Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids:A retrospective study

BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in the lower part of the rec-tum.Mixed hemorrhoids bleed easily and recurrently,and this can result in severe anemia.Hence,they may have a negative effect on the health of the patient and surgical treatment is required.Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.How-ever,most patients experience different degrees of postoperative pain that may cause anxiety.with mixed hemorrhoids post-surgery.METHODS The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively.The basic character-istics of the enrolled patients with mixed hemorrhoids were recorded,and based on the Goligher clinical grading system,the hemorrhoids were classified as grades III or IV.The endpoint of this study was the disappearance of pain in all patients.Quantitative data were presented as mean±SD,such as age,pain score,and QoL score.Student’s t-test was used to compare the groups.RESULTS A total of 164 patients were enrolled.The distribution of the visual analog scale pain scores of all patients at 3,7,14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time.Fourteen days after the operation,the pain had completely disappeared in some patients.Twenty-eight days after the surgery,none of the patients experienced any pain.Comparing the World Health Or-ganization Quality of Life-BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery,we observed that the quality-of-life scores of the patients post-surgery had significantly improved.There were six items that were compared at 14-and 28-d post-surgery.The mean QoL score 28 d after surgery(4.79±0.46)was higher than that at 14 d post-surgery(3.79±0.57).The mean health condition score 28 d after surgery(4.80±0.41)was also higher than that at 14 d post-surgery(4.01±0.62).The mean physical health score 28 d after surgery(32.10±2.96)was significantly higher than that at 14 d post-surgery(23.41±2.85).The mean psychological health score 28 d after surgery(27.22±1.62)was significantly higher than that at 14 d post-surgery(21.37±1.70).The mean social relations score 28 d after surgery(12.21±1.59)was significantly higher than that at 14 d post-surgery(6.32±1.66).The mean surrounding environment score 28 d after surgery(37.13±2.88)was significantly higher than that at 14 d post-surgery(28.42±2.86).The differences in quality-of-life scores at day 14 and day 28 post-surgery were ob-served to be statistically significant(P<0.001).CONCLUSION Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients.Age,sex,and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.

Investigation on photonic crystal nanobeam cavity based on mixed diamond–circular holes

A photonic crystal nanobeam cavity(M-PCNC)with a structure incorporating a mixture of diamond-shaped and circular air holes is pro-posed.The performance of the cavity is simulated and studied theoretically.Using thefinite-difference time-domain method,the parameters of the M-PCNC,including cavity thickness and width,lattice constant,and radii and numbers of holes,are optimized,with the quality factor Q and mode volume Vm as performance indicators.Mutual modulation of the lattice constant and hole radius enable the proposed M-PCNC to realize outstanding performance.The optimized cavity possesses a high quality factor Q 1.45105 and an ultra-small mode=×volume Vm 0.01(λ/n)[Zeng et al.,Opt Lett 2023:48;3981–3984]in the telecommunications wavelength range.Light can be progres-=sively squeezed in both the propagation direction and the perpendicular in-plane direction by a series of interlocked anti-slots and slots in the diamond-shaped hole structure.Thereby,the energy can be confined within a small mode volume to achieve an ultra-high Q/Vm ratio.

Better Initial Placement Algorithm for Large-Scale Mixed-Mode Detailed Placement

An algorithm is presented for better legal solution in detailed placement of large scale mixed macros and standard cells IC design.Due to the limitation of computing complexity,an effective and efficient initial placement is very important for detailed placement.Novelty of this algorithm lies in a better solution at initial stage by using network flow method to satisfy row capacity constraint and the thought of linear placement problem(LPP) to resolve overlaps.Moreover,divide and conquer strategy and other simplified methods are adopted to minimize complexity.Experimental results show that the algorithm can get an average of 16% wire length improvement on PAFLO in reasonable CPU time.

EXPERIMENTAL AND THEORETICAL STUDY OF STATIC-DYNAMIC MIXED MODE BRITTLE FRACTURE OF ROCK

A new criterion of static dynamic state mixed mode brittle fracture initiation in rock is suggested, i.e. the distortion strain energy criterion.When t →∞, the static state distortion strain energy criteria and the formula for determiming static state fracture angle are obtained. The new static state criterion, suggested by authors, is in good agreement with the author′s experimental results. In addition, the relative accuracy of three current fracture theories and the new criterion in predicting static state mixed mode initiation fracture loading and fracture angle in rock have been evaluated experimentally.

Application of a Current and Voltage Mixed Control Mode for the New Fast Control Power Supply at EAST

A feedback control system is needed to restrain plasma vertical displacement in EAST （Experimental Advanced Superconducting Toknmak）. A fast control power supply excites active feedback coils, which produces a magnetic field to control the plasma＇s displacement. With the development of EAST, new demands on the new fast control power supply have led to an enhanced ability of fast response and output current, as well as a new control mode. The structure of cascaded and paralleled H-bridges can meet the demand of extended capacity, and digital control can reMize current and voltage mixed control mode. The validity of the proposed scheme is confirmed by experiments.

A MIXED MODE FRACTURE CRITERION BASED ON THE MAXIMUM TANGENTIAL STRESS IN BRITTLE INCLUSION

A closed-form solution for predicting the tangential stress of an inclusion located in mixed mode Ⅰ and Ⅱ crack tip field was developed based on the Eshelby equivalent inclusion theory. Then a mixed mode fracture criterion, including the fracture direction and the critical load, was established based on the maximum tangential stress in the inclusion for brittle inclusioninduced fracture materials. The proposed fracture criterion is a function of the inclusion fracture stress, its size and volume fraction, as well as the elastic constants of the inclusion and the matrix material. The present criterion will reduce to the conventional one as the inclusion having the same elastic behavior as the matrix material. The proposed solutions are in good agreement with detailed finite element analysis and measurement.

MECHANISM ANALYSIS OF THICKNESS EFFECT ON MIXED MODE Ⅰ/Ⅱ FRACTURE OF LC4-CS ALUMINUM ALLOY

Mixed mode Ⅰ/Ⅱ fracture erperiments of LC4-CS aluminum alloy were conductedby using tension--shear specimens with thicknesses of 2, 4, 8 and 14mm. Fracturemechanisms of thickness effect on mixed mode Ⅰ/Ⅱ fracture were first examined fromfracture surface morphology to correlate with the macroscopic fracture behavior andstress state. It is found that specimen thickness has a strong influence on mixed modefracture. As thickness varies from thin to thick the macroscopic fracture surfacesappear the characteristics of plane stress state (2mm, 4mm--thick specimen), three--dimensional stress state (8mm--thick specimens), and plane strain state (14mm--thickspecimens), respectively. The specimens of all kinds of thicknesses are typical of ten-sile type failure under mode Ⅰ loading condition and shear type failure under mode Ⅱloading condition. Two distinct features coexist on the fracture surfaces under mixedmode loading conditions, and the corresponding proportion varies with loading mix-ity. Void--growth processes are the failure mechanism in both predominately tensile-and shears--type fractures. The size and depth of dimples on the fracture surface varygreatly with thickness. Therefore, it is extraordinary necessary to take into accountthe thickness effect when a mixed mode fracture criterion is being established.

Markov Chain Modelling of Reliability Analysis and Prediction under Mixed Mode Loading

The reliability assessment for an automobile crankshaft provides an important understanding in dealing with the design life of the component in order to eliminate or reduce the likelihood of failure and safety risks.The failures of the crankshafts are considered as a catastrophic failure that leads towards a severe failure of the engine block and its other connecting subcomponents.The reliability of an automotive crankshaft under mixed mode loading using the Markov Chain Model is studied.The Markov Chain is modelled by using a two-state condition to represent the bending and torsion loads that would occur on the crankshaft.The automotive crankshaft represents a good case study of a component under mixed mode loading due to the rotating bending and torsion stresses.An estimation of the Weibull shape parameter is used to obtain the probability density function,cumulative distribution function,hazard and reliability rate functions,the bathtub curve and the mean time to failure.The various properties of the shape parameter is used to model the failure characteristic through the bathtub curve is shown.Likewise,an understanding of the patterns posed by the hazard rate onto the component can be used to improve the design and increase the life cycle based on the reliability and dependability of the component.The proposed reliability assessment provides an accurate,efficient,fast and cost effective reliability analysis in contrast to costly and lengthy experimental techniques.

Adsorption behaviors of avian immunoglobulins and purification of immunoglobulin Y from chicken serum with mixed-mode resins

The importance of immunoglobulin Y(IgY) as a specific antibody equivalent to mammalian immunoglobulin G(IgG) is well recognized. However, production of highly purified IgY is still difficult due to the lack of specific purification methods. In this study, adsorption behaviors of Ig Y on four mixed-mode resins with functional ligands of 4-mercatoethyl-pyridine(MEP), 2-mercapto-1-methyli-midazole(MMI), 5-aminobenzi-midazole(ABI) and tryptophan-5-aminobenzi-midazole(W-ABI) were evaluated. The results showed that high adsorption ratio were found at p H 6.0–7.0 with little adsorption under acidic conditions. The resin with ABI ligand was then used to separate IgY from immunized chicken serum. An efficient process with Ig Y purity of 95% and recovery of 90% was developed after optimization of loading and elution p H and injection volume. The biological activity of the purified Ig Y was fully maintained. These results indicated that mixed-mode chromatography with specially-designed ligands has great potential for the separation of Ig Y from crude feedstock.

The connection of phytoplankton biomass in the Marguerite Bay polynya of the western Antarctic Peninsula to the Southern Annular Mode

Antarctic coastal polynyas are biological hotspots in the Southern Ocean that support the abundance of hightrophic-level predators and are important for carbon cycling in the high-latitude oceans.In this study,we examined the interannual variation of summertime phytoplankton biomass in the Marguerite Bay polynya(MBP)in the western Antarctic Peninsula area,and linked such variability to the Southern Annular Mode(SAM)that dominated the southern hemisphere extratropical climate variability.Combining satellite data,atmosphere reanalysis products and numerical simulations,we found that the interannual variation of summer chlorophyll-a(Chl-a)concentration in the MBP is significantly and negatively correlated with the spring SAM index,and weakly correlated with the summer SAM index.The negative relation between summer Chl-a and spring SAM is due to weaker spring vertical mixing under a more positive SAM condition,which would inhibit the supply of iron from deep layers into the surface euphotic layer.The negative relation between spring mixing and spring SAM results from greater precipitation rate over the MBP region in positive SAM phase,which leads to lower salinity in the ocean surface layer.The coupled physical-biological mechanisms between SAM and phytoplankton biomass revealed in this study is important for us to predict the future variations of phytoplankton biomasses in Antarctic polynyas under climate change.

Development of X-FEM methodology and study on mixed-mode crack propagation

The extended finite element method（X-FEM） is a novel numerical methodology with a great potential for using in multi-scale computation and multi-phase coupling problems. The algorithm is discussed and a program is developed based on X-FEM for simulating mixed-mode crack propagation. The maximum circumferential stress criterion and interaction integral are deduced. Some numerical results are compared with the experimental data to prove the capability and efficiency of the algorithm and the program. Numerical analyses of sub-interfacial crack growth in bi-materials give a clear description of the effiect on fracture made by interface and loading condition.

INFLUENCES OF HEAT-TREATING PROCESS ON DUCTILE FRACTURE MECHANISM UNDER MIXED MODE LOADINGS

１ＩＮＴＲＯＤＵＣＴＩＯＮＩｎｅｎｇｉｎｅｅｒｉｎｇｐｒａｃｔｉｃｅ，ａｌｏｔｏｆｃｒａｃｋｐｒｏｂｌｅｍｓｃａｎｂｅｉｎｃｌｕｄｅｄｉｎｄｉｆｅｒｅｎｔｃｏｍｂｉｎａｔｉｏｎｓｏｆｔｈｒｅｅｂａｓｉｃｆｒａｃｔｕｒｅｍｏｄｅｓ，ｉ．ｅ．ｍｉｘｅｄ...

MIXED MODE SCC OF 18-8 STAINLESS STEEL IN BOILING 42% MgCl_2 SOLUTION

A series of mixed mode tests were carried out on 18-8 stainless steel in boiling 42% MgCl_2 solution.The results show that for any K_Ⅱ/K_Ⅰ ratio,the SCC direction coin- cides well with the crack tip maximum normal stress plane,while the SCC resistance of the material reduces as the ratio of K_Ⅱ/K_Ⅰ increases.The experimental results were discussed in the light of anode dissolving mechanism and the effect of mixed mode loading on crack tip stress and strain.It is concluded that for fracture analysis if mixed mode cracks were simply taken into account as mode Ⅰ cracks,and only mode Ⅰ testing results as mode Ⅰ fracture criter- ion were employed,it may not be safe.

Elastic-viscoplastic field at mixed-mode interface crack-tip under compression and shear

For a compression-shear mixed mode interface crack, it is difficult to solve the stress and strain fields considering the material viscosity, the crack-tip singularity, the frictional effect, and the mixed loading level. In this paper, a mechanical model of the dynamic propagation interface crack for the compression-shear mixed mode is proposed using an elastic-viscoplastic constitutive model. The governing equations of propagation crack interface at the crack-tip are given. The numerical analysis is performed for the interface crack of the compression-shear mixed mode by introducing a displacement function and some boundary conditions. The distributed regularities of stress field of the interface crack-tip are discussed with several special parameters. The final results show that the viscosity effect and the frictional contact effect on the crack surface and the mixed-load parameter are important factors in studying the mixed mode interface crack- tip fields. These fields are controlled by the viscosity coefficient, the Mach number, and the singularity exponent.

MESHLESS METHOD FOR 2D MIXED-MODE CRACK PROPAGATION BASED ON VORONOI CELL

A meshless method integrated with linear elastic fracture mechanics(LEFM)is presented for 2D mixed-mode crack propagation analysis.The domain is divided automatically into sub-domains based on Voronoi cells,which are used for quadrature for the potential energy. The continuous crack propagation is simulated with an incremental crack-extension method which assumes a piecewise linear discretization of the unknown crack path.For each increment of the crack extension,the meshless method is applied to carry out a stress analysis of the cracked structure.The J-integral,which can be decomposed into mode Ⅰ and mode Ⅱ for mixed-mode crack,is used for the evaluation of the stress intensity factors(SIFs).The crack-propagation direction,predicted on an incremental basis, is computed by a criterion defined in terms of the SIFs. The flowchart of the proposed procedure is presented and two numerical problems are analyzed with this method.The meshless results agree well with the experimental ones,which validates the accuracy and efficiency of the method.

(Ⅰ+Ⅱ)MIXED MODE HYDROGEN INDUCED CRACKING

Hydrogen induced cracking(HIC)of 0.3% C,1% Cr,1% Mn,1% Si high strength steel has been studied under simple mode Ⅰ,mode Ⅱ and(Ⅰ+Ⅱ)mixed mode loading conditions.Af- ter being hydrogen-charged in IN H_2SO_4 solution,the material behaved hydrogen embrittlement in all the cases studied.The threshold K_(ⅡH)/K_(ⅡX) of HIC under mode Ⅱ load- ing was 0.27,which was nearly the same as that K(ⅠH)/K_(ⅠX)=0.29 under mode Ⅰ loading. While the thresholds of-HIC under(Ⅰ+Ⅱ)mixed mode loading were 0.36,0.41 and 0.37 cor- responding to the K_Ⅱ/K_Ⅰ ratio of 0.27,0.4 and O.81.The results show that simple mode Ⅰ or mode Ⅱ loading is more susceptible to hydrogen embrittlement than(Ⅰ+Ⅱ)mixed mode. For explaining the experimental results,the effects of triaxial stress as well as plastic deformation ahead of crack tip has been discussed.

Observation on the Application of“Online+Offline”Mixed Teaching Mode in Clinical Nursing Teaching

Objective:To observe the application effect of“online+offline”mixed teaching mode in clinical nursing teaching.Methods:A total of 72 clinical nursing workers,who work in PLA General Hospital and participated in the experiment from March 2019 to March 2021,were selected as the subjects of this study.According to the odd numbers assigned to the participants’names,the participants were divided into two groups:the experimental group and the control group,with 36 cases in each group.The experimental group received“online+offline”hybrid teaching,whereas the control group received traditional offline teaching.In order to evaluate the efficacy and safety of the two groups of nursing workers,their assessment scores,teaching satisfaction scores,and teaching evaluation indicators were observed.Results:The experimental group was significantly better than the control group in terms of assessment scores,teaching satisfaction scores,and teaching evaluation indicators(P<0.05).Conclusion:In clinical nursing teaching,the“online+offline”mixed teaching mode plays a unique role in improving students’scores and teaching quality;thus,it should be promoted.

The Sensitivity of Model Results to Specification of Network-Based Level of Service Attributes: An Application of a Mixed Logit Model to Trave Mode Choice

The need for travel demand models is growing worldwide. Obtaining reasonably accurate level of service (LOS) attributes of different travel modes such as travel time and cost representing the performance of transportation system is not a trivial task, especially in growing cities of developing countries. This study investigates the sensitivity of results of a travel mode choice model to different specifications of network-based LOS attributes using a mixed logit model. The study also looks at the possibilities of correcting some of the inaccuracies in network-based LOS attributes. Further, the study also explores the effects of different specifications of LOS data on implied values of time and aggregation forecasting. The findings indicate that the implied values of time are very sensitive to specification of data and model implying that utmost care must be taken if the purpose of the model is to estimate values of time. Models estimated on all specifications of LOS-data perform well in prediction, likely suggesting that the extra expense on developing a more detailed and accurate network models so as to derive more precise LOS attributes is unnecessary for impact analyses of some policies.

Computational Fracture Analysis of an AFM-Specimen under Mixed Mode Loading Conditions

Fracture processes in ship-building structures are in many cases of a 3-D character. A finite element （FE） model of an all fracture mode （AFM） specimen was built for the study of 3-D mixed mode crack fracture behavior including modes Ⅰ,Ⅱ, and Ⅲ. The stress intensity factors （SIFs） were calculated by the modified virtual crack closure integral （MVCCI） method, and the crack initiation angle assessment was based on a recently developed 3-D fracture criterion--the Richard criterion. It was shown that the FE model of the AFM-specimen is applicable for investigations under general mixed mode loading conditions, and the computational results of crack initiation angles are in agreement with some available experimental findings. Thus, the applicability of the FE model of the AFM-specimen for mixed mode loading conditions and the validity of the Richard criterion can be demonstrated.

FATIGUE GROWTH MODELING OF MIXED-MODE CRACK IN PLANE ELASTIC MEDIA

This paper presents an extension of a displacement discontinuity method with cracktip elements （a boundary element method） proposed by the author for fatigue crack growth analysis in plane elastic media under mixed-mode conditions. The boundary element method consists of the non-singular displacement discontinuity elements presented by Crouch and Starfield and the crack-tip displacement discontinuity elements due to the author. In the boundary element implementation the left or right crack-tip element is placed locally at the corresponding left or right crack tip on top of the non-singular displacement discontinuity elements that cover the entire crack surface and the other boundaries. Crack growth is simulated with an incremental crack extension analysis based on the maximum circumferential stress criterion. In the numerical simulation, for each increment of crack extension, remeshing of existing boundaries is not required because of an intrinsic feature of the numerical approach. Crack growth is modeled by adding new boundary elements on the incremental crack extension to the previous crack boundaries. At the same time, the element characteristics of some related elements are adjusted according to the manner in which the boundary element method is implemented. As an example, the fatigue growth process of cracks emanating from a circular hole in a plane elastic plate is simulated using the numerical simulation approach.