Secondary Hyperparathyroidism: Clinical Exploration of Endoscopic Total Parathyroidectomy Using the Oral Vestibular Approach with Forearm Autotransplantation.

Context: For secondary hyperparathyroidism (SHPT), physicians prefer conservative treatments, and surgical intervention has proven to be the best solution for some patients. Among the surgical interventions, total parathyroidectomy plus autotransplantation (TPTX+AT), using the forearm, is the major effective treatment. TPTX+AT, in conjunction with transoral endoscopic thyroidectomy vestibular approach (TOETVA), includes many advantages. Objective: The study intended to evaluate the clinical value of performing an endoscopic total parathyroidectomy TPTX+AT in conjunction with TOETVA in treating SHPT and to summarize and share the clinical experience. Design: The research team performed a prospective controlled study. Setting: The study took place at the Zhongshan Boai Hospital affiliated with Southern Medical University in Zhong Shan, Guangdong, China. Participants: Participants were 97 SHPT patients who were admitted to the hospital between March 2020 and March 2022. Intervention: The intervention group included 47 SHPT patients who received endoscopic TPTX+AT combined with the TOETVA, and the control group included 50 SHPT patients who received routine TPTX+AT. Outcome Measures: The research team performed comparisons between the groups regarding: (1) operating conditions, including intraoperative blood loss, operating time, and number of parathyroid glands detected intraoperatively; (2) clinical efficacy, (3) postoperative complications, (4) parathyroid hormone (PTH) and calcium (Ca) levels, (5) psychological status using the Hamilton Anxiety (HAMA) and the Hamilton Depression Scale (HAMD), and (9) life quality using the 36-Item Short Form Health Survey (SF-36). Results: The intervention group had significantly longer operation times and significantly greater intraoperative blood loss than the control group did, but the intervention group had fewer complications, lower PTH and Ca levels, and a higher efficacy (P < .05). The intervention group also had a significantly better psychological state and prognostic quality of life than the control group did (P < .05). Conclusions: Endoscopic treatment of SHPT using TPTX+AT in combination with TOETVA can significantly relieve clinical symptoms and lower serum PTH and Ca levels. The results suggest that the operation is safe and effective.

The Mechanism and Experimental Validation of Forsythoside A in the Treatment of Male Infertility Were Analyzed Based on Network Pharmacology and Molecular Docking.

Chinese medicine extracts are currently the hotspot of new drug research and development. Herein, we report the mechanism of action of the traditional Chinese medicine extract Forsythiaside A in the treatment of male infertility and experimental verification. We first obtained 95 intersection genes between the target protein of Forsythiaside A and the target genes of male infertility and screened 13 key genes. In molecular docking, Forsythiaside A can each have a higher total docking score with 12 key genes and have a better combination. These 95 intersection genes are mainly related to biological processes such as response to peptide hormone, response to oxidative stress, and participation in the oxidative stress of the forkhead box O (FoxO) signaling pathway. Therefore, we use ornidazole to induce an experimental model of oligoasthenospermia in rats and use different concentrations of Forsythiaside A to intervene. We proved that the semen quality and superoxide dismutase (SOD) activities of model group rats were significantly lower than those of the blank group, and semen quality and SOD activities of the low-dose group and high-dose group were significantly higher than those of the model group. The malondialdehyde (MDA) level of model group rats was significantly higher than that of blank group, while the MDA levels of the low-dose group and high-dose group were significantly lower than that of the model group. Forsythoside A is a potential drug substance for male infertility and improves the semen quality, MDA levels, and SOD activities of rats with oligoasthenospermia.