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Introduction: Surgical management of endometrial cancer is a total hysterectomy, bilateral salphingo-oophorectomy and pelvic lymph node dissection (THBSO-PLND), which is a challenging surgery in the morbidly obese. Data on morbidly obese women undergoing robotic surgery is limited in Asia. We share our experience in Singapore and aim to demonstrate that robotic surgery is safe and effective in morbidly obese women with endometrial cancer. Materials and Methods: We performed a retrospective analysis of patients with BMI > 40 kg/m2, who underwent robotic surgery from January 2016 to September 2023 at the Singapore General Hospital. We recruited a total of 33 patients who underwent robotic surgery for endometrial malignancy and analysed surgical outcomes, operative complications, and survival rates. Results: The average age of patients was 53 years and mean BMI 45.7. The average operative time was 232 min and average blood loss 184 ml. 3 patients had THBSO while 27 underwent THBSO-PLND. None required conversion to laparotomy. 4 patients required a mini-laparotomy for the retrieval of bulky uterus. 12 required adhesiolysis. 6 patients had additional omentectomy done. The average inpatient stay was 4.8 days. The 1-year mortality rate is 0. However, 1 patient passed away 13 months after surgery due to complications from bowel obstruction and another passed away 39 months later due to disease recurrence. 1 patient readmitted on POD6 due to post-op ileus and another for port-site hematoma. Both were managed conservatively. Conclusion: Robotic surgery is a safe and effective alternative surgical tool for women who are morbidly obese with endometrial cancer.

Ground motions and seismic site factors for the design and analysis of infrastructure systems are typically computed based on one-dimensional (1-D) site response analysis, assuming the ground surface is horizontal and the earthquake waves propagate vertically near the ground surface. The 1-D results may not be applicable for sloping ground surfaces and layer interfaces, and therefore, the 1-D results must be adjusted for sloping grounds. In this study, a general framework for developing seismic site factors for sloping grounds and its application for Charleston, SC is presented. The two-dimensional (2-D) site response analysis results of sloping ground were compared with the 1-D horizontal ground results to develop slope adjustment factors. A total of 385 2-D nonlinear finite element simulations of sloping grounds were performed considering seven ground inclinations, 11 shear wave velocity profiles, and five ground motions representative of the area. The results show that the surface responses computed from sloping ground analyses significantly differ from those of horizontal ground analyses. By comparing the 1-D and 2-D results, a set of slope adjustment factors was developed and expressed as an easy-to-use chart. The slope adjustment factor at a project site can be obtained from the proposed chart using site-specific VS30 and ground inclination at a selected period. [ABSTRACT FROM AUTHOR]

Metastasis to the breast from extra-mammary malignancies are rare, accounting for less than 1% of all breast cancers. Endometrial cancer, a common gynecological malignancy, often spreads to the pelvis, abdominal lymph nodes, peritoneum or the lungs. Endometrial metastasis to the breast is extremely rare, and while there have been isolated case reports of endometrial serous carcinoma with breast metastasis, it has not been reported in the case of clear cell carcinoma. We present a rare case of a 70 year old Chinese lady who had a metastatic endometrial clear cell carcinoma with metastasis to the breast, mimicking an inflammatory breast cancer clinically. We reviewed the current literature and describe the challenges in differentiating primary from metastatic breast lesions, as well as clinical, radiological and histopathological features that may help to differentiate the two. Tumour metastasis to the breast via lymphatic or hematogenous route can affect their radiological features: the former mimicking inflammatory breast cancer and the latter with features similar to benign breast lesions. Regardless, histological features with immunohistochemical staining is still the gold standard in diagnosing metastatic breast lesions and determining their tissue of origin. Breast metastases from extra-mammary malignancies are uncommon and it is even rarer for endometrial clear cell carcinoma to spread to the breast. Nonetheless, this case highlights the importance of keeping an open mind and engaging a multidisciplinary team for the care of complex patients.

Abstract Ovarian cancer is associated with poor prognosis. Platinum resistance contributes significantly to the high rate of tumour recurrence. We aimed to identify a set of molecular markers for predicting platinum sensitivity. A signature predicting cisplatin sensitivity was generated using the Genomics of Drug Sensitivity in Cancer and The Cancer Genome Atlas databases. Four potential biomarkers (CYTH3, GALNT3, S100A14, and ERI1) were identified and optimized for immunohistochemistry (IHC). Validation was performed on a cohort of patients (n = 50) treated with surgical resection followed by adjuvant carboplatin. Predictive models were established to predict chemosensitivity. The four biomarkers were also assessed for their ability to prognosticate overall survival in three ovarian cancer microarray expression datasets from The Gene Expression Omnibus. The extreme gradient boosting (XGBoost) algorithm was selected for the final model to validate the accuracy in an independent validation dataset (n = 10). CYTH3 and S100A14, followed by nodal stage, were the features with the greatest importance. The four gene signature had comparable prognostication as clinical information for two-year survival. Assessment of tumour biology by means of gene expression can serve as an adjunct for prediction of chemosensitivity and prognostication. Potentially, the assessment of molecular markers alongside clinical information offers a chance to further optimise therapeutic decision making.

Abstract Timely genetic testing leading to early diagnosis of A‐T is crucial due to its plethora of implications on clinical management, particularly in those who develop malignancies. Thus, clinicians have to be astute in identifying diagnostic clues of A‐T.

Taller wind turbines are preferred to access high and steady wind at a higher altitude to increase the efficiency of a wind turbine, but they require an extensive foundation, particularly when subsurface soil has poor engineering properties. One of the solutions to this problem is to improve the engineering properties of the poor near-surface ground to gain a net economic advantage for foundation construction. In this study, the effectiveness of the ground improvement around piled-raft foundation in weak soil is investigated using analytical and three-dimensional finite element (FE) methods. Five different ground improvement depths from 2.0 m to 3.6 m and radii from 6 to 15 m were considered to develop a relationship between the geometry of ground improvement, the performance of the foundation, and the cost of the foundation. The analytical analysis shows that the pile length required to meet the safety and serviceability requirements decreased from 48.4 m in the unimproved soil to 9.85 m in the 3.6 m improved soil, resulting in a 33.5% cost reduction. The cost-benefit for various depths of ground improvement shows a nonlinear variation, indicating that the most economical depth of ground improvement is within the range considered in this study. The finite element modeling was conducted using ABAQUS with frictional contacts at the soil-pile and raft-pile interfaces to capture the load transfer accurately. The ABAQUS results were much lower than the analytical results for the linear elastic and elastoplastic constitutive models. [ABSTRACT FROM AUTHOR]

This paper presents a quantitative framework to optimise embedded footing performance subjected to extreme historical climate events with respect to the uncertainties associated with site-specific soil and climatic parameters. The proposed framework is developed based on partially saturated soil mechanics principles in conjunction with a multi-objective optimisation algorithm called Non-dominated Sorting Genetic Algorithm (NSGA-II) to develop a robust optimised design procedure. The proposed method was applied to two semi-arid climate sites, Riverside and Victorville, both situated in California, United States. The results show that the proposed method generally improves the embedded footing design compared to conventional methods in terms of cost and performance. Based on the findings, under the extreme climate conditions, the proposed method estimates the average soil degree of saturation within the footing influence zone between 52% and 95%, with a mean value of 63.1% for the Victorville site, and 57% and 90% with a mean value of 81.6% for the site in Riverside. It is also found that the optimal design from the proposed method shows a lower total construction cost, 44% and 19%, for the Victorville and Riverside sites, respectively, compared to the ones designed by the conventional methods. [ABSTRACT FROM AUTHOR]

Extreme hydroclimatic events such as heavy rainfall and drought have occurred frequently in recent years, and their impacts on geotechnical systems must be understood for developing climate-adaptive design procedures. A fully coupled flow-deformation finite element method is best suited for accurately predicting the behavior of geotechnical structures under extreme hydroclimatic events. PLAXIS, a finite element software widely used by practicing engineers and researchers, models water flow accurately, but the deformation model is not fully coupled with the flow model because the constitutive models do not update the stiffness and failure criterion during water flow. Therefore, to improve the predictive capability, first, the elastic modulus and yield criterion of the Mohr-Coulomb (MC) model was modified, validated, and implemented as a user-defined constitutive model in PLAXIS. Then, the Modified Mohr-Coulomb (MMC) model was used to understand the hydromechanical behavior of foundations and earth slopes under site-specific extreme hydroclimatic events in a coupled manner. The temporal variation of the (a) safety factor of earth slopes, (b) skin and tip resistances and settlement of deep foundations, and (c) settlement of shallow foundations were estimated for the site-specific extreme hydroclimatic events. The results show that the traditional design limits are altered by the hydroclimatic events, and therefore the existing design methods must be updated. [ABSTRACT FROM AUTHOR]