Breakthrough intra-operative detection of the parathyroid glands

描述（由申请人提供）：目前，约有2000万美国人患有某种形式的甲状腺疾病。甲状腺疾病发生时，甲状腺不能提供所需的甲状腺激素的适当数量。甲状腺和甲状旁腺疾病联合收割机结合内分泌学和肿瘤学领域，导致病理条件的复杂组合。当疾病不能通过其他方法治疗时，使用手术手段来去除患病的腺体。在美国，每年约有10万例甲状腺手术切除部分或全部甲状腺。在甲状腺切除术中，甲状旁腺意外受伤或被切除时会发生并发症。这是因为甲状旁腺很难与甲状腺和颈部周围组织区分开来。腺体位置的变化使情况进一步复杂化。外科医生最终必须依靠视觉 检查以识别不同的组织，这可能是主观的和不确定的。对腺体的损伤可引起甲状旁腺功能减退和低钙血症，导致严重和有害的副作用。在最近（2011年6月）的出版物中，范德比尔特大学的PI教授Mahadevan-Jansen的小组首次报告了突破性发现，即甲状旁腺在785 nm照明下在NIR中具有独特的自体荧光特征。在一项超过44名患者的研究中，甲状旁腺的平均荧光强度比颈部其他组织高6倍以上。本提案的具体目的是在该工作的基础上，并寻求a）表征甲状腺和甲状旁腺组织的近红外荧光特征，以便了解甲状旁腺的这种更高的自体荧光的来源B）开发提供成像以及点分析的原型仪器，包括用于实现和自动化数据采集的软件接口，并提供真实的-时间反馈本提案的目标是开发甲状旁腺的术中检测平台。 公共卫生相关性：本项目的目标是建立一个术中检测器（外科医生），可以独特地检测甲状旁腺的近红外（NIR）自体荧光技术的基础上。在美国，每年约有10万例甲状腺手术切除部分或全部甲状腺。高达20%的手术会导致意外切除甲状旁腺，因为它们很难与甲状腺和其他颈部组织区分开来。甲状旁腺负责生产甲状旁腺激素，以维持整个身体的钙稳态。它们的去除或损伤可能导致健康问题，导致终身药物治疗。

DESCRIPTION (provided by applicant): Currently, about 20 million Americans have some form of thyroid disease. Thyroid disease occurs when the thyroid gland does not supply the appropriate amount of thyroid hormone needed. Thyroid and parathyroid diseases combine the fields of endocrinology and oncology leading to a complex combination of pathological conditions. When the disease cannot be treated by other methods, surgical means are used to remove the diseased gland(s). They are around 100,000 thyroid surgeries each year in the US to remove part or the entire thyroid. Complications occur when the parathyroid is accidentally injured or removed during thyroidectomies. This happens because Parathyroid glands are difficult to distinguish from the thyroid and surrounding tissues in the neck. The situation is further complicated by the glands' variability in position. Surgeons must ultimately rely on visual inspection to identify the different tissues, which can be subjective and inconclusive. Damage to the gland(s) can cause hypoparathyroidsim and hypocalcemia resulting in serious and deleterious side effects. In a recent (June 2011) publication, the PI Prof. Mahadevan-Jansen's group at Vanderbilt University reported for the first time the breakthrough finding that the Parathyroid Gland has a unique autofluorescence signature in the NIR under illumination at 785nm. The average fluorescent intensity of the parathyroid is over 6 times higher than other tissues in the neck area in a study of over 44 patients. The specific aim of this proposal is to build upon that work and it seeks to a) Characterize the the near-infrared fluorescence signatures of thyroid and parathyroid tissue in order to understand the source of this higher autofluorescence for the parathyroid gland b) To develop prototype instrumentation that provides imaging as well as point analysis including a software interface to implement and automate data acquisition and to provide real-time feedback The goal of this proposal is to develop an intra-operative detection platform for the parathyroid glands. PUBLIC HEALTH RELEVANCE: This goals of this project is to build an intra-operative detector (for surgeons) that can uniquely detect the parathyroid glands based on the technique of near-infrared (NIR) autofluorescence. There are around 100,000 thyroid surgeries each year in the US to remove part or the entire thyroid. Upto 20% of these surgeries lead to accidental removal of the parathyroid glands since they are difficult to distinguish from the thyroid and other neck tissue. The parathyroid glands responsible for the production of parathyroid hormone in order to maintain calcium homeostasis throughout the body. Their removal or injury could lead to health problems that result in lifelong medications to deal with.