Predictive analysis of severe hypocalcemia following total parathyroidectomy for renal secondary hyperparathyroidism.

OBJECTIVE: This study aimed to evaluate the incidence and identify risk factors for severe hypocalcemia following total parathyroidectomy (TPTX) in patients with renal secondary hyperparathyroidism (SHPT). PATIENTS AND METHODS: We included patients undergoing maintenance hemodialysis or peritoneal dialysis who underwent TPTX from January 1, 2018, to April 30, 2023. Participants were categorized into groups based on postoperative corrected serum calcium levels: severe hypocalcemia (<1.8 mmol/L) and non-severe hypocalcemia (≥1.8 mmol/L). We conducted univariate analyses of demographic and laboratory data to identify potential risk factors, which were further analyzed using a binary logistic regression model. RESULTS: Significant associations were observed with age, dialysis duration exceeding five years, type of dialysis (peritoneal dialysis), lower preoperative corrected serum calcium, elevated preoperative intact parathyroid hormone (iPTH), and increased preoperative alkaline phosphatase (ALP) levels (all p<0.05). Age, preoperative iPTH, and ALP levels were identified as independent risk factors for severe hypocalcemia post-TPTX. CONCLUSIONS: Younger patients with renal SHPT who have elevated preoperative iPTH and ALP levels are at an increased risk of experiencing severe hypocalcemia following TPTX. These findings underscore the importance of careful preoperative assessment and monitoring to mitigate the risk of this complication.

[Analysis of gene mutation spectrum and pharmacokinetics of fibrinogen infusion in 146 cases of congenital fibrinogen disorders].

Objective: To investigate the clinical type and gene mutations, clinical manifestations, laboratory tests, diagnosis, and fibrinogen replacement therapy of congenital fibrinogen disorders. Methods: Clinical data of 146 patients with congenital fibrinogen disorders diagnosed from April 2000 to November 2020 were retrospectively analyzed. Results: Among the 146 patients, 61 (41.8%) men and 85 (58.2%) women had a median age of 33.5 years at the time of consultation. 34 patients (34.7%) were found to suffer from the disease due to bleeding symptoms, 33 patients (33.7%) due to preoperative examination. 55 patients (56.1%) had at least one bleeding symptom, and 42 patients (42.9%) had no bleeding symptoms. There is a negative correlation between fibrinogen activity concentration and bleeding ISTH-BAT score (rs=-0.412, P=0.001) . A total of 34 gene mutations were detected in 56 patients, of which 84.1% were missense mutations, and 16 new mutations were found. FGA Exon2 and FGG Exon8 mutations accounted for 71.4% of all mutation sites. Patients with afibrinogenemia were younger, with a median age of 2 (1-12) years, an ISTH-BAT score of 4, and patients with dysfibrinogenemia had significantly longer thrombin time (TT) , with a median of 28.5 (19.2-36.6) s. The 1 hour in vivo recovery (IVR) after fibrinogen infusion was (127.19±44.03) %, and the 24 hour IVR was (101.78±43.98) %. In addition to the obvious increase in the concentration of fibrinogen activity, the TT and the prothrombin time (PT) both decreased significantly, and the TT decreased more significantly, with an average decrease of 15.2% compared to the baseline after 24 hours of infusion. Conclusion: Most patients with congenital fibrinogen disorders have mild or no bleeding symptoms. Patients with afibrinogenemia have more severe symptoms. There is a negative correlation between the fibrinogen and the degree of bleeding. Genetic testing is helpful for the diagnosis of disease classification. FIB∶C/FIB∶Ag<0.7 can be used as a basis for clinical diagnosis. The TT can be used as the basis for the diagnosis of dysfibrinogenemia and the effectiveness of fibrinogen infusion.

[Utility of the type 3 portable monitor for the diagnosis of sleep disordered breathing in patients with stable heart failure].

Objective: To evaluate the utility of a type 3 portable monitor (PM) at home for the diagnosis of sleep disordered breathing (SDB) in patients with stable congestive heart failure (CHF). Methods: Seventy-six consecutive patients with CHF (61 males, 15 females, mean±standard deviation age (57.0±16.9) years) were enrolled from the sleep center of Peking university People's Hospital during January 2016 to January 2019, and underwent overnight, unattended home sleep apnea testing (HSAT) with a portable monitor followed by an overnight simultaneous polysomnogram (PSG) with in-laboratory portable monitor (in-lab PM) recording within one week. The consistency of apnea hypopnea index (AHI), obstructive sleep apnea index (OAI), central sleep apnea index (CAI) between HSAT and PSG as well as the in-lab PM and PSG were analyzed by Bland-Altman plot; the sensitivity and specificity of PM for the diagnosis of SDB in patients with CHF were evaluated. Results: The number of patients included in the final analysis were 65 in HSAT, 63 in in-lab PM and 65 in PSG. AHI [M(Q1,Q3)] was 26.1 (10.9,40.1) events/h by HSAT, 27.9 (11.3,43.2) events/h by in-lab PM, both were not different from AHI 29.0 (10.2,45.0) events/h by PSG (P>0.05). The AHI, OAI and CAI assessed by HSAT correlated significantly with those by PSG (r=0.892, 0.903, 0.831, P<0.05). Bland-Altman analysis of AHI, OAI, CAI by PSG versus HSAT showed a mean difference of 3.1 events/h, 0.8 events/h, 1.2 events/h; limits of consistency were -15.2 to 21.4 events/h, -9.7 to 11.3 events/h, -10.9 to 13.2 events/h, respectively. Based on a threshold of AHI ≥5 events/h, HSAT had 94.6% sensitivity, 75% specificity, compared to PSG. For detecting Cheyne-Stokes respiration (CSR), a sensitivity of 96.4%,a specificity of 97.2% were achieved, compared to PSG. Conclusion: Type 3 PM can be used to diagnose SDB in patients with CHF.

Regulatory mechanism of TGF-ß1/SGK1 pathway in tubulointerstitial fibrosis of diabetic nephropathy.

OBJECTIVE: The aim of this study was to clarify the potential function of transforming growth factor-ß1/serum/glucocorticoid-regulated kinase 1 (TGF-ß1/SGK1) pathway in diabetic nephropathy-induced tubulointerstitial fibrosis. MATERIALS AND METHODS: Type 2 diabetes mellitus (T2DM) model was successfully established in rats by high-sucrose-high-fat diet combined with streptozotocin (STZ) induction. Subsequently, blood glucose level, renal function and pathological changes in kidneys of T2DM and control rats were evaluated. Western blot and quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) were conducted to determine the protein and mRNA expression levels of TGF-ß1, SGK1, fibronectin (FN) and α-smooth muscle actin (α-SMA) in rat kidney tissues, respectively. RESULTS: Blood glucose (BG), glycosylated hemoglobin (GHb), serum creatinine (Scr) and blood urea nitrogen (BUN) in T2DM rats were significantly higher than those of control rats (p<0.05). The morphology of glomeruli and renal tubules in rats of control group were normal. In contrast, T2DM rats showed significant lesions in glomeruli, renal tubules, and renal interstitium. Furthermore, the relative expression levels of TGF-ß1, SGK1, FN, and α-SMA in kidney tissues of T2DM rats were remarkably higher than those of controls (p<0.05). CONCLUSIONS: The TGF-ß1/SGK1 pathway is closely related to tubulointerstitial fibrosis in T2DM rats.

Prognostic significance of downregulated BMAL1 and upregulated Ki-67 proteins in nasopharyngeal carcinoma.

This study assessed the prognostic value of BMAL1 and Ki-67 expression in patients with nasopharyngeal carcinoma. Level of BMAL1 mRNA was assessed in tissue specimens from 36 nasopharyngeal carcinomas and 20 nasopharyngeal chronic inflammations using quantitative reverse transcriptase-polymerase chain reaction. Expression of BMAL1 and Ki-67 proteins was analyzed immunohistochemically in 90 paired nasopharyngeal carcinoma and distant normal tissues. The Kaplan-Meier curves and the Log-rank test were used to calculate prognostic significance stratified by BMAL1 and Ki67 protein expression and the COX regression model was to analyze the multivariate prognosis. BMAL1 mRNA was significantly reduced in nasopharyngeal carcinoma (4.67 ± 0.27 versus 6.64 ± 0.51 in chronic inflammation tissues, p = 0.002). Level of BMAL1 mRNA was associated with tumor distant metastasis (3.37 ± 0.66 versus 5.04 ± 0.27 compared with non-metastasis, p = 0.011). Level of BMAL1 protein was also reduced in tumor tissues and BMAL1 expression was associated with better 1-, 3- and 5-year overall survival (OS) of cancer patients (92.6%, 69.2% and 62.3% versus 59.1%, 40.9% and 0% in patients with low BMAL1 expressed tumors; p = 0.000). BMAL1 expression and age were independent prognostic factors for OS (p = 0.032). Furthermore, Ki-67 expression was high in tumor versus normal tissues and associated with poor OS of cancer patients (p = 0.035). The Pearson correlation analysis showed that there was an inverse association between BMAL1 and Ki-67 protein expression (p = 0.021). This study demonstrated that lost BMAL1 and Ki-67 overexpression were associated with poor OS of nasopharyngeal carcinoma patients.

A randomized phase II trial of induction chemotherapy followed by cisplatin chronotherapy versus constant rate delivery combined with radiotherapy.

Chronotherapy is no longer a novel concept in cancer treatment after approximately 20 years of development. Many clinical trials have provided strong supporting evidence that chronomodulated treatment yields better results than a traditional dosage regimen. This study aimed to evaluate the adverse reactions, effect on immune functions, and therapeutic efficacy of chronomodulated infusion versus flat intermittent infusion of cisplatin (DDP) combined with intensity-modulated radiation therapy (IMRT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). A total of 148 patients with biopsy-diagnosed untreated stage III-IVb NPC were randomly assigned to undergo two cycles of chronomodulated infusion (study group) or flat intermittent infusion (control group) of DDP (100 mg/m2 on day 1, 21 days/cycle) synchronized with radical radiotherapy. Patients in the study group received chronomodulated infusion, with peak delivery of DDP at 16:00 pm. Patients in the control group received a routine constant rate of infusion. Both groups were treated with the same radiotherapy techniques. Over a median follow-up of 20 months, the study group had better outcomes for adverse effects and immune functions compared with the control group. During the phase of concurrent chemoradiotherapy, the incidence of nausea, vomiting, and oral mucositis in the study and control groups was 66.7% and 79.5% (p < 0.05), 47.9% and 71.2% (p < 0.05), and 73.9% and 87.7% (p < 0.05), respectively. There was no significant difference in 2-year overall survival, progression-free survival, and distant metastasis-free survival between the two groups (p > 0.05). Chronochemotherapy significantly reduced the incidence of adverse reactions and enhanced the tolerance for treatment without affecting survival. It is worth mentioning that reduced destruction of immune function is a novel area of exploration in chronotherapy research.

[Hearing disorders at the candidates of the National Gendarmerie's competition, Ivory Coast].

Objective: Detect the hearing deficiencies of the candi­da­tes of the gendarmerie's competition. Material and method: Pros­pec­tive study realized over 3 years (2008-2010), in the ENT service of the Gendarmerie to Agban (Abidjan). Examination included an otoscopy and a pure tone audiometry. Results: On 23121 candidates, 1245 had a plug of earwax (5.4%). They were aged from 18 to 25 years old (average age: 22.85 years). Eardrum was pathological in 0.5 % of the cases. Prevalence of hearing loss was 1.5%. Hearing loss included sensorineural hearing loss (56.7%), deafness of transmission (29.4%) and mixed deafness (13.9%). Deafness was unilateral in 79.8% and bilateral in 20.2%. Conclusion: Result of audio­gram will be useful for tracking or assessing cases of noise-induced hearing loss attributable to military service.

[Submandibular dermoid cyst extended to the cervical region]. / Kyste dermoïde de la région submandibulaire étendu à la région cervicale.

INTRODUCTION: Dermoid cysts of the submandibular region are rare. We report an exceptional case with extension to the neck. OBSERVATION: The patient presented with a voluminous left submandibular cystic tumor with extension to the neck and to floor of the mouth. Ultrasonography and CT scan contributed to the diagnosis and to chose the best surgical approach in case of large cyst. In our case, the tumor was removed using a double cervical and intraoral approach. Histopathological examination confirmed a dermoid cyst. DISCUSSION: We report an exceptional case of dermoid cyst originating from submandibular region. A double surgical approach was necessary for tumor resection. Tumor removal must be complete; the submandibular gland may be removed if necessary.

[A specific plain X-ray in the diagnosis of elongated styloid apophysis in the Ivory Cost]. / Intérêt du profil oblique menton dégagé dans le diagnostic des apophyses styloïdes allongées en Côte d'Ivoire.

OBJECTIVES: To appreciate the value of a simple radiographic incidence and its effectiveness for the search and the measurement of elongated styloid apophysis (ESA) and to recommend it in the routine search of ESA in practice. PATIENTS AND METHOD: This prospective study was realized over a period of 3 years. It involved the study of ESA from conventional radiographic imaging; the face low incidence in comparison with an experimental incidence, the oblique profile chin lift (OPCL). 101 patients presenting with stylalgia were investigated. RESULTS: Out of the 101 patients, the low face cliché found 49 ESA having an average length of 5 cm. The OPCL allowed to identify 63 ESA, 54 of which were bilateral and 9 unilateral. It also helped identify other associated abnormalities: otitis media (5 cases), dental pathologies (4 cases), dental condensing osteitis (2 cases). The comparative analysis demonstrated a better efficiency of the OPCL in comparison to the standard incidence: the LOW FACE (Roc curve). The OPCL allowed the exposure in one incidence the styloid process and to better appreciate the lower and superior borders of the styloid process giving a better estimate of its measurements. CONCLUSION: It appears from this study that the experimental incidence, the OPCL presents a real interest in the investigation of the ESA but also in the study of the soft tissues of the pharynx, the cervical spine, and the temporo-mastoid region. It also allows the detection of other.

Retrospective study of the rhinoscleroma about 14 cases in ENT departments of university hospitals (Côte d'Ivoire).

PURPOSE OF STUDY: To report the epidemiological, clinical, therapeutic and evolutionary aspects of rhinoscleroma in ENT departments of university hospitals (Côte d'Ivoire). MATERIAL AND METHOD: Retrospective study of rhinoscleroma conducted in the ENT and head and neck surgery departments in Côte d'Ivoire from January 1980 to December 2008 including the cases of confirmed rhinoscleroma and the treated cases. RESULTS: Fourteen cases of rhinoscleroma were found in 28 years. The early manifestations were not specific enough so the patients were seen with clinical status with obvious disorders or physical discomfort. Treatment was medical and surgical. Medical therapy was based on streptomycin, thiopenicol or ciprofloxacin administration. Surgery consisted in removing the fibrous adhesions to correct the functional and aesthetic disorders. CONCLUSION: Rhinoscleroma has become a more and more rare disease because of the sensitivity to the new molecules. Diagnosis can be difficult and delayed because of its clinical polymorphism.

[A case of nasal NK/T cell lymphoma in Africa]. / Un cas de lymphome nasal T/NK en Afrique noire.

INTRODUCTION: Nasal NK/T cell lymphoma is an aggressive, locally destructive and necrotizing lesions. It is exceptional rare in Africa. CASE REPORT: We report a 73 year-old patient's case presenting a nasal obstruction with a chronic purulent nasal discharge. The physical examination showed a chronic nasal lesion involving the nose and infiltrating the pyramid. The histopathological examination performed in a french laboratory diagnosed a nasal T cell lymphoma. Chemotherapy was initiated; radiotherapy being unavailable. CONCLUSION: The difficulties in management of nasal NK/T lymphoma cases are due to diagnostic difficulties and therapeutic problems related to the absence of radiotherapy in our work environment.

[Ectopic thyroid: a report of a case and review of the literature]. / Ectopie thyroïdienne: à propos d'un cas et revue de la littérature.

Ectopic thyroid is the presence of thyroid tissue outside its normal cervical seat. It results from abnormal embryological development. We report the case of an ectopic lingual thyroid found during maneuvers of intubation in a patient of 56 years old. The examination found a rhonchopathy with sleep apnea syndrome and sleep in a sitting position. Endoscopy showed a posterior lingual tumour. The cervical echography showed an absent thyroid in the normal place. Scintigraphy, computed tomography and magnetic resonance imaging confirmed the diagnosis of ectopic lingual thyroid position. The treatment consisted of surgical excision by cervical route after a safety tracheotomy.

[Extraction of the esophageal foreign bodies by cervicotomy: our experience about 9 cases]. / Extraction de corps étrangers oesophagiens par voie de cervicotomie: à propos de 9 cas.

OBJECTIVE: To present our experience of the extraction of the esophageal foreign bodies by cervicotomy route. PATIENTS AND METHOD: Descriptive retrospective study from 2006 to 2010 realized in the ENT Departments of Yopougon and Treichville's Teaching Hospital. RESULTS: 9 (3.3%) of 270 patients underwent surgery to remove esophageal foreign bodies. The average age of the patients was of 14.6 years (extremes: 8 months and 49 years). The foreign bodies were fish bone, hook of clothes peg, medallion, denture and weld. Cervicotomy was performed at once in 4 cases and after failure of esophagoscopy in 5 cases. There were 2 complications (pharyngostoma and suppuration of the operating site). CONCLUSION: The cervicotomy must be quickly performed in case of perforation with or without neck abscess, sharp or voluminous bodies.

[Studies on multiwavelength absorbance ratio difference spectrophotometry and its application].

This paper provides a new method to determine mixed component system by multiwavelength absorbance ratio difference spectrophotometry and summarized the basic principle and experimental technique of this method. This method was applied to assay the contents of two kinds of mixed component system of diphenhydramine hydrochloride and ephedrine hydrochloride, amidopyrine and caffeine without separation. The mean recoveries with coefficient of variation (%) was 101.0% (1.0%) for ephedrine hydrochloride; 94.86% (0.56%) for diphenhydramine hydrochloride; 100.3% (0.70%) for amidopyrine and 100.1% (0.75%) for caffeine. The results obtained are satisfactory both in recovery and in precision. It is a simple and rapid method to determine mixed component system.