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.

Causal Relationship of Obstructive Sleep Apnea with Bone Mineral Density and the Role of BMI.

Background: Observational studies have yielded conflicting evidence concerning the relationships between obstructive sleep apnea (OSA) and bone mineral density (BMD). As the exact causal inferences remain inconclusive, we conducted a two-sample Mendelian randomization (MR) to identify the causal associations between OSA and BMD. Methods: Single-nucleotide polymorphisms associated with OSA were extracted from the FinnGen study. Summary statistics for 10 BMD measured at different age or skeletal sites were obtained from the publicly available IEU GWAS database. Inverse-variance weighted (IVW) method was chosen as the primary analysis, combined with several sensitivity analyses to evaluate the robustness of results. The study design included two-sample MR and network MR. Results: Our primary MR analysis revealed that genetically predicted OSA was positively linked to increased forearm BMD (ß = 0.24, 95% confidence interval [CI]: 0.06-0.41, p = 0.009) and heel BMD (ß=0.10, 95% CI = 0.02-0.18, p = 0.018), while no significant causal relationships were observed between OSA and total body BMD, lumbar spine BMD, or femoral neck BMD (all p > 0.05). Network MR suggests that OSA might act as a mediating factor in the effect of BMI on forearm BMD and heel BMD, with a mediated portion estimated at 73% and 84%, respectively. Conclusion: Our findings provide support for a causal relationship between genetically predicted OSA and increased forearm BMD and heel BMD. Furthermore, our results suggest that OSA may play a role in mediating the influence of BMI on BMD.

Uptake, accumulation, and translocation of organophosphate esters and brominated flame retardants in water hyacinth (Eichhornia crassipes): A field study.

Mechanisms underlying the plant uptake, accumulation, and translocation of organophosphate esters (OPEs) and brominated flame retardants (BFRs) in field environments remain ambiguous. To better understand these processes, we selected a typically polluted river with steady flow and rampant water hyacinth (Eichhornia crassipes) and investigated 25 OPEs and 23 BFRs in 24 sets of matched water-plant samples. Both OPEs and BFRs showed high or ultra-high levels in field water hyacinths, statistically positive water-plant/root concentration correlations, and dominant distributions in the roots. Passive root uptake was the dominant route for OPEs and BFRs to enter the water hyacinth. Both OPEs and BFRs in water hyacinth exhibited acropetal translocation from the root and possible basipetal translocation from the leaf. The accumulation and translocation of OPEs in water hyacinth were significantly affected by their substituents and structures, including the chlorination degree, alkyl chain length, side chain, and methylation degree of aryl-substituted OPEs. The translocation of BFRs in water hyacinth also showed close association with their bromination degree, but their accumulation in roots showed anomaly, indicating possible transformations. Overall, the enrichment and behavior of OPEs and BFRs in water hyacinth seemed to be mainly controlled by physicochemical parameters. OPE/BFR concentrations in total suspended particulate (TSP), TSP-associated organic carbon content, TSP concentration, and plant biomass all showed significant effects on their root accumulation and translocations in water hyacinth. This study provides rare field evidences and novel insights into the basipetal translocation of OPEs and BFRs in plants.

Spatiotemporal transitions of organophosphate esters (OPEs) and brominated flame retardants (BFRs) in sediments from the Pearl River Delta, China.

Recent regulations on the use of brominated flame retardants (BFRs, especially polybrominated diphenyl ethers, PBDEs) have led a sharp increase in the use of organophosphate esters (OPEs), which have become the subject of widespread environmental concern. To gain insights into their environmental transitions, we investigated the spatiotemporal trends and sources of 25 OPEs and 23 BFRs (21 PBDEs and two alternative BFRs) in sediments from the Pearl River Delta (PRD), the second economic/industrial region of China. Among them, PBDEs showed higher mean concentrations than OPEs and alt-BFRs in PRD sediments, a continual increase in most PRD areas, and positive correlations with most local socioeconomic parameters. The source analysis results indicated that all of these changes resulted from the substantial use/stock of PBDEs (especially deca-BDE) in this region, and BDE-209 displayed debromination in most sediments. OPEs demonstrated obvious increases in sediments from all major PRD rivers, especially those located in less-developed regions. This distribution might be related to the large-scale industry relocation from the central PRD area to its vicinities. Unexpectedly, decabromodiphenyl ethane (DBDPE), an important deca-BDE substitute, presented considerable declines in the PRD sediments while several novel OPEs showed considerably high proportions, especially aryl-substituted OPEs, which merit further screening analysis.

Organophosphate esters (OPEs) in a heavily polluted river in South China: Occurrence, spatiotemporal trends, sources, and phase distribution.

In the past decade, organophosphate esters (OPEs) undergo rapid increase in production and use. Meanwhile, owing to their additive property, OPEs exhibit liability to escape from related products and therefore ubiquity in various environments. Moreover, numerous researches verify their bioavailability and negative effects on biota and human, hence their occurrence and associated risks have caught much concern, particularly those in aquatic systems. So far, however, OPEs in water are generally investigated as a whole, their phase distribution and behavior in waterbodies are incompletely characterized. We examined 25 OPEs in water (including dissolved and particulate phases), sediment, and sediment core samples from the Lian River, which flows through the Guiyu e-waste recycling zone and Shantou specific economic zone in South China. Compared to most global waterbodies, the Lian River showed high or ultrahigh OPE levels in both water and sediments, particularly in the reaches surrounded by e-waste recycling and plastic-related industries, which were the top two greatest OPE sources. Non-industrial and agriculture-related anthropogenic activities also contributed OPEs. Sediment core data suggested that OPEs have been present in waters in Guiyu since the 1960s and showed a temporal trend consistent with the local waste-recycling business. The phase distribution of OPEs in the Lian River was significantly correlated with their hydrophobicity and solubility. Owing to their wide range of physicochemical properties, OPE congeners showed significant percentage differences in the Lian River water and sediments. Generally, OPEs in water reflect their dynamic real-time inputs, while those in sediment signify their accumulative deposition, which is another cause of their phase distribution disparities in the Lian River. The physicochemical parameters of OPEs first imposed negative and then positive influences on their dissolved phase-sediment distribution, indicating the involvement of both the adsorption of dissolved OPEs and the deposition of particle-bound OPEs.

Responses of aerobic granular sludge to fluoroquinolones: Microbial community variations, and antibiotic resistance genes.

In this study, aerobic granular sludge (AGS) was operated under high levels of ammonium for removing three fluoroquinolones (FQs), i.e., ciprofloxacin (CFX), ofloxacin (OFX), and norfloxacin (NFX) at 3, 300, and 900 µg/L, respectively. Two key objectives were to investigate the differential distribution of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) in sludge fractions and to evaluate correlations between ARGs and MGEs to nitrifying and denitrifying bacteria. AGS showed excellent stability under the exposure of FQs, with nitrite-oxidizing bacteria (NOB) more sensitive to FQs than ammonium-oxidizing bacteria (AOB). Specific oxygen utilization rates (SOUR) showed a reduction of 26.9% for NOB but only 4.0% of the reduced activity of AOB by 3 µg/L FQs. AGS performed better removal efficiencies for CFX and NFX than OFX, and the efficiencies increased with their elevated concentrations, except at 900 µg/L FQs. The elevated FQ concentrations led to a significant enrichment of intI1 and genus Thauera, while qnrD and qnrS showed no accumulation. Compared to nitrifiers, FQs relevant ARGs and the intI1 gene preferred to exist in denitrifiers, and the abundance of denitrifiers behaved a decreasing trend with the sludge size. Two quinoline-degrading bacteria were found in the AGS system, i.e., Alicycliphilus and Brevundimonas, possibly carrying qnrS and qnrD, respectively. Their relative abundance increased with the sludge size, which was 2.18% in sludge <0.5 mm and increased to 3.70% in sludge >2.0 mm, suggesting that the AGS may be a good choice in treating FQs-containing wastewater.