An anal fissure which does not heal with conservative measures as sits baths and laxatives is a chronic anal fissure. Physiologically, it is the high resting tone of the internal anal sphincter that chiefly interferes with the healing process of these fissures. Until now, the gold standard treatment modality is surgery, either digital anal dilatation or lateral sphincterotomy. However, concerns have been raised about the incidence of faecal incontinence after surgery. Therefore, pharmacological means to treat chronic anal fissures have been explored. A Medline and pub med database search from 1986-2012 was conducted to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure. Pharmacological sphincterotomy using Glyceryl trinitrate , Isosorbide dinitrate or calcium channel blockers are exciting alternative treatment , that relaxes the anal sphincter and, therefore, promote healing, the drawback of such medications are headache and poor compliance. With the introduction of Botulinum toxin as mean of chemical sphincterotom, topical injection of Botulinum toxin reduces the anal hypertonia which lasts for few months, allows the fissure to heal, thus eliminating the need for surgery without incidence of incontinence. Cure rates are over 60%, and the procedure can be repeated safely. Therefore, Botulinum toxin is a reasonable first-line management of chronic anal fissure and the relapses can be managed by surgery Keywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
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The avoidance strategy of prey to predation and the predation strategy for predators are important topics in evolutionary biology. Both prey and predators adjust their behaviors in order to obtain the maximal benefits and to raise their biomass for each. Therefore, this paper is aimed at studying the impact of prey’s fear and group defense against predation on the dynamics of the food-web model. Consequently, in this paper, a mathematical model that describes a tritrophic Leslie-Gower food-web system is formulated. Sokol-Howell type of function response is adapted to describe the predation process due to the prey’s group defensive capability. The effects of fear due to the predation process are considered in the first two levels
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—This paper studies the control motion of a single link flexible joint robot by using a hierarchical non-singular terminal sliding mode controller (HNTSMC). In comparison to the conventional sliding mode controller (CSMC), the proposed algorithm (NTSMC) not only can conserve characteristics of the convention CSMC, such as easy implementation, guaranteed stability and good robustness against system uncertainties and external disturbances, but also can ensure a faster convergence rate of the systems states to zero in a finite time and singularity free. The flexible joint robot (FJR) is a two degree of freedom (2DOF) nonlinear and underactuated system. The system here is modeled as a fourth order system by using Lagrangian method. Based on t
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In this paper, a single link flexible joint robot is used to evaluate a tracking trajectory control and vibration reduction by a super-twisting integral sliding mode (ST-ISMC). Normally, the system with joint flexibility has inevitably some uncertainties and external disturbances. In conventional sliding mode control, the robustness property is not guaranteed during the reaching phase. This disadvantage is addressed by applying ISMC that eliminates a reaching phase to ensure the robustness from the beginning of a process. To design this controller, the linear quadratic regulator (LQR) controller is first designed as the nominal control to decide a desired performance for both tracking and vibration responses. Subsequently, discontinuous con
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