Isolated gallbladder rupture following blunt abdominal trauma

The gallbladder is a relatively well‑protected organ; consequently its rupture following blunt abdominal injury is rare and usually associated with other visceral injuries. Isolated gallbladder rupture is extremely rare. We report a healthy Nigerian adult male who sustained isolated gallbladder rupture following blunt abdominal injury from riding a motor cycle (Okada). A high index of suspicion with positive bile aspirate might lead to early diagnosis. Open cholecystectomy is a safe option of treatment in a resource poor centre especially in delayed presentation and has a good outcome.Key words: Blunt abdominal trauma, gallbladder rupture, isolate

Outcome of surgery for toxic goitres in maiduguri: A single teaching hospital’s perspective

Background: Thyrotoxicosis a common endocrine disorder of the thyroid gland in Nigeria is commonly treated surgically. The outcome of thyroidectomy for toxic goiters in Maiduguri Nigeria is evaluated.Materials and Methods: Over the last 5 years (Jan 2005-July 2010), in a prospective review, the demographic, and clinical data of patients operated for toxic goiters in our department was entered, into a predesigned proforma and analyzed. The objective of the study is to review our experience with subtotal and near-total thyroidectomy as treatment for benign toxic goiters.Results: Seventy-eight patients, 11 males (14.1%) and 67 females (85.9%), with male: female ratio of 1:6.1 and the mean age of 30 ± 10.9 (range, 17-65 years), underwent thyroidectomy for toxic goiters. The mean duration of symptoms was 41.9 (range 3-126 months). There were 53 patients with toxic diffuse goiters (Grave’s disease) with their mean age of 27.6 ± 6.93 (range 17-38 years), 23 with toxic multinodular goiters, the mean age of 43.7 ± 15.68 (range 17-65 years) and two with toxic nodule. There was no case of permanent recurrent laryngeal nerve palsy or permanent hypocalcemia. Transient hypocalcemia occurred in 9 (11.5%) patients and hemorrhage with hematoma, requiring exploration in 4 (5.1%). There were two cases of wound infection and no postoperative mortality. The mean hospital stay was 7.6 ± 2.34 (range 5-15 days). There was no disease recurrence over a mean follow-up of 20.7 (range 2-48) months.Conclusion: Subtotal thyroidectomy is an effective procedure for the treatment of thyrotoxicosis with few postoperative complications and majority of patients being euthyroid after long follow-up

PENERAPAN MODEL PEMBELAJARAN INKUIRI TERBIMBING PADA MATERI POKOK LARUTAN ELEKTROLIT DAN NONELEKTROLIT UNTUK MELATIHKAN KETERAMPILAN BERPIKIR KRITIS SISWA KELAS X MA DARUL HIKMAH SOOKO MOJOKERTO (IMPLEMENTATION OF GUIDED INQUIRY LEARNING MODEL IN THE ELECTROLYTE AND NONELECTROLYTE SOLUTION MATTER TO TRAIN CRITICAL THINKING SKILLS STUDENTS X GRADE IN MA DARUL HIKMAH SOOKO MOJOKERTO)

Tujuan penelitian ini adalah mengetahui ketrelaksanaan model pembelajaran, aktivitas siswa, dan keterampilan berpikir kritis siswa setelah dilaksanakan model pembelajaran inkuiri terbimbing pada materi pokok larutan elektrolit dan nonelektrolit. Diskriptif kuantitatif adalah jenis penelitian ini. Dilaksanakan di kelas X IPA2 MA Darul Hikmah Sooko Mojokerto sebanyak 21 siswa. Instrumen yang digunakan lembar pengamatan keterlaksanaan pembelajaran inkuiri terbimbing, lembar pengamatan aktivitas siswa, dan lembar tes keterampilan berpikir kritis. Keterlaksanaan model pembelajaran rata-rata tiap-tiap fase pertemuan 1 dan 2 yaitu fase 1 sebesar 3,58 dan 3,7; fase 2 sebesar 3,6 dan 3,62; fase 3 sebesar 3,0 dan 3,0; fase 4 sebesar 3,4 dan 3,6; fase 5 sebesar 3,45 dan 3,3; fase 6 sebesar 3,6 dan 3,6 dengan kriteria sangat baik. Aktivitas siswa menunjukkan sintaks model pembelajaran inkuiri terbimbing dan siswa sudah berlatih keterampilan berpikir kritis. Posttest mendapat nilai 80,95%  siswa tuntas dan nilai rata-rata tiap keterampilan berpikir kritis yaitu interpretasi sebesar 3,17; analisis sebesar 3,41; dan inferensi sebesar 2,59 mengunakan  sekala 4. Kata Kunci :  Model Pembelajaran Inkuri Terbimbing, Keterampilan Berpikir Kritis, Larutan Elektrolit dan Nonelektroli

Rapid Synchronization for Ultra-Wideband Communication Systems

Very high data rate packet systems, such as those based on ultra-wideband (UWB) signaling, face an increasingly important challenge – UWB radio uses sub-nanosecond pulses to transmit information, resulting is high resolution in time implying that the acquisition algorithm must employ sub-pulse duration steps, thereby leading to a large search space, which consequently leads to large mean acquisition time (MAT). The role of synchronization is essentially to determine the relative delay of the received signal with respect to a template signal in the receiver. This paper addresses coarse synchronization in UWB multipath environments taking into account the specific properties of UWB signals. Since we are interested in low signalto-noise ratio environments, the serial search technique is considered and the performance measure is the MAT. This shows how the design of the correlation parameters affects the time to achieve synchronization

ULTRA-WIDEBAND (UWB) FOR MULTIMEDIA APPLICATIONS

UWB communication refers to impulse radio technology, in which wireless data is transferred using time domain modulation of data and extremely narrow radio impulses (i.e. nanosecond duration) that occupy typically several GHz of bandwidth. In this paper, we simulate an indoor environment whereby the channel characteristics model of UWB is observed - Saleh- Valenzuela-4 channel model is adopted-, and tested for the feasibility of UWB system in transmitting real time multimedia as incorporating a wireless link, which UWB is the first candidate to transfer these types of data due to its features, i.e. very high data rate (up to 500Mbps), multipath immunity, LPI. Certain aspects were emphasized such as multiple user and channel effects. Designing a wireless link for a streaming video and audio with a wire-like quality was the main objective of this paper

Sphenopalatine-sphenopalatine anastomosis: a unique cause of intractable epistaxis, safely treated with microcatheter embolization: a case report

Epistaxis is the most common emergency presenting to the ENT surgeon. Here we present a case of epistaxis arising from the sphenopalatine artery in a patient who had previously had the ipsilateral external carotid artery ligated due to previous epistaxis. On investigation the epistaxis was determined to arise from an anastamosis with the contralateral sphenopalatine artery. The anatomy was demonstrated with angiography and the epistaxis treated using microcatheter embolization. Anatomical variation can be a cause for failure of ligation as a permanent treatment for epistaxis. Embolization is used less frequently for epistaxis control due to concerns about the risks involved, but it can be a valuable treatment option in intractable epistaxis following a failure of arterial ligation

Atom-by-Atom Substitution of Mn in GaAs and Visualization of their Hole-Mediated Interactions

The discovery of ferromagnetism in Mn doped GaAs [1] has ignited interest in the development of semiconductor technologies based on electron spin and has led to several proof-of-concept spintronic devices [2-4]. A major hurdle for realistic applications of (Ga,Mn)As, or other dilute magnetic semiconductors, remains their below room-temperature ferromagnetic transition temperature. Enhancing ferromagnetism in semiconductors requires understanding the mechanisms for interaction between magnetic dopants, such as Mn, and identifying the circumstances in which ferromagnetic interactions are maximized [5]. Here we report the use of a novel atom-by-atom substitution technique with the scanning tunnelling microscope (STM) to perform the first controlled atomic scale study of the interactions between isolated Mn acceptors mediated by the electronic states of GaAs. High-resolution STM measurements are used to visualize the GaAs electronic states that participate in the Mn-Mn interaction and to quantify the interaction strengths as a function of relative position and orientation. Our experimental findings, which can be explained using tight-binding model calculations, reveal a strong dependence of ferromagnetic interaction on crystallographic orientation. This anisotropic interaction can potentially be exploited by growing oriented Ga1-xMnxAs structures to enhance the ferromagnetic transition temperature beyond that achieved in randomly doped samples. Our experimental methods also provide a realistic approach to create precise arrangements of single spins as coupled quantum bits for memory or information processing purposes

Mutation analysis of cell-free DNA and single circulating tumor cells in metastatic breast cancer patients with high CTC counts

Purpose: The purpose of this study was to directly compare mutation profiles in multiple single CTCs and cfDNA isolated from the same blood samples taken from patients with metastaic breast cancer (MBC). We aimed to determine whether cell-free DNA would reflect the heterogeneity observed in 40 single CTCs. Experimental design: CTCs were enumerated by Cellsearch. CTC count was compared with the quantity of matched cfDNA and serum CA15-3 and alkaline phosphatase (ALP) in 112 patients with metastatic breast cancer. In 5 patients with {greater than or equal to}100 CTCs, multiple individual EpCAM-positive CTCs were isolated by DEPArray and compared with matched cfDNA and primary tumour tissue by targeted next generation sequencing (NGS) of ~2200 mutations in 50 cancer genes. Results: In the whole cohort, total cfDNA levels and cell counts ({greater than or equal to}5 CTCs) were both significantly associated with overall survival, unlike CA15-3 and ALP. NGS analysis of 40 individual EpCAM-positive CTCs from 5 patients with MBC revealed mutational heterogeneity in PIK3CA, TP53, ESR1 and KRAS genes between individual CTCs. In all 5 patients cfDNA profiles provided an accurate reflection of mutations seen in individual CTCs. ESR1 and KRAS gene mutations were absent from primary tumour tissue and therefore likely reflect either a minor sub-clonal mutation or were acquired with disease progression. Conclusion: Our results demonstrate that cfDNA reflects persisting EpCAM-positive CTCs in patients with high CTC counts and therefore may enable monitoring of the metastatic burden for clinical decision-making. Experimental Design: DNA methylation was investigated in independent tumor cohorts using Illumina HumanMethylation arrays and gene expression by Affymetrix arrays and qRT-PCR. The role of Msh homeobox 1 (MSX1) in drug sensitivity was investigated by gene reintroduction and siRNA knockdown of ovarian cancer cell lines. Results: CpG sites at contiguous genomic locations within the MSX1 gene have significantly lower levels of methylation in independent cohorts of HGSOC patients, which recur by 6 months compared with after 12 months (P < 0.05, q < 0.05, n = 78), have poor RECIST response (P < 0.05, q < 0.05, n = 61), and are associated with PFS in an independent cohort (n = 146). A decrease in methylation at these CpG sites correlates with decreased MSX1 gene expression. MSX1 expression is associated with PFS (HR, 0.92; 95% CI, 0.85–0.99; P = 0.029; n = 309). Cisplatin-resistant ovarian cancer cell lines have reduced MSX1 expression, and MSX1 overexpression leads to cisplatin sensitization, increased apoptosis, and increased cisplatin-induced p21 expression. Conclusions: Hypomethylation of CpG sites within the MSX1 gene is associated with resistant HGSOC disease at presentation and identifies expression of MSX1 as conferring platinum drug sensitivity

Choosing the most suitable classifier For supporting assistive technology adoption In people with Parkinson’s disease: a fuzzy Multi-criteria approach

Parkinson’s disease (PD) is the second most common neurodegenerative disorder which requires a long-term, interdisciplinary disease management. While there remains no cure for Parkinson’s disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible. Owing to the global burden faced by chronic conditions such as PD, Assistive technologies (AT’s) are becoming an increasingly common prescribed form of treatment. Low adoption is hampering the potential of digital technologies within health and social care. It is then necessary to employ classification algorithms have been developed for differentiating adopters and non-adopters of these technologies; thereby, potential negative effects on people with PD and cost overruns can be further minimized. This paper bridges this gap by extending the Multi-criteria decision-making approach adopted in technology adoption modeling for people with dementia. First, the fuzzy Analytic Hierarchy Process (FAHP) is applied to estimate the initial relative weights of criteria and sub-criteria. Then, the Decisionmaking Trial and Evaluation Laboratory (DEMATEL) is used for evaluating the interrelations and feedback among criteria and sub-criteria. The Technique for Order of Preferences by Similarity to Ideal Solution (TOPSIS) is finally implemented to rank three classifiers (Lazy IBk – knearest neighbors, Naïve bayes, and J48 decision tree) according to their ability to model technology adoption. A real case study considering is presented to validate the proposed approach

PENGARUH BRAIN GYM TERHADAP KEMAMPUAN KOGNITIF LANSIA: NARRATIVE REVIEW

Latar Belakang : Proses penuaan dapat menyebabkan banyak perubahan yang terjadi pada lansia, salah satunya adalah menurunnya fungsi otak serta fungsi kognitif. Fungsi kognitif merupakan aktivitas mental secara sadar berupa kemampuan berpikir, mengingat, belajar dan bahasa. Untuk mengatasi penurunan kemampuan kognitif pada lansia tersebut adanya intervensi yaitu brain gym. Tujuan : Tujuan narrative review ini adalah untuk memberikan kepastian mengenai pengaruh brain gym terhadap kemampuan kognitif lansia. Metode Penelitian : Penyusunan skripsi ini menggunakan metode narrative review, yaitu mengumpulkan sebanyak 10 artikelartikel penelitian, dengan langkah awal yaitu melakukan identifikasi kata kunci menggunakan rumus atau format PICO (Population, Intervention, Comparison, Outcome) serta menetapkan kriteria inklusi dan ekslusi untuk menentukan artikel yang selanjutnya akan dipilih dan direview. Pencarian artikel-artikel penelitian dilakukan pada tiga database, yaitu Google Scholar, ResarchGate dan PubMed. Hasil Penelitian : Sebanyak sembilan artikel penelitian mengenai brain gym melaporkan hasil yang signifikan terhadap kemampuan kognitif lansia. Ada satu artikel penelitian mengenai brain gym melaporkan hasil yang tidak signifikan terhadap kemampuan kognitif lansia. Kesimpulan : Beberapa artikel penelitian membuktikan bahwa adanya pengaruh intervensi brain gym terhadap kemampuan kognitif lansia. Tetapi tidak semua artikel penelitian memberikan hasil yang signifikan. Saran : Peneliti selanjutnya dapat meneliti mengenai tema ini dengan metode penelitian lain, seperti eksperimental