Effects of hemodialysis and hemoperfusion combination treatment on maintenance hemodialysis patients / 上海交通大学学报（医学版）

Objective:To investigate the effects of hemodialysis (HD) and hemoperfusion (HP) combination treatment on maintenance hemodialysis (MHD) patients. Methods:A total of 80 MHD patients in Chongming Branch of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from July 2017 to July 2018 were randomly divided into two groups, i.e., HD+HP group (n=40) and HD group (n=40). The patients were followed up every 3 months for 1 year. The changes of laboratory indexes, dialysis adequacy indicators and quality of life scores of Kidney Disease Quality of Life-Short Form (KDQOL-SF) were compared between the two groups, and the prognosis, causes of death and adverse events were recorded. Results:At the end of one-year treatment, levels of parathyroid hormone (PTH), β2-microglobulin (β2-MG), high sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and left ventricular mass index (LVMI) were significantly lower in HD+HP group than those in HD group (P0.05). The overall mortality rates of HD+HP group and HD group were 12.5% and 32.5%, respectively. No significant adverse events were observed during the follow-up. Conclusion:The effects of HD combined with HP on clearing middle and large molecular toxins, reducing microinflammation status, and improving renal anemia and left ventricular hypertrophy are better than those of only HD. There may be potential advantages of HD and HP combination in improving quality of life in MHD patients as well.

The effects of parathyroid hormone on intracellular [Ca~(2+)]_i and apoptosis in rat cardiomyocytes / 中国药理学通报

AIM To study the effects of parathyroid hormone(PTH) on intracellular calcium concentration([Ca 2+ ] i), hypertrophy and apoptosis in rat cardiomyocytes. METHODS Neonatal rat cardiomyocyte hypertrophic response was assayed by measuring cell surface area and protein content. [Ca 2+ ] i was measured by confocal microscope using Fluo 3/AM as fluorescent indicator.Apoptosis was determined by flow cytometer and electron microscope. RESULTS After 7 d exposure to PTH 1～34 of 0 01 and 0 1 ?mol?L -1 ,[Ca 2+ ] i,surface area and protein content,and apoptosis rate(APO) of cardiomyocytes were significantly increased,especially in high concentration groups. While application of both nifedipine and PTH 1～34 significantly decreased lose indicators, they were still markedly higher than normal. CONCLUSIONS PTH 1～34 dose dependently induces hypertrophy and apoptosis of cardiomyocyte,and this is attributed able to augmented entry of calcium into cell via voltage dependent Ca 2+ channel.

The association of Vitamin D and Parathyroid Hormone with Bone Mineral Density in Korean Postmenopausal Women

BACKGROUND: Osteoporosis results from bone loss due to menopause [estrogen(E) deficiency] and aging. Initial skeletal effect of menopause is accelerated bone resorption with an increase in seurm calcium(Ca) and compensatory but inadequate bone formation. Secretion of parathyroid hormone(PTH) is suppressed at this time. Postmenopausal osteoporosis results in fractures predominantly of trabecular bone, i.e., vertebra. With aging, secondary hyperparathyroidism by low serum Ca and vitamin D deficiency superim poses. Senile osteoporosis produces hip fractures, area of cortical bone. The aim of this study was to- examine the association of vitamin D[25(OH)D] and intact(i) PTH with bone mineral density(BMD) after controlling for suggested confounding factors, and the possibility of low serum vitamin D and high serum iPTH concentration could impact bone loss in Korean postmenopausal women. METHODS: Data from 188 postmenopausal Korean women aged 42 to 69 were analyzed through BMD, serum 25(OH)D, iPTH, Ca, phosphorus(P), alkaline phosphatase(ALP) and clinical characteristics. Factors affecting BMD was determined by Pearson correlation and the relationship between lumbar and femoral neck BMD and vitamin D[25(OH)D] and iPTH was assessed by multiple regression analysis after adjus- ting for suggested confounding factors. RESULTS: Lumbar and femoral neck BMD, serum Ca, P were decresaed and serum iPTH was increased with aging. In Pearson`s correlation, significant contributing factors to lumbar BMD was age, height, weight, menarche, year since menopause(YSM) and ALP. And significant contributing factors to femoral neck BMD was age, height, weight, menarche, YSM and iPTH. No relationship could be demonstrated between serum vitamin D[25(OH)D] and lumbar and femoral neck BMD. How ever, after controlling for potential confounding factors, a correlation was found between vitamin D[25(OH)D] and both of lumbar (p=0.013) and femoral neck BMD(p=0.077). iPTH was inversely related to femoral neck BMD(p=0.004) only in multiple linear regression. CONCLUSION: Serum vitamin D[25(OH)D] was influencing both of vertebral and femoral neck BMD, which suggests a significant role of vitamin D deficiency in the pathogenesis of postmenopausal osteo- porosis. In age related remodeling and loss of bone, increased serum iPTH might have additive role in cortical bone of femur. These findings suggest that vitamin D is very important for optimal bone health and a deleterious effect of increased iPTH on cortical bone loss. Adequate calcium and vitamin D status have to be maintained to prevent osteoporosis in postmenopausal Korean women.

Clinical Characteristics Study of Pseudohypoparathyroidism / 대한소아내분비학회지

PURPOSE: Pseudohypoparathyroidism(PHP) is caused by a defect of G protein and receptor despite of normal parathyroid hormone(PTH) secretion. It is a rare disorder characterized by hypocalcemia, hyperphophatemia, elevated PTH levels and albright hereditory osteodystrophy(AHO). We retrospectively reviewed the clinical characteristics of PHP. METHODS: We reviewed clinical features, laboratory findings, and outcome to treatment of 8 PHP patients, diagnosed at Seoul National University Hospital from 1988 to rool. RESULTS: Male to Female ratio was 1.7:1 and mean age at diagnosis was 11.8 years old. The initial average height SDS was 0.13+/-.08 and the average weight SDS was 0.43+/-.31. The most common symptom was seizure. Only one patient had typical AHO, three patients had mental retardation. Brain MRI or CT showed basal ganglia calcification in 3 patients. All patients treated with vitamin D and calcium supplementation could maintained normal serum levels of calcium and phophorus. CONCLUSION: PHP should be suspected in patient with seizure of unknown origin, aged above 5 year-old. AHO and mental retardation could be adjuvant signs to the diagnosis of PHP. But definite diagnosis could be made by laboratory work up.

Bone Metabolism in the Hemiplegic Patients after Stroke

OBJECTIVE: To assess change of bone metabolism in hemiplegic patients after stroke. METHOD: Sera were collected from 19 hemiplegic patients after stroke. Sera were assayed for 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2D), parathyroid hormone (PTH), calcium and osteocalcin. RESULTS: Serum 25-OHD and 1,25-(OH)2D concentration were 15.13 mg/mL and 20.88 pg/mL, respectively. Serum PTH was 47.23 pg/mL. In 5 (26%) of the patients, the serum 25-OHD concentration were < 10 ng/mL (deficient level). Ten (52%) of the patients had vitamin D concentrations between 10 and 20 ng/mL (insufficient level). The mean PTH concentration was not significantly higher in patients with deficient levels of 25-OHD (61.80 pg/mL) than those with insufficient (43.63 pg/mL) or sufficient (38.05 pg/mL) levels of 25-OHD. Serum 25-OHD concentration were lower in the late group (11.11 mg/mL) than in the early group (18.05 mg/mL), whereas serum PTH concentration were higher in the late group (58.96 pg/mL) than in the early group (38.70 pg/mL). CONCLUSION: Compensatory hyperparathyroidism with hypovitaminosis D occurred in the hemiplgic patients after stroke, especially more than one year from onset.

Relationship Between Serum Magnesium and Parathyroid Hormone Levels in Hemodialysis Patients / 대한신장학회잡지

The important factors involved in the regulation of PTH are calcium, vitamin D, and phosphorus. However, recent studies have suggested that magnesium may also play a significant role in the modulation of PTH. The aims of this study was to analyze the relationship between serum magnesium and PTH levels in the hemodialysis patients. We studied 66 stable patients under maintenance hemodialysis for more than 6 months. Calcium carbonate was used as a phosphate binder in all patients. No patient had been previously treated with vitamin D and aluminum hydroxide. Biochemical parameters were evaluated 3 times during 7 months, and the mean values were computed. The mean serum magnesium level was 2.7+/-0.4 mEq/L. Hypermagnesemia(defined as serum Mg>2.2 mEq/L) was found in 60 patients(90.1%). Serum magnesium levels were inversely correlated with serum iPTH levels(r=-0.579; p<0.001). Serum total and ionized calcium levels were inversely correlated with serum iPTH levels(r=-0.743; p<0.001, r=-0.699; p<0.001, respectively). Serum alkaline phosphatase levels positively correlated with serum iPTH levels (r=0.364; p=0.003). In lower iPTH group(serum iPTH

Simultaneous elevation of serum parathyroid hormone(PTH) and parathyroid hormone-related protein(PTHrP) in a case of lung cancer with hypercalcemia / 결핵

The parathyroid hormone related protein(PTHrP) is the most common causative peptide of humoral hypercalcemia of malignancy. In contrast, the serum level of parathyroid hormone(PTH) is low to undetectable in the majority of patients with malignancy associated hypercalcemia. Few cases exist in which the production and secretion of PTH by malignant nonparathyroid tumors have been authenticated. To our knowledge, there is very rare case in which a nonparathyroid tumor expressed simultaneously both the PTH and PTHrP. We report a case of squamous cell carcinoma of the lung with hypercalcemia which presented with simultaneous elevation of serum PTH and PTHrP. Severe hypercalcemia (serum calcium, 7.5mEq/L) was found in a 65-year-old man who had a squamous cell carcinoma of the lung without any body metastasis and detectable parathyroid abnormalities on isotope scintigraphy. The serum level of intact parathyroid hormone (PTH) concentration was markedly elevated as measured in two site radioimmunoreactive PTH assays (intact PTH 150pg/mL ; normal 9~55). The serum level of a PTHrP was also increased as measured in C-terminal region specific radioimmunoassay (PTHrP 99.1 pmol/L ; normal 13.8~55.3). There are no evidences of coincidental primary hyperparathyroidism in parathyroid MIBI scan and other imaging studies including neck ultrasonography and computed tomography. These results suggest that simultaneous elevation of serum PTH and PTHrP in this patient can be caused by production of both PTHrP and PTH in other nonparathyroid lesions such as squamous cell carcinoma.