bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF Musa acuminata AND Ocimum basilicum MIXED EXTRACTS TO THE SURFACE HARDNESS OF BIOACTIVE COMPOSITE RESIN
Authors: Puspitasari Dewi , Apriasari Maharani Laillyza , Rahayu Dewi , Rachmadi Priyawan
Published: August 2020

ABSTRACTBackgrounds: The use of mouthwash daily may influence the mechanical properties of bioactive composite resin as a dental restoration, one of the mechanical properties is surface hardness. Herbal mouthwash can be used to minimize the side effect of mouthwash that contain alcohol. Mauli banana stem and basil leaf extracts can be produced into herbal mouthwash. Methods: Thirty specimens (10mm diameter x 2mm thick; n=5/group) bioactive composite resins were immersed in a mixed solution of Mauli banana and basil leaf extracts with concentration of 25%, 50%, 75 %%, 100%, the control group of chlorhexidine gluconate 0.2% and aquadest for 7 days in 37oC. Measurement of the surface hardness was using the Vickers Microhardness Tester with 100 gf load for 15 seconds. Results: One Way ANOVA and Post Hoc Bonferroni exhibited the significant differences (p <0.05) in hardness values between the specimens that immersed in the mixed solution Mauli banana and Basil leaf extracts, which in the concentration of 100% (4,49 ± 4,61 VHN) compared with 25% (38,20 ± 2,58 VHN), 50% (41,40 ± 3,84 VHN) and 75% concentration (40,40 ± 3,55 VHN). There was no siginificant difference (p >0.05) between specimens immersed in CHX, aquadest and the mixed solution of mauli banana and basil leaf extracts in all concentration. Conclusion: There is no change in bioactive composite resin surface hardness after immersed in the mixed solution of Mauli Banana stem (Musa acuminata) and Basil leaf (Ocimum basilicum) extracts.Keywords: Basil leaf extract, Bioactive resin, Mauli Banana stem extract, Surface hardness
GINGIVECTOMY AND GINGIVAL DEPIGMENTASION AFTER ORTHODONTIC TREATMENT
Authors: Ismullah Yenniy , Kurnia Shafira
Published: August 2020

ABSTRACTBackground : Gingival enlargement, a terminology for an increase in the size of the gingiva, is a general feature of gingival dis­eases. Gingival melanin pigmentation does not present a medical problem, but is likely to generate a concern in aesthetic function. Although melanin pigmentation is not a chief complain, this condition still need to be corrected. Clinicians are often confronted with a challenge in achieving gingival esthetics. Purpose : This case report aims to explain how to achieve esthetical and functional demands in gingival enlargement and gingival hyperpigmentation case with gingivectomy and gingival depigmentation. Case: This surgical procedure aim to retain esthetical and functional demands. Case Management: An 18-years-old male presenting with maxillary chronic inflam­matory gingival enlargement associated with prolonged orth­odontic therapy is reported. Orthodontic appliances are factors for irritation and plaque retention that interfere oral hygiene and regulate gingival inflammation. Surgical therapy was performed to provide a better aesthetic outcome and prevent plaque retention. Conclusion: The combination of gingivectomy and gingival depigmentation can resolve gingival enlargement and gingival hyperpigmentation perfectly with close proximity to the ideal gingival condition.Keyword : Gingival depigmentation, Gingivectomy, Orthodontic
Tari Persembahan Bersujud di Kabupaten Tanah Bumbu Kalimantan Selatan
Authors: Maulidya Dini
Published: August 2020

AbstractThis study aimed to describe the function and form of Persembahan Bersujud Dance in Tanah Bumbu, South Kalimantan. With descriptive qualitative approach, this research data obtained through observational studies in Tanah Bumbu, interviews with sources and documentation associated with prostration Dance Tribute. The results showed that the function dan form performance Persembahan Bersujud Dance in Tanah Bumbu regency is known as the entertainment on the way-local Goverment official events. In addition, this dance also serves as a medium of education through moral teachings in the lyrics or lyrics accompaniment. Persembahan Bersujud Dance is a new creation dance under the guidance of H. Bakhtiar Sanderta. This dance depicts the peculiarities of society Tanah Bumbu very thick with the influence of Islam and its plurality, that is a mix between Bugis and Banjar tribe.Keywords: persembahan bersujud dance, function, form performances, tanah bumbu
Makna Busana dan Penokohan Wajir dalam Teater Tradisional Mamanda
Authors: Khairunnida Khairunnida
Published: August 2020

AbstractResearch descriptive-qualitative manifold trying to make sense of fashion and the characteristics of the characterizations of the characters in the traditional theater Mamanda, Wajir. Data were obtained through observation, interviews and documentation. At the show Mamanda, Wajir is a character that has a very important role. Theater semiotic analysis is used as a method in conclusion. From the analysis, it was found that the difference between the figures Wajir with another character on the show Mamanda is on the clothing she was wearing. Wajir Clothing is known to contain the influence of Chinese culture and Arabic. From the characteristics and form of clothing Wajir, it can be concluded that the clothing and characterizations Wajir teach the values of religious and moral education.Keywords: mamanda, wajir, fashion, character, traditional theater
Etnokoreologi Tari Topeng Banjar pada Upacara Manuping Desa Banyiur Luar Banjarmasin
Authors: Sari Putri Yunita Permata Kumala
Published: August 2020

IntisariArtikel ini merupakan kajian etnokoreologi tari topeng Banjar dalam upacara manuping di Desa Banyiur Luar, Kota Banjarmasin. Pen-dekatan kualitatif-deskriptif dipilih dalam penelitian ini. Pengumpulan data menggunakan teknik triangulasi (observasi, wawancara, dokumentasi). Analisis data dilakukan dengan model Miles dan Huberman. Data bentuk topeng dianalisis dengan pende-katan ikonografi model Alessandra Iyer, fisiognomi, dan semiotika. Hasil kajian ini menemukan dalam upacara manuping di Desa Banyiur Luar terdapat sembilan ragam tarian atau karakter topeng. Tari topeng ini merupakan salah satu jenis tari klasik Banjar di Kalimantan Selatan yang memiliki keunikan. Dari aspek gerak, tari topeng ini bersifat spontan dengan memiliki unsur gerak tari japin, serta memiliki dua bentuk gerak yaitu pola tanda plus (+) dan pola lingkaran. Pada umumnya, iringan musik tari topeng pada upacara manuping ini menggunakan perangkat gamelan Banjar.Kata kunci: topeng banjar, tari banjar, manuping, etnokoreologi  AbstractThis article is an ethnocoreological study of Banjar mask dance in a manuping ceremony at Banyiur Luar Village, Banjarmasin City. A qualitative-descriptive approach was chosen in this study. Data collec-tion using triangulation techniques (observation, interviews, document-tation). Data analysis was performed using the Miles and Huberman model. Mask shape data were analyzed by using Alessandra Iyer's iconographic approach, physiognomy, and semiotics. The results of this study found that in the manuping ceremony in Banyiur Luar Village, there were nine types of dances or mask characters. This mask dance is one of the classic Banjar dances in South Kalimantan which is unique. From the aspect of dance moves, this mask dance is spontaneous by having elements of japin dance movements, and has two forms of motion, namely the plus sign (+) pattern and the circle pattern. In general, the mask dance music accompaniment at this manuping ceremony uses the Banjar gamelan instrument.Keywords: banjar mask, banjar dance, manuping, ethnocoreology
Strategi Pembelajaran Ekstrakurikuler Musik Rebana di RA Nahdlatus Shibyan (Rans) Kabupaten Jepara
Authors: Arliyanti Ayu Fitria , Wafa Mochammad Usman
Published: August 2020

IntisariPenelitian ini bertujuan untuk mengetahui dan menganalisis stra-tegi pembelajaran ekstrakurikuler musik rebana di RA Nahdlatus Shibyan Kabupaten Jepara. Penelitian dilakukan secara deskriptif melalui pendekatan kualitatif. Pengumpulan data penelitian dilakukan melalui tiga teknik yaitu observasi, wawancara, dan dokumentasi. Teknik analisis data dan uji keabsahan data dilaku-kan dengan derajad kepercayaan dan triangulasi. Komponen-komponen pembelajaran yang diteliti adalah kompinen proses, materi, metode, media dan evaluasi pembelajaran yang dilakukan oleh pelatih musik rebana. Hasil penelitian ini menjelaskan bahwa strategi pembelajaran ekstrakurikuler musik rebana di RA Nahdla-tus Shibyan menggunakan strategi pembelajaran langsung dan strategi penerapan metode ceramah, demonstrasi, dan metode drill.Kata Kunci: strategi pembelajaran, metode pembelajaran, musik rebana AbstractThis study aims to identify and analyze the extracurricular learning strategies of rebana music in RA Nahdlatus Shibyan, Jepara Regency. The research was conducted descriptively through a qualitative approach. Research data collection was carried out through three techniques, namely observation, interviews and documentation. Data analysis techniques and data validity tests were carried out by means of degree of confidence and triangula-tion. The learning components studied were process components, materials, methods, media, and learning evaluations carried out by the rebana music trainer. The results of this study explain that the extracurricular learning strategy of reban music at RA Nahdlatus Shibyan uses direct learning strategies and teaching strategies of lecture, demonstration, and drill methods.Keywords: learning strategy, learning methods, reban music
Makna Komunikasi di Balik Makanan Tradisional
Authors: Chusmeru Chusmeru
Published: August 2020

Indonesia memiliki beragam makanan tradisional yang khas di berbagai daerah. Penelitian ini bertujuan untuk mengetahui ragam makanan tradisional di Indonesia dan makna komunikasi di balik makanan tradisional tersebut. Penelitian dilakukan dengan metode deskriptif kulatitatif  dengan informan mahasiswa yang dipilih dengan teknik purporsive sampling. Pemilihan informan didasarkan pada asal daerah mahasiswa yang berasal dari Jawa Tengah, Jawa Barat, Jawa Timur, dan Sumatera Utara.

            Hasil penelitian menjukkan, bahwa meskipun makanan import banyak terdapat di Indonesia, namun makanan tradisional berbagai daerah masih dapat ditemui dan tidak ditinggalkan oleh masyarakat. Makanan tradisional berbagai daerah masih bisa bertahan, karena memiliki makna komunikasi di masayarakat. Makna yang terdapat di balik makanan tradisional adalah sebagai bagian dari ritual siklus kehidupan, simbol persaudaraan, serta akulturasi dua budaya yang berbeda.
Sistem Penghantaran Obat Transdermal Dissolving Microneedle (DMN) Serta Potensinya Sebagai Penghantaran Vaksin
Authors: Annisa Viviane
Published: August 2020

Keberhasilan vaksinasi tidak hanya tergantung pada efektivitasnya, tetapi juga pada teknologi dalam pembuatan, keamanan, serta kenyamanan pengguna. Penghantaran vaksin konvensional menggunakan jarum hipodermik memiliki keterbatasan yaitu sulitnya proses pembuatan, risiko jarum yang digunakan lebih dari satu kali, serta menimbulkan nyeri. Alternatif penghantaran sediaan vaksin yaitu melalui transdermal. Penghantaran vaksin melalui transdermal memiliki respon proteksi imun yang lebih besar dibandingkan dengan penghantaran melalui injeksi secara subkutan ataupun intramuskular. Dissolving Microneedle (DMN) merupakan sistem penghantaran transdermal yang banyak memiliki keunggulan. DMN telah berhasil menghantarkan sejumlah makromolekul seperti vaksin, insulin, eritropoietin, interferon-α, hormon pertumbuhan, dan heparin. Penggunaan vaksin mandiri dapat menjadi lebih hemat karena mengurangi limbah benda tajam, dan tidak memerlukan penyimpanan suhu rendah. Beberapa penelitian DMN vaksin telah dilakukan uji klinik pada manusia, seperti vaksin influenza.
The Role of Accommodation and Food Service Industry to The Development of Tourism In Jawa-Bali
Authors: Hidayati Wahyu , Faiz Ihda Arifin
Published: August 2020

The Role of Accommodation and Food Service Industry which is measured by its contribution, employment and its affecting factors, employment elasticity, as well as labor productivity towards economy, particulary tourism, has not been optimised. This research aims to analyse: (1) the impact of Provincial Minimum Wage (PMW), Gross Regional Domestic Product (GRDP), the Number of Businesses, and Inflation on employment in Accommodation and Food Service Industry; (2) its contribution toward economy, employment, employment elasticity, and labor productivity in the given industry. The analytical tools used in this research are Descriptive Statistics and Pooled Data Regression Model (FEM and REM Approaches). The data being analysed is secondary data series 2014-2018 and cross sectional which is taken (provinces in Jawa-Bali) and respective to this research problem and goal. The result shows that the factors influencing employment rate positively and significantly are GRDP and inflation, whilst those affecting insignificantly are PMW and the number of businesses. The average contribution during 2015-2018 was 7.43% annually, whereas in Bali and DIY, the contribution was 23.17% and 10.21%, respectively. The employment rate per business averaged to 497 people with the average growth of employment in the given industri of about 14.22% annually. The employment elasticity  was 0.63 and labor productivity per person averaged to IDR 84.99 million higher than national average of IDR 53.84 million/person in 2018. Consequently, in order to increase output, high multiplier effect in economy, stable inflation (3%-4% annually), and prudential PMW policy are required
The Effectiveness Of Using Gakushuugoi Module to Enhance Students Japanese Vocabulary Skills
Authors: Rizalia Ihda Rizka , Rosliah Yuyun
Published: August 2020

This research aims to determine the effectiveness of gakushuugoi module usage to improve Japanese vocabulary mastery for learners. The method used in this study is an experimental quantitative method, a pre-test and a post-test. The population of sample data in this study is the Japanese elementary level learners (Shokyuu A) of Bimbel AEC Semarang. To determine the effect of Gakushuugoi module usage in the use of Japanese vocabulary, the data analysis was carried out before and after the treatment. From the results of data analysis, it is known that the t count is 7.78 and the df is 9. It happens since the value of t table for df 9 is 2.26 at a significant level of 5% t table and 3.25 at a significant level of 1% t table. Thus, the value of the t count is greater than the t table. This shows that there are significant differences between the variables X (post-test) and variable Y (pre-test). Based on the analysis, it can be concluded that the use of effective gakushuugoi module can improve the mastery of Japanese vocabulary.
PEER EDUCATOR NUTRITION EDUCATION IN PREVENTION OF ANEMIA INCIDENCE
Authors: Kusumawati Erna , Rahardjo Setyowati , Kurnia Putri Widya Ayu
Published: August 2020

Teenagers are a growth period that requires higher nutrients such as iron. Factors that can affect the incidence of anemia are the knowledge and attitudes of teenagers. The result of previous studies showed that the average level of knowledge, attitude, and prevention of nutritional anemia in teenager girls in the working area of the Kedungbanteng health center 1 was still low. Nutrition education that was started often used is peer education. This study purpose to analyze the influence of nutrition education on increasing knowledge and attitude of peer educator in the effort of peer education development about prevention of anemia incidence. The method research is quasi-experimental with pretest and posttest design. The sampling technique using a total sampling of 49 teenagers in the working area of Kedungbanteng health center. The result of the statistical test using a wilcoxon test. The result showed that there is a difference of knowledge and attitude of peer educator after given nutrition education ( p = 0,000 ; p = 0,000). There is a difference of knowledge and attitude of peer educator after given nutrition education.
Modeled Wide-Awake, Local-Anesthetic, No-Tourniquet Surgical Procedures Do Not Impair Driving Fitness
Authors: Thompson Orfield Noah J. , Badger Ariel E. , Tegge Allison N. , Davoodi Maryam , Perez Miguel A. , Apel Peter J.
Published: August 2020

Background:

The use of wide-awake, local-anesthetic, no-tourniquet (WALANT) surgical techniques is increasingly common, and patients commonly ask whether they may drive home following these procedures. The impact of a numb hand and bulky dressing on driving fitness is unknown, and there is no literature to guide surgeons when counseling these patients. Thus, the primary objective of the present study was to determine driving fitness following a modeled-WALANT procedure.

Methods:

Twelve right-handed individuals (6 male and 6 female) with an average age of 50 years (range, 38 to 64 years) were enrolled. An instrumented vehicle was used to obtain driving kinematic and behavioral data, thus allowing for a multidimensional assessment of driving fitness. Participants first performed a drive to establish baseline kinematic metrics. The route included both public streets and a closed course. Several driving tasks were assessed, including reverse parking, parallel parking, and perpendicular parking. The total course length was 18 miles (29 kilometers) and took 45 to 55 minutes to complete. After the first drive, 10 mL of 1% lidocaine was injected in the volar aspect of the right wrist and another 10 mL was injected into the right carpal tunnel to model the anesthetic used for a WALANT carpal tunnel release, and a bulky soft dressing was applied. The modeled-WALANT drive included an identical route and tasks, in addition to a surprise event to evaluate emergency responsiveness. Driving metrics were analyzed for noninferiority of the modeled-WALANT state to baseline driving.

Results:

The modeled-WALANT state showed noninferiority to baseline driving on all 11 analyzed dimensions of driving behavior compared with the control drives. In the modeled-WALANT state, participants drove more conservatively, braked harder, and steered more smoothly. All participants safely performed the 3 parking tasks and emergency response maneuver. Driving fitness in the modeled-WALANT state was noninferior to driving fitness in the preoperative drive.

Conclusions:

A modeled-WALANT state has no clinically relevant negative impact on driving fitness, and thus surgeons should not discourage patients from driving home after unilateral WALANT surgical hand procedures.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
The Impact of Early Epidural Discontinuation on Pain, Opioid Usage, and Length of Stay After Periacetabular Osteotomy
Authors: Cunningham Daniel J. , Kovacs Daniel , Norcross William , Olson Steven , Lewis Brian
Published: August 2020

Background:

Periacetabular osteotomy (PAO) is the standard of care for treatment of symptomatic acetabular dysplasia. Patients undergoing PAO for acetabular dysplasia have postoperative pain that can be managed with epidural analgesia. The purpose of this study was to evaluate the impact of the timing of the discontinuation of epidural analgesia on pain, opioid usage, and hospital length of stay (LOS). The study hypothesis was that removal of the epidural catheter on postoperative day 1 (POD1) would lead to reduced overall opioid usage and LOS compared with removal on POD2.

Methods:

This is a retrospective before-and-after observational review of the impact of discontinuing epidural analgesia on POD1 versus POD2 in terms of in-hospital pain, opioid usage, and LOS. Baseline patient factors such as age, sex, and body mass index (BMI) as well as outcomes including mean and median of daily pain, total oral morphine milligram equivalents (MMEs) used per day, and LOS were recorded. Descriptive and comparative statistical analyses including multivariable main-effects linear regression modeling were performed to evaluate the impact of the timing of epidural removal on outcomes.

Results:

Directly comparing outcomes for the day of epidural removal, patients with removal on POD1 had significantly less pain (mean of 4.6 versus 5.1 on the numeric rating scale [NRS], p = 0.033) and opioid usage (130.7 versus 200.4 MMEs, p < 0.001) than patients with removal on POD2. Additionally, LOS (3.3 versus 4.6 days, p < 0.001) and total opioid usage (333.0 versus 674.8 MMEs, p < 0.001) were significantly reduced in patients with epidural removal on POD1. These results persisted in multivariable analyses that were adjusted for age, sex, and BMI.

Conclusions:

This study demonstrated that patients with epidural removal on POD1 have significantly lower pain and an overall decrease in opioid usage on the date of epidural removal compared with patients undergoing epidural removal on POD2. Additionally, they have a shorter LOS as well as lower total opioid usage. Decreasing the duration of epidural usage may reduce pain, opioid usage, and LOS in patients undergoing PAO.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Selecting the “Touched Vertebra” as the Lowest Instrumented Vertebra in Patients with Lenke Type-1 and 2 Curves
Authors: Beauchamp Eduardo C. , Lenke Lawrence G. , Cerpa Meghan , Newton Peter O. , Kelly Michael P. , Blanke Kathy M. ,   Harms Study Group Investigators*
Published: August 2020

Background:

The selection of the lowest instrumented vertebra (LIV) in patients with adolescent idiopathic scoliosis (AIS) is still controversial. Although multiple radiographic methods have been proposed, there is no universally accepted guideline for appropriate selection of the LIV. We developed a simple and reproducible method for selection of the LIV in patients with Lenke type-1 (main thoracic) and 2 (double thoracic) curves and investigated its effectiveness in producing optimal positioning of the LIV at 5 years of follow-up.

Methods:

The radiographs for 299 patients with Lenke type-1 or 2 AIS curves that were included in a multicenter database were evaluated after a minimum duration of follow-up of 5 years. The “touched vertebra” (TV) was selected on preoperative radiographs by 2 independent examiners. The LIV on postoperative radiographs was compared with the preoperative TV. The final LIV position in relation to the center sacral vertical line (CSVL) was assessed. The CSVL-LIV distance and coronal balance in patients who had fusion to the TV were compared with those in patients who had fusion cephalad and caudad to the TV. The sagittal plane was also reviewed.

Results:

In 86.6% of patients, the LIV was selected at or immediately adjacent to the TV. Among patients with an “A” lumbar modifier, those who had fusion cephalad to the TV had a significantly greater CSVL-LIV distance than those who had fusion to the TV (p = 0.006) or caudad to the TV (p = 0.002). In the groups with “B” (p = 0.424) and “C” (p = 0.326) lumbar modifiers, there were no differences among the TV groups.

Conclusions:

We recommend the TV rule as a third modifier in the Lenke AIS classification system. Selecting the TV as the LIV in patients with Lenke type-1 and 2 curves provides acceptable positioning of the LIV at long-term follow-up. The position of the LIV was not different when fusion was performed caudad to the TV but came at the expense of fewer motion segments. Patients with lumbar modifier “A” who had fusion cephalad to the TV had greater translation of the LIV, putting these patients at risk for poor long-term outcomes.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Factors Affecting Subjective Symptoms in Children with Pes Planovalgus Deformity
Authors: Min Jae Jung , Kwon Soon-Sun , Sung Ki Hyuk , Lee Kyoung Min , Chung Chin Youb , Park Moon Seok
Published: August 2020

Background:

Idiopathic pes planovalgus is one of the most common foot deformities in children and adolescents. However, there is a discrepancy between subjective symptoms and radiographic severity in idiopathic planovalgus deformity, and very few studies have investigated this aspect. Further, the assessment of subjective symptoms in patients with pes planovalgus requires a quantitative scoring system for making meaningful comparisons, such as the Oxford Ankle Foot Questionnaire for Children (OxAFQ-c) and that for parents (OxAFQ-p). Therefore, the purpose of this study was to evaluate the factors affecting the symptoms of idiopathic planovalgus using the OxAFQ.

Methods:

All patients who were ≤18 years of age, had visited our clinic for the evaluation of pes planovalgus deformity, and had completed the OxAFQ were included in this study. The anteroposterior talo-first metatarsal, lateral talo-first metatarsal, and hallux valgus angles were measured on weight-bearing radiographs. The data were analyzed using a multiple regression model, with age, sex, and radiographic indices as explanatory variables.

Results:

Overall, 123 patients were enrolled in this study, and 246 standing foot radiographs were evaluated along with scores in each domain of the OxAFQ. The factors affecting physical domain scores in the OxAFQ-c were female sex (p = 0.047) and the anteroposterior talo-first metatarsal angle (p = 0.033). Age of ≥10 years was a significant factor (p < 0.05) affecting all domains in both the OxAFQ-c and OxAFQ-p other than the physical domain score.

Conclusions:

Although pes planovalgus deformity is 3-dimensional, the forefoot abduction component of the deformity should be carefully assessed as it is closely related to subjective symptoms. Further, in female patients with a more severe anteroposterior talo-first metatarsal angle, an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Small Amount of Retraction Force Results in Inadvertent Piriformis Muscle Damage During a Piriformis-Sparing Approach to the Hip
Authors: Amanatullah Derek F. , Shah Harsh N. , Barrett Andrew A. , Storaci Hunter W.
Published: August 2020

Background:

Piriformis-sparing approaches to the hip allow surgeons to avoid releasing the piriformis tendon during total hip arthroplasty; however, the consequences of retracting an intact piriformis tendon during such an approach remain ill-defined. The present study aimed to determine the upper limit of force that can be applied during retraction of the piriformis tendon to expose the hip, and to quantify the resultant damage to the piriformis musculotendinous complex.

Methods:

A patent-pending instrumented retractor was designed to record the applied force, duration, and angle of retraction during a piriformis-sparing posterior approach to the hip. In addition to the data collected with use of the instrumented retractor, damage to the piriformis muscle and tendon was quantified by a blinded observer.

Results:

There was no damage to the piriformis tendon in 22 (96%) of 23 hips during piriformis retraction for visualization of the hip capsule; however, there was complete or partial damage to the piriformis muscle at the sacral origin, belly, or musculotendinous junction (i.e., outside the surgical field) noted in 21 (91%) of 23 hips. The mean peak force to failure of the piriformis muscle was exceedingly small (29.0 ± 9.4 N; range, 10.1 to 44.9 N).

Conclusions:

The mean peak force applied to the piriformis retractor is much less than the force required for several common daily activities, such as opening a door or crushing an empty aluminum can. Soft-tissue damage that occurs outside the surgical field during the retraction of unreleased muscles, like the piriformis muscle, is common and remains an uncontrolled surgical variable. This inadvertent soft-tissue damage is not routinely accounted for when accessing the invasiveness of a procedure. Hence, it is no longer adequate to define a minimally invasive surgical procedure simply as an approach that involves the limited release of anatomical structures.

Clinical Relevance:

The use of instrumented retractors may redefine surgical invasiveness by providing data that could alter our understanding of the soft-tissue damage caused by retraction and open the possibility of robot-assisted or damage-limiting retractor systems.
The Impact of Heterotopic Ossification on Self-Reported Outcomes After Total Hip Arthroplasty Using the Direct Anterior Approach
Authors: Rüdiger Hannes A. , Dittrich Michael , Robinson Jonathan , Mansour Toni , Schwab Tobias , Stadelmann Vincent A. , Leunig Michael
Published: August 2020

Background:

Heterotopic ossification (HO) is a known finding after total hip arthroplasty (THA) that potentially affects clinical outcomes. The incidence of HO is related to various factors, including soft-tissue trauma, postoperative medication, surgical approach, and the surgeon’s experience. Because use of the direct anterior approach (DAA) is gaining popularity, we aimed (1) to determine the incidence of HO after DAA-THA and (2) to evaluate the impact of HO on patient-reported outcomes (PROs).

Methods:

We retrospectively reviewed 401 THAs (67 ± 10 years old, 210 men). The incidence and grade of HO were evaluated using the Brooker classification with anteroposterior and lateral radiographs. PROs were collected with use of the Oxford Hip Score (OHS) and the Core Outcome Measures Index (COMI)-Hip and were correlated with HO grades using generalized multiple regression models.

Results:

The incidence of HO was 29.9% on the anteroposterior radiographic views (Brooker grade 1, 14.5%; grade 2, 11.1%; grade 3, 2.7%; and grade 4, 0.57%); the lateral radiographic views detected 9% additional HO when compared with the anteroposterior radiographs alone (Brooker grade 1, 8%, and grade 2, 1%). HO was more frequent in men. The American Society of Anesthesiologists (ASA) grade, age in women, and higher body mass index (BMI) in men were associated with higher HO grades. A transverse “bikini” incision was associated with a lower rate (4%) of Brooker grades 3 and 4 HO when compared with a longitudinal incision (12%). A Brooker grade of 0 to 3 HO did not impact outcomes. Only Brooker grade-4 HO was associated with significantly worse PROs; however, pain was not affected.

Conclusions:

Low-grade HO after DAA-THA is not uncommon, and its rate is underestimated when anteroposterior radiographic views are evaluated without lateral views. The risk factors for developing HO in our cohort were an ASA grade of >3, male sex (especially with a high BMI), older age in women, and use of longitudinal incisions. With use of the bikini incision, patients had lower rates of severe HO, but mostly senior surgeons with more experience performed their surgery. Age, ASA grade, experience level of the surgeon, and Brooker grade-4 HO all had a significant influence on PROs. Clinically important HO (Brooker grade 4) remains rare after DAA-THR.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Periacetabular Osteotomy as a Salvage Procedure
Authors: Brusalis Christopher M. , Peck Jeffrey , Wilkin Geoffrey P. , Robustelli Stacy , Buly Robert L. , Nawabi Danyal H. , Ranawat Anil S. , Kelly Bryan T. , Sink Ernest L.
Published: August 2020

Background:

A periacetabular osteotomy (PAO) can reduce pain and improve quality of life in patients with hip dysplasia. While its utility for patients without traditional radiographic parameters for hip dysplasia has not been previously established, the PAO may help treat patients with hip instability that does not improve following single or multiple hip arthroscopic procedures, or when such procedures lead to hip instability.

Methods:

A single-surgeon registry of patients at a single institution was queried to identify patients with a lateral center-edge angle (LCEA) of ≥24° and a Tönnis angle of <10° who underwent PAO because of hip pain and/or instability that failed treatment with hip arthroscopy. Descriptive summary statistics were reported on patient demographics, mean change in LCEA, and patient-reported outcome measures, including the modified Harris hip score (mHHS) and the International Hip Outcome Tool-33 (iHOT-33), at a minimum of 6 months of follow-up.

Results:

Among 25 patients (mean age, 27.3 ± 6.9 years; 100% women), the mean LCEA increased from 27.2° (range, 24° to 37°) preoperatively to 39.0° ± 5.1° postoperatively (net increase, 11.8° ± 4.5°). Overall, the mean improvement in the mHHS was 11.5 ± 16.9 (preoperative, 59.4 ± 11.6; postoperative, 70.9 ± 20.6) and the mean improvement in the iHOT-33 was 23.8 ± 23.6 (preoperative, 32.2 ± 17.2; postoperative, 56.0 ± 30.0). Eighteen patients (72%) achieved a minimal clinically important improvement in mHHS (mean improvement, 17.4 ± 12.9) and iHOT-33 (mean improvement, 32.4 ± 19.1) scores. In comparison with 7 patients who did not show improvement, the 18 patients who showed improvement had significantly greater mean baseline patient-reported outcome scores.

Conclusions:

To our knowledge, these findings provide the first report on outcomes of PAO in patients with hip pain following arthroscopy who do not meet the traditional criteria for acetabular dysplasia. Early benefits in clinical outcomes suggest a novel surgical indication for PAO as a potential salvage option for selected patients; however, longer-term studies are needed.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Combination Tests in the Diagnosis of Chronic Periprosthetic Joint Infection
Authors: Abdelbary Hesham , Cheng Wei , Ahmadzai Nadera , Carli Alberto V. , Shea Beverley J. , Hutton Brian , Fergusson Dean A. , Beaulé Paul E.
Published: August 2020

Background:

Our objective was to identify combination tests used to diagnose chronic periprosthetic joint infection (PJI) and develop a stepwise decision-making tool to facilitate diagnosis.

Methods:

We conducted a systematic review of existing combinations of serum, synovial, and tissue-based tests for diagnosing chronic PJI after hip or knee replacement. This work is an extension of our systematic review of single tests, from which we chose eligible studies that also described the diagnostic performance of combination tests.

Results:

Thirty-seven eligible articles described the performance of 56 combination tests, of which 8 combinations had at least 2 studies informing both sensitivity and specificity. We also identified 5 types of combination tests: (1) a type-I Boolean combination, which uses Boolean logic (AND, OR) and usually increases specificity at the cost of sensitivity; (2) a type-II Boolean combination, which usually increases sensitivity at the cost of specificity; (3) a triage-conditional rule, in which the value of 1 test serves to triage the use of another test; (4) an arithmetic operation on the values of 2 tests; and (5) a model-based prediction rule based on a fitted model applied to biomarker values.

Conclusions:

Clinicians can initiate their diagnostic process with a type-II Boolean combination of serum C-reactive protein (CRP) and interleukin-6 (IL-6). False negatives of the combination can be minimized when the threshold is chosen to reach 90% to 95% sensitivity for each test. Once a joint infection is suspected on the basis of serum testing, joint aspiration should be performed. If joint aspiration yields a wet tap, a leukocyte esterase (LER) strip is highly recommended for point-of-care testing, with a reading of ++ or greater indicating PJI; a reading below ++ should be followed by one of the laboratory-based synovial tests. If joint aspiration yields a dry tap, clinicians should rely on preoperative tissue culture and histological analysis for diagnosis. Combinations based on triage-conditional, arithmetic, and model-based prediction rules require further research.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Reduced Risk of Reoperation Using Intramedullary Nailing with Femoral Neck Protection in Low-Energy Femoral Shaft Fractures
Authors: Bögl Hans Peter , Zdolsek Georg , Michaëlsson Karl , Höijer Jonas , Schilcher Jörg
Published: August 2020

Background:

In Sweden, approximately 1 in 4 women who are ≥50 years of age will sustain a hip fracture. Patients treated for a femoral shaft fracture are likely to have an even higher risk. We hypothesized that intramedullary nails protecting the femoral neck reduce the risk of subsequent hip fracture and allow the patient to avoid a challenging reoperation.

Methods:

Between 2008 and 2010, 5,475 fractures of the femoral shaft, in patients who were ≥55 years of age, were registered in a national registry in Sweden. Of these patients, 897 fulfilled the inclusion criteria. We used radiographs and register data to identify the reasons for and the types of reoperation that occurred between the index surgical procedure and December 31, 2014. The categories of implants were determined through a review of radiographs as intramedullary nails with and without femoral neck protection. Reoperations related to peri-implant fractures (including hip fractures) were analyzed as a subgroup of all major reoperations. Multivariable-adjusted, cause-specific hazard ratios (HRs) were calculated to compare the risk of reoperation between cases with nails with and without femoral neck protection.

Results:

Among the 897 patients, a total of 82 reoperations were performed. In 640 patients who were treated with intramedullary nails with femoral neck protection, there were 7 peri-implant fractures (no hip fractures) and 27 major reoperations. Among the 257 patients who were treated with intramedullary nails without femoral neck protection, 14 peri-implant hip fractures and 24 major reoperations were identified. Patients who received nails with femoral neck protection had a lower hazard for any peri-implant fracture (multivariable-adjusted cause-specific HR, 0.19 [95% confidence interval (CI), 0.07 to 0.5]) and major reoperation (multivariable-adjusted cause-specific HR, 0.51 [95% CI, 0.28 to 0.92]).

Conclusions:

Intramedullary nails with femoral neck protection in the treatment of low-energy femoral shaft fractures prevent secondary hip fractures and decrease the overall risk of reoperation for 4 to 6 years postoperatively.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Trends in Gender Disparities in Authorship of Arthroplasty Research
Authors: Xu Raylin F. , Varady Nathan H. , Chen Antonia F.
Published: August 2020

Background:

Despite efforts to address gender disparities in medicine, female representation in orthopaedics lags behind that of other fields, and little work has evaluated gender disparities within the subspecialty of arthroplasty surgery. The objective of this study was to analyze female authorship trends in arthroplasty research from 2002 to 2019.

Methods:

Articles published from 2002 to 2019 in 12 clinical orthopaedic and arthroplasty journals were extracted from PubMed. Articles that provided the full name of the first author and contained the terms “arthroplasty,” “hip replacement,” “knee replacement,” or “joint replacement” in the title and/or as keywords were analyzed. The gender of the author was determined with the validated Genderize algorithm, and publication trends were analyzed over time. Descriptive and comparative statistics were computed, and logistic regression was used to evaluate gender trends.

Results:

From 2002 to 2019, 14,692 articles met the inclusion criteria, and the gender of 63,628 authors was identified. There were 23,626 unique authors; 4,003 (16.9%) were women and 19,623 (83.1%) were men. Female involvement in arthroplasty publications increased from 11.1% in 2002 to 12.6% in 2019 (p < 0.001), and the percentage of female first authors increased from 5.0% in 2002 to 11.3% in 2019 (p < 0.001). Critically, however, the proportion of women as senior authors significantly declined from 8.5% in 2002 to 6.2% in 2019 (p < 0.001). From our analysis of U.S. publications with physician senior authors, the proportion of female senior authors remained relatively stable from 1.7% in 2002 to 2.4% in 2019 without a significantly increasing trend (p = 0.88). Overall, on average, women published a mean (and 95% confidence interval) of 1.9 ± 0.1 publications, while men published 2.9 ± 0.1 publications (p < 0.001). The proportion of female senior authors in arthroplasty publications (6.6%) was lower than that of other orthopaedic subspecialties such as sports medicine (9.2%), spine (13.6%), and foot and ankle (13.1%).

Conclusions:

While overall female representation and first authorship in arthroplasty literature have increased over time, the paucity of women in senior author roles remains troubling. Future studies should examine why the proportion of women publishing in arthroplasty remains lower than that in most other orthopaedic subspecialties.
Long-Term Assessment of Highly Cross-Linked and Compression-Molded Polyethylene Inserts for Posterior Cruciate-Substituting TKA in Young Patients
Authors: Kim Young-Hoo , Park Jang-Won
Published: August 2020

The purpose of the present study was to determine the long-term clinical and radiographic results, survival rate, prevalence of osteolysis, and prevalence of fracture of the tibial polyethylene insert following total knee arthroplasty (TKA). Three hundred patients (600 knees) were included in this follow-up study. The mean age of the patients (and standard deviation) was 60.3 ± 4.3 years, and the mean duration of follow-up was 13.2 years (range, 12 to 14 years). Revision of the TKA prosthesis was performed in 7 knees (2.3%) with a compression-molded polyethylene (CPE) tibial insert and 6 knees (2%) with a highly cross-linked polyethylene (HXLPE) tibial insert. The rate of survival at 14 years was 97.7% (95% confidence interval [CI], 94%-100%) in the CPE group and 98% (95% CI, 94%-100%) in the HXLPE group with reoperation for any reason as the end point. The rate of survival at 14 years was 98% (95% CI, 94%-100%) in both groups with reoperation for mechanical failure as the end point. No knee had osteolysis or fracture of the tibial polyethylene insert. There were no between-group differences.

Level of Evidence:

Therapeutic Level I. See Instruction for Authors for a complete description of levels of evidence.
Revision Elbow Arthroplasty Using a Proximal Ulnar Allograft with Allograft Triceps for Combined Ulnar Bone Loss and Triceps Insufficiency
Authors: Burnier Marion , Nguyen Ngoc Tram V. , Morrey Mark E. , O’Driscoll Shawn W. , Sanchez-Sotelo Joaquin
Published: August 2020

Background:

When revision elbow arthroplasty is required in the presence of structural proximal ulnar bone loss and triceps insufficiency, structural ulnar bone-grafting and triceps reconstruction are both required to reconstruct the skeleton and to restore active extension. We have developed a technique utilizing a structural proximal ulnar allograft with its attached triceps as an allograft-prosthetic composite (APC) to provide reconstruction of the proximal ulnar bone and deficient extensor mechanism with the same allograft.

Methods:

Between 2010 and 2017, the senior author performed 10 revision elbow arthroplasties using a proximal ulnar allograft with its intact triceps tendon allograft. The allograft ulna was combined with an ulnar component in an APC fashion, whereas the remaining triceps was repaired to the triceps allograft. Indications for a revision surgical procedure included aseptic loosening in 4 elbows, periprosthetic ulnar fracture with component loosening in 2 elbows, and the second stage of a 2-stage reimplantation in 4 elbows. Two elbows also required humeral APCs due to associated structural humeral bone loss. Postoperatively, all elbows were immobilized in extension for 6 weeks. The mean follow-up time was 45 months (range, 24 to 76 months).

Results:

Revision elbow arthroplasty resulted in pain improvement in all elbows in a 10-point visual analog scale. The mean flexion-extension arc was 95°, the mean Mayo Elbow Performance Score was 76 points (range, 45 to 95 points), and the mean triceps strength score was 4. There were 6 reoperations: 3 for humeral loosening, 1 for deep infection, 1 for fracture of the ulnar allograft, and 1 for wound debridement and closure. For the 8 elbows with an intact ulnar reconstruction, no ulnar components were radiographically loose, and the ulnar graft was considered radiographically intact and healed in 8 elbows.

Conclusions:

Reconstruction of the proximal part of the ulna and triceps in failed elbow arthroplasties with structural ulnar bone loss can be effectively accomplished using a structural proximal ulnar allograft as an APC with the preserved triceps tendon for the extensor mechanism reconstruction, but the procedure is associated with an expected high reoperation rate, as is the case in complex revision elbow arthroplasty.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Electronic Sterilization of Tableware Using Ultraviolet Light Radiation
Authors: Zuhri Ramdhani Farros , Riyanto Didik Riyanto , Desriyanti Desriyanti
Published: August 2020

The hospital is one of the health service institutions that conducts complete individual health services that provide inpatient, outpatient and emergency services. Where in the hospital is also a gathering place for many people, namely the patient and also the patient's family. This is also a factor that bacteria and microorganisms can grow rapidly. As found on the patient's tableware. Because the tableware used continuously and alternately will make bacteria grow faster, especially if the process of washing the cutlery is less clean. From this problem emerged the idea to design a tool "Electronic sterilization of tableware using ultraviolet radiation". This tool utilizes ultraviolet radiation that has been studied and has been tested to inhibit bacterial growth. This design is made by finding references originating from journals, books and also articles which are then made a plan or description of the tool that aims to plan what kind of tool will be made, design in the form of hardware in the form of connections between input devices, processes and also outputs , while the software in the form of a program as a system driver. After the design is complete, the tool will be tested and analyzed. Based on the analysis conducted, there are several types of bacteria found in these tableware. After being irradiated with UV light for 15 minutes of exposure, it is found that the bacteria that were originally attached to the cutlery can die completely. This is evidenced by testing conducted in the microbiology laboratory with supervision by experts in their field.