Implementasi Routing Protocol DSR pada Skenario Mobility Random Waypoint dengan menggunakan Propagasi Nakagami

Mobile Ad hoc Network (MANET) merupakan jaringan wireless yang berasal dari kumpulan mobile node yang topologinya dapat berubah dengan cepat dan kapan saja. Aspek yang penting dalam MANET adalah protokol rute dimana protokol  inilah yang mengatur sistem pencarian rute paket data dalam jaringan tersebut. Ada beberapa macam protokol rute pada MANET salah satunya adalah DSR. DSR merupakan pengembangan dari AODV. Perbedaan antara AODV dengan DSR adalah jumlah rute yang ditemukan dalam setiap proses pencarian rute. Dalam Tugas Akhir ini, dilakukan penelitian terhadap kinerja DSR menggunakan Network Simulator 2 (NS-2). Uji coba dilakukan dengan membuat pola traffic connection dan pola pergerakan node yang kemudian disimulasikan dengan menggunakan script DSR.tcl. Proses tersebut akan menghasilkan file otuput berupa trace file. Trace file hasil dari simulasi akan dianalisis untuk menghitung Packet Delivery Ratio (PDR), Routing Overhead (RO), dan End-to-End Delay

The Relationship of Inflammatory Regulation and Pain Intensity in SIRS Patients

Aims of this study were to investigate the changes in inflammatory regulation as shown by proinflammatory cytokines (IL-6) and anti-inflammatory cytokines (IL-10) from patients with systemic inflammatory responses syndrome (SIRS) that affect pain intensity changes with the marked increase of critical-care pain observation tools (CPOT) and decreased of the pain pressure threshold (PPT). A cross-sectional analysis to compare the values of IL-6, IL-10, PPT, and CPOT of SIRS patients and patients without SIRS. Of the 46 patients who were the subjects of the study, there were 21 SIRS patients and 25 patients non-SIRS

Prospects for the development of probiotics and prebiotics for oral applications

There has been a paradigm shift towards an ecological and microbial community-based approach to understanding oral diseases. This has significant implications for approaches to therapy and has raised the possibility of developing novel strategies through manipulation of the resident oral microbiota and modulation of host immune responses. The increased popularity of using probiotic bacteria and/or prebiotic supplements to improve gastrointestinal health has prompted interest in the utility of this approach for oral applications. Evidence now suggests that probiotics may function not only by direct inhibition of, or enhanced competition with, pathogenic micro-organisms, but also by more subtle mechanisms including modulation of the mucosal immune system. Similarly, prebiotics could promote the growth of beneficial micro-organisms that comprise part of the resident microbiota. The evidence for the use of pro or prebiotics for the prevention of caries or periodontal diseases is reviewed, and issues that could arise from their use, as well as questions that still need to be answered, are raised. A complete understanding of the broad ecological changes induced in the mouth by probiotics or prebiotics will be essential to assess their long-term consequences for oral health and disease

Secondary metabolites from Eupenicillium parvum and their in vitro binding affinity for human opioid and cannabinoid receptors

Phytochemical investigation of the soil microfungus Eupenicillum parvum led to the isolation of two new compounds: a chromone derivative euparvione (1) and a new mycophenolic derivative euparvilactone (2), as well as thirteen known compounds. The structures of the new compounds were elucidated by means of extensive IR, NMR, and MS data and by comparison of data reported in the literature. The structure of the known compound 6 was confirmed by X-ray crystallography. Several isolated compounds were evaluated for in vitro binding assays using opioid receptors (subtypes δ, κ, and μ) and cannabinoid receptors (CB1 and CB2). Compound 10 displayed the best selective μ-opioid receptor and CB1 receptor binding affinities showing values of 47% and 52% at a 10 μM concentration, respectively. These findings provide insight into the potential therapeutic utility of this class of compounds

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. Conclusions Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture

2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis

OBJECTIVE:To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). METHODS:We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. RESULTS:The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. CONCLUSION:The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA

2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis

Objective. To develop an evidence- based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). Methods. We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/compara-tor/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. Results. The guideline covers the management of active PsA in patients who are treatment- naive and those who con-tinue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin- 12/23 inhibitors (IL- 12/23i), IL- 17 inhibitors, CTLA4- Ig (abatacept), and a JAK inhibitor (tofaciti nib). We also de-veloped recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat- to- target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indi-cating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. Conclusion. The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA