OBJECTIVE:Exercise intervention is considered the cornerstone of rehabilitation after anterior cruciate ligament reconstruction.However,no clear conclusion has been reached regarding which exercise therapy is more effective in improving knee muscle strength and function in patients after anterior cruciate ligament reconstruction.To this end,this study used a network meta-analysis method to compare the efficacy of exercise therapy after anterior cruciate ligament reconstruction,providing evidence-based medical basis for selecting the best exercise therapy. METHODS:A computer search was conducted in PubMed,Web of Science,Embase,The Cochrane Library,and EBSCO to collect randomized controlled trials addressing exercise therapy following anterior cruciate ligament reconstruction.The search time limit was from the establishment of the database to 2023-11-20.Outcome indicators included three continuous variables:quadriceps muscle strength,hamstring muscle strength,and knee joint function score.EndNote X9.1 was used for literature screening.The Cochrane risk of bias assessment tool was used to evaluate the quality of the included literature.The GRADE score was used to rate the strength of evidence for the results of the article.Network meta-analysis was performed using Stata 16.0. RESULTS:A total of 36 randomized controlled trials were included,involving 1 179 patients undergoing anterior cruciate ligament reconstruction.The overall quality of the included literature was moderate.Nine types of exercise therapies were involved:isokinetic training,cross training,eccentric training,aquatic rehabilitation,blood flow restriction training,motor control training,plyometric training,whole-body vibration training,and multimodal training;the control measure was conventional rehabilitation training.The results of the network meta-analysis showed that compared with conventional rehabilitation training,eccentric training[standardized mean difference(SMD)=2.08,95%confidence interval(CI):0.56 to 3.60,P=0.007)had the best improvement effect on quadriceps muscle strength in patients undergoing anterior cruciate ligament reconstruction,followed by multimodal training(SMD=1.69,95%CI:0.11 to 3.27,P=0.249)and whole body vibration training(SMD=0.81,95%CI:0.11 to 1.51,P=0.042).In terms of improving patients'hamstring muscle strength,multimodal training(SMD=2.08,95%CI:0.30 to 3.86,P=0.022)had the best effect,followed by plyometric training(SMD=1.51,95%CI:0.18 to 2.84,P=0.026)and isokinetic training(SMD=1.37,95%CI:0.06 to 2.67,P=0.039).Multimodal training(SMD=4.60,95%CI:2.40 to 6.80,P<0.001)was the most effective in improving knee joint function scores,followed by eccentric training(SMD=1.75,95%CI:0.24 to 3.25,P=0.023)and aquatic rehabilitation(SMD=1.65,95%CI:0.07 to 3.24,P=0.041). CONCLUSION:Evidence of low to moderate strength suggests that multimodal training may be the most effective exercise therapy in improving knee muscle strength and function in patients after anterior cruciate ligament reconstruction,followed by eccentric training,plyometric training,isokinetic training,whole body vibration training,and aquatic rehabilitation.More high-quality clinical randomized controlled trials are still needed in the future to verify the reliability of the conclusions.

BACKGROUND:A large number of studies have investigated the effects of whole body vibration training at different frequencies on muscle strength,but less is reported on the differences in the efficacy of vibration training at different frequencies on patellar tendinopathy. OBJECTIVE:To explore the effect of eccentric training of quadriceps combined with different frequency of whole body vibration training on patellar tendinopathy. METHODS:From April to June 2022,48 patients with patellar tendinopathy were recruited from Wuhan Sports University and randomly divided into eccentric training group(n=12),30 Hz group(n=12),40 Hz group(n=12),and 50 Hz group(n=12).The eccentric training group only completed eccentric training of the quadriceps.The 30 Hz,40 Hz and 50 Hz groups performed the whole body vibration training with the amplitude of 2 mm and frequencies of 30 Hz,40 Hz and 50 Hz respectively on the basis of the eccentric training of the quadriceps.The intervention lasted for 8 weeks,three times a week.Before and after the intervention,the patients'surface electromyography signals of the quadriceps,kinematics and dynamics data of knee joint at the time of landing in deep jump and the time of peak vertical ground reaction,Visual Analogue Scale score,Victorian Institute of Sports Assessment-Patellar score were evaluated. RESULTS AND CONCLUSION:After 8 weeks of intervention,compared with the eccentric training group,the median frequency of the lateral and medial femoris muscles were significantly higher in the 40 Hz and 50 Hz groups(P＜0.05).At the time of landing,the knee joint flexion angle and external rotation moment in the 40 Hz and 50 Hz groups were significantly lower than those in the eccentric training group(P＜0.05),while the knee joint flexion angle in the 50 Hz group was significantly lower than that in the 30 Hz group(P＜0.05).At the peak moment of vertical ground reaction,the knee extension torque in the 40 Hz group was significantly lower than that in the eccectric training group(P＜0.05);the knee flexion angle and knee extension torque in the 50 Hz group were significantly lower than those in the eccentric training group(P＜0.05).The Visual Analogue Scale scores in the 50 Hz and 40 Hz groups were significantly lower than those in the eccentric training group(P＜0.05).The Victorian Institute of Sports Assessment-Patellar score in the 50 Hz group was significantly higher than that in the eccentric training group and 30 Hz group(P＜0.05).To conclude,eccentric training of the quadriceps combined with 50 Hz whole body vibration training can significantly improve quadriceps'strength,endurance and activation rate of the vastus lateralis muscle,reduce the pain of knee joint,and improve the function of the knee joint in patients with patellar tendinopathy.

OBJECTIVE:Some studies have shown that kinesio taping has positive effects in elevating muscle strength,improving joint stability and reducing pain and oedema in patients after anterior cruciate ligament reconstruction.However,existing studies have divergent results on the clinical efficacy of kinesio taping.In this study,a meta-analysis was conducted to systematically evaluate the effect of kinesio taping in postoperative rehabilitation period following anterior cruciate ligament reconstruction. METHODS:Randomized controlled trials about the effects of kinesio taping on anterior cruciate ligament reconstruction were electronically searched in PubMed,Web of Science,Embase,The Cochrane Library,EBSCO,CNKI,WanFang,and VIP databases,from database inception to December 06,2022.The outcome measures included six continuous variables:quadriceps strength,hamstring strength,knee swelling,knee range of motion,Lysholm knee function score,and Visual Analogue Scale score.EndNote X9.1 was used to screen the literature.The Cochrane Risk Bias Assessment Tool and Jadad Scale were used to evaluate the quality of the included literature.RevMan 5.3 software was used for Meta-analysis. RESULTS:A total of 6 randomized controlled trials involving 252 patients undergoing anterior cruciate ligament reconstruction were finally included.There were 126 cases in control group and 126 in kinesio taping group.The results of Meta-analysis showed that compared with the control group,kinesio taping significantly improved hamstring strength[standardized mean difference(SMD)=0.68,95%confidence interval(CI):0.12 to 1.23,P=0.02)and reduced Visual Analogue Scale score[mean difference(MD)=-0.56,95%CI:-1.04 to-0.08,P=0.02).However,for quadriceps strength,knee swelling,knee range of motion,and Lysholm knee function score,kinesio taping did not show significant difference from the control group(P＞0.05). CONCLUSION:Kinesio taping may help to improve hamstring strength and reduce pain in patients after anterior cruciate ligament reconstruction.However,it cannot significantly improve quadriceps strength,knee swelling,knee range of motion,and functional scores.

Objective:To investigate the prevalence of adult skeletal fluorosis caused by drinking tea-type endemic fluorosis in Yushu Tibetan Autonomous Prefecture (hereinafter referred to as Yushu Prefecture), Qinghai Province, and provide scientific basis for prevention and control of the disease.Methods:In August 2021, one village was selected as a survey site in six counties (cities) in Yushu Prefecture, including Nangqian, Chindu, Yushu, Zadoi, Qumarlêb, and Zhiduo. Drinking water samples and 10 brick tea samples were collected from each village to determine the fluoride content in water and brick tea; at least 100 permanent residents aged ≥ 25, who had a habit of drinking brick tea and had lived in the local area for more than 5 years, were selected for X-ray imaging to examine the prevalence of adult skeletal fluorosis.Results:A total of 75 samples of residential drinking water were collected, with a fluoride content of (0.21 ± 0.05) mg/L, ranging from 0.11 to 0.34 mg/L; 60 samples of brick tea, with a fluoride content of (626.70 ± 157.27) mg/kg, ranging from 324.00 to 2 102.00 mg/kg. A total of 1 136 adults were examined, and 318 cases of skeletal fluorosis were diagnosed, with a detection rate of 27.99%. Among them, the detection rates of mild, moderate, and severe skeletal fluorosis were 20.95% (238/1 136), 6.07% (69/1 136), and 0.97% (11/1 136), respectively, with mild symptoms being the main. The detection rates of skeletal fluorosis in males and females were 29.09% (121/416) and 27.36% (197/720), respectively, with no statistically significant difference between the gender (χ 2 = 0.39, P = 0.533). Comparison of the skeletal fluorosis in different gender, the differences were statistically significant (χ 2 = 22.31, P < 0.001). The detection rates of skeletal fluorosis in the age groups of 25 - 35, 36 - 45, 46 - 55, 56 - 65, 66 - 75, and ≥76 years old were 6.86% (7/102), 22.37% (51/228), 24.02% (92/383), 37.44% (73/195), 43.48% (70/161), and 37.31% (25/67), respectively. The differences between the groups were statistically significant (χ 2 = 59.84, P < 0.001). Moreover, there was a statistically significant difference in the composition of skeletal fluorosis among different age groups ( H = 37.66, P < 0.001). The Spearman correlation analysis results showed that the severity of adult skeletal fluorosis was positively correlated with age ( r = 0.34, P < 0.001). Conclusions:There is a certain degree of prevalence of adult skeletal fluorosis in Yushu Prefecture. And as age increases, the condition of skeletal fluorosis becomes more severe.

Objective To investigate the impact of ropivacaine on apoptosis of lippolysaccharide(LPS)-induced ulcerative colitis cell line NCM-460 and on activity of nucleotide oligomerization domain(NOD)-like receptor protein-3(NLRP3)inflammatome.Methods Human colon epithelial cell line NCM-460 was cultured in vitro and divided into control group(no intervention),model group(10 μg/mL LPS treatment),low/medium/high concentration ropivacaine group(10 μg/mL LPS and 0.5,1,1.5 mmol/L ropivacaine co-treatment,respectiv-oly).Cell viability was determined by cell counting kit 8(CCK-8)and the appropriate concentration was selected.The cells were then divided into control group,model group,ropivacaine group(10 μg/mL LPS and 1.5 mmol/L ropivacaine treatment)and ropivacaine+inhibitor group(10 μg/mL LPS,1.5 mmol/L ropiva-caine and 1 μmol/L NF-κB pathway inhibitor BAY 11-7082 treatment),inhibitor group(10 μg/mL LPS+1 μmol/L NF-κB pathway inhibitor BAY 11-7082 treatment)and ropivacaine+activator group(10 μg/mL LPS,1.5 mmol/L ropivacaine and 1 μmol/L NF-κB pathway activator Prostratin),all groups were treated for 24 h.The level of IL-6,IL-8 and TNF-α were detected by enzyme-linked immunosorbent assay(ELISA).The proliferation rate was detected by EdU incorporation.Hoechst 33258 staining microscopy was used to detect the apoptosis rate.Level of cyclinD1,caspase-3,NLRP3 and NF-κB pathway-related proteins were detected by Western blot.Results Compared with the control group,the cell viability of the model group was significantly decreased and the cell viability of high-concentration experimental group was increased after adding ropivacaine(P＜0.05).So,1.5 mmol/L ropivacaine was selected for the follow-up experiment.Compared with the control group,the concentration of inflammatory cytokines IL-6,IL-8,TNF-α,apoptosis rate and the protein expression of caspase-3,NLRP3 and phosphorylated p-NF-κB in model group were all significantly increased(P＜0.05),while the proliferation rate and cycilnD1 protein expression were decreased(P＜0.05).Com-pared with model group,the concentrations of IL-6,IL-8,TNF-α,apoptosis rate and the expression of caspase-3,NLRP3 and p-NF-κB protein in ropivacaine group and inhibitor group were significantly decreased(P＜0.05),while the proliferation and cycilnD1 protein expression were increased(P＜0.05).Compared with ropivacaine group,the trend of the above indexes in ropivacaine+inhibitor group was more significant(P＜0.05),and the trend of these indexes in ropivacaine+agonist group was significantly reversed(P＜0.05).Conclusions Ropivacaine can inhibit the activation of NLRP3 inflammasome and block the signal transduction of NF-κB pathway,further inhibit LPS-induced apoptosis of NCM-460 cells and promote proliferation.

Objective:To learn about the detection quality and external quality control assessment of fluoride and arsenic in laboratories at all levels in Qinghai Province.Methods:The Z-score method was used to analyze and evaluate the evaluation results of 1 provincial, 8 municipal and 43 county level laboratories of disease prevention and control institutions participating in the external quality control assessment of water fluoride and brick tea fluoride in Qinghai Province in 2021, as well as 1 provincial, 1 municipal and 2 county level laboratories of disease prevention and control institutions participating in the external quality control assessment of water arsenic and urine arsenic. The feedback rate and qualification rate of external quality control of each assessment laboratory were calculated.Results:In 2021, the feedback rate of external quality control of water fluoride, brick tea fluoride, water arsenic and urine arsenic in provincial and municipal level laboratories of Qinghai Province were 100.00%; except that the qualified rate of water fluoride was 7/9, the qualified rate of external quality control of other projects was 100.00%. The feedback rate of external quality control of water fluoride, brick tea fluoride, water arsenic and urine arsenic in county level laboratories was 100.00%; except that the qualified rate of water fluoride was 86.05% (37/43), the qualified rate of external quality control of other projects was 100.00%. In the specific assessment results of the laboratory, the assessment results of water fluoride sample FS20210101 from 1 provincial, 1 municipal and 2 county level laboratories, and FS20210102 from 1 county level laboratory were suspicious; the assessment results of water fluoride sample FS20210101 from 3 county level laboratories were not satisfactory; the assessment results of fluoride and arsenic sample in other laboratories were satisfactory.Conclusions:The qualified rate of external quality control of fluoride and arsenic in laboratories at all levels in Qinghai Province is relatively high, but some county level laboratories are still dissatisfied with the assessment results of water fluoride. Therefore, it is necessary to strengthen the detection level of water fluoride in laboratories.

Objective:To observe the changes of serum C-terminal peptide of type Ⅰ collagen (CTX-1) and N-terminal lengthening peptide of type Ⅰ collagen (P1NP) in adult patients with skeletal fluorosis in the tea-drinking-borne endemic fluorosis area in Qinghai Province, and to find sensitive indicators for diagnosis of skeletal fluorosis.Methods:From April to August 2019, a case-control study was carried out in tea-drinking-borne endemic fluorosis area in Zhiduo County, Yushu Tibetan Autonomous Prefecture, and Gangcha County, Haibei Tibetan Autonomous Prefecture of Qinghai Province. According to the Diagnostic Standard for Endemic Skeletal Fluorosis (WS/T 192-2008), the clinical diagnosis and X-ray examination of skeletal fluorosis were carried out for permanent residents ≥25 years old and living for more than 10 years in the area, combined with face-to-face inquiry and investigation of past disease history, lifestyle and clinical manifestations. The patients with skeletal fluorosis and healthy people were selected as skeletal fluorosis group and control group, respectively. Randomized urine samples and fasting venous blood from the two groups were collected. The content of fluoride in urine was determined by ion selective electrode method, and the contents of CTX-1 and P1NP in serum were determined by enzyme-linked immunosorbent assay (ELISA).Results:A total of 127 people in the disease area were investigated, including 63 cases in skeletal fluorosis group and 64 cases in control group. There was no statistically significant difference in age and sex ratio between the two groups ( t = 0.42, χ 2 = 0.07, P > 0.05). The X-ray examination results showed that the patients with skeletal fluorosis were mainly mild, accounting for 71.43% (45/63); X-ray changes were mainly ossification of interosseous membrane and tendon. The urinary fluoride in control group and skeletal fluorosis group was 1.62 (1.12, 1.95) and 3.22 (2.38, 4.89) mg/L, respectively, with statistically significant difference between the two groups ( Z = 7.07, P < 0.001). The difference of serum CTX-1 and P1NP contents between the two groups was statistically significant ( Z = 2.00, 4.89, P < 0.05). Conclusions:The levels of serum CTX-1 and P1NP in patients with skeletal fluorosis are higher than those in healthy people. Serum CTX-1 and P1NP may be used as sensitive indicators for diagnosis of skeletal fluorosis.

Objective:To follow up the iodine nutrition and intellectual development of school children aged 8-10 years old in Nangqian County of Qinghai Province after 9 years of the implementation of iodine deficiency disorders intervention measures with iodine supplement as the main measure.Methods:In order to improve the iodine nutritional status of the population in Nangqian County, free iodized salt distribution, health education and other intervention measures for iodine deficiency disorders were implemented for 9 consecutive years since 2013. In May 2012 (before iodine supplementation) and September 2021 (after iodine supplementation), the same 5 townships (towns) were selected, and children aged 8-10 years old (half male and half female, age balanced) born locally in the central primary school of each township (town) were selected as the survey subjects. Household edible salt samples and random urine samples were collected for salt iodine and urinary iodine detection; the second revised version of the Chinese Combined Raven's Test (rural version) was used to assess the intelligence quotient (IQ) of children. The Flynn effect (FE) gain was used to adjust IQ, the corrected IQ = (IQ starting point value - current year's IQ value) - FE gain (calculated by 0.74/year). The differences of salt iodine and urinary iodine related indexes, IQ value and corrected IQ were compared before and after iodine supplementation.Results:After iodine supplementation, the coverage rate of iodized salt reached 100.00% (300/300), and the consumption rate of qualified iodized salt reached95.00% (285/300), the median urinary iodine increased to 157.20 μg/L, and all indexes met the elimination standard of iodine deficiency disorders. The IQ value of children aged 8-10 years old after iodine supplementation was 99.00 ± 14.90, significantly higher than that before iodine supplementation (82.00 ± 13.20, F = 156.82, P < 0.001). The FE gain in 9 years was 6.66, and the actual IQ gain of children aged 8-10 years old after iodine supplementation was 10.34. There were statistically significant differences in IQ value before and after iodine supplementation in male and female children ( F = 78.84, 78.88, P < 0.001). After iodine supplementation, there was a statistically significant difference in IQ value between children in the 8-year-old group and the 10-year-old group ( P = 0.010). There were statistically significant differences in IQ value before and after iodine supplementation in 8, 9 and 10 years old groups ( F = 55.23, 65.79, 36.85, P < 0.001). Conclusion:Intervention measures for iodine deficiency disorders, mainly iodine supplement, can significantly improve the iodine nutrition status of children aged 8-10 years old, and significantly promote the intellectual development of children.

Objective:To evaluate the water fluoride detection ability of county (city, district) level (referred to as the county-level) laboratories in Qinghai Province.Methods:During the "13th Five-Year Plan" period (2016 - 2020), 4, 4, 4, 43, 43 county-level laboratories in Qinghai Province were organized to participate in the national water fluoride external quality control assessment, and the assessment results were evaluated by Z-ratio scoring method.Results:The response rate of county-level laboratories was 86.05% (37/43) in 2019, and 100.00% in other years. The qualified rate of county-level laboratories was 100.00% from 2016 to 2018; in 2019 and 2020, the assessment was fully covered, and the qualified rate was 81.40% (35/43) and 95.35% (41/43), respectively. Compared with 2019, the response rate and qualified rate in 2020 increased significantly, and the differences were statistically significant (χ 2 = 6.450, 4.074, P < 0.05). In the past 5 years, two assessment samples│Z│ < 1 in each laboratory were the most common, but with two assessment samples 2≤│Z│ < 3 in some qualified laboratories. Conclusion:The consistency of water fluoride determination in Qinghai Province is not very ideal, and the detection ability of county-level laboratories still needs to be strengthened.

ObjectiveTo explore the syndrome and treatment rules of traditional Chinese medicine （TCM） in treating chronic obstructive pulmonary disease （COPD） based on the medical literature and cases with the help of TCM inheritance support system platform （V2.5）， thus providing new ideas for TCM to treat COPD. MethodThe medical cases of TCM treating COPD were retrieved from China national knowledge infrastructure （CNKI）， Wanfang Database， and VIP China Science and Technology Journal Database. The medical cases that met the inclusion literature were collected in a new Word document， and then input into the TCM inheritance support system platform （V2.5） after data standardization. With the help of the algorithm carried by this software， the frequency statistics of "symptoms， syndrome types of TCM， Chinese medicine， and meridians of Chinese medicine" in the included COPD medical cases were performed， and the correlation analysis of the "prescription rules" in the included medical cases was carried out， thus excavating the potential core drug pairs and new prescriptions for the treatment of COPD. ResultA total of 103 articles were included with 126 medical cases and 131 diagnoses and treatments. According to statistics， the common symptoms of COPD were cough， expectoration， chest tightness， and asthma， and the common TCM syndromes included phlegm-heat obstructing lung， phlegm and blood stasis blocking lung， and lung-spleen Qi deficiency. The common TCM treatment methods included clearing heat and resolving phlegm， banking up earth to generate metal， and descending adverse and relieving dyspnea， among which the high-frequency Chinese medicines for the treatment of COPD were Pinelliae Rhizoma， Armeniacae Semen Amarum， Ephedrae Herba， Citri Reticulatae Pericarpium， and so on. The commonly used drug pairs included Asari Radix et Rhizoma-Pinelliae Rhizoma， Pinelliae Rhizoma-Schisandrae Chinensis Fructus-Glycyrrhizae Radix et Rhizoma， etc. Twelve new prescriptions for the treatment of COPD were found. ConclusionTCM believes that COPD is a lung disease formed by external evil， phlegm， blood stasis， and other pathological factors， with cough， phlegm， and asthma as the main symptoms. The main syndromes of COPD are phlegm-heat obstructing lung， phlegm and blood stasis blocking lung， and lung-spleen qi deficiency. "Strengthening the upright and dispelling evil" is the basic principle of the treatment COPD. In clinical， TCM methods with dispelling phlegm and removing blood stasis， and tonifying lung， spleen， and kidney should be adopted to treat COPD.