High complex anal fistula managed by the modified transanal opening of the intersphincteric space via the inter-sphincteric approach:A case report

BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.

Effect of Mouth Opening Training Stick Combined with Oral Massage on Mouth Opening Difficulty in Head and Neck Cancer Patients after Treatment

Objective: To study the application effect of mouth-opening training sticks combined with oral massage on patients with mouth-opening difficulty after treatment for head and neck cancer. Methods: Using convenient sampling, 60 patients with mouth-opening difficulty after treatment for head and neck cancer admitted to the Oncology Department from February 2022 to October 2023 were selected for a 2-week exercise and nursing program. The patients were divided into a control group (February 1, 2022 to November 30, 2022) and an observation group (December 1, 2022 to October 31, 2023), with 30 patients in each group. The control group underwent routine mouth-opening functional exercises combined with cork for oral support training, while the observation group underwent routine mouth-opening functional exercises combined with oral massage and mouth-opening training sticks for oral support training. The mouth-opening degree, mouth-opening difficulty level, comfort level, compliance, and quality of life were observed in both groups. Results: Before the intervention, there were no statistically significant differences in mouth-opening degree and mouth-opening difficulty level between the two groups (P > 0.05). After the intervention, the mouth-opening degree, mouth-opening difficulty level, oral comfort level, compliance, and QLICP-HN scores in the observation group were all better than those in the control group, with statistically significant differences (P < 0.05). Conclusion: The combination of mouth-opening training sticks and oral massage with mouth-opening functional exercises can effectively improve the degree of mouth-opening difficulty, enhance oral comfort, increase compliance with mouth-opening exercises, and improve quality of life.

National Image Construction from the Perspective of Multimodal Metaphor-A Case Study of the Opening Ceremony of the Beijing Winter Olympics

The national image is a comprehensive concept with a distinct political feature,including the international image presented to the outside world,and also encompassing the national identity of the people.With the development of globalization,international cultural communication has become a crucial part of shaping the national image,and the opening ceremony of the Beijing Winter Olympics has become an important opportunity for China to showcase its national image to the world in the post-pandemic era.Based on Forceville’s multimodal metaphor theory,this paper examines the metaphorical phenomena contained in the performance and their functions,effects,and purposes in the construction of the national image.It is found that there are many scenes,images,and narratives in the opening ceremony,including war metaphor,competition metaphor,personification metaphor,and other conceptual metaphors.The focus of this paper is on multimodal metaphor in a broad sense,mainly encompassing auditory and visual modes.Through the use of these multimodal metaphors,the opening ceremony of the Winter Olympics builds an image of a vibrant,peace-loving,and responsible country,which not only demonstrates China’s cultural self-confidence,but also expresses the Chinese people’s beautiful vision for the early reunification of the motherland.

CIIE to Promote High-Level Opening Up

The 7th China International Import Expo(CIIE),scheduled to be held in Shanghai from 5 to 10 November,will play a part in promoting highlevel opening up,said Tang Wenhong,China’s assistant minister of commerce,at a press conference on 23 October.The CIIE serves to showcase China’s major opening-up measures and confidence,to share China’s new development opportunities with other countries.

FURTHER OPENING- UP IS KEY FOR CHINA’S HIGH-QUALITY DEVELOPMENT

The Central Economic Work Conference was held in Beijing from December 11 to 12.The conference discussed the plans,prospects and challenges for China’s economy heading into 2024,as well as evaluating the events of this year.It goes without saying that 2023 has been a challenging year for countries around the world as the global context has been unsatisfactory.Various geopolitical tensions have created a rise in uncertainties which have led to reduced growth worldwide and sent many economies into stagnation.In light of the critical factors affecting the stability of the global economy,China’s primary economic goal corresponds with the promotion and sustaining of free trade.

Effect of fence opening configurations on dune development

Fences have been widely used in coastal protection engineering for their low cost,simple deployment,and easy integration with ecosystems.The effects of fence porosity and height on dune development have been investigated while not much attention has been paid to the effects of fence opening configurations,such as opening size and geometry,and porosity distributions.In this study,we deployed eight fences with same height and similar porosity,but different opening configurations on a sandy beach in Pingtan,Fujian Province.Results indicate that there is a similar two-dune-one-trough pattern for all fences at the beginning of dune development,and opening size,orientation,and geometry,and porosity distribution control the leeward dune peak locations.Fences with small openings and non-uniform porosity have high trapping efficiency,and upper denser porosity may be the optimal design as these fences have the highest trapping efficiency and capacity.The conclusions from this study can provide guidance on practical fence design.

MdDGK3-like as a negative regulator participates in ALA-induced PP2AC to promote stomatal opening in apple leaves

5-Aminolevulinic acid(ALA)can inhibit abscisic acid(ABA)-induced stomatal closure.However,the molecular mechanism is unclear.In this study,we found that ALA upregulated the MdPP2AC expression and PP2A activity in the apple(Malus domestica Borkh.cv.‘Fuji’)leaves.With the promoter of MdPP2AC as bait,a diacylglycerol kinase MdDGK3-like was selected by the Yeast One Hybrid(Y1H)from the cDNA library of the epidermis of apple leaves treated by exogenous ALA.Additional to binding the promoter of MdPP2AC,MdDGK3-like was found to inhibit the transcription activity of MdPP2AC promoter,while ALA significantly eliminated the role of MdDGK3-like.In tobacco leaves,MdDGK3-like was localized in the nucleus of stomatal guard cells.Therefore,MdDGK3-like might act as a transcription factor negatively regulating MdPP2AC expression and causing stomatal closure.To further identify MdDGK3-like functions,several transiently transgenic apple leaves(including overexpression and interference)were established.The results revealed that overexpression of MdDGK3-like promoted stomatal closure by increasing Ca^(2+)and H_(2)O_(2)and decreasing flavonol levels in the guard cells.Conversely,MdDGK3-like(i)led the stomatal opening with lower levels of Ca^(2+)and H_(2)O_(2)but higher flavonols.Based on these,we proposed a new hypothesis that ALA up-regulated MdPP2AC expression via negatively regulating the expression of MdDGK3-like to up-regulate PP2A expression and the enzyme activity,which improved the stomatal aperture.Since it was the first time that MdDGK3-like was showed to act as a transcription factor,the proposed model provided a new insight onto the mechanisms of ALA-induced stomatal opening.

CsIPT1b and CsUGT85A2 delay female corolla opening in cucumber by regulating the content of cytokinins

Corolla opening is essential for the propagation of unisexual flowering plants,meanwhile commodity fruits with opening corolla have higher commodity value in cucumber fresh food market.Until now,there is little research on the mechanism of corolla opening in cucumber.In a previous paper,we identified a unique cucumber(Cucumis sativus)line(‘6457’)that possesses super ovaries and shows delayed corolla opening when nutrient supplies are abundant.We also previously showed that the expression of CsIPT1b(isopentenyl transferase)and CsUGT85A2(cytokinin glycosyltransferase)is correlated with the delayed opening of the female corolla.Here,we investigated the mechanism of delayed female corolla opening in cucumber by conducting transgenic experiments,hormone assays,and yeast one-hybrid assays.CsIPT1b and CsUGT85A2 positively and negatively regulated delayed female corolla opening,respectively.In CsIPT1b-overexpressing plants and CsUGT85A2 knockout plants,the content of the trans-zeatin riboside,trans-zeatin,and N6-isopentenyladenosine was increased.Overall,our findings indicate that CsIPT1b and CsUGT85A2 were important regulators of the timing of female corolla opening.These genes could thus be targets to cucumber molecular breeding of fruit with flowers remaining on the tip.

Has China-ASEAN Trade opening increased China’ s carbon emissions?

This study uses carbon emission data at the provincial level in China between 1998-2018 and the proportion of the total import and export trade between provinces and the Association of Southeast Asian Nations(ASEAN)in GDP to measure the level of China-ASEAN trade openness.It examines the impact of China ASEAN trade openness on carbon emissions and its transmission mechanism,and selects the RMB/USD exchange rate as an instrumental variable to address the endogeneity of China-ASEAN trade openness variables.The impact of China-ASEAN trade openness on China’s environment is estimated within a two-stage least squares framework.The results show that trade openness between China and ASEAN positively impacts China’s environment and can facilitate carbon emission reduction.The scale,structural,and technology effects brought by China-ASEAN trade liberalization jointly promote China’s carbon dioxide emission reduction.An inverted“U”relationship is found between economic growth and environmental quality in China,and some provinces and municipalities have now crossed the inflection point of the curve,in which carbon emi ssions decrease with an increase in per capita wealth.

Postdoctoral Openings in Wenzhou University(China)for Chemistry,Chemical Engineering and Materials Science

About us:The Clige of Cemistry and Materials Engineering(CME)in Wenzhou University(Zhejing Province,China)is looking for postdoctoral candidates(up to 25) specialized in Chemistry Chemical Engineering and Materials Secence. The college has is Chemistry program ranking ESI Top 6‰ worldwide.

Application of Opening and Closing Morphology in Deep Learning-Based Brain Image Registration

In order to improve the registration accuracy of brain magnetic resonance images(MRI),some deep learning registration methods use segmentation images for training model.How-ever,the segmentation values are constant for each label,which leads to the gradient variation con-centrating on the boundary.Thus,the dense deformation field(DDF)is gathered on the boundary and there even appears folding phenomenon.In order to fully leverage the label information,the morphological opening and closing information maps are introduced to enlarge the non-zero gradi-ent regions and improve the accuracy of DDF estimation.The opening information maps supervise the registration model to focus on smaller,narrow brain regions.The closing information maps supervise the registration model to pay more attention to the complex boundary region.Then,opening and closing morphology networks(OC_Net)are designed to automatically generate open-ing and closing information maps to realize the end-to-end training process.Finally,a new registra-tion architecture,VM_(seg+oc),is proposed by combining OC_Net and VoxelMorph.Experimental results show that the registration accuracy of VM_(seg+oc) is significantly improved on LPBA40 and OASIS1 datasets.Especially,VM_(seg+oc) can well improve registration accuracy in smaller brain regions and narrow regions.

A Model of China’s Opening-up and Development

Over the past decade,China’s free trade zones have progressively formed a high-level innovation pattern of reform and opening-up in areas that extend from coastal regions to border provinces.They have become a leading force of high-level opening-up,a pioneer of in-depth reform,and a major platform that serves the national strategy.As pilot platforms for comprehensive reform and opening-up,they are now taking on a more arduous mission.

New Blueprint for China’s Opening-up The country seeks a broader agenda of opening-up across more areas and in greater depth

The first session of the 14th National People’s Congress(NPC)of China held a press conference on March 13,wherein Chinese Premier Li Qiang met Chinese and foreign reporters and answered their questions.When asked about the priorities of the new government,Premier Li stressed that reform and opening-up has been a crucial move that transformed China into what it is today.He also said that China would promote highlevel opening-up and inject stronger vitality into national development by deepening reform.

Showcasing Chengdu to the World 2023 Opening Ceremony of Culture City of East Asia: Year of Chengdu Events in China

On June 29,2023 Opening Ceremony of Culture City of East Asia:Year of Chengdu Events in China,took place in Chengdu,which was co-sponsored by the Sichuan Provincial Department of Culture and Tourism and the Chengdu Municipal People's Government.

Diversity of Flower Opening Time and Duration in Rice (Oryza sativa ssp. indica) Landraces of South and Southeast Asia in Different Cultivation Seasons

Different cultivars of rice(Oryza sativa)open at different times of the day,and the overlap of anthesis time in rice between the neighbouring cultivars is of crucial importance to the degree of cross pollination in rice.Nevertheless,none of the past experiments with cross pollination between different rice cultivars ever reported the respective flower opening time(FOT)and flower exposure duration(FED)of the parent cultivars,until recently.The authors present here the first record of FOT and FED of 1114 indica rice landraces of South and Southeast Asia,growing during sum-mer and winter seasons in three consecutive years.The authors also present an analysis of the influences of the grow-ing season on the anthesis behaviour,and present the first records of the FOT and FED variability on sunny and cloudy days of a large number of landraces.The data show that rice florets tend to open later in the morning(that is,take longer time to anthesis after sunrise)on sunny days than on cloudy days,and also significantly later during long day seasons(spring and summer)than during short day season(winter);and that FED is inversely related to both FOT and the length of duration from sunrise to first flower opening.The wide ranges of FOT(8:50 a.m.to 12:40 p.m.)and FED(15 to 194 minutes)also suggest the ample time window for receiving pollen from neighbouring cultivars with differ-ent FOT,enhancing the chances of cross pollination between hundreds of rice landraces with FOT and FED overlaps.

Hydrodynamic Characteristics of Square Heaving Plates with Opening Under Forced Oscillation

The existence of the heaving plates can improve the heaving motion performance of an offshore structure significantly by providing both extra added mass and damping.In the current research,numerical investigation is carried out on the hydrodynamic characteristics of both isolated square heaving plate and double square heaving plates with opening by an immersed boundary-lattice Boltzmann method.The effects on hydrodynamic performance of plates due to Keulegan-Carpenter(KC)number,frequency number,opening ratio,opening distribution and spacing of plates are examined.It is found that the heaving plates with optimized opening ratio can provide additional damping compared with the plates without opening.Better hydrodynamic characteristics of double plates can be obtained with the increase of plate spacing.

OPENING TO THE CHALLENGE --An economy thrives in openness and withers in seclusion

pening-up has always been a hot topic at the China International Import Expo(CIIE),the world's first import expo held at the national level.During the sixth CIIE,the Hongqiao International Economic Forum held on November 6 attracted many participants from government departments,academia,and the business sector to conduct in-depth discussions on global trade and the challenges it faces.Participants agreed that multi-party dialogue is key to the issue.

RIDING ON OPENING-UP

Forty-five years on,China’s opening-up drive has raked in an accumulated foreign investment of US$2.9 trillion with more than 1 million foreign-funded firms established in the country.A raft of policies and measures have been rolled out for greater integration in globalization.China’s first pilot free trade zone(FTZ)in Shanghai’s Pudong New Area,established to undertake transformative reforms on a trial basis that could later be applied across the country,is also celebrating its 10th year.From that single pioneer,China today has 22 FTZs,and the Hainan Free Trade Port,which are all testbeds for advancing reform and opening-up.

Stomatal Opening Induced by Acetylcholine Is Associated with Cytoskeletal Components

Acetylcholine (Ach) is a key component of animal cholinergic system. Recent experiments demonstrated that Ach, choline acetyltransferase, acetylcholinesterase and Ach receptors are present in all parts of plants and have many functions, including inducing stomatal movement. The authors' previous work has evidenced that microtubules and microfilaments are involved in regulating both stomatal closing and opening. The present investigation is to determine whether stomatal opening induced by Ach is associated with microtubules and microfilaments. The results showed that Ach could induce stomatal opening of Vicia faba L. with or without addition of KCl in the dark. Ach also stimulated protoplast swelling in a K +_free solution in the dark. However, the induction was partially suppressed when the strips and protoplasts were pretreated with either cytochalasin B, an inhibitor of F_actin polymerization, or oryzalin, an inhibitor of plant microtubule polymerization. Thus, our data suggest for the first time that stomatal opening induced by Ach is associated with the dynamics of microtubules and microfilaments.

Wind-induced internal pressure fluctuations of structure with single windward opening

A frequency domain method for estimating wind-induced fluctuating internal pressure of structure with single windward opening is presented in this paper and wind tunnel tests were carried out to verify the theory. The nonlinear differential equation of internal pressure dynamics and iteration algorithm were applied to calculate fluctuating internal pressure and time domain analysis was used to verify the accuracy of the proposed method. A simplified estimation method is also provided and its scope of application is clarified. The mechanism of internal pressure fluctuation is obtained by using the proposed method in the frequency domain and a new equivalent opening ratio is defined to evaluate internal pressure fluctuation. A series of low-rise building models with various openings and internal volumes were designed for wind tunnel tests with results agreeing well with analytical results. It is shown that the proposed frequency domain method based on Gaussian distribution of internal pressure fluctuations can be applied to predict the RMS internal pressure coefficient with adequate accuracy for any opening dimensions, while the simplified method can only be used for structure with single dominant opening. Helmholtz resonance is likely to occur when the equivalent opening ratio is adequately high, and controlling individual opening dimension is an effective strategy for avoiding Helmholtz resonance in engineering.