Objective：To investigate the clinical management strategy and clinical outcomes of kidney retransplantation.Methods：According to the clinical management strategies of kidney retransplantation of the eighth medical center of PLA General Hospital and Peking University International Hospital,a total of 17 patients who took kidney retransplantation from donation after citizen death(DCD) in both hospitals from June 2017 to June 2019 were managed in the formulated standardized strategies.The clinical outcomes such as acute rejection(AR),delayed graft function(DGF),pulmonary infection were observed.Results：14 cases(82.4%) were second kidney transplantation and 3 cases(17.6%) were three times transplantation;5 cases(29.4%) with nephrectomy and 12 cases(70.6%) with the previous kidney graft preserved;5 cases(29.4%) endured desensitization because of population reactive antibody positive and 12 cases(70.6%) were negative.There were 4 cases of AR(23.5%),6 cases of pulmonary infection(35.3%) and 1 case of DGF(5.9%).There were 1 case(20%) of AR in the nephrectomy group,1 case(20%) of pulmonary infection;3 cases(25%) of AR and 5 cases(41.7%) of lung infection in the transplantation group.In desensitization group,there were 1 case of AR(20%),2 cases of lung(40%),3 cases of AR(25%) and 4 cases of pulmonary infection(33.3%) in nondesensitization group.Median follow-up time was 14.5 months (636 months).The 1year renal survival rate was 94.1%(16/17 cases) and 1 case(5.9%) died.Conclusion：Although kidney retransplantation recipients were in immunologically high risk,reasonable and standardized clinical management strategy can achieve better clinical outcomes.There are significantly the risk of pulmonary infection after renal transplantation in patients without nephrectomy.Desensitization therapy could significantly reduce the risk of rejection after renal transplantation,and did not significantly increase the risk of infection.

Objective：To elucidate the application of individual thoracic endovascular aortic repair(TEVAR)strategy in Stanford type B aortic dissection with an aberrant right subclavian artery(ARSA).Methods：Type B aortic dissection patients with ARSA were studied.An individual TEVAR strategy was made according to the distance between primary entry tear and ARSA and left subclavian artery(LSA),and left or right vertebral artery predominance type.Results：Twelve cases were enlisted in this study.Individual TEVAR strategy included:two cases of simple TEVAR,two cases of TEVAR+LSA fenestration,four cases of TEVAR+ single branched stent graft for LSA,one case of TEVAR+ARSA fenestration,one case of TEVAR+ hybrid operation(left carotid artery to LSA bypass),two cases of TEVAR+ open chest hybrid operation(ascending aorta to ARSA bypass in one patient,and ascending aorta to LSA and ARSA bypass in the other).During perioperative period,no retrograde dissection of ascending aorta,or neurologic complication,or paraplegia was recorded.During one year follow up,a mild type I endoleak was noted in one patient with ARAS fenestration,and remained stable.No other aortarelated or neurologic complication was recorded.LSA and ARSA with fenestration or branched stent graft remained patent.No death was noted during one year follow up.〖WTHZ〗Conclusion〓〖WTBZ〗Individual TEVAR strategy is a safe and effective technique in management of type B aortic dissection with ARSA.However,further largescale followup studies are required to verify its longterm efficacy.

Objective：To observe the shortterm and midterm clinical effect of transcatheter closure of secundum atrial septal defect through femoral vein transesophageal echocardiography and the indications for operation.Methods：65 cases of secundum atrial septal defect were analyzed by echocardiography before operation and the results of treatment.Results：All the 65 cases were successfully occluded without residual shunt.Conclusion：Transcatheter closure of secundum atrial septal defect through femoral vein transesophageal echocardiography is safe and effective,with less trauma and avoiding radiation.The occluder with preformed holes provides a new treatment opportunity for patients with severe pulmonary hypertension with atrial septal defect.

Objective：To assess the prognosis of patients with nonsmall cell lung cancer(NSCLC) by the ratio of platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR) and lymphocyte to monocyte ratio(LMR) before operation value.Methods：120 patients with NSCLC who underwent surgical treatment in Suqian People’s Hospital of Nanjing Gulou Hospital Group from January 2013 to January  2015 were selected.The receiver operating characteristic(ROC) curve was used to determine the critical values of PLR,NLR,and LMR,to compare the clinicopathological characteristics between different groups,and to analyze the factors affecting the prognosis of NSCLC patients.Results：The area under the ROC(AUC) of PLR,NLR,LMR and NSCLC patients’ overall survival(OS) was 0.706(95%CI:0.616～0.785),0.617(95%CI:0.523～0.704),0.658(95%CI:0.565～0.742),the critical values are 128.87,3.30,and 3.93,respectively.Cox regression analysis showed that age(HR:2.074,95%CI:0.760～2.669,P=0.036),TNM stage(HR:2.264,95%CI:1.054～4.862,P=0.036),PLR(HR:2.964,95%CI:1.003～8.762,P=0.049) are independent risk factors that affect the OS of NSCLC patients,age(HR:1.829,95%CI:1.031～3.246,P=0.039),TNM stage(HR:1.883,95%CI:1.065～3.329,P=0.030) was an independent risk factor affecting the diseasefree survival(DFS) of patients.Conclusion：The predictive value of preoperative PLR for the prognosis of NSCLC patients is better than that of NLR and LMR,or it can be used as a prognostic index.

Objective：To observe the clinical value of intraoperative methylene blue(MB) nearinfrared fluorescence imaging and mapping in the sentinellymph node biopsy(SLNB) of early stage breast cancer.Methods：The clinical datas of 79 patients of early stage breast cancer(cT12N0M0)who were admitted from January 2018 to December 2019 in the department of thyroid & breast of Hubei Maternal and Children’s Hospital were analyzed retrospectively. These cases were divided into two groups according to admission orders:control group(A) and observation group(B).Group A (39 cases) were applied by intraoperative MB mapping of SLNs.Group B(40 cases) were applied by intraoperative MB nearinfrared fluorescence imaging and mapping of SLNs.To compare the biopsy results and surgical indicators of the two groups.Results：The two groups of SLNB success rates were 100%.There were significant differences in the aspects of the numbers lymph nodes detected and the operation time of the two groups (P<0.05).The mean operation time of the observation group(B) was less than the control group(A).The mean numbers of the lymph nodes detected in observation group(B) were less than the control group(A) .There were no significant differences in the aspects of the intraoperative blood loss, surgical incision complications (such as incision infection/dehiscence, incision hydrops) of the two groups(P>0.05).Conclusion：Compared with simple MB mapping, the application by intraoperative MB nearinfrared fluorescence imaging and mapping was more intuitive, simple, efficient for SLNB of the early stag breast cancer and there was high clinical value for it. 

Objective：To explore the therapeutic value of endoscopic retrograde appendicitis therapy(ERAT) in acute appendicitis.Methods：197 patients with acute appendicitis admitted to our hospital from June 2016 to June 2018 were randomly divided into endoscopic retrograde appendicitis therapy(ERAT) group and laparoscopic appendectomy((LA) group.The operation time,hospital day,operation cost,treatment effect and postoperative complications were compared between the two groups.Results：Endoscopic surgery was successfully performed in all ERAT patients,and no surgical treatment was transferred.Compared with LA group,ERAT group had shorter operation time,less bleeding,shorter bedrest time and hospitalization time after operation(P<0.05),faster pain relief after operation(P<0.05),and fewer complications than Laparoscopic appendectomy(LA) group(P<0.05).Conclusion：ERAT is a safe and effective method in the treatment of acute appendicitis with small trauma and quick recovery.

Objective：To establish a rapid scoring system for acute appendicitis in patients with acute abdomen and verify its diagnostic efficacy.Methods：1 387 patients with acute abdomen were divided into appendicitis group and nonappendicitis group according to whether they were acute appendicitis or not.Compare the clinical characteristics and laboratory indexes between the two groups,established and verified the prediction model of acute appendicitis.Results：Leukocytes,percentage of neutrophils,body temperature,metastatic pain,aggravation of pain symptoms and other clinical characteristics were the independent influencing factors to predict the occurrence of acute appendicitis.The consistency index of prediction model of nomogram based on this model was 0.917.Conclusion：The nomogram model based on clinical symptoms and laboratory indexes can effectively predict acute appendicitis.

Objective：To explore the risk factors of recurrence of fractures in elderly patients with osteoporotic spinal fractures treated with minimally invasive surgery.Methods：Retrospective analysis was performed on the clinical data of 90 elderly patients with osteoporotic fracture treated with microsurgery in our hospital from January 2015 to June 2019.Logistic regression analysis was performed to analyze the independent risk factors for postoperative refracture in elderly patients with osteoporotic spine fracture treated with microsurgery.Results：During the followup of 90 patients for 6 months,16 patients were found to have fractures.The incidence of refracture was 17.78%.The results in the single factor analysis showed:age,gender,bone density,antiosteoporosis drugs used in accordance with the doctor’s advice,accidents during the recovery period,insufficient nutritional supply,bone cement leakage,calcium absorption disorders and diabetes mellitus were all related factors that affect postoperative refracture(P<0.05),multivariate Logistic regression analysis showed that female patients aged > 80 years,with bone cement leakage,bone density ≤-2.5SD and taking antiosteoporotic drugs without the doctor’s advice were all independent risk factors for refracture after surgery(OR=2.19,1.91,2.59,1.79,1.92,P<0.05).Conclusion：The incidence of postoperative fracture recurrence in elderly patients with osteoporotic spine fracture treated after minimally invasive surgery is relatively high,and the postoperative recurrence of fracture is affected by a variety of factors,so appropriate measures should be taken to prevent the recurrence of fracture in clinical practice.

Objective：To investigate the Shortterm effectiveness and clinical significance of Arthroscopic anterior cruciate ligament anatomic single bundle  reconstruction with remnant preservation.Methods：The clinical data were retrospectively analyzed from 79 patients treated by arthroscopic anterior cruciate ligament anatomic single bundle reconstruction with remnant preservation between January 2012 and July 2016.they were divided into two groups according to handing stump.There were 38 patients with remnant preservation(RP) group and 41 patients with conventional group.Postoperative followup assessment included the Lachman test，pivot shift test and KT1000 measurement International Knee Documentation Committee(IKDC) grading ，Lysholm score，proprioception measurements.Results：All the patients were followed up for 12 months.At the time of 6 months after the operation,There were significant differences between the RP group and conventional group in Lachman test positive rate(10.5% vs.26.8%)，pivot shift test positive rate (13.2% vs.29.2%)and proprioception evaluation measured with angle repetitive test[(3.56±1.73)°vs(4.84±1.85)°]，There were no significant differences between groups in KT1000[(1.8±0.9)mm vs.(2.2±1.3)mm].At the time of 12 months after the operation,there were significant differences between the RP and conventional group in Lachman test positive rate(7.9% vs.21.9%)，pivot shift test positive rate (7.9% vs.24.3%)，KT1000[(1.2±0.8)mm vs.(1.7±1.0)mm]，IKDC grading(cases with A gradings：81.6% vs.68.3%)and Lysholm score(96.4±3.1 vs.92.1±4.3)(P＜0.05).There were no significant differences between groups in proprioception evaluation measured with angle repetitive test [(2.75±1.33)°vs.(3.28±1.51)°](P＞0.05).Conclusion：The shortterm effectiveness of arthroscopic anterior cruciate ligament anatomic single bundle reconstruction in the treatment of ACL injury was fine.Arthroscopic ACL reconstruction combined with remnant preserved was benefited for the stability and proprioception of the knee，and the shortterm outcome was better．

Objective：To investigate the application value of nextgeneration sequencing technology in the detection of pathogenic bacteria in the joint fluid of delayed infection after knee arthroplasty.Methods：41 patients with joint infection after knee replacement in our hospital from February 2014 to March 2019 were selected.The bacteria in joint fluid were identified by nextgeneration sequencing technology and traditional bacterial culture.Then the detection rate of the two methods for different bacteria was calculated.Results：In the secondgeneration sequencing,31.71%,21.95%,24.39%,14.63%,17.07%,9.76% and 12.20% of the patients infected with grampositive Staphylococcus aureus,Staphylococcus epidermidis,Staphylococcus haemolyticus,human Staphylococcus,Streptococcus lactis,Streptococcus pyogenes and Streptococcus lactis were detected,moreover,19.51%,14.63%,4.88%,12.20% and 14.63% of the patients were  infected with gramnegative Pseudomonas aeruginosa,Escherichia coli,Haemophilus influenzae,Klebsiella pneumoniae and Acinetobacter baumannii.Bacterial culture found no Streptococcus lactis.No fungi were detected by the two methods.The detection rate of Staphylococcus aureus was 70.73%(13/41) by nextgeneration sequencing technology,which was higher than 12.20%(5/41) by traditional bacteria culture(P<0.05).The nextgeneration sequencing technology results showed that the average bacterial ACE index(12 834.06±317.52),Chao1 index(8 025.37±351.08),Simpson index(0.53±0.01) and Shannon index(5.06±0.11) in the samples of 41 patients were obtained.Conclusion：nextgeneration sequencing technology has a great advantage in the detection of bacteria in the joint fluid of infected patients after knee replacement,has good application prospect and value.

Objective：To explore the risk factors of preoperative hypoalbuminemia and the effects of hypoalbuminemia on complications after the primary hip arthroplasty.Methods：A total of 152 elderly hospitalized patients who underwent hip arthroplasty in the Zhongnan Hospital of Wuhan University from January 2019 to October 2019 were collected. All patients were divided into control group (serum albumin ≥ 35g/L,100 cases) and case group (serum albumin < 35g/L,52 cases). The perioperative conditions of the two groups of patients were recorded and compared. The relevant risk factors of preoperative hypoalbuminemia and the relationship between preoperative hypoalbuminemia and postoperative complications were analyzed.Result：Compared to the control group, the patients in the case group were older, had lower BMI, more likely fracture patients, had longer lengths of stay, the American Society of Anesthesiologists (ASA) scores and cardiac function scores were higher.Compared to controls, hypoalbuminemia patients had higher risk for any complications. There were no significant differences in surgical methods, anesthesia methods, intraoperative time, and intraoperative blood loss between the two groups.Conclusion：Patients who were older and have more comorbidities are more likely to have preoperative hypoalbuminemia.Preoperative hypoalbuminemia is associated with an increased incidence of various postoperative complications. The findings in the present study indicate the need to develop better pre and postoperative medical and nutritional care for primary hip arthroplasty patients in order to potentially mitigate their increased risk.

Objective：To explore the clinical efficacy of arthroscopic single bone tunnel with double endobuttons fixation for the treatment of tibial posterior cruciate ligament avulsion fracture.Methods：A retrospective analysis of 22 patients with tibial posterior cruciate ligament avulsion fracture who met the selection criteria between January 2013 to January 2018 were made.Surgery were treated with arthroscopic single bone tunnel with double endobuttons fixation.The preoperative and postoperative maximum displacement of the sagittal CT fracture block,knee laxity,International Knee Documentation Committee(IKDC) grading,Visual Analogue Score(VAS),Lysholm score and the angle of knee flexion were compared.Results：All incisions healed by first intention without complications.The maximum displacement of the sagittal CT fracture block was (1.5±0.6)mm after operation,which was significantly improved when compared with that before operation(P<0.05).All patients were followed up,and Xray showed fracture healed at 3 months after operation,and the last followup time was 24 months.All patients showed negative knee laxity and IKDC grade A at 24 months after operation,which was significantly improved when compared with that before operation(P<0.05).VAS score was(0.1±0.3),Lysholm score was(96.1±4.3),and the angle of knee flexion was(129.3±6.4)°at 24 months after operation,which were significantly improved when compared with those before operation(P<0.05).Conclusion：Arthroscopic single bone tunnel with double Endobuttons fixation for the treatment of tibial posterior cruciate ligament avulsion fracture can significantly improve postoperative pain and restore knee function.

Objective：To analyze and compare the clinical efficacy of coracoclavicular ligament reconstruction technique and hook plate technique in the treatment of acute Rockwood Ⅴ acromioclavicular joint dislocation.Methods：Clinical date of 33 patients with acute Rockwood Ⅴ acromioclavicular joint dislocation who were admitted and followed up inour department from January 2016 to January 2019 were retrospectively analyzed. In 15 cases, LARS artificial ligament was used to reconstruct coracoclavicular ligament (reconstruction group), and in 18 cases, clavicular hook plate was used for open reduction and internal fixation (hook plate group). Xray films were reviewed at the 1st, 3rd, 6th and 12th months after the operation to assess whether there was reduction loss. VAS score and ConstantMurley score were used to assess the patients’ pain degree and shoulderfunction.Results：All the incisions in the two groups were grade a healed, and there were no early complications such as infection, nerve and vascular injury. In the hook plate group, the internal fixation was removed about 12 months after the operation.VAS score of injured shoulder in the ligament reconstruction group was lower than that in the hook plate group [(2.40±0.91)vs (3.61±1.58)],with statistically significant difference (P<0.05).The ConstantMurley function score of injured shoulder in the ligament reconstruction group was higher than that in the hook plate group [(68.07±8.84)vs(58.78±7.92)], with statistically significant difference (P<0.05). At 3,6 and 12 months after surgery, VAS score of injured shoulder the ligament reconstruction group was slightly lowerthan that in the hook plate group ,(1.93±0.80)vs(2.56±1.10), (0.87±0.74)vs(1.17±0.99), (0.53±0.64)vs(0.67±0.69), but the difference was not statistically significant (P>0.05). The ConstantMurley function score of injured shoulder in the ligament reconstruction group was slightly higher than that in the hook plate group, (68.07±8.84)vs(58.78±7.92), (80.93±6.35)vs(76.61±6.73), (90.80±3.10)vs(87.72±5.39),(93.13±2.80)vs(91.39±4.78), but the difference was not statistically significant (P>0.05).Conclusion：Both coracoclavicular ligament reconstruction technique and hook plate technique are satisfactory in the treatment of acute Rockwood Ⅴ acromioclavicular joint dislocation.However, the reconstruction of the coracoclavicular ligament has the advantages of quick recovery after operation and no need to remove the internal fixation again.

Objective：To investigate the clinical effect of percutaneous curved vertebroplasty(PCVP) in the treatment of thoracolumbar osteoporotic vertebral compression fractures.Methods：80 patients with thoracolumbar osteoporotic vertebral compression fractures in our hospital from January 2017 to January 2019 were selected,33 patients(PCVP group) were underwent PCVP operation,27patients(unilateral group) were underwent unilateral approach and 20 patients(bilateral group) were underwent bilateral approach,the operation time,Xray exposure times,the amount of bone cement injection and adverse reactionsand so on were observed,and VAS score and ODI index before surgery,1 week after surgery and 12 months after surgery were observed.Results：The operation time and Xray exposure times of PCVP group were(21.19±3.80)min and(8.89±1.98)times,which were significantly lower than those of bilateral group(P<0.05),but there was no significant difference between PCVP group and unilateral group(P>0.05);There were no significant difference in VAS score and ODI index,tThe anterior and posterior margins of the vertebral body are highly compressible between unilateral group,bilateral group and PCVP group at 1 weeks,12 months after operation(P>0.05);No fracture or collapse occurred again in unilateral group,bilateral group and PCVP group,and no adverse reactions such as cement displacement occurred.Conclusion：PCVP has a good clinical effect in the treatment of thoracolumbar osteoporotic vertebral compression fracture,which is worth clinical use.

Objective：This paper was to explore the value of combined examination of urinary bladder tumor antigen(BTA),urine exuviate cytology and urinary CT in the diagnosis of upper urinary tract urothelial carcinoma(UTUC).Methods：BTA test,Urinary exfoliative cytology and CT of the urinary system were performed on 51 patients who were suspected UTUC and admitted to our hospital from September 2018 to May 2020 were collected.Results：The sensitivity of urinary BTA(80.00%) and urinary CT(85.71%) was higher than that of urinary cytology(62.86%),but the specificity of urinary cytology(93.75%) was higher than that of urinary BTA(75.00%) and urinary CT(81.25%),and there were significant differences between each two groups(P<0.05).The sensitivity,negative predictive value and diagnostic coincidence rate of the combined tests were higher than those of each single test.And the BTA sensitivity increased along with the rise of pathological grade and stage of UTUC.Conclusion：BTA combined with exfoliative cytology and CT scan of urinary system improved the detection rate of UTUC and had high clinical value.

Objective：To investigate the status of urinary tract infection and cellular inflammatory mechanism in elderly patients with prostate hyperplasia.ethods：A total of 186 elderly patients with benign prostatic hyperplasia admitted to our hospital from October 2016 to October 2019 by transurethral plasma resection of prostate were selected as the research objects,and the patients were divided into the infected group and the uninfected group according to the diagnostic criteria of clinical urinary tract infection.Postoperative inflammatory factors were compared between the two groups.To compare the general information of the two groups,multivariate Logistic regression was used to analyze the risk factors of urinary tract infection after BPH in the elderly.Results：Postoperative urinary tract infection occurred in 28 of 186 patients,with an incidence of 15.05%.The levels of monocyte chemokine 1(MCP1),fibroblast growth factor 2(FGF2),fibroblast growth factor 7(FGF7),tumor necrosis factor(TNF) and interleukin6(IL6) in the infected group were significantly higher than those in the noninfected group(P<0.05).Patients in the infected and uninfected groups were statistically significant in age,prostate size,preoperative preventive antibiotic use,urinary catheterization due to urinary retention,surgical time,postoperative indwelling catheter,total hospital stay,and diabetes(P<0.05).Twocategory multivariate Logistic regression analysis showed that preoperative urinary catheterization due to urinary retention,postoperative indwelling catheterization time ≥7 days,and diabetes mellitus were all independent risk factors(OR = 2.08,1.76,1.78,P<0.05).Conclusion：Patients with postoperative urinary tract infections have obvious cellular inflammatory reactions,postoperative urinary tract infections in elderly patients with benign prostatic hyperplasia are affected by a variety of factors,these include preoperative urethral catheterization due to urinary retention,prolonged indwelling catheter after operation,and diabetes.

Objective：To investigate the correlation between the diameter size of communicating vein and chronic ulcer of lower extremities.Methods：Retrospectively analyse the datas of 60 cases with venous ulcers of lower extremities which were received and cured in authors,hospital from Jan.2016 to Jan.2020.Put them into observation group.The other 60 cases with physical examination at outpatient department are put into control group.All the patients in two groups have a color Doppler ultrasonography examination in the veins of lower extremity.The diameter sizes of communicating veins in two group were measured and recorded.Result：The average reflus time of communicating vein in the observation group is more than 0.5 second.The average reflus time of communicating vein in the matched group is less than 0.35 second.The mean diameter size of communicating vein in observation group is morn than 4 millimeters.The mean diameter size of communicating vein in matched group is less than 3.3mm.Conclusion：When the diameter communicating vein size is more than 4mm,Chronic ulcer will be found in the lower extremities.

Objective：To investigate the effectiveness and safety of endovasculartreatment of inferior vena cava filter thrombosis (IVCFT) during the retrieval window period.Methods：Retrospective analysis of 41 patients with IVCFT who developed IVCFT during the retrieval window from January 2012 to October 2019 in our department through intracavitary techniques such as filter retrieval,catheterdirectedthrombolysis(CDT), mechanical thrombectomy data.Results：5 cases successfully underwent filter retrieval.30 cases underwent CDT treatment. After treatment the review of inferior vena cava angiography showed 21 cases with complete thrombolysis,7 cases with the maximum diameter of residual thrombus ≤1cm,and 2 cases with a maximum diameter 1.7cm and 1.9cm respectively.Filter retrieval was successful in 28 cases.Filter retrieval of 2 cases was abandoned because of residual thrombus being more than 1.5cm. 6 cases received mechanical thrombectomy, of which 3 received mechanical thrombectomyonly. The reviews of inferior vena cava angiography showed their residual thrombus were all less than 1cm, and the filters were successfully retrieved. The other 3 cases received assisted CDT treatment, among which filter retrieval of 2 cases with the maximum diameter less than 1cm was successful and filter retrieval of 1 case with the the maximum diameter 1.7cm was abandoned. The filter retrieval rate was 92.7% (38/41). No related complications occurred during endovascular treatment and filter retrieval. No adverse occurrences during the followup of 41 cases.Conclusion：Filter retrieval, CDT, and mechanical thrombectomy are safe and effective for IVCFT in the retrieval window period,which can effectively improve the filter retrieval rate and avoid various serious complications caused by longterm filter retention.

Objective：To investigate the reconstructive effect of soft tissue defect of Foremidfoot by the lower lateral supramalleolar reversed island flap with the wellknown branch vessel of the ankle.Methods：From January 2017 to August 2019, using anterior malleolus artery and Lateral iliac artery alone or combined, and according to the wound repair needs, and the flap rotation point was anatomied to the source vessel root, and Protect the vascular pedicle and the tissue integrity around its fascia, and the longest vascular pedicle was 12cm, 16 Foremidfoot soft tissue defect were repaired by lateral supramalleolar reversed island flap. The area of the wound ranged from 3.0cm×5.0cm to 8.0cm×13.0cm, and the defects on the donor sites were sutured directly or reduced or closed with a mediumthickness skin.Results：14 flaps were survival without infection and vascular crisis. One case had partial necrosis of the distal superficial tissue, and the Wound healed after dressing change. One case had venous reflux dysfunction blister at the distal flap, and the flap survived after the suture removal timely. The15 patients were followed up from 6 to15 months ,and one patient failed to follow up. 4 flaps of the obese patients had Flap thinning surgery. The remaining cases, the appearance of the flaps were good, without pigmentation, and some sensations were restored. Soft tissue was adhesion in the donor sites where were closed with a mediumthickness skin, but the ankle tendon sliding was not affected, and the functionwas restored satisfaction.Conclusion：Using anterior malleolus artery and Lateral iliac artery alone or combined, the rotation point of the lateral supramalleolar reversed island flap could move lower significantly.

Intestinal microecology is the most important microecosystem of human body,which is composed of a large number of intestinal microflora and their living environment.Intestinal microecology is related to human immune and metabolic function,and is an important media of gutliver circulation.In the liver transplant population,because of the liver disease itself and the liver transplant operation influence,the intestinal microecology will have the change,this kind of change will directly affect the transplant liver function recovery.At present,how to adjust the intestinal microecology to promote the postoperative recovery of liver transplantation patients is still in the exploratory stage.This article reviews the changes of intestinal microecology in liver transplant patients,the relationship between intestinal microecology and complications after liver transplantation,and the effect of Intestinal microecological regulation program on postoperative recovery of liver transplant patients.The aim of this study was to reveal the importance of intestinal microecology and to provide reference for the future perioperative intestinal treatment of liver transplantation.

The prognosis of De novo glomerular diseases and secondary glomerular disease depends on the type of Glomerular Diseases and the degree of disease activity.Renal transplantation is associated with good outcomes in patients with ESRD due to lupus nephritis.The prognosis of patients with amyloidosis after transplantation is related to their hematologic response and the presence of severe cardiac involvement.In patients with antiGBM disease,the recurrence after transplatation is very low and allograft failure from disease recurrence exceedingly rare.However,the patients with serum positive antiGBM were forbidden for transplantation.The prognosis of different subtypes of ANCAassociated vasculitis nephritis is quite variable,the outcome is favorable and transplantation can be performed safely when the patient has achieved clinical remission before transplantation.Simultaneous pancreaskidney transplantation is the preferred treatment for type 1 diabetes patients with endstage renal disease,the management of  diabetes is very critical as well.Patient with renal transplantation in lightchain deposition disease has a high disease recurrence but a low survival rate.However,patients with lightchain deposition disease may still be considered for renal transplantation,but the treatment for recurrence is controversial.De novo MN and IMN can be identified by podocyte HLADR expression and phospholipase A2 receptor staining.FSGS has been reported as the leading form of de novo glomerular disease,The pathogenic factors are various,and the treatment is mainly to remove the persistent effect of the possible pathogenic factors.

In recent years,the number of overweight and obese people in China has increased significantly,which will increases the possibility of a series of chronic diseases.Domestic and foreign scholars have reported that obesity is related to the onset of hyperuricemia and obesity is one of the risk factors for hyperuricemia.Hyperuricemia is a major risk factor for symptomatic gout,which can lead to a variety of diseases,including gout,kidney damage,and arthritis.The mechanism of hyperuricemia in obese patients is very complicated.In addition,more and more clinicians advocate weight loss metabolic surgery for the treatment of obesity combined with hyperuricemia as a safe and effective treatment.In this paper,the mechanism of correlation between obesity and hyperuricemia and the progress of surgical treatment were reviewed for clinical reference.

To study on influence factors of blood calcium decline after surgery for primary hyperparathyroidism, to predict and analyze the extent of blood calcium decline after surgery, to provide a reference for the development of effective calcium supplement strategy after surgery, reduce the incidence of transitory or persistent hypocalcemia.