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Background: Radiotherapy exposure is known to have a lethal effect on blood cells because hematopoietic cells are very sensitive to radiation exposure even at low doses. Cervical cancer with radiotherapy can have the effect of reducing blood cells. Blood cells that may experience the effects of radiotherapy include haemoglobin, leukocytes and platelets. Objective: Knowing the effects of radiotherapy towards blood components of cervical cancer patients. Methods: This study was an observational study with the type of study before and after design. Data collected from medical records as secondary data in the Radiotherapy Unit of Dr. Kariadi Semarang in 2019-2020 with a total of 128 cervical cancer patients undergoing 3D radiotherapy. The statistical test used the Saphiro Wilk data normality test and the result data analysis used the Paired T Test and the Wilcoxon test. Results: Hypothesis testing for Hb levels using the Paired T Test showed an insignificant value of p=0.749 and p=0.141. Hypothesis test for the number of leukocytes and platelets using the Wilcoxon test. Leukocytes received a significant value of p=0.000 and insignificant p=0.957. Platelets received a significant value of p=0.000 and p=0.000. Hb value decreased by -0.44, leukocytes by -3.5, and platelets by -84.34. Conclusion: There was an insignificant decrease in haemoglobin levels yet significant decrease in leukocyte and platelet counts in cervical cancer patients undergoing radiotherapy where the platelets experienced the most decrease compared to haemoglobin and leukocytes.

Background: Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function, assisting in clinical decision making, and quantifying outcomes of surgical and nonsurgical management. However, PROMs are often designed using patients with preexisting pathology and typically assume that a patient without the pathology would have a perfect or near perfect score. This may result in unrealistic expectations or falsely underestimate how well a patient is doing after treatment. The influence of age on PROMs about the hip of healthy individuals has not been studied. Hypothesis: We hypothesize that in asymptomatic individuals hip-specific PROM scores will decrease in an age-dependent manor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In this multicenter survey study, volunteers who denied preexisting hip pathology and previous hip surgery completed 3 PROMs online or as traditional paper questionnaires. The International Hip Outcome Tool (iHOT), the modified Harris Hip Score (mHHS), and the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and HOS—Sport were completed. Analysis of variance with a Tukey post hoc test was used to analyze differences in PROMs among subgroups. An independent-samples Student t test and a χ2 test were used to analyze differences in continuous and categorical data, respectively. Results: In total 496, 571, 534, and 532 responses were collected for the iHOT, mHHS, HOS-ADL, and HOS–Sport, respectively. Respondents’ PROMs were scored and arranged into 3 groups by age: 60 years. The iHOT, mHHS, HOS-ADL, and HOS–Sport of these asymptomatic respondents all decreased in an age-dependent manner: iHOT (60, 87.0), mHHS (60, 89.1), HOS-ADL (60, 90.9), and HOS–Sport (60, 72.9) (analysis of variance between-group differences, P < .05). Conclusion: This study demonstrated that the iHOT, mHHS, and HOS-ADL and HOS–Sport scores in asymptomatic people decrease in an age-dependent manner. It is important to compare a patient’s outcome scores with the age-normalized scores to establish an accurate reference frame with which to interpret outcomes.

Background: Asthma is a chronic life-threatening disease as the airways in the lungs often swollen or inflamed, which makes the airways very sensitive. So, the exposure to the environment in day-to-day life triggers asthma. Asthma can affect at any age group. This study mainly focuses on comparing the effects of Buteyko breathing technique and Pranayama on improving Pulmonary Function in subjects with Bronchial Asthma. Method: Total of 79subjects selected, out of those 66 subjects were included after obtaining the consent document. Subjects are divided into two groups by lottery method, in which 6 subjects dropped. So, the study was completed with 60 subjects. Both groups performed intervention for 1 hour a day 5 days week for 4 weeks. The outcomes of the study were FEV1, FVC & FEV1/FVC ratio. Results: Paired t test was used to assess statically significance between pre and post test scores with in the groups, independent t test was used to access statistical significance of post-test mean score between the groups, statistical analysis of the data revealed that Buteyko Breathing technique group has more difference when compare to Pranayama group. Conclusion: The results had shown that both Group-A (Buteyko Breathing Group) and Group-B (Pranayama Group) has improved significantly on pre and post-test values within the groups but when compared between the groups statistical significance is noted in Group-A. So, this study concludes that Group-A showed significant improvement on Pulmonary Function in subjects with Bronchial Asthma. Keywords: Buteyko Breathing technique, Nadishuddhi Pranayama, FEV1/FVC, Bronchial Asthma.

To investigate the clinical relevance of liver stiffness (LS) in evaluating liver function properties in patients with Budd-Chiari syndrome (BCS) with different severities and LS variation before and after endovascular intervention.Between December 2016 and March 2019, patients with a diagnosis of BCS were considered for enrollment consecutively in our study. Liver function of these patients was classified according to Child-Pugh grading standard before treatment. Liver function parameters were recorded, including albumin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, and total bilirubin. LS was measured with MR elastography (MRE) before and after treatment. Pearson correlation analysis was performed to measure the correlation between LS and liver function-related parameters. Univariate analysis of variance test was used to compare LS and clinical quantitative variables of patients in three different Child-Pugh categories. Paired t test with a significant threshold of p = 0.05 was used to compare LS and pressure gradient of these patients before and after treatment. Correlation analysis between changes in LS and that in pressure gradient was performed by linear regression.A total of 43 patients (23 males and 20 females) were finally enrolled in this study. The mean LS in the three groups was 5.67 ± 1.15 kPa (Child-Pugh A), 6.31 ± 1.13 kPa (Child-Pugh B), and 8.27 ± 2.22 kPa (Child-Pugh C), respectively. LS showed significant difference for patients with different Child-Pugh grades (F = 9.536, p0.001). Prothrombin time and total bilirubin were positively correlated with LS (p0.05). After treatment, mean LS in three groups was 4.83 ± 1.06 kPa, 5.12 ± 0.93, and 7.37 ± 1.96, respectively. LS decreased significantly in all three Child-Pugh grades (p0.001 from Child-Pugh A, p0.001 from Child-Pugh B, p = 0.009 from Child-Pugh C). The mean pressure gradient before intervention was 17.6 ± 4.9 mm Hg, and 8.7 ± 7.2 mm Hg after the treatment (p0.001). The changes in LS were correlated to that in pressure gradients (r = 0.439; rMR elastography for LS measurement has been demonstrated to act as an effective tool to evaluate liver function, and to monitor the BCS patients in follow-up treatments.

Introdução: A doença hepática gordurosa não-alcoólica (DHGNA) atinge em média 25% da população mundial. De acordo com o estágio da doença podem ocorrer alterações metabólicas e declínio da capacidade física. O objetivo do estudo foi analisar e associar o estágio da DHGNA com a capacidade física dos pacientes. Métodos: Foi realizado um estudo observacional transversal em pacientes do Serviço de Gastroenterologia/Hepatologia da Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), submetidos a biópsia hepática e análise histopatológica conforme a classificação de Kleiner. Os pacientes informaram dados autorreferidos, executaram o Teste de Caminhada de Seis Minutos (TC6M) e o Teste de Força de Preensão Palmar (FPP) para avaliação da capacidade física. Na análise estatística foi utilizado o teste de Kolmogorov-Smirnov e Wilcoxon para verificar a normalidade, o teste T pareado para a significância do TC6M observado x previsto, a Análise de Variâncias (ANOVA) com Post-Hoc de Tukey para histologia, TC6M e FPP, e o teste não paramétrico de Spearman para as correlações. Resultado: Foram analisados 54 pacientes, de ambos os sexos, diagnosticados com DHGNA. Houve correlação entre a prática de exercícios físicos com o TC6M (ρ ,462; p

Central obesity is associated with increased level and activity of endothelin-1. The waist and hip circumferences are simple indicators of central obesity. Waist circumference correlates with visceral adiposity, whereas hip circumference associates with gluteofemoral peripheral adiposity. Both measurements have independent and opposite correlation with coronary artery disease (CAD) risk factors. The relation between serum endothelin-1 in stable CAD and both parameters of central obesityneeds to be investigated. This study aims to examine the correlation between serum endothelin-1 level and waist and hip circumferences as parameters of central obesity in patients with stable CAD. This was a cross-sectional study. Consecutive subjects were enrolled among those who underwent elective coronary angiography with significant CAD. Serum endothelin-1 was measured from peripheral blood samples taken before coronary angiography procedure. The measurement of waist circumference, hip circumference, and ratio derived from them, was performed. Central obesity was determined by waist circumference cut-off for Indonesian population. The correlation analysis was performed with Pearson test. The multivariate analysis was performed with multiple linear regression test. The comparison of serum endothelin-1 level between groups was performed with Student T test. We enrolled 50 subjects. The majority of subjects was male (80.0%), hypertensive (86.0%), dyslipidemic (68%) and smoker (52%). Most subjects had history of acute coronary syndrome (64%). Mean waist circumference was 87.6 +/– SD cm, hip circumference was 95.3 cm +/– SD, mean waist-to-hip ratio was 0.92 +/– SD and mean waist-to-height ratio was 0.54 +/– SD. Central obesity occurred in 32% of subjects. Mean serum endothelin-1 level was 2.2 ± 0.7 pg/mL. Serum endothelin-1 level tended to be higher in subjects with central obesity as compared to those without. Serum endothelin-1 level was significantly correlated with age, hemoglobin level, waist circumference (coefficient of 0.311, p value = 0.023) and hip circumference (coefficient of 0.359, p value = 0.010). Multivariable analysis indicated that age (coefficient of –0.353, p value = 0.007) and hip circumference (coefficient of 0.335, p value = 0.011) were independently correlated with serum endothelin-1. For conclusion, in patients with stable CAD, serum endothelin-1 was positively correlated with both waist circumference and hip circumference. Hip circumference independently and positively correlated with serum endothelin-1 level.

This study was conducted to provide diametric and volumetric data of mandibular condyles from patients with Angle class 2 and 3 malocclusions by semiautomatic segmentation based upon cone-beam computed tomography.Cone-beam computed tomography images of 79 patients were analyzed. By using the open-source software "ITK-SNAP", diametric and volumetric measurements of 158 mandibular condyles were performed. Descriptive statistics were calculated for all normally distributed variables. Correlations between patients with Angle class 2 and 3 were calculated with the independent Student t test. P values P

Background: Total knee arthroplasty (TKA) demonstrates excellent durability using jig-based manual techniques (manual TKA [mTKA]), but significant rates of dissatisfaction remain. Modifications of mTKA techniques and TKA implant designs to improve outcomes have had minimal success. Studies comparing relative outcomes of mTKA and robotic-assisted TKA (raTKA) are limited. Purpose: This study sought to compare outcomes of mTKA and raTKA in patients at a single institution. Methods: We retrospectively reviewed all primary TKAs performed by 1 surgeon from 2015 to 2017. In all, 139 consecutive mTKAs (2015–2016) and 148 consecutive raTKAs (2016–2017) were included. No cases were excluded. Patient demographics, complications, readmission rates, and clinical and patient-reported outcomes were compared at a minimum of 1-year follow-up. A post hoc student t test and Pearson χ2 test were used for continuous and categorical data. Results: We found that mTKA patients compared with raTKA patients required significantly longer length of stay (LOS) (1.73 vs 1.18 days, respectively), greater morphine milligram equivalents consumption (89.6 vs 65.2, respectively), and increased physical therapy (PT) visits (13.0 vs 11.0, respectively) with increased 30-day readmission rates (4.3 vs 0.7%, respectively) that approached significance. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and the University of California at Los Angeles activity score did not differ significantly comparing raTKA with mTKA patients at 1 year. There were no differences in complication rates. Conclusion: Significant early clinical benefits were noted with raTKA, including lower opioid requirements, shorter LOS, and fewer PT visits when compared with mTKA. A reduction in 30-day readmission rates was noted with raTKA that was not significant. Excellent clinical results with similar patient-reported outcomes were noted in both groups at 1-year follow-up. Further prospective investigations at longer follow-up intervals comparing these techniques are warranted.

The problem of adolescent reproductive health in Indonesia is about sexuality, HIV / AIDS and drugs. The problem occurs due to low knowledge of the TRIAD KRR which will affect the attitudes that adolescents will take in relation to the TRIAD KRR. The low level of knowledge occurs due to the lack of education that adolescents get about TRIAD KRR. The aim of this study was to find out the effect of providing counseling through audio-visual and webtoon on increasing knowledge and attitudes about the three basic threats to adolescent reproductive health (TRIAD KRR). This research is a quasi experimental study using a two groups pretest-posttest design approach. The research sample was students of SMAN 8 Cirebon City. The data analysis used was univariate and bivariate analysis using the Wilxocon test, paired t test and the Man-witney test. The measuring instrument used is a questionnaire. The analysis of the median pretest obtained for knowledge in the audiovisual group was 8.0000 and the posttest was 11,000. In the attitude, the median value for pretest was 36.00 and posttest was 37.00. Bivariate analysis in the audio-visual group, both knowledge and attitude, obtained p value 0.000 ( 0.05). Differences in knowledge of audio visual media with webtoon obtained p value of 0.411 and for attitude that is 0.033. There is no significant difference in knowledge through audio-visual media and webtoon but in attitude there is a difference

Background: Impulsivity, due to high comorbidities, is considered as one of the residual symptoms in patients with psychiatric illnesses. There is dearth of literature with respect to the effect of available treatment options on impulsivity and clinical outcome in major psychiatric disorders. Hence, our study aims to observe the change in impulsivity from baseline after 10 days of treatment and clinical outcome in patients with major psychiatric disorders [Schizophrenia, Bipolar Affective disorder (BPAD) and Alcohol Dependence Syndrome (ADS)]. Materials and Methods: This is a prospective analytical, non-randomized, quantitative open label study wherein total of 112 patients diagnosed with either of the three major psychiatric illness i.e., schizophrenia or BPAD or ADS were recruited into the study. BIS-11 was used to assess impulsivity at baseline and 10 days post admission. Clinical outcome was assessed using CGI scale. Data was analyzed using one-was ANOVA, paired t test and Post hoc analysis.Results: The difference between baseline mean scores and post treatment mean scores on all the subscales of BIS-11 was found to be statistically significant (p value

Purpose This study was conducted to elucidate volumetric data of mandibular condyles of orthognathic patients by analyzing cone beam computed tomography images based upon semiautomatic segmentation. Methods Cone beam computed tomography images of 87 patients with malocclusions were analyzed in this retrospective study. Patients were between 17 and 53 years old and diagnosed with Angle class I, II, or III malocclusion. By using the validated open-source software “ITK-SNAP,” the volumetric measurements of 174 mandibular condyles were performed. Volumetric analysis was performed according to intra-subject side differences by paired Student t test. In accordance to inter-subject side, gender, age and type of malocclusion differences bivariate analysis and ANOVA were applied. Results The mean volume for the right condyle was 1.378 ± 0.447 cm3, with a maximum of 2.379 cm3 and a minimum of 0.121 cm3. The mean volume for the left side was 1.435 ± 0.474 cm3, with a maximum of 3.264 cm3 and a minimum of 0.109 cm3. Bivariate analysis indicated a highly significant inter-subject difference between the volume of the left and right mandibular condyles (p p p Conclusion The fact that shape and volume of mandibular condyles show a high susceptibility to pathological alterations and particularly malocclusions makes a precise knowledge about volumetric changes indispensable. Our results show that significant inter-subject differences in condyle volume could be found with respect to the side and gender. Larger volumes could be assessed for the left condyle and for male patients.

Jian Jiang,1 Jingjing Xu,1 Yuwen Wang,1 Jingwei Zheng,2 Dan Xu3 1Clinical Optometry Center, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325027, People’s Republic of China; 2Clinical Research Center, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325027, People’s Republic of China; 3School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325027, People’s Republic of ChinaCorrespondence: Dan XuSchool of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325027, People’s Republic of ChinaTel +86 577 86689937Email xudammmc@163.comObjective: This study aims to investigate the correlation of dominant eye and refractive error between monozygotic twins.Methods: The data of dominant eye and refractive error of 13 pairs of monozygotic twins who were treated at the Optometry Clinic were collected. The paired chi-square test and Kappa consistency test were used to analyze the data of dominant eye between monozygotic twins, while the paired t test and Pearson correlation analysis were adopted to analyze the refractive error data. SPSS version 22.0 software was used to analyze the above statistics.Results: In the Kappa consistency test of dominant eye between monozygotic twins, Kappa value = 0.451, p = 0.052, p> 0.05, and in the paired chi-square test, p = 0.250. In the spherical equivalent paired t test for the right eye of monozygotic twins, t = 1.491 and p = 0.162, while in the spherical equivalent paired t test for the left eye, t = 0.753 and p = 0.466. In the spherical equivalent correlation analysis of monozygotic twins, for the spherical equivalent refraction of the right eye, the Pearson correlation results were r = 0.901 and p = 0.00, and for the spherical equivalent refraction of the left eye, the Pearson correlation results were r = 0.971 and p = 0.00.Conclusion: The difference in the chi-square test of dominant eye is not statistically significant between monozygotic twins, but dominant eye and refractive error are correlated to some extent. It is suggested that heredity may be the main determinant of the dominant eye. There is no difference in refractive error between identical twins which are highly correlated, however.Keywords: refractive error, dominant eye, monozygotic twins/identical twins, heredity, genes

Background : Most human activities cannot be separated from the use of computers. Long-term and uncontrolled use of computers can lead to Computer Vision Syndrome (CVS). According to the Ministry of Health of the Republic of Indonesia (KEMENKES) CVS can be handled with ergonomics use of computers resultantly reducing the impact of computer exposure. Education on ergonomics use of computer and PERMATA-KU exercise is expected to improve CVS scores.Research Purpose : Proving the effect of PERMATA-KU exercises toward CVS score improvementMethod : Research subjects are divided into treatment group and control group, each group consists of 15 people. The treatment group received education about the ergonomics use of computer and PERMATA-KU exercises while the control group received education on the ergonomics use of computers. The measurement’s instrument is the CVS questionnaire. The dependent variable of the study was the CVS score and the independent variable of the study was the type of treatment. Statistical test with Wilcoxon, paired t test, unpaired t test, Mann whitney and chi square. Meaning value p

Background To probe the feasibility and reproducibility of diffusion kurtosis tensor imaging (DKTI) in renal cell carcinoma (RCC) and to apply DKTI in distinguishing the subtypes of RCC and the grades of clear cell RCC (CCRCC). Methods Thirty-eight patients with pathologically confirmed RCCs [CCRCC for 30 tumors, papillary RCC (PRCC) for 5 tumors and chromophobic RCC (CRCC) for 3 tumors] were involved in the study. Diffusion kurtosis tensor MR imaging were performed with 3 b-values (0, 500, 1000s/mm2) and 30 diffusion directions. The mean kurtosis (MK), axial kurtosis (Ka), radial kurtosis (Kr) values and mean diffusity (MD) for RCC and contralateral normal parenchyma were acquired. The inter-observer agreements of all DKTI metrics of contralateral renal cortex and medulla were evaluated using Bland-Altman plots. Statistical comparisons with DKTI metrics of 3 RCC subtypes and between low-grade (Furman grade I ~ II, 22 cases) and high-grade (Furman grade III ~ IV, 8 cases) CCRCC were performed with ANOVA test and Student t test separately. Receiver operating characteristic (ROC) curve analyses were used to compare the diagnostic efficacy of DKTI metrics for predicting nuclear grades of CCRCC. Correlations between DKTI metrics and nuclear grades were also evaluated with Spearman correlation analysis. Results Inter-observer measurements for each metric showed great reproducibility with excellent ICCs ranging from 0.81 to 0.87. There were significant differences between the DKTI metrics of RCCs and contralateral renal parenchyma, also among the subtypes of RCC. MK and Ka values of CRCC were significantly higher than those of CCRCC and PRCC. Statistical difference of the MK, Ka, Kr and MD values were also obtained between CCRCC with high- and low-grades. MK values were more effective for distinguishing between low- and high- grade CCRCC (area under the ROC curve: 0.949). A threshold value of 0.851 permitted distinction with high sensitivity (90.9%) and specificity (87.5%). Conclusion Our preliminary results suggest a possible role of DKTI in differentiating CRCC from CCRCC and PRCC. MK, the principle DKTI metric might be a surrogate biomarker to predict nuclear grades of CCRCC. Trial registration ChiCTC, ChiCTR-DOD-17010833, Registered 10 March, 2017, retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=17559.

Background. With coronavirus disease-19 (COVID-19), patients with diabetes mellitus are dealing with two pandemics and are at a higher risk of mortality. The present study was undertaken to evaluate interactions between hyperglycemia and clotting factors in COVID-19 patients. Methods. In this retrospective observational study, 53 real-time RT-PCR SARS-CoV-2 positive cases in 40 to 70 years of age, representing both sexes, were enrolled in the study from SMS Medical College, Jaipur (Rajasthan, India). Based on their history of diabetes mellitus and exclusion criterion, patients were divided into diabetics (N = 11) and non-diabetics (N = 17) groups. The data on clinical profile and coagulation profile was recorded along with the markers of inflammation and infection. The two groups were compared using the Mann-Whitney test and the Fisher’s exact test. Correlation coefficients between clotting factors were compared between two groups using Student t test. Results. There was no significant difference in age (p = 0.25) or gender (p = 0.12) between the two groups. The coagulation indicators FDP (p = 0.79), D-dimer (p = 0.30), APPT (p = 0.96), PT (p = 0.79), INR (p = 1.00) PLT (p = 0.17) and the markers of inflammation and infection did not differ significantly between the two groups. There was no significant difference in correlation coefficients among coagulation indicators between the two groups (p > 0.05). Conclusion. The study concludes that pathogenesis in clotting system is not significantly different in stud-ied groups. Further research is needed to explain the higher mortality in diabetic patients suffering from COVID-19.

This cross-sectional study was undertaken to compare 24-h urine protein estimation with spot urine protein-creatinine ratio (PCR). 72 patients having proteinuria of > 150 mg/day were included in this study. 24-h urine total protein (UTP) test were also asked to give their mid-morning spot urine sample the following day for urine protein-creatinine ratio. The subjects were grouped according to their UTP into Groups as described follows: Group A 3.5 g/day. Pearson’s correlation (r) and paired Student’s T test were done. The paired T test showed no difference in the UTP and PCR in the subgroup having qualitative protein of zero and in group A. There was no agreement between the two methods used for quantitation. In the overtly proteinuric patients, the correlation between the UTP and PCR was positive in group A which was statistically significant (p = 0.05) whereas it was not significant (p = 0.07) in group B. Though there was a negative correlation in the massive proteinuria group C it was not significant (p = 0.65). Our study demonstrates that spot PCR can be reliable parameter for initial diagnostic criterion of proteinuria but for follow-up measurements and for proteinuria > 0.5 gm/day, 24-h UTP is the single most accurate measurement of protein excretion.

The aim of this study was to determine the efficacy of arthroscopic lysis and lavage on pain in patients with unilateral Wilkes stage III derangement of the temporomandibular joint. Authors retrospectively evaluated whether the arthroscopic lysis and lavage has an impact on pain decrease in patients with moderate osteoarthritis. Patients with unilateral Wilkes III of temporomandibular joint were included in this study. All patients underwent arthroscopic lysis and lavage (ASC-L), assessed pain before and after the procedure (primary outcome variable), maximal interincisal opening (MIO) was recorded as secondary outcome variable. The patients also subjectively assessed whether they were satisfied with the outcome of the arthroscopy or whether their condition required further interventions. The disc position was evaluated by magnetic resonance imaging (MRI) 24 months after the arthroscopy and compared with the disc position on the MRI prior to the arthroscopy. The R Project for Statistical Computing 3.4.1 and the Gretl Pro programs were used for statistical analysis. In addition to the descriptive statistics methods, the Shapiro-Wilk normality test was used to verify data normality and the two sample t test used to test the hypotheses themselves. The sample consisted of 62 patients who underwent arthroscopic lysis and lavage (ASC-L) in 2015 and 2016. It included 6 men and 56 women with an average age of 34.37. Pain and MIO were recorded during regular check-ups 1, 3, 6, 12, and 24 months. A therapeutic effect (MIO over 34 mm, VAS score 0–1) was recorded in 69% of cases 24 months after the ASC-L. Nonetheless, the work demonstrated the importance of subjective assessment, as 87% of patients perceived their condition as satisfactory after 24 months and not requiring further intervention, while 8 patients (13%) perceived it as unsatisfactory. Disc reposition 24 months following the ASC-L was recorded in only 44% of patients who assessed their condition as satisfactory. Patients with persistent disc dislocation 24 months after the arthroscopy were older, had a lower average maximal interincisal opening value before the ASC-L and a longer duration of mandibular movement restriction before the ASC-L (evaluated as a statistically significant difference). In this study, the authors confirmed that ASC-L is an effective therapeutic method in patients with WIII, from both clinical and subjective perspectives. This work demonstrated that improvement in patients with Wilkes stage III is not related to disc reposition. Postoperative physiotherapy is an integral component of ASC-L and is reflected in the final results.

Pain is considered a stressful experience, related to real or possible tissue damage with emotional, sensory, social and cognitive components. The aim of the study was to evaluate and compare, using a digital algometer, the pressure pain threshold of temporal and masseter muscles of children and adolescents with and without intellectual disability. A cross-sectional study was conducted. Data regarding gender and age were collected from the caregiver of children and adolescents with and without intellectual disability. The evaluations followed this sequence: pressure pain threshold of the masseter and temporal muscles, evaluation of pain on touch using the visual analog scale and signs and symptoms of Temporomandibular disorder. The χ2 test, the Kolgomorov–Smirnov test, Student t test and Mann–Whitney test were performed. The significance level was set at 5%. Two homogeneous groups by gender (P = 0.258) and age (P = 0.727) were evaluated, of which 25 children and adolescents presented intellectual disability and another 25 did not have intellectual disability. No significant difference was observed between groups on the pressure pain threshold of the masseter and temporal muscles, nor pressure average or exam time (P > 0.05). Regarding Temporomandibular dysfunction, no difference in signs or symptoms frequency was found (P > 0.05). However, the range of maximum mouth opening was smaller in the intellectual disability group (P = 0.006). Children and adolescents with intellectual disability and preserved basic functionalities do not present alterations in pain perception when evaluated with computerized pressure algometer and visual analog scale. They present similar threshold of pain to pressure as those reported by normative children and adolescents. These results emphasize the importance to treat these children and adolescents with intellectual disability with respect to their pain threshold.

STUDY DESIGN A case-control association study. OBJECTIVES The aim of this study was to investigate whether CHD7 was associated with adolescent idiopathic scoliosis in Chinese Han population and to further explore the functional role of CHD7 in the development of adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Several studies have explored the association of CHD7 with scoliosis in patients of European descent, while the results were inconsistent. There was a lack of study investigating the association of CHD7 with AIS in Chinese Han population. METHODS Variants within CHD7 were genotyped in 965 AIS patients and 976 healthy controls. Whole exome sequencing was performed in 96 AIS patients. Paraspinal muscles of 43AIS patients and 38 lumbar disc herniation patients were collected for the evaluation of the gene expression. Intergroup comparison was performed with the χ2 test for genotyping data or Student t test for tissue expression. The relationship of CHD7 expression with clinical phenotypes was determined by the Pearson correlation. RESULT Variant rs121434341 of CHD7 was significantly associated with AIS. AIS patients were found to have a remarkable higher frequency of allele G when compared with healthy controls (2.89% vs. 1.57%, P = 0.0018), with an odds ratio value of 1.89. A pathogenic mutation affecting normal splicing was identified in a patient. Moreover, the expression level of CHD7 in AIS patients was significantly lower than in the controls (0.0008437 ± 0.00004583 vs. 0.001129 ± 0.00003773, P

Introdução: a Doença Pulmonar Obstrutiva Crônica (DPOC) é caracterizada pela obstrução do fluxo aéreo e com consequência alteração na função pulmonar, comprometendo a força dos músculos respiratórios e a mobilidade da caixa torácica. A mobilização articular visa restabelecer a mobilidade artrocinemática das articulações da caixa torácica, entretanto, são escassos os estudos que investiguem a eficácia deste tipo de abordagem em pacientes com DPOC. Objetivo: Avaliar os efeitos agudos da mobilização articular na função pulmonar de indivíduos com DPOC. Materiais e métodos: A amostra foi composta por seis participantes com idade média de 56,33 anos (± 12,27), de ambos os sexos, portadores de DPOC. A função pulmonar foi avaliada por meio da espirometria, manuvacuometria e oximetria de pulso. Os participantes foram avaliados em dois momentos, antes e após o tratamento. A intervenção terapêutica foi constituída por técnicas de mobilização da coluna torácica, mobilização do esterno, e mobilização dos arcos costais respectivamente. Análise Estatística: Para a análise dos resultados foi confeccionado um banco de dados eletrônico, foi utilizado a estatística analítica. Foi aplicado o Teste Sharipo Wilk para análise de distribuição dos dados. Para análise pareada foi utilizado o teste de T-Student pareado, no caso de distribuição normal. Foram consideradas significativas as variações p > 0,05. Resultados: Não houveram variações estatisticamente significativas após a aplicação das técnicas em nenhum dos parâmetros avaliados. Mais estudos são necessários para investigar os efeitos de técnicas mobilizatórias nesses pacientes.

This study is an attempt to clinically analyze the independent effect of Karimbirumbadi kashayam and Vasaguluchiadi kashayam in Panduroga and also compare their efficacy. Aims and Objectives: To evaluate the comparative efficacy of Karimbirumbadi kashayam and Vasaguluchyadi kashayam in Panduroga with special reference to iron deficiency anemia in the reproductive age group of women. Methodology: Among 46 registered subjects, 22 were registered in group A and 24were registered in group B. Out of which 20 subjects of A group and 20 subjects of B group completed the study. Group A was administered with 25ml of Karimbirumbadi kashayam with 40ml of luke warm water twice daily before food for 2 months and Group B was administered with 25ml of Vasaguluchyadi kashayam with 40ml of luke warm water and 10ml of Madhu as Anupana twice daily before food for 2 months. Objective and subjective parameters were analyzed using paired T test and Wilcoxon signed rank test respectively. Independent T test and Mann-Whitney U test were used to compare the parameters between the groups. Result: There was statistically significant improvement in the objective and subjective parameters (p

Background Visual information is crucial for performing laparoscopic surgery. While surgeons lose depth perception and spatial orientation in conventional 2D laparoscopy, the 4th generation 3D system gives a better depth perception. Objective In this sstudy, we aimed to investigate the feasibility, safety, and short-term efficacy of 4th generation 3D-HD visualization technology applied in laparoscopic colon cancer surgery. Methods One hundred and twenty patients with colon adenocarcinoma were recruited in this study. Patients were randomized on the day of surgery by a random computer-generated allocation list to undergo either a 3D-HD display or 2D-HD imaging system laparoscopic colon cancer surgery. In total, 60 patients underwent laparoscopic colon resection by 3D-HD laparoscope (3D group) and 60 patients underwent 2D-HD laparoscope (2D group). After the insertion of the access ports, both surgical procedures were divided in component tasks, and the execution times were compared. Data analysis was done using SPSS (version 15.0). Quantitative and qualitative variables were compared applying Student t test and Pearson's chi-square test. Results Two groups were homogenous in terms of demographic data. Operation time was significantly shorter for the 3D group than for the 2D group (123.2±34.2 min vs. 142.2±23.5 min, P=0.018). There was no statistically significant difference between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery, and postoperative complications (P>0.05). Conclusion The 4th generation 3D-HD vision system reduced the operating time compared to 2D-HD vision system. It seems that use of the 3D-HD technology can significantly enhance the possibility of achieving better intraoperative results. .

Objective To evaluate the change of metabolic syndrome indicators among workers with premorbid metabolic syndrome (pre-MetS), who fully completed all intervention’s activities of the “Life Reform” program, affiliated to five EsSalud’s health centers from Lima, between January and December 2015. Design A cross-sectional, non-concurrent study. Methods Secondary data was obtained from medical records of 29 companies´ workers (older than 18 years-old) affiliated to five EsSalud’s centers in Lima (1 hospital, 3 outpatient clinics, 1 primary care center) who fully completed the 12-weeks “Life Reform” program. Demographic characteristics, blood pressure (systolic and diastolic), waist circumference (cm) and laboratory tests (HDL, triglycerides, and fasting blood glucose) were registered. The difference between baseline and final values was analyzed with Student t test for paired data and Z test for difference of proportions. Results The frequency of premorbid metabolic syndrome was 24.7 %. A statistically significant difference was observed in all parameters of metabolic syndrome after the "Life Reform" intervention. Hypertriglyceridemia and low HDL were the most affected parameters. After the intervention, 114 workers (46.4 % of included workers that fully completed the program) did not meet criteria of pre-morbid Metabolic Syndrome. Conclusions The results of “Life Reform” program are promising, but future studies should explore new methods in order to improve adherence.

Objectives Patients with type 1 and type 2 diabetes mellitus (DM) are 2 times as predisposed to developing mood disorders, such as major depressive disorder (MDD), compared with patients without diabetes. Management of comorbid MDD and DM remains a challenge because patients often suffer from poor medication compliance, lifestyle factors and refractory depression. Integration of psychiatric care into diabetes education clinics (DECs) has been suggested as an effective method of managing the comorbid conditions. As this strategy is being implemented into clinical care, its effectiveness in practice warrants further research. Methods A retrospective chart review of 24 patients (10 men and 14 women) followed by an integrated psychiatry-DEC in Newmarket, Ontario, Canada, between April 2016 and July 2019 was performed. Depressive symptom severity at each appointment was assessed with the Patient Health Questionnaire-9 (PHQ-9) depression rating scale. Results There was no significant change in PHQ-9 depression rating scale scoring between the first and most recent appointments (paired t test, p=0.356); however, patients who had improved PHQ-9 scoring were more likely to have more clinic visits (analysis of variance, p=0.0271). A significant negative correlation was found between both number of visits (Pearson coefficient, −0.56; p=0.005) and overall time the patients were followed by DEC (Pearson coefficient, −0.42; p=0.040) and PHQ-9 score changes between the first and most recent appointments. PHQ-9 change between individual appointments also displayed a positive correlation with time between appointments (Pearson coefficient, 0.26; p=0.027). Conclusions Regular follow up in a psychiatry-DEC service might be beneficial in managing MDD symptom severity for comorbid MDD and DM.

Purpose To apply a deep neural network to predict dose distributions of rectal cancer patients for accelerated volume modulated arc technique (VMAT) planning. Materials and methods Computed tomography scans and approved VMAT plans together with Doseapproved of 187 patients treated from February 2018 to April 2019 were randomly selected for this retrospective study. The deep neural network DeepLabv3+ was applied for dose distribution prediction. A prior dose information-aided planning scheme was introduced. Prediction precision was evaluated by mean square error (MSE), normalized dose difference (δD), and dose–volume histogram (DVH) indices using a paired t test. Information-aided and experienced replanning were performed by 1-year and 6-year experienced dosimetrists, respectively. Replanning time and DVH indices were evaluated by two-way variance analysis. Results The DeepLabv3+ prediction results (DoseDeepLabv3+) were all clinically acceptable. Taking Doseapproved as the baseline, the MSE was 0.001 and mean δD was 0.40% with an inter-quartile range of 0.079%–0.30% for DoseDeepLabv3+. No significant differences were found for the planning target volume quantitative parameters between Doseapproved and DoseDeepLabv3+, except for the conformality index. For the two-way variance analysis, a significantly different replanning time was found between the information-aided and experienced replanning with maximum time-saving of 15.76 min. Information-aided replans had the advantage of lower maximum dose, higher minimum dose, and lower homogeneity index, and the disadvantage of lower conformality index and higher machine unites with significant differences. Conclusion DeepLabv3+ successfully predicted rectal cancer dose distribution, and the predicted prior information helped save planning times for multi-level experienced dosimetrists.

According to Riskesdes data (2018), the prevalence of mental disorders has increased when compared to the 2013 Riskesdes from 1.7% to 7%. In addition, the prevalence of mental emotional disorders in people aged> 15 years rose from 6% to 9.8%. Based on the results of data analysis the World Drug Report states that in this decade showed about 208 million people or 5% of the world's population who use narcotics and other addictive substances. Users of narcotics, psychotropic substances and other addictive substances are aged 15 years to 64 years and it is estimated that in 2025 it will increase to 15% of the world's population (Syahrial, 2015). One method that can be used to help control depression or mood due to narcotics consumption is complementary yoga therapy (Streeter, Gerbarg, Domenic, & Brown, 2012). The research design used was quasy experimental. In this study, One group pretest posttest design. The subjects in this study were 40 people with kiteria. The results of the study are based on paired t test results obtained that the value of the statistical test results obtained p value (0,000)

BACKGROUND Authors of several studies have reported differences in the prevalence of metabolic syndrome (MetS) between men and women. However, information is lacking on gender difference among military personnel. OBJECTIVE The aim of this study was to examine the prevalence of MetS and its component abnormalities among Taiwanese Air Force personnel by gender and age groups. METHODS A population-based study was conducted including 14 872 Taiwanese Air Force personnel. Data were retrieved from the military's Health Management Information System. Analyses were performed using Student t test, χ test, and linear-by-linear χ test. Statistical significance was defined as P < .05. RESULTS The MetS prevalence was 14.0% (15.1% in men and 5.3% in women). Metabolic syndrome was associated with age for both men and women (both Ptrend < .001), with a greater prevalence of MetS in men aged 18 to 44 years than in women, but not in the age group of 45 years or older. In men, MetS was most prevalent in those with increased waist circumference (78.2%), followed by those with elevated blood pressure (75.6%). By contrast, in women, it was most prevalent in those with increased waist circumference (86.5%), followed by those with reduced high-density lipoprotein cholesterol (84.3%). CONCLUSIONS Our findings suggest that military nurses and other health providers should consider the gender- and age-based MetS prevalence trend among Taiwanese Air Force personnel when designing interventions to identify vulnerable subgroups at a high risk of MetS. Health management programs should be adapted to minimize metabolic risks.

OBJECTIVES To examine the effect of adding automated fetal fractional limb volume (FLV) with conventional 2-dimensional (2D) fetal weight estimation procedures in a cohort of diabetic pregnancies. METHODS A pilot study of diabetic pregnancies measured standard fetal biometry within 7 days of delivery. Fractional arm volume (AVol) and fractional thigh volume (TVol) soft tissue parameters were measured with a commercially available automated software utility (5D Limb Vol; Samsung Medison Co, Ltd, Seoul, Korea). Three conventional weight prediction models that included only 2D size parameters were compared to FLV models that included AVol or TVol. Estimated and actual birth weight (BW) were assessed for the mean percent difference ± standard deviation of the percent differences. Systematic errors were evaluated by the Student t test, and random errors were compared by the Pitman test for correlated variances. The proportion of neonates with estimated fetal weight within 10% of BW was compared between groups by the McNemar test. RESULTS Ninety gravid women were enrolled with pregestational (26.7%) or gestational (73.3%) diabetes. All prediction models were accurate, with the exception of small underestimations by the model of Schild et al (-3.8%; Ultrasound Obstet Gynecol 2004; 23:30-35). Random errors for the AVol (6.2%) and TVol (6.9%) models were significantly more precise than the other 3 prediction models: Hadlock et al (7.8%; Am J Obstet Gynecol 1985; 151:333-337), INTERGROWTH-21st (8.0%; Ultrasound Obstet Gynecol 2017; 49:478-486), and Schild et al (8.6%; P

The aim was to estimate the physiological standardized uptake values (SUVs) on Ga-DOTATATE PET-computed tomography (CT) in normal organs and metastatic tumor lesions (both standard and delayed), and correlating the uptake values and ratios with Krenning Scores (K-score) in patients with metastatic/advanced neuroendocrine tumors (NETs) undergoing PET-CT studies for their management work-up. A total of 32 patients of metastatic NET with 95 discrete tumor lesions were included in this analysis. These patients underwent standard whole-body PET-CT following injection of 2-3 mCi (74-111 MBq) of Ga-DOTATATE at 1-1.5 h. The normal physiological SUVmean of the liver and spleen and SUVmax and SUVmean of tumor lesions were estimated by an in-built automated procedure. These patients also underwent a delayed scan (2.5-3 h) and the same parameters were obtained for the delayed study. The tumorous lesions were further classified on the basis of K-score, and this was correlated with the mean SUVmax on both early and delayed scans. SUVmean ratios (tumor-to-liver and tumor-to-spleen) were also calculated for both time-points and correlated with individual K-scores. In lesions with K-score 4, the mean SUVmax was 32.5 in early and 30.5 in delayed scan, for lesions with K-score of 3 and 2, the mean SUVmax were 17.3, 20, and 9.3, 9.2, respectively, while in K-score 1 (n = 1), the delayed mean SUVmax was found to be more than early mean SUVmax (3.2 to 2.3). Statistical significance was evaluated by paired t test, and the changes in SUVmax was found to be statistically insignificant (P > 0.05) in all 3 K-scores. The paired t test was also performed between early and delayed tumor/liver and tumor/spleen mean SUVmean ratios, and no significant changes were observed across all K scores. The mean SUVmean values of the liver in the standard 1-h scan and delayed scans were 8.05 (range: 3-15) and 8.17 (range: 3.2-16), while for spleen, the values were 18 (range: 8.4-36.7) and 20 (range: 10-38.6), respectively. Statistically significant changes were observed in delayed spleen SUVmean values compared to the early scan (P < 0.05), while for liver SUVmean, the difference was not significant. Thus, in the present study, the SUVmax and SUVmean (range and mean values) for normal liver and spleen, and malignant NET lesions, and tumor-to-liver and tumor-to-spleen SUVmean ratios of different K-scores were generated. As could be theoretically expected in receptor-based PET-CT, there was no significant change in the delayed scan compared to the standard 1-1.5 h values.

Introduction: The nurses' assessment accuracy and confidence in the handling of mass victims of traffic accidents in the prehospital phase was an important success key of subsequent handling of victims when taken to the hospital, and vice versa if there was an error in providing help could be fatal for victims. The purpose of this study was to determine the comparison of face-to-face and watch video simulations of the assessment accuracy and nurses’ confidence in conducting prehospital disaster triage of victims of land traffic accidents using the SALT Triage model.Research Methods: Quasi experimental research with nonequivalent control group design. The sample size was 32 nurses who were divided into 2 groups, namely the face-to-face simulation group and the watch video SALT Triage simulation group. The samples were taken by non-random sampling with purposive sampling technique. Data analysis used was Paired t test and Independent t-testResults: There was no difference in the average nurses’ assessment accuracy and confidence in the face-to-face group with the group watching the simulation video. Statistical test results obtained p value> α = 0.05Conclusion: The sorting mass victims of the SALT Triage model can teach nurses by providing face-to-face or watching a simulation video about SALT Triage. Both ways were equally good at conveying information

Background: Early marriages are at high risk of marital failure, poor family quality, young pregnancies at risk of maternal death, and the risk of being mentally ill to foster marriage and be responsible parents. Objective: To determine the effect of reproductive health education on peer groups (peers) on the knowledge and perceptions of adolescents about marriage age maturity. Method: This research uses the Quasi experimental method with One group pre and post test design, conducted from May to September 2018. The statistical analysis used in this study is a paired T test with a confidence level of 95% (? = 0, 05). Results: There is an average difference in the mean value of adolescent knowledge between the first and second measurements is 0.50 with a standard deviation of 1.922. The mean difference in mean scores of adolescent perceptions between the first and second measurements was 4.42 with a standard deviation of 9.611. Conclusion: There is a significant difference between adolescent knowledge on the pretest and posttest measurements with a value of P = 0.002, and there is a significant difference between adolescent perceptions on the pretest and posttest measurements with a value of p = 0.001. Increasing the number of facilities and facilities related to reproductive health education by peer groups (peers) in adolescents is carried out on an ongoing basis at school, in collaboration with local health workers as prevention of risky pregnancy.

In an examination-oriented culture, test anxiety becomes a vital hindrance among students, leading to them developing a false belief concerning their innate capabilities. By implementing cognitive behavioral group therapy, students will develop a positive outlook and reduce test anxiety. The present study was aimed at examining the effectiveness of cognitive behavioral group therapy in alleviating test anxiety among primary school students. The study employed one-group pretest-posttest design. The sample of this study consists of forty (n=40) primary school students. Before cognitive behavioral group therapy, respondents completed the Westside Test Anxiety Scale (Driscoll, 2004). Respondents participated in four sessions of cognitive behavioral group therapy. Afterwards, the Westside Test Anxiety Scale was administered as a post-test. Findings revealed a reduction in test anxiety scores among the respondents who have received cognitive behavioral group therapy. Based on these findings, training of this paradigm should be implemented at primary school level as a preventative initiative to alleviate student test anxiety. The results of the present study are encouraging and should be re-examined with a larger sample size.

Introduction: Telenursing is a simple method to provide and maintain nursing care for patients with chronic illness such as diabetes. This study aimed to determine the effectiveness of telenursing on body mass index (BMI) and glycosylated hemoglobin (HbA1c) in illiterate patients aged 50 years and older with type 2diabetes. Methods: A randomized controlled clinical trial was performed. Sixty patients with type 2 diabetes who referred to Aligoodarz diabetes clinic (Lorestan, Iran) were randomly assigned to the intervention and control group. Each patient was assessed before and after intervention for the following clinical parameters: HbA1c by Drew-DS5 analyzer and weight by scale (Sahand BMI electronic scale /Iran). All patients received diabetes self-care training for 3 days before the study. Telephone follow ups were applied in intervention group for 12 weeks. The data were analyzed using chi-square, paired t test and independent t test by SPSS11. Results: Results showed statistically significant decrease in BMI at the end of the training from 29.28 (3.29) to 28.35 (3.37) kg/m2 and statistically significant decrease in HbA1c from 8.96 (1.24) to 7.56 (0.71) in the intervention group. The effect size base on Cohen’s formula for BMI and HbA1c was Cohen’s d=2.85, effect size r=0.81 and Cohen’s d=2.04, effect size r=0.71, respectively. Conclusion: The findings indicate that nurse-led telephone follow up can increase adherence from treatment program and has beneficial effects on HbA1c and BMI in illiterate patients aged 50 years and older with type 2 diabetes.

Aims and Objectives: The study was performed to evaluate the efficacy and safety of bipolar transurethral resection of prostate (BP-TURP) in the oldest old (>85yrs) with large glands. Methods: Patients of age >85 years and gland size >60 g, who were operated for Benign Prostatic Hyperplasia (BPH) (BP-TURP) at our institution from January 2014 to January 2018 , were included in the study and data was collected retrospectively. Exclusion criteria were any evidence of suspected neurogenic bladder, bladder cancer, increased serum prostate specific antigen (PSA) (> 4 ng/ml) & history of urethral or prostatic surgery. The patients were divided into two groups according to gland size, one was with an estimated size of >60 g but ≤90 g (Group 1) and the other with >90g (Group 2). Pearson’s Chi square test was used to test for the significant differences for categorical data and Student t test and Mann Whitney U test for continuous variables. The difference was considered significant if p value was 85 years) with large glands can be safely treated with BP -TURP with good outcomes and low complication rates.

Qualification for bariatric surgery is based upon strict medical guidelines, but individual insurance companies may introduce additional requirements for approval and coverage as they deem necessary. A mandatory preoperative medical weight loss management (MWM) program is commonly such a requirement. The primary objective of this study is to assess the effect of MWM programs on weight loss outcomes. A retrospective review of all sleeve gastrectomies performed between 2012 and 2016 at our institution was conducted. Patients were divided into two groups: those who required a preoperative MWM program, and those who did not. A 1:1 greedy nearest-neighbor method matching algorithm was used to match patients based on age, BMI, smoking, gender, race, sleep apnea, and diabetes. Total weight loss and percent excess weight loss at 1 year for each group were compared. A total of 3059 sleeve gastrectomy patients were reviewed. Of these, 941 patients had adequate data points to be evaluated. The matching algorithm resulted in 530 patients for the final analysis, 265 patients in each group. There were no significant differences between the groups in terms of age, BMI, smoking, gender, race, sleep apnea, or diabetes. A paired t test found no significant differences between the MWM group and the control group at 1 year in both total weight loss (36.7 kg vs 36.2 kg) and in percent excess weight loss (56.5% vs 55.8%, p = 0.24). There was no significant difference in weight loss outcomes after 1 year in patients required by insurance to participate in MWM programs compared to those who were not. The necessity of these programs should be questioned.

Background : Overweight and obesity are the conditions where lumbar have to bear more load, and it will decrease its flexibility. Decrease of lumbar flexibility will affect the range of motion. Based on some literatures, mat pilates will increase the ability on lumbar flexibility, however there is no evidence effect of mat pilates in children, especially overweight and obese children. Aim : To know the effect of mat pilates on lumbar flexibility of overweight and obese children. Method : This study was pre experimental one group pre and post test design with 20 subjects based on inclusion dan exclusion criteria. Subjects did mat Pilates exercise for 12 times. Lumbar flexibility was measured by Modified Modified Schober Test for lumbal flexion and extension before intervention and after 4 weeks mat pilates exercise. Data analyzed by SPSS using Saphiro Wilk test as data’s nomalities test and Paired T test as hypothesis test. Result : The mean of MMST Flexion pre and post test after Mat Pilates have increased from 3,15±0,3118 cm to 7,63±0,4 cm. The mean of MMST extension pre and post test after Mat Pilates hav e increased from 1,415±0,21 cm to 3±0,236 cm. The means of a BMI Post test (24,89 ± 0,9 kg/m 2 ) is higher than the mean of a BMI Pre test (24,86 ± 0,8 kg/m 2 ).The significant result proves the effect of mat pilates in lumbar flexibility of overweight and obese children which measured by MMST Flexion and MMST Extension. The result of p value for MMST Flexion is p=0,00 and the result of p value for MMST Extension is p=0,00 which both of MMST flexion and Extension are significant or different. Conclusion : Mat pilates can increase the lumbar flexibility of overweight and obese children. Keyword: Mat Pilates, Lumbar Flexibility, overweight and obese children.

Significance Automated low-contrast letter acuity (LCLA) has several advantages: consistent luminance, reduced chance of individuals memorizing test letters, and convenient and accurate visual acuity reporting functions. Although automated LCLA might report slightly worse acuity than Sloan LCLA chart, considering its advantages, it may be a viable alternative to Sloan LCLA chart in clinical practice and research. Purpose The purpose of this study was to determine the repeatability of an automated LCLA measurement and its agreement with the Sloan LCLA chart test in normal participants and reduced-vision participants. Methods Adult participants (n = 49) were measured with both automated Early Treatment Diabetic Retinopathy Study and Sloan LCLA tests, including normal and reduced-vision groups. Low-contrast letter acuity at two contrast levels (2.5 and 10%) was measured at 3 m in a random sequence with both LCLA tests. To test repeatability, participants were retested 1 week later. Repeatability of the two tests between two visits and agreement between automated and Sloan LCLA tests were evaluated using 95% limits of agreement. Results In terms of the 95% limits of agreement, the repeatability of both tests was as follows: automated LCLA at 2.5%, ±0.26; automated LCLA at 10%, ±0.22; Sloan LCLA at 2.5%, ±0.23, and Sloan LCLA at 10%, ±0.16. The agreement of the two tests was as follows: ±0.19 at 2.5% and ±0.24 at 10%. The automated LCLA at 2.5 and 10% levels was generally reported one-half to one logMAR line lower than Sloan LCLA (mean differences, -0.04 at 2.5% and -0.13 at 10%; paired t test, P Conclusions The automated LCLA test shows fairly good test-retest repeatability at both 2.5 and 10% contrast levels. The agreement between the automated and the Sloan low-contrast letter acuity tests was comparable with test-retest agreement. Although the automated LCLA test reports slightly worse acuity than the Sloan LCLA test, it could be an appropriate alternative to the Sloan LCLA test.

Pregnant women have a risk of anemia. The incidence of anemia in first trimester of pregnancy is 20%, second trimester of 70% and third of 70%. More than ¾ pregnant women experience iron deficiency and more than 1/3 pregnant women have anemia.The purpose of this research was to determine effectiveness of consumption iron tablets with orange juice to increase hemoglobin levels in pregnancy in the working area of Singaparna Public Health Center Tasikmalaya in 2019. Research used quantitative analytical with Quasi Experiment with design pre-test and post-test with control group. The analysis used is univariate, bivariate analysis used paired T- test and Wilcoxon test. The population in this research were all Trimester II pregnant women in Singaparna Public Health Center area with a sampling technique using purposive sampling to obtain a sample of 50 pregnant women. Based on the results of the research found that there was an increase in the average levels of Haemoglogin in the intervention group from 11.62% gr to 11.79 gr%, but these results were not statistically significant using the Wilcoxon test (P value 0.979). Control group (water) showed a decrease in haemoglobin levels from 11.68% gr to 11.38 gr% and this result was not statistically significant using the Paired T Test. The conclusion in this research is an increase in the average level of Hb in the intervention group (orange juice). Recommendations There is a need for control of diet which can also have an impact on increasing levels of Hb.

To compare longitudinal hepatic proton density fat fraction (PDFF) changes estimated by magnitude- vs. complex-based chemical-shift-encoded MRI during a weight loss surgery (WLS) program in severely obese adults with biopsy-proven nonalcoholic fatty liver disease (NAFLD). This was a secondary analysis of a prospective dual-center longitudinal study of 54 adults (44 women; mean age 52 years; range 27–70 years) with obesity, biopsy-proven NAFLD, and baseline PDFF ≥ 5%, enrolled in a WLS program. PDFF was estimated by confounder-corrected chemical-shift-encoded MRI using magnitude (MRI-M)- and complex (MRI-C)-based techniques at baseline (visit 1), after a 2- to 4-week very low–calorie diet (visit 2), and at 1, 3, and 6 months (visits 3 to 5) after surgery. At each visit, PDFF values estimated by MRI-M and MRI-C were compared by a paired t test. Rates of PDFF change estimated by MRI-M and MRI-C for visits 1 to 3, and for visits 3 to 5 were assessed by Bland-Altman analysis and intraclass correlation coefficients (ICCs). MRI-M PDFF estimates were lower by 0.5–0.7% compared with those of MRI-C at all visits (p

PURPOSE To determine the correlation and agreement between intraocular pressure (IOP) parameters evaluated by the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in primary open-angle glaucoma (POAG) in an indigenous African population. MATERIALS AND METHODS This was a prospective, interventional, comparative study of 50 newly diagnosed, previously untreated primary open-angle glaucoma patients at the out-patient clinic of the Eleta Eye Institute, Ibadan. A series of IOP measurements were taken 2 hourly (from 7:00 AM to 3:00 PM) for the mDTC, using Goldmann applanation tonometer. The WDT was performed thereafter. The patients drank 800 mL of water within 5 minutes, and another series of IOP measurements were taken every 15 minutes for a duration of 1 hour from the moment water was fully ingested. Both the mDTC and the WDT were performed on the same day. IOP peak, mean, and IOP fluctuations were estimated from the data collected. Comparison between the mDTC and the WDT was performed using the paired Student T test for means, Pearson correlation analysis for correlation, and Bland-Altman analysis for agreement. RESULTS Estimated IOP parameters were significantly higher for the WDT than for the mDTC. The average peak IOP was 27.8±4.0 mm Hg during the WDT and 24.9±3.1 mm Hg during the mDTC (P

Objectives The aims of this study is to determine the effect of communication patterns on HIV/AIDS prevention efforts in Badung Regency. Method The design of this study is quasi-experiment involving 30 samples selected with purposive sampling technique. The study was conducted at VCT Polyclinic in Badung Hospital. Sample divided into two groups as treatment and control. The treatment group has provided with module to be learned a month. Data was collected by likert-scale questionnaires. Data analyzed with paired t test with α = 0.05. Results The finding of the study showed that there is a significant increase in the average score of HIV/AIDS prevention efforts when comparing between pre and post intervention in the treatment group [3.42 (SD = 0.317) vs 3.76 (SD = 0.218), p = 0.001] and control group [3.18 (SD = 0.279) vs 3.22 (SD = 0.281), p = 0.003]. Conclusion This research has found the effect of communication pattern in family on prevention efforts of transmission HIV/AIDS. Open Communication in family could prevent the transmission of HIV/AIDS to family members. This research recommended health workers to provide counseling plus module.

Background: DWI and ADC values are noninvasive MRI techniques, which provide quantitative information about tumor heterogeneity. Aim: To determine the minimum and mean ADC values in breast carcinoma and to correlate ADC values with various prognostic factors. Settings and Design: Prospective observational study. Materials and Methods: Fifty-five patients with biopsy-proven breast carcinoma were included in this study. MRI with DWI was performed with Siemens 3T Skyra scanner. ADC values were measured by placing regions of interest (ROIs) within the targeted lesions on ADC maps manually. The histopathological and immunohistochemical analysis of surgical specimen was done to determine the prognostic factors. Statistical Analysis: Students T test and ANOVA were used to study the difference in ADC between two groups. Pearson correlation coefficient was used to quantify the correlation between ADC values and prognostic factors. Results: Lower grade (grade I) breast carcinoma had a significantly high ADC value as compared to higher grade carcinoma (grade II and III). For differentiating Grade I tumors from grade II and III, a minimum ADC cut-off value was 0.79 × 10−3 mm2/sec (83% sensitivity and 84% specificity) and a mean ADC cut-off value was 0.82 × 10-3 mm2/sec (83% sensitivity and 71% specificity) was derived. There was no significant correlation between ADC and other prognostic factors. Conclusion: ADC values can be used to differentiate lower grade breast carcinoma (grade I) from higher grades (grade II and III). Minimum ADC values are more accurate in predicting the grade of the breast tumor than mean ADC value.

OBJECTIVE Accurate volume assessment is essential for the management of vestibular schwannoma after stereotactic radiosurgery (SRS). A cuboidal approximation for volume is the standard surveillance method; however, this may overestimate tumor volume. We sought to evaluate several volumetric models and their suitability for post-SRS surveillance. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS We evaluated 54 patients with vestibular schwannoma before and after SRS. INTERVENTION(S) Gold-standard volumes were obtained by a radiation oncologist using contouring software. Volume was also calculated by cuboidal, ellipsoidal, and spherical formulae using tumor diameters obtained by a neuroradiologist. MAIN OUTCOME MEASURE(S) Percent error (PE) and absolute percent error (APE) were calculated. Paired t test evaluated bias, and the Bland-Altman method evaluated reproducibility. Linear regression evaluated predictors of model error. RESULTS All models overestimated volume compared with the gold standard. The cuboidal model was not reproducible before SRS (p

BACKGROUND AND OBJECTIVES Limb salvage surgery remains the standard treatment in bone and soft tissue tumors. Toronto Extremity Salvage Score (TESS) is the most used quality of life measure. Our objective was to perform cross-cultural adaptation and validation in Italian, testing test-retest reliability, construct validity, and responsiveness. METHODS We interviewed patients already treated for content validity. A total of 124 patients completed TESS and other questionnaires presurgery, at 3 months, 3 months + 2 weeks, and 6 months follow-up. We calculated intraclass correlation coefficients (ICCs) for reliability, associations with Pearson's r, and change over time with paired T tests. RESULTS A new item regarding touch-screen devices was added to the upper extremity (UE) questionnaire. ICC resulted of 0.99 for lower extremity (LE) and 0.98 for UE patients, Pearson's r between TESS and Musculoskeletal Tumor Society was .66 and .64, EuroQol-5D-5L r was .62 and .61, and r between TESS and short form-36 physical function subscale was .76 and .71 for LE and UE groups, respectively. Paired T test results were statistically significant to detect change over time (0.03, 0.04, and 0.04 for LE groups and 0.03, 0.01, and 0.04 for UE groups). CONCLUSION The Italian version of TESS can be used for the bone and soft tissue sarcoma population in clinical trials in Italy and with Italian speaking patients abroad to ensure patients' perspectives for efficacy and efficiency of treatments.

Purpose The purpose of this study was to prospectively investigate the intra- and inter-observer repeatability of a new 2-dimensional (2D) shear wave elastography (SWE) technique (S-Shearwave Imaging) for assessing liver fibrosis in chronic liver disease patients, and to compare liver stiffness measurements (LSMs) made using 2D-SWE with those made using point SWE (pSWE). Methods This prospective study received institutional review board approval and informed consent was obtained from all patients. Fifty-three chronic liver disease patients were randomly allocated to group 1 (for intra-observer repeatability [n=33]) or group 2 (for inter-observer repeatability [n=20]). In group 1, two 2D-SWE sessions and one pSWE sessions were performed by one radiologist. In group 2, one 2D-SWE session and one pSWE session were performed by the aforementioned radiologist, and a second 2D-SWE session was performed by another radiologist. The intraclass correlation coefficient (ICC) was used to assess intra- and inter-observer reliability. LSMs obtained using 2D-SWE and pSWE were compared and correlated using the paired t test and Pearson correlation coefficient, respectively. Results LSMs made using 2D-SWE demonstrated excellent intra- and inter-observer repeatability (ICC, 0.997 [95% confidence interval, 0.994 to 0.999]) and 0.995 [0.988 to 0.998], respectively). LSMs made using 2D-SWE were significantly different from those made using pSWE (2.1±0.6 m/sec vs. 1.9±0.6 m/sec, P

BACKGROUND To determine the trustworthiness of graded exercise test to exhaustion (GXT) to assess maximal oxygen uptake ( V˙O2max ) in metabolic syndrome individuals with obesity and poor cardiorespiratory fitness. METHODS V˙O2max was assessed in 100 metabolic syndrome adults (57 ± 8 years; 34% women), with obesity (BMI 32 ± 5 kg·m-2 ) using GXT followed by supramaximal constant-load verification test (VerT) at 110% of maximal GXT work rate. V˙O2 data from GXT and VerT were compared using paired t test and plotted for Bland-Altman analysis. GXT sensitivity and specificity to detect V˙O2max were also calculated. RESULTS Seventy individuals did not achieve V˙O2 plateau during GXT. GXT underestimated V˙O2max in 40 subjects. In these subjects, the magnitude of V˙O2max underestimation with GXT was 9% (167 mLO2 ·min-1 ; P

Purpose: To perform a systematic review and meta-analysis of literature and to evaluate the relationship between abnormal femoral version and the development of hip osteoarthritis (OA). Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluating Level I and II studies. Included studies had to provide granular femoral version (FV) information. The severity of OA was ranked on the Kellgren–Lawrence (KL) scale. Excel version 1808 (Microsoft, Redmond, WA) was used to perform a student t test statistical analyses. Results: Our review identified 19 qualifying studies—5 Level I and 14 Level II with 1,756 patients. Patients with FV above normal range (>14°) had greater KL scores than patients with normal range FV (mean ± standard deviation; 3.37 ± 1.44 vs 2.05 ± 1.72, P < .05). Analysis of KL scores in patients with FV >24° (>1 standard deviation) versus patients with FV >14° but

Creation of an auricular framework plays the main role on first stage of microtia reconstruction. The size of framework is determined based on the size of the contralateral healthy ear and customized with Nagata theory. The height of rib that added behind the previous framework is the same with the projection of the normal ear. But the height of rib needed and framework in bilateral cases is unknown. A population based auricular framework pattern and projection are urgently needed.This study aimed at determining the mean values of normal anthropometric measurement of external ear and projection of human ear in males and females and their comparison on either sides and in either sex.Measurements are taken from 524 subjects (96 men and 428 women) aged 17 to 35 years using a Vernier caliper. The parameters measured were total ear height, ear width, lobular height, lobular width, upper pole, middle upper pole, middle pole, lower middle pole, lower pole, each subject's right and left ears.Comparisons between gender were performed by independent t test and paired t test for comparison between right and the left ear. All dimensions were significantly different between male and female ( P 0.05) except the right lobular height ( P 0.05). There was no significant difference both side among groups (P 0.05) except total ear height on female group (P 0.05). All projection dimensions were significantly different between male and female. There was no significant difference of auricular projection of right and left auricular on the male (P 0.05) groups except the projection of lower pole. There were significant between auricular projection of right and left ears on the female groups (P 0.05).These findings suggest that the normal anthropometric study will have implication in the ear reconstruction especially on bilateral cases as a baseline for reconstruction.

Test taking is ubiquitous in academic life. Often, a student’s desire to perform well in these evaluative situations leads them to experience test-anxiety. However, test-anxiety has been repeatedly correlated with reduced test performance. Research suggests that reappraisal interventions promote the reduction of test anxiety which may result in improved test performance. But can linguistic tense mediate the effect of these interventions? If so, are these interventions helpful for GT students for whom test anxiety is a significant concern? This intervention study tested whether reading a message containing a type of reappraisal technique, objective psychological distancing, in a certain linguistic tense could reduce test anxiety and improve test performance for high school GT algebra students. Two hours before taking an exam, students read one of three messages: a first-person distancing, a third-person distancing, or a control message. There existed a slight improvement in student test performance from the control condition to the distancing conditions, yet this trend was not statistically significant.

Decisions regarding which rapid diagnostic test (RDT) for bloodstream infections to implement remain challenging given the diversity of organisms detected by different platforms. We used the desirability of outcome ranking management of antimicrobial therapy (DOOR-MAT) as a framework to compare two RDT platforms on potential desirability of antimicrobial therapy decisions. An observational study was performed at University of Maryland Medical System comparing Verigene blood culture (BC) to GenMark Dx ePlex blood culture ID (BCID) (research use only) panels on blood cultures from adult patients. Positive percent agreement (PPA) between each RDT platform and Vitek MS was calculated for comparison of on-panel targets. Theoretical antimicrobial decisions were made based on RDT results, taking into consideration patient parameters, antimicrobial stewardship practices, and local infectious diseases epidemiology. DOOR-MAT with a partial credit scoring system was applied to these decisions, and mean scores were compared across platforms using a paired t test. The study consisted of 160 unique patients. The Verigene BC PPA was 98.6% (95% confidence interval [CI], 95.1 to 99.8), and ePlex BCID PPA was 98% (95% CI, 94.3 to 99.6). Among the 31 organisms not on the Verigene BC panels, 61% were identified by the ePlex BCID panels. The mean (standard deviation [SD]) DOOR-MAT score for Verigene BC was 86.8 (28.5), while that for ePlex BCID was 91.9 (23.1) (P = 0.01). Both RDT platforms had high PPA for on-panel targets. The ePlex BCID was able to identify more organisms than Verigene, resulting in higher mean DOOR-MAT scores.