Type Of Closure Research Articles

Reinforcement learning‐based approach for urban road project scheduling considering alternative closure types

AbstractGrowth in urban population, travel, and motorization continue to cause an increased need for urban projects to expand road capacity. Unfortunately, these projects also cause travel delays, emissions, driver frustration, and other road user adversities. To alleviate these ills, road agencies often face two work zone design choices: close the road fully and re‐reroute traffic or implement partial closure. Both options have significant implications for peri‐construction road capacity, traveler costs, and the project duration and cost. This study presents a decision‐making methodology to facilitate the choice between full road closure and partial closure. The presented decision‐making methodology is a bi‐level optimization problem: at the upper level, the road agency seeks to optimally schedule road construction work to minimize net vehicle emissions and road construction costs. The lower‐level of the problem captures two types of travelers’ route choice behaviors: rational travelers who minimize their travel time and path‐loyal travelers who do not change their routes from their pre‐construction routes. The bi‐level mixed integer nonlinear model is solved using a reinforcement learning‐based algorithm (the multi‐armed bandit‐guided particle swarm optimization [PSO] technique). The computational experiments suggest the superiority of the proposed algorithm, compared to the classic PSO algorithm in terms of solution quality. The numerical results suggest that if the percentage of path‐loyal travelers increases, the agency needs to invest more in road project construction to implement under partial closure to avoid a significant increase in vehicle emissions.

Wound complication rates after anterior total hip arthroplasty: A case series comparison of interrupted vs. continuous sutures for skin closure

BackgroundThe anterior approach for total hip arthroplasty (THA) carries a higher risk of wound complications, which can significantly affect patient outcomes and increase healthcare costs. There is limited research comparing infection rates based on closure techniques in patients who undergo THA. Therefore, this study aims to compare wound complications based on interrupted or continuous sutures for skin closure after anterior approach THA. MethodsThis single-surgeon retrospective study extracted data from 388 patients who had undergone a primary THA using the anterior approach. Patient demographics, comorbidities, perioperative factors, and infection-related complications were recorded. All variables associated with a given infection complication were controlled for in a binary logistic regression model. ResultsAfter controlling for confounding variables, wound closure type was not associated with any infectious complications. BMI was a strongly associated factor in PJI (p = 0.028; 95 % CI = 1.02–1.34), prolonged drainage (p < 0.001; 95 % CI = 1.08–1.28), readmission (p = 0.023; 95 % CI = 1.01–1.20), and I&D and revision surgery (p = 0.021; 95 % CI = 1.02–1.31). ConclusionBody mass index was the sole factor associated with a higher risk of wound complications postoperatively. These findings suggest a non-inferiority between continuous and interrupted suture closure techniques regarding wound-related infectious complications in anterior total hip arthroplasty.

Effectiveness of negative-pressure wound therapy with instillation compared to standard negative-pressure wound therapy and traditional gauze layer dressing for the treatment of acute traumatic wounds: A randomized controlled trial

Acute traumatic wounds often require prolonged healing time and hospitalization. Negative-pressure wound therapy with instillation and dwell time (NPWTi-d) has demonstrated effectiveness in accelerating patient healing over traditional NPWT, and its benefits are well established in the treatment of chronic infected wounds. However, randomized studies examining the use of NPWTi-d in acute traumatic wounds are scarce. This study aimed to examine the effectiveness of NPWTi-d compared to traditional gauze layer dressing and standard NPWT. This single-center, randomized, pragmatic, controlled clinical trial included 120 adult patients with acute traumatic wounds from traffic accidents randomized to NPWTi-d (n=39), NPWT (n=41), and gauze dressing (n=40). Following surgical debridement of the wound bed, all patients underwent definitive wound closure with delayed primary closure, skin grafting, or surgical flaps. The primary outcomes were wound closure time, number of surgical procedures, and hospital length of stay. The secondary outcomes were primary closure type, amputations, complications, and death. Wound closure time was significantly lower in patients with NPWTi-d compared to patients with NPWT and gauze dressing (6.1 vs. 10 vs. 11.7 days, respectively; p<0.001). Patients with NPWTi-d had fewer surgical procedures than patients with NPWT and gauze dressing (3.0 vs. 3.5 vs. 6.2, respectively; p<0.001). No significant differences in length of stay were observed among the groups. In this study, patients with acute traumatic wounds who received NPWTi-d experienced shorter wound closure time and fewer surgical procedures than patients who received NPWT or gauze dressing. The current study is registered on the Brazilian Clinical Trials Registry (ReBec) platform under the name Comparison between Traditional Dressing, V.A.C. Dressing and V.A.C. Dressing with Instillation in Complex Wounds, ID nº RBR-658g535 at https://ensaiosclinicos.gov.br/rg/RBR-658g535.

Assessment of Postoperative Complications Between Interrupted Modified Smead-Jones Rectus Closure and Conventional Rectus Closure in Midline Laparotomy Wounds: A Comparative Study.

Introduction The abdomen comprises several layers that enhance its strength and flexibility, extending from the superficial to the deep layers of the anterior abdominal wall. Among these, the rectus sheath serves as a fibromuscular compartment essential for structural integrity, providing mechanical support and safeguarding the underlying tissues and organs. This study evaluates two midline closure techniques employed after midline laparotomy surgery to determine which technique offers superior strength and mechanical support. Materials and methods A single-center prospective comparative study was conducted over 18 months, from October 2022 to April 2024, at Sree Balaji Medical College & Hospital in Chennai, India. The study population comprised 92 outpatients and inpatients from the general surgery and emergency departments who underwent emergency and elective midline laparotomy surgery. Patients were selected using simple random sampling and categorized into two groups based on the type of rectus closure: conventional rectus closure (CRC) and interrupted modified Smead-Jones (IMSJ) rectus closure. Results In our study, approximately 34% (N = 31) of participants were aged 46-60 years, with a mean age of 53.45 ± 7.98 years. The sex distribution did not show significant preponderance. Complications included three cases of burst abdomen postoperatively, with 66.67% (N = 2) occurring in the CRC group. Incisional hernias were observed in six cases, with five belonging to the CRC group, indicating statistical significance. Additionally, wound infections were recorded in 10 cases, all within the CRC group. Out of 20 patients who developed localized collections, 32.6% (N = 15) were in the CRC group, while five belonged to the IMSJ group. Conclusions This study demonstrates that the IMSJ technique is superior to CRC in reducing postoperative complications. This advantage is attributed to its enhanced tensile strength and improved distribution of tension across the wound.

Analysis of Aromatic Fraction of Sparkling Wine Manufactured by Second Fermentation and Aging in Bottles Using Different Types of Closures

Analysis of Aromatic Fraction of Sparkling Wine Manufactured by Second Fermentation and Aging in Bottles Using Different Types of Closures

Single institution review of operative management of giant omphalocele

PurposeOperative management of giant omphalocele that cannot be closed primarily varies based on several factors, and there is little data to guide choice of operative approach and how this impacts long-term outcomes. We aimed to characterize whether surgical approach – staged closure during the neonatal period, or delayed closure – affects outcomes. MethodsWe conducted a retrospective review of children treated for giant omphalocele who did not undergo primary closure at Children's Hospital Colorado from 2010–2022. We included patients with giant omphalocele who underwent treatment at the study site. Data collected included patient characteristics, clinical course, and outcomes. Comparisons were made based on type of closure, delayed versus staged. ResultsWe identified 24 patients; 6 delayed and 16 staged. 2 patients died prior to closure. Delayed and staged groups did not differ regarding demographics. Infants undergoing staged repair tended to have more total hospital and total ventilator days, and more post-closure ventral hernia requiring repair; short-term outcomes were otherwise comparable. There was no difference between groups in long-term outcomes, including neurodevelopmental milestones and mortality. ConclusionsLong term outcomes are equivalent between staged repair and delayed repair of giant omphalocele. However, staged repair may be associated with more ventilator days, total hospital days and higher risk of ventral hernia.

A Single-Centre Analysis of Surgical Techniques for Myelomeningocele Closure: Methods, Outcomes, and Complications.

(1) Background: Neural tube defects are a prevalent cause of congenital malformations, myelomeningocele (MMC) being the most severe form. This study evaluates the clinical outcome and postoperative-associated complications following MMC surgical closures, focusing on the following three techniques: direct suture (DS); VY advancement flap (VYF); and Limberg flap (LF). (2) Methods: A retrospective observational study was conducted from March 2015 to February 2023, and the inclusion criteria were newborns who underwent lumbosacral MMC within 24 h of birth. (3) Results: Out of 20 cases, 45% underwent DS closure; 25% underwent VY-F closure; 15% underwent LF closure, and 15% (n = 3) underwent combined flap closure. A significant statistical correlation was observed between intracranial hypertension (IH), the need for external ventricular drainage (EVD), and DS closure type. In the DS group, 60% of patients required EVD (p = 0.041), and 90% had IH (p = 0.027). CSF fistula was present in 40% of LF cases and 30% of DS cases, while wound dehiscence was observed in 60% of LF cases and 30% of DS cases. (4) Conclusions: Our study demonstrated that DS was linked to higher rates of complications. The VY-F is the safest method for closing MMC defects.

SEQUENTIAL PARS PLANA VITRECTOMY AND INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENTS WITH PERIPHERAL BREAKS AND CONCOMITANT NONCAUSATIVE MACULAR HOLE IN NONHIGHLY MYOPIC PATIENTS.

To present the anatomical and functional results of sequential pars plana vitrectomy for treating rhegmatogenous retinal detachment with peripheral breaks and concomitant noncausative macular holes (MHs) in nonhighly myopic patients. Medical records of patients who underwent rhegmatogenous retinal detachment surgical repair between 2017 and 2023 were reviewed. Of 980 patients with rhegmatogenous retinal detachment, 10 had concurrent MH and underwent sequential pars plana vitrectomy for rhegmatogenous retinal detachment repair and air endotamponade, followed by MH repair using the inverted internal limiting membrane flap technique and C2F6 endotamponade after a minimum of 1 week. The main outcomes measured were best-corrected visual acuity change, retinal reattachment rate, MH closure rate, and closure type. The retinal reattachment rate was 90% after the primary surgery and 100% after subsequent surgery. Macular hole closure was achieved in all cases. Macular hole diameters ranged from 291 to 702 µm. Anatomical recovery showed mainly 1A closure types (90%). Functional recovery demonstrated significant best-corrected visual acuity improvement, with a mean visual acuity gain of 1.58 ± 0.41 the logarithm of the minimum angle of resolution. For this infrequent pathology, sequential surgery using the inverted internal limiting membrane flap technique and air/gas endotamponade yielded favorable anatomical and functional outcomes. This controlled and standardized approach using sequential surgeries contributes to the achievement of consistent results.

Tensile testing in feline ventral abdominal coeliotomy closure with different sizes of polydioxanone suture material: a biomechanical study.

The aim of this study was to evaluate, in vitro, the load and type of failure of the sutured ventral abdominal fascia of cats with different sizes of suture material made of polydioxanone (PDX) (2-0, 3-0, 4-0, 5-0 USP). A total of 32 samples of the ventral abdominal wall from 16 cadaveric cats were harvested using an hourglass-shaped template. The samples were sectioned longitudinally along the linea alba and then sutured together in a continuous pattern using four different randomly assigned sizes of pdx suture material (2-0, 3-0, 4-0, 5-0 USP). A universal testing machine was used for linear distraction of the samples. The tensile strength and type of failure were recorded and analysed. Three types of failure were defined: suture material failure (S), suture line failure (T1) and failure of the abdominal wall further away from the linea alba (T2). The frequency of suture material failure decreased with increasing suture size. Suture size 5-0 failed due to a S failure in 6/8 samples, PDX 4-0 failed in 2/8 samples and PDX 3-0 failed in only 1/8 samples. However, PDX 2-0 failed due to only T1 or T2 failures, with both failures being almost equally represented. No statistically significant differences in the load to failure between PDX 2-0, 3-0 and 4-0 were noted (P >0.05). The risk of suture failure increased with decreasing suture size diameter. PDX 2-0 and 3-0 can be used without reservation for the closure of ventral midline coeliotomy in cats. Although there was no statistically significant difference between PDX 2-0, 3-0 and 4-0, PDX 4-0 showed a higher probability for suture breakage and should be used only after careful consideration of the patient while clinical evaluation is pending. Pdx 5-0 cannot be recommended as a safe suture size for this type of surgical closure.

The Efficacy of Modified Ilizarov Distraction-Tension Device on Limb Wound Difficult to Cover with Skin Flaps.

Closure of complex limb wounds poses challenges and requires innovative approaches. This research aimed to evaluate the effectiveness of a modified distraction-tension device using Ilizarov external fixation for wound closure in challenging cases. A retrospective analysis was conducted on 43 patients with extremity wounds that were difficult to cover with skin flaps between January 2019 and December 2022. Tension-relieving traction was applied using the Ilizarovexternal fixator apparatus, tailored to individual wound characteristics. Three types of wire-pin connections were used in this study. The distraction begins on the third postoperative day, with a speed of 0.5mm/d. Clinical wound healing scores were evaluated at 5 and 30 days postoperatively. Complications were documented following the Paley classification system. Traction using modified Ilizarovexternal fixation promoted a significant reduction in wound size. The mean traction period was 11.2 ± 7.3 days, and the mean healing duration was 17.0 ± 3.7 days. The clinical wound healing score improved from 3.7 ± 2.9 at 5 days to 1.7 ± 0.7 at 30 days postoperatively (p < 0.05). Complications were minimal, with no significant obstacles or sequelae observed. Direct closure healing was achieved in 21 cases, skin graft healing in 13 cases, and suture healing in 9 cases. No recurrences were reported. Using Paley's classified complications, there were 17 problems, 9 obstacles, and 0 sequelae. The Ilizarov tension-relieving traction shows promise in facilitating wound closure that is challenging to manage with skin flaps. The modified three types of pin-skin connection configuration could satisfy various types of wound closure.

Bridging Large Eddy Simulation and Reduced-Order Modeling of Convection-Dominated Flows through Spatial Filtering: Review and Perspectives

Reduced-order models (ROMs) have achieved a lot of success in reducing the computational cost of traditional numerical methods across many disciplines. In fluid dynamics, ROMs have been successful in providing efficient and relatively accurate solutions for the numerical simulation of laminar flows. For convection-dominated (e.g., turbulent) flows, however, standard ROMs generally yield inaccurate results, usually affected by spurious oscillations. Thus, ROMs are usually equipped with numerical stabilization or closure models in order to account for the effect of the discarded modes. The literature on ROM closures and stabilizations is large and growing fast. In this paper, instead of reviewing all the ROM closures and stabilizations, we took a more modest step and focused on one particular type of ROM closure and stabilization that is inspired by large eddy simulation (LES), a classical strategy in computational fluid dynamics (CFD). These ROMs, which we call LES-ROMs, are extremely easy to implement, very efficient, and accurate. Indeed, LES-ROMs are modular and generally require minimal modifications to standard (“legacy”) ROM formulations. Furthermore, the computational overhead of these modifications is minimal. Finally, carefully tuned LES-ROMs can accurately capture the average physical quantities of interest in challenging convection-dominated flows in science and engineering applications. LES-ROMs are constructed by leveraging spatial filtering, which is the same principle used to build classical LES models. This ensures a modeling consistency between LES-ROMs and the approaches that generated the data used to train them. It also “bridges” two distinct research fields (LES and ROMs) that have been disconnected until now. This paper is a review of LES-ROMs, with a particular focus on the LES concepts and models that enable the construction of LES-inspired ROMs and the bridging of LES and reduced-order modeling. This paper starts with a description of a versatile LES strategy called evolve–filter–relax (EFR) that has been successfully used as a full-order method for both incompressible and compressible convection-dominated flows. We present evidence of this success. We then show how the EFR strategy, and spatial filtering in general, can be leveraged to construct LES-ROMs (e.g., EFR-ROM). Several applications of LES-ROMs to the numerical simulation of incompressible and compressible convection-dominated flows are presented. Finally, we draw conclusions and outline several research directions and open questions in LES-ROM development. While we do not claim this review to be comprehensive, we certainly hope it serves as a brief and friendly introduction to this exciting research area, which we believe has a lot of potential in the practical numerical simulation of convection-dominated flows in science, engineering, and medicine.

Associations between hypopharyngeal defect closure and quality of life in long-term total laryngectomy survivors.

Few studies have examined health-related quality of life (HRQOL) outcomes in long-term total laryngectomy survivors in relation to the type of hypopharyngeal defect. A cross-sectional study was performed in long-term total laryngectomy survivors, treated between 2000 and 2020. The primary outcome was HRQOL, assessed using the FACE-Q Head and Neck Cancer Module, in relation to the type of hypopharyngeal closure (primary closure, partial or circumferential reconstruction). Seventy-nine survivors were included with a median follow-up of 92.1 months (IQR 75.6-140.2 months). Patients requiring partial hypopharyngeal reconstruction (n = 18) scored significantly worse than patients with primary closure (n = 51) on 4 of 13 FACE-Q domains: functional domains of eating (p = 0.03), speech (p = 0.05), and swallowing (p = 0.03), and the psychological domain of speaking-related distress (p = 0.02). No statistically significant differences were found between the circumferential hypopharyngeal defect reconstruction group (n = 10). Stricture occurrence was the only clinical factor associated with worse eating, speaking, swallowing, eating-related distress, and cancer worry in multivariable analyses. Several functional and psychological domains were significantly worse following partial hypopharyngeal reconstruction than in patients who received primary closure. Efforts to reduce stricture rates to enhance reconstructive outcomes following total laryngectomy merit further research.

Modified ILM flap techniques versus classical inverted ILM flap technique for large macular holes: a systematic review and meta-analysis of randomized controlled trials

BackgroundMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.MethodsWe searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the classic inverted ILM flap technique to modified ILM flap techniques as initial surgical treatment of eyes with large MHs of more than 400 microns. We sought to evaluate the following outcomes: (1) MH closure. (2) Best-corrected visual acuity (BCVA). (3) Foveal closure type (4) Rate of ellipsoid zone (EZ) defects and external limiting membrane (ELM) defects. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.ResultsFour RCTs that enrolled 220 participants were deemed eligible. The analysis revealed no statistically significant differences in MH closure between both groups (95% CI: 0.20, 7.96; P = 0.81). No statistically significant differences in mean BCVA were found at 1 and 3 months between both groups (SMD: 0.04; 95% CI: −0.16, 0.23; P = 0.70 and SMD: −0.167; 95%CI: −1.240, 0.906; P = 0.760, respectively). In addition, there were no significant differences between the two groups in the pattern of foveal closure, namely U-shape, V-shape, and flap open at 3, 6, and 12 months (RR: 0.87; 95% CI: 0.67, 1.12; P = 0.28, RR: 0.96; 95% CI: 0.58, 1.61; P = 0.89, and RR: 1.95, 95% CI: 0.26, 14.50; P = 0.51, respectively). Finally, the analysis showed no statistically significant difference in both groups’ EZ and ELM defect rates at 3, 6, and 12 months (RR: 1; 95% CI: 0.85; 1.18: P = 1 and RR: 1.14; 95% CI: 0.90, 1.45; P = 0.27).ConclusionMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.

Clinical evidence of autologous platelet-rich plasma as treatment in macular holes

Abstract Background: A prospective observational study was conducted with the purpose of evaluating the role of autologous platelet-rich plasma (PRP) in the form of a clot as an adjunct in surgery for the closure of large full-thickness macular holes (&gt;400 μm). Methodology: Thirteen patients with a diagnosis of full-thickness macular hole larger than 400 μm, without associated pathologies or previous vitreoretinal surgeries, were selected. Each patient underwent a complete ophthalmological evaluation, including visual acuity (uncorrected or best corrected), optical coherence tomography (OCT Optovue), and in some cases, retinal photographs. On the day of the procedure, blood samples were taken to prepare PRP and form a clot according to institutional protocol. Patients were followed for 1 year with periodic evaluations that included OCT, retinal photographs, and assessments by a retina specialist and optometry. Results: Of the 13 patients, 46% (6 cases) had an epiretinal membrane as the triggering factor for the macular hole and 54% (7 cases) had vitreomacular traction. Complete closure of the macular hole was achieved in 92.31% (12 cases) and partial closure in 7.69% (1 case). Postoperative best-corrected visual acuity ranged from 20/30 to 20/200 according to the Snellen chart. No patient experienced a deterioration in visual acuity after the procedure. Conclusions: The use of PRP as an adjunct treatment for macular hole surgery in patients without previous vitreoretinal surgeries has proven to be effective in achieving complete or partial closure in a high percentage of cases. Pre-and postoperative changes in visual acuity, hole size, and type of closure provide valuable information on the efficacy of PRP treatment in these patients.

Understorey Plant Functional Traits of Platycladus orientalis Depends on Crown Closure and Soil Properties in the Loess Plateau, China

The crown closure of Platycladus orientalis forests has a wide-ranging impact on vegetation and soil, thereby affecting the overall functioning of the ecosystem. There is limited research on the effects of the Platycladus orientalis forest crown closure on changes in community plant functional traits, and their interactions are not yet clear. Therefore, we investigated 50 plots of different types of Platycladus orientalis crown closure, and we measured the functional traits of nine shrub species and 68 herb species in 50 plots under five different densities of Platycladus orientalis forests in the Loess Plateau. The consequence of Pearson’s correlation analysis showed significant positive correlations between LC and LTD, LN and LP, LN and LNP, LN and LV, LN and H, LP and LV, LP and H, and SLA and LV (p &lt; 0.05). LC was significantly negatively correlated with LP, LC with SLA, LC with LV, LN with LTD, LP with LNP, LP with LTD, and LTD with H (p &lt; 0.05). Only the soil phosphorus content (SP) and soil water content (SWC) showed a significant positive correlation with multiple plant functional traits. The crown closure of Platycladus orientalis forests increased significantly, as did the plant functional features. Changes in the Platycladus orientalis forest crown closure significantly increased the LC, LV, LN, LP, and SLA in plant functional traits. An increase in Platycladus orientalis forest crown closure significantly increased the soil organic carbon (SC), soil phosphorus content (SP), soil nitrogen content (SN), soil water content (SWC), field capacity (FC), and soil porosity (PO). Based on a structural equation model, we found that, while changes in the Platycladus orientalis forest crown closure did not directly affect plant functional traits, they could indirectly influence these traits through soil factors, primarily the soil water content (SWC) and soil phosphorus content (SP) (p &lt; 0.05). Additionally, the mechanisms of the Platycladus orientalis forest crown closure’s impact on different functional traits vary. The research results provide scientific elements for the ecological restoration of Platycladus orientalis forests on the Loess Plateau.

The use of a surgical logbook to improve training and patient safety: A retrospective analysis of 6years' experience in Bristol, UK.

Logbooks can be a useful educational tool. Although their use in medical training has been greatly explored, there is limited research into their application throughout a clinician's career. We created a surgical logbook to allow clinicians to record their skin surgery procedures and reflect on the histological diagnosis and clearance margins achieved. We provide a retrospective analysis to evaluate the usefulness of the logbook as an analytical and educational tool in a dermatology department, particularly for maintaining exemplary complete excision rates. Data was collected from clinicians who conducted skin surgery in Bristol, UK. Cases were entered at the time of surgery, collecting data on body site, clinical margin, suspected diagnosis, type of procedure and closure. Following receipt of histological results, data on histological excision margins and tumour type was entered. Each clinician submitted data for a minimum of 3months each year, and data collection ran from April 2012 until March 2018. Data from 5161 excision surgeries was collected over the 6-year period. On histological diagnosis, excisions constituted 50% Basal Cell Carcinoma (BCC), 12% Squamous Cell Carcinoma (SCC), 9% Malignant Melanoma (MM) and 1% Lentigo Maligna (LM), and 28% 'Other' (rarer malignancies, melanoma wide local excision scars and pre-cancerous/benign lesions). The department was found to have good diagnostic concordance: BCC 92%, SCC 87%, MM 80% and LM 53%. Overall complete excision rate was high at 97.07%. The most successfully excised cancer was BCC (97.50%), then SCC (97.14%) MM (96.48%) and LM (95.23%). The department provided many complex surgeries including 8.3% flaps and 8.5% grafts. Average lesion diameter was 11mm (range 2-90mm). There was a significant improvement in excision rates seen over the years for BCC, MM and LM. Although there was no significant difference found for SCC, this group began the study with already high clearance rates. This surgical logbook supports improved training and continues professional development. We encourage more departments to use this logbook and share the data that they produce. This could improve their excision rates, patient experience, and save them up to £28000 per year.

Morbidity and neurodevelopmental outcomes at 2 years in preterm infants undergoing percutaneous transcatheter closure vs. surgical ligation of the PDA.

Review a cohort of preterm infants ≤29 weeks of gestation at birth and compare morbidities and neurodevelopmental outcomes based on PDA status and type of PDA closure. Single center observational retrospective-prospective case control study of premature infants who had no hsPDA, underwent surgical ligation or percutaneous transcatheter closure of the PDA. Neurodevelopmental testing was done using the Bayley Scales of Infant Development 3rd ed. The percutaneous transcatheter closure group had an older post menstrual age and greater weight at the time of procedure, and started enteral feeds and achieved room air status at an earlier post procedure day. Infants in the surgical ligation group were more likely to experience vocal cord paralysis. There was no difference in neurodevelopmental outcomes between groups. Waiting for infants to achieve the appropriate size for percutaneous transcatheter closure of the PDA may lead to reduced short-term complications without increasing the risk of neurodevelopmental impairment.

Duration after Macular Hole Surgery for Stabilisation of Visual Acuity: A Long-term Retrospective Review

The purpose of the study is to determine the median duration for visual recovery to achieve visual stability and visual acuity gain after macular hole surgery in our local population. This was a retrospective study. Patients with full-thickness macular holes (FTMH) from surgical logs were included between January 2009 and December 2019. The patients' medical records were reviewed for pre-, intra-, and post-operative data collection. Patients who fulfilled the inclusion and exclusion criteria were recruited and analysed. Data collected from the medical record pre-operatively, which included baseline best corrected visual acuity (BCVA), interval of symptoms development to surgery, any ocular co-morbidities, optical coherence tomography (OCT) for size and stage of macular hole and central subfield thickness (CST). Intra-operative notes included whether vitrectomy with or without phacoemulsification and with the internal limiting membrane (ILM) peel or ILM flaps, types of dye, and tamponade agent used. Post-operative data included BCVA and CST on each visit, types of macular hole closure, or any complications. Data were analysed using SPSS.Thirty-one patients were diagnosed with FTMH. Sixteen patients who underwent pars plana vitrectomy (PPV) were included and analysed. Fifteen patients (93.75%) achieved successful macular hole closure after the primary operation. The median duration BCVA reached at stability was 19.5 months (IQR 9 – 26.25), and visual acuity gained by 0.44 LogMAR (IQR 0.165 – 0.565). Ten patients (62.5%) underwent combined PPV with phacoemulsification. CST showed improvement from baseline, 444 (IQR 347.5 – 519.75) to 273 (IQR 232 -285.5), 230 (IQR 221.5-255), and 270 (IQR 254-322) at the period interval of 0 to 3 months, 3 to 6 months, and 6 to 12 months respectively. Gas C3F8 and membrane blue were commonly used as tamponade agents and dyes, and PPV with ILM peel was the common surgery performed. Six patients (40%) achieved type 1 macular hole closure within 12 months of follow-up. Despite the small sample size, our study provided practical information regarding patient’s expectations of when their vision can become stable after macula hole surgery in our local population.

Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery).

Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.

Tratamiento quirúrgico en la hidradenitis supurativa: análisis de una serie de casos

IntroductionHidradenitis suppurativa is a chronic disease with challenging treatment favoring the emergence of surgical options. This study describes a series of procedures, types of closure, their recurrence and complications. Materials and methodsWe conducted a retrospective observational study of 33 surgical procedures in 28 patients diagnosed with hidradenitis suppurativa performed from January 2017 to March 2023. Results84.8% of the procedures were performed on women. Recurrence in infiltration and drainage was 57.14% (n=12), 33.33% with deroofing (n=1) and 11.11% with local resection (n=1). Recurrence in primary closure was 16.66% (n=1) and 12.5% in closure by secondary intention (n=1). Patients with severe disease had less recurrence, followed by moderate and mild disease. ConclusiónWe highlight primary closure with the highest rate of complications and local resection as the procedure with the lowest recurrence. It is proposed that a more aggressive approach could represent a decrease in recurrence; however, it is pertinent to carry out studies with a larger sample to achieve greater standardization.