Converting a probe-based fluorescence system into an easy-to-use adjunct for the detection of parathyroid glands accidentally resected intraoperatively.

Objective To compare the effects of in situ parathyroid preservation during total thyroidectomy and immediate active parathyroid transplantation (parathyroid tissue homogenate injection) on the level of parathyroid hormone (PTH) and serum calcium in patients after thyroidectomy. Methods The clinical data of 74 patients undergoing total thyroidectomy were analyzed. The patients were divided into two groups: in situ preservation group (control group) and immediate active autotransplantation group (experimental group) according to the different managements of parathyroid gland during operation. The levels of serum Ca2+ and PTH on day 1, 3, 5, 7 and 30 after operation in the two groups were analyzed. Results There was no significant difference in PTH between the experimental group and the control group (46.2±17.3), (50.6±15.7) pg/ml, before operation (P>0.05). There was no significant difference in serum calcium between the experimental group and the control group (2.21±0.12), (2.17±0.10) mmol/L, before operation (P>0.05). The PTH of the control group was (19.8±7.6), (22.4±9.4), (18.8±8.5) pg/ml, on the 1st 3rd and 5th day after operation, and the PTH, of the experimental group was significantly higher than that of the experimental group (11.7±5.5), (12.6±7.9), (13.5±8.7) pg/ml, had significant difference (P 0.05). The levels of PTH [(16.5±7.5) pg/ml] and serum calcium [(1.85±0.17) mmol/L] in the control group were significantly lower than those in the experimental group [(22.3±8.4) pg/ml and (2.02±0.18) mmol/L], on the 30th day after operation. The difference was statistically significant (P<0.05). Conclusion Immediate active autotransplantation of multiple parathyroid gland is helpful to reduce the hypoparathyroid function after total thyroidectomy, and the injection of parathyroid tissue homogenate is easier to carry out and the effect is better. Key words: Total thyroidectomy; Parathyroid gland autotransplantation; Parathyroid hormone

This randomized-controlled trial demonstrates that an exercise consultation, based on the transtheoretic model of exercise behavior change, significantly improves short-term adherence to exercise.

Background: A double-blind randomized control trial was conducted to compare the clinical efficacy of topical triamcinolone acetonide 0.1% and amlexanox 5% in recurrent apthous stomatitis (minor). Materials and Methods: Forty adult patients were assessed for erythema, ulcer size, pain scores, and ulcer healing on three evaluation visits within 24 h of ulcer formation, third day, and fifth day. All participants were monitored for compliance with treatment protocols of four times daily application of calibrated quantity of medication. Results and Discussion: Ninety percent of controls when compared with 65% of the participants in the amlexanox group showed complete improvement of peri-ulcer erythema. Pain reduction was marked from the first to the fifth day (F = 15.249, P = 0.000). The control participants showed 90% reduction in pain in comparison to 70% in the amlexanox group. The mean ulcer size was shown to reduce from the first to fifth day in both groups (F = 18.611, P = 0.000). Completely healed ulcers were seen in 70% of the participants in the control group compared with 75% of the participants in the amlexanox group. Conclusion: The data suggest that the clinical efficacy of topical amlexanox 5% is comparable to topical 0.1% triamcinolone acetonide and may be considered a substitute except in pain control, which was marginally less for the treatment for recurrent apthous stomatitis (minor).

The success of parathyroidectomy depends on accurate intraoperative localization and identification of all diseased glands in parathyroid exploration based on surgeon expertise to prevent persistent hyperparathyroidism. Near-infrared autofluorescence (NIRAF) imaging has recently emerged as a promising adjunctive intraoperative tool for localizing parathyroid glands; however, its potential utility in the assessment of parathyroid glands has yet to be established. To analyze the differences in NIRAF signatures of parathyroid glands in single vs multiple glands in primary hyperparathyroidism (pHPT). This prospective diagnostic study analyzed in vivo NIRAF images of parathyroid glands obtained during parathyroidectomies between November 18, 2019, and December 31, 2023, at a single tertiary referral center. Pixel intensities of the images were measured using third-party software. Patients who underwent parathyroidectomy for sporadic pHPT using a second-generation NIRAF imaging device were included. Patients with multiple endocrine neoplasm disorders were excluded. In vivo NIRAF images obtained during the procedures were analyzed. Near-infrared autofluorescence imaging during parathyroidectomy. The primary outcomes were the autofluorescence intensity and heterogeneity of single adenomas and multigland disease (ie, double adenomas and 3- or 4-gland hyperplasia) in sporadic pHPT. Normalized autofluorescence intensity was calculated by dividing the mean pixel intensity of the parathyroid gland by the background tissue. A heterogeneity index was calculated by dividing the standard deviation by the mean pixel intensity of the gland. The secondary outcome was the visibility of each parathyroid gland on NIRAF imaging before it became apparent to the naked eye during exploration. A total of 1287 in vivo NIRAF images obtained from 377 patients (median [IQR] age, 66 [56-73] years; 299 female [79.3%]) were analyzed. Of all patients, 230 (61.0%) had a single adenoma, 91 (24.1%) had double adenomas, and 56 (14.9%) had 3- or 4-gland hyperplasia. A mean (SD) of 3.4 (1.1) parathyroid glands were identified in the procedures. A comparison of 581 diseased glands (45.1%) and 706 normal glands (54.9%) showed a lower median normalized autofluorescence intensity of 2.09 (95% CI, 1.07-4.01) vs 2.66 (95% CI, 1.43-4.20; effect size = 0.36) and higher heterogeneity index of 0.18 (95% CI, 0.07-0.41) vs 0.11 (95% CI, 0.01-0.27; effect size = 0.45), respectively. Of diseased glands, single adenomas (233 [40.1%]) vs double adenomas (187 [32.2%]) and 3- or 4-gland hyperplasia (161 [27.7%]) had a lower median autofluorescence intensity of 1.92 (95% CI, 1.02-4.44) vs 2.22 (95% CI, 1.10-3.97; effect size = 0.21), respectively. On receiver operating characteristic analysis, the optimal autofluorescence intensity threshold to differentiate between single adenomas vs multigland disease was 2.14, with a sensitivity of 64.4%, specificity of 58.1%, and area under the curve of 0.626. These findings suggest that parathyroid glands in single- vs multigland disease may exhibit different autofluorescence characteristics. Although the effect size was modest, the differences identified should be kept in mind when assessing the parathyroid glands during surgical exploration.

Objective To explore the significance of carbon nanoparticles in routine central lymph node dissection of papillary thyroid microcarcinoma (PTMC) . Methods 272 cases of PTMC admitted from 2013 to 2015 were retrospectively analyzed and they were divided into two groups, the experimental group who were given carbon nanoparticles during surgery (136 cases) and the control group (136 cases) without carbon nanoparticles. The total number of central lymph nodes, number of transfer, and the black dye lymph node number and transfer number in the experimental group were recorded. The total number of lymph nodes, and number of transfer in the control group were recorded. The metastasis rate of the two groups were analyzed. The number of parathyroid mistakenly cut and hypocalcemia cases of the two groups were counted. Parathyroid function was observed by determination of Ca2+ and PTH in blood. The incidence of recurrent laryngeal nerve (RLN) injury of the two groups was compared. Results The total number of central lymph nodes was 1216 and the transfer number was 481 in the experimental group, higher than those of the control group. The positive lymph node rate of the two groups was 39.6% and 25.9% respectively, and the difference was statistically significant. The mumber of patients with central lymph node metastasis was 63 and 42 respectively for the experimental group and the control group, and the transfer rate was 46.3% and 30.8% respectively. The difference was statistically significant. The rate of parathyroid mistakenly cut was 2.6% (7/261) and 14.7% (28/193) respectively for the experimental group and the control group, and the difference was statistically significant. The difference of Ca2+ and PTH value at 3h, 6h, and 12h after surgery between the two group was statistically significant. No RLN injury occured. 5 cases in the experimental and 8 cases in the control group had temporary RLN injury. The difference was not statistically significant. Conclusions The application of carbon nanoparticles in PTMC surgery can help to improve the thoroughness of central lymph node dissection and to protect parathyroid function. However, its benefits to protect the recurrent laryngeal is uncertain. Key words: Carbon nanoparticles; Papillary thyroid microcarcinoma; Central lymph node dissection; Parathyroid; Recurrent laryngeal nerve

Objective To study the application value of parathyrod in situ exposure and protection in differentiated thyroid cancer thyroid carcinoma(DTC)surgery. Methods 500 cases of DTC admitted from Jan. 2012 to Dec. 2014 were selected for the research. According to whether the parathyroid was anatomically exposed during the surgery, the patients were divided into experimental group(exposed group)and the control group(unexposed group). Then, depending on tumor extent and risk factors, the experimental group were divided into group E1(lateral affected glandular lobe, isthmus lobe resection and unilateral VI lymph node dissection)and E2(total or subtotal thyroidectomy and bilateral VI lymph node dissection), while the control group were divided into group C1(surgical treatment same as E1)and group C2(surgical treatment same as E2). Patients' postoperative nerve and muscle symptoms were observed, such as clinical manifestations of face, lips, hand and foot numbness or convulsions. Both preoperatively and postoperatively, patients' parathyroid hormone(PTH)and serum calcium level indicators were detected before surgery and at the 1st, 3rd, 5th, 7th, 14th and 28th day after surgery. Results The lymph node metastasis rate and number between experimental group and the control group had statistical insignificance(χ2=1.02, 0.79, P=0.14, 0.96). The recurrence rate of the 2 groups had no significant difference during the follow-up(χ2=0.23, P=0.65). Group E1 was significantly lower than Group C1 in postoperative parathyroid function decline rate, incidence of hypocalcemia and parathyroid mistakenly cut rate. Group E2 was also obviously lower than Group C2 in all these aspects. The difference had statistical significance(P<0.05). Conclusion Parathyrod in situ exposure and protection assisted by direct vision of the magnifying glass can reduce the mistakenly cut rate of parathyroid and the temporary hypoparathyroidism, which can effectively avoid the adverse effects caused by total thyroidectomy. Key words: Differentiated thyroid Cancer; Parathyroid; In situ exposure and protection

To determine the effect of kangaroo mother care (KMC) on perfusion index, heart rate, and oxygen saturation in premature infants who were discharged early and admitted to the neonatal intensive care unit (NICU) in the following days. This study has a randomized controlled experimental design and uses a pretest-posttest control group model. This study included infants between December 2019 and December 2020 who were discharged early and subsequently admitted to the NICU. Experimental (n=38) and control (n=38) groups were assigned using the simple randomization technique at the NICU of a private university hospital in Istanbul, Türkiye. Heart rate, perfusion index, and oxygen saturation levels of the experimental group in which KMC was applied and the control group in which KMC was not applied were compared. Measurements of these parameters were made at 15-minute intervals for 45 minutes (0-1, 15, 30, 45 minutes). Data were collected via the Mother and Infant Introductory Information Form, Kangaroo Mother Care Preparation Checklist, Kangaroo Mother Care Physiological Parameter Monitoring Form, and Noninvaziv Pulse Co-Oximetry. Statistics of these data were performed with the independent sample t-test, Pearson's Chi-square, Fisher's exact test. In the experimental and control groups, infants' gestational age (31.11 ± 3.25 and 31.61 ± 3.04, respectively; p = .491) and weight (1778.29 ± 436.93 and 1953.29 ± 345.74, respectively; p = .057) were similar, and the differences were statistically insignificant. Before KMC, there was no difference between the heart rate, oxygen saturation, and perfusion index values of the experimental and control groups (p > .05). From the first 15 minutes after the application of KMC to 45 minutes post-KMC, there was a significant decrease in (p=0.001) and stabilization of heart rate and oxygen saturation in the experimental group compared with the control group. The heart rates in the experimental group at 15th, 30th, and 45th minutes during KMC were lower than in the control group (147.63 ± 11.04; 142.47 ± 11.94; 136.82 ± 13.22 and 153.13 ± 8.73; 154.50 ± 7.27; 154.84 ± 7.05, respectively). Also, their oxygen saturation during KMC was higher than in the control group (96.68 ± 2.08; 97.24 ± 2.18; 97.87 ± 1.66 and 94.79 ± 1.27; 94.66 ± 1.45; 94.39 ± 1.38, respectively). This significant difference between KMC on heart rate and oxygen saturation in the experimental group compared to the control group continued for 45 minutes after KMC. The perfusion index was significantly higher at 30 minutes and 45 minutes during KMC. However, although it continued after KMC, this change in perfusion index was not statistically significant. Kangaroo mother care helps to regulate the heart rate, oxygen saturation, and perfusion index of premature infants who were discharged early and admitted to the NICU in the following days.

BACKGROUND AND OBJECTIVES:Thyroidectomy is a commonly performed procedure for thyroid problems. Inadvertent removal of the parathyroid glands is one of its recognized complications, which occurs more frequently in certain high-risk patients. The aim of this study was to identify the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery.DESIGN AND SETTING:A retrospective review of thyroid operations performed at a tertiary referral hospital between January 2004 and December 2008.METHODS:Pathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid pathology. Postoperative calcium levels were reviewed in these patients.RESULTS:During the study period, 287 thyroidectomies were performed and 47 (16.4%) patients had incidentally removed parathyroid glands. Risk factors for inadvertent parathyroid resection included total thyroidectomy (P=.0001), Hashimoto thyroiditis (P=.004), and extrathyroidal spread (P=.0003). Postoperative hypocalcemia occurred in 18 (38.3%) of the patients in whom the parathyroid gland was removed inadvertently and in 48 (20%) of the rest of the patients (P=.0123).CONCLUSION:The incidence of incidental removal of parathyroid tissue during thyroidectomy is 16.4%. Total thyroidectomy, extrathyroidal extension of the tumor, and thyroiditis were found to be the risk factors. Hypocalcemia was significantly higher among patients who had inadvertent parathyroidectomy.

Objective To summarize the experience of intraoperative rapid parathyroid hormone (PTH) detection by immunochromatography in thyroid surgery. Methods Patients undergoing thyroid surgery in Shanghai Tenth People’s Hospital from Nov. 2016 to Jul. 2017 were collected and the clinical data including level of blood calcium, serum phosphorus and PTH, and pathological findings were analyzed. Results In this study, immunochromatographic assay was used in 45 cases (experimental group) and nano carbon method was used in 47 cases (control group) . In benign cases, levels of blood calcium and PTH in experimental group were higher than those in the control group ( (2.07±0.09) vs (2.04±0.06) and (3.41±1.82) vs (3.34±1.84) , P>0.05) . In malignant cases, blood calcium level in experimental group was higher than that in the control group ( (2.02±0.13) vs (1.99±0.38) , P>0.05) and PTH level was significantly higher than that in the control group ( (2.22±1.27) vs (1.44±1.44) , P<0.05) . Serum phosphorus level in experimental group group was much lower than that in the control group ( (1.02±0.17) vs (1.14±0.23) , P<0.05) . Conclusions Using intraoperative rapid PTH detection by immunochromatography can identify parathyroid and avoid accidental injury of parathyroid gland, which can reduce the postoperative incidence of hypocalcemia. Key words: Thyroid surgery; Parathyroid hormone; Immunochromatography

Objective To explore the value and method of using carbon nanoparticles in endoscopic treatment of papillary thyroid microcarcinoma. Method 74 cases were randomly divided into two groups, 34 cases in experimental group which were injected with carbon nanoparticles, and 40 cases in the control group without any injection. All cases were analyzed in terms of the tumor size, the number of lymph nodes and parathyroid gland injury. Results All patients underwent the operation smoothly. The postoperative pathological specimens result showed there was no statistical difference of carcinoma size between the two groups. The number of lymph nodes dissected was 177 in the control group and 220 in the experimental group (the rate of lymph node black staining rate was 89%) . In the experimental group, the average number of lymph node detected in each patient was 6.47±2.13, more than 4.42±1.91 in the control group. The number of parathyroid glands found in the experimental group was 3 and 11 in the control group, and the difference had no statistical significance. Postoperative temporary laryngeal recurrent nerve injury occurred to 2 cases in each group, and no statistical difference was found. Conclusion Using carbon nanoparticles in endoscopic treatment of papillary thyroid microcarcinoma can increase the detection rate of lymph node, and to some extent, reduce the parathyroid injury. It has a certain clinical significance, However, care should be taken to avoid contamination of the mirror field of view. Key words: Endoscopy; Papillary thyroid microcarcinoma; Carbon nanoparticles; Lymph node; Parathyroid gland

Hypoparathyroidism is an important factor that seriously affects the quality of life of patients after thyroidectomy. This study aimed to optimize the surgical procedure for parathyroid identification using near-infrared autofluorescence (NIRAF) during thyroidectomy. This was a prospective controlled study that included 100 patients with primary papillary thyroid carcinoma diagnosed in Beijing Tongren Hospital between June 2021 and April 2022 who were awaiting total thyroidectomy and bilateral neck dissection. The patients were randomly divided into an experimental group in whom step-by-step NIRAF imaging was used to identify parathyroid glands, and a control group in whom NIRAF was not used. The number of parathyroid glands identified in the NIRAF group was higher than that in the control group (195 vs. 161, p=0.000, Z=-5.186). The proportion of patients with parathyroid glands inadvertently removed in the NIRAF group was lower than that in the control group (2.0% vs. 18.0%, respectively; p=0.008, χ2 = 7.111). In the NIRAF group, we found that more than 95% of the superior parathyroid glands and more than 85% of the inferior parathyroid glands were identified before the dangerous phase, which was much higher than that in the control group. The incidences of temporary hypoparathyroidism, hypocalcemia, and symptomatic hypocalcemia were higher in the control group than those in the NIRAF group. On the first postoperative day, the average parathyroid hormone (PTH) level in the NIRAF group decreased to 38.1% of the preoperative level and that in the control group decreased to 20.0% of the preoperative level (p=0.000, Z=-3.547). On the third postoperative day, the PTH level in 74% of the patients in the NIRAF group recovered to normal levels, whereas it recovered in only 38% of the patients in the control group (p=0.000, χ2 = 13.149). The PTH levels in all patients in the NIRAF group had recovered within 30 days after surgery, whereas one patient in the control group failed to return to the normal level 6 months after surgery and was diagnosed with permanent parathyroidism. The step-by-step NIRAF parathyroid identification method can effectively locate the parathyroid gland and protect its function.

Heterogeneous and low-intensity parathyroid autofluorescence: Patterns suggesting hyperfunction at parathyroid exploration

Pretreatment with oral contraceptives in infertile anovulatory patients with polycystic ovary syndrome who receive gonadotropins for controlled ovarian stimulation

BackgroundThe aim of this study was to explore a new method to identify and protect parathyroid glands in neck lymph node dissection for patients with thyroid cancer.Material/MethodsOne hundred patients with thyroid cancer underwent total thyroidectomy combined with central neck lymph node dissection. During the operation, 50 patients receiving nano-carbon suspension were included in the experiment group, and 50 patients without nano-carbon suspension were included in the control group. We compared changes in parathyroid hormone levels before surgery and at 48 h after surgery between the 2 groups and of serum Ca2+ level within 48 h after surgery, as well as postoperative parathyroid pathological and lymph node dissection results.ResultsEight and 1 parathyroid glands were detected pathologically in the control and experimental group, respectively. Decrease in parathyroid hormone level at 48 h occurred in 7 patients in the control group and 1 patient in the experimental group. Hypocalcemia was found at 48 h after surgery in 10 patients in the control group and 2 patients in the experimental group.ConclusionsNano-carbon suspension can cause development of the thyroid gland and the central lymph node and a negative development of parathyroid glands. Careful identification and removal of black-stained lymphatic tissues in the process of total thyroidectomy with neck lymph node dissection can ensure a complete lymph node dissection and prevent parathyroid damage, thus effectively reducing the incidence of hypoparathyroidism.

Introduction: Premenstrual syndrome has several physical and psychological complications. Since healthy family relationships and normal marital interactions are affected by a woman's physical and mental health, any disorder in this area decreases marital satisfaction and consequently endangers the mental health and survival of the family. Objective: This study aimed to determine the effect of Fordyce happiness training on marital satisfaction and mental health in women with premenstrual syndrome. Materials and Methods: This randomized controlled trial was performed in 2018-2019. A total of 40 women with the premenstrual syndrome were selected by convenience sampling and randomly divided into experimental (n=20) and control (n=20) groups. The experimental group received six sessions of the Fordyce happiness training program at weekly intervals in groups of 10. In both groups, the level of marital satisfaction and mental health was measured by Enriching and Nurturing Relationship Issues‚ Communication‚ and Happiness (ENRICH) marital satisfaction questionnaire, and the Goldberg Mental Health questionnaire three times: before, immediately after, and 45 days after the training sessions. The Chi-square test, Fisher exact test, independent t test, and repeated measures analysis of variance were conducted to analyze the obtained data. Results: The Mean±SD ages of the experimental and control groups were 32.45±7.33 and 33.10±6.25 years, respectively. The mean scores of mental health in the experimental group compared to the control group in the pretest, post-test, and follow-up (43.95±4.38, 41.20±5.73, 40.25±5.88) had a decreasing trend (P&lt;0.05) but the mean scores of marital satisfactions in the experimental group (81.90±7.18, 86.35±8.16, 86.80±7.96, respectively) increased (P&lt;0.05). However, no significant change was observed in the control group. Time significantly affects the mean changes in mental health (P=0.002) and marital satisfaction (P=0.001) in the samples. The time-group effect also shows a significant change for both variables (partial eta-squared for mental health=0.174 and marital satisfaction=0.165); the changes in the mean mental health and marital satisfaction of the research samples over time are different between the experimental and control groups; there are changes in the mean score of the two variables in three time points. Conclusion: The findings of the present study showed that Fordyce happiness training is effective in improving the level of marital satisfaction and mental health of women with premenstrual syndrome. Therefore, it is suggested that this training program is used to adapt women psychologically to the mood and physical changes of premenstrual syndrome.