In recent years, the number of patients with vaginal relaxation has increased year by year, and the minimally invasive vaginal contraction has been carried out more and more widely in clinical practice, but the treatment normalization and safety have not been thoroughly studied. We summarized six cases of characteristics and treatment measures for patients with various complications after minimally invasive vaginal contraction surgery from September 2021 to December 2023 at Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital. The patients' age ranged from 26 to 44 years. Two cases accepted vaginal contraction with embedded vaginal thread, and four accepted vaginal contraction with acellular allogenic dermis. One patient showed vaginal hyper-tightness, one patient showed subcutaneous suture nodules, two patients showed explosion of acellular allogenic dermis, and three patients showed vaginal infection symptoms such as yellow leucorrhea and peculiar smell. All patients had sexual pain and discomfort. One patient underwent vaginal orifice dilation, one patient underwent suture extraction and secondary vaginal contraction, one patient underwent acellular allogenic dermis extraction and immediate vaginal contraction, two patients underwent acellular allogenic dermis extraction and secondary vaginal contraction, and one patient underwent secondary vaginal contraction. The symptoms of all six patients were relieved after treatment. Despite the short operation time and fast postoperative recovery of minimally invasive vaginal contraction, there are still complications after surgery, causing physical and mental damage to patients. Plastic surgeons, therefore, should be cautious in the treatment process to avoid collateral damage, so that patients get the best treatment effect.

In recent years, the number of patients with vaginal relaxation has increased year by year, and the minimally invasive vaginal contraction has been carried out more and more widely in clinical practice, but the treatment normalization and safety have not been thoroughly studied. We summarized six cases of characteristics and treatment measures for patients with various complications after minimally invasive vaginal contraction surgery from September 2021 to December 2023 at Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital. The patients' age ranged from 26 to 44 years. Two cases accepted vaginal contraction with embedded vaginal thread, and four accepted vaginal contraction with acellular allogenic dermis. One patient showed vaginal hyper-tightness, one patient showed subcutaneous suture nodules, two patients showed explosion of acellular allogenic dermis, and three patients showed vaginal infection symptoms such as yellow leucorrhea and peculiar smell. All patients had sexual pain and discomfort. One patient underwent vaginal orifice dilation, one patient underwent suture extraction and secondary vaginal contraction, one patient underwent acellular allogenic dermis extraction and immediate vaginal contraction, two patients underwent acellular allogenic dermis extraction and secondary vaginal contraction, and one patient underwent secondary vaginal contraction. The symptoms of all six patients were relieved after treatment. Despite the short operation time and fast postoperative recovery of minimally invasive vaginal contraction, there are still complications after surgery, causing physical and mental damage to patients. Plastic surgeons, therefore, should be cautious in the treatment process to avoid collateral damage, so that patients get the best treatment effect.

Objective:To identify a new type of hypertrophy of the clitoral hood-labia minora complex(CLC), to propose a classification system for the hypertrophy, and to evaluate surgical techniques and clinical outcomes for fused lateral clitoral hood and labia minora.Methods:A retrospective analysis was conducted on clinical data from patients who underwent labiaplasty surgery at the Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital from January 2013 to October 2023. CLC hypertrophy was classified into three types based on whether the CLC was hypertrophic and their free edges fused. Type Ⅰ: isolated labia minora hypertrophy; Type Ⅱ: independent lateral clitoral hood and labia minora hypertrophy; Type Ⅲ: fused type of lateral clitoral hood and labia minora hypertrophy. Type Ⅲ patients were divided into a wedge excision group and a four-step excision group. A satisfaction survey was conducted three months postoperatively using the Goodman female genital aesthetic surgery questionnaire, distributed online to evaluate the surgical outcomes based on vulvar appearance improvement rate, preoperative discomfort improvement rate, postoperative discomfort rate, sexual quality improvement rate, partner satisfaction, and overall satisfaction. Statistical analysis was performed using SPSS 26.0 software, with normal distribution data presented as Mean±SD, intergroup comparisons conducted using t-test, and count data expressed as frequency and(or) percentage with chi-square tests. A P-value < 0.05 was considered statistically significant. Results:A total of 651 female patients (1 243 sides) with CLC hypertrophic deformities were enrolled, aged 18-55 years, with a mean age of 30.7 years. Type Ⅰ consisted of 198 patients with 301 sides(24.22%), Type Ⅱ consisted of 420 patients with 743 sides(59.77%), and Type Ⅲ consisted of 116 patients with 199 sides(16.01%). Some patients had different classifications of CLC on the left and right sides. Among the Type Ⅲ patients, 22 cases were in the wedge resection group and 94 cases in the four-step resection group. Three months postoperatively, 112 patients (195 sides) out of 116 Type Ⅲ patients (199 sides) completed the satisfaction survey. The wedge resection group had 22 patients (44 sides), with an age of (31.6±5.2) years, and the four-step resection group had 90 patients (151 sides), with an age of (32.6±5.5) years. There was no statistically significant difference in age between the two groups ( P>0.05). The four-step resection group had significantly higher vulvar appearance improvement rate [61.11%(55/90) vs. 22.73%(5/22)], preoperative discomfort improvement rate[92.68%(76/82) vs. 58.82%(10/17)], and overall satisfaction [90.00% (81/90) vs. 68.18% (15/22)] compared to the wedge resection group ( P<0.05 for all). The four-step resection group had a sexual quality improvement rate of 21.05%(16/76) and partner satisfaction of 91.14% (72/79), which were not statistically different from the wedge resection group [12.50%(2/16) and 75.00% (12/16)]( P>0.05 for both). The proportion of patients with postoperative discomfort in the four-step resection group was 8.89% (8/90), significantly lower than the 31.82% (7/22) in the wedge resection group ( P< 0.05). There was no statistically significant difference in complication rate between the four-step resection group [2.65% (4/151)] and the wedge resection group [4.55% (2/44)]. Conclusion:CLC hypertrophy can be classified based on clitoral hood and labia minora hypertrophy and fusion type, including isolated labia minora hypertrophy, independent lateral clitoral hood and labia minora hypertrophy, and fused type of lateral clitoral hood and labia minora hypertrophy. The four-step excision method for correcting fused type of lateral clitoral hood and labia minora hypertrophy yields excellent surgical outcomes, low complication rates, and high patient satisfaction.

Objective:To identify a new type of hypertrophy of the clitoral hood-labia minora complex(CLC), to propose a classification system for the hypertrophy, and to evaluate surgical techniques and clinical outcomes for fused lateral clitoral hood and labia minora.Methods:A retrospective analysis was conducted on clinical data from patients who underwent labiaplasty surgery at the Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital from January 2013 to October 2023. CLC hypertrophy was classified into three types based on whether the CLC was hypertrophic and their free edges fused. Type Ⅰ: isolated labia minora hypertrophy; Type Ⅱ: independent lateral clitoral hood and labia minora hypertrophy; Type Ⅲ: fused type of lateral clitoral hood and labia minora hypertrophy. Type Ⅲ patients were divided into a wedge excision group and a four-step excision group. A satisfaction survey was conducted three months postoperatively using the Goodman female genital aesthetic surgery questionnaire, distributed online to evaluate the surgical outcomes based on vulvar appearance improvement rate, preoperative discomfort improvement rate, postoperative discomfort rate, sexual quality improvement rate, partner satisfaction, and overall satisfaction. Statistical analysis was performed using SPSS 26.0 software, with normal distribution data presented as Mean±SD, intergroup comparisons conducted using t-test, and count data expressed as frequency and(or) percentage with chi-square tests. A P-value < 0.05 was considered statistically significant. Results:A total of 651 female patients (1 243 sides) with CLC hypertrophic deformities were enrolled, aged 18-55 years, with a mean age of 30.7 years. Type Ⅰ consisted of 198 patients with 301 sides(24.22%), Type Ⅱ consisted of 420 patients with 743 sides(59.77%), and Type Ⅲ consisted of 116 patients with 199 sides(16.01%). Some patients had different classifications of CLC on the left and right sides. Among the Type Ⅲ patients, 22 cases were in the wedge resection group and 94 cases in the four-step resection group. Three months postoperatively, 112 patients (195 sides) out of 116 Type Ⅲ patients (199 sides) completed the satisfaction survey. The wedge resection group had 22 patients (44 sides), with an age of (31.6±5.2) years, and the four-step resection group had 90 patients (151 sides), with an age of (32.6±5.5) years. There was no statistically significant difference in age between the two groups ( P>0.05). The four-step resection group had significantly higher vulvar appearance improvement rate [61.11%(55/90) vs. 22.73%(5/22)], preoperative discomfort improvement rate[92.68%(76/82) vs. 58.82%(10/17)], and overall satisfaction [90.00% (81/90) vs. 68.18% (15/22)] compared to the wedge resection group ( P<0.05 for all). The four-step resection group had a sexual quality improvement rate of 21.05%(16/76) and partner satisfaction of 91.14% (72/79), which were not statistically different from the wedge resection group [12.50%(2/16) and 75.00% (12/16)]( P>0.05 for both). The proportion of patients with postoperative discomfort in the four-step resection group was 8.89% (8/90), significantly lower than the 31.82% (7/22) in the wedge resection group ( P< 0.05). There was no statistically significant difference in complication rate between the four-step resection group [2.65% (4/151)] and the wedge resection group [4.55% (2/44)]. Conclusion:CLC hypertrophy can be classified based on clitoral hood and labia minora hypertrophy and fusion type, including isolated labia minora hypertrophy, independent lateral clitoral hood and labia minora hypertrophy, and fused type of lateral clitoral hood and labia minora hypertrophy. The four-step excision method for correcting fused type of lateral clitoral hood and labia minora hypertrophy yields excellent surgical outcomes, low complication rates, and high patient satisfaction.

Objective:To examine the prognosis factors of postoperative cardiac complications in colorectal cancer patients co-morbidated with coronary artery disease.Methods:Clinical data of 449 patients colorectal cancer patients co-morbidated with coronary artery disease accepted redical surgery from April 2013 to April 2020 at Department of General Surgery, Peking Union Medical College Hospital were analyzed retrospectively. There were 306 males and 143 females, aging (68.7±8.9) years (range: 44 to 89 years). Postoperative acute coronary syndrome, new-onset arrhythmia and heart failure that causes clinical symptoms were recorded as cardiac complications. t test, χ 2 test and Fisher exact test were used for univariate analysis of prognosis factors of postoperative cardiac events. The variables with P<0.05 were included in the multivariate Logistic regression was used to determine the independent prognosis factors. Results:After surgery, 44 patients (9.8%) suffered from at least one cardiac event, including 30 patients with acute coronary syndrome, 19 patients with new-onset arrhythmia and 9 patients with heart failure. There were 3 deaths in the cohort within 30 days after surgery. Two patients died from cardiac-related complications, and one from septic shock due to postoperative anastomotic leaks. On Univariate analysis showed that cardiac complications were associated with age ≥80 years, co-morbidated diabetes, emergency surgery, re-operation, anastomotic leakage, intestinal flora disorder and elevation of preoperative neutrophil-lymphocyte ratio (χ 2: 4.308 to 12.219, all P<0.05). Multivariate Logistic regression analysis identified age ≥80 years ( OR=3.195, 95% CI: 1.379 to 7.407, P=0.007), co-morbidated diabetes ( OR=2.551, 95% CI: 1.294 to 5.025, P=0.007), emergency surgery ( OR=4.717, 95% CI: 1.052 to 20.833, P=0.043), and elevated preoperative neutrophil-lymphocyte ratio ( OR=1.114, 95% CI: 1.018 to 1.218, P=0.018) as independent prognosis factors for cardiac complications. Conclusions:Emergency surgery, advanced age, co-morbidated type 2 diabetes and elevated preoperative neutrophil-lymphocyte ratio may increase the risk of postoperative cardiac complications in colorectal cancer patients with coronary artery disease. Surgeons should strictly master surgical indications, pay attention to preoperative assessment, perioperative monitoring, and diagnosis and treatment of postoperative complications in order to reduce the risk of complications.

Objective:To examine the prognosis factors of postoperative cardiac complications in colorectal cancer patients co-morbidated with coronary artery disease.Methods:Clinical data of 449 patients colorectal cancer patients co-morbidated with coronary artery disease accepted redical surgery from April 2013 to April 2020 at Department of General Surgery, Peking Union Medical College Hospital were analyzed retrospectively. There were 306 males and 143 females, aging (68.7±8.9) years (range: 44 to 89 years). Postoperative acute coronary syndrome, new-onset arrhythmia and heart failure that causes clinical symptoms were recorded as cardiac complications. t test, χ 2 test and Fisher exact test were used for univariate analysis of prognosis factors of postoperative cardiac events. The variables with P<0.05 were included in the multivariate Logistic regression was used to determine the independent prognosis factors. Results:After surgery, 44 patients (9.8%) suffered from at least one cardiac event, including 30 patients with acute coronary syndrome, 19 patients with new-onset arrhythmia and 9 patients with heart failure. There were 3 deaths in the cohort within 30 days after surgery. Two patients died from cardiac-related complications, and one from septic shock due to postoperative anastomotic leaks. On Univariate analysis showed that cardiac complications were associated with age ≥80 years, co-morbidated diabetes, emergency surgery, re-operation, anastomotic leakage, intestinal flora disorder and elevation of preoperative neutrophil-lymphocyte ratio (χ 2: 4.308 to 12.219, all P<0.05). Multivariate Logistic regression analysis identified age ≥80 years ( OR=3.195, 95% CI: 1.379 to 7.407, P=0.007), co-morbidated diabetes ( OR=2.551, 95% CI: 1.294 to 5.025, P=0.007), emergency surgery ( OR=4.717, 95% CI: 1.052 to 20.833, P=0.043), and elevated preoperative neutrophil-lymphocyte ratio ( OR=1.114, 95% CI: 1.018 to 1.218, P=0.018) as independent prognosis factors for cardiac complications. Conclusions:Emergency surgery, advanced age, co-morbidated type 2 diabetes and elevated preoperative neutrophil-lymphocyte ratio may increase the risk of postoperative cardiac complications in colorectal cancer patients with coronary artery disease. Surgeons should strictly master surgical indications, pay attention to preoperative assessment, perioperative monitoring, and diagnosis and treatment of postoperative complications in order to reduce the risk of complications.

Objective: To investigate the clinical value of combined detection of serum miR-378 and miR-21 in gastric cancer (GC). Methods: Eighty-seven patients with GC and 78 patients with colorectal cancer(CRC) from National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences were selected, 83 individuals undergoing healthy physical examination were selected as the healthy controls. The levels of serum miR-378 and miR-21 were detected by quantitative real-time PCR (RT-qPCR) (result data were transformed as log2 for analysis). Results: Relative expression levels of miR-378 in the serum were -1.24, -3.25 and -2.73 in healthy controls, GC and CRC patients, respectively. Compared with the healthy controls, the levels of serum miR-378 were significantly decreased in GC and CRC patients (both P<0.05). Relative expression levels of miR-21 in the serum were 0.11, 2.34 and 2.47 in healthy controls, GC and CRC patients, respectively. Compared with the healthy controls, the levels of serum miR-21 were significantly up-regulated in GC and CRC patients (both P<0.05). Moreover, the serum level of miR-378 in GC patients was inversely associated with tumor clinical stage (P<0.05). However, the level of miR-21 showed no significant differences among patients with different clinical and pathological characteristics (all P>0.05). The area under the receiver operating characteristic curve (AUC), sensitivity and specificity of miRNA-378 to diagnose GC was 0.770, 82.0% and 66.0%, respectively, and were 0.900, 85.0%, and 88.0% of miR-21, respectively. The AUC, sensitivity and specificity of combined detection of serum miR-378 and miR-21 to diagnose GC were 0.930, 92.0% and 87.0%, respectively, while the AUC of combined detection of serum CEA and CA-199 was 0.767, the AUC of combined all of the four factors was 0.946. Conclusion The combined detection of serum miR-378 and miR-21 have a certain effect on diagnosis of GC.

Objective To study the optimum combination of orientation parameter of total hip prosthesis and acetabular safe zone on condition that the range of motion for activities of daily living (ADL) is fulfilled.Methods A three-dimensional generic parametric and visually kinematic simulation module of THA was developed.Range of motion ( ROM ) of hip flexion ≥ 110°,internal-rotation ≥30° at 90° flexion,extension ≥30° and external rotation ≥40° were defined as the normal criteria for ADL.ROM of hip flexion ≥ 120°,internal-rotation ≥45° at 90° flexion,extension ≥30° and external rotation ≥40° were as the severe criteria.The ranges of changes in general ratios (GRs) of head-neck,femoral neck antevemion ( FNA ),operative inclination (OI) and anteversion (OA) of acetabulur components were 2.0-2.92,0°-30°,10°-60°,and 0°-70° respectively.Within the limits of the upper two activity criteria,the synchronous OA of acetabulur components was calculated with every 5°change in OI of the cup,and the collodiaphyseal angle ( CDD ) was set as 135°.The safe-zone of combination of acetabulur operative anteversion (OA) and inclination (OI) was defined as the area that fulfilled the two mentioned criteria of ROM without cup-neck impingement.All parameters were analyzed by using SAS 6.12 software.Results The safe zone of acetabdar angle rose with the increase of GRs of head-neck and the safe zone of severe criteria was smaller than that of normal criteria.When the CDD angle was 135°,the sum of average aeetabular OA and acetahular OI plus 0.816 times of the FNA equaled to 84.76° innormal criteria; and the sum of average acetabular OA and acetabular OI plus 0.873 times of the FNA equaled to 92.04° in severe criteria.Conclusions A high GR of head-neck greatly increases the size of safe-zone of acetabular angle.The higher demand of ROM of hip joint requires the smaller safe zone of acetabular angle,as can be corrected by increasing the GR of head-neck.The optimum combination between the sum of average acetabular OA and acetabular OI ( Y) plus FA (X)in the normal criteria and severe criteria can be estimated by using the following formulae:Y1 =-0.816X1 + 84.76 (R2 =0.993 ),Y2 =-0.873X2 + 92.04( R2 =0.999) respectively.

Objective To investigate the feasibility and clinical effects of suture anchors technique for acute distal avulsion fracture of patella. Methods From January 2007 to July 2009, 33 patients(18males and 15 females, ranging from 28 to 72 years, with an average of 49.3 years) were treated with the suture anchors technique. The average time from injury to surgery was 3.5 days(2 to 7 d). Injury reason: traffic accident in 12 cases, injured in daily life in 11 cases, sports injury 9 cases, no clear trauma history in one case. The Bostman evaluation system, follow-up X-ray, and knee mobility were used to analyze the clinical effects of suture anchors technique. Results All patients obtained the follow-up and the average time was 16.5 months(12 to 23 months ). One patient suffered foreign body reaction, and his wound healing was good after operation. The remaining patient wound healing was good. No complications were found in all patients,such as popliteal fossa artery, tibial nerves or peroneal nerve complication. Bostman patella fracture functional score 27.3±2.3 points at the sixth months follow up, 28 cases were rated as excellent, 5 cases were good, and the excellent and good rate was 100%. Six months later, X-ray showed bone healing, knee activity recovered well. The Range of Motion was extension for -2.5°±2.1° and flexion for 122°±5.3°. Conclusion Suture anchors fixation in treatment of acute distal avulsion fracture of patella has a good efficacy, safety and reliability advantages, and without the second operation. This technique provides an alternative in lower pole patella fracture.

Objective To evaluate the accuracy of thoracic pedicle screw placement using the "funnel technique" and investigate its consistency in experimental study and clinical application.Methods The clinical data of three human cadavers and 11 patients with the installation of at least one thoracic pedicle screw at T1 -T12 from August 2006 to July 2008 were retrospectively analyzed. One junior spine surgeon lack of experience were responsible for placing these screws with the "funnel technique".The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing postoperative CT scans. Results The mean follow-up time was 23.1 months,which showed no vascular or visceral complications, or iatrogenic neurological injury. The rate of unintended cortex perforations was 14% (10/72) in cadavers and 15% (8/55) in patients, respectively.The critical perforation occurred in two screws (3%) in cadavers and one screw (2%) in patients. There was no statistical difference between the percentage of cortex perforations in cadavers and patients. Of all the 11 patients, screw violation occurred laterally in six ( 11% ), medially in one ( 2% ) and superiorly in one (2%). No violations occurred inferiorly or anteriorly. For all patients, only one screw needed revision. The perforations made by the junior spine surgeon occurred in six screws in the first cadaver, three in the second cadaver and one in the third cadaver. Conclusions The "funnel technique" is a simple,safe, accurate and cost-effective technique for pedicle screw placement. The result of the experimental study is consistent with that of the clinical application. "funnel technique" is helpful for junior spine surgeons to master the technique of thoracic pedicle screw placement.