Glucometabolic-Related Genes as Diagnostic Biomarkers and Therapeutic Targets for Alzheimer's Disease and Type 2 Diabetes Mellitus: A Bioinformatics Analysis.

Background: Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM) are two widespread chronic disorders characterized by shared risk factors and molecular pathways. Glucose metabolism, pivotal for cellular homeostasis and energy supply, plays a critical role in these diseases. Its disturbance has been linked to the pathogenesis of both AD and T2DM. However, a comprehensive investigation into the specific roles of glucometabolic genes in the onset and progression of AD and T2DM has yet to be conducted. Methods: By analyzing microarray datasets from the Gene Expression Omnibus (GEO) repository, we identified differentially expressed glucometabolic genes (DEGs) in AD and T2DM cohorts. A range of bioinformatics tools were employed for functional annotation, pathway enrichment, protein interaction network construction, module analysis, ROC curve assessment, correlation matrix construction, gene set enrichment analysis, and gene-drug interaction mapping of these DEGs. Key genes were further validated using quantitative real-time polymerase chain reaction (qRT-PCR) in AD and T2DM murine models. Results: Our investigation identified 41 glucometabolic-related DEGs, with six prominent genes (G6PD, PKM, ENO3, PFKL, PGD, and TALDO1) being common in both AD and T2DM cohorts. These genes play crucial roles in metabolic pathways including glycolysis, pentose phosphate pathway, and amino sugar metabolism. Their diagnostic potential was highlighted by area under curve (AUC) values exceeding 0.6 for AD and 0.8 for T2DM. Further analysis explored the interactions, pathway enrichments, regulatory mechanisms, and potential drug interactions of these key genes. In the AD murine model, quantitative real-time polymerase chain reaction (qRT-PCR) analysis revealed significant upregulation of G6pd, Eno3, and Taldo1. Similarly, in the T2DM murine model, elevated expression levels of G6pd, Pfkl, Eno3, and Pgd were observed. Conclusion: Our rigorous research sheds light on the molecular interconnections between AD and T2DM from a glucometabolic perspective, revealing new opportunities for pharmacological innovation and therapeutic approaches. This study appears to be the first to extensively investigate glucometabolic-associated DEGs and key genes in both AD and T2DM, utilizing multiple datasets. These insights are set to enhance our understanding of the complex pathophysiology underlying these widespread chronic diseases.

Tailoring Efficient Fluorogenic Tactic for Ultrasensitive Detection of Dopamine in Urine and Rat Brain through Real-Time and In Situ Formation of High-Performance Fluorophore.

Owing to the predominance of dopamine (DA) in controlling mental health, planning an innovative method for DA detection with simplicity and high efficacy is conducive to the assessment of neurological disorders. Herein, an efficient fluorogenic tactic has been elaborated for ultrasensitive detection of DA with remarkably enhanced turn-on response. Utilizing a twisted intramolecular charge-transfer (TICT)-suppressing strategy, a highly emissive azocine derivative 11-hydroxy-2,3,6,7,11,12,13,14-octahydro-1H,5H,10H-11,14a-methanoazocino[5',4':4,5]furo[2,3-f]pyrido[3,2,1-ij]quinolin-10-one (J-Aza) is generated via a one-step reaction between DA and 8-hydroxyjulolidine. It is marvelous that J-Aza not only possesses ideal fluorescence quantum yield (ΦF) as high as 0.956 but also exhibits bathochromic shifted fluorescence (green emissive) and stronger anti-photobleaching capacity superior to traditional azocine-derived 1,2,3,4-tetrahydro-5H-4,11a-methanobenzofuro[2,3-d]azocin-5-one (Aza) with moderate ΦF, blue fluorescence, and poor photostability. By confining the TICT process, the detection limit to DA can be reduced to 80 pM, which is competitive in contrast to previously reported fluorescence methods. Encouraged by the instant response (within 90 s), wide linear range (0.1-500 nM), great selectivity, and excellent sensitivity, this fluorogenic method has been used for the real-time measurement of DA contents in practical urine samples with satisfactory results. Furthermore, the cerebral DA level in the reserpine-induced depression rat model has also been evaluated by our designed method, demonstrating its potent analytical applicability in the biosensing field.

Controllable atomic collision in a tight optical dipole trap.

Single atoms are interesting candidates for studying quantum optics and quantum information processing. Recently, trapping and manipulation of single atoms using tight optical dipole traps has generated considerable interest. Here we report an experimental investigation of the dynamics of atoms in a modified optical dipole trap with a backward propagating dipole trap beam, where a change in the two-atom collision rate by six times has been achieved. The theoretical model presented gives a prediction of high probabilities of few-atom loading rates under proper experimental conditions. This work provides an alternative approach to the control of the few-atom dynamics in a dipole trap and the study of the collective quantum optical effects of a few atoms.

Efficacy of the No. 10 lymphadenectomy with spleen preservation on patients with gastric cancer and/or esophagogastric junction adenocarcinoma who underwent total gastrectomy: a systematic review and meta-analysis.

Background: Surgery with total gastrectomy and D2 lymph node dissection (LND) has been recommended as the standard treatment for patients with advanced upper and middle gastric carcinoma and/or Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG). However, whether the No. 10 lymph node (No. 10 LN, also known as splenic hilar LN) should be dissected in total gastrectomy remains controversial. We aimed to evaluate whether the No. 10 LND with spleen preservation has survival benefit for patients with gastric cancer and/or AEG who underwent the total gastrectomy. Methods: The PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and American Society of Clinical Oncology.org (ASCO.org) were electronically searched to identify eligible studies. The primary outcome was the survival rate, and secondary outcomes included the disease-free survival (DFS) rate and side effects. The Review Manager 5.3.5 software was used for the meta-analysis. The odds ratio (OR) and mean difference with 95% confidence interval (CI) were calculated. The statistical heterogeneity was assessed using chi-square (χ2) and I2 tests. Results: Eight studies enrolling a total of 4,131 patients were eligible for our review. The meta-analysis results demonstrated that the No. 10 LND group was significantly better than the non-No. 10 LND group in terms of the 3- (OR =0.71, 95% CI: 0.62-0.81, P<0.00001) and the 5-year (OR =0.66, 95% CI: 0.58-0.75, P<0.00001) survival rates but not in the 1-year survival rate (OR =0.91, 95% CI: 0.75-1.11, P=0.36). The DFS rates in the No. 10 LND group were significantly increased after 1 (OR =0.76, 95% CI: 0.61-0.93, P=0.008), 3 (OR =0.69, 95% CI: 0.60-0.81, P<0.00001), and 5 (OR =0.66, 95% CI: 0.56-0.76, P<0.00001) years compared with those in the non-No. 10 LND group. Discussion: Evidence shows that the No. 10 LND with spleen preservation can improve the survival and the DFS rates for patients with gastric cancer and/or Siewert type II/III AEG who underwent the total gastrectomy. High-quality prospective trials are expected.

Combining of chemotherapy with targeted therapy for advanced biliary tract cancer: A systematic review and meta-analysis.

BACKGROUND: Targeted therapy (TT) has resulted in controversial efficacy as first-line treatment for biliary tract cancer (BTC). More efficacy comparisons are required to clarify the overall effects of chemotherapy (CT) combined with TT and CT alone on advanced BTC. AIM: To conduct a meta-analysis of the available evidence on the efficacy of CT combined with TT for advanced BTC. METHODS: The PubMed, EMBASE, ClinicalTrials, Scopus and Cochrane Library databases were systematically searched for relevant studies published from inception to August 2022. Only randomized clinical trials (RCTs) including comparisons between the combination of gemcitabine-based CT with TT and CT alone as first-line treatment for advanced BTC were eligible (PROSPERO-CRD42022313001). The odds ratios (ORs) for the objective response rate (ORR) and hazard ratios (HRs) for both progression-free survival (PFS) and overall survival (OS) were calculated and analyzed. Subgroup analyses based on different targeted agents, CT regimens and tumor locations were prespecified. RESULTS: Nine RCTs with a total of 1361 individuals were included and analyzed. The overall analysis showed a significant improvement in ORR in patients treated with CT + TT compared to those treated with CT alone (OR = 1.43, 95%CI: 1.11-1.86, P = 0.007) but no difference in PFS or OS. Similar trends were observed in the subgroup treated with agents targeting epidermal growth factor receptor (OR = 1.67, 95%CI: 1.17-2.37, P = 0.004) but not in the subgroups treated with agents targeting vascular endothelial growth factor receptor or mesenchymal-epithelial transition factor. Notably, patients who received a CT regimen of gemcitabine + oxaliplatin in the CT + TT arm had both a higher ORR (OR = 1.75, 95%CI: 1.20-2.56, P = 0.004) and longer PFS (HR = 0.83, 95%CI: 0.70-0.99, P = 0.03) than those in the CT-only arm. Moreover, patients with cholangiocarcinoma treated with CT + TT had significantly increased ORR and PFS (ORR, OR = 2.06, 95%CI: 1.27-3.35, PFS, HR = 0.79, 95%CI: 0.66-0.94). CONCLUSION: CT + TT is a potential first-line treatment for advanced BTC that leads to improved tumor control and survival outcomes, and highlighting the importance of CT regimens and tumor types in the application of TT.

Management Strategy for Gallbladder Polypoid Lesions: Results of a 5-Year Single-Center Cohort Study.

INTRODUCTION: Controversy remains about the classification, differential diagnosis, and treatment strategy for gallbladder polypoid lesions (GPLs). This study sought to explore the individualized treatment strategy for GPLs. METHODS: We retrospectively studied 642 consecutive patients with GPLs from January 2015 to May 2020. Univariate and multivariable analyses were performed to explore the potential risk factors for neoplastic polyps. The outcome of laparoscopic gallbladder-preserving polypectomy (GPP) was evaluated and compared with that of laparoscopic cholecystectomy (LC). RESULTS: Of 642 enrolled patients, 572 underwent LC, and 70 underwent GPP. Pathologically, the majority of GPLs were cholesterol polyps (68.4%), followed by adenomyomatosis (19.9%), benign adenoma (7.3%), adenocarcinoma (3.6%), and rare pathological types (0.8%). Additionally, 66.3% (379/572) of the LC cases were classified as non-neoplastic, and 33.7% (193/572) neoplastic polyps. Multivariate analysis demonstrated that single polyps (OR 1.956, 95% CI: 1.121-3.412; p = 0.018), polyps located at the gallbladder fundus (OR 4.326, 95% CI: 2.179-8.591; p < 0.001), polyps not less than 14 mm (OR 2.833, 95% CI: 1.614-4.973; p < 0.001), and polyps with a broad base (OR 4.173, 95% CI: 1.743-9.990; p = 0.001) were independent risk factors for neoplastic polyps. The 5-year prospective results after GPP showed that the 1-year and 3-year polyp recurrence rates were 13.2% and 23.4%, respectively. CONCLUSION: The majority of GPLs are cholesterol or other benign lesions without malignant potential. LC is the main treatment procedure for GPLs with a high neoplastic risk. GPP is potentially feasible and could be an alternative management strategy for a group of GPLs patients who meet the selection criteria.

Characteristics of lymph node (No.5 and No.6) metastasis and significance of lymph node dissection in Siewert type II esophagogastric junction adenocarcinoma (AEG): No.5 and No.6 lymph node metastases of AEG and clearance.

BACKGROUND: To analyze the characteristics, related risk factors, and prognosis of lymph node metastasis (Number [No.] 5 and No.6) in the group of adenocarcinoma of esophagogastric junction (AEG). METHODS: The patients with Siewert II AEG who underwent total gastrectomy and D2 lymph node dissection from September 2015 to December 2018 in Lanzhou University Second Hospital were enrolled in this study. The pathological features of the postoperative specimens were analyzed (sex, age, maximum diameter, location, depth of invasion, degree of differentiation, neurological and vascular invasion, etc), and the lymph node metastasis rate of No.5, No.6 groups were calculated. The analysis was performed by IBM SPSS statistical software. The risk factors associated with lymph node metastasis in No.5 and No.6 groups were analyzed. Survival analysis was performed by Kaplan-M method, and survival rate was estimated, Log-rank test was used for comparison, and the difference was statistically significant at P < .05. RESULTS: There were 142 cases of Siewert type II AEG with the positive rate of No.5 lymph nodes being 10.81% (8/74), and the positive rate of No.6 lymph nodes was 8.33% (11/132). No.5 and No.6 lymph nodes metastasis were not associated with gender, age, tumor maximum diameter, location (cardiac left/cardiac right) (P > .05), and were associated with invasion depth, differentiation degree, nerve and vascular invasion (P < .05). In the No.5 lymph node-positive group, the 3-year Overall Survival (OS) was 25.0%, and the No.5 lymph node-negative group had a 5-year OS of 57.8%, which was statistically different (P < .05). The 3-year OS was 18.2% in No.6 node-positive group and 53.8% in No.6 node-negative group, and the difference was statistically significant (P < .05). CONCLUSION: For Siewert type II AEG, the lymph node metastasis rate was higher in No.5 and No.6 groups when the tumor invaded all layers of gastric wall and was poorly differentiated complicated with vascular nerve invasion, and the lymph node metastasis rate was lower at 3 years, which may be more appropriate for total gastrectomy +D2 lymph node dissection.

Risk factors for preoperative carcinogenesis of bile duct cysts in adults.

BACKGROUND: Bile duct cyst (BDC) is a rare congenital bile duct malformation. The incidence of bile duct malignancy in BDC patients is markedly higher than that in the general population. However, few studies have been conducted on the risk factors for preoperative carcinogenesis in BDC patients. AIM: To analyze the risk factors associated with preoperative carcinogenesis in BDC patients. METHODS: The medical records of BDC patients treated at our hospital between January 2012 and December 2018 were retrospectively reviewed. We constructed a database and compared the characteristics of BDC patients with dysplasia and carcinoma against those with benign cysts. The risk factors for preoperative carcinogenesis were identified using univariate and multivariate analyses. RESULTS: The cohort comprised 109 BDC patients. Ten patients had preoperative dysplasia or adenocarcinoma. Univariate and multivariate analyses showed that gallbladder wall thickness > 0.3 cm [odds ratio (OR), 6.551; 95% confidence interval (CI), 1.351 to 31.763; P = 0.020] and Todani type IV (OR, 7.675; 95%CI, 1.584 to 37.192; P = 0.011) were independent factors associated with preoperative carcinogenesis. CONCLUSION: BDC is a premalignant condition. Our findings show that gallbladder wall thickness > 0.3 cm and Todani type IV are independent risk factors for preoperative carcinogenesis of BDC. They are therefore useful for deciding on the appropriate treatment strategy, especially in asymptomatic patients.

Multi-omics: Opportunities for research on mechanism of type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is a burdensome global disease. In-depth understanding of its mechanism will help to optimize diagnosis and treatment, which reduces the burden. Multi-omics research has unparalleled advantages in contributing to the overall understanding of the mechanism of this chronic metabolic disease. In the past two decades, the study of multi-omics on T2DM-related intestinal flora perturbation and plasma dyslipidemia has shown tremendous potential and is expected to achieve major breakthroughs. The regulation of intestinal flora in diabetic patients has been confirmed by multiple studies. The use of metagenomics, 16S RNA sequencing, and metabolomics has comprehensively identified the overall changes in the intestinal flora and the metabolic disturbances that could directly or indirectly participate in the intestinal flora-host interactions. Lipidomics combined with other "omics" has characterized lipid metabolism disorders in T2DM. The combined application and cross-validation of multi-omics can screen for dysregulation in T2DM, which will provide immense opportunities to understand the mechanisms behind T2DM.

Mussel Adhesive Mimetic Silk Sericin Prepared by Enzymatic Oxidation for the Construction of Antibacterial Coatings.

With the rapid development and advancement in orthodontic and orthopedic technologies, the demand for biomedical-grade titanium (Ti) alloys is growing. The Ti-based implants are susceptible to bacterial infections, leading to poor healing and osteointegration, resulting in implant failure or repeated surgical intervention. Silk sericin (SS) is hydrophilic, biocompatible, and biodegradable and could induce a low immunological response in vivo. As a result, it would be intriguing to investigate the use of hydrophilic SS in surface modification. In this work, the tyrosine moiety in SS was oxidized by tyrosinase (or polyphenol oxidase) to the 3,4-dihydroxyphenylalanine (DOPA) form, generating the catechol moiety-containing SS (SSC). Inspired by the adhesion of mussel foot proteins, the SSC coatings could be directly deposited onto multiple surfaces in SS and tyrosinase mixed stock solutions to create active surfaces with catechol groups. Further, the SSC-coated Ti surfaces were hybridized with silver nanoparticles (Ag NPs) via in situ silver ion (Ag+) reduction. The antibacterial properties of the Ag NPs/SS-coated Ti surfaces are demonstrated, and they can prevent bacterial cell adhesion as well as early-stage biofilm formation. In addition, the developed Ag NPs/SSC-coated Ti surfaces exhibited a negligible level of cytotoxicity in L929 mouse fibroblast cells.

Hollow-Sphere-Structured Na4Fe3(PO4)2(P2O7)/C as a Cathode Material for Sodium-Ion Batteries.

The mixed polyanionic material Na4Fe3(PO4)2(P2O7) combines the advantages of NaFePO4 and Na2FeP2O7 in capacity, stability, and cost. Herein, we synthesized carbon-coated hollow-sphere-structured Na4Fe3(PO4)2(P2O7) powders by a scalable spray drying route. The optimal sample can deliver a high discharge capacity of 107.7 mA h g-1 at 0.2C. It also delivers a capacity of 88 mA h g-1 at 10C and a capacity of retention of 92% after 1500 cycles. Ex situ X-ray diffraction analysis indicates a slight volume change (less than 3%) in the Na4Fe3(PO4)2(P2O7) lattice cell. Therefore, such a spraying-derived carbon-coated Na4Fe3(PO4)2(P2O7) powder is a very attractive cathode electrode for sodium-ion batteries.

Stabilizing a laser frequency by the Pound-Drever-Hall technique with an acousto-optic modulator.

We develop and demonstrate a method of optical phase modulation in the Pound-Drever-Hall (PDH) technique. The phase modulation in this paper is realized by an acousto-optic modulator (AOM) operating in the Bragg diffraction regime. In this process, a light beam separated from a laser (780 nm) is sent through the AOM twice and coupled to a high finesse Fabry-Perot cavity. Then, the light power coupling into the cavity is stabilized by modulating the optical amplitude with this AOM. The coupling light power is stabilized to a level of 10-3. In the meantime, the PDH error signal is obtained by modulating the optical phase with the same AOM. After the error signal is fed back to the laser current, the laser linewidth is suppressed to approximately 907.91 Hz. This method of phase modulation is simple and convenient, and we believe it can be widely used in modulation transfer spectroscopy and frequency-modulation sideband spectroscopy.

Self-Template Synthesis of NaCrO2 Submicrospheres for Stable Sodium Storage.

Sodium-ion batteries (SIBs) are the appropriate alternatives to lithium-ion batteries (LIBs) for the large-scale energy storage applications because of the abundant resources and wide distribution of sodium on earth. O3-NaCrO2 is a promising cathode material for SIBs due to its stable structure and low-cost raw materials. In this paper, we design and synthesize a powder consisting of submicrometer-sized O3-NaCrO2 spheres (s-NaCrO2) self-assembled with nanoflakes, which exhibits faster ion migration ability and strong structure robustness. The galvanostatic intermittent titration technique test reveals the higher apparent Na+ diffusion coefficient of s-NaCrO2 when compared with a normal NaCrO2 powder with an irregular particle morphology. The s-NaCrO2 shows impressive electrochemical properties with a capacity of 90 mAh g-1 at 50 C. In addition, outstanding cycling stability is shown when tested at 20 C, where a capacity of 90 mAh g-1 is maintained with a retention of 87% after 1500 cycles. Also, s-NaCrO2 is advantageous at high (50 °C) and low (-10 °C) temperatures. The full cells assembled employing Sb/C as the anode exhibit good rate capability with 85 mAh g-1 obtained at 50 C.

In Situ-Formed Cr2O3 Coating on NaCrO2 with Improved Sodium Storage Performance.

Cr2O3 is generally considered as an impurity phase with negative effects on the electrochemical performance of NaCrO2 because it may cause a certain degree of capacity loss. In this study, however, we have found the bright side of Cr2O3 as a protective coating material, which greatly improves the Na+ storage capability, especially the cycling stability, of NaCrO2. After 1000 cycles at 10C, a capacity of 100.4 mAh g-1 with a high capacity retention of 84.8% can be achieved for a Cr2O3-coated NaCrO2 sample. The optimal sample exhibits a rate performance with 108.0 mAh g-1 at a high rate of 60C. Cyclic voltammetry analysis indicates that such an in situ-formed inactive Cr2O3 layer has little influence on Na+ diffusion in NaCrO2 electrodes, but it prevents the direct contact between the active material and the electrolyte, suppressing the side reactions effectively.

Erratum: Andrographolide Suppress Tumor Growth by Inhibiting TLR4/NF-κB Signaling Activation in Insulinoma: Erratum.

[This corrects the article DOI: 10.7150/ijbs.7723.].

Predictive factors for central lymph node metastases in papillary thyroid microcarcinoma.

Papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in its longest dimension. The incidence of PTMC is increasing worldwide. Surgery is the primary treatment; however, prophylactic central lymph node dissection is controversial, and discrepancies between different guidelines have been noted. Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis, while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients. To selectively perform prophylactic lymph node dissections in high-risk patients, it is important to identify predictive factors for lymph node metastases in patients with PTMC. Several studies have reported on this, but their conclusions are not entirely consistent. Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases, and the most commonly reported factors include age, gender, tumor size and location, multifocality, bilaterality, extrathyroidal extension, and abnormal lymph node found using ultrasound. Here, we provide an overview of previous studies along with a favorable opinion on or against these factors, with the aim of increasing the understanding of this topic among the medical community. In addition, current opinions about prophylactic central lymph node dissection are reviewed and discussed.

La4NiLiO8-Shielded Layered Cathode Materials for Emerging High-Performance Safe Batteries.

Low theoretical capacities of the commercial cathode materials (olivine: ∼170 mA h g-1 and spinel: ∼140 mA h g-1) dictate the need for higher energy density alternates such as nickel-rich (denotes as NCM) materials with a theoretical capacity of ∼270 mA h g-1. However, low conductivity and the bulk degradation after direct contact with liquid electrolytes, especially at temperatures higher than 50 °C, are the biggest issues to resolve for safe use and confident commercialization of the NCM materials. In this context, we first report "La4NiLiO8 shields" to simultaneously boost charge conduction characteristics and circumvent the electrolytic degradation of NCM. Consequently, the La4NiLiO8-shielded LiNi0.5Co0.2Mn0.3O2 (LSN5) not only offers a 4.1× less charge transfer resistance and significantly higher discharge capacity (219.7 mA h g-1) than the nonshielded NCM (187 mA h g-1) and theoretical capacities of commercial cathode materials but also maintains more than 91.7% of capacity retention at 25 °C after 500 cycles and 84.2% at 60 °C after 200 cycles. In contrast, the nonshielded NCM cathodes can only provide 58.9 and 45.5% capacity retentions at corresponding test temperatures and performance cycles. The acquired excellent electrochemical performance and battery stability at both the ambient and high-temperature conductions infer great importance of the novel La4NiLiO8 shields in developing high-performance safe secondary batteries.

Surface Li+/K+ Exchange toward Double-Gradient Modification of Layered Li-Rich Cathode Materials.

Surface coating and lattice doping are widely used to enhance the interfacial and structural stabilities of Li1.2Ni0.13Co0.13Mn0.54O2 (LNCM). In this paper, KF is used to modify LNCM for the first time. A Li+/K+ exchange in the Li slabs is realized via a high-temperature treatment. Consequently, subsurface K+ gradient doping and surface K1-xLixF gradient coating are obtained simultaneously on LNCM. Such an Li+/K+ exchange mechanism and double-gradient modification are clarified by X-ray diffraction, energy-dispersive spectrometry line scans, and high-resolution transmission electron microscopy analyses. As a result, the optimal 0.5 wt % KF-modified LNCM material shows markedly alleviated voltage degradation (0.0031 V@1 cycle), improved cycling stability (88%@100 cycles@0.5 C), and rate capability (108 mA h g-1@10 C), revealing large application potential in high-energy materials.

Huge brown tumor of the rib in an unlocatable hyperparathyroidism patient with "self-recovered" serum calcium and parathyroid hormone: A case report.

BACKGROUND: The brown tumor is a kind of complication of hyperparathyroidism (HPT). The ultimate therapy usually is the resolution of HPT. We herein report an unlocatable HPT patient who received resection of a huge brown tumor of the rib, and experienced "self-recovery" of serum calcium and parathyroid hormone. CASE SUMMARY: A 34-year-old female patient who suffered from a gradually increasing mass of the left chest wall since 2007 came to our hospital for treatment. The patient had a history of serum Ca and parathyroid hormone (PTH) increasing since June 2015 and received zoledronic acid treatment for 17 mo. When she came to our hospital in November 2017 after discontinuing medical treatment for 3 mo, the serum Ca and PTH levels were within normal ranges. The patient had no imaging abnormalities of parathyroid ultrasound or 99mTc-methoxyisobutyl isonitrile. Enhanced computed tomography revealed a local soft tissue mass of 96 mm × 113 mm with bone erosion of the left 8th rib, and the mass presented irregular enhancement with an unclear boundary between the mass and spleen. The mass was thought to likely be caused by HPT, but a malignancy could not be ruled out. Resection of the mass was performed, and the pathology proved that the mass was a brown tumor. A diagnosis of unlocatable HPT was considered. Since the serum Ca and PTH levels were both normal pre- and post-operation, the patient did not receive exploratory surgery for HPT, and received regular follow-up. CONCLUSION: The huge brown tumor of the rib and "self-recovered" serum PTH and Ca levels are relatively rare in HPT patients. An exploratory operation may be deferred for these patients, and long-term follow-up should be performed.