Superior Aspect Research Articles

Orbital Septum in Lateral Canthus

ABSTRACT Purpose To disclose the precise attachment site of the orbital septum in the lateral canthus. Methods Nine specimens of 7 Japanese cadavers aged 66 to 85 years at death were included. The attachment site of the orbital septum in the lateral canthus was grossly dissected. Two of the 9 specimens were exenterated and used to explore the anatomy from lateral and superior aspects, respectively. Results The orbital septum in the lateral canthus attached slightly lateral to the outer edge of the lateral commissure with the levator aponeurosis and the lower eyelid retractors in the upper and lower regions, respectively. In addition, the orbital septum attached to the arcus marginalis with regard to the orbital bone. Fat tissue occupied the space between the orbital septum and the lateral retinaculum. Conclusion The orbital septum in the lateral canthus attached around the lateral commissure and the orbital rim.

Right ventricular outflow tract arrhythmias in patients with obstructive sleep apnea- electrophysiological insights

Abstract Background Obstructive sleep apnea (OSA) was associated with atrial fibrillation and heart failure. Furthermore, the arrhythmic sudden death during sleep in patients with OSA raises serious concerns. Non-ischemic ventricular arrhythmias arise frequently from the right ventricular outflow tract (RVOT). The involvement of obstructive sleep apnea in the genesis of arrhythmia (premature ventricular contraction or tachycardia) originating specifically in the RVOT is not yet coherently established. Purpose This study aims to demonstrate the possible relationship between untreated obstructive sleep apnea and the occurrence of RVOT arrhythmia and to follow the electrophysiological features and outcomes after radiofrequency catheter ablation (RFA) in patients carrying this double burden. Methods One-hundred-twelve (112) consecutive asymptomatic and symptomatic patients admitted with RVOT arrhythmia ((PVCs and VTs) underwent a sleep study (polysomnography). Apnea was set out as the cessation of breathing and hypopnea was defined as shallow, slow, and restricted breathing occurring in episodes of ten seconds or more. The patients had normal left and right ventricle ejection fractions and no structural cardiovascular disease or other known extracardiac arrhythmia predisposing conditions. No significantly elevated systolic pressure in the pulmonary artery was assessed at echocardiography. Every patient was investigated by electrophysiologic study (EPS) and RFA of the clinical ventricular arrhythmia was immediately performed. Practicing and former professional athletes were excluded. Results Seventy-eight (69 %) of the included patients had an apnea-hypopnea index > 10/h. The included patients had the following characteristics: mean age 52 ± 8 years, 62% males, 81% had a BMI >30kg/m². The cardiac electrophysiologic study did not induce sustained VTs. The distribution of the PVCs and non-sustained VTs evidenced a predilection for the superior, septal and anterior (68%) and also superior and anterolateral aspects of the RVOT (23%). Radiofrequency catheter ablation (RFA) guided by activation mapping, precocity (the site of earliest activation > 30 ms before the setting of the QRS complex) and pace-mapping were performed in all patients. Immediate success was obtained in 98 patients (88%). After a mean follow-up of 24± 6 months, 28 patients (28%) from the success arm had a recurrence of the PVCs or the non-sustained VTs, 22 patients (22%) with and 6 patients (6%) without sleep apnea. Conclusions RVOT arrhythmia genesis and relapse after successful RFA seem highly associated with sleep apnea. Furthermore, patients with sleep apnea are more prone to have recurrent arrhythmias after radiofrequency catheter ablation in the absence of appropriate control of OSA.

HEPATECTOMIA CONVENCIONAL EM DOIS ESTÁGIOS VERSUS ALPPS: UMA REVISÃO DE LITERATURA SOBRE O TRATAMENTO DE METÁSTASE HEPÁTICA COLORRETAL

This study compared the outcomes of two modalities of hepatectomies for the treatment of colorectal liver metastasis. The research is justified by the high morbidity and mortality associated with hepatic surgical interventions, as these require a delicate approach and intricate techniques, posing a challenge in the surgical field. The aim was to highlight the operative technique with greater efficacy, outlining its associated benefits and risks, in order to identify the definitively superior aspects within the literature among the analyzed modalities. The methodology involved a literature review of 46 articles, written in Portuguese and English, available in various databases from 2019 to 2024. The results indicated that ALPPS had limited advantages compared to HDE, demonstrating greater surgical efficacy, while the rates of perioperative complications and short-term outcomes were comparable between the two techniques, with no evidence of differences in reducing morbidity and mortality. Conversely, there were discrepancies in determining the overall survival rates between the two techniques, underscoring the need for further studies on the topic and the exploration of less invasive methods with lower rates of surgical morbidity and mortality.

Investigating the influence of various metakaolin combinations with different proportions of pond ash and Alccofine 1203 on ternary blended geopolymer concrete at ambient curing.

This paper explores the use of a ternary blended geopolymer concrete (TBGPC) incorporating metakaolin (MK), pond ash (PA), and Alccofine 1203 (AF). Three combinations of MK (25%, 50%, and 75%) with varying proportions of PA and AF were prepared, validating against M30 grade cement concrete (CC). TBGPC was prepared with an 8 molarity sodium hydroxide, sodium silicate to sodium hydroxide ratio of 2.0, liquid to binder ratio of 0.5, and an ambient curing mode. For CC, a water to cement ratio of 0.42 and water curing mode were adopted. The mechanical properties and durability behavior of TBGPC and CC specimens were evaluated through compressive strength, rapid chloride penetration test, permeability test, sorptivity test, and water absorption test. The M50P35A15 mix demonstrated remarkable compressive strength improvements, showing a 203% increase over the CC mix at 1day and 250% by 3days. This trend continued with a 155% increase at 7days, 68% at 28days, and 52% at 90days, consistently outperforming the CC mix. Additionally, microstructure characteristics of the M50P35A15 mix were analyzed through SEM studies, providing validation for the observed strength development. Notably, M50P35A15 mix demonstrated substantially higher early and later strength gain. This enhancement in strength was attributed to the gradual densification of the microstructure over time and the formation of additional NASH and CASH gel in M50P35A15 mix. At 28days, the M50P35A15 mix exhibited excellent durability characteristics, with a Coulomb value of 1008, permeability of 10mm, sorptivity of 0.45mm/√min × 10-4, and water absorption of 1.07%. This study demonstrates the potential of MK, PA, and AF as viable materials for sustainable geopolymer concrete, offering a low-carbon alternative to traditional cement concrete with superior strength and durability aspects.

Identification of an anatomical safe zone for humeral cerclage passage

BackgroundCerclage techniques have been utilized in the humerus in the setting of fractures and shoulder arthroplasty. Cerclage usage in the humerus has the potential to injure neurovascular structures. There is current literature describing deeper anatomic structures surrounding the humerus but not more superficial landmarks in reference to neurovascular structures. The purpose of this study was to determine safe zones for cerclage passage around the humerus. MethodsEight fresh-frozen cadaveric specimens with no history of deformity, prior surgery, or trauma to the shoulder or arm were utilized in this study. A standard extended deltopectoral approach was performed in all 8 specimens. Dissection was performed to identify the various musculotendinous and neurovascular structures surrounding the humerus. Cerclage sutures were placed around the humerus. Measurements were made from the radial and axillary nerve to anatomic structures and the cerclage sutures. ResultsThe radial nerve entered the spiral groove on average 45.8 mm distal (range: 30.4 to 63.3 mm) to the inferior aspect of the pectoralis major tendon. Cerclage suture passed just distal to the inferior aspect of the pectoralis major tendon did not violate the radial nerve. The axillary nerve was located on the humerus an average of 5.3 mm (range: 2.4-10 mm) proximal to the superior aspect of the latissimus dorsi tendon insertion. A safe zone for cerclage passage was not identified distal to the radial nerve entering the spiral groove. ConclusionThe radial nerve entered the spiral groove on the humerus distal to the pectoralis insertion in all specimens. The axillary nerve started to contact the humerus proximal to the latissimus dorsi in all specimens. In this study, we found that cerclage passage medial to lateral from the latissimus dorsi proximally to the area just distal to the inferior pectoralis major insertion distally is a safe zone for cerclage passage.

Reliability and validity of a method to measure trunk rotation angle from images using a camera and posture mirror

This study aimed to measure trunk rotation angle representations from images using a single camera combined with a posture mirror and to examine its reliability and validity. We applied a trunk rotation angle model using a tripod and markers simulating trunk rotation. We compared two methods of trunk rotation angle measurement: the conventional method from the superior aspect using a manual goniometer and a novel measurement method using images from a digital camera and a posture mirror. Measurement error was calculated as the average absolute error between the angle measured by the goniometer and that calculated from the camera and mirror image. The intraclass correlation coefficient (ICC 1, 1) and ICC (2, 1) were calculated as the intra-rater reliability and agreement between the measurement angles of the two methods, respectively. Systematic errors of the angles measured by the two methods were examined by a Bland‒Altman analysis. The mean (SD) of the mean absolute error was 1.17° (0.71°). ICC (1, 1) was 0.978, and ICC (2, 1) was 0.991. The Bland‒Altman analysis showed no systematic errors. The results suggest the validity and accuracy of our novel method to measure the angle of trunk rotation, which does not require high-cost equipment or a special environment.

Analisis Aspek-Aspek Keunggulan Daya Saing dalam Meningkatkan Kualitas Pendidikan di SDI Al-Akbar Bangsal

A superior school is a school that is able to bring every student to achieve their abilities in a measurable manner and can be demonstrated through their achievements. The background to writing this research is the demand for quality educational institutions which will be able to create schools that have competitive advantages. The aim of the research is to analyze aspects of competitive advantage that have been implemented at SDI Al-Akbar Bangsal in improving the quality of education. This research uses a descriptive method with a qualitative approach. Data was obtained through in-depth interviews with school principals, teachers, classroom observations, documentation, academic journals, books, articles and relevant research reports. Respondents consisted of the Principal, Deputy Principal, teachers and also staff at SDI Al-Akbar Bangsal. The results of this research show three things: first; SDI Al-Akbar Bangsal prepares for competitiveness in the 5.0 era; second; form aspects of competitive advantage at SDI Al-Akbar Bangsal; third; strategic concepts and approaches in improving the quality of education at SDI Al-Akbar Bangsal. Based on the research results, there are still limitations, namely the number of respondents is still small and there is only one SDI Al-Akbar institution so there is a lack of comparison with other institutions. It is recommended for future researchers to take more sample, this aims to have better data accuracy in their research. Researchers also recommend to institutions to always improve quality by always evaluating the superior aspects of SDI Al-Akbar.

CT scan-based 3D fracture mapping in civilian gunshot intracapsular fractures of the femur neck.

IntroductionDisplaced intracapsular neck of femur (NOF) fractures secondary to civilian gunshots are rare injuries with universally poor outcomes following surgical fixation. No studies have been published on fracture mapping in NOF fractures secondary to civilian gunshots. ObjectivesWe performed CT scan-based fracture mapping to identify the most common fracture patterns in these injuries. MethodsDesign: Retrospective search of prospectively collected data. Setting: Single Level 1 Trauma hospital. Patient selection criteria: All patients presenting with gunshot fractures to the femur neck between 01 January 2009 and 31 December 2022 were identified. Once identified from Picture Archiving and Communication System (PACS), computed tomography (CT) scans in Digital Imaging and Communication in Medicine (DICOM) format were imported into Mimics 16 software and fracture fragments were segmented and three-dimensional (3D) reconstruction was generated. The reduced fractures were exported to 3-Matic software to merge the fragments and adjust the orientation in three planes. An uninjured femur model was used as a template for reduction. Fracture lines and heat maps were then generated. Our outcome measures were successful mapping of the identified fracture lines. ResultsA total of 25 intracapsular femur neck fractures were identified and suitable for CT scan mapping. All patients were male with an average age of 22 (range 18-32). Once generated, fracture maps were used to show the location, distribution and frequency of the fracture lines. In all but two cases the fracture line propagation remained within the confines of the hip joint capsule. In three cases there was fracture extension into the superior aspect of the femur head, and in one case extension into the inferior aspect. ConclusionThis is the first study to perform 3D fracture mapping for intracapsular femur neck fractures secondary to civilian gunshot injuries. The exercise has helped us better understand the commonest fracture patterns and assisted us with surgical planning and execution.

Validation of the Residual Feed Intake Model in Brangus Heifers: Determination of the Optimal Days on Feed Interval to Estimate Dry Matter Intake and Average Daily Gain.

Brangus cattle are gaining popularity in the Southeast U.S. due to the desirable heat tolerance from their Brahman influence combined with the superior carcass merit aspects of Angus genetics. However, little is known about the optimal evaluation conditions for this hybrid breed when placed on test for Residual Feed Intake (RFI), a heritable measure of feed efficiency that allows improvement in performance without altering carcass traits. To address this, dry matter intake (DMI) was measured on Brangus heifers for 70-d to determine the optimal days on feed required to estimate feed intake and ADG and assess if inclusion of ultrasound measures of carcass merit into the model impact RFI rankings for this breed. The 56-d test period had a regression coefficient of 0.96 (p < 0.0001), R2 = 0.94, rp = 0.97 (p < 0.0001), and rs = 0.97 (p < 0.0001), indicating little change in rank of cattle for DMI compared to a 70-d test. ADG was the limiting factor in determining test duration. Based upon examining only heifers that calved, ultrasound backfat measures should be included in the RFI model to normalize for differences in heifer maturity. Results from this study indicate that a test duration of 56-d is sufficient to accurately estimate DMI in this population. This data indicates on-test duration can be shortened, enhancing the rate of genetic change by reducing cost and increasing the number of animals that can be tested annually.

Transcranial Orbitotomy for Resection of Orbital Intraconal Arteriovenous Malformation: 2-Dimensional Operative Video

Intraorbital arteriovenous malformations (AVMs) are not common, and their prevalence is unknown. 1,2 They can cause significant morbidity, including vision loss, diplopia, chronic pain, and cosmetic deformity. 3 Treatment can be technically difficult because of the challenging anatomical location with multiple adjacent nerves and ophthalmic vascularity, and it may involve endovascular and open surgical procedures or both. 4-6 We present a video illustrating the case of a 45-year-old man with progressive right-sided proptosis and chemosis with intact vision. Magnetic resonance imaging demonstrated an orbital intraconal lesion in the superior lateral aspect. Angiogram confirmed the presence of an AVM fed by branches of the ophthalmic artery and draining to the superior ophthalmic vein. We performed a transcranial orbitotomy for resection of the AVM. Intraoperative angiogram confirmed complete resection of the AVM. The patient consented to the procedure and the publication of his images. Institutional review board approval is waived for single case reports. The patient did well postoperatively, and his proptosis and chemosis resolved. It is important for the skull base surgeon to be adept in treating orbital pathologies safely and effectively given the overlapping of pathologies that may involve the orbit and skull base such as this.

Comparative Anatomy of the Contralateral Transmaxillary Approach Alone and With Ipsilateral Transpterygoid Extension: Quantitative Insights on Surgical Exposure and Maneuverability in the Petroclival Region.

Beyond qualitative evidence legitimizing endoscopic corridors through contralateral transmaxillary (CTM) and endonasal ipsilateral transpterygoid (ITP) corridors to the petrous apex and petroclival region, surgical feasibility by direct quantitative comparative anatomy is sparse. Our cadaveric study addresses this by performing the CTM approach followed by ITP extension to quantify the extent of petrous apex resection, instrument maneuverability, and working distance to petrous apex. Anatomic dissections were performed bilaterally on 5 latex-injected human cadaveric heads (10 petrous bones). After CTM dissections were quantified, the ITP approach was added enlarging initial exposure. Differences were measured with statistical significance when P values are < .05. The mean petrosectomy volume was 0.958 cm3 with CTM and 1.987 cm3 with CTM + ITP, corresponding to 14.53% and 30.52% petrous apex resection, respectively. Craniocaudal instrument mobility was more limited in the lateral extent of dissection compared with the midline for both CTM (8.062° vs 14.416°) and CTM + ITP (5.4° vs 14.4°). The CTM approach achieved the lateral-most dissection at the body of the petrous apex (15.936 mm), with lateralization more limited in the superior petroclival region (9.628 mm) and the inferior petroclival region (8.508 mm). Angle of surgical maneuverability increased superiorly vs inferiorly in the CTM approach (mean 12.596° vs 8.336°, respectively). The CTM approach offered the shortest mean working distance (88.624 mm) to the petroclival region compared with the bi-nares approach (100.5 mm). CTM + ITP achieved greater lateralization in the superior (21.237 mm) and inferior (22.087 mm) aspects of the petroclival region compared with the CTM approach. Operative considerations are discussed in accessing target neurovascular structures through the uniquely shaped corridors formed by the CTM or combined CTM + ITP. Allowing mobilization of the internal carotid artery laterally and eustachian tube inferiorly, addition of the ITP allowed for larger petrosectomy than CTM alone, especially in the inferior and lateral aspects of the petrous bone.

Anatomic-guided ablation of the right ganglionated plexi validated by the automatic fractionation map

Abstract Background and aim Cardiac autonomic modulation through endocardial ablation of atrial ganglionated plexi (GP) is an alternative strategy in selected patients with severe vagal induced bradyarrhythmias. A strictly anatomical approach targeting the right GPs has demonstrated good success rates but is an empirical approach and has yet to be validated. The presence of fractionated electrograms has been associated with the areas of GPs and can be automatically mapped (fractionation map). The aim of this study was to compare the empirical ablated area, to the automatically assessed area of GPs based on the presence of fractionated electrograms (FEs). Methods We studied eight consecutive patients referred for parasympathetic modulation. A high-density map of the left and right atria (LA, RA) in sinus rhythm was performed. The settings for the automatic map were as follows: bipolar high pass filter of 500 Hz, a fractionation threshold of 4, and a width of 5 ms. The ablation was empirically performed by an operator blinded to the results of the fractionation map, as per site protocol. The ablation was aimed at the anatomic locations of the right GPs in the LA and RA. At the anterior and inferior aspect of the right superior pulmonary vein and inferior aspect of the right inferior pulmonary vein on the LA, and posterior RA opposite to the LA RF applications and around the coronary sinus ostium on the RA (Figure). Before ablation, 2 mg of atropine was administered in bolus, and the increase in heart rate was registered and repeated at the end of the procedure. After the operator completed the ablation, access to the fractionation map was available, and additional radiofrequency (RF) applications were applied as needed (Figure). The number of additional RF applications to cover all the areas with FEs was assessed. Success was defined as an absence of response to atropine after the procedure. Results Three patients underwent autonomic system modulation only, and five underwent additional pulmonary vein isolation (PVI). The mean age was 66 (50-77) years, five males. The median mapping time of the LA and RA was 11 (17-7) and 14 (9-18) min. All patients underwent successful parasympathetic modulation. The initial median (Q1-Q3) increase in heart rate with atropine was 34 (23-39)% versus 0 (0-2)% after ablation, p=0.012. The differences between empiric and FEs map-guided ablation are depicted in the Table. The additional number of points was low. However, a median of 9 (5-15) additional points were added. Conclusions A purely anatomic-guided procedure directed only at the atrial right GPs is usually enough as a therapeutic approach for cardiac autonomic modulation, however, the fractionation map tool helped validate the method and ensure success at the first pass.

Multielectrode catheter-based pulsed field ablation of persistent and long-standing persistent atrial fibrillation

Abstract Background Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF maintenance. Purpose We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via the multielectrode FarawaveTM pulsed field ablation (PFA) catheter in patients with persistent AF sustained beyond 6 months (PerAF&amp;gt;6m) and long-standing persistent AF (LSPAF). Methods The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia (AT) regionalization and ablation (Stage 3). Results Seventy-two [age:68±10y, 61.1%males; AF history: 25 (18-45) months] patients with PerAF&amp;gt;6m (52.8%) and LSPAF (47.2%) underwent their first PFA via the FarapulseTM system. LA substrate ablation (Stage 1 and 2) led to AF termination in 95.8% of patients. AF termination occurred while ablating the mitral edge of the postero-lateral ridge (40.3%), the inferior left atrium above the proximal coronary sinus (27.4%), the interatrial septum (22.6%), the superior aspect of the postero-lateral ridge (6.5%), the base of the appendage (3.2%). AF organized into a left-sided atrial flutter (AFlu) in 46 (74.2%) patients. The FarawaveTM catheter was used to identify LA sites showing diastolic, low-voltage electrograms and entrainment from its splines was performed to confirm the pacing site was inside the AFlu circuit (Figure 1). Left AFlu termination was achieved in all cases via PFA delivery. Total procedural and LA dwell times were 112±25min and 59±22 min, respectively. Major complications occurred in 2 (2.8%) patients with pre-existing left ventricular systolic dysfunction (EF&amp;lt;35%) who required inotropic therapy due to acute heart failure. Hemodynamics normalized within 24h and both patients were discharged after 2 and 3 additional hospital days. Transient ST-segment elevation was documented in 4 patients after peri-mitral PFA; timely nitrate administration led to ECG normalization within 10 minutes. Single-procedure success rate was 81.8% after 13.3±1.9 months of follow-up; AF-free survival was 93.1% (Figure 2). A subgroup of 36 patients completed a follow-up transthoracic echocardiography study to assess left atrial mechanical contraction changes after ablation. Median A-wave velocity was 30 (IQR: 20-35) cm/s post-ablation and 50 (IQR: 41-70) cm/s after a mean of 7.3±1.8 months post-ablation. Conclusions In our cohort, PFA-based AF substrate ablation led to AF termination in 95.8% of cases. Very favorable clinical outcomes were observed at one year of follow-up.Entrainment from the PFA Catheter.Kaplan-Meier Analysis.

Abstract PO2-20-12: Breast Implant-associated Squamous Cell Carcinoma

Abstract A 54-year-old female with a history of bilateral breast implants presented with intermittent left breast pain for 6 months. She first had bilateral breast implants placed in 1996 and had no reported issues until 2010, when she had bacteremia and seeding infection with subsequent removal of both implants. She then had a second set of silicone-based implants placed in 2012 with no issues for 10 years. Family history was negative for breast cancer or any other malignancy. She had no prior smoking history. Vital signs and laboratory values were unremarkable. On exam, the left breast appeared larger than the right, dense, thickened, and slightly edematous. No lymphadenopathy was palpated. Both mammogram and ultrasound of bilateral breasts, done at the onset of her pain, were normal. Given the patient’s symptoms, an MRI of the breasts was done, with findings concerning an infection or lymphoma. It revealed an irregular fluid collection in the left breast. The fluid collection was rim-enhancing with frond-like areas of enhancing tissue, extending through the inferior aspect of the capsule into the subcutaneous tissue of the lower outer quadrant of the left breast. Enhancement and edema extended off of the superior and posterior aspect of the prosthesis into the pectoralis muscle. It was particularly prominent along the medial aspect of the prosthesis where it extended in the chest wall between the sternum and the costal cartilage. There were 3 mildly enlarged left intramammary lymph nodes measuring up to 7 mm in short axis, with diffuse edema seen within the breast. No axillary adenopathy was seen in the MRI. She was referred to surgery and had both right and left breast implants removed, and a left breast JP drain was placed. The pathology from the left breast capsule excision revealed squamous cell carcinoma, well-differentiated and invasive, associated with a scar and extending to the surgical margin. She was diagnosed with a rare case of breast implant-associated squamous cell carcinoma (BIA-SCC). Subsequent staging imaging showed postsurgical inflammatory changes with no nodal metastatic disease. She continued to follow up outpatient with plans of multidisciplinary meeting to discuss long-term treatment options. Most patients undergoing breast augmentation experience no serious complications. Previously, rare incidences of breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL) had been reported, with 1234 cases as of 2022. More recently, cases of BIA-SCC have been seen. Primary SCC of the breast is extremely rare in both augmented and non-augmented women. 19 cases of BIA-SCC are reported in the literature as of 2022, all seen in females, typically arising from capsular tissue around the breast implant. It is a rare and potentially aggressive malignancy, with unclear etiology and undefined therapy regimen due to a paucity of data. Suggested treatments include resection with a negative margin, although this could require an extensive and complex reconstruction, including plastic surgery soft tissue coverage of the resection defect. Definitive radiation to obtain local control can be considered in an organ-sparing approach. Consideration can also be given to either chemosensitization with agents such as cisplatin or combining radiation with immunotherapy. Citation Format: Farhan Azad, Ajay Siva, Prutha Patel, Clive Miranda, Matthew Gravina. Breast Implant-associated Squamous Cell Carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-20-12.

Abstract PO3-20-10: Case Series: Invasive Secretory Carcinoma

Abstract Secretory variant invasive ductal carcinoma is not well described in the literature but is defined by its unique histopathology. These tumors stain positive for S100 and are typically triple negative hormonal cancers with an overall good prognosis. There is speculation that secretory carcinoma in adults is more aggressive with a greater likelihood for tumor recurrence. We present two case studies of this rare histopathologic diagnosis. First, a 76-year-old female with a recurrent secretory variant, invasive ductal carcinoma of the left breast. Second, a 68-year-old male who presented with invasive and in situ secretory carcinoma. A thorough chart review of all available institutional and outside institution records was performed from initial diagnosis to current treatment. Background information and de-identified patient information was summarized for this case series. This is a 76-year-old female who presented to her physician in 2011 with a palpable left breast and axillary mass. Her workup demonstrated ER+/PR+/HER2- invasive ductal carcinoma with lobular features of the left breast measuring 2.3 cm, along with a 1.5 cm malignant axillary lymph node. She underwent a left breast lumpectomy with axillary dissection. She underwent adjuvant whole breast radiation, axillary nodal radiation, and was placed on anastrozole therapy for 5 years. Seven years later a recurrence was noted in the superior aspect of the left breast. MRI guided biopsy revealed recurrent left breast cancer with pathology of invasive ductal carcinoma, secretory variant. She elected to undergo lumpectomy alone. Final pathology demonstrated invasive ductal carcinoma, secretory variant, ER negative (0%), PR negative (0%), HER2 negative (0%), pT1bNx. She underwent accelerated adjuvant partial breast radiation. Follow up and surveillance with bilateral breast MRI two years later demonstrated a new left breast mass, found to be triple negative, recurrent secretory variant invasive ductal carcinoma. She underwent definitive treatment with a left skin sparing mastectomy, right sentinel lymph node biopsy, and a latissimus dorsi flap with implant placement. Final pathology demonstrated multifocal recurrent secretory carcinoma, two foci measuring 6 and 11 mm. Our second patient was a 68-year-old male who initially presented to the clinic for evaluation of a ventral incisional hernia. During his initial assessment, a palpable retro-areolar nodule was noted on physical exam. Subsequent mammography demonstrated a hypoechoic mass with irregular margins measuring 2.8 x 2.3 x 1.7 cm along with increased vascularity and calcifications. An ultrasound guided biopsy demonstrated invasive secretory carcinoma. Initial pathologic testing of the tumor demonstrated ER positive (5%), PR positive (1%), and HER2 negative. The patient was taken to the operating room for a total mastectomy with sentinel lymph node biopsy. His postoperative pathology demonstrated negative margins, and invasive secretory carcinoma with lymph nodes negative for metastatic disease. Secretory variant of invasive ductal carcinoma is rare and is determined by its unique immunohistochemical features. We present two cases of secretory carcinoma at our institution. Data suggests that local recurrence is common in patients with secretory breast cancer, occurring in 33-44% of cases. Ki-67 index has been used as a prognostic indicator for metastases and recurrence of disease. Current treatment regimens are diverse; however, surgery is favored as the primary method. This report shows that although indolent, multifocality and recurrence is plausible. Given the limited data on this subset of carcinoma, more investigation is warranted to describe the effectiveness of adjuvant treatment options. Case 1 –insert figure image– Histopathologic examination at 200x shows invasive carcinoma with dense eosinophilic secretory material. By immunohistochemistry, the cells are negative for ER (0%) and PR (0%) with a HER2Neu score of 0, supporting the diagnosis of invasive secretory carcinoma. Case 2 –insert figure image– Histopathologic examination at 200x shows invasive carcinoma with dense eosinophilic secretory material. The tumor cells are positive for CK5/6 (patchy), CD117, ER (focal and weakly), and S100; negative for p63 and calponin, supporting the diagnosis of invasive secretory carcinoma. NTRK3 gene rearrangement was detected on fluorescence in situ hybridization (FISH). Citation Format: Lauren Geisel, Hemanth Venkatesh, Alyssa Obermiller, Quyen Chu, Jessica Gielow, Danielle Henry. Case Series: Invasive Secretory Carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-20-10.

A spherical fuzzy-based DIBR II-AROMAN model for sustainability performance benchmarking of wind energy power plants

Wind energy power plants (WEPPs) are renewable energy generation facilities that are increasingly used today. The performance evaluations of these energy plants are generally based on technical performance. Although there are studies in the literature focusing on determining the technical performance of WEPPs, there is a lack of research on evaluating their sustainable performance. The primary motivation of this study is to develop a decision model for identifying the sustainable performance of WEPPs. The model incorporates fuzzy logic and multi-criteria decision-making (MCDM) approaches, incorporating expert opinions and both qualitative and quantitative criteria. To determine the influence levels of experts, spherical fuzzy (SF) sets are utilized. The weighting of criteria is achieved using the SF-defining interrelationships between ranked criteria II (DIBR II) method, which is a novel extension of the DIBR II method based on SF sets. Additionally, an SF-alternative ranking order method accounting for two-step normalization (AROMAN) method is developed for ranking the sustainable performance of WEPPs, building upon the AROMAN method, and adapting it to SF sets. This hybrid model is named the SF-DIBR II-AROMAN hybrid model. The step-by-step procedures of this model are presented in the research, and an algorithm for these procedures is developed. To demonstrate its practicality, a case study is conducted, focusing on WEPPs with a capacity ranging from 25 to 150 megawatts in Çanakkale, Turkey. According to the research results, among the fifteen WEPPs in the Çanakkale region, “Saros WEPP” is identified as having the best one. The robustness of the obtained results is ensured through sensitivity analyses. Based on the results of two sensitivity analysis scenarios, “Saros WEPP” is found to have the highest sustainable performance. The SF-DIBR II-AROMAN hybrid model results are compared with different alternative ranking method results, highlighting its superior aspects. Overall, SF-DIBR II-AROMAN is consistent and robust. The research also provides insights and managerial implications, as well as explains the benefits of the proposed model for evaluating WEPPs’ sustainable performance.

MODERNISASI PENDIDIKAN PESANTREN ASWAJA; PENGEMBANGAN KURIKULUM BERBASIS IDENTITAS DAN KONTINUITAS

As a traditional Islamic educational institution, Islamic boarding schools are often identified as conservative, static and underdeveloped educational institutions. This kind of stereotype cannot be fully justified, because in reality, Islamic boarding schools continue to transform both institutionally, systems, curriculum, etc. Regarding the development of Islamic boarding school curricula, not many researchers and academics are concerned with this field of study. This research is a literature review based on several previous studies. The results of this research show several conclusions. First, as a traditional Islamic educational institution in Indonesia, Islamic boarding schools have demonstrated success in maintaining their existence amidst globalization. Second, the Islamic boarding school curriculum has several superior aspects, including; aspects of identity, continuity, independence and flexibility. However, the Islamic boarding school curriculum also has shortcomings, namely Kiai-centric and Alineasi (alienation). Third, the components that an Islamic boarding school education curriculum must have consist of; objectives, knowledge content and learning experiences, strategies and evaluation

Electronic Sales Partnership Network Management Information System Model Of In Multi-Level Marketing

Advertising is a commercial activity that has found its place in our lives since the earliest known periods of trade. The impact of developing technologies has led to changes in advertising techniques and media. An important part of trade has recently moved online. Similarly, advertising activities have also moved online. Advertising activities to be carried out online have superior and weak sides. One of the marketing methods adopted and accepted by businesses today is multi-level marketing. Another working method adopted by businesses is the sales revenue partnership system. Within the scope of our research, we have tried to put forward a working model that brings together the superior aspects of multi-level marketing and sales revenue partnership system organization. On the one hand, it is aimed to create a management information system model that accepts the advertising campaigns organized by advertisers and acts as an affiliate system, and on the other hand, it is aimed to create a management information system model for promoting these campaigns quickly and reliably on the internet through publishers who have come together with the multi-level marketing organization. The question "How can a management information system be designed for this type of working model?" was adopted as the main problem of the research and a literature review was conducted in this direction. Leading global and local companies adopting both working models were analyzed in terms of structure and terms used. With the information gathered, an application software based on the theoretical model was developed and tested in terms of all stakeholders and workflows. In cases where the objectives of the theoretical model could not be achieved, the model was revised and workflow problems were eliminated. After the successful operation of the application software, concrete results were presented on how this new working model should be managed as a management information system. Suggestions are presented for the superior aspects of the new model, as well as the points that may create vulnerabilities.

A rare case of unilateral double Stafne bone defects and literature review.

Stafne bone defect (SBD) is a rare developmental bone defect characterized by an asymptomatic focal concavity of the cortical bone, typically on the lingual aspect of the mandibular body, which generally contains salivary gland tissue. It can be detected during routine dental examinations and typically appears as an ovoid, well-defined, well-corticated, radiolucent depression in the posterior mandibular region below the inferior alveolar nerve (IAN) (in: Neville et al, Oral and maxillofacial pathology, Elsevier, Inc, St. Louis, MO, 2016).An 80-year-old male presented to our clinic for a routine dental examination. Panoramic radiography and cone-beam computed tomography (CBCT) displayed two well-defined, well-corticated, ovoid radiolucencies inferior to the IAN canal on the left mandibular molar region. The working diagnosis was SBD, and the patient was informed of the findings. Irregular margins on the superior aspect of the anterior defect were noted on CBCT imaging; therefore, follow-up with panoramic images at 6months, 1 and 5years was recommended.

KONSEP DAN MODEL MADRASAH UNGGUL : MENJAWAB TANTANGAN PASAR GLOBAL

This research aims to determine the concept and model of superior madrasah that are able to answer the challenges of today's global market. This research model is library research using qualitative research methods where the results are in the form of criteria for superior madrasah models and aspects of change towards these madrasah. The research results show that the criteria for a superior madrasah model are appropriate to the challenges market global is madrasah which still maintain its specialty as an Islamic boarding school (pesantren) mouthpiece accompanied addition eye lessons with teacher criteria as already researcher convey, and infrastructure including teaching materials and output which no only ready fill in field work but also capable think critical, creative, innovative, own spirit and ability entrepreneurshipand skilled in digital or native digital. To realize this madrasah, it is necessary to change with carry out a strategy of keeping old things that are good and adopting new things that are better, both regarding the quality of teachers, curriculum, teaching materials and regulations or other things that need to be followed up accordingly researcher recommendations