【Abstract】ObjectiveTo investigate the effect of xenotransplantation of microencapsulated rabbit parathyroid tissue in different sites in rats for the treatment of hypoparathyroidism. MethodsThe parathyroid glands from Wistar rats were removed to make them aparathyroid. Ultimately, sixteen rats were included because their serum calcium values were continuously below 1.6 mmol/L. We also encapsulated the cultured rabbit parathyroid tissue with alginateBaCl2 microcapsule. According to the transplantation sites, rats were randomly divided into two groups: renal adipose microcapsule group and peritoneal microcapsule group, eight in each group. Encapsulated rabbit parathyroid tissues were then transplanted accordingly to different microcapsule groups. The calcium serum contents were examined on 5，15，25，35，45，55 and 65 d respectively after transplantation and the grafts were observed through electron microscope on the 65 d in particular. ResultsThe calcium contents after transplantation in renal adipose microcapsule group restored to normal and the observation outcomes of grafts showed that they survived well. The calcium contents of posttransplantation in peritoneal group also restored to normal with an exception that it dropped to a level lower than 1.6 mmol/L on the 65 d. Electron microscope also showed that there were necrotic tissues in the center and only a few cells survived on the edge of the grafts. Within peritoneal microcapsule group, the values were significantly lower than others taken at different phases. ConclusionMicroencapsulated rabbit parathyroid tissue that was xenotransplanted into rats can survive and function without administration of immunodepressant. There are significant differences of calcium contents at varying phases between two transplantation sites, which demonstrate that renal adipose may be an optimal site for microcapsule xenotransplantation.
【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.
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.
【Abstract】Objective To search for the significance of endoscopic thyroidectomy and parathyroidectomy. Methods Literatures about endoscopic thyroidectomy and parathyroidectomy were collected and reviewed. Results Thyroidectomy and parathyroidectomy may be performed with endoscope or with the help of endoscope. Conclusion By endoscopic thyroidectomy and parathyroidectomy, the patients are lightly injured without scar in the neck. The quality of life is improved.
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 assess the efficacy and safety of parathyroid hormone (PTH) on bone mineral density (BMD) and fractures in postmenopausal women with osteoporosis. Methods We searched MEDLINE (1966 to March 2008), EMBASE (1974 to March 2008), The Cochrane Library (Issue 1, 2008), Current Controlled Trials, The National Research Register, CBM (1983 to March 2008) and CNKI (1994 to March 2008). Some related journals were hand searched as well. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by The Cochrane Collaboration’s software RevMan 4.2.10. Results Twelve studies involving 5550 patients were included. PTH alone or in combination with antiresorptive drugs reduced the risk of vertebral fracture (RR=0.34, 95%CI 0.26 to 0.45, Plt;0.000 01), and increased spine BMD (SMD 0.41, 95%CI 0.17 to 0.65, P=0.0009) and femoral neck BMD (SMD 0.13, 95%CI 0.03 to 0.22, P=0.008). The rate of drop out and loss to follow-up because of adverse events was significantly higher in the PTH group (Peto-OR=1.69, 95%CI 1.39 to 2.05, Plt;0.000 01). Conclusion PTH is effective in the prevention and treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH alone or in combination with antiresorptive drugs can reduce the risk of vertebral fractures and increase spine and femoral neck BMD. PTH is more effective than alendronate, but these two should not be used as a combined treatment.
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.
Objective To investigate the function and survival of parathyroid tissue transplanted into the rectus of rat by different pre-treatment. Methods Male，adult Wistar rats （seventy）as donors and adult SD rats （thirty-five）as receptors. Model rats were established by resection of parathyroid and randomly divided into five groups （digital random method）：direct transplantation group， high-oxygen culture group， ciclosporin A （CsA） group， 60Co irradiated group， and integrated treatment group. Each receptor received four PTG from two donors and the PTG were transplanted into the rectus of the receptors. Changes in concentration of serum calcium and PTH at different time points before and after parathyroid transplantation in each group recipient rats were observed. Results Serum calcium and PTH could reach or remain normal level after thyroid tissue transplantation in all groups in 1 week after operation， which significantly differed from those of pre-transplanted （P＜0.01）. The survival time among the five groups were different： the duration for keeping serum calcium and PTH at normal level（only 3 week and 4 weeks）in direct transplantation group was shortest than that in high-oxygen culture group （5 weeks and 8 weeks）， CsA group （6 weeks and 8 weeks）， 60Co irradiated group （5 weeks and 7 weeks）, and integrated treatment group （5 weeks and 9 weeks）. Compared with direct transplantation group， the levels of serum calcium and PTH in high-oxygen culture group，CsA group，60Co irradiated group, and integrated treatment group were significantly higher in 4-9 weeks point （P＜0.05， except high-oxygen culture group in 9 weeks and 60Co irradiated group in 8 weeks after operation had no significant difference）. Compared with integrated treatment group， the levels of serum calcium and PTH in high-oxygen culture group，CsA group， and 60Co irradiated group were significantly lower in 7-9 weeks point （P＜0.05）. Conclusions PTG tissues transplanted in rectus can maintain serum calcium level at normal range，and measurement on graft or receptors can prolong the survival period of parathyroid graft. Tissue transplantation of parathyroid after culture may provide a potent way to cure hypothyroidism.
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.
【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.