bluuebunny/crossref_metadata_2025 huggingface dataset:
Pendekatan Diagnosis dan Tatalaksana Infark Ventrikel Kanan
Authors: Santoso R. Fidiaji H , Nasution Sally Aman
Published: March 2018

Fungsi optimal jantung merupakan hasil interaksi dari berbagai bagian jantung, baik ventrikel kiri maupun ventrikel kanan. Namun, perkembangan diagnosis dan tatalaksana kegawatan jantung umumnya berpusat pada disfungsi ventrikel kiri. Perkembangan keilmuan saat ini memperlihatkan bahwa disfungsi ventrikel kanan juga mengakibatkan gangguan hemodinamik yang signifikan dan membutuhkan tatalaksana yang berbeda dengan tatalaksana disfungsi ventrikel kiri. Infark ventrikel kanan umumnya bukan merupakan suatu kasus tunggal, namun seringkali menyertai infark ventrikel kiri. Identifikasi infark ventrikel kanan pada kondisi tersebut, dapat mempengaruhi tatalaksana yang dilakukan pada suatu sindrom koroner akut.
Pemeriksaan Kadar Laktat pada Tata Laksana Sepsis: Apakah Benar Diperlukan?
Authors: Sinto Robert
Published: March 2018

Berbagai upaya telah dilakukan oleh berbagai klinisi dan peneliti di seluruh dunia untuk menurunkan mortalitas pasien sepsis, khususnya sepsis yang disertai dengan gangguan fungsi organ atau yang dikenal dengan sepsis berat. Perumusan kriteria diagnosis, upaya stratifikasi derajat berat sepsis, penyusunan protokol resusitasi, penyusunan pedoman tata laksana komprehensif, hingga penggunaan berbagai modalitas terapi ajuvan adalah beberapa contoh upaya yang telah dikerjakan. Hasilnya, laporan penelitian pada beberapa daerah menunjukkan penurunan angka mortalitas, namun di beberapa daerah lain angka mortalitas tetap tinggi. Sebagai contoh Gattinoni, dkk. mencatat angka kematian pada penelitian sepsis di Perancis dapat mencapai 60-62%, sementara penelitian di Australia dan Selandia Baru hanya berkisar 22,9-25,6%. Ketimpangan yang besar ini boleh jadi tidak semata-mata menggambarkan perbedaan kualitas layanan sepsis di kedua negara maju tersebut, namun hanya merupakan akibat perbedaan yang besar pada derajat berat penyakit pasien yang diinklusi dalam penelitian-penelitian tersebut.
Salah Perlakuan terhadap Orang Tua: Faktor Risiko dan Tatalaksana
Authors: Madina Ummi Ulfah , Dwimartutie Noto
Published: March 2018

Salah perlakuan terhadap orang usia lanjut merupakan masalah kesehatan yang serius dan mampu menurunkan kualitas hidup, namun dapat dicegah. Perlakuan salah dapat dilakukan secara sengaja maupun tidak sengaja oleh pramurawat maupun pasien sendiri. Definisi yang belum seragam, faktor risiko yang beragam dan perbedaan kultural di tiap daerah merupakan kesulitan yang dihadapi dalam mengenali dan menatalaksana salah perlakuan terhadap orang tua. Kelebihan dan keterbatasan metode penapisan salah perlakuan yang ada saat ini harus dipahami dengan baik. Dengan demikian, upaya pencegahan dan penatalaksanaan salah perlakuan dapat dilakukan dengan tepat.Kata kunci: penapisan, salah perlakuan, tatalaksana, usia lanjutElderly Mistreatment: Risk Factors and Therapy Elderly mistreatment is a preventable serious health problem that lowering older adults quality of life. Elderly mistreatment can be done by the caregiver or even the patient himself, regardless the intention. Meanwhile, defining an elderly mistreatment is still a challenge due to varied risk factors and cultural differences in each country. Those conditions result in challenges in identifying and managing elderly mistreatment. This review will also discuss screening modalities to identify elderly who is at risk or currently abused to prevent and manage elderly mistreatment properly. Keywords: elderly, management, mistreatment, older adults, screening
HIV pada Geriatri HIV in Geriatrics
Authors: Ainun Nur , Yunihastuti Evy , Roosheroe Arya Govinda
Published: March 2018

Jumlah pasien HIV yang berusia lanjut semakin bertambah dikarenakan angka kesintasan pasien yang meningkat dan infeksi HIV pada pasien usia lanjut. Populasi pasien tersebut membutuhkan penatalaksaan tersendiri dikarenakan terdapat sejumlah komorbid baik yang berhubungan dengan HIV maupun tidak, polifarmasi, penurunan kapasitas fungsional dan isu sosial.Kata kunci: geriatri, HIV, komorbid, kronik, penuaanHIV in GeriatricsThrough both prolonged survival and late acquisition of the disease, numbers of older adults with HIV are climbing. Along with ageing process is an accumulation of HIV-associated non-AIDS related comorbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and social issues. Keywords: ageing, chronic, comorbidity, geriatrics, HIV
Hiperimunoglobulin E, Atopi dan HIV
Authors: Yunihastuti Evy
Published: March 2018

Infeksi Human Immunodeficiency Virus (HIV) selama dikenal karena menyebabkan penurunan kekebalan tubuh akibat deplesi masif jumlah limfosit CD4+. Diperkirakan HIV menghancurkan sejumlah 1-2 miliar sel T CD4+ setiap harinya. Infeksi oportunistik sebagai konsekuensi penurunan limfosit CD4+ adalah manifestasi tersering yang dibicarakan. Padahal, HIV tidak hanya menginfeksilimfosit CD4+, tapi juga menginfeksi makrofag dan sel dendritik. Dalam perjalanan penyakit selanjutnya, sistem imun adaptif humoral dan seluler teraktivasi sebagai respons terhadap antigen virus. Namun, respons imun tersebut hanya mampu mengontrol infeksi dan produksi virus secara parsial, sehingga sistem imun akan terus menerus teraktivasi.
Peran Kombinasi Hidrasi dan N-Acetyl Cysteine terhadap Nefropati akibat Kontras 48 Jam Pasca Percutaneous Coronary Intervention pada Pasien Penyakit Ginjal Kronik Stadium 3
Authors: Simatupang Lydia D , Susalit Endang , Wijaya Ika Prasetya
Published: March 2018

Pendahuluan. Penyakit Ginjal Kronik (PGK) stadium 3 merupakan faktor risiko tinggi untuk nefropati akibat kontras (NAK) setelah percutaneous coronary intervention (PCI). NAK belum dapat diobati sempurna tetapi dapat dicegah. Hidrasi dan N-Acetyl Cysteine (NAC) merupakan modalitas mencegah NAK walaupun efek proteksinya masih kontroversial.Metode. Studi kohort prospektif terhadap 38 pasien PGK stadium 3 di Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo (PJT RSCM) Jakarta selama Agustus 2013-Januari 2014. Pada pasien, dilakukan pengukuran kreatinin plasma sebelum dan 48 jam sesudah PCI, serta diidentifikasi ada tidaknya perlakuan pemberian hidrasi dan NAC pada pasien PGK stadium 3 tersebut.Hasil. 43,4% pasien PGK stadium 3 diberikan hidrasi dan NAC. Insidens NAK adalah 5.26% dan terjadi pada kelompok yang tidak mendapat hidrasi dan NAC. Berdasarkan uji Fischer Exact test, tidak didapatakan hubungan yang bermakna antara pemberian hidrasi dan NAC dengan NAK (p=0,486). Nilai RR tidak dapat dihitung, namun demikian didapatkan nilai Attributable Risk (AR) sebesar 100%, artinya kejadian NAK dapat dihilangkan 100% apabila diberi hidrasi dan NAC.Simpulan. Hidrasi dan NAC memiliki indikasi dapat memproteksi terhadap kejadian NAK pada populasi PGK stadium 3 yang menjalani PCI.Kata Kunci: hidrasi, N-acetyl cysteine, nefropati akibat kontras, percutaneous coronary interventionThe Role of Hydration and N-Acetyl Cysteine Combination in 48 Hours Contrast-Induced Nephropaty after Percutaneous Coronary Intervention in Stage Three Chronic Kidney Disease PatientsIntroduction. Contrast Induced Nephropathy (CIN) after percutaneous coronary intervention (PCI) is common in stage 3 chronic kidney disease (CKD) patients. While there is no cure for CIN and some cases are fatal for the kidney or even life, it is preventable. Eventhough controversial, hydration and N-Acetyl Cysteine (NAC) are modalities to prevent CIN. Not having a certain guideline to prevent CIN in Integrated Cardiac Services (ICS) Cipto Mangunkusumo Hospital for PCI patients generates interest to study it. Methods. A prospective cohort is conducted to evaluate plasma creatinine before and 48 hours after PCI, meanwhile recording whom is given combined hydration and NAC and which not. Results. 43,4% of stage 3 CKD patients are given hydration and NAC, and incidence of CIN occurred in 5.26% patients all belonging to the non hydration and NAC group. Attributable risk is 100% means CIN can be prevented with hydration and NAC. Conclusions. Hydation and NAC is indicated to be protective against CIN in s tage 3 CKD patients undergoing PCI. Keywords: contrast induced nephropathy, hydration, N-Acetyl Cysteine, percutaneous coronary intervention
Fungsi Ginjal dan Kematian Akibat Sindrom Koroner Akut
Authors: Ginanjar Eka
Published: March 2018

Penyakit kardiovaskuler merupakan salah satu penyebab kematian utama di dunia. World Health Organization (WHO) melaporkan 17,5 juta orang meninggal akibat penyakit kardiovaskuler pada tahun 2012, atau diperkirakan 3 dari 10 kematian terjadi akibat penyakit jantung.1 Penyakit Jantung Koroner (PJK) berkontribusi sebagai penyebab kematian pada lebih dari separuh jumlah pasien dengan penyakit kardiovaskuler (53%).2 Di era Jaminan Kesehatan Nasional (JKN) ini penyakit kardiovaskuler khususnya PJK, bersama kanker dan penyakit ginjal merupakan penyakit paling banyak menyedot anggaran Badan Penyelenggara Jaminan Kesehatan (BPJS). Peningkatan mortalitas dan morbiditas akibat penyakit ginjal sering disebabkan PJK dan begitu pula sebaliknya bahwa mortalitas suatu sindrom koroner akut juga dipengaruhi oleh kondisi ginjal, terutama laju filtrasi glomerulus (LFG).
Densitas Massa Tulang pada Pasien HIV/AIDS
Authors: Mulansari Nadia Ayu , Sukmana Nanang , Setyohadi Bambang , Setiati Siti
Published: March 2018

Pendahuluan. Tingginya angka kejadian HIV/AIDS pada usia muda yang mencapai 50% dari total kasus HIV/AIDS di Indonesia menjadi permasalahan yang serius, khususnya terkait kualitas hidup pasien. Selain infeksi oportunistik, keadaan osteopenia dan juga osteoporosis sering ditemukan pada pasien dengan HIV/AIDS. Namun demikian, penelitian mengenai gambaran massa tulang pada pasien HIV/AIDS di Indonesia sampai saat ini belum didapatkan.Metode. Studi potong lintang dilakukan pada pasien dewasa dengan infeksi HIV naif antiretroviral di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada Februari-Mei 2008. Pemeriksaan bone mineral density (BMD) dilakukan dengan menggunakan DXA scanning. Hasil. Berdasarkan pemeriksaan BMD didapatkan sebanyak 29,3% subjek ostopenia, 1,3% osteoporosis dan sisanya normal. Osteopenia/osteoporosis didapatkan lebih besar pada subjek yang mengonsumsi alkohol, merokok, hitung limfosit CD4+ <200 sel/mm3 dan IMT<18,5 dengan proporsi masing-masing secara berturut-turut yaitu 53,6%; 36,9%; 35,5%; dan 37,6%. Lama infeksi HIV pada penelitian ini tidak menunjukkan hasil yang berbeda.Simpulan. Didapatkan keadaan osteopenia dan osteoporosis pada pasien dengan HIV/AIDS. Pada pasien HIV/AIDS dengan riwayat merokok, konsumsi alkohol, hitung limfosit CD4+ <200 sel/mm3 dam IMT rendah, didapatkan angka osteopenia/osteoporosis yang lebih tinggi.Kata kunci: HIV, naif antiretroviral, osteopenia/osteoporosis Bone Mass Density in HIV/AIDS PatientsIntroduction. Indonesia has a high incidence of young HIV-positive population which is 20-29 years of age is in the highest group (50%). For this reason, it is important to make a better quality of life for them. Unfortunately, beside all the opportunistic infection, it was proved that osteopenia/osteoporosis has become a new emerging metabolic condition for HIV-infected patients. There is still no study about the description of bone mass density in HIV/AIDS patients in Indonesia. Methods. A cross sectional study was conducted in a total of 75 HIV-seropositive antiretroviral-naïve patients. Bone mineral density (BMD) was determined by dual energy X-ray absorptiometry in lumbar spine. Results. Seventy-five subjects had been recruited. Low BMD was found in 29.3% HIV-seropositive patients with osteopenia and 1,3% with osteoporosis. There was a higher number of osteopenia/osteoporosis in subjects who consume alcohol, smoking, lymphocyte CD4 <200 cells/mm3 and low body mass index (BMI). Duration of infection did not show any differences in both HIV with osteopenia/osteoporosis and subjects with normal bone condition. Conclusions. Osteopenia and osteoporosis were found in patients with HIV/AIDS in RSCM with lower bone density in subjects who consumed alcohol, smoke, lymphocyte CD4 <200 cells/mm3 and low BMI. Keywords: HIV, antiretroviral naïve, osteopenia/osteoporosis
Diagnosis dan Tata Laksana Acquired Hemophilia A (AHA) dengan Pemfigoid Bulosa
Authors: Sihombing Rasco Sandy , Silalahi Henry Ratno Diono , Shatri Hamzah , Sukrisman Lugyanti , Rinaldi Ikhwan , Prasetyawati Findy , Novianto Endy , Yunir Em
Published: March 2018

Acquired hemophilia A merupakan kondisi dimana faktor koagulasi VIII menjadi tidak aktif akibat pembentukan autoantibodi. Kondisi ini dikaitkan dengan kehamilan, keganasan, dan penyakit auitoimun dengan kelainan kulit. Pada kasus ini, seorang wanita berusia 66 tahun, datang dengan keluhan perdarahan paska tindakan yang disertai dengan lesi kulit. Pasien didiagnosis dengan acquired hemophilia A dengan ditemukannya inhibitor faktor VIII terkait dengan pemfigoid bulosa.Kata Kunci: Acquired hemophilia A, diagnosis, pemfigoid bulosa, tata laksana  Diagnosis and Treatment of Acquired Hemophilia A (AHA) with Bullous PemphigoidAcquired hemophilia A is a condition in which coagulation factor VIII become inactive due to autoantibody formation. This condition is related to pregnancy, malignancy, and autoimmune disease with skin disorder. In this case report, a 66 years woman with a post procedural bleeding with skin disorder. Later on, patient diagnosed with acquired hemophilia A with a factor VIII inhibitors related to bullous pemphigoid. Keywords : Acquired hemophilia A, bullous pemphigoid, diagnosis, treatment
Pencegahan Transmisi Vertikal Hepatitis B: Fokus pada Penggunaan Antivirus Antenatal
Authors: Khumaedi Anandhara Indriani , Gani Rino Alvani , Hasan Irsan
Published: March 2018

Hepatitis B merupakan penyebab utama penyakit hati kronik dan dapat menyebabkan sirosis, gagal hati dan karsinoma hepatoselular pada 15-40% populasi. Terhitung sebanyak dua miliar penduduk dunia terinfeksi hepatitis B. Sebanyak 240 juta diantaranya mengidap hepatitis B kronik dan 780.000 jiwa meninggal karena komplikasi akut dan kronik hepatitis B. Transmisi hepatitis B berbeda di berbagai belahan dunia. Pada negara maju, transmisi hepatitis B sebagian besar melalui transmisi horizontal, sedangkan pada negara berkembang transmisi heptitis B 90% melalui transmisi vertikal. Upaya pencegahan transmisi vertikal berupa pemberian imunoglobulin mencapai tingkat keberhasilan hingga 95%, namun menyisakan sebagian kecil populasi yang mengalami kegagalan imunoprofilaksis yang berisiko untuk berkembang menjadi hepatitis B kronik. Pemberian antivirus pada saat antenatal berperan dalam mencegah transmisi vertikal pada populasi yang berisiko mengalami kegagalan imunoprofilaksis.Kata Kunci: analog nukleos(t)ida, hepatitis B, kegagalan imunoprofilaksis, transmisi vertikal  Prevention of Hepatitis B Vertical Transmission: Focus on Antenatal Antiviral AdministrationHepatitis B is one of the main cause of chronic liver disease, and potentially cause cirrhosis, liver failure and hepatocellular carcinoma in 15-40% population. Globally, 2 billion people are infected by Hepatitis B. Two hundred and forty million people are suffering from chronic hepatitis B, and more than 780 000 people are dying from both acute and chronic complication of hepatitis B. In developed countries, horizontal transmission is the main mode of virus transmission, while in developing countries vertical transmission occured in 90% population with hepatitis B. Immunoglobulin administration as a prevention strategy for vertical transmission has 95% success rate, but it left 5-10% of those who has immunoprophylaxis failure to be at risk to develop chronic hepatitis B. Antiviral administration during pregnancy is considered to prevent hepatitis B vertical transmission in population at risk on developing immunoprophylaxis failure. Keywords: hepatitis B, immunoprophylaxis failure, nucleos(t)ide analog, vertical transmission
Keberhasilan Pengobatan Terapi Antiretroviral
Authors: Karyadi Teguh H
Published: March 2018

Pengobatan antiretroviral (ARV) kombinasi merupakan terapi terbaik bagi pasien terinfeksi Human Immunodeficiency Virus (HIV) hingga saat ini. Tujuan utama pemberian ARV adalah untuk menekan jumlah virus (viral load), sehingga akan meningkatkan status imun pasien HIV dan mengurangi kematian akibat infeksi oportunistik. Pada tahun 2015, menurut World Health Organization (WHO) antiretroviral sudah digunakan pada 46% pasien HIV di berbagai negara. Penggunaan ARV tersebut telah berhasil menurunkan angka kematian terkait HIV/AIDS dari 1,5 juta pada tahun 2010 menjadi 1,1 juta pada tahun 2015. Antiretroviral selain sebagai antivirus juga berguna untuk mencegah penularan HIV kepada pasangan seksual, maupun penularan HIV dari ibu ke anaknya. Hingga pada akhirnya diharapkan mengurangi jumlah kasus orang terinfeksi HIV baru di berbagai negara.
Pendekatan Diagnosis dan Tata Laksana Alergi Obat
Authors: Pandapotan Roy Akur , Rengganis Iris
Published: March 2018

Alergi obat merupakan salah satu masalah kesehatan yang cukup serius. Alergi obat dapat didefinisikan sebagai reaksi simpang obat yang melibatkan mekanisme imunologis. Meskipun demikian, tidak mudah menentukan apakah suatu reaksi simpang obat merupakan reaksi alergi dan dibutuhkan suatu pendekatan diagnosis yang sistematis. Selain anamnesis, pemeriksaan fisis, pemeriksaan penunjang alergi obat yang terdiri dari pemeriksaan penunjang umum dan khusus yang dapat dilakukan baik in vivo, in vitro, maupun dengan biopsi. Tata laksana alergi obat adalah menghindari faktor yang menimbulkan gejala, mengobati reaksi secara benar dan cara-cara khusus seperti threating through, tes dosing, desensitisasi dan pramedikasi terhadap obat-obat tertentu.Kata Kunci: alergi, diagnosis,obat, tata laksana Approach to Diagnosis and Treatment of Drug AllergyDrug allergy is a serious medical problem. Drug allergy can be defined as an adverse drug reaction involving immunological mechanism. However, it is not easy to decide whether an adverse drug reaction is an allergic reaction, and it requires a systematically diagnostic approach. Beside a thorough history taking and physical examination, there are general and specific laboratory examination to investigate drug allergy which can be done in vivo, in vitro, or biopsy. The management of drug allergy include the avoidance of the precipitating event, and specific methods to reduce the drug reaction which include threating through, dosing test, desensitization, and the administration of premedication for certain drugs.
Vaksinasi pada Lansia
Authors: Rengganis Iris
Published: March 2018

Influenza masih terus menjadi salah satu penyebab utama morbiditas dan mortalitas terutama pada lansia. Hingga saat ini, vaksinasi influenza merupakan satu-satunya modalitas promosi kesehatan yang tersedia untuk mencegah infeksi dan komplikasi influenza. Sebuah systematic review memperkirakan efikasi secara keseluruhan vaksin influenza terhadap influenza pada orang dewasa yang sehat berusia <65 tahun adalah 70-90%. Meskipun demikian, keberhasilannya bervariasi tergantung musim influenza. Sementara efikasi vaksin influenza terhadap influenza pada orang berumur >65 tahun diperkirakan sebesar 17-53% (ketika sirkulasi virus tinggi).1 Respon imun yang lebih rendah pada lansia ini dipikirkan karena terjadinya proses penuaan pada sistem imun, yang dikenal dengan istilah imunosenesens.
Analisis Karakteristik dan Persepsi Pengguna Pelayanan Terhadap Pemanfaatan Puskesmas Sebagai Gatekeeper di Dua Puskesmas Kota Bekasi Tahun 2016
Authors: Wulandari Fitria Kusumawati , Achadi Anhari
Published: March 2018

AbstrakKonsep pelayanan kesehatan primer pada era Jaminan Kesehatan Nasional (JKN) dikembangkan dengan penguatan pelayanan primer sebagai gatekeeper dengan konsep managed care. Pada konsep managed care, suksesnya sistem gatekeeper salah satunya dinilai dari angka kunjungan dan angka rujukan ke Fasilitas Kesehatan Tingkat Lanjutan (FKTL). Penelitian ini bertujuan untuk mengetahui karakteristik dan persepsi pengguna pelayanan terhadap pemanfaatan Puskesmas sebagai gatekeeper di dua puskesmas Kota Bekasi. Penelitian ini menggunakan desain cross sectional dan pengumpulan data melalui pengisian kuesioner oleh 208 pasien peserta JKN di dua puskesmas Kota Bekasi dengan metode pengambilan sampel secara stratified purposive sampling. Hasil penelitian menunjukkan pekerjaan (nilai p=0,018), persepsi terhadap sikap petugas kesehatan (nilai p=0,000), dan lama berobat (nilai p=0,048) berhubungan dengan pemanfaatan puskesmas sebagai gatekeeper. Persepsi terhadap sikap petugas kesehatan merupakan faktor dominan yang mempengaruhi pemanfaatan Puskesmas sebagai gatekeeper (r=0.720). Penerapan konsep gatekeeper dengan baik dapat meningkatkan pemanfaatan Puskesmas dan menekan angka rujukan ke FKTL. AbstractThe concept of primary health care in the era of National Health Insurance (JKN) is developed by strengthening primary health care as a gatekeeper with the concept of managed care. In this concept of managed care, one og the success story of the gatekeeper system is assessed by the visit and referral rates to the Higher Level of Health Facilities (ALHF/Fasilitas Kesehatan Tingkat Lanjut). This study aimed to determine the characteristics and perception of service users towards utilization of public health centers (PHC/Puskesmas) as gatekeeper in two PHC in City of Bekasi. This study used cross-sectional design and data collection by filling up questionnaires by 208 patients of JKN members in two health centers in Bekasi with stratified purposive sampling methods. The results showed that job(p=0.018), perceptions of the health workers’ attitudes (p=0.000), and treatment duration (p=0.048) were related to the utilization of PHC as a gatekeeper. Perceptions of the health workers’ attitude was the dominant factor affecting the utilization of PHC as a gatekeeper (r=0.720). The health workers’ attitude affected the repeated utilization services in PHC and its utilization as a gatekeeper, especially for continuum care. The proper application of gatekeeper concept should be able to increase the utilization of PHC and reduce the number of referrals to the Advanced Level of Health Facilities (ALHF).
Assessing the disturbance potential of small unoccupied aircraft systems (UAS) on gray seals (Halichoerus grypus) at breeding colonies in Nova Scotia, Canada
Authors: Arona Lauren , Dale Julian , Heaslip Susan G. , Hammill Michael O. , Johnston David W.
Published: March 2018

The use of small unoccupied aircraft systems (UAS) for ecological studies and wildlife population assessments is increasing. These methods can provide significant benefits in terms of costs and reductions in human risk, but little is known if UAS-based approaches cause disturbance of animals during operations. To address this knowledge gap, we conducted a series of UAS flights at gray seal breeding colonies on Hay and Saddle Islands in Nova Scotia, Canada. Using a small fixed-wing UAS, we assessed both immediate and short-term effects of surveys using sequential image analysis and between-flight seal counts in ten, 50 m2 random quadrats at each colony. Counts of adult gray seals and young-of-the-year animals between first and second flights revealed no changes in abundance in quadrats (matched pair t-test p > 0.69) and slopes approaching 1 for linear regression comparisons (r2 > 0.80). Sequential image analysis revealed no changes in orientation or posture of imaged animals. We also assessed the acoustic properties of the small UAS in relation to low ambient noise conditions using sound equivalent level (Leq) measurements with a calibrated U-MIK 1 and a 1/3 octave band soundscape approach. The results of Leq measurements indicate that small fixed-wing UAS are quiet, with most energy above 160 Hz, and that levels across 1/3 octave bands do not greatly exceed ambient acoustic measurements in a quiet field during operations at standard survey altitudes. As such, this platform is unlikely to acoustically disturb gray seals at breeding colonies during population surveys. The results of the present study indicate that the effects of small fixed-wing UAS on gray seals at breeding colonies are negligible, and that fixed-wing UAS-based approaches should be considered amongst best practices for assessing gray seal colonies.
Large-scale assessment of commensalistic–mutualistic associations between African birds and herbivorous mammals using internet photos
Authors: Mikula Peter , Hadrava Jiří , Albrecht Tomáš , Tryjanowski Piotr
Published: March 2018

Birds sitting or feeding on live large African herbivorous mammals are a visible, yet quite neglected, type of commensalistic–mutualistic association. Here, we investigate general patterns in such relationships at large spatial and taxonomic scales. To obtain large-scale data, an extensive internet-based search for photos was carried out on Google Images. To characterize patterns of the structural organization of commensalistic–mutualistic associations between African birds and herbivorous mammals, we used a network analysis approach. We then employed phylogenetically-informed comparative analysis to explore whether features of bird visitation of mammals, i.e., their mean number, mass and species richness per mammal species, are shaped by a combination of host mammal (body mass and herd size) and environmental (habitat openness) characteristics. We found that the association web structure was only weakly nested for commensalistic as well as for mutualistic birds (oxpeckers Buphagus spp.) and African mammals. Moreover, except for oxpeckers, nestedness did not differ significantly from a null model indicating that birds do not prefer mammal species which are visited by a large number of bird species. In oxpeckers, however, a nested structure suggests a non-random assignment of birds to their mammal hosts. We also identified some new or rare associations between birds and mammals, but we failed to find several previously described associations. Furthermore, we found that mammal body mass positively influenced the number and mass of birds observed sitting on them in the full set of species (i.e., taking oxpeckers together with other bird species). We also found a positive correlation between mammal body mass and mass of non-oxpecker species as well as oxpeckers. Mammal herd size was associated with a higher mass of birds in the full set of species as well as in non-oxpecker species, and mammal species living in larger herds also attracted more bird species in the full set of species. Habitat openness influenced the mass of birds sitting on mammals as well as the number of species recorded sitting on mammals in the full set of species. In non-oxpecker species habitat openness was correlated with the bird number, mass and species richness. Our results provide evidence that patterns of bird–mammal associations can be linked to mammal and environmental characteristics and highlight the potential role of information technologies and new media in further studies of ecology and evolution. However, further study is needed to get a proper insight into the biological and methodological processes underlying the observed patterns.
Gastrointestinal Angiodysplasia Resolution After Transcatheter Aortic Valve Implantation
Authors: Goltstein Lia C. M. J. , Rooijakkers Maxim J. P. , Thierens Naomi D. E. , Schoormans Selene C. M. , van Herwaarden Antonius E. , Beaumont Hanneke , Houdeville Charles , Hoeks Marlijn P. A. , van Geenen Erwin-Jan M. , Rijpma Sanna R. , Dray Xavier , van Royen Niels , Drenth Joost P. H.
Published: October 2024

Importance

Heyde syndrome is the cooccurrence of aortic stenosis and gastrointestinal bleeding secondary to vascular lesions, including angiodysplasias. Several studies have demonstrated cessation of gastrointestinal bleeding after transcatheter aortic valve implantation (TAVI), but the etiology and effects on vascular lesions are largely unknown.

Objective

To examine the associations of TAVI with gastrointestinal vascular lesions and identify factors associated with recovery among patients with iron deficiency anemia and severe aortic stenosis.

Design, Setting, and Participants

In this prospective, single-center cohort study, patients with iron deficiency anemia on the TAVI waiting list from September 2020 to February 2022 were assessed by capsule endoscopy. Those with vascular lesions were reassessed 6 months after TAVI. Endoscopic images were anonymized and evaluated by 2 independent researchers. Data were analyzed from September 2022 to August 2024.

Exposure

TAVI.

Main Outcomes and Measures

The primary outcome was the mean difference in the number of vascular lesions before vs after TAVI.

Results

A total of 24 patients (mean [SD] age, 77.4 [7.1] years; 18 [75.0%] male) underwent capsule endoscopy, and vascular lesions were present in 18 patients (75.0%). TAVI was performed in 15 of 18 patients with vascular lesions, of whom 11 agreed to a second capsule endoscopy. The mean (SD) number of vascular lesions across the gastrointestinal tract decreased from 6.4 (5.6) lesions before TAVI to 2.0 (2.1) lesions 6 months after TAVI (P = .04). The number of vascular lesions decreased in 9 of 11 patients (81.8%), including 6 patients (54.5%) who no longer had typical angiodysplasias. Resolution of angiodysplasias was less frequent in patients who had multiple valvular heart disease before TAVI (0 of 3 patients) vs those without multiple valvular heart disease (6 of 8 patients [75.0%]) and in patients with significant paravalvular leakage after TAVI (2 of 5 patients [40.0%]) vs those without significant leakage (4 of 6 patients [66.7%]).

Conclusions and Relevance

In this cohort study of 24 patients with iron deficiency anemia and severe aortic stenosis, angiodysplasias were present in 75.0% of patients. TAVI was associated with reduced size and number of angiodysplasias in these patients. These findings suggest that TAVI not only improves aortic stenosis but may also reduce gastrointestinal bleeding by resolving vascular lesions, offering a dual benefit for patients with Heyde syndrome.
Elimination of the Percentile Score From the Surgical ABSITE—The Program Director Perspective
Authors: Sarosi George A. , Spain David A. , Johnson Shaneeta
Published: October 2024

This Viewpoint discusses the elimination of the percentile score from the American Board of Surgery In-Training Examination (ABSITE) from the program director’s perspective.
Molecular Engineering of Xanthene Dyes with 3D Multimodal‐Imaging Ability to Guide Photothermal Therapy
Authors: Zhang Li‐Na , Ran Xiao‐Yun , Zhang Hong , Zhao Yu , Zhou Qian , Chen Shan‐Yong , Yang Cheng , Yu Xiao‐Qi , Li Kun
Published: October 2024

Phototheranostics integrates light‐based diagnostic techniques with therapeutic interventions, offering a non‐invasive, precise, and swift approach for both disease detection and treatment. The efficacy of this approach hinges on the multimodal imaging potential and photothermal conversion efficiency (PCE) of phototheranostic agents (PTAs). Despite the promise, crafting multifunctional phototheranostic organic small molecules brims with challenges. In this research, four innovative xanthene‐derived PTAs are synthesized by fine‐tuning the donor‐π‐acceptor (D‐π‐A) system to strike a balance between radiative and nonradiative decay. The inherent robust photostability and intense fluorescence of the traditional xanthene core are preserved, meanwhile the addition of highly electron‐withdrawing groups boosts the non‐radiative decay rate to enhance PCE and photoacoustic imaging capabilities. Remarkably, one of the PTAs, DMBA, demonstrates an exceptional absolute fluorescence quantum yield of 2.46% in PBS, and when encapsulated into nanoparticles, it achieves a high PCE of 79.5%. Consequently, DMBA nanoparticles (DMBA‐NPs) are effectively employed in fluorescence, 3D photoacoustic, and photothermal imaging‐guiding tumor photothermal therapy. This represents the first instance of a multimodal phototheranostic xanthene agent achieving synergistic fluorescence and photoacoustic imaging for diagnostic purposes. Furthermore, this work paves the way for leveraging xanthene fluorophores as versatile tools in the development of multifunctional reagents.
Omics‐Enhanced Nanomedicine for Cancer Therapy
Authors: Qi Lin , Li Zhihong , Liu Jianping , Chen Xiaoyuan
Published: October 2024

Cancer nanomedicine has emerged as a promising approach to overcome the limitations of conventional cancer therapies, offering enhanced efficacy and safety in cancer management. However, the inherent heterogeneity of tumors presents increasing challenges for the application of cancer nanomedicine in both diagnosis and treatment. This heterogeneity necessitates the integration of advanced and high‐throughput analytical techniques to tailor nanomedicine strategies to individual tumor profiles. Omics technologies, encompassing genomics, epigenomics, transcriptomics, proteomics, metabolomics, and more, provide unparalleled insights into the molecular and cellular mechanisms underlying cancer. By dissecting tumor heterogeneity across multiple levels, these technologies offer robust support for the development of personalized and precise cancer nanomedicine strategies. In this review, the principles, techniques, and applications of key omics technologies are summarized. Especially, the synergistic integration of omics and nanomedicine in cancer therapy is explored, focusing on enhanced diagnostic accuracy, optimized therapeutic strategies and the assessment of nanomedicine‐mediated biological responses. Moreover, this review addresses current challenges and outlines future directions in the field of omics‐enhanced nanomedicine. By offering valuable insights and guidance, this review aims to advance the integration of omics with nanomedicine, ultimately driving improved diagnostic and therapeutic strategies for cancer.
Reversible Configurations of 3‐Coordinate and 4‐Coordinate Boron Stabilize Ultrahigh‐Ni Cathodes with Superior Cycling Stability for Practical Li‐Ion Batteries
Authors: Yu Haifeng , Cheng Jin , Zhu Huawei , Chen Ling , Lian Cheng , Hu Yanjie , Liu Honglai , Jiang Hao , Li Chunzhong
Published: October 2024

Ultrahigh‐Ni layered oxide cathodes are the leading candidate for next‐generation high‐energy Li‐ion batteries owing to their cost‐effectiveness and ultrahigh capacity. However, the increased Ni content causes larger volume variations and worse lattice oxygen stability during cycling, resulting in capacity attenuation and kinetics hysteresis. Herein, a Li2SiO3‐coated Li(Ni0.95Co0.04Mn0.01)0.99B0.01O2 ultrahigh‐Ni cathode that well‐addresses all the above issues, which is also the first time to realize the real doping of B ions is demonstrated. The as‐obtained cathode delivers a reversible capacity of up to 237.4 mAh g−1 (924 Wh kg−1cathode) and a superior capacity retention of 84.2% after 500 cycles at 1C in pouch‐type full‐cells. Advanced characterizations and calculations verify that the boron‐doping is existed in terms of 3‐coordinate and 4‐coordinate configurations and their high electrochemical reversibility during de‐/lithiation, which greatly stabilizes oxygen anions and impedes Ni‐ion migration to Li layer. Furthermore, the B‐doping engineers the primary particle microstructure for better relaxing the lattice strain and accelerating Li‐ion diffusion. This work advances the energy density of cathode materials into the domain of above 900 Wh kg−1, and the concept will inspire more intensive study on ultrahigh‐Ni cathodes.
The landscape genetics of a mass‐flowering fire‐ephemeral plant
Authors: Jordan Mira , Bragg Jason , Ooi Mark , van der Merwe Marlien , Rossetto Maurizio , Cornwell Will
Published: October 2024

Premise

Obligate fire ephemerals are annual plants that have germination and reproduction cued by fire occurrence, persisting between fire events in a long‐lived soil seed bank. Within these species, gene flow is restricted not only geographically but also temporally because individuals are limited to reproducing with others affected by the same fire event. The patchwork‐like distribution of fires may therefore promote population isolation. In contrast to past fires, the Australian fires of 2019–2020 were of unprecedented extent, providing an opportunity to investigate the landscape genetics of a fire ephemeral, Actinotus forsythii, across multiple populations and to compare it to a common congener, Actinotus helianthi.

Methods

For both species, we used single nucleotide polymorphisms to infer patterns of population structure and calculate measures of genetic diversity. We also estimated a phylogeny of Actinotus forsythii to understand the differentiation of a geographically isolated population.

Results

For A. forsythii, the within‐population diversity (allelic richness = 1.56) was greater, and the among‐population differentiation (FST = 0.30) was lower than that observed for A. helianthi (allelic richness = 1.33, FST = 0.57). Actinotus forsythii had distinct geographic groupings, and a geographically isolated population of this species was genetically highly differentiated.

Conclusions

Despite the fire‐dependent, asynchronous gene flow, predicted between site disconnect, and possible within‐site homogeneity, our results suggest that burn mosaic could be influencing gene flow patterns and fire‐triggered mass flowering may promote genetic diversity within Actinotus forsythii.
ARSA Variant Associated With Late Infantile Metachromatic Leukodystrophy and Carrier Rate in Individuals of Ashkenazi Jewish Ancestry
Authors: Rabin Rachel , Hirsch Yoel , Booth Kevin T. A. , Hall Patricia L. , Yachelevich Naomi , Mistry Pramod K. , Ekstein Josef , Pappas John
Published: October 2024

Metachromatic leukodystrophy (MLD) is a rare neurodegenerative lysosomal storage disease resulting from bi‐allelic pathogenic variants in the ARSA gene. MLD is distinguished clinically based on the age of onset into late‐infantile, juvenile, and adult. The late‐infantile type is the most severe phenotype presenting with hypotonia, weakness, gait abnormalities, which progresses to mental and physical decline leading to early death. MLD is considered to be pan‐ethnic and no founder variants have previously been described in the Ashkenazi Jewish population. We identified three unrelated individuals of Ashkenazi Jewish descent with homozygosity or compound heterozygosity for the c.178C>T (p.Arg60Trp) variant in the ARSA gene, with a phenotype consistent with late‐infantile MLD. The carrier frequency was calculated among 93,293 individuals of Ashkenazi Jewish descent through the Dor Yeshorim screening program and found to have a carrier frequency on 1 in 1554 or 0.06%, which may be representative of a founder variant. Molecular protein modeling showed that the variant affects regional folding. Late‐infantile MLD should be considered when the c.178C>T (p.Arg60Trp) variant in the ARSA gene is present in either the homozygous or the compound heterozygous states.
Ambient particulate matter and frequency of outpatient visits for chronic rhinosinusitis in the United States
Authors: Yang Hong‐Ho , Grimm David , Velasquez Esther , Hwang Peter H.
Published: October 2024

Background

Emerging evidence has underscored the harmful effects of air pollution on the upper airway. We investigated the relationship between ambient particulate matter (PM) level and the frequency of outpatient visits for chronic rhinosinusitis (CRS).

Methods

We conducted an ecological cohort study of US adults enrolled in The Merative MarketScan outpatient database from 2007 to 2020. For each geographical subunit (core‐based statistical area [CBSA]), we calculated the annual rate of CRS‐related outpatient visits per 1000 well‐patient checkup visits (CRS‐OV). Using data from the Environmental Protection Agency's Air Quality System, we mapped the rolling statistical average of daily PM2.5 and PM10 over the preceding year onto each CBSA × year combination. We employed multivariable negative binomial regression modeling to estimate the association between PM levels and subsequent CRS‐OV.

Results

Across 3933 observations (CBSA × year combinations), encompassing ∼4 billion visits, the median CRS‐OV was 164 (interquartile range 110–267). The mean PM2.5 level was 8.9 µg/m3 (SD 2.6) and the mean PM10 level was 20.2 µg/m3 (SD 7.2). Adjusting for patient demographics and respiratory comorbidities, a compounded rise in subsequent CRS‐OV was observed with increasing PM levels. Each µg/m3 rise in PM2.5 independently predicted a 10% increase in CRS‐OV (adjusted incidence rate ratio [aIRR]) 1.10, 95% confidence interval [CI] 1.08–1.13) and each µg/m3 rise in PM10 independently predicted a 3% increase in CRS‐OV (aIRR 1.03, 95% CI 1.02–1.04).

Conclusion

Elevated ambient PM2.5 and PM10 levels are associated with a subsequent compounded increase in the frequency of CRS‐OV, with PM2.5 predicting a more pronounced rise compared to PM10.
Hydroaminoalkylation for Amine Functionalization of Vinyl‐Terminated Polyethylene Enables Direct Access to Responsive Functional Materials
Authors: Ataie Saeed , Malmir Amir , Scott Sabrina S. , Goettel James T. , Clemens Steven N. , Morrison Darryl J. , Mackie Cyrus , Heyne Belinda , Hatzikiriakos Savvas G. , Schafer Laurel L.
Published: October 2024

While functionalized polyethylenes (PEs) exhibit valuable characteristics, the constraints of existing synthetic approaches limit the variety of readily incorporated functionality. New methods to generate functionalized PEs are required to afford new applications of this common material. We report 100 % atom economic tantalum‐catalyzed hydroaminoalkylation of vinyl‐terminated polyethylene (VTPE) as a method to produce amine‐terminated PE. VTPEs with molecular weights between 2200–16800 g/mol are successfully aminated using solvent‐free conditions. Our catalytic system is efficient for the installation of both aromatic and aliphatic amines, and can be carried out on multigram scale. The associating amine functional groups afford modified material properties, as measured by water contact angle, differential scanning calorimetry (DSC) and polymer rheology. The basic amine functionality offers the opportunity to convert inert PE into stimuli‐responsive materials, such that the protonation of aminated PE affords the generation of functional antibacterial PE films.
Absorption and fluorescence profiles of biodiesel blends from Acrocomia aculeata kernel and pulp oils: Optical responses of α‐tocopherol and β‐carotene under thermal degradation
Authors: Passos Wilson Espíndola , Segovia Maydla Vasconcelo Adriano , Lescano Caroline Honaiser , de Pires de Oliveira Ivan , Caires Anderson Rodrigues Lima , Muzzi Rozanna Marques
Published: October 2024

The search for new, more sustainable, and ecologically safe sources of energy has encouraged studies involving the production of biofuels from non‐petroleum origin. Among the options for new energy sources, biodiesel is an important substitute for polluting fuels, with several cleaner and greener oils being suggested, especially new plant resources. This field evolved significantly in the last decades, and new raw materials for biodiesel production are welcome for new advances. In this vein, a potential source for biodiesel production is explored here, that is, two distinct biodiesels produced from different parts of the Acrocomia aculeata fruits—pulp and kernel. Results showed that biodiesel from pulp had an induction period of 12.77 h, ~3× higher than biodiesel from kernel, 3.96 h; iodine values in biodiesel pulp were ~7.5× higher than the kernel, 82 and 11 g I2/100 g, respectively. These results are due to the profile of different antioxidants in these biodiesels and unsaturations in the fatty acids carbon chains. The degradation behavior of these biodiesels was monitored by the acid value via the traditional titration method, attesting the blend oxidation until 48 h of thermal degradation. In parallel, UV–Vis absorbances and fluorescence compared pure biodiesels and its blends with β‐carotene and α‐tocopherol standards. The wavelength at 445 nm was efficient in monitoring the degradation of blends rich in β‐carotene—B25, B50, B75, B100. Primary and secondary compounds produced in the oxidative process were monitored at 230 and 270 nm, respectively, showing the pulp biodiesel antioxidant effect on the kernel one. Additionally, from the fluorescence contour map, it was possible to analyze regions of excitation/emission capable of monitoring the degradation process of the blends, found 415 nm, similar to expected for kernel and pulp oils described in the literature. Thus, the study provides information about changes in the optical profiles of biodiesel naturally rich in tocopherol and carotenoid antioxidants, encouraging the development of analytical methods based on absorption and fluorescence spectroscopies for this important resource of vegetable oils.
LIFs‐Based Fluorescent Analysis of Silver Ions in Water Using AIEgen‐Embedded PVA Hydrogel
Authors: Yao Li , Feng Lixia , Wang Mengting , Wu Shujun , Zhou Zhibiao , Xie Sheng
Published: October 2024

The detection and quantification analysis of silver ions is important to protect human health and improve the level of wastewater treatment. In this work, a polyvinyl alcohol (PVA) hydrogel‐based sensing material based on an aggregation‐induced emission strategy was developed and combined with a portable laser‐induced fluorescence spectroscopy (LIFs) device for the direct detection and quantification of silver ions in water. Considering the requirements of environmental water analysis regarding portability, reliability, and convenience, this fluorescence turn‐on strategy was optimized accordingly to ensure the accuracy and stability of the analysis in complex natural water environmental. This sensing method showed operational excellence and good sensitivity (down to 1 ppb) and may provide a stable and convenient strategy for the on‐site, real‐time analysis of environmental water samples.
Toward circular economy: Implementing circular economy strategies to reduce carbon emissions in Chinese cities
Authors: Ren Qiuzhen , Li Jinkai , Albrecht Johan
Published: October 2024

To avert the worst impacts of climate change, greenhouse gas emissions must be reduced by 45% by 2030 and reach net zero by 2050, as outlined in the Paris Agreement. The circular economy (CE) is expected to play a key role in achieving this goal by changing consumption and production patterns. However, the actual impact of CE on reducing carbon emission intensity remains unclear, especially in developing countries. This paper examines the effect of CE‐associated actions on reducing carbon emission intensity in Chinese cities, utilizing CE pilot policy experimentation. We employ difference‐in‐differences (DID) methods with data from 282 cities spanning 2002 to 2012 to analyze the average treatment effect of CE actions. Our results show a significant reduction in carbon emission intensity in CE pilot cities compared to non‐pilot cities after the implementation of CE practices. Moreover, our estimates indicate that the carbon reduction effect strengthens over time, driven by the improvements in green innovation capacity and industrial structure upgrades. The effectiveness of CE varies across city types, with more pronounced impacts observed in economically underdeveloped and resource‐based cities. However, while CE practices reduce carbon emission intensity in pilot cities, significant spatial spillover effects increase emissions in neighboring cities. In conclusion, our findings underscore both the effectiveness and complexity of the CE pilot policy in reducing carbon emission intensity in Chinese cities.