BACKGROUND: Ischemia/reperfusion can induce degenerative alterations in articular cartilage. However, the precise mechanism remains poorly understood. OBJECTIVE: To observe the morphological changes and the apoptosis of articular cartilage of femoral head epiphyses with ischemia/reperfusion. METHODS: A total of 80 Sprague-Dawley rats were randomly assigned to two groups: ischemia/reperfusion (model of ischemia/reperfusion in hip joint) and sham-surgery (exposure of abdominal aorta for 5 minutes) groups, with 40 animals in each group. Articular cartilages of femoral head epiphysis were col ected in 6, 12, 24, and 48 hours, 5 days, and 2 and 4 weeks after operation. Morphology of articular cartilage of femoral head epiphyses was examined by light microscope, and cel apoptosis was detected by TUNEL method. RESULTS AND CONCLUSION: Light microscopy showed chondrocytes degeneration and reduction, as wel as fibrosis in matrix of cartilage in the ischemia/reperfusion group. Chondrocyte apoptosis was observed in both groups by TUNEL. Several apoptotic cells, less than five, were observed in the sham-surgery, while 10-30 apoptotic cells were found in ischemia/reperfusion group at 48 hours. Results indicated that ischemia/reperfusion can induce degenerative changes in articular cartilage of femoral head epiphyses, and cel apoptosis in developing hip joint may participate in damage of articular cartilage. Inhibition of chondrocyte apoptosis in articular cartilage may be useful for the prevention and cure of early osteoarthritis.

Objective To study the influence of sufentanil on analgesic effect and hemodynamics during recovery period of general anesthesia in elderly patients.Methods Eighty patients with general anesthesia were randomly divided into 4 groups (20 cases in each group).Ten min before surgery ended patients in each group were intravenous injected different dose of sufentanil:group S1 with sufentanil 0.2 μg/kg,group S2 0.4 μg/kg,group S3 0.6 μg/kg,and group C (control group) with saline 5 ml.The time of spontaneous breath restores,the time of summon opening eyes and extubation,the cases occurred cough,nausea,vomiting during recovery period were recorded and the VRS pain scores and Ramsay score 10 min after extubation were also recorded.Mean arterial pressure (MAP) and the heart rate (HR) were recorded before the anesthesia induction(T0),stopped anesthetic (T1),pre-extubation (T2),5 min and 10 min after extubation (T3 or T4)Results As group S1 and S2 compared with group C,there was no significant difference on the time of spontaneous breath restores,the time of summon opening eyes,and the time of extubation and leaving the operating room (P ＞ 0.05).However,there was significant difference on the time of spontaneous breath restores ((7.3 ± 4.1) min vs (10.2 ± 4.7) min),the time of summon opening eyes ((8.1 ± 3.1) min vs (11.2 ± 3.7)min),the time of extubation ((12.3 ± 3.1) min vs (16.3 ± 5.9) min),and the time of leaving the operating room((21.4 ±3.0)min vs (24.2 ±3.5)min) between the group S3 and group C(P＜0.01 or P ＜0.05)Patients occurred cough in group S1,S2 and S3 were less than those in group C (P ＜0.05),but there was no significant difference on the occurrence of nausea and vomiting between group S1-3 and group C (P ＞ 0.05)There was significant difference on VRS pain score and Ramsav score between group S1-3 and group C(P ＜0.01).MAP and HR were increased in all points of time as compared with T0 (P ＜ 0.05 or P ＜ 0.01).And there was significant difference on MAP and HR between group S1-3 and group C (P ＜ 0.05 or P ＜ 0.01).Conclusion Before the end of anesthesia sufentanil 0.2 ～ 0.4 μg/kg intravenous injection could be able to enhance analgesic effect,stabilize hemodynamics and do not affect regain consciousness in elderly patients.

Objective To explore the risk factors for upper gastrointestinal haemorrhage (UGH) in hepatocellular carcinoma (HCC) with portal hypertension (PH). Methods We retrospectively reviewed the medical records of 231 patients with HCC-PH treated in our Department from 1st January 2005 to 1st August 2009. The clinicopathologic factors were evaluated for their possible association with UGH in univariate analysis followed by multivariate analysis using Logistic regression model. The overall survival (OS) was calculated by the Kaplan-Meier method. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity were carried out to assess the predictive ability of the independent risk factors. Results Among 247 patients diagnosed with HCC-PH, 231 patients met the inclusion criteria and were entered into this study. UGH occurred in 28 patients (12.12 %, 28/231). Patients suffering from UGH had a higher 30-and 60-d mortality when compared with the non UGH group (53.57% vs. 4.43%, 96.43%vs. 10.34%, P＜0. 001, 0. 001). The 1-,2-and 3-year overall survival (OS) rates in the non-UGH and the UGH groups were 3. 57% (1/28), 0% (0/28), 0% (0/28) and 21.18% (43/203), 14.29% (29/203), 4.43% (9/203), respectively. There was a trend towards a non-significantly statistical difference in long-term (≥3 yr) survival (P=0. 605). UGH had a dismal prognosis with a median OS of 0. 8 months (0. 10-2. 40 months). Multivariate analysis of the risk factors showed elevated alpha-fetoprotein (AFP) (P = 0. 026) and aspartate aminotransferase (AST) more than twice normal (2N)(P=0. 004) were predictive factors, in particular, AST≥2N. A cutoff value (PI≥7. 242) predicted UGH with an AUC of 0.828 (95%CI, 0.698-0.957), sensitivity of 81.0% and a specificity of 81.0%, as calculated from the ROC. Risk score stratification predicted UGH to show a statistically significant difference (P＜0. 001). Conclusions UGH, as one of the end-stage incidents of HCC-PH,had a dismal prognosis. Patients with elevated AFP levels and AST levels above 2N were associated with high risks for UGH and should be monitored carefully or offered prophylactic treatments. Risk score stratification was useful for prediction of UGH.

Objective To evaluate factors affecting early recurrence and overall survival after curative hepatectomy for hepatocellular carcinoma (HCC) in cirrhotic patients. Methods Sixty two HCC cases with concomitant liver cirrhosis were retrospectively reviewed after curative hepatectomy in our department during the period between Jan. 2002 and Jan. 2009. Clinicopathologic data were evaluated for their possible association with postoperative early recurrence (ER) and overall survival (OS) in univariate analysis followed by multivariate analysis using COX proportional hazard model. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity was applied to assess predictive ability of independent risk factors. Results During follow-up period, 47 patients developed postoperative ER. The 1-, 2-, 3-and 5-year cumulative recurrence rate was 62.9% (39/62) ,75.8% (47/62), 80.7% (50/62), 83.9% (53/62) ,respectively. The 1-, 3- and 5-year OS rates were 59. 7% (37/62), 21.0% (13/62) and 1.6% (1/62), respectively. Multivariate analysis revealed that increased BCLC staging, severity of liver cirrhosis and tumoral residue resectional edge as independent risk factors influencing ER. Cutoff point value ( PI ≥2.171 ) predicted ER with AUC of 0.874(95%CI, 0.757～0.990), sensitivity was 85. 1% and specificity was 77. 8% calculated from ROC.Difference of median recurrence time according to risk stratification reached statistical significance ( 18.7mons, 7.7 mons vs. 2.9 mons, Log-rank test,λ2 =25. 288, P =0.000. While ER, post-recurrence treatment and severity of liver cirrhosis affected OS, cutoff point value ( PI ≥ 2. 893 ) predicted OS with sensitivity 86. 8%, and specificity 88.9%, with AUC 0.894(95% CI,0.798 ～ 0.990). Median OS time according to risk stratification demonstrated significant difference (27.8 mons, 21.5 mons vs. 8.5 mons,Log-rank test, λ2 = 30. 869, P = 0. 000). Conclusion Severity of liver cirrhosis and surgical tumor margin determines postoperative ER and OS for HCC after curative hepatectomy. Effective management of ER also contributes to good prognosis. Risk stratification can be used for evaluation of ER and OS of HCC.

Objective To observe the clinical effect and comfortable degree of the mode of super hair removal. Methods The mode of super hair removal was used to depilate the hair nearby the hair line, cheeks, upper lip, beard, ventrum, areola of breast, axillary cavity, extremities, bikini area and so on. The total number of sites was 1 000. Some sites that were especially susceptible to pain, for example, upper lip and buccal region, were smeared with compound lidocaine cream for 1 hour at least before treatment. Results Hairs in the areas of extremities, ventrum, back and axillary cavity generally needed 4 to 5 times to eradicate, and the patients had no evident discomfortableness; hairs near to the upper lip and lower mandible generally needed 5 to 7 times to reach the effect which the patient was content, and anesthetics was indispensable, or the patients would present discomfortableness. Conclusions The mode of super hair removal is more effective, quicker and more comfortable in comparison with conventional methods. Therefore, it deserves to be spread.

Objective To determine the value of helical computed tomography (HCT) and color doppler flowing imaging (CDPI) in evaluating the resectability of pancreatic cancer. Methods The clinical data of 114 patients with pancreatic cancer who had been admitted to the Affiliated Hospital of North Sichuan Medical College from January 1995 to December 2002 were retrospectively analyzed. The values of HCT and CDPI in assessing the resectability of pancreatic cancer were determined according to the results of operation and pathological examina-tion. All the data were analyzed by chi-square test and Fisher exact probability. Results Of all patients, 109 were examined by HCT, 97 by CDPI and 96 by HCT+CDPI. For patients examined by HCT, the resection rates of pancreatic head cancer, pancreatic body and tail cancer and total pancreatic cancer were 45.3% (39/86), 26.3% (5/19) and 0 (0/9), respectively. The resection rate of pancreatic head cancer was higher than that of pancreatic body and tail cancer (χ2=8.965, P<0.05). With the increase of tumor size, the invasion rate and metastasis rate were increased and the resection rate was decreased (z=6.15, 5.35, 7.18, P<0.01). The sensitivity rate and specificity rate were 77.8% and 82.2% of HCT, 73.3% and 80.6% of CDPI, 90.6% and 92.4% of HCT+CDPI in assessing the resectability of pancreatic cancer. The values of Kappa identity test of HCT, CDPI and HCT+CDPI were 0.58, 0.52 and 0.82, respectively. Conclusions Combined application of HCT and CDPI can further improve the accuracy in assessing the resectability of pancreatic cancer.

Objective To evaluate the clinical results of indirect reduction and fixation with the self-manufactured external fixator as a viable alternative in the surgical treatment of intraarticular calcaneal fractures.Methods From May 2006 to May 2009,a total of 30 patients undergone surgical treatment of intraarticular calcaneal fractures were analyzed,including 20 males and 10 females with an average age of 36 years (range,15-53).According to Sanders classification based on the computed tomography scan of intraarticular calcaneal fractures,16 patients were classified as type-Ⅲ,and 14 type-Ⅳ in this series.All fractures were treated first with the external fixator as indirect reduction and fixation device on the whole,which can enlarge the interspace of the subtalar joint significantly.Then,posterior articular facet of calcaneus was exposed and reduced through a small lateral incision.The calcaneal's length,breadth,thalamus height,maximum vertical displacement of the post-articular surface,and B(o)hler angle were measured preoperatively,3 days and 6 months after operation in X-ray film.Reduction results were evaluated by CT scan according to the standard of Buckley.Results The average follow-up time of all patients was 29 months (range,4-45).Lateral and axial roentgenograms showed satisfactory restoration of the calcaneal's anatomical structure.There were significant differences between preoperative values and those 3 days or 6 months postoperatively.There were no significant differences between values 3 days postoperatively and those 6 months postoperatively.The reduction results of posterior articular facet were evaluated by CT scan.Twenty-seven patients obtained anatomical reduction,3 patients obtained uneven articular facet within 2 mm.Conclusion This selfmanufactured external fixator is a vialbe alternative in the treatment of intraarticular calcaneal fractures,which has advantages of minimal invasion,practicality and less complications.

Objective:To explore a surgical method for patients with moderate to severe hypertrophy of the labia minora, obvious pigmentation, and bilateral asymmetry.Methods:From August 2016 to August 2018, we applied a combined wedge resection and marginal arc resection to 23 cases of labia minora hypertrophy.Results:There were no complications such as infection and hematoma, and the incision healed in one stage. The follow-up period was from 1 month to 6 months. The width of the labia minora did not exceed 1.5 cm, and the appearance was natural, beautiful and rejuvenated. The patients were satisfied.Conclusions:Layered wedge resection combined with edge arc resection of the labia minora has the advantages of natural youthful appearance, low secondary surgical repair rate, fewer postoperative complications, and high patient satisfaction. It is agood approach for the labia majora, especially the moderate to severe type. Patients with obvious pigmentation and bilateral asymmetry are an ideal candidates for this method.

Objective:To explore a surgical method for patients with moderate to severe hypertrophy of the labia minora, obvious pigmentation, and bilateral asymmetry.Methods:From August 2016 to August 2018, we applied a combined wedge resection and marginal arc resection to 23 cases of labia minora hypertrophy.Results:There were no complications such as infection and hematoma, and the incision healed in one stage. The follow-up period was from 1 month to 6 months. The width of the labia minora did not exceed 1.5 cm, and the appearance was natural, beautiful and rejuvenated. The patients were satisfied.Conclusions:Layered wedge resection combined with edge arc resection of the labia minora has the advantages of natural youthful appearance, low secondary surgical repair rate, fewer postoperative complications, and high patient satisfaction. It is agood approach for the labia majora, especially the moderate to severe type. Patients with obvious pigmentation and bilateral asymmetry are an ideal candidates for this method.

Objective:To study the safety and efficacy of laparoscopic liver resection in treatment of intrahepatic cholangiocarcinoma (ICC).Methods:A retrospective study was conducted on the clinicopathological data of 65 patients with ICC who underwent hepatectomy from January 2014 to May 2020 in the Affiliated Hospital of North Sichuan Medical College. There were 37 males and 28 female with an average age of 52 years old. There were 23 patients in the laparoscopy group and 42 patients in the open liver resection (laparotomy) group. The surgical data, complications, long-term recurrence and survival rates were compared between groups.Results:The blood transfusion rate in the laparoscopy group was 8.7% (2/23), which was significantly lower than that in the laparotomy group (16.7% or 7/42) ( P=0.028). The recovery time of gastrointestinal function in the laparoscopy group was (2.8±1.6) days, which was significantly shorter than that in the laparotomy group (4.3±1.1 days, P=0.006). The incidence of complications in the laparotomy group was 31.0% (13/42), which was significantly higher than that in the laparoscopy group (17.4% or 4/23) ( P=0.033). There were 11 patients (47.8%) in the laparoscopy group and 22 patients (52.4%) in the laparotomy group who developed tumor recurrence, with no significant difference in the recurrence rates between the two groups ( P=0.788). The 1, 3, and 5-year cumulative survival rates in the laparoscopy group were 82.6%, 47.8%, and 34.8%, and 83.3%, 42.9%, and 28.6% respectively in the laparotomy group. There were no significant differences in the cumulative survival rates between the two groups ( P=0.494). Conclusions:Laparoscopic radical resection of ICC was technically feasible, safe, and efficacious. Laparoscopic liver resection achieved better results in blood transfusion, gastrointestinal function recovery, and perioperative complications rates than laparotomy.