Abstract: The high recurrent rate and insufficient protection of anal function in treatment of anal fistula were reviewed in this article. To solve the problems in the treatment of complex fistula-in-ano including ignorance of preoperative assessment and lack of consciousness of preserving anal function, the authors raised the countermeasures to carry out the "gold standard" of preoperative assessment and the system of medical delivery, form the new principle of incision of anal sphincters, collect the high-level evidence-based medicine proof, improve the healing rate and significantly reduce the postoperative continence disturbance, so as to develop a new guideline for the treatment of fistula-in-ano.

Objective To evaluate the effects of flurbiprofen axetil and fentanyl in postoperative analgesia on immune function and stress response of the patients undergoing esophagectomy. Methods Sixty patients were randomly divided into three groups with 20 cases in each group, including Group F_1 (pre-operative: flurbiprofen axetil 50mg, postoperative : flurbiprofen axetil 50mg + fentanyl 10μg/kg + droperidol 2.5 mg), F_2 (postoperative: flurbiprofen axetil 100mg + fentanyl 10μg/kg + droperidol 2. 5 mg) , and group C (postoperative: fentanyl 10μg/kg + droperidol 2.5 mg). The VAS score was recorded at 1, 24, 48 hours after surgery. Blood samples were obtained from peripheral vein for determination of NE, ACTH, COS, CD3~ + , CD4~+ , CD8~+ and CD4 VCD8~+ at 30min before surgery, 1 d, 2d after surgery. Results Patients in the three groups did not show any significant difference in the VAS scores ( P > 0.05). NE was significantly lower in group F_1 than group F_2 and group C at 1 d after surgery ( P < 0. 05). There were significantly decreased ACTH in group F_2 and F_1 than group C at 1d after surgery( P <0. 05), and it was significantly decreased in group F, than that in group C at 2d after surgery( P < 0.05). COS was significantly decreased in group F_1 than that group C at 1d after surgery( P <0.05 ). CD3~+ T-lymphocytes were significantly higher in group F_2 and F_1 than that group C at 1h after surgery ( P <0. 05) , and group F, was significantly higher than group C at 2d after surgery( P <0.05). CD4~+ T-lymphocytes were significantly increased in group F_1 than that in group C and F_2 at 1d after surgery( P < 0.05). CD8~+ T-lymphocytes were no significantly change in 3 groups and at each time point ( P >0.05). CD4~+/ CD8~+ were significantly higher in group F_1 than that in group C and F_2 at 1 d after surgery( P <0.05). Conclusion Postoperative analgesia by using flurbiprofen axetil and fentanyl can diminish the using dose of postoperative opoiod drug, it can decrease patients postoperative stress level and improve patients cellular immune function.

Crohn's disease (CD) is a chronic nonspecific inflammatory disease.CD can affect any location in the digestive tract,and it also affect other organs,including the eyes,skin,liver and joints,which are termed extraintestinal manifestations (EIMs).The cutaneous manifestations of CD are common and occur in about one-third of patients.EIMs of CD have been divided into 3 categories.(1) Specific lesion,cutaneous manifestations of CD were the same as histopathologic findings of underlying gastrointestinal lesion.(2) Reactive lesion,it was also inflammatory lesion which was usually accompanied by underlying gastrointestinal disease while inflammatory injury was different from histopathologic findings of gastrointestinal lesion.(3) Associated lesion,it was caused by sequelae of human leucocyte antigen and chronic inflammation.In the current era of ever-expanding therapeutic options for CD,some investigators have proposed a fourth category of EIMs,namely those that are therapy-related lesion.The therapy-related lesion is closely related to disease-associated conditions in light of certain skin findings,and there is potential overlap between them.

Objective To evaluate ligation of the intersphincteric fistula tract plus core-out fistulectomy for complex cryptoglandular anal fistulas.Methods Forty-one patients were divided into ligation and control group randomly.In ligation group (20 cases),patients underwent ligation of the intersphincteric fistula tract plus core-out fistulectomy procedure.While in control group (21 cases) fistulotomy on low sphincter with cutting-seton on high sphincter procedure was performed.The primary end points of the study were healing rate and continence by using the Wexner score.Secondary end points were postoperative pain in the third and seventh day with the use of the visual analog scale,length of hospital stay and followed measures for a recurrent fistula.Comparison of measurement data using independent samples t-test or paired samples t-test,compared with the count data using Fisher's exact test.Results There was no statistical difference in the healing rate between ligation group (90％) and control group (95％) (P ＞0.05).Postoperatively,one case in ligation group reported incontinence for gas,compared to 7 cases in control group,among these 7 cases 2 cases also had incontinence for watery stool.Statistical differences were found between two groups in Wexner scores,visual analog scale scores and length of hospital stay (P ＜0.05).Conclusion Ligation of the intersphincteric fistula tract plus core-out fistulectomy is an economical,safe,little painful,recovery enhanced and minimally invasive technique to treat complex anal fistulas.

BACKGROUND: Animal experimental study on spinal cord injury used injury mode and similarity of clinical spinal cord injury as an important reference index of selecting modeling approach.
OBJECTIVE: To compare the difference among the use of precision impactor, homemade Al en’s impactor, spinal cord compression method and clamping method in rat models of spinal cord injury, and to provide a new basis for the selection of the modeling method of a rat model.
METHODS: PubMed, CNKI, Wanfang and VIP databases were retrieved with computer from Building to June 20, 2015. Eligible literatures were included and analyzed by ADDIS software.
RESULTS AND CONCLUSION: A total of 26 studies met inclusion criteria, containing 599 rats. After analysis of the inclusion studies, the model could be effectively made in each modeling method. The modeling method with effects from best to poor is as fol ows in order: precision impactor, clamping method, homemade Al en’s impactor and spinal cord compression method. According to the lowest mortality, there were precision impactor, homemade Al en’s impactor and clamping method. From the point of view of function and mortality, the use of precision impactor is the best. The use of homemade Al en’s impactor is the most economical. The clamp method could achieve a balance between them.

Objective To evaluate magnetic resonance imaging (MRI) in the diagnosis of deep anorectal abscess. Methods Twenty-one patients who were suspected of having deep anorectal abscess were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2006 to December 2007, and their clinical data were retrospectively analyzed. Phased-array coil MRI was applied to all patients before the operation. We compared the efficacy of MRI and rectal digital examination in the classification of deep anorectal abscess and the diagnosis rate of internal opening according to the postoperative results. All data were analyzed using the chi-square test. Results Nineteen patients were diagnosed with deep anorectal abscess, one patient had presacral cyst combined with infection and one patient had perianal mucinous adenocarcinoma. A total of 25 lesions were identified, including 14 ischiorectal abscesses, five pelvirectal abscesses, and six high intersphincteric abscesses. Thirteen patients had single space abscesses and six had multiple space abscesses. There were no significant differences in the diagnosis rate between MRI (12/19) and rectal digital examination for internal opening (13/19) (χ2 =0. 116, P>0.05). The accuracy rate was significantly different between MRI (25/25) and rectal digital examination (16/25) in the classification of deep anorectal abscess (χ2 = 10.970, P <0.05). Operative exploration revealed that there were 13 patients with single space abscesses and six with multiple space abscesses. The accuracy rate was significantly different between MRI (19/19) and the rectal digital examination (13/19) for detecting multiple space abscesses (χ2 =7. 125, P <0. 05). Conclusions MRI with a phased-array coil can accurately detect the extent of deep anorectal abscess and its relationship with anorectal sphincters. MRI examination is helpful in excluding potential lesions in the anorectal region.

BACKGROUND:Establishing a highly successful, safe, reliable standard spinal cord transection model is the precondition of studying spinal cord injury repair. OBJECTIVE:To evaluate the value of preparing spinal cord transection model in rats and the effects of laminectomy on spinal cord. METHODS: We searched the randomized controled trials involving rat models of spinal cord transection in the databases of PubMed, CNKI, VIP and WanFang. RESULTS AND CONCLUSION:11 randomized controled trials (RCTs) met the inclusion criteria (two in English, 9 in Chinese), and a total of 394 rats were included in the study. There were significant differences in the lower limb motor function scores (BBB scores) within 1-6 weeks after injury (WMD=-12.86, 95%CI-16.10 to-9.62,P < 0.01) and electrophysiological indices within 4 weeks after injury (WMD=15.36, 95%CI 11.36 to 19.36,P < 0.01) between spinal cord hemisection group and laminectomy group. The BBB scores after 6 weeks were not significantly different between these two groups (WMD=-10.28; 95%CI-24.20 to 3.64;P=0.15). There were significant differences in the lower limb motor function scores (BBB scores) within 1-6 weeks after injury (WMD=

Objective To investigate the clinical characteristics of perianal Crohn's disease (CD) with or without proctitis and compare the treatment effect of surgery combined with biological preparation.Methods The retrospective cohort study was conducted.The clinical data of 52 patients with perianal CD who were admitted to the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2011 to October 2014 were collected.Thirty patients with inflammation involvement of the rectum and 22 patients without inflammation involvement of the rectum were respectively divided into the proctitis group and non-proctitis group.All the 52 patients underwent surgery combined with infliximab therapy.Observation indicators included:(1) clinical characteristics:gender,age,body mass index (BMI),lesion location,disease behavior,type of perianal lesions,history of perianal surgeries,CD activity index (CDAI),perianal disease activity index (PDAI),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC),platelet (PLT) and albumin (Alb),(2) treatment and follow-up.Follow-up using outpatient examination was performed to evaluate the perianal lesions up to December 2015.Measurement data with normal distribution were described as-x ± s and comparison between groups was analyzed by the t test.Count data were described as the percentage,and comparison between groups was analyzed by the chi-square test and Fisher's exact probability.Results (1)Clinical characteristics:number of patients with BMI ＜ 18.5 kg/m2 and with normal BMI were respectively 17,13 in the proctitis group and 6,16 in the non-proctitis group.Lesions located at ileum,colon and ileocolon were respectively detected in 3,9,18 patients in the proctitis group and 9,4,9 patients in the non-proctitis group.CDAI≥ 150 and ＜ 150,CRP≥8 mg/L and ＜ 8 mg/L,ESR ＞ normal level and =normal level,Alb ＜ 35 g/L and between 35 g/L and 50 g/L were respectively detected in 23,7,25,5,24,6,12,18 patients in the proctitis group and 8,14,8,14,8,14,2,20 in the non-proctitis group,with statistically significant differences between the 2 groups (x2 =4.446,6.855,8.563,12.076,10.211,6.163,P ＜ 0.05).(2) Treatment and follow-up:all the 52 patients underwent more than 3 times infliximab therapies and perianal surgeries within 1 week after infliximab therapy.All the patients were followed up for a median time of 28 months (range,8-52 months).Thirty-four patients still underwent maintenance therapy of immunosuppressive agents and 18 didn't undergo maintenance therapy up to the end of follow-up.Twenty-two patients in the proctitis group and 12 patients in the non-proctitis group underwent maintenance therapy,with no statistically significant difference between the 2 groups (x2 =1.979,P ＞ 0.05).The total healed rate,improvement rate and unhealed rate of perianal lesion were 55.8％ (29/52),34.6％ (18/52) and 9.6％ (5/52),respectively.The number of patients with healed,improved and unhealed perianal lesions were 16,11,3 in the proctitis group and 13,7,2 in the non-proctitis group,respectively,showing no significant difference in treatment effects between the 2 groups (x2 =O.173,P ＞ 0.05).Conclusions Patients with perianal CD combined with proctitis have higher activity of intestinal inflammation and worse nutritional status compared with patients without proctitis.However,there is no significant difference in the type and activity of perianal lesion between patients with or without proctitis.Surgery combined with biological preparation could render better clinical outcomes in treatment of perianal CD with proctitis.

Objective To study the effect of baicalin on the apoptosis and cell cycle of colorectal cancer cells in orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.Methods Sixty orthotopic transplantation mice models of human colorectal cancer cell line HCT1 16 expressing green fluorescent protein (GFP) were established,and were randomly divided into the control group and the 50,100,200 mg/kg baicalin groups according to the random number table.Mice in the 50,100,200 mg/kg baicalin groups received intragastric infusion of baicalin at the corresponding dosages twice a day,while mice in the control group received intragastric infusion of 5％ NaHCO3.Cell cycles and apoptotic rates of the HCT116-GFP cells were detected by flow cytometry and TUNEL method respectively.Differences between the 2 groups were analyzed using the analysis of variance or chi-square test,and differences within each group were analyzed using the LSD-t test.Results The orthotopic transplantation mice models of human colorecta] cancer were successfully constructed,and there was no significant difference in the body weight of the mice and tumor size among the 4 groups (F =0.343,0.107,P ＞0.05).The proportion of HCT116-GFP cells in the G2/M phase in the 50,100,200 mg/kg baicalin groups were 22％±6％,18％±7％ and 19％±6％,which were significantly higher than 7％ ±5％ of the control group (t =5.421,3.483,3.575,P ＜0.05).There were no significant differences in the proportion of HCT116-GFP cells in the G2/M phase among the 50,100,200 mg/kg baicalin groups (F =1.291,P ＞ 0.05).The apoptotic rates of HCT116-GFP cells in the 50,100,200 mg/kg baicalin groups were significantly higher than the control group (t =7.163,3.703,2.688,P ＜0.05).The apoptotic rate of the 50 mg/kg baicalin group was significantly higher than that of the 200 mg/kg baicalin group (t =2.259,P ＜ 0.05).Conclusions Baicalin significantly inhibits tumor growth in the orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.After treated with baicalin,the cell cycle is arrested at the G2/M phase,thus the tumor growth is inhibited.

Objective To establish a stable orthotopic model with high green fluorescent protein (GFP) expression in nude mice and observe its biological features.Methods Human HCT116 colon cancer cells transfected with GFP pLPCX retroviral plasmid were used to build a subcutaneous tumor model in nude mice.Fifteen BALB/C nude mice were selected to underwent orthotopic transplantation of colon when the GFP-labeled tumor grew to 10 mm × 10 mm as observed by in vivo fluorescent microscopy.The growth and metastasis of orthotopically implanted colon cancer cells were observed with fluorescent imaging system at different time points.The differences of the tumor size measured by peripheral vernier caliper and fluorescent imaging system were analyzed using the t test,and the differences in different groups were analyzed using the analysis of variance.Results GFP-labeled colon cancer models were successfully established in all the 15 nude mice,and there was no surgery-related complications or death.Tumors marked by GFP were observed under fluoroscope in week 3.The size of the tumors progressively increased with time.The volumes of the orthotopically transplanted tumors obtained from global measurement using fluorescent imaging system were greater than those measured by peripheral vernier calipers at postoperative week 3,4,5,6,7,while no statistically significant difference was observed (t =-1.280,-1.115,-0.718,-0.199,-0.386,P ＞0.05).There was a significant difference in the interation of measure method and different time points (F =29.546,P ＜ 0.05).Eight nude mice survived at the end of the experiment,and tumor metastasis was observed in 6 mice.Conclusions It is technically feasible to construct GFP-labeled colon cancer orthotopic transplantation model.The mice model could be used for real-time,in vivo,non-invasive and dynamic observation and analysis of the growth and metastasis of tumor cells.