Efficacy and Safety of Endorectal Advancement Flap for the Treatment of Anal Fistula: A Systematic Review and Meta-Analysis.

AIM: Complex anal fistula poses a significant challenge for anorectal surgeons due to its high risks of recurrence and incontinence. A sphincter-preserving procedure named endorectal advancement flap (ERAF) is gradually being applied to clinical practice. Therefore, this meta-analysis aims to evaluate the efficacy and safety of ERAF in managing anal fistula. METHODS: We searched PubMed, Embase, Cochrane, and Web of Science databases for relevant manuscripts published from 29 August 2003 to 29 August 2023. Among these studies, outcomes included healing rate, recurrence rate, incontinence rate, and complications. Furthermore, the quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane risk-of-bias tool. The heterogeneity was determined using the chi-squared test and I2 statistic. A random effects model was applied if significant heterogeneity (p < 0.05 and I2 > 50%) was observed. Sensitivity analysis was conducted by excluding studies with a high risk of bias. RESULTS: Thirty-eight studies were included in the present analysis, involving 1559 participants. The pooled healing rate and recurrence rate of ERAF were 65.5% (95% confidence intervals (CI): 57.6%-73.4%) and 19.6% (95% CI: 14.8%-24.4%), respectively. The pooled incontinence rate was 10.6% (95% CI: 6.0%-15.1%). According to the subgroup analysis, the healing rate, recurrence rate, and incontinence rate of ERAF for fistula associated with inflammatory bowel disease (IBD) were 53.9% (95% CI: 38.1%-69.7%), 32.6% (95% CI: 21.3%-43.8%), and 2.8% (95% CI: 0%-10.6%), respectively. For patients without IBD, the healing rate, recurrence rate, and incontinence rate of ERAF were 70.6% (95% CI: 63.9%-77.4%), 15.7% (95% CI: 9.9%-21.5%), and 16.5% (95% CI: 8.1%-24.9%), respectively. We observed that bleeding, local infection or abscess, flap dehiscence, and haematomas were the common complications, with incidences of 2.2% (95% CI: 0%-4.5%), 9.5% (95% CI: 4.7%-14.4%), 10.4% (95% CI: 0.0%-21.6%), and 12.4% (95% CI: 0%-27.6%), respectively. CONCLUSIONS: ERAF may be an optional treatment for anal fistula from the perspective of effectiveness and safety. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42023451451.

A novel MCDM approach for design concept evaluation based on interval-valued picture fuzzy sets.

The assessment of design concepts presents an efficient and effective strategy for businesses to strengthen their competitive edge and introduce market-worthy products. The widely accepted viewpoint acknowledges this as a intricate multi-criteria decision-making (MCDM) approach, involving a multitude of evaluative criteria and a significant amount of data that is frequently ambiguously defined and subjectively influenced. In order to tackle the problems of uncertainty and fuzziness in design concept evaluation, our research creatively combines interval-valued picture fuzzy set (IVPFS) with an MCDM process of design concept evaluation. Firstly, this study draws on the existing relevant literature and the experience of decision makers to identify some important criteria and corresponding sub-criteria and form a scientific evaluation indicator system. We then introduce the essential operational concepts of interval-valued picture fuzzy numbers (IVPFNs) and the interval-valued picture fuzzy ordered weighted interactive averaging (IVPFOWIA) operator. Thirdly, an entropy weighting method based on IVPFS is proposed in this research to calculate the weights of criteria and sub-criteria, and based on this, an integrated IVPF decision matrix is further constructed based on the presented IVPFOWIA operator. Finally, the best design concept alternative is selected by applying the extended TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) approach with IVPFS. The IVPFS combined with improved MCDM method have been proven to be superior in complex and uncertain decision-making situations through experiments and comparative assessments. The information ambiguity in the evaluation of design concept is well characterized by our augmentation based on IVPFS.

Symptoms associated with nucleic acid turning-negative-time in COVID-19 patients?

To explore on the association between nucleic acid turning-negative-time and traditional Chinese medicine (TCM) symptoms in coronavirus disease 2019 (COVID-19) patients with the Omicron variant. Method: For this retrospective cross-sectional study, we enrolled 189 patients with COVID-19 (age 20-90 years) were included. multiple linear regression models were used to investigate the TCM symptoms affecting the nucleic acid turning-negative-time of COVID-19 patients, during the process of data analysis, taking with nucleic acid turning-negative-time as the dependent variable, and TCM symptoms as independent variables, and at the same time, sex, age, hypertension, diabetes, and coronary heart disease were as confounding variables. Results: The study found that the most common TCM symptoms of COVID-19 patients with Omicron were cough, dry throat, expectoration, fever, sore throat, pharyngeal itching, running nose, and nasal congestion. Regression analysis showed that the fit regressive equation showed a significant difference (F = 4.286, P < 0.001), R = 0.400, the adjusted R 2 = 0.123, and three variables in the regression equation showed significant difference (P < 0. 05). The results showed that nucleic acid turning-negative-time was mostly related to constipation, fever, and expectoration. If the patients had the symptoms of constipation, fever, and expectoration; that is, if patients showed these symptoms, the turning-negative-time of nucleic acid in patients with Omicron will be prolonged. Conclusions: Treatment based on symptoms for patients with constipation, fever, and expectoration may have important clinical significance for the COVID-19 patients with Omicron.

Perineal burn injury with hidradenitis suppurativa: A case report.

RATIONALE: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease which usually presents with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas. Severe HS has interconnecting sinus tracts and when it occurs in the perianal region, perianal fistulas can form. Obesity and smoking are 2 risk factors for the development of HS. PATIENT CONCERNS: We report a case of a 33-year-old male diagnosed with perianal HS and perianal fistula following a burn injury to the area that occurred during childhood. DIAGNOSIS: Through integration of the clinical signs and imaging results, the patient was diagnosed with HS, Hurley stage III with perianal fistulas. INTERVENTIONS: The patient accepted surgical therapy. Performed under the general anesthesia, the procedure comprised sinus tracts excision and drainage. OUTCOMES: The patient was discharged from the hospital 6 weeks after surgery. LESSONS: The pathogenesis of the HS in this case was the burn injury interfering with sweat gland formation around the anus. Moreover, the scar from the burn made surgical treatment difficult.

Experimental study and dynamic characteristics analysis of partially liquid-filled annulus tubes.

As a useful technology, the horizontal drilling for underground coalmine has been applied in many fields such as gas drainage, water control, exploration and accurate drilling borehole engineering. In this paper, the annulus tubes are used to simulate the fluid transportation process between drilling rod and casing tube when drilling horizontally. The main goal of this research is to analyze the effects of eccentricity, fluid velocity, outer tube length and volume fraction on dynamic characteristics of partially liquid-filled annulus tube in a drillstring system. According to the Euler-Bernoulli beam model, the partially liquid-filled inner tube model and outer tube model are established respectively when considering the effect of transport fluid inside the annulus tubes. Based on the vibration characteristics of the tube, the added mass coefficient is proposed to calculate the natural frequencies of the outer tubes. And natural frequency is the frequency at which a system tends to oscillate in the absence of any driving or damping force. According to the compared results of experiments and simulations, the natural characteristics of outer tube depend on the tube design parameter (outer tube length) and the volume fraction of liquid filled in the outer tube. Furthermore, experiments have verified that the natural frequencies of the outer tubes can be directly calculated from the length of outer tubes. Therefore, it is feasible to propose the method of attaching liquid mass to tube mass to obtain the natural frequencies of outer tubes. According to the results, it can be concluded that: (i) The natural frequencies of tube decrease as the length of the tube increases; (ii) The increase of volume fraction of liquid in the tube can significantly reduce the natural frequencies of tube; (iii) The fluid velocity and eccentricity have less effects on the natural frequencies of tube; (ⅳ) The added mass coefficient of outer tubes can be calculated and it is not a fixed value, it varies with the volume fraction of fluid in annulus tubes. In this work, the inner and outer tube models are established respectively for fluid transportation process between a horizontal drilling rod and casing tube. The effects of four factors on the natural frequencies are compared, and the concept of added mass coefficient is proposed to obtain reasonable tube natural frequencies.

Crystal structure of a new cyclomaltoheptaose hydrate: beta-cyclodextrin.7.5H2O.

The crystallographic study of a partially hydrated form of cyclomaltoheptaose (beta-cyclodextrin, betaCD) is reported. C(42)H(70)O(35).7.5H(2)O; space group P2(1) with unit cell constants a=15.1667(5), b=10.1850(3), c=20.9694(7)A, beta=110.993(2) degrees ; final discrepancy index R=0.0760 for the 6181 observed reflections and 784 refined parameters. One water molecule is included in the cavity and distributed over two partially occupied positions, the other 6.5 waters distributed over eight positions are located as space-filler between the macrocycles. The crystal structure belongs to the cage-type, like that observed in Form I (betaCD.12H(2)O; Lindner, K; Saenger, W. Carbohydr. Res. 1982, 99, 103-115) and Form II (betaCD.11H(2)O; Betzel, C., et al. J. Am. Chem. Soc., 1984, 106, 7545-7567).

Redox-responsive vesicles prepared from supramolecular cyclodextrin amphiphiles.

Redox-responsive vesicles self-assembled by supramolecular cyclodextrin amphiphiles, consisting of the guest (N-1-decyl-ferrocenylmethylamine, 1) and the host (2-O-carboxymethyl-beta-cyclodextrin, CM-beta-CD), were prepared. The morphologies and sizes of these novel vesicles in an aqueous solution were observed by transmission electron microscopy (TEM) and were confirmed by atomic force microscopy (AFM) and dynamic light scattering (DLS) measurements. The effects of the host-guest ratio, the concentration and the solvent composition of water and methanol on vesicles were investigated in detail. The interactions between the host and the guest, the complex stoichiometry, the stability constant and conformations of 1.CM-beta-CD in aqueous solution were investigated by cyclic voltammetry (CV), UV and nuclear magnetic resonance (NMR) measurements. According to the complex stoichiometry and 'tadpole-like' spatial conformations, the supramolecular cyclodextrin amphiphiles made from 1.CM-beta-CD were proposed to form the membranes of the vesicles. This kind of vesicle system was responsive to an oxidizing agent, which could pave the way to combine supramolecular host-guest chemistry and membrane chemistry for potentially functional applications.

A convenient preparation of 6-oligo(lactic acid)cyclomaltoheptaose as kinetically degradable derivative for controlled release of amoxicillin.

6-Oligo(lactic acid)cyclomaltoheptaose (6-OLA-betaCD) with an average substitution of about 7.0 lactic acid units was prepared as a new water-soluble cyclomaltoheptaose (betaCD) derivative (solubility of about 70.7-fold that of betaCD), based on the ring-opening polymerization of 3,6-dimethyl-1,4-dioxane-2,5-dione (lactide). The product was characterized by (1)H NMR, (13)C NMR, IR, and MS spectroscopy. The complexation of amoxicillin with 6-OLA-betaCD was found to be much stronger than that with betaCD at first, and then 6-OLA-betaCD was shown to decompose moderately into betaCD and lactic acid. 6-OLA-betaCD might be greatly valuable in a controlled release system for Amoxicillin (AMX).