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.

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.

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.

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.

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.

AN APPLICATION OF THEORETICAL SOLUTIONS ABOUT CYLINDRICAL SHELLS WITH SMALL OPENINGS

Stress concentrations about thin cylindrical shells with small openings are reconsidered front a nerv angle. There is a sort of special internal relation between theoretical solutions about cylindrical shells,vith large openings and one,with small openings. Using this relation, the extent of applying the theory about small openings to engineering practice is estimated again, thus an idea of how to use this theory and a nerv appraisal of the application of theoretical solutions about cylindrical shells with small openings to engineering practice are given.

一种基于改进path opening的道路提取新方法

提出了一种基于改进path opening的高分辨率遥感影像道路提取新方法。为检测曲率较大的道路,构造了新的邻接图;为有效提取有损或有部分遮挡的道路,将path opening算法中的最大路径长度与区域的几何特征相结合,建立了道路区域的判定准则,减少了人工干预。通过多组实验结果证明,该方法对于不完整道路的提取有更好的效果。

Opening Moves Involved in Text-based Computer-Mediated-Communication (CMC) by Chinese Adults

The development of science and technology has made it not only possible but very convenient for people living in different parts of the world to communicate with each other, thus bringing forth a new form of communication: computer-mediated communication (CMC). Text-based CMC is one of the most popular forms of CMC in which people send instant messages to others in different settings. Since this mode of interaction combines features of both the written and spoken language (Greenfield & Subrahmanyam, 2003), it's of great interest whether it follows the same sequential rule as the telephone conversation. However, compared to telephone conversations, computer-mediated communication has received much less attention, let alone text-based CMC. The existing body of literature mostly focuses on content analysis and linguistic features but neglects the sequential organization of such interaction (Paolillo, 1999; Greenfield and Subrahmanyam, 2003; Herring, 1999). In light of this, this paper examines the opening moves of instant message exchanges among Chinese adults in an attempt to find out the unique features characterizing the way they open an online chat. The framework that was chosen for data analysis was the sequential model proposed by Schegloff for American telephone openings.

DEVELOPMENT THROUGH OPENING——Mr.Jiang Xingzhen on Shaanxi's Dual Opening Strategy

At the east-west economic and tradeexchange and cooperation conferencesponsored by the China Council forthe Promotion of International Trade, Shaanxi’sVice-Governor Jiang Xingzhen spoke aboutShaanxi’s investment environment and itsdual opening strategy. Firstly Mr. Jiang made a briefintroduction on Shaanxi. Shaanxi, located atthe junction of the middle and western areasof China, is one of the origins of China’ssplendid ancient civilization. Its rich mineralresources include 92 varieties of provenreserves, 28 of which, including molybdenum,rhenium, mercury, coal and natural gas havereserves ranking in the first three and 58ranking in the top ten in the country.

Study on transient aerodynamic characteristics of parachute opening process

In the research of parachute, canopy inflation process modeling is one of the most complicated tasks. As canopy often experiences the largest deformations and loa-dings during a very short time, it is of great difficulty for theoretical analysis and experimental measurements. In this paper, aerodynamic equations and structural dynamics equations were developed for describing parachute opening process, and an iterative coupling solving strategy incorpo- rating the above equations was proposed for a small-scale, flexible and flat-circular parachute. Then, analyses were carried out for canopy geometry, time-dependent pressure difference between the inside and outside of the canopy, transient vortex around the canopy and the flow field in the radial plane as a sequence in opening process. The mechanism of the canopy shape development was explained from perspective of transient flow fields during the inflation process. Experiments of the parachute opening process were conducted in a wind tunnel, in which instantaneous shape of the canopy was measured by high velocity camera and the opening loading was measured by dynamometer balance. The theoretical predictions were found in good agreement with the experimental results, validating the proposed approach. This numerical method can improve the situation of strong dependence of parachute research on wind tunnel tests, and is of significance to the understanding of the mechanics of parachute inflation process.

Investigating the mechanical and acoustic emission characteristics of brittle failure around a circular opening under uniaxial loading

The size of underground openings in rock masses in metal mines is critical to the performance of the openings. In this study, the mechanical and acoustic emission (AE) characteristics of brittle rock-like specimens containing a circular opening with different ratios of opening diameter to sample size λ (λ = 0.1, 0.13, 0.17, 0.2, and 0.23) were investigated under uniaxial compression with AE monitoring. The results indicate that the opening size strongly affected the peak strength and the elastic modulus. Crack initiation first started from the upper surface of the specimens, not from the periphery of the openings. Tensile and shear cracks coexisted on the roof and floor of the specimens, whereas tensile cracks were dominant on the two sides. The fracture mode of samples with openings was partially affected by the relative size of the pillars and openings. The AE response curves (in terms of counts, cumulative energy, cumulative counts, and b-value) show that brittle failure was mainly a progressive process. Moreover, the AE information corresponded well with microcrack evolution in the samples and thus can be used to predict sample failure.

Wind-induced internal pressure response for structure with single windward opening and background leakage

Theoretical analysis and wind tunnel tests were carried out to study wind-induced intemal pressure response for the structure with single windward opening and background leakage. Its goveming differential equation was derived by the Bemoulli equation in an unsteady-isentropic form. Numerical examples were provided to study the additive damping caused by background leakage in laminar and turbulent flow, and the influence of background leakage on fluctuating internal pressure response was quantized. A series of models for low-rise building with various opening ratios and background leakage were designed and wind tunnel tests were conducted. It is shown that the fluctuating intemal pressure reduces when the background leakage are considered and that the effect of background leakage can be predicted accurately by the governing differential equation deduced in this paper.

Opening Angle Rules of the Aerodynamic Brake Panel

In order to get the relationship between aerodynamic brake effect and the opening angle,based on a high-speed train model in CFD software FLUENT,the aerodynamic force properties from brake panels with different opening angles were analyzed as well as the flow field's variation laws. Six cases were researched,taking opening angles 45°,60°,75°,80°,85° and 90° respectively.Three-dimensional Reynolds-average Navier-Stokes equation combined with k-ε turbulence model was utilized. The control equation was discretized and solved by finite volume method.SIMPLE method was also considered to couple the pressure and velocity fields and search the numeric solutions. Conclusions can be achieved from the results which are shown as follows. When the opening angle increases from 45° to 75°,the aerodynamic forces and the central area with larger pressure increase fast,and the flow field distribution changes greatly; when the opening angle increases from75° to 90°,the aerodynamic forces and the central area with larger pressure increase slowly, and the flow field distribution changes slightly; considering train boundary and opening performance of the wind resistance brake mechanism,the opening angle should be 75°.

Responses of wind-induced internal pressure in a two-compartment building with a dominant opening and background porosity Part 1:Theoretical formulation and experimental verification

The equations governing wind-induced internal pressure responses for a two-compartment building with a dominant opening and background porosity were derived.The unsteady form of the Bernoulli equation,the law of mass conservation,and adiabatic equation were used for the derivation.The precision of the governing equations was verified by a wind tunnel test on a rigid model of a low-rise building.The results show that the governing equations can effectively analyze the wind-induced internal pressure responses.The internal pressure responses in both compartments are suppressed due to the additional damping provided by background porosity.The responses of internal pressure in both compartments,especially in the compartment without an external opening,decrease with increased lumped leakage area.

Wave Radiation and Diffraction by A Two-Dimensional Floating Body with An Opening Near A Side Wall

The radiation and diffraction problem of a two-dimensional rectangular body with an opening floating on a semi- infinite fluid domain of finite water depth is analysed based on the linearized velocity potential theory through an analytical solution procedure. The expressions for potentials are obtained by the method of variation separation, in which the unknown coefficients are determined by the boundary condition and matching requirement on the interface. The effects of the position of the hole and the gap between the body and side wall on hydrodynamic characteristics are investigated. Some resonance is observed like piston motion in a moon pool and sloshing in a closed tank because of the existence of restricted fluid domains.

EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report

Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.