BackgroundStaged palliation of hypoplastic left heart syndrome and variants begins with the Norwood or hybrid procedure. Hybrid palliation is used in a minority of cases and often reserved for high‐risk patients. Stented hybrid (SH) comprises bilateral pulmonary artery bands and ductal stenting, and medical hybrid (MH) comprises bilateral pulmonary artery bands and prostaglandins. MH use and outcomes have not been well described. We sought to compare MH, SH, and surgical stage 1 (SS1) using a national database.MethodsPatients from the National Pediatric Cardiology Quality Improvement Collaborative database born between 2016 and 2021 were categorized by initial intervention: MH, SH, or SS1. Statistical comparisons and Kaplan–Meier analysis were performed.ResultsThis study included 2423 patients from 65 centers: 277 (11%) MH, 133 (5%) SH, and 2013 (83%) SS1. MH had lowest birth weight and gestational age, most noncardiac anomalies, and most preoperative risk factors. Most centers had minority MH, though use ranged from 0% to 82% at centers with ≥10 patients. Transplant‐free 1‐year survival was MH 56%, SH 66%, and SS1 81% (P<0.0001). Using multivariable logistic regression, predictors of MH versus SS1 were lower birth weight, lower gestational age, genetic syndrome, noncardiac anomaly, and ≥4/12 preoperative risk factors. Predictors of MH versus SH were hypoplastic left heart syndrome and ≥4/12 preoperative risk factors. Cox proportional hazards regression showed MH had higher adjusted risk of 1‐year mortality/transplant compared with SS1 (hazard ratio [HR], 1.86 [95% CI, 1.44–2.39]) and no difference compared with SH (HR, 1.20 [95% CI, 0.84–1.70]).ConclusionsSurvival after MH is similar to SH and worse than SS1. This may be due to patient risk factors not controlled for in this study.

BackgroundPrimary small bowel cancer (SBC) is an infrequent tumor recognized internationally, but lacks prognostic prediction models. This study aims to develop and validate prognostic nomograms for overall and specific mortality in SBC patients based on a cohort of SBC patients.MethodsPatients with SBC between 2010 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were randomized into training and verification sets at a ratio of 7:3. Univariate and multivariate analyses were performed using Cox proportional hazards and competing risk models to screen independent predictors for overall and specific mortality in these patients. Based on these predictors, nomograms were constructed to predict the risks of overall and specific mortality in SBC patients. The accuracy and reliability of the nomograms were assessed utilizing the concordance index (C-index), area under the receiver operating characteristic curve (AUC), and calibration curve.ResultsThis study included 6,863 patients with SBC, who were randomly split into a training set (70%, N=4,804) and a verification set (30%, N=2,059). In the training set, there were 1,630 all-cause deaths and 1,057 cancer-specific deaths, while in the verification set, 708 patients died from all causes and 431 died from cancer-specific causes. Univariate and multivariate analyses identified 12 independent predictors for overall mortality, including age, race, marital status, primary tumor location, pathological type, histological grade, tumor (T) stage, node (N) stage, metastasis (M) stage, and surgical procedure. There were also 12 independent predictors for specific mortality, encompassing age, marital status, primary tumor location, pathological type, histological grade, T stage, N stage, M stage, surgical procedure, and radiotherapy. Based on these factors, Cox proportional hazards and competing risk models were established to predict overall and specific mortality at 1, 3, and 5 years for SBC patients. The calibration curves suggested that the predicted values of the models aligned with the observed values, indicating good accuracy of the models. In the training and verification groups, the C-index values for overall survival (OS) rate were 0.789 and 0.785, respectively, and for cancer-specific mortality were 0.878 and 0.851, respectively. The AUC values for predicting OS rate at 1, 3, and 5 years were 0.827, 0.803, and 0.787 in the training set and 0.794, 0.800, and 0.807 in the verification set, respectively. These results consistently indicate that the model has good discriminatory power and predictive performance.ConclusionsThis study constructed and validated risk predictive nomograms for overall and specific mortality risks in patients with primary SBC. These models are accurate and reliable and can assist clinicians in predicting survival rates in individuals with SBC.

Lung cancer is leading in death reasons among oncological diseases. Accurate mediastinal staging of the disease influences not only the prognosis of the disease, but also the strategy of complex antitumor treatment. Objective. To evaluate the clinical effectiveness of mediastinal staging using video-assisted mediastinal lymphadenectomy (VAMLA) in treatment planning for patients with resectable forms of non-small cell lung cancer. Material and methods. From august 2020 to March 2025 results and clinical efficiency of VAMLA were analyzed. 110 patients were included. The median age was 66 years, there was a male preponderance (90:20). Central cancer was detected in 33 (32.4%) patients. More than half of the patients (62.7%) had squamous cell cancer. Results. The median number of resected lymph nodes was 19. In 110 patients, 58 (52.7%) were restaged. 46 (41.8%) patients were down-staged, 12 (10.9%) patients were up-staged. False-positive results of PET-CT were diagnosed on 45.4% of patients, whom PET-CT was performed. False-negative results were diagnosed in 1.8% of these cases. After invasive staging, in 63 (57.2%) cases radical lung surgery was performed. 43 (39.1%) patients were treated by chemo-immunotherapy, in which 30 patients has already undergone radical surgery. Conclusion. VAMLA has the highest diagnostic accuracy among staging techniques, minimizing the rate of false-negative results and excluding multizonal N2 lymph node involvement. Optimizing indications for invasive mediastinal staging, considering individual risk factors, disease prognosis, and multimodal treatment strategies, requires further research and may eventually reduce unnecessary staging procedures. Indications for invasive staging should be based on a multidisciplinary team decision.

Rationale:Ovarian granulosa cell tumor is a rare sex cord-stromal malignancy (2%–5% of ovarian carcinomas). Its diagnosis and management become particularly challenging when this tumor is associated with pregnancy and complicated by intraoperative rupture.Patient concerns:A 40-year-old multiparous woman underwent emergency cesarean section for fetal distress at 39 weeks. A previously unidentified 2 cm left ovarian cyst was discovered and incidentally ruptured during cystectomy.Diagnoses:Histopathology analysis revealed the diffuse nests of monomorphic cells exhibiting nuclear grooves and Call-Exner bodies. Immunohistochemistry analysis was positive for FOXL2, inhibin, and vimentin, confirming adult granulosa cell tumor classified as International Federation of Gynecology and Obstetrics IC1.Interventions:Initial cystectomy was performed. The patient subsequently underwent a postpartum fertility-sparing, including laparoscopic staging procedure, which included left salpingo-oophorectomy and omentectomy; no residual disease was identified.Outcomes:No evidence of recurrence was detected during follow-up. The patient retained fertility potential and declined adjuvant therapy.Lessons:Systematic adnexal evaluation during cesarean sections is essential for detecting occult ovarian neoplasms, emphasizing the importance of multidisciplinary collaboration and accessible intraoperative frozen section analysis, particularly in resource-limited settings.

Background & aims:Hepaticojejunostomy (HJ) for portal biliopathy (PB) in extrahepatic portal venous obstruction is considered to be difficult and associated with major intraoperative bleeding due to the raised pressure in periportal collaterals. Upfront HJ is deemed unsafe and advocated to be a second stage procedure after a prior decompressive splenorenal shunt to reduce the pressure in the periportal veins. However, in some cases with dominant biliary presentation or if the shunt is not possible/ineffective, upfront HJ is an alternate. The study is done to assess the feasibility, complications and effectiveness of an upfront HJ in patients with PB.Methods:The outcome of HJ was analyzed in two groups of patients with PB. Group A had 11 (HJ after a prior decompressive splenorenal shunt) while group B had 9 patients (upfront HJ). The end points were the feasibility of the procedure, postoperative complications and long-term stricture rate.Results:The upfront HJ was feasible in 8/9 patients in group B with lesser duration of surgery (325.4 ± 167.3 vs 396.3 ± 147.8 min), blood loss (750 ± 775.4 vs 803.6 ± 787.1 mL) and blood transfusion (4.1 ± 1.9 vs 4.3 ± 3.13 units). It had lesser grade III and above complications. Biliary obstruction was relieved in 8/9 patients in group B with one intrahepatic biliary stricture.Conclusions:In patients of PB with dominant biliary presentation and non-shuntable vein, despite limitations, upfront HJ without a prior shunt, albeit a difficult procedure, is a feasible and an effective option with acceptable complications.

Background: Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in early-stage breast cancer. However, its necessity for some patient groups is being reevaluated. This change mainly arises from the procedure’s impact on quality of life and new evidence suggesting that some patients can forgo it without affecting their overall survival. Objective: This study focuses on the omission of SLNB in elderly patients aged 80 and older with HER2-positive (HER2+) or triple-negative breast cancer (TNBC) who are clinically node-negative (cN0), comparing outcomes to other relevant studies. Methods: In this retrospective study, we analyzed 39 cN0 women aged 80 and older (mean age at surgery 85.8) with HER2+ or TNBC treated between 2016 and 2024. We assessed overall survival (OS), disease-free survival (DFS), and locoregional recurrence without performing SLNB. We used Kaplan–Meier estimates and Cox proportional hazards models to evaluate survival outcomes by subtype, tumor size, and Ki-67 index. Results: The median OS was 3.9 years (95% confidence interval [CI]: 3.1 years, not estimable [NE]); the 5-year OS was 43.4% (95% CI: 25.3–74.6). The 5-year DFS was 37.7% (95% CI: 21.5–66.2). The median follow-up was 36.5 months (approximately 3.0 years). Five recurrences (12.8%) and two complications (5.1%) occurred. Patients with TNBC had a 5-year OS of 58.2% compared with 35.9% in those with HER2+ disease (p = 0.414). Patients with a low Ki-67 index (≤25%) had a 5-year OS of 78.6% compared with 25.9% in those with higher Ki-67 (p = 0.080). Tumor size ≥pT2 was associated with a worse prognosis. Conclusions: In carefully selected elderly patients with HER2+ or TNBC and no clinical nodal involvement, omitting SLNB was not linked to significantly lower survival rates. The observed numerical differences according to Ki-67 and tumor size suggest that surgical de-escalation may be feasible in selected elderly patients to limit complications without compromising oncological safety.

The article is devoted to substantiating the theoretical and methodological foundations and developing recommendations for the implementation of public-private partnership mechanisms as a key institutional and organisational mechanism for the post-war restoration of tourism infrastructure. Public-private partnerships are a key institutional and organisational mechanism for the post-war reconstruction of tourism infrastructure, as they ensure the attraction of critically needed private capital (including foreign investment), effective management competencies and enables the implementation of state socio-economic development tasks based on long-term cooperation and shared responsibility. The synergy effects of public-private partnership ensure the coordination of actions between the public and private sectors around the interests of consumers, which stimulates the development of the tourism industry by implementing an anti-entropy strategy through the inflow of investment and innovation. The implementation of public-private partnership projects in war-affected regions is burdened by a unique range of security, legal, financial and political risks. The choice of public-private partnership model depends on the areas in which the agreement is implemented. Models of public-private partnerships and mechanisms for their adaptation for post-war restoration of tourism infrastructure are disclosed. It is confirmed that the success of public-private partnership in the post-war restoration of Ukraine's tourism infrastructure critically depends on the state's ability to effectively assume or minimise risks that are atypical for commercial projects, which can be achieved through the introduction and use of relevant risk distribution and minimisation mechanisms (creation of a National Military Risk Insurance Fund; comprehensive insurance and risk distribution in contracts; administrative optimisation and implementation of a «Fast-Track» procedure for key stages of project implementation; use of escrow accounts to finance projects). Together, these mechanisms provide the necessary regulatory and financial guarantees, which are a prerequisite for attracting long-term investment in the reconstruction of tourism infrastructure.

Objective: In order to streamline patient care and optimize outcomes, we have undertaken a protocol for patients with cranial/intracranial tumors whereby coordinated resection and reconstruction are performed in a single stage procedure using a virtually planned craniotomy, guides, and implants. This represents an advanced interdisciplinary approach offering operative efficiency while avoiding many clinical and technical challenges. We present our experience and a 9-patient series using this method. Methods: Patients with cranial/intracranial tumors which would create a defect from extirpation or with inadequate bone following repeated craniotomies were evaluated by neurosurgery and craniofacial surgery teams. A virtual surgical planning (VSP) webinar was attended by both services, where extirpation and reconstruction were simultaneously planned. For resection cases, cranial CT images were superimposed with MRI to register precise tumor location in relation to bone anatomy. The virtually planned craniotomy position was transferred to the operating room with a custom cutting guide registered to the patient’s cranial contours. Finally, immediate reconstruction was performed using a custom 3D polyether ether ketone (PEEK) implant designed to extend precisely to the edges of the guided craniotomy. Results: Nine patients age 29 to 79 years old (mean = 55) underwent coordinated tumor extirpation and cranial reconstruction via our workflow. They were followed for 28 to 65 months (mean = 42.2). There were no intraoperative complications. One patient developed transient blurry vision which resolved. One patient with history of repeated meningioma removal developed recurrence. All patients have healed without long-term complications, and there have been no explants from these procedures. Conclusion: Our single-stage protocol for cranial tumor extirpation and cranial reconstruction, which includes collaborative preoperative consultation and VSP, is versatile and effective. The use of computer-generated cutting guides and custom implants obviates intraoperative improvisation and minimizes reoperation. Ultimately, this interdisciplinary approach improves the esthetic and functional results for patients, representing an advancement in cranial defect reconstruction.

Poultry production is affected by weather-related perils, disease outbreak, financial risk, market risk, and technological failure of the production. The study assesses the extent of poultry farmers’ participation in the Nigerian Agricultural Insurance Scheme in Kwara State, Nigeria. A 2-stage sampling procedure was used in selecting 600 respondents for the study. Data were collected using questionnaire and interview schedule and analyzed using both descriptive and inferential statistical tools. The mean age of the respondents is 49 years, household size of 6 persons, monthly income of N105,430.00. they rarely visit places for NAIS information (84.1%) as agreed by most (58.6%) of them with mean farming experience of 11 years and flock size of 1,050 birds. Majority are males (78.1%), Muslims (86.4%), with tertiary education (60.3%). Majority (58.6%) of the respondents shows low participation in NAIS program. They have high knowledge level (87.3%) of NAIS. The Chi-square analysis shows positive relationship between knowledge level and participation in NAIS (χ²= 34.313; p=0.000 @ 1% level of significance). There are several constraints to participation in NAIS except; poor knowledge (and inaccessibility to insurance personnel (=0.98), cultural influences ( =0.54), poor infrastructures ( =0.88) =0.67). It was concluded that the clienteles have more knowledge of NAIS but poor participation. It was recommended that all severe constraints to participation in NAIS be mitigated, more awareness campaign on NAIS be instituted on the benefits of NAIS utilization to increase participation of clienteles in the study area.

BackgroundUniportal robotic-assisted thoracic surgery (URATS) has been increasingly adopted in some centers; however, its global acceptance and clinical impact remain uncertain. This study compared the perioperative outcomes of URATS and multiportal robotic-assisted thoracic surgery (MRATS) pulmonary resections.MethodsEighteen patients who underwent URATS pulmonary resection between February 2023 and April 2024 were compared with 54 patients who underwent MRATS pulmonary resection between February 2016 and February 2023. Propensity score matching, incorporating age, sex, frailty index, clinical tumor size, nodal stage, operative side, prior treatment, and surgical procedure, was performed to reduce confounding. Perioperative outcomes were analyzed in 18 matched patient pairs.ResultsThe URATS group had significantly lower analgesic requirements intraoperatively (12.5 [10.5–13.1] vs. 19 [12.3–21.5] mg; P = 0.02) and on the operative day (1.0 [0–3.1] vs. 4.2 [2.0–6.3] mg; P = 0.005). They also had shorter intensive care unit stay (0 [0–0] vs. 1 [0–2] day; P = 0.03) and postoperative hospital stay (4 [2–7] vs. 7 [5–11] days; P = 0.003). However, the docking time was longer in the URATS group than in the MRATS group (11 [8–15] vs. 7 [5–8] min, P = 0.006).ConclusionURATS appears to be a feasible approach. Lower analgesic requirements in the immediate postoperative period and shorter hospital stays may indicate improved postoperative recovery compared with MRATS.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-025-03221-z.

Sentinel lymph node (SLN) biopsy is a diagnostic staging procedure in early-stage oral squamous cell carcinoma (OSCC). The conventional method using tracers labeled with 99mTc is limited by the’shine-through’ phenomenon, a situation where intense tracer uptake at the injection site obscures nearby lymph nodes, making them difficult to detect. This effect is particularly problematic in floor of mouth tumors, where the sentinel nodes are often located close to the primary tumor. Tracing lymphatic drainage of the tumor with superparamagnetic iron oxide nanoparticles (SPIO) in combination with magnetic resonance imaging (MRI) provides superior anatomical detail over the use of radioactive tracers, which may improve the detection of SLNs. This multicenter clinical trial aims to evaluate the diagnostic accuracy of a complete magnetic SLN biopsy procedure in early-stage OSCC. This prospective multicenter trial will enroll 82 patients with early-stage OSCC undergoing transoral resection and SLN biopsy. The complete magnetic SLN biopsy procedure includes peritumoral SPIO injection, preoperative SPIO-enhanced magnetic resonance (MR) lymphography, and intraoperative SLN detection by a magnetometer. Results will be compared to the conventional SLN biopsy using a [99mTc]Tc-nanocolloid tracer and indocyanine green. Sensitivity, negative predictive value (NPV), interobserver reliability, and patient perspectives will be assessed. A complete magnetic SLN biopsy may improve staging accuracy in OSCC by addressing radiotracer limitations and potentially reducing false-negative rates. This technique could potentially be expanded to other cancers, offering a radiation-free alternative to conventional SLN biopsy methods. This trial is approved by the Medical Research Ethical Committee NedMec (number: 2023/157) and registered in the Netherlands Trial Register (registration number: NL81165.041.22).

268 Background: De-escalation of breast cancer treatment in older adults with early-stage, hormone receptor-positive disease is supported by evidence showing reduced treatment burden without compromising outcomes. However, little is known about how often these strategies are discussed or implemented in racially and ethnically diverse populations. This study aimed to evaluate the frequency of de-escalation discussions and identify associated clinical factors. Methods: We conducted a retrospective chart review of women aged ≥65 with localized breast cancer treated at the University of Colorado system in 2024. Inclusion was limited to patients self-identifying as members of underrepresented racial or ethnic groups. Abstracted data included demographics, tumor characteristics, comorbidities, use of geriatric decision tools, and documentation of treatment de-escalation. The primary outcome was documentation of a de-escalation discussion, defined as provider-patient communication regarding potential omission of surgery, chemotherapy, radiation, or staging procedures. Logistic regression was used to identify predictors. Results: Fifty-nine patients met inclusion criteria. The mean age was 70.6 years (range 65–85), and median comorbidity count was 3 (range 1–10). Racial/ethnic distribution was 33% Hispanic, 22% Black, 11% Asian, 7% Native American, 8% mixed, and 10% other. Most tumors were Stage I (49%), hormone receptor-positive (92%), and HER2-negative (88%). Only 12% of patients had documentation of a geriatric assessment. Oncotype DX was used to guide therapy in 34% of cases. Axillary staging was omitted in 27% of HR+ patients, while radiation was omitted in 42% of patients with Stage I disease. Overall, 57% of patients had documented discussions about de-escalation with members of the multidisciplinary team (46% with radiation oncology, 29% with medical oncology, and 19% with surgical oncology). In univariate analysis, lower tumor stage (p = 0.03) and availability of Oncotype DX (p = 0.047) were associated with higher likelihood of discussion. Race and ethnicity were not significantly associated with the likelihood of de-escalation discussions (p &gt; 0.1). On multivariate analysis, only stage remained significant (OR 0.40, 95% CI 0.16–0.99, p = 0.04). Age and Oncotype availability were not statistically significant. Conclusions: De-escalation of breast cancer care is discussed in just over half of older adults from underrepresented racial and ethnic groups, mirroring rates seen in majority populations. Tumor stage was the key determinant of whether de-escalation was addressed. Greater integration of geriatric principles and structured shared decision-making could promote more equitable and individualized care.

Objective: to systematically analyze the data available in the modern literature on sentinel lymph node biopsy in breast cancer in various clinical situations. Material and Methods. The search was conducted in the Web of science, PubMed, scopus, Google scholar databases. A total of 213 sources devoted to sentinel lymph node biopsy in breast cancer were analyzed, of which 48 were included in the review. Results. Sentinel lymph node biopsy has been established as a standard procedure in early stages of breast cancer, demonstrating efficacy and safety in small tumors, intact lymph nodes and micrometastases. Currently, there is a clear trend toward expanding sentinel lymph node biopsy indications into more complex cases, including changes in lymph node status after neoadjuvant chemotherapy, multicentric cancer, and recurrent breast cancer. Studies are underway to evaluate the safety of sentinel lymph node biopsy during pregnancy, opening up new perspectives for the treatment of this vulnerable group of patients. Expanding the indications for sentinel lymph node biopsy will help avoid radical lymphadenectomy and its associated complications, such as postmastectomy syndrome. this, in turn, will significantly improve the quality of life of cancer patients by reducing postoperative morbidity and accelerating rehabilitation. Conclusion. Further study and implementation of expanded indications for sentinel lymph node biopsy is a promising direction in modern oncology aimed at optimizing treatment and maintaining the quality of life of patients.

Sentinel lymph node (SLN) biopsy is an essential procedure for accurate disease staging and treatment planning in patients with melanoma and breast cancer. Conventional preoperative imaging primarily utilizes lymphoscintigraphy with technetium-99m (Tc-99m), which presents several limitations, including radiation exposure, logistical challenges, and potential delays in surgical workflow. Photoacoustic imaging (PAI) has emerged as a promising alternative, leveraging optical contrast provided by indocyanine green (ICG). A feasibility study was conducted at Erasmus MC, University Medical Center Rotterdam, to assess the potential of dual-wavelength PAI for SLN mapping. PAI was employed to perform spectroscopic measurements in healthy volunteers, supporting the development of an optimal excitation protocol. Subsequently, in the patient phase, SLN mapping was performed using PAI with ICG, and the results were compared to the standard-of-care method utilizing Tc-99m. The excitation wavelengths of 800 nm and 860 nm were selected for ratiometric imaging to effectively visualize ICG while suppressing clutter from hemoglobin and melanin. Among the eleven evaluated sentinel nodes, seven were successfully identified using PAI. The maximum SLN detection depth achieved with PAI was 22 mm. This study illustrates the feasibility of ICG-enhanced dual-wavelength PAI for preoperative SLN mapping in patients with melanoma and breast cancer, as an alternative to lymphoscintigraphy. Analysis of false-negative detections suggests improvements to PAI and optimal patient selection. The proposed ratiometric PAI methodology, compared to multiwavelength spectroscopic imaging, enables faster imaging speeds and facilitates the transition to cheaper light sources.

Fertility Attitudes of Adolescents and Young Adults With Turner Syndrome and Their Parents/Guardians: A Pilot Cross-Sectional Survey Study.

Intravenous leiomyomatosis is a rare condition in which a smooth muscle tumor originates from the uterus and extends into the pelvic and systemic vasculature, frequently involving the inferior vena cava and the right atrium. Despite its benign histology, intravenous leiomyomatosis poses significant clinical challenges due to its potential to cause life-threatening complications. Conventional management involves a combined surgical approach: intracardiac tumor resection performed via sternotomy, with abdominal and pelvic tumor removal, including hysterectomy, conducted through laparotomy. Alternatively, an abdominal-only approach allows for complete tumor resection through inferior vena cava incision and hysterectomy without sternotomy. Surgical timing is an important consideration, with single-stage procedures addressing all tumor components in 1 operation, while 2-stage procedures separate cardiac and abdominal/pelvic resections into distinct surgeries to reduce risks in patients with extensive cardiac involvement or limited surgical tolerance. Post-operative management includes careful resumption of anti-coagulation for several months to prevent thromboembolic complications, particularly in patients with vascular involvement. Hormonal therapy, such as aromatase inhibitors, is considered for patients with residual disease. Advanced imaging techniques, including magnetic resonance imaging, computed tomography, and echocardiography, are essential in both preoperative planning and post-operative surveillance to ensure optimal surgical strategy and to help monitor for residual tumors. Multidisciplinary collaboration is crucial in the management of intravenous leiomyomatosis, ensuring a comprehensive approach that optimizes patient outcomes.

Barong Burutuk staging is one form of sacred tradition performed by the people of Trunyan Village to honor and glorify their supreme god called Ratu Sakti Pancering Jagat. The staging process requires a variety of communication, interaction, ethics and also special and distinctive tools and the same understanding in interpreting the tradition of barong burutuk dance. Intra-cultural communication is established in the barong brutuk dance performance through interaction between people who certainly have the same understanding of the values, norms, beliefs, and communication processes in the barong burutuk dance performance. This type of research is a qualitative research that describes and interprets the object of research in the field of Barong Burutuk dance performance in Truyan Village. Starting from the description of the discussion, it can be concluded that Barong Burutuk Dance is a sacred dance (wali) that is offered in the Full Moon Ceremony of kapat Lanang, sasih kapat where at that time it was a long dry season, so that efforts arose from Pakraman Truyan village to ask for natural fertility. The necessary equipment or means is a barong Brutuk dance costume made of Keraras, namely dried banana leaves, white clay powder, rice flour and fragrant oil. And the procedure for staging is staged at the peak of the ceremony precisely on the eighth and ninth days. Barong burutuk dance performance aims to build a more harmonious relationship between people and nature, one of which is to ask for fertility and maintain the tradition of local cultural values.

Abstract Background : Axillary lymph node dissection (ALND) has been part of the surgical treatment of Carcinoma breast. Recently, increasing number of early detections of breast cancer patients led to a reconsideration of the need for axillary dissection, as many of patients with carcinoma of the breast show no involvement of axillary lymph nodes. The dissection is carried out as a staging procedure, to rule out occult metastases. Sentinel node biopsy (SNB) has been introduced to avoid unnecessary axillary dissection. In contrary as a non-invasive modality is FDG-PET computed tomography scanner, a method which may be able to detect clinically occult metastases pre operatively. AIM &amp; OBJECTIVES: Comparison between SNB and FDG-PET to asses reliability in detecting occult axillary metastasis in clinically node negative Carcinoma breast patient. MATERIAL AND METHOD: 126 diagnosed breast cancer patients with clinically node negative, operated with mastectomy plus SNB were studied. All patients were pre operatively evaluated with 18-FDG-PET. All patients underwent sentinel lymphoscintigraphy. Patient with positive 18-FDG-PET, SNB underwent axillary dissection. Pre operative PET-CT result is compared with histopathology results of SNB and ALND. RESULTS: Out of 126, age group of 33 to 86 year. 45 had metastasis in axillary nodes. Sensitivity of FDG-PET for detection of axillary occult metastases was low (13.33%), although specificity was acceptable (91.36%) while Sensitivity of SLNB for detection of axillary occult metastases was high (73.33%), although specificity was very high (95.06%). Both FDG-PET and Sentinel Lymph Node Biopsy show correlation with histopathology in detecting loco-regional (axillary) lymph node metastasis in breast carcinoma. However, SLNB has much higher sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy compared to FDG-PET, indicating SLNB is a more reliable method for this detection. Conclusion : Conclusion of this study strongly supported by the statistical significance of both tests but favours SLNB as the superior diagnostic tool. As the specificity is high, sentinel lymph node biopsy can be avoided in FDG-PET positive for axillary metastasis breast carcinoma and straight away proceed with axillary lymph node detection. But as sensitivity is low, FDG-PET negative breast carcinoma patients shouldn’t exclude possibility of axillary metastasis and further should do SLNB to detect axillary occult metastases.

Liver transplantation may be a curative treatment option in patients with otherwise unresectable liver metastases. We sought to evaluate the long-term outcomes of transplantation candidates by comparing 2 groups: one treated with living-donor liver transplantation and the other, due to the absence of available living donors, receiving the current gold standard of chemotherapy only. Eligibility for inclusion of patients with unresectable liver metastases required either stable disease or tumor regression after systemic chemotherapy with no extrahepatic tumor burden. Patients were divided into 2 cohorts according to the availability of a suitable living donor. The fundamental technical principle is a 2-stage transplantation procedure, also referred to as the RAPID technique (Resection and Partial Liver Transplantation with Delayed Hepatectomy). In the first operation, a left hemihepatectomy is carried out in the recipient, followed by orthotopic transplantation of the left lateral liver lobe (segments II and III) from a living donor. To promote graft hypertrophy, portal vein ligation is undertaken. In the second step of the operation, the remaining right lobe of the liver will be removed. The 3-year and 5-year survival rates for the transplantation group were 71.3% and 57%, respectively, compared with 33.3% and 11.1%, respectively, for 15 patients with a negative donor evaluation. The recurrence rate among transplanted patients was 58%. The median disease-free survival time between liver transplantation and recurrence or death was 17.4 months. For those who experienced a recurrence, the median survival time from recurrence was 25.6 months. Liver transplantation for patients with unresectable colorectal liver metastases leads to a significant survival advantage compared with chemotherapy alone. Living-donor liver transplantation is a suitable and safe method to expand organ availability for selected patients.

Objective: This retrospective cohort study compares surgical outcomes among patients with endometrial carcinoma (EC) after the implementation of a robotic-assisted (RA) surgical program at a tertiary care center. Methods: A total of 122 EC patients who underwent surgery between March 2022 and February 2025 were included. Patients were divided into two cohorts based on the implementation of RA surgery: Group 1 (March 2022-August 2023) and Group 2 (September 2023-February 2025). Data collected included demographics, surgical approach, operative time, hospital stay, completion of staging procedures, and 30-day postoperative complications. Results: RA laparoscopy was used predominantly in Group 2, replacing conventional laparoscopy (CL). Laparotomy was significantly less frequent in group 2 (11.9% vs. 36.4%; p < 0.001). Among patients with FIGO stage I, all patients underwent minimally invasive surgery (MIS) in Cohort 2 (100% vs. 71.9%; p < 0.001). Median hospital stay was significantly shorter in Group 2 (3 days vs. 4 days; p < 0.001). A 30-day mortality occurred in one patient (n = 1) within the total study cohort (0.82%) and was attributed to pulmonary embolism on postoperative day 14 after RA laparoscopy. Rates of Grade ≥3 postoperative complications were similar (7.3% vs. 7.5%), as were wound complications (5.5% vs. 3%). The use of sentinel lymph node (SLN) mapping increased significantly in Group 2 (91% vs. 54.5%; p < 0.001). Completion staging procedures were significantly reduced in group 2 (9.1% vs. 0%; p = 0.017). Conclusions: The integration of RA laparoscopy significantly reduced laparotomy rates and hospital stays while increasing SLN mapping. These results support the continued adoption of RA laparoscopy to enhance MIS and improve patient outcomes.