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.

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.

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.

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.

Evaluation of the Degree of Opening to the Outside World in Guizhou Province

The goal of economic opening to the outside world is an important basis for formulating and implementing the policy of opening. Different economic development strategies have different requirements for the degree of economic opening to the outside world. Guizhou should implement the open economy and adopt the export-oriented development strategy, which objectively requires Guizhou to gradually improve the degree of opening to the outside world.

The development of an open economy in China——A retrospective analysis of 30 years of opening to the outside world

China’s three decades of opening to the outside world are a historical process of establishing and developing an open economy. This process can be divided into four stages:1) reducing regulation,rejuvenating the trade regulatory regime and delegating management rights to foreign-trade operators;2) developing foreign trade firms into de facto market entities; 3)pursuing trade liberalization and establishing an open economic system in conformity with international rules;4) furthering improvement and innovation in infrastructure. At the initial stage of establishing an open economy,China restructured its foreign trade system and learned valuable lessons about liberalization through system transition.China experimented with bold breakthrough initiatives in special economic zones and open coastal cities,and correctly selected an export-oriented development strategy. Two core policies underlying China’s open economy are the strengthening of bilateral and multilateral trade relationships,and realigning the institutional environment to comport with international rules.China’s open economy occupies an important position in the national economy. Moreover,it has become an important part of state’s macro-economic regulation and is exerting growing influence on the world economy.

China Needs the World,and the World Needs China——Mr.Li Lanqing on China's economic opening to the outside world

Mr. Li Lanqing, Vice Premier of the State Council, expounded on China’s economy heading towards the 21st century,at the 32nd ICC World Congress. He said: China is greeting the 19th year of its reform and opening to the outside world. In the past 18 years, especially in the 1990s,China’s economy, as an integral part of the world economy, has assumed three interrelated new features, under the circumstances of speeding up the development, deepening the reform, and expanding the opening. 1. Lasting trend for sustained and rapid economic growth. China has 1.2 billion people with everrising income and consumption levels and huge market demand, and the Chinese people have the habit of saving. So there are large amounts of bank deposits to

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.

China's Finance Opening to the Outside World

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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.

China's Onshore Oil Industry is in Full Scale Opening to the Outside World

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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.