甲状旁腺切除术治疗继发性甲状旁腺功能亢进的疗效观察与分析

目的探讨甲状旁腺切除术（TPTX）对继发性甲状旁腺功能亢进（SHPT）的临床疗效。方法回顾总结18例继发性甲状旁腺功能亢进的慢性。肾功能衰竭尿毒症期患者行甲状旁腺切除术的病例,比较术前、术后血甲状旁腺素（parathyrojdhormone,PrrH）值和血钙值及临床表现的变化。结果术后18例患者中15例血PTH值恢复正常,1例正常偏高但较原来降低10倍,2例低于正常：18例患者中16例血钙值均恢复正常,2例低于正常;所有患者骨痛、骨质疏松症状明显改善。结论甲状旁腺切除术对继发性甲状旁腺功能亢进的患者具有较好的治疗作用,TPTX治疗SHPT可能是更好的选择。     

长期血透患者甲状旁腺素测定的临床意义

目的　探讨检测长期血透患者甲状旁腺素对继发性甲状旁腺功能亢进的早期诊断、预防和治疗的临床意义。方法　选择 84例长期血液透析患者 ,分为服钙剂组与不服钙剂组 ,另选择 30例非肾功能减退患者为正常对照组 ,分别检测患者血清甲状旁腺素、钙、磷、尿素氮、肌酐等。结果　服钙剂组患者血清甲状旁腺素、磷明显低于不服钙剂组 ,两者之间有显著性差异 (P<0 .0 5) ;而两组患者间的血清钙没有显著性差异 (P>0 .0 5) ;长期血透患者的血清甲状旁腺素明显大于正常对照组 ,与尿素氮、肌酐和磷呈正相关。结论　甲状旁腺素检测对长期血透患者继发甲状旁腺功能亢进的早期诊断、预防和治疗有重要指导意义 ;服用钙剂能预防和治疗继发性甲状旁腺功能亢进 ,减少继发性甲状旁腺功能亢进的发生率     

甲状旁腺切除术治疗尿毒症继发性甲状旁腺功能亢进的疗效观察

目的：观察应用甲状旁腺切除术治疗尿毒症患者继发性甲状旁腺功能亢进的临床疗效。方法20例尿毒症继发甲状旁腺功能亢进而行甲状旁腺切除术的患者,观察术前及术后血清全段甲状旁腺激素（iPTH）、血清磷（P）、血清钙（Ca）、骨痛、肿瘤样钙化的变化。结果行甲状旁腺切除术后患者血iPTH、血磷、血钙水平均明显下降,骨痛症状明显缓解,尿毒症肿瘤样钙化明显缩小。结论对尿毒症继发性甲状旁腺功能亢进并有手术指征的患者行甲状旁腺切除术是有效的治疗方法。     

骨化三醇在继发性甲状旁腺功能亢进中的应用

目的 研究维持血液透析患者继发性甲状旁腺功能亢进,应用骨化三醇治疗的效果及安全性.方法 对37例血液透析甲状旁腺功能亢进患者检测甲状旁腺素(iPTH)在300pg/ml以上,进行血液透析加骨化三醇冲击治疗6～8周.结果 36例甲状旁腺素均有不同程度下降,1例甲状旁腺素下降不理想.结论 血液透析加骨化三醇冲击治疗效果明显,安全性及耐受性好.     

继发性甲状旁腺功能亢进手术术中快速甲状旁腺激素测定33例临床分析

目的：探讨术中甲状旁腺激素(PTH)测定在继发性甲状旁腺功能亢进手术中的应用效果。方法33例患者术中应用甲状旁腺激素测定指导继发性甲状旁腺功能亢进甲状旁腺次全切除术,分析患者术前、术后相关并发症和血液指标变化。结果术后30例患者符合手术成功标准,甲状旁腺激素恢复正常,与术前相比,血磷、血钙均下降(P<0.01)。结论术中甲状旁腺激素测定指导继发性甲状旁腺功能亢进手术是安全有效的方法。     

高频彩超对诊断继发甲状旁腺功能亢进的价值

目的探讨运用高频彩超对继发甲状旁腺功能亢进的临床应用价值。方法应用高频彩超东芝NEMIO（纳米）20和ACUSONSEQUOIA512对46例慢性肾功能不全继发甲状旁腺功能亢进患者的甲状旁腺进行超声检查,并观察甲状旁腺区彩色多谱勒超声表现。结论高频彩超是诊断继发甲状旁腺功能亢进的有效检测手段。     

继发性甲状旁腺功能亢进联合西那卡塞治疗后行甲状旁腺切除术临床疗效观察

目的 探讨继发性甲状旁腺功能亢进联合西那卡塞治疗后行甲状旁腺切除术的临床疗效。方法 将2015年7月～2021年7月收治的继发性甲状旁腺功能亢进患者193例随机分为观察组100例与对照组93例,对照组患者采用甲状旁腺切除术治疗,观察组患者联合西那卡塞治疗后行甲状旁腺切除术。观察两组患者治疗前后血钙、血磷、血清全段甲状旁腺激素（intact parathyroid hormone,iPTH）水平的变化,对比两组患者治疗后临床疗效。结果 治疗后,两组患者血钙、血磷、血清iPTH水平均降低,观察组降低幅度优于对照组（P <0.05）;观察组患者总体有效率（97.00%）高于对照组（89.25%）(P <0.05)。结论 继发性甲状旁腺功能亢进患者联合西那卡塞治疗后再行甲状旁腺切除术,可有效降低血钙、磷、i PTH水平,皮肤瘙痒、骨痛、不宁腿等临床症状得到极大的改善,临床疗效更为显著,对提高患者生存质量有重要价值。     

手术治疗继发性甲状旁腺功能亢进的适应证及临床疗效研究

目的探讨手术治疗继发性甲状旁腺功能亢进的适应证及临床疗效。方法随机选取我院在2017年1月至2018年7月收治的继发性甲状旁腺功能亢进患者60例,分别观察术前、术后6个月的临床症状、钙磷高低、骨密度变化、甲状旁腺激素(PHT)水平的变化。结果所有患者在经过手术治疗的临床症状、钙磷高低、骨密度变化、甲状旁腺激素(PHT)水平的变化均显著优于术前,差异明显,有统计学意义(P <0.05)。结论手术治疗继发性甲状旁腺功能亢进的适应证能有效提高临床疗效,加快患者病情恢复,改善患者的生活质量,值得临床推广应用。     

原发性甲状旁腺功能亢进临床分析

目的 总结原发性甲状旁腺功能亢进（PHPT）的诊断、治疗经验.方法 回顾性分析手术治疗的19例PHPT的临床资料.结果 术后均发生不同程度的低血钙症状.1～6周好转.本组术中冰冻病理与术后石蜡病理相符,7例术中检测血PTH者于切除肿瘤10 min后PTH下降〉50%.术后15例获得随访,随访时间3个月～12年,血钙均于正常范围,骨关节痛症状有不同程度的缓解,关节畸形无改善.结论 血钙及PTH测定是PHPT重要的定性方法,超声、99mTC-MIBI、增强CT扫描是原发性甲状旁腺功能亢进有效的术前定位手段.甲状旁腺危象经内科治疗一旦平稳即应手术治疗.定位明确的甲状旁腺瘤可以行单侧探查.术中测定免疫反应性甲状旁腺素是判断手术效果的最佳指标.     

骨化三醇治疗慢性肾脏病继发性甲状旁腺功能亢进的疗效

目的探讨骨化三醇冲击治疗慢性肾脏病继发性甲状旁腺功能亢进的临床疗效。方法根据血清全段甲状旁腺激素(iPTH)水平选择尚未进入替代治疗的慢性肾脏病(CKD 4、5期)65例,比较治疗前及治疗后4、8、12周的iPTH、血钙、血磷的变化及临床症状的缓解情况。结果 65例患者经治疗12周后,血清iPTH水平明显下降,与治疗前比较差异具有统计学意义(P<0.05)。患者的血钙较治疗前有上升趋势,而血磷有下降趋势。在治疗8、12周时,患者的Ca2+×P3-明显低于治疗前,差异具有统计学意义(P<0.05)。临床症状有不同程度改善,72.3%患者症状明显改善。结论骨化三醇口服治疗慢性肾脏病合并继发性甲状旁腺功能亢进的非透析患者疗效显著,临床症状改善明显。     

复发性流产的免疫机制和药物治疗进展

复发性流产(Recurrent spontaneous abortion,RSA)是指妊娠140 d之前两次及以上的自然流产,发病几率逐年升高,其发病原因复杂,包括子宫畸形、激素和代谢紊乱、感染因素、抗磷脂综合症以及细胞遗传学变异等,但是40%~60%的复发性流产的发病机制尚不明确,对其免疫机制的研究是近年来的研究重点。生殖免疫学认为妊娠是一种半同种移植过程,母-胎界面的免疫耐受可以维持妊娠的继续,打破这种免疫耐受会导致复发性流产的发生。复发性流产的免疫发生机制主要与抗磷脂抗体、自然杀伤细胞、调节性T细胞、滤泡辅助性T细胞以及细胞因子有关,对其进行免疫调节治疗可以降低流产率。文章对RSA的免疫机制的研究和药物治疗提供系统性的总结,包括抗凝血药物、免疫疗法、激素疗法和干细胞疗法等。     

尿毒症继发性甲状旁腺功能亢进症患者应用甲状旁腺全切除加自体移植术5年随访资料分析

目的:观察慢性肾脏病(5D期)患者因继发性甲状旁腺功能亢进症(SHPT)行甲状旁腺全切除加自体移植术(TPTX+AT)的远期临床疗效。方法:回顾性分析2011年3月—2014年12月慢性肾脏病(5D期)患者因继发性甲状旁腺功能亢进症行TPTX+AT的41例患者的临床资料(随访至2019年12月),收集患者术前、术后全段甲状旁腺激素及血清钙、磷、碱性磷酸酶等变化情况,临床症状改善情况,复发和死亡情况,判断临床疗效。结果:共41例患者,年龄(47.0±9.0)岁,透析(76.0±38.9)个月。患者术后1周、1个月、6个月各时间点血全段甲状旁腺素(iPTH)、血清磷、血清钙均较术前显著下降(P<0.001)。术后早期甲状旁腺功能亢进持续状态2例,术后第1年复发5例,其中3例共行5次移植物切除手术。随访期满共有27例存活,血清钙(2.17±0.26)mmol/L,血清磷(2.16±0.47)mmol/L,iPTH达标率70.4%(19/27)。结论:甲状旁腺全切除加自体移植术,能安全、有效治疗尿毒症难治性SHPT,可以改善SHPT患者远期预后。     

原发性甲状旁腺功能亢进症9例临床分析

目的总结原发性甲状旁腺功能亢进症(PHPT)的诊断及治疗经验。方法回顾性分析9例PHPT患者的临床资料。结果 9例中,男3例,女6例。9例患者甲状旁腺素均升高,7例血钙升高。99mTc-MIBI核素扫描检查发现病灶9例,均为单发病灶。单侧手术探查9例;术后均出现不同程度的低血钙症,予静脉补钙3-7d后好转。结论 PHPT的诊断主要依据为血清甲状旁腺素及血钙的检测,B超、99mTc-MIBI核素扫描检查是首选定位诊断方法;定位明确的患者可手术切除。     

Cinacalcet HCl: a calcimimetic agent for the management of primary and secondary hyperparathyroidism

Cinacalcet HCl (AMG 073) is an investigational oral calcimimetic drug currently being evaluated for the treatment of primary and secondary hyperparathyroidism (HPT). Calcimimetics bind to the calcium-sensing receptors of the parathyroid glands and lower the sensitivity for receptor activation by extracellular calcium, thereby diminishing parathyroid hormone release. Cinacalcet HCl has demonstrated efficacy in controlling the hypercalcaemia of severe primary HPT and in reducing parathyroid hormone levels in patients with secondary HPT. Asymptomatic dose-dependent hypocalcaemia has occurred in some clinical trials. This drug has a favourable pharmacokinetic profile compared to its precursors and will prove useful as an additional/alternative agent in patients with primary and secondary HPT.     

Calcium agonists in hyperparathyroidism

Primary hyperparathyroidism (PHPT), in addition to cancer, represents an important cause of hypercalcaemia in the general population. Furthermore, hypercalcaemia, in the course of uraemic HPT, represents the late stage of chronic renal failure refractory to therapy. Neck surgery is still the only curative approach for these forms of HPT and medical treatment rarely exhibits an effective control on HPT and HPT-dependent hypercalcaemia. Moreover, some HPT patients may not undergo neck surgery due to the presence of other concomitant disorders. Therefore, more effective therapeutic approaches are needed than the commonly used ‘palliative’ treatments. The identification of a specific membrane receptor able to bind extracellular calcium on cells of the parathyroid and other tissues has allowed the development of new molecules acting through this receptor to reduce both parathyroid hormone secretion and the rate of parathyroid cell proliferation. Consequently, they may substantially contribute to the regulation of bloodstream calcium levels in HPT patients. Preliminary results obtained in clinical trials are encouraging, demonstrating a good efficacy and safety of such drugs. However, more in vitro and in vivo, as well as long-term clinical studies, will be necessary before they can be commonly used as therapeutical molecules in the clinical practice.     

Treatment of recurrent depression: a sequential psychotherapeutic and psychopharmacological approach

The chronic and recurrent nature of major depressive disorder is receiving increasing attention. Approximately eight of ten people experiencing a major depressive episode will have at least one more episode during their lifetime, i.e. recurrent major depressive disorder. In the 1990s, prolonged or lifelong pharmacotherapy emerged as the main therapeutic tool for preventing relapses of depression. This therapeutic approach is based on the effectiveness of antidepressant drugs compared with placebo in decreasing relapse risk and on the improved tolerability profile of the newer antidepressants compared with their older counterparts. However, outcome after discontinuation of antidepressant therapy does not seem to be affected by the duration of administration. Loss of clinical effects, despite adequate compliance, has also emerged as a vexing clinical problem. The use of intermittent pharmacotherapy with follow-up visits is an alternative therapeutic option. This leaves patients with periods free of drugs and adverse effects and takes into account that a high proportion of patients would discontinue the antidepressant anyway. However, the problems of resistance (that a drug treatment may be associated with a diminished chance of response in subsequent treatments in those patients whose symptoms successfully responded to it but who discontinued it) and of discontinuation syndromes are substantial disadvantages of this therapeutic approach. In recent years, several controlled trials have suggested that sequential use of pharmacotherapy in the treatment of the acute depressive episode and psychotherapy in its residual phase may improve long-term outcome. Patients, however, need to be motivated for psychotherapy, and skilled therapists have to be available. Despite an impressive amount of research into the treatment of depression, there is still a paucity of studies addressing the specific problems that prevention of recurrent depression entails. It is important to discuss with the patient the various therapeutic options and to adapt strategies to the specific needs of patients.     

原发性甲状旁腺功能亢进症合并甲状腺疾病15例临床分析

目的探讨原发性甲状旁腺功能亢进症(PHPT)患者合并甲状腺疾病的临床特征。方法回顾性分析29例手术治疗并经病理检查确诊的PHPT患者的临床资料。结果29例PHPT患者中,无甲状腺疾病组14例,合并甲状腺疾病组15例(51.7%)。其中,甲状腺良性病变10例(结节性甲状腺肿9例,桥本氏甲状腺炎1例),恶性病变5例(甲状腺乳头状癌4例,甲状腺隐匿性癌1例)。合并甲状腺疾病组的平均年龄大于无甲状腺疾病组(P<0.05)。结论 PHPT患者合并甲状腺疾病的发病率高,且甲状腺恶性病变较多。     

Effects of a <Emphasis Type="Italic">Rhodiola rosea</Emphasis> L. extract on the acquisition,expression, extinction,and reinstatement of morphine-induced conditioned place preference in mice

Rationale  

Opioid addiction is a chronic, recurrent brain disease that is characterised by compulsive drug seeking and a high rate of relapse even after long periods of abstinence. Prevention of relapse is the primary goal of addiction treatment and is still the major limitation in drug therapy.     

Lapatinib ditosylate: expanding therapeutic options for receptor tyrosine-protein kinase erbB-2-positive breast cancer

Receptor tyrosine-protein kinase erbB-2 (HER2)-positive breast cancer is a specific entity with an aggressive behavior. Trastuzumab, a monoclonal antibody targeting erbB-2 (HER2) deeply transformed the outcome in patients. Nevertheless, resistance to trastuzumab is still a major concern. Lapatinib ditosylate is an orally available, small molecule targeting the tyrosine activity of the HER2 receptor. Lapatinib as a single agent and in combination therapy showed interesting activity in trastuzumab-resistant advanced tumors. In addition, lapatinib use seemed suitable in recurrent locally advanced inflammatory breast cancer and brain metastases. More recently, the Neo-ALTTO (NeoAdjuvant Lapatinib and/or Trastuzumab Treatment Optimisation) trial showed that lapatinib in combination with trastuzumab and paclitaxel significantly improved the pathological complete response in a neoadjuvant setting. Several clinical trials are still ongoing and data that may change current clinical practice are awaited with much interest.