Is Placing Prophylactic Dural Tenting Sutures a Dogma?

Objective In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. Methods Results from 437 patients aged 18 to 91 years (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups, patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1), at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2), or no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. Results Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. Conclusion Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important

Climate Change Impact on Multi-Objective Optimization: A Case Study on Educational Buildings

The changing weather conditions due to global climate change is expected to have a direct impact on buildings’ energy demand and occupant comfort. These conditions are estimated to become more challenging for educational facilities due to their high occupant density and the students’ sensitivity to heat. This study aims to present an approach for a comparative analysis for multi-objective optimization results that are projected under different climate change conditions. Two separate optimization processes were performed using NSGA-II for an existing educational building, with the goal of minimizing occupant discomfort and energy use. The differences between the resulting Pareto-sets were analyzed based on the hypervolume difference and statistical evaluations, including the T-test and the distribution of properties. The results of the two optimization processes showed that future weather conditions should be considered on the retrofit process as two Pareto-set have resulted differently in terms of decision variable values and the hypervolume calculation. The discomfort hours (Y1-Current) for optimization with current data resulted in lower values compared to the optimization with projected data (Y1-Projected), on the contrary, the total energy demand (Y2-Current) objective results have resulted in higher values than the projected data results (Y1-Projected)