bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Treatment for Volumetric Muscle Loss in a Porcine Tibia Segmental Bone Defect Model
Authors: Diggins Nicklaus , Sun Seungyup , Corona Benjamin T. , Tucker Aamir , Brinker Alex , Savaglio Michael , Adam Gremah , Gunderson Zachary , Natoli Roman M. , McKinley Todd O. , Kacena Melissa A.
Published: October 2019

Background and Hypothesis: Injury to soft tissue with volumetric muscle loss (VML) concomitant to segmental bone defects (SBDs) can be difficult to treat. One potential option is skeletal muscle autograft (SMA). We hypothesize the maximal torque measured in vivo and Radiographic Union Scale for Tibial Fractures (RUST) scores will be increased in the VML+SBD+SMA group compared to the VML+SBD group, but will be decreased compared to SBD alone.
Experimental Design or Project Methods: 18 male, Yucatan minipigs aged 1821 months were randomized into 3 groups: VML+SBD+SMA, VML+SBD, and SBD. This study is still ongoing with 12 pigs having had the surgery performed to date. In vivo muscle testing was performed prior to surgery in both hindlimbs to assess baseline strength. RUST scores and in vivo muscle testing was/will be performed at 1, 2, and 3 months post-injury. All procedures were conducted following approved IACUC protocol.
Results: Muscle testing results demonstrate no significant difference between control and operative limbs pre-surgery (T-tests, p= 0.673, 0.824, and 0.739 for VML+SBD+SMA, VML+SBD and SBD groups, respectively), or between the 3 different groups pre- or post-surgery (2-way ANOVA, p=0.788). The average RUST score for each treatment group at 2 months was 6.8±2.2, 7.7 7.7±1.1, and 8.6 8.6±0.4 for VML+SBD+SMA (n=2), VML+SBD (n=5), and SBD (n=3) groups, respectively.
Conclusion and Potential Impact: The lack of difference amongst groups on pre-operative muscle testing and a difference post-operatively between control and operative legs post-operatively help to validate this study. Preliminary results demonstrate a reduced RUST score for the VML+SBD+SMA group; however, this along with the lack of difference found in muscle testing results postoperatively may be an artifact due to small sample size and/or timing. Development of a model for VML and SBD will allow for testing of therapies for treat clinical problems.
INVESTIGATING A NOVEL MODIFIABLE FACTOR AFFECTING RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY: CORTICAL RENORRHAPHY
Authors: Fenner Anna , Bahler, MD Clint
Published: October 2019

Background: Partial nephrectomy is a common treatment for the removal of renal masses. Typically, during the procedure, stitches are used to close two layers of the kidney—both deep and superficial. Renorrhaphy of the superficial layer, thought to reduce the risk of bleeding and urine leak, is routinely performed but has not been sufficiently studied.
Hypothesis: Cortical renorrhaphy is a modifiable factor affecting renal function after partial nephrectomy. Omitting this step will preserve renal parenchyma without significantly increasing complications.
Methods: A randomized, controlled trial is underway. Interim statistical analysis has been performed on the data being collected. Patients underwent partial nephrectomy with or without cortical renorrhaphy according to their randomized group assignment. Three-dimensional models were constructed using semi-automatic segmentation planimetry of the kidney prior to surgery and at 4-months after tumor resection to determine volume loss in the operated kidney.
Results: The median (range) volume loss in the non-renorrhaphy group (n=8), 13% (0-24%), was trending lower than the renorrhaphy group (n=8), 22% (12-39). Using multiple linear regression, experimental group (p=0.0808) and warm-ischemia time (p=0.0995) were significant at the 0.1 level. Tumor size was not statistically significant (p=0.2644). There was one Clavien 3 complication in each group: The renorrhaphy group had one urine leak requiring a drain, and the non-renorrhaphy group had one postoperative bleed requiring selective embolization. Demographics were comparable among the two groups with both having 4 white males and 4 white females. The mean age (58 and 55 for renorrhaphy and non-renorrhaphy, respectively) and tumor size were also comparable.
Conclusion and impact: A trend of increased volume loss from cortical renorrhaphy is seen as predicted by retrospective data. Completion of the trial is needed to conclude whether this is statistically significant.
Building Public Health System Capacity for Diabetes and Hypertension Care in Western Kenya
Authors: Harding Michael , Turissini Matthew
Published: October 2019

Background and Hypothesis: In western Kenya, estimates for prevalence of hypertension are 6-24% and diabetes are 3-5%. Complications of hypertension and diabetes are some of the fastest growing causes of morbidity and mortality in Kenya. There is limited knowledge and poor training pertaining to noncommunicable diseases (NCDs) making treatment difficult. With shortages of physicians and mid-level providers, protocol driven nursing care of hypertension and diabetes has shown to be effective. Through partnerships with counties, the NCD care program has screened 134,923 and treated 12,566 individuals for diabetes and screened 238,078 and treated 29,377 individuals for hypertension. My summer project was to utilize Academic Model Providing Access to Healthcare’s (AMPATH) partnership with the Kenyan Ministry of Health (MOH) to improve access and quality of hypertension and diabetes care delivery at county MOH facilities. These improvements can be achieved through increasing our joint mentorship program led by AMPATH and county MOH staff; introducing the AMPATH Medical Record System (AMRS) into county clinics to improve care; and quality improvement with the Home Glucose Monitoring team.
Personal Role: I created Standard Operating Procedures (SOPs) for Integrative Screening, Clinical Mentorship, and Home Glucose Monitoring (HGM); designed a user manual for AMRS; helped develop a M&E plan for the HGM program; and assisted in the authorship of a grant to scale mentorship for diabetes and hypertension to 60 more clinical sites.
Conclusion and Potential Impact:
This project is a product of the partnership of AMPATH and the MOH to make accessible, high-quality care for hypertension and diabetes available across levels of care. By partnering with the Kenyan government and implementing care in the public sector, improvements in care are sustainable. My involvement will facilitate scaling the project to treat more patients through improving organizational capacity and helping apply for funds to implement in new areas.
Impact of a Long-Term High Fat Diet on Bone Microarchitecture and Muscle Structure in Adult Male and Female Normal Mice
Authors: He Weston , Trivedi Trupti , Pagnotti Gabriel , Murthy Sreemala , She Yun , John Sutha , Truitt Jack , Mohammad Khalid S. , Guise Theresa A.
Published: October 2019

Background and Hypothesis: Hyperglycemia is a major source of disease and morbidity among the adult population. Prior studies correlate long-term high fat diet (HFD) mediated hyperglycemia with bone fragility and muscle weakness. Furthermore, the mechanism driving hyperglycemia between sexes are unknown. Our group previously showed that HFDs induced insulin resistance in male mice and glucose intolerance in female mice. This establishes the need to study the impact of long-term HFDs on the bones and muscles using an older cohort of both male and female mice. For that, we hypothesized a long-term HFD mediated hyperglycemia will change bone and muscle structures and impair their functions in adult male and female mice.
Experimental Design or Project Methods: 22-week C57Bl6 mice were fed either a HFD or low fat diet (LFD) for 25 weeks. After euthanasia, bones and muscles were harvested and evaluated using MicroCT, histology, and mechanical testing. Statistical analysis was performed using GraphPad Prism with p<0.05 considered significant.
Results: MicoCT data saw significant reductions to cortical thickness (p<0.05), bone mineral density (p<0.001), and increases to medullary area (p<0.05) among HFD males and females compared to LFD. HFD-males also experienced significant increase in cortical porosity (P<0.001) whereas no changes were noted in HFDfemales. Trabecular bone volume was relatively unchanged. HFD increased cortical osteoclast surface (p<0.001) for both sexes. Bone histology saw increased marrow adiposity among HFD-females (p<0.05). Muscle histology exhibited HFD-related reductions in myofiber diameter (p<0.001) for both sexes. Mechanical testing demonstrated reduced young’s modulus (p<0.05) and yield stress (p<0.05) among HFD mice, despite non-significant differences in ultimate strength.
Conclusion and Potential Impact: The changes associated with a long-term HFD differed between sexes but still led to functional impairments of bone and muscle for both sexes, emphasizing the importance of looking further into the mechanisms responsible for these changes. This can potentially translate to the clinic in the treatment of musculoskeletal complications associated with HFDs.
Efficiency and Blood Loss of Various Spacer and Intramedullary Dowel Constructs in Two-Stage Treatment of Total Knee Arthroplasty
Authors: House, BS Hanna , Ziemba-Davis, BA Mary , Meneghini, MD Michael
Published: October 2019

Background and Hypothesis: Treatment for infected total knee arthroplasty (TKA) employs antibiotic-eluding articulating or static spacers, with or without intramedullary (IM) dowels between implant resection and reimplantation. While it is unknown which spacer type is more efficient intra-operatively, IM dowels require additional time for fabrication. Surgical efficiency is critical to minimizing anesthesia time and blood loss, especially in complex surgeries with compromised hosts. We quantified operative time and postoperative intra-articular blood loss based on spacer type and the use of IM dowels.
Project Methods: 103 consecutive infected TKAs treated from 2010-2019 were retrospectively reviewed. Outcome variables included operative time and intraarticular drain rate. Covariates included sex; age, BMI; ASA-PS classification; surgeon; McPherson infection classification; tourniquet time; tranexamic acid (TXA) use; intrathecal anesthesia, length of stay, and blood transfusion. Multivariate analyses were used.
Results: The sample was 52% female with average age of 66±9 years and average BMI of 36±9 kg/m2. Articulating spacers without dowels (ASwoD), articulating spacers with dowels (ASwD), and static spacers with dowels were used in 57.3%, 21.4%, and 21.4% of knees, respectively. Longer mean operating time was observed when static spacers with dowels were used at resection (162 vs.130 ASwoD/140 ASwD minutes; p=0.001) and reimplantation (187 vs. 149 ASwoD/148 ASwD minutes; p=0.017). At reimplantation, drain rate was highest when articulating spacers with dowels were used (37 vs. 20/26 mL/hr), but not when TXA was used (p=0.002).
Conclusion and Potential Impact: Articulating and static spacers provide equivalent infection eradication, and the necessity of IM dowels has not been thoroughly studied. In light of this equivalency, it is important to understand other costs associated with spacer types and IM dowels. Our observations that spacer/dowel constructs affect time under anesthesia and blood loss may contribute to the efficiency and safety of the two-stage treatment protocol.
Physician Receptiveness of Ventilation-Perfusion Imaging in a Randomized Clinical Trial
Authors: Junod, BS Colton , Mitchell, MD, MS Alice M.
Published: October 2019

Background and Hypothesis: Computed Tomography of the pulmonary arteries (CTPA) is the most common imaging modality for evaluating patients for suspected pulmonary embolism (PE), but carries the risk of acute kidney injury (AKI) from contrast media exposure. In appropriately selected patients, ventilation scintigraphy (VQ) imaging is a diagnostically equivalent alternative. We hypothesized that physician perceptions of diagnostic accuracy and study availability contribute to under-utilization of VQ imaging.
Project Methods: Patients with suspected PE at increased risk of acute kidney injury, were randomly selected to undergo VQ instead of CTPA. Patients unable to consent, patients with a history of pulmonary surgery, and those undergoing contrastenhanced imaging for other indications were excluded. A screening chest radiograph was obtained prior to study imaging allocation. All cases were reviewed by a nuclear medicine radiologist blinded to acceptance or refusal of VQ imaging allocation. The primary outcome was defined as the rate of physician-refusal of VQ imaging. The unprompted physician-reported reason for refusal was recorded, in real-time, along with any other general responses.
Results: Following exclusions, 42 subjects were enrolled. Notably, chest radiograph findings excluded only 2 subjects. The reviewing nuclear radiologist agreed with all study-selections for VQ appropriateness and there was no instance of nondiagnostic VQ imaging. Treating physicians refused VQ imaging randomization in 48% (20/42). Physicians also believed VQ imaging lacked sufficient diagnostic accuracy in the context of active non-pulmonary malignancy in 29% (12/42) of cases. Although CT did not identify cases not seen on chest radiograph, in 12% (5/42) cases suspected pneumonia was the reason for refusal. Statements such as “VQ is inferior [for PE],” and “VQ takes too long” were characteristic of general responses from treating providers.
Conclusion and Potential Impact: VQ imaging remains under-utilized in patients at risk of AKI. Perceived limitations to diagnostic accuracy and study availability are contributors to under-utilization.
XPC-Related Protection Against Carcinogen-Induced Lung Adenocarcinoma is Independent of Lung Inflammation
Authors: Lamb Isaac , Zhou Huaxin , Smith Patricia , Sears, M.D. Catherine R.
Published: October 2019

Background and Hypothesis: Cigarette smoke (CS) exposure causes lung cancer, with both DNA damage and local inflammation playing a critical role in development. Our previous research links the DNA repair protein Xeroderma Pigmentosum Group C (XPC) with protection against lung cancer in CS- and carcinogen-exposed mouse models. In mice (XPC-deficient and wild-type [WT] littermates) exposed to continuous CS for 9 months, neither XPC-deficient nor WT mice develop lung cancer. XPC-deficient but not WT mice exposed to 5 months CS + 4 months air control (AC) (recovery model) develop lung cancer. In a direct carcinogen model, XPC-deficiency accelerates NTCU lung squamous cell development. Our hypothesis is that lung cancers in XPC-deficient mice are independent of treatment alterations in BAL inflammation.
Experimental Design or Project Methods: Acellular bronchoalveolar lavage (BAL) samples from the three different mouse CS and carcinogen models were analyzed for the inflammatory cytokines IL-6, IL10, IL-12p70, IL-17A, IFN-γ, MCP-1, and TNF-α by a cytometric bead array (BD Biosciences) using a flow cytometer (FACScan) according to the manufacturer’s instructions. Raw data (mean fluorescence intensity) was analyzed by BD CBA Software. Statistical comparisons were by ANOVA, with p<0.05 considered significant.
Results: All measured cytokine levels were low or undetectable in BAL from AC and CS mice, with no significant XPC genotype or treatment-related changes in the measured cytokines. Differences were observed in TNF-α and IL-6 between continuous and recovery CS models independent of treatment or genotype. NTCU caused a significant increase in BAL IL-6 independent of genotype. IL-17a was elevated in NTCU-treated mice that developed lung squamous cell carcinoma.
Conclusion and Potential Impact: The XPC genotypic variation seen in lung carcinogenesis appears to be independent of BAL cytokines, suggesting that the variation is due to DNA damage rather than differences in local inflammation. Further mechanistic investigations will focus on DNA damage and repair as drivers of XPC-deficient lung cancers.
Probing the Dynamics of Neuronal Proteins In Vivo Using Non-Canonical Amino Acids Tagging
Authors: Lin Kevin P. , Saleh Aya M. , Jacobson Kathryn R. , Calve Sarah , Kinzer-Ursem Tamara L.
Published: October 2019

Background and Hypothesis: More than 600 neurological disorders have been identified, each with varying degrees of complexity and level of molecular understanding. However, current approaches are inadequate to capture the complex progressive nature of most neurological diseases. Therefore, developing techniques capable of probing the temporal dynamics of neuronal proteins in rodents, the most commonly used experimental models, is imperative for proper understanding of mechanisms driving neurological disorders. In this project, a protein labeling technique that enables selective labeling of newly synthesized proteins in vivo is utilized. In this technique, the non-canonical amino acid azidohomoalanine (AHA) is injected into mice to achieve global proteome labeling. AHA is an azide-tagged methionine (Met) analog that is incorporated into the nascent proteins using endogenous translational mechanisms. The azide functional group of AHA allows selective enrichment of the newly synthesized proteins from brain tissues via click-chemistry using alkynebearing affinity tags. This will be followed by detecting the AHA-labeled protein using mass spectrometry. We hypothesize that this labeling technique will help map the dynamics of the brain proteome in health and disease. This will ultimately provide insights into mechanisms underlying complex neurological diseases.
Experimental Design or Project Methods: C57Bl/6 murine dams were injected with 0.1 mg/g AHA for two days. Brain tissues were harvested, homogenized and lysates were reacted with biotin-alkyne using copper-catalyzed click reaction. Biotinylated proteins were then enriched using NeutrAvidin beads and eluted by boiling in 2% SDS.
Results: Tissues were fractionated into different subcellular components (cytosolic, nuclear, membrane, cytoskeletal, and extracellular matrix) using buffers of different stringency. Western blot analysis of clicked tissues using Streptavidin-fluorophore indicated effective incorporation of AHA into different cellular fractions of brain tissues. Additionally, the analysis of eluted proteins revealed successful enrichment and elution of AHA-labeled proteins.
Conclusion and Potential Impact: Successful incorporation of AHA in nascent neuronal proteins can lead to a comprehensive quantitative approach for elucidating changes in the regulation of neuronal proteins in disease states.
Effect of Biomechanical and Anatomic Characteristics on Patient-Reported Outcomes Following Total Hip Arthroplasty
Authors: Pitz, BS Lauren , Estes, BS Braeden W. , Deckard, BSE Evan R. , Meneghini, MD R. Michael
Published: October 2019

Background and Hypothesis: The success of total hip arthroplasty (THA) is often reported in terms of infection and dislocation rates. While studies have examined the effect of acetabular cup position, anteroposterior (AP) femoral stem alignment, changes in leg length and femoral stem offset on dislocation rates, few studies have investigated the effect of these biomechanical parameters on patient-reported outcome measures (PROMS). The purpose of this study was to evaluate how PROMS may differ by THA component placement in a consecutive series of primary THAs. Awareness of the importance of implant positioning may lead to improved surgical technique and optimized PROMS.
Experimental Design or Project Methods: 933 consecutive posterolateral approach primary THAs performed between 2011 and 2018 by one surgeon were retrospectively reviewed. Acetabular cup abduction, femoral stem alignment, changes in leg length and total femoral offset were measured on APview radiographs. Prospectively collected Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., University of California Los Angeles/UCLA Activity Level, and satisfaction (5-point Likert scale) were evaluated at minimum one-year.
Results: 743 THAs were analyzed. Mean age and BMI were 64 years and 31 kg/m2, respectively. After multivariate analysis, females with neutral to valgus stem placement (p=0.020) and patients with neutral to valgus stem placement regardless of lumbar pain (p=0.034) were more satisfied. In addition, patients with lumbar pain (p<0.001) and patients with high BMI in combination with increased change in femoral offset (p=0.056) had lower overall HOOS Jr. scores. Interestingly, change in leg length was not a significant predictor of any PROMS (power [1-β]≥88.4%).
Conclusion and Potential Impact: AP stem alignment may play a role in increased activity level and satisfaction. In addition, high BMI in combination with increased change in femoral offset negatively influenced HOOS Jr. scores. Unsurprisingly, the presence of lumbar pain continues to negatively affect PROMS. Further research is warranted on the influence of THA component placement, spinopelvic parameters, and PROMS.
Risk Factors for Unplanned Admission to the Pediatric Intensive Care Unit in Pediatric Trauma Patients
Authors: Schrock William , Raymond, MPH Jodi , Landman, MD, MPH Matthew
Published: October 2019

Background and Hypothesis: A number of risk factors for unplanned pediatric intensive care unit (PICU) admission and readmission have been identified. However, little is known of the risk factors associated with unplanned admission to the PICU in pediatric trauma populations. We hypothesize specific risk factors can be identified which may be associated with unplanned admission to the PICU following traumatic injury.
Methods: For this national retrospective study, we queried the 2016 National Trauma Data Bank for patients younger than 18 years experiencing a traumatic injury requiring hospital admission from the Emergency Department (ED). We excluded patients who had experienced burn injuries. Statistically significant (p<.05) risk factors for unplanned PICU admission were identified in bivariate analysis and used to build a multiple logistic regression model.
Results: Patients experiencing unplanned admission to the PICU had lower ED Glasgow Coma Scale (11.83 vs. 14.31; p<0.001), higher Injury Severity Scores (ISS) (17.96 vs. 7.32; p<0.001), and were older (age 11.35 vs. 9.60; p<0.001). Initial ED disposition to the PICU was significantly associated with unplanned admission to the PICU (p<0.001). Initial ED disposition to the OR was significantly associated with unplanned admission to the PICU (p=.018). After multiple logistic regression, ISS (p<0.001), initial ED disposition to the PICU (p=0.002), initial ED disposition to the OR (p=0.005), and older age (p=0.005) remained statistically significant risk factors for unplanned admission to the PICU.
Conclusion: ISS and ED disposition to the PICU, OR disposition to the PICU and age are significant risk factors for unplanned admission to the PICU in pediatric trauma. These findings will assist in identifying patients at risk for unplanned admission to the PICU, thereby reducing the adverse effects of unplanned PICU admission and ultimately improving the quality of care for pediatric trauma populations.
Bone-muscle crosstalk between osteocytes and skeletal muscle through microRNA21 removal leads to sex dependent increase in muscle mass
Authors: Sickbert Andrew , Plotkin Dr. Lillian
Published: October 2019

Background and Hypothesis: Previous studies suggested that microRNA removal from osteocytes, the cells embedded in the bone matrix, not only has effects on bone, but also increases muscle mass only in female mice. This suggested that changes in bone cells alters skeletal muscle through bone-muscle crosstalk. We therefore tested the hypothesis that osteocytic microRNA21 removal leads to release of factors that can influence skeletal muscle.
Experimental Design or Project Methods: Osteocytic microRNA21-deficient mice were generated by mating microRNA21flox/flox mice with mice expressing Cre recombinase in osteocytes. Lean body mass was measured in 4-month-old male and female mice by DXA/Piximus. Femurs/tibias were isolated and cultured in the presence of growing media for 48h. Media was collected (CM) and transferred to differentiating C2C12 myoblastic cells. After 48h, cells were fixed and stained for myosin heavy chain. Myotube diameter was measured using ImageJ software. RNA was extracted from gastrocnemius muscle using Trizol, and gene expression was measured by qPCR. Statistical analysis was performed by t-test within each sex.
Results: Percent lean body mass was 3.33% higher in female microRNA21 knockouts compared to female microRNA21flox/flox (control) mice, with no changes observed in males. Further, CM from female knockout mice increased the mean myotube diameter by 24.3% compared to control females. However, we did not find any differences in the levels of expression of skeletal muscle genes in females or males.
Conclusion and Potential Impact: We conclude that microRNA21 deletion from osteocytes in female mice results in the release of factor(s) with anabolic or anticatabolic effects in skeletal muscle. As we determined that osteocytes must be releasing factors that influences muscle growth, future studies can be directed at specifically finding which osteocyte cytokines and/or genes are directly involved in muscle homeostasis, and whether microRNA deletion also affects skeletal muscle function/strength.
Role of CaMKK2 in Osteoclast Development and Function
Authors: Smith Maddie , Sankar Uma
Published: October 2019

Background and Hypothesis: In bone remodeling there are two opposing forces, osteoclast resorption and osteoblast synthesis of bone. When there is an imbalance, osteoporosis is likely found. We look to determine the role that Ca2+/calmodulin (CaM)-dependent protein kinase kinase 2 (CaMKK2) has on osteoclast development and attachment. Previous studies show that Camkk2-/- mice have fewer mature osteoclasts that display poor attachment to the bone. These results suggest that there is a defect in facilitating osteoclast differentiation, or a defect in the attachment itself. Thus, we hypothesize that CaMKK2 plays an integral role in the development and function of the osteoclast cytoskeleton.
Experimental Design or Project Methods: We plated different concentrations of bone marrow cells isolated from male and female, wildtype and Camkk2-/- mice to investigate size and number of mature osteoclasts present. We examined the size of the resorption pits made by these osteoclasts, when plated on calcium phosphate-coated surfaces. We analyzed the RNA and protein and stained the cells immunohistochemically for proteins associated with cell attachment.
Results: There were greater numbers of mature osteoclasts in the Camkk2-/- males at each density than the wildtype males. The female mice followed the same trend, but with fewer osteoclasts overall.
The average area per resorbed pit was two-times larger in the WT males than the Camkk2-/- males. But, for the females the opposite trend is shown, the pits from the Camkk2-/- females were twice as large as those formed from the wildtype females.
To gauge efficiency, we calculated the average area resorbed per osteoclast. For the males, significantly greater efficiency from the wildtype osteoclasts was found than the Camkk2-/- osteoclasts. For the females, there was no difference in efficiency at the lower plating densities, but the osteoclasts from the Camkk2-/- females had greater efficiency at the greater densities.
Remaining results are to be finalized. 
Conclusion and Potential Impact: With the decrease in efficiency of Camkk2-/- mice osteoclasts, we believe that CaMKK2 is necessary for the attachment of OCs. CaMKK2 could be a target to slow the pathologic breakdown of bone.
Diffusion-Weighted and Intravoxel Incoherent Motion MRI of the pregnant cervix as a tool to monitor cervical ripening
Authors: Warner, BS Adam , Hutchins, PhD Gary , Wu, MD PhD Yu-Chien , Brown, MD Brandon , Forbes-Amrhein, MD PhD Monica
Published: October 2019

Background and Hypothesis: Preterm delivery is a major source of infant morbidity and mortality and is difficult to predict. The process of cervical ripening prior to delivery has known histologic changes including breakdown of collagen and increasing water content. It is hypothesized that the diffusion of water, which can be measured on MRI, will increase as the cervical water content increases. Diffusion weighted imaging (DWI) is a form of MRI that measures the random Brownian motion of water molecules (represented as the apparent diffusion coefficient (ADC)). Intravoxel incoherent motion (IVIM) MRI further subdivides the ADC into microcapillary perfusion (D*) and diffusion (D). We hypothesize that as the pregnant cervix ripens near delivery, diffusion of water within the cervix (ADC and D) will increase without changes in the capillary perfusion (D*). We sought to determine the relationship between ADC, D*, D, gestational age, and time to delivery in a cohort of volunteer pregnant females.
Experimental Design or Project Methods: DWI and IVIM MR studies from a cohort of 45 volunteer pregnant females with no known underlying fetal anomalies were examined. Subglandular and stromal cervix thickness and cervical length were measured along with the ADC, D*, and D of the subglandular and stromal cervix. Gestational history and delivery information was documented.
Results: Subglandular ADC inversely correlated with time to delivery (r=-0.393, p=0.052). Although not significant, subglandular D revealed a trend of increasing with increased gestation age (r=0.261, p=0.149). Subglandular ADC also varied inversely with thickness of the subglandular cervix (r=-0.352, p=0.047). Subglandular D* varied inversely with maternal age (r=-0.380, p=0.028).
Conclusion and Potential Impact: Our data support the hypothesized trend of increased diffusion of water within the cervix with unchanged capillary perfusion as a normal pregnancy progressed throughout the second and third trimesters. This study suggests that diffusion measures (ADC and D) follow a predictable progression during the course of a normal pregnancy and have the potential to provide a means of predicting preterm labor in the setting of preterm cervical ripening.
A study showing effectiveness of surgical site skin preparation, with two step use of povidone-iodine and postoperative out come in orthopaedic patients
Authors: Kumar Naresh
Published: October 2019

Background: The most common cause or source of infection in operating room is bacteria coming from inadequate cleaning of skin, surrounding environment, from the staff and from patient itself; especially geriatric with low immunity and diabetic patients. Surgical site skin infection complicates an estimated 5% of all surgeries performed in operation theater. Every measure must be taken to reduce the surgical site infection henceforth reducing the cost of treatment and morbidity of the patient. Povidone-iodine seems to be the best and cheap option.

Methods: One hundred and forty two patients who underwent orthopaedic surgery has been studied for the postoperative outcome following pre-surgical skin preparation with 2 step use of povidone iodine (PVP-I). The area to be operated is scrubbed with PVP-I scrub 7.5% and then painted with 10% PVP-I solution on operative area and wide area above and below. The paint is kept for at least 10 min or till it dry and then washed with normal saline or cleaned with sterile gauze soaked in normal saline. All postoperative patients were given intravenous antibiotics for at least 3 days. Dressing was done with PVP-I as per protocol.

Results: It has been found that out of one hundred and forty two patients studied, only 3.52% developed infection. Out of five infected patients, two were female and three with fracture were male patients.

Conclusions: PVP-I is still one of the best anti-microbial preparation widely used in orthopaedic surgery till date. It has broad spectrum anti-microbial activity and do not have any history of developing any resistance to its content.
Efficacy of autologous platelet rich fibrin matrix in the management of non-healing ulcers
Authors: Gole Prachi V. , Muhammed Naziya , Patadia Siddhi R.
Published: October 2019

Background: Non healing ulcers have a worldwide prevalence of 1.9%-13.1% with lower extremity being the commonest site. They are difficult to manage for the physician and frustrating for the patient due longer duration of treatment, cost, unsatisfactory outcomes and impairment caused due to them. Standard conventional management may fail at times and hence growth factors derived from platelets have been tried in the management of these ulcers. The purpose of our study was to evaluate the efficacy of platelet rich fibrin matrix (PRFM) in treatment of these ulcers.

Methods: Twelve patients with fifteen non-healing ulcers more than 3 months duration were included in the study. 10cc of venous blood was withdrawn in plain tube without anti-coagulants and centrifuged at 1500 rpm for 14 minutes as early as possible as per advanced PRF protocol. Middle layer of PRFM was applied to the clean ulcer followed by a secondary dressing. All patients received PRFM sittings every 7-10 days or till ulcer healed. Baseline photographs and measurements of length, breadth and depth were taken to calculate the area of ulcer at every sitting.

Results: The average percentage reduction in area and volume of the ulcer was 95.84% and 98.18% respectively at the end of six sittings. Twelve out of fifteen ulcers showed complete healing by 6 weeks, while three ulcers showed significant improvement but did not heal completely. The procedure was safe, well tolerated without any side effects.

Conclusions: Platelet rich fibrin matrix is a novel modality and an ideal, safe, affordable therapeutic option for non-healing wounds of varied causes.
Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018
Authors: Monteverde Malena , Tarragona Sonia
Published: October 2019

Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.
Sumário
Authors: Científico Editor
Published: October 2019

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Prevalence of Dyslipidaemia in HIV-infected Children Treated with Protease Inhibitors in South Africa
Authors: Sipambo Nosisa , Coovadia Ashraf , Meyers Tammy , Sawry Shobna
Published: October 2019

Background: HIV infection and antiretroviral therapy (ART) are associated with dyslipidaemia in children. Protease-inhibitor-based regimens, in particular, have shown the highest association.

Methods: We conducted a retrospective study of children treated with either a first- or second-line lopinavir/ritonavir (LPV/r) regimen who had any non-fasting lipid tests done from 2004 to 2015. Dyslipidaemia was defined as hypercholesterolaemia (total cholesterol ≥5.13 mmol/l) and/or hypertriglyceridaemia (total triglycerides ≥1.69 mmol/l). There were four cross-sectional points of analysis in this study: ART start, LPV/r start, 12 and 24 months. Demographic and clinical characteristics were compared using univariate and multivariate analyses to determine risk factors for dyslipidaemia at each time point.

Results: The median age at ART start was 1.6 (0.4; 4.4) increasing to 3.6 (2.6; 6.2) years by 24 months. The majority (51%) of the children had severe immune suppression (CD4 count <200 or CD4% < 15%) at ART start. The prevalence of dyslipidaemia at ART start was 47%, decreasing to 36% at 24 months. Multivariate analysis at 12 months found that children less than 10 years of age and despite having near suppressed/suppressed viral loads (<10,000 copies/ml) were more likely to have dyslipidaemia. Furthermore, ART duration more than 24 months was associated with less dyslipidaemia.

Conclusion: The high prevalence of dyslipidaemia in young children is concerning as LPV/r is the mainstay of ART in young children for the foreseeable future.
A Cross-sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates
Authors: Ngubane-Mwandla NAN , Motara F. , Ballot DE
Published: October 2019

Background: Very low birth weight (VLBW) neonates with symptomatic patent ductus arteriosus (PDA) are at increased risk of complications of prematurity.

Objective: To describe the incidence and clinical conditions associated with symptomatic PDA in VLBW neonates.

Methods: This was a cross-sectional, retrospective, descriptive study of VLBW neonates admitted to a large urban public hospital between 1 January 2013 and 30 June 2016. Survival outcome and characteristics between VLBW neonates with PDA and those without PDA were compared and analysed using univariate analysis. Binary logistic regression was used to obtain characteristics most significantly associated with symptomatic PDA.

Results: There were 1844 eligible neonates of whom 308 were excluded (24 major birth defects, 34 missing records and 250 discharged or died in the first 72 h). There was echocardiographic confirmation of symptomatic PDA in 184 (11.9%) of the remaining neonates. Blood transfusion (odds ratio 3.180, 95% confidence interval 1.578–6.405, p = 0.001), surfactant therapy (3.190, 1.215–8.381, p = 0.019), intermittent positive pressure ventilation (2.746, 1.703–4.429, p < 0.001) and age on discharge (1.028, 1.017–1.039, p < 0.001) were most associated with increased incidence of PDA. Antenatal steroid use (0.459, 0.285–0.738, p = 0.001) was associated with a decreased incidence of PDA. The majority of symptomatic PDAs received oral ibuprofen (n = 110) compared to conservative treatment (n = 60) and oral indomethacin (n = 5). A few had surgical ligation (n = 9). There was no statistical significance in mortality rates between neonates with and without PDA.

Conclusion: Symptomatic PDA occurred in a minority of VLBW neonates and was not associated with an increased risk of mortality.
The current state of the art in STEM research: A systematic review study
Authors: Bozkurt Aras , Ucar Hasan , Durak Gurhan , Idin Sahin
Published: October 2019

In the 21st century, when the knowledge-based economy is steering improvement and development, STEM education has gained increasing momentum and importance. This study aims to identify the current trends in STEM education, and also explores and identifies research trends and patterns in articles published between 2014 and 2016 on STEM education through a systematic review study. The research findings indicate that interest in STEM education in scholarly venues has witnessed a marked increase since 2014, with researchers preferring mostly quantitative, conceptual/descriptive, qualitative, mixed and practice-based research methods. In contrast, no interest is currently being shown in data mining and analytical methodologies. The patterns being in STEM education are identified as follows: (1) the scope of the STEM education, (2) the need for a new curriculum for the STEM in higher education, (3) gender studies in STEM education and (4) the need for student-centred future studies on the effectiveness of STEM education.
Keywords: STEM, research trends, systematic review, content analysis, text mining.
Low achievers and the quest for institutional standard in mathematics education: A phenomenology of subject matter experts’ opinions from Nigerian higher education
Authors: ABAH Joshua Abah
Published: October 2019

This study adopts a phenomenological paradigm to present mathematics experts’ opinions on the existence of low achievers in Nigeria’s higher education system. Six career mathematicians volunteered from among the participants at a conference of one of Nigeria’s elite academic group to give their in-depth opinion on the role of educational institutions in handling low achievers, their impact on Nigeria’s quest for quality education, and personal approaches for managing low achievers in the mathematics classroom. The explication of the responses of the mathematics experts indicates concerns about the admission system of higher educational institutions and some pertinent pedagogical inadequacies of pure mathematicians. The study also revealed that the continual existence of low achievers in the discipline encourages high rate of dropping-out, poor quality of mathematics educators, and examination malpractice. Participants suggest counseling intervention, retraining of mathematics lecturers in teaching methodologies, and special mindset-boosting programmes as ways of handling low achievers in mathematics education. The phenomenology also unveiled certain unintended outcomes that may form the basis for future research into the peculiar attitudinal characteristics of academic mathematicians.
RELASI AGAMA DAN SOSIAL MASYARAKAT SEBAGAI FENOMENA RELIGIUS
Authors: Miftahusyai'an Mohammad
Published: October 2019

Historically, all religions born, grew, and developed from the area of Eastern civilization (or rather Asian). There are two central points of eastern civilization that caused those religions, namely: 1) Middle East (and South Asia) in this area was appeared some religions: Judaism, Christianity, Islam, Hinduism and Buddhism, and 2) East Asia was appeared some religions: Tao (ism), Confucianism (Konfusianism), and Shinto. From these central points was born and grew religion to be a part of the history of mankind. The real society is a religious phenomenon. This religiousness is revealed from the fact that people are always trying to worship extraordinary things such as: nature (sun, sea, fire, mountain, etc.), charismatic spiritual leaders, technology or Individual ”Supra-Inderawi" are identified the name of the Lord. A big confusion modernism that encourages people to looks for The Real God. The Real God who is worthy to worship and also missing The Real Religion, real religion which become the guides of life.
Keywords: Religion, Society
PENERAPAN AKUNTANSI DAN MANAJEMEN KEUANGAN PADA PENGATURAN KEUANGAN PRIBADI
Authors: Kusumadyahdewi Kusumadyahdewi
Published: October 2019

Manage of personal finance is very important, because many products and services offered in the market. We must more carefully to spend our money not fulfill what we want but what we need, Management for personal finance can adapted from accounting and Finance Management for corporation with adjustment. We must record income and outcome of our money as responsibility to our self and controlling our spiritual quotient, and then we can measure our achievement. Residual of our income can saved for the sudden need, or invest in many thing as our basic need, for example land and building or in portfolio, for future. This article discuss about how we apply accounting and finance management to personal finance management and also the application for personal finance in our gadget.

Keywords: Accounting, Finance Management, Personal Finance Management
PERAN ORANG TUA DALAM MENANAMKAN NILAI-NILAI PENDIDIKAN KEWIRAUSAHAAN di SENTRA INDUSTRI KRIPIK TEMPE KAWASAN SANAN
Authors: Istiqomah Nurul
Published: October 2019

Entrepreneurship is very important to instill independence in the younger generation. There are a number of things that have an important influence on a child's soul, including family, school and the environment. The role of the family, especially mothers as early educators who put the most important foundation for the growth of the personality and maturity of children's thinking. There are several research focuses that exist in, among others, (1) to know parents in instilling entrepreneurial education values in the central tempe chips industry in Sanan, Malang. (2) to knowing the form or result of the cultivation of entrepreneurial education values in the central tempe chips industry in Sanan, Malang (3) to knowing the obstacles in cultivating entrepreneurial education values in the Tempe chips industry center in Sanan, Malang. This study uses a qualitative approach to the type of research of community phenomena because researchers take data directly in the field. The technique of collecting data uses observation, interviews, and documentation. Data analysis techniques include data collection, data reduction, and data presentation. The conclusion of this study is the role of parents in instilling entrepreneurial values is to guide and support the activities of their children in the field of entrepreneurship. The results have been well implemented through habituation. The obstacle in implementing entrepreneurship for children is the lack of parental trust so that it is difficult to teach entrepreneurship, it is difficult to determine which products are sold because they are too expensive, and the difficulty of the child to divide time.

Keywords: the role of parents; entrepreneurship
Experiencia de reconocimiento territorial con estudiantes pobladores de los municipios de Ventaquemada (Boyacá) y Sabanalarga (Casanare)
Authors: Vergara-Buitrago Paulina Alejandra
Published: October 2019

Las personas, las instituciones y los ecosistemas que integran un territorio forman parte de una misma realidad. Este artículo resalta las estrategias de conservación que, sobre los ecosistemas de sabana y páramo, han sido apropiados por los estudiantes de la Institución Educativa Jorge Eliécer Gaitán del municipio de Sabanalarga (Casanare) y de la escuela de Matanegra en el municipio de Ventaquemada (Boyacá). Se desarrollaron procesos de investigación acción participación entre abril y mayo de 2017. Con estos se reconoció que el principal recurso para los estudiantes es el hídrico; así mismo, que la capacitación a comunidades rurales debe ser implementada, con el fin de generar la apropiación de los saberes locales por parte de las comunidades. Al afianzar los saberes relacionados con la protección de los recursos naturales, se realiza una valorización de lo propio, que es fundamental para conservar el patrimonio cultural de las poblaciones rurales
El concepto de tiendas de conveniencia en Perú
Authors: Barrientos-Felipa Pedro
Published: October 2019

Las estrategias comerciales cuentan con nuevos sistemas de distribución que permiten aumentar la eficiencia del marketing. El desarrollo más reciente en Perú son las tiendas de conveniencia (TdC), un concepto diferente al que exponen los mercadólogos en sus publicaciones. Los objetivos del artículo son exponer la definición actual de las TdC y su repercusión comercial, identificar los factores que permiten la aceptación del cliente objetivo y conocer la posición del líder y las acciones de los actuales y potenciales retadores. Su elaboración se basa en el uso inicial de datos secundarios. Se complementa con una encuesta realizada, para la cual se aplicó muestreo simple estratificado (seis territorios en Lima con características particulares) y un tamaño de muestra de 400 elementos. Así mismo, se realizaron entrevistas a expertos en el tema. Los resultados muestran que este tipo de negocio está en su etapa de introducción y que la competencia será intensa.