[Reoperation treatment of persistent postoperative secondary hyperparathyroidism].

Objective:To evaluate the clinical effect of reoperation in persistent hyperparathyroidism （PHPT） patients after operation of parathyroidectomy combined with autotransplantation（PTX+AT） on secondary hyperparathyroidism （SHPT） . Methods:18 PHPT patients who treated with reoperation after PTX+AT were enrolled in this study during the period from Aug 2012 to Dec 2021 in the Department of Otolaryngology Head and Neck Surgery of Peking University Civil Aviation School of Clinical Medicine, Civil Aviation General Hospital. The remaining parathyroid glands were located by preoperative colour Doppler ultrasonography, radionuclide imaging, enhanced CT and MR imaging in the neck region . Based on the imaging findings, the remaining parathyroid glands were removed in situ, and the missed ectopic or extra parathyroid glands were resected with an extended surgical scope according to the parathyroid dissection method. The surgical effect was evaluated by the changes of clinical symptoms, the dynamic change of serum intact paramyroidhomone（i-PTH） between preoperative and postoperative periods and the surgical complications. Results:All the 18 patients accepted successful operation. 30 parathyroid glands were resected confirmed by postoperative pathology, including 16 in situ and 14 ectopic glands（5 in superior mediastinum, 4 in thymus, 2 in posterior mediastinum ,2 in thyroid glands, 1 in carotid sheath）.Osteoarthropathy and skin itching were significantly relieved or even disappeared at 6 h after surgery. The levels of serum i-PTH, calcium and phosphorus reached the standards and muscle weakness was significantly improved 1 week after surgery. 16 patients presented hypocalcemia and returned to normal after supplement of calcium. Hoarseness due to temporary injury of laryngeal nerve was found in 6 cases. No serious complications or death occurred after the operation.There was no recurrence after 1 year follow-up. Conclusion:Reoperation is the first choice for SHPT patients complicated with persistent hyperparathyroidism. Multiple imaging examinations are used to locate the residual parathyroid, especially the ectopic gland. Expanded surgical scope is applied to resect all the residual parathyroid glands（ectopic, in situ and concealed parathyroid） according to the concept of dissection parathyroidectomy. The surgery is effective and safe. Patients'quality of life and long-term survival rate is improved.

[Influence of acupuncture of Zusanli (ST 36) on connectivity of brain functional network in healthy subjects].

OBJECTIVE: To observe the effect of acupuncture of Zusanli (ST 36) on electroencephalogram (EEG) so as to probe into its law in regulating the interconnectivity of brain functional network. METHODS: A total of 9 healthy young volunteer students (6 male, 3 female) participated in the present study. They were asked to take a dorsal position on a test-bed. EEG signals were acquired from 22 surface scalp electrodes (Fp1, Fp2, F7, F3, F2, F4, F8, A1, T3, C3, C2, C4, T4, A2, T5, P3, P2, P4, T6, O2, O1 and O2) fixed on the subject's head. Acupuncture stimulation was applied to the right Zusanli (ST 36) by manipulating the filiform needle with uniform reducing-reinforcing method and at a frequency of about 50 cycles/min for 2 min. Then the stimulation was stopped for 10 min, and repeated once again (needle-twirling frequency: 150 and 200 cycles/min), 3 times altogether. The acquired EEG data were analyzed by using coherence estimation method, average path length, average clustering coefficient, and the average degree of the articulation points (nodes) for analyzing the synchronization of EEG signals before, during and after acupuncture. RESULTS: In comparison with pre-acupuncture, the coherence amplitude values of EEG-delta (1-4 Hz) and y (31-47 Hz) waves were increased significantly after acupuncture of ST 36. No significant changes were found in the amplitude values of EEG-theta (5-8 Hz), -alpha (9-13 Hz) and-beta (14-30 Hz) waves after acupuncture stimulation. During and after acupuncture, the synchronism values of EEG-delta waves of different leads and numbers of interconnectivity between every two brain functional regions in majority of the 9 volunteers were increased clearly. In all volunteers, the degree values of all nodes except A1 and A2, the average clustering coefficients along with the increase of the threshold (r), and the average path lengths of the brain functional network of EEG-delta waves during and after acupuncture were also increased evidently (the latter two items, P < 0.05), suggesting an increase of the information exchange and functional connectivity of different brain regions. CONCLUSION: Acupuncture of Zusanli (ST 36) can increase the amplitude and synchronization of EEG-delta waves of different leads, and potentiate the functional interconnectivity of brain functional network.