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To translate, adapt, and validate the Simplified Chinese Athlete Sleep Behavior Questionnaire (ASBQ-CN) for both adolescent and adult athletes. Cross-sectional psychometric evaluation. A total of 480 Chinese athletes (19.9 ± 4.4 years) and 408 non-athletes (23.3 ± 3.9 years, for discriminant validity evaluation) were recruited. Psychometric testing included internal consistency, test-retest reliability, content validity, exploratory and confirmatory factor analyses, and convergent and discriminant validity. For robust factor analysis of ordinal data, parallel analysis with polychoric correlations and ordinary least squares estimations were choose. The ASBQ-CN demonstrated acceptable internal consistency (Cronbach's αtotal of 0.76) and test-retest reliability (intraclass correlation coefficient of 0.78). The standard error of measurement and minimal detectable change were 3.13 and 8.67, respectively. Content validity achieving indices of 1.0 at toth item- and scale-level. Factor analyses supported a four-factor structure with acceptable model fit indices (comparative fit index = 0.95, Tucker Lewis index = 0.94, root mean square error of approximation = 0.06, and standardized root mean square residual = 0.09). Convergent validity was confirmed by moderate correlations with the Pittsburgh Sleep Quality Index (rtotal = 0.44) and Sleep Hygiene Index (rtotal = 0.50). Although total ASBQ-CN scores did not significantly differ between athletes and non-athletes, significant item-level differences were identified (p < 0.0028). Furthermore, athletes with poor sleep hygiene showed significant higher ASBQ-CN score (p < 0.001). The ASBQ-CN is a valid and reliable instrument for evaluating sleep behavior in both adolescent and adult Chinese athletes, which could inform personalized interventions.

Background Decreased strength and increased stiffness of the quadriceps have been associated with a higher risk of developing knee osteoarthritis (OA) in elders. Dynamic joint stiffness (DJS) represents collective resistance from active and passive knee structures for dynamic knee motions. Elevated sagittal knee DJS has been associated with worsening of cartilage loss in knee OA patients. Altered quadriceps properties may affect DJS, which could be a mediator for associations between quadriceps properties and knee OA. Hence, this study aimed to examine whether DJS and quadriceps properties would be associated with the development of clinical knee OA over 24 months, and to explore the mediation role of DJS in associations between quadriceps properties and knee OA. Methods This was a prospective cohort study with 162 healthy community-dwelling elders. Gait analysis was conducted to compute DJS during the loading response phase. Quadriceps strength and stiffness were evaluated using a Cybex dynamometer and shear-wave ultrasound elastography, respectively. Knee OA was defined based on clinical criteria 24 months later. Logistic regression with generalized estimating equations was used to examine the association between quadriceps properties and DJS and incident knee OA. Mediation analysis was performed to explore the mediation role of DJS in associations between quadriceps properties and the incidence of knee OA. Results A total of 125 participants (65.6 ± 4.0 years, 58.4% females) completed the 24-month follow-up, with 36 out of 250 knees identified as clinical knee OA. Higher DJS (OR = 1.86, 95%CI: 1.33–2.62), lower quadriceps strength (1.85, 1.05–3.23), and greater quadriceps stiffness (1.56, 1.10–2.21) were significantly associated with a higher risk of clinical knee OA. Mediation analysis showed that the DJS was not a significant mediator for the associations between quadriceps properties and knee OA. Conclusions Higher sagittal knee dynamic joint stiffness, lower quadriceps strength, and greater quadriceps stiffness are potential risk factors for developing clinical knee OA in asymptomatic elders. Associations between quadriceps properties and knee OA may not be mediated by dynamic joint stiffness. Interventions for reducing increased passive properties of the quadriceps and knee joint stiffness may be beneficial for maintaining healthy knees in the aging population.

Background Although aerobic exercise is widely recommended to enhance cardiopulmonary fitness and mitigate cardiovascular risk, the efficacy and effectiveness of aerobic exercise interventions have not been comprehensively evaluated among people with knee osteoarthritis (OA). This systematic review and meta-analysis aimed to synthesize the current evidence on the impact of aerobic exercise on cardiopulmonary fitness in people with knee OA. Methods PubMed, Embase, Scopus, and Web of Science were searched from inception to March 1, 2024, for randomized controlled trials (RCTs). Eligible RCTs included those with an aerobic exercise intervention (e.g., aerobic walking, cycling, aquatic aerobics), a primary outcome of maximum oxygen consumption (VO 2 max), and participants with knee OA. The aerobic exercise programs were compared to control interventions (e.g., education, light-intensity exercise, usual activities, and routine care). Secondary outcomes included distance (m) walked during the six-minute walk test (6MWD), and Patient-Reported Outcome Measures (i.e., pain score and disability score). The overall level of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Out of 988 studies, 5 RCTs with 459 people with knee OA were included in the analysis. Aerobic exercise programs included walking, cycling, jumping, stepping, and aquatic aerobics. Pooled mean differences and 95% confidence intervals (CIs) were 0.90 ml/kg/min (95% CI 0.43 to 1.38; moderate evidence), 46.97 m (95% CI 33.71 to 60.23; high evidence), 5.59 points (95% CI 2.93 to 8.25; low evidence), and 3.03 points (95% CI 1.05 to 5.01; moderate evidence) for VO 2 max, 6MWD, pain and disability, respectively. Conclusion These results support the hypothesis that aerobic exercise can elicit improvements in cardiopulmonary fitness for people with knee OA. Future research should focus on optimizing current exercise regimens for people with knee OA and exploring how to improve adherence while minimizing symptom exacerbation by other exercise modalities, e.g., Nordic walking and inspiratory muscle training. Systematic review registration CRD42022340966, 07/07/2022, PROSPERO.

The COVID-19 pandemic has exerted a significant toll on individual health and the efficacy of health care systems. However, the influence of COVID-19 on the frequency and outcomes of out-of-hospital cardiac arrest (OHCA) within the Chinese population, both before and throughout the entire pandemic period, remains to be clarified. This study aimed to fill the gaps by investigating the prevalence and outcomes of OHCA in Hong Kong (HK) both before and during the whole pandemic period. This is a retrospective regional registry study. The researchers matched OHCA data with COVID-19-confirmed case records between December 2017 and May 2023. The data included information on response times, location of OHCA, witness presence, initial rhythm, bystander cardiopulmonary resuscitation (CPR), use of public-access defibrillation, resuscitation in the accident and emergency department, and survival to admission. Descriptive analyses were conducted, and statistical tests such as analysis of variance and χ were used to examine differences between variables. The incidence of OHCA and survival rates were calculated, and logistic regression analysis was performed to assess associations. The prevalence of OHCA and COVID-19 during the peak of the pandemic was also described. A total of 43,882 cases of OHCA were reported in HK and included in our analysis. Around 13,946 cases were recorded during the prepandemic period (2017-2019), and the remaining 29,936 cases were reported during the pandemic period (2020-2023). During the pandemic period, the proportion of female patients increased to 44.1% (13,215/29,936), and the average age increased slightly to 76.5 (SD 18.5) years. The majority of OHCAs (n=18,143, 61.1% cases) occurred at home. A witness was present in 45.9% (n=10,723) of the cases, and bystander CPR was initiated in 44.6% (n=13,318) of the cases. There was a significant increase in OHCA incidence, with a corresponding decrease in survival rates compared to the prepandemic period. The location of OHCA shifted, with a decrease in incidents in public places and a potential increase in incidents at home. We found that CPR (odds ratio 1.48, 95% CI 1.17-1.86) and public-access defibrillation (odds ratio 1.16, 95% CI 1.05-1.28) were significantly associated with a high survival to admission rate during the pandemic period. There was a correlation between the development of OHCA and the prevalence of COVID-19 in HK. The COVID-19 pandemic has had a significant impact on OHCA in HK, resulting in increased incidence and decreased survival rates. The findings highlight the importance of addressing the indirect effects of the pandemic, such as increased stress levels and strain on health care systems, on OHCA outcomes. Strategies should be developed to improve OHCA prevention, emergency response systems, and health care services during public health emergencies to mitigate the impact on population health.

This study examined the recovery of smell and taste after SARS-CoV-2 viral-clearance and explored biological factors associated with chemosensory outcomes. Participants were enrolled at 3, 6, or 12 months (Group 1, 2 and 3) after viral-clearance (Visit 1) and re-evaluated three months later (Visit 2). Chemosensory functional tests were performed, and biomarkers related to protein aggregation and neurodegeneration, astroglial activation, neuronal injury, and oxidative stress were measured. 120 participants were recruited. In the cohort, gustatory function had largely normalised at the first visit across all groups and remained stable at follow-up. In contrast, significant improvement in olfactory function was observed within 3–6 months post–viral clearance (Group 1), while Groups 2 and 3 exhibited stable olfactory performance at subsequent follow-up assessments. Biomarker α-synuclein is significantly correlated with olfactory performance, however, plasma concentration did not exhibit a significant decline until approximately one-year post-recovery (Group 3), suggesting a delayed biomarker response relative to clinical symptom resolution. These findings suggest that protein aggregation–related processes or underlying susceptibility may be associated with SARS-CoV-2–related olfactory dysfunction. Further long-term mechanistic studies are warranted.

Background This study aimed to investigate the association between sensor-based assessment of daily physical activity patterns and physical fitness among older adults by meta-analyses of relevant studies. Methods A systematic search was conducted across six databases (PubMed, CINAHL by EBSCOhost, Web of Science, PsycInfo by ProQuest, Embase, and Scopus) from inception until January 18, 2025. Manual searches of reference lists and Google Scholar were also performed, utilizing predefined keywords to identify observational studies with bivariate association analyses. Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies was employed to assess study quality. The association analyses were further categorized based on the characteristics of daily activity (sedentary, light, moderate-to-vigorous) and physical fitness (e.g., grip strength, knee muscle strength, leg power, walking endurance, mobility function, and gait speed). Results Thirteen cross-sectional studies were included in the meta-analyses. On average, older adults spent 78% of their day sedentary, 15% in light-intensity activity, and 7% in moderate-to-vigorous activity. Sedentary behavior was linked to lower physical fitness ( to ), while moderate-to-vigorous activity was linked to better fitness ( to 0.43); light-intensity activity showed only weak and selective associations with better mobility function and gait speed ( to 0.26). Conclusion This review shows that while older adults spend much of their day sedentary, both moderate-to-vigorous and light-intensity physical activity are linked to better physical fitness. Promoting light-intensity activities may be a practical strategy to support mobility and independence, especially for those unable to meet higher activity guidelines. However, recommendations should remain cautious, as the evidence supporting an association between light-intensity physical activity and physical fitness is currently weak. PROSPERO registration The protocol of this systematic review was registered on PROSPERO (Registration number: CRD42023471302).

Early osteoarthritis (EOA) detection is crucial for timely intervention, yet current methods often fail to identify early-stage disease. The popliteal crease obliquity angle (PCOA) shows promise as a novel anatomical marker, but its relationship with functional movement patterns remains unclear. This cross-sectional study employed a two-phase machine learning approach in 43 manufacturing workers (86 legs, aged 40-70 years). Phase I used regression analysis to predict PCOA from step-down frontal plane kinematics using five algorithms. Phase II applied PCOA measurements to classify EOA status based on the Early Osteoarthritis Questionnaire. Performance was evaluated using coefficient of determination (R ) and area under the curve (AUC). To interpret and explain the predictions, we used SHapley additive explanation values and partial dependence analysis. Extreme gradient boosting achieved optimal Phase I performance in predicting PCOA from step-down kinematics (R =0.668) on the hold-out test set. Femur horizontal displacement (valgus movement), pelvis horizontal displacement, and ankle horizontal displacement were key predictors. Random Forest demonstrated superior Phase II performance (AUC=0.885, accuracy=0.824) on the hold-out test set, with PCOA as the dominant feature. Partial dependence analysis identified a critical 7° threshold above which EOA probability increased. This study establishes a strong functional-anatomical relationship between step-down kinematics and PCOA, demonstrating PCOA's association with EOA status. The 7° threshold, measurable via smartphone photography, offers a practical alternative to complex kinematic analysis for early OA screening in clinical practice.

Background In aging, muscle stiffness is considered as one of the factors associated with the reduction of force generation capability. There have been inconsistent findings on age-related alteration in the passive stiffness of quadriceps muscle in the female adults. Thus, the aim of this study was to determine the effect of aging on the shear moduli of the superficial muscle heads of the quadriceps and to explore its relationship with knee extension force. Methods Passive shear moduli of the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) were measured at rest using shear wave elastography in 20 young and 20 senior female adults. Measurements were repeated at four knee joint positions, that is, 30°, 60°, 90°, and 105° of knee flexion. Maximal isometric voluntary knee extension force was assessed at 30°, 60°, and 90° of knee flexion. Results As per our findings, senior adults were determined to have significantly higher passive muscle shear moduli in the RF (by 34% – 68%; all p  < 0.05) and the VL muscle heads (by 13%–16%, all p  < 0.05) at and beyond 60° of knee flexion. Age-related increase in the VM was evident at 105° knee flexion (by11%, p  = 0.020). The RF shear modulus was negatively correlated to the maximal isometric voluntary contraction force measured at 60° ( r  =  − 0.485, p  = 0.030) in senior adults. Conclusions Senior female adults had greater passive stiffness at the superficial muscle heads of the quadriceps muscles when measured at long muscle length. Among the senior female adults, the passive stiffness of RF has been determined to have a negative association with the knee extensor force only at 60° knee flexion. No significant association was noted for other angles and muscles.

Characterization of the elastic properties of a tendon could enhance the diagnosis and treatment of tendon injuries. The purpose of this study was to examine the correlation between the shear elastic modulus on the patellar tendon captured from a Supersonic Shear Imaging (SSI) and the tangent traction modulus computed from a Material testing system (MTS) on 8 fresh patellar pig tendons (Experiment I). Test-retest reliability of the shear elastic modulus captured from the SSI was established in Experiment II on 22 patellar tendons of 11 healthy human subjects using the SSI. Spearman Correlation coefficients for the shear elastic modulus and tangent traction modulus ranged from 0.82 to 1.00 (all p<0.05) on the 8 tendons. The intra and inter-operator reliabilities were 0.98 (95% CI: 0.93-0.99) and 0.97 (95% CI: 0.93-0.98) respectively. The results from this study demonstrate that the shear elastic modulus of the patellar tendon measured by the SSI is related to the tangent traction modulus quantified by the MTS. The SSI shows good intra and inter-operator repeatability. Therefore, the present study shows that SSI can be used to assess elastic properties of a tendon.

Standardization on Shear wave ultrasound elastography (SWUE) technical settings will not only ensure that the results are accurate, but also detect any differences over time that may be attributed to true physiological changes. The present study evaluated the variations of elastic modulus of muscle and tendon using SWUE when different technical aspects were altered. The results of this study indicated that variations of elastic modulus of muscle and tendon were found when different transducer's pressure and region of interest (ROI)'s size were applied. No significant differences in elastic modulus of the rectus femoris muscle and patellar tendon were found with different acquisition times of the SWUE sonogram. The SWUE on the muscle and tendon should be performed with the lightest transducer's pressure, a shorter acquisition time for the SWUE sonogram, while measuring the mean elastic modulus regardless the ROI's size.