Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX bet...Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.展开更多
<strong>Introduction:</strong> Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal ...<strong>Introduction:</strong> Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal parathyroidectomy is an effective technique in the treatment of these disorders. <strong>Method:</strong> Our study is retrospective of 33 cases of hyperparathyroidism secondary to chronic renal failure in dialysis patients operated by the 7/8 technique. Identified over a period of 10 years (January 2010 to December 2019), in the ENT department of the Fann University Hospital. <strong>Results:</strong> Out of 33 cases of secondary hyperparathyroidism, the average age of our patients was 51.24 years with a sex ratio of 0.43. Causal nephropathy was dominated by nephro-angiosclerosis, which was found in 27.27% of cases. Bone pain found in 23 patients or 69.69% was the predominant clinical sign. The average calcemia was 92.7 mg/l. Parathormone was dosed in all our patients and the average was 1611.05 ng/l. The consequences were clinically marked by recurrent paresis in one patient. No case of hematoma or postoperative infection was found. On the biological level 10 patients or 30.30% had a transient hypocalcaemia. The results were marked by a drop in PTH in 23 patients or 78.78% of cases. <strong>Conclusion:</strong> Subtotal parathyroidectomy remains an effective and beneficial therapeutic method for kidney failure patients with secondary hyperparathyroidism.展开更多
BACKGROUND Secondary hyperparathyroidism(SHPT)is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients.SHPT can increase bone fragility and calcification of bloo...BACKGROUND Secondary hyperparathyroidism(SHPT)is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients.SHPT can increase bone fragility and calcification of blood vessels and soft tissues,which greatly increases the risk of death.AIM To discuss the outcome,safety and other potential benefits of paricalcitol injection in hemodialysis patients with SHPT.METHODS We recruited 40 patients who received hemodialysis at our hospital for chronic renal failure with SHPT between March and December 2019.They received paricalcitol injection for 24 wk(starting dose,0.06–0.08μg/kg),three times per week.They were followed up at the baseline(week 0),week 4,week 12 and week 24.The primary outcome indicator was the percentage of patients with a>30%decrease in intact parathyroid hormone(iPTH)levels at week 24 compared with the baseline.The secondary outcome indicators included percentage decrease in iPTH levels at week 24,standard-reaching rate of iPTH(percentage of patients with iPTH down to 130–585 pg/mL),changes in serum levels of calcium(Ca),phosphate(P),Ca×P product,alkaline phosphatase(ALP),creatinine(Cre),hemoglobin(Hb),and C-reactive protein(CRP),and incidence of adverse events(AEs).RESULTS After 24 wk of treatment,iPTH levels decreased significantly(598.88±381.29 pg/mL vs 888.84±376.88 pg/mL,P<0.05).More than 30%decrease of iPTH was found in 21 of 36(58.33%)patients.The average decrease in iPTH levels was 32.16±4.33%;the standard-reaching rate of iPTH levels was 66.67%(24/36);and ALP levels decreased significantly compared with the baseline(113.72±41.73 IU/L vs 133.45±56.86 IU/L)(t=2.798,P<0.05).There were no significant differences in the serum levels of calcium,Hb,Cre and CRP compared with the baseline(P>0.05).After 24 wk of treatment,serum P levels decreased compared with the baseline(1.91±0.40 mmol/L vs 2.16±0.66 mmol/L)(t=2.830,P<0.05).Ca×P product decreased significantly compared with the baseline(56.38±13.22 mg2/dL2 vs 63.97±20.30 mg2/dL2)(t=2.717,P<0.05).No serious adverse events occurred.CONCLUSION Paricalcitol was a safe and effective treatment for hemodialysis patients with SHPT.It decreased serum levels of iPTH,ALP and P and maintained stability of serum Ca levels.展开更多
BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH oc...BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after TPTX.METHODS This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital.From January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium levels.From October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)levels.The patients were defined as lowrisk(ALP<500 U/L)and high-risk(ALP>500 U/L)for SH.All preoperative blood samples were collected in the fasting state on the day before surgery.Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.RESULTS A total of 271 patients were included.These patients were 47.7±11.1 years old,and 57.6%were male.Their mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS groups.Compared with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with SH.In patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with SH.CONCLUSION This study suggests that preventive CS could reduce the occurrence of SH,indicating its critical value for hypocalcemia after TPTX.展开更多
BACKGROUND Sagliker syndrome(SS)resulting from uncontrolled secondary hyperparathyroidism(SHPT)in chronic renal failure(CRF)is seldom reported.CASE SUMMARY A 24-year-old woman presented with asymmetric facial deformit...BACKGROUND Sagliker syndrome(SS)resulting from uncontrolled secondary hyperparathyroidism(SHPT)in chronic renal failure(CRF)is seldom reported.CASE SUMMARY A 24-year-old woman presented with asymmetric facial deformity and stature shortening.She was diagnosed with SS,SHPT,CRF,and thyroid cancer.The patient underwent a total parathyroidectomy and thyroidectomy with central lymph node dissection.The patient’s condition was stable and was discharged from the hospital.CONCLUSION Undergoing dialysis vintage,presenting high serum phosphate levels,and female gender may be risk factors for SS.Intramembranous ossification in the craniomaxillofacial region is possibly activated in this special pathophysiological condition.What’s more,the choice of surgery mainly depends on the treatment goal and the experience of the individual surgeon.展开更多
Purpose: To describe the epidemiological, clinical and therapeutic aspects of secondary hyperparathyroidism inrenal failure chronic. Patients and methods: We collected 11 cases of hyperparathyroidism secondary to rena...Purpose: To describe the epidemiological, clinical and therapeutic aspects of secondary hyperparathyroidism inrenal failure chronic. Patients and methods: We collected 11 cases of hyperparathyroidism secondary to renal failure terminal operated in the Service of surgery B of the Central Hospital University of Point G between December 2016 and November 2018. Results: The sex ratio was 0.22 in favor of women. The average age of the patients was 43 or 27 years with extremes of 63 and 25 years. Secondary hyperparathyroidism in renal failure chronic represented 1.9% of interventions to cold in the Service of surgery B. 100% of patients (11/11) were haemodialysis. 100% of the patients had clinical and biological signs. 45.5% (5/11) had radiological signs. The average rate of parathyroid hormone was 2413.51 pg/ml with extremes of 1264 pg/ml and 3616 pg/ml. The reference value was 15 - 65 pg/ml. The surgical technique of choice was the 7/8th parathyroidectomy in 100% of cases. The postoperative were simple in 81.8%, and complicated in 18.2%. There were no death. The average duration of postoperative follow-up was 6 months. After surgery, 50% of patients (5/10) had normal levels of parathyroid hormone and 50% (5/10) made a persistent hyperparathyroidism. Conclusion: Secondary hyperparathyroidism is a frequent complication in renal insufficient chronic in hemodialysis. Surgery is indicated in the resistant cases of medical treatment. The 7/8th parathyroidectomy is the surgical technique of choice. The rate of post operative complications is higher in our context.展开更多
Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination,clinical,radiological and laboratory data.Here we report a case of multiple brown tumours...Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination,clinical,radiological and laboratory data.Here we report a case of multiple brown tumours localised in collarbone,rib and in the distal ulna due to secondary hyperparathyroidism in a 37-year-old women with chronic renal failure.The clinical management of brown tumour aimed primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment.In our experience,clinicians usually consider brown tumor of hyperparathyroidism is caused by giant cell lesions in maintenance hemodialysis recipients,and multiple brown tumours are rarely seen in these patients.展开更多
<strong>Introduction:</strong> Conjunctival-corneal or choroidal calcifications are frequent in SHPT, blindness is however exceptional. We report a case of blindness secondary to compressive ischemic optic...<strong>Introduction:</strong> Conjunctival-corneal or choroidal calcifications are frequent in SHPT, blindness is however exceptional. We report a case of blindness secondary to compressive ischemic optic neuropathy. <strong>Case Report:</strong> Mr. B.E.K., 49 years old, has a chronic renal failure secondary to unlabeled glomerular nephropathy for 17 years. He has been on chronic hemodialysis for 12 years and has had SHPT for nine years. He secondarily developed disabling segmental osteoarticular deformities associated with kyphoscoliosis, “drumstick” fingers and facial dysmorphism. Five months before admission he developed eye pain and reduced visual acuity progressing within one month to blindness. Biology noted: serum creatinine at 726 umol/l (60 - 120 umol/L), azotemia at 14.3 mmol/l (2.5 - 7.5 mmol/L), serum calcium at 2.25 (2.25 - 2.55 mmol/L), phosphatemia at 1.13 (0.8 - 1.35 mmol/L), alkaline phosphatases at 2196 (5 - 270 IU/L) and parathyroid hormone level at 2257 (10 - 60 pg/mL). Retinal angiography revealed lesions suggestive of ischemic neuropathy. The orbit CT scan with 3D coronal reconstruction revealed narrowing of the caliber of the optical channels with dystrophic thickening of the skull base and cranial vault. Cranioencephalic and orbital MRI revealed diffuse brown tumors and pre-chiasmatic optic atrophy. <strong>Discussion:</strong> The most frequent ocular complications of SHPT are conjunctival-corneal or sclero-choroidal calcifications, asymptomatic, associated with hypercalcemia. Compressive manifestations are rarer, represented mainly by an amputation of the visual field, diplopia, ptosis or blindness, as described in our patient. The main cause is osteodystrophy and brown tumors of the skull base (1% - 2%). <strong>Conclusion:</strong> This case report underlines the importance of early detection of SHPT, in order to avoid its major complications, such as blindness, especially since current preventive and curative measures have proven their effectiveness.展开更多
Parathyroidectomy is useful for the treatment of secondary hyperparathyroidism(SHPT)caused by chronic renal failure.The following three types of parathyroidectomy can be performed:subtotal parathyroidectomy,total para...Parathyroidectomy is useful for the treatment of secondary hyperparathyroidism(SHPT)caused by chronic renal failure.The following three types of parathyroidectomy can be performed:subtotal parathyroidectomy,total parathyroidectomy and total parathyroidectomy plus autologous transplantation(tPTX+AT).Each of the three types of surgery has advantages and disadvantages.The present study retrospectively analyzed the efficacy of tPTX+AT for the treatment of SHPT over 1 year.Thirty-seven patients who were diagnosed with secondary nephrogenic hyperparathyroidism and treated with tPTX+AT were selected between September 2014 and October 2016 and followed up for 1 year.Their average age was 66.5±46.0 years,and the average time of dialysis was 48.1±8.2 months.The patients1 conditions,including the levels of intact parathyroid hormone(iPTH)and bone metabolism,were compared preoperatively and 1 and 7 days and 1,3,6 and 12 months after surgery.In addition,the postoperative complications,pathological data,SHPT recurrence and prognosis were examined.The results showed that the postoperative level of ostalgia and cutaneous pruritus significantly decreased in the patients.An inspection of the parathyroid tissues during the operation confimied the presence of parathyroid gland hyperplasia with no carcinoma detected?Three patients with hoarseness recovered within 1 month,and 1 patient with unilateral recurrent laryngeal nerve injury improved after 6 months of voice training.Conipared to the preoperative condition,the postoperative serum iPTH,serum calcium and serum phosphate levels were significantly decreased(P<0.001),and these differences remained significant 12 months after surgery.Compared to the preoperative condition,the alkaline phosphatase(ALP)concentration was decreased on postoperative day 1(P<0.05),but no differences were observed on day 7 or at 1 month(P>0.05).The ALP levels continuously decreased at 3,6 and 12 months(P<0.01).In conclusion,tPTX+AT significantly improves the quality of life and serum biomarker levels of these patients.The convenient surgical removal of the hyperplastic parathyroid gland for postoperative recurrence supports tPTX+AT as the recommended treatment for relevant patients.展开更多
Leontiasis ossea is a rare medical condition which is characterized by an overgrowth of the facial and cranial bones secondary to chronic renal failure and secondary hyperparathyroidism. We reported a case of leontias...Leontiasis ossea is a rare medical condition which is characterized by an overgrowth of the facial and cranial bones secondary to chronic renal failure and secondary hyperparathyroidism. We reported a case of leontiasis ossea with history of secondary hyperparathyroidism due to end-stage renal disease on regular hemodialysis. A 37-year-old female with end-stage renal disease from lupus disease on regular hemodialysis complaining of progressive facial deformity for two years causing dyspnea, dental malocclusion and dysarthria with the final diagnosis of uremic leontiasis ossea. It is important to recognize features of leontiasis ossea, as it may result in life-threatening upper airway obstruction and compressive cranial neuropathy while after parathyroidectomy, facial changes can be stabilized or improved mildly.展开更多
Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of t...Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of the dynamic changes in hemostasis during surgery are prerequisites of safe patient management. The perioperative management of patients with chronic kidney failure is a huge challenge due to both the hypercoagulable state and increased risk of bleeding. Classic laboratory exams performed for the evaluation of blood clotting seem insufficient regarding the determination of the risk of bleeding and thrombosis in surgical patients. As patients with chronic kidney failure develop secondary hyperparathyroidism, the aim of the present study was to describe a case series and correlate the perioperative thromboelastographic profile of patients with chronic kidney failure submitted to parathyroidectomy with their secondary hyperparathyroidism.展开更多
Objective: Due to the lack of studies assessing hypovitaminosis D and secondary hyperparathyroidism in Brazilian HIV-infected population, especially in the northeastern population, this study aimed to determine the pr...Objective: Due to the lack of studies assessing hypovitaminosis D and secondary hyperparathyroidism in Brazilian HIV-infected population, especially in the northeastern population, this study aimed to determine the profile of these conditions in patients infected with HIV and its correlation with immuno-virological, sociodemographic data and associated comorbidities. Methods: Comparison studies were obtained from routine clinical samples of HIV infected patients submitted for 25-OH Vitamin D, PTH and alkaline phosphatase determination. Results: A total of 78 patients were included, 42 (53.8%) males, mean age 45.7 years. Antiretroviral regimens most used in this study were Zidovudine/Lamivudine/Efavirenz 17.9%, Tenofovir/Lamivudine/Efavirenz 17.9%,Tenofovir/Lamivudine/Atazanavir-r 15.4%. The mean value CD4 count was 592.1 ± 247.2 cells/mm3, CD8 cell count was 1026.5 ± 467.3 cells/mm3, mean detectable viral load was 2220 ± 15703 copies and CD4/CD8 ratio was 0.63 ± 0.33. A total of 34 vitamin D dosages were collected with 41.2% representing sufficient amount and 58.8% insufficient. Alkaline Phosphatase (ALP) dosage was elevated in 49.3% (N=35) of the patients. Parathormone (PTH) was elevated in 18% (N = 11). Among patients with elevated PTH levels, 81.9% had elevated levels of ALP (p = 0.01). In the group of patients with high levels of ALP, 45.7% had a CD4 count 3 (p = 0.02). There was no significant difference in vitamin D related to gender (p = 0.21), age (p = 0.23), CD4 count (p = 0.26), suppressed viral load (p = 0.44) or blood glucose (p = 0.45). Conclusions: This study evidenced a high prevalence of Vitamin D insufficiency in Northeast Brazil, which suggests HIV infection correlation. A high prevalence of Hyperparathyroidism was detected and related with inflammatory condition persistence and low CD4 count. We suggest improve vitamin D follow up and measurements in this population with better CD4 count control to avoid future osteoarticular complications of HIV treatment.展开更多
Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robus...Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robust imaging method with high diagnostic accuracy, becoming increasingly popular among surgeons and radiologists. Purpose: To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. Methods: We analyzed patients with primary and secondary hyperparathyroidism who had intraoperative reports, pathology, parathyroid hormone levels, and preoperative 4D-CT. Histology, surgical findings, and decreased parathyroid hormone levels were used as gold standards. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95% confidence interval were calculated. Fleiss’ kappa was used to assess the inter-observer agreement. Results: Sixty-seven patients were included. Sixty-two patients had a single adenoma, and five patients had a multiple gland disease (adenomas or hyperplasia). A total of 72 glands were proven to have parathyroid adenomas or hyperplasia. The sensitivity, specificity, PPV, NPV and accuracy are 85%, 97%, 96%, 87% and 91% for lateralization and 76%, 96%, 85%, 92% and 90% for quadrant localization, respectively in single-gland disease. The sensitivity, specificity, PPV, NPV and accuracy are 88%, 100%, 100%, 50% and 90% for lateralization and 71%, 100%, 100%, 60% and 80% for quadrant localization respectively in multiple-gland disease. Fleiss’ kappa value is 5.6 (moderate inter-observer agreement). Conclusion: 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement.展开更多
Cotton is one of the most important economic crops in the world,and it is a major source of fiber in the textile industry.Strigolactones(SLs)are a class of carotenoid-derived plant hormones involved in many processes ...Cotton is one of the most important economic crops in the world,and it is a major source of fiber in the textile industry.Strigolactones(SLs)are a class of carotenoid-derived plant hormones involved in many processes of plant growth and development,although the functions of SL in fiber development remain largely unknown.Here,we found that the endogenous SLs were significantly higher in fibers at 20 days post-anthesis(DPA).Exogenous SLs significantly increased fiber length and cell wall thickness.Furthermore,we cloned three key SL biosynthetic genes,namely GhD27,GhMAX3,and GhMAX4,which were highly expressed in fibers,and subcellular localization analyses revealed that GhD27,GhMAX3,and GhMAX4 were localized in the chloroplast.The exogenous expression of GhD27,GhMAX3,and GhMAX4 complemented the physiological phenotypes of d27,max3,and max4 mutations in Arabidopsis,respectively.Knockdown of GhD27,GhMAX3,and GhMAX4 in cotton resulted in increased numbers of axillary buds and leaves,reduced fiber length,and significantly reduced fiber thickness.These findings revealed that SLs participate in plant growth,fiber elongation,and secondary cell wall formation in cotton.These results provide new and effective genetic resources for improving cotton fiber yield and plant architecture.展开更多
After spinal cord injury,there is an extensive infiltration of immune cells,which exacerbates the injury and leads to further neural degeneration.Therefore,a major aim of current research involves targeting the immune...After spinal cord injury,there is an extensive infiltration of immune cells,which exacerbates the injury and leads to further neural degeneration.Therefore,a major aim of current research involves targeting the immune response as a treatment for spinal cord injury.Although much research has been performed analyzing the complex inflammatory process following spinal cord injury,there remain major discrepancies within previous literature regarding the timeline of local cytokine regulation.The objectives of this study were to establish an overview of the timeline of cytokine regulation for 2 weeks after spinal cord injury,identify sexual dimorphisms in terms of cytokine levels,and determine local cytokines that significantly change based on the severity of spinal cord injury.Rats were inflicted with either a mild contusion,moderate contusion,severe contusion,or complete transection,7 mm of spinal cord centered on the injury was harvested at varying times post-injury,and tissue homogenates were analyzed with a Cytokine/Chemokine 27-Plex assay.Results demonstrated pro-inflammatory cytokines including tumor necrosis factorα,interleukin-1β,and interleukin-6 were all upregulated after spinal cord injury,but returned to uninjured levels within approximately 24 hours post-injury,while chemokines including monocyte chemoattractant protein-1 remained upregulated for days post-injury.In contrast,several anti-inflammatory cytokines and growth factors including interleukin-10 and vascular endothelial growth factor were downregulated by 7 days post-injury.After spinal cord injury,tissue inhibitor of metalloproteinase-1,which specifically affects astrocytes involved in glial scar development,increased more than all other cytokines tested,reaching 26.9-fold higher than uninjured rats.After a mild injury,11 cytokines demonstrated sexual dimorphisms;however,after a severe contusion only leptin levels were different between female and male rats.In conclusion,pro-inflammatory cytokines initiate the inflammatory process and return to baseline within hours post-injury,chemokines continue to recruit immune cells for days post-injury,while anti-inflammatory cytokines are downregulated by a week post-injury,and sexual dimorphisms observed after mild injury subsided with more severe injuries.Results from this work define critical chemokines that influence immune cell infiltration and important cytokines involved in glial scar development after spinal cord injury,which are essential for researchers developing treatments targeting secondary damage after spinal cord injury.展开更多
BACKGROUND As research on diabetes continues to advance,more complex classifications of this disease have emerged,revealing the existence of special types of diabetes,and many of these patients are prone to misdiagnos...BACKGROUND As research on diabetes continues to advance,more complex classifications of this disease have emerged,revealing the existence of special types of diabetes,and many of these patients are prone to misdiagnosis and underdiagnosis,leading to treatment delays and increased health care costs.The purpose of this study was to identify four causes of secondary diabetes.CASE SUMMARY Secondary diabetes can be caused by various factors,some of which are often overlooked.These factors include genetic defects,autoimmune disorders,and diabetes induced by tumours.This paper describes four types of secondary diabetes caused by Williams–Beuren syndrome,Prader–Willi syndrome,pituitary adenoma,and IgG4-related diseases.These cases deviate significantly from the typical progression of the disease due to their low incidence and rarity,often leading to their neglect in clinical practice.In comparison to regular diabetes patients,the four individuals described here exhibited distinct characteristics.Standard hypoglycaemic treatments failed to effectively control the disease.Subsequently,a series of examinations and follow-up history confirmed the diagnosis and underlying cause of diabetes.Upon addressing the primary condition,such as excising a pituitary adenoma,providing glucocorticoid supplementation,and implementing symptomatic treatments,all patients experienced a considerable decrease in blood glucose levels,which were subsequently maintained within a stable range.Furthermore,other accompanying symptoms improved.CONCLUSION Rare diseases causing secondary diabetes are often not considered in the diag-nosis of diabetes.Therefore,it is crucial to conduct genetic tests,antibody detection and other appropriate diagnostic measures when necessary to facilitate early diagnosis and intervention through proactive and efficient management of the underlying condition,ultimately improving patient outcomes.展开更多
BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To det...BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To determine appropriate diagnostic methods,therapeutic options,and factors related to maternal and fetal outcomes for PHPT-induced AP in pregnancy.METHODS A literature search of articles in English,Japanese,German,Spanish,and Italian was performed using PubMed(1946-2023),PubMed Central(1900-2023),and Google Scholar.The Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA)protocol was followed.The search terms included“pancreatite acuta,”“iperparatiroidismo primario,”“gravidanza,”“travaglio,”“puerperio,”“postpartum,”“akute pankreatitis,”“primärer hyperparathyreoidismus,”“Schwangerschaft,”“Wehen,”“Wochenbett,”“pancreatitis aguda,”“hiperparatiroidismo primario,”“embarazo,”“parto,”“puerperio,”“posparto,”“acute pancreatitis,”“primary hyperparathyroidism,”“pregnancy,”“labor,”“puerperium,”and“postpartum.”Additional studies were identified by reviewing the reference lists of retrieved studies.Demographic,imaging,surgical,obstetric,and outcome data were obtained.RESULTS Fifty-four cases were collected from the 51 studies.The median maternal age was 29 years.PHPT-induced AP starts at the 20th gestational week;higher gestational weeks were seen in mothers who died(mean gestational week 28).Median values of amylase(1399,Q1-Q3=519-2072),lipase(2072,Q1-Q3=893-2804),serum calcium(3.5,Q1-Q3=3.1-3.9),and parathormone(PTH)(384,Q1-Q3=123-910)were reported.In 46 cases,adenoma was the cause of PHPT,followed by 2 cases of carcinoma and 1 case of hyperplasia.In the remaining 5 cases,the diagnosis was not reported.Neck ultrasound was positive in 34 cases,whereas sestamibi was performed in 3 cases,and neck computed tomography or magnetic resonance imaging was performed in 9 cases(the enlarged parathyroid gland was not localized in 3 cases).Surgery was the preferred treatment during pregnancy in 33 cases(median week of gestation 25,Q1-Q3=20-30)and postpartum in 12 cases.The timing was not reported in the remaining 9 cases,or surgery was not performed.AP was managed surgically in 11 cases and conservatively in 43(79.6%)cases.Maternal and fetal mortality was 9.3%(5 cases).Surgery was more common in deceased mothers(60.0%vs 16.3%;P=0.052),and PTH values tended to be higher in this group(910 pg/mL vs 302 pg/mL;P=0.059).Maternal mortality was higher with higher serum lipase levels and earlier delivery week.Higher calcium(4.1 mmol/L vs 3.3 mmol/L;P=0.009)and PTH(1914 pg/mL vs 302 pg/mL;P=0.003)values increased fetal/child mortality,as well as abortions(40.0%vs 0.0%;P=0.007)and complex deliveries(60.0%vs 8.2%;P=0.01).CONCLUSION If serum calcium is not tested during admission,definitive diagnosis of PHPT-induced AP in pregnancy is delayed,while early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.展开更多
Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptoma...Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.展开更多
The use of entomopathogenic fungi (EF) in recent years has been highly effective against the different orders of insects considered pests of agricultural importance and their conidia have been commonly applied, but it...The use of entomopathogenic fungi (EF) in recent years has been highly effective against the different orders of insects considered pests of agricultural importance and their conidia have been commonly applied, but it has been reported that these are sensitive to the environmental conditions. For this reason, biopesticides products have been formulated based on secondary metabolites, recently. These biomolecules participate as biological control agent, such as: cyclic depsipeptides, amino acids, polyketides, polyphenols and terpenoids, affecting their morphology, life cycle and insect behavior. The use of secondary metabolites of entomopathogenic fungi opens the possibility of application in a more efficient way for the control of agricultural pests in a compatible with the environment and human health;therefore, it is important to know, analyzing the type of molecules, their effects, and their different methods of application.展开更多
文摘Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.
文摘<strong>Introduction:</strong> Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal parathyroidectomy is an effective technique in the treatment of these disorders. <strong>Method:</strong> Our study is retrospective of 33 cases of hyperparathyroidism secondary to chronic renal failure in dialysis patients operated by the 7/8 technique. Identified over a period of 10 years (January 2010 to December 2019), in the ENT department of the Fann University Hospital. <strong>Results:</strong> Out of 33 cases of secondary hyperparathyroidism, the average age of our patients was 51.24 years with a sex ratio of 0.43. Causal nephropathy was dominated by nephro-angiosclerosis, which was found in 27.27% of cases. Bone pain found in 23 patients or 69.69% was the predominant clinical sign. The average calcemia was 92.7 mg/l. Parathormone was dosed in all our patients and the average was 1611.05 ng/l. The consequences were clinically marked by recurrent paresis in one patient. No case of hematoma or postoperative infection was found. On the biological level 10 patients or 30.30% had a transient hypocalcaemia. The results were marked by a drop in PTH in 23 patients or 78.78% of cases. <strong>Conclusion:</strong> Subtotal parathyroidectomy remains an effective and beneficial therapeutic method for kidney failure patients with secondary hyperparathyroidism.
基金Supported by 2019 Anhui University Natural Science Research Project,No.KJ2019A0094,No.KJ2019A0095Huainan City"50 Science and Technology Stars"Innovation Team Projectand Scientific Research Platform of Huainan Science and Technology Bureau,No.2017G32.
文摘BACKGROUND Secondary hyperparathyroidism(SHPT)is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients.SHPT can increase bone fragility and calcification of blood vessels and soft tissues,which greatly increases the risk of death.AIM To discuss the outcome,safety and other potential benefits of paricalcitol injection in hemodialysis patients with SHPT.METHODS We recruited 40 patients who received hemodialysis at our hospital for chronic renal failure with SHPT between March and December 2019.They received paricalcitol injection for 24 wk(starting dose,0.06–0.08μg/kg),three times per week.They were followed up at the baseline(week 0),week 4,week 12 and week 24.The primary outcome indicator was the percentage of patients with a>30%decrease in intact parathyroid hormone(iPTH)levels at week 24 compared with the baseline.The secondary outcome indicators included percentage decrease in iPTH levels at week 24,standard-reaching rate of iPTH(percentage of patients with iPTH down to 130–585 pg/mL),changes in serum levels of calcium(Ca),phosphate(P),Ca×P product,alkaline phosphatase(ALP),creatinine(Cre),hemoglobin(Hb),and C-reactive protein(CRP),and incidence of adverse events(AEs).RESULTS After 24 wk of treatment,iPTH levels decreased significantly(598.88±381.29 pg/mL vs 888.84±376.88 pg/mL,P<0.05).More than 30%decrease of iPTH was found in 21 of 36(58.33%)patients.The average decrease in iPTH levels was 32.16±4.33%;the standard-reaching rate of iPTH levels was 66.67%(24/36);and ALP levels decreased significantly compared with the baseline(113.72±41.73 IU/L vs 133.45±56.86 IU/L)(t=2.798,P<0.05).There were no significant differences in the serum levels of calcium,Hb,Cre and CRP compared with the baseline(P>0.05).After 24 wk of treatment,serum P levels decreased compared with the baseline(1.91±0.40 mmol/L vs 2.16±0.66 mmol/L)(t=2.830,P<0.05).Ca×P product decreased significantly compared with the baseline(56.38±13.22 mg2/dL2 vs 63.97±20.30 mg2/dL2)(t=2.717,P<0.05).No serious adverse events occurred.CONCLUSION Paricalcitol was a safe and effective treatment for hemodialysis patients with SHPT.It decreased serum levels of iPTH,ALP and P and maintained stability of serum Ca levels.
基金Supported by the Subject of Beijing Science and Technology Plan,No.Z191100006619014.
文摘BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after TPTX.METHODS This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital.From January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium levels.From October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)levels.The patients were defined as lowrisk(ALP<500 U/L)and high-risk(ALP>500 U/L)for SH.All preoperative blood samples were collected in the fasting state on the day before surgery.Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.RESULTS A total of 271 patients were included.These patients were 47.7±11.1 years old,and 57.6%were male.Their mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS groups.Compared with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with SH.In patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with SH.CONCLUSION This study suggests that preventive CS could reduce the occurrence of SH,indicating its critical value for hypocalcemia after TPTX.
文摘BACKGROUND Sagliker syndrome(SS)resulting from uncontrolled secondary hyperparathyroidism(SHPT)in chronic renal failure(CRF)is seldom reported.CASE SUMMARY A 24-year-old woman presented with asymmetric facial deformity and stature shortening.She was diagnosed with SS,SHPT,CRF,and thyroid cancer.The patient underwent a total parathyroidectomy and thyroidectomy with central lymph node dissection.The patient’s condition was stable and was discharged from the hospital.CONCLUSION Undergoing dialysis vintage,presenting high serum phosphate levels,and female gender may be risk factors for SS.Intramembranous ossification in the craniomaxillofacial region is possibly activated in this special pathophysiological condition.What’s more,the choice of surgery mainly depends on the treatment goal and the experience of the individual surgeon.
文摘Purpose: To describe the epidemiological, clinical and therapeutic aspects of secondary hyperparathyroidism inrenal failure chronic. Patients and methods: We collected 11 cases of hyperparathyroidism secondary to renal failure terminal operated in the Service of surgery B of the Central Hospital University of Point G between December 2016 and November 2018. Results: The sex ratio was 0.22 in favor of women. The average age of the patients was 43 or 27 years with extremes of 63 and 25 years. Secondary hyperparathyroidism in renal failure chronic represented 1.9% of interventions to cold in the Service of surgery B. 100% of patients (11/11) were haemodialysis. 100% of the patients had clinical and biological signs. 45.5% (5/11) had radiological signs. The average rate of parathyroid hormone was 2413.51 pg/ml with extremes of 1264 pg/ml and 3616 pg/ml. The reference value was 15 - 65 pg/ml. The surgical technique of choice was the 7/8th parathyroidectomy in 100% of cases. The postoperative were simple in 81.8%, and complicated in 18.2%. There were no death. The average duration of postoperative follow-up was 6 months. After surgery, 50% of patients (5/10) had normal levels of parathyroid hormone and 50% (5/10) made a persistent hyperparathyroidism. Conclusion: Secondary hyperparathyroidism is a frequent complication in renal insufficient chronic in hemodialysis. Surgery is indicated in the resistant cases of medical treatment. The 7/8th parathyroidectomy is the surgical technique of choice. The rate of post operative complications is higher in our context.
文摘Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination,clinical,radiological and laboratory data.Here we report a case of multiple brown tumours localised in collarbone,rib and in the distal ulna due to secondary hyperparathyroidism in a 37-year-old women with chronic renal failure.The clinical management of brown tumour aimed primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment.In our experience,clinicians usually consider brown tumor of hyperparathyroidism is caused by giant cell lesions in maintenance hemodialysis recipients,and multiple brown tumours are rarely seen in these patients.
文摘<strong>Introduction:</strong> Conjunctival-corneal or choroidal calcifications are frequent in SHPT, blindness is however exceptional. We report a case of blindness secondary to compressive ischemic optic neuropathy. <strong>Case Report:</strong> Mr. B.E.K., 49 years old, has a chronic renal failure secondary to unlabeled glomerular nephropathy for 17 years. He has been on chronic hemodialysis for 12 years and has had SHPT for nine years. He secondarily developed disabling segmental osteoarticular deformities associated with kyphoscoliosis, “drumstick” fingers and facial dysmorphism. Five months before admission he developed eye pain and reduced visual acuity progressing within one month to blindness. Biology noted: serum creatinine at 726 umol/l (60 - 120 umol/L), azotemia at 14.3 mmol/l (2.5 - 7.5 mmol/L), serum calcium at 2.25 (2.25 - 2.55 mmol/L), phosphatemia at 1.13 (0.8 - 1.35 mmol/L), alkaline phosphatases at 2196 (5 - 270 IU/L) and parathyroid hormone level at 2257 (10 - 60 pg/mL). Retinal angiography revealed lesions suggestive of ischemic neuropathy. The orbit CT scan with 3D coronal reconstruction revealed narrowing of the caliber of the optical channels with dystrophic thickening of the skull base and cranial vault. Cranioencephalic and orbital MRI revealed diffuse brown tumors and pre-chiasmatic optic atrophy. <strong>Discussion:</strong> The most frequent ocular complications of SHPT are conjunctival-corneal or sclero-choroidal calcifications, asymptomatic, associated with hypercalcemia. Compressive manifestations are rarer, represented mainly by an amputation of the visual field, diplopia, ptosis or blindness, as described in our patient. The main cause is osteodystrophy and brown tumors of the skull base (1% - 2%). <strong>Conclusion:</strong> This case report underlines the importance of early detection of SHPT, in order to avoid its major complications, such as blindness, especially since current preventive and curative measures have proven their effectiveness.
文摘Parathyroidectomy is useful for the treatment of secondary hyperparathyroidism(SHPT)caused by chronic renal failure.The following three types of parathyroidectomy can be performed:subtotal parathyroidectomy,total parathyroidectomy and total parathyroidectomy plus autologous transplantation(tPTX+AT).Each of the three types of surgery has advantages and disadvantages.The present study retrospectively analyzed the efficacy of tPTX+AT for the treatment of SHPT over 1 year.Thirty-seven patients who were diagnosed with secondary nephrogenic hyperparathyroidism and treated with tPTX+AT were selected between September 2014 and October 2016 and followed up for 1 year.Their average age was 66.5±46.0 years,and the average time of dialysis was 48.1±8.2 months.The patients1 conditions,including the levels of intact parathyroid hormone(iPTH)and bone metabolism,were compared preoperatively and 1 and 7 days and 1,3,6 and 12 months after surgery.In addition,the postoperative complications,pathological data,SHPT recurrence and prognosis were examined.The results showed that the postoperative level of ostalgia and cutaneous pruritus significantly decreased in the patients.An inspection of the parathyroid tissues during the operation confimied the presence of parathyroid gland hyperplasia with no carcinoma detected?Three patients with hoarseness recovered within 1 month,and 1 patient with unilateral recurrent laryngeal nerve injury improved after 6 months of voice training.Conipared to the preoperative condition,the postoperative serum iPTH,serum calcium and serum phosphate levels were significantly decreased(P<0.001),and these differences remained significant 12 months after surgery.Compared to the preoperative condition,the alkaline phosphatase(ALP)concentration was decreased on postoperative day 1(P<0.05),but no differences were observed on day 7 or at 1 month(P>0.05).The ALP levels continuously decreased at 3,6 and 12 months(P<0.01).In conclusion,tPTX+AT significantly improves the quality of life and serum biomarker levels of these patients.The convenient surgical removal of the hyperplastic parathyroid gland for postoperative recurrence supports tPTX+AT as the recommended treatment for relevant patients.
文摘Leontiasis ossea is a rare medical condition which is characterized by an overgrowth of the facial and cranial bones secondary to chronic renal failure and secondary hyperparathyroidism. We reported a case of leontiasis ossea with history of secondary hyperparathyroidism due to end-stage renal disease on regular hemodialysis. A 37-year-old female with end-stage renal disease from lupus disease on regular hemodialysis complaining of progressive facial deformity for two years causing dyspnea, dental malocclusion and dysarthria with the final diagnosis of uremic leontiasis ossea. It is important to recognize features of leontiasis ossea, as it may result in life-threatening upper airway obstruction and compressive cranial neuropathy while after parathyroidectomy, facial changes can be stabilized or improved mildly.
文摘Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of the dynamic changes in hemostasis during surgery are prerequisites of safe patient management. The perioperative management of patients with chronic kidney failure is a huge challenge due to both the hypercoagulable state and increased risk of bleeding. Classic laboratory exams performed for the evaluation of blood clotting seem insufficient regarding the determination of the risk of bleeding and thrombosis in surgical patients. As patients with chronic kidney failure develop secondary hyperparathyroidism, the aim of the present study was to describe a case series and correlate the perioperative thromboelastographic profile of patients with chronic kidney failure submitted to parathyroidectomy with their secondary hyperparathyroidism.
文摘Objective: Due to the lack of studies assessing hypovitaminosis D and secondary hyperparathyroidism in Brazilian HIV-infected population, especially in the northeastern population, this study aimed to determine the profile of these conditions in patients infected with HIV and its correlation with immuno-virological, sociodemographic data and associated comorbidities. Methods: Comparison studies were obtained from routine clinical samples of HIV infected patients submitted for 25-OH Vitamin D, PTH and alkaline phosphatase determination. Results: A total of 78 patients were included, 42 (53.8%) males, mean age 45.7 years. Antiretroviral regimens most used in this study were Zidovudine/Lamivudine/Efavirenz 17.9%, Tenofovir/Lamivudine/Efavirenz 17.9%,Tenofovir/Lamivudine/Atazanavir-r 15.4%. The mean value CD4 count was 592.1 ± 247.2 cells/mm3, CD8 cell count was 1026.5 ± 467.3 cells/mm3, mean detectable viral load was 2220 ± 15703 copies and CD4/CD8 ratio was 0.63 ± 0.33. A total of 34 vitamin D dosages were collected with 41.2% representing sufficient amount and 58.8% insufficient. Alkaline Phosphatase (ALP) dosage was elevated in 49.3% (N=35) of the patients. Parathormone (PTH) was elevated in 18% (N = 11). Among patients with elevated PTH levels, 81.9% had elevated levels of ALP (p = 0.01). In the group of patients with high levels of ALP, 45.7% had a CD4 count 3 (p = 0.02). There was no significant difference in vitamin D related to gender (p = 0.21), age (p = 0.23), CD4 count (p = 0.26), suppressed viral load (p = 0.44) or blood glucose (p = 0.45). Conclusions: This study evidenced a high prevalence of Vitamin D insufficiency in Northeast Brazil, which suggests HIV infection correlation. A high prevalence of Hyperparathyroidism was detected and related with inflammatory condition persistence and low CD4 count. We suggest improve vitamin D follow up and measurements in this population with better CD4 count control to avoid future osteoarticular complications of HIV treatment.
文摘Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robust imaging method with high diagnostic accuracy, becoming increasingly popular among surgeons and radiologists. Purpose: To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. Methods: We analyzed patients with primary and secondary hyperparathyroidism who had intraoperative reports, pathology, parathyroid hormone levels, and preoperative 4D-CT. Histology, surgical findings, and decreased parathyroid hormone levels were used as gold standards. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95% confidence interval were calculated. Fleiss’ kappa was used to assess the inter-observer agreement. Results: Sixty-seven patients were included. Sixty-two patients had a single adenoma, and five patients had a multiple gland disease (adenomas or hyperplasia). A total of 72 glands were proven to have parathyroid adenomas or hyperplasia. The sensitivity, specificity, PPV, NPV and accuracy are 85%, 97%, 96%, 87% and 91% for lateralization and 76%, 96%, 85%, 92% and 90% for quadrant localization, respectively in single-gland disease. The sensitivity, specificity, PPV, NPV and accuracy are 88%, 100%, 100%, 50% and 90% for lateralization and 71%, 100%, 100%, 60% and 80% for quadrant localization respectively in multiple-gland disease. Fleiss’ kappa value is 5.6 (moderate inter-observer agreement). Conclusion: 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement.
基金supported by the National Natural Science Foundation of China (32170367 and 32000146)the Fundamental Research Funds for the Central Universities, China (2021TS066 and GK202103063)the Excellent Graduate Training Program of Shaanxi Normal University, China (LHRCCX23181).
文摘Cotton is one of the most important economic crops in the world,and it is a major source of fiber in the textile industry.Strigolactones(SLs)are a class of carotenoid-derived plant hormones involved in many processes of plant growth and development,although the functions of SL in fiber development remain largely unknown.Here,we found that the endogenous SLs were significantly higher in fibers at 20 days post-anthesis(DPA).Exogenous SLs significantly increased fiber length and cell wall thickness.Furthermore,we cloned three key SL biosynthetic genes,namely GhD27,GhMAX3,and GhMAX4,which were highly expressed in fibers,and subcellular localization analyses revealed that GhD27,GhMAX3,and GhMAX4 were localized in the chloroplast.The exogenous expression of GhD27,GhMAX3,and GhMAX4 complemented the physiological phenotypes of d27,max3,and max4 mutations in Arabidopsis,respectively.Knockdown of GhD27,GhMAX3,and GhMAX4 in cotton resulted in increased numbers of axillary buds and leaves,reduced fiber length,and significantly reduced fiber thickness.These findings revealed that SLs participate in plant growth,fiber elongation,and secondary cell wall formation in cotton.These results provide new and effective genetic resources for improving cotton fiber yield and plant architecture.
基金supported by the National Institutes of HealthNo.R56 NS117935(to ASH and WLM)+1 种基金funded by Institutional Clinical and Translational Science AwardNo.UL1 TR002373。
文摘After spinal cord injury,there is an extensive infiltration of immune cells,which exacerbates the injury and leads to further neural degeneration.Therefore,a major aim of current research involves targeting the immune response as a treatment for spinal cord injury.Although much research has been performed analyzing the complex inflammatory process following spinal cord injury,there remain major discrepancies within previous literature regarding the timeline of local cytokine regulation.The objectives of this study were to establish an overview of the timeline of cytokine regulation for 2 weeks after spinal cord injury,identify sexual dimorphisms in terms of cytokine levels,and determine local cytokines that significantly change based on the severity of spinal cord injury.Rats were inflicted with either a mild contusion,moderate contusion,severe contusion,or complete transection,7 mm of spinal cord centered on the injury was harvested at varying times post-injury,and tissue homogenates were analyzed with a Cytokine/Chemokine 27-Plex assay.Results demonstrated pro-inflammatory cytokines including tumor necrosis factorα,interleukin-1β,and interleukin-6 were all upregulated after spinal cord injury,but returned to uninjured levels within approximately 24 hours post-injury,while chemokines including monocyte chemoattractant protein-1 remained upregulated for days post-injury.In contrast,several anti-inflammatory cytokines and growth factors including interleukin-10 and vascular endothelial growth factor were downregulated by 7 days post-injury.After spinal cord injury,tissue inhibitor of metalloproteinase-1,which specifically affects astrocytes involved in glial scar development,increased more than all other cytokines tested,reaching 26.9-fold higher than uninjured rats.After a mild injury,11 cytokines demonstrated sexual dimorphisms;however,after a severe contusion only leptin levels were different between female and male rats.In conclusion,pro-inflammatory cytokines initiate the inflammatory process and return to baseline within hours post-injury,chemokines continue to recruit immune cells for days post-injury,while anti-inflammatory cytokines are downregulated by a week post-injury,and sexual dimorphisms observed after mild injury subsided with more severe injuries.Results from this work define critical chemokines that influence immune cell infiltration and important cytokines involved in glial scar development after spinal cord injury,which are essential for researchers developing treatments targeting secondary damage after spinal cord injury.
文摘BACKGROUND As research on diabetes continues to advance,more complex classifications of this disease have emerged,revealing the existence of special types of diabetes,and many of these patients are prone to misdiagnosis and underdiagnosis,leading to treatment delays and increased health care costs.The purpose of this study was to identify four causes of secondary diabetes.CASE SUMMARY Secondary diabetes can be caused by various factors,some of which are often overlooked.These factors include genetic defects,autoimmune disorders,and diabetes induced by tumours.This paper describes four types of secondary diabetes caused by Williams–Beuren syndrome,Prader–Willi syndrome,pituitary adenoma,and IgG4-related diseases.These cases deviate significantly from the typical progression of the disease due to their low incidence and rarity,often leading to their neglect in clinical practice.In comparison to regular diabetes patients,the four individuals described here exhibited distinct characteristics.Standard hypoglycaemic treatments failed to effectively control the disease.Subsequently,a series of examinations and follow-up history confirmed the diagnosis and underlying cause of diabetes.Upon addressing the primary condition,such as excising a pituitary adenoma,providing glucocorticoid supplementation,and implementing symptomatic treatments,all patients experienced a considerable decrease in blood glucose levels,which were subsequently maintained within a stable range.Furthermore,other accompanying symptoms improved.CONCLUSION Rare diseases causing secondary diabetes are often not considered in the diag-nosis of diabetes.Therefore,it is crucial to conduct genetic tests,antibody detection and other appropriate diagnostic measures when necessary to facilitate early diagnosis and intervention through proactive and efficient management of the underlying condition,ultimately improving patient outcomes.
文摘BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To determine appropriate diagnostic methods,therapeutic options,and factors related to maternal and fetal outcomes for PHPT-induced AP in pregnancy.METHODS A literature search of articles in English,Japanese,German,Spanish,and Italian was performed using PubMed(1946-2023),PubMed Central(1900-2023),and Google Scholar.The Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA)protocol was followed.The search terms included“pancreatite acuta,”“iperparatiroidismo primario,”“gravidanza,”“travaglio,”“puerperio,”“postpartum,”“akute pankreatitis,”“primärer hyperparathyreoidismus,”“Schwangerschaft,”“Wehen,”“Wochenbett,”“pancreatitis aguda,”“hiperparatiroidismo primario,”“embarazo,”“parto,”“puerperio,”“posparto,”“acute pancreatitis,”“primary hyperparathyroidism,”“pregnancy,”“labor,”“puerperium,”and“postpartum.”Additional studies were identified by reviewing the reference lists of retrieved studies.Demographic,imaging,surgical,obstetric,and outcome data were obtained.RESULTS Fifty-four cases were collected from the 51 studies.The median maternal age was 29 years.PHPT-induced AP starts at the 20th gestational week;higher gestational weeks were seen in mothers who died(mean gestational week 28).Median values of amylase(1399,Q1-Q3=519-2072),lipase(2072,Q1-Q3=893-2804),serum calcium(3.5,Q1-Q3=3.1-3.9),and parathormone(PTH)(384,Q1-Q3=123-910)were reported.In 46 cases,adenoma was the cause of PHPT,followed by 2 cases of carcinoma and 1 case of hyperplasia.In the remaining 5 cases,the diagnosis was not reported.Neck ultrasound was positive in 34 cases,whereas sestamibi was performed in 3 cases,and neck computed tomography or magnetic resonance imaging was performed in 9 cases(the enlarged parathyroid gland was not localized in 3 cases).Surgery was the preferred treatment during pregnancy in 33 cases(median week of gestation 25,Q1-Q3=20-30)and postpartum in 12 cases.The timing was not reported in the remaining 9 cases,or surgery was not performed.AP was managed surgically in 11 cases and conservatively in 43(79.6%)cases.Maternal and fetal mortality was 9.3%(5 cases).Surgery was more common in deceased mothers(60.0%vs 16.3%;P=0.052),and PTH values tended to be higher in this group(910 pg/mL vs 302 pg/mL;P=0.059).Maternal mortality was higher with higher serum lipase levels and earlier delivery week.Higher calcium(4.1 mmol/L vs 3.3 mmol/L;P=0.009)and PTH(1914 pg/mL vs 302 pg/mL;P=0.003)values increased fetal/child mortality,as well as abortions(40.0%vs 0.0%;P=0.007)and complex deliveries(60.0%vs 8.2%;P=0.01).CONCLUSION If serum calcium is not tested during admission,definitive diagnosis of PHPT-induced AP in pregnancy is delayed,while early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.
文摘Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.
文摘The use of entomopathogenic fungi (EF) in recent years has been highly effective against the different orders of insects considered pests of agricultural importance and their conidia have been commonly applied, but it has been reported that these are sensitive to the environmental conditions. For this reason, biopesticides products have been formulated based on secondary metabolites, recently. These biomolecules participate as biological control agent, such as: cyclic depsipeptides, amino acids, polyketides, polyphenols and terpenoids, affecting their morphology, life cycle and insect behavior. The use of secondary metabolites of entomopathogenic fungi opens the possibility of application in a more efficient way for the control of agricultural pests in a compatible with the environment and human health;therefore, it is important to know, analyzing the type of molecules, their effects, and their different methods of application.
