Objective To explore the clinical effect of applying an improved"outside-in"technique in hip arthroscopic surgery.Methods Totally 136 patients undergoing hip arthroscopic surgery between June 2021 and July 2023 were selected and studied retrospectively.According to their different surgi-cal approach,they were divided into a modified approach group(n=75,including 30 males and 45 fe-males,with an average age of 36±14)and a classic approach group(n=61,including 33 males and 28 females,with an average age of 31±11).Before as well as 4 weeks,3 months and 6 months after the surgery,both groups were evaluated using the visual analog scale(VAS)and Harris hip score,and observed their surgical complications.Moreover,the surgical outcomes and time of sur-gical approach establishment were compared between the two groups.Results There was no significant difference between the two groups in general information,preoperative VAS and Harris scores.More-over,no significant difference was found between the two groups in the Harris score after surgery.Compared with the classic approach group,the improved group had significantly less surgical time(49.0±16.9 min vs.66.0±13.3 min,P<0.05),without using the C-arm fluoroscopy during surgery.Moreover,in the modified approach group,the time for establishing the mid-anteriorapproach was sig-nificantly shortened(10.4±5.9 min vs.25.9±15.1 min,P<0.05),along with the traction time during surgery(66.0±13.3 min vs.49.0±16.9 min,P<0.05).Conclusion The modified"outside-in"hip ar-throscopy technique is a safe and effective surgical method,easier to operate,with shorter surgical time.

Objective To evaluate the position of the talus on the axial images of magnetic resonance imaging(MRI)of the ankle joint in patients with chronic ankle instability(CAI)and to identify the indirect signs for diagnosing CAI.Methods Fifty patients hospitalized in our hospital between January 1,2021 and July 1,2023 for chronic ankle instability(CAI)were selected into the experimental group,while 50 counterparts treated in our hospital for other diseases were chosen into the control group.The basic information of both groups was recorded.The internal measurement tools of the Picture Ar-chiving and Communication System(PACS)were used to measure the malleolar talus index(MTI)and two new measurement methods:talus movement index(TMI)and talus comprehensive index(TCI)on the axial images of ankle MRI to evaluate the position of the talus in the ankle mortise.Sta-tistical analysis was then performed.Results There was no significant difference between the two groups in terms of age,sex ratio,affected side ratio,height,weight and body mass index(BMI)(P>0.05).Compared with the control group,the MTI(86.56°±3.54° vs.85.28°±2.77°,P<0.05),TMI(2.00°±2.36° vs.-2.00°±2.54°,P<0.001)and TCI(4.70°±2.98° vs.1.90°±2.01°,P<0.001)of the experi-mental group increased.The area under the ROC curve of TMI and TCI was 0.841 and 0.794,respec-tively.The optimal cut-off points for diagnosing CAI based on TMI and TCI were 0.5° and 4.5°,re-spectively.Conclusion Patients with CAI show changes in the bony structure of the ankle joint.Specifi-cally,on the axial MRI images of the ankle joint,there are simultaneous posterior displacement and internal rotation of the talus,which may be an indirect sign for the diagnosis of CAI.

Objective To explore the effect of exercise under cold exposure on hepatic protein ki-nase B(AKT)/forkhead box O1(FoxO1)expression in obese rats.Methods Among rats successfully induced nutritional obesity by high-fat diet,forty were selected and randomly divided into a normal-temperature control group(NC,n=10),a normal-temperature exercise group(NE,n=10),a sus-tained-cold control group(SC,n=10),and a sustained-cold exercise group(SE,n=10).The normal temperature was kept at 25°C±1°C,while the low temperature remained at 4°C±1°C,with 50%to 60%relative humidity.The exercise protocol was every other day at a speed of 25 m/min for 2 sets of 30 min each,with an interval of 10 minutes.After 5 weeks,glucose and insulin tolerance were tested by oral glucose tolerance test(OGTT)and insulin tolerance test insulin tolerance test(ITT).Then,all rats were weighed and sacrificed,then taken blood from the abdominal aorta to sepa-rate serum,followed by detection of serum alanine aminotransferase(ALT)and aspartate aminotransfer-ase(AST)levels using fully automatic biochemical analyzer.Moreover,livers were weighed to calcu-late the liver index.Meanwhile,the mRNA expressions of hepatic AKT,FoxO1 and PEPCK were de-tected using RT-qPCR,while the protein expressions of AKT,phosphorylated protein kinase B(p-AKT),and FoxO1 in the liver were measured using Western blotting.Results(1)The average body weights of the NE,SC and SE groups were significantly lower than the NC group(P<0.01),with that of the SC and SE groups significantly lower than the NE group(P<0.01).(2)Compared with the NC group,the area under the OGTT curve of the SC group decreased(P<0.01).Moreover,the area under the ITT curve of the SE group was significantly lower than the other 3 groups(P<0.01,P<0.01,P<0.05),with that of the NE and SC groups significantly lower than the NC group(P<0.05,P<0.01).(3)The liver indices of the NE,SC and SE groups were all significantly lower than the NC group(P<0.01),while the serum ALT level of the NE group was significantly lower than the NC and SE groups(P<0.05),with that of the SC group significantly lower than the NC group(P<0.01).(4)Compared with the NC group,hepatic AKT mRNA expression increased significantly in the SE group(P<0.05),while the hepatic FoxO1 and PEPCK mRNA expression decreased significantly in the other three groups(P<0.01).(5)Compared with the NC group,the liver AKT protein phosphorylation levels were significantly higher in the other three groups(P<0.05,P<0.05,P<0.01),while the FoxO1 protein expression decreased significantly(P<0.05,P<0.01,P<0.01).(6)Body mass,liver FoxO1,PEPCK mRNA expression,AKT protein phosphorylation level and FoxO1 protein expression level of obese rats were affected by cold exposure,exercise and cold exposure+exercise,and the liver index and serum ALT level were done by exercise and cold exposure+exercise.However,the area un-der the ITT curve and liver AKT mRNA content were impacted by cold exposure and exercise,while that under the OGTT curve was influenced by cold exposure and cold exposure+exercise.Conclu-sion Exercise under cold exposure can activate hepatic AKT/FoxO1 signaling pathway,protect liver function,increase insulin sensitivity,and effectively improve glucose metabolism in obese rats.

Objective To explore the effect of progressive intensity muscle training on joint function and inflammatory response after arthroscopic rotator cuff tear surgery.Methods Totally 226 patients with rotator cuff tear injuries and admitted to Shaoxing Traditional Chinese Medicine Hospital between April 2020 and April 2022 were selected,and randomly divided into a study group and a control group,each of 113,using a double-blind random number table.After the arthroscopic surgery,the study group received progressive intensity muscle strength training,while the control group was given routine functional training and rehabilitation.Before and 8 weeks after surgery,both groups were evaluated us-ing the Constant Murley shoulder joint function(CMSJF),Unilaterally Controlled Latin Assets(UCLA),and Fugl Meyer scale(FMA).Moreover,their Activities of Daily Living(ADL)score,se-rum inflammatory factors,and upper limb function score were compared.Results Before surgery,there was no significant difference between the two groups in the average CMSJF score,UCLA score,EMA score,ADL score and the range of motion(ROM)(P>0.05).However,8 weeks after the surgery,all the above values improve significantly,with significantly greater improvement in the study group than the control group(P<0.05).Moreover,before the surgery,there was no significant difference be-tween the two groups in the serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleu-kin-10(IL-10)and transformative growth factor-β(TGF-β)(P>0.05).However,8 weeks after the surgery,a significant increase was observed in the average IL-10 and TGF-β,with a significant de-crease in the average TNF-α and IL-6(P<0.05 for both).Conclusion After arthroscopic surgery for ro-tator cuff tear,progressive muscle strength training has a significant clinical effect on relieving pain,promoting muscle function and strength,and improving the function of the affected limb.

Objective To examine and compare the effect of personalized progressive aerobic-exercise and resistance-training prescriptions on anxiety of undergraduates.Methods This was a randomized controlled trial.Sixty-six undergraduates with anxiety were recruited and randomized into an aerobic ex-ercise(AE)group,a resistance exercise(RE)group and a control group,each of 22.The aerobic and resistance exercise groups underwent 12-week aerobic and resistance exercise respectively,while the control group only received health education.Before as well as after 4-,8-and 12-week interven-tion,and 4 weeks after the intervention,all groups were evaluated using Self-Rating Anxiety Scale(SAS)and Chinese College Students Mental Health Scale--Anxiety Subscale(CCSMHS-AS).More-over,before and 16 weeks after the intervention,all groups were assessed physical activity(PA)us-ing the International Physical Activity Questionnaire-Short Form(IPAQ-SF).Results The average SAS scores of the AE and RE groups decreased significantly from 6.95±6.32 and 56.41±5.45 before the intervention to 38.29±5.82 and 41.18±7.51 after 12-week exercise,while the average CC-SMHS-AS score decreased significantly from 20.00±5.66 and 19.41±3.70,to 13.18±4.81 and 14.32±4.16 during the same period of time(P<0.01 for all).Four weeks after the intervention,the SAS score of the AE group was significantly higher than 4 weeks earlier(49.18±11.84 vs.38.29±5.82,P<0.01),while that of the RE group increased without significant differences compared with 4 weeks earlier(42.50±9.57 vs.41.18±7.51,P>0.05),with the value of both groups significantly lower than right after the intervention(P<0.01,P<0.05).In the control group,the SAS score de-creased significantly from 55.73±5.27 before the intervention to 47.09±5.55 right after the interven-tion,and further to 46.95±9.70 4 weeks later(P<0.05),but no significant differences were ob-served in the CCSMHS-AS score(P>0.05).Meanwhile,right after the intervention,the average SAS scores of the AE and RE groups were significantly lower than the control group(P<0.01,P<0.05),without significant differences among the three groups 4 weeks after the intervention(P>0.05).The CC-SMHS-AS scores of AE group right after and 4 weeks after the intervention were significantly higher than the control group(P<0.01),but no significant differences were found in it between either the AE and RE group,or the RE and control group(P>0.05).Besides,the PA levels of the AE and RE groups 4 weeks after the intervention were significantly higher than before the intervention,while no significant changes were observed in the PA level of the control group(P>0.05).Conclusion Twelve-week personalized progressive aerobic-exercise and resistance-training prescriptions both result in a similar effect on relieving anxiety and improving spontaneous PA of college students.However,the prognosis of aerobic exercise is poorer than the other.

Objective To explore the effect of maternal exercise on blood pressure,cardiac pheno-type and susceptibility to myocardial is chemia/reperfusion(MI/R)injury in adult male offsprings of mice.Methods Pregnant mice were randomly divided into a sedentary group(p-Ctr)and an exercise group(p-EX),each of 12.The exercise group underwent daily 60-minutenon-weight bearing swim-ming from gestational day(GD)1 to 18,6 days a week.Then,their male offsprings at 3 months of age(3M)were selected as the research subjects,namely the Ctr-3M group and the EX-3M group,with 12 mice in each group.The MI/R model was established by ligation of the anterior descending branch of the left coronary artery(LAD)surgery(30 min of ischemia,24 h of reperfusion).Then,the systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)were monitored non-invasively via tail artery blood pressure measurement,while the cardiac function was detected by using the small animal ultrasound.Moreover,the cardiac morphology and col-lagen volume fraction(CVF)of myocardium was observed by HE staining and Masson staining,respec-tively.Meanwhile,the cross-sectional area(CSA)of myocardial cells and myocardial infarction area(INF/AAR)was measured using WGA staining and Evans Blue-TTC double staining,accordingly.What's more,the apoptosis index(AI)of myocardial cells and serum cardiac troponin I(cTnI)were de-tected by using TUNEL staining and ELISA,respectively,while the expression levels of Bax and Bcl-2 proteins were determined by using Western blotting.Results 1)From GD11 to GD19,the body weight of females in the p-EX group was always significantly lower than that in the p-Ctr group(GD11,GD13;P<0.05;GD12,GD14～GD19;P<0.01),but there was no significant difference in the litter size and abortion rate(P>0.05).2)There were no significant differences between the EX-3M and Ctr-3M groups in the heart weight(HW),body weight(BW)and heart weight to body weight ratio(HW/BW),SBP,DBP,MAP,myocardial CVF,and CSA of male offsprings(P>0.05).After MI/R surgery,in both p-Ctr and p-EX groups,myocardial transverse striations disappeared and cardiomyocytes were disarranged with degeneration and necrosis.Moreover,CVF of the EX-3M group was significantly lower than the Ctr-3M group after MI/R surgery(P<0.05).3)No significant differenc-es were found between the Ctr-3M and EX-3M groups in the average cardiac ejection fraction(EF),fractional shortening(FS),left ventricle internal diameter in diastole(LVIDd),and left ventricle inter-nal diameter in systole(LVIDs)(P>0.05).However,after the MI/R surgery,the postoperative EF and FS(P<0.01),and LVIDs(P<0.05)in the EX-3M group were significantly higher than the Ctr-3M group,without significant difference in LVIDd(P>0.05).4)After MI/R surgery,the average AI,INF/AAR and serum cTnI level of the EX-3M group were significantly lower than the Ctr-3M group(P<0.01 for all).5)The relative expression level of myocardial Bcl-2 protein after MI/R surgery in the EX-3M group was significantly higher than the Ctr-3M group(P<0.05),while that of myocardial Bax protein(P<0.05)and the Bax/Bcl-2 ratio(P<0.01)were significantly lower than the latter.Conclu-sions Prenatal exercise significantly reduces the susceptibility to myocardial ischemia injury in 3-month-old male mice offspring,improves the contractile function of their heart,and attenuates the degree of cardiomyocyte apoptosis and necrosis,exerting a cardioprotective effect in MI/R injury.

Objective To establish a finite element model of thoracolumbar kyphosis(TLK)for young patients with idiopathic Scheuermann's disease(SD),validate its effectiveness,and perform fi-nite element analysis to identify biomechanical factors contributing to low back pain caused by SD.Methods One TLK patient(26 years old)and one healthy(30 years old)subject were recruited.Spi-nal DICOM data were reconstructed three-dimensionally using Mimics software.Surface repair and fit-ting were performed in Geomagic Studio 2017,followed by modeling of intervertebral discs and end-plates in 3-matic software.Volume meshing and ligament construction were completed in Hypermesh 2017.Static simulations of the T8-S1 spinal segments for both groups were conducted in ANSYS.Af-ter validating the model using mechanical data,stress and strain distributions across vertebral bodies,intervertebral discs,and facet joint cartilage were calculated under identical constraints and loads.Re-sults 1)Significant differences were observed between the TLK patient and healthy subject in the me-chanical distribution of the T8-S1 segments of the spine.The healthy spine exhibited a peak strain of 1.62 mm,while the TLK patient showed a peak strain of 6.97 mm,330.2%higher than the former.Moreover,the peak stress in the TLK patient(10.51 MPa)exceeded the healthy subject(9.07 MPa)by 16.0%.2)Both groups demonstrated peak vertebral stress at the L5 level(9.07 MPa in the healthy individual vs.10.51 MPa in the TLK patient,15.8%higher).Stress distribution in the TLK patient was markedly uneven,with significant concentrations at the pedicles and laminae of L2,L3,and L4 vertebrae.3)Peak disc stress in the TLK patient was consistently higher,most notably at the L5/S1 segment(0.78 MPa in the TLK patient vs.0.16 MPa in the healthy subject,387.5%higher).4)Facet joint cartilage stress distribution in the TLK patient was abnormal.The healthy subject exhib-ited peak stress at L5/S1(1.53 MPa),whereas TLK patient showed peak stress at L1/L2(7.44 MPa),14.18 times higher than the former.Conclusion This study validates the finite element model of TLK deformity,confirming its utility for TLK-related research.Moreover,significant differences in stress-strain distribution and magnitude are observed between the TLK patient and healthy subject.Meanwhile,prolonged abnormal biomechanical loading,particularly localized stress concentrations in the L1-S1 vertebral bodies,discs,and facet joints,may accelerate degenerative changes and elevate the risk of low back pain.

Objective To explore the intervention effect of tight-fitting equipment on delayed onset muscle soreness(DOMS)after exercise using nuclear magnetic resonance diffusion tensor imaging com-bined with physiological and biochemical indices.Methods Seven healthy adult males participated in a randomized crossover study,and each subject underwent two experiments,with an interval of 7 days,as an elution period to eliminate the effect of the previous experiment.In both experiments,all sub-jects were induced DOMS by finishing 80 times of deep jumps,in 4 groups.In the first experiment,all subjects(the Con group)wore loose clothes during and in 24 hours after the jumping,while in the second one they(the compression sleeve group,Cs)were in full-leg tight leggings.Before,as well as 0 h,24 h and 48 h after the exercise,the muscle soreness,the peak isokinetic torque of the knee extensor muscle group,and the activities of creatine kinase(CK)and lactate dehydrogenase(LDH)were measured.Moreover,before and 24 h after exercise,MRI was performed to measure bi-lateral thigh fractional anisotropy(FA),mean diffusivity(MD),radial diffusivity(RD)and their ei-genvalues(λ1,λ2,λ3).Results The time and group interaction effect for muscle soreness was signifi-cant after exercise(P<0.01),with that of the Cs group significantly lower than the Con group at all three time points after exercise(P<0.01).However,no significant time or group interaction effects were found in the peak isokinetic torque(P>0.05).Moreover,the time and group interaction was sig-nificant in the serum enzyme activity(P<0.05),with CK activity of the Cs group significantly lower than the Con group at 24 h and 48 h after exercise(P<0.05)and LDH activity significantly lower than the latter at 0 h and 24 h after exercise(P<0.05).Meanwhile,MRI showed that the λ2(P<0.05),λ3(P<0.05),and RD(P<0.01)values of quadriceps femoris in the Cs group were significant-ly lower than the Con group at 24 h post-exercise,while the FA values were significantly higher than the latter at the same time point(P<0.05).Conclusion Wearing tight-fitting gear during exercise and within 24 hours after exercise can suppress the elevation of serum CK and LDH activities,and relieve DOMS.Moreover,magnetic resonance diffusion tensor imaging results suggest that it may be realized by limiting the development of localized edema through sustained pressure on the body.

Objective To establish the regression equation for the maximum oxygen uptake(VO2max)of male young endurance athletes at altitudeby modeling relevant indicators.Methods A total of 81 young male endurance athletes(long-distance runner,marathoner,and race walker)aged 15～18 years old were selected as the research subjects.The VO2max,3000-meter timed run,400-meter timed run,body morphology,body composition,hematological indicators,and cardiac function of the ath-letes were tested in Kunming,Yunnan Province(1890 meters altitude high)in four consecutive days.The testing sequence of the exercise was randomly arranged.The data of the first 65 athletes were used for multiple linear regression modeling,while those of the rest 16 were employed for the verifica-tion of the established model.Results Based on the data of 65 athletes,the multiple linear regression equation of VO2max was:VO2max=2616.661+60.389×lean body mass(kg)-3.108×3000-meter run-ning time(s)-16.665×lower limb length A(cm)+6.356×maximum heart rate(bpm),R2=0.858,and that of the relative VO2max was:relative VO2max=119.685-0.058×3000-meter running time(s)-0.224×body weight(kg)-0.452×Achilles tendon length(cm),R2=0.681.Accord-ing to the data of the rest 16 athletes,there was no significant difference in the calculated values of VO2max and relative VO2max.Moreover,the calculated values and the direct test values of VO2max and rel-ative VO2max were positively correlated(r=0.735,P=0.001;r=0.509,P=0.044).Conclusion A regression model of VO2max and relative VO2max for young male endurance athletes at altitude(1890 meters altitude high)was established and verified through direct testing.The model established is worth popularization and application,and can provide references for indicators selection of young male endurance athletes at altitude(1890 meters altitude high).

Objective To analyze the technical movement characteristics of female table tennis play-ers with shoulder impingement syndrome when hitting a forehand topspin loop ball,in order to explore the reasons for shoulder impingement syndrome.Methods Thirteen female table tennis athletes with shoulder impingement syndrome were recruited for the shoulder impingement group(age 20.31±2.56 years,height 165.69±4.00 cm,weight 56.62±6.00 kg)and 13 healthy female table tennis athletes(age 21.54±2.78 years,height 165.54±4.45 cm,weight 60.08±8.02 kg)were selected for the healthy group.Kinematic and electromyographic data of the upper limbs were collected during six tri-als of forehand topspin strokes using a three-dimensional motion capture system and a wireless surface electromyographic system.The data were then averaged and compared between the groups.Results The shoulder impingement group had a greater shoulder flexion angular velocity at the end of the forward swing compared to the healthy group(t=-3.689,P=0.001).In addition,the shoulder impingement group showed significantly smaller trunk torsion angular amplitude(t=2.614,P=0.015)and average an-gular velocity of trunk torsion(t=3.958,P=0.001).Furthermore,the peak activation level of the anteri-or serratus muscle was smaller in the shoulder impingement group compared to the healthy group(t=2.363,P=0.027).Finally,the deactivation duration of both the triceps brachii and brachioradialis mus-cles was shorter in the shoulder impingement group compared to the latter(t=3.705,P=0.002;t=3.29,P=0.004).Conclusion Female table tennis players with shoulder impingement syndrome exhibit the fol-lowing characteristics in their forehand topspin:1)insufficient trunk rotation and premature deactiva-tion of the brachioradialis muscle,which lead to excessive loading on the shoulder during flexion;2)inadequate activation of the serratus anterior muscle,resulting in compromised scapular stability;3)premature deactivation of the triceps brachii muscle,which negatively affects the control of eccentric contraction velocity at the shoulder joint.