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Lestariningsih Lestariningsih,1 Suharyo Hardisaputro,2 Ayudyah Nurani,1 Damai Santosa,3 Gunawan Santoso41Division of Nephrology, Department of Internal Medicine, School of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia; 2Division of Tropic Infection, Department of Internal Medicine, School of Medicine, Diponegoro University, Semarang, Indonesia; 3Division of Hematology Medical Oncology, Department of Internal Medicine, School of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia; 4Department of Radiology, School of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, IndonesiaBackground: Several emerging problems of regular hemodialysis (HD) including cardiovascular complication or atherosclerosis formation caused by chronic inflammation. Intima-media thickness (IMT) of the carotid artery can be applied as a marker of atherosclerosis progression. This study was designed to identify the predictive of IMT progression among end-stage renal disease (ESRD) subject.Methods: This cohort study was performed at the Hemodialysis Unit of Dr. Kariadi Hospital and Telogorejo Hospital Semarang between October 2009 and April 2010. The study subjects were the ESRD patients with regular HD.Results: This study enrolled 78 subjects with regular HD, follow-up 6 months. The subjects which completed the study were divided into two groups that consist of IMT progressive group (n=53) and IMT non-progressive group (n=12). There were no differences between two groups according to age, gender, history of diabetes, blood pressure, duration of HD, urea, creatinine, blood glucose, HbA1C, cholesterol, triglyceride, HDL, uric acid, phosphate, calcium, homocysteine, and albumin. Subject with high-sensitive C-reactive protein (hsCRP) level >0.52 mg/L had an IMT progression. There was a correlation between hsCRP and the thickening of carotid artery wall after 6-month HD (RR=3.6; 95% CI=2.2–22.9). The subject with hsCRP level >9.00 mg/L after 6-month dialysis progress to thickening of carotid artery wall of >0.03 mm. There was a correlation between hsCRP level (cut-off point: 9.0 m/L) and the progression of the carotid artery wall (RR=2.1; 95% CI=1.3–3.37). Statistically, there was no correlation between IL-6–174 G/C gene and eNOS gene polymorphism with IMT progression.Conclusion: hsCRP is a significant predictive of IMT progression at hemodialysis subject. IL −174 G/C gene and eNOS gene polymorphism are not significant predictive of IMT progression at hemodialysis subject.Keywords: hemodialysis, atherosclerosis, IMT, hsCRP

Background: Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy remains the standard of first-line treatment for diffuse large B-cell lymphoma (DLBCL). Up to 40% of DLBCL is characterized by relapse and refractory after treatment. Preliminary study reported Hypoxia-inducible factor-1a (HIF-1a) overexpression in 88.5% of DLBCL tumors in the Dr. Kariadi Hospital. Moreover, the role of hypoxia and HIF-1a has previously never been explored in DLBCL. Objectives: To evaluate the effect of hypoxia modulation to increased chemotherapeutic response in DLBCL. Methods: Single blind randomized control study was performed, with pre-test and post-test control group design. Research sampling consisted of DLBCL patients. The inclusion criteria include newly diagnosed DLBCL with HIF-1a overexpression and randomized to receive hypoxia modulation consisting of carbogen inhalation and nicotinamide administration, before R-CHOP chemotherapy. The tissue biopsy, histopathology and immunohistochemical studies were done. Chemotherapeutic responses were evaluated after 10-14 days following the first cycle of R-CHOP chemotherapy. Results: Out of twenty-six DLBCL participants with HIF-1a overexpression, there were 20 participants who completed the research protocol: 10 participants each in the intervention and control group. Demographic, clinicopathological, laboratory and disease characteristics were not statistically different between the two research groups (p>0.05). Baseline tumor volume to be evaluated was also considered equal (172.3 cm3 vs. 152.8 cm3 , p=0.597). Following the carbogen inhalation and nicotinamide administration, serum HIF-1a and lactate reduction can be observed. There was also a significant tumor volume shrinkage in both the intervention and control (mean -85.7 cm3 vs. -118.27 cm3 ) group, though the reduction was not statistically different (Delta 58.85% vs. 65.63%, p=0.474). Conclusion: The addition of hypoxia modulation to R-CHOP chemotherapy for DLBCL has shown beneficial effects on both serum HIF-1a and lactate concentration. However, the benefits did not correlate to increase a better tumor response compared to the control group.

The manual detection of osteoarthritis using Kellgren Lawrence system depends on experience and agreement between doctors. The study was conducted to develop DenseNet201 to assist doctors in making a diagnosis of osteoarthritis grading. This study analyzes the accuracy; sensitivity; specificity; positive predictive value (PPV) and negative predictive value (NPV) of DenseNet201 in grading osteoarthritis and compares the classification results between DenseNet201 and radiologists in detecting osteoarthritis on knee joint images. This study is an applied experiment that compares the classification results of DenseNet201 and radiology specialists. Firstly, DenseNet201 is built with the MATLAB R2021a. Tests are carried out by measuring accuracy, sensitivity, specificity, PPV and NPV of 75 images of knee joint. Lastly, the data is analyzed using the Wilcoxon statistical test. The study has shown that the performance of DenseNet201 was good in detecting osteoarthritis, with accuracy value 91.84%; sensitivity value 76.61%; specificity value 94.32%; PPV 82.60% and NPV 94.32%. There was no significant difference between classification results using DenseNet201 and radiologist with a value (p>0.05) of 0.119. DenseNet201 can be considered as an alternative diagnostic tool for osteoarthritis with the condition that verification of the diagnostic decision still refers to the confirmation and justification of the radiologist.

Due to polymeric wear debris causing osteolysis from polymer, metal ions causing metallosis from metal, and brittle characteristic causing fracture failure from ceramic in the application on bearing of total hip prosthesis requires the availability of new material options as a solution to these problems. Polycrystalline diamond (PCD) has the potential to become the selected material for hard-on-hard bearing in view of its advantages in terms of mechanical properties and biocompatibility. The present study contributes to confirming the potential of PCD to replace metals and ceramics for hard-on-hard bearing through von Mises stress investigations. A computational simulation using a 2D axisymmetric finite element model of hard-on-hard bearing under gait loading has been performed. The percentage of maximum von Mises stress to respective yield strength from PCD-on-PCD is the lowest at 2.47%, with CoCrMo (cobalt chromium molybdenum)-on-CoCrMo at 10.79%, and Al 2 O 3 (aluminium oxide)-on-Al 2 O 3 at 13.49%. This confirms that the use of PCD as a hard-on-hard bearing material is the safest option compared to the investigated metal and ceramic hard-on-hard bearings from the mechanical perspective.

Bearing on artificial hip joint experiences friction, wear, and surface damage that impact on overall performance and leading to failure at a particular time due to continuous contact that endangers the user. Assessing bearing hip joint using clinical study, experimental testing, and mathematical formula approach is challenging because there are some obstacles from each approach. Computational simulation is an effective alternative approach that is affordable, relatively fast, and more accessible than other approaches in examining various complex conditions requiring extensive resources and several different parameters. In particular, different gait cycles affect the sliding distance and distribution of gait loading acting on the joints. Appropriate selection and addition of gait cycles in computation modelling are crucial for accurate and reliable prediction and analysis of bearing performance such as wear a failure of implants. However, a wide spread of gait cycles and loading data are being considered and studied by researchers as reported in literature. The current article describes a comprehensive literature review adopted walking condition that has been carried out to study bearing using computational simulation approach over the past 30 years. Many knowledge gaps related to adoption procedures, simplification, and future research have been identified to obtain bearing analysis results with more realistic computational simulation approach according to physiological human hip joints., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Due to various concerns about the use of metal-on-metal that is detrimental to users, the use of metal as acetabular cup material was later changed to ultra high molecular weight polyethylene (UHMWPE). However, the wear on UHMWPE releases polyethylene wear particles, which can trigger a negative body response and contribute to osteolysis. For reducing the wear of polyethylene, one of the efforts is to investigate the selection of metal materials. Cobalt chromium molybdenum (CoCrMo), stainless steel 316L (SS 316L), and titanium alloy (Ti6Al4V) are the frequently employed materials. The computational evaluation of contact pressure was carried out using a two-dimensional axisymmetric model for UHMWPE acetabular cup paired with metal femoral head under gait cycle in this study. The results show Ti6Al4V-on-UHMWPE is able to reduce cumulative contact pressure compared to SS 316L-on-UHMWPE and CoCrMo-on-UHMWPE. Compared to Ti6Al4V-on-UHMWPE at peak loading, the difference in cumulative contact pressure to respective maximum contact pressure is 9.740% for SS 316L-on-UHMWPE and 11.038% for CoCrMo-on-UHMWPE.