张家口学院

This review examines the critical role of extracellular vesicles, specifically exosomes, as mediators of intercellular and inter-organ communication in the context of skeletal muscle aging and regeneration. Skeletal muscle, traditionally viewed as a simple contractile tissue, is now recognized as a potent endocrine organ that secretes a diverse array of signaling molecules, collectively termed “exerkines,” in response to physical activity. We integrate contemporary evidence demonstrating how exercise modulates the release and molecular composition of muscle-derived exosomes, which in turn influence key cellular processes. The report details how exosomal cargo, including non-coding RNAs and proteins, regulates muscle stem cell activation and differentiation, counteracts age-related decline (sarcopenia) by modulating protein homeostasis and inflammation, and facilitates systemic metabolic crosstalk with distant tissues such as adipose tissue. We also critically discuss the burgeoning therapeutic potential of engineered exosomes for musculoskeletal health, while highlighting significant and interconnected challenges in the field, including the lack of standardized methodologies and regulatory frameworks. This review provides a nuanced perspective on the “exerkine” hypothesis, underscoring the potential of exercise-modulated exosomes as both diagnostic biomarkers and novel therapeutic agents for maintaining lifelong muscle health.

Objective:To compare the efficacy of different scoliosis-specific exercise protocols on the Cobb angle in adolescent idiopathic scoliosis (AIS) using a network meta-analysis, and to rank the five key prescription parameters-exercise type, intervention period, session duration, frequency, and intensity-within a unified evidence framework, thereby moving beyond the traditional question of "whether exercise works" to address "which parameter combinations have the highest probability of producing optimal improvement." Methods:A systematic search was performed in PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data, and VIP databases for randomized controlled trials from inception to December 2025. Two researchers independently screened studies, extracted data, and assessed risk of bias. RevMan 5.3 and Stata 16.0 were used for data analysis. Results:A total of 24 studies involving 1,149 patients were included. The network meta-analysis showed that: regarding exercise type, Schroth combined with sensory integration training showed the greatest effect size [MD = -8.01, 95% CI (-11.47, -4.54)]; regarding intervention period, 12-18 weeks showed the greatest effect size [MD = -3.67, 95% CI (-5.52, -1.81)]; regarding session duration, 60 min showed the greatest effect size [MD = -4.00, 95% CI (-5.76, -2.23)]; regarding frequency, three times per week showed the greatest effect size [MD = -3.55, 95% CI (-4.76, -2.35)]; regarding intensity, moderate intensity showed the greatest effect size [MD = -3.78, 95% CI (-5.99, -1.57)]. The SUCRA rankings placed these parameters first in their respective networks. Conclusion:Based on probability ranking, Schroth combined with sensory integration training, delivered at moderate intensity, three times per week, 30-60 min per session, for 12-18 weeks, is likely to be among the most effective protocols for improving the Cobb angle in AIS. However, this finding is derived from a limited number of studies, and each protocol component is supported by sparse evidence within its respective network. These results should be interpreted with caution and must be individualized in clinical practice. Systematic Review Registration:identifier PROSPERO CRD420251249777.

Gamification has emerged as an innovative pedagogical strategy with considerable potential to enhance competency development in health professions education. However, its systematic integration into pharmacy clinical skills training remains underexplored. This review systematically synthesises current evidence on the design principles, theoretical foundations, and educational outcomes of gamified learning in pharmacy curricula. Particular emphasis was placed on its influence on learner motivation, knowledge retention, clinical reasoning, and interprofessional collaboration. A comprehensive literature search encompassing pharmacy, medical, and health sciences education was conducted to identify core components and best practice frameworks for effective gamification. Evidence indicates that well-designed gamification models can significantly improve learner engagement and promote the meaningful integration of theoretical knowledge with authentic clinical practice. Nonetheless, several barriers, including limited instructional resources, inadequate faculty expertise, underdeveloped evaluation tools, and ethical concerns related to data security and digital equity, continue to constrain widespread implementation. This review proposes actionable strategies such as precise alignment of gamification elements with course objectives, structured faculty capacity building, enhancement of technological infrastructure, adoption of multidimensional evaluation systems, and strengthened interprofessional collaboration. Future research should focus on adaptive, artificial intelligence (AI)-driven gamification approaches, evaluate their long-term impacts on clinical competence, and develop standardised, evidence-based guidelines for sustainable integration, as outlined in the proposed frameworks within this review.

Regular physical activity is a powerful non-pharmacological strategy for preventing and managing cardiovascular diseases (CVDs), including heart failure, by promoting cardioprotective adaptations through molecular mechanisms that remain incompletely elucidated. This review explores the central role of non-coding RNAs (ncRNAs), particularly microRNAs (miRNAs), in exercise-induced cardioprotection, highlighting their interactions within miRNA-lncRNA and miRNA-circRNA axes, as well as the function of exosomal miRNAs as key exerkines facilitating inter-organ crosstalk. Synthesizing current literature, we examine ncRNA biogenesis, canonical functions, and exercise-responsive profiles, focusing on pivotal miRNAs such as miR-1, miR-133, miR-21, miR-126, miR-29, miR-208a, and miR-499; lncRNA-miRNA networks including MALAT1/miR-150-5p, H19/miR-139, and GAS5/miR-217; circRNA-miRNA interactions like circUtrn/miR-132/212; and exosomal miRNAs derived from skeletal muscle (e.g., miR-130a, miR-1), brown adipose tissue (e.g., miR-17-3p), endothelium (e.g., miR-126), and cardiomyocytes (e.g., miR-21-3p). These elements are evaluated in models of physiological cardiac remodeling, myocardial infarction, ischemia-reperfusion injury, diabetic cardiomyopathy, and heart failure, with consideration of influencing factors such as sex, age, and training modality. Exercise-modulated miRNAs differentiate benign “athlete’s heart” from pathological hypertrophy by governing angiogenesis, fibrosis, metabolic shifts, and arrhythmia risk, while lncRNA-miRNA and circRNA-miRNA axes regulate apoptosis, inflammation, mitochondrial dynamics, and extracellular matrix remodeling in CVD contexts. Exosomal miRNAs enable remote protection by activating survival, angiogenic, and anti-fibrotic pathways via signaling cascades like PI3K/AKT and NF-κB. Responses exhibit variability based on demographic and exercise variables, underscoring ncRNAs' promise as diagnostic biomarkers, therapeutic targets, or mimics of exercise benefits for heart failure management.

Objective This article aims to examine whether adjunctive electroacupuncture was associated with more favorable rehabilitation outcomes among individuals with spinal cord injury (SCI) receiving standard exercise rehabilitation. Methods In this single-center retrospective cohort study, 174 patients with SCI treated between January 2020 and December 2025 were screened. After 1:1 propensity score matching for age, sex, body mass index, injury level, broad etiology (traumatic vs non-traumatic), and American Spinal Injury Association Impairment Scale grade, 86 patients were analyzed: 43 received exercise rehabilitation alone, and 43 received adjunctive electroacupuncture. Both groups completed an 8-week rehabilitation course. Outcomes included residual urine volume, daily urination frequency, Modified Ashworth Scale (MAS), Composite Spasticity Index (CSI), Spinal Cord Independence Measure III (SCIM-III), International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores, oxidative-stress markers, and documented adverse events. Results The covariates included in the matching model were balanced after matching. Within-group comparisons showed improvement in bladder parameters, spasticity, independence, neurological scores, and oxidative-stress markers. At 8 weeks, the adjunctive electroacupuncture group had lower residual urine volume, urination frequency, MAS and CSI scores, and malondialdehyde, together with higher SCIM-III, ISNCSCI motor and sensory scores, glutathione peroxidase, and superoxide dismutase than the exercise-only group (all P < 0.05). Documented adverse-event proportions were 13.95% and 11.63% ( P = 0.747); however, the complete-case retrospective design was not sufficient to establish comparative safety. Conclusion Among complete cases, adjunctive electroacupuncture was associated with more favorable post-treatment functional, neurological, and oxidative-stress values during an 8-week rehabilitation course. These findings should be interpreted cautiously because the exact interval from injury or disease onset to rehabilitation, detailed non-traumatic etiologies, and several treatment-related confounders were unavailable.