Breakthrough intra-operative detection of the parathyroid glands

描述(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。当甲状腺不能提供所需的适量甲状腺激素时，就会发生甲状腺疾病。甲状腺和甲状旁腺疾病结合了内分泌学和肿瘤学领域，导致了复杂的病理情况组合。当疾病不能用其他方法治疗时，使用外科方法切除病变的腺体(S)。在美国，每年大约有10万例甲状腺手术切除部分或全部甲状腺。当甲状旁腺在甲状腺切除术中意外受伤或被移除时，就会出现并发症。这是因为甲状旁腺很难与颈部的甲状腺和周围组织区分开来。由于腺体位置的变化，情况变得更加复杂。外科医生最终必须依靠视觉 检查以确定不同的组织，这可能是主观的和不确定的。腺体受损(S)可导致甲状旁腺功能低下和低钙血症，从而导致严重和有害的副作用。在最近(2011年6月)发表的一篇文章中，范德比尔特大学PI教授Mahadean-Jansen的团队首次报告了这一突破性发现，即甲状旁腺在785 nm光照下的近红外光谱中具有独特的自体荧光特征。在一项对超过44名患者的研究中，甲状旁腺的平均荧光强度是颈部其他组织的6倍以上。这项建议的具体目的是在这项工作的基础上，寻求a)表征甲状腺和甲状旁腺组织的近红外荧光特征，以便了解甲状旁腺较高的自体荧光的来源；b)开发提供成像和点分析的原型仪器，包括实施和自动化数据采集并提供实时反馈的软件接口。 公共卫生相关性：该项目的目标是构建一种术中检测器(供外科医生使用)，该检测器可以基于近红外(NIR)自体荧光技术唯一地检测甲状旁腺。在美国，每年大约有10万例甲状腺手术切除部分或全部甲状腺。高达20%的此类手术会导致甲状旁腺的意外切除，因为它们很难与甲状腺和其他颈部组织区分开来。甲状旁腺负责产生甲状旁腺激素，以维持全身钙平衡。它们的移除或受伤可能会导致健康问题，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.