scholarly journals The Usefulness of Intraoperative PTH as a Predictor for Successful Parathyroidectomy in Secondary Hyperparathyroidism

2021 ◽  
Vol 8 ◽  
Author(s):  
Karla Verónica Chávez ◽  
Horacio Márquez-González ◽  
Mariana Chavez-Tostado
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Prospective Observational Study ◽  
Study Cohort ◽  
Bone Homeostasis ◽  
Subtotal Parathyroidectomy ◽  
Failure Group ◽  
Significant Difference ◽  
Intraoperative Pth ◽  
Successful Group ◽  
Endocrine Surgeon

Introduction: Secondary hyperparathyroidism (SHPT) is a multisystemic syndrome that affects calcium and bone homeostasis in patients with chronic kidney disease (CKD). Despite medical treatment, 1–2% of patients require parathyroidectomy annually. The use of an intraoperative parathormone protocol (IOPTH) to predict cure is still in debate, due to the lack of standardized protocols, the use of different assays, and uneven PTH clearance. This study aimed to determine the diagnostic accuracy of an IOPTH in patients with SHPT for predicting successful surgery after parathyroidectomy.Methods: About 30 patients were enrolled. A prospective observational study (cohort) was performed in patients who were submitted to parathyroidectomy by an endocrine surgeon for SHPT. All were submitted to a bilateral neck exploration with a subtotal parathyroidectomy. Three IOPTH determinations were withdrawn: at anesthetic induction (PTH0), 15 min (PTH15), and 30 min (PTH30) after completion of gland resection. Another sample was taken 24 h after the procedure (PTH24), values <150 pg/mL defined a successful surgery, and patients were assigned to the success or failure group. IOPTH drop was analyzed to predict successful surgery with drops of 70 and 90% at 15 and 30 min, respectively.Results: A total of 26 patients were included, 19 patients were in the successful group. IOPTH showed a significant difference between groups in their absolute PTH15 and PTH30 values. A significant difference was also found in their PTH drop at 30 min (81 vs. 91%, p = 0.08). For predicting a successful surgery, having a PTH drop >90% at 30 min was the most significant factor [Odds Ratio (OR) 3.0 (1.5–4) IC 95%].Conclusions: This study points toward a stricter and staggered IOPTH protocol to predict a successful surgery. Our results suggest taking a PTH15 expecting a PTH drop of >90%. If this is not achieved, reexploration and a PTH30 sample are suggested to accurately predict success.

Calcium and Vitamin D Supplementation. Myths and Realities with Regard to Cardiovascular Risk

2019 ◽  
Vol 17 (6) ◽  
pp. 610-617 ◽  
Author(s):  
Giovanna Muscogiuri ◽  
Luigi Barrea ◽  
Barbara Altieri ◽  
Carolina Di Somma ◽  
Harjit pal Bhattoa ◽  
...  
Keyword(s):  
Vitamin D ◽  
Side Effects ◽  
Secondary Hyperparathyroidism ◽  
Calcium Supplementation ◽  
Physiological Role ◽  
Bone Diseases ◽  
Current Evidence ◽  
Bone Homeostasis ◽  
Mineral Density ◽  
Muscle Health

Vitamin D and calcium are considered crucial for the treatment of bone diseases. Both vitamin D and calcium contribute to bone homeostasis but also preserve muscle health by reducing the risk of falls and fractures. Low vitamin D concentrations result in secondary hyperparathyroidism and contribute to bone loss, although the development of secondary hyperparathyroidism varies, even in patients with severe vitamin D deficiency. Findings from observational studies have shown controversial results regarding the association between bone mineral density and vitamin D/calcium status, thus sparking a debate regarding optimum concentrations of 25-hydroxyvitamin D and calcium for the best possible skeletal health. Although most of the intervention studies reported a positive effect of supplementation with calcium and vitamin D on bone in patients with osteoporosis, this therapeutic approach has been a matter of debate regarding potential side effects on the cardiovascular (CV) system. Thus, the aim of this review is to consider the current evidence on the physiological role of vitamin D and calcium on bone and muscle health. Moreover, we provide an overview on observational and interventional studies that investigate the effect of vitamin D and calcium supplementation on bone health, also taking into account the possible CV side-effects. We also provide molecular insights on the effect of calcium plus vitamin D on the CV system.

Reducing Gingivitis Remotely using the iGAM mHealth app (part 2): Prospective Observational Study (Preprint)

2020 ◽  
Author(s):  
Guy Tobias ◽  
Assaf B Spanier
Keyword(s):  
Oral Health ◽  
Tooth Loss ◽  
Prospective Observational Study ◽  
Dental Clinics ◽  
Significant Difference ◽  
Observational Cohort ◽  
Group 2 ◽  
And Behavior ◽  
Oral Hygiene Habits ◽  
Group 1

BACKGROUND Gingivitis is a non-painful, inflammatory condition that can be treated with home remedies. Left untreated gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. In order to contain the spread of the corona virus, governments, including in Israel, have restricted movements of their citizens which has caused routine dental checkups to be postponed. OBJECTIVE This study aimed to examine the ability of an mHealth app- iGAM to reduce gingivitis. METHODS A prospective observational cohort study was performed, 160 unpaid participants were divided into 2 equal groups and downloaded the iGAM app. Group 1 photographed their gums weekly for eight weeks. Group 2 photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the message "It is recommended to read the information contained within the app regarding maintaining oral hygiene habits". A single blinded researcher examined the images and scored them according to the Modified Gingival Index (MGI). RESULTS The average age of group 1 was 26.77 (S.D. ± 7.43), and 28.53 (S.D. ± 10.44) for group 2. The majority were male (74.7% in group 1 vs. 66.7% in group 2), most participants described themselves as "secular", most were "single", non-smokers (74.7% vs. 78.4%) and did not take medications (85.3% vs. 78.4%). 126 subjects completed the study. A statistically significant difference (P <.001) was found in the dependent variable (MGI) in a linearly negative manner. As time passed, the gum condition improved, there were significantly lower gingivitis scores in group 1 (M = 1.16, S.D. ± 1.18) compared to group 2 (M = 2.16, S.D. ± 1.49), after eight weeks. Those with more recent dental visits had a lower MGI (p = .037). No association was found between knowledge and behavior, most participants were familiar with the recommendations for maintaining oral health, yet they only performed some. CONCLUSIONS A dental selfie taken once a week using an mHealth app (iGAM) reduced the signs of gingivitis and promoted oral health. During the current pandemic where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health. CLINICALTRIAL The protocol was approved by Hadassah research ethics committee (IRB, 0212-18-HMO)

Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity

Neurosurgery ◽  
2020 ◽  
Author(s):  
Se-Jun Park ◽  
Jin-Sung Park ◽  
Yunjin Nam ◽  
Tae-Hoon Yum ◽  
Youn-Taek Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Scan ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Study Cohort ◽  
Related Factors ◽  
Fixation Failure ◽  
Failure Group ◽  
Pelvic Fixation ◽  
Spinopelvic Fixation

Abstract BACKGROUND Rigid internal fixation of the spine is an essential part of adult spinal deformity (ASD) surgery. Despite the use of pelvic fixation and anterior column support, spinopelvic fixation failure (SPFF) still remains an issue. Few studies have evaluated the types of such failure or its related factors. OBJECTIVE To classify the types of SPFF and investigate its risk factors, including the fusion status at L5-S1 on CT scan. METHODS The study cohort consisted of ninety-eight ASD patients who underwent more than 4-level fusions to the sacrum with interbody fusion at L5-S1. Patients with SPFF were divided into the two groups: above-S1 and below-S1 failure groups. The patient, surgical, and radiographic variables in each group were compared to those of the no-failure group. The L5-S1 fusion status was assessed using 2-yr computed tomography (CT) scan. Univariate and multivariate analyses were performed to determine the risk factors for each failure group. RESULTS The mean age was 68.5 yr. Follow-up duration was 55.7 mo. The SPFF developed in 46 (46.9%) patients at 32.7 mo postoperatively. There were 15 patients in the above-S1 failure group and 31 patients in the below-S1 failure group. Multivariate analysis revealed that nonunion at L5-S1 was a single risk factor for above-S1 failure. In contrast, the risk factors for below-S1 failure included a greater number of fused segments and postoperative less thoracic kyphosis. CONCLUSION SPFF develops in different patterns with different risk factors. Above-S1 SPFF was associated with nonunion at L5-S1, while below-S1 SPFF was associated with mechanical stress.

scholarly journals Complete remission of metastatic osteosarcoma using combined modality therapy: a retrospective analysis of unselected patients in China

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lu Xie ◽  
Jie Xu ◽  
Xiaowei Li ◽  
Zuli Zhou ◽  
Hongqing Zhuang ◽  
...  
Keyword(s):  
Pulmonary Metastases ◽  
Local Therapy ◽  
Hypofractionated Radiotherapy ◽  
Study Cohort ◽  
Sufficient Information ◽  
Progression Rate ◽  
Entire Study ◽  
Pulmonary Lesions ◽  
Metastatic Osteosarcoma ◽  
Significant Difference

Abstract Background Complete surgical remission (CSR) is the best predictor of overall survival (OS) for patients with metastatic osteosarcoma. However, metastasectomy has not been widely implemented in China in the last decade due to various factors, and instead, most physicians choose hypofractionated radiotherapy to treat pulmonary lesions. This study aimed to retrospectively evaluate the outcomes of different local treatments for pulmonary lesions and identify the best local therapy strategies for these patients. Methods We reviewed the clinical courses of osteosarcoma patients with pulmonary metastases who were initially treated in two sarcoma centres in Beijing, China, from June 1st, 2009, to March 26th, 2020. With a median follow-up of 32.4 (95% confidence interval (CI): 30.8, 36.1) months, a total of 127 patients with 605 pulmonary nodules, all of whom had received local therapy and firstly achieved CSR or complete radiated/metabolic remission (CRR), were included in the analysis. A total of 102 patients with 525 nodules were initially diagnosed with resectable lung metastases, while 25 patients had 80 indeterminate nodules at presentation and relapsed with pulmonary metastases within 6 months after the completion of adjuvant chemotherapy. Results Eighty-eight of 127 (69.3%) patients had fewer than 5 nodules at the time of local therapy, with 48 of 127 (37.8%) located in the unilateral pleura. No patient underwent thoracotomy, and 42 of 127 patients (85 nodules) received video-assisted thoracoscopic surgery (VATS). In addition, 79 of 127 patients (520 nodules) received hypofractionated stereotactic body radiotherapy (RT), such as Gamma Knife radiosurgery or CyberKnife radiosurgery. The twelve-month event-free survival (EFS) (from local therapy to progression) rate of this entire study cohort was 35.6% (95% CI: 26.8, 44.4%), without a significant difference between the two groups (44.7% for VATS vs. 28.4% for RT, P = 0.755). Radiation-induced pneumonitis was observed in 62 of 86 (72.1%) patients, with one patient (1/86, 1.2%) in grade 4. Conclusions Our past data showed a similar prognosis with the use of hypofractionated radiotherapy and VATS for the treatment of pulmonary metastasis and no inferiority to thoracotomy regarding historical outcomes. Currently, high-resolution chest computed tomography (CT) provides sufficient information on nodules, and less invasive modalities can thus be considered for treatment.

scholarly journals Disparity between Preoperative and Pre-Excisional Intraoperative Parathyroid Hormone in Parathyroid Surgery

2018 ◽  
Vol 22 (04) ◽  
pp. 382-386
Author(s):  
Maheer Masood ◽  
Trevor Hackman
Keyword(s):  
Parathyroid Hormone ◽  
Clinic Visit ◽  
Time Interval ◽  
Parathyroid Surgery ◽  
Academic Center ◽  
Significant Difference ◽  
Intraoperative Pth ◽  
Gland Function ◽  
Intraoperative Parathyroid Hormone ◽  
Clinic Visits

Introduction Intraoperative parathyroid hormone (ioPTH) testing is a widely accepted standard for assessing the parathyroid gland function. A decline of preoperative parathyroid hormone (PTH) levels by more than 50% is one accepted measure of parathyroid surgery adequacy. However, there may be a variation between preoperative PTH levels obtained at a clinic visit and pre-excisional ioPTH. Objective Our study explores the differences between preoperative PTH and pre-excisional ioPTH levels, and the potential impact this difference has on determining the adequacy of parathyroid surgery. Methods A retrospective study that consisted of 33 patients that had undergone parathyroid resection between September 2009 and March 2016 at a tertiary academic center was performed. Each subject's preoperative PTH levels were obtained from clinic visits and pre-excisional ioPTH levels were recorded along with the time interval between the measurements. Results There was a significant difference between the mean preoperative PTH and the pre-excisional ioPTH levels of 147 pg/mL (95% confidence interval [CI] 11.43 to 284.47; p = 0.0396). The exclusion of four outliers revealed a further significant difference with a mean of 35.09 pg/mL (95% CI 20.27 to 49.92; p < 0.0001). The average time interval between blood draws was 48 days + 32 days. A weak correlation between the change in PTH values and the time interval between preoperative and pre-excision blood draws was noted (r2 = 0.15). Conclusion Our study reveals a significant difference between the preoperative PTH levels obtained at clinic visits and the pre-excisional intraoperative PTH levels. We recommend routine pre-excisional intraoperative PTH levels, despite evidence of elevated preoperative PTH levels, in order to more accurately assess the adequacy of surgical resection.

Procalcitonin levels in sepsis and its association with clinical outcome in southern India

2017 ◽  
Vol 47 (4) ◽  
pp. 331-336
Author(s):  
Alex Rebello ◽  
Molly Mary Thabah ◽  
Tarun Kumar Dutta ◽  
Zachariah Bobby ◽  
BN Harish ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Prospective Observational Study ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Antibiotic Administration ◽  
Mean Values ◽  
Good Marker ◽  
Significant Difference ◽  
Medical Intensive Care ◽  
Medical Wards

Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, data on procalcitonin levels to predict the clinical outcome in patients with sepsis are limited. The aim of our study was to estimate serum procalcitonin levels in patients with sepsis and to identify its relationship with the clinical outcome. This was a prospective observational study conducted on 112 patients with sepsis admitted to the medical wards and medical intensive care unit of a tertiary care teaching hospital. Serum procalcitonin was measured at baseline before antibiotic administration and on day 5. The clinical outcome studied was death or survival on day 28. Baseline mean serum procalcitonin was highest in patients with septic shock and lowest in patients having sepsis without organ dysfunction. Mean values of procalcitonin at baseline and on day 5 were significantly higher in non-survivors when compared with survivors. There was a significant difference in the change in procalcitonin levels from baseline to day 5 between survivors and non-survivors, with survivors having declining values on day 5 while non-survivors had increasing values from baseline. The baseline APACHE II and SOFA scores also showed a significant correlation with the baseline procalcitonin level. Declining values of procalcitonin therefore indicate a favourable clinical outcome in patients with sepsis.

scholarly journals SURGICAL ANATOMY OF PARATHYROID GLANDS IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

2015 ◽  
Vol 7 (3) ◽  
pp. 23-28 ◽  
Author(s):  
K Yu Novokshonov ◽  
Y N Fedotov ◽  
V Y Karelin ◽  
T S Pridvizhkin ◽  
R A Chernikov ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Surgical Anatomy ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Thyroid Lobe ◽  
Subtotal Parathyroidectomy ◽  
Carotid Sheath ◽  
Treat Ment ◽  
Gland Tissue ◽  
Surgical Failure

Ectopic or supernumerary parathyroid glands (PTg) can be the reason of surgical failure in treat- ment of secondary hyperparathyroidism in patients, who underwent dialysis. The aim of this study is to estimate the number and localization of PTgs in patients with secondary hyperparathyroidism. We included 165 patients, who underwent total parathyroidectomy with heterotopic autotransplantation of parathyroid gland tissue or subtotal parathyroidectomy. All identified PTgs were separated in two groups: eutopic and ectopic. Preoperative localization was performed by multispiral computed tomog- raphy of neck and mediastinum, neck ultrasonography, two-isotope Tc99 MIBI of PTgs. In postopera- tive period, we estimated the level of parathyroid hormone in the serum and performed morphological verification. There were found 659 PTgs. 12 (7,2%) patients had 3 parathyroid glands, and 11 (6.7%)had 5 PTgs. 4 Ptgs were found in 142 (86,1%) patients. 520 (78,9%) PTgs were eutopic, 139 (21,1%) - ectopic. The most common ectopic place for upper PTgs were paraesophageal and retrotracheal spaces, carotid sheath. Ectopic lower PTgs were most commonly located in the horns of the thymus. All super- numerary PTg were ectopic and often located in area between lower pole of the thyroid lobe and the thymus.Conclusion. During the operation in case when ectopy is suspected, upper PTgs should be located in in paraesophageal and paratracheal areas or in carotid sheath, if it necessary. If lower PTgs is absence, surgery should be completed cervical thymectomy.

scholarly journals Prevalence and associated factors for Pterygium in Han and Mongolian adults: across-sectional study in inner Mongolian, China

2019 ◽  
Author(s):  
Yuhan Wang ◽  
Guangliang Shan ◽  
Linyang Gan ◽  
Yonggang Qian ◽  
Ting Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Rural Areas ◽  
Inner Mongolia ◽  
Univariate Analysis ◽  
Education Level ◽  
Study Cohort ◽  
Sectional Study ◽  
Factors Associated ◽  
Significant Difference

Abstract Background: To investigate the prevalence of and factors associated with pterygium in Han and Mongolian adults at four survey sites in Inner Mongolia, China. Methods: A population-based, cross-sectional study was conducted. Using a stratified sampling method, we eventually included 2,651 participants of at least30 years of age from a total of 3,468 eligible residents. Factors associated with pterygium were analysed using univariate analysis and logistic regression models. Results: There were 1,910 Han adults and 741 Mongolian adults included in this study. The mean± standard deviation of age for individuals in the study cohort was 48.93±11.06 years. The overall prevalence of pterygium was 6.4% (n=169), and the prevalences of bilateral and unilateral pterygium were 1.4% (n=38) and 4.8% (n=128), respectively. The most common grade of pterygium was Grade 2. After univariate analysis, eleven factors were considered in a multivariate analysis. The results indicated that age (P<0.001), education level (P<0.001), outdoor occupation (P=0.026), and time spent in rural areas (P<0.001) were significantly associated with pterygium, whereas gender and ethnicity were not risk factors. In subgroup analysis, BMI≥28 was a protective factor for Han individuals (OR 0.42, 95% CI 0.21-0.81, P=0.01), but a risk factor for Mongolian individuals (OR 2.39, 95% CI 1.02-5.58, P=0.044). The BF% in Han and Mongolian individuals had significant difference (P<0.001). Conclusions: Our results indicated that an outdoor occupation, old age and time spent in rural areas are risk factors for pterygium in Inner Mongolia. Living near an urban survey site (Hohhot and Tsining District) and having a higher education level are protective factors for pterygium. Ethnicity, gender, smoking, diabetes and high blood pressure are not associated with pterygium. Different dietary structures in Han and Mongolian adults may lead to different fat content of body and therefore contributes to the prevalence of pterygium. Keywords: Pterygium, prevalence, Han and Mongolian, risk factors, protective factors

Evaluation of Real-World Smart Sock-Based Temperature Monitoring Data as a Physiological Indicator of Early Diabetic Foot Injury: Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Alexander M Reyzelman ◽  
Chia-Ding Shih ◽  
Gregory Tovmassian ◽  
Mohan Nathan ◽  
Ran Ma ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Monitoring Program ◽  
Temperature Monitoring ◽  
Lower Extremity Injury ◽  
Study Cohort ◽  
Temperature Differential ◽  
Comparator Group ◽  
Foot Injury ◽  
Useful Signal ◽  
Significant Difference

BACKGROUND Diabetic foot ulcers represent major health care complications both in terms of cost and impact to quality of life for patients with diabetic peripheral neuropathy. Temperature monitoring has been shown in previous studies to provide a useful signal of inflammation that may indicate the early presence of a foot injury. OBJECTIVE In this study we evaluated the temperature data for patients that presented with a diabetic foot injury while utilizing a sock-based remote temperature monitoring device. METHODS The study abstracted data from patients enrolled in a remote temperature monitoring program in year 2020-2021 using a smart sock (Siren Care, San Francisco, California, USA). In the study cohort, a total of 5 participants with a diabetes-related lower extremity injury during study period were identified. In the second comparison cohort, a total of 26 patients met the criteria for monitoring by the same methods that did not present with a diabetes-related podiatric injury during the same period. The 15-day temperature differential between six defined locations on each foot was the primary outcome measure among subjects who presented a diagnosed foot injury. Paired t-tests were used to compare the differences between the two groups. RESULTS A significant difference in temperature differential was observed in the group that presented with a podiatric injury over the course of evaluation vs. the comparator group that did not present with a podiatric injury with temperature measured in °F. The average difference from all six measured points was 1.4°F between the injury group (mean 3.6 +/- 3.0) and the comparator group (mean 2.2 +/- 2.5, t=-71.4; P<.000). CONCLUSIONS The presented study demonstrated significant temperature difference for patients presenting with a foot injury in a 15-day period prior to the diagnosis of an injury compared with a similar period for patients without an injury. The findings suggest temperature monitoring may be a predictor of a developing foot injury. The continuous temperature monitoring system employed has implications for further algorithm development to enable early detection. The study was limited by a nonrandomized, observational design with limited injuries present in the study period.

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