OBJECTIVE: To compare the effects of piriformis muscle release versus preservation in total hip arthroplasty (THA) via supercapsular percutaneously-assisted total hip (SuperPATH) approach on muscle injury. METHODS: Forty-nine patients undergoing initial THA via SuperPATH approach between June 2022 and June 2023 were randomly divided into two groups, with 24 patients in trial group and 25 patients in control group. The trial group received piriformis muscle release intraoperatively, whereas the control group underwent muscle preservation. There was no significant difference in baseline data such as gender, age, body mass index, disease type, American Society of Anesthesiologists (ASA) grading, and preoperative muscle infiltration, muscle atrophy, muscle injury serological indicators, Harris score, etc. ( P>0.05). The incision length, operation time, intraoperative blood loss, total blood loss, hospital stay, preoperative and postoperative 1-day muscle injury serological indicators [including creatine kinase (CK) and lactic dehydrogenase (LDH)], and incidence of complications between two groups were recorded. Harris score was used to evaluate the recovery of hip joint function. MRI was used to evaluate the extent of hip muscle injuries (gluteus minimus, gluteus medius, piriformis, obturator internus, quadratus femoris), including tendon integrity, degree of muscle fat infiltration, and degree of muscle atrophy preoperative and 1 year postoperatively. RESULTS: The operation time, intraoperative blood loss, and total blood loss in the trial group were significantly shorter than those in the control group ( P<0.05). There was no significant difference in the incision length and length of hospital stay between the two groups ( P>0.05). Both groups showed a significant increase in serum CK and LDH levels on postoperative day 1 compared to preoperative levels ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up, the follow-up time for the trial group and the control group was (14.8±2.8) and (15.1±3.0) months, respectively, with no significant difference ( t=-0.400, P=0.691). Incisions healed by first intention in both groups, with 1 case in the trial group and 2 cases in the control group experiencing venous thrombosis in the calf muscle space. There was no complication such as deep vein thrombosis, pulmonary embolism, hip dislocation, prosthesis loosening, or periprosthetic infection in the lower limbs. There was no significant difference in the incidence of complications between the two groups ( P>0.05). At 1 year after operation, both groups of patients showed a significant increase in Harris scores compared to preoperative levels ( P<0.05), but there was no significant difference between the two groups ( P>0.05). Compared with preoperative results, both groups showed significant fat infiltration in the piriformis and obturator muscles at 1 year after operation ( P<0.05), while there was no significant fat infiltration in the gluteus minimus, gluteus medius, and quadratus femoris muscles ( P>0.05). At 1 year after operation, except for the higher incidence of piriformis muscle fat infiltration in the control group compared to the trial group ( P<0.05), there was no significant difference in the incidence of other muscle infiltrations between the two groups ( P>0.05). At 1 year after operation, both groups of piriformis and obturator muscles showed significant muscle atrophy compared to preoperative levels ( P<0.05). The gluteus minimus and gluteus medius showed mild atrophy compared to preoperative levels, while the maximum transverse diameter of the quadriceps muscle slightly increased, but the differences were not significant ( P>0.05). There was no significant difference in the maximum cross-sectional diameter or cross-sectional area changes of each muscle between the two groups ( P>0.05). At 1 year after operation, the continuity of the gluteus medius and quadratus femoris muscles in both groups was intact. Both groups had some patients with incomplete continuity of the piriformis muscle, obturator internus, and gluteus minimus, but the difference was not significant ( P>0.05). CONCLUSION The SuperPATH approach THA may cause injury to the piriformis, gluteus minimus, and obturator internus. The piriformis muscle release does not increase muscle injury, but it can shorten the operation time and reduce bleeding.
Humans ; Arthroplasty, Replacement, Hip/adverse effects* ; Male ; Female ; Muscle, Skeletal/surgery* ; Middle Aged ; Aged ; Postoperative Complications/epidemiology* ; Adult ; Operative Time ; Muscular Atrophy ; Creatine Kinase/blood* ; Length of Stay ; Treatment Outcome

Critical care medicine(CCM)is a multifaceted discipline challenged by the inherent heterogeneity and complexity of critical illnesses.Establishing precise,standardized diagnostic and therapeutic systems has emerged as a crucial challenge requiring urgent resolution in this field.Surgical critical care,a pivotal branch of CCM,plays an indispensable role in managing patients with severe trauma,postoperative intra-abdominal infections,solid organ transplantation,and other life-threatening conditions.Evidence-based,etiology-guided therapy serves as the cornerstone of surgical critical care,where accurate identification and timely interventions constitute vital determinants for enhancing patient survival rates and improving prognoses.This article proposes an innovative diagnostic and therapeutic paradigm termed the urgency/physics-biology-chemistry(U/P-B-C)model.Built upon the established principle of urgent(urgency,U)life support in surgical critical care,this model emphasizes a novel conceptual framework centered on etiology-based(physics-biology-chemistry,P-B-C)diagnosis and treatment.Implementing the U/P-B-C innovative diagnostic and therapeutic model in surgical critical care facilitates precise identification of the fundamental pathological mechanisms underlying critical clinical conditions with complex and dynamic clinical environments,enables systematic clarification of clinical reasoning,and ultimately supports evidence-informed decision-making.Its core objectives encompass enhancing surgical intensivists' diagnostic-therapeutic capabilities and ensuring rigorous adherence to the principle of etiology-guided therapy,thereby providing both theoretical foundation and practical guidance for improving the success rate of patient resuscitation and optimizing prognosis in surgical critical care settings.

Critical care medicine(CCM)is a multifaceted discipline challenged by the inherent heterogeneity and complexity of critical illnesses.Establishing precise,standardized diagnostic and therapeutic systems has emerged as a crucial challenge requiring urgent resolution in this field.Surgical critical care,a pivotal branch of CCM,plays an indispensable role in managing patients with severe trauma,postoperative intra-abdominal infections,solid organ transplantation,and other life-threatening conditions.Evidence-based,etiology-guided therapy serves as the cornerstone of surgical critical care,where accurate identification and timely interventions constitute vital determinants for enhancing patient survival rates and improving prognoses.This article proposes an innovative diagnostic and therapeutic paradigm termed the urgency/physics-biology-chemistry(U/P-B-C)model.Built upon the established principle of urgent(urgency,U)life support in surgical critical care,this model emphasizes a novel conceptual framework centered on etiology-based(physics-biology-chemistry,P-B-C)diagnosis and treatment.Implementing the U/P-B-C innovative diagnostic and therapeutic model in surgical critical care facilitates precise identification of the fundamental pathological mechanisms underlying critical clinical conditions with complex and dynamic clinical environments,enables systematic clarification of clinical reasoning,and ultimately supports evidence-informed decision-making.Its core objectives encompass enhancing surgical intensivists' diagnostic-therapeutic capabilities and ensuring rigorous adherence to the principle of etiology-guided therapy,thereby providing both theoretical foundation and practical guidance for improving the success rate of patient resuscitation and optimizing prognosis in surgical critical care settings.

Objective To explore the effect of music therapy on children with autism spectrum disorder(ASD).Methods A systematic search was conducted in databases including CNKI,Wanfang data,VIP,PubMed,Elsevier Sci-ence Direct and Google Scholar for randomized controlled trials(RCT)on the effect of music therapy on children with ASD.The search period was from database inception to April,2024.The control group received non-music therapy interventions,including medication,educational therapy,cognitive-behavioral therapy,and structured treatment.The observation group received music therapy.Studies were systematically reviewed following the Co-chrane Handbook for Systematic Reviews,with two researchers independently screening literatures,extracting data,and assessing the risk of bias in the included studies.Statistic analysis was performed using Review Manag-er 5.4.Results Nine RCTs were included,involving 828 patients from France,China,Norway,Iran,the United States and Aus-tralia.The intervention types mainly included music therapy,parent-child cooperative music therapy,Orff music therapy,group music therapy,improvisational music therapy,Orff-Schulwerk-based music therapy,music inter-vention and family-centered music therapy.The overall outcomes(SMD=-0.30,95%CI-0.55 to-0.04,P=0.02),language function(MD=-2.09,95%CI-2.89 to-1.30,P<0.001)and physical behavior(SMD=-0.27,95%CI-0.53 to-0.01,P=0.040)improved better in the observation group.Conclusion Music therapy can improve the overall outcome of children with ASD,especially in language function and physical behavior.

Objective:To analyze the epidemic characteristics and trends of visceral leishmaniasis (VL) in Shaanxi Province, and provide a basis for formulating control strategies.Methods:The information on VL cases in Shaanxi Province from January 2012 to December 2024 were obtained from the Shaanxi Provincial Infectious Disease Reporting Management System, and demographic data were collected from the Shaanxi Statistical Yearbook. Descriptive epidemiological method was used to analyze the prevalence and the distribution by the three dimensions (time, region, and population). Joinpoint 4.9.1.0 software and Geoda 1.6 software were used for regression analysis and spatial clustering analysis, respectively. SuperMap 8C software was used for visualization.Results:From January 2012 to December 2024, a total of 304 cases of VL were reported in Shaanxi Province, with an annual incidence rate of 0.06/100 000. VL cases occurred in all months of the year in Shaanxi Province with no significant seasonality, yet the onset was predominantly concentrated from April to August(52.30%, 159/304). The majority of cases were male (61.51%, 187/304), aged 5 months to 4 years (17.11%, 52/304), and farmers (67.11%, 204/304). A total of 54 districts (counties, cities) of 10 cities in the province had reported cases, mainly concentrated in Weinan City (49.34%, 150/304). Joinpoint regression analysis revealed a significant overall upward trend in the VL incidence rate in Shaanxi Province from 2012 to 2024 [average annual percent change (AAPC) = 12.60%, 95% confidence interval ( CI): 6.01% - 19.62%, t = 3.95, P < 0.001]. The year 2020 was identified as a turning point in the trend. The incidence rate showed a rapid upward trend from 2012 to 2020 [annual percent change (APC) = 23.75%, 95% CI: 13.33% - 35.12%, t = 5.62, P < 0.001]. Global spatial autocorrelation analysis indicated significant positive spatial autocorrelation in VL incidence in 2012, 2014, 2015, 2018, and 2022 (Moran's I > 0, Z > 1.96, P < 0.05). Local spatial autocorrelation analysis identified 12 "high-high" clustering areas from 2012 to 2024, mainly located in Shangluo City in southern Shaanxi Province, and Weinan City and Yan'an City in northern Shaanxi Province. Conclusions:From 2012 to 2024, VL cases in Shaanxi Province are predominantly male farmers. The incidence of VL shows an overall upward trend, with significant spatial clustering. The prevention and control situation is severe. It is imperative to strengthen control measures, including vector disinfection and health education, to effectively control the spread and transmission of VL.

Objective:To explore the role of the gut microbiota in the effect of orlistat on pancreatic exocrine function in mice.Methods:Sixty male C57BL/6J mice were divided into normal drinking water group and antibiotic group by using random number table method. In antibiotic group, vancomycin hydrochloride 0.5 g/L, ampicillin sodium 1 g/L, neomycin sulfate 1 g/L and metronidazole 1 g/L were added to the drinking water, which were administrated in combination for 2 weeks. The normal drinking water group and the antibiotic group were fed by normal diet (ND group, AND group), high-starch diet (HSD group, AHSD group), and high-fat diet (HFD group, AHFD group), respectively. The six groups were then gavaged with orlistat (O, 50 mg/kg) twice a day on the basis of the same diet, and were designated as ND+O group, AND+O group, HSD+O group, AHSD+O group, HFD+O group and AHFD+O group. The corresponding control groups were gavaged with the same amount of sterilized water, and the antibiotic group continued to drink antibiotic water. The intervention lasted for 12 weeks. Body weight and pancreatic weight were measured and recorded, and the pancreatic-to-body weight ratio was calculated. Blood samples were collected for the detection of inflammatory factor IL-6 and TNF α by ELISA. Pancreatic tissues were harvested for hematoxylin-eosin staining and subsequent pathological evaluation. Proteins were extracted from pancreatic tissues, and Western blot analysis was performed to detect the expression levels of pancreatic lipase and amylase.Results:In condition of normal diet and high fat diet, the body weights in the HFD group, HFD+O group, AHFD group [(37.22±4.49), (32.36±1.12), (33.64±2.52)g], were higher than that of ND group, ND+O group and AND group [(29.46±2.48), (27.48±1.98), (24.78±1.50)g], respectively; while the body weight of HFD+O group and AHFD+O group[(32.36±1.12), (27.82±0.61)g] were greatly lower than that of HFD group and AHFD group [(37.22±4.49), (33.64±2.52)g], respectively and body weight of ANFD+O group decreased to the level of normal diet group. In condition of normal diet, high fat diet and high starch diet, the pancreatic weight/body weight ratio was significantly higher in ND+O group (7.51±1.51)mg/g than ND group (5.19±1.06)mg/g, in HSD+O group and AHSD+O group [(6.68±0.34), (6.80±0.72)mg/g] higher than HSD group (4.37±0.91), in HFD+O group and AHFD+O group [(6.43±0.20), (6.67±0.53)mg/g] higher than HFD group (4.58±0.42)mg/g. The pancreatic acinar cells in mice from the ND+O, AND, AND+O, HSD+O, AHSD, AHSD+O, HFD+O, AHFD, and AHFD+O groups had significantly higher density of zymogen granules and exhibited larger eosinophilic stained area. The expression of pancreatic lipase was higher in AND+O group (1.96±0.39) than ND group and ND+O group [(1.00±0.28), (1.16±0.49)], in AHSD+O group (1.70±0.36) than HSD group (0.83±0.15), in AHFD+O group (1.71±0.45) than HFD group and HFD+O group [(0.89±0.23), (0.98±0.17)]. All the differences above were statistically significant (all P values <0.05). Conclusions:The gut microbiota can reduce the damage of orlistat to exocrine function of the pancreas and has a protective effect on the exocrine function of the pancreas.

Objective:To analyze the epidemic characteristics and trends of visceral leishmaniasis (VL) in Shaanxi Province, and provide a basis for formulating control strategies.Methods:The information on VL cases in Shaanxi Province from January 2012 to December 2024 were obtained from the Shaanxi Provincial Infectious Disease Reporting Management System, and demographic data were collected from the Shaanxi Statistical Yearbook. Descriptive epidemiological method was used to analyze the prevalence and the distribution by the three dimensions (time, region, and population). Joinpoint 4.9.1.0 software and Geoda 1.6 software were used for regression analysis and spatial clustering analysis, respectively. SuperMap 8C software was used for visualization.Results:From January 2012 to December 2024, a total of 304 cases of VL were reported in Shaanxi Province, with an annual incidence rate of 0.06/100 000. VL cases occurred in all months of the year in Shaanxi Province with no significant seasonality, yet the onset was predominantly concentrated from April to August(52.30%, 159/304). The majority of cases were male (61.51%, 187/304), aged 5 months to 4 years (17.11%, 52/304), and farmers (67.11%, 204/304). A total of 54 districts (counties, cities) of 10 cities in the province had reported cases, mainly concentrated in Weinan City (49.34%, 150/304). Joinpoint regression analysis revealed a significant overall upward trend in the VL incidence rate in Shaanxi Province from 2012 to 2024 [average annual percent change (AAPC) = 12.60%, 95% confidence interval ( CI): 6.01% - 19.62%, t = 3.95, P < 0.001]. The year 2020 was identified as a turning point in the trend. The incidence rate showed a rapid upward trend from 2012 to 2020 [annual percent change (APC) = 23.75%, 95% CI: 13.33% - 35.12%, t = 5.62, P < 0.001]. Global spatial autocorrelation analysis indicated significant positive spatial autocorrelation in VL incidence in 2012, 2014, 2015, 2018, and 2022 (Moran's I > 0, Z > 1.96, P < 0.05). Local spatial autocorrelation analysis identified 12 "high-high" clustering areas from 2012 to 2024, mainly located in Shangluo City in southern Shaanxi Province, and Weinan City and Yan'an City in northern Shaanxi Province. Conclusions:From 2012 to 2024, VL cases in Shaanxi Province are predominantly male farmers. The incidence of VL shows an overall upward trend, with significant spatial clustering. The prevention and control situation is severe. It is imperative to strengthen control measures, including vector disinfection and health education, to effectively control the spread and transmission of VL.

Objective:To explore the role of the gut microbiota in the effect of orlistat on pancreatic exocrine function in mice.Methods:Sixty male C57BL/6J mice were divided into normal drinking water group and antibiotic group by using random number table method. In antibiotic group, vancomycin hydrochloride 0.5 g/L, ampicillin sodium 1 g/L, neomycin sulfate 1 g/L and metronidazole 1 g/L were added to the drinking water, which were administrated in combination for 2 weeks. The normal drinking water group and the antibiotic group were fed by normal diet (ND group, AND group), high-starch diet (HSD group, AHSD group), and high-fat diet (HFD group, AHFD group), respectively. The six groups were then gavaged with orlistat (O, 50 mg/kg) twice a day on the basis of the same diet, and were designated as ND+O group, AND+O group, HSD+O group, AHSD+O group, HFD+O group and AHFD+O group. The corresponding control groups were gavaged with the same amount of sterilized water, and the antibiotic group continued to drink antibiotic water. The intervention lasted for 12 weeks. Body weight and pancreatic weight were measured and recorded, and the pancreatic-to-body weight ratio was calculated. Blood samples were collected for the detection of inflammatory factor IL-6 and TNF α by ELISA. Pancreatic tissues were harvested for hematoxylin-eosin staining and subsequent pathological evaluation. Proteins were extracted from pancreatic tissues, and Western blot analysis was performed to detect the expression levels of pancreatic lipase and amylase.Results:In condition of normal diet and high fat diet, the body weights in the HFD group, HFD+O group, AHFD group [(37.22±4.49), (32.36±1.12), (33.64±2.52)g], were higher than that of ND group, ND+O group and AND group [(29.46±2.48), (27.48±1.98), (24.78±1.50)g], respectively; while the body weight of HFD+O group and AHFD+O group[(32.36±1.12), (27.82±0.61)g] were greatly lower than that of HFD group and AHFD group [(37.22±4.49), (33.64±2.52)g], respectively and body weight of ANFD+O group decreased to the level of normal diet group. In condition of normal diet, high fat diet and high starch diet, the pancreatic weight/body weight ratio was significantly higher in ND+O group (7.51±1.51)mg/g than ND group (5.19±1.06)mg/g, in HSD+O group and AHSD+O group [(6.68±0.34), (6.80±0.72)mg/g] higher than HSD group (4.37±0.91), in HFD+O group and AHFD+O group [(6.43±0.20), (6.67±0.53)mg/g] higher than HFD group (4.58±0.42)mg/g. The pancreatic acinar cells in mice from the ND+O, AND, AND+O, HSD+O, AHSD, AHSD+O, HFD+O, AHFD, and AHFD+O groups had significantly higher density of zymogen granules and exhibited larger eosinophilic stained area. The expression of pancreatic lipase was higher in AND+O group (1.96±0.39) than ND group and ND+O group [(1.00±0.28), (1.16±0.49)], in AHSD+O group (1.70±0.36) than HSD group (0.83±0.15), in AHFD+O group (1.71±0.45) than HFD group and HFD+O group [(0.89±0.23), (0.98±0.17)]. All the differences above were statistically significant (all P values <0.05). Conclusions:The gut microbiota can reduce the damage of orlistat to exocrine function of the pancreas and has a protective effect on the exocrine function of the pancreas.

Objective To explore the effect of music therapy on children with autism spectrum disorder(ASD).Methods A systematic search was conducted in databases including CNKI,Wanfang data,VIP,PubMed,Elsevier Sci-ence Direct and Google Scholar for randomized controlled trials(RCT)on the effect of music therapy on children with ASD.The search period was from database inception to April,2024.The control group received non-music therapy interventions,including medication,educational therapy,cognitive-behavioral therapy,and structured treatment.The observation group received music therapy.Studies were systematically reviewed following the Co-chrane Handbook for Systematic Reviews,with two researchers independently screening literatures,extracting data,and assessing the risk of bias in the included studies.Statistic analysis was performed using Review Manag-er 5.4.Results Nine RCTs were included,involving 828 patients from France,China,Norway,Iran,the United States and Aus-tralia.The intervention types mainly included music therapy,parent-child cooperative music therapy,Orff music therapy,group music therapy,improvisational music therapy,Orff-Schulwerk-based music therapy,music inter-vention and family-centered music therapy.The overall outcomes(SMD=-0.30,95%CI-0.55 to-0.04,P=0.02),language function(MD=-2.09,95%CI-2.89 to-1.30,P<0.001)and physical behavior(SMD=-0.27,95%CI-0.53 to-0.01,P=0.040)improved better in the observation group.Conclusion Music therapy can improve the overall outcome of children with ASD,especially in language function and physical behavior.

OBJECTIVE To evaluate the impact of the specialized centralized procurement policy for insulin on daily cost and affordability of insulin,and provide data support for the enhancement of relevant policies.METHODS In this research,the insulin purchasing data were obtained from provincial centralized procurement platforms in provinces before and after the specialized centralized procurement of insulin(October-December 2021 and October-December 2022),and the cost variations of insulin before and after the centralized procurement were analyzed by the defined daily dose cost(DDDc)of various types of insulins.The changes in the affordability of various types of insulins before and after the specialized centralized procurement were evaluated,using the percentage of annual expenditure on various types of insulins relative to annual per capita disposable income(i.e.the proportion of annual expenditure)as an indicator.RESULTS After the specialized centralized procurement,DDDc of various types of insulins decreased by 20.7%-71.8%,with an average reduction of 45.7%.Moreover,the reduction in DDDc for third-generation insulin exceeded that for second-generation insulin.The reduction in the proportion of annual expenditure on insulin ranged from 24.3%to 73.4%,with an average decrease of 48.5%.Premixed insulin analogs experienced the greatest reduction(73.4%).Following the specialized centralized procurement,DDDc of insulin decreased in all provinces.Except for Guangxi(10.2%),the average proportion of annual expenditure on insulin in the remaining provinces dropped to below 10%.CONCLUSIONS The specialized centralized procurement policy for insulin has significantly reduced insulin costs and improved affordability,thereby alleviating the economic pressure on patients with diabetes.There are notable cost disparities among provinces and among insulin categories,which require attention.