Secondary and tertiary hyperparathyroidism are common complications in patients with chronic kidney disease, especially in end stage renal disease. Surgery is an important method for the treatment of secondary and tertiary hyperparathyroidism. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism is the first evidence based guideline focus on renal hyperparathyroidism surgical management. Recommendations using the best available evidence by a panel of 10 experts in secondary and tertiary renal hyperparathyroidism constructed this guideline, which provides evidence-based, individual and optimal surgical management of secondary and tertiary renal hyperparathyroidism. This paper made a guideline interpretation on the indications of surgery, imaging examination, preoperative and perioperative management, relevant evaluation and treatment during perioperative period, and intraoperative parathyroid hormone monitoring during operation, and so on.
Objective The basic terms of the technical specifications for case-control studies in the field of traditional Chinese medicine (TCM) are formed by expert consensus methods, in order to develop detailed texts of the technical specifications. Methods According to the process of international guidelines, a total of 44 experts participated in the Delphi survey. Results The three rounds of questionnaire response rates were 73.3%, 86.4%, and 86.8%, respectively. The experts' authority coefficients were 0.82, 0.85, and 0.86, respectively; and the expert opinion coordination coefficients were 0.356, 0.349, and 0.422, respectively. Expert enthusiasm, authority, opinion centralization, and degree of coordination were relatively high. There were many opinions raised in the expert consensuses on how to measure TCM syndrome, TCM constitution, the time point of measurement and the selection of new cases. Conclusion The case-control studies in TCM field should pay more attention to the characteristics of TCM. The draft of technical specification involves the study design and reporting, which can improve the methodological and reporting quality of case-control studies.
ObjectiveTo investigate the role of multiple disciplinary team (MDT) during surgical treatment of renal secondary hyperparathyroidism (SHPT), and identify management points of Departments of Nephrology and Endocrinology.MethodsThe data of patients with chronic kidney disease undergoing surgical treatment for SHPT in West China Hospital of Sichuan University between January 2009 and December 2018 were retrospectively collected. We explained the surgical treatment of MDT in the management of renal SHPT, and compared the changes before and after the establishment of MDT.ResultsA total of 187 patients including 101 males and 86 females were enrolled, with an average age of (47.60±11.28) years old and median dialysis vintage of 7 years. Under MDT, the number of patients with parathyroidectomy increased [(8.50±5.10) vs. (59.50±2.12) patients/year, P<0.001] and the completion rate of preoperative examinations were greatly improved (P<0.001). The success rate of surgery was also increased (86.8% vs. 97.5%, P=0.010). Proportion of patients who were admitted to the Department of Nephrology was significantly increased (39.7% vs. 84.9%, P<0.001). Most patients after surgery were transferred to the Department of Endocrinology (5.9% vs. 77.3%, P<0.001) to manage postoperative complications and metabolic bone disease, and thus normalized the management of SHPT.ConclusionsThe MDT contributes to management of renal SHPT, which is worthy of popularization and spreading. The management of internal medicine departments during surgical treatment of SHPT based on MDT is important, because they can be helpful to complete preoperative examinations and preoperative preparation as well as to alleviate postoperative complications.
