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Objective: This research is aimed to investigate the activity of various extracts and fractions of yellow champaka (Michelia champaca L.) by mechanism-based yeast bioassay (MBYB) against the mutant yeasts. Liriodenin content, an active compound in M. champaca, will analyze to know the correlation with this assay. Methods: The bark of M. champaca was extracted by maceration and graded maceration using n-hexane, ethyl acetate, and methanol. The methanol extract was fractionated using water, n-hexane and ethyl acetate in the liquid-liquid extraction process. Each extract and fractions were tested in vitro by mechanism-based yeast bioassay for their topoisomerase inhibitor activity. Liriodenine content of all samples was analyzed by thin layer chromatography (TLC) densitometry method. Results: The yeast bioassay results showed that all extracts were active as topoisomerase inhibitors (IC12 values under 8000 µg/ml) except MGM. Liriodenine can be used as a marker of active compound in ethyl acetate samples that were EAM, EAGM and EAF with Pearson analysis value-0.887 (P=0.153) and these samples were relatively more active than others. Conclusion: This research showed that various extracts and fractions of yellow champaka bark have topoisomerase inhibitor's activity. Liriodenine can be used as a marker of the active compound so yellow champak bark is a potent natural agents for breast cancer.

This study was conducted to determine whether the User Centered Design approach can build a better User Interface and User Experience on the Flavor Fog application so that it can meet the needs and desires of users. The method used is the System Usability Scale to determine the score of the application. The score obtained before the design was carried out was 70.8 which entered category C, while after designing using the User Centered Design approach, a score of 81.1 was obtained which entered category A. From these results it can be seen that there is an upgrade in the Flavor Fog application, so that it can be concluded that the application design using a User Centered Design approach with measurements using the System Usability Scale, can produce a User Interface and User Experience design that is in accordance with the needs and desires of the user., Penelitian ini dilakukan untuk mengetahui apakah pendekatan User Centered Design dapat membangun User Interface dan User Experience yang lebih baik pada aplikasi Flavour Fog sehingga dapat memenuhi kebutuhan dan keinginan pengguna. Metode yang digunakan yaitu System Usability Scale untuk menentukan skor dari aplikasi. Hasil skor yang diperoleh sebelum dilakukan perancangan yaitu 70,8 yang masuk kategori C, sementara setelah perancangan mengunakan pendekatan User Centered Design, diperoleh skor 81,1 yang masuk kategori A. Dari hasil tersebut maka dapat dilihat adanya peningkatan terhadap aplikasi Flavour Fog, sehingga dapat disimpulkan bahwa perancangan aplikasi menggunakan pendekatan User Centered Design dengan pengukuran menggunakan System Usability Scale, dapat menghasilkan suatu rancangan User Interface dan User Experience yang sesuai dengan kebutuhan dan keinginan pengguna.

Indomethacin is accepted therapy for patent ductus arteriosus (PDA) in ELBW infants (1000 g). We hypothesize that surgical ligation may provide comparatively superior outcomes in select ELBW infants.Predischarge outcomes of 298 ELBW infants with echocardiography-proven PDA were retrospectively compared by treatment provided: no treatment (group 1, n = 54), indomethacin (group 2, n = 140), ligation (group 3, n = 46), and ligation after indomethacin failure (group 4, n = 58). chi(2) and Wilcoxon rank sum tests were used to test for significance. Institutional review board approval was obtained (IRB/05-00395).Group 3 had significantly lower gestational age (P.001), birth weight (P = .006), and 5-minute Apgar scores (P = .03) compared with group 2. Group 3 and group 1 had a higher rate of pretreatment intraventricular hemorrhage (IVH) compared with group 2 (P.001). By contrast, posttreatment complications including acute renal failure, necrotizing enterocolitis, thrombocytopenia, and IVH occurred more frequently in groups 2 (P = .004) and 4 (P = .001) compared with group 3. Survival was 57.7% in group 1 compared with groups 2, 3, and 4 (82.4%, 86.0%, and 92.7% respectively; P = .001). Preoperative conditions associated with nonsurvival include gestational age (P = .009), birth weight (P = .002), maternal preeclampsia (P = .015), 5-minute Apgar score (P = .013), and sepsis (P = .018). Posttreatment complications associated with nonsurvival include acute renal failure (P = .002), thrombocytopenia (P = .002), and necrotizing enterocolitis (P = .034). Survival was not influenced by any congenital comorbidity, pre- or posttreatment IVH, diameter of the PDA, or recurrence of the PDA after indomethacin therapy.(1) Patent ductus arteriosis requires treatment in ELBW infants to maximize survival. (2) Indomethacin and surgical ligation permit equivalent survival in low-risk ELBW infants, but indomethacin results in a high failure and complication rate requiring operative salvage in a number of patients. (3) Surgical ligation permits survival of high-risk ELBW infants with a low complication rate and is preferable to indomethacin in ELBW infants with the above risk factors.

Ileal pouch anal anastomosis (IPAA) is associated with complications in a significant number of patients, including ileal-anal separation, anal stricture, pouchitis, pelvic sepsis, and small bowel obstruction. In most cases, these complications may be successfully treated using either medical or surgical therapy and do not result in long-term pouch dysfunction. Important preventative measures include accrual of experience or creation of a team with experienced surgical leadership and scrupulous selection of patients who have no features of Crohn's disease. Despite these precautions, 5% to 15% of patients will develop chronic pouch dysfunction and pouch failure requiring diversion with or without excision of the pouch. Medical measures, such as antibiotics, immunomodulators, and biologic agents, and surgical measures such as advancement flap anoplasty may be attempted to salvage pouch function and are successful in more than 50% of cases. Indeterminate colitis does not preclude IPAA; however, Crohn's colitis is absolute contraindication for same. Patients who require colectomy and are suspected for any reason to have CD may undergo ileorectal anastomosis with preservation of anorectal continence and excellent functional results.

Start-ups face several issues and challenges in the course of their development as a compa-ny. Open innovation has been discussed in research for more than a decade as a concept, which can bring benefits to a company. Even though most of the research has been focus-ing on large enterprises, some researchers discuss also benefits for small companies like start-ups. Nevertheless, it can be observed that some start-ups decide to adopt the opposite of open innovation, namely closed innovation, through not sharing internal knowledge to the outside world. Hence, start-ups perceive the benefits of open innovation differently and decide accordingly whether to adopt open innovation or not. The purpose of this study is to explore if start-ups decide to actually do the former and what reasons they have to do so. Therefore, this study will further discover at what point in the development of their start-up and with whom they adopt open innovation. As an attractive industry for start-ups, the mobile services industry is selected as a scope for this study. Furthermore, Sweden is selected as the country of study, due to its reputation as one of the most innova-tive countries in the world. A qualitative study has been conducted using in-depth interviews with founders and co-founders of start-ups to retrieve narrative stories about their start-up’s development from the first day of an idea to a scalable business, and their experiences and motivations in re-gards to the application of open innovation practices. The analysis of this study detects pat-terns among the interviewed start-ups and concludes that start-ups in the mobile services industry in Sweden adopt open innovation in each phase of their development process. Furthermore, these patterns include several reasons why the start-ups applied open innova-tion practices and with whom, which are changing over the course of their development.

Animal studies have shown that visceral circulation is well preserved when intraabdominal pressure does not exceed 20 mm Hg. Our aim was to analyze the outcomes of a series of infants with gastroschisis whose surgical management was directed by the intraoperative measurement of bladder pressure.Forty-two neonates with gastroschisis were surgically managed using intraoperative measurement of bladder pressure at a tertiary care center between July 31, 1992, and March 20, 2004, and their outcome was evaluated. Primary closure with or without prosthetic material was performed when pressures measured 20 mm Hg or less. Delayed closure using a silon pouch was performed when pressures measured more than 20 mm Hg. Categorical variables were analyzed including mode of delivery, associated anomalies, type of closure, complications, and mortality. Continuous variables were analyzed including gestational age, birth weight, bladder pressure, time to full feeds, and length of hospital stay. Categorical and continuous variables for both groups were compared using Fisher's Exact and Wilcoxon's rank-sum tests, respectively, and a significance level of .05 was used. Preapproval of this study was obtained from the Institutional Review Board (No. 6690).Thirty-three (79%) neonates with a mean bladder pressure of 16 mm Hg underwent primary closure and 9 neonates with a mean bladder pressure of 27 mm Hg underwent delayed closure with a silon pouch that was not spring loaded ( P.03). Patients treated with primary closure had faster return to full feeds and significantly shorter hospital length of stay compared with patients treated by delayed closure ( P = .04). Surgical morbidity and mortality was nil in patients after primary closure. One patient with total abdominal evisceration died during attempted delayed closure and another patient required reoperation for bowel necrosis after delayed closure.Primary closure was safely accomplished in 100% of neonates with gastroschisis whose bladder pressure measured 20 mm Hg or less. Further, this group of patients had a faster return to full feeds and a significantly shorter hospital length of stay compared with neonates who required delayed closure.

Background/Purpose: Some Health Maintenance Organizations (HMO) limit access of their members to specialists to lower costs. The purpose of this study is to determine whether this policy affects the outcome of children with appendicitis. Methods: At a large academic medical center, children 17 years or younger with appendicitis were treated either by an HMO Adult General Surgical Service (group A) or a Pediatric Surgical Service (group B). Board certified pediatric surgeons were not available on the HMO surgical service. Anesthesia, surgical residents, nursing, and ancillary support services were identical in both groups. Study parameters included imaging tests performed, operation type, complications, readmissions, and length of stay. Results were analyzed using X 2 and Fischer's Exact tests. Results: One-hundred seventy-five consecutive children underwent appendectomy, 96 in group A and 79 in group B. In patients with simple acute appendicitis, there was no significant difference between group A and group B for complications, readmissions, second operation, or length of stay. In patients with gangrenous or perforated appendicitis there was a significant difference between group A and group B for type of operation (laparoscopic appendectomy, group A, 4 of 27 v group B, 0 of 34; P = .04); complications (group A, 9 of 27 v group B, 3 of 34; P = .025); readmissions (group A, 6 of 27 v group B, 0 of 34; P = .001); second operation (group A, 6 of 27 v group B, 2 of 34; P = .001); and mean total length of stay in days (group A, 8.6 of 27 v group B, 5.4 of 34; P = .05). Conclusions: Children with significantly perforated appendicitis have lower complication rates and shorter lengths of hospital stay when treated by pediatric surgeons as compared with HMO adult general surgeons. J Pediatr Surg 36:1510-1513. Copyright © 2001 by W.B. Saunders Company.

Background: The purpose of this study was to evaluate the incidence of dysplasia and the mucosal adaptation patterns of pelvic pouches in children and adolescents who had undergone ileal pouch-anal anastomosis for ulcerative colitis. Methods: Between 1982 and 1996, 176 pediatric patients with ulcerative colitis underwent ilial pouch-anal anastomosis. Seventy-six patients were followed up after surgery at the Cleveland Clinic. Pouch biopsy specimens were reviewed for dysplasia and to determine mucosal adaptation patterns. Fifty-eight of the 76 patients had an average of three mucosal biopsies during a mean follow-up of 5 years. Demographic and surgical data were abstracted from archives of medical records. All previously obtained pouch biopsy specimens were re-evaluated by a single pathologist to ensure standardized interpretation. Results: No dysplasia was identified in screening specimens of 76 children and adolescents including 5 patients who showed dysplasia in resected colon specimens. The pattern of mucosal adaptation was categorized using previously reported criteria. Type A was defined as normal mucosa or mild villous atrophy with no or mild inflammation. Type B mucosa showed transient atrophy with temporary moderate inflammation followed by normalization of architecture. Type C mucosa was defined as a pattern of persistent atrophy with severe inflammation. In the study cohort, the patterns of mucosal adaptation, type A (56.9%; n = 33 type B (32.8%; n = 19), and type C (10.3%; n = 6), were comparable with those reported in adults. The rate of pouch failure and diagnosis of Crohn's disease were similar in each group and were not related to the specific adaptation pattern. Most of the patients with type C mucosa had clinical symptoms of pouchitis requiring periodic antibiotic therapy. No dysplasia was identified in any biopsy specimen reviewed. Conclusions: Similar morphologic changes can be seen in ileal pouches in pediatric and adult patients. There seemed to be no increased risk of dysplasia in children and young adults who had undergone ilial pouch-anal anastomosis surgery for ulcerative colitis during a 5 year follow-up. Because the long-term risk of development of dysplasia is unknown, an initial screening should be performed 5 years after the creation of a pelvic pouch in children or when the total disease duration exceeds 7 years. Once identified, patients with Type C mucosa should have annual screening for dysplasia until further data become available.

Our purposes were to determine whether sonography can distinguish between obstructed and nonobstructed rats and to compare the diagnostic accuracy of sonography and radiography in the diagnosis of small bowel obstruction. Nonstrangulating small bowel obstruction was created in 19 rats; sham laparotomies were performed in 18 controls. Serial radiographs and sonograms, including duplex Doppler sonography, were obtained. Bowel diameter and bowel wall thickness were evaluated retrospectively. Bowel diameter, bowel wall thickness, and resistive indices increased in the animals with obstruction; controls remained unchanged (P = 0.002). Sonography demonstrated a significantly higher diagnostic accuracy than radiography at 24 hours and beyond (P = 0.023). Ultrasonography is sensitive and more accurate than radiography in diagnosing small bowel obstruction using objective criteria in the animal model.

Background. Nissen fundoplication (NF) has a relatively high failure rate in neurologically impaired children with gastroesophageal reflux (GER). In 1990 we began to use routine technetium 99m sulfur colloid emptying scans and pyloroplasty with NF for delayed gastric emptying (DGE) in our neurologically impaired patients. The aim of this study was to determine the influence of DGE and pyloroplasty on the outcome of NF in neurologically impaired children. Methods. One hundred neurologically impaired children underwent NF by a single surgeon between August 1986 and July 1995. Beginning in January 1990 emptying scans were routinely obtained, and patients with DGE underwent pyloroplasty with NF. Outcome analysis was performed for recurrence/wrap failure and other parameters. Mean follow-up was 5.8 years, with a minimum of 18 months. Results. DGE was found in 35 (65%) of the 54 children who had emptying scans. All 11 children with normal scans had successful NF without recurrent reflux (100%). Forty (93%) of 43 children who underwent pyloroplasty and NF had successful outcomes. Thirty-eight children underwent NF without evaluation of gastric emptying with success in 30 of them (78.9%). Overall success improved from 34 (83%) of 41 in the first half of the study, when 3 (7%) of 41 children underwent emptying scans, to 55 (93%) of 59 in the second half, when 51 (86%) of 59 of the children underwent emptying scans. Conclusions. DGE is common in neurologically impaired children with GER. NF in children with normal gastric emptying has a high probability of success. Pyloroplasty improves the outcome of NF in children with DGE. Neurologically impaired children should be evaluated for DGE before operation for GER.

The authors reviewed four cases of ureteropelvic junction obstruction (UPJ) in duplicated systems. Associated abnormalities included contralateral duplication, vesicoureteral reflux, and a case of ipsilateral upper pole ectopic ureter with a dysplastic upper pole moiety. Surgical management included dismembered pyeloplasty, ureteral reimplantation, end-to-side pyeloureterostomy to the upper-pole ureter, and upper-pole heminephrectomy with lower-pole dismembered pyeloplasty. UPJ obstructions occurring in duplicated systems often are associated with other anomalies.

Various techniques of vaginal repair used in the reconstruction of cloacal deformities are discussed. In 4 years we performed primary reconstruction of cloacal anomalies in 4 children, 3 of whom had hydrocolpos and 1 vaginal agenesis. Vaginal reconstruction was done using a variety of techniques tailored to the primary anomaly. Distal vaginal occlusion related to ischemia occurred in 2 patients and in both the vagina was successfully reconstructed at a second stage procedure. Overall cosmetic and functional results were good. All patients are dry but require clean intermittent catheterization and 3 currently require a bowel regimen at followup of 18 months to 4 years.

This study is a retrospective review of eight pediatric patients with multifocal intestinal Crohn's disease who underwent strictureplasty with or without concomitant bowel resection between January 1978 and April 1992. The patients ranged in age from 9.9 years to 18.5 years. Indications for surgery were partial intestinal obstruction (n = 6), failure of medial therapy or steroid dependence (n = 4), growth failure (n = 2), and enterocutaneous fistula (n = 2). Thirty-six strictureplasties were performed in the eight patients (median, 4.5 strictureplasties per patient; range, 1-12). Bowel resection was performed in six of the eight patients in areas where strictureplasty was not feasible. The mean length of resection was 40 cm (range, 15-82 cm). The only complication was intestinal hemorrhage, which was conservatively managed in two patients. The patients were followed for a mean of 19 months (range, 3-55 months). Five patients had a weight below the fifth percentile prior to surgery. Postoperatively, there was a weight gain in seven patients, including all five patients who were originally below the fifth percentile. A statistically significant weight gain was found when a paired t test analysis was applied to the entire group (p = 0.04). Five of six patients who were on steroid medication at the time of surgery were successfully weaned within 1.5-3 months (mean, 2.3 months) from the time of surgery. Seven of eight patients had relief of their intestinal symptoms. Strictureplasty with small-bowel resection, or perhaps strictureplasty alone, in pediatric patients with multifocal intestinal Crohn's disease can improve gastrointestinal symptoms, promote weight gain, and allow discontinuation of steroid medications.(ABSTRACT TRUNCATED AT 250 WORDS)