The problems in using relative pronouns faced by the tenth grade students of MA Darul Ulum Palangka Raya

ABSTRACT The study is intended to know the problems in using relative pronouns faced by the tenth grade students of MA Darul ulum Palangka Raya.The sample of this study was the tenth grade students of MA Darul ulum Palangka Raya. The number of sample taken in this study was 67 students. The type used in this study was content analysis. It was done by analyzing students answers of test items. It was about the students’ problem in using relative pronouns in sentences. In collecting the data, it was used a test as the instrument in this study. They were who, whom, which, and whose. The data were processed through procedures such as editing, coding, scoring, and tabulating. The result of this study showed that the tenth grade students of MA Darul Ulum Palangka Raya had poor ability in using relative pronoun in sentence. It showed that they got 57.54% of their achievement mark in average. The students got problem in using the appropriate relative pronouns (who, whom, which, whose) in sentence. The students’ problem percentage in using relative pronoun whose was 32.69%, relative pronoun whom was 29.15%, relative pronoun which 24.38%, and relative pronoun who 13.78%. ABSTRAK Penelitian ini bertujuan untuk mengetahui masalah siswa dalam menggunakan Relative Pronouns yang dihadapi oleh siswa kelas X MA Darul Ulum Palangka Raya. Sampel penelitian ini adalah siswa kelas X MA Darul Ulum Palangka Raya. Jumlah sampel yang digunakan dalam penelitian ini adalah 67 siswa. Jenis penelitian yang digunakan dalam penelitian ini adalah penelitian content analysis.. Penelitian ini dilakukan dengan menganalisis isi dari jawaban siswa. Dalam pengumpulan data, digunakan tes sebagai instrument dalam penelitian ini. Instrumen itu mengacu kepada penggunaan who, whom, which, and whose. Data diolah sesuai dengan prosedur seperti editing, coding, scoring, dan tabulating. Hasil penelitian ini menunjukkan bahwa siswa kelas X MA Darul Ulum Palangka Raya memiliki kemampuan yang buruk dalam menggunakan Relative Pronouns dalam kalimat. Ini telah ditunjukkan bahwa sebanyak 57,54% mendapatkan nilai dibawah ketuntasan belajar. Persentase masalah siswa dalam menggunakan Relative Pronouns: whose adalah 32,69%, whom 29,15%, which 24,38%, dan who 13,78%

Jednostrana blizanačka tubarna trudnoća i slijedeća heterotopična trudnoća u bolesnice nakon izvantjelesne oplodnje

Unilateral twin tubal gestations are extremely rare with a reported incidence of 1 per 200 ectopic pregnancies. In recent years, the incidence of heterotopic pregnancy associated with in vitro fertilization and embryo transfer (IVF-ET) has risen to 1%-3% of achieved pregnancies. We report a very rare case of a 32-year-old woman with 6-year primary infertility with unilateral twin tubal pregnancy and subsequent heterotopic pregnancy following two IVF treatments. Her gynecologic history was notable for previous distal occlusion of the left fallopian tube treated by laparoscopic reconstructive surgery. After ovulation induction and IVF with ET of two embryos, transvaginal sonography at 6 weeks revealed two separate gestational sacs in the left adnexal mass. Emergency laparoscopy showed unruptured ampullar pregnancy and salpingectomy was carried out. On second IVF two years later, after ovulation induction and ET of three embryos, endovaginal sonography at 6 weeks revealed only one intrauterine sac. One week later, the patient complained of intermittent episodes of lower abdominal pain in the right quadrant. Ultrasound confirmed intrauterine pregnancy and revealed right tubal gestational sac. Laparoscopy showed unruptured right ampullar pregnancy and salpingectomy was performed. Histology of salpingectomy specimens showed signs of chronic infection in both tubes. The intrauterine pregnancy progressed to term when a healthy infant was delivered vaginally. Gynecologists should always consider the possibility of ectopic pregnancy in pregnancies following IVF-ET, particularly in cases with tubal disease and abdominal pain.Jednostrana blizanačka tubarna trudnoća je iznimno rijetka s pojavnošću od 1:200 ektopičnih trudnoća. Pojavnost heterotopične trudnoće u postupku izvantjelesne oplodnje je posljednjih godina u porastu i kreće se od 1% do 3% postignutih trudnoća. Prikazujemo vrlo rijedak slučaj 32-godišnje žene sa 6-godišnjom primarnom neplodnošću s jednostranom, blizanačkom trudnoćom u jajovodu i slijedećom heterotopičnom trudnoćom nakon dva postupka izvantjelesne oplodnje. Anamnestički je ranije utvrđeno terminalno začepljenje lijevog jajovoda uz rekonstrukcijski zahvat na njemu. Nakon indukcije ovulacije i postupka izvantjelesne oplodnje te prijenosa 2 zametka, sa 6 tjedana trudnoće transvaginalnim ultrazvukom otkrivene su 2 gestacijske vreće u predjelu lijevih adneksa. Pri laparoskopiji je prikazana nerupturirana tubarna trudnoća i odstranjen je lijevi jajovod. Pri drugom pokusaju izvantjelesne oplodnje 2 godine kasnije nakon indukcije ovulacije i prijenosa 2 zametka, sa 6 tjedana trudnoće transvaginalnim ultrazvukom prikazana je intrauterina trudnoća. Tjedan dana kasnije bolesnica je dobila povremene bolove u donjem dijelu trbuha desno. Ultrazvučno je potvrđena intrauterina trudnoća, a otkrivena trudnoća u desnom jajovodu. Laparoskopski je prikazana nerupturirana desnostrana tubarna trudnoća i odstranjen je jajovod. Patohistološki su kod oba jajovoda nađeni znaci kronične upale. Intrauterina trudnoća je napredovala do termina kada je vaginalno porođeno zdravo dijete. Svaki bi ginekolog trebao razmišljati o mogućnosti izvanmaternične trudnoće nakon postupka izvantjelesne oplodnje, a naročito u slučajevima oštećenih jajovoda i bolova u trbuhu

Plodnost nakon miomektomije

The aim of the present study was to analyze the effect of abdominal myomectomy on subsequent fertility. Medical records of 78 women having undergone myomectomy between 1980 and 2000 were retrospectively analyzed. A questionnaire was e-mailed to all women. The overall pregnancy rate in 66 patients that attempted pregnancy following myomectomy was 59.1%. The pre-myomectomy abortion rate of 35.4% fell to 22% after myomectomy. The incidence of cesarean section before and after myomectomy was 7.3 and 15.6%, respectively. Age above 30 at the time of myomectomy significantly reduced the chance of conception (P<0.0001). Subsequent fertility was significantly reduced by greater number and deeper localization of myomas (P<0.005 to P<0.001). The coexistence of pelvic infection and adhesiolysis significantly reduced the pregnancy rate (P<0.0001). Recurrence of uterine leiomyomas was recorded in 12.8% of study patients. More than half of the women with uterine leiomyomas were able to conceive and nearly half (48.5%) of them were able to bear children following myomectomy. Patient age at the time of myomectomy, the number and localization of leiomyomas, and coexistence of pelvic adhesions significantly reduced subsequent fertility. In spite of the emergence of new treatment options, it is evident that conventional abdominal myomectomy still has a major role in the treatment of women with fibroids.Cilj studije bio je analizirati utjecaj abdominalne miomektomije na kasniju plodnost. Od 1980. do 2000. godine miomi su enukleirani u 236 žena. Na upitnik je odgovorilo 78 (33,1%) žena, a od 66 žena koje su željele zatrudnjeti zanijelo ih je 39 (59,1%). Pojavnost spontanih pobačaja od 35,4% prije miomektomije smanjila se na 22% nakon operacije, a dovršenje trudnoće carskim rezom povisilo se sa 7,3% na 15,6%. Dob bolesnica iznad 30 godina u vrijeme operacije znakovito smanjuje izglede za začeće (P<0,0001). Veći broj mioma i njihova dublja lokalizacija znakovito smanjuju kasniju plodnost (P<0,005 do P<0,001). Istodobna prisutnost zdjelične upalne bolesti i operacijskog zahvata radi rješavanja priraslica znakovito smanjuju kasniju stopu začeća (P<0,0001). Ponovno javljanje mioma nakon operacije zabilježeno je u 12,8% žena. Više od polovice žena s miomima zainteresiranih za trudnoću je zanijelo, a gotovo polovica (48,5%) ih je rodila nakon miomektomije. životna dob bolesnice u vrijeme enukleacije mioma, broj i njihova lokalizacija te istodobna prisutnost priraslica u zdjelici znakovito smanjuju kasniju plodnost. Unatoč pojavljivanja novih terapijskih mogućnosti konvencionalna abdominalna miomektomija još uvijek igra glavnu ulogu u liječenju bolesnica s miomima

SINDROM HIPERSTIMULACIJE JAJNIKA

In the article all the basic characteristics, clinical significance, risk factors, pathogenesis, prevention and treatment modalities of ovarian hyperstimulation syndrome were described. In the introduction all the main characteristics,¬ classifications and incidence of the syndrome were noted. The best known risk and predictive factors that characterize the patients at risk with their significance include polycystic ovarian disease, multiple and immature follicles, young age (3000 pg/ml), hypothyroidism, hyperprolactinemia, oligomenorrhea, anovulatory infertility, stimulation protocols with gonadotrophin releasing hormone agonists, and human chorionic gonadotrophin for the induction of ovulation and luteal support were reported. To understand modern etiologic aspects and pathophysiologic mechanisms in the development of the syndrome the underlying causes of all relevant vasoactive substances¬ were described. In the prophylaxis of the syndrome all significant and judicious methods and procedures which could prevent the appearance of symptoms were reported. Modern strategies for the treatment of OHSS which include macromolecular plasma expanders with its usefulness and controversies, diuretics, paracentesis, anticoagulants and surgery, that could reduce the complications and long-term sequels were described.U članku su opisane temeljne karakteristike, rizični faktori, patogeneza, prevencija i liječenje sindroma hiperstimulacije jajnika. U uvodu članka istaknut je patološki supstrat, klinički značaj bolesti i komplikacije koje mogu vitalno ugroziti zdravlje bolesnica. Učestalost i klinička slika sindroma hiperstimulacije klasificirana je prema težini i brojnosti postojećih simptoma, lokalnom nalazu, poremećajima u krvnoj slici, pojavi ascitesa i općem stanju, na tri stupnja bolesti: blagi, srednji i teški. U poglavlju o rizičnim faktorima istaknute su skupine bolesnica koje treba uočiti prije profilakse i liječenja bolesti, od kojih su najvažniji sindrom policističnih jajnika, multipli i nezreli folikuli, mlađa životna dob (3000 pg/ml), hipotireoza, hiperprolaktinemija, oligomenoreja, anovulacijska neplodnost, stimulacijski protokoli s agonistima gonadotropnih oslobađajućih hormona te egzogeni ili endo¬geni (rana trudnoća) humani korionski gonadotropin. U poglavlju o patofiziologiji koja još nije potpuno razjašnjena, navedeni su, prema najnovijim spoznajama, značaj citokina i mehanizmi njihova djelovanja u nastanku bolesti. Istaknuta je ključna uloga prevencije u olakšavanju ili sprečavanju sindroma hiperstimulacije primjenom raznih metoda, od kojih se navode prestanak ili prolazno odustajanje od stimulacije u tom ciklusu, smanjivanje doze humanog korionskog gonadotropina te primjena rekombinantnog luteinizirajućeg hormona ili agonista gonadotropnog oslobađajućeg hormona za induk¬ciju ovulacije, antidota ili inhibitora citokina, kortikosteroida, metformina te aspiracije folikula. U liječenju bolesti potvrđena je vrijednost plazma ekspandera albumina, premda su kasnija istraživanja relativizirala njegovu djelotvornost, učinivši ju prijepornom, upitnom ili čak štetnom. U terapijskom pristupu nadalje su istaknuti važnost, opravdanost te indikacije za primjenu diuretika, antikoagulancija, paracentezu i kirurškog liječenja

LIJEČENJE RAKA DOJKE I KASNIJA PLODNOST

The article presents an overview regarding the influence of breast cancer treatment on later fertility. Al-though breast-conserving surgery is desirable in nulliparous women regarding later fertility, however because of a greater risk of local recurrence it is often accompanied by adjuvant therapy including chemotherapy, ovarian ablation, anti-estro-gen therapy and combination of these. Although chemotherapy and radiotherapy have increased long-term survival of premenopausal women with breast cancer, sometimes the price paid is ovarian failure with subsequent amenorrhea and infertility. However, currently several fertility-sparing options including the use of endocrine therapy and assisted reproduc-tive technologies, cryopreservation and ovarian tissue transplantation, are showing a very promising role. The offspring of patients who became pregnant after completion of chemotherapy have shown no adverse effects and congenital anomalies from the treatment, but sometimes high abortion (29%) and premature deliveries with low birth weight (40%) rates have been demonstrated. Therefore, the issue of recent cytotoxic treatment remains controversial and further researches are required to define a »safety period« between cessation of treatment and pregnancy.Rak dojke kao najčešći maligni tumor u žena nalazimo uglavnom u starijoj životnoj dobi, nakon menopauze, ali je u oko četvrtine svih slučajeva u žena mlađih od 50. godine. U razvijenim zemljama suvremenog svijeta zbog brojnih razloga opća je pojava kasnijeg sklapanja braka i rađanja, što je pridonijelo snižavanju nataliteta i relativno većem broju nulipara kasnije reprodukcijske dobi. S druge strane, viši životni standard i razvoj znanosti poboljšali su kvalitetu življenja koja uključuje i kvalitetniju zdravstvenu uslugu. Premda bi suvremena medicina trebala dovesti do zdravije populacije, ipak bolja dijagnostika i liječenje na sve brojnijoj populaciji žena poodmakle životne dobi koje još nisu rodile, omogućuje sve češće i ranije otkrivanje raka dojke žena kojima još predstoji rađanje. Stoga je za očekivati da ćemo se sve češće susretati s problemom kako će se liječenje novootkrivenog raka dojke u populaciji žena koje su odgodile rađanje, odraziti na kasniju fertilnost. Premda bi konzervativni kirurški zahvat kod ranog stadija raka dojke bio poželjan što se tiče rizičnosti i utjecaja na kasniju plodnost, nažalost zbog češće kasnije pojave lokalnih recidiva bolesti to nije konačno liječenje i zato je potrebna adjuvantna terapija. Nakon liječenja raka dojke zračenjem nisu opaženi nepovoljni učinci na kasniju plodnost, osim reducirane laktacije, a kod djece ni nakon nekoliko godina nisu uočene nikakve malformacije. Nakon primjene kemoterapije raka postiže se relativno povoljan terapijski učinak, no nažalost često se dugoročno javljaju nepoželjne ili toksične nuspojave te zbog oštećenja jajnika pojava amenoreje od 40% do 68%, uz druge simtome prijevremene meno-pauze. Oštećenje tkiva jajnika ovisno je od starosti bolesnice i veće je kod manje ovarijske pričuve, a ovisi još i o trajanju, dozi, vrsti liječenja te o drugim čimbenicima. Mehanizam nepovoljnog djelovanja na tkivo jajnika je uglavnom izazivanje apoptoze zrnatih stanica primordijalnih folikula, uz nepovratni gubitak svih folikula i jajnih stanica s posljedičnom fibro-zom i atrofijom. Preporučeno prosječno vrijeme nezanošenja nakon kemoterapije je između dvije i pet godina; u to se vrijeme preporuča uporaba barijernih metoda kontracepcije. Da bi se izbjegli dugoročni nepovoljni učinci toksičnosti kemoterapije na plodnost u premenopauzalnih žena s rakom jajnika, koje bi htjele kasnije rađati, alternativno je indicirana primjena endokrinološke terapije (gonadotropni otpuštajući hormon i tamoksifen). Kako učinkovitost citostatične terapije povoljno djeluje na izlječenje, zbog čega preživljava sve više žena u premenopauzi s rakom dojke, sve je veća kasnije zainteresiranost tih bolesnica za trudnoćom. Kod takvih bolesnica suočenih s prijetećom prijevremenom menopauzom i željom za potomstvom, zahvaljujući znanstvenom i tehnološkom napretku, danas se primjenjuje više tehnološki asistiranih postupaka. U izboru je mogućnost liječenja kasnije plodnosti postupkom izvantjelesne oplodnje u prirodnom ili induciranom ciklusu (tamoksifen, letrozol, polovične doze folikularnog stimulirajućeg hormona), krioprezervacijom embrija ili ovarij-skog tkiva s reimplantacijom

Local Definability of HOD\mathsf{HOD} in L(R)L(\mathbb{R})

We show that in $L(\mathbb{R})$, assuming large cardinals, $\mathsf{HOD} {\parallel}\eta^{+\mathsf{HOD}}$ is locally definable from $\mathsf{HOD} {\parallel}\eta$ for all $\mathsf{HOD}$-cardinals $\eta\in [\boldsymbol{\delta}^2_1,\Theta)$. This is a further elaboration of the statement "$\mathsf{HOD}^{L(\mathbb{R})}$ is a core model below $\Theta$" made by John Steel

General Business Procedures and Practices Standardization as an Instrument for Ensuring Business Survival: An Empirical Based Proposition

The worst state of a business is that of failure that may result into liquidation. A business owner or other business stakeholders never pray to experience such state. It, however, occurs very frequently, most especially, to small businesses and sometimes to big businesses and it is usually with enormous consequences. Whether an endeavor prospers or fails is, generally, a big function of the way and manner of the procedures and operations of that endeavor. It, therefore, implies that business procedures and practices should be executed in such a manner that they ensure prosperity. The general objective of this study was to investigate if business procedures and practices standardization can help businesses and consequently reduce business failure rate. Primary data were collected through a well-structured questionnaire, administered to stakeholders of business organizations in Nigeria. The responses were analyzed using the mean and standard deviation and the results were tested using the ‘Z’ statistics which was revalidated with ANOVA. The study revealed that stakeholders are of the opinion that business practices and procedures can be standardized and are in support of it. The study, consequently, recommended that existing standard setting agencies, that are related to business, should come together with other related and experienced experts, at national and international levels, to develop, on a continuous basis, standards that can guide and regulate relevant, yet standardized, activities of business organizations

Novi uvidi u predskazivanju ovarijskog hiperstimulacijskog sindroma

Ovarian hyperstimulation syndrome is the most dangerous complication following the administration of gonadotropins. There is no preventive and pharmacological intervention that can fully prevent development of this syndrome. The best strategy to reduce the incidence of the condition is to identify the patients at risk before ovarian stimulation and to recognize potential predictors. A history of ovarian hyperstimulation is an important risk factor for recurrence of the syndrome. The risk of the syndrome is evident with elevated gonadotropin dosages and with the use of gonadotropin releasing hormone agonists. Human chorionic gonadotropin is the main risk factor. The combination of pretreatment diagnosis of polycystic ovary disease and estradiol of 4500 pg/ mL gives higher prediction rates for the risk factor. Serum concentration of inhibin is not a reliable predictor of the syndrome. Recent evaluation of antimüllerian hormone as a reliable predictor candidate, vascular endothelial growth factor with cadherin as indicators of vascular permeability, and detection of mutations in the follicular stimulating hormone receptor as predictors of severity offer new insights in the prognosis of the syndrome. Identification of these prognostic markers in patients at risk would be very useful for prevention of the syndrome prior to the appearance of symptoms.Ovarijski stimulacijski sindrom je najopasnija komplikacija nakon primjene gonadotropina. Ne postoji nijedna preventivna ni farmakološka intervencija koja u potpunosti sprječava pojavu ovoga sindroma. Najbolja strategija koja smanjuje pojavnost takvog stanja je identifikacija rizičnih bolesnica prije stimulacije ovulacije te prepoznavanje mogućih predznaka bolesti. Anamnestički podatak o ranijoj hiperstimulaciji jajnika predstavlja važan rizični čimbenik za ponovno javljanje sindroma. Rizičnost za nastanak sindroma je očita pri korištenju gonadotropina u većim dozama, kao i kod primjene agonista gonadotropnog otpuštajućeg hormona. Humani korionski gonadotropin je glavni rizični čimbenik. Kombinacija prethodno utvrđene dijagnoze policističnih ovarija te koncentracija estradiola iznad 4500 pg/mL omogućuju bolje predskazivanje čimbenika rizičnosti. Koncentracija inhibina u serumu nije pouzdana u predikciji sindroma. Nedavne spoznaje o antimilerovom hormonu kao pouzdanom kandidatu u predskazivanju sindroma, vaskularnom faktoru rasta s kaderinom kao pokazateljima vaskularne propusnosti te otkriće mutacija receptora folikularno stimulirajućeg hormona koji ukazuju na težinu bolesti predstavljaju nove uvide u prognozi ovoga sindroma. Prepoznavanje ovih prognostičkih biljega u rizičnoj skupini bolesnica bilo bi vrlo korisno u prevenciji sindroma prije pojave simptoma bolesti

Liječenje ovarijskog hiperstimulacijskog sindroma: novi uvidi

Ovarian hyperstimulation syndrome is the most serious iatrogenic complication resulting from ovarian stimulation. Currently there is no clear evidence of absolute efficacy for most of standard preventive and curative methods. Recent studies indicate that human chorionic gonadotropin increases vascular endothelial growth factor, vascular endothelial cadherin and vascular permeability via endothelial adherence junctions. Vascular endothelial growth factor plays a pivotal role in the pathophysiology of the condition and therefore vascular endothelial factor antagonism has been suggested for the prevention of the syndrome. Since vascular endothelial growth factor is also a physiological regulator of folliculogenesis, progesterone secretion and endometrial angiogenesis, its complete inactivation by specific blockers could produce undesirable effects interfering with early pregnancy development and therefore they cannot be used clinically. Recently, low doses of dopamine agonists (cabergoline) have been shown to counteract vascular endothelial growth factor induced vascular hyperpermeability, reducing the incidence of the syndrome by prophylactic treatment without compromising pregnancy outcome. The absence of undesirable side effects could make cabergoline an effective and safe etiologic approach for the prevention and treatment of the syndrome. A novel approach has suggested that metformin may also be helpful in the syndrome prevention in women with or without polycystic ovary disease.Ovarijski hiperstimulacijski sindrom je najozbijnija jatrogena komplikacija koja nastaje nakon stimulacije jajnika. Zasad nema jasnih dokaza o apsolutnoj djelotvornosti većine standardnih i preventivnih i kurativnih metoda. Novije studije pokazuju da humani korionski gonadotropin povisuje vaskularni čimbenik rasta, vaskularni endotelni kaderin i vaskularnu propusnost na spojevima adherentnog endotela. Kako vaskularni endotelni čimbenik rasta igra ključnu ulogu u patofiziologiji sindroma, ukazuje se na onemogućavanje djelovanja vaskularnog čimbenika rasta u prevenciji bolesti. Budući da je vaskularni čimbenik rasta ujedno i fiziološki regulator folikulogeneze, stvaranja progesterona i krvnih žila endometrija, njegova bi potpuna inaktivacija specifičnim blokatorima dovela do neželjenih nuspojava koje bi ometale razvoj rane trudnoće, što onemogućuje njihovu kliničku primjenu. Odnedavno se pokazalo kako niske doze agonista dopamina (kabergolin) suzbijaju pojačanu vaskularnu propusnost izazvanu vaskularnim endotelnim čimbenikom rasta, smanjujući profilaktično pojavnost sindroma bez nepovoljnog djelovanja na ishod trudnoće. Zbog izostanka nepoželjnih nuspojava kabergolin bi mogao biti djelotvoran i siguran u etiološkom pristupu te u prevenciji i liječenju sindroma. Noviji pristup ukazuje na to da primjena metformina može isto koristiti u prevenciji sindroma kod žena s policističnim jajnicima ili bez njih