1.Total Saponins of Dioscoreae Nipponicae Rhizoma Alleviates Gouty Arthritis by Down-regulating COX-2-mediated M1 Macrophage Reprogramming
Lin HUANG ; Shumin LIU ; Huijuan SUN ; Geyu DENG ; Donghua YU ; Yu WANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):200-207
ObjectiveTo explore the mechanism of total saponins of Dioscoreae Nipponicae Rhizoma (TSDN) in treating gouty arthritis (GA) by regulating cyclooxygenase-2 (COX-2)-mediated M1 macrophage reprogramming by in vivo and in vitro experiments. MethodsIn vivo experiment: 24 male SD rats were randomly allocated into blank, model (GA), TSDN, and celecoxib groups, with 6 rats in each group. After 7 days of administration, pathological changes in the ankle synovial tissue were observed via hematoxylin-eosin (HE) staining. Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) was used to quantify the mRNA levels of NOD-like receptor protein 3 (NLRP3) inflammasome, apoptosis-associated speck-like protein (ASC), Caspase-1, COX-2, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in the synovial tissue. Enzyme-linked immunosorbent assay (ELISA) was employed to measure the serum levels of inducible nitric oxide synthase (iNOS), IL-1β, CD86, CD80, CD206, and arginase-1 (Arg-1). In vitro experiment: The GA model was established by lipopolysaccharide (LPS) + MSU induction, and the inhibitor concentration was screened by the methyl thiazolyl tetrazolium (MTT) assay. RAW264.7 cells were allocated into blank, model, TSDN, dexamethasone, COX-2 inhibitor (celecoxib), and TSDN + COX-2 inhibitor groups. The levels of iNOS, IL-1β, CD86, CD80, CD206, and Arg-1 in the cell supernatant of each group were determined by enzyme-linked immunosorbent assay (ELISA). The mRNA and protein levels of NLRP3 inflammasome, COX-2, IL-1β, and TNF-α in each group were determined by Real-time PCR and Western blot, respectively. ResultsIn vivo experiment: compared with the model group, TSDN reduced the mRNA levels of NLRP3 inflammasome, COX-2, IL-1β, and TNF-α in the synovial tissue (P<0.05, P<0.01). ELISA results showed that TSDN lowered the serum levels of iNOS, IL-1β, CD86, and CD80 (P<0.01) while increasing the serum levels of CD206 and Arg-1 (P<0.01). In vitro experiment: compared with the model group, TSDN and inhibitor down-regulated the mRNA levels of NLRP3 inflammasome, COX-2, IL-1β, and TNF-α and the protein levels of NLRP3 inflammasome, COX-2, cleaved IL-1β, and TNF-α (P<0.01). Compared with TSDN alone, TSDN + COX-2 inhibitor further reduced the mRNA and protein levels of the markers above (P<0.01). Compared with the model group, TSDN and COX-2 inhibitor decreased the levels of IL-1β, iNOS, CD80, and CD86 (P<0.01) and increased the levels of CD206 and Arg-1 (P<0.01) in cells. Compared with TSDN alone, TSDN + COX-2 inhibitor reduced IL-1β, iNOS, CD80, and CD86 levels (P<0.05, P<0.01) and elevated CD206 and Arg-1 levels (P<0.01) in cells. ConclusionTSDN can alleviate GA by downregulating COX-2-mediated M1 macrophage reprogramming and suppressing the inflammatory factors.
2.Total Saponins of Dioscoreae Nipponicae Rhizoma Alleviates Gouty Arthritis by Down-regulating COX-2-mediated M1 Macrophage Reprogramming
Lin HUANG ; Shumin LIU ; Huijuan SUN ; Geyu DENG ; Donghua YU ; Yu WANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):200-207
ObjectiveTo explore the mechanism of total saponins of Dioscoreae Nipponicae Rhizoma (TSDN) in treating gouty arthritis (GA) by regulating cyclooxygenase-2 (COX-2)-mediated M1 macrophage reprogramming by in vivo and in vitro experiments. MethodsIn vivo experiment: 24 male SD rats were randomly allocated into blank, model (GA), TSDN, and celecoxib groups, with 6 rats in each group. After 7 days of administration, pathological changes in the ankle synovial tissue were observed via hematoxylin-eosin (HE) staining. Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) was used to quantify the mRNA levels of NOD-like receptor protein 3 (NLRP3) inflammasome, apoptosis-associated speck-like protein (ASC), Caspase-1, COX-2, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in the synovial tissue. Enzyme-linked immunosorbent assay (ELISA) was employed to measure the serum levels of inducible nitric oxide synthase (iNOS), IL-1β, CD86, CD80, CD206, and arginase-1 (Arg-1). In vitro experiment: The GA model was established by lipopolysaccharide (LPS) + MSU induction, and the inhibitor concentration was screened by the methyl thiazolyl tetrazolium (MTT) assay. RAW264.7 cells were allocated into blank, model, TSDN, dexamethasone, COX-2 inhibitor (celecoxib), and TSDN + COX-2 inhibitor groups. The levels of iNOS, IL-1β, CD86, CD80, CD206, and Arg-1 in the cell supernatant of each group were determined by enzyme-linked immunosorbent assay (ELISA). The mRNA and protein levels of NLRP3 inflammasome, COX-2, IL-1β, and TNF-α in each group were determined by Real-time PCR and Western blot, respectively. ResultsIn vivo experiment: compared with the model group, TSDN reduced the mRNA levels of NLRP3 inflammasome, COX-2, IL-1β, and TNF-α in the synovial tissue (P<0.05, P<0.01). ELISA results showed that TSDN lowered the serum levels of iNOS, IL-1β, CD86, and CD80 (P<0.01) while increasing the serum levels of CD206 and Arg-1 (P<0.01). In vitro experiment: compared with the model group, TSDN and inhibitor down-regulated the mRNA levels of NLRP3 inflammasome, COX-2, IL-1β, and TNF-α and the protein levels of NLRP3 inflammasome, COX-2, cleaved IL-1β, and TNF-α (P<0.01). Compared with TSDN alone, TSDN + COX-2 inhibitor further reduced the mRNA and protein levels of the markers above (P<0.01). Compared with the model group, TSDN and COX-2 inhibitor decreased the levels of IL-1β, iNOS, CD80, and CD86 (P<0.01) and increased the levels of CD206 and Arg-1 (P<0.01) in cells. Compared with TSDN alone, TSDN + COX-2 inhibitor reduced IL-1β, iNOS, CD80, and CD86 levels (P<0.05, P<0.01) and elevated CD206 and Arg-1 levels (P<0.01) in cells. ConclusionTSDN can alleviate GA by downregulating COX-2-mediated M1 macrophage reprogramming and suppressing the inflammatory factors.
3.Relationship between home reading-writing illuminance and screening myopia among children and adolescents
ZHANG Jingji, LUO Chunyan, YANG Huijuan, YANG Dongling, HUANG Shenglei, ZHENG Keyang, QU Shuangxiao
Chinese Journal of School Health 2025;46(8):1190-1193
Objective:
To understand the home reading-writing levels among children and adolescents in Shanghai after school, and to explore its association with screening myopia, so as to provide a scientific basis for the prevention and control of myopia.
Methods:
From April to December 2024, 641 primary and middle school students were recruited from 2 urban schools and 1 rural school in Shanghai to participate in the survey. An illuminance meter was used to measure the illuminance of home reading-writing activities after school. Screening myopia was determined through visual acuity examination and refractive detection under non ciliary muscle paralysis conditions among children and adolescents. A binary Logistic regression model was used to analyze the association between home reading-writing illuminance and screening myopia.
Results:
The detection rate of screening myopia among children and adolescents in Shanghai was 59.9%. The median home reading-writing illuminance after school was 340.9(112.2, 753.5) lx, and 45.4% was found of less than 300 lx. The family illuminance in the primary school stage [432.0 (136.9, 837.0) lx] was higher than that in the junior high school stage [113.1(53.7, 375.1) lx], and main urban area group [503.9 (212.6, 969.5) lx] was higher than that in the rural group [141.6 (53.7, 416.9) lx], the differences were statistically significant (Z=-7.56, -9.95,both P<0.05). The results of Logistic regression analysis showed that compared with the family illuminance of 150-500 lx, children and adolescents with family illuminance<150 and >500 lx had increased risks of screening myopia detection[OR(95%CI)=1.56(1.01-2.42), 1.74(1.15-2.62),both P<0.05].
Conclusions
The home reading-writing illuminance after school is suboptimal. Both excessively low and high home reading-writing illuminance levels are associated with screen-detected myopia. It is necessary for children and adolescents to improve lighting conditions during evening reading-writing activities, and strengthen health education according to different regions and school stages.
4.Wendan Decoction ameliorates metabolic phenotypes in rats with metabolic syndrome and phlegm syndrome by modulating the gut microbiota-bile acid axis.
Kaiyue HUANG ; Jingxin QI ; Wenqian LUO ; Yixuan LIN ; Meimei CHEN ; Huijuan GAN
Journal of Southern Medical University 2025;45(6):1174-1184
OBJECTIVES:
To investigate the therapeutic mechanism of Wendan Decoction for phlegm syndrome in rats with metabolic syndrome (MS).
METHODS:
Forty Wistar rats were randomly divided into normal control group (n=8) and 3 phlegm syndrome model groups (induced by high-fat, high-sugar, and high-salt feeding and a single-dose intraperitoneal STZ injection; n=24) treated with daily gavage of saline, Wendan Decoction (3.6 g/kg), or metformin (0.1 g/kg) for 4 weeks. General conditions and glucose and lipid metabolism parameters of the rats were monitored, and serum LPS, liver histopathology, hepatic expressions of FXR, CYP7A1 and FGFR4 and ileal expressions of FXR and FGF15 were examined. Gut microbiota structure was analyzed using 16S rDNA sequencing, and serum bile acids were quantified with UHPLC-MS/MS.
RESULTS:
The rat models of phlegm syndrome exhibited severe hepatic steatosis and necrosis, increased body weight, abdominal circumference, Lee's index, FBG, FINS, HOMA-IR, TG, TC, LDL and LPS, and decreased HDL level. The abundance of Bacteroidetes, Megamonas, and Bacteroides in gut microbiota increased while Firmicutes, Lachnospiraceae_NK4A136_group, isohyodeoxycholic acid, and glycohyodeoxycholic acid decreased significantly; hepatic FXR and FGFR4 expressions and ileal FXR and FGF15 expressions decreased while hepatic CYP7A1 expression increased significantly in the rat models. Treatment with Wendan Decoction effectively alleviated hepatic pathology, reduced body weight and abdominal circumference, improved glucose and lipid metabolic profiles and gut microbiota structure, and reversed the changes in hepatic and ileal protein expressions. Correlation analysis revealed that Firmicutes and Lachnospiraceae_NK4A136_group were positively correlated while Bacteroidetes, Megamonas and Bacteroides were negative correlated with the levels of isohyodeoxycholic acid and hyodeoxycholic acid.
CONCLUSIONS
Wendan Decoction can significantly improve metabolic profiles in rats with phlegm syndrome of MS possibly by regulating the intestinal flora-bile acid axis to modulate the intestinal flora structure and maintain bile acid homeostasis via the FXR signaling pathway.
Animals
;
Gastrointestinal Microbiome/drug effects*
;
Metabolic Syndrome/microbiology*
;
Bile Acids and Salts/metabolism*
;
Rats, Wistar
;
Drugs, Chinese Herbal/therapeutic use*
;
Rats
;
Male
;
Fibroblast Growth Factors/metabolism*
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Liver/metabolism*
;
Cholesterol 7-alpha-Hydroxylase/metabolism*
;
Receptors, Cytoplasmic and Nuclear/metabolism*
5.Exploring Central Regulatory Effect of Chaishao Liujuntang on Chronic Atrophic Gastritis Rats with Liver Depression and Spleen Deficiency Syndrome Based on Metabolomics
Yinjie HONG ; Wenling TU ; Jingru ZHU ; Wenqian LUO ; Kaiyue HUANG ; Huijuan GAN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(2):148-155
ObjectiveBased on ultra performance liquid chromatography-mass spectrometry(UPLC-MS) and non-targeted metabolomics technology to discuss the central regulatory effect of Chaishao Liujuntang on chronic atrophic gastritis(CAG) rats with liver-depression and spleen-deficiency, and to look for the correlation between cerebral cortex, hypothalamus and metabolic status of gastric tissues. MethodA CAG rat model with liver-depression and spleen-deficiency was established by chemical induction, hunger and satiety disorders, chronic restraint and tail clamping stimulation, lasting for 16 weeks. Twenty-eight Wistar rats were randomly divided into a blank group of 8 rats and a model group of 20 rats. After the completion of modeling, 4 rats in the model group were taken to observe the pathological changes of gastric mucosa. The remaining model rats were randomly divided into a model group of 8 rats and a Chaishao Liujuntang group of 8 rats. Chaishao Liujuntang group rats were given 5.1 g·kg-1 by gavage, and the remaining rats were given equal volume sterilized water by gavage for 4 weeks. Macroscopic characteristics, behavioral indicators and histopathological changes of the gastric mucosa of rats in each group were observed and compared. UPLC-MS non-targeted metabolomics was used to explore the metabolic regulation effect of Chaishao Liujuntang on the cerebral cortex, hypothalamus and stomach tissues of CAG rats with liver-depression and spleen-deficiency. Pearson correlation coefficient method was used to analyze the correlation between different tissue metabolites. ResultCompared with the model group, the macroscopic characteristics of rats in Chaishao Liujuntang group were improved, such as hair color, mental state and stool properties, and the number of times of crossing and standing in the open field experiment was significantly increased, and the static time of forced swimming was significantly reduced(P<0.01), and the gastric mucosa atrophy was reduced. The metabolic data from the cerebral cortex of rats in each group identified a total of 3 common potential biomarkers, but not enriched in pathways, 26 common potential biomarkers were identified in the hypothalamus, and the key metabolic pathways involved were mainly enriched in purine metabolism, glycerol phospholipid metabolism, D-glutamine and D-glutamic acid metabolism. Seventeen common potential biomarkers were identified in the stomach, and the key metabolic pathways involved were mainly enriched in thiamine metabolism, valine, leucine and isoleucine biosynthesis, and taurine and taurine metabolism. Correlation analysis of metabolites in different tissues revealed that multiple amino acids and their derivatives mediated metabolic connections between the cerebral cortex, hypothalamus and stomach of rats. ConclusionThe metabolic disorders in the cerebral cortex, hypothalamus and stomach of CAG rats with liver-depression and spleen-deficiency have their own characteristics, mainly manifested by changes in the content of glycerol phospholipids, fatty acids and bile acid metabolites. Moreover, Chaishao Liujuntang may play a central regulatory role in CAG rats with liver-depression and spleen-deficiency by correcting the metabolic disorders of amino acids.
6.The correlation between dietary nutrition and skeletal muscle mass in the elderly with advanced age
Xiaoxiao LIANG ; Shiyuan CAI ; Huijuan RUAN ; Jiaoyan HUANG ; Youyang HUANG ; Hanping SHI ; Dawei CHEN ; Xue LI
Shanghai Journal of Preventive Medicine 2024;36(6):589-595
ObjectiveThis research focused on examining the distinctive characteristics of nutrient intake and dietary patterns among long-lived elderly individuals. Additionally, the study was aimed to explore the specific dietary components that may impact the skeletal muscle mass in this particular group. MethodsThis study was conducted in the Chongming area of Shanghai, China. A total of 206 long-lived elderly individuals aged 90 or above were recruited. The 3-day 24-hour dietary recall method was used to collect dietary information and general demographic data through face-to-face interviews with professional nutritionists. The skeletal muscle mass index(SMI) was measured by bioelectrical impedance analysis(BIA), and low skeletal muscle mass was diagnosed based on the 2019 Asian Working Group for Sarcopenia criteria. T-test analysis, chi-square test, and logistic regression were used to analyze the relationship between dietary nutrient intake and skeletal muscle mass. ResultsIn terms of food intake categories, compared with the long-lived elderly people with normal muscle mass, the intake of cereals containing miscellaneous beans and vegetables in the long-lived elderly people with low muscle mass was significantly lower(P<0.05). In terms of the nutrient intake, compared with the long-lived elderly people with normal muscle mass, the intake of total energy, carbohydrate, dietary fiber, vitamin D, folic acid, phosphorus, potassium, magnesium, iron, and manganese in the long-lived elderly people with low muscle mass was significantly lower(P<0.05). After continuous adjustment for the covariates, multivariate logistic regression analysis found that the intake levels of folic acid and dietary fiber were important factors influencing skeletal muscle mass, Individuals with lower intake levels of folic acid and dietary fiber are at a higher risk of low muscle mass in long-lived elderly individuals [ORfolic acid T1, dietary fiber T1 (95%CI): 2.90 (1.11‒7.61); 4.09 (1.53‒10.91)]. ConclusionThe consumption of cereals that include a variety of beans and vegetables was noticeably lower in the long-lived elderly individuals with lower muscle mass when compared to those with normal muscle mass. Furthermore, low levels of folic acid and dietary fiber intake are associated with an increased risk of low skeletal muscle mass.
7.Contamination of Staphylococcus aureus in food sold in Jiading District, Shanghai from 2021 to 2023
Peichao CHEN ; Fangzhou CHENG ; Qiang HUANG ; Huijuan CHEN ; Pan SUN ; Yuting DONG ; Qian PENG
Shanghai Journal of Preventive Medicine 2024;36(7):644-649
ObjectiveTo investigate the contamination status of Staphylococcus aureus in food and the presence of enterotoxin genes in Jiading District, Shanghai, and to provide a basis for the prevention and treatment of foodborne Staphylococcus aureus disease. MethodsFrom 2021 to 2023, 15 types of food were sampled for S. aureus testing, and the presence of five enterotoxin genes, including sea⁃see, was tested in the strains. ResultsOut of 705 food samples, 88 (12.48%) were positive for S. aureus. S. aureus was detected in 12 of the 15 food types, with the three food types with the highest positive rates being cold noodles (45.00%), raw poultry (26.25%), and vegetable salads (20.00%). The enterotoxin gene carriage rate was 32.95% in food strains. The carriage rates for sea, seb, and sec were 7.95%, 12.50%, and 14.77%, respectively. Neither sed nor see was detected. The detection rate of strains carrying two types of enterotoxin genes was 2.27%. The enterotoxin carriage rates in strains from vegetables, beverages, and raw meat were 57.14%, 40.00%, and 30.00%, respectively. ConclusionThe S. aureus detection rate in food in Jiading District is much higher than the national average. The enterotoxin gene carriage rates are high, with food strains carrying sea, seb, and sec, with sec being the most prevalent. There is a need to enhance monitoring of S. aureus and enterotoxins, especially in high-risk foods such as noodles, vegetables, and non-packaged beverages.
8.Analysis of Staphylococcus aureus infection and enterotoxin gene carriage in diarrhoeal patients in Jiading District, Shanghai
Peichao CHEN ; Qiang HUANG ; Fangzhou CHENG ; Huijuan CHEN ; Zhiqi MA ; Pan SUN ; Qian PENG
Shanghai Journal of Preventive Medicine 2024;36(11):1039-1044
ObjectiveTo investigate the prevalence of Staphylococcus aureus in patients with diarrhea, and to analyze the genes carriage of enterotoxin in the strains of these patients in Jiading District, Shanghai. MethodsFrom 2021 to 2023, anal swabs of diarrhea outpatients from one sentinel hospital and nine community health service centers in different townships in Jiading District, Shanghai, were tested for Staphylococcus aureus, from which five enterotoxin virulence genes such as SEA, SEB, SEC, SED, and SEE were tested simultaneously. ResultsA total of 1 080 anal swabs were collected, 81 of which were tested positive for S. aureus, with a detection rate of 7.50%, and the detection rate of S. aureus was similar in patients with diarrhea from 2021‒2023. There was no statistically significant difference in detection rates between males and females (χ2=0.821, P=0.365). S. aureus detection rate was highest in infants and young children with diarrhea (29.51%), followed by 14.06% in the people aged between 4‒<31 years, and 2.99% in those aged ≥31 years. Significant differences were observed in the detection rate of S. aureus in the diarrhoeal patients from different townships of Jiading District(χ2=66.134,P<0.05). The carriage rates of the 5 enterotoxin genes, namely SEA, SEB, SEC, SED, SEE, were 13.58%, 14.81%, 11.11%, 7.41%, and 0, respectively. ConclusionThe prevalence of S. aureus among the patients with diarrhea in Jiading District is relatively stable but with distinct geographical patterns. Children and adolescents are high-risk groups. SEB were the dominant gene, followed by SEA.
9.Effect of Sanjie Quban recipe on keloid model of BALB/C nude mice and influence on transforming growth factor-β1
Chuhan HUANG ; Dingquan YANG ; Shiyi ZHONG ; Ruiying WU ; Zhishan YANG ; Huijuan FANG ; Qingwu LIU
Chinese Journal of Comparative Medicine 2024;34(3):51-56
Objective This study aimed to investigate the therapeutic efficacy of Sanjie Quban recipe in a keloid nude mice model and its impact on transforming growth factor-β 1(TGF-β1).Methods Keloid tissue after surgical resection was subcutaneously transplanted into the backs of healthy SPF BALB/C female nude mice,aged 6~8 weeks,and a keloid nude mice model was thus established.The mice were randomly divided into three groups,the Sanjie Quban recipe group,the Asiaticoside tablet group and the control gnup,with five in each group.They were respectively treated with Sanjie Quban recipe,Asiaticoside tablets,or sterile pure water.After 28 days of continuous gavage,the keloid tissue was exfoliated and weighed,and HE staining,Masson staining,and immunohistochemical staining for TGF-β1 were conducted.Differences in keloid weight between the three groups before and after treatment were compared,as were the differences in collagen fiber,fibroblast numbers,and TGF-β1 expression between the three groups after treatment.Results The difference in keloid weight before and after treatment in the Asiaticoside tablet group was greater than that of the control group,and the weight difference before and after treatment keloid treatment was the largest in the Sanjie Quban recipe group(P<0.01).Compared with the control group,collagen fibers in the Sanjie Quban recipe group were looser and less numerous,and fibroblasts were decreased in number.The expression of TGF-β1 in the Sanjie Quban recipe group was decreased compared with that of the control group(P<0.01).Conclusions Sanjie Quban recipe has certain therapeutic effects on keloids.The mechanism may involve reducing the expression of TGF-βl in keloid tissue and thereby reducing the proliferation of fibroblasts and the synthesis of extracellular matrix.This study provides experimental and theoretical bases for the clinical treatment of keloids with Chinese medicine.
10.Biomechanics during cutting movement in individuals after anterior cruciate ligament reconstruction
Shuang REN ; Huijuan SHI ; Zixuan LIANG ; Si ZHANG ; Xiaoqing HU ; Hongshi HUANG ; Yingfang AO
Journal of Peking University(Health Sciences) 2024;56(5):868-873
Objective:To evaluate knee biomechanics of patients about 12 months after anterior cruciate ligament(ACL)reconstruction during cutting and determine the abnormal biomechanical characteristics.Methods:Sixteen males about 12 months after ACL reconstruction were recruited for this study.Three-dimensional kinematic and kinetic data were collected during cutting movement.Knee joint angles and moments were calculated.Paired t-tests were used to compare the differences in knee biomechanics be-tween the surgical leg and nonsurgical leg.Results:The peak posterior ground reaction force(surgical leg:0.380±0.071;nonsurgical leg:0.427±0.069,P=0.003)and vertical ground reaction force(surgical leg:1.996±0.202,nonsurgical leg:2.110±0.182,P=0.001)were significantly smaller in the surgical leg than in the nonsurgical leg.When compared with the uninjured leg,the surgical leg demonstrated a smaller knee flexion angle(surgical leg:38.3°±7.4°;nonsurgical leg:42.8°±7.9°,P<0.001)and larger external rotation angle(surgical leg:10.3°±2.4°;nonsurgical leg:7.7°±2.1°,P=0.008).The surgical leg also demonstrated a smaller peak knee extension moment(surgical leg:0.092±0.031;nonsurgical leg:0.133±0.024,P<0.001)and peak knee external rotation moment(surgical leg:0.005±0.004;nonsurgical leg:0.008±0.004,P=0.015)when com-pared with the nonsurgical leg.Conclusion:The individuals with ACL reconstruction mainly showed asymmetrical movements in the sagittal and horizontal planes.The surgical leg demonstrated a smaller peak knee flexion angle,knee extension moment,and knee external rotation moment,with greater knee external rotation angle.


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