality of donor kidneys and repair the damage by preserving organs under physiological conditions，and has been applied in clinic gradually in recent years.This review summarizes the progress of kidney normothermic machine perfusion research in organ preservation，repairing and evaluation.