Journal articles on the topic 'Adrenaline sports'

Background and Study Aim. Stimulation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis are a crucial mechanism of adaptation to physical exercise, in particular in combat sports. This study assesses changes of the relevant hormonal profiles upon performance in selected combat sports. Material and Methods. Participants (130 men practicing combat sports at a high level) were divided by discipline: karate (K), taekwondo (T), and judo, wrestling, and sumo combined (JWS). Blood concentration of adrenaline, noradrenaline, cortisol, testosterone, and brain-derived neurotrophic factor (BDNF) was determined before and after fighting. Results. Following fighting, the adrenaline concentration was significantly higher in all athletes, most markedly in K ( p < 0.001 ). Baseline cortisol and BDNF levels did not differ among the groups and rose significantly in all the groups after the performance. Baseline testosterone concentration was slightly higher in K than in JSW and rose in all the groups to reach similar levels; the increase in T was significantly higher than in K. Conclusions. Despite substantial differences in the characteristics of the combat sports investigated, including the type of physical effort and the required balance between restraint and aggression, the performance in each of them gives rise to similar hormonal changes with a possible exception of karate showing higher stress hormone levels.

Extreme sports are sport branches which include actions, adventures, risks and difficulties more rather than other sports. Special materials are used in sport branches such as surfing, kite surfing, sailing, snowboarding, paragliding, diving, mountaineering, motor sports and adrenaline release is more rather than in other sport branches. On the contrary, the situation for being eager to seek excitement and take risks with a view to having new experiences has been observed. It has been considered whether sensation seeking requirement and risk-taking behavior had effects upon each other. The aim of the study was to analyze sensation seeking and risk-taking behavior in extreme athletes. Total 101 extreme athletes including 31 females, 70 males with an age average of 22.03 ± 6.77 participated in the research. In order to determine athletes’ sensation seeking levels, “Arnett Inventory of Sensation Seeking” developed by Arnett (1994) and in order to determine their risk-taking behavior, “Risk Involvement and Perception Scale” developed by Siegel et al. (1994) were used. In evaluation of research data, frequency analysis, independent t test, in determination of relation between risk-taking and sensation seeking, correlation test were utilized.In conclusion, significant differences were found in risk-taking behavior, sensation seeking requirement and gender variable among the extreme athletes. In the male athletes sensation seeking requirement and risk-taking behavior had higher averages than the female athletes. Among the extreme athletes, significant relations were determined between risk-taking behavior and sensation seeking requirement. When risk-taking behavior values were high, sensation seeking requirement values were regarded to be high.

The authors give an explanation of individually dosed heat-cold treatments in combination with electro laser myostimulation and external contre-pulsation carried out at 70 athletes aged 28-32 years involved in cyclic sports. The results of clinical and biochemical laboratory tests, determination of adrenaline and noradrenaline by liquid chromatography, the content of vitamins and betacarotene - demonstrated normalization of auto-nomic functions, such as reducing the signs of emotional stress.

Local infiltration anaesthesia with a bloodless operation field (WALANT) allows for performing hand surgery without a tourniquet. This effect is obtained through an injection of greater than standard volume of the anaesthetic solution composed of lignocaine and adrenaline. The addition of adrenaline induces spasm of small arteries within the infiltration area, which inhibits bleeding and allows visualization of most of the subtle but important structures in the hand and fingers. This article presents a method of preparation of the anaesthetic solution and the technique of anaesthesia for several common procedures in hand surgery. In 2019, our centre performed 340 operations under WALANT anaesthesia, with no serious complications observed. Data from the literature are presented showing that this technique is attracting increasing popularity worldwide. Our centre was the first in Poland to introduce the WALANT method to hand surgery.

Abstract: Dusun Kinahrejo has diverse and interesting regional characteristics, with a dynamic regional order in the development of tourist areas. Kinahrejo hamlet is located in an area prone to eruption of Merapi, which is on the slopes of Mount Merapi Umbulharjo village, Cangkringan, Sleman. The declining interest of tourists during the visit in 2015 has an impact on the sustainability of the tourism potential and the economy of the people who rely heavily on the tourism sector. So the passion of the attraction of existing tourism potential needs to be improved and new potential that can increase the interest of tourists to visit. This research uses descriptive qualitative research method. Data were collected through observation, interviews, and documentation. While data analysis is done through (1) data reduction; (2) data presentation; and (3) conclusion/verification. The tourism potential of dusun Kinahrejo is diverse, all of them berinduk on nature tourism (ecotourism); There is a passive and active nature tour: the main attractions enjoy nature as scenery, nature as a sports arena, nature as a vehicle of adrenaline triggers, and there are support tours. The continuity of tourism in dusun Kinahrejo is highly dependent on community participation. Potential development of dusun Kinahrejo has 5 tourism potential, 1) religious tourism and cultural pilgrimage of dusun Kinahrejo, 2) nature tourism, 3) adrenaline tourism, 4) culinary tourism and 5) comunal farming of agro-agricultural.Keywords: tourism potential, area characteristics and sustainabilityAbstraksi: Dusun Kinahrejo memiliki karakteristik wilayah yang beragam dan menarik, dengan tatanan kawasan yang dinamis dalam pengembangan kawasan wisata. Dusun Kinahrejo berada pada kawasan rawan bencana erupsi Merapi, yaitu pada lereng gunung Merapi desa Umbulharjo, Cangkringan, Sleman. Menurunya minat wisatawan dalam kunjungan tahun 2015 berdampak keberlanjutan potensi wisata dan perekonomian warga yang banyak bergantung pada sektor pariwisata. Gairah dan daya tarik potensi wisata yang ada perlu ditingkatkan dan potensi baru yang dapat meningkatkan minat wisatawan untuk berkunjung. Penelitian ini menggunakan metode penelitian deskriptif kualitatif. Data dikumpulkan melalui observasi, wawancara, dan dokumentasi. Sementara itu, analisis data dilakukan melalui (1) reduksi data; (2) penyajian data; dan (3) penarikan kesimpulan/verifikasi. Potensi wisata dusun kinahrejo beragam, semua berinduk pada wisata alami (ekowisata); ada wisata alam pasif dan aktif: wisata utama menikmati alam sebagai pemandangan, alam sebagai arena olahraga, alam sebagai wahana pemicu adrenalin, dan ada wisata pendukung. Keberlanjutan wisata di dusun Kinahrejo sangat tergantung pada partisipasi masyarakat. Pengembangan potensi dusun Kinahrejo memiliki 5 potensi wisata yaitu, 1) wisata religi dan budaya ziarah Kinahrejo, 2) wisata jelajah alam, 3) wisata adrenalin, 4) wisata kuliner dan 5) agrowisata peternakan sapi perah komunal.Kata kunci: potensi wisata, karakteristik wilayah dan keberlanjutan

Context: Night games are a regular occurrence for team-sport athletes, yet sleep complaints following night competitions are common. The mechanisms responsible for reported sleep difficulty in athletes are not understood. Methods: An observational crossover design investigating a night netball game and a time-matched rest day in 12 netball athletes was conducted to ascertain differences in physiological (core temperature), psychometric (state and trait), and neuroendocrine (adrenaline, noradrenaline, and cortisol) responses. Results: Following the night game, athletes experienced reduced sleep durations, lower sleep efficiency, early awakenings, and poorer subjective sleep ratings compared with the rest day. No differences were found between core temperature, state psychometric measures, and cortisol at bedtime. Adrenaline and noradrenaline concentrations were elevated compared with the time-matched rest day prior to (26.92 [15.88] vs 12.90 [5.71] and 232.6 [148.1] vs 97.83 [36.43] nmol/L, respectively) and following the night game (18.67 [13.26] vs 11.92 [4.56] and 234.1 [137.2] vs 88.58 [54.08] nmol/L, respectively); however, the concentrations did not correlate to the sleep variables (duration, efficiency, and sleep-onset latency). A correlation (rs = −.611) between sleep efficiency and hyperarousal (trait psychometric measure) was found. Conclusions: Athletes experienced poor sleep following a night game. Furthermore, results suggest that athletes who have a tendency toward a high trait arousal may be more susceptible to sleep complaints following a night game. These data expand knowledge and refute frequently hypothesized explanations for poor sleep following night competition. The results may also help support staff and coaches target strategies for individual athletes at a higher risk of sleep complaints.

Aim. The paper deals with the adrenergic reactivity of erythrocytes and its connection with quantitative and qualitative characteristics of cells in young women with different levels of motor activity depending on the rs4646994(I/D) polymorphic variant of the angiotensin-converting enzyme (ACE) gene. Materials and methods. Young female students took part in the study: the 1st group (n = 33) included young women with a relatively inactive lifestyle, the 2nd group (n = 18) included those regularly involved in sports activity (volleyball and lapta). Red blood cells were counted with the ADVIA 60 hematology analyzer (BAYER, Germany). The adrenergic reactivity of erythrocytes (ARE) was assessed by changes in erythrocyte sedimentation rate (ESR) under the effect of adrenaline in vitro in final concentrations of 10–5; 10–6; 10–7; 10–8 (stress concentration – SCA) and 10–9; 10–11; 10–13 (physiological concentration – PCA) g/ml. The type of the adrenergic reactivity of erythrocytes was established depending on the direction of ESR changes in the presence of adrenaline – aggregative (Ag) with an ESR increase, anti-aggregative (AnAg) with a ESR decrease, and affectless (Af). The average and maximum values of changes were also taken into account. PCR analysis was performed on the rs4646994 polymorphic variant of the ACE gene. Results. A direct correlation was found between the I/D polymorphism of the ACE gene with average values of ARE when exposed to PCA (R = 0.52, P = 0.04), with the maximum ESR change under the effect of SCA (R = 0.52, P = 0.04), as well as with the direction of ESR changes induced by adrenaline (R = 0.55, P = 0.03). Thus, among individuals with the I/D genotype erythrocyte aggregation prevails, while female athletes with the D/D genotype are not characterized by the same type of ARE. Conclusion. Young female athletes, carriers of the D/D genotype of the АСЕ gene, are the most resistant to the effect of both PCA and SCA.

The article proves scientific and social importance of studying the impact of advertising on young people, and presents the results of an empirical research into peculiarities of young people’s perception of two popular Adrenaline Rush commercials that demonstrate extreme sportsmanship. Basing on the postulates of psychosemiotics and narrative psychology, the author makes a complex psychological analysis of the two promoting narratives. The study shows that the commercials have a high suggestive potential. The slogan “There’s nothing you can’t do!” addressed to the target audience is provocative and, according to the research hypothesis, is able to stimulate young people’s need for risky behavior, which they may demonstrate not in sports, but in life in the form of antisocial conduct. The empirical research involved a survey of 94 respondents including 70 university students and 24 senior pupils. Having watched each commercial, they tried to determine a potential volition action of the character by estimating on 1-10 scale every of the 50 variants to finish the sentence “He can do it”. The factor analysis of the numerical data enables the author to point out six factors that form semantic categories of potential actions, namely, the common, the humanist, the antisocial, the extreme, betrayal, and power. It is inferred that both commercials extensively stimulate readiness for antisocial conduct, and senior pupils are more affected than students are. Young people do not think critically when they hear the pitch for risky behavior, so, in their minds, the risk zone expands into the area of social destruction.

The ubiquitous transcriptional coactivators Yap (gene symbol Yap1) and Taz (gene symbol Wwtr1) regulate gene expression mainly by coactivating the Tead transcription factors. Being at the center of the Hippo signaling network, Yap and Taz are regulated by the Hippo kinase cassette and additionally by a plethora of exercise-associated signals and signaling modules. These include mechanotransduction, the AKT-mTORC1 network, the SMAD transcription factors, hypoxia, glucose homeostasis, AMPK, adrenaline/epinephrine and angiotensin II through G protein-coupled receptors, and IL-6. Consequently, exercise should alter Hippo signaling in several organs to mediate at least some aspects of the organ-specific adaptations to exercise. Indeed, Tead1 overexpression in muscle fibers has been shown to promote a fast-to-slow fiber type switch, whereas Yap in muscle fibers and cardiomyocytes promotes skeletal muscle hypertrophy and cardiomyocyte adaptations, respectively. Finally, genome-wide association studies in humans have linked the Hippo pathway members LATS2, TEAD1, YAP1, VGLL2, VGLL3, and VGLL4 to body height, which is a key factor in sports.

Multi-species ethnography calls for new ways of engaging the contact zones or areas of entanglements among humans and other species. A number of studies identify and describe the roles of embodiment and bonding in developing a sense of partnership or co-being between horse and rider that challenge hegemonic dualisms of horse-human or nature-culture. Less attention is paid to potential roles that the local physical environment or terrain where riding takes place can play in the development of particular horse-human relationships. Informed by a grounded practice theory approach, analysis of narrative data collected in sixty open-ended interviews with US Midwestern and north Norwegian horse people, who participate in different equestrian sports and ride within a variety of local settings, demonstrates complex ways in which terrains ridden effect a complex series of interwoven constructions of shared ecologies of horse-rider relations, identities, and psyches. Riding venues for this study include walled arenas, open spaces of the Great Plains, and forested mountains of Arctic Norway, wherein riders and horse enact their selves as highly schooled, deep thinkers; fearless, adrenaline junkies; self-pacing, heroic stoics, and/or as connoisseurs of nature’s versatility.

The main goal of this study was to recognize the motives of participation in mass running events (Poznan Half Marathon case study). The second aim was to examine the motivations to participate in a half-marathon among two groups of respondents: men and women, and to evaluate the differences between them. The empirical research among runners (n = 560) conducted during the one of the most important running events in Poland recognized the motives for participation in the sports event in accordance with the four basic types of orientation: social orientation, experience orientation, factual orientation, and result orientation (Freyer & Gross, 2002). The significant difference between surveyed men and women appeared in the motives of desire to get away from everyday life and its prevailing fashion, which turned out to be more important for women than for men. The desire to win was not important for the respondents. All respondents reported that what was very important for them was the need to experience strong emotions related to participation, the desire to feel unity and integration with other people, and the desire to test themselves. In general, the results show that people participate in running events not only for physical activity, but also for mental well-being and socio-psychological effects. They experience strong emotions, adrenaline, pleasure, relaxation, and an escape from the duties and hardships of everyday life and have an opportunity to build social relationships thanks to mass sports events organized in urban agglomerations. The article constitutes a conceptualization of the running event in the dimension of social and psychological interactions, which reveal and demonstrate its creative layers and contemporary meaning which has already gone deeply beyond functions of running for health and improving the physical condition.

Hungary offers abundant opportunities for discovering the mysterious world of caves. In Hungary there are around 4100 caves; although only a small number of them are open to the public, they offer a variety of attractions. As they are an important part of tourism, switching them, exploring them and making them accessible for a wider audience generates interest for visitors from different parts of the country. The adrenaline releasing sports offers us new ways of coping with stress, and has had an increasing importance in our lives in the 21st century. Discovering these underground miracles presents a new challenge for travelers. The interest in caves exploded in the 20th century, when ecotourism, longing to get back to nature, and the goal of improving one’s health became leading motivations for travelling. The present research is aimed at surveying, to what extent students of the recreation department are familiar with the opportunities provided by cave tourism and how up-to-date their related knowledge is. The following work introduces opportunities in cave tourism and intends to expose upon gaps in the related marketing strategy. The research questions are the following: Are students familiar with opportunities of cave tourism? What services do the caves they know offer? Are they up-to-date in cave-related news? On what forums do cave tourism appear?

The Relationships Between Plasma Adrenomedullin and Endothelin-1 Concentrations and Doppler Echocardiographic Indices of Left Ventricular Function During Static Exercise in Healthy MenOur previous study showed a significant relationships between static exercise-induced changes in plasma adrenomedullin (ADM) and those in endothelin-1 (ET-1), noradrenaline (NA) and pre-ejection period/left ventricular ejection time ratio (PEP/LVET) in older healthy men. It is hypothesized that ADM, ET-1, NA and adrenaline (A) may function as endogenous regulators of cardiac function by modulating myocardial contractility during static exercise. The present study was undertaken to assess the relationships between exercise-induced changes in plasma ADM, ET-1, NA, A concentrations and those in ascending aortic blood flow peak velocity (PV) and mean acceleration (MA) measured by Doppler echocardiography in 24 healthy older men during two 3-min bouts of handgrip at 30% of maximal voluntary contraction, performed alternately with each hand without any break between the bouts. Plasma ADM, ET-1, NA and A as well as heart rate (HR), blood pressure (BP), PV and MA were determined. During handgrip, plasma ADM, ET-1, NA and A as well as HR, BP increased, whereas PV and MA decreased. The increases in plasma ADM correlated positively with those in ET-1, NA and diastolic BP, and correlated negatively with changes in PV (r = -0.68) and MA (r = -0.62). The increases in plasma ET-1 correlated positively with those in NA and BPs and correlated negatively with changes in PV (r= -0.67) and MA (r= -0.60). The results of this study suggest that in healthy older men the exercise-induced changes in plasma ADM, ET 1 and catecholamines are related to alterations in left ventricular contractile state and may co-operatively counteract age-related deterioration of cardiac performance in men.

Abstract Tourism is one of the areas which is constantly making progress. While 10 years ago tourists enjoyed a holiday by the sea in a beautiful resort with even more beautiful weather and clean beach, eventually winter holiday in the ski resort with regularly adjusted slope, enough snow and comfortable accommodation, today it is different. Based on a survey among the clients of the Slovak travel agency it was found out that the clients are interested in the trip involving the climb on the Matterhorn mountain which has not been offered in the proposition yet. Travel agency together with the specialized academic workplace processed the trip project for more demanding clientele to this less common destination, this means on Matterhorn mountain, accompanied by the mountain guides. This way the travel agency gained a competitive advantage because no other Slovak travel agency organizes a tour of this type. It has to be considered the safety of the participants of the trip and wind conditions in the final destination. The profit margin was established at 45%. Under the term „ demanding clientele” we mean the clients who do not long for a stay at the seaside but on the contrary they love to increase adrenaline and are not afraid to test their abilities in extreme situations. There is a competition not only among the individual travel agencies but due to access to information via the Internet there are more and more tourists who are able to arrange a demanding sightseeing trip to various countries themselves. The special exception is mountain tourism and climbing which is demanding for the accompanying services – providing mounting guides, transport of the backpacks in hilly terrain. Climbing is the risky sport, it is necessary to have a secure professional accompaniment.

The review discusses the hormonal changes during exercise stress. The exercise generally produces a rise of adrenaline (A), noradrenaline (NA), adrenocorticotropic hormone (ACTH), cortisol, glucagon, growth hormone, arginine vasopressine, etc., and a drop of insulin. The hormonal events during reestablishment of homeostasis due to exercise stress can be divided into a catabolic phase, with decreased tolerance of effort, and reversible biochemical, hormonal and immunological changes, and an anabolic phase, with a higher adaptive capacity, and enhanced performance. The two main hormonal axes activated in the catabolic phase are sympathetic–adrenal–medullary system and hypothalamic-pituitary-adrenal (HPA) axis, while in the anabolic phase, growth hormone-insulin-like factor I axis, and gonadal axes. The hormonal responses during exercise and recovery can be regarded as regulatory and integrated endocrine responses. The increase of catecholamines and ACTH is dependent on the intensity of exercise; a marked increase in plasma A occurs during exercises with high emotional content. The response of cortisol is correlated with the duration of exercise, while the effect of exercise duration on β-endorphin changes is highly dependent on the type of exercise performed. Cortisol and β-endorphin changes usually occur in phase, but not during exercises with high emotional content. Glucocorticoids and iodothyronines are involved in meeting immediate energy demands, and a model of functional interactions between HPA axis and hypothalamic-pituitary-thyroid axis during exercise stress is proposed. A modulation of coping responses to different energy demanding physical activities required for sport activities could be hypothesized. This review supports the proposed regulation of hypophysiotropic TRHergic neurons as metabolic integrators during exercise stress. Many hormonal systems (ghrelin, leptin, glucose, insulin, and cortisol) are activated to control substrate mobilizations and utilization. The cardiovascular homeostasis, the fluid and electrolyte balance during exercise are highly dependent on vasoactive hormones (antidiuretic hormone, atrial natriuretic peptide, renin–angiotensin–aldosterone, and prostaglandins) control.

Objectives: The aim of this study was to analyze the postoperative effects of extended nerve blocks and local infiltration analgesia (LIA) on postoperative pain control, muscle weakness, and blood loss after total knee arthroplasty (TKA). Patients and methods: Between February 24th 2020 and July 10th 2020, a total of 161 patients (55 males, 106 females; median age: 69.0 years [IQR 63.0-75.0], range, 41 to 81 years) who underwent primary TKA were randomly allocated into three parallel groups according to their concomitant procedure in a double-blind fashion: (i) those to whom nerve blockade was performed after competition of surgery under the duration of spinal anesthesia (n=50); (ii) those to whom LIA was performed during surgery (n=52), and (iii) control group (n=59). The content of LIA was 10-10 mL of 20 mg lidocaine with 0.01 mg adrenalin and 100 mg ropivacaine, 1 mL (30 mg) ketorolac, and 5 mL (500 mg) tranexamic acid was diluted by 50 mL 0.9% NaCl under aseptic conditions. Outcome parameters were the evaluation of pain until the evening of first postoperative day (24 to 36 h), mobilization, and blood loss within the first three postoperative days. Results: The pain was maximal between 4 and 8 h postoperatively, when the effect of the spinal anesthetic drugs disappeared. During this critical period, tolerable pain (Numerical Rating Scale, NRS ≤3) was observed in 52%, 42%, and 19% of nerve blockade in LIA and control groups, respectively. None of the patients complained of high-intensity pain (NRS >8) in the LIA group, which was a significant difference from the block and control groups (10% and 14%, p<0.008, respectively). There was no significant muscle weakness associated with the use of this extended block. The decrease in hemoglobin level was significantly lower in the LIA group than in the control and block groups (odds ratio [OR]: 0.379, 95% confidence interval [CI]: 0.165-0.874 for nerve blockade vs. LIA, OR: 1.189, 95% CI: 0.491-2.880 for nerve blockade vs. control, OR: 0.319, 95% CI: 0.140-0.727, respectively). The common language effect size for pain in each referred interval in each group and for decrease of hemoglobin between the first and third postoperative days fell between 0.507 and 0.680. Conclusion: This study demonstrates that LIA technique offers a fast and safe treatment option for pain relief after TKA. No clinically relevant muscle weakness was observed among groups according to field block applications. Significant advantages were also achieved in blood loss.

Abstract Glanzmann’s Thrombasthenia (GT) is an autosomal recessive inherited platelet function disorder that is due to defect platelet aggregation in response to multiple physiologic agonists. The defect may be because of mutations in the genes encoding either ITGA2B or ITGB3 that result in qualitative or quantitative abnormalities of the platelet receptor aIIbb3. A total of 45 unrelated GT patients were analyzed for mutations in all the exons of ITGA2B and ITGB3 genes by a mutation screening technique, Conformation Sensitive Gel Electrophoresis (CSGE). Mutation was identified in 36 out of 45 patients; and in 9 patients no causative gene alterations were identified in both the genes. Only polymorphisms were identified in 5 patients; however, 4 patients did not show any sequence variation in both the genes. Though their mutation status was not identified, their hematological parameters, platelet aggregation, flow cytometry and western blot revealed that they were definite GT (Table 1). Of these 9 patients with no mutations, 5 patients had family history of bleeding; that included death episode, due to prolonged bleeding in all four families and bleeding complication in sibling in one family. The clinical manifestations included epistaxis, Gum bleeding and petechiae in 8 patients and Echymotic spots in 6 patients. The major bleeding complication of gastro- intestinal bleed and eye bleed was seen in 4 patients and 2 patients respectively; one patient had hematuria. Among the 9 patients with no mutation, a blood transfusion was required in 8 patients. Normal values of Prothrombin time, Activated partial thromboplastin time and platelet count in these patients excluded the possibility of other factor deficiencies and thrombocytopenia. Platelet aggregation was absent with all the four agonists in all these patients. Platelet aIIbb3 analysis by flow cytometry classified 5 patients as type I, one as type II and 3 patients as type III GT. Western blot analysis revealed complete absence of both aIIb and b3 in 6 patients. In remaining 3 patients, one had trace amount of aIIb and reduced amount of b3; another had mild amount of b3 with no trace of aIIb, the third patient had abnormal aIIb protein. GT in these 9 patients may be due to defect in a regulatory element affecting the transcription of these two genes or abnormalities in mechanisms that are responsible for post-translational modifications and trafficking of integrin subunits. Moreover, the strategy to detect mutations in these patients was based on CSGE, whose sensitivity is not 100%. Even though the CSGE technique was carefully set up and tested with known mutations, making it unlikely that nucleotide substitutions were missed in these patients, the literature reports that the sensitivity of the CSGE technique is approximately 80%. The above data shows that these patients need to be considered as definite GT and treated based on Clinical, hematological parameters and flow cytometry, even though they did not show mutations. Hematological evaluation protein analysis GT No Age/Sex CG FH Bld Tfn Bleeding Symptoms P/S PC BT (min) CR (%) Platelet aggregation FCM Western blot Polymorphisms ADP ADR AA Collag. Risto. aIIb/b3 aIIb b3 4 15/M N Y Y P, Ep, GB, HU Isolated plt N 8′ 20 Abs Abs Red Abs Red 20.4% AN N IIb c.2188-7C&gt;G IIIa c.1126-30delT IIIa c.1545C&gt;A IIbc.2188-7C&gt;G 5 19/F Y Y Y P, Ep, GB, Mr Isolated plt N &gt;15′ 5 Abs Abs Abs Abs N 0.13% Abs Red IIb c.2187+34_42 del 9bp 6 44/M N Y Y P, ES, Ep, GB, GI Isolated plt N &gt;15′ 0 Abs Abs Abs Abs N 7.72% Red Red Nil 7 12/M N Y Y P, ES, Ep, GB Isolated plt N &gt;15′ 12 Abs Abs Abs Abs N 1.02% Abs Red Nil 8 46/M N Y Y P, ES, Ep, GB, GI Isolated plt N &gt;15′ 0 Abs Abs Abs Abs N 0.27% Abs Abs Nil 13 4/M Y N N P, ES, GB Isolated plt N &gt;15′ 0 Abs Abs Abs Abs N 20% Abs Abs IIbc.2188-7C&gt;G IIbc.2188-47C&gt;T IIb c.1600+100delT IIIa c.2040T&gt;C 21 14/M N N Y ES, Ep, GB, GI, EB Isolated plt N &gt;15′ 0 Abs Abs Abs Abs N 0.2% Abs Abs Nil 22 11m/M Y N Y P, ES, Ep, GI, EB Isolated plt N 9′ 0 Abs Abs Abs Abs N 21.7% Abs Abs IIb c.2188-7C&gt;G IIb c.3063C&gt;T 33 1/F Y N Y P, Ep, GB Isolated N &gt;15′ 0 Abs Abs Abs Abs N 3.5% Abs Abs IIb c.2188-7C&gt;G Table 1: The clinical and hematological parameters along with polymorphisms identified in GT patients with no mutations Note: CG: Consanguinity, Bld Tfn: Blood transfusion, P/S: Peripheral smear, PC: Platelet count, BT: Bleeding time, CR: Clot retraction, FCM: Flow cytometry, ADP: Adenosine 5′-diphosphate, ADR: Adrenaline, AA: Arachidonic acid, Collag: Collagen, Risto: Ristocetin sulphate, P: Purpura, Ep: Epistaxis, GB: Gum bleed, HU: Hematuria, Mr: Menorrhagia, ES: Epistaxis, GI: Gastrointestinal bleed, EB: Eye bleed

Introduction Such symptoms as hard, complex, bodily or mental feelings, that turn our everyday life into a hell, at first, lead us to a doctor, and then - to a psychotherapist. A sick man is keen to get rid of a symptom. A doctor prescribes medication, that is ought to eliminate a symptom. A psychotherapist searches for a reason of the problem that needs to be removed. There is such an idea that a neurotic symptom, in particular, an anxiety - is a pathological (spare or extra) response of a body. It is generally believed that such anxiety doesn’t have some real, objective reasons and that it is the result of a nervous system disorder, or some disruption of a cognitive sphere etc. Meanwhile, it is known that in the majority of cases, medical examinations of anxious people show that they don’t have any organic damages, including nervous system. It often happens that patients even wish doctors have found at least any pathology and have begun its treatment. And yet - there is no pathology. All examinations indicate a high level of functionality of a body and great performance of the brain's work. Doctors throw their hands up, as they can't cure healthy people. One of my clients told me her story of such medical examinations (which I’ll tell you with her permission). She said that it was more than 10 years ago. So, when she told her doctor all of her symptoms - he seemed very interested in it. He placed a helmet with electrodes on her head and wore some special glasses, when, according to her words, he created some kind of stressful situation for her brain, as she was seeing some flashings of bright pictures in her eyes. She said that he had been bothered with her for quite a long time, and at the end of it he had told her that her brain had been performing the best results in all respects. He noted that he’d rarely got patients with such great health indicators. My client asked the doctor how rare that was. And he answered: “one client in two or three months.” At that moment my client didn’t know whether to be relieved, flattered or sad. But since then, when someone told her that anxiety was a certain sign of mental problems, or problems with the nervous system, or with a body in general, she answered that people who had anxiety usually had already got all the required medical examinations sufficiently, and gave them the advice to go through medical screening by themselves before saying something like that. Therefore, we see a paradoxical situation, when some experts point to a neurotic anxiety as if it is a kind of pathology, in other words - some result of a nervous system disorder. Other specialists in the same situation talk about cognitive impairments. And some, after all the examinations, are ready to send such patients into space Main text I don’t agree with the statement that any neurotic anxiety that happens is excessive and unfounded. It often happens that there is objective, specific and real causes for appearance of anxiety conditions. And these causes require solutions. And it’s not about some organic damages of the brain or nervous system. The precondition that may give a rise to anxiety disorder is the development of such a life story that at some stage becomes too toxic - when, on the one hand, a person interacts with the outside world in a way that destroys his or her personality, and, on the other hand, this person uses repression and accepts such situation as common and normal. Repression - is an essential condition for the development of a neurotic symptom. Sigmund Freud was the first who pointed this out. Repression is such a defense mechanism that helps people separate themselves from some unpleasant feelings of discomfort (pain) while having (external or internal) irritations. It is the situation when, despite the presence of irritations and painful feelings, a person, however, doesn't feel any of it and is not aware of them in his or her conscious mind. Repression creates the situation of so-called emotional anesthesia. As a result, a displacement takes place, so a body starts to signal about the existing toxic life situation via a symptom. Anxiety disorder is usually an appropriate response (symptom) of a healthy body to an unhealthy life situation, which is seen by a person as normal. And it’s common when such a person is surrounded by others (close people), who tend to benefit from such situation, and so they actively maintain this state of affairs, whether it is conscious for them or not. At the beginning of a psychotherapy almost all clients insist that everything is good in their lives, even great, as it is like in everyone else’s life. They say that they have only one problem, which is that goddamn symptom. So they focus all of their attention on that symptom. They are not interested in all the other aspects of their life, and they show their irritation when it comes to talking about it. People want to get rid of it, whatever it takes, but they often tend to keep their lives the way that it was. In such cases a psychotherapist is dealing with the resistance of clients, trying to turn their attention from a symptom to their everyday situation that includes their way of thinking, interactions with themselves and with others and with the external world in order to have the opportunity to see the real problem, to live it through, to rethink and to change the story of their lives. For better understanding about how it works I want to tell you three allegorical tales. The name of the first tale is “A frog in boiling water”. There is one scientific anecdote and an assumption (however, it is noted that such experiments were held in 19 century), that if we put a frog in a pot with warm water and start to slowly heat the water, then this frog get used to the temperature rise and stays in a hot water, the frog doesn’t fight the situation, slowly begins to lose its energy and at the last moment it couldn’t find enough strength and energy to get out of that pot. But if we throw a frog abruptly in hot water - it jumps out very quickly. It is likely that a frog, that is seating in boiling water, will have some responses of the body (symptoms). For example, the temperature of its body will rise, the same as the color of it, etc., that is an absolutely normal body response to the existing situation. But let us keep fantasizing further. Imagine a cartoon where such a frog is the magical cartoon hero, that comes to some magical cartoon doctor, shows its skin, that has changed the color, to the doctor, and asks to change the situation by removing this unpleasant symptom. So the doctor prescribes some medication to return the natural green color of the frog’s skin back. The frog gets back in its hot water. For some period of time this medication helps. But then, after a while, the frog’s body gets over the situation, and the redness of the frog's skin gets back. And the magical cartoon doctor states that the resistance of the body to this medication has increased, and each time prescribes some more and more strong drugs. In this example with the frog it is perfectly clear that the true solution of the problem requires the reduction of the water temperature in that pot. We could propose that magical cartoon frog to think and try to realize that: 1) the water in that pot is hot, and that is the reason why the skin is red; 2) the frog got used to this situation and that is why it is so unnoticeably for this frog; 3) if the temperature of the water in the pot still stay so hot, without any temperature drop, then all the medication works only temporarily; 4) if we lower the temperature in that pot - the redness disappears on its own, automatically and without any medication. Also this cartoon frog, that will go after the doctor to some cartoon physiotherapist, will face the necessity to give itself some answers for such questions as: 1) What is going on? Who has put this frog in that pot? Who is raising the temperature progressively? Who needs it? And what is the purpose or benefit for this person in that? Who benefits? 2) Why did the frog get into the pot? What are the benefits in it for the frog? Or why did the frog agree to that? 3) What does the frog lose when it gets out of this pot? What are the consequences of it for the frog? What does the frog have to face? What are the possible difficulties on the way? Who would be against the changes? With whom the frog may confront? 4) Is the frog ready to take control over its own pot in its own hands and start to regulate the temperature of the water by itself, so to make this temperature comfortable for itself? Is this frog ready to influence by itself on its own living space, to take the responsibility for it to itself? The example “A frog in boiling water” is often used as a metaphorical portrayal of the inability of people to respond (or fight back) to significant changes that slowly happen in their lives. Also this tale shows that a body, while trying to adjust to unfavorable living conditions, will react with a symptom. And it is very important to understand this symptom. Symptom - is the response of a body, it’s a way a body adjusts to some unfriendly environment. Symptom, on the one hand, informs about the existence of a problem, and from the other hand - tries to regulate this problem, at least in some way (like, to remove or reduce), at the level on which it can do it. The process is similar to those when, for example, in a body, while it suffers from some infectious disease, the temperature rises. Thus, on the one hand, the temperature informs about the existence of some infection. On the other hand, the temperature increase creates in a body the situation that is damaging for the infection. So, it would be good to think about in what way does an anxiety symptom help a body that is surrounded by some toxic life situation. And this is a good topic for another article. Here I want to emphasize that all the attempts to remove a symptom without a removal of a problem, without changing the everyday life story, may lead to strengthening of the symptom in the body. Even though the removal of a symptom without elimination of its cause has shown success, it only means that the situation was changed into the condition of asymptomatic existence of a problem. And it is, in its essence, a worse situation. For example, it can cause an occurrence of cancer. The tale “A frog in boiling water” is about the tendency of people to treat a symptom, instead of seeing their real problems, as its cause, and trying to solve it. People don’t want to see their problems, but it doesn’t mean that the problem doesn’t exist. The problem does exist and it continues to destroy a person, unnoticeably for him or her. A person with panic disorder could show us anxiety that is out of control (fear, panic), which, by its essence, seems to exist without any logical reason. Meanwhile the body of such a person could be in such processes that are similar to those that occur in the conditions of some real dangers, when the instinct for self-preservation is triggered and an automatic response of a body to fight or flight implements for its full potential. We can see or feel signs of this response, for example, in cases when some person tries to avoid some real or imaginary danger via attempts to escape (the feeling of fear), or tries to handle the situation by some attempts to fight (the feeling of anger). As I mentioned before, many doctors believe that such fear is pathological, as there is no real reason for such intense anxiety. They may see the cause of the problem in worrisome temper, so they try to remove specifically anxiety rather than help such patients to understand specific reason of their anxiety, they use special psychotherapeutic methods that are designed to help clients to develop logical thinking, so it must help them to realize the groundlessness of their anxiety. In my point of view, such anxiety often has specific, real reasons, when this response of a body, fight or flight, is absolutely appropriate, but not excessive or pathological. Inadequacy, in fact, is in the unconsciousness, but not in the reactions of a body. For a better understanding of the role of anxiety in some toxic environment, that isn’t realized, I want to tell you another allegorical tale called “The wolf and the hare”. Let us imagine that two cages were brought together in one room. The wolf was inside one cage and the hare was in another. The cages were divided by some kind of curtain that makes it impossible for them to see each other. At this point a question arises whether the animals react to each other in some way in such a situation, or not? I think that yes, they will. Since there are a lot of other receptors that participate in the receiving and processing of the sensory information. As well as sight and hearing, we have of course a range of other senses. For example, animals have a strong sense of smell. It is well known that people, along with verbal methods of communicating information, like language and speaking, also have other means of transmitting information - non-verbal, such as tone of voice, intonation, look, gestures, body language, facial expressions etc., that gives us the opportunity to receive additional information from each other. The lie detector works by using this principle: due to detecting non-verbal signals, it distinguishes the level of the accuracy of information that is transmitted. It is assumed, that about 30% of information, that we receive from the environment, comes through words, vision, hearing, touches etc. This is the information that we are aware of in our consciousness, so we could consciously (logically) use it to be guided by. And approximately 70% of everyday information about the reality around us we receive non-verbally, and this information in the majority of cases could remain in us without any recognition. It is the situation when we’ve already known something, and we even have already started to respond to it via our body, but we still don’t know logically and consciously that we know it. We can observe the responses of our own body without understanding what are the reasons for such responses. We can recognize this unconscious information through certain pictures, associations, dreams, or with the help of psychoanalysis. Psychoanalysis is a great tool that can help to recognize the information from the unconscious mind, so that it can be logically processed further on, in other words, a person then receives the opportunity to indicate the real problems and to make right decisions. But let us return to the tale where the hare and the wolf stay in one room and don’t see each other, and, maybe, don’t hear, though - feel. These feelings (in other words - non-verbal information that the hare receives) activate a certain response in the hare’s body. And it reacts properly and adequately to the situation, for instance, the body starts to produce adrenaline and runs the response “fight or flight”. So the hare starts to behave accordingly and we could see the following symptoms: the hare is running around his cage, fussing, having some tremor and an increased heart rate, etc.. And now let us imagine this tale in some cartoon. The hare stays in its house, and the wolf wanders about this house. But the hare doesn’t see the wolf. Though the body of the hare gives some appropriate responses. And then that cartoon hare goes to a cartoon doctor and asks that doctor to give it some pill from its tremor and the increased heart rate. And in general asks to treat in some way this incomprehensible, confusing, totally unreasonable severe anxiety. If we try to replace the situation from this fairy-tale to a life story, we could see that it fits well to the script of interdependent relationships, where there are a couple “a victim and an aggressor”, and where such common for our traditional families’ occurrences as a domestic family violence, psychological and physical abuse take place. Only in 2019 a law was passed that follows the European norms and gives a legislative definition of such concepts as psychological domestic abuse, sexual abuse, physical abuse, bullying, that criminalizes all of these occurrences, establishes the punishment and directly points to people that could be a potential abuser. Among them are: a husband towards his wife, parents towards their children, a wife towards her husband, a superior towards a subordinate, a teacher towards his or her students, children towards each other etc.. When it comes to recognition of something as unacceptable, it seems more easy to put to that category such occurrences as physical and sexual abuse, as we could see here some obvious events. For example, beating or sexual harassment. Our society is ready to respond to these incidents in more or less adequate way, and to recognize them as a crime. But it is harder to deal with the recognition of psychological abuse as an offence. Psychological abuse in our families is common. Psychological abuse occurs through such situations, when one person, while using different psychological manipulations, such as violation of psychological borders, imposition of feeling of guilty or shame, etc., force another person to give up his or her needs and desires, and so in such a way make this person live another’s life. Such actions have an extremely negative effect on the mental health of these people, just as much as physical abuse. It can destroy a person from the inside, ruin self-esteem and a feeling of self-worth, create the situation of absolute dependence such victim from an abuser, including financial dependence etc.. It often happens that psychological abuse takes place against the backdrop of demonstrations of care and love. So you've got this story about the wolf and the hare, that are right next to each other, and the shield between two of them is a repression - a psychological defense mechanism, when a person turns a blind eye to such offences, that take place in his or her own life and towards him or her. And this person considers this as normal, doesn't realize, doesn't have a resource to realize, that it is a crime. Most importantly - doesn’t feel anything, as a repression takes place. But a body responds in a right way - from a certain point of the existence of such a toxic situation the response “fight or flight” is launched in a body at full, in other words - the fear and anxiety with the associated symptoms. The third allegorical tale I called “Defective suit”, which I read in the book of Clarissa Pinkola Estés with the name “Running With the Wolves". “Once one man came to a tailor and started to try on a suit. When he was standing in front of a mirror, he saw that the costume had uneven edges. - Don’t worry, - said the tailor. - If you hold the short edge of the suit by your left hand - nobody notices it. But then the man saw that a lapel of a jacket folded up a little bit. - It's nothing. You only need to turn your head and to nail it by your chin. The customer obeyed, but when he put on trousers, he saw that they were pulling. - All right, so just hold your trousers like this by your right hand - and everything will be fine, - the tailor comforts him. The client agreed with him and took the suit. The next day he put on his new suit and went for a walk, while doing everything exactly in the way that the tailor told him to. He waddled in a park, while holding the lapel by his chin, and holding the short edge of the suit by his left hand, and holding his trousers by his right hand. Two old men, who were playing checkers, left the game and started to watch him. - Oh, God! - said one of them. - Look at that poor cripple. - Oh, yes - the limp - is a disaster. But I'm wondering, where did he get such a nice suit?” Clarissa wrote: “The commentary of the second old man reflects the common response of the society to a woman, who built a great reputation for herself, but turned into a cripple, while trying to save it. “Yes, she is a cripple, but look how great her life is and how lovely she looks.” When the “skin” that we put on ourselves towards society is small, we become cripples, but try to hide it. While fading away, we try to waddle perky, so everyone could see that we are doing really well, everything is great, everything is fine”. As for me, this tale is also about the process of forming a symptom in a situation when one person tries very hard to match to another one, whether it is a husband, a wife or parents. It’s about a situation when such a person always tries to support the other one, while giving up his or her own needs and causing oneself harm in such a way by feeling a tension every day, that becomes an inner normality. And so this person doesn’t give oneself a possibility to relax, to be herself (or himself), to be spontaneous, free. As a result, in this situation the person, who was supported, looks perfect from the outside, but those who tried to match, arises some visible defect, like a limp - a symptom. And so this person lives like a cripple, under everyday stress and tension, trying to handle it, while sacrificing herself (or himself) and trying to maintain this situation, so not to lose the general picture of a beautiful family and to avoid shame. The tailor, who made this defective suit and tells how to wear the suit properly, in order to keep things going as they are going, often is a mother who raised a problematic child and then tells another person how to deal with her child in the right way. It is the situation when a mother-in-law tells her daughter-in-law how to treat her son properly. In other words, how to support him, when to keep silent, to handle, how to fit in, so that her problematic son and this relationship in general looks perfect. Or vice versa, when a mother-in-law tells her son-in-law how to support her problematic daughter, how to fit in etc.. When, for example, a woman acts like this in her marriage and with her husband, with these excessive efforts to fit in - then after a while everybody will talk like: “Look at this lovely man: he lives with his sick wife, and their family seems perfect!”. But when such a woman becomes brave enough to relax and to just let the whole thing go, everybody will see that the relationship in her marriage isn’t perfect, and it is the other one who has problems. Each time when someone tries excessively to match up to another one, while turning oneself in some kind of a cripple, - he or she, on the one hand, supports the comfort of that person, to whom he or she tries to match up, and on the other hand - such a situation always arises in that person such conditions as a continuous tension, anxiety, fear to act spontaneously. A symptom - is like a visible defect, that shows itself through the body (and may look like some kind of injury). It is the result of a hidden inner prison. As a result of evolution, a pain tells us about a problem that is needed to be solved. When we repress our pain we can’t see our needs and our problems at full. And then a body starts to talk to us via a symptom. Psychotherapy aims for providing a movement from a symptom to a resumption of sensitivity to feelings, a resumption of the ability to feel your psychological pain, so you can realize your own toxic story. In this perspective another fairy-tale looks interesting to analyze - it is Andersen's fairytale “Princess and the Pea”. In the tale a prince wanted to find a princess to marry. There was one requirement for women candidates, so the prince could select her among commoner - high level of sensitivity, as the real princess would feel a pea through the mountain of mattresses, and so she could have the ability to feel discomfort, to be in a good contact with her body, to tell about her discomfort without such feeling as shame and guilt, and to refuse that discomfort, so to have the readiness to solve her problems and to demand from others the respect for her needs. It is common for our culture that the expression “a princess on a pea” very often uses for a negative meaning. So people who are in good contact with their body and who can demand comfort for themselves are often called capricious. At the same time the heroes who are ready to suffer and to tolerate their pain, who are able to repress (stop to feel) their pain represents a good example to be followed in our society. So, we may see the next algorithm in cases of various anxiety disorders: the existence of some toxic situation that brings some danger to a person. And we need not to be confused: a danger exists not for a body, but for a personality. A toxic live situation as well as having a panic attack is not a threat for the health of a body (that is what medical examinations show), and vice versa - it’s like every day intensive sport training, that could be good for your health only to some degree. A toxic situation destroys a person as a personality, who longs for one self’s expression; the existence of such a defense mechanism as repression - it’s a life with closed eyes, in pink glasses, when there is inability (or the absence of the desire) to see its own toxic story; 3.the presence of a symptom - a healthy response of a body “fight or flight” to some toxic situation; displacement - it’s replacement of the attention from the situation to a symptom, when a person starts to see and search for the problem in some other place, not where it really is. A symptom takes as some spare, pathological reaction that we need to get rid of. The readiness to fight the symptom arises, and that is the goal of such methods of therapy as pharmacological therapy, CBT and many others; the absence of adequate actions that are directed towards the change of a toxic situation itself. The absence of the readiness to show aggression when it comes to protect its space. All of it is a mechanism of formation of primary anxiety and preparation for launch of secondary anxiety. A complete anxiety disorder is the interaction between a primary and a secondary anxiety.

AbstractAlthough local infiltration analgesia (LIA) is effective in relieving pain after total knee arthroplasty (TKA), its effect is short lasting and the optimal combination of drugs is unknown. Steroids being a potent and long-acting anti-inflammatory drug might extend LIA's effect. This study aims to evaluate the role of steroids in LIA. This is a paired-randomized controlled study involving one-stage bilateral TKA patients. LIA containing ropivacaine, ketorolac, and adrenaline with or without triamcinolone was given. One knee was randomized to receive LIA with steroids, while the other received LIA without steroids. The primary outcome was knee pain in terms of the visual analog scale (VAS). Secondary outcomes were rehabilitation progress, functional scores, and complications. Outcomes were compared between the knees of the same patient and documented up to 1 year. A total of 45 patients (90 TKAs) were included. LIA with steroid knees showed lower VAS score at rest and during activity from postoperation day 1 to 5 and at 6 weeks (p < 0.05). Passive and active range of movement was also greater in LIA with steroid group from day 1 to 7 and day 2 to 5, respectively (p < 0.05). Steroid-treated knees also achieved active straight leg raise earlier (1.2 vs. 2.0 days, p < 0.05). No differences in Knee Society Score and complication rates between both groups. Steroids in LIA offer additional and extended benefit in pain control and rehabilitation after TKA, while no adverse effects were found up to 1-year follow-up.

Abstract Purpose In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We compared this technique to the gold standard the 3 in 1 femoral nerve block (FNB) in postoperative pain management after total knee arthroplasty (TKA) in a large patient population. This trial analyzes in the early postoperative phase the pain, range of motion, and consumption of pain medications after TKA. Methods We conducted a retrospective trial that included all patients who were undergoing primary TKA by one single surgeon in a high-volume arthroplasty center in 2015. Patients who have secondary osteoarthritis due to rheumatoid arthritis or previous knee arthrotomy, as well as revision cases, were excluded. The included patients were divided into 2 groups according to the applied pain management (group 1 FNB, group 2 LIA). Concerning the LIA group, a modified form of composition compared to the first describer without the use of adrenaline was carried out. Post-operative additional pain medications were given on a fixed scheme to the patient. The primary outcome was pain at rest over 7 days after surgery labeled by the numeric pain rating scale (NRS). The secondary outcome measures were the total amount of opioid consumption over the hospital stay and the additional need for non-opioid medication. The conversion of the opiate medications on the morphine preparation was carried out according to the conversion data from the literature. For functional recovery, we compared the range of motion in both groups, which was recorded from the second postoperative day by the attending physiotherapist. Results In total, 202 patients were assessed for eligibility and included in this clinical trial. Hundred patients were allocated to the continuous FNB group (group 1) and 102 patients to the LIA group (group 2). No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: The LIA group had a significantly lower NRS score than the continuous FNB group for the measurement in the morning on days 1, 2, and 3 after surgery (day 1, 1.5; day 2, 1.6; day 3, 1.3; p < 0.05). Secondary outcome measurements: The total volume of morphine consumption for the first six postoperative days was significantly lower in the LIA group than the FNB group (FNB 159.8 vs. LIA 96.07). There is also a significant difference between the total morphine consumption of both groups in the direct postoperative course with respect to time and group (two way ANOVA, p < 0.05) On the day of the operation and on the first postoperative day, the intake of additional non-opioids in the LIA group was also significantly reduced compared to the FNB group. No significant difference was observed on the second to sixth postoperative day concerning an additional consumption of non-opioid medications. In terms of range of motion, the LIA group showed a higher active range of motion at the operated extremity than the FNB group during the hospital stay. Conclusion The local intraarticular infiltration therapy (LIA) is a sufficient alternative to regional anesthesia avoiding the known risks of regional procedures. The results of this study reflect the efficiency of this pain management with a lower consumption of analgesics, identical to reduced postoperative pain ratings and an improved ROM in the first postoperative days. Level of evidence Retrospective trial

Objective How well the heart and cardiovascular system operate will directly influence the ability that female athletes bear the training and competition load.The accurate evaluation of heart and cardiovascular system is the important part of female athletes training processes monitor and medical supervision. Nowadays, there are many evaluation index to assess the condition of the heart and cardiovascular system .Due to the differences of tested mechanisms ,there are huge differences lay between the focus of index to show the cardiac function of female athletes. As a result, to clarify the significance of different evaluation index will be benefit to accurately evaluate the cardiac function of female athletes. This research clarifies different significance of different index to evaluate female athletes’ cardiac function by comparing two indexes(CRI, HRr) to evaluate the cardiac contractility of female athletes in different programs ,and also offers grounds for accurately applying these two indexes to evaluate female athletes’ cardiac function. Methods The study subjects of this research are the female athletes from sports team in Hubei province. We select 63 female athletes whose ages are between 14 and 18 and average age is 17±1.6.They have been trained to play basketball game, soccer ,badminton or table tennis for move than four years. This research applies quantitative exercise experiment to get the cardiac index --CI2（CI=CO/BSA）after the female athletes’ doing sports .We can compare the difference between the cardiac indexes during the female athletes doing sports and they becoming calm and the work done by exercise load (PP) to get the cardiac reserve index(CRI) .The formula of this process is CRI=PP/(CI2- CI1)/10. We can also dividing CRI by cardiac function index to get heart recovery rate (HRr) .We divide CRI by CFI to get the value of HRr . CFI=（HR1+HR2+HR3-200）/10. Thereinto, HR1、HR2、HR3 respectively mean the athletes’ heart rates when they are calm ,when they just finish doing sports and when they are in restoration stage. Data assessment and statistical analysis was performed in this research ,using the value of female athletes’ CRI and HRr in different programs. Results There are huge differences between the average CRI values of female athletes in different programs. Among them, the highest value is 11.13±1.1,which is the average CRI values of female athletes who play soccer .And the lowest one is 7.56±0.7, which is the average CRI values of female athletes who play table tennis. The values of CRI of female athletes in basketball group and badminton group are 10.07±0.9 and 7.82±0.8 respectively. However, there is no significant difference between the values of female athletes’ HRr in different groups. The values are 0.94±0.05 (women’ s basketball) , 0.97±0.06 (women’ s football) ,0.93±0.04 (women’ s table tennis) ,0.97±0.08 (women’ s badminton) respectively. ;mso-font-kerning:1.0000pt;" >+HR2+HR3-200）/10. Thereinto, HR1、HR2、HR3 respectively mean the athletes’ heart rates when they are calm ,when they just finish doing sports and when they are in restoration stage. Data assessment and statistical analysis was performed in this research ,using the value of female athletes’ CRI and HRr in different programs. Conclusions The phrase “cardiac reserve ” means the ability that cardiac output can increase according to the need of the body's metabolism. When people do some vigorous exercise.sympathetic will be active, and adrenalin production will increase. At the same time ,cardiac output will increase because of the increasing of heart rate reserve and mental efforts .The cardiac storage function can be more comprehensive reflected by the indexes such as heart rate and SV during people doing sports and being calm .Cardiac reserve includes heart rate reserve and cardiac contractile capacity reserve. This research shows the condition of female athletes’ cardiac reserve by using ultrasonic cardiography to directly test the change of cardiac output before and after people doing sports .Using this method ,we can get more straightforward results .Considering the big change of female athletes’ height and weight during puberty ,we use the change of cardiac index to replace it of cardiac output .In this way ,we can make the assessment index more unique .When people do the same amounts of exercise ,the ones whose heart rate and cardiac output increase less have greater heart reserve .Therefore ,we can compare the work done by the exercise (PP) and the difference of cardiac index CI1 and CI2 to get cardiac reserve index (CRI) . The research result shows that there are significant differences between the average value of female athletes’ CRI in different programs .We can get the conclusion that the CRI has the typical item features .So we can apply CRI to be the assessment index which reflects the item features of female athletes .We can also apply CRI in selecting youth athletes of different programs .We can divide CRI by heart functional index to get HRr . Heart functional index can be figured out by calculating the HR1 ,HR2,HR3 .It can reflect the heart health status of athletes .This research also shows that there is no significantly difference between female athletes’ HRr in different programs .But this research do not include the data of normal women .As a result ,we still need to compare the test result of female athletes and that of normal women in the further research .According to the result of this research ,it is more reasonable and accurate to apply HRr to be the health assessment index of female athletes’ cardiac function .

“A bunch of faggots for watching men hug each other in tights.”For the past five Marches, World Wrestling Entertainment (WWE) has produced an awards show which honours its aged former performers, such as Jimmy “Superfly” Snuka and Ricky “The Dragon” Steamboat, as pro-wrestling Legends. This awards show, according to WWE, is ‘an elegant, emotional, star-studded event that recognizes the in-ring achievements of the inductees and offers historical insights into this century-old sports-entertainment attraction’ (WWE.com, n.p.). In an episodic storyline leading up to the 2009 awards, however, the real-life personal shortcomings of these Legends have been brought to light, and subsequently mocked in one-on-one interview segments with WWE’s Superstar of the Year 2008, the dastardly Chris Jericho. Jericho caps off these tirades by physically assaulting the Legends with handy stage props. Significantly, the performances of Jericho and his victims have garnered positive attention not only from mass audiences unaware of backstage happenings in WWE, but also from the informed community of pro-wrestling fans over at the nihilistic humour website SomethingAwful. During Jericho’s assault on the Legend Jimmy “Superfly” Snuka at the March 02 WWE Raw event, a WWE-themed forum thread on SomethingAwful logged over sixty posts all reiterating variations of ‘gently caress me Jericho is amazing’ (Jerusalem, n.p.). This is despite the community’s passive-aggressive and ironically jaded official line that they indeed are ‘a bunch of faggots for watching men hug each other in tights. Thank you for not telling us this several times’ (HulkaMatt, n.p.). Why were these normally cynical fans of WWE enthusiastically expressing their love for the Jericho-Legends feud? In order to answer this question, this paper argues that the feud articulates not only the ideal of the “giving wrestler”, but also Roland Barthes’s version of jouissance. Consuming and commenting on WWE texts within the SomethingAwful community is further argued to be a performative ritual in which informed wrestling fans distance themselves from audiences they perceive as uncritical and ill-informed cultural dupes. The feud, then, allows the SomethingAwful fans to perform enthusiasm on two interconnected levels: they are not only able to ironically cheer on Jericho’s morally reprehensible actions, but also to genuinely appreciate the present-day in-ring efforts of the Legends. The Passion of the SuperflyTo properly contextualise this paper, though, the fact that “pro wrestling is fake” needs to be reiterated. Each match is a choreographed sequence of moves. Victory does not result from landing more damaging bodyslams than one's opponent, but is instead predetermined by scriptwriters—among whom wrestlers are typically not numbered—backstage. In the 1950s, Roland Barthes thus commented that pro wrestling ‘is not a sport, it is a spectacle’ (Mythologies 13). Yet, pro wrestling remains popular because this theatricality allows for the display of spectacular excesses of passion—here Barthes not only means “an intensity of emotion”, but refers to the physically tortured heroes of medieval passion plays as well—giving it an advantage over the legitimate sport of amateur wrestling. ‘It is obvious that at such a pitch, it no longer matters whether the passion is genuine or not. What the public wants is the image of passion, not passion itself’ (Mythologies 16). This observation still holds true in today’s WWE. On one hand, the SomethingAwful fans go ‘gently caress Jericho, [Superfly] will MURDER you’ (Jerusalem, n.p.) in disapproval of Jericho’s on-screen actions. In the same thread, though, they simultaneously fret over him being slightly injured from an off-screen real life accident. ‘Jericho looks busted up on his forehead. Dang’ (Carney, n.p.).However, Barthes’s observations, while seminal, are not the be-all and end-all of pro wrestling scholarship. The industry has undergone a significant number of changes since the 1950s. Speeches and interview segments are now seen as essential tools for furthering storylines. Correspondingly, they are given ample TV time. At over ten minutes, the Jericho-“Superfly” confrontation from the March 02 Raw is longer than both the matches following it, and a fifteen minute conversation between two top wrestlers capstones these two matches. Henry Jenkins has thus argued that pro wrestling is a male-targeted melodrama. Its ‘writers emphasize many traits that [legitimate sports such as] football share with melodrama-the clear opposition between characters, the sharp alignment of audience identification, abrupt shifts in fortune, and an emotionally satisfying resolution’ (Jenkins, “Never Trust a Snake” 81). Unlike football, though, the predetermined nature of pro wrestling means that its events can be ‘staged to ensure maximum emotional impact and a satisfying climax’ (Jenkins, “Never Trust a Snake” 81). Further, Jenkins notes that shouting is preferred over tears as an outlet for male affect. It ‘embodies externalised emotion; it is aggressive and noisy. Women cry from a position of emotional (and often social) vulnerability; men shout from a position of physical and social strength (however illusory)’ (Jenkins, “Never Trust a Snake” 80). Pro wrestling is seen to encourage this outlet for affect by offering its viewers spectacles of male physical prowess to either castigate or cheer. Jericho’s assault of the Legends, coupled with his half-screaming, half-shouting taunts of “‘Hall of Famer’? ‘Hall of Famer’ of what? You’re a has-been! Just like all the rest!” could be read to fit within this paradigm as well. Smarts vs. MarksWWE has repeatedly highlighted its scripted nature in recent years. During a 2007 CNN interview, for instance, WWE Chairman Vince McMahon constantly refers to his product as “entertainment” and laughingly agrees that “it’s all story” when discussing his on-screen interactions with his long-lost midget “son” (Griffin, n.p.). These overt acknowledgments that WWE is a highly choreographed melodrama have boosted the growth of a fan demographic referred to the "smart" in pro-wrestling argot. This “smart” fan is a figure for whom the fabricated nature of pro-wrestling necessitates an engagement with the WWE spectacle at a different level from mass audiences. The “smart” not only ‘follow[s] the WWE not just to see the shows, but to keep track of what “the Fed[eration]” is doing’ (McBride and Bird 170) with regards to off-camera events, but also 'has knowledge of the inner-workings of the wrestling business’ (PWTorch, n.p.). One of the few “GOLD”-rated threads on the SomethingAwful smart forums, accordingly, is titled “WWE News and Other Top Stories, The Insider Thread”, and has nearly 400 000 views and over 1000 posts. As a result, the smarts are in a subject position of relative insider-ness. They consume the WWE spectacle at a deeper level—one which functions roughly like an apparatus of capture for the critical/cynical affect mobilised around the binary of ‘real’ and ‘fake’—yet ultimately remain captured by the spectacle through their autodidact enthusiasm for knowledge which uncovers its inner workings.By contrast, there is the category of the “mark” fan. These “marks” are individuals who remain credulous in their reception of WWE programming. As cuteygrl08 writes regarding a recent WWE storyline involving brotherly envy:I LOVE JEFF HARDY!!!! i cried when i heard his brother say all the crap about him!! kinda weird but i love him and this video is soooo good!! JEFF hardy loves his fans and his fans love him no matter what he does i'll always love JEFF HARDY!!!!!!!!!!! (n.p.)This unstinting faith in the on-screen spectacle is understandable insofar as WWE programming trades upon powerful visual markers of authenticity—nearly-bare bodies, sweat, pained facial expressions­—and complements them with the adrenaline-producing beats of thrash metal and hard rock. Yet, smarts look down upon marks like cuteygrl08, seeing them as Frankfurt School-era hypnotised sots for whom the WWE spectacle is ‘the common ground of the deceived gaze and of false consciousness’ (Debord 117), and additionally as victims of a larger media industry which specialises in mass deception (Horkheimer and Adorno 41). As Lawrence McBride and Elizabeth Bird observe:Marks appear to believe in the authenticity of the competition—Smarts see them as the stereotypical dupes imagined by wrestling critics. Smarts approach the genre of wrestling as would-be insiders, while Marks root unreflexively for the most popular faces. Smart fans possess truly incredible amounts of knowledge about the history of wrestling, including wrestler’s real names and career histories, how various promotions began and folded, who won every Wrestlemania ever. Smart fan informants defined a Mark specifically as someone who responds to wrestling in the way intended by the people who write the storylines (the bookers), describing Marks with statements such as “Kids are Marks.” or “We were all Marks when we were kids.” Smarts view Marks with scorn. (169)Perhaps feeding on the antagonistic binaries drawn by WWE programming, there exists an “us vs them” binary in smart fan communities. Previous research has shown that fan communities often rigidly police the boundaries of “good taste”, and use negatively constructed differences as a means of identity construction (Fiske 448; Jenkins, “Get a Life!” 432; Theodoropoulou 321). This ritual Othering is especially important when supporting the WWE. Smarts are aware that they are fans of a product denigrated by non-fans as ‘trash TV’ (McKinley, n.p.). As Matt Hills finds, fandom is a mode of performative consumption. It is ‘an identity which is (dis)claimed, and which performs cultural work’ (Hills xi). Belonging to the SomethingAwful smart community, thus, exerts its own pressures on the individual smart. There, the smart must perform ‘audiencehood, knowing that other fans will act as a readership for speculation, observation, and commentaries’ (Hills 177). Wrestling, then, is not just to be watched passively. It must be analysed, and critically dissected with reference to the encyclopaedic knowledge treasured by the smart community. Mark commentary has to be pilloried, for despite all the ironic disaffection characterising their posts, the smarts display mark-like behaviour by watching and purchasing WWE programming under their own volition. A near-existential dread is hence articulated when smarts become aware of points where the boundaries between smart and mark overlap, that ‘the creatures that lurk the internet ...carry some of the same interests that we do’ (rottingtrashcan, n.p.). Any commonalities between smarts and marks must thus be disavowed as a surface resemblance: afterall, creatures are simply unthinking appetites, not smart epicures. We’re better than those plebs; in fact, we’re nothing like them any more. Yet, in one of the few forms of direct address in the glossary of smart newsletter PWTorch, to “mark out” is ‘to enthusiastically be into [a storyline] or match as if you [emphasis added] were “a mark”; to suspend one's disbelief for the sake of enjoying to a greater extent a match or [a storyline]’ (PWTorch, n.p.). The existence of the term “marking out” in a smart glossary points to an enjoyably liminal privileged position between that of defensively ironic critic and that of credulous dupe, one where smarts can stop their performance of cooler-than-thou fatigue and enthusiastically believe that there is nothing more to WWE than spontaneous alarms and excursions. The bodily reactions of the Legends in response to Jericho's physical assault helps foster this willing naiveté. These reactions are a distressing break from the generic visual conventions set forth by preceding decades of professional wrestling. As Barthes argues, wrestling is as much concerned with images of spectacular suffering as with narratives of amazing triumphs:the wrestler who suffers in a hold which is reputedly cruel (an arm- lock, a twisted leg) offers an excessive portrayal of Suffering; like a primitive Pieta, he exhibits for all to see his face, exaggeratedly contorted by an intolerable affliction. It is obvious, of course, that in wrestling reserve would be out of place, since it is opposed to the voluntary ostentation of the spectacle, to this Exhibition of Suffering which is the very aim of the fight. (17)Barthes was writing of the primitively filmed wrestling matches of the 1950s notable for their static camera shots. However, WWE wrestlers yet follow this theatrical aesthetic. In the match immediately following Jericho’s bullying of Superfly, Kane considerately jumps the last two feet into a ringside turnbuckle after Mike Knox pushes him into its general vicinity. Kane grunts at the impact while the camera cuts to a low-angled shot of his back—all the better to magnify the visual of the 150 kg Knox now using his bulk to squash Kane. Whenever Jericho himself traps his opponent in his “Walls of Jericho” submission manoeuvre, both their faces are rictuses of passion. His opponent clutches for the safety of the ring ropes, shaking his head in heroic determination. Audiences see Jericho tighten his grip, his own head shaking in villainous purpose. But the Legends do not gyrate around the set when hit. Instead, they invariably slump to the ground, motionless except for weakly spasming to the rhythm of Jericho’s subsequent attacks. This atypical reaction forces audiences—smart and mark alike—to re-evaluate any assumptions that the event constitutes a typical WWE beatdown. Overblown theatricality gives way to a scene which seems more related to everyday experiences with pain: Here's an old man being beaten and whipped by a strong, young man. He's not moving. Not like other wrestlers do. I wonder... The battered bodies of these Legends are then framed in high angle camera shots, making them look ever so much more vulnerable than they were prior to Jericho’s assault. Hence the smart statements gushing that ‘gently caress me Jericho is amazing’ (Jerusalem, n.p.) and that Jericho’s actions have garnered a ‘rear end in a top hat chant [from the crowd]. It has been FOREVER since I heard one of those. I love Chris Jericho’ (Burrito, n.p.).Jouissance and “Marking Out”This uninhibited “marking out” by normally cynical smarts brings to mind Barthes's observation that texts are able to provoke two different kinds of enjoyment in their readers. On one hand, there is the text which provides pleasure born from familiarity. It ‘contents, fills, grants euphoria; [it is] the text that comes from culture and does not break with it, is linked to a comfortable practice of reading’ (Barthes, Image-Music-Text 14). The Knox-Kane match engendered such a been-there-done-that-it's-ok-I-guess overall reaction from smarts. For every ‘Mike Knox throwing Mysterio at Kane was fantastic’ (Burrito, n.p.), there is an ‘Ahahaha jesus Knox [sic] that was the shittiest Hurracanrana sell ever’ (Axisillian, n.p.), and a ‘Hit the beard [sic] it is Knox's weakpoint’ (Eurotrash, n.p.). The pleasant genericity of the match enables and necessitates that these smarts maintain their tactic of ironic posturing. They are able to armchair critique Knox for making his opponent's spinning Hurracanrana throw look painless. Yet they are also allowed to reiterate their camp affection for Knox's large and bushy beard, which remains grotesque even when divorced from a WWE universe that celebrates sculpted physiques.By contrast, Barthes praises the text of rapturous jouissance. It is one where an orgasmic intensity of pleasure is born from the unravelling of its audience’s assumptions, moving them away from their comfort zone. It is a text which ‘imposes a stage of loss, [a] text that discomforts (perhaps to the point of boredom), unsettles the reader's historical, cultural, psychological assumptions, the consistency of his tastes, values, memories, brings to crisis his relation with language’ (Barthes, Image-Music-Text 14). In addition to the atypical physical reactions of the Legends, WWE cynically positions the Jericho-Legends segments during Raw events which also feature slick video montages highlighting the accomplishments of individual Legends. These montages—complete with an erudite and enthusiastic Voice-of-God narrator— introduce the long-retired Legends to marks unfamiliar with WWE's narrative continuity: “Ladies and gentlemen! Rrriiiicky “The Draaagon” Steeeeamboat!”. At the same time, they serve as a visually and aurally impressive highlight-reel-cum-nostalgic-celebration of each Legend's career accomplishments. Their authoritative narration is spliced to clips of past matches, and informs audiences that, for instance, Steamboat was ‘one of the first Superstars to combine technical skills with astounding aerial agility ... in a match widely regarded as one of the best in history, he captured the Intercontinental title from Randy Savage in front of a record-breaking 93 173 fans’ (“Raw #636”, WWE). Following the unassailably authentic video footage of past matches, other retired wrestlers speak candidly in non-WWE stages such as outdoor parks and their own homes about the Legend's strengths and contributions to the industry.The interesting thing about these didactic montages is not so much what they show —Legends mythologised into triumphant Titans — but rather, what they elide. While the Steamboat-centred package does reflect the smart consensus that his Intercontinental bout ‘was a technical classic, and to this day, is still considered one of the greatest matches of all-time’ (NPP, n.p.), it does not mention how Steamboat was treated poorly in the WWE. Despite coming to it as the widely-known World Champion of [the NWA] rival promotion, WWE producers ‘dressed Steamboat up as a dragon and even made him blow fire. ...To boot, he was never acknowledged as a World Champion and [kept losing] to the stars’ (NPP, n.p.). The montages, overtly endorsed by the gigantic WWE logo as they are, are ultimately pleasant illusions which rewrite inconvenient truths while glamorising pleasant memories.Jericho’s speeches, however, sharply break from this celebratory mode. He references Steamboat’s previous success in the NWA, ‘an organisation that according to this company never even existed’(“Raw #636”, WWE). He then castigates Steamboat for being a real-life sellout and alludes to Steamboat having personal problems unmentioned in the montage:It wasn't until you came to the WWE that you sold your soul to all of these parasites [everyone watching] that you became “The Dragon”. A glorified Karate Kid selling headbands and making poses. Feeding into stereotypes. And then you eventually came to the ring with a Komodo Dragon. Literally spitting fire like the circus freak you'd become. It was pathetic. But hey, it's all right as long as you're making a paycheck, right Steamboat? And then when you decided to retire, you ended up like all the rest. Down and out. Broken. Beaten down. Dysfunctional family ...You applied for a job working for the WWE, you got one working backstage, and now here you are. You see, Steamboat, you are a life-long sellout. And now, with the Hall of Fame induction, the loyal dog gets his bone. (WWE)Here, Jericho demonstrates an apparent unwillingness to follow the company line by not only acknowledging the NWA, but also by disrespecting a current WWE backstage authority. Yet, wrestlers having onscreen tangles with their bosses is the norm for WWE. The most famous storyline of the 1990s had “Stone Cold” Steve Austin and the WWE Chairman brutalising each other for months on end, and the fifteen minute verbal exchange mentioned earlier concerns one wrestler previously attacking the Raw General Manager. Rather, it is Jericho’s reinterpretation of Steamboat’s career trajectory which gives the storyline the intensely pleasurable uncertainty of jouissance. His confrontational speeches rupture the celebratory nostalgia of the montages, forcing smarts to apply extra-textual knowledge to them. This is especially relevant in Steamboat’s case. His montage was shown just prior to his meeting with Jericho, ensuring that his iconic status was fresh in the audience’s memory. Vera Dika’s findings on the conflict between memory and history in revisionist nostalgia films are important to remember here. The tension ‘that comes from the juxtaposition of the coded material against the historical context of the film itself ...encourages a new set of meanings to arise’ (Dika 91). Jericho cynically views the seemingly virtuous and heroic Steamboat as a corporate sycophant preying on fan goodwill to enrich his own selfish ends. This viewpoint, troublingly enough for smarts, is supported by their non-WWE-produced extra-textual knowledge, allowing for a meta-level melodrama to be played out. The speeches thus speak directly to smarts, simultaneously confounding and exceeding their expectations. The comfortingly pleasant memories of Steamboat’s “amazing aerial prowess” are de-emphasised, and he is further linked to the stereotypical juvenilia of the once-popular The Karate Kid. They articulate and capitalise upon whatever misgivings smarts may have regarding Steamboat’s real-life actions. Thus, to paraphrase Dika, ‘seen in this clash, [the Jericho-Legends feud] has the structure of irony, producing a feeling of nostalgia, but also of pathos, and registering the historical events as the cause of an irretrievable loss [of a Legend’s dignity]’ (91). “C’mon Legend! Live in the past!” taunts Jericho as he stuffs Superfly’s mouth with bananas and beats him amidst the wreckage of the exactingly reproduced cheap wooden set in the same way that “Rowdy” Roddy Piper did years ago (“RAW #637”, WWE). This literal dismantling of cherished memories results from WWE producers second-guessing the smarts, and providing these fans with an enjoyably uncomfortable jouissance that cleverly confounds the performance of a smart disaffection. “Marking out” —or its performance at least—results.The Giving WrestlerLastly, the general physical passivity of the Legends also ties into the ethos of the “giving wrestler” when combined with the celebratory montages. In a business where performed passion is integral to fan enjoyment, the “giving wrestler” is an important figure who, when hit by a high-risk move, will make his co-worker’s offense look convincing (McBride and Bird 173). He ‘will give his all in a performance to ensure a dual outcome: the match will be spectacular, benefiting the fans, and each wrestler will make his “opponent” look good, helping him “get over with the fans” (McBride and Bird 172). Unsurprisingly, this figure is appreciated by smarts, who ‘often form strong emotional attachments to those wrestlers who go to the greatest lengths to bear the burden of the performance’ (McBride and Bird 173). As described earlier, the understated reactions of the Legends make Jericho’s attacks paradoxically look as though they cause extreme pain. Yet, when this pathetic image of the Legends is combined with the hypermasculine images of them in their heyday, a tragedy with real-life referents is played out on-stage. In one of Jenkins’s ‘abrupt shifts of fortune’ (“Never Trust a Snake” 81), age has grounded these Legends. They can now believably be assaulted with impunity by someone that Steamboat dismisses as ‘a snotty brat wrestler of a kid[sic] ...a hypocrite’ (“Raw #636”, WWE), and even in this, they apparently give their all to make Jericho look viciously “good”, thus exceeding the high expectations of smarts. As an appreciative thread title on SomethingAwful states, ‘WWE Discussion is the RICKY STEAMBOAT OWN [wins] ZONE for 02/23/09’ (HulkaMatt, n.p.) ConclusionThe Jericho-Legends feud culminated the day after the Hall of Fame ceremony, at the WWE’s flagship Wrestlemania event. Actor Mickey Rourke humiliated Jericho for the honour of the Legends, flattening the cocky braggart with a single punch. The maximum degree of moral order possible was thus temporarily restored to an episodic narrative centred around unprovoked acts of violence. Ultimately though, it is important to note the three strategies that WWE used The Legends were scripted to respond feebly to Jericho’s physical assault, slick recap montages were copiously deployed, and Jericho himself was allowed candid metatextual references to incidents that WWE producers normally like to pretend have “never even existed”. All these strategies were impressive in their own right, and they eventually served to reinforce each other. 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