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.

Fairness in Olympic sports:How can we control the increasing complexity of doping use in high performance sports?

With the Rio Olympics just a few months past,we remember the excitement,the incredible performances,and the controversies.As happens so often,the Olympic Games focus attention not only on athletic achievements but also on how athletes may reach ever-increasing levels of performance.Doping,medical

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot program.Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes.If proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients.AIM To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care.METHODS The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.RESULTS The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach.The coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient complexity.The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of care to be replicated.

Gamma-aminobutyric acid A receptors in Alzheimer＇s disease： highly localized remodeling of a complex and diverse signaling pathway

Alzheimer＇s disease （AD）, the predominant form of dementia, is a chronic, incurable neurodegenerative disorder presenting with symptoms includ- ing progressive memory loss and disturbed emotional state. It has been estimated that dementia affects over 47 million people worldwide （Prince et al., 2015）, and with 60-80% of cases attributable to AD.

SVNTHESES AND CHARACTERIZATION OF TWO HIGH VALENCE VANADIUM COMPLEXES (?) SCHIFF-BASE LIGAND WITH RICH PHENOLATE OXVGEN AND THEIR CONVERSION

Two vanadium complexes of schiff base vith rich phenolate oxygen,o-(?)-salicylideneamino- methylphenol,had been synthesized and characterized.One is a V(Ⅳ)complex with an interaction via vanadyl oxygen and the other is a novel dinuclear V(V,V)complex with an oxo bridge.The conversion between the two complexes had been discussed.

“Place Making”in Urban Complex Design: A Case Study of Tianfu Pearl Design Scheme

This paper introduced basic situation and challenges of Block 9, Dongdajie, Chengdu City, expounded basic definition and design concept of "place making", briefed the design scheme from three aspects, namely planning layout, space environment and architectural style, and concluded the application of the idea of "place making" in Block 9 design scheme in view of the multi-functional urban complex with high plot ratio.

A policy gradient algorithm integrating long and short-term rewards for soft continuum arm control

The soft continuum arm has extensive application in industrial production and human life due to its superior safety and flexibility. Reinforcement learning is a powerful technique for solving soft arm continuous control problems, which can learn an effective control policy with an unknown system model. However, it is often affected by the high sample complexity and requires huge amounts of data to train, which limits its effectiveness in soft arm control. An improved policy gradient method, policy gradient integrating long and short-term rewards denoted as PGLS, is proposed in this paper to overcome this issue. The shortterm rewards provide more dynamic-aware exploration directions for policy learning and improve the exploration efficiency of the algorithm. PGLS can be integrated into current policy gradient algorithms, such as deep deterministic policy gradient(DDPG). The overall control framework is realized and demonstrated in a dynamics simulation environment. Simulation results show that this approach can effectively control the soft arm to reach and track the targets. Compared with DDPG and other model-free reinforcement learning algorithms, the proposed PGLS algorithm has a great improvement in convergence speed and performance. In addition, a fluid-driven soft manipulator is designed and fabricated in this paper, which can verify the proposed PGLS algorithm in real experiments in the future.

Focusing on the meso-scales of multi-scale phenomena-In search for a new paradigm in chemical engineering

To celebrate the 90th birthday of Professor Mooson Kwauk, who supervised the multi-scale research at this Institute in the last three decades, we dedicate this paper outlining our thoughts on this subject accumulated from our previous studies. In the process of developing, improving and extending the energy- minimization multi-scale （EMMS） method, we have gradually recognized that meso-scales are critical to the understanding of the different kinds of multi-scale structures and systems. It is a common challenge not only for chemical engineering but also for almost all disciplines of science and engineering, due to its importance in bridging micro- and macro-behaviors and in displaying complexity and diversity. It is believed that there may exist a common law behind meso-scales of different problems, possibly even in different fields. Therefore, a breakthrough in the understanding of meso-scales will help materialize a revolutionary progress, with respect to modeling, computation and application.