Clinical Study on Safety and Efficacy of Microwave Ablation for Primary Hyperparathyroidism.

OBJECTIVE: To evaluate the safety, feasibility, and efficacy of microwave ablation (MWA) for the treatment of primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: This study enrolled 67 PHPT patients (22 men, 45 women; mean age, 56.0 ± 16.3 years; range, 18-83 years) from January 2015 to December 2018. The laboratory data, including the serum intact parathyroid hormone (iPTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels, were evaluated before MWA and again 2 hours, 1 day, 7 days, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months after. RESULTS: Complete ablation was achieved with all 72 hyperplastic parathyroid glands found on the 67 patients enrolled, 64 of whom were treated in one session and 3 were treated over two sessions. The technical success rate was 100%. The median follow-up time was 13.6 months (range, 10.0-31.1 months). The clinical success rate was 89.4%. The volume reduction rate was 79.4% at 6 months. Compared to pre-MWA, the serum iPTH, calcium, phosphorus, and ALP levels had significantly improved 6 months post-MWA (iPTH, 157.3 pg/mL vs. 39.2 pg/mL; calcium, 2.75 ± 0.25 mmol/L vs. 2.34 ± 0.15 mmol/L; phosphorus, 0.86 ± 0.20 mmol/L vs. 1.12 ± 0.22 mmol/L; ALP, 79 U/L vs. 54 U/L, respectively; all, p < 0.01). Hoarseness was a major complication in 4 patients (6.0%), but it improved spontaneously within 2-3 months. CONCLUSION: MWA is safe, feasible, and effective for the treatment of PHPT.

Effect of Dietary Selenium Supplementation on Growth and Reproduction of Silkworm Bombyx mori L.

The effects of selenium (Se) on the growth and reproduction of the Lepidoptera insect, the silkworm, Bombyx mori L were investigated. Initially, the silkworms were divided into eight groups (150 larvae/group) on the basis of feeding with mulberry leaves saturated with different concentrations of Se (25, 50, 100, 125, 150, 175, and 200 µM) and control from the first day of the fourth instar larvae. After feeding, growth and reproductive performance of B. mori L. were investigated with standard techniques used in sericulture. After the data analysis, 50 µM of Se was recognized as the optimal level which positively influenced the growth and production, with prolonged stage of larvae, increased larval, cocoon, and pupal weights, and enhanced number of eggs laid by the female moth as compared to the control group. On the contrary, 200 µM of Se treatment displayed toxic to silkworm and induced significant decrease in the growth, cocoon production, and reproduction. The weight of the cocoon shell, the cocoon shell ratio, number of eggs produced, and fertilization ratio in all the Se-treated groups were lower than the control group. The present study indicated that lower levels of (50 µM) of Se can promote the larval and pupal growth of the B. mori L. resulting in the higher yield of cocoon crop and significantly influencing the fecundity, while high concentration was toxic to silkworm. Our data supply the novel application of Se which could be highly beneficial to sericulture farmers.

Transcriptome analysis reveals gene expression changes of the fat body of silkworm (Bombyx mori L.) in response to selenium treatment.

A comparative transcriptome analysis was conducted to investigate the gene expression changes in the fat body of silkworm after treatment with different concentrations (50 µM and 200 µM) of selenium (Se). 912 differential expression genes (DEGs) (371 up-regulated and 541 down-regulated) and 1420 DEGs (1078 up-regulated and 342 down-regulated) were identified in silkworm fat body treated with 50 µM and 200 µM of Se, respectively. In case of 50 µM group, DEGs were mainly enriched in the peroxisome pathway and fatty acid metabolism pathway, and later were associated with antioxidant defense and nutrition regulation. After 200 µM Se-treatment, DEGs were mainly located in the glycerolipid metabolism and arachidonic acid metabolism pathways, which further encoded detoxification related genes. Furthermore, 32 candidate DEGs from these pathways had been selected to confirm the RNA-seq data. Among these DEGs, 14 genes were up-regulated in the 50 µM Se-treated group (only three genes in the 200 µM Se-treated group) which were involved in lipid metabolism and antioxidant defense, and 13 up-regulated genes (only two genes were up-regulated in the 50 µM Se-treated group) were involved in detoxification of the 200 µM Se-treated group. These changes showed that lower concentration of Se could regulate the nutrition and promote antioxidation pathways; whereas, high levels of Se promoted the detoxification of silkworm. These findings can be helpful to understand the possible mechanisms of Se action and detoxification in silkworm and other insects.

Complications encountered in the treatment of primary and secondary hyperparathyroidism with microwave ablation - a retrospective study.

Purpose: To evaluate the complications encountered during microwave ablation (MWA) for primary and secondary hyperparathyroidism (HPT).Materials and methods: The retrospective study enrolled 213 secondary hyperparathyroidism (SHPT) and 51 primary hyperparathyroidism (PHPT) patients who received MWA between July 2015 and September 2018. The major and minor treatment-related complications were documented. The baseline data, clinical parameters, laboratory indices and characteristics of the parathyroid glands were analyzed to assess the risk factors associated with these complications.Results: The incidence of post-MWA complications in HPT patients was 12.1% (32/264). In total, five (5/264, 1.9%) patients with SHPT had major complications, including aphonia/hoarseness (n = 4) and Horner syndrome (n = 1). A total of 27 (10.2%, 27/264) HPT patients had minor complications, including neck hematoma (0.8%, 2/264), bucking (4.2%, 11/264) and phonasthenia (5.3%, 14/264). The incidence of severe hypocalcemia (SH) after MWA was 18.2%. Cutaneous necrosis occurred in two SH patients after intravenous calcium supplementation. There were no significant differences in the incidence of overall complications, major complications and minor complications between SHPT and PHPT patients (12.7% vs 9.8%, p = 0.811; 2.3% vs 0, p = 0.587; 10.3% vs 9.8%, p = 1.000). A history of parathyroidectomy (PTX) (p = 0.031) and multiple symptoms (p = 0.000) were risk factors for the occurrence of complications in SHPT patients. One patient sustained a permanent injury to a unilateral recurrent laryngeal nerve (RLN), and the two patients who experienced cutaneous necrosis underwent debridement plus autologous skin transplantation. The remaining patients recovered without sequelae.Conclusion: The incidence of major complications was low which only occurred in SHPT patients. Most of the patients with complications recovered spontaneously. MWA is safe for the treatment of HPT.

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study.

Objective: To assess the feasibility of microwave ablation (MWA) in treating ectopic secondary hyperparathyroidism (SHPT) in patients with chronic renal failure. Methods: In this retrospective study, MWA was used to manage 22 SHPT nodules in 20 patients. The laboratory test results, including intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels; clinical symptoms; complications before, at one day after MWA, and at the end of follow-up were recorded and compared. Both echogenicity and size of SHPT nodules on ultrasound were documented before and after MWA. Results: iPTH levels decreased from 1106 ± 396 pg/mL to 264 ± 251 pg/mL (p < .001). Serum calcium and phosphorus levels decreased from 2.53 ± 0.21 mmol/L to 2.14 ± 0.25 mmol/L (p < .001) and from 1.96 ± 0.52 mmol/L to 1.76 ± 0.49 mmol/L (p < .05), respectively. There was no significant change in ALP levels across the different measurements (p = .895). No significant differences were detected in iPTH, serum calcium and phosphorus levels, which were all in the normal range during the follow-up period (3-26 months, mean: 15.49 months) after MWA (p = .186). The echogenicity of SHPT nodules changed from hypoechogenicity to uneven hyperechogenicity with a volume decrease in the majority of the nodules. Mild symptoms of Horner's syndrome occurred in one patient (5%), which improved during the follow-up period. A hematoma was encountered during ablation (5%). Hypocalcemia occurred in four patients one day after MWA (20%). No other complications were associated with MWA. Conclusion: MWA is a feasible option to treat ectopic SHPT nodules for destroying parathyroid gland tissue in ectopic SHPT with long-lasting clinical effects.

Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: A retrospective pilot study.

BACKGROUND: Recurrent and persistent secondary hyperparathyroidism (SHPT) nodules have an incidence of 10-70% after surgery. The treatment of recurrent and persistent SHPT nodules is a challenge, and surgical resection of difficult-to-reach or post-operative adhesions often fails. PURPOSE: The aim of this research was to study the safety and effectiveness of microwave ablation (MWA) for recurrent and persistent SHPT. MATERIALS AND METHODS: This was a retrospective study of 11 patients enrolled with a total of 16 nodules, and MWA was employed to manage SHPT. The laboratory test results, including the intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels, improvement of SHPT-related symptoms after ablation, and complications during and after MWA were recorded and analysed. RESULTS: After ablation the value of iPTH was markedly decreased from 1570 ± 1765 pg/mL to 287 ± 239 pg/mL 1 day after MWA (p < 0.05). The levels of serum calcium and phosphorus decreased from 2.51 ± 0.23 mmol/L to 2.06 ± 0.27 mmol/L (p < 0.001) and 1.80 ± 0.43 mmol/L to 1.48 ± 0.32 mmol/L (p < 0.05), respectively, 1 day after MWA. There was no significant difference in the ALP value before and after MWA (p > 0.05). The clinical symptoms, including ostalgia, pruritus, disability, and restless legs, improved after MWA. Minor complications and side effects encountered during or after MWA include haematoma (1/11, 9%), transient hoarseness (2/11, 18.2%), hypocalcemia (6/11, 54.5%). No major complication occurred. CONCLUSION: MWA may be safe and effective to manage recurrent and persistent SHPT nodules; a definite conclusion needs to expand the sample size with a longer follow-up time.