bluuebunny/crossref_metadata_2025 huggingface dataset:
Analisis Mutasi Gen SRY dan AZF serta Fungsi Gonad pada Penderita 46,XY Disorder of Sex Development (DSD)
Authors: Erawati Meira , Winarni Tri Indah , Juniarto Ahmad Zulfa , Santosa Ardy , Faradz Sultana MH
Published: February 2018

Disorder of sex development (DSD) includes congenital conditions in which development of chromosomal,gonadal or anatomy of urogenital is atypical. SRY and AZF genes have relationships with sex development andfertility in 46,XY DSD patients. Therefore, the condition of those genes and gonadal function on 46,XY DSD patientsare needed to be explored deeply. The aim of this study was to know the incident number of SRY and AZF genes andgonadal function of 46,XY DSD patients. So that it can be used as one of basic analyses of DSD and infertility statuson 46,XY DSD patients .Methods: This is an observational descriptive study with cross sectional approach. This study involved 36 patientsthat fulfilled the criteria of 46,XY DSD. The DNA of each sample was analyzed by PCR electrophoresis. The data ofhCG stimulation test were obtained from secondary data of patient’s medical record.Results: A hundred percent (100%) of 36 samples did not have deletion on their SRY gene. About 22,22% of sampleshad AZFa gene deletion especially on STS sY84. There were 19,44% samples that showed negative response to hCGstimulation test. Chi square test showed that AZFa deletion did not have relation with gonadal response positifity on46,XY DSD patients.Conclusion: Patients of 46,XY DSD need to be evaluated for their fertility especially on the sperm analysis afterreaching puberty period. It is done to patients with positive or negative gonadal responses to know whether infertilityis influenced by AZF gene or other factors.
Perbandingan Efek Pemberian Emulsi Kedelai dan Emulsi Tempe Terhadap Hitung Limfosit Total pada Tikus Putih yang Telah Diberi Prednison
Authors: Nurcahyani Rizka Bekti , Pardede Imelda T , Masdar Huriatul
Published: February 2018

Adequate nutrition is one of important factors in immunodeficiency repairment. Soybean and tempeh contains proteins,zinc, ferrum, vitamins and isoflavon. Fermentation in tempeh makes it having better nutrients digestion and absorptionthan soybean. The objective of this study was to compare the effects of soy and tempeh emulsions on total lymphocytecount in rats treated with prednisone. The test was done on 24 male white rats divided into four groups. Group A wasgiven distilled water and group B, C and D had prednisone 2.5 mg/day for 6 days. After that, group A and B werecontinued having distilled water while groups C or D was fed with soy or tempeh emulsion 0.71 mL/day for 10 days,respectively. The results shown that soy and tempeh emulsion could increase total lymphocyte count significantly (p <0,05) but there was no significant difference of total lymphocyte count between soy and tempeh emulsion groups (p >0,05).
Perancangan Objective Structured Clinical Examination (OSCE) untuk Menilai Kompetensi Klinik
Authors: Zulharman Zulharman
Published: February 2018

When planned and organized correctly, OSCE can be highly successful as an instrument to assess competence inmedicine. Knowledge about how to plan and organize OSCE is required by OSCE’s designers in medical education, sothat OSCE which had been designed become valid, reliable and feasible. The elements in designed OSCE consisted ofdefining of clinical competency which be assessed, design station, patient, examiners, pass or fail scoring, logistics andcosts.
Gambaran Penderita Fraktur Maksilofasial di RSUD Arifin Achmad Pekanbaru Periode Januari 2009-desember 2011
Authors: Juwita Nanda , Zulfikar Welli , Restuastuti Tuti
Published: February 2018

Maxillofacial fracture can cause facial deformity up to threat life saving thing due to disturbance of airway. Maxillofacialfracture is most happen in productive age because of more high activities. This research purpose to know thedemography maxillofacial fracture patient. This research was a descriptive retrospective study which was done atArifin Achmad General Hospital Pekanbaru. Base on secondary data research results that take from patient’s medicalrecord from 195 patients maxillofacial fracture, only 135 cases include to criteria. Maxillofacial fracture 117 patientswere men (86,67%) and 18 patients were women (13,33%). Most of patients were 11-20 years old 53 cases (39,26%).Traffic accident was the most etiology maxillofacial fracture 128 cases (94,81%.). Most often clinical manifestationswere edema of soft tissue, epistaxis, deformity and malocclusion. Mandibula fracture as the first top case were 62patients (45,92%). Surgery (ORIF) was mostly done in 87 patient (64,45%), include combine with close reduction.
Efektivitas Ekstrak Etanol Daun Jeruk Purut (Citrus hystrix DC) Sebagai Larvasida Nyamuk Aedes aegypti
Authors: Maryanti Esy , Marta R. Della , Hamidy M Yulis
Published: February 2018

Dengue Hemorrhagic Fever is caused by dengue virus and spread by Aedes aegypti as primarily vector. Preventingdengue virus transmission depends on control of the mosquito vectors. Kiffer lime is one of the potential plants as abotanical larvacidal. The aim of this study was to investigate kiffer lime larvacidal ability against Ae.aegypti larvaebased on LC50 and LC90 levels by probit analize. The design of this research was experimental including preliminarytest and final test. 525 samples of Ae.aegypti larvae instar III/IV were used in this study and divided in to six groupsof experiment. The result were from observation of the larvae mortalities within 24 hours. Assassement of larvacidalefficacy demonstrated that kiffer lime leaf were toxic against Ae.aegypti larvae. LC50 value is 4015,880 ppm and LC90value is 6961,822 ppm. Ethanol extract of kiffer lime leaf could be considered as a potentially alternative source forbotanical larvacides.
Luaran Kehamilan Dengan Sistemik Lupus Eritematosus
Authors: Savira Maya
Published: February 2018

Systemic lupus erythematosus often abbreviated to SLE or lupus, is a systemicautoimmune disease (or autoimmuneconnective tissue disease) that can affect any part ofthe body. As occurs in other autoimmune diseases, the immunesystem attacks the body’scells and tissue, resulting in inflammation and tissue damage. It is a type IIIhypersensitivityreaction caused by antibody-immune complex formation. Women with lupus are at risk for various complications ofpregnancy, and those with antiphospholipid antibodies may have an increased risk of miscarriage. Systemic lupuserythematosus increases the risk of spontaneous abortion, intrauterine fetal death, preeclampsia, intrauterine growthretardation, and preterm birth. The outcome for both mother and child is best when systemic lupus erythematosus hasbeen under good control for at least six months before pregnancy and when the kidney disease is in remission.
Identifikasi dan Hitung Koloni Bakteri pada Tangan Perawat Kamar Operasi Instalasi Bedah Sentral (IBS) RSUD Arifin Achmad Pekanbaru Sebelum dan Sesudah Cuci Tangan dengan Antiseptik Klorheksidin Glukonat
Authors: Devi Devi , Andrini Fauzia , Pamungkas Kuswan Ambar
Published: February 2018

Handwashing is an important thing to do and the most effective way in order to prevent nosocomial infection andinfection control. The most popular surgery’s handwashing is fuerbringer method. The purpose of this study was toknow the effectivity of hand washing from the nurses that work at central operation theather Arifin Achmad GeneralHospital Pekanbaru before and after washing hand with chlorhexidine gluconat antiseptic. This study method waslaboratoric descriptive with 22 samples which got from total sampling method. Bacterial was found from all sample.Bacterial which were found from the samples before hand washing were Coagulase negative staphylococci (CONS)(62.9%), Bacillus sp (20%), Metichillin resistant Staphylococcus aureus (MRSA) (11.4%) and Metichillin sensitiveStaphylococcus aureus (MSSA) (5.7%). Bacterial which found after doing hand wash were CONS (52.9%), Bacillussp (17.7%), Escherichia coli (8.8%), MRSA (11.8%), and MSSA (5.9%). The result of this bacterial colonizationarea showed the reduction of bacterial colonization after doing hand wash in 90.1% sample , which mostly reductionwas happen from II degree to I (36.4%).
Anisakis sp. dan Alergi yang Diakibatkannya
Authors: Adawiyah Robiatul , Maryanti Esy , E.Siagian Forman
Published: February 2018

Parasitic diseases were initially found in many endemic areas, but currently also found in non endemic areas.One is anisakiasis caused by Anisakis sp. Humans can be infected by this parasite by direct consumpt the organismand contact with the fish / products of food that containing this parasite.There are some points that can increase therisk of infection of this parasite, high movement of people from one area to another either temporary or permanent,the food processing especially in the case of the fish packing, the advance of transportation that enables the widespreadof marine products which contaminated and how to eat the fish which contaminated. Anisakis sp. Antigen derivedfrom the excretion-secretion products, somatic and cuticular of the parasite larvae. Good hygiene and understandingof the problem and potential risk will increase alertness and awareness of Anisakis sp.infections
Modifikasi Sistem Asistensi dan Responsi Kelas Kecil pada Praktikum Parasitologi Blok Digestif dan Hematoimunologi Fakultas Kedokteran Universitas Riau
Authors: Lesmana Suri Dwi , Maryanti Esy
Published: February 2018

Faculty of Medicine University of Riau has been implementing Competency Based Curriculum (KBK) with theProblem Based Learning (PBL) since 2007 with the implementation of teaching and learning activities of the systemconsists of a tutorial activities, skillab, expert lectures, independent and practical. However, there are still manyproblems in the implementation of the KBK on preclinic degree. One part of the block that is identified to be one ofthe causes of low graduation exam block is less efective coaching laboratory practice. Parasitology is one part of thetask is to provide laboratory practice in several blocks on the stage of preclinic especially digestive and hematoimunologyblock. This study aimed to compare the results of the evaluation of parasitology laboratory practice in hematoimunologyand digestive assistance and posttest in large classes with small class. Assistance and posttest in large class performedon the digestive block implementation and hematoimunologi in 2011 while assisting and posttest of small classes ona block implementation in 2012. Average value of small class digestive laboratory practice was not significantlylower than the large class but the proportion of the value of quality B and C more many in small classes. The meanvalue of the block hematoimunologi laboratory practice significantly higher on small class assistance and posttest aswell as the proportion of the value of quality A, B and C was higher in small classes than large classes.
Efek Analgetik Ekstrak Etanol Kelopak Rosella (Hibiscus sabdariffa L) Pada Mencit Jantan (Mus musculus)
Authors: Baihaqi Ridwan , Hamidy M. Yulis , Bebasari Eka
Published: February 2018

Indonesia has been known for its traditional medicine and one of the plants used for tradisional medicine is Hibiscussabdariffa L. The roselle (Hibiscus sabdariffa L) calyx has antipyretic effect by blocking prostaglandin synthesis. Thepurpose of this study was to find out the existences of analgesic effect of roselle (Hibiscus sabdariffa L) calyx ethanolextract. This experimental research used a post test only design that was conducted on 25 male mices weighting 20-35 g. The mices were divided into 5 treatment groups and given the CMC-Na 0,5% (negative control), asetosal 65 mg/kgBB (positive control) and groups of roselle (Hibiscus sabdariffa L) calyx ethanol extract dose of 200 mg/kgBB,400 mg/kgBB and 800 mg/kgBB. Pain stimulus was given chemically by using 1% acetic acid that injectedintraperitoneally 30 minutes after sample was given the extract, the response of the mices will be writhing. It calledpositive response if percentage potency of analgesic e” 50%. The result of this research showed that all dosage ofroselle (Hibiscus sabdariffa L) calyx ethanol extract had an analgesic effect.
Pengetahuan dan Perilaku Kesehatan Gigi pada siswa SDN 174 Muara Fajar Pekanbaru
Authors: Restuastuti Tuti , Handayani Handayani , Ernalia Yanti
Published: February 2018

Dental caries and gingivitis are often found in Indonesia primary school students. The data from Puskesmas MuaraFajar noted, only 14.06% of Elementary Students who received dental care and 52% of them required treatment. TheObjective of study was to assess the students’ dental health knowledge and behavior level of SDN 174 Pekanbaruand to associate with dental health status, including dental caries, DMF-T OHI-S, Debris Index (DI-S) and CalculusIndex (CI-S). The methodology used a cross-sectional survey research design. The sample were 61 students whotaken by all students in grade 6 of SDN 174 Muara Fajar Pekanbaru. Examination of student’s dental health statuslike dental caries, DMF-T OHI-S, Debris Index (DI-S) and Calculus Index (CI-S) was made, and followed by askingthe knowledge and behavior questionnaire about dental health. Processed data with the statistical program SPSSversion 17. the data presented in the narrative, univariate analysis to look at the frequency distribution of the data,and bivariate analysis to find an association between the knowledge and behavior to the dental health status. Theresults showed that most characteristics respondents were female (50.8%), aged 12 years (41%) and have enoughnutrition (68.9%). Then there were 25 students (41%) having less knowledge about dental health and as many as 25students (41%) have the less behavior about dental health. While the results of the examination of the dental healthstatus showed as many as 24 students (39%) had problems in the DI-S, 12 students (20%) had problems in the CI-S,and as many as 26 students (43%) had problems in dental health (OHI -S). There was no relationship betweenknowledge of dental health to dental health status, but there is a relationship regarding student behavior of dentalhealth to dental health status(p = 0.02, OR = 3.4).
Penerapan Metode Mind Mapping untuk Meningkatkan Hasil Belajar PKn Pada Siswa Kelas IX SMPN 1 Kalidawir
Authors: Nisak Eny Djauharatun
Published: February 2018

Hasil observasi yang dilakukan di Kelas IX A pada waktu pembelajaran Pendidikan Kewaarganegaraan diperoleh hasil belajar siswa kurang memuaskan, yaitu dari 34 siswa hanya 8 siswa yang nilainya dapat mencapai KKM atau 70, sedangkan 26 siswa lainnya masih belum dapat mencapai KKM atau 69. Untuk itu, dilakukan penelitian ini dengan menerapkan metode mind mapping guna menyelesaikan masalah tersebut. penelitian ini merupakan suatu penelitian tindakan kelas dengan subyek siswa kelas IX A SMPN 1 Kalidawir. Adapun materi yang dipilh adalah Peran Indonesia dalam Hubungaan Internasional Dalam Era Globalisasi. Hasil penelitian menunjukkan adanya peningkatan Hasil belajar siswa berdasarkan nilai post test per siklus dengan nilai di atas KKM yaitu persentase pada siklus I 52,9% dan pada siklus II 88,2%.
Penerapan Metode Think Pair Share untuk Meningkatkan Keterampilan Menulis Iklan Baris Pada Siswa Kelas IX SMPN 1 Kalidawir
Authors: Juminah Juminah
Published: February 2018

Dalam rangka meningkatkan Ketrampilan Menulis Bahasa Indonesia yang memuat Menulis Iklan Baris pada Siswa Kelas IX A SMP Negeri 1 Kalidawir Tulungagung, Peneliti melakukan penelitian tindakan kelas dengan menerapkan pendekatan Think Pair Share pada pembelajaran Bahasa Indonesia. Sasaran penelitian ini adalah siswa Kelas IX A SMP Negeri 1 Kalidawir Tulungagung yang berjumlah 30 siswa. Berdasarkan hasil observasi yang dilakukan di Kelas IX A pada waktu pembelajaran Bahasa Indonesia diperoleh hasil bahwa Ketrampilan Menulis siswa kurang memuaskan, yaitu dari 30 siswa hanya 10 siswa yang nilainya dapat mencapai KKM atau ≥ 70, sedangkan 20 siswa lainnya masih belum dapat mencapai KKM atau ≤ 69. Simpulan dari penelitian ini adalah pendekatan Think Pair Share dapat meningkatkan Ketrampilan Menulis siswa pada pembelajaran Bahasa Indonesia yang memuat Menulis Iklan Baris.
Penerapan Teori Konstruktivisme untuk Meningkatkan Prestasi Belajar Materi Nilai Kebersamaan dalam Merumuskan Pancasila Pada Siswa Kelas IV SDN 4 Sumberagung
Authors: Supriadi Eko
Published: February 2018

Berdasarkan hasil observasi diketahui prestasi belajar siswa kurang memuaskan, yaitu dari 21 siswa hanya 7 siswa yang nilainya dapat mencapai KKM atau ≥ 70, sedangkan 14 siswa lainnya masih belum dapat mencapai KKM atau ≤ 69. Untuk itu agar dapat meningkatkan prestasi belajar siswa dalam menyelesaikan soal tentang Nilai kebersamaan dalam proses perumusan Pancasila serta untuk tercapainya tujuan pembelajaran perlu diadakan perbaikan pembelajaran dengan menerapkan Teori Konstruktivisme. Penerapan pembelajaran Nilai kebersamaan dalam proses perumusan Pancasila melalui Teori Konstruktivisme dapat meningkatkan Prestasi belajar siswa Kelas VI  SD Negeri 4 Sumberagung Tulungagung dan dapat mempermudah siswa dalam menyelesaikan persoalan Nilai kebersamaan dalam proses perumusan Pancasila.
Peningkatan Hasil Belajar Bahasa Indoneia melalui Metode DRTA (Directed Reading Thingking Activity)
Authors: Yamini Yamini
Published: February 2018

Rendahnya hasil belajar bahasa Indonesia salah satu penyebabnya adalah pembelajaran Bahasa Indonesia cenderung kepada pembelajaran bersifat konvensional yaitu hanya  menggunakan metode ceramah, sedangkan pada hakekatnya pembelajaran Bahasa Indonesia  menuntut siswa dapat berpartisipasi aktif dalam pembelajaran, siswa dapat mencari dan  menemukan  masalahnya sendiri. Subjek Penelitian tindakan kelas ini pada siswa kelas III SDN 1 Pandean Kecamatan Dongko dengan jumlah siswa sebanyak 23 siswa terdiri dari 10 siswa laki-laki dan 13siswa perempuan. Hasil penelitian menunjukkan metode DRTA dapat meningkatkan hasil belajar yang ditunjukkan dengan nilai studi awal hanya 56,52 naik menjadi 66,96 pada siklus pertama, dan  78,26 pada siklus kedua, dengan tingkat ketuntasan belajar sebanyak 4 siswa (17,39%) pada studi awal,  65,22% atau 15 siswa pada siklus pertama, 22 siswa atau 95,65% pada siklus kedua.
Lionfishes Pterois miles and Pterois volitans in the North-eastern Mediterranean Sea: Distribution, Habitation, Predation and Predators
Authors: Turan Cemal , Uygur Necdet , İğde Mahmut
Published: February 2018

The lionfish Pterois miles was first recorded in the Iskenderun Bay on 2014 in Turkish
Marine waters, and then its distribution was extended to Mersin and Antalya Bays in 2014 in
the Mediterranean part of Turkey. The first observation of P. miles in the Aegean Sea was
from Fethiye region in July 2015. The extension of P. miles in Turkish marine waters seems
to be fast even though it’s slow moving feature. Second species of the lionfish, red lionfish
Pterois volitans, was also recorded from Turkish Marine waters on May 2016 by a
commercial purse seine at 30 m depth at İskenderun Bay and underwater observation was also
recorded on October 2016 at Antakya Bay. Therefore, the number of Pterois species in the
Mediterranean Sea has reached to two, P. miles and P. volitans. Based on underwater
observations, P. miles and P. volitans are usually observed in rocky and cave habitats and
prefer 10-40 meters for feeding that may cause the reduction of populations of vanikoro
sweeper (Pempheris spp.), cardinal fish (Apogon spp.) and red coat (Sargocentron rubrum)
species. P. miles and P. volitans also show cohabitation and gathering usually with 2-5
individuals. Grouper species such as dusky gruper Ephinephelus marginatus and goldblotch
grouper Ephinephelus costae are the main predators of the lionfishes
Genetic Structure of Anchovy Engraulis encrasicolus in the Adriatic Sea using Microsatellite DNA Analysis
Authors: TURAN Cemal , TUNCAY Serap S. , SOLDO Alen , BOSNİC Neven , BARDAKÇI Fevzi
Published: February 2018

Stock structure analysis of anchovy from the Rovinj, Maslenica and Island of Korčulain in theAdriatic Sea was carried out by using 13 microsatellite loci. Overall, 259 alleles were detected in13 loci, the number of alleles per locus and population ranged from 4 to 28. The allelic richness ofoverall loci was found to be highest in the Rovinj population and lowest in the Island of Korčulapopulation. The highest and lowest value of population specific alleles was found in the Rovinjpopulation and Island of Korčula population, respectively. Observed heterozygosity per populationwas ranged from 0.714 (Rovinj) to 0.678 (Maslenica). Pairwise FST values revealed that there is nosignificant genetic differences between populations (P>0.05). However, the highest and lowestgenetic distance were found between the Rovinj and Maslenica populations (FST=0.00626) andbetween the Island of Korčula and Maslenica populations, respectively. The UPGMA dendrogramclustered the Maslenica and Island of Korčula populations together, and the Rovinj population wasa distinct cluster from these two.
"Real Baby - Real Family": Holdable tangible baby VR
Authors: Hsieh Rex , Mochizuki Yuya , Asano Takaya , Higashida Marika , Agatsuma Daiki , Nishikizawa Tatsuya , Shirai Akihiko
Published: February 2018

“Real Baby - Real Family” is a Virtual Reality baby nursery simulator that aims at conveying the parental and family love to the audiences. It has since been exhibited at Laval Virtual 2017, Anime Expo 2017, and SIGGRAPH 2017. This article will attempt to discuss the feedback and reviews gathered during the international exhibitions and shed light on the future development of this project.
Relationship between pelvic morphology and functional parameters in standing position for patient-specific cup planning in THA
Authors: Fischer Maximilian , Schörner Stephanie , Rohde Stefan , Lüring Christian , Radermacher Klaus
Published: February 2018

The sagittal orientation of the pelvis commonly called pelvic tilt has an effect on the orientation of the cup in total hip arthroplasty (THA). Pelvic tilt is different between individuals and changes during activities of daily living. In particular, the pelvic tilt in standing position should be considered during the planning of THA to adapt the target angles of the cup patient-specifically to minimize wear and the risk of dislocation. Methods to measure pelvic tilt require an additional step in the planning process, may be time consuming and additional devices or x-ray imaging are necessary.

In this study, the relationship between three functional parameters describing the sagittal pelvic orientation in standing position and seven morphological parameters of the pelvis was investigated. Correlations might be used to estimate the pelvic tilt in standing position by the morphology of the pelvis in order to avoid additional measuring techniques of pelvic tilt in the planning process of THA. For 18 subjects a semi-automatic process was established to match a 3D-reconstruction of the pelvis from CT scans to orthogonal EOS imaging in standing position and to calculate the morphological and functional parameters of the pelvis subsequently.

The two strongest correlations of the linear correlation analysis were observed between morphological pelvic incidence and functional sacral slope (r = 0.78; p = 0.0001) and between morphological pubic symphysis-posterior superior iliac spines- ratio and functional tilt of anterior pelvic plane (r = -0.59; p = 0.0098). The results of this study suggest that patient-specific adjustments to the orientation of the cup in planning of THA without additional measurement of the sagittal pelvic orientation in standing position should be based on the correlation between morphological pelvic incidence and functional sacral slope.
Digital Prehabilitation Reduces Length of Stay in Patients Prior to TKA
Authors: Bogue Emily , Twiggs Joshua , Miles Brad , Liu David
Published: February 2018

Provision of prehabilitation prior to total knee arthroplasty (TKA) through a digital mobile application is a novel concept. Traditionally, prehabilitation is provided face to face by a Physiotherapist. Kwok et al (2015) in a systematic review concluded future research should be directed at methods of prehabilitation that are cost effective method. Our research evaluates a resource effective and cost effective method of delivering prehabilitation. DoironCadrin et al 2016 have reported a randomised control trial protocol involving pre-habilitation through audio-visual software, this protocol still requires a health care practitioners time in real time, whereas our methodology enables multiple patients to be managed simultaneously, optimising health care utility.

Prehabilitation is believed to have multiple benefits for the patients’ recovery and outcome. Prehabilitation may impact on length of stay (LOS) through aspects of Social Cognitive Theory (SCT). A mobile application allows a patient’s exercise participation to be recorded, monitored continuously and progressed drives greater self-efficacy, outcome expectation, self-regulation and motivation which could be a mechanism by which patients receive benefit (Brown et al 2014). Another mechanism may be through lower levels of pain and function in the early period after TJR surgery, as reported in the meta-analysis completed by Wang et al (2016). The primary aim of our research is to determine whether provision of prehabilitation through a mobile digital application impacts inpatient LOS after TKA. The secondary objective is to understand the effect of digital prehabilitation on hospital costs.
Development of a Knee Physical Exam Haptic Training Simulator: Validation of the Computational Haptic Environment
Authors: Giles Joshua W , Chen Yawen , Bowyer Stuart
Published: February 2018

This paper presents the development and validation of an early computational model intended to drive a haptic simulator for knee physical exam skills training. Specifically, an analytical model of knee soft tissues was developed and validated against existing computationally expensive open source software and through cadaveric experimentation.
A New Approach in High Precision Bone Surgery: Semi-Automatic Alignment of an Application-Specific Instrument Guide Adjusted by a Smart Screwdriver
Authors: Theisgen Lukas , Jeromin Sabine , Vossel Manuel , Billet Sylvain , Radermacher Klaus , de La Fuente Matías
Published: February 2018

Robotic surgical systems reduce the cognitive workload of the surgeon by assisting in guidance and operational tasks. As a result, higher precision and a decreased surgery time are achieved, while human errors are minimised. However, most of robotic systems are expensive, bulky and limited to specific applications.

In this paper a novel semi-automatic robotic system is evaluated that offers the high accuracies of robotic surgery while remaining small, universally applicable and easy to use. The system is composed of a universally applicable handheld device, called Smart Screwdriver (SSD) and an application specific kinematic chain serving as a tool guide. The guide mechanism is equipped with motion screws. By inserting the SSD into a screw head, the screw is identified automatically and the required number of revolutions is executed to achieve the desired pose of the tool guide.

The usability of the system was evaluated according to IEC 60601-1-6 using pedicle screw implementation as an example. The achieved positioning accuracies of the drill sleeve were comparable to those of SpineAssist from Mazor Robotics Ltd., Caesarea (IL) with -0.54 ± 0.93 mm (max: 2.08 mm) in medial/lateral-direction and 0.17 ± 0.51 mm (max: 1.39 mm) in cranial/caudal-direction in the pedicle isthmus. Additionally, the system is cost-efficient, safe, easy to integrate in the surgical workflow and universally applicable to applications in which a static position in one or more DOF is to be adjusted.
A Smart Registration Assistant for Joint Replacement: Concept Demonstration
Authors: Liu He , Bowyer Stuart , Auvinet Edouard , Rodriguez Y Baena Ferdinando
Published: February 2018

In robot-assisted orthopaedic surgery, registration is a key step, which defines the position of the patient in the robot frame so that the preoperative plan can be performed. Current registration methods have their limitations, such as the requirement of immobilising the limb or maintaining the line of sight (LOS). These issues cause inconvenience for the surgeons and interrupt the surgical workflow in the operating room.

Targeting these issues, we propose a smart camera-robot registration system for joint replacement. The bone geometry, which is measured directly by a depth camera, is aligned to a preoperatively obtained bone model to calculate the pose of the target. Simultaneously, in order to avoid registration failure caused by LOS disruptions, the depth camera tracks objects that may occlude the target bone, and a robot manipulator is used to move the camera away from the nearest obstacle. An appropriate camera motion to “escape” the obstacle is calculated based on the position and velocity of the obstacle, with the aim of avoiding the occlusion efficiently without changing the general target position in the camera frame. The inverse kinematics of the robot is used to project the Cartesian velocity of the end-effector into the joint space, with kinematic singularities considered for stable robotic control. An admittance controller is designed as the human-robot interface so that the surgeon can directly set the robot configuration by hand according to a given intraoperative scenario.

Simulations and experiments with a redundant manipulator were conducted to test the performance of a proof-of-concept implementation. The results show that the proposed obstacle avoidance method can effectively increase the distance between the obstacle and the LOS, which lowers the risk of registration failure due to obstacle occlusion. This pilot study is promising in reducing distractions to the surgeon and could help achieve a fluent and surgeon-centred workflow.
Total Knee Arthroplasty Using a Contemporary Computer-Assisted Surgical System: A Review of Resection Alignment on 7000 Clinical Cases
Authors: Dai Yifei , Jung Amaury , Hamad Cyril , Angibaud Laurent
Published: February 2018

This study investigated the accuracy of Distal Femoral Cut and Proximal Tibial Cut during navigated total knee arthroplasty on a large cohort of patient. The findings demonstrated that CAOS is an accurate and precise solution to assist the surgeons achieve his/her surgical resection goals with substantial reduction of unacceptable resections.
Hip center localization in computer assisted orthopaedic surgery: an in-vitro study
Authors: Dib Zoheir , Dardenne Guillaume , Hamitouche Chafiaa , Lefèvre Christian , Stindel Eric
Published: February 2018

The hip center (HC) in Computer Assisted Orthopedic Surgery (CAOS) can be determined either with anatomical (AA) or functional approaches (FA). AA is considered as the reference while FA compute the hip center of rotation (CoR). Four main FA can be used in CAOS: the Gammage, Halvorsen, pivot, and least-moving point (LMP) methods. The goal of this paper is to evaluate and compare with an in-vitro experiment (a) the four main FA for the HC determination, and (b) the impact on the HKA. The experiment has been performed on six cadavers. A CAOS software application has been developed for the acquisitions of (a) the hip rotation motion, (b) the anatomical HC, and (c) the HKA angle. Two studies have been defined allowing (a) the evaluation of the precision and the accuracy of the four FA with respect to the AA, and (b) the impact on the HKA angle. For the pivot, LMP, Gammage and Halvorsen methods respectively: (1) the maximum precision reach 14.2, 22.8, 111.4 and 132.5 mm; (2) the maximum accuracy reach 23.6, 40.7, 176.6 and 130.3 mm; (3) the maximum error of the frontal HKA is 2.5°, 3.7°, 12.7° and 13.3°; and (4) the maximum error of the sagittal HKA is 2.3°, 4.3°, 5.9°, 6.1°. The pivot method is the most precise and accurate approach for the HC localization and the HKA computation.
An optimized Least-Moving-Point algorithm to detect the hip center
Authors: Dardenne Guillaume , Dib Zoheir , Hamitouche Chafiaa , Lefèvre Christian , Stindel Eric
Published: February 2018

Functional approaches for the localization of the hip center (HC) are widely used in Computer Assisted Orthopedic Surgery (CAOS). These methods aim to compute the HC defined as the center of rotation (CoR) of the femur with respect to the pelvis. The Least-Moving-Point (LMP) method is one approach which consists in detecting the point that moves the least during the circumduction motion. The goal of this paper is to highlight the limits of the native LMP (nLMP) and to propose a modified version (mLMP). A software application has been developed allowing the simulation of a circumduction motion of a hip in order to generate the required data for the computation of the HC. Two tests have been defined in order to assess and compare both LMP methods with respect to (1) the camera noise (CN) and (2) the acetabular noise (AN). The mLMP and nLMP error is respectively: (1) 0.5±0.2mm and 9.3±1.4mm for a low CN, 21.7±3.6mm and 184.7±13.1mm for a high CN, and (2) 2.2±1.2mm and 0.5±0.3mm for a low AN, 35.2±18.5mm and 13.0±8.2mm for a high AN. In conclusion, mLMP is more robust and accurate than the nLMP algorithm.
Monster Cleaner: a serious game to learn cleaning
Authors: Kosaka Takayuki , Matsushita Mitsunori
Published: February 2018

Children generally do not like cleaning their rooms. To change their behavior, we propose a serious game that makes cleaning fun and motivates children to clean their room. In our game “Monster Cleaner,” children collect virtual monsters by sucking dust using a vacuum cleaner-like device. Two people participate in the game in a competitive manner. The more dust a player cleans, the more monsters the player will collect. The system not only makes children clean their room in a fun manner but also teaches them to the use of a vacuum cleaner. The system was demonstrated in an exhibition and the observation of game play suggested that our system can make cleaning enjoyable for children and help them learn to use a vacuum cleaner.
Learning curve of patient specific templates for TKA. Assessment with a navigation system and the CUSUM test.
Authors: Jenny Jean-Yves , De Gori Marco
Published: February 2018

The CUSUM analysis allows monitoring the learning curve when introducing PSTs for TKA in an academic department. There may be a significant learning curve to achieve the steady state of accuracy and obtain an acceptable alignment. The decision was taken to discontinue using PSTs for TKA..
Towards a Surgical Phase Detection Using Markov Logic Networks
Authors: Philipp Patrick , Bleier Johannes , Fischer Yvonne , Beyerer Jürgen
Published: February 2018

The use of assistance functions for diagnosis and surgical interventions has become an evolving area for mastering challenges of contemporary medicine. Inter alia, these assistance functions can help to prevent malpractices and preserve a high level of satisfaction for patients as well as employees.

To enable such functions in context of a computer-assisted orthopaedic surgery (CAOS), we elaborate the use of Markov Logic Networks (MLNs) for modelling surgical phases. In contrast to commonly researched systems for surgical process modelling, MLNs combine rule-based as well as probabilistic approaches. This allows us to integrate soft and hard constraints into our network – which greatly expands the scenery of currently researched models for phase detection in surgical interventions.

In our contribution, we present the necessary fundamentals of MLNs and show the application to a comprehensible test case. The results are promising concerning the use of MLNs for surgical phase detection. In particular, MLNs have shown two advantages: Firstly, due to their template characteristics, few logic rules allow to model numerous interdependencies between the different surgical phases. Secondly, the combination of probabilistic and logic approaches allows to handle sensor inaccuracies and misclassifications of features directly. E.g., the inaccuracy of a sensor can be expressed by reducing the weight of corresponding formulas, allowing for a softening of constraints.
Integration of Robotic Applications in Open and Safe Medical Device IT Networks Using IEEE 11073 SDC
Authors: Vossel Manuel , Strathen Benjamin , Kasparick Martin , Müller Meiko , Radermacher Klaus , de La Fuente Matías , Janß Armin
Published: February 2018

Modern operating rooms (OR) undergo a constant rise in the amount and complexity of technical systems. Due to a lack of inter-device communication and integration, each device works stand-alone resulting in redundant sensors, input devices, monitors and—last but not least—crowded ORs and error prone human- machine-interaction. Therefore, various manufacturers such as Brainlab and Karl Storz provide proprietary integrated workstations. However, those “monolithic” solutions restrict the flexibility of the users and the clinical operators regarding integration of innovative third party devices.

In view of this, the OR.NET initiative (www.ornet.org) strives to develop international open standards for secure dynamic networks of medical devices in ORs. In the scope of the OR.NET project, based on service oriented architecture (SOA), the SDC (Service-oriented Device Connectivity) approach is currently in the process of standardization under IEEE 11073 to link medical devices in the OR (short OR.NETwork). It paves the way to interoperability between various medical devices due to its independence of license holders.

However, the SDC network does not suit real time (RT) requirements of a deterministic data transmission and low maximum latency, e.g. for robotic applications. This paper shows an approach to extend the secure dynamic OR by a real-time capable network to allow the integration of robotic systems. Exemplarily, this paper outlines an orthopaedic robotic system that is released by a universal configurable footswitch. This significantly extends the scope of applications for integrated ORs with the IEEE 11073 standard.
Non-invasive navigated assessment of the lower limb axis prior to total knee arthroplasty. Comparison with conventional navigated assessment.
Authors: Jenny Jean-Yves , Dillmann Gauthier , Gisonni Vincent , Favreau Henri
Published: February 2018

The non-invasive navigation system may help the surgeon to assess the lower limb axis at least as accurately as with the conventional radiographic techniques without exposure. But validation of this system used was only performed experimentally, and the present study is the first step of clinical validation.
CAS guided RFA can be a safe and effective treatment in OFD like adamantinoma in a child.
Authors: Jutte Paul , Ploegmakers Joris
Published: February 2018

Background

Osteo Fibrous Dysplasia (OFD) like adamantinoma is considered a benign condition that is usually located in the tibia. The condition is mainly found in children and has an association with classical adamantinoma, a malignancy of bone. The preferred treatment is surgical.

The lesion often requires a segment resection to eradicate the tumor as the margins of healthy bone are often too small to save continuity of bone and the lesion is located in the cortical area. Segmental resection in a young child is associated with a high complication rate.

To avoid these complications it would be ideal to spare the continuity of tibial bone by treating the tumor in situ. Radiofrequency Ablation (RFA) may be a safe and reliable option for treatment of OFD like adamantinoma, without vital tumor spill.

To ensure accurate ablation, the guidance and monitoring of antenna placement, planning and execution are performed with computer assisted surgery (CAS).

Results

Two young patients with OFD like adamantinoma of the tibia were treated with CAS guided open intra-operative RFA in our institution. Because of the heat generation and the proximity of the skin we performed the procedures half open. In both patients successful local tumor ablation was achieved without complications. At baseline MRI there was no sign of residual tumor activity in either patient.

Discussion

Follow-up is short and number of treated patients too low to draw definitive conclusions yet.

What we can say is that there is considerable less damage done to the patient if compared to classical open surgery like segmental resection or hemicortical resection.

Another great advantage is that it allows accurate local tumor ablation without tumor spill and it does not prohibit a local resection as a plan b if there still is viable local tumor tissue visible on MRI. It allows classical treatment in case of insufficient ablation.

Conclusion

Local tumor ablation with RFA has the potential to become a safe and effective treatment alternative in OFD like adamantinoma in a child.
Robotic assisted fixation of sacral fractures – initial experience
Authors: Weil Yoram , Shroeder Josh , Mosheiff Rami , Liebergall Meir , Khoury Amal
Published: February 2018

Robotic assisted fixation of sacral fractures – initial experience

Unstable sacral fractures are challenging for orthopaedic trauma surgeons. In most cases percutaneous fixation techniques are utilized after reduction. However, these techniuqes are not risk free mainly due to anatomical considerations. Screw misplacement is quite common and concerning. As spine surgery evolved, a miniature robotic guidance system was successfully utilized in pedicular screw insertion. The aim of the study was to demonstrate th use of the miniature robot in the fixation of unstable sacral fracutres.

Patients and Methods: 9 patients with unstable sacral fracutres without significant displacement were eligible for percutaneous fixation. These included 7 traumatic fractures and 2 pathological fractures. All fixation constructs were planned using a preoperative CT scans. The patients were placed prone and the robot was mounted on a Dynamic Reference Bridge (DRB) and a 2 verification fluoroscopic images were taken. The robot was mounted on the DRB and was sent by the computer to point to the desired screw(s) trajectory. The guide wires were inserted through stab wounds and screws were placed subsequently. CT scans were made postoperatively and fluoroscopic and operative time were recorded intraoperatively. Results: Mean patient age was 29 (17-63) number of screws ranged 1-6 (average 2). Mean operative time was 50 min (range 15-90), and average fluoroscopic time was 18 sec (7-42). None was the screw was misplaced. Conclusion: Robotic assisted fixation of sacral fracture is promising. At this time it is limited to nondisplaced fractures.
LightAir: Augmented Reality System for Human-Drone Communication using Foot Gestures and Projected Image
Authors: Tsetserukou Dzmitry , Matrosov Mikhail , Volkova Olga , Tsykunov Evgeny
Published: February 2018

We propose a new paradigm of human-drone interaction through projecting image on the ground and foot gestures. The proposed technology allowed creating a new type of tangible interaction with drone, e.g., DroneBall game for augmented sport and FlyMap to let a drone know where to fly.

We developed LightAir system that makes possible information sharing, GPS- navigating, controlling and playing with drones in a tangible way. In contrast to the hand gestures, that are common for smartphones, we came up with the idea of foot gestures and projected image for intelligent human-drone interaction. Such gestures make communication with the drone intuitive, natural, and safe. To our knowledge, it is the world’s first system that provides the human-drone bilateral tangible interaction. The paper also introduces the novel concept of Drone Haptics.
Feasibility of Using Optical Sensing to Measure Bore Depth in Surgical Bone Drilling
Authors: Demsey Daniel , Gomez Arrunategui Juan Pablo , Carr Nick , Hodgson Antony J.
Published: February 2018

The depth gauge is used in many osteosynthesis surgeries to measure drilled bore depth for screw selection, and has significant limitations. Its use has been shown to contribute to placement of incorrectly sized screws, which can lead to adverse outcomes in patients.

We have developed an automatic depth gauge prototype which mounts on an existing surgical drill and makes use of an optical sensor. This builds off previous work in our lab which showed that drilled bore depth could be computed from continuous measurement of drill displacement relative to the bone. We tested our device in animal models and compared it with digital calipers as a gold standard. In a simple porcine model the prototype showed potentially superior performance (mean error 2.05mm, SD 0.67mm) compared with the conventional depth gauge (mean error 0.83 mm, SD 1.55 mm). However, this could not be reproduced in a more realistic porcine model.An automated depth gauge mounted on a conventional surgical drill shows potential as a replacement for the existing depth gauge, but the design needs to be refined for use in an operating room setting.
The Direct Repair of Unilateral Spondylolysis with the Guidance Aid of a Personalised Rapid Prototping Template
Authors: Mohar Janez
Published: February 2018

The reported incidence of spondylolysis in athletes varies between 15% and 47%, considerably more than 6% in the general population, with most common types of related sport activities being gymnastics, weight lifting, soccer, swimming, cricket and tennis. (Reitman, Stanitski). The repeated tension stress microtrauma on the ventro-caudal part of the inferior articular facet during lumbar hyperextension and trunk twisting movements, together with anatomical predispositions can result in complete symptomatic fracture defect, preventing further participation in sports activities. Although less common and more benign, unilateral isthmic stress fractures tend to be resistant to conservative management if not properly addressed initially, therefore warranting early operative treatment (Debnath).
A Novel Tibiafemoral Kinematics Measurement System Based on Multi-Channel A-Mode Ultrasound System
Authors: Niu Kenan , Sluiter Victor , Sprengers André , Homminga Jasper , Verdonschot Nico
Published: February 2018

Improving the accuracy of measuring 6 degree of freedom tibiofemoral kinematics is a crucial step in gait analysis. The skin-marker estimated kinematics is subject to soft tissue artefacts. Fluoroscopic systems have been reported to achieve high accurate kinematics, but induced irradiation and a limited field of view and its high cost hampers routine usage on large patient cohorts. The aim of this study is to assess the feasibility of measuring tibiofemoral kinematics using multi-channel A-mode ultrasound system in cadaver experiment and assess its achievable accuracy. A full cadaver was placed on the surgery table and legs were hanging in the air. Upper body was fixated and right leg was pulled by rope to generate a movement. To track the ground truth of the motion, two bone pins with optical markers were mounted to the femur and tibia separately. Six custom A-mode ultrasound holders containing 30 A-mode ultrasound transducers and 18 optical markers were mounted on six anatomical regions. Calculating the bone to each ultrasound transducer distance from ultrasound echo, and using the spatial information of the optical markers on the holders, 30 points were determined. The segmented bone models acquired from CT or MRI were registered to the corresponding points. Then the tibiofemoral kinematics were determined from the positions of registered femur and tibia per frame. This study has presented a multi-channel A-mode ultrasound system and proven its feasibility of reconstructing tibiofemoral kinematics in cadaver experiment. Although the reconstructed tibiofemoral kinematics is less accurate than fluoroscopic system, it outperforms skin-mounted markers system. Thus, this A- mode Ultrasound approach could provide a non-invasive and non-radiative method for measuring tibiofemoral kinematics, which may be used in clinic gait analysis or even computer-aided orthopedic surgery.