Clinical Research And Machnism Of Vascular Of Secondary Hyperparathyroidism Perform Parathyroidectomy And Forearm Transplantation

Background Chronic kidney disease stage 5(CKD-5)is a kind of irreversible pathological process,when the progress goes to end-stage,patients need to rely on renal replacement therapy.With the development of all kinds of dialysis technology,including the development of peritoneal dialysis and hemodialysis,many end-stage chronic kidney disease patients survival period was extended obviously.On the other hand,due to long-term continuous function of hyperphosphatemia,there was a significant increase in the incidence of the secondary hyperparathyroidism(s HPT).Some patients treated with internal medicine medications probably get improvement of symptoms,but some patients are inevitably enduring severe bone pain,itching,systemic calciphylaxis,thus can lead to the whole body bone,coronary artery and small artery of serious complications,greatly affected the quality of life of the patients with CKD-5,even to reduce their lifetime.Some patients eventually need to select parathyroidectomy and forearm transplantation.Vascular calcification is one of the major characteristics in patients with various types of chronicinflammatory disorders.mi RNAs have been shown to be involved in many normal biological functions as well as diseases,however,their role in vascular calcification has not received much attention.Objective To discuss the effects of parathyroidectomy and forearm autotransplantation for the treatment of patients with chronic kidney disease(CKD)stage 5 secondary hyperparathyroidism.Vascular calcification is one of the major characteristics in patients with various types of chronic inflammatory disorders.To research the role and machnism in the progression of calcification of vascular through the detect of mi RNAs and their targeting genes.Methods Part 1 Clinical research of Secondary Hyperparathyroidism perform parathyroidectomy and forearm transplantation 1 We retrospectively analyzed 86 cases of patients with chronic kidney disease(CKD-5)dialysis(average age of 54,average dialysis age 7.2 years).Detection in patients with preoperative and postoperative blood calcium,phosphorus,alkaline phosphatase,(ALP),blood impact segment parathyroid hormone(i PTH)value.2 Analyzing the changes after preoperative,analysis preoperative patients with bone pain,pathologic fractures,shrinking men syndrome(SMS),such as clinical symptoms and symptoms in patients with postoperative,comparing preoperative ultrasound and SPECT parathyroid positioning seen with intraoperative and postoperative pathologic results and relationships.Part 2 Micro RNA-297 a Regulates Vascular Calcification by Targeting Fibroblast Growth Factor 23 1 In the current study,we built vascular calcification rat model using vitamin D3 plus nicotine and analyzed mi RNA expression profile by mi RNA chip assay.2 Potential target of one selected mi RNA with sharpest variation in expression were predicted by both Pic Tar and Target Scan.The impact of the selected mi RNA on the expression of the potential target on both m RNA and protein levels were measured by RT-PCR and western blot,respectively.Results Part 1 Clinical research of Secondary Hyperparathyroidism perform parathyroidectomy and forearm transplantation Postoperative patients are all healing perfect,no unexpected complications like bleeding,infection and hoarse.Postoperative hypocalcemia in different degree,by the deep vein catheter calcium supplements and oral calcium supplements,calcitriol to normal,obviously postoperative hypophosphorus concentration with weak need intravenous supplement phosphorus of 15 cases.2 Preoperative ultrasonic positioning parathyroid 198,SPECT positioning parathyroid 181,surgical removal of the parathyroid gland,a total of 343,postoperative pathological results suggest parathyroid hyperplasia 224,parathyroid adenoma,119.3 cases of merged thyroid cancer,surgical removal of the same period.After comparing preoperative serum calcium(p < 0.01),serum phosphorus(p < 0.01),i PTH(p < 0.01),preoperative and postoperative half year comparison of alkaline phosphatase(p < 0.01).Only 1 case after preoperative obvious bone pain postoperative bone pain relief is not obvious,the further diagnosis of the lumbar spine tumor bone pain relief after surgery,the rest of the patients with bone pain,fatigue,itching and other symptomswere significantly alleviated.Postoperative recurrence in 2 cases,Perform parathyroidectomy in 1 case,forearm autotransplant recurrence in 1 case are cured after the second surgery.After perform the operation one patients successful perform renal transplantation.Part 2 Micro RNA-297 a Regulates Vascular Calcification by Targeting Fibroblast Growth Factor 23 1 Our results identified 16 dysregulated mi RNAs,among which mi R-297 a showed the sharpest variation.Further analysis focusing on mi R-297 a revealed that fibroblast growth factor 23(FGF23)was a potential target of mi R297 a.2 Measurement of FGF23 and its regulator Klotho on both m RNA and protein levels demonstrated that FGF23 was significantly increased while Klotho was decreased in rats with vascular calcification.Conclusion 1 TPTX + AT treated patients with chronic kidney disease-stage 5(CKD-5)s HPT clinical safe,effective,has the high feasibility;Ultrasound and SPECT and CT on s HPT parathyroid positioning,the significance of the former meaning on parathyroid adenoma or adenomatous hyperplasia of diagnosis,the latter focuses on positioning of intraoperative search parathyroid gland,the comprehensive application have great significance to the clinical.2 Our results indicated that FGF23 was target of mi R-297 a and decreased mi R-297 a in vascular calcification lead to the increase of FGF23,which together with Klotho might enhance vascular calcification.The findings of this study could provide valuable information for the understanding of mechanisms underlying mi R-dependent vascular calcification as well as potential treatment target for the disease.