Objective To investigate the effect of dexmedetomidine combined with the preemptive analgesia with dezocine on the treatment of patients with prolapse and prolapse of hemorrhoids (PPH).Methods A total of 60 patients with PPH were randomly divided into dexmedetomidine + dezocine group (group A) and normal saline + dezocine group (group B).All patients received lowdose saddle anesthesia,and at the time points of saddle anesthesia fixed plane (T0),firing the stapler (T1) and at the end of operation (T2),systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),Ramsay sedation score,the incidence of postoperative analgesic effect and complications were compared between two groups.Results At T1 and T2,the SBP,DBP and HR of group A were significantly lower than those of group B (P ＜ 0.05),and the score of Ramsay sedation was significantly higher than that of group B (P ＜ 0.05).The analgesic effect VAS scores of group A at 4,8,12,24 and 48 h after operation were significantly lower than those in group B (P ＜0.05).There was no significant difference in anal distention and discomfort between the two groups (P ＞ 0.05).There were significant differences in the incidence of urinary retention,nausea and vomiting,and nocturnal sleep disorders between the two groups (P ＜ 0.01).Conclusion Dexmedetomidine combined with preemptive analgesia with dezocine is effective in treatment of patients with PPH surgery.

Objective To investigate the effect of dexmedetomidine combined with the preemptive analgesia with dezocine on the treatment of patients with prolapse and prolapse of hemorrhoids (PPH).Methods A total of 60 patients with PPH were randomly divided into dexmedetomidine + dezocine group (group A) and normal saline + dezocine group (group B).All patients received lowdose saddle anesthesia,and at the time points of saddle anesthesia fixed plane (T0),firing the stapler (T1) and at the end of operation (T2),systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),Ramsay sedation score,the incidence of postoperative analgesic effect and complications were compared between two groups.Results At T1 and T2,the SBP,DBP and HR of group A were significantly lower than those of group B (P ＜ 0.05),and the score of Ramsay sedation was significantly higher than that of group B (P ＜ 0.05).The analgesic effect VAS scores of group A at 4,8,12,24 and 48 h after operation were significantly lower than those in group B (P ＜0.05).There was no significant difference in anal distention and discomfort between the two groups (P ＞ 0.05).There were significant differences in the incidence of urinary retention,nausea and vomiting,and nocturnal sleep disorders between the two groups (P ＜ 0.01).Conclusion Dexmedetomidine combined with preemptive analgesia with dezocine is effective in treatment of patients with PPH surgery.

Pancreatic neoplasms have characteristics of indiscoverable growth and complex anatomy,which lead to difficulties of diagnosis and treatment.With the development of medicine,multidisciplinary team has become increasingly prevalent in the management of pancreatic neoplasms.In the paper,the definition of multidisciplinary team,domestic and international development of multidisciplinary management,the value of multidisciplinary management in pancreatic neoplasms,and our experiences of multidisciplinary management are discussed to further improve the level of multidisciplinary management and prognosis of patients with pancreatic neoplasms in China.

Objective To summarize the strategy of sequential parathyroidectomy for secondary hyperparathyroidism.Methods Between January 2009 and December 2017,32 patients with secondary hyperparathyroidism underwent parathyroidectomy in Department of General Surgery,Peking Union Medical College Hospital.There were 11 male and 21 female patients with a mean age of 51.3 years.Eleven of them underwent bilateral neck exploration under general anesthesia,while the rest of them underwent sequential parathyroidectomy.For the patients with sequential parathyroidectomy,a unilateral neck exploration was performed in the initial operation under cervical plexus blocking anesthesia.Second operation for contralateral parathyroid lesions was performed if the serum intact parathyroid hormone (iPTH) was still higher than 1 000 ng/L or related symptoms were not relieved significantly 6 months later after initial surgery.Fisher exact test was used to compare the date between the 2 groups.Results In the bilateral exploration group,the serum iPTH level gradually exceeded above 1 000 ng/L in 5 patients during followup,and reoperation were performed in 3 patients of them.In the group with sequential parathyroidectomy,the serum iPTH level after initial operation exceeded above 1 000 ng/L in 15 patients.Eleven of them underwent contralateral parathyroidectomy,which decreases the serum iPTH levels to less than 1 000 ng/L in 10 patients.Compared with the sequential parathyroidectomy group (1/11),more patients needed to be treated in the intensive care unit after operation in bilateral exploration group (6/11),although the difference was statistically insignificant (P=0.063).Conclusions Sequential parathyroidectomy strategy is feasible for the secondary hyperparathyroidism with severe complications.Prospective controlled observation with large sample size is needed to confirm its effect.

Objective To summarize the strategy of sequential parathyroidectomy for secondary hyperparathyroidism.Methods Between January 2009 and December 2017,32 patients with secondary hyperparathyroidism underwent parathyroidectomy in Department of General Surgery,Peking Union Medical College Hospital.There were 11 male and 21 female patients with a mean age of 51.3 years.Eleven of them underwent bilateral neck exploration under general anesthesia,while the rest of them underwent sequential parathyroidectomy.For the patients with sequential parathyroidectomy,a unilateral neck exploration was performed in the initial operation under cervical plexus blocking anesthesia.Second operation for contralateral parathyroid lesions was performed if the serum intact parathyroid hormone (iPTH) was still higher than 1 000 ng/L or related symptoms were not relieved significantly 6 months later after initial surgery.Fisher exact test was used to compare the date between the 2 groups.Results In the bilateral exploration group,the serum iPTH level gradually exceeded above 1 000 ng/L in 5 patients during followup,and reoperation were performed in 3 patients of them.In the group with sequential parathyroidectomy,the serum iPTH level after initial operation exceeded above 1 000 ng/L in 15 patients.Eleven of them underwent contralateral parathyroidectomy,which decreases the serum iPTH levels to less than 1 000 ng/L in 10 patients.Compared with the sequential parathyroidectomy group (1/11),more patients needed to be treated in the intensive care unit after operation in bilateral exploration group (6/11),although the difference was statistically insignificant (P=0.063).Conclusions Sequential parathyroidectomy strategy is feasible for the secondary hyperparathyroidism with severe complications.Prospective controlled observation with large sample size is needed to confirm its effect.

Three-dimensional printing is a technology that prints the products layer-by-layer, in which materials are deposited according to the digital model designed by computer aided design (CAD) software. This technology has competitive advantages regarding product design complexity, product personalization, and on-demand manufacturing. The emergence of 3D technology provides innovative strategies and new ways to develop novel drug delivery systems. This review summarizes the application of 3D printing technologies in the pharmaceutical field, with an emphasis on the advantages of 3D printing technologies for achieving rapid drug delivery, personalized drug delivery, compound drug delivery and customized drug delivery. In addition, this article illustrates the limitations and challenges of 3D printing technologies in the field of pharmaceutical formulation development.