Objective To compare the effects of intramuscular or subcutaneous forearm parathyroid autotransplantation after total parathyroidectomy on patients with renal hyperparathyroidism.Methods From Jan.2012 to Dec.2013,total parathyroidectomy was carried out in 90 patients with renal hyperparathyroidism.According to the location of their parathyroid autograft,patients were divided into intramuscular group (n =39)and subcutaneous group(n =51).One patient in the intramuscular group and two in the subcutaneous group were excluded for the high levels of intact parathyroid hormone (iPTH) the day after operation.iPHT was analyzed 2 weeks,1 month,3 and 6 months after surgery.Results The time of autotransplantation was significantly shorter in subcutaneous group than in intramuscular group (11.46 (2.63) min vs 22.12 (3.78) min;t =0.632,P ＜ 0.05).iPTH levels were significantly lower in subcutaneous group than in intramuscular group 2 weeks after operation (P ＜ 0.05).There was no significant difference between the 2 groups regarding iPTH levels at 1 month,3 or 6 months after surgery.In the follow-up one patient in intramuscular group and one in subcutaneous group had graft-dependent hyperparathyroidism.Conclusion As compared to intramuscular parathyroid autotransplantation,subcutaneous parathyroid autotransplantation has advantages of simpler to operate,shorter autoimplantation time and easier to autograftectomy.

Purpose To investigate the clinicopathological characteristics and treatment of combined hepatocellular carcinoma-cholangio carcinoma (cHCC-CC).Methods 24 cases of cHCC-CC were collected.The clinical pathological characteristics,imaging,immunophenotyping and clinical features were retrospectively analyzed and reviewed the literature.Results There were 18 males and 6 females in 24 cases of cHCC-CC.The age ranged from 36 to 68 years (mean age was 54.38).Tumour location:right hepatic lobe in 15 cases,left hepatic lobe in 6 cases,both left lobe and right hepatic lobe in 1 case,hepatic caudate and left lateral lobe in 1 case,diffuse nodular liver tumors in 1 case.Grossly,the texture and color of tumor was related to the composition of tumor.Microscopically,classic cHCC-CC had two areas composed of hepatocellular carcinoma area and cholangiocar cinoma area of mixed distribution or migration distribution.3 cases were cHCC-CC with stem cell properties (cholangiolocellular carcinoma type,CLC type).Immunohistochemical staining revealed that HCC like area mainly expressed CD10,CK8,Hepatocyte and CD10,cHCC-CC area expressed CK7 and EMA.CLC type expressed the immunophenotypic features of intermediate type of HCC.Conclusion The clinical manifestations of cHCC-CC are not specific,the preoperative diagnosis is difficult,and it should be combined with pathological characteristics,imaging features and immunophenotype diagnosis.

Objective To study the clinical effect of total parathyroidectomy with subcutaneous autotransplantation (TPTX + AT) in the treatment of secondary hyperparathyroidism(SHPT) in patients with chronic renal failure.Methods One hundred and thirty-four patients undergoing TPTX + AT in our hospital from January 2013 to October 2014 were includud in this study.The preoperative,postoperative and follow-up intact parathyroid hormone (iPTH),serum calcium,serum phosphorus and calcium-phosphorus product were statistically analyzed.The Kidney Disease Quality of Life Short Form (KDQOL-SFTM) scale was used to evaluate quality of life before and one year after parathyroidectomy.Postoperative complications and recurrence were observed.Results Postoperative iPTH,serum calcium,serum phosphorus and calciumphosphorus product decreased significantly compared with that before surgery.The difference had statistical significance (all P ＜ 0.05).One patient died in perioperative period.Temporary injury of recurrent laryngeal nerve was found in eight patients.Early postoperative hypocalcemia was frequently seen in 124 patients (92.5％) and in 7 cases (5.2％) occured intractable hypocalcemia.The quality of life was significantly improved one year after parathyroidectomy.Recurrence developed in 5 patients after operation.Conclusions TPTX + AT is safe and effective in the treatment of SHPT in patients with chronic renal failure and can significantly improve the patient's quality of life.

Objective:To investigate the expression of hippocampal synapse-related proteins including synaptophysin (SYN), postsynaptic density protein 95 (PSD95) and growth-associated protein 43 (GAP43) in rats with epilepsy accompanied by depression.Methods:The 3-month-old female clean grade SD rats were selected for the experiment.Lithium chloride pilocarpine was used to establish an epileptic rat model. Rats with successful epilepsy models were divided into epileptic depressive group (EWD group)and epileptic group with 10 in each group based on whether they were accompanied by depression. Furthermore, ten rats with matched body mass were taken as the depressive group and 10 were taken as control group. As for the depressive group rats, chronic unpredictable mild stress stimulation combined with orphanage was adopted to establish a model of depression.The depressive behaviors of rats were evaluated by body mass, sucrose preference test and open field test. Immunohistochemical staining and Western blot were used to detect the expression of SYN, PSD95 and GAP43 proteins in rat hippocampal tissue. SPSS 17.0 software was used for data statistical analysis, repeated measurement ANOVA was used for behavioral results, one-way ANOVA was used for inter group comparison of protein expression data, and LSD test was used for further pairwise comparison.Results:As for the body mass, there was significant interaction effect between the time and group among the 4 groups ( F=7.33, P<0.01). On the 8th day and the 29th day, the body weight of rats in the EWD group and the depressive group were lower than those in the epilepsy group (all P<0.05). The body weight of rats in the EWD group on the 29th day was lower than that on the first day ( P<0.05). As for the sucrose preference rates, there was significant interaction effect between the time and group among the 4 groups( F=2.67, P<0.05). The sucrose preference rate of EWD group on the15th and 29th day were lower than that on the first day (both P<0.05). The results of the open field test showed that the interaction effects of the number of vertical standing times( F=2.74) and the number of horizontal movement lattices ( F=1.76) both were not significant (both P>0.05), but both the time effect and group effect were significant (vertical standing times: Ftime=4.35, P<0.05, Fgroup=25.64, P<0.01; horizontal movement lattices: Ftime=12.75, P<0.01, Fgroup=21.37, P<0.01). The immunohistochemical results showed that there was a statistically significant difference in the number of positive cells expressing synaptic proteins SYN, PSD95 and GAP43 among the four groups of rats ( F=93.85, 58.66, 98.84, all P<0.05). The numbers of positive cells of SYN (11.73±4.30), PSD95 (24.47±7.58) and GAP43 (9.40±3.50) in the epilepsy group were lower than those in the control group ((51.00±15.39), (55.60±13.17) and (29.53±4.05)) (all P<0.05). The numbers of positive cells of SYN (5.80±3.53), PSD95 (12.87±4.03) and GAP43 (5.33±3.50) in the EWD group were lower than those in the depressive group ((11.33±3.22), (48.13±12.69) and (15.47±5.21) )(all P<0.05). Western blot results showed that there were statistically significant differences in the expression of synaptic proteins SYN, PSD95 and GAP43 among the four groups of rats ( F=13.19, 9.38, 16.80, all P<0.05). The expression levels of SYN, PSD95 and GAP43 in the epilepsy group were lower than those in the control group (all P<0.05). The expression levels of SYN, PSD95 and GAP43 in the EWD group were lower than those in the epilepsy group and the depressive group (all P<0.05). Conclusion:The low expression of SYN, PSD95 and GAP43 proteins in the hippocampus of rats with epilepsy accompanied by depression may be related to their pathogenesis.

Multiple myeloma(MM)is a malignant plasmacyte disease that often presents with symptoms such as bone pain and anemia.Currently,there is an increasing number of literature re-ports on malignant tumors combined with hyperamylasemia,but this is more common in tumors such as gastric cancer,and MM with hyperamylasemia is clinically rare and has not been found in plateau areas.Due to the complex clinical manifestations of MM patients with hyperamylasemia,there is no standard treatment therapy.There is no literature report on the use of daretuumab in combination.Based on the results of the retrospective analysis of the first case of MM with hyperamylasemia in a plateau area,it is recommended that clinicians in plateau areas take amylase level as a sensitive indi-cator to evaluate the severity of MM in order to reduce the misdiagnosis rate of MM and provide a new treatment option for the promotion and application of MM with hyperamylasemia.

Multiple myeloma(MM)is a malignant plasmacyte disease that often presents with symptoms such as bone pain and anemia.Currently,there is an increasing number of literature re-ports on malignant tumors combined with hyperamylasemia,but this is more common in tumors such as gastric cancer,and MM with hyperamylasemia is clinically rare and has not been found in plateau areas.Due to the complex clinical manifestations of MM patients with hyperamylasemia,there is no standard treatment therapy.There is no literature report on the use of daretuumab in combination.Based on the results of the retrospective analysis of the first case of MM with hyperamylasemia in a plateau area,it is recommended that clinicians in plateau areas take amylase level as a sensitive indi-cator to evaluate the severity of MM in order to reduce the misdiagnosis rate of MM and provide a new treatment option for the promotion and application of MM with hyperamylasemia.

Objective:To assess two methods for peritoneal dialysis catheter removal in elderly patients on peritoneal dialysis.Methods:A retrospective cohort study was conducted and clinical data were collected for 107 elderly patients on peritoneal dialysis with catheters removed at the peritoneal dialysis center of the Second Hospital of Shanxi Medical University from August 2010 to May 2020.The 107 patients were divided into the open surgical extubation group and the 'pull' technique group.Sex, age, disease leading to dialysis, dialysis age, reason for extubation and preoperative test results were compared between the two groups.Operative time, length of postoperative hospitalization, perioperative pain and postoperative complications of the two groups were examined.Results:Higher levels or values were observed in operative time[(71.2±13.4)min vs.(19.3±5.6)min, t=16.933, P<0.01], length of postoperative hospitalization[(9.5±1.8)d vs.(2.2±0.5)d, t=10.988, P<0.01]and intraoperative pain score(4.4±1.6 vs.1.4±1.1, t=6.909, P<0.01)and pain score 24h after surgery(3.7±1.4 vs.0.5±0.3, t=9.995, P<0.01)in the open surgical extubation group than in the 'pull' technique group, but there was no statistical difference in the incidence of postoperative complications between the two groups(6.8% vs.5.0%, χ2=0.037, P>0.05). Conclusions:either the open surgical removal method or 'pull' technique.can safely and effectively remove the peritoneal dialysis catheter in elderly patients on peritoneal dialysis of the two methods, the 'pull' technique has advantages including less trauma, shorter and simpler surgery, helping achieve improved quality of life for elderly patients on peritoneal dialysis.

Objective To analyze the correlation between the pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism (SHPT),so as to improve the efficacy and safety of treatment.Methods The pathological and clinical data of 130 patients with renal SHPT and maintenance hemodialysis (MHD) who had undergone total parathyroidectomy with autotransplantation (TPTX + AT) were collected.A total of 545 parathyroid glands were obtained and 998 slices were made and read.According to the pathological types of parathyroid hyperplasia,the patients were divided into diffuse hyperplasia (DH) group,diffuse between hyperplasia and nodular hyperplasia (DH/NH) group as well as nodular hyperplasia (NH) group.The clinical and biochemical characteristics of different groups before and after operation (1-,3-,6-,9-,12-month) were compared and analyzed by statistical tests.Results (1) The preoperative status:the dialysis age,serum calcium as well as incidence of bone pain,skin itching and shorten height in the NH group were significantly higher than those in the DH group (all P ＜ 0.05),and the serum phosphorus and iPTH in the NH group were significantly higher than those in DH and DH/NH group (all P ＜ 0.05).(2) The postoperative status:the serum calcium of the NH group at 1-month was lower than that of the DH group,and the incidence of hypocalcemia of the NH group at 1-month was higher than that of the DH group (P ＜ 0.05);the serum phosphorus at 3-,6-,9-month and iPTH at 1-,3-month of the NH group were significantly lower than that of the DH group (all P ＜ 0.05),and the serum phosphorus at 3-month and iPTH at 1-month of the NH group were lower than that of the DH/NH group (all P ＜ 0.05).Among the 3 groups the serum phosphorus change from 1 to 12 months had difference (F=3.241,P=0.042),while the differences of serum calcium and iPTH changes were statistically insignificant.Conclusions The clinical manifestations,serum calcium,phosphorus and iPTH in patients with renal SHPT before and after TPTX+AT are closely related to the pathological types of parathyroid hyperplasia.Compared with the DH patients,before the operation the NH patients have longer dialysis age,more serious the clinical symptoms such as bone disease,higher calcium,phosphorus and iPTH,while greater reduction of the serum calcium,phosphorus and iPTH in the short term after operation.