bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical conundrums in the management of diabetic ketoacidosis in the elderly
Authors: Sehgal Vishal , Ulmer Brian 
Published: April 2019

Abstract
One of the dreaded life-threatening complications of diabetes mellitus (DM) is diabetic ketoacidosis (DKA). American Diabetic Association (ADA) came out with 2018 guidelines on the management of DM and its complications, but these are woefully silent on the clinical conundrums that accompany DKA in elderly patients. In elderly patients, DKA is often complicated by sepsis, atrial fibrillation, polypharmacy, nonketotic hyperosmolar states, atypical clinical presentations, acute kidney injury (AKI), dementia, and noncompliance with medications. Here in we highlight these conundrums that need to be addressed to improve morbidity and mortality in elderly patients.
Importance of studying the levels of hepcidin and vitamin D in Egyptian children with chronic hepatitis C
Authors: Mohamed Amal Ahmed , Abd Almonaem Eman R. , Mansour Amira I. , Algebaly HebatAllah Fadel , Khattab Rania Abdelmonem , El Abd Yasmine S. 
Published: April 2019

Abstract

Background and Objective
Hepcidin is the key regulator of iron metabolism and is a significant biomarker for systemic inflammatory states. Vitamin D is a powerful immunomodulator and plays a significant role in the inflammatory responses and fibrosis occurring due to hepatitis C virus (HCV) infection. This study assessed the level of vitamin D and serum hepcidin and its expression in peripheral blood of children with chronic hepatitis C (CHC) and correlated them with other serum markers to reflect iron metabolism and liver disease severity.

Methods
A total of 100 children were included in this study: 50 with HCV infection and 50 healthy controls. Biochemical parameters together with vitamin D, hepcidin, and its expression were all measured.

Results
The level of hepcidin and its expression together with vitamin D and hepcidin-to-ferritin (H/F) ratios were significantly reduced in patients, but the iron and ferritin levels were higher (P<0.001). Serum hepcidin level showed significant positive correlation with hepcidin expression, HCV titer, iron, ferritin, and H/F ratio (r = 0.43, 0.31, 0.34, 0.28, and 0.91, respectively) but significant negative correlation with vitamin D (r = −0.37). Both hepcidin and ferritin were higher in patients with Child Pugh scores B and C than those with score A (P<0.001).

Conclusion
Measuring serum hepcidin and its expression together with vitamin D levels in patients may have a prognostic value and is promising in the follow-up of the severity of liver disease.
Management of patients with liver cirrhosis and invasive bladder cancer: A case-series
Authors: Zachos Ioannis , Zachou Kalliopi , Dalekos George N. , Tzortzis Vasileios 
Published: April 2019

Abstract
Liver cirrhosis is a major risk factor for increased mortality and morbidity in patients undergoing non-hepatic surgery with overall mortality rates as high as 45–50%. However, cirrhotic patients are often in need of surgical procedures including urological surgeries like cystectomies for muscle invasive bladder cancer. Data on the prognosis of these patients undergoing cystectomy for bladder cancer are scarce in the literature. In the present case-study, we describe the outcomes of 3 patients with liver cirrhosis who underwent radical cystectomy for muscle invasive bladder cancer. To the best of our knowledge, this is the first study reporting on this kind of urological surgery in patients with liver cirrhosis. Accordingly, we provide a review in the literature on prognosis and factors influencing the survival of cirrhotic patients who undergo surgical procedures.
Favorable outcome in a patient with systemic BCGitis after intra-bladder instillation of Calmette-Guerin Bacillus highlighting the importance of making the correct diagnosis in this rare form of sepsis
Authors: Attou Rachid , Albrich Thomas , Kadou Joe , Redant Sebastien , Honoré Patrick M. , Bels David De 
Published: April 2019

Abstract
We present the case of a patient with sepsis following a traumatic intra-bladder instillation of Calmette-Guerin Bacillus with pneumonia and possibly hepatitis. These complications are rare and could be induced by both immuno-allergic reaction and bacteremia. There is no specific guideline to treat this condition, but many clinicians depicting similar cases seem to agree on prolonged anti-tuberculous antibiotics with associated corticosteroid therapy. Following this therapy, the prognosis is generally favorable depending upon the fact that diagnosis has correctly been made. Our case highlights the fact that correct diagnosis has to be made especially in the presence of sepsis without a clear septic source.
Strength and Deformation of Sand-Tire Rubber Mixtures (STRM): An Experimental Study
Authors: Al-Rkaby Alaa H. J. 
Published: April 2019

Abstract
Waste material such as used tires is increasing every year, which poses environmental problems. However, such material has been used in several geotechnical applications as alternative lightweight backfill in highway embankments and/or behind retaining walls, providing environmental, economic and technical benefits. These applications require knowledge of engineering properties of soil-tire rubber mixtures. The present study aims to show the possibility of tire rubber usage in sand by evaluating the shear strength and deformability of sand mixed with granulated rubber, in weight percentages between 0 and 50%. The tire rubber content was found to influence the stress-strain and deformation behavior of the mixtures. The shear strength of sand mixed with 10% or 20% tire rubber was higher than that measured for sand only. However, the trend for TRC = 30–50% was different. Samples with a rubber content of 30-50% exhibited a rapid decrease in the stress ratio compared with that of sand. The major principal strain at maximum stress ratio was found to increase with increasing tire rubber content. However, it was observed that the lateral strains (minor and intermediate principal strains) of samples reduced significantly with the addition of tire rubber to the sand.
QEVO® - A new digital endoscopic microinspection tool - A cadaveric study and first clinical experiences (case series)
Authors: Schebesch Karl-Michael , Brawanski Alexander , Tamm Ernst R. , Kühnel Thomas S. , Höhne Julius 
Published: April 2019

Background:
The use of endoscopes in neurosurgery is well established, but the integration of a full high definition signaling, 45° angled endoscopic tool into a digital surgical microscope, is new. We report our first experiences in a cadaveric study and a clinical case series using the new microinspection tool QEVO® that serves as a plug-in feature for the recently launched KINEVO 900 digital visualization platform (CARL ZEISS MEDITEC, Oberkochen, Germany). For illustration purposes, we offer video footage.

Methods:
The handling, workflow, and visualization patterns of the QEVO® microinspection tool were critically evaluated in cadaver specimens by simulating four standardized neurosurgical approaches: (1) pterional, (2) retrosigmoidal, (3) transsphenoidal, (4) and transcallosal. Similarly, we evaluated the QEVO® tool in corresponding clinical cases of (1) aneurysm clipping, (2) removal of cerebellar cavernoma, (3) and pituitary adenomectomy.

Results:
In both the cadaveric study and clinical case series, the QEVO® tool was found to be beneficial in terms of high-quality visualization of fine structures and for displaying hidden anatomical details (“looking around the corner”). The handling was good, and the workflow was easy. However, the use of this tool was restricted by the lack of an external fixation and a working channel, the shortness of the tool, and the impossibility to switch to a 0° or 30° optic.

Conclusion:
Despite some restrictions, the QEVO® microinspection tool is an innovative, handheld, endoscopic tool that allows excellent additional visualization of the surgical field. In our opinion, this tool effectively enhances the modern neurosurgical armamentarium.
Avoiding inappropriate spine surgery in a patient with major cardiac comorbidities
Authors: Epstein Nancy E. 
Published: April 2019

Background:
We as spine surgeons increasingly need to carefully screen our own patients for major medical/cardiac comorbidities to determine if they are candidates for spine surgery. Our medical/cardiac colleagues rarely understand how long anti-platelet aggregates and non-steroidal anti-inflammatories (NSAIDs) have to be stopped prior to spine operaeitons, and when it is safe for them to be reinstated.

Case Study:
A patient over 65 years of age, presented with 6 months of increased bilateral lower extremity sciatica, and 2-block neurogenic claudication. The MR scan showed moderate to severe lumbar stenosis L2-S1 with grade I L4-L5 spondylolisthesis, and multiple bilateral synovial cysts. Nevertheless, his neurological examination was normal. Further, he had > 5 stents placed within the last five years, and had undergone cardiac surgery two years ago requiring placement of a bovine aortic valve, and resection of a left ventricular wall aneurysm. He was also still on full dose Aspirin (325 mg/day), and Clopidogrel (75 mg po bid). Notably, 3 prior spinal surgeons (neurosurgery/orthopedics) had recommended multilevel lumbar laminectomy with instrumented fusions (e.g. including multilevel transforaminal lumbar interbody fusions (TLIF)).

Conclusions:
Despite multilevel L2-S1 stenosis, Grade I L4-L5 spondylolisthesis, and multilevel bilateral synovial cysts, the patient’s normal neurological examination and multiple cardiac comorbidities (i.e. requiring continued full-dose ASA/Clopidogrel) precluded, in my opinion, offering surgical intervention. Rather, I referred the patient to neurology for conservative management. What would you have done?
Ethical and therapeutic dilemmas in glioblastoma management during pregnancy: Two case reports and review of the literature
Authors: Policicchio Domenico , Doda Artan , Muggianu Giampiero , Dipellegrini Giosuè , Boccaletti Riccardo 
Published: April 2019

Introduction:
There are no guidelines about the management of glioblastoma multiforme (GBM) during pregnancy: treatment of these patients presents therapeutic and ethical challenges.

Case Description:
Two patients, respectively, 28 years old at the 14th week of gestation with a thalamic GBM and 38 years old at the 28th week of gestation with fronto-mesial GBM. Patients and their relatives were deeply informed about the natural history of GBM and potential risks and benefits of surgery, radiotherapy (XRT), and chemotherapy (CTX) for both, mother and fetus. The first patient’s will was to preserve her fetus from any related, even minimal, risk of XRT, and CTX until safe delivery despite progression of GBM, accepting only surgery (tumor debulking and shunting of hydrocephalus). The second one asked to deliver the baby as soon as possible (despite the risks of prematurity) to receive the standard treatments of GBM. The two patients survived, respectively, 16 and 46 months after delivery. The first patient’s son is in good clinical conditions; the second one suffered problems linked to prematurity.

Conclusions:
Standard treatment of GBM in a pregnant woman could improve the mother’s survival but can expose the fetus to several potential risks. Ethically, relatives should understand that mother has anyway a poor prognosis and, at the same time, fetus prognosis depends on mother’s condition and therapy. It is not possible to warrant absence of risk for both. Considering the absence of guidelines and the relatively poor current data available about management of GBM in a pregnant woman, after a deep explanation of the situation, we think that the will of the mother and her relatives should prevail.
Syringomyelia resolution after anterior cervical discectomy: A case report and literature review
Authors: Athanasiou Alkinoos , Magras Ioannis 
Published: April 2019

Background:
Syringomyelia is rarely associated with cervical disc herniations and/or spinal stenosis.

Case Description:
A 62-year-old male presented with a 4-month history of right brachial pain and hyposensitivity in the C5 distribution. The cervical magnetic resonance (MR) imaging scan revealed a C5–C6 right anterolateral disc herniation with syringomyelia extending from C5–C6 to T1. Following a C5–C6 anterior cervical discectomy and fusion (ACDF), the patient’s symptoms resolved. The 3-month postoperative MR documented total resolution of the syrinx. Notably, due to residual neuropathic pain, the patient required a subdural spinal cord stimulator which was placed without any complications.

Conclusion:
Syringomyelia rarely occurs in conjunction with cervical disc disease and stenosis, and even more infrequently resolves following an ACDF. Future research should focus on the etiology of syrinx formation in these patients and should explore their response to various treatment modalities.
Bilateral cervical facet dislocations at two adjacent levels: A case report
Authors: Zemmar Ajmal , Zhou Hanbing , Ye Vincent , Schewchuk Jason , Volders David , Dea Nicolas 
Published: April 2019

Background:
Cervical facet dislocations are rare in patients sustaining traumatic subaxial injuries. They occur due to hyperflexion-distraction and can occur unilaterally or bilaterally resulting in significant spinal instability. Bilateral facet dislocations at one level are less common than unilateral dislocations, while bilateral facet dislocations at adjacent spinal levels have only been reported twice in literature.

Case Description:
A 31-year-old male presented with bilateral facet dislocations at two adjacent cervical levels (C6/C7 and C7/T1) following a fall from 40 to 50 feet. The patient had undergone a C6/C7 disk arthroplasty a few weeks before the traumatic event.

Conclusion:
Here, we present the unique case of cervical bilateral jumped facets occurring at two adjacent levels (i.e., C6–C7 and C7–T1). Notably, the antecedent cervical C6–C7 arthroplasty likely contributed to the altered load distribution, leading to this unusual instance of bilateral adjacent level facet dislocations. In such cases, surgical reduction and fixation may prove technically challenging warranting, therefore, careful preoperative planning.
Entropi Temelli Maut Yöntemi İle Yenilikçi Girişimlerin Faaliyetlerinin Değerlendirilmesi
Authors: ÖMÜRBEK Nuri , KİŞİ Esin 
Published: April 2019

Bu çalışmada farklı sektörlerden 100 girişimin yenilik faaliyetleri Çok Kriterli Karar Verme (ÇKKV) Yöntemleri ile değerlendirilmiştir. 100 girişimin 2014-2016 yılları arasındaki üç yıllık dönem verileri TUİK resmi web sitesinden alınmıştır. Çalışmada Ar-Ge dışındaki yenilik faaliyetleri; ürün yeniliği, süreç yeniliği, pazarlama yeniliği ve organizasyonel yenilik faaliyetleri olarak ayrılmıştır.Kriter ağırlıkları Entropi yöntemi ile hesaplanmıştır. 100 girişimin yenilik faaliyetleri değerlendirilirken de Çok Kriterli Karar Verme yöntemlerinden en çok faydayı sağlayan alternatifin seçimini amaçlayan MAUT (Multi Attribute Utility Theory) yöntemi kullanılmıştır. Çalışmaya göre yenilik faaliyetleri değerlendirildiğinde pazarlama yeniliği açısından en iyi performans İmalat Sanayi, en düşük performans Elektrik, Gaz, Buhar ve İklimlendirme Üretimi ve Dağıtımı sektöründe; organizasyon yeniliği açısından en iyi performans Reklamcılık ve Piyasa Araştırması, en düşük performans Bilgi ve İletişim sektöründe görülürken ürün yeniliği açısından değerlendirildiğinde en iyi performans İmalat Sanayi, en düşük performans Mimarlık ve Mühendislik, Teknik Test ve Analiz faaliyetleri alanında ve süreç yeniliği açısından da en yüksek performans Madencilik ve Taş Ocakçılığı, en düşük performans finans ve sigorta faaliyetlerinde izlenmektedir.
audit laporan keuangan dan tanggung jawab auditor matkuliah audit sistem
Authors: Kusnandar Adit 
Published: April 2019

Audit Keuangan atau lebih tepat disebut sebagai Audit laporan keuangan merupakan penilaian atas suatu perusahaan atau badan hukum lainnya (termasuk pemerintah) sehingga dapat dihasilkan pendapat yang independen tentang laporan keuangan yang relevan, akurat, lengkap, dan disajikan secara wajar. Audit keuangan biasanya dilakukan oleh firma-firma akuntan karena pengetahuannya akan laporan keuangan
TENTANG SEJARAH TOSHIBA
Authors: Suhendar Aldi 
Published: April 2019

Toshiba adalah perusahaan pemroduksi elektronik teknologi tinggi yang bermarkas di Tokyo, Jepang. Toshiba dibentuk pada tahun 1939, merupakan hasil merger dari dua perusahaan. Tokyo Denki adalah perusahaan yang bergerak dibidang consumer goods dan perusahaan mesin Shibaura Seisakusho. Mengambil beberapa huruf didepan dari masing-masing perusahaan “TO” dan “SHIBa” maka lahirlah merek Toshiba. Pada tahun 1984 perusahaan itu resmi berubah menjadi Toshiba Corporation. Grup ini makin kuat melalui pertumbuhan internal dan melalui akuisisi perusahaan rekayasa alat berat dan perusahaan industri primer pada 1940-an dan 1950-an. Kemudian pada 1970-an dan seterusnya, anak perusahaan mulai didirikan, yaitu: grup Toshiba Lighting &amp; Teknologi (1989), Toshiba Carrier Corporation (1999), Toshiba Elevator &amp; Building System Corp (2001), Toshiba Solutions Corp (2003), Toshiba Medical Systems Corp (2003) dan Toshiba Materials Co Ltd (2003).
Hypertension artérielle pulmonaire au cours de la drépanocytose : complication aiguë ou chronique ?
Authors: Jamoussi A. , Merhabene T. , Neji H. , Ayed K. , Ben Khelil J. , Besbes M. 
Published: April 2019

Introduction : Au cours de la drépanocytose (DPC), l’hypertension artérielle pulmonaire (HTAP) est fréquente et aggrave le pronostic. Son diagnostic précoce revêt un intérêt capital sur ce terrain.
Observations : Le premier cas est celui d’un patient avec HTAP chronique et retentissement fonctionnel respiratoire, suspectée à l’occasion d’un épisode aigu et confirmée à distance. Le second cas rapporte une HTAP aiguë au cours d’un syndrome thoracique aigu ; spontanément réversible après résolution de la crise.
Conclusion : L’HTAP découverte lors d’une exacerbation de la DPC peut être aiguë et réversible ou chronique et permanente. À distance de cet épisode aigu, une exploration de la fonction cardiaque droite est nécessaire pour étiqueter la forme clinique de l’HTAP et préconiser la surveillance adéquate.
PEMBELAJARAN INKUIRI MODEL SILVER UNTUK MENGEMBANGKAN KEMAMPUAN PEMECAHAN MASALAH DAN DISPOSISI MATEMATIK SISWA SEKOLAH MENENGAH ATAS
Authors: Wardani Sri 
Published: April 2019

Penelitian ini merupakan eksperimen dengan design kontrol grup dan hanya postes, yang bertujuan untuk mengetahui kemampuan pemecahan masalah dan disposisi matematik siswa melalui pembelajaran inkuiri model Silver. Penelitian melibatkan siswa kelas X Sekolah Menengah Atas kelompok sekolah tinggi dan sedang di Kota Cimahi. Instrumen penelitian mencakup tes kemampuan awal matematika, tes pemecahan masalah matematik, skala disposisi matematik, lembar observasi, dan pedoman wawancara. Data dianalisis menggunakan anova satu dan dua jalur, uji Scheffe, asosiasi kontingensi. Hasil penelitian ini adalah: 1) Kemampuan pemecahan masalah matematik siswa yang belajar inkuiri model Silver grup lebih baik dari inkuiri model Silver klasikal dan biasa, demikian pula kemampuan pemecahan masalah matematik siswa yang belajar inkuiri model Silver klasikal lebih baik dari pembelajaran biasa; 2) Model pembelajaran, kelompok sekolah, dan kemampuan awal matematika memberikan pengaruh yang signifikan terhadap kemampuan pemecahan masalah matematik. Namun model pembelajaran mempunyai peranan lebih besar terhadap kemampuan pemecahan masalah matematik.; 3) Tidak terdapat interaksi antara kelompok sekolah dan model pembelajaran, dan juga antara kelompok pembelajaran dan kemampuan awal matematika dalam mengembangkan kemampuan pemecahan masalah matematik; 4) Disposisi siswa terhadap matematika positif; 5) Terdapat asosiasi antara kemampuan pemecahan masalah matematik dan disposisi siswa terhadap matematika.
MODEL PEMBELAJARAN GENERATIF DALAM UPAYA MENINGKATKAN HASIL BELAJAR MATEMATIKA
Authors: Madio Sukanto Sukandar 
Published: April 2019

The aim of this research is to analyze, (a) mathematical achievement capability of student after learning by Generative model, (b) mastery learning of student after learning by Generative model, and (c) student activities while learning Generative models. This research is directed to class action research in one of public high school in Garut as population subject are all eleventh grade student by taking one class of 41 sttudents as a sample. The result of research shows, (a) mathematical achievement capability of student after learning by Generative model have been changed (increased) in score that received by student, of cycle I to cycle II, of cycle II to cycle III, and of cycle III to cycle IV, (b) mastery learning of student after learning by Generative models not reached yet on cycle I, but reached on cycle II, cycle III, and cycle IV, (c) Learning Condition of implementation of Generative Model have been increased to be better and student learning activity have been increased to be better too.
FAKTOR-FAKTOR YANG MEMPENGARUHI KEMAMPUAN MAHASISWA DALAM PRAKTIKUM ANALISIS DATA STATISTIK
Authors: Sundayana Rostina 
Published: April 2019

Kegiatan penelitian merupakan salah satu bagian dari tridharma perguruan tinggi, sehingga baik mahasiswa maupun dosen berkewajiban untuk melakukan kegiatan penelitian tersebut. Dalam melakukan penelitian, salah satu kegiatan peneliti adalah harus melakukan analisis data statistik. Kenyataan di lapangan pengolahan data ini masih dianggap hal yang sulit, sehingga perlu diupayakan jalan keluarnya untuk mengatasi persoalan tersebut. Dalam penelitian ini diungkap mengenai faktor-faktor yang mempengaruhi kemampuan mahasiswa dalam melakukan praktikum analisis data statistika, diantaranya faktor kesiapan mahasiswa dalam mengikuti perkuliahan, kemampuan mahasiswa dalam memecahkan masalah statistik secara teoritik, kualitas proses pembelajaran, dan tanggapan mahasiswa mengenai sarana dan prasarana laboratorium komputer. Dari hasil penelitian ini terungkap bahwa: dari masing-masing faktor tersebut berpengaruh secara signifikan dengan besar pengaruh sebagai berikut: 1) pengaruh kesiapan mahasiswa terhadap kemampuan praktikum sebesar 22,2%; 2) pengaruh kemampuan mahasiswa dalam memecahkan masalah statistik secara teoritik terhadap kemampuan praktikum sebesar 19,2%; 3) pengaruh kualitas proses pembelajaran perkuliahan praktikum analisis data statistika terhadap kemampuan praktikum sebesar 28,9%; serta 4) pengaruh tanggapan mahasiswa mengenai kondisi sarana dan prasarana laboratorium komputer yang digunakan untuk pelaksanaan praktikum terhadap kemampuan praktikum sebesar 30,6%; Adapun pengaruh secara simultan dari keekmpat faktor yang diteliti sebesar 96,4%.
IMPLEMENTASI PMRI DALAM MATERI SIFAT KOMUTATIF DAN ASSOSIATIF PADA BILANGAN BULAT UNTUK LEVEL SISWA SD/MI
Authors: Afriansyah Ekasatya Aldila 
Published: April 2019

Abstract Implementing PMRI in teaching process using a little sheet box and straw as a media for helping students in learning commutative and associative properties in integer numbers is the aim of this study. Design research is used as appropriate means to achieve the aim; conducted in three phases: preliminary design, teaching experiment (first and second cycle), and retrospective analysis. This study enables students to work with contextual situations within integer numbers properties; uses media tool (a straw and little sheet box). Pendidikan Matematika Realistik Indonesia (PMRI) underlies the design of the context and the activities. Sample of population is students from Madrasah Ibtidaiah Negeri 1 Palembang. This study involves fourth grade students, 3 students in first cycle and 36 students in second cycle (4 students were analyzed in detail). The result of this study could show that the activities could bring students’ learning from the contextual situation to more formal situation. The activities within this study have been succeed to be implemented in this school so that these activities could be used for the others.