Aim To investigate the effect of ranolazine postconditioning on myocardial apoptosis, the reperfusion injurysalvage kinase and the opening of MPTP in isolated rat hearts subjected to ischemia and reperfusion.Methods The langendorff mode was set up.Fifty-five SD rat hearts were randomly divided into 8 groups (n=7): ischema and reperfusion (I/R group),20 μmol·L~(-1) ranolazine postconditioning group(RPostC),ranolazine and the specific MPTP opener atractyloside group (RA), ranolazine and the specific ERK1/2 inhibitor PD98059 group (RP), ranolazine and the specific PI3K inhibitor PD98059 wortmannin group(RW), atractyloside group(A), PD98059 group (P) and wortmannin group (W). The isolated hearts were subjected to 30 minutes ischemia,10minutes drug postconditioning and 5 mitutes K-H buffer reperfusion.Myocardial apoptosis (TUNEL-positive cells), apoptotic index (AI), the opening of MPTP (spectrophotometry) and the The expression of p-AKT and p-ERK1/2 protein were measured at the end of reperfusion in each group.Results Compared with IR group, Myocardial AI and opening of MPTP were decreased in RPostC groups (P<0.05), the expression of p-AKT, p-ERK1/2 protein were increased in RPostC, RA, RP, and RW groups (P<0.05).There were no significant differences in other groups(P>0.05). Compared with RPostC group, Myocardial AI and opening of MPTP were increased in RA, RP, RW, A, P and W groups (P<0.05), and the expression of p-AKT、p-ERK1/2 protein were decreased in RP, RW, A, P and W groups (P<0.05). There were no significant differences of the expressions of p-AKT,p-ERK1/2 protein in RA groups (P>0.05). Compared with RA group, there were no significant differences in myocardial AI and opening of MPTP (P>0.05) and the expression of p-AKT and p-ERK1/2 protein were decreased in RP, RW, A, P and W groups (P<0.05).Conclusions Ranolazine postconditioning can attenuate myocardial apoptosis in isolated rat hearts subjected to ischemia and reperfusion via activation RISK pathway and inhibition of the opening of MPTP.

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.

Objective: To discuss the diagnosis, preoperative imaging and surgical technique of patients who underwent reoperation for persistent hyperparathyroidism. Methods: A prospective database about primary hyperparathyroidism in Department of General Surgery, Peking Union Medical College Hospital was searched for the patients who underwent reoperation for persistent hyperparathyroidism from January 2009 to December 2016. The information about the initial operation, preoperative imaging study and result of reoperations were collected and reviewed. A total of 58 patients underwent reoperation for hyperparathyroidism. Eleven of these patients were referred to this institute for reoperation after missing single parathyroid lesion in the initial parathyroidectomy. Nine patients were female, and the mean patient age at reoperation was 54.9 years. Results: For this group, the accuracy of ultrasound neck scan and sestamibi scintigraphy was 10/11 in identifying diseased parathyroid gland before reoperation. Combined with enhanced CT and SPECT, all parathyroid lesions were localized before reoperations. With general anesthesia or cervical plexus block, all diseased parathyroid glands were removed in the reoperations. No signs of hyperparathyroidism appeared during follow-up. Conclusions The initial surgery for primary hyperparathyroidism should be performed in experienced center to avoid reoperations. Combining preoperative localization and cervical exploration will help to increase the success rate of reoperation.

Objective To investigate the preoperative localizaion diagnosis and surgical strategies of primary hyperparathyroidism (pHPT).Methods The clinical data of pHPT patients who underwent initial parathyroid surgery at the Peking Union Medical College Hospital from Jan.2009 to Apr.2017 were retrospectively analyzed to explore preoperative localization and surgical options.Results There were a total of 902 surgical cases included in the study with 674 women and 228 men.All had preoperative parathyroid ultrasonography (US) (sensitivity 97.18％,positive predictive value (PPV) 98.40％) and 99Tcm-sestamibi (MIBI) scan (sensitivity 94.24％,PPV 98.00％).The combination of US and MIBI scan had a sensitivity of 92.39％ and PPV of 97.37％.MIBI scan showed negative results in 51 cases.We found that male patients with cystic lesions were more likely related to negative MIBI scan (P＜0.05).Among 89 patients with negative MIBI and/or US,39 received neck CT,17 received positron emission tomography (PET)/CT,and 9 received ultrasound-guided biopsy for further localization.800 patients (88.69％) underwent minimally invasive parathyroid surgery (MIP) with anesthesia of cervical plexus block.656 patients (72.72％) had normal parathyroid hormone (PTH) level on the first post-operative day,140 patients (15.52％) had postoperative hypocalcaemia and 234 patients (25.94％) presented hypocalcaemic symptoms within 3 days after operation,which could be relieved by intravenous calcium or continuous medicine taken by mouth.During the follow-up of the 800 MIP patients,4 had recurrence and one patient was not cured.Conclusions Parathyroid US and MIBI scan are of good value in localizaion diagnosis.Neck CT or PET/CT should be used as supplementary approaches in patients with negative US and/or MIBI scan.MIP with anesthesia of cervical plexus block is simple and feasiable for pHPT cases with accurate localization.

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.

Objective: To explore the imaging characteristics of large vestibular aqueduct syndrome (LVAS) patients and their relationship with the acoustically evoked short latency negative response (ANSR), so as to provide reference for the diagnosis of LVAS. Methods: Clinical data of 174 patients(334 ears) with LVAS diagnosed and treated by the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Guangxi Medical University, from October 2009 to December 2017 were retrospectively analyzed, including 117 males and 57 females, aged from 5 months to 47 years old, with the median age of 4 years and 4 months. ABR and imaging data of patients were collected. Midpoint diameter and the outlet diameter of the vestibular aqueduct were measured on CT images, the midpoint diameter of the intraosseous parts and the extraosseous parts of enlarged endolymphatic sac(EES) were measured on MRI images. The correlation between the above measurements was analyzed by Pearson test using SPSS 17.0. According to whether ASNR was detected in ABR, the above data were divided into two groups, and the differences of the above imaging measurements were compared by the Independent-Sample Test. Results: The average midpoint diameter of the vestibular aqueduct was (1.87±0.58) mm (±s, the following was the same), and the outlet diameter was (3.07±0.99) mm on CT; the average midpoint diameter of the intraosseous parts in enlarged endolymphatic sac(EES) was (2.39±1.37) mm, and the extraosseous parts was (2.50±2.18) mm on MRI. There was a correlation between the four measurements (P<0.05), among which the midpoint diameter of vestibular aqueduct was strongly positively correlated with the outlet diameter (r=0.760), and the remaining pairs were weakly correlated. ASNR was detected in 241 ears (72.16%,241/334) and undetected in 93 ears (27.84%, 93/334) of the 334 ears with LVAS. Midpoint diameter and the outlet diameter of the vestibular aqueduct in no ASNR group were smaller than the ASNR group, and the difference was statistically significant (t value was 2.814 and 2.754, P<0.05). There was no significant difference in the midpoint diameter of the intraosseous parts and the extraosseous parts of enlarged endolymphatic sac between the two groups, and the difference was no statistically significant(t value was 0.101 and 0.683, P>0.05). Conclusions There is a strong positive correlation between the midpoint diameter of vestibular aqueduct and the outlet diameter in LVAS patients. There is a certain correlation between the size of vestibular aqueduct and the size of endolymphatic sac. The smaller the diameter of vestibular aqueduct, the lower the occurrence rate of ASNR.

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.

ObjectiveTo review the ancient and modern literature of Huanglian Ejiaotang and learn about the historical evolution and clinical application， thereby providing a theoretical basis for the modern application of the classical prescription. MethodLiterature in the Chinese Medical Classics Database was retrieved with "Huanglian Ejiaotang" as the keyword. In China National Knowledge Infrastructure （CNKI） and PubMed， "Huanglian Ejiaotang" in Chinese and English was used as the keyword to retrieve literature. The items and modern clinical application studies related to the prescription， medicine， dosage， syndrome， and treatment of Huanglian Ejiaotang were selected and recorded. The inclusion and exclusion criteria were used to screen out literature. The information about the dynasty， book title， function， and indication was integrated to understand the history， evolution， and clinical application of Huanglian Ejiaotang. ResultFinally， 89 ancient books were included with 111 items. Huanglian Ejiaotang was initially recorded in ZHANG Zhongjing's Treatise on Cold Damage and Miscellaneous Diseases in the Han dynasty. It was composed of five herbs， namely Coptidis Rhizoma， Scutellariae Radix， Paeoniae Radix Alba， Asini Corii Colla， and egg yolk. With the change of historical dynasties， the composition， origin basis， dosage， and preparation method of Huanglian Ejiaotang all changed， but the changes in the processing were not obvious， which was basically consistent with Treatise on Cold Damage and Miscellaneous Diseases. In addition， 48 studies were included to analyze the clinical application of Huanglian Ejiaotang， which was mainly used for insomnia， anxiety， depression， diabetes， and so on. ConclusionAccording to the ancient and modern literature， the origin basis， dosage， processing， decoction， administration， and other content of Huanglian Ejiaotang are consistent with Treatise on Cold Damage and Miscellaneous Diseases. The present clinical application has expanded the usage scale of the ancient record， which promotes the innovation and development of the classic prescription and provides references for later research， development， and accurate application.