Profil Rasio Koleterol Ldl dan Hdl pada Pasien Stroke di Bagian Saraf RSUD Arifin Achmad Provinsi Riau Periode Januari Sampai Desember 2012

Dyslipidemia is one of an important stroke risk factor. This case would be strengthened if there are other risk factors for stroke. One form of dyslipidemia is high of LDL and HDL cholesterol ratio causes atherosclerosis. The purpose of this research was to know the profile of LDL and HDL cholesterol ratio in stroke patients in Neurology Department Arifin Achmad General Hospital of Riau Province during January – December 2012. This was a descriptive retrospective study. Data is used about 95 medical record of stroke patients. The LDL and HDL cholesterol levels of patients were classified based on the NCEP ATP III classification. Data obtained from this study is that stroke patients have optimal LDL cholesterol (9,47%), above optimal (15,79%), borderline high (26,31%), high (24,21%, very high (24,21%). Low HDL cholesterol (50,53%), moderate (44,21%), and high (5,27%). LDL and HDL cholesterol ratio of 3,5 (60%). The result of this study indicate that the majority of stroke patients had LDL and HDL cholesterol ratio of >3,5

Critical design factors on performance of car jack lifting operations

Car jack is an equipped accessory package in every units of car sold to customer that used to uplift the cars while replacing tires during an emergency or repair. The automotive manufacturers are actively conducting their Product Improvement Campaign and the objective of the campaign is to improve the quality of product sold to the customers. The current jack design has a possibility of failure during its operations. The customer satisfaction point of view will be converted to engineering characteristic to acquire the concept of design and input into new design proposal and at the same time eliminate the possibility of failure of the current design. The research is conducted to improve the current jack design on its performance in lifting operations. The scope of research is to identify the critical zone in jack design structure that possibly causing the failure during its operations. To optimize the existing design, it is proposed some modification on the jack structure with a minimum weight increment but improve the design structural strength. The failure root cause analysis, reliability test and Design Failure Mode and Effect Analysis have been used to identify the specific critical area in the structure and resolve them by proposing the new improved jack design. The current car jack sample in market is used as an industrial sample for design analysis to find the target area for further improvement. From the analysis, we can know the critical design factors in the current car jack design and the required design improvement to enhance its performance in lifting operations

Polyoxymethylene (POM) integrity resulting from its dependencies on material geometries and processing methodology

POM-copolymer bond breaking leads to change depending with respect to processing methodology and material geometries. This paper present the oversights effect on the material integrity due to different geometries and processing methodology. Thermo-analytical methods with reference were used to examine the degradation of thermomechanical while Thermogravimetric Analysis (TGA) was used to judge the thermal stability of sample from its major decomposition temperature. Differential Scanning Calorimetry (DSC) investigation performed to identify the thermal behaviour and thermal properties of materials. The result shown that plastic gear geometries with injection molding at higher tonnage machine more stable thermally rather than resin geometries. Injection plastic gear geometries at low tonnage machine faced major decomposition temperatures at 313.61˚C, 305.76 ˚C and 307.91 ˚C while higher tonnage processing method are fully decomposed at 890˚C, significantly higher compared to low tonnage condition and resin geometries specimen at 398˚C. Chemical composition of plastic gear geometries with injection molding at higher and lower tonnage are compare based on their moisture and VOC content, polymeric material content and the absence of filler. Results of higher moisture and VOC content are report in resin geometries (0.120%) compared to higher tonnage of injection plastic gear geometries which is 1.264%. The higher tonnage of injection plastic gear geometry are less sensitive to thermo-mechanical degradation due to polymer chain length and molecular weight of material properties such as tensile strength, flexural strength, fatigue strength and creep resistance

Characterization of the colonic response to bisacodyl in children with treatment-refractory constipation

Background: Colonic manometry with intraluminal bisacodyl infusion can be used to assess colonic neuromuscular function in children with treatment‐refractory constipation. If bisacodyl does not induce high‐amplitude propagating contractions (HAPCs), this can be an indication for surgical intervention. A detailed characterization of the colonic response to intraluminal bisacodyl in children with constipation may help to inform clinical interpretation of colonic manometry studies. / Methods: Studies were performed in five pediatric hospitals. Analysis included identification of HAPCs, reporting HAPCs characteristics, and an area under the curve (AUC) analysis. Comparisons were performed between hospitals, catheter type, placement techniques, and site of bisacodyl infusion. / Results: One hundred and sixty‐five children were included (median age 10, range 1‐17 years; n = 96 girls). One thousand eight hundred and ninety‐three HAPCs were identified in 154 children (12.3 ± 8.8 HAPCs per child, 0.32 ± 0.21 HAPCs per min; amplitude 113.6 ± 31.5 mm Hg; velocity 8.6 ± 3.8 mm/s, propagation length 368 ± 175 mm). The mean time to first HAPC following bisacodyl was 553 ± 669 s. Prior to the first HAPC, there was no change in AUC when comparing pre‐ vs post‐bisacodyl (Z = −0.53, P = .60). The majority of HAPCs terminated in a synchronous pressurization in the rectosigmoid. Defecation was associated with HAPCs (χ 2(1)=7.04, P < .01). Site of bisacodyl administration, catheter type, and hospital location did not alter the response. / Conclusions and Inferences: Intraluminal bisacodyl induced HAPCs in 93% of children with treatment‐refractory constipation. The bisacodyl response is characterized by ≥1 HAPC within 12 minutes of infusion. The majority of HAPCs terminate in a synchronous pressurization in the rectosigmoid. Optimal clinical management based upon colonic manometry findings is yet to be determined

Effects of monochromatic infrared energy therapy on diabetic feet with peripheral sensory neuropathy: a randomised controlled trial

ABSTRACT Introduction: Peripheral diabetic neuropathy, which is a cause of increasing morbidity and mortality following foot ulcers and amputations

Corneal Confocal Microscopy to Image Small Nerve Fiber Degeneration: Ophthalmology Meets Neurology.

Neuropathic pain has multiple etiologies, but a major feature is small fiber dysfunction or damage. Corneal confocal microscopy (CCM) is a rapid non-invasive ophthalmic imaging technique that can image small nerve fibers in the cornea and has been utilized to show small nerve fiber loss in patients with diabetic and other neuropathies. CCM has comparable diagnostic utility to intraepidermal nerve fiber density for diabetic neuropathy, fibromyalgia and amyloid neuropathy and predicts the development of diabetic neuropathy. Moreover, in clinical intervention trials of patients with diabetic and sarcoid neuropathy, corneal nerve regeneration occurs early and precedes an improvement in symptoms and neurophysiology. Corneal nerve fiber loss also occurs and is associated with disease progression in multiple sclerosis, Parkinson's disease and dementia. We conclude that corneal confocal microscopy has good diagnostic and prognostic capability and fulfills the FDA criteria as a surrogate end point for clinical trials in peripheral and central neurodegenerative diseases

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery