Objective:To observe any effect of electroacupuncture (EA) on the expression of phosphorylated extracellular signal-regulated protein kinase (p-ERK1/2) and phosphorylated cyclic adenosine monophosphate response element binding protein (p-CREB) in the spinal dorsal horns of diabetics experiencing neuropathic pain.Methods:Eight rats were randomly selected from 30 healthy male Sprague-Dawley rats as the normal group (N), and the remaining twenty-two rats were treated with a single high-dose intraperitoneal injection of streptozotocin (STZ) to establish a neuropathic pain model. The rats modeled successfully were randomly divided into a model group (M, n=8) and an EA group ( n=8). In the EA group, electroacupuncture was applied at the bilateral Hou san li and Kunlun acupoints starting on the 15th day after the STZ injection. The daily sessions lasted 30 minutes for 1 week. Body weight (BW), fasting blood glucose (FBG) and paw withdrawal latency (PWL) were observed before the STZ injection and on the 7th, 14th, and 21st days afterward. The expression of p-ERK1/2 and p-CREB in the dorsal horns of the rats′ spinal cords was detected using western blotting. The count of p-CREB-positive cells in the dorsal horns and their co-localization with neurons was detected using immunofluorescence. Results:In comparison with the N group, the average BW of the M group on the 7th, 14th and 21st days after the STZ injection was significantly lower, while the average FBG was significantly higher. There was no significant difference between the M and N groups in the average PWL on the 7th day after the STZ injection, but it had decreased significantly in the M group on the 14th and 21st days. Compared with the M group, the average PWL of the EA group was significantly longer on the 21st day after the injection. The expression of p-ERK1/2 and p-CREB protein in the spines of the M group was significantly higher than in the N group. p-CREB positive cells were more numerous in the M group compared with the N group, while in the EA group they were fewer. P-CREB was co-located with neurons in the spinal dorsal horn.Conclusion:EA can alleviate neuropathic pain effectively, perhaps by inhibiting the expression of p-ERK1/2 and p-CREB in the dorsal horns of the spinal cord.

Objective:To investigate the clinical features, treatment and prognosis in pediatric Crohn′s disease (CD) with anal fistula.Methods:A retrospective case-control study was conducted. Clinical data of 66 children with CD diagnosed at the Department of Gastroenterology of Children′s Hospital of Nanjing Medical University from September 1st, 2014 to August 31th, 2020. According to the presence of anal fistula or not before diagnosis, the children were divided into anal fistula group and non-anal fistula group. The clinical features at initial onset between the above two groups were analyzed statistically. According to the use of infliximab (IFX) or not, children with anal fistula were divided into IFX group and non-IFX group and the clinical remission of anal fistula in the two groups was analyzed statistically.Results:Thirty CD children combined with anal fistula before diagnosis were set as anal fistula group, including 20 children of complex anal fistula and 10 of simple anal fistula. Eleven children underwent anal fistula incision-seton drainage and 19 did not receive surgery. The left 36 children without anal fistula were set as non-anal fistula group. The male proportion of children with anal fistula was higher than that of the children without anal fistula, and the difference was statistically significant (86.7% vs. 58.3%, P = 0.011) . Among the 30 children with anal fistula, 20 were treated with IFX-induced remission and maintenance therapy, and were set as IFX group, 10 were treated with enteral nutrition-induced remission and azathioprine-induced maintenance therapy, and were set as non-IFX group. The clinical remission rate of anal fistula in IFX group was significantly higher than that in non-IFX group after the follow-up period of 6 to 12 months (95% vs. 30%, P = 0.0001) . Conclusion:The CD children with anal fistula is more common in male, and the clinical remission rate of anal fistula is higher after IFX treatment.

Objective:To investigate the clinical features, treatment and prognosis in pediatric Crohn′s disease (CD) with anal fistula.Methods:A retrospective case-control study was conducted. Clinical data of 66 children with CD diagnosed at the Department of Gastroenterology of Children′s Hospital of Nanjing Medical University from September 1st, 2014 to August 31th, 2020. According to the presence of anal fistula or not before diagnosis, the children were divided into anal fistula group and non-anal fistula group. The clinical features at initial onset between the above two groups were analyzed statistically. According to the use of infliximab (IFX) or not, children with anal fistula were divided into IFX group and non-IFX group and the clinical remission of anal fistula in the two groups was analyzed statistically.Results:Thirty CD children combined with anal fistula before diagnosis were set as anal fistula group, including 20 children of complex anal fistula and 10 of simple anal fistula. Eleven children underwent anal fistula incision-seton drainage and 19 did not receive surgery. The left 36 children without anal fistula were set as non-anal fistula group. The male proportion of children with anal fistula was higher than that of the children without anal fistula, and the difference was statistically significant (86.7% vs. 58.3%, P = 0.011) . Among the 30 children with anal fistula, 20 were treated with IFX-induced remission and maintenance therapy, and were set as IFX group, 10 were treated with enteral nutrition-induced remission and azathioprine-induced maintenance therapy, and were set as non-IFX group. The clinical remission rate of anal fistula in IFX group was significantly higher than that in non-IFX group after the follow-up period of 6 to 12 months (95% vs. 30%, P = 0.0001) . Conclusion:The CD children with anal fistula is more common in male, and the clinical remission rate of anal fistula is higher after IFX treatment.

BACKGROUND: Ilioinguinal approach and modified Stoppa approach are commonly used to treat pelvic and acetabular fractures, but which one is safer and more effective remains controversial, so a meta-analysis is necessary.OBJECTIVE: To compare the efficacy of modified Stoppa approach and ilioinguinal approach for pelvic and/or acetabular fractures.METHODS: A computer-based retrieval of Cochrane library, PubMed, Embase, OVID, CNKI, WanFang, CBM and VIP databases was performed for the randomized controlled trials concerning modified Stoppa approach and ilioinguinal approach for pelvic and/or acetabular fractures published before October 2016. Meta-analysis was performed on RevMan5.3 software.RESULTS AND CONCLUSION: (1) Finally 11 randomized controlled trials were enrolled, including 722 patients. (2) Meta-analysis showed that the operation time, intraoperative blood loss, length of incision, volume of drainage and hospitalization time in the modified Stoppa approach group were significantly less than those in the ilioinguinal approach group (P < 0.05), and the clinical efficacy in the modified Stoppa approach group was significantly superior to that in the ilioinguinal approach group (P < 0.05). But there were no significant differences in Matta scores and postoperative complications between two groups (P > 0.05). (3) To conclude, modified Stoppa approach is safer and more effective for pelvic and/or acetabular fractures.

Objective To investigate the clinical efficacy of posterior anti‐rotation plate plus cancellous screws for treating unicondylar Hoffa fracture and to systematically analyze its injury mechanism ,clinical diagnosis ,treatment method and clinical fol‐low up results .Methods The imageological and clinical data in 9 cases of unicondylar Hoffa fractures treated by anti‐rotation plate plus cancellous screws from March 2009 to April 2014 were retrospectively analyzed .Results All fractures were healed within 4 months .The average follow up time of the patients was 34 months(24~50 months) .Seven cases obtained the anatomic reduction and 2 cases got the satisfactory reduction .The reduction loss and fixation failure were not found in all the cases .One cases of wound infection occurred early after operation and healed within 1 week after anti-infection .One case of knee joint ankylosis complicating pain occurred during the follow up period .According to the KSSs scoring standard ,the knee joint prognosis function scores were ex‐cellent in 4 cases ,good in 4 cases and poor in 1 case .Conclusion Using anti‐rotation plate combined with cancellous screws for con‐ducting the Hoffa fracture fixation can confront the strong shear force beard by femoral condyle with the advantages of rigid fixa‐tion ,reliability fixation and early weight bearing functional exercise .

Objective To assess the outcomes of the surgical treatment of supination external rotation trimalleolar fractures,comparing the techniques of lateral plating and antiglide plating as described previously.Methods This is a retrospective review.A total of 31 patients meeting our inclusion criteria,with supination external rotation trimalleolar fractures surgically treated between 2009 and 2011,were studied.17 patients were treated with antiglide plating,whereas the remaining 14 patients underwent traditional lateral plating.They were followed up by a period ranging from 14 to 38 months(average,26 months).The functional results were evaluated with olerud and molander scoring system described previously.All the data including time to surgery,operating room time,tourniquet time,hospital stay and ankle joint function scores,were respectively analyzed in accordance with the complete randomized design t-test.Results There was no statistically significant in time to surgery,operating room,tourniquet time,hospital stay and ankle joint functional scores.Conclusions The outcome of the surgical management of supination external rotation trimalleolar fracture is comparable with both techniques.Our data do not support one technique over the other.