Advanced Organ Research Articles

The Effect of Advance Organizer Model on Physics Learning Outcomes in Terms Prior Knowledge

This research is experimental research which aims to determine the effect of the advance organizer model on physics learning outcomes in terms of prior knowledge. This research uses a one group pretest-posttest design type . The sample in this research was class X MIA 1 SMAN 8 Mataram which consisted of 24 students. The data collection technique uses test sheets in the form of pre-test and post-test given before and after treatment. The pre-test data results were obtained with an average of 35.6 and 81.5 for the post-test average . The results of the prerequisite test with the Shapiro Wilk test showed that the pre-test and post-test data were normally distributed. Then, a t-test was carried out using a paired sample t-test showing a significant value (sig. 2 tailed) of 0.000, which means (sig. 2 tailed) < 0.005 so it can be concluded that there is an influence of the advance organizer learning model on physics learning outcomes in terms of priors knowledge.

Preoperative prolapse phenotype is predictive of surgical outcome with minimally invasive sacrocolpopexy

The gold-standard treatment for advanced pelvic organ prolapse is sacrocolpopexy. However, the preoperative features of prolapse that predict optimal outcomes are unknown. This study aimed to develop a clinical prediction model that uses preoperative scores on the Pelvic Organ Prolapse Quantification examination to predict outcomes after minimally invasive sacrocolpopexy for stages 2, 3, and 4 uterovaginal prolapse and vaginal vault prolapse. A 2-institution database of pre- and postoperative variables from 881 cases of minimally invasive sacrocolpopexy was analyzed. Data from patients were analyzed in the following 4 groups: stage 2 uterovaginal prolapse, stage 3 to 4 uterovaginal prolapse, stage 2 vaginal vault prolapse, and stage 3 to 4 vaginal vault prolapse. Unsupervised machine learning was used to identify clusters and investigate associations between clusters and outcome. The k-means clustering analysis was performed with preoperative Pelvic Organ Prolapse Quantification points and stratified by previous hysterectomy status. The "optimal" surgical outcome was defined as postoperative Pelvic Organ Prolapse Quantification stage <2. Demographic variables were compared by cluster with Student t and chi-square tests. Odds ratios were calculated to determine whether clusters could predict the outcome. Age at surgery, body mass index, and previous prolapse surgery were used for adjusted odds ratios. Five statistically distinct prolapse clusters (phenotypes C, A, A>P, P, and P>A) were found. These phenotypes reflected the predominant region of prolapse (apical, anterior, or posterior) and whether support was preserved in the nonpredominant region. Phenotype A (anterior compartment prolapse predominant, posterior support preserved) was found in all 4 groups of patients and was considered the reference in the analysis. In 111 patients with stage 2 uterovaginal prolapse, phenotypes A and A>P (greater anterior prolapse than posterior prolapse) were found, and patients with phenotype A were more likely than those with phenotype A>P to have an optimal surgical outcome. In 401 patients with stage 3 to 4 uterovaginal prolapse, phenotypes C (apical compartment predominant, prolapse in all compartments), A, and A>P were found, and patients with phenotype A>P were more likely than those with phenotype A to have ideal surgical outcome. In 72 patients with stage 2 vaginal vault prolapse, phenotypes A, A>P, and P (posterior compartment predominant, anterior support preserved) were found, and those with phenotype A>P were less likely to have an ideal outcome than patients with phenotype A. In 297 patients with stage 3 to 4 vaginal vault prolapse, phenotypes C, A, and P>A (prolapse greater in posterior than in anterior compartment) were found, but there were no significant differences in rate of ideal outcome between phenotypes. Five anatomic phenotypes based on preoperative Pelvic Organ Prolapse Quantification scores were present in patients with stages 2 and 3 to 4 uterovaginal prolapse and vaginal vault prolapse. These phenotypes are predictive of surgical outcome after minimally invasive sacrocolpopexy. Further work needs to confirm the presence and predictive nature of these phenotypes. In addition, whether the phenotypes represent a progression of prolapse or discrete prolapse presentations resulting from different anatomic and life course risk profiles is unknown. These phenotypes may be useful in surgical counseling and planning.

Abstract CT287: LINNOVATE: A Phase 1/2 study of safety/efficacy using lurbinectedin, combined with ipilimumab, and nivolumab for advanced soft tissue sarcomas (NCT05876715)

Abstract Background: Sarcoma cells are most immunogenic earlier in the course of the disease. Therefore, immune checkpoint inhibitors such as ipilimumab (ipi) and nivolumab (nivo), that promote sustained T-cell activation by suppressing T regs would be most effective when given as first line therapy, together with a tumoricidal agent, such as lurbinectedin, whose plausible mechanism of action is not only to destroy the cancer cells and expose the tumor neoantigens for immune recognition, but also to destroy growth promoting factors in the tumor microenvironment. In the SAINT phase 2 study using ipi, nivo and trabectedin as first line therapy for advanced soft tissue sarcomas (STS; n=79), there were 6 complete responses, 14 partial responses, 49 stable disease, 25.3% best response rate, 87.3% disease control rate; median PFS, 6.7 months, median OS, 24.6 months (Gordon et al, Cancers vol. 15, 906, 2023). Lurbinectedin is a synthetic marine-derived agent and an analog of trabectedin. Therefore, we expect that lurbinectedin will be as effective as trabectedin when used together with ipi and nivo as first line therapy for advanced STS. Methods: Objective 1: Assess MTD of lurbinectedin. Objective 2: Evaluate PFS, OS, incidence and severity of adverse events; Correlative: Correlate response with ctDNA using Signatera. This is an open label, dose-seeking phase 1/2 study. The phase 1 part employs standard “cohort of three” design with a DLT window of 6 weeks. Treatment schedule: Ipi 1 mg/kg IV q 12 weeks; Nivo 3 mg/kg IV q 2 weeks; escalating doses of lurbinectedin from 2.6 mg/m2 to 3.2 mg/m2 IV q 3 weeks. Phase 2 part follows completion of phase 1 part wherein additional 28-34 participants will receive lurbinectedin at the MTD with fixed doses of Ipi and Nivo. Participants may continue treatment until significant disease progression or unacceptable toxicity occurs. Eligible patients are 18 years of age or older, previously treated in phase 1 and previously untreated in phase 2 with confirmed diagnosis of advanced STS, adequate hematologic and organ function, and no history of autoimmune disorder. To date, 6 patients in phase 1 have been dosed. Citation Format: Erlinda M. Gordon, Nadezhda Omelchenko, Samantha Jeffrey, Vaishali Kumar, Neal S. Chawla, Mahesh Seetharam, Victoria Chua, Ania Moradkhani, Doris Quon, Steven Wong, Sant Chawla. LINNOVATE: A Phase 1/2 study of safety/efficacy using lurbinectedin, combined with ipilimumab, and nivolumab for advanced soft tissue sarcomas (NCT05876715) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT287.

Vaginal assisted laparoscopic sacrocolpopexy (VALS) for gals with advanced pelvic organ prolapse

Vaginal assisted laparoscopic sacrocolpopexy (VALS) for gals with advanced pelvic organ prolapse

A REVIEW: ADVANCE ORGANIZER MODEL – AN EFFICIENT MODEL OF TEACHING AND LEARNING

Teachers can use an advance organizer model (AOM) to assist pupils understand, retain, and remember new learning content. It is intended to introduce the lesson topic and show the connection between what the pupils are about to learn and what they have already learned. Many studies were undertaken by educational scholars to evaluate the usefulness of the advance organizer model in the teaching learning process. Some of these researches are discussed in this article. All investigations concluded that the Advance organizer model of learning outperformed the standard technique. This methodology is extremely beneficial for teaching courses such as science, social science, mathematics, and English. The advance organizer model aids in the development of curiosity and the habit of exact thinking.

Anterior-apical Transvaginal Mesh (Calistar-S) for Treatment of Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year.

Calistar-S is a single-incision synthetic mesh kit that addresses apical and anterior compartment prolapse. The aims of this study were to evaluate the short-term objective and subjective outcomes at the 1-year follow-up. The secondary objectives were to evaluate quality of life and lower urinary tract symptoms (LUTS) outcomes, as well as surgical complications. Records of 108 patients with symptomatic advanced pelvic organ prolapse (stages III and IV) who underwent prolapse surgery using the Calistar-S system from June 2018 to August 2022 were reviewed. The primary outcome was the objective cure of anterior and apical prolapse < stage 1, and the subjective cure was the negative response to questions 2 and 3 of the Pelvic Organ Prolapse Distress Inventory-6. Secondary outcomes measured quality of life, the presence of lower urinary tract symptoms, and complications. A total of 101 patients were evaluated. The overall objective cure rate is 97% and the subjective cure rate is 92.1%. Good outcomes were seen in all three compartments. Secondary outcomes show significant improvement in all validated questionnaires. Persistence and de novo urinary incontinence were 15.2% and 18.2% post-operatively. There is one case of bladder injury and one case of vaginal mesh exposure. The Calistar-S System is a safe and efficient method for treating advanced-stage POP. We observed good anatomical results and subjective relief with a minimal complication rate. LUTS have also been positively affected, showing a high success rate. Additional studies are needed to establish the long-term efficacy of this system.

Chalk Talks for the Clinical Setting: Evaluation of a Medical Education Workshop for Fellows.

Chalk talks are effective teaching tools in the clinical setting. However, data on optimal strategies for teaching medical educators how to develop and deliver them are limited. We designed and implemented two 50-minute workshops to help subspecialty fellows across GME create and deliver a chalk talk. The first workshop comprised a demonstration of an effective chalk talk and a discussion of best practices for creating chalk talks; the second was a practice session where fellows presented their chalk talks and received feedback from faculty and peers. We evaluated pre- and postworkshop confidence in the ability to create and deliver a chalk talk and develop learning objectives. Secondary outcomes were faculty and peer evaluations of the chalk talks. Eighteen of 33 participants (54% response rate) completed both pre- and postsession surveys. Fellows reported improved confidence in their ability to create a chalk talk (22% vs. 83%, p < .001), deliver a chalk talk (17% vs. 83%, p < .001), and develop well-written learning objectives (11% vs. 83%, p < .001). After the workshop, participants were more likely to correctly identify a chalk talk that made use of an advanced organizer (67% vs. 89%, p < .05). Thirty-eight faculty and peers completed feedback evaluations of participants' chalk talks; most rated fellows' chalk talks highly in domains of content, delivery, design, learning objectives, and engagement. The incorporation of these workshop within a course on medical education can effectively develop clinical teaching skills among subspecialty fellows in GME.

Social capital for carers of patients with advanced organ failure: a qualitative exploration of stakeholders’ perspectives

BackgroundCarers of patients with advanced organ failure (AOF) experience a tremendous caregiving burden. Social capital utilizes the internal strength of a community to support its members and may provide carers with comprehensive support. This study aimed to identify the different sources of social capital that can support carers of patients with AOF from the perspectives of stakeholders.MethodA descriptive qualitative study was conducted in community settings from April 2021 to May 2022. Stakeholders from medical social work departments, self-help groups, and non-governmental organizations were recruited, while some community members were invited through online media platforms. Individual semi-structured interviews were conducted using an interview guide. Interview transcripts were analyzed using a qualitative description approach. In total, 98 stakeholders, including 25 carers, 25 patients, 24 professionals, and 24 community members, were recruited using purposive and snowball sampling.ResultsSix categories about social capital for carers emerged, namely, carer attributes, the community, social care services, healthcare services, information, and policies. While the attributes of carers and their relationships with care recipients had a significant influence on caregiving, support from different groups in the community, such as neighbors and employers, was valued. Good communication of information about caregiving and social services was emphasized as being helpful by carers and other stakeholders. While carers presented a need for various healthcare and social care services, several features of these services, including their person-centeredness and proactive reach, were deemed useful. At the societal level, policies and research on comprehensive supportive services are warranted. The different sources of social capital constitute a multi-layer support system in the community.ConclusionCarers can utilize personal attributes, interpersonal relationships, community resources, and societal contexts to enhance their caregiving. While this system can serve as a framework for building carer-friendly communities, interventions may be required to strengthen some aspects of social capital.

Effectiveness of Advanced Organizer Learning Strategies on the Achievement of Fiqh with Varied Cognitive Styles

This study aimed to ascertain the treatment variable's primary influence and interaction effect on learning achievement in the Fiqh course. This study used a quasi-experimental approach, namely the nonequivalent control group design. The participants of the study were divided into two classes, namely Class A and Class B. A random process is conducted in the selection of the study subject class. In contrast, allocating students within each class is considered a fixed entity (intact group) that cannot be altered. The gathered data underwent statistical inference processing utilizing the two-lane 2x2 variant analysis technique. The findings indicated significant variations in learning outcomes in Fiqh courses between two groups of students instructed using different advanced organizer strategies, namely mind maps and concept maps. Additionally, no significant disparity in student achievement in Fiqh courses was observed between students with field dependence and field independence cognitive styles. Furthermore, no interaction effect was found between the learning strategies of advanced organizer types (mind maps and concept maps) and field dependence and field independence cognitive styles on learning achievement in Fiqh courses. The descriptive statistics analysis indicates that implementing the mind map advance organizer strategy (mean 78.59) exhibits a higher level of effectiveness than the concept map advance organizer strategy (mean 67.61) in enhancing student academic performance. It can be inferred that the advanced organizer technique known as the mind map type is consistently more effective than the concept map type, irrespective of variations in cognitive styles. In essence, using mind maps as an advanced organizer by students renders the consideration of cognitive style unnecessary, as it does not exert a differential impact on enhancing academic performance.

Quality of Life and Sexual Function after Laparoscopic Posterior Vaginal Plication Plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse.

Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for women with apical/anterior pelvic organ prolapse (POP). For isolated posterior vaginal prolapse, instead, the literature suggests fascial native tissue repair. This is a retrospective 2-year quality-of-life follow-up study after laparoscopic posterior plication (LPP) combined with LSC in patients with anterior/apical prolapse combined with severe posterior colpocele. The primary endpoint was to evaluate the subjective outcomes quality of life (QoL), sexual function, and patient satisfaction rate. The secondary endpoint was to evaluate perioperative and anatomical outcomes at the 2-year follow-up. A total of 139 consecutive patients with anterior and/or apical prolapse (POP-Q stage ≥ II) and severe posterior vaginal prolapse (posterior POP-Q stage ≥ III) were retrospectively selected from our database among women who underwent, from November 2018 to February 2021, a "two-meshes" LSC. The patients were classified into Group A (81 patients; LSC plus LPP) and Group B (67 patients; LSC alone). The primary endpoint was evaluated using the Patient Global Impression of Improvement (PGI-I), the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the Female Sexual Distress Scale (FSDS), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol (EQ-5D). The secondary endpoint was studied using the POP-Q study and an intra-, peri-, and post-operative complications assessment. Two-year follow-up data were analyzed for the study. At 2 years, all women showed a statistically significant amelioration of their symptoms on the QoL questionnaires. We found a statistical difference in favor of posterior plication in terms of the PGI-I successful outcome rate (Group A versus B: 85.3% versus 67.1%), FSDS (median 11 versus 21), and PISQ-12 (median 89 versus 62) (p < 0.05 for all comparisons). A significant improvement of all EQ-5D values was observed from baseline to 2-year follow-up, and only for the "pain/discomfort" domains did we observe a significant improvement in LSC plus LPP patients versus LSC alone (p < 0.05). LSC plus LPP women showed, at 2 years, a significant amelioration of their Ap and GH POP-Q points. We observed no statistical differences in terms of intra-post-operative complications or anatomic failure rate between groups. Our LPP approach to LSC appears to be a safe, feasible, and effective treatment for advanced pelvic organ prolapse with a significant impact on the patient's general health and sexual quality of life. Adding laparoscopic posterior vaginal plication to "two-meshes" sacral colpopexy is recommended in patients with apical/anterior prolapse and concomitant severe posterior colpocele. This surgical approach, in addition to improving the anatomical results of these patients, is associated with a significant improvement in sexual and quality of life indexes.

Overcoming barriers and stigma: new frontiers in solid organ transplantation for people with HIV.

There is a growing need for solid organ transplantation (SOT) for people living with human immunodeficiency virus (HIV). With the advent of antiretroviral therapy, people living with HIV are experiencing increased life expectancies and are, therefore, developing more comorbidities, including end-stage organ disease. In cases of advanced organ failure, SOT is often the best therapeutic option to improve quality of life and overall survival. As organ shortages persist, transplantation of organs from donors with HIV to recipients with HIV has become a potential therapeutic option. This article first reviews the current state of organ transplantation from donors without HIV to recipients with HIV (HIV D-/R+) by organ and discusses key lessons learned from these transplant trials, including those about drug-drug interactions, rejection, and opportunistic infections. It then explores transplantation from donors with HIV to recipients with HIV (HIV D+/R+), a new frontier. Finally, it investigates challenges of implementation, including public awareness and regulatory requirements, and explores future directions for SOT in people living with HIV.

Uncontrolled organ donation after out-of-hospital cardiac arrest. Literature review

Organ transplantation is the best therapy for terminal and irreversible organ failure. The global development of organ transplantation as a type of medical care is inextricably linked to the establishment of neurological criteria for declaring human death (brain death). In the early evolutionary period of transplantation, organs were used, mainly kidneys, obtained from donors whose death was ascertained in accordance with the generally accepted criteria of cessation of blood circulation and respiration. As this type of organ donation developed, numerous terms were used in the world literature to designate it, such as ‘asystolic donors’, ‘non-heart beating donors’, ‘donors after cardiac death’, etc. In Russia, there is an established practice of dealing with donors after cardiac death (DCD), but the active development of Russian transplantology in the last 20 years is primarily associated with brain-dead organ donation. However, countries with the most active and advanced organ donation practices have in recent years been successfully dealing with donors who have suffered sudden out-of-hospital cardiac arrest (OHCA). Previously, this type of donation was considered inaccessible due to the unacceptable warm ischemia time and consequently severe damage to donor organs. Due to the development of new technologies in emergency medical care, it became possible to transport a patient with clinical death that occurred in an outof-hospital setting, to the hospital, while providing cardiopulmonary resuscitation by means of automatic chest compression and artificial ventilation. The article presents historical aspects of donation after cardiac death, and the most actualized definitions and practices of dealing with such donors.

Advance Organizer Learning Model to Improve Critical Thinking Skills

This classroom action research aims to improve students' critical thinking skills in class V at UPTD SDI Osmok Kupang for the 2022/2023 academic year through the application of the Advance Organizer learning model. The subjects of this research were 16 students class V of UPTD SDI Osmok Kupang. Data collection techniques use tests and observations. The results of this research show that the percentage of cycle I teacher activity at meetings I and II was 58.75% and the activity of cycle I students at meetings I and II was 55,00%. In cycle II, teacher activity at meetings I and II increased with a percentage of 98.12% and for students in cycle II meetings I and II with a percentage of 96.90%. Apart from that, the results of the critical thinking ability test of students from cycle I to cycle II also increased with the percentage of posttests completed in the cycle, namely 37.50% with an average of 53.43% and in cycle II with a percentage of 93.75% with an average of an average of 86.25% completed in the very good category.

TEORI BELAJAR KOGNITIVISTIK DAN IMPLIKASINYA DALAM PROSES PEMBELAJARAN DI SEKOLAH DASAR

Learning theory will make it easier for educators to carry out the form of learning that will be carried out. This article will review the theory of cognitive learning and will provide a complete understanding and explanation so that it can be applied in learning activities. This research is a literature study research, where in this research the writer tries to collect data related to the theory put forward by Ausubel and Gagne and then analyzes how the theory of the two figures is applied in learning in elementary schools. The results of this study are the first cognitive theory developed by Ausubel in his theory which states that cognitive processes are advanced organizers (initial arrangements), progressive differentiation, reconciliation reconciliation (integrative reconciliation), consolidation. Meanwhile, Gagne said that cognitive processes are through receptors, sensory registers, short-term memory, long-term memory, and response generators. In the learning process in elementary schools, cognitive theory is more directed and adapted to the age of students.

Curability of Light Chain (AL) Amyloidosis with Conventional Dose Regimens

Novel immunotherapies in AL amyloidosis (AL) are associated with improved outcomes while the use of ASCT in selected patients can offer long term remissions. Since the plasma cell clones are usually small or modest, sustained hematologic remissions are not uncommon in AL amyloidosis; however, the “curability” of the disease remains to be demonstrated: even in patients (pts) who achieve deep and sustained hematologic responses, irreversible organ damage can lead to inferior survival. To identify clinical and disease characteristics that are associated with potential “functional cure” (“cure”) of the disease we analyzed a cohort of patients with AL treated without ASCT and with a follow up of at least 5 years. We defined“ ”cure“ as survival of at least 5 years without hematologic disease progression (PD) and without need for any salvage therapy. The analysis included consecutive pts with AL, treated in the Department of Clinical Therapeutics, Athens Greece, diagnosed until 6/2018; pts who survived &amp;lt; 6 months were excluded to adjust for early mortality associated with severe cardiac involvement. The final cohort included 210 pts and we focused on pts who: had not had hematologic PD, had not received any salvage therapy, were still alive or had died from causes not related to AL. These pts were defined as “functionally cured” while the rest as “non-cured”. Among the “cured” we identified a group of pts that despite hematologic response they progressed to end-stage renal disease. We considered that this was “predetermined” due to the advanced organ damage already at diagnosis. Lastly, we compared the outcome of “cured” pts with the outcome of “non-cured” pts who were on CR/VGPR and had ≥1-year or ≥5-year OS. The rate of “curability” was 17% (N=35). “Cured” pts had more often renal (84% vs 61%, p=0.045) and less frequent cardiac involvement (53% vs 62%, p=0.049), lower BM infiltration (8% vs 15%, p&amp;lt;0.001) and lower baseline dFLC (p=0.031) but higher levels of baseline proteinuria (p=0.031). The characteristics as well as the differences between “cured” and “non-cured” pts, are shown in Table 1. Most “cured” pts received bortezomib-based therapies (27 pts, 77%), oral melphalan was given in 4 pts (11%), while in 15 pts (42%) treatment also included lenalidomide and in 7 (20%) daratumumab (with or without bortezomib). Regarding hematologic response, 33 (94%) “cured” pts had achieved ≥ VGPR (CR: 22, VGPR: 11) vs 46% for “non-cured” (p&amp;lt;0.001), 18 pts (51%) had ≥ VGPR with low dFLC response criteria (dFLC &amp;lt;10mg/L) vs 20% (p&amp;lt;0.001); 6 pts (17%) had only low dFLC VGPR and 4 (11%) were not evaluable for response due to low dFLC levels. At 1- and 3-months from start of therapy, 24 (68%) and 27 pts (77%) “cured” pts had achieved ≥VGPR. MRD evaluation was available in 19 “cured” pts, and 11 (31%) were MRD negative (vs 3 (2%) for “non-cured” pts, p&amp;lt;0.001). Cardiac response was observed in 9 pts (25%) and renal response in 18 “cured” pts (51%). Among “cured” pts there was a group of 7 pts (20%) with end-stage renal disease; 1 (2.8%) was already on dialysis at the time of diagnosis, while 6 (17%) initiated dialysis during disease course, despite deep hematologic responses (3 CR, 3 VGPR); 3 pts were renal stage 2 and 3 were renal stage 3. Median time to dialysis was 27 months. Baseline clinical and disease characteristics were comparable among pts with and without end-stage renal disease. The median follow-up of the whole cohort was 88 months, and among “cured” pts, 3 (8.5%) died from causes unrelated to AL amyloidosis. The 7- year OS rate for “cured” pts was 100% and for “non-cured” was 41%, respectively. In 1- and 5-year landmark survival analysis, “cured” pts had significantly superior outcome compared to “non-cured” pts with CR/VGPR, with median OS not reached vs 66 months (p&amp;lt;0.001) and not reached vs 98 months (p=0.014), respectively (Fig 1). In conclusion, a subgroup of pts with AL, not treated with ASCT, can have long-term survival (≥ 5 years) without need for additional or salvage therapy. Such patients could be considered as functionally “cured”. High rates of rapid and deep hematologic responses, relatively high rates of MRD negativity and relatively low tumor and free light chain burden characterize this subset, further emphasizing the need for early diagnosis and active therapy to maximize clonal responses. Thus, “curability” in AL amyloidosis is feasible, especially in the era of novel therapies.

IMPELEMENTASI MODEL PEMBELAJARAN ADVANCE ORGANIZER DALAM PENDIDIKAN AGAMA ISLAM

The existing teaching and learning process determines success in achieving educational goals, as well as in Islamic education. The process of such change is influenced by two factors, among them internal factors and external factors. Internal factors include physiological aspects and psychological aspects and external factors, one of which is the learning model. One of the good learning models that can be applied to the teaching and learning process is the advanced organizer learning model. This study aims to explore the specifics of the advanced organizer learning model that can also be used in learning Islamic education. This research is literature research, which is analyzed using the method of description, interpretation, and data analysis. The discussion in this study includes the understanding of the advanced organizer learning model, its forms and objectives, steps, and advantages and disadvantages. The results showed that this model is a learning model that emphasizes the importance of strengthening students' initial knowledge as a preparation effort to receive new material. There are two forms, namely: Expository Advance Organizer and Comparative Advance Organizer. The model has four objectives, and three Step phases. This model also has some advantages as well as disadvantages.

Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up

Background and purposeWe present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. MethodsThis is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. ResultsObjective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. ConclusionThe UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.

Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors

Study ObjectiveTo determine the outcome of voiding function 1 year following Pelvic Reconstructive Surgery (PRS) in women with Bladder Outlet Obstruction (BOO). DesignRetrospective cohort study SettingTertiary Referral Hospital PatientsOne thousand eight hundred and ninety-four (1894) women underwent PRS for advanced Pelvic Organ Prolapse (POP) stage III-IV with urodynamic findings of BOO InterventionsPelvic Reconstructive Surgery MeasurementsThe primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic (UDS) testing at one year post-operatively. The secondary outcomes are to identify the different risk factors for persistence voiding dysfunction after 1 year after PRS. Main ResultsTotal of 431 women with POP-Q Stage III and IV, UDS of Qmax ≤15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have voiding dysfunction (VD) 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveals factors associated with post-operative VD are pre-operative MCC ≥500 ml and PVR ≥ 200ml. ConclusionVoiding Dysfunction may persist in women with BOO following PRS, particularly in those with pre-operative maximal cystometric capacity (MCC) of >500ml and post-void residual volume > 200ml.

Real-Word Analysis of Clinical Characteristics and Outcomes Among Elderly Patients (pts) with Multiple Myeloma (MM)

Multiple Myeloma (MM) occurs commonly among older adults and the median age at diagnosis is 70 years old. While modern MM therapeutic agents have increased overall survival (OS), the prognosis of elderly patients (pts) (defined as age &amp;gt;75 yo) has been trailing behind younger pts (age &amp;lt;65 yo). This gap has been ascribed to frailty. However, it is unknown if older MM pts have different disease biology compared with younger pts. The MMRF CoMMpass study is a longitudinal international, multicentric prospective study of 1143 pts with newly diagnosed MM. We interrogated this dataset to describe the disease characteristics and to identify prognostic factors for OS amongst pts. The MMRF CoMMpass IA19 dataset was used for all analyses. Pts were followed for a minimum of 8 years after diagnosis. One hundred forty-six patients were &amp;gt; 75 yo, referred to as the elderly patient group (EPG), (12.8% of the cohort). Patient and disease characteristics are described in Table 1. Overall, 59% are male, and 41% are female; 79.5% were white, and 18.5% were black. At presentation, 63% of pts have anemia, 15.1% have hypercalcemia, and 9.6% have renal insufficiency (defined as Cr&amp;gt;2mg/dL). The EPG more commonly presented with advanced staging (ISS III: 46.6% vs. 22.9%, p&amp;lt;0.001), anemia (63.0% vs. 52.6%, p&amp;lt;0.001), lower performance status (ECOG ≥2: 26% vs. 8.9% (p&amp;lt;0.001) compared to the &amp;lt;65 yo group. Regarding treatment, the EPG are more likely to receive only PI-based first-line treatment (45.2%), followed by PI/IMIDs-based combined therapy (36.3%). Only 10 elderly pts (6.9%) underwent high-dose melphalan and autologous stem cell transplant (ASCT). In terms of best overall response to any line of therapy, the EPG is much less likely to achieve deep responses (sCR or better: 22.2 vs. 3.5%, p &amp;lt; 0.001) and had worse OS compared to the &amp;lt;65 and 65-75 yo groups (47 months vs. NR vs. 80 months, respectively). The cause of death in the three age groups (disease progression vs. others was not statistically different, p=0.278). Notably, elderly pts who received triplet therapy versus double therapy at diagnosis have improved clinical outcomes with deeper responses (≥ sCR of 22.2 vs. 3.5%, p &amp;lt; 0.001) and increased median OS (47.6 months vs. 20.3 months, p &amp;lt; 0.001). We performed Cox regression analysis to evaluate prognostic factors for OS (Figure 1). Triplet therapy in the first line is associated with better OS (p=0.004). Conversely, decreased performance status (ECOG &amp;gt;1) and advanced ISS stage at presentation portend a worse prognosis (p=0.049 and p=0.044, respectively). Noteworthy, there is a higher attrition rate (defined as death or lost to follow-up) in the EPG. The attrition rate was 50.7% after first-line therapy, compared to 34.0% and 33.3% for the under 65 and 65-75 age groups, respectively (p&amp;lt;0.001). The attrition rate for elderly pts remained significantly higher after second and third-line therapies (p&amp;lt;0.001 and p=0.004, respectively). We analyzed if the clinical characteristics of the EPG differ based on race. We found that non- white patients were more likely to present with advanced stage (p=0.039) and target organ damage: anemia, p&amp;lt;0.001), hypercalcemia (p=0.046), and renal insufficiency (p&amp;lt;0.001). We did not find other differences in clinical characteristics, treatment received, attrition rates, and overall survival. In conclusion, our study adds to the knowledge that elderly pts are more likely to present with advanced disease and diminished functional status. They are less likely to receive combined PI/IMIDs therapy and ASCT as first-line treatment and to obtain deeper treatment responses. Moreover, our data showed high attrition rates in this population. These factors could result in the shorter overall survival seen in the elderly population and underscore the importance of prompt initiation of effective and safe therapies in the elderly population. Further clinical studies are needed to characterize disease heterogeneity better and to identify interventions to improve clinical outcomes of older adults with myeloma.

Percutaneous Transhepatic Biliary Drainage for Malignant Biliary Obstruction in Advanced Solid Organ Malignancy: Clinical Outcomes and a Perspective on Quality of Life

Background: Malignant obstructive jaundice is associated with a poor prognosis. Patients can undergo percutaneous transhepatic biliary drainage (PTBD), but the impact it has on quality of life is not well understood.Objective: To assess the potential impact of PTBD on quality of life in patients with obstructive jaundice from advanced malignancy using surrogate markers including complications, hospital length of stay, readmission, reintervention, and mortality. Methods: A retrospective analysis of a single-centre cohort of all patients with advanced solid organ malignancy undergoing PTBD between April 2020 and February 2022. Data was collected from electronic medical records.Results: Among the sixteen patients, abdominal pain and cholangitis were observed in 62.5% and 37.5% patients, respectively. Peritonitis, biliary leak, perihepatic abscess, and haemobilia occurred in individual cases. The median hospital length of stay post PTBD was nine days. The 30-day readmission rate for PTBD-related complications was 31.3% with a median of three total readmissions per patient. The 30-day reintervention rate was 62.5%. The 30-day all-cause mortality was 25% (95% CI:8.9-53.3), which included one procedure-related death. Conclusions: Quality of life in patients with obstructive jaundice from advanced solid organ malignancy undergoing PTBD can be adversely impacted due to the high risk of complications, reintervention, hospitalisation, and mortality. Thorough patient assessments are crucial in selecting appropriate candidates for PTBD.