Search

Chemistry is a subject that is closely related to learning that requires students to be active in problem solving. Because of this, a worksheet development is needed to support chemistry learning activities. This study aims to develop a Student Based Worksheet (LKPD) based on Problem Based Learning (PBL) hydrolysis material to improve mathematical logical intelligence. The quality of LKPD is measured by the criteria of validity, effectiveness, and practicality in the learning process. The development model used in this study is a 3D model (define, design and develop). Data analysis techniques using qualitative and quantitative tests. The product development validation was carried out by the validator of media experts and material experts, while the trial was conducted by 36 students of class XI IPA 5. The results of the validator analysis stated that the quality of learning material was included in the excellent category with a percentage of 93.77% of the material experts and 94.46% of media experts. The effectiveness of LKPD indicated an increase in mathematical logical intelligence of students with the achievement of N-gain of 0.56 in the medium category and classical completeness of 86.11%. Student responses to the practicality of using LKPD showed results of 77.78% which included in the very good category and 22.22% included in the good category. Based on the results obtained, it can be concluded that LKPD fulfills valid, effective, practical criteria, and can improve mathematical logical intelligence.

Self-confidence Not everyone has good self-confidence. Therefore, it needs to be encouraged in several ways: through public speaking combined with personal branding. The purpose of this service was to develop public speaking and personal branding skills for student organization managers at SMA Dharma Wanita Surabaya through the PIKAT scheme. The training is divided into two; offline and online. The training program is carried out by carrying out counseling on public speaking and personal branding based on theories in communication. The second activity is to train public speaking and personal branding where the participants can practice their public speaking skills. Monitoring after mentoring and training activities is still carried out. At the end of the program, there are four outputs/recommendations, training modules, activity news, and community service journals. It can be concluded that this activity encourages the development of public speaking and personal branding skills for student organization managers at SMA Dharma Wanita Surabaya.

Context: Cancer is the leading cause of death in the human population, ensuing from the accumulation of damage to genetic materials and affecting various parts of the organs. This review is focused on the cell signaling cross-talk mechanism of colorectal cancer (CRC) and its regulations. Genomic instability acts as the major driving force for CRC. The major CRC cascade mechanisms such as Wnt, Ras, TOPK, p53, and ubiquitin pathways were discussed. These interlinked signals cross-talk with one another in various regulatory mechanisms and play a unique role in CRC. Evidence Acquisition: The major cross-talking signals of CRC are the most significant part of this review. Wnt is a resource and center of axis for cross-talk and interlinked signaling mechanism. Wnt/β-catenin signaling was regulated by frizzled receptor, co-factors, Ras, TOPK, and many other mechanisms; related literature of CRC were collected through a literature survey and categorized using the keywords. The pathways with high specificity interlinked with Wnt were identified and used as the major targets for this review. Results and Conclusion: The interlinked signaling pathways and gene networks were explained with their specificity role in CRC. We highlighted the major regulatory signaling and interlinked pathways of CRC, as new multi targets approach. Furthermore, we discussed the potent targeted genes, bio-markers for a better prognosis, and therapies for CRC patients. Through highlighting the gene cross-talking signaling cascade; we have provided the source for gene network interaction and targeted therapy. This study paves the way for multi-targeting of interlinked pathways and suggesting these would be perfect for suppressing of CRC. The signaling pathways discussed in this review are not only focused on CRC but also the new potent targets and bio-markers for different types of cancers. Targeting multiple interlinked pathways could be useful for developing new potential bio-markers for treatment and diagnosis purposes.

Abstract We show that Weinberg’s leading soft photon theorem in massless abelian gauge theories implies the existence of an infinite-dimensional large gauge symmetry which acts non-trivially on the null boundaries ± of (d + 2)-dimensional Minkowski spacetime. These symmetries are parameterized by an arbitrary function ε(x) of the d-dimensional celestial sphere living at ± . This extends the previously established equivalence between Weinberg’s leading soft theorem and asymptotic symmetries from four and higher even dimensions to all higher dimensions.

Background: Conventional Cervical Cytology is the most widely used cervical cancer screening test. The incidence of cervical carcinoma is incredibly high in developing countries due to lack of proper knowledge. The extensive use of cervical screening with Papanicolau smears had considerably increased the detection of precancerous and cancerous lesion of uterine cervix. Study was conducted to evaluate cytohistological correlation and to calculate concordance and discordance of Pap smear in detection of precancerous and cancerous lesions of uterine cervix. Materials and Methods: A total of 54 samples reported in Pap smear as cervical intraepithelial lesions and suspicious for invasive malignancies were selected and correlated with corresponding histopathological findings. It was an observational study done for a period of 18 months from November 2016 to May 2018 at UCMS-TH. All the statistical evaluation was done by using SPSS version 20. Results: During the study period 54 cases were evaluated. Atypical Squamous Cell of Undetermined Significance was the common abnormal findings in the Pap smear with frequency of 26 (48.1%). Out of total 54 cases of Pap smears, 30 (55.55%) were concordant while discrepancies occurred in 24(44.44%) cases with cervical biopsy. Conclusions: The study revealed a good correlation between cervical cytology and cervical biopsy. We also concluded that conventional Pap smear is a cost effective test for the early detection of precancerous and cancerous cervical lesions.

Mental health has been long neglected. Even though it causes substantial loss of disability-adjusted life years, it does not receive proportionate funding. India spends

Summary: Background: Regimens for palliation in patients with head and neck cancer recommended by the US National Comprehensive Cancer Network (NCCN) have low applicability (less than 1–3%) in low-income and middle-income countries (LMICs) because of their cost. In a previous phase 2 study, patients with head and neck cancer who received metronomic chemotherapy had better outcomes when compared with those who received intravenous cisplatin, which is commonly used as the standard of care in LMICs. We aimed to do a phase 3 study to substantiate these findings. Methods: We did an open-label, parallel-group, non-inferiority, randomised, phase 3 trial at the Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India. We enrolled adult patients (aged 18–70 years) who planned to receive palliative systemic treatment for relapsed, recurrent, or newly diagnosed squamous cell carcinoma of the head and neck, and who had an Eastern Cooperative Oncology Group performance status score of 0–1 and measurable disease, as defined by the Response Evaluation Criteria In Solid Tumors. We randomly assigned (1:1) participants to receive either oral metronomic chemotherapy, consisting of 15 mg/m2 methotrexate once per week plus 200 mg celecoxib twice per day until disease progression or until the development of intolerable side-effects, or 75 mg/m2 intravenous cisplatin once every 3 weeks for six cycles. Randomisation was done by use of a computer-generated randomisation sequence, with a block size of four, and patients were stratified by primary tumour site and previous cancer-directed treatment. The primary endpoint was median overall survival. Assuming that 6-month overall survival in the intravenous cisplatin group would be 40%, a non-inferiority margin of 13% was defined. Both intention-to-treat and per-protocol analyses were done. All patients who completed at least one cycle of the assigned treatment were included in the safety analysis. This trial is registered with the Clinical Trials Registry-India, CTRI/2015/11/006388, and is completed. Findings: Between May 16, 2016, and Jan 17, 2020, 422 patients were randomly assigned: 213 to the oral metronomic chemotherapy group and 209 to the intravenous cisplatin group. All 422 patients were included in the intention-to-treat analysis, and 418 patients (211 in the oral metronomic chemotherapy group and 207 in the intravenous cisplatin group) were included in the per-protocol analysis. At a median follow-up of 15·73 months, median overall survival in the intention-to-treat analysis population was 7·5 months (IQR 4·6–12·6) in the oral metronomic chemotherapy group compared with 6·1 months (3·2–9·6) in the intravenous cisplatin group (unadjusted HR for death 0·773 [95% CI 0·615–0·97, p=0·026]). In the per-protocol analysis population, median overall survival was 7·5 months (4·7–12·8) in the oral metronomic chemotherapy group and 6·1 months (3·4–9·6) in the intravenous cisplatin group (unadjusted HR for death 0·775 [95% CI 0·616–0·974, p=0·029]). Grade 3 or higher adverse events were observed in 37 (19%) of 196 patients in the oral metronomic chemotherapy group versus 61 (30%) of 202 patients in the intravenous cisplatin group (p=0·01). Interpretation: Oral metronomic chemotherapy is non-inferior to intravenous cisplatin with respect to overall survival in head and neck cancer in the palliative setting, and is associated with fewer adverse events. It therefore represents a new alternative standard of care if current NCCN-approved options for palliative therapy are not feasible. Funding: Tata Memorial Center Research Administration Council. Translations: For the Hindi, Marathi, Gujarati, Kannada, Malayalam, Telugu, Oriya, Bengali, and Punjabi translations of the abstract see Supplementary Materials section.

Study Region: Semi-Arid Regions of Marathawada, Vidarbha and Saurashtra in IndiaStudy Focus: To understand and evaluate the impact of Managed Aquifer Recharge (MAR) efforts.New Hydrological Insights for the Region: Since 1990, the Saurashtra region of Gujarat, India witnessed a massive community-based distributed groundwater recharge movement, initially catalyzed by NGOs and later supported by the government. The region has witnessed visible improvement in groundwater resources during recent years, which was attributed by some researchers to the recharge movement. A competing hypothesis holds that improvement in groundwater levels in Saurashtra are a result more due to a succession of good rainfall years during 2001–2014, aided by transfer of surface water from a big dam on Narmada River, rather than the distributed recharge movement. We develop and implement a 2-way test of these competing hypotheses: First, we compare groundwater recharge patterns in Saurashtra during a recent period of high rainfall years with a similar period before the onset of the recharge movement; second, for both these high rainfall periods, we also compare groundwater recharge patterns in two other comparable aquifer and terrain regions, viz., Vidarbha and Marathawada in Maharastra, which did not experience recharge movement on the same scale as Saurashtra did. Our results support the hypothesis that the community supported distributed recharge movement is the key to improved groundwater recharge in Saurashtra during 2004-09.

Many recent developments in machine learning have come from the field of “deep learning,” or the use of advanced neural network architectures and techniques. While these methods have produced state-of-the-art results and dominated research focus in many fields, such as image classification and natural language processing, they have not gained as much ground over standard multivariate pattern analysis (MVPA) techniques in the classification of electroencephalography (EEG) or other human neuroscience datasets. The high dimensionality and large amounts of noise present in EEG data, coupled with the relatively low number of examples (trials) that can be reasonably obtained from a sample of human subjects, lead to difficulty training deep learning models. Even when a model successfully converges in training, significant overfitting can occur despite the presence of regularization techniques. To help alleviate these problems, we present a new method of “paired trial classification” that involves classifying pairs of EEG recordings as coming from the same class or different classes. This allows us to drastically increase the number of training examples, in a manner akin to but distinct from traditional data augmentation approaches, through the combinatorics of pairing trials. Moreover, paired trial classification still allows us to determine the true class of a novel example (trial) via a “dictionary” approach: compare the novel example to a group of known examples from each class, and determine the final class via summing the same/different decision values within each class. Since individual trials are noisy, this approach can be further improved by comparing a novel individual example with a “dictionary” in which each entry is an average of several examples (trials). Even further improvements can be realized in situations where multiple samples from a single unknown class can be averaged, thus permitting averaged signals to be compared with averaged signals.

A reasonably good network intrusion detection system generally requires a high detection rate and a low false alarm rate in order to predict anomalies more accurately. Older datasets cannot capture the schema of a set of modern attacks; therefore, modelling based on these datasets lacked sufficient generalizability. This paper operates on the UNSW-NB15 Dataset, which is currently one of the best representatives of modern attacks and suggests various models. We discuss various models and conclude our discussion with the model that performs the best using various kinds of evaluation metrics. Alongside modelling, a comprehensive data analysis on the features of the dataset itself using our understanding of correlation, variance, and similar factors for a wider picture is done for better modelling. Furthermore, hypothetical ponderings are discussed for potential network intrusion detection systems, including suggestions on prospective modelling and dataset generation as well.

Dalam rangka penyelenggaraan pemerintahan desa maka disusun perencanaan pembangunan desa sebagai satu kesatuan dalam sistem perencanaan pembangunan daerah kabupaten/kota. Dalam kenyataannya masyarakat desa Kuapan Kecamatan Tambang Kabupaten Kampar masih sulit mengidentifikasi potensi dan permasalahan serta kebutuhan pembangunan di desa. Untuk itu pemerintahan desa perlu diberikan wawasan dan pengetahuan bagaimana menggali potensi dan permasalahan yang ada didesa agar bisa memetakan persoalan desa sehingga bisa dimasukkan dalam rencana kegiatan pembangunan desa melalui Musrenbang desa. Metode yang digunakan dengan cara Focus Group Discusion (FGD) melalui pendekatan Paricipatory Rural Appraisal (PRA) kepada aparatur pemerintahan dan masyarakat desa. Hasil pengabdian menunjukkan terjadi peningkatan pengetahuan dan pemahaman aparatur desa dalam menyusun rencana pembangunan desa dengan terpetakannya persoalan desa dan pembangunan dengan melibatkan lembaga-lembaga yang ada didesa sehingga partisipasi masyarakat dalam pembangunan menjadi meningkat. Dengan adanya peran aktif dan partispasi dari masyarakat desa maupun lembaga-lembaga yang ada di desa untuk ikut aktif dalam kegiatan perencanaan pembangunan desa maka diharapkan hasil pembangunan sesuai dengan kebutuhan masyarakat dan tujuan dari pembangunan itu sendiri.

Percutaneous nephrolithotomy (PCNL) using a nephrostomy tube as a drainage has been considered the standard procedure. However, recently many literatures have reported the use of tubeless and totally tubeless drainage following PCNL with excellent results. A literature search was conducted using MEDLINE databases to review each drainage technique following PCNL (tubeless, totally tubeless, or nephrostomy tube) and also to assess the most recent evidence that compare the safety of these drainage procedures with a clear-cut clinical parameter imposed. Tubeless or totally tubeless PCNL is significantly superior to standard PCNL in terms of length of hospital stay, postoperative pain (visual analog scale) score, demands or dosage of analgesics required, as well as faster return to activity for the patients. However, despite the many advantages of tubeless or totally tubeless PCNL over standard PCNL, there are a number of situations requiring the consideration of nephrostomy tube placement. Nonetheless, decision to use or not to use nephrostomy tube after PCNL depends on the surgeon’s experience and clinical judgment.

For sustainable electrification of surface transportation, a viable charging infrastructure is necessary. Firstly, this paper focuses on emphasizing the viability of a free fuel-based photovoltaics and/or wind turbines and lithium-ion battery-based power network to enable sustainable electric power. The importance of power electronics for a DC-based power network and extremely fast charger based on DC power is presented. Finally, the core design concepts of intelligent charging infrastructure using an intelligent energy management system are discussed. The paper aims to cover all aspects associated with a clean, reliable, efficient, and cost-effective solution to the novel charging infrastructure.

Bacteria adapt to different environments by regulating cell division and several conditions that modulate cell division have been documented. Understanding how bacteria transduce environmental signals to control cell division is critical in understanding the global network of cell division regulation. In this article we describe a role for Bacillus subtilis YpsA, an uncharacterized protein of the SLOG superfamily of nucleotide and ligand-binding proteins, in cell division. We observed that YpsA provides protection against oxidative stress as cells lacking ypsA show increased susceptibility to hydrogen peroxide treatment. We found that the increased expression of ypsA leads to filamentation and disruption of the assembly of FtsZ, the tubulin-like essential protein that marks the sites of cell division in B. subtilis. We also showed that YpsA-mediated filamentation is linked to the growth rate. Using site-directed mutagenesis, we targeted several conserved residues and generated YpsA variants that are no longer able to inhibit cell division. Finally, we show that the role of YpsA is possibly conserved in Firmicutes, as overproduction of YpsA in Staphylococcus aureus also impairs cell division.

With the rise in the utilization of free fuel energy sources, namely solar and wind, across the globe, it has become necessary to study and implement models of a sustainable power network. This paper focuses on the design of a conceptual power network based on photovoltaics (PV) for power generation and lithium-ion batteries for storage. The power system showcases the various metrics that are involved in a grid-tied PV- and battery-based power network. It also encompasses the various design parameters and sizing considerations to design and conceptualize such a power network. The model focuses on the importance of the conservation of power by avoiding wastage of generated power through inverter sizing and design considerations. Finally, an economic and feasibility analysis is carried out to showcase the economic viability of the PV- and battery-based power network in today’s alternating current (AC)-based grid.

Binary fission has been well studied in rod-shaped bacteria, but the mechanisms underlying cell division in spherical bacteria are poorly understood. Rod-shaped bacteria harbor regulatory proteins that place and remodel the division machinery during cytokinesis. In the spherical human pathogen Staphylococcus aureus, we found that the essential protein GpsB localizes to mid-cell during cell division and co-constricts with the division machinery. Depletion of GpsB arrested cell division and led to cell lysis, whereas overproduction of GpsB inhibited cell division and led to the formation of enlarged cells. We report that S. aureus GpsB, unlike other Firmicutes GpsB orthologs, directly interacts with the core divisome component FtsZ. GpsB bundles and organizes FtsZ filaments and also stimulates the GTPase activity of FtsZ. We propose that GpsB orchestrates the initial stabilization of the Z-ring at the onset of cell division and participates in the subsequent remodeling of the divisome during cytokinesis.

Background: the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones. Methods: a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Review manager 5.3. Results: we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 – 1.55); p

Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi penerimaan diri dan tahapan-tahapan dalam penerimaan diri pada remaja putri penderita Lupus. Subjek penelitian berjumlah tiga orang, dengan karakteristik usia 13- 18 tahun, minimal telah hidup dengan penyakit Lupus selama dua tahun, tergabung dalam Komunitas Panggon Koepoe Semarang dibawah naungan Yayasan Lupus Indonesia.. Data diperolah dengan menggunakan metode observasi, wawancara dan dianalisis secara kualitatif dengan pendekatan studi kasus. Hasil penelitian menunjukkan bahwa tahapan penerimaan diri yang dilewati oleh masing-masing subyek tidaklah sama. Dimulai dari tahap pengingkaran, kemarahan, depresi, tawar menawar sampai penerimaan diri. Dalam proses menuju penerimaan diri, ada enam faktor yang mempengaruhi. Faktor pemahaman diri, tidak adanya tekanan emosi, konsep diri yang stabil dan harapan yang realistis mempengaruhi penerimaan diri dari ketiga subyek. Sedangkan faktor tidak hadirnya hambatan dari lingkungan serta sukses yang terjadi tidak mempengaruhi penerimaan diri ketiga subyek. Hambatan yang dirasakan ketiga subyek sebagai seorang remaja semua sama, yaitu adanya hambatan dalam bidang pendidikan. Hambatan ini mempengaruhi faktor sukses yang terjadi pada ketiga subyek. Namun penerimaan diri yang terjadi disini bersifat episodik.

Objective:To find out effectiveness of percutaneous nephrostomy (PCN) and patient survival rate as palliative decompression of the obstructed urinary system due to malignancy (urogenital neoplasias). Materials & Methods: A cohort retrospective study was performed with 76 patients (58 female and 18 male) with malignancy process who were undergoing percutaneous nephrostomy during January 2009 – December 2012, in Sardjito General Hospital Yogyakarta. Survival analysis was done by Kaplan-Meier method and differences were assessed using the log-rank test. Results:There was no procedure-related mortality. The mean of age was 49.14 years. The primary tumoral site was the uterine cervix in 56.6 %, the bladder in 17.1 %, the prostate in 2.6% and other sites (intestinal, ovarium and other malignancies caused obstructive uropathy) in 23.7%. The patients died during the hospitalization period due to advanced neoplasia are 17.1%. The mortality rate was higher in patients with interval between diagnose of obstructive uropathy and nephrostomy > 7 days (HR=5.7; 95%CI 4.5-6.9; p = 0.001) and in those who required hemodialysis before the procedure (HR=6.1; 95%CI 4.7-7.4; p = 0.001). The survival rate was 55.2% (42/76) at 6 months and 32.9% (25/76) at 12 months. The percentage of the lifetime spent in hospitalization was 17.1% (13/76). There are no differences on survival rate in that patients based on neoplasias type and age.Conclusion: The urinary obstruction must be immediately relieved. The percutaneous nephrostomy is a safe and effective method for relief the obstruction. Patient with hemodialysis before the procedure had a poor prognosis.

Aim: to develop a prediction risk model of prostate cancer based on Indonesia population. Methods: we included all benign prostate hyperthrophy (BPH) and PCa patients who had prostate biopsy and prostatectomy between January 2009 and December 2013 from 5 urology centers in Indonesia. The relationship between the possibility of PCa with the following variables including: age; PSA level, prostate volume (by transabdominal ultrasound or transrectal ultrasound) and digital rectal examination (DRE) finding. We calculated a predictive scoring equation to predict the possibility of PCa using chi-square analysis, Kolmogorov-Smirnov test, multiple logistic regression and ROC curve. Then, we designed an application for predicting prostate cancer risk called Indonesian Prostate Cancer Risk Calculator (IPCRC). Results: there were 784 PCa and 1173 BPH patients were used for developing the risk calculator in our study. The mean ages, PSA and prostate volume are 66.9±8.1 years old; 72.4±248.9 ng/ml and 49.6±28.2 ml, respectively. Abnormal DRE was found in 637 PCa and 56 BPH. We included age, PSA level, abnormal DRE finding (all showed significant p

Abstract Background Anti-citrullinated protein/peptide antibodies (ACPA), have high specificity for rheumatoid arthritis (RA). Some children with juvenile idiopathic arthritis (JIA), phenotypically resemble RA and test positive for rheumatoid factor (RF) a characteristic biomarker of RA. We investigated the prevalence of ACPA and its relationship to other serologic markers associated with RA in a well-characterized JIA cohort. Methods Cases were 334 children with JIA, 30 of whom had RF + polyarticular JIA. Sera from all cases and 50 healthy pediatric controls were investigated by ELISA at a single time point for anti-cyclic citrullinated peptide (anti-CCP) IgG, RF IgM, IgA and IgG, anti-RA33 IgG, and antinuclear antibodies (ANA). Comparisons between cases and controls were made using Chi-square or Fisher exact tests and T-tests. Results The prevalence of RF was 8% among controls, and 12% among cases (ns). The prevalence of ACPA was 2% in controls and 14.3% in cases (OR 8.2, p Conclusions ACPAs are detectable in 14% of children with JIA. Children with positive ACPA but negative RF are frequent, and may define a distinct subset of children with JIA. ACPA testing should be included in the classification of JIA.

Abstract Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy of childhood which is believed to be influenced by both genetic and environmental factors. The progress in identifying genes underlying JIA susceptibility using candidate gene association studies has been slow. Several associations between JIA and variants in the genes encoding the human leukocyte antigens (HLA) have been confirmed and replicated in independent cohorts. However it is clear that genetic variants outside the HLA also influence susceptibility to JIA. While a large number of non-HLA candidate genes have been tested for associations, only a handful of reported associations such as PTPN22 have been validated. In this review we discuss the principles behind genetic studies of complex traits like JIA, and comprehensively catalogue non-HLA candidate-gene association studies performed in JIA to date and review several validated associations. Most candidate gene studies are underpowered and do not detect associations, and those that do are often not replicated. We also discuss the principles behind genome-wide association studies and discuss possible implications for identifying genes underlying JIA. Finally we discuss several genetic variants underlying multiple clinically distinct autoimmune phenotypes.

Abstract Objective Cytokines play important roles in mediating inflammation in autoimmunity. Several cytokines are elevated in serum and synovial fluid samples from children with Juvenile Idiopathic Arthritis (JIA). Soluble CD154 (sCD154) is elevated in other autoimmune disorders, but has not been characterized in JIA. Our objectives were to determine if sCD154 is elevated in JIA, and to examine correlations between sCD154 and other inflammatory cytokines. Methods Serum from 77 children with JIA and 81 pediatric controls was analyzed for interleukin (IL)1β, IL2, IL4, IL5, IL6, IL8, IL10, IL12, IL13, sCD154, interferon-γ (IFNγ), soluble IL2 receptor (sIL2R), and tumor necrosis factor-α (TNFα), using the Luminex Multi-Analyte Profiling system. Differences in levels of cytokines between cases and controls were analyzed. Logistic regression was also performed. Results sCD154 was significantly elevated in cases compared to controls (p < 0.0001). IL1β, IL5, IL6, IL8, IL13, IFNγ, sIL2R, and TNFα were also significantly elevated in JIA. Levels of sCD154 were highly correlated with IL1β, IL6, IL8, and TNFα (p < 0.0001). Logistic regression analysis suggested that IL6 (odds ratio (OR): 1.4, p < 0.0001), sCD154 (OR: 1.1, p < 0.0001), and TNFα (OR: 1.1, p < 0.005) were positively associated with JIA, while IL10 (OR: 0.5, p < 0.002) was protective. sCD154 was elevated in all JIA subtypes, with highest levels among more severe subtypes. IL1β, IL6, IL8, sIL2R and TNFα were also elevated in several JIA subtypes. Conclusion Serum levels of sCD154, IL1β, IL6, IL8, sIL2R and TNFα are elevated in most JIA subtypes, suggesting a major role for sCD154, and these cytokines and cytokine receptors in the pathogenesis of JIA.

Abstract Background Endometriosis (EMS) can be implanted everywhere, especially in pelvic organs. EMS can be asymptomatic, but it can result in pelvic pain and infertility by inducing local inflammation and pelvic adhesion. The prevalence of EMS is about 10% in reproductive-age women and higher in women with pelvic pain or infertility. For young patients with ovarian EMS, laparoscopic ovarian cystectomy is effective in relieving pelvic pain and preventing local recurrence. However, there is a concern that the ovarian reserve would decrease after the operation because of the removal of a part of the normal ovarian tissue and thermal damage during hemostasis, which depends on the types of hemostasis such as bipolar electrocoagulation, suturing, and the use of a hemostatic agent. In this study, we aim to evaluate the protective effect for the ovarian reserve and hemostasis between a hemostatic agent and suturing during laparoscopic ovarian cystectomy for patients with ovarian EMS. Methods This study is a randomized controlled, non-inferiority trial, where a total of 90 patients with ovarian EMS will be randomly assigned to the experimental (hemostatic agent) and control (suturing) groups. In the control group, a barbed suture will be applied for hemostasis, whereas a hemostatic agent will be applied in the experimental group. If two methods are insufficient, bipolar electrocoagulation will be applied for complete hemostasis. As the primary endpoint, the reduction rate of serum anti- Müllerian hormone (AMH) levels reflecting the ovarian reserve will be compared between the two groups 12 weeks after surgery. As secondary endpoints, we will compare the reduction rate of AMH level 48 weeks after surgery, the time required to complete hemostasis, the success rate of hemostasis within 10 min, and adverse events associated with operation. Discussion We expect that the protective effect for the ovarian reserve and hemostasis may be comparable between the two methods, suggesting that a hemostatic agent may be preferred considering that it is easy to use during laparoscopic ovarian cystectomy. Trial registration ClinicalTrials.gov NCT04643106 . Registered on 22 November 2020

Abstract The preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], − 36.7 vs. − 13.3%; per-protocol [PP], − 36.8 vs. − 13.3%; P

The swelling method constitutes a component of the hierarchical synthesis step of Natural Zeolite Lampung (NZL). The literature review results indicate that NZL swelling is a pretreatment integral to the synthesis process of NZL. The synthesis of Lampung natural zeolite (NZL) was conducted to form hierarchical zeolites. NZL, as a hierarchical zeolite, is defined as a system containing additional pores. The formation of secondary porosity distinguishes it, reduction of alkali and alkaline earth metals, removal of impurities, transformation of symmetric to asymmetric strains, increase in acidity, and most importantly, the occurrence of dealumination and desilication processes as the cause of the achievement of these indicators. Generally, the initial post-synthesis modification sequence, which typically involves acid and base treatment, is carried out separately. In this study, however, the dealumination and desilication modifications will be carried out simultaneously in a single process, namely by the swelling method. Consequently, it is essential to ascertain the optimal operating parameters at the requisite atmospheric pressure, thus enabling the simultaneous dealumination and desilication processes within the NZL swelling method. In this case, the swelling method is a pretreatment analogous to the initial zeolite activation conducted in previous studies. The swelling NZL method can potentially overcome the laborious and expensive synthesis procedures that currently limit the scale-up of this material into large-scale production.

Commercial kitchen towels (basis weight 39 to 56 g/m²) made of virgin and recycled fiber, produced by Through-Air-Drying (TAD), and conventional Yankee cylinder drying (with creping) were analyzed. The properties of these commercial tissue products were compared to those of handsheets made from them. Laboratory tissue handsheets were also prepared from northern bleached softwood kraft (NBSK), eucalyptus, bamboo, and straw pulp. Fibers were refined with up to 5000 revolutions of a PFI mill. Commercial kitchen towels (kitchen tissue) absorbed 9 to 14 g water per 1 g of fiber, with higher absorption by virgin fibers, and when using TAD. The tensile index (dry) was 3 to 14 Nm/g. Laboratory tissue handsheets made of commercial samples absorbed less water, but the tensile index (dry) was higher in most cases. Higher beating levels (tested at NBSK, eucalyptus, bamboo, straw pulp) increased tensile index. Curl, bulk, softness, absorption capacity, and suction lift were reduced with refining. Best values for absorption capacity (almost 8 g/g), bulk (almost 5 cm³/g), and softness were observed in laboratory bamboo tissue sheets made of non-refined fibers. After refining (2000 revolutions), the tensile index of such tissue sheets made of bamboo increased from 10 to 30 Nm/g.

RM Sonny Sasotya, Andi Rinaldi, Eppy Darmadi Achmad, Aria Prasetya Ma’soem, Kania Praharsini, Efriyan Imantika, Fridya Wulandari, Nathania Nathania, Kevin Dominique Tjandraprawira Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Kevin Dominique Tjandraprawira, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Jalan Pasteur No. 38, Bandung, 40161, Indonesia, Email kevin14007@mail.unpad.ac.idPurpose: Non-puerperal uterine inversion (NPUI) is a rare gynaecological entity with unknown actual incidence. It presents diagnostic and surgical challenges, due to its rarity and lack of clinical experience.Methods: Case series of 5 NPUI cases.Case Description: (1) A 44-year-old P3A0 presented with chronic profuse vaginal bleeding and a prolapsed pedunculated fibroid measuring 9x8x7 cm. In theatre, the pedunculated fibroid was extirpated. Haultain procedure was performed to reposition the uterus, followed by suturing the uterus. (2) A 65-year-old P4A0 presented with a solid vaginal mass, with brisk bleeding measuring 10x10x8 protruding from the introitus. In theatre, the mass was excised, followed by Kustner procedure and a subtotal hysterectomy. (3) A 46-year-old P1A1 presented with a large pedunculated fibroid, hypovolemic shock and loss of consciousness. Upon presentation, she was in shock and severely anaemic (Hb 1.4 gr/dL). In theatre, the fibroid was excised followed by uterine repositioning. A large left ovarian cyst (Ø 10 cm) was identified. A subtotal hysterectomy and left salpingo-oophorectomy were performed. (4) A 34-year-old P3A0 presented with an acute vaginal lump measuring 10x6x5 cm. She had delivered her infant 2 months prior. In theatre, a Huntington procedure was performed to reposition the uterus, followed by a total abdominal hysterectomy. (5) A 60-year-old P3A0 presented with vaginal mass measuring 10× 10× 8 cm and chronic profuse vaginal bleeding. In theatre, uterine inversion was diagnosed. A Haultain procedure was performed, followed by a total abdominal hysterectomy and bilateral salpingo-oophorectomy. All cases had presented with vaginal mass and bleeding to varying degrees. The degree of inversion required various procedures (eg, Kustner, Haultain, Huntington) and different forms of hysterectomy.Conclusion: Non-puerperal uterine inversion is a difficult pathology. Management is always surgical with different types of hysterectomy performed. With conservative surgery, Kustner, Huntington and Haultain procedures are indicated according to the severity and uterine position.Keywords: uterine inversion, hysterectomy, diagnosis