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IntroductionAthletes’ capability to perform activities with body rotation could be weakened by fatigue accumulation. Making pivot turning in unanticipated scenarios after fatigue may greatly challenge athletes’ ability to adapt rational motion strategies, elevating the risk of anterior cruciate ligament (ACL) injury. This study aimed to investigate the effects of fatigue and anticipation on biomechanical risk factors of ACL injury during 180° pivot turns in female soccer players.MethodsTwenty-one female soccer players were selected as participants. The participants performed anticipated turning maneuver before the fatigue intervention. The participants sprinted along the runway, decelerated and planted their foot on the force plate, and then executed a 180° pivot turn. For unanticipated tests, the pivot turn was mixed with side/cross-cuts, which were indicated to the participant using a custom-designed light system. The tests were repeated by the participant after receiving a fatigue intervention. Lower-limb joint angles and moments were characterized. Peak ground reaction forces (GRFs) and GRF loading rates were determined. Two-way repeated measures analysis of variance was applied to examine the effects of fatigue and anticipation on the variables of interest.ResultsCompared to the anticipated conditions, the approach speed was significantly lower in the unanticipated tests (P < 0.0001). Lower-limb kinematics showed varied angular patterns across conditions: greater hip joint variations in flexion, abduction, and internal rotation during unanticipated turns; consistent knee joint flexion and ankle plantarflexion with dorsiflexion observed mid-turn. Significant interactions (P = 0.023 to P = 0.035) between fatigue and anticipation influenced hip joint angles. Anticipation effects were notable at initial contact and peak ground reaction force, increasing hip, knee, and ankle joint angles (P < 0.0001 to P = 0.012). Participants showed consistent ground reaction force (GRF) patterns during pivot turns across fatigue and anticipation conditions, with the first peak occurring approximately 10% into the turn period. Significant interaction effects (P = 0.016) between fatigue and anticipation were observed for knee flex/extension moments at the first peak vertical GRF. Anticipation significantly increased first peak vertical (P < 0.0001), anteroposterior (P < 0.0001), and mediolateral (P < 0.0001) GRFs. Fatigue increased first peak vertical (P = 0.022), anteroposterior (P = 0.018), and mediolateral (P = 0.019) GRFs. Post-fatigue, participants exhibited reduced first peak GRFs and loading rates compared to pre-fatigue conditions, with higher rates observed in unanticipated turns (vertical GRF: P = 0.030; anteroposterior GRF: P < 0.0001).ConclusionFemale soccer players’ lower-limb Biomechanical characterization could be greatly affected by the change of anticipatory scenarios. With the associated increase of GRF, the risk of their ACL injury might be elevated. Fatigue affected female soccer players’ abilities on movement performances, but the interaction of these two factors could potentially weaken their knee’s functions during pivot turns. Cognitive training on unanticipated tasks may be important for rehabilitation training after ACL injury.

Objective: This study aimed at quantifying the difference in kinematic and joint moments calculation for lower limbs during gait utilizing a markerless motion system (TsingVA Technology, Beijing, China) in comparison to values estimated using a marker-based motion capture system (Nokov Motion Capture System, Beijing, China).Methods: Sixteen healthy participants were recruited for the study. The kinematic data of the lower limb during walking were acquired simultaneously based on the markerless motion capture system (120 Hz) and the marker-based motion capture system (120 Hz). The ground reaction force was recorded synchronously using a force platform (1,200 Hz). The kinematic and force data were input into Visual3D for inverse dynamics calculations.Results: The difference in the lower limb joint center position between the two systems was the least at the ankle joint in the posterior/anterior direction, with the mean absolute deviation (MAD) of 0.74 cm. The least difference in measuring lower limb angles between the two systems was found in flexion/extension movement, and the greatest difference was found in internal/external rotation movement. The coefficient of multiple correlations (CMC) of the lower limb three joint moments for both systems exceeded or equaled 0.75, except for the ad/abduction of the knee and ankle. All the Root Mean Squared Deviation (RMSD) of the lower limb joint moment are below 18 N·m.Conclusion: The markerless motion capture system and marker-based motion capture system showed a high similarity in kinematics and inverse dynamic calculation for lower limbs during gait in the sagittal plane. However, it should be noted that there is a notable deviation in ad/abduction moments at the knee and ankle.

Postural control impairment is one of the primary motor symptoms in patients with Parkinson’s disease, leading to an increased risk of falling. Several studies have been conducted on postural control disorders in Parkinson’s disease patients, but no relevant bibliometric analysis has been found. In this paper, the Web of Science Core Collection database was searched for 1,295 relevant papers on postural control in Parkinson’s disease patients from December 2011 to December 2021. Based on the Citespace knowledge graph, these relevant papers over the last decade were analyzed from the perspectives of annual publication volume, countries and institutes cooperation, authors cooperation, dual-map overlay of journals, co-citation literature, and keywords. The purpose of this study was to explore the current research status, research hotspots, and frontiers in this field, and to provide a reference for further promoting the research on postural control in Parkinson’s disease patients.

BackgroundChronic hypoxia induces pulmonary microvascular endothelial dysfunction. The left atrial pressure (LAP) represents the hydrostatic pressure of pulmonary microcirculation. The conjunction of the LAP and any abnormal pulmonary microvascular endothelial barrier function will have an impact on pulmonary exudation, resulting in prolonged mechanical ventilation. This study aimed to investigate the tolerance threshold of the pulmonary microcirculation to LAP in children with tetralogy of Fallot (TOF) to avoid prolonged mechanical ventilation after surgery.MethodsThis retrospective study included 297 Chinese patients who underwent TOF correction at Fuwai Hospital. Patients were categorized according to their preoperative oxygen saturation (SpO2) level. One-to-one propensity score matching (PSM) revealed a total of 126 participants in the SpO2

ObjectivesThe aim of the present study was to explore the prevalence and risk factors of sarcopenia without obesity (S) and sarcopenic obesity (SO) among community-dwelling older people in the Chongming District of Shanghai, China, according to the Asian Working Group for Sarcopenia (AWGS) 2019 Consensus as the diagnostic criteria of sarcopenia.MethodsIn this cross-sectional study, a total of 1,407 subjects aged ≥65 years were included, where the mean age of the subjects was 71.91 ± 5.59 years and their mean body mass index (BMI) was 24.65 ± 3.32 kg/m2. According to the Asian Working Group for Sarcopenia (AWGS) 2019 Consensus, sarcopenia was defined as a low appendicular skeletal muscle mass index (≤7.0 kg/m2 in males and ≤5.7 kg/m2 in females), decreased handgrip strength (9 h (OR = 1.881, 95% CI: 1.117–3.166, p = 0.017) were risk factors for SO.ConclusionOur study showed the high prevalence of S and SO among community-dwelling older people in the Chongming District. The SO was more prevalent in males. Behavioral factors and lifestyle (such as farming and sleep duration) were associated more with the development of S, while age and male gender were associated more with the development of SO.

BackgroundAs an easily accessible and intervened clinical indicator, preoperative pulse oximeter oxygen saturation (SpO2) is an important factor affecting the prognosis of patients with tetralogy of Fallot (TOF). However, whether SpO2 is associated with postoperative mechanical ventilation (MV) time remains unknown. Therefore, this study aimed to investigate the impact of preoperative SpO2 on postoperative prolonged mechanical ventilation (PMV) in children with TOF.Materials and methodsThe study included children younger than 18 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital, China. Univariate and multivariate logistic regression analyses were used to evaluate the influence of preoperative SpO2 on postoperative PMV. After identifying SpO2 as an independent risk factor for PMV, patients were further divided into two groups according to the cutoff value of SpO2, and propensity score matching (PSM) analysis was used to eliminate the effect of confounding factors. The logistic regression was used to compare the outcomes between the two groups after PSM.ResultsA total of 617 patients were finally enrolled in this study. By the univariable and multivariate logistic analysis, four independent risk factors for PMV were determined, namely, SpO2, surgical technique, aortic cross-clamp time, and intraoperative minimum temperature. According to the outcomes of 219 paired patients after PSM, the incidence of PMV was significantly higher in patients with lower preoperative SpO2 (P = 0.022). Also, there was significant increase in mechanical ventilation time (P = 0.019), length of intensive care unit stay (P = 0.044), postoperative hospital stay (P = 0.006), hospital stay (P = 0.039), and hospitalization cost (P = 0.019) at the lower preoperative SpO2 level.ConclusionLow preoperative SpO2 represents an independent risk factor of postoperative PMV in children with TOF.

BackgroundStudies have reported early liver dysfunction (LD) after cardiac surgery is associated with short and long-term mortality. In this study, we aimed to investigate risk factors for persistent LD after total cavopulmonary connection (TCPC) surgery.MethodsThis is a retrospective case-control study. We defined persistent LD as LDs occurring between postoperative day 1 (POD1) and POD7 and sustaining at least on POD7, while transient LD as LDs occurring between POD1 and POD7 and recovering at least on POD7. Multivariable logistic regression analysis was applied and central venous pressure (CVP) was considered continuously or in quantiles.ResultsPostoperative LD occurred in 111 (27.1%) patients. Transient and persistent LD occurred in 65 (15.9%) and 46 (11.2%) patients, respectively. Aortic cross-clamping (ACC) (odds ratio [OR] 2.55, 95% CI 1.26–5.14) and postoperative CVP (OR 1.34, 95% CI 1.18–1.51) were risk factors for persistent LD, also identified for postoperative any LD and transient LD. Adding postoperative CVP to the model only including ACC significantly improved persistent LD prediction (△AUC 0.15, p = 0.002). Compared with CVP ≤ 14 mmHg, adjusted ORs and 95% CI of persistent LD for CVP of 14–16 and >16 mmHg were 3.11 (1.24, 7.81) and 10.55 (3.72, 29.93), respectively. Patients with persistent LD might have a longer length of mechanical ventilation (mean difference, 13.5 h) and postoperative hospital stay (mean difference, 7 days), and higher postoperative costs (mean difference, 6.7 thousand dollars) compared to those with transient LD.ConclusionsIntra-operative application of ACC and postoperative elevated CVP were independent risk factors for persistent LD in pediatric patients following TCPC surgery. Compared to patients with transient LD, patients with persistent LD might have a longer length of mechanical ventilation and postoperative hospital stay, and higher postoperative costs. We should pay more attention to patients with high postoperative CVP to prevent their persistent LD occurrence.

Exosomes participate in many physiological and pathological processes by regulating cell-to-cell communication. This affects the etiology and development of diseases, such as osteoarthritis (OA). Although exosomes in the OA tissue microenvironment are involved in the progression of OA, exosomes derived from therapeutic cells represent a new therapeutic strategy for OA treatment. Recent studies have shown that exosomes participate in OA treatment by regulating the proliferation, apoptosis, inflammation, and extracellular matrix synthesis of chondrocytes. However, studies in this field are scant. This review summarizes the therapeutic properties of exosomes on chondrocytes in OA and their underlying molecular mechanisms. We also discuss the challenges and prospects of exosome-based OA treatment.

Background: Acute kidney injury (AKI) after cardiac surgery contributes to adverse outcomes. We aimed to assess the incidence and identify the predictors for persistent AKI after total cavopulmonary connection (TCPC) surgery.Methods: A retrospective study, including 465 children undergoing TCPC surgery from 2010 to 2019, was conducted. We used pRIFLE criteria to define AKI and defined persistent AKI as AKIs occurring between post-operative day1 (POD1) and POD3 and sustaining at least on POD7. Univariate and multivariate logistic regressions were applied to analyze the predictors for persistent AKI.Results: A total of 35.3% patients developed AKI between POD1 to POD3 and 15.5% patents had persistent AKI after TCPC. Patients with persistent AKI had prolonged mechanical ventilation and ICU stay, and had higher rates of renal replacement treatment and reintubation, which was associated with higher hospitalization costs and in-hospital mortality. The independent predictors for persistent AKI were peripheral oxygen saturation (SpO2) upon admission, intraoperative fluid balance, POD0 maximal lactic acid, renal perfusion pressure (RPP), POD0 estimated glomerular filtration rate and POD0 total bilirubin. The areas under receiver operating characteristic curve (AUC) in the total cohort and the subgroup undergoing TCPC surgery after 2017 were 0.75 (95% CI, 0.66–0.82) and 0.87 (95% CI, 0.77–0.97), respectively. The acceptable AUCs (nearly 0.7) were achieved in other 5 subgroups and good calibration ability (p ≥ 0.05) were achieved in the total cohort and all six subgroups.Conclusions: Persistent AKI after TCPC was common and strongly associated with poorer in-hospital outcomes in Chinese pediatric patients. Six perioperative variables, including SpO2, intraoperative fluid balance, POD0 maximal lactic acid, RPP, POD0 moderate-to-severe kidney injury and POD0 total bilirubin, were identified as independent predictors for persistent AKI. Our findings may help to perform an early risk stratification for these vulnerable patients and improve their outcomes.

A novel device has been developed to assess eccentric hamstring strength during the Nordic hamstring exercise (NHE) by measuring the contact force at the ankle hook (brace). The purpose of this study was to determine the correlation between the force measured at the ankle hook and the hamstring force estimated by a low extremity model. Thirteen male college sprinters were recruited to perform NHE on an instrumented device Nordbord (Vald Performance, Australia). Contact forces were measured at a sampling rate of 50 Hz at the hooks using the uniaxial load cells. 3D kinematics were measured simultaneously at a sampling rate of 200 Hz using a 16-camera motion analysis system (Vicon Motion Analysis, Oxford, United Kingdom) during the NHE. The data were processed with Visual 3D (C-Motion, Germantown, MD, United States) and OpenSim (NCSRR, Stanford, CA, United States) to calculate the knee joint center’s coordinates and hamstring moment arms during NHE. A static low extremity model was built to estimate the hamstring force during NHE. We have observed a significant but not very high correlation (r2 = 0.58) between peak hamstring force and the peak contact force at the ankle hook. The peak contact force measured at the ankle hook can only explain a little more than half of the variations in peak hamstring muscle forces during NHE. Caution must be exercised when assessing the eccentric hamstring strength using the ankle contact force during NHE.

Stroke survivors adopt cautious or compensatory strategies for safe and successful obstacle crossing. Although knee extensor spasticity is a common independent secondary sensorimotor disorder post-stroke, few studies have examined the step adjustment and compensatory strategies used by stroke survivors with knee extensor spasticity during obstacle crossing. This study aimed to compare the differences in the kinematics and kinetics during obstacle crossing between stroke survivors with and without knee extensor spasticity, and to identify knee extensor spasticity-related differences in step adjustment and compensatory strategies. Twenty stroke subjects were divided into a spasticity group [n = 11, modified Ashworth scale (MAS) ≥ 1] and a non-spasticity group (n = 9, MAS = 0), based on the MAS score of the knee extensor. Subjects were instructed to walk at a self-selected speed on a 10-m walkway and step over a 15 cm obstacle. A ten-camera 3D motion analysis system and two force plates were used to collect the kinematic and kinetic data. During the pre-obstacle phase, stroke survivors with knee extensor spasticity adopted a short-step strategy to approach the obstacle, while the subjects without spasticity used long-step strategy. During the affected limb swing phase, the spasticity group exhibited increased values that were significantly higher than those seen in the non-spasticity group for the following measurements: pelvic lateral tilt angle, trunk lateral tilt angle, medio-lateral distance between the ankle and ipsilateral hip joint, hip work contributions, the inclination angles between center of mass and center of pressure in anterior–posterior and medio-lateral directions. These results indicate that the combined movement of the pelvic, trunk lateral tilt, and hip abduction is an important compensatory strategy for successful obstacle crossing, but it sacrifices some balance in the sideways direction. During the post-obstacle phase, short-step and increase step width strategy were adopted to reestablish the walking pattern and balance control. These results reveal the step adjustment and compensatory strategies for obstacle crossing and also provide insight into the design of rehabilitation interventions for fall prevention in stroke survivors with knee extensor spasticity.

Background: Levosimendan, a calcium sensitizer, enhances the myocardial function by generating more energy-efficient myocardial contractility than that achieved through adrenergic stimulation with catecholamines. We conducted this meta-analysis to primarily investigate the effects of levosimendan on all-cause mortality in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass.Methods: The databases of Pubmed, Embase, and Cochrane Library were searched till 21st March 2020. The eligible criteria were participants with age

Background: The benefit–risk profile of perioperative corticosteroids in pediatric patients undergoing cardiac surgery remains controversial.Objective: To investigate the influence of perioperative corticosteroids on the postoperative mortality and clinical outcomes in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.Methods: We conducted a systematic search using MEDLINE, EMBASE, and Cochrane Database through August 31, 2019. We included randomized controlled trials comparing perioperative corticosteroids with other clinical interventions, placebo, or no treatment in children between 0 and 18 years of age undergoing cardiac surgery. The primary outcome of interest was all-cause in-hospital mortality. The secondary outcomes were length of intensive care unit stay (LOIS), duration of mechanical ventilation (DMV), postoperative insulin therapy, postoperative low cardiac output syndrome (LCOS), postoperative infection, maximal temperature (Tmax) in the first 24 h postoperatively, urine output (UO) in the first 24 h postoperatively, serum lactate at postoperative day (POD) 1, blood glucose at POD 1, vasoactive inotrope score (VIS) at POD 1, and postoperative acute kidney injury (AKI). Study quality was assessed using the Cochrane Risk of Bias Assessment Tool.Results: Our analysis included 17 studies and 848 pediatric patients. The data demonstrated that children receiving corticosteroids showed no significant difference on the all-cause in-hospital mortality with a fixed-effect model (RR = 0.59, 95% CI = 0.28–1.25, P = 0.55) compared with controls. For the secondary outcomes, corticosteroids had a statistically significant reduction on the VIS at POD1 (MD = −2.04, 95% CI = −3.96 −0.12, P = 0.04), while it might be significantly associated with an increased blood glucose at POD1 (MD = 1.38, 95% CI = 0.68–2.09, P = 0.0001) and a 2.69-fold higher risk of postoperative insulin therapy (RR = 2.69, 95% CI = 1.37–5.27, P = 0.004). No statistical significance was shown in other secondary outcomes.Conclusion: Perioperative corticosteroids might not significantly improve clinical outcomes identified as mortality, LOIS, DMV, AKI, and LCOS other than VIS at POD1. However, it might increase the blood glucose and episodes of insulin therapy. Perioperative corticosteroids to attenuate the inflammatory response are not supported by available evidence from our study. Further results from ongoing randomized controlled trials with a larger sample size are required.

Background: Prolonged pleural effusion (PPE) contributes to adverse outcomes after total cavopulmonary connection (TCPC) completion. We aimed to identify risk factors for PPE following TCPC surgery.Methods: We studied a retrospective cohort of 525 who undergoing TCPC surgery from 2010 to 2019. We defined PPE as the duration of pleural effusion exceeding 14 days. Logistic regression was applied to identify risk factors for PPE and Cox regression was used to identify risk factors for predicting the duration of pleural effusion. The impacts of PPE on the short-term outcomes were evaluated.Results: The rate of PPE was 27.4% in our study and independent risk factors for PPE included: young age, no fenestration, low postoperative total protein, prolonged mechanical ventilation and chylothorax. These predictors were also achieved in the Cox regression for predicting the duration of pleural effusion. The applicability of the model was acceptable in different subgroups, which derived from the total cohort. Patients with PPE were associated with more renal replacement treatment, longer length of ICU and hospital stay, more hospitalization costs and a higher rate of in-hospital mortality.Conclusions: PPE in our study occurs at a relatively lower rate than that reported in previous studies and patients with PPE was associated with higher rate of in-hospital mortality when compared to patients without PPE. Young age, no fenestration, low postoperative total protein, prolonged mechanical ventilation, and chylothorax were identified as independent risk factors to predict PPE. A preventive strategy that targets the identified risk factors to reduce the incidence of PPE following TCPC surgery could be beneficial for in-hospital outcomes, and the model needs further validation before its application.

Background: Cigarette smoking is associated with sexual dysfunction in the general population. Both smoking and sexual dysfunction are common in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT), but their association in MMT HDPs is rarely studied. This study examined the association between smoking and sexual dissatisfaction in Chinese HDPs receiving MMT. Methods: In total, 480 Chinese HDPs, who had sex with their regular or irregular sex partners within one month prior to the study, were included from three MMT clinics in Wuhan, China. Sexual dissatisfaction was assessed with one single question. Socio-demographic and clinical data and smoking characteristics were collected with a standardized questionnaire. Multiple binary logistic regression was used to analyze the association between smoking and sexual dissatisfaction, as well as the associations between levels of smoking and nicotine dependence and sexual dissatisfaction. Results: The prevalence of current smoking was 95.6% in HDPs receiving MMT. Rates of sexual dissatisfaction were higher in current smokers than non-smokers (32.9% vs. 14.3%) with a borderline significant P value of 0.074. After adjusting potential socio-demographic and clinical confounders, current smoking was significantly linked to sexual dissatisfaction (OR = 1.95, P = 0.026), and heavy smoking and severe nicotine dependence were significantly linked to sexual dissatisfaction (OR = 1.80, P = 0.025; OR = 3.27, P < 0.001). Conclusion: Smoking is significantly associated with sexual dysfunction in HDPs receiving MMT. It deserves further investigation as to whether quitting smoking can improve the sexual function of methadone-maintained patients. [ABSTRACT FROM AUTHOR]

Background: There is paucity of data regarding the prevalence and methods of deliberate self-harm (DSH) in patients with heroin dependence in international literature. In China, there have been a few studies investigating the prevalence of DSH in heroin-dependent patients (HDPs), but their rates varied widely. We thus conducted a meta-analysis of studies assessing the prevalence of DSH among Chinese HDPs. Methods: Relevant studies were retrieved from major Chinese databases (China National Knowledge Infrastructure, Wanfang data, and SinoMed) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently identified eligible studies and extracted data. Studies that included a representative sample of Chinese HDPs and ascertained DSH caseness in a reliable way were considered as high quality. Statistical analysis was performed using R software. Results: In total, 15 eligible studies with a total of 37,243 Chinese HDPs were included. All included studies were conducted in heroin detoxification settings. Only two studies were rated as high quality. The pooled prevalence of DSH in Chinese HDPs was 4.4% (95%CI: 2.9, 6.2%), but the heterogeneity of prevalence rates across studies was significant (I2 = 98%, P < 0.001). Studies rated as high quality had significantly higher prevalence of DSH than those rated as low quality (13.2 vs. 3.4%, P < 0.001). Swallowing foreign objects was the most common method of DSH, with a combined prevalence of 2.7% (95%CI: 1.6, 4.4%). Extreme DSH methods such as cutting off fingers and jumping from height were also not uncommon in this patient population. Conclusion: Due to methodological problems in available studies, we find a relatively low prevalence of DSH among Chinese HDPs receiving detoxification treatment. Nevertheless, the self-harmers of Chinese HDPs are more likely to harm themselves in a dangerous or life-threatening way. Restricting the availability of DSH methods may be an effective way to prevent or reduce DSH in China's detoxification treatment settings. [ABSTRACT FROM AUTHOR]

The Late Pleistocene-Holocene climate fluctuations have greatly influenced the phylogeographic structure and historical dynamics of many marine organisms in the western Pacific marginal seas. Here, we investigated the impact of Pleistocene glacial-interglacial cycles on the phylogeographic structure and demographic dynamics of Decapterus maruadsi, an economically important fish along the coast of the East China Sea (ECS) and northern South China Sea (NSCS). We obtained 430 concatenated sequences (Cyt b + control region, 1548–1554 bp) of D. maruadsi, including 246 newly sampled from the ECS and 184 previously determined from the NSCS. Genetic structure and phylogenetic analysis demonstrated a lack of significant population structure among 16 populations. Moreover, there was no significant differentiation among populations from Chinese coastal waters and northern Vietnam. Neutrality tests, unimodal mismatch distributions, Bayesian skyline plots, and the star-like haplotype networks all indicated a recent demographic expansion for D. maruadsi population during the Late Pleistocene-Holocene, explaining the low genetic diversity in D. maruadsi along the southeast coast of China. Notably, phylogenetic analyses and net genetic distances based on Cyt b jointly confirmed that 57 Cyt b haplotypes identified as D. maruadsi from the previously defined Sundaland-Rosario-Ranong clade actually represented D. russelli. These results not only reveal the complex effects of Pleistocene-Holocene climate fluctuations on the phylogeographic structure and demographic history of D. maruadsi but also provide useful genetic information for the management of genetic resources.

Pearl gentian grouper (Epinephelus fuscoguttatus ♀ × E. lanceolatus ♂) is a hybrid fish with high commercial value. It is widely cultured on the Asian coast; however, it is not cold-tolerant. Although we have previously characterized the liver transcriptomic responses of this grouper to cold stress, the roles of miRNAs and transcription factors (TFs) in cold resistance and the underlying regulatory mechanisms are still unclear. In this study, we integrated miRNA and mRNA sequencing data for pearl gentian grouper under cold stress and constructed a miRNA-TF-mRNA regulatory network. Furthermore, we screened seven key miRNAs (i.e., gmo-miR-221-5p, ssa-miR-7132b-5p, ola-let-7c, ssa-miR-25-3-5p, ccr-miR-489, gmo-miR-10545-5p, ccr-miR-122) that regulated target genes (including TF ACSS2, TF PPARD, TF PPP4CB; CYP2J2, EHHADH, RXRs, NR1D2, PPP1CC-A, PPP2R1A, FOXK2, etc.). These miRNAs participated in several important pathways and biological processes by the direct or indirect regulation of target genes, such as antioxidation and membrane fluidity, glucose and lipid metabolism, circadian rhythm, DNA repair, and apoptosis. The key cold-related miRNAs, TFs, and genes and their potential regulatory relationships identified in this study provide a deeper understanding of the complex molecular basis of the response to low-temperature environments in the grouper. In particular, our results provide the first identification for the role of NR1D2 gene in the cold tolerance of fish via the regulation of circadian rhythm. Furthermore, the key miRNAs and genes provide a basis for the molecular breeding of new cold-tolerant varieties of the pearl gentian grouper.