Background: Achieving a complete cure while maintaining continence constitutes a considerable challenge in the treatment of patients with high anal fistula. This study aimed to evaluate the effectiveness of loose combined cutting seton (LCCS) for treating patients with high intersphincteric fistula.Methods: Consecutive patients with high intersphincteric fistula who underwent LCCS were retrospectively enrolled. Patient data including demographics, medical history, comorbidities, details of the fistula, operative procedure, and prognosis were collected. Postoperative pain was assessed using a visual analog scale (VAS), which ranged from 0 (no pain) to 10 (extremely severe pain). The severity of fecal incontinence was assessed using the Wexner Continence Grading Scale, with a total score ranging from 0 (no incontinence) to 20 (complete incontinence). The primary outcome was the healing rate of fistula. Secondary outcomes included the recurrence rate of fistula and the severity of fecal incontinence. Results:The 22 patients (male: female =18:4) in our study had a median follow-up of 55 (range, 32-568) days. The healing rate was 100%, and none of the patients experienced fistula recurrence. At the follow-up visit, 19 patients (86.4%) reported no fecal incontinence. The median total Wexner score was 0.95.5% patients had VAS score of 0 and only 1 patient (4.5%) had a VAS score of 1, which indicated a low level of postoperative pain.Conclusions: LCCS achieved a high healing rate with an increased level of continence, as well as a low level of postoperative pain, in most patients with high anal fistula in our study. Further randomized controlled trials are needed to confirm the effectiveness of this novel seton-based technique.

Background: The treatment of high anal fistula (HAF) is still difficult for clinical surgeons. Our previous study demonstrated the short-term benefit of loose combined cutting seton (LCCS) for patients with HAF.This study aimed to evaluate the long-term effectiveness of LCCS for treating HAF patients.Methods: We retrospectively enrolled consecutive HAF patients who received LCCS therapy in our hospital between March 2014 and July 2017. After enrollment, all patients were followed up by clinical review. The patients' clinical information and most recent follow-up results were collected. Pain was assessed by the visual analog scale (VAS), and the severity of fecal incontinence was assessed by the Wexner Continence Grading Scale. We also assessed the patients' quality of life (QOL) using a the MOS item short from health survey (SF-36) questionnaire. HAF healing was considered the primary outcome, while the fistula recurrence rate, severity of fecal incontinence, and QOL were the secondary outcomes.Results: In total, 22 patients (18 male, four female) were enrolled in the final analysis. The mean duration of follow-up was 3.65 years (interquartile range: 3.55-4.22; range, 3.50-5.43). All patients were cured and there was no recurrence during the follow-up period. Eight patients reported a Wexner score of 1, while the remaining patients reported a score of 0 at the final follow-up. Furthermore, one patient had a VAS score of 1, while the remaining patients had a VAS score of 0, which indicated almost no postoperative pain. The QOL of all patients improved significantly.Conclusions: LCCS is an effective method to treat HAF patients. Large, multicenter randomized controlled trials are warranted.

Background Anal fistula is an anorectal infectious disease caused by a perianal abscess or perianal disease. Accurate anorectal examinations are of great significance. The two-finger digital rectal examination (TF-DRE) has been used in clinical practice, with a lack of comprehensive research on the value of the TF-DRE in the diagnosis of anal fistula. This study will compare the difference in the diagnostic value of the TF-DRE, traditional digital rectal examination (DRE), and anorectal ultrasonography in the diagnosis of anal fistula. Methods For patients who meet the inclusion criteria, a TF-DRE will be performed to explore the number and location of the external and internal orifices, the number of fistulas, and the relationship between the fistula and the perianal sphincter. A DRE and anorectal ultrasonography will also be performed, and the same data will be recorded. To make a comparison, the final diagnosis results of the clinicians during the operation will be taken as the gold standard, the accuracy of the TF-DRE in diagnosing anal fistula will be calculated, and the significance of the TF-DRE in the preoperative diagnosis of anal fistula will be studied and analyzed. All the statistical results will be analyzed using SPSS22.0 (IBM, USA), and a P value <0.05 will be considered statistically significant. Discussion The research protocol details the advantages of the TF-DRE compared to the DRE and anorectal ultrasonography in the diagnosis of anal fistula. This study will provide clinical evidence of the diagnostic value of the TF-DRE in the diagnosis of anal fistula. Currently, there is a lack of high-quality research using scientific methods on this innovative anorectal examination method. This study will provide rigorously designed clinical evidence on the TF-DRE. Registration Chinese Clinical Trials Registry ChiCTR2100045450.

Purpose Anal fistula is an anorectal infectious disease caused by perianal abscess or perianal disease. Surgery is the main treatment method for anal fistula. Accurate anorectal examination is of great significance to reduce the missed diagnosis rate of anal fistula, especially the misdiagnosis of anal fistula with no clear external opening. Two-Fingers digital rectal examination (TF-DRE) is a method improved by Professor Zheng Lihua on the basis of traditional digital anus examination. It has been used since 2012 and has accumulated a lot of clinical experience. However, there is a lack of comprehensive research on the value of TF-DRE for the diagnosis of anal fistula. The main purpose of this study is to compare the difference in the diagnostic value of TF-DRE, traditional digital rectal examination, and anorectal ultrasonography in the diagnosis of anal fistula. Methods For patients who met the inclusion criteria, TF-DRE was performed to explore the number and location of the external orifice, internal orifice, the number of fistula and the relationship with the perianal sphincter, as well as the data recorded by digital rectal examination and anorectal ultrasonography To make a comparison, the final diagnosis results from clinicians during the operation was taken as the gold standard, the diagnostic accuracy of TF-DRE for anal fistula is calculated, and the significance of TF-DRE in the preoperative diagnosis of anal fistula is studied and analyzed. All statistical results were analyzed using SPSS22.0, and P < 0.05 indicated that the difference was statistically significant. Conclusion The research protocol details the advantages of TF-DRE compared with digital rectal examination and anorectal ultrasonography in the diagnosis of anal fistula, and provides clinical evidence for the diagnostic value of TF-DRE in anal fistula. As an innovative anorectal examination method, there is still a lack of high-quality research using scientific methods in the current literature. This study will provide rigorously designed clinical evidence for TF-DRE.

BackgroundOnline collaborative learning has been widely adopted in the field of education. However, learners often find it difficult to engage in collaboratively building knowledge and jointly regulating online collaborative learning.ObjectivesThe study compared the impacts of the three learning approaches on collaborative knowledge building, group performance, socially shared regulation, behavioural engagement, and cognitive load in an online collaborative learning context. The first is the automatic construction of knowledge graphs (CKG) approach, the second is the automatic analysis of topic distribution (ATD) approach, and the third one is the traditional online collaborative learning (OCL) approach without any analytic feedback.MethodsA total of 144 college students participated in a quasi‐experimental study, where 48 students learned with the CKG approach, 48 students used the ATD approach, and the remaining 48 students adopted the OCL approach.Results and ConclusionsThe findings revealed that the CKG approach could encourage collaborative knowledge building, socially shared regulation, and behavioural engagement in building knowledge better than the ATD and OCL approaches. Both the CKG and ATD approaches could better improve group performance than the OCL approach. Furthermore, the CKG approach did not increase learners' cognitive load, but the ATD approach did.ImplicationsThis study has theoretical and practical implications for utilising learning analytics in online collaborative learning. Furthermore, deep neural network models are powerful for constructing knowledge graphs and analysing topic distribution.