Closure Time Research Articles

Radiographic evaluation of the forelimb bone development in maned wolves (Chrysocyon brachyurus).

This study aimed to assess the fusion of growth plates and the development of secondary ossification centres in the forelimb bones of maned wolves (Chrysocyon brachyurus), contrasting the findings with established data from domestic dogs. Three maned wolves, comprising one male and two females, initially aged between 3 and 4 months, were subjected to monthly radiographic evaluations until 10-11 months of age, followed by bimonthly assessments until 18-19 months of age, encompassing both forelimbs. The closure times of growth plates were observed as follows: supraglenoid tubercle (7-8 months), proximal humerus (17-19 months), distal humerus (8-9 months), medial epicondyle of the humerus (8-9 months), proximal ulna (9-10 months), proximal radius (13-15 months), distal ulna (13-15 months) and distal radius (17-19 months). Statistical analysis revealed significant differences in the areas of secondary ossification centres in the proximal epiphyses of the humerus and radius, respectively, observed from the initial evaluation at 8-9 months and 6-7 months. Conversely, the epiphyses of the supraglenoid tubercle, distal humerus, proximal ulna, distal ulna, medial epicondyle of the humerus and distal radius did not exhibit significant area differences between 3-4 months and 4-5 months, yet notable distinctions emerged at 5-6 months. In summary, while the radiographic appearance of epiphyseal growth plates and secondary ossification centres in maned wolves resembles that of domestic dogs, closure times vary. These findings contribute to understanding the dynamics of epiphyseal growth plates in this species.

Speech Outcomes after Delayed Hard Palate Closure and Synchronous Secondary Alveolar Bone Grafting in Patients with Cleft Lip, Alveolus and Palate.

Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG). Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively. Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% ( p < 0.001). Grimacing decreased in 27% ( p = 0.015). Articulation disorders remained present in 85% ( p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively ( p < 0.001). Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.

Anti-Nociceptive Effect of Sufentanil Polymeric Dissolving Microneedle on Male Mice by Hot Plate Technique

Despite the widespread use of opioids to manage severe pain, its systemic administration results in side effects. Among the subcutaneous and transdermal drug delivery systems developed to deal with adverse effects, microneedles have drawn attention due to their rapid action, high drug bioavailability, and improved permeability. Sufentanil (SUF) is an effective injectable opioid for treating severe pain. In this study, we investigated the analgesic effects of SUF using dissolvable microneedles. SUF polymeric dissolvable microneedles were constructed through the mold casting method and characterized by SEM and FTIR analysis. Its mechanical strength was also investigated using a texture analyzer. Fluorescence microscopy was applied in vitro to measure the penetration depth of microneedle arrays. Irritation and microchannel closure time, drug release profile, and hemocompatibility test were conducted for the validation of microneedle efficiency. Hot plate test was also used to investigate the analgesic effect of microneedle in an animal model. Local administration of SUF via dissolving microneedles had an effective analgesic impact. One hour after administration, there was no significant difference between the subcutaneous and the microneedle groups, and the mechanical properties were within acceptable limits. Microneedling is an effective strategy in immediate pain relief compared to the traditional methods.

Analysis of the influence of ice-hole constraint on the oblique water-entry characteristics of a high-speed cylinder

It is crucial for the water-entry stability and safety of the polar ocean equipment to study the process of the cylinder entering the water and passing through ice holes. In this study, based on the volume of fluid model and Schnerr–Sauer cavitation model, the influences of the ice-hole constraint on the cavity evolution process, the flow field characteristics, and the motion characteristics of the oblique water-entry process of the cylinder under different ice-hole diameter conditions are investigated numerically. The numerical method is verified. Results show that the influence of the ice-hole constraint on cavity evolution is mainly reflected in three aspects: surface splash, cavity wall, and cavity surface closure time. The ice-hole constraint changes the flow range of the water near the free surface, affecting the direction and shape of the surface splashing. The ice-hole inhibits the cavity expansion near the free surface. Under the smaller ice-hole diameter condition, the left-sided cavity wall directly collides with the inner wall of the ice-hole, which causes the curvilinearity of the left wall of the cavity near the free surface. Simultaneously, under the ice-hole condition, the surface closure time of the cavity is altered, and the distribution of the air and vapor inside the cavity is changed. A larger shear deformation region appears near the free surface, and there are more large-scale vortices inside the cavity, which leads to the acceleration of the velocity of the fluid and the decrease in the pressure near the free surface. Moreover, the impact force is changed at the initial stage of the cylinder passing through the ice-hole. The ice-hole condition leads to a faster velocity attenuation and a greater deflection during the oblique water-entry process of the cylinder.

Diverticulitis Surgery Outcomes: Insights from Our Clinical Practice

Aim: To assess outcomes of diverticulitis surgery, focusing on various patient phases at a tertiary center and incorporating literature insights. Materials and Method: Analysis included diverticular disease surgeries at *** University's General Surgery Clinic over five years, examining demographics, disease specifics, surgical details, stoma aspects, and complications. Patients were categorized into emergency and elective groups for comparison based on Hinchey scores and stoma status. Results: Of the patients, 72% were male, with an average age of 58.46. The sigmoid colon was predominantly affected (84%). Percutaneous drainage was used preoperatively in 44%, and 56% required a stoma, primarily Hartmann colostomies (36%). The median stoma closure time was 5 months, with 10 patients unable to have their stoma closed. Emergency surgeries were associated with higher Hinchey stages (III-IV) and an increased need for stoma creation (81% vs. 16% in elective surgeries). Conclusion: The study indicates a median 5-month duration for stoma reversal, with sigmoid colon being the common site regardless of gender. Emergency surgeries showed a higher rate of stoma creation, suggesting elective surgeries could reduce stoma necessity. Further investigation is needed for broader applicability.

Impact of pandemic and socioeconomic influences on decision-making for emergency ostomy procedures: Key factors affecting hospital visit decisions.

Emergency surgeries are linked with increased morbidity and reduced life expectancy, often associated with low socioeconomic status, limited access to healthcare, and delayed hospital admissions. While the influence of socioeconomic status on elective surgery outcomes is well-established, its impact on emergency surgeries, including ostomy creation and closure, is less clear. This study aimed to explore how the pandemic and socioeconomic status affect emergency ostomy procedures, seeking to determine which has a greater effect. It emphasizes the importance of considering socioeconomic factors in patient care pathways for ostomy procedures. A total of 542 patients who underwent emergency ostomy formation between 2016 and 2022 were retrospectively analyzed and divided into pre-pandemic and pandemic periods. The pre-pandemic and pandemic periods were compared between themselves and against each other. Demographic data (age and sex), comorbidities, socioeconomic status, etiology of the primary disease, type of surgery, stoma type, length of hospital stay, ostomy closure time, and postoperative complications were retrospectively analyzed for all patients. In total, 290 (53%) patients underwent surgery during the pandemic period, whereas 252 (47%) underwent surgery during the pre-pandemic period. Emergency surgery was performed for malignancy in 366 (67%) patients. The number of days patients underwent ostomy closure was significantly higher in the low-income group (P = .038, 95% CI: 293,2, 386-945). The risk of failure of stoma closure was 3-fold (95% CI: 1.8-5.2) in patients with metastasis. The risk of mortality was 12.4-fold (95% CI: 6.5-23.7) when there was failure of stoma closure. When compared to pandemic period, the mortality risk was 6.3-fold (95% CI: 3.9-10.2) in pre-pandemic period. Pandemic patients had a shorter hospital stay than before the pandemic (P = .044). A high socioeconomic status was significantly associated with early hospital admission for ostomy closure, and lower probability of mortality. More metastases and perforations were observed during the pandemic period and mortality was increased during pandemic and in patients without ostomy closure. The socioeconomic status lost its effect in cases of emergency ostomy creation and had no impact on length of hospital stay in either the pre-pandemic or pandemic period.

Commercial suture passer improves efficiency and ease of use versus conventional needle in minimally invasive thoracolumbar fascia closure: a cadaveric analysis

BackgroundLow-profile suture passers have been introduced to facilitate thoracolumbar fascia closure in minimally invasive spine (MIS) surgery. The purpose of this study was to evaluate the closure time of a modern suture passer to a conventional curved need for MIS fascia closure in a cadaveric model. MethodsSix clinicians specializing in orthopedic spine surgery were recruited for the study and randomly assigned 1 cadaveric torso. Subcutaneous tissue was resected at L4-L5, replicating MIS surgery, followed by placement of a 60×18-mm or 100×18-mm tubular retractor for access. Clinicians were required to close the fascia with three unknotted, simple interrupted sutures using a swaged curved needle or suture passer (Spine Scorpion™, Arthrex, Inc., Naples, FL). The completion time was recorded, starting immediately before suturing and ending after the last pass. A time cutoff of 10 min was implemented in consideration of reasonable operating room time, and the number of achieved suture passes (of 6) were recorded. Clinicians were asked to qualitatively grade ease of use in relation to prior fascial closure experience per a 0-5 scale, where 0 is impossible and 5 is easiest. ResultsThe mean change in fascial closure completion time (Δ) was significantly reduced with the Spine Scorpion compared to the curved needle with the 60×18-mm retractor (Δ=5.80 min; 95% CI, 2.92-8.67 min; p=.004) and 100 × 18-mm retractor (Δ=5.28 min; 95% CI, 2.76-7.80 min; p=.003). Full closure was achieved within the time limit for all trials of the Spine Scorpion, while the standard needle achieved full closure in 67% (4 of 6) and 50% (3 of 6) of trials with the 60 × 18-mm and 100×18-mm retractors, respectively. Median ease-of-use scores with the 60×18-mm and 100×18-mm retractors, respectively, were 4.5 (range, 4-5) and 4.5 (range, 3-5) for the Spine Scorpion, and both 1.0 (range, 1-2) for the curved needle. ConclusionResults from this laboratory investigation using a suture passer for thoracolumbar fascia closure show a significant reduction in closure time and completion of the procedure compared to a conventional curved needle.

Effects of kinematic hardening of mucus polymers in an airway closure model

The formation of a liquid plug inside a human airway, known as airway closure, is computationally studied by considering the elastoviscoplastic (EVP) properties of the pulmonary mucus covering the airway walls for a range of liquid film thicknesses and Laplace numbers. The airway is modeled as a rigid tube lined with a single layer of an EVP liquid. The Saramito–Herschel–Bulkley (Saramito-HB) model is coupled with an Isotropic Kinematic Hardening model (Saramito-HB-IKH) to allow energy dissipation at low strain rates. The rheological model is fitted to the experimental data under healthy and cystic fibrosis (CF) conditions. Yielded/unyielded regions and stresses on the airway wall are examined throughout the closure process. Yielding is found to begin near the closure in the Saramito-HB model, whereas it occurs noticeably earlier in the Saramito-HB-IKH model. The kinematic hardening is seen to have a notable effect on the closure time, especially for the CF case, with the effect being more pronounced at low Laplace numbers and initial film thicknesses. Finally, standalone effects of rheological properties on wall stresses are examined considering their physiological values as baseline.

Railway track settlement patterns and control measures for multi-tunnel construction underneath a station track group: a case study

This paper is based on the proximity engineering project of the Baishiyi tunnel group passing under the Chongqing West Station track group. Considering the train load and the spatial relationship of the tunnel and track groups, the settlement patterns, horizontal displacement, and differential settlement of the tunnel–strata–tracks system during the excavation process are studied through theoretical calculations and numerical simulation methods. The results indicate that the tunnel vault, strata, and track settlement deformation patterns are similar. Throughout the tunnel construction process, the tracks underwent uplift, settlement, and eventually stabilized. The settlement trough formed by the excavation of the three tunnels below the track group has an impact range of 25–145 m. Between 35 and 75 m, the differential settlement of the double track gradually increases with excavation. As the tunnel face reaches 75 m, the track differential settlement gradually converges and tends to stabilize. To minimize the impact of underpass tunnel construction on track groups, it is recommended to use a combination of full-section hole grouting and surface reinforcement grouting for ground reinforcement. Additionally, optimizing the construction parameters, including the step length and primary support closure time, and strengthening the locking anchor can further reduce the impact.

Comparison of the effect of two recruitment manoeuvres to conventional ventilation on lung atelectasis in paediatric laparoscopic surgery- a prospective randomised controlled trial

BackgroundThere is a high incidence of pulmonary atelectasis during paediatric laparoscopic surgeries. The authors hypothesised that utilising a recruitment manoeuvre or using continuous positive airway pressure may prevent atelectasis compared to conventional ventilation.ObjectiveThe primary objective was to compare the degree of lung atelectasis diagnosed by lung ultrasound (LUS) using three different ventilation techniques in children undergoing laparoscopic surgeries.DesignRandomised, prospective three-arm trial.SettingSingle institute, tertiary care, teaching hospital.PatientsChildren of ASA PS 1 and 2 up to the age of 10 years undergoing laparoscopic surgery with pneumoperitoneum lasting for more than 30 min.InterventionRandom allocation to one of the three study groups:CG group: Inspiratory pressure adjusted to achieve a TV of 5–8 ml/kg, PEEP of 5 cm H2O, respiratory rate adjusted to maintain end-tidal carbon dioxide (ETCO2) between 30-40 mm Hg with manual ventilation and no PEEP at induction.RM group: A recruitment manoeuvre of providing a constant pressure of 30 cm H2O for ten seconds following intubation was applied. A PEEP of 10 cm H2O was maintained intraoperatively.CPAP group: Intraoperative maintenance with PEEP 10 cm H2O with CPAP of 10 cm H2O at induction using mechanical ventilation was done.Outcome measuresLung atelectasis score at closure assessed by LUS.ResultsPost induction, LUS was comparable in all three groups. At the time of closure, the LUS for the RM group (8.6 ± 4.9) and the CPAP group (8.8 ± 6.8) were significantly lower (p < 0.05) than the CG group (13.3 ± 3.8). In CG and CPAP groups, the score at closure was significantly higher than post-induction. The PaO2/FiO2 ratio was significantly higher (p < 0.05) for the RM group (437.1 ± 44.9) and CPAP group (421.6 ± 57.5) than the CG group (361.3 ± 59.4) at the time of pneumoperitoneum.ConclusionApplication of a recruitment manoeuvre post-intubation or CPAP during induction and maintenance with a high PEEP leads to less atelectasis than conventional ventilation during laparoscopic surgery in paediatric patients.Trial registry.CTRI/2019/08/02058.

The Effect of Using Ofloxacin Ear Drops in Traumatic Tympanic Membrane Healing: A Systematic Review and Meta-Analysis.

Objectives: To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled trials (RCTs). Data Sources: Medline/PubMed, CENTRAL, Clinical Trials.Gov, and Google Scholar. Study Selection: Inclusion criteria: (1) English language; (2) RCT studies; (3) reported the outcomes on the application of ofloxacin and outcomes of spontaneous healing. Exclusion criteria: (1) studies without a control group; (2) patient with severe otologic disease such as chronic suppurative otitis media or ossicular disruption or patients with craniocerebral injury; (3) studies with no pretreatment values or single-arm clinical studies. Data Extraction: Country, year of publication, number of participants in each arm, patient characteristics such as age, sex, intervention details, laterality, cause of TM perforation, position of perforation, follow-up time, hearing gain, rate of TM closure, and closure time. Results: A total of 6 RCTs studies were analyzed. A total of 502 participants were included; the relative risk for closure rate of ofloxacin treatment was 1.18 [95% confidence interval (CI), 1.08 to 1.28, P < .001] and the mean difference (MD) for healing time was -18.4 (95% CI, -19.96 to -16.82, P < .001), suggesting ofloxacin has a significant effect on closure of TM perforations. However, no clinically significant effect in hearing (SMD: 0.21, 95% CI, 0.02 to 0.40, P = .03) was seen in ofloxacin group. Also, patients in the ofloxacin group were associated with a 13% reduction in the risk of infections compared to their observation-assigned counterparts, but this estimate was not statistically significant. Conclusion: Ofloxacin use in patients with traumatic TM perforation is effective in reducing healing time and increasing rate of TM perforation closure. No evidence of increased risk of hearing loss or infection rates are encountered when ofloxacin is prescribed to patients with traumatic TM perforation.

Role of natural isotopic fractionation in isotope geo- and cosmo-chronology: A theoretical investigation

We introduce a new isotope chronological model in which the natural mass-dependent isotopic fractionation effects of the radioactive (“parent”) and radiogenic (“daughter”) elements are systematically and rigorously considered. Using this model, we show that internally-normalized radiogenic isotopic ratios, commonly determined for daughter elements such as Sr, Nd, Cr, Ni, Hf, W, and Os, are dependent on the extent of natural isotopic fractionation of the daughter and parent elements at the time of system closure. This dependence indicates that (1) in two samples derived from the same isotopically homogeneous source at the same time and with identical radiogenic ingrowth over time, the present-day internally-normalized radiogenic isotope ratios would be different if they were initially fractionated to different degrees, and (2) if different internally-normalized radiogenic isotopic ratios are observed for two co-genetic objects, the difference between them would include contributions from both radiogenic ingrowth and natural isotopic fractionation. Consequently, the isochron dating equations employed in traditional chronological studies will yield inaccurate results when significant natural isotopic fractionation is present among the studied samples. Modified isochron equations that can be used to retrieve correct chronological information from isotopically-fractionated samples are presented. These theoretical considerations are applied to the 87Rb–87Sr, 147Sm–143Nd, and 146Sm–142Nd isotope systems of calcium–aluminium-rich inclusions (CAIs), a set of samples that have undergone significant natural Sr, Nd, and Sm isotope fractionation during their formation. The large natural Sr isotope fractionation (up to ca. 5.3 ‰ for 88Sr/86Sr) in fine-grained CAIs can generate analytically well-resolvable biases (>120 ppm) in the internally-normalized 87Sr/86Sr ratios and lead to significant scatters of their 87Rb–87Sr isochron (in conjunction with scatters induced by open-system disturbances). The 87Rb–87Sr systems of coarse-grained CAIs, on the contrary, are essentially not affected by natural Sr isotopic fractionation due to their much subdued fractionation degrees, resulting in a more robust isochron. Similarly, the large natural Nd (up to ca. 4.0 ‰ for 146Nd/144Nd) and Sm (up to ca. 7.1 ‰ for 152Sm/148Sm) isotopic fractionation in fine-grained CAIs can induce significant scatters of the 147Sm–143Nd isochron if the natural fractionation followed the kinetic or power law, and 146Sm–142Nd isochron if the natural fractionation followed the equilibrium, Rayleigh, or power law. This implies that when studying radioactive isotope systems in objects whose daughter and parent elements can undergo significant isotope fractionation in nature, accompanying stable isotope analyses are necessary for accurate chronological interpretations.

Enhanced after-treatment warm up in diesel vehicles through modulating fuel injection and exhaust valve closure timing

Enhanced after-treatment warm up in diesel vehicles through modulating fuel injection and exhaust valve closure timing

UK neonatal stoma practice: a population study

ObjectiveThe optimal time for neonatal stoma closure is unclear and there have been calls for a trial to compare early and late surgery. The feasibility of such a trial will...

Recruitment of European sea bass (Dicentrarchus labrax) in northerly UK estuaries indicates a mismatch between spawning and fisheries closure periods.

European sea bass (Dicentrarchus labrax) is a species of high commercial and recreational value, but it exhibits highly variable recruitment rates and has been subject to recent declines. Emergency management measures put in place to protect spawning stocks include the annual closure of commercial and recreational fisheries over a 2-month, February-March, window. Whether this protection measure is having the desired outcome for this data-poor species remains unclear. Otolith microstructural analyses (counts and widths of daily growth rings and check marks indicative of settlement) were used to estimate (1) spawn timing, (2) pelagic larval duration and settlement timing, (3) growth rate and condition, and (4) the otolith-fish size relationship for juvenile European sea bass caught from two estuaries in Wales (Dwyryd, Y Foryd), located at the northern edge of the species range. We observed a significant mismatch between the timing of fisheries closures and the spawning, with 99.2% of recruits having been spawned after the fishery had reopened (back-calculated median spawn date = May 5 ± 17 days SD), suggesting that the closure may be too early to adequately protect this population. Further, we present the first empirically derived estimates of pelagic larval duration for sea bass recruits settling in UK habitats, which showed a strong negative relationship with spawn date. Finally, we found significant differences in fish condition between the two estuaries, suggesting local variation in habitat quality. The results suggest that the timing of current fisheries closures may not be adequately protecting the spawners supplying these northernmost estuaries, which are likely to become increasingly important as sea bass distributions shift northward in our climate future.

A prospective single-arm clinical trial to assess the safety and efficacy of monofilament polydioxanone barbed suture, MONOFIX®, on abdominal fascial closure.

For abdominal fascial closure, the choice of optimal suture material and appropriate suture technique are of paramount importance to prevent the incidence of incisional hernia. Although barbed sutures are widely used in various surgical fields, their safety and feasibility on abdominal fascial closure which requires the most tensile strength for security have not been established yet. We conducted a prospective, single-arm, interventional clinical trial to present the postoperative outcomes of using barbed sutures in abdominal fascial closure between April 2021 and August 2021. Patients with colorectal cancer who underwent minimally invasive surgery in elective setting were included. For all participants, monofilament polydioxanone barbed suture, MONOFIX®, was used to secure the abdominal fasica. The primary outcome was the 1-year incidence of incisional hernia assessed by computed tomography. A total of 30 patients were included. The median fascial incision length and suture length were 6.5cm (range, 6-7.5cm) and 31cm (range, 27.5-39.0cm), respectively. The median procedure time of abdominal fascial closure was 4min (range, 3-9min). There was no incidence of unexpected event related to suturing including suture cutting, stopper separation from threads, and suture loosening. One case of superficial surgical site infection occurred during postoperative hospital stays. There was no fascial dehiscence, incisional hernia, and adhesive ileus during a median follow-up period of 17.5months. Monofilament polydioxanone barbed suture, MONOFIX®, may be used safely and effectively on abdominal fascial closure. NCT05872334.

The Summer Drop in Female Employment

Abstract We provide the first systematic account of summer declines in women's labor market activity. From May to July, US women's employment-to-population ratio declines 1.1pp, whereas men's rises; women's hours worked fall 9.8%, twice the decline among men. School closures for summer break provide a unifying explanation. The summer drop aligns with cross-state differences in school closure timing, is concentrated among mothers with young school-aged children, and coincides with increased time spent on childcare. Gender differences both within and across jobs explain gender gaps in summer exits from employment. Women's summer work interruptions contribute to gender gaps in pay.

Transrectal ultrasonographic assessment of the fetal proximal phalanx: A new tool to assess fetal age and bone development in horses

Fetal age in Quarter Horses can be predicted within 2 weeks from 100- to 200- days of gestation using femur length, biparietal diameter (cranium diameter) and eye approximated volume. However, as pregnancy advances, the femur and cranium become too large to be imaged in their entirety using ultrasound and the corresponding biometric parameters can no longer be measured. In this longitudinal study, the proximal phalanx (P1) was evaluated as a novel biometric parameter for late gestation to predict fetal age and bone maturation. Transrectal ultrasound was performed in ten pregnant mares with known ovulation dates, every two weeks from 240- days of gestation until parturition. P1 was imaged in 69 % of the examinations. Inability to image P1 was due to obstructive positioning such as carpal or fetlock flexion, or posterior presentation of the fetus. Advancing fetal age did not affect visibility of P1. P1 length correlated significantly with days of gestation and a correlation equation was established: y = 0.3837x -69.55 where y is the predicted value of P1 length and x is the day of gestation (with day 0 being the day of ovulation). When P1 length was equal to or larger than the width of the ultrasound image (52.5 mm), 90 % of mares (9/10) were above 300- days of gestation. Ossification of the proximal and distal epiphysis of P1 typically appeared between 277- and 303 -days of gestation (mean: 288 days). The proximal epiphysis did not close before parturition whereas the distal one closed between 306- and 333-days of gestation (mean: 320 days). P1 epiphyseal appearance and closure occurred chronologically reflecting bone maturation. Radiographic findings at birth and prenatal ultrasound findings were in agreement, apart from timing of P1 distal epiphyseal closure. In conclusion, P1 length can be used as a new fetal biometric parameter to assess fetal age and growth after 240- days of gestation. The knowledge of P1 bone maturation process in utero as a marker for fetal bone development, may also be valuable in clinical decision-making when considering inducing parturition in the mare.

Effect of endoscopic full-thickness resection assisted by distal serosal turnover with floss traction for gastric submucosal masses

BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection (EFTR). Successful perforation repair under endoscopy, thereby avoiding surgical intervention and postoperative complications such as peritonitis, are pivotal for effective EFTR. AIM To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors. METHODS A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted. The total operation time, tumor dissection time, wound closure time, intraoperative bleeding volume, length of hospital stay and incidence of complications were analyzed. RESULTS There were 93 patients, aged 55.1 ± 12.1 years. Complete tumor resection was achieved in all cases, resulting in a 100% success rate. The average total operation time was 67.4 ± 27.0 min, with tumor dissection taking 43.6 ± 20.4 min. Wound closure times varied, with gastric body closure time of 24.5 ± 14.1 min and gastric fundus closure time of 16.6 ± 8.7 min, showing a significant difference (P &lt; 0.05). Intraoperative blood loss was 2.3 ± 4.0 mL, and average length of hospital stay was 5.7 ± 1.9 d. There was no secondary perforation after suturing in all cases. The incidence of delayed bleeding was 2.2%, and the incidence of abdominal infection was 3.2%. No patient required other surgical intervention during and after the operation. CONCLUSION Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss, making it a viable approach for gastric submucosal tumors.

Decisions and Influential Factors Regarding Class-Specific School Closures Against Seasonal Influenza Outbreak.

Background One of the characteristics of school closure in Japan is class-specific school closure, which involves a reactive, short-term closure in the event of an infectious disease outbreak. These closures are implemented at each school in reaction to the annual seasonal influenza outbreaks. Very little research has addressed the formation of class-specific school closures to combat infectious diseases in elementary schools.We carried out a survey on factors involved in the decision to close classes and the determination of the timing and duration of class closures in elementary schools in Japan. Methods A mail-based questionnaire survey of elementary schools from four prefectures in western Japan was conducted between August and September 2021. The questions addressed the criteria for school closures (the timing and duration of class closure), various considerations, and confusion regarding class closures, with answers analyzed using descriptive statistical methods. Results In total, 714 elementary schools responded to the survey (37.9%). Furthermore, 398 (55.7%) schools established criteria for class closures during seasonal influenza. Class closure was most frequently initiated in schools with criteria when either 20% or 30% of class pupils were absent; the most common duration was three days. The duration of class closures was decided upon depending on the outbreak in some schools (69.8%), depending on the circumstances of the outbreak. Regarding class closure decisions, schools viewed school physicians' opinions as a priority, followed by school events, adjustments for Saturdays and Sundays, and Yogo teachers' opinions. Schools answering "no criteria for class closure" or "adjustments for Saturdays and Sundays" had difficulty determining class closure duration. Conclusion To guarantee the continuation of children's education and improve the effectiveness of preventive efforts against seasonal influenza, the following were considered important and helpful in class closure decision-making in elementary schools: scientific evidence, the school physician's opinion, and Yogo teachers' analysis of children's health information.