Open Cases Research Articles

"Open" reincarnation stories: The dialectic between doubt and certainty.

This phenomenological study concerns the Druze cultural idiom Notq-the remembrance and talking about the previous incarnation. Specifically, it deals with stories that are open or referred to in the literature as unsolved. "Open" Notq stories are in contrast to solved ones in which the person's identity in the previous life is known and in many cases the person meets the previous life family. The study's core question is: What is the phenomenological experience of Druze who live with an "open" Notq? The study was based on interviews with 11 Israeli Druze women and men who have an open Notq story. The findings illustrate the open Notq scenario, the elements that validate it and the individual and collective implications of these stories. Through the open Notq cases we discuss the intersection between personal and master cultural narratives and the effects of this intersection on psychological well-being. We propose that the open Notq, despite its ambiguity and many unsolved questions, does not essentially harm the individual psychologically and may contain therapeutic value due to being consistent with the Druze reincarnation master narrative.

Mastoid Fascia Tissue Graft as a Tip Camouflage Technique in Rhinoplasty: A Reliable Alternative to Soft Cartilage Grafts.

Traditional rhinoplasty tip grafts often lead to visibility issues, prompting patients to seek revision surgery. The mastoid fascia tissue graft (MFTG) provides a natural-appearing alternative with an acceptable risk of complication. The MFTG remains less visible through the skin and helps camouflage and conceal tip irregularities. This study of 193 patients examines the MFTG's effectiveness in nasal tip refinement, evaluating revision and infection rates. A retrospective analysis of MFTG use for nasal tip appearance during open rhinoplasty in the senior author's (R.G.R.) practice was conducted, covering the period from January of 2019 to June of 2022. Inclusion criteria encompassed open rhinoplasty cases using mastoid tissue for tip appearance with at least 12 months of follow-up. Among 2003 cases, 193 met these criteria and were evaluated for subsequent revision and infection rates. The average patient age was 34.2 years (175 female patients and 18 male patients). Primary rhinoplasty was performed in 113 patients, with 80 receiving revision operations. The average follow-up was 14.8 months. Six patients (3.1%) overall needed extended antibiotics, including 1 primary rhinoplasty patient (0.9%) and 5 secondary rhinoplasty patients (6.3%). Overall, revision rhinoplasty was required in 6 patients (3.1%) (1 primary patient [0.9%] and 5 secondary rhinoplasty patients [6.3%]). MFTG use for an aesthetically pleasing nasal tip appearance is a safe, convenient, and effective technique for camouflaging and concealing nasal tip contour irregularities in both primary and revision rhinoplasty. Use of the MTFG is associated with minimal morbidity. Therapeutic, IV.

Integrating machine learning for treatment decisions in anterior open bite orthodontic cases: A retrospective study.

This article explores the integration of machine learning (ML) algorithms to aid in treatment planning and extraction decisions for anterior open bite cases, leveraging demographic, clinical, and radiographic data to predict treatment outcomes and informed decision-making. A retrospective study was conducted using patient data from the University of Illinois Chicago Department of Orthodontics. Data included demographic, clinical, and radiographic information from 115 anterior open bite patients who successfully completed their treatment. ML algorithms, including random forest, support vector machine, k-nearest neighbor, and convolutional neural networks (CNN), were trained on a subset of the data to predict treatment outcomes. Significant differences were observed in the percentages of males and females between the extraction and nonextraction groups and cephalometric variables between the two groups, which include maxillary depth, maxillary height, SN-palatal plane, facial angle, facial axis-Ricketts, FMA, total facial height, lower facial height, SNA, SNB, and SN-MP e ML algorithms examined consisted of CNN2, CNN1, and Random Forest, which demonstrated the highest accuracy rates (∼83%), while k-Nearest Neighbor had the lowest (∼73%). Key features influencing accuracy included crowding, SN-palatal plane, SNA, FMA, molar relation, and facial height measurements. The study's evaluation of AI algorithms showed that CNN2, CNN1, and random forest had an accuracy of approximately 83% in classifying extraction versus nonextraction cases. Notably, features such as U-crowding, L-crowding, SN-palatal plane, SNA, FMA, molar relation, total facial height, lower facial height, and facial axis-Ricketts were most influential in achieving accuracy rates comparable to traditional methods.

Complexity of scheduling few types of jobs on related and unrelated machines

Abstract The task of scheduling jobs to machines while minimizing the total makespan, the sum of weighted completion times, or a norm of the load vector are among the oldest and most fundamental tasks in combinatorial optimization. Since all of these problems are in general -hard, much attention has been given to the regime where there is only a small number k of job types, but possibly the number of jobs n is large; this is the few job types, high-multiplicity regime. Despite many positive results, the hardness boundary of this regime was not understood until now. We show that makespan minimization on uniformly related machines ( $$Q|HM|C_{\max }$$ Q | H M | C max ) is -hard already with 6 job types, and that the related Cutting Stock problem is -hard already with 8 item types. For the more general unrelated machines model ( $$R|HM|C_{\max }$$ R | H M | C max ), we show that if the largest job size $$p_{\max }$$ p max or the number of jobs n is polynomially bounded in the instance size |I|, there are algorithms with complexity $$|I|^{{{\,\mathrm{\textrm{poly}}\,}}(k)}$$ | I | poly ( k ) . Our main result is that this is unlikely to be improved because $$Q||C_{\max }$$ Q | | C max is $$\mathsf {W[1]}$$ W [ 1 ] -hard parameterized by k already when n, $$p_{\max }$$ p max , and the numbers describing the machine speeds are polynomial in |I|; the same holds for $$R||C_{\max }$$ R | | C max (without machine speeds) when the job sizes matrix has rank 2. Our positive and negative results also extend to the objectives $$\ell _2$$ ℓ 2 -norm minimization of the load vector and, partially, sum of weighted completion times $$\sum w_j C_j$$ ∑ w j C j . Along the way, we answer affirmatively the question whether makespan minimization on identical machines ( $$P||C_{\max }$$ P | | C max ) is fixed-parameter tractable parameterized by k, extending our understanding of this fundamental problem. Together with our hardness results for $$Q||C_{\max }$$ Q | | C max , this implies that the complexity of $$P|HM|C_{\max }$$ P | H M | C max is the only remaining open case.

Complications and Cost in Open Versus Endoscopic Lumbar Decompression

Study Design: A retrospective database study. Objective: To compare complications and costs associated with endoscopic and open lumbar decompression on a large scale. Background: Though open lumbar decompression is considered the gold standard, endoscopic procedures are on the rise. The majority of studies comparing endoscopic to open decompression have been limited to small retrospective studies or studies in other countries. Methods: Patients who underwent single-level endoscopic or open lumbar decompression from 2017 to 2021 with a 2-year follow-up were identified in the PearlDiver database using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. Multilevel surgery, concomitant fusion, or cervical/thoracic procedures were excluded. Postoperative complications, including infection, wound dehiscence, and dural tear, were evaluated for both groups, as well as additional lumbar surgery within 2 years. Costs, complications, and rate of repeat surgery were compared between groups. Results: A total of 895 endoscopic and 102,258 open lumbar decompression cases met the inclusion criteria. The median age range was 60–64 for both groups, and the majority were low risk on the Charlson Comorbidity Index. Rates of dural tear, infection, and dehiscence were similar between groups. Total cost at 2 years was slightly higher for the endoscopic group ($20,347 vs $18,089, P = 0.03). Patients who underwent endoscopic lumbar decompression were more than twice as likely to undergo a second lumbar surgery in the following 2 years (16% vs 7%, P < 0.00001). Of the patients who underwent additional surgery, there was a higher proportion of patients undergoing reexploration in the open group (33.4% vs 13.8%, P < 0.00001) and a higher proportion undergoing endoscopic decompression in the endoscopic group (35.5% vs 0.64%, P < 0.00001). Conclusions: Cost and complication profiles are similar between endoscopic and open lumbar decompression. However, endoscopic decompression patients are more than twice as likely to undergo a second procedure within 2 years. Prospective studies are needed to determine the cause of additional surgery.

Explaining political turnarounds on minimum wages: the Italian case in a comparative perspective

Abstract While the majority of OECD countries have a national minimum wage, a minority relies on collective bargaining as a functionally equivalent alternative model. Some countries have recently changed model or started discussing it. We ask when and why advanced capitalist democracies make such change, testing functionalist, power resource and institutional explanations. The article looks at the cases of UK and Germany (which introduced a national minimum wage) and Italy (which have started discussing it), against the background of Sweden, which, like other countries, refuse to do so. In doing so, we identify some conditions and contributing factors that allow to better understand how institutional legacies affect shifts in regulatory approaches to wage setting, and draw some implications for labour market policies, especially in the particularly open Italian case.

Kewenangan Mahkamah Konstitusi Dalam Memutus Perkara Open Legal Policy Menurut Sistem Ketatanegaraan Indonesia

The issue of the Constitutional Court's authority in assessing a decision related to open legal policy has become a very interesting discussion and has received a lot of attention from the public. As explained above, when rejecting a case, the Constitutional Court always argues that the case is an open legal policy, which is the authority of the DPR as the legislator. In several recent decisions, the Constitutional Court has been inconsistent in viewing and adjudicating cases that have an open legal policy nuance. One example of the court being inconsistent in the decisions it makes is regarding the election law regarding age limits, which has recently become a legal debate. The Constitutional Court as the guardian and interpreter of the constitution or “the guardian and the sole and the highest interpreter of the constitution” in several of its decisions regarding age in elections, it provides its interpretation contained in various decisions related to open legal policies made by legislators. Therefore, the formulation of the problem contained in this research is how to regulate the authority of the Constitutional Court in reviewing laws related to open legal policy and what are the legal implications of the authority of the Constitutional Court in deciding cases related to open legal policy. The research used in this writing uses normative legal research. This research uses a statutory approach, a conceptual approach. The research results show that the authority of the constitutional court in deciding open legal policy cases is contrary to the authority possessed by the constitutional court and has implications for the concept of the division of power. The Constitutional Court must have a clear legal basis in looking at cases related to open legal policy so that in the future the constitutional court will have a clear perspective. the same so that there are no more inconsistencies in the Constitutional Court's decisions regarding cases that have an open legal policy nuance. Regulations regarding open legal policy must be regulated in detail so that the norm testing process carried out has clear standards and mechanisms so as to provide legal certainty for the community

The Toxicity Mechanism and Treatment Methods of Poisonous Mushrooms

Poisonous mushrooms act as decomposers in the ecosystem. Because of their confusing resemblance to common mushrooms, they are often eaten inadvertently and cause serious poisoning. Different poisonous mushrooms contain different kinds of toxins, such as goitrogens and umbrella toxins. Poisoning can cause irreversible damage to organs such as the liver and kidneys. Clinical symptoms and duration of poisoning vary among different types of poisonous mushrooms in different regions. The most common clinical manifestations include gastrointestinal symptoms, liver failure and neurological disorders. Current diagnostic tools are mainly based on symptomatology and laboratory tests such as high-performance liquid chromatography. Treatment after poisoning is generally supportive therapy and antidotes, and in extreme cases liver transplantation is considered. In this research, two of the most typical poisonous mushrooms, the gooseberry and the death cap, were used as examples by analyzing open source information and cases. Their toxin composition poisoning symptoms as well as the principles of toxicogenesis were studied. Treatment strategies for poisonous mushroom poisoning are proposed, which can provide scientific basis for future prevention and treatment.

Robotic Pancreaticoduodenectomy for Pancreatic Head Tumour: A Single-Centre Analysis.

Background: The robotic approach is an appealing way to perform minimally invasive pancreaticoduodenectomy. We compare robotic cases' short-term and oncological outcomes to a historical cohort of open cases. Methods: Data were collected in a prospective database between 2016 and 2024; complications were graded using the ISGPS definition for the specific pancreas-related complications and the Clavien-Dindo classification for overall complications. Furthermore, the Comprehensive Complication Index was calculated. All patients undergoing pancreaticoduodenectomy were included, except those with acute or chronic pancreatitis, vascular tumour involvement or multi-visceral resections. Only the subset of patients with malignancy was regarded for the oncologic outcome. Results: In total, 100 robotic and 102 open pancreaticoduodenectomy cases are included. Equal proportions of patients have a main pancreatic duct ≤3 mm (p = 1.00) and soft consistency of the pancreatic remnant (p = 0.78). Surgical time is longer for robotic pancreaticoduodenectomy (p < 0.01), and more patients have delayed gastric emptying (44% and 28.4%, p = 0.03). In the robotic group, the number of patients without any postoperative complications is higher (p = 0.02), and there is less chyle leak (p < 0.01). Ninety-day mortality, postoperative pancreatic fistula, and postpancreatectomy haemorrhage are similar. The lymph node retrieval and R0 resection rates are comparable. Conclusions: In conclusion, after robotic pancreaticoduodenectomy, remembering all cases during the learning curve are included, less chyle leak is observed, the proportion of patients without any complication is significantly larger, the surgical duration is longer, and more patients have delayed gastric emptying. Oncological results, i.e., lymph node yield and R0 resection rate, are comparable to open pancreaticoduodenectomy.

Torsion points and concurrent exceptional curves on del Pezzo surfaces of degree one

Abstract The blow-up of the anticanonical base point on a del Pezzo surface S of degree 1 gives rise to a rational elliptic surface $\mathscr {E}$ with only irreducible fibers. The sections of minimal height of $\mathscr {E}$ are in correspondence with the $240$ exceptional curves on S. A natural question arises when studying the configuration of these curves: if a point on S is contained in “many” exceptional curves, is it torsion on its fiber on $\mathscr {E}$ ? In 2005, Kuwata proved for the analogous question on del Pezzo surfaces of degree $2$ , where there are 56 exceptional curves, that if “many” equals $4$ or more, the answer is yes. In this paper, we prove that for del Pezzo surfaces of degree 1, the answer is yes if ‘many’ equals $9$ or more. Moreover, we give counterexamples where a non-torsion point lies in the intersection of $7$ exceptional curves. We give partial results for the still open case of 8 intersecting exceptional curves.

Condylectomy for Treatment of Neglected Bilateral Mandibular Condyle Fracture : A Case Report

Fractures of the mandibular condyle have been estimated up to 27–50% of all mandibular fractures. Although there is a growing trend towards internal fixation over closed reduction, the evidence is still limited. Treatment depends on the type and location of the fracture, associated facial injuries, and concomitant diseases. Oral surgeon is faced with decision of conservative treatment, such as removal of the fragments by condylectomy. The principle of condylectomy is the surgically removing the fractured of condyle as it was obstructing mandibular function Purpose: Interdisciplinary care is needed to complement surgical treatment so that the patient's condition can return to normal both in terms of function and esthetics. The following case report aims to explain the management plan for bilateral mandibular condyle fractures. Case(s): A 17 years old male patient with complaints his mouth couldn’t close tightly and limited mouth opening. He fell from a motorcycle about a month before. There was anterior openbite, radiographic examination showed discontinuity in bilateral mandibular head condyle. He has been diagnosed with Neglected fracture at the bilateral condyle region, treated with bilateral condylectomy with the result posterior intact occlusion and wider mouth opening Case Management: The patient performed bilateral condylectomy under general anesthesia. Conclusion: The management of bilateral mandibular condyle fractures with condylectomy in this case was chosen because the condyle fracture leads medially which causes a limited mouth opening, and this treatment resulted in an intact occlusion and mouth opening becomes wider. Keywords: Bilateral condyle fracture, Neglected fracture, Condylectomy

Integrated vascular training may not prepare graduates to care for vascular trauma patients.

Vascular surgery board eligibility may be secured through 5+0 integrated programs (IV) as well as 5+2 general surgery/vascular fellowship pathway (VF). We hypothesized that IV graduates accrue less experience relevant to vascular trauma than VF graduates. We assessed the first decade of IV graduate experience and compared it to contemporaneous VF graduates. The 2013-2022 Accreditation Council for Graduate Medical Education case log data were collected for IV and VF graduates. Vascular fellows' data were combined with synchronousgeneral surgery residency data. Open vascular cases were classed as cerebrovascular, upper extremity, thoracic, abdominopelvic, infrainguinal, and infrapopliteal. Nonvascular open cases were categorized as neck, thoracic, and abdominopelvic. Nonoperative trauma and critical care data were recorded. There were 1,224 VF and 397 IV graduates. In 2012, 8.3% of graduating vascular surgeons trained in IV programs. By 2022, this proportion was 32.6%. The number of IV programs increased by 4.4 programs per year over the study period ( p < 0.05), whereas VF programs remained unchanged. Integrated vascular chiefs logged significantly more lower extremity cases, and VFs logged more upper extremity cases ( p < 0.05). IV graduates reported a fraction of the VF open nonvascular cases. Integrated vascular graduates logged 5% of the abdominopelvic, 18% of the thoracic, and 3% of the neck cases of VFs ( p < 0.05). Vascular fellows' critical care and nonoperative trauma were each higher than those of IV fellows ( p < 0.05). Integrated vascular graduates logged six vascular repairs for every vascular exposure. The proportion of vascular surgeons trained through IV programs has nearly quadrupled. Integrated vascular graduates have a fraction of the experience in critical care, trauma, and nonvascular surgery compared with VF graduates. Relative inexperience with open surgical anatomy and with critically ill patients may limit IV graduates' ability to care for the patient with vascular trauma. Diagnostic Test/Criteria; Level IV.

A novel TCN-GRU based open set method for unknown damage diagnosis

Abstract In the aerospace and high-speed rail industries, carbon fiber reinforced polymer (CFRP) has seen widespread application. CFRP plates and connectors in operation are often subjected to impacts that can cause damage. The unpredictable nature of the impacts introduces uncertainties in both the location and extent of the damage, posing significant challenges to traditional supervised learning models, which often struggle with missed detections or misclassifications when identifying unknown damages. To address the issue, a deep learning model based on temporal convolutional network-gated recurrent unit (TCN-GRU) is proposed. TCN extracts features from the raw time domain signals, and GRU selectively retains the significant features and completes sequence modeling. A center loss function is incorporated into the fully connected layer to improve the effects of intra-class aggregation and inter-class separation. An unknown detection module is introduced to realize the identification and classification of unknown damages based on a predefined threshold. The experimental results indicate that the proposed method can achieve effective unknown damage diagnosis in the open set case. This study provides a feasible solution for open set unknown damage diagnosis in CFRP plates and connectors.

Fibula fixation is not associated with a higher rate of wound complications during pilon fracture open reduction internal fixation

There is a lack of consensus regarding indications for fibula fixation in pilon fractures. Reduction of the fibula fracture can assist with restoring lateral column length and reduction of the tibial plafond during pilon ORIF. However, there are theoretical concerns with wound complications and soft tissue insult. The purpose of this study is to compare short-term outcome measures after tibial plafond ORIF with and without supplemental fibula fixation using a validated national database. The American College of Surgeons' NSQIP database was utilized to identify all patients undergoing tibial plafond ORIF with and without fibula fixation between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27827 and 27828, respectively. Open fractures and cases with concurrent open procedures were excluded from analysis. Demographic data, medical comorbidities, surgical variables, and various 30-day outcome measures were compared between the two groups. Multivariate logistic regression was used to identify independent variables associated with various outcome measure of interest. A total of 3120 patients were included in the final cohort: 1530 patients underwent tibia fixation alone and 1590 patients underwent both tibia and fibula fixation. The supplemental fibula fixation group had a higher rate of reoperation (2.3% vs. 1.1%, p=0.013) and non-home discharge (14.8% vs. 11.2%, p=0.003). The rate of surgical site infection was comparable between groups. Supplemental fibula fixation was independently associated with unplanned reoperation (RR: 1.939 [1.081-3.477], p=0.026). Patients undergoing supplemental fibula fixation during tibial plafond ORIF had a higher rate of 30-day reoperation and non-home discharge. Supplemental fibula fixation during pilon fracture ORIF was independently associated with a higher rate of 30-day reoperation. There was no difference in the rates of surgical site infection or wound dehiscence between the two groups. 3.

Attachment & biobehavioral catch-up participation & reunification in a family treatment court

Children impacted by substances are at increased risk for child welfare involvement, which often leads to out-of-home care. Substance use disorder (SUD) impacts the family unit, and thus, prevention and intervention efforts need to target the family, not just the individual with a SUD. There are efficacious interventions for families impacted by SUD, but limited information exists on family reunification outcomes following services. This study examined whether participation in the Attachment and Biobehavioral Catch-Up (ABC) model was associated with a higher likelihood of reunification among families involved with a family treatment court (FTC) per conditions of an open child welfare case. The study sample includes a total of 215 children from 112 families, ages six months to forty-seven months, and their caregivers, all enrolled in an FTC due to SUD. Children were considered exposed to the intervention (N=39; 18.1%) if either they or a sibling participated with either a biological or foster parent. The ABC treatment was delivered by a trained therapist either in the home or via telehealth. 74% of children exposed to the ABC model reunified by study end compared to 57% of children who were not exposed to the intervention. In a multivariable Cox regression model controlling for covariates, reunification was driven by cases with biological parent participation. Compared to no exposure, cases with biological parent exposure were 2.3 times more likely to reunify. Reunification was not impacted by foster parent exposure. Families impacted by substances need interventions that target the caregiver-child dyad. Facilitating family bonding and attachment with direct caregiver involvement is critical to serving caregivers and their children. This study shows the ABC model, particularly when delivered to biological parent-child dyads, is associated with a higher likelihood of reunification for children in child welfare, an outcome that, when safe, secure, and stable, critically improves long-term, healthy development.

BN SO36 - Robotic versus laparoscopic giant hiatus hernia repair - is one superior in clinical outcomes?

Abstract Background The number of robotic giant hiatal hernia repair (RGHHR) procedures is steadily increasing. RGHHR offers several potential advantages over traditional laparoscopy, including enhanced visualisation, superior ergonomics, and the use of articulating instruments, which can be particularly beneficial in the restrictive operating field of the diaphragmatic hiatus. However, the outcomes of RGHHR remain heterogeneous, both when reported alone and in comparison to laparoscopic giant hiatus hernia repair (LGHHR). This study aims to evaluate and compare the key clinical outcomes of RGHHR and LGHHR in adult patients. Method All patients undergoing primary giant hiatus hernia (GHH) surgery between March 2019 and March 2024 at a tertiary institution and a five surgeon upper GI service. Retrospective review of electronic records were utilised to document: patient demographics, hernia type, operative details. Use of mesh and gastropexy (as proxy measures to indicate difficulty of operation). Follow-up duration in weeks. Open cases within this cohort were excluded. Outcomes were: length of stay (LOS), 30-day morbidity measured using Clavien-Dindo (CD) grading, RTT and 30-day mortality. Analysis was undertaken using un-paired t-test and Chi2. A p-value of &amp;lt;0.05 was considered statistically significant. Results Table 1. Patients LGHHR RGHHR p n 56 29 Age (median) 71 (31-93) 66 (39-85) 0.1303 Female (%) 68.7 70 0.8988 BMI 31.8 (±6.4) 29.9 (±3.4) 0.1715 ASA grade (average) 2.4 2.2 0.0587 Hernia Types (median) 3 3 0.4411 Median follow-up (weeks) 8 (1-161) 12 (3-172) 0.5763 Table 2. Operative details LGHHR RGHHR p Mesh used (%) 9.1 0 0.0907 Gastropexy (%) 12.7 6.9 0.4175 Table 3. Outcomes LGHHR RGHHR p LOS (median) 1 (0-161) 2 (0-15) 0.4177 30-day morbidity (CD≥3, %) 3.6 6.9 0.9193 RTT (%) 9.1 6.9 0.5570 30-day mortality 0 0 NA Conclusion RGHHR approach has been successful in managing complex GHH, with low RTT, low co-morbidity and no mortality. In our institution RGHHR has demonstrated non-inferiority to LGHHR in respect to clinical outcomes. Patient factors and hernia types did not affect case selection. Use of mesh and gastropexy showed no difference in outcomes between the two groups. Cost, operative time and surgeon strain/fatigue were not evaluated in this study, however, these would provide useful additional comparative markers for the future.

MS O11 - HPB Laparoscopic vs open liver resections for hepatocellular cancer in a tertiary care hepatobiliary unit; outcomes of cases over 10 years

Abstract Background Despite its established role in liver resection surgery, minimally invasive surgery is still not a favoured option in cases of hepatocellular cancer (HCC) due to perceived risks of intra- and post-operative surgical morbidity and poorer oncological outcomes. This study aims to look at the outcomes of liver resections performed for HCC cases over ten years comparing laparoscopic and open cohorts. Method A retrospective study including all liver resections for HCC cases performed in our tertiary care hepatobiliary unit between 2013 and 2022 (10 years) was conducted. Data on demographics, underlying degree of liver cirrhosis, types of liver resection and post-operative outcomes, including recurrence rates and resections margins were collected and reported using descriptive statistics. Survival analysis was performed with compared between these two groups with log rank test in GraphPad prism 10. Results 200 liver resections performed for HCC were grouped into laparoscopic and open cohorts containing 147 and 53 patients respectively. 21 (40%) laparoscopic cases had background liver cirrhosis as compared to 24 (16%) in open cases. Major liver resection comprised 9% and 43% of all cases and one and five patients had Grade B/C PHLF in laparoscopic and open groups. All 8 (4%) cases with 90-day mortality were from the open group. Negative resection margins (68% vs 71%), local recurrence (51% vs 47%) and overall survival (75 months vs 67 months (p=0.29)) were similar in laparoscopic and open groups, respectively. Conclusion Post-operative and oncological outcomes of liver resections for HCC were comparable in laparoscopic and open groups. Laparoscopic liver resections could be safely performed in patients with background liver cirrhosis.

HPB SO19 - Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. First evaluation of efficacy and safety of AEONTM stapler

Abstract Background In 2019, preliminary data matching 40 cases demonstrated improved outcomes of laparoscopic major liver resections using the BOWA-LOTUSTM liver blade (Devon, UK). An updated and expanded comparison between open and laparoscopic major hepatectomies is presented as well as evaluating of an endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA). Method January 2020 to June 2023 patients were identified from a prospectively maintained database. Propensity score matching analysis used R statistical tool in SPSS (IBM, New York, USA) to isolate matched open and laparoscopic cases. LOTUSTM ultrasonic energy device was used for parenchymal transection in laparoscopic cases and CUSA (Valleylab, Colorado, USA) in open procedures. AEONTM endovascular stapler was used from early 2021. Results 86 patients constitute the study population after applying propensity score matching analysis in a 1:1 ratio. The median (range) age in the matched sample was 63 (27-83) yrs. Hospital stay (mean 7.8 v 14.7 days; p=0.025) and blood transfusion requirement (0 v 4 units; p=0.035) were all significantly improved when comparing laparoscopic to open. Comparison of the AEONTM stapler with Endo-GIA (Medtronic, MN, USA) showed no significant difference in any outcome measure, although AEONTM demonstrated (non-significantly) a reduced trend in operating time comparing all cases (56 v 69 mins; p=0.300) and laparoscopic (56 v 71 min; p=0.295). Conclusion The LOTUS liver blade continues to be associated with acceptable outcomes in laparoscopic liver resections. The AEONTM endovascular stapler was equivalent to other staplers with a trend towards a shorter operating time in liver transectional surgery.

On the Chow and cohomology rings of moduli spaces of stable curves

In this paper, we ask: For which (g, n) is the rational Chow or cohomology ring of \bar{\mathcal{M}}_{g,n} generated by tautological classes? This question has been fully answered in genus 0 by Keel (the Chow and cohomology rings are tautological for all n (1992)) and genus 1 by Belorousski (the rings are tautological if and only if n \leq 10 (1998)). For g \geq 2 , work of van Zelm (2018) shows the Chow and cohomology rings are not tautological once 2g + n \geq 24 , leaving finitely many open cases. Here, we prove that the Chow and cohomology rings of \bar{\mathcal{M}}_{g,n} are isomorphic and generated by tautological classes for g = 2 and n \leq 9 and for 3 \leq g \leq 7 and 2g + n \leq 14 . For such (g, n) , this implies that the tautological ring is Gorenstein and \bar{\mathcal{M}}_{g,n} has polynomial point count.

Bogota Bag as Temporary Abdominal Closure

The Bogotá bag, a sterile plastic device for temporary abdominal closure, has become integral in managing open abdomen cases due to trauma, intra-abdominal infections, and abdominal compartment syndrome (ACS). This review outlines its indications, advantages, disadvantages, and technique. Known for its cost-effectiveness and simplicity, the Bogotá bag allows for reoperations and drainage, making it valuable in resource-limited settings. However, limitations include infection risk, evisceration, inadequate fascial traction, and entero atmospheric fistulas. Proper patient assessment, secure placement, and close monitoring are essential for minimizing complications. While effective, the device's drawbacks highlight the need for further research to refine its use in surgical care.