The triceps surae muscle-tendon unit(MTU)is the key for effective force generation,transmission,and energy storage and release in human movement,with great influences on sports efficiency,but its injury rate remains high.This review summarizes MTU function and its biomechanical adaptations during running,aiming to deepen the understanding of MTU's role in movement and explore how external factors influence its biomechanical properties,offering scientific insights for improving running performance and preventing injuries.During running,under forefoot striking and wearing shoes with greater stiffness,such as shoes with carbon plate,the energy contraction or return could be achieved through a more economical MTU behavior,namely reducing energy consumption by more economically muscle contraction and more energy storage of elastic elements,and the muscle contraction was exerted at a length closer to the optimal muscle fascicle length and reduced energy consumption caused by muscle contraction.However,adopting forefoot striking,barefoot running,or wearing minimalist shoes during running could increase the mechanical loads on the MTU.After gait retraining,the MTU could contract or return energy more efficiently during running,while the impact of other training methods on MTU was relatively poor,and the research in this area is still not sufficient.Therefore,future research should focus on optimizing the biomechanical properties of the MTU,MTU interaction and balanced development through changes in movement patterns,equipment,and training methods to enhance performance and reduce injuries.

Objective To compare the effect of immediately wearing different running shoes and foot-strike patterns on the in vivo Achilles tendon(AT)length and loading of habitual rearfoot striking(RFS)runners.Methods Eleven male running enthusiasts were recruited(age:33.7±8.7 years old,running experience:5.3±2.3 years).They were randomly assigned to wear cushioned running shoes or minimalist shoes,and run at 10 km/h on a Bertec 3-D force platform with forefoot striking(FFS)and RFS,respectively.The ultrasound imaging probe was fixed at the junction of the AT and the me-dial head of the gastrocnemius muscle with an elastic bandage,synchronized with the Vicon high-speed infrared motion capture system,which collected and calculated real-time length changes and loading characteristics of the AT in vivo.A 2×2 two-way ANOVA was used to determine the effect of different running shoes(cushioned running shoes vs.minimalist shoes)and foot strike patterns(FFS vs.RFS)on the in vivo AT loading characteristics during running,and the significance level α was set at 0.05.Results There was a significant interaction between footwear type and footstrike patterns on the foot strike angle.Within the same shoe condition(cushioned or minimalist),foot strike angle(FSA)was significantly greater during RFS than during FFS(P<0.05).Moreover,during RFS,FSA was significantly greater in cushioned shoes than in minimalist shoes(P<0.05).In addition,under acute manipulations of footwear and strike pattern,the instantaneous AT loading rate also exhibited a signifi-cant footwear and foot strike patterns interaction(P<0.05).The instantaneous AT loading rate was sig-nificantly greater when immediately wearing minimalist shoes with RFS than when wearing cushioned running shoes with RFS,as well as significantly greater when immediately wearing cushioned running shoes with FFS than when running with RFS(P<0.05).In addition,there was no interaction effect for the other parameters,except the significant group or time main effects(P<0.05).The peak AT force,average AT loading rate,AT impulse,peak AT stress,peak AT length change,and AT work during FFS were significantly greater than those during RFS(P<0.05).What's more,the peak AT force when immediately wearing minimalist shoes was significantly greater than that when wearing cushioned run-ning shoes(P<0.05).Conclusion It is suggested that immediately wearing minimalist shoes and/or transi-tioning to FFS could provide higher tendon loading intensity,which might improve the morphology and mechanical properties of the AT.However,the increased AT loading rate also indicated that if RFS was maintained while running in minimalist shoes,the reduced cushioning could have led to a greater risk of injury without an appropriate adaptation process.

Objective:To evaluate the efficacy of liposomal bupivacaine transversus abdominis plane block (TAPB) in combination with general anesthesia for elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods:In this randomized controlled trial, 70 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, aged 60-80 yr, with body mass index of 18-28 kg/m 2, scheduled for elective laparoscopic radical resection of colorectal cancer at the General Hospital of Ningxia Medical University from September 2023 to June 2024, were divided into 2 groups ( n=35 each) using a table of random numbers: liposomal bupivacaine group (LB group) and hydrochloride bupi-vacaine group (HB group). After anesthesia induction, bilateral TAPB was performed under ultrasound guidance. In LB group, 0.44% liposomal bupivacaine 30 ml was injected on each side. In HB group, 0.25% hydrochloride bupivacaine 30 ml was injected on each side. Total intravenous anesthesia was adopted for both groups. Patient-controlled intravenous analgesia (PCIA) with sufentanil was carried out after surgery. When the visual analogue scale (VAS) score at rest was ≥ 4 within 72 h after surgery, hydromorphone 0.5 mg was intravenously injected for rescue analgesia. The area under the curve of VAS scores at rest and during activity was calculated within 12-72 h after surgery. The first pressing time of patient-controlled analgesia (PCA) and the effective pressing numbers of PCA, requirement for rescue analgesia, and score for satisfaction with analgesia were recorded. The sleep quality on 1 day before surgery and 1, 2 and 3 days after surgery was evaluated using the Richards-Campbell Sleep Questionnaire. The occurrence of adverse reactions, duration of post-anesthesia care unit stay, time to first ambulation, time to first flatus, and time to first oral intake, and postoperative length of hospital stay were recorded within 72 h after surgery. Results:Compared with HB group, the area under the curve of VAS scores at rest and during activity was significantly reduced at 12-72 h after operation, the first pressing time of PCA was prolonged, and the effective pressing numbers of PCA was reduced, the rate of rescue analgesia was decreased, the score for satisfaction with analgesia was increased, the Richards-Campbell Sleep Questionnaire scores were increased on the 2nd and 3rd days after surgery, the duration of post-anesthesia care unit stay and postoperative length of hospital stay were shortened, and the incidence of postoperative nausea was decreased in LB group ( P<0.05). Conclusions:The efficacy of liposomal bupivacaine TAPB combined with general anesthesia is superior to that of hydrochloride bupivacaine TAPB combined with general anesthesia in elderly patients undergoing laparoscopic colorectal cancer radical resection.

OBJECTIVE To analyze the non-genetic risk factors for severe cutaneous adverse reactions （SCARs） related to antiepileptic drugs （AEDs） in HLA-B*15：02 negative patients， and provide a basis for clinical precision medication. METHODS A retrospective case-control design was used to include patients who underwent HLA-B*15：02 testing at our hospital from January 2022 to December 2024. Patients were divided into SCARs group （15 cases who were HLA-B*15：02 negative and diagnosed with SCARs） and control group （38 cases who were HLA-B*15：02 negative and used AEDs）. Risk factors were evaluated using univariate analysis and a multivariable Firth penalty likelihood logistic regression model （Firth regression）， and Benjamin-Hochberg false discovery rate （FDR） and Firth regression were used for correction， and sensitivity analysis was used to quantify the impact of potential biases in carbamazepine exposure rates in the control group on the results. RESULTS Univariate analysis showed that age≥50 years， use of carbamazepine， and combination use of antibiotics/antiviral drugs were risk factors for developing AEDs- related SCARs （OR＝18.15， 7.54， 13.46， 95%CI of 4.13-79.84， 1.89-30.08， 1.36-133.18， all P＜0.05）， while taking lamotrigine was a protective factor [OR＝0.10， 95%CI of 0.02-0.39， P＜0.05]. After FDR correction， the above factors still maintained statistical significance （P＜0.05）. The results of multivariate analysis showed that age≥50 years [adjusted OR＝16.27， 95%CI of 3.98-66.55， P＜0.001] and taking carbamazepine [adjusted OR＝7.11， 95%CI of 1.82-27.85， P＝0.005] were independent risk factors for the occurrence of SCARs-related AEDs. The results of sensitivity analysis showed that the adjusted risk OR range for taking carbamazepine was between 14.2 and 28.4. CONCLUSIONS Age≥50 years and use of carbamazepine are independent non- genetic risk factors for the development of SCARs-related AEDs in HLA-B*15：02 negative patients. It is recommended that elderly patients should prioritize the use of AEDs other than carbamazepine.

Objective:To evaluate the efficacy of liposomal bupivacaine transversus abdominis plane block (TAPB) in combination with general anesthesia for elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods:In this randomized controlled trial, 70 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, aged 60-80 yr, with body mass index of 18-28 kg/m 2, scheduled for elective laparoscopic radical resection of colorectal cancer at the General Hospital of Ningxia Medical University from September 2023 to June 2024, were divided into 2 groups ( n=35 each) using a table of random numbers: liposomal bupivacaine group (LB group) and hydrochloride bupi-vacaine group (HB group). After anesthesia induction, bilateral TAPB was performed under ultrasound guidance. In LB group, 0.44% liposomal bupivacaine 30 ml was injected on each side. In HB group, 0.25% hydrochloride bupivacaine 30 ml was injected on each side. Total intravenous anesthesia was adopted for both groups. Patient-controlled intravenous analgesia (PCIA) with sufentanil was carried out after surgery. When the visual analogue scale (VAS) score at rest was ≥ 4 within 72 h after surgery, hydromorphone 0.5 mg was intravenously injected for rescue analgesia. The area under the curve of VAS scores at rest and during activity was calculated within 12-72 h after surgery. The first pressing time of patient-controlled analgesia (PCA) and the effective pressing numbers of PCA, requirement for rescue analgesia, and score for satisfaction with analgesia were recorded. The sleep quality on 1 day before surgery and 1, 2 and 3 days after surgery was evaluated using the Richards-Campbell Sleep Questionnaire. The occurrence of adverse reactions, duration of post-anesthesia care unit stay, time to first ambulation, time to first flatus, and time to first oral intake, and postoperative length of hospital stay were recorded within 72 h after surgery. Results:Compared with HB group, the area under the curve of VAS scores at rest and during activity was significantly reduced at 12-72 h after operation, the first pressing time of PCA was prolonged, and the effective pressing numbers of PCA was reduced, the rate of rescue analgesia was decreased, the score for satisfaction with analgesia was increased, the Richards-Campbell Sleep Questionnaire scores were increased on the 2nd and 3rd days after surgery, the duration of post-anesthesia care unit stay and postoperative length of hospital stay were shortened, and the incidence of postoperative nausea was decreased in LB group ( P<0.05). Conclusions:The efficacy of liposomal bupivacaine TAPB combined with general anesthesia is superior to that of hydrochloride bupivacaine TAPB combined with general anesthesia in elderly patients undergoing laparoscopic colorectal cancer radical resection.

The triceps surae muscle-tendon unit(MTU)is the key for effective force generation,transmission,and energy storage and release in human movement,with great influences on sports efficiency,but its injury rate remains high.This review summarizes MTU function and its biomechanical adaptations during running,aiming to deepen the understanding of MTU's role in movement and explore how external factors influence its biomechanical properties,offering scientific insights for improving running performance and preventing injuries.During running,under forefoot striking and wearing shoes with greater stiffness,such as shoes with carbon plate,the energy contraction or return could be achieved through a more economical MTU behavior,namely reducing energy consumption by more economically muscle contraction and more energy storage of elastic elements,and the muscle contraction was exerted at a length closer to the optimal muscle fascicle length and reduced energy consumption caused by muscle contraction.However,adopting forefoot striking,barefoot running,or wearing minimalist shoes during running could increase the mechanical loads on the MTU.After gait retraining,the MTU could contract or return energy more efficiently during running,while the impact of other training methods on MTU was relatively poor,and the research in this area is still not sufficient.Therefore,future research should focus on optimizing the biomechanical properties of the MTU,MTU interaction and balanced development through changes in movement patterns,equipment,and training methods to enhance performance and reduce injuries.

Objective To compare the effect of immediately wearing different running shoes and foot-strike patterns on the in vivo Achilles tendon(AT)length and loading of habitual rearfoot striking(RFS)runners.Methods Eleven male running enthusiasts were recruited(age:33.7±8.7 years old,running experience:5.3±2.3 years).They were randomly assigned to wear cushioned running shoes or minimalist shoes,and run at 10 km/h on a Bertec 3-D force platform with forefoot striking(FFS)and RFS,respectively.The ultrasound imaging probe was fixed at the junction of the AT and the me-dial head of the gastrocnemius muscle with an elastic bandage,synchronized with the Vicon high-speed infrared motion capture system,which collected and calculated real-time length changes and loading characteristics of the AT in vivo.A 2×2 two-way ANOVA was used to determine the effect of different running shoes(cushioned running shoes vs.minimalist shoes)and foot strike patterns(FFS vs.RFS)on the in vivo AT loading characteristics during running,and the significance level α was set at 0.05.Results There was a significant interaction between footwear type and footstrike patterns on the foot strike angle.Within the same shoe condition(cushioned or minimalist),foot strike angle(FSA)was significantly greater during RFS than during FFS(P<0.05).Moreover,during RFS,FSA was significantly greater in cushioned shoes than in minimalist shoes(P<0.05).In addition,under acute manipulations of footwear and strike pattern,the instantaneous AT loading rate also exhibited a signifi-cant footwear and foot strike patterns interaction(P<0.05).The instantaneous AT loading rate was sig-nificantly greater when immediately wearing minimalist shoes with RFS than when wearing cushioned running shoes with RFS,as well as significantly greater when immediately wearing cushioned running shoes with FFS than when running with RFS(P<0.05).In addition,there was no interaction effect for the other parameters,except the significant group or time main effects(P<0.05).The peak AT force,average AT loading rate,AT impulse,peak AT stress,peak AT length change,and AT work during FFS were significantly greater than those during RFS(P<0.05).What's more,the peak AT force when immediately wearing minimalist shoes was significantly greater than that when wearing cushioned run-ning shoes(P<0.05).Conclusion It is suggested that immediately wearing minimalist shoes and/or transi-tioning to FFS could provide higher tendon loading intensity,which might improve the morphology and mechanical properties of the AT.However,the increased AT loading rate also indicated that if RFS was maintained while running in minimalist shoes,the reduced cushioning could have led to a greater risk of injury without an appropriate adaptation process.

Objective To investigate the effects of different foot strike patterns during running on Achilles tendon(AT)morphology and mechanical loading.Methods Fourteen habitual rearfoot strike runners and 14 habitual forefoot strike runners were recruited.Morphological characteristics(tendon length,cross-sectional area,and thickness)of the AT were collected using ultrasound imaging.The AT loading characteristics(plantar flexion moment,tendon force,load rate,impulse,and stress)of subjects wearing cushioned running shoes while running at a speed of 10 km/h were collected and calculated using a three-dimensional force measurement treadmill.Results Compared to habitual rearfoot strike runners,habitual forefoot strike runners showed a significant increase in peak plantar flexion moment of ankle joint,AT peak force,average loading rate,and peak loading rate(P<0.05).However,the differences in AT length,cross-sectional area,and thickness between the two groups were not statistically significant(P>0.05).Conclusions Long-term forefoot strike patterns can adaptively enhance the mechanical loading characteristics of the AT during repetitive stretch-shortening cycles.

The occurrence of perioperative adverse events (PAEs) significantly affects postoperative recovery of patients. In recent years, more and more studies have found that the start time of surgery is closely related to the occurrence of PAE, especially in terms of hospital stay and cost, intraoperative and postoperative complications, and postoperative mortality. This review aims to summarize the impact of different types of surgeries on PAE starting in the morning or afternoon, and to elucidate the possible mechanisms by which morning or afternoon surgeries affect PAE occurrence from the perspectives of circadian rhythms, human factors, and infrastructure, in order to provide reference for reducing patient PAE and accelerating patient recovery.

Objective:To investigate the effects of forced-air warming blankets combined with conventional warming strategies on the quality of postoperative recovery and cognitive recovery in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods:This was a prospective, randomized, controlled trial.A total of 70 patients aged 65-75 years, who were classified as American Society of Anesthesiologists(ASA)grade-Ⅱ or Ⅲ, undergoing the laparoscopic radical resection of colorectal cancer under general anesthesia, were enrolled.Patients were randomly divided into two groups: the forced-air warming group(group FAW, n=35)and the conventional warming group(group CW, n=35). The inadvertent perioperative hypothermia(IPH), postoperative shivering, postoperative agitation, anesthesia recovery time and other postoperative complications were compared between the two groups.The post-operative quality of recovery scale(PQRS)was used to evaluate the quality of postoperative recovery and the recovery of cognitive function before and 1, 3, and 7 days after operation.Results:As compared with the group CW, the group FAW showed that the incidences of IPH, postoperative shivering and agitation were decreased(5.7% vs.22.8%, 2.8% vs.28.6%, 5.7% vs.31.4%, χ2=4.200, 10.057 and 7.652, P=0.042, 0.003 and 0.006), and the satisfaction degree of patients was increased at 48 hours after operation( P<0.01). The postoperative wake-up time was prolonged in the group CW as compared with the group FAW( P<0.01). Compared with the group CW, the proportion of patients with excellent overall recovery quality was increased in the group FAW 1 day after surgery( P<0.05). There was no significant difference in general recovery quality and cognitive recovery between the two groups at 3 and 7 days after operation. Conclusions:For elderly patients undergoing laparoscopic radical resection of colorectal cancer, the forced-air warming blanket combined with conventional warming strategies is more helpful to decrease the incidence of IPH, reduce postoperative shivering and improve the overall recovery quality at 1 day after operation, but no significant effect on postoperative recovery of cognitive function is found.