OBJECTIVE:The optimal non-surgical therapy for chronic ankle instability remains unclear due to the continuous introduction of novel treatment methods despite the availability of several non-surgical options for improving foot and ankle function and dynamic balance in chronic ankle instability patients.This study aims to investigate the most effective non-surgical therapy options to improve foot and ankle function and dynamic balance for patients with chronic ankle instability using a network meta-analysis. METHODS:Using"CAI,exercise,and randomized controlled trial"as search terms,a literature search of PubMed,Embase,Cochrane Library,and Web of Science databases was conducted through a computer network to collect information from the databases from their inception to March 2024 on non-surgical therapies for the treatment of chronic ankle instability randomized controlled trials on foot and ankle function or dynamic balance in patients.EndNote software was utilized for literature management.RevMan 5.4 software and Cochrane Risk of Bias Assessment Tool were used to evaluate the risk of bias of the included literature.Paired meta-analysis and network meta-analysis of the outcomes such as the Foot and Ankle Ability Measure in daily living subscale score,Foot and Ankle Ability Measure in sports activities subscale score,Star Excursion Balance Test-Anterior score,Star Excursion Balance Test-Posteromedial score,Star Excursion Balance Test-Posterolateral score and Cumberland ankle instability tool score were performed using the network commands of Stata 14.0 software.The strength of evidence rating of the outcome metrics was evaluated according to the GRADE Level of Evidence and Strength of Recommendation Grading Criteria. RESULTS:Of the 22 randomized controlled trials that met the inclusion criteria,1 study was rated as low risk,8 studies were rated as medium risk,and 13 studies were rated as high risk,enrolling a total of 952 patients and 25 treatments.(1)Network meta-analysis showed that compared with the control group,Isokinetic Strength Training,Balance Training,Balance+Stroboscopic Glasses Training,Strength Training,Joint Mobilizations Training,CrossFit Training,CrossFit Training+Self-Mobilization,Wobble Board Training,National Academy of Sport Medicine corrective exercise program,Trigger Point Dry Needling,and Neuromuscular Training had different significant enhancement effects on improving foot and ankle function and dynamic balance in patients with chronic ankle instability(P<0.05).(2)Cumulative probability ranking results showed that the three treatments with the highest ranked Cumberland ankle instability tool score were Joint Mobilizations Training(88.6%)>Visual Feedback Balance Training(83.1%)>CrossFit Training+Self-Mobilization(74.8%);the three treatments with the highest ranked Star Excursion Balance Test-Anterior score were Joint Mobilizations Training(88.4%)>Isokinetic Strength Training(86.9%)>National Academy of Sport Medicine corrective exercise program(65.0%);the three treatments with the highest ranked Star Excursion Balance Test-Posteromedial score were Balance+Stroboscopic Glasses Training(87.4%)>Neuromuscular Training(74.6%)>Strength Training(68.9%);the three treatments with the highest ranked Star Excursion Balance Test-Posterolateral score were CrossFit Training+Self-Mobilization(74.6%)>Balance+Stroboscopic Glasses Training(70.0%)>Neuromuscular Training(63.7%);the three treatments with the highest ranked Foot and Ankle Ability Measure in daily living subscale score were National Academy of Sport Medicine corrective exercise program(91.9%)>Balance+Stroboscopic Glasses Training(85.6%)>Wobble Board Training(82.2%);the three treatments with the highest ranked Foot and Ankle Ability Measure in sports activities subscale score were Balance+Stroboscopic Glasses Training(93.5%)>Balance Training(86.7%)>National Academy of Sport Medicine corrective exercise program(86.4%). CONCLUSION:Non-surgical therapies can significantly improve foot and ankle function and dynamic balance in patients with chronic ankle instability.National Academy of Sport Medicine corrective exercise program had the best efficacy in improving foot and ankle daily activity function in chronic ankle instability patients;Balance+Stroboscopic Glasses Training had the best efficacy in improving foot and ankle sports function and posterior medial dynamic balance;Joint Mobilizations Training had the best efficacy in improving anterolateral dynamic balance and ankle instability condition;and CrossFit Training+Self-Mobilization had the best efficacy in improving posterior lateral dynamic balance.The strength of evidence for each outcome was low,influenced by the risk of methodological bias and risk of publication bias of the included studies.Therefore,the above conclusions need to be validated by more high-quality pilot studies.

It is believed that traditional Chinese medicine （TCM） Daoyin （conduction exercise） therapy has potential in treating diabetic foot， which is a concrete embodiment of HUANG Yuanyu's theory of one qi circulation applied in practice. Based on Daoyin therapy of Baduanjin and the Origin and Indicators of Disease （《诸病源候论》）， a Daoyin prescription for diabetic foot was compiled and created. Based on the zang-fu concept of "One Qi Circulation"， combined with the theory of chief， deputy， assistant and envoy， this article explained the theoretical basis and functional mechanism of the Daoyin prescription for diabetic foot. This Daoyin therapy is mainly based on the prone position movements， which includes seven movements， namely， pull-up， knee bending， toe tilting， phoenix nodding， internal rotation of taiji， two hands climbing feet and closing. With "phoenix nodding" and "tilting toes" as the chief， with the help of toes opening-closing and pointing-pressing momentum in prone position， regulating the central qi； with "bending the knee" and "internal rotation of taiji" as the deputy， knee and ankle flexion and extension can unblock the meridians of liver and lungs； with "pull-up" and "two hands climbing feet" as the assistant， on the one hand， assisting to unblock zang-fu organs， on the other hand， applying the yang of the foot taiyang bladder channel and du mai to warm the cold and dampness； with "closing" as the envoy to regulate all organs， so that the blood return to the natural flow of circulation. Diabetic foot Daoyin therapy could regulate internal organs and qi circulation of body， and provides a new idea for the treatment of diabetic foot.

Objective:To compare the postoperative functional prognosis of transanal mesorectal excision (taTME) and conventional total mesorectal excision (TME) in rectal cancer.Methods:Totally 49 patients underwent taTME and 478 patients underwent conventional TME at Department of Gastroenterological Surgery, Peking University People′s Hospital from January 2015 to December 2019 were retrospectively collected. Propensity score matching method was used to perform 1 versus 1 matching between the taTME and conventional TME groups, and 36 pairs of patients were successfully matched. After matching, the median age of patients in taTME group and conventional TME group was 60.5 (16.0) years and 60.5 (13.0) years ( M( Q R)), respectively, and the proportion of male patients was 66.7% (24/36) and 55.6% (20/36) , respectively. EORTC QLQ-C30 scale was used to assess quality of life, low anterior resection syndrome (LARS) scale and Wexner constipation score were used to evaluate anal function, international prostate symptom score (IPSS) was used to evaluate urinary function,international index of erectile function (IIEF) -5 and female sexual function index (FSFI) score were used to evaluate male and female sexual function, respectively, and generalized anxiety disorder (GAD-7) and patient health questionnaire (PHQ-9) scale were used to evaluate psych function. The t test, Mann-Whitney U test, χ 2 test, and Fisher exact test were used for comparison between groups, and Wilcoxon rank sum test or McNemar test was used for comparison between paired data. Results:There were no significant differences in surgery time, postoperative hospital stays, conversion rate, morbidity rate, surgery cost, and numbers of lymph node yield between the two groups (all P>0.05). Compared with the conventional TME group, the intraoperative blood loss in the taTME group was significantly higher (100 (100) ml vs. 80 (50) ml, U=424.5, P=0.010), the prophylactic stoma rate was significantly higher (96.9%(31/36) vs. 63.6%(21/36), χ 2=11.218, P<0.01), the total hospitalization cost was significantly lower (74 297.7 (16 746.4) CNY vs. 91 781.3 (26 228.4) CNY, U=413.0, P=0.008). There were no significant differences in anal and urinary function between the two groups (LARS scalescore: Z=-0.513, P=0.608, Wexner constipation score: Z=-0.992, P=0.321, IPSS: Z=-1.807, P=0.071). In terms of psych function, significant difference in GAD-7 scale was seen between the two groups ( Z=-2.311, P=0.021), patients with generalized anxiety disorder accounting for 26.7% (8/30) and 46.9% (15/32), respectively. Conclusions:Compared with conventional TME surgery, taTME has a significantly increased blood loss and prophylactic stoma rate. There are no significant difference in the incidence of postoperative anal, urinary, and sexual dysfunction between taTME and conventinal TME. taTME can alleviate the financial burden and general anxiety disorder to a certain extent.

Objective:To compare the postoperative functional prognosis of transanal mesorectal excision (taTME) and conventional total mesorectal excision (TME) in rectal cancer.Methods:Totally 49 patients underwent taTME and 478 patients underwent conventional TME at Department of Gastroenterological Surgery, Peking University People′s Hospital from January 2015 to December 2019 were retrospectively collected. Propensity score matching method was used to perform 1 versus 1 matching between the taTME and conventional TME groups, and 36 pairs of patients were successfully matched. After matching, the median age of patients in taTME group and conventional TME group was 60.5 (16.0) years and 60.5 (13.0) years ( M( Q R)), respectively, and the proportion of male patients was 66.7% (24/36) and 55.6% (20/36) , respectively. EORTC QLQ-C30 scale was used to assess quality of life, low anterior resection syndrome (LARS) scale and Wexner constipation score were used to evaluate anal function, international prostate symptom score (IPSS) was used to evaluate urinary function,international index of erectile function (IIEF) -5 and female sexual function index (FSFI) score were used to evaluate male and female sexual function, respectively, and generalized anxiety disorder (GAD-7) and patient health questionnaire (PHQ-9) scale were used to evaluate psych function. The t test, Mann-Whitney U test, χ 2 test, and Fisher exact test were used for comparison between groups, and Wilcoxon rank sum test or McNemar test was used for comparison between paired data. Results:There were no significant differences in surgery time, postoperative hospital stays, conversion rate, morbidity rate, surgery cost, and numbers of lymph node yield between the two groups (all P>0.05). Compared with the conventional TME group, the intraoperative blood loss in the taTME group was significantly higher (100 (100) ml vs. 80 (50) ml, U=424.5, P=0.010), the prophylactic stoma rate was significantly higher (96.9%(31/36) vs. 63.6%(21/36), χ 2=11.218, P<0.01), the total hospitalization cost was significantly lower (74 297.7 (16 746.4) CNY vs. 91 781.3 (26 228.4) CNY, U=413.0, P=0.008). There were no significant differences in anal and urinary function between the two groups (LARS scalescore: Z=-0.513, P=0.608, Wexner constipation score: Z=-0.992, P=0.321, IPSS: Z=-1.807, P=0.071). In terms of psych function, significant difference in GAD-7 scale was seen between the two groups ( Z=-2.311, P=0.021), patients with generalized anxiety disorder accounting for 26.7% (8/30) and 46.9% (15/32), respectively. Conclusions:Compared with conventional TME surgery, taTME has a significantly increased blood loss and prophylactic stoma rate. There are no significant difference in the incidence of postoperative anal, urinary, and sexual dysfunction between taTME and conventinal TME. taTME can alleviate the financial burden and general anxiety disorder to a certain extent.

Objective Along with the development of science and technology , increase in the number of species gradually distal femoral fractures internal fixation materials , the choice of performer operation method is put forward to the test .To provide theo-retical basis for surgery of adult distal femoral fractures by systematically compare the distal femoral fractures in adults treated by intr -amedullary nail and plate . Methods We searched for articles comparing intramedullary nail and plate for distal femoral fractures in adults in Cochrane library, HighWire, CNKI, PubMed, super star MedaLink, Wanfang database.Manual retrieval related magazines, the retrieve date from June 2003 to June 2013.The RevMan5.1 provided for the extraction of available data after evaluate the quality of eligible literature . Results A total of 1200 patients were included ( 545 in the intramedullary nailing group and 655 in the plate group).Compared with the plate, intramedullary nail significantly reduced the risk of total complications (RR=0.48,95%CI[0.35, 0.67],P<0.01).Shorten the hospital stay (WMD =-3.55,95%CI[ -4.89, -2.24], P <0.01),full weight-bearing time (WMD=-0.80,95%CI[-1.49,-0.10],P=0.02), healing time(WMD=-3.32,95%CI[ -3.72,-2.92],P<0.01), all the above differences are statistically significant .In addition, this study found that intramedullary nail group is better in operation time and blood loss than steel group , but the conclusion by contrast in some literature . Conclusion Intramedullary nailing treatment of distal femoral fractures in adults can decrease the occurrence of postoperative complications .And in the operation time , hospitalization time, healing time, load time and blood loss, etc is superior to the steel group .Influenced by quality into literature , the above conclu-sion needs high quality case-control study further confirmed .

Objective To evaluate the clinical effect of talonavicular arthrodesis and the influence of adjacent joints use trephine percutaneous osteotomy in the treatment of talonavicular arthralgia.Methods From June 1999 to June 2009,24 patients were performed talonavicular arthrodesis due to a variety of painful disorder of talonavicular joint with trephine percutaneous osteotomy.There were 13 males and 11 females,with an average age of 45 years(range,37-72 years).The indications for the procedure included 15cases with posttraumatic arthritis,6 cases with rheumatoid arthritis,and 3 cases with degenerative arthritis.AOFAS system and visual analogue scale(VAS)were used to evaluate the change of function and arthralgia.Graves score system was used to evaluate the influence of adjacent joints.Results All patients were followed up 10-120 months,with the mean of 48 months.Only one case suffered skin brim necrosis of incision and got delayed healing after 3 weeks.The average AOFAS ankle-hind foot score improved from 45.2 points preoperatively to 84.5 points postoperatively.The excellent and good rate was 87.5%.VAS pain scores decreased from 8.1 to 2.4 postoperatively.Twenty-three patients were satisfied and one dissatisfied with the results.Postoperative radiology showed the union evidence in 23 patients at 6 months postoperatively(successful fusion rate of 95.8%).One joint nonunion occurred and required revision arthrodesis with iliac crest bone graft.There was an increase of Ⅰ grade in arthritic scores for 8 cases and Ⅱ grade for 1 case.Conclusion Talonavicular arthrodesis with trephine percutaneous osteotomy has the advantages of low trauma,high successful fusion rate and can acquire satisfactory clinical effect in the treatment of painful malalignment of talonavicular joints.

Objective To investigate the characteristics of memory impairment in patients with amnestic mild cognitive impairment (aMCI). Methods Thirty-five patients with aMCI and 35 healthy adults matched with age and education level were administered with a neuropsychological battery of tests including conception and perception implicit priming tasks (category exemplar, picture identification), as well as explicit memory tasks (immediate recall, delay recall, delay recognition ). Results Compared with healthy elders, patients with aMCI were impaired in the conception implicit priming task(t=-4.33, P<0.01), as well as in explicit memory (immediate recall, t=6.40, P<0.01;delay recall, t=9.29,P<0.01; delay recognition, t=7.65,P<0.01),but not in perception implicit priming task (t=-0.78, P＞0.05).The conception implicit priming is positively correlated with verbal fluency (r=0.74,P<0.01). Conclusions The present results indicate that patients with aMCI are impaired in both explicit memory and conception implicit priming. The conception implicit priming impairment in aMCI may be related to their frontal lobe dysfunction.

Objective To test the overall characteristic curve on a computed radiography system. Methods Imaging plate was exposed by scale-time expose using conventional X-ray equipment. It was processed by CR system. Density of different optical density wedge on CR film was measured by using densimeter. Then, characteristic curve was plotted. Results (1) Overall characteristic curve of CR system was affected by gradation processing. (2) Average gradient of overall characteristic curve was 1.98, 3.10, and 3.75 when GA was 0.8,1.4, and 2.4. (3) Overall characteristic curve rotated around rotation center when rotation amount was changed. Conclusion According to the diagnostic purpose and different body position, rotation amount can be selected, and different contrast imaging can be acquired.