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

[Objective]To explore the function and clinical significance of pig bile in Baitong Plus Pig Bile Decoction.[Methods]The pathogenesis of Baitong Plus Pig Bile Decoction syndrome was re-sorted by combining with the pulse and the development of Shaoyin disease,to analyze the limitations in previous physicians'comprehension of the efficacy of pig bile in Baitong Plus Pig Bile Decoction,and further explore the key roles of pig bile in ancient medical texts and modern research.[Results]As the heart governs blood circulation,in the progression of Shaoyin disease,the pulse transitions from weak to absent,indicating a progressively increasing degree of Yang deficiency,the pathogenesis of heart-Yang desire removal was concluded as Baitong Plus Pig Bile Decoction.Previous physicians held the belief that pig bile possessed properties conducive to using corrigent and nourishing Yin,which may have contradicted ZHANG Zhongjing's original intentions.It had been proven that the heart and gallbladder were in contact,and the gallbladder's Qi was hidden in the bile,which had the effect of calming the heart's Yang.Pig as a water animal,pig bile was more effective than sheep bile in restricting the inner Yang,the use of bile in small quantities could cause the pulse to renew itself slightly,so that there was a chance of survival.[Conclusion]This understanding can better explain the connotation of the articles of Treatise on Febrile Diseases and expand the scope of clinical application of porcine bile,so as to provide a useful reference for better application of animal bile and bile concoctions of traditional Chinese medicines in the treatment of cardiac diseases and even cardiac emergencies and critical illnesses.

Objective: To analyze the trajectory of dietary behaviors among middle school students in Jiading District, Shanghai, from 2021 to 2023, and longitudinally verify their association with anxiety and depression symptoms, aiming to provide scientific evidence for promoting the mental health of adolescents. Methods: The data were sourced from the National Monitoring and Intervention Project on Common Diseases and Health Impact Factors of students in Jiading District, Shanghai. A total of 1 217 middle school students who participated in at least two surveys from 2021 to 2023 were selected as the research objects, and group-based trajectory model was constructed to identify their dietary behavior scores trajectories. Modified Poisson regression was used to investigate the impact of dietary behavior scores trajectories on anxiety and depression, while Logistic regression was employed to explore the association between trajectories and changes in depression score levels. Results: The dietary behavior scores trajectories of middle school students were divided into three groups: Persistent Healthy Dietary Behavior (9.5%), Persistent Relatively Unhealthy Dietary Behavior (85.0%), and Persistent Very Unhealthy Dietary Behavior (5.5%). Students who perceived their academic performance as poor and whose parents had a cultural level of high school or below had a significantly lower proportion in the Persistent Healthy Dietary Behavior group compared to students with other characteristics ( χ 2=12.87, 8.69, 6.50, P <0.05). Compared with the Persistent Healthy Dietary Behavior group, the risk of anxiety symptoms in middle school students in the Persistent Very Unhealthy Dietary Behavior group was significantly increased ( aRR=3.04, 95%CI =1.15-8.02); Persistent Relatively Unhealthy Dietary Behavior and Persistent Very Unhealthy Dietary Behavior increased the risk of depressive symptoms ( aRR = 1.80 , 2.45, respectively), and were positively correlated with the increase in depression scores ( aOR =1.70, 2.24) ( P <0.05). Conclusions The dietary behavior of middle school students have not changed significantly in the past three years, with persistent unhealthy dietary behavior being the most common. Unhealthy dietary behaviors are positively correlated with the risk of anxiety and depressive symptoms and an increase in depression scores.

Objective: To analyze the epidemiological characteristics and changing trends of non suicidal self injury (NSSI) behaviors among middle school students in Jiading District of Shanghai, from 2015 to 2023, so as to provide a basis for the development of NSSI prevention and control measures among students. Methods: Using a stratified cluster random sampling method, a total of five times for Shanghai Adolescent Health Risk Behavior Surveys were conducted for every two years in Jiading District of Shanghai from 2015 to 2023. A total of 5 231 middle school students from junior high schools and senior high schools were selected for questionnaire surveys. Intergroup comparisons were performed using the x 2 test or the χ 2 trend test, and the JointPoint 5.0 software was used to analyze the changing trends, with the annual percent change (APC) used for evaluation. A binary Logistic regression model was employed to analyze the related factors of NSSI behavior among middle school students. Results: In 2023, the reported NSSI rate among middle school students in Jiading District was 14.2%. The rate was significantly higher among junior high school students (17.1%) than that among senior high school students (11.1%), and higher among females (19.2%) than that among males (10.0%) ( χ 2=10.04, 23.21, both P <0.01). From 2015 to 2023, the overall reported NSSI rate showed an increasing trend, rising from 8.6% in 2015 to 14.2% in 2023 ( χ 2 trend =22.25), with an APC of 6.64% ( t =3.49), and the APC for girls was 9.79 % ( t =3.20) (all P <0.05). Among students reporting NSSI, the proportion experiencing ≥6 episodes increased from 10.8% in 2015 to 19.2% in 2023 ( χ 2 trend =6.57, P <0.05). Multivariate Logistic regression analysis indicated that girls, junior high school students, those with insomnia, depressive emotion and drinkers had higher risks of NSSI, compared to boys, senior high school students, those without insomnia, non depressive emotion students and non drinkers ( OR =1.71, 1.96, 3.44, 4.76, 1.77, all P < 0.05 ). Conclusions The reported rate of NSSI among middle school students in Jiading District of Shanghai, increased annually from 2015 to 2023, and the proportion of repeated NSSI also showed an upward trend. Early intervention measures targeting middle school students, especially junior high school students and females, should be implemented to prevent and control its occurrence and development.

Objective: To review the current development of artificial intelligence (AI) technology in the field of transfusion medicine. Methods: A systematic search was conducted in the Clarivate Web of Science Database from inception to December 2024 for literature related to AI and transfusion. A total of 4 775 publications were identified. Based on inclusion and exclusion criteria, 133 original studies were ultimately included and analyzed using a narrative synthesis approach. Results: Research on AI in transfusion has surged since 2020 (accounting for 77% of all publications), with China ranking second globally in publication volume. Among the included studies, 69.2% focused on predicting individual transfusion needs, followed by inventory management (8.3%), diagnosis and prediction of adverse transfusion reactions (6.0%), factors influencing transfusion outcomes (5.3%), blood group identification (5.3%), blood quality testing (4.5%), and precise blood volume measurement (1.5%). Additionally, 4.5% of the studies were published in journals with an impact factor greater than 10; 19.5% developed software or applications; 31.5% were multi-center studies; 48.1% utilized decision tree methods, while 31.5% employed neural network approaches; and 14.2% conducted external validation of the algorithms. Conclusion: AI demonstrates significant potential in transfusion risk prediction, decision support, and blood management. However, challenges remain, including limited model generalizability, insufficient algorithm interpretability, and barriers to clinical translation. The deep integration of AI with transfusion medicine will accelerate the advent of precision transfusion era, maximizing blood resource utilization, reducing waste, and ensuring transfusion safety.

Objective To investigate whether microRNA-21-5p(miR-21)plays a protective role in hyperoxia-induced acute lung injury(HALI)by regulating ferroptosis through the STAT3/P53/SLC7A11 axis.Methods The interaction between STAT3 and P53 was analyzed by co-immunoprecipitation(Co-IP).Fifty 9-week-old male C57BL/6J mice were randomly divided into normoxia(Control)group,HALI group,miR-21 overexpression(miR-21)group,STAT3 inhibitor(HY-13818)group,and ferrostatin-1(Fer-1)group.After the mice from the miR-21 group received miR-21-5p AAV6 or empty vector via tracheal catheter instillation,the animals were then monitored for 3 weeks.The HY-13818 group was intraperitoneally injected with HY-13818(10 mg/kg)3 times weekly for 2 weeks.The Fer-1 group received 0.8 mg/kg ferrostatin-1 via tail vein injection once daily for 2 consecutive days during modeling.The HALI model was established by exposure to>90%oxygen.After 48 h of hyperoxia,blood samples were collected via orbital sampling for RT-PCR analysis of miR-21 expression.Lung tissues were harvested for wet/dry weight ratio and assessment of histopathological changes via HE staining for lung injury score.Activity of superoxide dismutase(SOD)and contents of malondialdehyde(MDA),Fe2?,glutathione(GSH),and reactive oxygen species(ROS)were measured using photocolorimetry,spectrophotometry and fluorometry.Western blotting was used to evaluate the protein expression of STAT3,P53,SLC7A11,and GPX4.Results The results of Co-IP showed that STAT3 could bind to P53.The HALI group exhibited obviously destroyed alveolar structure,disordered arrangement,thickened interval,with a large number of infiltrated neutrophils and collapsed alveoli,and had significantly increased pathological score of lung injury and ratio of lung Wwet/Ddry weight when compared with the Control group(P<0.05).In the miR-21 group,HY-13818 group and Fer-1 group,the severity of lung injury was significantly reduced,and the pathological score of lung injury and the ratio of Wwet/Ddry weight were decreased(P<0.05)when compared with the HALI group.Compared with the control group,the contents of MDA,Fe2+and ROS were increased(P<0.05),the activity of SOD and content of GSH were declined(P<0.05),the protein levels of STAT3 and P53 were increased(P<0.05),and those of SLC7A11 and GPX4 were decreased(P<0.05)in the HALI group.Compared with the HALI group,decreased MDA and ROS levels(P<0.05),enhanced SOD activity,Fe2+and GSH levels(P<0.05),down-regulation of STAT3 and P53(P<0.05)and up-regulation of SLC7A11 and GPX4(P<0.05)were observed in the miR-21 group and HY-13818 group.Conclusion MiR-21 alleviates HALI,which may be related to its inhibition of ferroptosis through the STAT3/P53/SLC7A11 axis.

OBJECTIVE To explore and establish the working mechanism for prevention and control of hospital-as-sociated infections in regional oral medical institutions so as to standardize the prevention and control of the hospi-tal-associated infections in the regional oral medical institutions.METHODS Taking an administrative division of Chongqing as example,the matrix evaluation was carried out based on the quality control mode for management of hospital-associated infections in oral medical institutions' action planning,training guidance,quality control super-vision,summary review' organically in combination with'quality control plus law enforcement',a color-co-ded management of the oral medical institutions in the region was implemented,and the effectiveness of improved work in infection control was examined.RESULTS From the perspective of the grade of medical institution,the qualified rates of hospital infection management system construction,architectural layout and process,cleaning,disinfection and sterilization of oral instruments,environmental cleaning and disinfection,isolation,safe injection,use of occupational protection supplies and disposal of medical waste of the primary and unrated medical institu-tions were respectively 26.51％,49.40％,24.10％,37.35％,31.33％,46.99％,67.47％and 51.81％before the improvement and were respectively increased to 67.47％,63.86％,45.78％,66.27％,63.86％,73.49％,84.34％and 66.27％after the improvement,and there were significant differences(P＜0.05).From the perspec-tive of the property of the medical institution,the qualified rates of the above items of the private medical institu-tions were respectively 24.66％,47.95％,21.92％,34.25％,31.51％,45.21％,69.86％and 50.68％before the improvement and were respectively increased to 65.75％,61.64％,42.47％,64.38％,63.01％,71.23％,84.93％and 63.01％after the improvement,and there were significant differences(P＜0.05).CONCLUSION The working mechanism on prevention and control of hospital-associated infections in regional oral medical institu-tions that is established based on'quality control plus law enforcement'with the introduction of social credit can effectively raise the qualified rates of the infection prevention and control measures,which achieves more remarka-ble improvement effectiveness in grass-roots oral medical institutions such as the private,primary and unrat-ed medical institutions.

Objective To explore the expression of epidermal growth factor and nuclear transcrip-tion factor kappa B(NF-κB)in elderly gliomas and their roles in malignant progression of the dis-ease.Methods A total of 240 elderly glioma patients undergoing surgical resection in our hospital from January 2020 to January 2023 were enrolled and served as an observation group.Another 100 patients receiving surgical treatment due to traumatic brain injury in our hospital during the same period were recruited and served as the control group.Immunohistochemical assay was used to detect the expression of epidermal growth factor and NF-κB in brain tissue.Cox regression analy-sis was employed to determine the independent influencing factors of malignant progression in the elderly glioma patients.Results The observation group had significantly higher epidermal growth factor expression score and NF-κB expression score than the control group(7.44±1.16 vs 3.68±0.51,6.49±1.02 vs 3.56±0.64,P＜0.01).The age,tumor pathological grade,surgical approach,postoperative radiotherapy,and epidermal growth factor and NF-κB expression levels were inde-pendent factors affecting the progression of elderly glioma patients(P＜0.05,P＜0.01).Conclusion The epidermal growth factor and NF-κB expression levels are independent influen-cing factors of progressive disease in elderly glioma patients,and can serve as evaluation indicators for postoperative progression in the patients.

Objective:To establish a framework of entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology, standardize the training process, and provide an effective evaluation method.Methods:Based on literature review and discussions, a preliminary expert consultation questionnaire was developed. From July to November 2024, a modified Delphi method was adopted and relevant experts were invited to assess the importance, validity, and feasibility of each indicator using a 5-point Likert scale. The results were used to screen and refine the entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology.Results:In the two rounds of expert consultation, the valid questionnaire return rate reached 100.00%, with an expert judgment basis coefficient of 0.73 and a familiarity coefficient of 0.90. Based on expert feedback, the final framework retained 3 first-level indicators and 12 second-level indicators. Modifications included renaming "Anesthesia Management" to "Anesthetic Drug Management", swapping the order of "Intraoperative Emergency Management" and "Airway Management", and removing the indicator "Resuscitation Assessment".Conclusions:This study preliminarily developed a framework of entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology. The framework provides a simple and practical competency evaluation method for standardized training, which can enhance training quality and effectiveness.

Objective:To establish a framework of entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology, standardize the training process, and provide an effective evaluation method.Methods:Based on literature review and discussions, a preliminary expert consultation questionnaire was developed. From July to November 2024, a modified Delphi method was adopted and relevant experts were invited to assess the importance, validity, and feasibility of each indicator using a 5-point Likert scale. The results were used to screen and refine the entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology.Results:In the two rounds of expert consultation, the valid questionnaire return rate reached 100.00%, with an expert judgment basis coefficient of 0.73 and a familiarity coefficient of 0.90. Based on expert feedback, the final framework retained 3 first-level indicators and 12 second-level indicators. Modifications included renaming "Anesthesia Management" to "Anesthetic Drug Management", swapping the order of "Intraoperative Emergency Management" and "Airway Management", and removing the indicator "Resuscitation Assessment".Conclusions:This study preliminarily developed a framework of entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology. The framework provides a simple and practical competency evaluation method for standardized training, which can enhance training quality and effectiveness.