Multiple pathological fractures and muscle atrophy caused by a parathyroid carcinoma with postoperative hungry bone syndrome: A case report.

BACKGROUND: Parathyroid carcinoma (PC) is a rare endocrine malignancy causing pathological changes such as abnormal bone metabolism, elevated serum calcium, and impaired renal function, and uncontrollable hypercalcemia is the main cause of death in PC patients. The diagnosis of PC is challenging and relying on postoperative histopathology. Radical surgery at the first time is the only effective therapy to cure PC. Hungry bone syndrome (HBS) is a relatively uncommon complication of parathyroidectomy characterized by profound and prolonged hypocalcemia, timely electrolyte monitoring and alternative interventional protocols can prevent symptomatic hypocalcemia. CASE: A 57-year-old man presented with multiple pathological fractures and muscle atrophy as the main symptoms accompanied by bone pain, hypercalcemia, elevated parathyroid hormone (PTH), and an enlarged left-sided neck mass. After consultation of multidisciplinary team, he was treated conservatively with plaster bandage fixation and infusion of intravenous zoledronic acid; and then complete resection of parathyroid mass + removal of involved tissue structures + left thyroid and isthmus lobectomy + lymph node dissection in the VI region in left neck were performed. The postoperative histopathology suggested a diagnosis of parathyroid carcinoma. Calcium and fluid supplementation and oral levothyroxine tablets were given postoperatively. Unexpectedly, the patient's PTH level decreased rapidly at 24 h postoperative, and serum calcium and phosphorus decreased continuously, and he felt numb around perioral sites and fingertips, which considered to be postoperative HBS complicated by parathyroidectomy. Then, a large amount of calcium supplementation and vitamin D were given timely and the patient got better at 1 month postoperatively. At 9-month postoperative, his bone pain and fatigue were significantly relieved compared with before with calcium, phosphorus, and PTH levels at normal range. CONCLUSION: The possibility of parathyroid disease, particularly PC, should be considered in the presence of multiple pathological fractures, muscle atrophy, generalized bone pain, hypercalcemia, and clear neck mass. Radical resection of the tumor lesions at the first surgery is a key element affecting the prognosis of PC, and the effective management of preoperative hypercalcemia and postoperative HBS is also of great significance for improving prognosis.

Operational and Intervention Effects of Targeted Tuina in Lumbar Intervertebral Disc Degeneration Model Rabbits.

Tui Na or massage therapy alleviates symptoms related to intervertebral disc degeneration (IDD). However, precise, repeatable, standardized instructions for Tuina manipulation are lacking. This study establishes IDD model rabbits induced by fibrous ring puncture, creates targeted Tuina stimulation protocols at the acupuncture points in the lumbar region, and describes in detail the operation methods and requirements of kneading, pointing, and flicking. New Zealand male white rabbits (n = 15) were selected and randomly divided into a blank group, a model group, and a Tuina group. The rabbits in the model group and the Tuina group were molded by fibrous ring puncture; the rabbits in the model group were only immobilized on the operating table without treatment. In contrast, the Tuina group used the "8N/10N, 30 cycles/min" prescription for kneading, pointing, and flicking to perform the intervention, using tactile sensory aids to monitor and regulate the intensity of the Tuina operation. Imaging diagnosis and pathological tests were used to assess the effect of Tuina in rabbits, and the results showed improved imaging features and significantly lowered pathology scores of lumbar disc degeneration in the Tuina group compared to the model group (P < 0.01). Targeted Tuina in the lumbar region may be beneficial in the alleviation of lumbar disc degeneration, but further verification is needed. By regularly performing Tuina and recording the mechanical information involved enables reproducible manipulation prescriptions and helps to observe the basic features of the underlying mechanism of Tuina for IDD.

Predicting the Efficacy of 5-Fluorouracil-Based Adjuvant Chemotherapy in Gastric Cancer by Microsatellite Instability: A Meta-Analysis.

Microsatellite instability (MSI) implies the deletion of mismatch repair genes caused by DNA methylation or gene mutation. MSI is a good predictor for efficacy of 5-fluorouracil (FU)-based chemotherapy in the treatment of colorectal cancer. Some gastric cancer studies have reported that MSI has no apparent impact on prognosis after patients receive 5-FU-based adjuvant chemotherapy. However, other studies suggest that high-frequency MSI (MSI-H) status reduced survival in patients receiving 5-FU-based adjuvant chemotherapy. Thus, the correlation between MSI status and efficacy of 5-FU-based adjuvant chemotherapy for gastric cancer remains controversial. We performed a PubMed, Embase, and Cochrane search to retrieve studies that explore the correlation between MSI status and 5-FU-based adjuvant chemotherapy efficacy in gastric cancer. After extracting 65 potentially eligible studies, four were ultimately included in this meta-analysis using Stata software (ver. 12.0). For each study, we estimated the hazard ratio (HR) value for overall survival (OS), and HR was extracted per the survival curve in the studies. Heterogeneity was estimated using the random-effects model. Overall, 1174 patients after operation were included: 84 patients were classed as MSI-H and 1090 as microsatellite stable (MSS)/low-frequency MSI (MSI-L). For the four studies, the overall estimate of HR for OS between MSI-H and MSS/MSI-L groups was 1.90 (95% confidence interval: 0.91-3.93; p = 0.08). We found no correlation to exist between MSI status and efficacy of 5-FU-based adjuvant chemotherapy for gastric cancer. Although MSI can effectively predict efficacy of 5-FU-based chemotherapy in patients with colorectal cancer, the correlation between MSI status and efficacy of 5-FU-based adjuvant chemotherapy for gastric cancer remains controversial. This meta-analysis suggests that MSI status is unrelated to efficacy of 5-FU-based adjuvant chemotherapy in gastric cancer, and more prospective clinical studies are needed to further investigate predictive value of MSI status in patients with gastric cancer who, after operation, receive 5-FU-based adjuvant chemotherapy.

The potential of residues of furfural and biogas as calcareous soil amendments for corn seed production.

Intensive corn seed production in Northwest of China produced large amounts of furfural residues, which represents higher treatment cost and environmental issue. The broad calcareous soils in the Northwest of China exhibit low organic matter content and high pH, which led to lower fertility and lower productivity. Recycling furfural residues as soil organic and nutrient amendment might be a promising agricultural practice to calcareous soils. A 3-year field study was conducted to evaluate the effects of furfural as a soil amendment on corn seed production on calcareous soil with compared to biogas residues. Soil physical-chemical properties, soil enzyme activities, and soil heavy metal concentrations were assessed in the last year after the last application. Corn yield was determined in each year. Furfural residue amendments significantly decreased soil pH and soil bulk density. Furfural residues combined with commercial fertilizers resulted in the greater cumulative on soil organic matter, total phosphorus, available phosphorus, available potassium, and cation exchange capacity than that of biogas residue. Simultaneously, urease, invertase, catalase, and alkaline phosphatase increased even at the higher furfural application rates. Maize seed yield increased even with lower furfural residue application rates. Furfural residues resulted in lower Zn concentration and higher Cd concentration than that of biogas residues. Amendment of furfural residues led to higher soil electrical conductivity (EC) than that of biogas residues. The addition of furfural residues to maize seed production may be considered to be a good strategy for recycling the waste, converting it into a potential resource as organic amendment in arid and semi-arid calcareous soils, and may help to reduce the use of mineral chemical fertilizers in these soils. However, the impact of its application on soil health needs to be established in long-term basis.

Intense infrared emission of Er(3+) in Ca(8)Mg(SiO(4))(4)Cl(2) phosphor from energy transfer of Eu(2+) by broadband down-conversion.

We report on conversion of near-ultraviolet and visible radiation ranging from 250 to 500 nm into near-infrared emission by a Ca(8)Mg(SiO(4))(4)Cl(2): Eu(2+), Er(3+) phosphor. Efficient 1530-1560 nm Er(3+) emission ((4)I(13/2)-->(4)I(15/2)) was detected under the excitation of Eu(2+) (4f?5d) absorption band as a result of energy transfer from Eu(2+) to Er(3+), which is confirmed by both steady state and time-resolved emission spectra. The laser power dependent emission intensity changes were investigated to analysis the energy transfer mechanism. Energy transfer from Eu(2+) to Er(3+) followed by a multi-photon quantum cutting of Er(3+) is proposed. The result indicates that the phosphor has potential application in enhancement of conversion efficient of germanium solar cells because the energy difference of Er(3+): (4)I(13/2)-->(4)I(15/2) transition matches well with the bandgap of Ge (Eg~0.785 eV).