International Federation Research Articles

Development and validation of the Continuing Professional Development Scale: A knowledge transfer perspective

Purpose: Professional groups and bodies for librarians and information professionals such as the Continuing Professional Development and Workplace Learning (CPDWL) Section of the International Federation of Library Associations and Institutions (IFLA) strongly encourage continuing professional development. The purpose of this study is to develop and validate a scale for measuring the effectiveness of continuing professional development (CPD) and knowledge transfer (KT) among information professionals. The study identifies four factors (CPD purposes, forms of CPD, effectiveness of CPD and KT, and factors affecting KT during CPD) to measure the effectiveness of CDP and KT practices. Design: The pilot instrument, based on the literature, was empirically validated by collecting data from 220 library professionals having at least five years of professional experience. Findings: The construct validity of the scale was verified through exploratory factor analysis (EFA). The scale reliability was further calculated through the Cronbach's alpha internal reliability coefficient. Consequently, a valid and reliable 72-item scale was developed to measure the effectiveness of CPD and KT among information professionals.

Comment on: International consensus position statement on the role of obesity management medications in the context of metabolic bariatric surgery: expert guideline by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

Comment on: International consensus position statement on the role of obesity management medications in the context of metabolic bariatric surgery: expert guideline by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

The expression and clinical significance of serum exosomal-long non-coding RNA DLEU1 in patients with cervical cancer

Background Accumulating evidence has demonstrated that the long non-coding RNA (lncRNA) lymphocytic leukaemia deletion gene 1 (DLEU1) is abnormally overexpressed in many cancer types, including cervical cancer (CC). However, the potential clinical significance of DLEU1 in serum exosomes of patients with CC remains unclear. Methods The expression of serum exosomal DLEU1 was detected by quantitative real-time polymerase chain reaction (qRT-PCR). A receiver operating characteristic (ROC) curve was plotted to evaluate the clinical diagnostic efficacy of DLEU1. The Kaplan–Meier survival curve and Cox proportional hazards model were used to assess the effect of DLEU1 on postoperative recurrence, metastasis and prognosis among patients with CC. Results Our research showed that DLEU1 expression in the serum exosomes of patients with CC was significantly upregulated compared to that in patients with cervical intraepithelial neoplasia (CIN) and healthy controls (HCs) (both p < .001). DLEU1 relative expression was significantly correlated with tumour size, cervical invasion depth, pathological grade, International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis among patients with CC (p < .01 all). The combined detection of DLEU1, carbohydrate antigen 125 (CA-125) and squamous cell carcinoma (SCC) exhibited significantly higher diagnostic efficiency (p < .01). Furthermore, the overall survival (OS) and disease-free survival (DFS) of CC patients in the high DLEU1 expression group were markedly lower than those in the low DLEU1 expression group (both p < .01). Cox univariate and multivariate regression analyses indicated that DLEU1 was an independent risk factor for postoperative recurrence and metastasis in CC patients. Conclusions Our findings suggest that serum exosome DLEU1 has certain clinical value for diagnosing, monitoring recurrence and metastasis, and evaluating CC prognosis.

Bone Marrow Inequality: The Importance of Exchanges in Cancer Education.

This article described an exchange program in Kenya, organized by the International Federation of Medical Students Associations at the University of Nairobi. The author, motivated by parallels between Kenya and Brazil, engaged with hematologic, pain management, and palliative care departments at Kenyatta National Hospital. Despite the global advancements in bone marrow transplant (BMT) procedures, Kenya has only recently begun to offer this treatment, with the first transplant occurring in 2022 at a private facility. The high cost of BMT, ranging from $20,000 to $30,000, limits access for most Kenyans, prompting wealthier patients to seek treatment abroad. The article highlights alarming cancer mortality rates in Kenya, exacerbated by disparities in healthcare access compared to Brazil's universal healthcare system. With a significant proportion of pediatric cancers being hematologic, the need for accessible BMT is urgent. The exchange program provided the author with insights into global oncologic health disparities and emphasized the necessity of improving medical training, increasing hospital resources, and securing support to enhance BMT access in Kenya and West Africa.

A Clinical Study to evaluate the therapeutic effect of Akulyaabdadi Kashaya in Madhumeha (Type-II Diabetes Mellitus)

Introduction: In 2024 approximately 540 million adults (20-70 years) are living with diabetes as per data of IDF (international diabetes Federation). WHO states that diabetes will be 7th leading cause of death by 2030. Ayurveda says Madhumeha is a variety of Vataja Parmeha where the patient passes the urine with sweetness and astringency. The main symptoms involved are Prabhoota Mootrata (excessive urination) and Avila-Mootrata (non-transparency of urine). The major cause of disease is sedentary lifestyle and indulgence in Kapha-Medakar Aahara along with Divaswapana (day sleeping), avoidance of any form of exercise, hence indicating Santarpanjanya origin of disease. Methods: Akulyaabdadi Kashaya, the first Kashaya mentioned in Pramehahara Kashayas if Sahasrayoga is taken for single blind clinical study on 30 patients and the efficacy is established post 30-days of treatment. Results: During the study, it was found that signs and symptoms like polyuria, turbidity in urine, polyphagia, excessive thirst, burning sensation and numbness in feet, weakness, excessive sweating and lassitude were significantly reduced and Akulyaabdadi Kashaya, the trial drug was found highly significant at 0.1% level with p- value &lt;0.001 to improve the FBS, PPBS, urine glucose (FUS &amp; PPUS) and establishes it as a good treatment of Diabetes as a long term drug.

Associations between MRI radiomic phenotypes and clinical outcomes in endometrial cancer: Implications for preoperative risk stratification.

This study aimed to investigate the correlation between imaging phenotypes of endometrial cancer (EC) and clinical, pathologic, and molecular characteristics, as well as disease-free survival (DFS). The clinical, pathologic, and molecular characteristics, along with MRI radiomics features, of 356 patients with EC were collected retrospectively. The patients were divided into 2 groups based on radiomics features using unsupervised machine learning. The obtained characteristics and DFS of patients were compared between the various imaging phenotypes. The lesions with deep myometrial invasion (DMI), lymphovascular space invasion (LVSI), cervical stromal invasion (CSI), lymph node metastasis, aggressive histologic type, advanced postoperative International Federation of Gynecology and Obstetrics (FIGO) stage, overexpression of p53, and absent expression of estrogen receptor or progesterone receptor were associated with poor DFS. Two clusters were identified and defined as imaging phenotype 1 and 2, respectively. Compared with phenotype 2, phenotype 1 exhibited a higher correlation with DMI (33.7 % vs 13.0 %), LVSI (23.8 % vs 9.2 %), CSI (16.3 % vs 3.8 %), aggressive histologic type (36.0 % vs 17.4 %), and advanced FIGO stage (IB or higher, 43.6 % vs 22.3 %) (p < 0.001). The incidence of p53 overexpression was higher in phenotype 1 than in phenotype 2 (20.2 % vs 8.5 %, p = 0.022). Survival analysis exhibited a higher risk of poor DFS in phenotype 1 than in phenotype 2 (log-rank p = 0.002). EC imaging phenotypes identified through MRI radiomics features were associated with pathologic, molecular characteristics, and DFS, suggesting potential for preoperative risk stratification.

Analysis of the effectiveness of laparoscopic myomectomy using a standardized technique

BACKGROUND: Uterine fibroids are a benign monoclonal tumor arising from myometrial smooth muscle cells and fibroblasts with the deposition of extracellular matrix components in response to vascular injury. Diagnosis of uterine fibroids is steadily growing every year due to the introduction of new and accessible research methods. At the moment, the preferred organ-preserving surgical method for treating uterine fibroids is laparoscopic myomectomy, which allows preserving reproductive function. Considering the high risk of intra- and postoperative bleeding during surgery, the development and use of blood-saving technologies remains relevant. This article contains results of the effectiveness of the surgical technique without performing the stage of vessel clipping, which involves assessing the volume of intraoperative blood loss and the duration of the operation. AIM: The aim of this study was to analyze the effectiveness of using a standardized technique of laparoscopic myomectomy without uterine artery clipping. MATERIALS AND METHODS: This study included 77 patients with symptomatic uterine fibroids who underwent surgical treatment in Gynecological Department I with Operating Unit, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott (St. Petersburg, Russia). Implying an assessment of the volume of intraoperative blood loss and the duration of the operation. RESULTS: The average number of removed myomatous nodes was 2.2 ± 1.2 (from 1 to 11). The size of the removed fibroids averaged 5.1 ± 1.8 cm in diameter. At the same time, the minimum size of the remote node was 1.5 cm, and the maximum size was 15 cm. Intramural [International Federation of Gynecology and Obstetrics (FIGO) types 3 and 4] localization of myomatous nodes was found in 30 (17.6%) cases, intramural subserosal (FIGO type 5) in 45 (26.4%) cases, subserosal (FIGO type 6) in 54 (31.7%) cases, subserosal pedunculated (FIGO type 7) in 30 (17.6%) cases, and intramural submucosal and submucosal forms (FIGO types 0–2) in ten (5.8 %) cases. The average intraoperative blood loss was 187.7 ± 16.71 ml, average hemoglobin level in the postoperative period was 117.1 ± 13.15 g/l, with an initial level of 126 ± 12.1 g/l. The average duration of the operation was 95 ± 30.3 minutes, and the average bed-day was 8 ± 1.5. CONCLUSIONS: The data obtained allow for drawing a reasonable conclusion about the effectiveness and safety of the standardized technique of laparoscopic myomectomy, developed in Gynecological Department I with Operating Unit, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott (Saint Petersburg, Russia), and for recommending its widespread use.

Entirely Exophytic HPV-associated Endocervical Adenocarcinoma: A Rare But Potentially Aggressive Neoplastic Phenomenon.

A subset of human papillomavirus (HPV)-associated endocervical adenocarcinoma (EA) displays exclusively exophytic growth, with or without a classic villoglandular appearance. Given that increased depth and extent of destructive stromal invasion are associated with poorer prognosis for HPV-associated EA, it is believed that exclusively exophytic tumors are associated with a relatively indolent clinical course. There is, however, a paucity of data regarding the behavior of these neoplasms. We assembled a cohort of 73 patients with entirely resected cervix-confined HPV-associated EA treated with primary operative therapy. The tumors were classified based on architecture and presence/extent of stromal invasion, and histopathologic parameters, including the International Federation of Gynecology and Obstetrics (FIGO) 2018 substage and lymphovascular invasion (LVI). Clinical outcomes including local recurrence, metastasis, and death were evaluated. Of 73 tumors, 4 (6%) demonstrated exclusively exophytic growth (0.4-2.2cm in maximal dimension). All lacked LVI as well as nodal involvement. None of the 4 patients with exclusively exophytic tumors received adjuvant therapy. Two of the 4 (50%), however, experienced recurrence and both patients eventually died of causes related to EA. Of the remaining 69 cases with a component of nonexophytic growth, <6% of patients experienced tumor recurrence. Our study has found that, in at least a subset of cases, exclusively exophytic HPV-associated EA is associated with adverse outcomes. Additional studies are needed to substantiate these findings and to identify additional features (pathologic, molecular, etc.) that may aid in identifying those patients who could benefit from more aggressive treatment.

The predictive value of miR-29b-2-5p on the prognosis of cervical cancer and its inhibitory effect on cervical cancer progression.

The poor prognosis of cervical cancer patients leads to an annual increase in mortality, while microRNAs are involved in various cancers, including cervical cancer. This study aimed to investigate the clinical value and possible effect of miR-29b-2-5p on the progression of cervical cancer. The expression level of miR-29b-2-5p in cervical cancer tissues and cells was analyzed by polymerase chain reaction. The Kaplan-Meier curve was used to evaluate the role of miR-29b-2-5p in cervical cancer prognosis. The independent prognostic factors of cervical cancer were explored by the multivariate Cox regression analysis. The effect of miR-29b-2-5p on the proliferation, migration, and invasion of cervical cancer cells was determined by in vitro cell experiments. A significantly downregulated miR-29b-2-5p expression was observed in cervical cancer tumor tissues and cervical cancer cells compared with the adjacent tumor tissues (tissues of the negative surgical margin) and H8 cells, respectively. Higher miR-29b-2-5p expression correlated with a better 5-year progression-free survival of cervical cancer. MiR-29b-2-5p was also associated with the indicators (tumor size, tumor differentiation, FIGO (International Federation of Gynecology and Obstetrics) stage, and invasion depth) of the progression of cervical cancer tumors. And miR-29b-2-5p, along with tumor size, tumor differentiation, FIGO stage, histology type, and invasion depth, were independent prognostic factors for poor cervical cancer prognosis. MiR-29b-2-5p showed a suppressive effect on the proliferation, migration, and invasion of cervical cancer cells. MiR-29b-2-5p was downregulated in cervical cancer tumor tissues and could serve as an independent prognostic factor for cervical cancer. The overexpressed miR-29b-2-5p could be considered a tumor suppressor to inhibit the progression of cervical cancer.

Intramural myomas and fertility: To operate or not?

Intramural uterine myomas are very common among women of reproductive age, but their impact on natural and assisted fertility remains controversial. Although international federation of gynecology and obstretrics type 3 myomas may have the most negative impact on receptivity, available data are still not convincing. Surgical removal of these myomas is encouraged when they are symptomatic, but myomectomy for fertility-only reasons cannot be offered in daily clinical practice before in vitro fertilization treatment, as data are still inconclusive. Moreover, myomectomy is strongly associated with short and long-term complications, some of which may also affect the fertility outcome. A better understanding of the association between intramural myomas and fertility may open up new perspectives for the individualized management of infertile women with uterine myomatous masses.

Premature adoption of adjuvant chemotherapy for locally advanced cervical carcinoma before the OUTBACK trial: cautionary tale on outcomes

ObjectiveThe aim of this study was to investigate the use and outcomes of adjuvant chemotherapy for patients with locally advanced cervical carcinoma receiving definitive chemoradiation.MethodsThe National Cancer Database was accessed,...

Construction and validation of prognostic models for young cervical cancer patients: age stratification based on restricted cubic splines

Cervical cancer (CC) ranks as the second highest cause of morbidity and mortality among young women; however, there are currently no age-specific definitions for young cervical cancer or prognostic models tailored to this demographic. Data on CC diagnosed between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Age stratification is based on the relationship between age and cancer-specific mortality, as demonstrated by restricted cubic spline analyses (RCS). Cox proportional hazards regression analyses were employed to identify independent prognostic factors in the young CC group. Two novel nomograms for this population were developed and validated using an external validation cohort obtained from a local hospital database, evaluated with concordance index (C-index) and calibration plots. Receiver operating characteristic (ROC) curves were utilized to compare the accuracy of the established models against the International Federation of Gynaecology and Obstetrics (FIGO) staging system (2018). A total of 27,658 patients from the SEER database were classified into three age groups (<36 years, 36-60 years, >60 years) based on RCS analyses, with 4,990, 16,922, and 5,746 patients in each group, respectively. The independent prognostic factors identified for young CC included stage, tumour size, grade, histologic type, and surgical intervention. The results of the C-index and calibration in both the training and validation sets confirmed that the two nomograms can accurately predict the occurrence and prognosis of young CC patients. The area under the curve (AUC) values indicated that these models demonstrated higher efficacy in predicting overall survival (OS) compared to the FIGO staging system (2018). These models could potentially serve as effective tools for clinicians to estimate the prognosis of young CC patients.

Delayed functional rescue of section of the flexor tendons of the last four (4) fingers at a gold miner in a Sahelian hospital in Niamey (Niger)

Introduction: Secondary reconstructions of flexor tendon section have become rare nowadays. We report the result of delayed functional rescue of a traumatic section of the hand flexor tendons in a young adult. Clinical case: This is a 20-year-old patient, admitted for inability to flex the last 4 fingers of the right hand. The interrogation revealed a history of open trauma to the hand from a stab dating back 3 months following a fight. The physical examination found a transverse scar located on the palmar aspect of the right hand measuring 6 cm in zone three (3) of Verdan. Exploration in the operating room revealed a complete section of the superficial and deep flexor tendons of the last four (4) fingers. An end-to-end suture of the tendons was performed using Kessler stitches using Nylon thread 4.0. After one (1) year and eight (8) months of follow up, we found an excellent result according to the IFSSH (International Federation of Societies for Surgery of the Hand) classification with a score of 88/100. Conclusion: Secondary repair of late flexor tendon ruptures by end-to-end suture gives good results and remains an alternative when a tendon graft is impossible. Keywords: Secondary suture, Flexor tendons, Hand, Niger.

International consensus position statement on the role of obesity management medications in the context of metabolic bariatric surgery: expert guideline by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).

International consensus position statement on the role of obesity management medications in the context of metabolic bariatric surgery: expert guideline by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).

The Seismic Station IO.EVN at Pyramid EvK2cnr (Everest): 10 Yr of Activity

Abstract This article presents an overview of the first 10 yr of activity of the IO.EVN seismographic broadband station, managed by the Istituto Nazionale di Oceanografia e di Geofisica Sperimentale - OGS and installed near the Observatory-Laboratory Pyramid, about 6 km from Everest Base Camp (Nepal) at 5000 m above sea level. The IO.EVN station is registered in the International Federation of Digital Seismograph Networks (FDSN; see Data and Resources). It has been in operation since 2014 and played a crucial role during the 2015 crisis following the Gorkha earthquake because it was the closest broadband seismometer to the epicenter. The site is located in a remote area with ideal conditions for noise attenuation and is suitable for recording environmental microtremors and earthquakes in the Himalayas and worldwide. Khumbu Valley (Mount Everest) is one of the Himalayan regions that has not been struck by significant earthquakes (Mw &amp;gt; 7.8) in living memory. Although the analysis of microseismicity deserves further investigation, this article focuses more on the analysis of seismic noise, which was conducted to identify the various weather and climate phenomena affecting the region. In our case, we have found that for the major weather phenomena such as typhoons the main effect is due to the reflection of ocean waves on the coasts, whereas local effects such as rain and wind during the monsoon are more significant as the noise level of waves is probably constant throughout the year. The Pyramid is an important station for weather and climate, and the role of the IO.EVN could prove relevant in understanding climate change in the future.

Dedifferentiated endometrial carcinoma/undifferentiated endometrial carcinoma with loss of expression of SMARCA4: clinicopathological features analysis

Objective: To investigate the clinicopathological characteristics of dedifferentiated endometrial carcinoma/undifferentiated endometrial carcinoma (DDEC/UDEC) with loss of expression of SMARCA4. Methods: A total of 10 cases with loss of expression of SMARCA4 were diagnosed at Fujian Cancer Hospital between January 2019 and December 2023. A retrospective analysis was conducted on the clinical characteristics, morphology, immunophenotype, molecular classification, and prognosis. Results: (1) Clinical characteristics: among 10 cases of DDEC/UDEC with loss of expression of SMARCA4, the patients' age ranged from 48 to 65 years, with a median age of 56 years.Five cases were classified as International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ-Ⅱ, while the remaining five were categorized as stages Ⅲ-Ⅳ. (2) Pathological features: tumor cells exhibited poor cell adhesion, with common intravascular tumor emboli (8/10), occasional vacuolated nuclei (6/10), rhabdoid cells (4/10), and starry sky phenomenon formed by tissue cell phagocytosis apoptosis bodies or fragments (4/10). Six cases (6/10) showed loss of mismatch repair (MMR) protein expression, two cases (2/10) exhibited p53 mutant expression, and five cases (5/10) tested positive for programmed cell death ligand 1 (PD-L1). (3) Molecular subtyping: molecular subtyping revealed POLEmut in 1 case (1/10), mismatch repair deficient (MMR-d) in 5 cases (5/10), p53 abn in 1 case (1/10), and no specific molecular profile (NSMP) in 3 cases (3/10). (4) Prognosis: the follow-up period ranged from 7 to 42 months, with a median of 20 months. Five patients succumbed to the tumor, whereas the remaining five exhibited no recurrence during subsequent postoperative evaluations. The 2-year progression-free survival rates and overall survival rates were 58.3% and 52.5%, respectively. Conclusions: Loss of expression of SMARCA4 occurs in approximately 1/5 of DDEC/UDEC, which presents with an aggressive clinical course and a poor prognosis. About half of them show MMR protein loss expression and PD-L1 positive expression, suggesting that there might be benefit from treatment with immune checkpoint inhibitors.

Predictive impact of clinical factors on chemosensitivity in advanced high-grade serous ovarian carcinoma according to chemotherapy response score

The use of neoadjuvant chemotherapy (NAC) as a first-line therapy for advanced high-grade serous ovarian carcinoma (HGSOC) has increased. However, several studies have reported NAC-induced platinum resistance. This study aimed to evaluate the predictive impact of clinical factors on chemotherapy response score (CRS) and to select patients who would respond well to NAC. This multicenter retrospective (study included patients treated between January 2016 and December 2021). International Federation of Gynecology and Obstetrics stage IIIC and IV HGSOC patients were eligible. Institutionally strict complete resectability criteria were used in the present study. Pathological slides were scored according to the CRS criteria. Among 172 patients with HGSOC, 87 (50.6%) had stage IIIC disease and 85 (49.4%) had stage IV disease. And 35 (20.4%) had CRS1, 103 patients were CRS2 (59.9%), and 34 patients were CRS3 (19.7%). Compared with CRS1, simultaneous metastases to distant lymph nodes and solid organs confirmed by imaging were associated with a 75% reduction in CRS2 (odds ratio = 0.25; 95% confidence interval: 0.09–0.70; P = .008). And breast cancer susceptibility gene 1/2 mutation was positively (odds ratio = 8.41; 95% confidence interval: 2.25–31.52; P = .002) associated with CRS3 compared to CRS1. Patients with CRS3 had significantly longer progression-free survival (PFS), with median PFS of 9.8, 14.8, and 27.0 months for CRS of 1, 2, and 3, respectively (P &lt; .001). Overall survival was also prolonged in patients with CRS3 (P &lt; .001). Germline breast cancer susceptibility gene 1/2 mutation was a predictor of CRS3 and a good prognostic factor for the survival rate. Simultaneous metastasis to distant lymph nodes and solid organs is a predictor of CRS1. CRS inversely correlated with PFS and overall survival.

Development of a nomogram based on whole-tumor multiparametric MRI histogram analysis to predict deep myometrial invasion in stage I endometrioid endometrial carcinoma preoperatively.

The depth of myometrial invasion determines whether International Federation of Gynecology and Obstetrics stage I endometrioid endometrial carcinoma (EEC) patients undergo lymph node dissection. However, subjective evaluation results relying on magnetic resonance imaging (MRI) are not always satisfactory. To develop a nomogram based on whole-volume tumor MRI histogram parameters to preoperatively predict deep myometrial invasion (DMI) in patients with stage I EEC. This retrospective analysis included 131 EEC patients and a training/validation cohort of 92/39 patients at a 7:3 ratio. The histogram parameters were obtained from multiple sequences (ADC mapping and T2-weighted imaging) within volumes of interest. Univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression were used for feature selection. The performance of clinical model, histogram model, and histogram nomogram was evaluated by calculating the area under the receiver operating characteristic curve (AUC). Age and two morphological features (maximum anteroposterior tumor diameter on sagittal T2-weighted images [APsag] and the tumor area ratio [TAR]) were selected to construct the clinical model. Five histogram parameters were selected for the creation of the histogram model. The nomogram, which combines the histogram parameters, age, APsag, and TAR, achieved the highest AUCs in both the training and validation cohorts (nomogram vs. histogram vs. clinical model: 0.973 vs. 0.871 vs. 0.934 [training] and 0.972 vs. 0.870 vs. 0.928 [validation]). The MR histogram nomogram can help predict the DMI of patients with stage I EEC preoperatively, assisting physicians in the development of personalized treatment strategies.

Molecular classification of endometrial cancer: Impact on adjuvant treatment planning

Objective: The traditional histopathological analysis of endometrial cancer (EC) is the main risk group classification tool (low, intermediate, high-intermediate, and high) for the implementation of adjuvant treatment. The International Federation of Gynecology and Obstetrics staging system of EC has incorporated a new molecular classification that serves as a new triage tool for optimal treatment planning for these patients. Our study aimed to investigate the prognostic role of the new molecular classification in EC. Material and Methods: A prospective study was conducted in the 1st Department of Obstetrics and Gynecology from January 1, 2022, to March 30, 2024, and included all new EC cases that presented the multidisciplinary tumor (MDT) board after surgery. We considered the traditional pathologic analysis and new molecular classification after performing tests on microsatellite instability (MSI), DNA polymerase epsilon (POLE) mutation, and p53 immunohistochemistry testing. Results: The study included 65 patients with presumed early endometrial. All patients underwent surgery and subsequent molecular testing. Among the patients, 35 (54%) had a “positive” result in all of the three markers of molecular classification: 14 patients presented with MSI-H, 5 with POLE gene mutation, and 17 with p53 abnormal expression. One case of multiple classifiers was presented. After the integration of molecular classification, a change was observed in the final MDT board decision in 23 cases (35.4%), including six cases of overtreatment and 17 cases of undertreatment, with statistical significance (P = 0.03469). Conclusion: The data suggest that the new molecular classification, that is, testing for POLE mutation, MSI, and p53 mutation and for endometrial carcinoma, is a valuable tool for the recurrence risk prognosis and improved planning of adjuvant treatment for EC.

MGB-OAGB International Club-Results of a Modified Delphi Consensus on Controversies in OAGB.

One anastomosis gastric bypass (OAGB) presently constitutes 7.6% of all metabolic and bariatric surgery (MBS) procedures globally. Despite being approved by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) as a standalone MBS procedure and two consensus efforts in the past, multiple areas of controversies remain. This consensus builds upon previous consensus efforts to address unresolved controversies in the field. A modified Delphi consensus exercise was conducted over 4weeks under the aegis of the MGB-OAGB International Club. A panel of 86 bariatric experts from 25 countries participated in 3 rounds of voting on 29 questions on patient selection, technical standardization, revisional surgeries, and post-operative care. Consensus was defined as at least 70% agreement. Consensus was achieved on 22 out of 29 questions. Key areas of agreement included suitability of OAGB for adolescents above the age of 15years and patients with class 1 obesity with uncontrolled type 2 diabetes. Patients with severe esophagitis and Barrett's esophagus were not considered as good candidates for OAGB. Crural repair with OAGB was considered as an appropriate procedure in patients with large hiatus hernia. While a bilio-pancreatic limb (BPL) length of 150 - 200cm was deemed suitable, it was recommended to tailor the BPL length to prevent protein energy malnutrition. It was also agreed to routinely administer ursodeoxycholic acid and proton-pump inhibitors for 6months post-operatively. This modified Delphi consensus represents a critical step forward in addressing the controversies surrounding OAGB. It also emphasizes on the importance of individualized patient care and the need for ongoing research to refine surgical practices and improve outcomes.