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Objective To study the clinical effect of total parathyroidectomy (TPTX) on treatment of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure.Methods 24 patients undergoing TPTX in Mianyang Central Hospital from Jan.2014 to Nov.2016 were retrospectively analyzed.The preoperative,postoperative and follow-up intact parathyroid hormone (iPTH),serum calcium,serum phosphorus and calciumphosphorus product were statistically analyzed.The postoperative complications and recurrence were observed.Results For preoperative,1 week after operation,3 months after operation,6 months after operation,12 months after operation,24 months after operation and 36 months after operation,the mean values of iPTH were (1771.7± 244.5) pg/ml,(70.2±18.2) pg/ml,(106.5±35.3) pg/ml,(114.3±31.3) pg/ml,(122.1±27.8) pg/ml,(128.1±12.5) pg/ml and (113.8±24.9) pg/ml.The mean values of serum calcium were (2.6±0.4) mmol/L,(1.9±0.4) mmol/L,(2.1±0.3) mmol/L,(2.1±0.2) mmol/L,(1.8±0.2) mmol/L,(1.8±0.2) mmol/L and (1.8±0.3) mmol/L.The mean values of serum phosphorus were (2.1±0.7) mmol/L,(1.4±0.6) mmol/L,(1.3±0.4) mmol/L,(1.4±0.3) mmol/L,(1.3±0.3) mmol/L,(1.5±0.2) mmol/L and (1.4±0.4) mmol/L.The mean values of calcium-phosphorus product were (61.9±17.0) mg2/dl2,(34.6±19.4) mg2/dl2,(37.4±14.4) mg2/dl2,(40.4±12.3) mg2/dl2,(29.2±5.3) mg2/dl2,(35.0 ±7.1) mg2/dl2 and (32.4 ± 11.3) mg2/dl2,respectively.Compared with those before operation,postoperative iPTH,serum calcium,serum phosphorus and calcium-phosphorus product decreased significantly at 1 week after operation,3 months after operation,6 months after operation,12 months after operation,24 months after operation and 36 months after operation,and the differences had statistical significance (all P＜0.05).Temporary injury of recurrent laryngeal nerve was found in one patient (4.2％).Early postoperative hypocalcemia rate was 91.7％ (22/24).No recurrence developed after operation.Conclusion TPTX is safe and effective in treatment of SHPT in patients with chronic renal failure,with low recurrence rate and satisfactory treatment outcome.
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Objective To build a core competence evaluation index system for new nurses which was scientific and comprehensive. Methods 23 nursing experts was consulted by a two-round Delphi method, and finally determined the index system and the weight of each index. Results The core competence evaluation index system for new nurses consisted of 6 first-level indicator, 20 second-level indicator, 66 third-level indicator. The coefficient and authoritative coefficient were 0.370, 0.84. Conclusions The formation of the core competence evaluation index system for new nurses is scientific and reliable, which can provide objected and quantitative standards for assessment, training and evaluation of new nurses.
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Objective To investigate the intracellular signal transduction pathway of insulin promoting stem cell factor (SCF) expression in colonic smooth muscle cells (SMCs).Methods Colonic SMCs from SD rats were isolated and cultured, which were identified by α-actin immunofluorescence cytochemistry staining.SMCs were divided into 3 groups for experiment. ①Insulin concentration gradient group:Adding different insulin concentrations (0,2.5,5,20,40 and 80 mg/L) into SMCs culture and cultured for 16 hours; ② Insulin time point group:SMCs were cultured with insulin (40 mg/L) for different time durations (0,8,16,24 hours); ③ Signal pathway blocking group:SMCs were pretreated with LY-294002 or PD-98059,and then induced with insulin (40 mg/L) for 16 h.The proliferation of SMCs was examined by MTT method.The change of SCF expression was determined by Western blot and RT-PCR.Results ① Insulin at concentration of 5 mg/L remarkably promoted SMCs proliferation,and there was no significant difference in its effect with insulin concentrations at 20,40,80 mg/L (all P＜0.05).② Compared with no insulin adding group,low and medium dose of insulin (2.5,5,20 mg/L) already had a role in promoting SCF mRNA and SCF protein expression (all P ＜ 0.05). It reached maxium effect when insulin concentration was at 40 mg/L(P＜0.05),and there was no significant difference between insulin concentration at 40 mg/L and 80 mg/L (P＞0.05).③ Compared with time 0 hour,the expression of SCF increased after insulin worked on SMC (40 mg/L) for 8 hours (P＜0.05),and reached the peak after 16 hours (P＜0.05),and there was no significant difference between 24 hours and 16 hours (P＞0.05).④ Compared with blank control group and solvent control group,both insulin-induced SCF expression reduced after pretreated with LY-294002 or PD-98059 (all P＜0.05).Conclusions Insulin can promote SMCs proliferation,and in certain range the induction of SCF synthesis in colon SMCs is in dose and time dependent manners.The effect may be related to PI3K and MAPK signal pathway.