Prefrailty is a reversible transitional stage of frailty and is associated with impaired postural stability and increased fall risk. Tai Chi may improve balance-related performance in older adults, but its effects on postural stability and gait biomechanics in prefrail populations remain insufficiently characterized. In this single-blind randomized controlled trial, 68 prefrail older adults defined by the Fried Frailty Phenotype were allocated to a Tai Chi plus health education group or a health education control group. Sixty-four participants completed the study (mean age 71.1 years; 31 women; 33 men). The intervention group performed 24-form Tai Chi three times weekly for 12 weeks, while both groups received health education. Functional postural stability was assessed using the Timed Up-and-Go Test (TUGT), Berg Balance Scale (BBS), and Short Physical Performance Battery (SPPB). Static balance was evaluated using center-of-pressure (COP) measures, and gait biomechanics were assessed using three-dimensional gait analysis. Continuous outcomes were analyzed using baseline-adjusted ANCOVA, with complementary group × time interaction analyses. Exploratory change-score correlations were conducted within the intervention group, with full-sample sensitivity analyses adjusted for group assignment. After 12 weeks, the intervention group showed better postural stability than controls, including shorter TUGT time (P < 0.001), higher BBS (FDR q < 0.001) and SPPB scores (FDR q = 0.002), lower COP path length and sway velocity under eyes-open conditions (both FDR q = 0.003), and lower COP path length, sway ellipse area, and sway velocity under eyes-closed conditions (FDR q = 0.014–0.018). Gait analysis showed significant improvements in gait speed (FDR q = 0.033), gait profile score (GPS; FDR q < 0.001), gait deviation index (GDI; FDR q < 0.001), and hip rotation deviation (FDR q = 0.007), whereas other joint-specific kinematic variables were only nominally significant. Group × time analyses supported changes in TUGT, BBS, SPPB, gait speed, GPS, and GDI. Exploratory correlation analyses showed that changes in postural stability were mainly associated with changes in hip kinematics, step length, and selected ankle-related features; however, these associations did not remain significant after FDR correction. A 12-week Tai Chi program improved functional performance and static postural control in prefrail older adults and was associated with favorable changes in gait speed and global gait-quality indices. Correlation findings should be interpreted as preliminary mechanistic clues. Larger studies with longer follow-up are needed. Trial registration Chinese Clinical Trial Registry, ChiCTR2300073905, Registered on [2023-07-25]. https://www.chictr.org.cn.

The dynamic change of N6-methyladenosine (m6A) modification on substrate RNA molecules plays a critical role in different biological processes and disease pathogenesis. Although the beneficial effects of exercise training (ET) on skeletal muscle insulin resistance (IR) are well-established, the contribution of RNA m6A modification in ET-related adaptations in high-fat diet (HFD)-induced IR remains unclear. In this study, we show that exercise stimulation triggers a dynamic shift in skeletal muscle m6A modification levels during HFD consumption. As a key m6A methyltransferase, METTL16 was downregulated in HFD-fed mice and upregulated by ET at both the mRNA and protein levels. In vitro, METTL16 knockdown disrupted mitochondrial ultrastructure, reduced electron transport chain complex activities, and decreased the NAD+/NADH ratio, ATP content, and mitochondrial membrane potential, indicating impaired mitochondrial function. Concomitantly, METTL16 loss lowered m6A on PGC-1α mRNA, reducing its stability and protein abundance and blunting insulin signalling, whereas PGC-1α overexpression partially reversed these defects. In conclusion, METTL16 functions as an exercise-responsive m6A methyltransferase that may modulate PGC-1α, mitochondrial function, and insulin-related signalling in HFD skeletal muscle, implicating the METTL16-m6A-PGC-1α axis in exercise-induced metabolic adaptations.

Background: Post-stroke cognitive impairment is a challenge for clinical rehabilitation, and it has become a consensus to find a multimodal joint intervention approach. Irisin, isolated from fibronectin type 3 structural domain protein 5 (FNDC5), is a motor-induced myokine that has been shown to exert neurotrophic effects and improve cognition. Meanwhile, acupuncture has been shown to be an effective means of reducing neuroinflammation. The aim of this study was to investigate whether exercise combined with electroacupuncture could be more effective in improving cognitive impairment via Irisin in rats with cerebral ischemia-reperfusion injury. Methods: Post-stroke cognitive impairment induced by the middle cerebral artery occlusion (MCAO) in Sprague-Dawley rats, the electroacupuncture group used electroacupuncture at "Baihui" (GV 20) and "Shenting" point (GV 24); the exercise group used exercise training on a treadmill; and the combined group was treated with exercise training followed by electroacupuncture therapy. Before and after the intervention, Zea-longa was used to detect the neurological deficit score of rats; 7.0T small animal magnetic resonance imaging (MRI) scanning was used to observe the volume of cerebral infarction. After intervention, Morris water maze was used to observe the learning and memory ability of rats in each group; RT-qPCR was used to detect the expression of mRNA of FNDC5 and its interacting proteins, and Western Blot was used to detect the expression of FNDC5/Irisin and its interacting proteins, inflammatory factors. Results: Exercise combined with electroacupuncture improved post-stroke cognitive deficits and reduced neurological deficits in MCAO rats. And the efficacy of the combined intervention was superior to signal exercise or electroacupuncture. Affinity Purification Mass Spectrometry screened and identified the interacting protein of hippocampal Irisin in MCAO rats as Vim. Exercise combined with electroacupuncture promoted the interaction between Irisin and Vim, reduced neuroinflammation and improved neurological damage and cognition. Conclusions: Exercise combined with electroacupuncture induces skeletal muscle to release Irisin into the hippocampus, interacts with Vim, attenuates neuroinflammation, and improves cognitive function in MCAO rats. Keywords: Irisin, Vim, MCAO, nueroinflammation, cognitive function

Functional ankle Instability (FAI) is a common sequela of ankle sprains, characterized by recurrent “giving way” sensation and functional deficits associated with impaired lower-limb proprioception, neuromuscular control, and postural control. While Tai Chi, a traditional mind-body exercise, has been shown to positively affect balance ability and self-reported instability in patients with Chronic Ankle Instability (CAI), but its influence on lower-limb coordination patterns remains unclear. This study aimed to evaluate the effects of a 12-week Tai Chi intervention on the clinical outcomes and lower-limb gait coordination patterns in patients with FAI. A single-blinded randomized controlled trial was conducted, recruiting 28 FAI patients who were randomly divided into a Tai Chi intervention group and a health education control group. The Tai Chi group underwent 12 weeks of simplified 24-form Tai Chi training. Primary outcomes included lower-limb joint coordination patterns and coordination variability during walking, quantified using the Vector Coding technique via three-dimensional motion analysis system. Secondary outcomes included the Cumberland Ankle Instability Tool (CAIT) and the American Orthopaedic Foot & Ankle Society-Ankle Hindfoot Scale (AOFAS-AHS) scores, were also assessed pre- and post-intervention. Post-intervention, both groups showed improvements in CAIT and AOFAS-AHS scores, however the Tai Chi group exhibited significantly higher CAIT and AOFAS-AHS scores compared to the education group (P < 0.01). Regarding gait coordination patterns, the Tai Chi group showed a significant reduction in Hip-Ankle Pro-phase in the transversal plane and Knee-Ankle Dis-phase in the coronal plane (P < 0.05). No significant changes were observed in other coordination patterns. No significant between-group differences were observed in coordination variability. A 12-week Tai Chi intervention effectively improves subjective ankle stability and function outcomes in FAI patients. Furthermore, Tai Chi may enhance motor function in patients with FAI by suppressing maladaptive proximal compensatory strategies and improving distal joint dynamic control. These findings provide biomechanical evidence supporting the use of Tai Chi as a rehabilitation strategy for FAI.

Children with developmental coordination disorder (DCD) exhibit significant deficits in both gross and fine motor functions. Baduanjin, a traditional Chinese mind-body exercise, has demonstrated potential in improving motor functions, including balance and neuromuscular coordination, in various rehabilitation settings. This study aims to investigate the effects of Baduanjin intervention on motor function in children with DCD, and further explore whether its potential benefits are mediated through improved cortical activation in motor-related brain regions, as reflected by cerebral hemodynamic responses. This single-blind randomized controlled trial enrolled 40 children aged 5–10 years who met the DSM-5 diagnostic criteria for DCD and had an MABC-2 standard score of ≤ 7. Participants were randomly assigned, using a SAS 9.4-generated randomization sequence with sealed opaque envelopes for allocation concealment, to either an experimental group receiving Baduanjin training plus health education or a control group receiving health education alone. The intervention lasted 8 weeks, with five sessions per week, including two instructor-led hospital sessions and three parent-supervised home sessions. After the intervention, motor coordination and balance were assessed using the Movement Assessment Battery for Children-2 (MABC-2) and the ProKin 254 balance test system, respectively. In addition, functional near-infrared spectroscopy (fNIRS) was used to measure hemodynamic responses in motor-related cortical regions during functional tasks, to evaluate cortical activation and examine its associations with changes in motor function. The per-protocol (PP) dataset included 36 participants, whereas the intention-to-treat (ITT) dataset included all 40 randomized children. Both PP and ITT analyses showed that the experimental group had significantly higher total MABC-2 scores than the control group (PP: P = 0.002; ITT: P = 0.001). Subscale analyses demonstrated significant improvements in aiming and catching (PP: P = 0.019; ITT: P = 0.005) and balance (PP: P = 0.008; ITT: P = 0.004). In addition, the experimental group showed significant improvements in key static balance parameters, including reduced sway area (PP and ITT: P < 0.001) and shorter sway path length (PP and ITT: P < 0.001). Dynamic postural stability also improved significantly (PP and ITT: P = 0.004). However, no statistically significant between-group differences were observed in manual dexterity (PP and ITT: P > 0.05). fNIRS results revealed that during the aiming and catching task, the experimental group exhibited significantly greater activation in the left premotor cortex and supplementary motor area (PMC + SMA) compared to the control group (CH31: FDR-adjusted P = 0.015; CH32: FDR-adjusted P = 0.041). In the one-leg balance task, the experimental group showed significantly enhanced activation in the left hemispheric regions, including the frontopolar area (FPA), dorsolateral prefrontal cortex (DLPFC), inferior frontal gyrus (IFG), primary motor cortex (M1), as well as the PMC + SMA (FDR-adjusted P = 0.018). No significant between-group differences in brain activation were observed during the manual dexterity task (FDR-adjusted P ≥ 0.05). Furthermore, correlation analysis indicated a significant positive association between improvements in motor performance and activation of motor-related brain regions in the experimental group. Baduanjin training improved motor coordination and balance in children with DCD. The observed changes in activation within motor-related cortical regions provide preliminary support for a possible neurophysiological basis of these functional improvements, although the underlying mechanisms require further investigation. ChiCTR, ChiCTR2300078980. Registered 22 December 2023, https//www.chictr.org.cn. The study protocol has been published (doi 10.1136/bmjopen2024084061).

BackgroundMeniscal injury is a common knee disorder that may alter lower-limb loading patterns during walking and contribute to functional impairment and secondary joint degeneration. However, whether gait kinetic alterations differ across MRI-defined Stoller grades remains unclear.ObjectiveTo investigate the effects of isolated meniscal injuries of different Stoller grades on gait kinetics, focusing on ground reaction forces (GRF) and joint moments in both affected and contralateral limbs.MethodsA total of 114 participants were categorized into three groups based on MRI findings: normal, Grade I-II, and Grade III. Three-dimensional gait analysis recorded GRF components and sagittal-plane joint moments. Multivariate analysis of covariance, adjusting for age and body mass index (BMI), followed by Bonferroni post hoc tests, was used to compare intergroup differences.ResultsThere were significant differences in BMI and Lysholm scores between groups, and these factors were corrected in subsequent analyses. Compared with controls, patients with meniscal injury demonstrated altered GRF components (anterior, posterior, and lateral) and reduced ankle dorsiflexion, knee extension, and hip flexion/extension moments on the affected limb. Similar kinetic alterations were identified in the contralateral limb. Peak joint moments at the ankle, knee, and hip were significantly correlated with GRF parameters. No significant differences were detected between the Grade I-II and Grade III groups in any gait kinetic variables.ConclusionGait kinetic alterations appear to be associated with the presence of meniscal injury rather than MRI-defined injury severity. These findings underscore the importance of functional gait assessment and support individualized rehabilitation strategies regardless of Stoller grade.

Background and aim The traditional Chinese formula Shanyu Wan (SYW), comprising Panax ginseng, Dioscorea opposita Thunb and Atractylodes Rhizoma, has been empirically employed for metabolic regulation, although its mechanistic basis remains incompletely elucidated. Experimental procedure Senescence-accelerated mouse prone 8 (SAMP8) mice were orally administered SYW by gavage at 2.56 g/kg for 8 weeks, with age-matched senescence-accelerated mouse resistant 1 (SAMR1) mice serving as controls. Muscle phenotype was evaluated by forelimb grip strength, rotarod performance, spontaneous locomotor activity, and magnetic resonance imaging (MRI). Histopathological alterations were evaluated by Masson's trichrome staining. Mitochondrial ultrastructure was examined by transmission electron microscopy (TEM), and mitochondrial functional parameters were subsequently determined. Furthermore, the effects of SYW-containing serum on oxidative injury were examined in t-BHP-treated C2C12 myoblasts, together with pharmacological interference analysis of PGC-1α-related signaling. Results and conclusion Oral administration of SYW significantly improved muscle volume, grip strength, and motor performance in SAMP8 mice. These protective effects were accompanied by partial restoration of mitochondrial ultrastructure, increased mitochondrial respiratory chain complex activity, reduced oxidative stress, and changes in PGC-1α-related signaling. In vitro, SYW-containing serum attenuated t-BHP-induced oxidative and mitochondrial injury in C2C12 myoblasts, while pharmacological interference experiments suggested the involvement of PGC-1α-related signaling. These findings provide preclinical evidence that SYW may alleviate age-related muscle alterations by improving mitochondrial function and redox balance.

Objectives:To evaluate the effects of a 12-week Tai Chi Chuan (TCC) program on ankle instability/function, pain, and gait/balance performance in patients with functional ankle instability (FAI). Design:Prospective, single-blind randomized controlled trial. Setting:Clinical gait analysis laboratory with community-based recruitment. Participants:Fifty patients with FAI were randomly divided 1:1 to a TCC group (n=25; age 65.44±8.75y; 18 women/7 men) or a control group (n=25; age 67.08±4.76y; 22 women/3 men). By eligibility criteria, all participants had experienced at least 1 severe ankle sprain within the prior year and had recurrent episodes of giving way/instability in the prior year. Interventions:The TCC group completed supervised simplified 24-form TCC training 3 sessions/wk for 12 weeks; controls received structured health education once every 4 weeks for 12 weeks. Main Outcome Measures:The primary outcome was the Cumberland Ankle Instability Tool (CAIT). Secondary outcomes included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score, pain intensity (visual analog scale [VAS]), 3-dimensional gait spatiotemporal and sagittal kinematic parameters, and postural control (Huber360 static balance metrics and the Y-Balance Test [YBT]). Results:After 12 weeks, CAIT increased by 10.32 points in the TCC group (14.48±5.53 to 24.80±4.21) compared with 2.84 points in the control group (15.16±5.98 to 18.00±5.05), with a significant between-group difference (P<.01), exceeding the CAIT minimal clinically important difference (MCID) (≥3 points); American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and VAS also improved more with TCC (all P<.05), with changes within/above published AOFAS MCID estimates (7.9-30.2 points) and exceeding the commonly used VAS MCID (∼1.4 cm). The TCC group also demonstrated improvements in step width, selected sagittal-plane hip/ankle kinematics, and Y-Balance Test performance compared with controls (P<.05). Conclusions:A 12-week TCC program may provide clinically meaningful improvements in ankle stability and function, reduce pain, and enhance gait and balance performance in patients with FAI.

Background:Frailty is a common geriatric syndrome characterized by a progressive decline in physical function and an increased susceptibility to adverse outcomes, including falls. Although diminished postural stability is a hallmark of frailty, the neural correlates associated with balance impairments throughout the progression of the syndrome remain unclear. This study aims to elucidate the brain functional activity of older adults with varying degrees of frailty during a resting state, as well as the relationship between this activity and postural stability.Methods:Sixty-eight older adults were divided into non-frail (n = 23), pre-frail (n = 30), and frail (n = 15) groups based on the Fried frailty phenotype. Postural stability was assessed using the Huber®360 neuromuscular control training and assessment system. Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired on a 3.0 T scanner, and the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) were utilized as indicators of brain functional activity. Spearman correlation analysis was employed to examine the correlations between the brain functional activity and the postural stability.Results:Compared to the non-frail group, the frail and pre-frail groups were significantly older and exhibited poorer performance in grip strength, Short Physical Performance Battery (SPPB) scores, and Timed Up and Go Test (TUGT) results, as well as a greater burden of comorbidities—such as depressive symptoms and sleep disturbances (all p < 0.05). Significant inter-group differences were observed across all postural stability parameters. Relative to the non-frail group, the pre-frail group exhibited significantly decreased ALFF in the left inferior frontal gyrus (pars opercularis) extending to the insula, while the frail group demonstrated reduced ALFF in bilateral posterior cerebellum; additionally, the frail group showed decreased ReHo in the left posterior cerebellum/pons and increased ReHo in the right middle temporal/occipital gyrus. ALFF was significantly correlated with right single-leg sway area, the limits of stability, SPPB score, and TUGT completion time, whereas ReHo was significantly correlated only with SPPB score and TUGT completion time (all p < 0.05).Conclusions:Resting-state brain function exhibits significant differences among older adults in varying states of frailty, primarily involving spontaneous activity and local synchronization within the cerebellum-pons circuitry and cognition-related brain regions. These functional brain abnormalities are closely associated with diminished postural stability, suggesting that alterations in central nervous system function may represent a significant neural correlate of impaired balance in frail older adults. This study provides neuroimaging evidence to support the early screening of frailty and balance-related interventions in older adults, while also laying a foundation for future longitudinal and multimodal investigations.

BackgroundAnkle sprains are common in physically active populations and may progress to functional ankle instability, which can impair gait. Excess body mass increases lower-limb loading and may further compromise walking function in this population.ObjectiveTo examine whether overweight status influences spatiotemporal gait parameters, gait deviation/variability indices, and sagittal-plane hip, knee, and ankle biomechanics during level walking in individuals with functional ankle instability.MethodsIn this cross-sectional comparative analysis, forty-four adults with functional ankle instability were enrolled (22 normal-weight and 22 overweight). Three-dimensional motion analysis was used during self-selected speed walking to quantify spatiotemporal parameters, gait deviation/variability indices, and sagittal-plane hip, knee, and ankle kinematics and kinetics. Multiple comparisons across gait outcomes were controlled using a Holm-Bonferroni correction (family-wise error rate 0.05).ResultsAfter Holm–Bonferroni correction, spatiotemporal parameters did not differ significantly between groups. For gait deviation/variability indices, several measures showed nominal (unadjusted) between-group differences, but none remained significant after correction. For discrete sagittal-plane biomechanics, the overweight group demonstrated lower peak hip flexion after correction (P_adj < 0.05), whereas hip flexion at toe-off showed a nominal difference but did not remain significant after correction (P_adj ≥ 0.05).ConclusionAfter multiplicity control, overweight status was mainly associated with reduced hip flexion-related mechanics rather than consistent spatiotemporal or deviation/variability alterations in adults with functional ankle instability.

Objectives To evaluate the effects of a 12-week Tai Chi Chuan (TCC) program on ankle instability/function, pain, and gait/balance performance in patients with functional ankle instability (FAI). Design Prospective, single-blind randomized controlled trial. Setting Clinical gait-analysis laboratory with community-based recruitment. Participants Fifty patients with FAI were randomized 1:1 to a TCC group (n=25; age 65.44±8.75 years; 18 women/7 men) or a control group (n=25; age 67.08±4.76 years; 22 women/3 men). By eligibility criteria, all participants had experienced at least one severe ankle sprain within the prior year and had recurrent episodes of giving way/instability in the prior year. Interventions The TCC group completed supervised simplified 24-form TCC training three sessions/week for 12 weeks; controls received structured health education once every 4 weeks for 12 weeks. Main Outcome Measures The primary outcome was the Cumberland Ankle Instability Tool (CAIT). Secondary outcomes included the American Orthopaedic Foot & Ankle Society Ankle–Hindfoot Score (AOFAS-AHS), pain intensity (Visual Analog Scale, VAS), three-dimensional gait spatiotemporal and sagittal kinematic parameters, and postural control (Huber360 static balance metrics and the Y-Balance Test, YBT). Results After 12 weeks, CAIT increased by 10.32 points in the TCC group (14.48±5.53 to 24.80±4.21) compared with 2.84 points in the control group (15.16±5.98 to 18.00±5.05), with a significant between-group difference (p<0.01), exceeding the CAIT MCID (≥3 points); AOFAS-AHS and VAS also improved more with TCC (all p<0.05), with changes within/above published AOFAS MCID estimates (7.9–30.2 points) and exceeding the commonly used VAS MCID (∼1.4 cm). The TCC group also demonstrated improvements in step width, selected sagittal-plane hip/ankle kinematics, and YBT performance compared with controls (p<0.05). Conclusions A 12-week Tai Chi Chuan program may provide clinically meaningful improvements in ankle stability and function, reduce pain, and enhance gait and balance performance in patients with functional ankle instability.

Long-term trials evaluating exercise’s impact on systemic aging biomarker profiles in older populations remain limited, particularly regarding multi-component exercise (MCE)-the modality prioritized in the WHO’s 2020 physical activity guidelines. The original study prospectively enrolled well-functioning old adults aged 65 to 85 years. Participants were randomly assigned to a center-based MCE intervention group or a control group. Serum samples were collected at baseline, year 1, year 2, and year 3. Circulatory aging-related biomarkers were measured using a 48-plex cytokine screening technique and enzyme-linked immunosorbent assays. A total of 161 participants were included (87 MCE, 74 control), with mean ages of 73.48 ± 4.56 and 73.24 ± 4.11 years, respectively. At the 1-year follow-up, the MCE group showed greater improvement in physical function, demonstrated by a larger reduction in five-times sit-to-stand test time (-1.27 ± 1.65 vs. -0.56 ± 1.89 s, p = 0.012). Compared to the control group, the decrease of SDF-1α and SCGF-β was attenuated in the MCE group (mean relative increase: 0.09, p = 0.004; mean relative increase: 0.13, p = 0.048, respectively). Whereas, the MCE group showed a greater decrease of G-CSF and a smaller increase of IL-9 than controls (mean relative decrease: −0.19, p = 0.017; mean relative decrease: −0.17, p = 0.005, respectively). Linear regression modeling over a 3-year follow-up identified SDF-1α, TNF-β, SCGF-β, GRO-α, PDGF-BB, and IL-16 as MCE biomarkers with significantly positive trajectories (all p < 0.005), while IL-9 was highlighted as a negatively altered MCE biomarker (p < 0.005). Within the MCE group, the levels of TNF-β, SDF-1α, SCGF-β, IL-12, and IL-2Rα were consistently and positively correlated with exercise frequency, whereas IL-9 levels were negatively associated. Long-term MCE preserved age-related declines in SDF-1α and SCGF-β while attenuating elevations of IL-9 in older adults.

Postoperative cognitive dysfunction (POCD) is a serious and common complication after total knee arthroplasty (TKA) in the elderly. Studies have suggested that repetitive transcranial magnetic stimulation (rTMS) can reduce the levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) inflammatory factors in the hippocampus, inhibit neuroinflammatory responses in the brain, and reduce the damage to synapses, thereby improving cognitive dysfunction. However, the effectiveness of rTMS for POCD remains to be explored. Therefore, the aim of this study is to treat POCD after TKA in the elderly with rTMS to evaluate the clinical efficacy of rTMS for POCD. This single-center, randomized, sham-controlled, assessor-blinded, parallel-group trial will enroll 207 elderly patients undergoing TKA and allocate them 1:1:1 to control group, active rTMS group, or sham rTMS group. All participants will receive standardized perioperative management. In addition, patients randomized to the active rTMS group will undergo stimulation of the left dorsolateral prefrontal cortex (DLPFC) at 10 Hz, 2000 pulses per session (5 s trains with 25 s inter-train intervals; 100

BACKGROUND:Postoperative cognitive dysfunction (POCD) is a major complication in elderly patients undergoing total knee arthroplasty (TKA), often linked to neuroinflammation. Repetitive transcranial magnetic stimulation (rTMS) has shown potential in modulating neural activity and reducing inflammation, but its perioperative efficacy in preventing POCD remains underexplored. This study aimed to evaluate the effectiveness of perioperative rTMS in reducing POCD and inflammation in elderly patients undergoing TKA. METHODS:In this single-center, randomized, double-blind trial, 60 elderly patients (≥ 60 years) scheduled for primary, elective TKA were randomly assigned to either an active-rTMS or sham-rTMS group. The active-rTMS group received 10 Hz stimulation targeting the dorsolateral prefrontal cortex for five consecutive days perioperatively, while the sham-rTMS group underwent identical procedures with the coil positioned perpendicularly to the skull to ensure no active stimulation. Cognitive function was assessed using the Montreal Cognitive Assessment, and serum inflammatory biomarkers, including interleukin-1 beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor alpha, and high mobility group box 1, were measured on preoperative days six and one and postoperative days three (POD three) and seven (POD seven). RESULTS:The active-rTMS group demonstrated significantly higher Montreal Cognitive Assessment scores at postoperative days three and seven (POD three: 25.3 ± 1.4 versus 23.7 ± 2.1, P = 0.001; POD seven: 26.1 ± 1.2 versus 24.4 ± 1.7, P < 0.001) and a lower cumulative POCD incidence (two versus 10 cases, P = 0.01). Postoperative levels of IL-1β, IL-6, tumor necrosis factor alpha, and high mobility group box 1 were significantly reduced in the active-rTMS group (P ≤ 0.002), indicating attenuated neuroinflammation. CONCLUSIONS:Perioperative rTMS significantly reduces POCD incidence and inflammation in elderly patients undergoing TKA, supporting its potential as a noninvasive strategy to preserve cognitive function.

Ankle sprains, the most common sports injury, often progress to functional ankle instability (FAI), characterized by recurrent instability and neuromuscular deficits. This study utilizes three-dimensional (3D) gait analysis system to quantify lower limb biomechanical alterations in FAI during gait, aiming to identify objective markers for guiding targeted rehabilitation strategies. This case–control study enrolled 31 matched subject pairs (FAI subjects vs. healthy controls) through propensity score matching based on stringent inclusion/exclusion criteria. Demographic data were collected, and functional assessments including the Cumberland Ankle Instability Tool (CAIT), American Orthopedic Foot and Ankle Society (AOFAS) scale, and Visual Analog Scale (VAS) for pain were administered. 3D gait analysis was performed using an infrared motion capture system (BTS SMART-D 400) to quantify biomechanical parameters characterizing FAI-related gait abnormalities. In individuals with FAI gait quality is significantly compromised, predominantly evidenced by alterations in pelvic tilt (P < 0.05, r = − 0.67, 95

Abstract Objectives This study aimed to examine the relationships between kinesiophobia and injury severity, balance ability, knee pain intensity, self-efficacy, and functional status in patients with meniscus injuries and to identify key predictors of kinesiophobia. Design A single-center, prospective cross-sectional study. Methods A cross-sectional study involving 123 patients diagnosed with meniscus injuries at Fujian Provincial Hospital was conducted. The knee range of motion test was used to determine limitations in knee joint mobility, whereas magnetic resonance imaging (MRI) was used to assess the severity of meniscus damage. Several validated scales were administered: the Tampa Scale of Kinesiophobia (TSK-17) to measure kinesiophobia, the visual analog scale (VAS) to assess pain intensity, the general self-efficacy scale (GSES) to evaluate self-efficacy, and the Lysholm knee score (LKS) to assess knee functional status. Additionally, balance ability was assessed using the Huber 360 Neuromuscular Control Training and Assessment System (DJO, USA). Spearman’s correlation analysis was applied to explore factors associated with kinesiophobia, whereas simple linear regression analysis was used to identify its predictors. Results Among the 123 participants included in the study, 60.16% were identified as experiencing kinesiophobia. Among these participants, 69.10% had grade III meniscus injuries, and 33.3% exhibited limited joint movement. The key clinical characteristics were as follows: the median VAS score was 4 (IQR 2–6), the GSES score was 22 (IQR 20–29), and the LKS score was 45 (IQR 38–55). Kinesiophobia was significantly correlated with injury severity, limited joint movement, pain intensity, self-efficacy, and other functional parameters (P < 0.05). However, no significant correlation was detected between kinesiophobia and limits of stability. Simple linear regression analysis (R²=0.917) revealed several significant predictors of kinesiophobia, including injury severity (β = 2.08), pain intensity (β = 0.882), Romberg quotient (RQ) (β = 3.239), and limited joint movement (β = 0.868). In contrast, self-efficacy (β =-0.455) was negatively associated with kinesiophobia. Furthermore, Grade III injuries and RQ were found to be associated with markedly higher levels of kinesiophobia. Conclusion Kinesiophobia is strongly associated with knee injury severity, limited joint movement, RQ, pain intensity, and self-efficacy, which are key predictors. Clinical interventions should focus on these factors to enhance rehabilitation outcomes.

The aim of this study was to investigate the differences in gait kinematics and kinetics among pre-frail, frail, and non-frail older adults during routine walking tasks. A total of 106 older adult participants were classified into frail, pre-frail, and non-frail groups based on the Fried frailty scale. Kinematic and kinetic data were acquired via a three-dimensional gait analysis system. Multivariate analysis of covariance (MANCOVA) was employed to assess the differences in gait kinematics and kinetics among the groups, followed by Bonferroni post-hoc tests. MANCOVA revealed significant differences in peak ankle plantar flexion, ankle range of motion (ROM), knee heel strike angle, and hip toe-off angle among the groups on the right side (P < 0.002). On the left side, significant differences were found in peak ankle plantar flexion, ankle ROM, and hip toe-off angle (P < 0.002). However, no significant differences in gait kinetics were observed among the three groups (P > 0.002). There is a weak correlation between gait kinematic parameters and dynamic postural stability. Compared with non-frail individuals, frail older adults reduced peak ankle plantar flexion, ankle ROM, and knee heel strike angle during walking. In contrast, the hip toe-off angle was found to be increased in the frail group.

BackgroundAnkle osteoarthritis (AOA) is a prevalent condition that affects joint function, often leading to pain, inflammation, and impaired mobility, significantly impacting patients' quality of life.ObjectiveThis study explores the effects of electroacupuncture treatment on clinical outcomes and gait characteristics in patients with ankle osteoarthritis (AOA).MethodsA total of 78 patients with AOA were randomly divided into a experiment group and a control group. The control group was treated with strength training, and the experiment group was additionally treated with electroacupuncture. The Ankle Osteoarthritis Scale (AOS), American Foot and Ankle Society's Ankle and Hindfoot Scale (AOFAS-AHS), and the 3D Motion Analysis System were used before and after the intervention to assess the clinical outcomes and changes in kinematic parameters in the AOA patients before and after therapy.ResultsAfter treatment, the differences in intra-group comparisons and inter-group comparisons of AOS scores, AOFAS-AHS scores, stride length, stride length, single-support phase, and gait variable scores (GVS) of ankle dorsiflexion-plantarflexion of the patients in the experiment group were statistically significant; the differences in inter-group comparisons of GVS scores of hip rotation of the patients in the experiment group were statistically significant; and the differences in the gait profile scores (GPS) and gait deviation indices of the patients in the experiment group were statistically significant. The differences in the intra-group comparisons were statistically significant. The within-group comparisons of AOS score, AOFAS-AHS score, GPS score and GVS score of ankle dorsiflexion-plantarflexion were statistically significant in the control group patients.ConclusionsElectroacupuncture has shown promise as an adjunctive therapy for patients with AOA, offering a more holistic rehabilitation strategy. By improving joint mobility and optimizing gait mechanics, electroacupuncture can effectively reduce pain, facilitate the restoration of normal gait patterns, and enhance patients' overall quality of life.

Our aim is to investigate the effects of a innovative modular prone positioning tools on patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 during awake prone positioning (AW-PP). This prospective randomized controlled study initially enrolled 168 patients with COVID-19 due to ARDS. However, 92 were subsequently disqualified, leaving 76 patients who were randomly assigned to either the observation group (n = 38) or the control group (n = 38). The observation group utilized innovative modular prone positioning tools for non-invasive respiratory support (NIRS), while the control group used soft pillows for the same treatment. Data were collected on comfort levels, adverse events, and efficacy indicators. Additionally, the comfort, incidence of adverse events, and treatment efficacy in both groups were evaluated. The observation group had shorter the daily duration spent on executing the AW-PP (2.74 ± 0.86 min vs. 4.64 ± 1.02 min, P < 0.001), longer the daily total AW-PP (8.52 ± 1.01 h vs. 6.03 ± 0.66 h, P < 0.001), longer the daily duration until the first position adjustment (59.89 ± 12.73 min vs. 36.57 ± 8.69 min, P < 0.001), and lower the daily frequency of position adjustments during the AW-PP (11.03 ± 2.67 vs. 17.95 ± 2.58, P < 0.001) in comparison with the control group. No significant differences were observed in intubation rates, mortality, the daily number of hours under HFNO and NIV, escalated to NIV from HFNO, and hospital length of stay between the groups (P > 0.05). However, the observation group experienced significantly fewer adverse events, including kinking NIRS circuit, pain, shortness of breath, dizziness, and pressure ulcers (P < 0.05). Innovative modular prone positioning tools improved efficiency, comfort, and reduced adverse events during AW-PP but did not affect intubation rates or mortality.

PurposeThe aim of the study was to synthesize previous evidence and clarify the prevalence of developmental coordination disorder (DCD) in children by meta-analysis.MethodsA comprehensive computerized search of databases, including PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, and PsycINFO databases, was conducted to identify relevant national and international articles published before 18 December 2023 on DCD prevalence in children. The meta-analysis of prevalence was conducted using Stata 18.0.ResultsA total of 18 papers involving 31,203 patients were included. The prevalence of children with DCD was found to be 5%. A subgroup analysis showed that prevalence was 7% [95% confidence interval (CI) 4%–10%] and 4% (95% CI 3%–7%) for boys and girls, respectively; 4% (95% CI 2%–8%), 2% (95% CI 2%–2%), and 6% (95% CI 3%–10%) in Asia, Europe, and North America, respectively; and 18% (95% CI 8%–31%) and 6% (95% CI 4%–7%) for preterm (<37 weeks) and term infants (≥37 weeks), respectively. The prevalence of very low birth weight children (<1,250 g) with DCD was found to be 31%.ConclusionIn this study, we found that the prevalence of children with DCD in the general population was 5% and that preterm infants (<37 weeks) and very low birth weight infants (<1,250 g) have a higher prevalence of DCD and require early screening and regular follow-up.Systematic Review Registrationhttps://www.crd.york.ac.uk/, Identifier (CRD42024503320).