To verify the role of mAbCD28 in allograft transplantation. The biological action of mAbCD28 had been tested in mixed-lymphocyte-reaction and parathyroid gland allotranplantation in rats. Results: mAbCD28 could significantly suppress the proliferation of T cells in vitro and prolong the survival time of allograft in vivo. The results showed that mAbCD28 could block the costimulatory signals transmitted by CD28 molecules, and played an immunosuppressive role in parathyroid gland transplantation in rats.
Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively. Results There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperativeserum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case ofadenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 monthsprior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up. Conclusions The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.
【Abstract】ObjectiveTo investigate the technique of establishing a model of aparathyroid rat which could be used in the study of parathyroid cells transplantation. Methods Parathyroid glands were surgically excised and identified pathologyically. Serum calcium and parathyroid hormone in rats before operation and on day 2，5，10，15 and 30 after operation were measured. Results Parathyroid glands were resected successfully in 8 rats, and the resection rate was 80% (8/10). No obvious changes of serum calcium and parathyroid hormone levels were found before and after operatiion in sham parathyroid gland excision group (Pgt;0.05). However, statistically significant changes of those data were found perioperatively in parathyroid gland excision group (P＜0.01). Conclusion The model of aparathyroid rat can be established successfully after parathyroid glands in rats are excised exactly. Parathyroid allotransplantation could be performed ten days after parathyriodectomy.
ObjectiveTo evaluate the value of parathyroid hormone (PTH) in predicting hypocalcemia at different time after thyroidectomy. MethodsThe literatures in CBM, WanFang, CNKI, VIP in Chinese, and OVID, PUBMED, EMBASE, and MEDLINE in English were searched. Hand searches and additional searches were also conducted. The studies of predicting hypocalcemia after thyroidectomy by detecting postoperative PTH at different time were selected, and the quality and tested the heterogeneity of included articles were assessed. Then the proper effect model to calculate pooled weighted sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were selected. The summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUC) was computed. ResultsTwenty-three articles entered this systematic review, 21 articles were English and 2 articles were Chinese. Fifteen of 23 articles were designed to be prospective cohort study (PC) and 8 of 23 articles were retrospective study (Retro). These articles were divided into two groups. Group 1 was the studies of detecting postoperative PTH in 1 hour, which included 2 012 cases (494 of them occurred hypocalcemia). Group 2 was the studies of detecting postoperative PTH between 4-12 hours, which included 693 cases (266 of them occurred hypocalcemia). The publication bias of 2 groups were smaller that founded through the literature funnel. Meta analysis showed that in addition to merge SEN, between the 2 groups with merge SPE, LR+, LR-, and AUC differences were statistically significant (P < 0.01);the forecast effect of group 1 was better than group 2, and the AUC was the largest area when the PTH value in 1 hour after operation was below 16 ng/L. ConclusionDetection of postoperative PTH value is an effective method for predicting postoperative hypocalcemia. The 1 hour after operation for detecting PTH value below 16 ng/L to predict postoperative hypocalcemia have the best effect.
【Abstract】Objective To study the influence of transplantation of cultured parathyroid cells on the survival of the allografts in rats. Methods Parathyroid cells digested with collagenase and trypsin were cultured and transplanted under the left renal capsule. The survival time of the allografts was recorded and the allografts were examined by transmission electron microscopy.Results In fresh parathyroid cells group, the mean survival time was (9.25±3.45) days. While in cultured parathyroid cells group, the survival time was (46.25±7.44) days (P＜0.01). During the 50 days of observation, serum calcium and PTH remained normal in 6 of 8 rats. There were intact parathyroid cells in the allografts which had abundant rough endoplasmic reticula,mitochondria and secretory granules. Conclusion Transplantation of cultured parathyroid cells in rats can prolong the survival time of allografts and is a potent way to cure hypoparathyroidism.
Objective To learn the postoperative wound complications of thyroid and parathyroid, respiratory complications, duration of hospital stay and postoperative mortality, so as to further clarify the clinical effectiveness of placing drainage tube after thyroid and parathyroid surgery. Methods The following databases as The Cochrane Library, MEDLINE, EMbase, SCI and CNKI were retrieved orderly from the date of their establishment to March 29th, 2011. The literature was screened strictly according to inclusive criteria, included studies were analyzed using RevMan5.1.2 software, and the evidence levels of all indicators were evaluated using GRADEpro 3.5.1 software. Results A total of 16 studies involving 1 907 participants were included. There was no high-quality literature. No case reports of death and respiratory distress syndrome. Comparing the drainage group with the non-drainage group among the 16 studies, no significant difference was found in the incidence of re-operation, wound hematoma/seroma, wound infection and subcutaneous fluids. Incision pain score was significantly different between the two groups (RR=2.15, 95%CI 1.10 to –4.23, P=0.03); and the duration of hospital stay was significantly prolonged in the drainage group (SMD=0.79, 95%CI 0.38 to –1.20, I2=93%, P=0.000 2). Conclusion The evidence shows that drainage after thyroid and parathyroid surgery can not significantly reduce the incidence of postoperative complications; but increase the duration of hospital stay. Current evidence is based on the circumstance of non-substernal goiter surgery, normal coagulation indexes and non neck lymphadenectomy, which does not apply to the conclusion of this study. It is suggested that this issue should be further studied in the future due to the lack of high-quality, multi-center and large-scale RCTs.
Objective To study the effect of signal-selective parathyroid hormone (PTH) analogue peptide on Wnt signal ing factors in osteoblasts isolated from neonatal mouse, and provide theoretical basis for the mechanism of PTH’s function in bone metabolism. Methods Osteoblasts were isolated from calvaria of 2-3-day-old C57BL neonatal mouse and identified by alkal ine phosphatase (ALP) staining, and Alizarin red staining. The cells at passage 1 were divided into 4 groups: control group, PTH (1-34) group, G1R19 (1-34) group, and G1R19 (1-28) group. Then the medium was changed to α-MEM supplemented with 1%FBS. After 12 hours, trifluoroacetic acid or three peptides [(10 nmol/L PTH (1-34), 10 nmol/L G1R19 (1-34), and 100 nmol/L G1R19 (1-28)] were added into the culture medium. After 4 hours, the cells were washed gently ithcold PBS 3 times before total RNA was isolated. The expressions of Wnt related genes were measured by quantitative eal-time PCR. Results Most of the cells were polygonal and triangular; the cells were positive for ALP staining with blue cytoplasm at 14 days and the Al izarin red staining showed the formation of red mineral ized nodules in the special mineral ization induction medium at 28 days. The expressions of osteocalcin mRNA and Wnt5b mRNA in PTH (1-34) group, G1R19 (1-34) group, and G1R19 (1-28) group were significantly higher than those in control group (P lt; 0.05); the expression of Wnt2 mRNA was significantly lower than that in control group (P lt; 0.05); the expression of β-catenin mRNA in PTH (1-34) group was significantly higher than that in control group (P lt; 0.05); the expression of Wnt7b mRNA in PTH (1-34) group and G1R19 (1- 34) group was higher than that in control group, and the G1R19 (1-34) group was higher than PTH (1-34) group and G1R19 (1-28) group (P lt; 0.05). Conclusion In the Wnt-related factors, PTH (1-34) and G1R19 (1-34) affect mainly canonical Wnt signal factors, but the G1R19 (1-28) chiefly acts on non-canonical Wnt signal factors.
Objective To introduce the advanced diagnostic technologies and share the surgical experience of parathyroid adenoma. Methods From November 1986 to August 2000, 9 patients with parathyroid adenoma who underwent operations were analyzed retrospectively. Out of them, there were 3 males and 6 females and their ages ranged from 12 to 55 years with an average of 32 years. The average disease course was 4 years and 9 months. General decreased density of the bone cortex and subperiosteum absorption were found in all 9 cases, while multi bone cyst lesion in 3 cases; obsolete fracture in 5 cases, in\cluding 2 cases of nephrolithiasis. Before operation, one child bore claudication and the other 8 patients suffered from disability. Serum parathyroid hormone (PTH) level increased markedly in 5 patients examined (633.87-1017.40 pmol/L, normal value: 28.50-90.50 pmol/L. Radionuclide scan showed tha imagings of parathyroid adenoma appeared in 4 patients. Results Parathryriod adenoma was resected via neek approach in 7 cases, and by way of sternum in the other 2 of the adnomas located in the chest, Parathyroid adenoma was diagnosed pathologically in 9 cases. All the 9 patients had no relapse during the 2-16 years of follow-up, with apparent relief of ostealgia and the normal serum PTH level, and roentgenogram showed fracture healing, great allevation of the osetopathia. Conclusion PTH examination as an advanced technique plays an important role in the differential diagnosis of hypercalcaemia. Color Dopperler and radionuclide scan can locate the lesion. It is vital to judge the nature of the lesion by naked eyes, while frozen slices serves as a necessity to confrrm. Enough parathyroid tissue should to be remained to assure normal parathyroid function. The variable number and ectopic possibility of parathyroid glands should be consiered. Both the short-term and long-term surgical outcome of parathyroid adenoma are satisfactory.
ObjectiveTo explore optimal current intensity for neural monitoring of vagus nerve and recurrent laryngeal nerve during the thyroid and parathyroid surgery, so that we can judge function, location, identify, and protect the nerve more effectively and more quickly. MethodA total of 100 patients who underwent thyroid or parathyroid operations by the same surgeon in West China Hospital, meanwhile accepted intraoperative neuromonitoring (IONM), and 186 nerves at risk were enrolled in this study. According to the standardized process of nerve monitoring, we stimulated the vagus nerve with the current strength of 1-5 mA, and respectively stimulated laryngeal recurrent nerve with 1-3 mA indirectly and directly, and recorded the amplitude of electromyographic signal, and changes of heart rate and blood pressure during the process. The purpose was seeking the optimum current strength for each stage of IONM. ResultsIn 186 vagus nerves being tested, when monitoring the vagus nerve outside the carotid sheath, 109 vagus nerves (58.6%) sent out signals and got stable electromyography and warning tone with 1 mA, 164 (88.2%) vagus nerves had signals with 2 mA, 177 (95.2%) vagus nerves had signals with 3 mA, 182 (97.8%) vagus nerves had signals with 5 mA. Before and after the vagus nerve stimulation, heart rate and blood pressure of patients had no significant change. When directly monitoring the vagus nerve with 1 mA, V1 signals had no response in 2 vagus nerves (1.1%), V2 signals had no response in 9 vagus nerves (4.8%). But if the current intensity of stimulation was 2 mA or 3 mA, all patients got stable electromyographic signals. When searching for the laryngeal recurrent nerve, 92 (49.5%) got signals with 1 mA, 171 (91.9%) got signals with 2 mA, 184 (98.9%) got signals with 3 mA. When identifying laryngeal recurrent nerve and others, if the intensity of current was more than 2 mA, the current might conduct around and produce illusion. However, if the intensity of stimulation current was 1 mA, there's no electromyographic signal when we put the probe onto the tissue close to the laryngeal recurrent nerve. During identification of branches of laryngeal recurrent nerve with current strength of 1 mA, each electromyographic signal could be obtained. The chief branch into the throat produced the highest amplitude. The esophagus and trachea branch emg amplitude value was similar, equalling to 1/3-1/4 of the amplitude value in chief branch. ConclusionsWe suggest using current intensity of 5 mA on the surface of the carotid sheath to monitor the vagus nerve indirectly and obtain V1 signal, as an alternative to opening the carotid sheath. If fail, dissecting the carotid sheath, and using current intensity of 3 mA to monitor the vagus nerve directly; 3 mA is the optimal current intensity to search for the laryngeal recurrent nerve, and 1 mA is the optimal current intensity to identify the laryngeal recurrent nerve and its branches of esophagus and trachea, blood vessels, and so on.
Objective To investigate the indications and prevention of complications of total thyroidectomy in the management of thyroid diseases. Methods Eighty five patients who received total thyroidectomy between Jan. 2009 and Dec. 2011 were retrospectively analyzed with regard to the surgical procedures and postoperative complications. There were 46 thyroid cancers， 38 nodular goiters， and 1 Hashimoto thyroiditis. Results The postoperative pathological exam-inations revealed that 9 （19.6%） of 46 thyroid cancers were bilateral， and all of nodular goiters were also bilateral multiple nodule. Bilateral recurrent laryngeal nerves were exposed in all of the patients in which 4 recurrent laryngeal nerves were invaded by cancer and 1 was sacrificed. There were 5 patients whose parathyroids were not identified and protected during the operation. Two patients developed postoperative bleeding and needed reoperation， 6 patients developed hoarseness of whom 5 patients recovered except for the one whose nerve was sacrificed. And in terms of hypoparathyroidism， 33 （38.8%） patients developed transient hypocalcemia related symptoms. The permanent hypoparathyroidism occurred only in 2 patients. Conclusions Total thyroidectomy is a safe procedure in the management of thyroid cancer and bilateral nodular goiter. Exposing the recurrent laryngeal nerve and parathyroid is an effective method to prevent major complica-tions. Invasion of recurrent laryngeal nerve by thyroid cancer might not lead to hoarseness.