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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.
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Fístula Retal , Recidiva , Retalhos Cirúrgicos , Fístula Retal/cirurgia , Humanos , Resultado do Tratamento , Incontinência Fecal/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reto/cirurgiaRESUMO
Intelligent polymer nanocomposites are multicomponent and multifunctional materials that show immense potential across diverse applications. However, to exhibit intelligent traits such as adaptability, reconfigurability and dynamic properties, these materials often require a solvent or heating environment to facilitate the mobility of polymer chains and nanoparticles, rendering their applications in everyday settings impractical. Here intelligent azopolymer nanocomposites that function effectively in a solvent-free, room-temperature environment based on photocontrolled reversible solid-fluid transitions via switching flow temperatures (Tfs) are shown. A range of nanocomposites is synthesized through the grafting of Au nanoparticles, Au nanorods, quantum dots, or superparamagnetic nanoparticles with photoresponsive azopolymers. Leveraging the reversible cis-trans photoisomerization of azo groups, the azopolymer nanocomposites transition between solid (Tf above room temperature) and fluid (Tf below room temperature) states. Such photocontrolled reversible solid-fluid transitions empower the rewriting of nanopatterns, correction of nanoscale defects, reconfiguration of complex multiscale structures, and design of intelligent optical devices. These findings highlight Tf-switchable polymer nanocomposites as promising candidates for the development of intelligent nanomaterials operative in solvent-free, room-temperature conditions.
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Plasma-based CO2 conversion has attracted increasing interest. However, to understand the impact of plasma operation on post-plasma processes, we studied the effect of adding N2, N2/CH4 and N2/CH4/H2O to a CO2 gliding arc plasmatron (GAP) to obtain valuable insights into their impact on exhaust stream composition and temperature, which will serve as feed gas and heat for post-plasma catalysis (PPC). Adding N2 improves the CO2 conversion from 4 % to 13 %, and CH4 addition further promotes it to 44 %, and even to 61 % at lower gas flow rate (6â L/min), allowing a higher yield of CO and hydrogen for PPC. The addition of H2O, however, reduces the CO2 conversion from 55 % to 22 %, but it also lowers the energy cost, from 5.8 to 3â kJ/L. Regarding the temperature at 4.9â cm post-plasma, N2 addition increases the temperature, while the CO2/CH4 ratio has no significant effect on temperature. We also calculated the temperature distribution with computational fluid dynamics simulations. The obtained temperature profiles (both experimental and calculated) show a decreasing trend with distance to the exhaust and provide insights in where to position a PPC bed.
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The performance of contact resistive pressure sensors heavily relies on the intrinsic characteristics of the active layers, including the mechanical surface structure, conductivity, and elastic properties. However, efficiently and simply regulating the conductivity, morphology, and modulus of the active layers has remained a challenge. In this study, we introduced electro-polymerized polypyrrole (ePPy) to design flexible contact piezoresistive sensors with tailored intrinsic properties. The customizable intrinsic property of ePPy was comprehensively illustrated on the chemical and electronic structure scale, and the impact of ePPy's intrinsic properties on the sensing performance of the device was investigated by determining the correlation between resistivity, roughness, and device sensitivity. Due to the synergistic effects of roughness, conductivity, and elastic properties of the active layers, the flexible ePPy-based pressure sensor exhibited high sensitivity (3.19 kPa-1, 1-10 kPa, R2 = 0.97), fast response time, good durability, and low power consumption. These advantages allowed the sensor to offer an immediate response to human motion such as finger-bending and grasping movements, demonstrating the promising potential of tailorable ePPy-based contact piezoresistive sensors for wearable electronic applications.
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The directional multiple signal classification (Dir-MUSIC) algorithm based on the antenna gain array manifold has been proposed to find the direction of the partial discharge (PD) source in substations. However, PD signals are wideband signals and the antenna gain pattern functions are always different at different frequencies; therefore, the accuracy can be improved using a wideband Dir-MUSIC algorithm. In this paper, wideband Dir-MUSIC algorithms are discussed and a novel wideband Dir-MUSIC algorithm using the strength proportion (DirSP) is proposed. This algorithm estimates a focusing PD signal at a certain frequency using the strength proportion among different directions, and then the Dir-MUSIC algorithm can process the focusing PD signal at this frequency. In simulations, when the antenna gain functions among different frequency bins are quite different, the Dir-MUSIC algorithm loses accuracy; meanwhile, DirDP performs very well. In the experiments, we deal with six sets of samples, and the mean error and standard deviation are both smaller than 4° better than other methods.
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Photoresponsive polymers can be conveniently used to fabricate anti-counterfeiting materials through photopatterning. However, an unsolved problem is that ambient light and heat can damage anti-counterfeiting patterns on photoresponsive polymers. Herein, photo- and thermostable anti-counterfeiting materials are developed by photopatterning and thermal annealing of a photoresponsive conjugated polymer (MC-Azo). MC-Azo contains alternating azobenzene and fluorene units in the polymer backbone. To prepare an anti-counterfeiting material, an MC-Azo film is irradiated with polarized blue light through a photomask, and then thermally annealed under the pressure of a photonic stamp. This strategy generates a highly secure anti-counterfeiting material with dual patterns, which is stable to sunlight and heat over 200 °C. A key for the stability is that thermal annealing promotes interchain stacking, which converts photoresponsive MC-Azo to a photostable material. Another key for the stability is that the conjugated structure endows MC-Azo with desirable thermal properties. This study shows that the design of photopatternable conjugated polymers with thermal-annealing-promoted interchain stacking provides a new strategy for the development of highly stable and secure anti-counterfeiting materials.
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We investigate three azo-chromophore-containing photoswitches (1, 2 and 3) for molecular solar thermal storage (MOST) based on reversible Z-E isomerization. 1, 2 and 3 are photoswitchable compounds that contain one, two and three azo chromophores, respectively. In solution, 1, 2 and 3 were charged via UV-light-induced E-to-Z isomerization. Among these three compounds, 2 exhibited an energy density as high as 272 ± 1.8 J g-1, which showed the best energy storage performance. This result originated from the low molecular weight, a high degree of photoisomerization, and moderate steric hindrance of 2, which demonstrated the advantages of the meta-bisazobenzene structure for MOST. In addition, we studied the performances of these photoswitches in the solvent-free state. Only 1 showed photoinduced reversible solid-to-liquid transitions, which enabled the charging of 1 in a solvent-free state. The stored energy density for 1 in a solvent-free state was 237 ± 1.5 J g-1. By contrast, 2 and 3 could not be charged in the solvent-free state due to the lack of solid-state photoisomerization. Our findings provide a better understanding of the structure-performance relationship for azobenzenebased MOST and pave the way for the development of high-density solar thermal fuels.
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Inspection robots are widely used in the field of smart grid monitoring in substations, and partial discharge (PD) is an important sign of the insulation state of equipment. PD direction of arrival (DOA) algorithms using conventional beam forming and time difference of arrival (TDOA) require large-scale antenna arrays and high computational complexity, making them difficult to implement on inspection robots. To address this problem, a novel directional multiple signal classification (Dir-MUSIC) algorithm for PD direction finding based on signal strength is proposed, and a miniaturized directional spiral antenna circular array is designed in this paper. First, the Dir-MUSIC algorithm is derived based on the array manifold characteristics. This method uses strength intensity information rather than the TDOA information, which could reduce the computational difficulty and the requirement of array size. Second, the effects of signal-to-noise ratio (SNR) and array manifold error on the performance of the algorithm are discussed through simulations in detail. Then, according to the positioning requirements, the antenna array and its arrangement are developed and optimized. Simulation results suggested that the algorithm has reliable direction-finding performance in the form of six elements. Finally, the effectiveness of the algorithm is tested by using the designed spiral circular array in real scenarios. The experimental results show that the PD direction-finding error is 3.39°, which meets the need for partial discharge DOA estimation using inspection robots in substations.
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The fabrication of dual-mode patterns in the same region of a material is a promising approach for high-density information storage, new anti-counterfeiting technologies, and highly secure encryption. However, dual-mode patterns are difficult to achieve because the two patterns in one material may interfere with each other during fabrication and usage. The development of noninterfering dual-mode patterns requires new materials and patterning techniques. Herein, a novel orthogonal photopatterning technique is reported for the fabrication of noninterfering dual-mode patterns on an azopolymer P1. P1 is a unique material that exhibits both photoinduced reversible solid-to-liquid transitions and good stretchability. In the first step of orthogonal photopatterning, patterned photonic structures are fabricated on a P1 film via masked nanoimprinting controlled by photoinduced reversible solid-to-liquid transitions. In the second step, the P1 film is stretched and irradiated with polarized light through a photomask, which generates a chromatic polarization pattern. In particular, the photonic structures and chromatic polarization in the dual-mode pattern are noninterfering. Another feature of dual-mode patterns is that they are rewritable via photo-, thermal, or solution reprocessing, which are useful for recycling and reprogramming. This study opens an avenue for the development of novel materials and techniques for photopatterning.
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BACKGROUND AND AIMS: Chronic hepatitis B virus (CHB) infection remains a major global health burden and the non-invasive and accurate diagnosis of significant liver fibrosis (≥ F2) in CHB patients is clinically very important. This study aimed to assess the potential of the joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients' clinical parameters in a deep learning model to improve the diagnosis of ≥ F2 in CHB patients. METHODS: Of 527 CHB patients who underwent US examination, liver elastography and biopsy, 284 eligible patients were included. We developed a deep learning-based data integration network (DI-Net) to fuse the information of ultrasound images of liver parenchyma, liver stiffness values and patients' clinical parameters for diagnosing ≥ F2 in CHB patients. The performance of DI-Net was cross-validated in a main cohort (n = 155) of the included patients and externally validated in an independent cohort (n = 129), with comparisons against single-source data-based models and other non-invasive methods in terms of the area under the receiver-operating-characteristic curve (AUC). RESULTS: DI-Net achieved an AUC of 0.943 (95% confidence interval [CI] 0.893-0.973) in the cross-validation, and an AUC of 0.901 (95% CI 0.834-0.945) in the external validation, which were significantly greater than those of the comparative methods (AUC ranges: 0.774-0.877 and 0.741-0.848 for cross- and external validations, respectively, ps < 0.01). CONCLUSION: The joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients' clinical parameters in a deep learning model could significantly improve the diagnosis of ≥ F2 in CHB patients.
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Aprendizado Profundo , Técnicas de Imagem por Elasticidade , Hepatite B Crônica , Biópsia , Técnicas de Imagem por Elasticidade/métodos , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico por imagem , Hepatite B Crônica/patologia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Curva ROCRESUMO
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.
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Fístula Cutânea , Hidradenite Supurativa , Fístula Retal , Masculino , Humanos , Adulto , Hidradenite Supurativa/complicações , Hidradenite Supurativa/cirurgia , Fístula Retal/complicações , Canal Anal , Pele , Fístula Cutânea/complicaçõesRESUMO
Piebaldism is a rare, autosomal dominant and congenital pigmentary disorder characterized by stable depigmentation of the skin and white forelock. Mutations in KIT or SNAI2 genes result in piebaldism. Most individuals with piebaldism have a family history of the disorder. Herein, we report a 5-month-old Chinese girl with severe piebaldism but no family history thereof. She has white forelock and large patches of depigmentation in the jaw, central anterior trunk, perineum and extremities. We performed whole-exome and Sanger sequencing and identified a de novo KIT mutation (NM_000222.2: c.2657G>A, p.Gly886Val) in exon 18 of KIT in the proband. Currently, this mutation is located in the most extreme C-terminal of the tyrosine kinase domain 2 of the KIT gene amongst all reported mutations and causes a severe clinical phenotype. We further reviewed literature on piebaldism and summarized 79 KIT gene mutations that lead to this disease. Our study may expand knowledge on the genotype-phenotype correlation in piebaldism and serve as a reference for genetic counseling and prenatal diagnosis of affected families.
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Predisposição Genética para Doença , Piebaldismo/genética , Transtornos da Pigmentação/genética , Proteínas Proto-Oncogênicas c-kit/genética , Pré-Escolar , Feminino , Humanos , Mutação/genética , Linhagem , Piebaldismo/patologia , Transtornos da Pigmentação/patologia , Sequenciamento do ExomaRESUMO
Heating and cooling can induce reversible solid-to-liquid transitions of matter. In contrast, athermal photochemical processes can induce reversible solid-to-liquid transitions of some newly developed azobenzene compounds. Azobenzene is photoswitchable. UV light induces trans-to-cis isomerization; visible light or heat induces cis-to-trans isomerization. Trans and cis isomers usually have different melting points (Tm ) or glass transition temperatures (Tg ). If Tm or Tg of an azobenzene compound in trans and cis forms are above and below room temperature, respectively, light may induce reversible solid-to-liquid transitions. In this Review, we introduce azobenzene compounds that exhibit photoinduced reversible solid-to-liquid transitions, discuss the mechanisms and design principles, and show their potential applications in healable coatings, adhesives, transfer printing, lithography, actuators, fuels, and gas separation. Finally, we discuss remaining challenges in this field.
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An unprecedented use of trifluoromethanesulfonyl hydrazides as effective SCF3 sources has been established in the sulfenylation of indoles. A range of substituted indoles participated in CuCl-catalyzed oxidative sulfenylation reaction with TfNHNHBoc in the presence of dimethyl sulfoxide to furnish structurally diverse 3-indolyl trifluoromethyl thioethers in moderate to good yields with very high regioselectivity.
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With 2-(trimethylsilyl)aryl triflates as aryne precursors, an unprecedented three-component carboarylation reaction of unactivated imines with arynes and carbon nucleophiles has been developed to access a variety of functionalized tertiary amines under transition metal-free conditions. Suitable carbon nucleophiles include chloroform, acetonitrile, and methyl propiolate.