Universitas Jember

Autologous bone grafts harvested from the iliac crest are commonly used in reconstructive orthopaedic surgery. Autologous bone is used to help promote bone healing in fractures and to provide structural support for reconstructive surgery. The results of autologous bone grafting are more predictable than the use of xenografts, cadaveric allografts, or synthetic bone substitutes because autologous bone grafts provide osteoinductive and osteoconductive properties, are not immunogenic, and are usually well incorporated into the graft site. In a retrospective review of 414 consecutive cases of iliac crest bone graft procedures performed at Brooke Army Medical Center from 1983 to 1993, 41 (10%) minor and 24 (5.8%) major complications were identified. Minor complications included superficial infections, superficial seromas, and minor hematomas. Major complications included herniation of abdominal contents through massive bone graft donor sites, vascular injuries, deep infections at the donor site, neurologic injuries, deep hematoma formation requiring surgical intervention, and iliac wing fractures. Harvesting of iliac crest bone graft can be associated with significant morbidity. However, with adequate preoperative planning and proper surgical technique, the incidence of these complications can be reduced.

Anesthesia Research Unit and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada *Corresponding author. McGill University, Anesthesia Research Unit, 3655 Prom. Sir William Osler, Room 1220, Montreal, Quebec H3G 1Y6. Tel.: +1-514-398-3493; fax: +1-514-398-8241 E-mail: [email protected] Submitted December 19, 2001; accepted December 20, 2001.

PURPOSE: To evaluate the complication rate of corneal crosslinking (CXL) for primary keratectasia and to develop recommendations for avoiding complications. SETTING: Institut für Refraktive und Ophthalmo-Chirurgie, Zurich, Switzerland. METHODS: In a prospective study, eyes with verified progressive keratectasia had standard CXL. Preoperative and 6- and 12-month postoperative examinations included corrected distance visual acuity (CDVA), slitlamp evaluation, applanation tonometry, and Scheimpflug imaging (Pentacam). Statistical analysis included analysis of variance and the Mann-Whitney U test to detect risk factors for complications. RESULTS: The study evaluated 117 eyes of 99 patients; approximately 90% completed the 12-month follow-up. The complication rate (percentage of eyes losing 2 or more Snellen lines) was 2.9% (95% confidence interval, 0.6%-8.5%). The failure rate of CXL (percentage of eyes with continued progression) was 7.6%. Age older than 35 years and a preoperative CDVA better than 20/25 were identified as significant risk factors for complications. A high preoperative maximum keratometry (K) reading was a significant risk factor for failure. Sterile infiltrates were seen in 7.6% of eyes and central stromal scars, in 2.8%. CONCLUSIONS: Results indicate that changing the inclusion criteria may significantly reduce the complications and failures of CXL. A preoperative maximum K reading less than 58.00 diopters may reduce the failure rate to less than 3%, and restricting patient age to younger than 35 years may reduce the complication rate to 1%.

PURPOSE: To report the clinical results of small incision lenticule extraction to correct refractive errors using a femtosecond laser to refine the femtosecond lenticule extraction technique. SETTING: Private laser center, Vadodara, India. DESIGN: Prospective clinical study. METHODS: The VisuMax femtosecond laser system was used to perform small incision lenticule extraction to treat refractive errors. The laser was used to cut a refractive lenticule intrastromally to correct myopia and myopic astigmatism. The lenticule was then extracted from the stroma through a 3.0 to 5.0 mm incision. Outcome measures were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), and manifest refraction during 6 months of follow-up. Corneal topography and ocular wavefront aberrations were also measured. RESULTS: The study enrolled 51 eyes of 41 patients. The mean spherical equivalent was -4.87 diopters (D) ± 2.16 (SD) preoperatively and +0.03 ± 0.30 D 6 months postoperatively. Refractive stability was achieved within 1 month (P<.01). Six months after surgery, 79% of all full-correction cases had a UDVA of 20/25 or better. The 6-month postoperative CDVA was the same as or better than the preoperative CDVA in 95% of eyes. Two eyes lost 1 line of CDVA. CONCLUSION: All-in-one femtosecond refractive correction using a small incision technique was safe, predictable, and effective in treating myopia and myopic astigmatism. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Over recent years, enthusiasm towards the manufacturing of biopolymers has attracted considerable attention due to the rising concern about depleting resources and worsening pollution. Among the biopolymers available in the world, polylactic acid (PLA) is one of the highest biopolymers produced globally and thus, making it suitable for product commercialisation. Therefore, the effectiveness of natural fibre reinforced PLA composite as an alternative material to substitute the non-renewable petroleum-based materials has been examined by researchers. The type of fibre used in fibre/matrix adhesion is very important because it influences the biocomposites' mechanical properties. Besides that, an outline of the present circumstance of natural fibre-reinforced PLA 3D printing, as well as its functions in 4D printing for applications of stimuli-responsive polymers were also discussed. This research paper aims to present the development and conducted studies on PLA-based natural fibre bio-composites over the last decade. This work reviews recent PLA-derived bio-composite research related to PLA synthesis and biodegradation, its properties, processes, challenges and prospects.

PURPOSE: To analyze the reasons for patient dissatisfaction after phacoemulsification with multifocal intraocular lens (IOL) implantation and the outcomes after intervention. SETTING: Emory Eye Center, Atlanta, Georgia, USA. METHODS: This retrospective review comprised eyes of patients dissatisfied with visual outcomes after multifocal IOL implantation. Outcomes analyzed included type of visual complaint, treatment modality for each complaint, and degree of clinical improvement after intervention. RESULTS: Thirty-two patients (43 eyes) reported unwanted visual symptoms after multifocal IOL implantation, including in 28 eyes (65%) with an AcrySof ReSTOR IOL and 15 (35%) with a ReZoom IOL. Thirty patients (41 eyes) reported blurred vision, 15 (18 eyes) reported photic phenomena, and 13 (16 eyes) reported both. Causes of blurred vision included ametropia (12 eyes, 29%), dry eye syndrome (6 eyes, 15%), posterior capsule opacification (PCO) (22 eyes, 54%), and unexplained etiology (1 eye, 2%). Causes of photic phenomena included IOL decentration (2 eyes, 12%), retained lens fragment (1 eye, 6%), PCO (12 eyes, 66%), dry-eye syndrome (1 eye, 2%), and unexplained etiology (2 eyes, 11%). Photic phenomena attributed to PCO also caused blurred vision. Thirty-five eyes (81%) had improvement with conservative treatment. Five eyes (12%) did not have improvement despite treatment combinations. Three eyes (7%) required IOL exchange. CONCLUSIONS: Complaints of blurred vision and photic phenomena after multifocal IOL implantation were effectively managed with appropriate treatment. Few eyes (7%) required IOL exchange. Neodymium:YAG capsulotomy should be delayed until it has been determined that IOL exchange will not be necessary.

Ionic and osmotic relations in quinoa (Chenopodium quinoa Willd.) were studied by exposing plants to six salinity levels (0-500 mM NaCl range) for 70 d. Salt stress was administered either by pre-mixing of the calculated amount of NaCl with the potting mix before seeds were planted or by the gradual increase of NaCl levels in the irrigation water. For both methods, the optimal plant growth and biomass was achieved between 100 mM and 200 mM NaCl, suggesting that quinoa possess a very efficient system to adjust osmotically for abrupt increases in NaCl stress. Up to 95% of osmotic adjustment in old leaves and between 80% and 85% of osmotic adjustment in young leaves was achieved by means of accumulation of inorganic ions (Na(+), K(+), and Cl(-)) at these NaCl levels, whilst the contribution of organic osmolytes was very limited. Consistently higher K(+) and lower Na(+) levels were found in young, as compared with old leaves, for all salinity treatments. The shoot sap K(+) progressively increased with increased salinity in old leaves; this is interpreted as evidence for the important role of free K(+) in leaf osmotic adjustment under saline conditions. A 5-fold increase in salinity level (from 100 mM to 500 mM) resulted in only a 50% increase in the sap Na(+) content, suggesting either a very strict control of xylem Na(+) loading or an efficient Na(+) removal from leaves. A very strong correlation between NaCl-induced K(+) and H(+) fluxes was observed in quinoa root, suggesting that a rapid NaCl-induced activation of H(+)-ATPase is needed to restore otherwise depolarized membrane potential and prevent further K(+) leak from the cytosol. Taken together, this work emphasizes the role of inorganic ions for osmotic adjustment in halophytes and calls for more in-depth studies of the mechanisms of vacuolar Na(+) sequestration, control of Na(+) and K(+) xylem loading, and their transport to the shoot.

Polylactic acid (PLA) is a thermoplastic polymer produced from lactic acid that has been chiefly utilized in biodegradable material and as a composite matrix material. PLA is a prominent biomaterial that is widely used to replace traditional petrochemical-based polymers in various applications owing environmental concerns. Green composites have gained greater attention as ecological consciousness has grown since they have the potential to be more appealing than conventional petroleum-based composites, which are toxic and nonbiodegradable. PLA-based composites with natural fiber have been extensively utilized in a variety of applications, from packaging to medicine, due to their biodegradable, recyclable, high mechanical strength, low toxicity, good barrier properties, friendly processing, and excellent characteristics. A summary of natural fibers, green composites, and PLA, along with their respective properties, classification, functionality, and different processing methods, are discussed to discover the natural fiber-reinforced PLA composite material development for a wide range of applications. This work also emphasizes the research and properties of PLA-based green composites, PLA blend composites, and PLA hybrid composites over the past few years. PLA's potential as a strong material in engineering applications areas is addressed. This review also covers issues, challenges, opportunities, and perspectives in developing and characterizing PLA-based green composites.

Purpose Institutional governance theory is used to explain voluntary corporate greenhouse gas (GHG) reporting in the context of a market governance system in the absence of climate change public policy. This paper seeks to hypothesise that GHG reporting is related to internal organisation systems, external privately promulgated guidance and EU ETS trading. Design/methodology/approach A two‐stage approach is used. The initial model examines whether firms' GHG disclosures are associated with internal organisation systems factors: environmental management systems (EMS), corporate governance quality and environmental management committees as well as external private guidance provided by the Global Reporting Initiative (GRI) and the Carbon Disclosure Project (CDP) for 187 ASX 300 firms. EU ETS trading is also included. Determinants of the extent and credibility of GHG disclosure is examined in the second stage where an index constructed from the GHG reporting standard “ISO 14064‐1” items for a sub‐sample of 80 disclosing firms as the dependent variable. Findings Firms that voluntarily disclose GHGs have EMSs (uncertified and certified), higher corporate governance quality and publicly report to the CDP, tend to be large and in the energy and mining and industrial sectors. The credibility and extent of disclosures are related to the existence of a certified EMS, public reporting to the CDP, and use of the GRI. Firms that disclose more credible information are more likely to be large and in the energy and mining, industrial and services sectors. Originality/value The paper shows that some proactive but pragmatic Australian firms are disclosing their GHGs voluntarily for competitive advantage in the current market governance system in the absence of public policy.

To get a compliant active exoskeleton controller, the force interaction controllers are mostly used in form of either the impedance or admittance controllers. The impedance or admittance controllers can only work if they are followed by either the force or the position controller respectively. These combinations place the impedance or admittance controller as high-level controller while the force or position controller as low-level controller. From the application point of view, the exoskeleton controllers are equipped by task controllers that can be formed in several ways depend on the aims. This paper presents the review of the control systems in the existing active exoskeleton in the last decade. The exoskeleton control system can be categorized according to the model system, the physical parameters, the hierarchy and the usage. These considerations give different control schemes. The main consideration of exoskeleton control design is how to achieve the best control performances. However, stability and safety are other important issues that have to be considered.

PURPOSE: To compare the repeatability of three measures of corneal thickness: Orbscan Slitscan pachymetry, ultrasound pachymetry, and optical pachymetry. METHODS: Twenty normal subjects were tested on three occasions. Two occurred on the same day and the third was on a different day at approximately the same time of day as one of the first two visits. Central corneal thickness of the right eye was measured with a Haag-Streit optical pachymeter, a Humphrey Model 855 ultrasound pachymeter, and the Orbscan system. Day-to-day and same-day repeatability was assessed by calculating the difference between the values from two visits and determining the mean difference, the SD, and the 95% limits of agreement (LoA) (LoA = mean +/- 1.96 SD). RESULTS: Mean (+/- SD) central corneal thickness as measured by each instrument was as follows: 539 +/- 33 microm for optical pachymetry, 542 +/- 33 microm for ultrasound pachymetry, and 596 +/- 40 microm for Orbscan pachymetry. For day-to-day comparisons, optical pachymetry showed the poorest repeatability with 95% LoA of -61 to +32 microm. Ultrasound pachymetry showed better repeatability with 95% LoA of -22 to +24 microm. The Orbscan showed the best repeatability centrally with 95% LoA of -10 to +17 microm. Peripheral Orbscan pachymetry was less repeatable than that measured centrally but still more repeatable than central optical pachymetry. Similar results were found with same-day comparisons. CONCLUSION: The Orbscan system is the most repeatable technique for measuring corneal thickness but shows a significant bias toward greater corneal thickness measures than both ultrasound and optical pachymetry.

Background: Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV2 recently became a pandemic worldwide, such as in Indonesia. Social distancing is one of the recommended mitigations to reduce the risk of disasters, such as morbidity and mortality caused by COVID-19. Community compliance with social distancing is a part of the pandemic control.Aims: This study identified knowledge, attitudes, and behavior towards the prevention of SARS-CoV-2 transmission through social distancing during COVID-19 pandemic among Indonesian community.Methods: This descriptive study applied a cross-sectional design and distributed closed questions with online questionnaire randomly to 34 provinces in Indonesia on social media networks and e-mail. This study successfully collected 1,102 respondents from 29 provinces in Indonesia. The data were analyzed descriptively by calculating frequency, percentage, and cross-tabulation.Results: This study had successfully identified 99%, 59%, and 93% of respondents with good knowledge, positive attitudes, and good behavior respectively towards social distancing..Among the respondents who had good knowledge showed positive attitudes (58.85%) and good behavior (93.3%). The respondents who had positive attitudes showed good behavior (96.7%).behaviorConclusion: Indonesian community had good knowledge, attitude and behavior towards social distancing as a way to prevent the virus transmission. This strongly supports disaster mitigation in controlling the COVID-19 pandemic in Indonesia. Keywords: attitudes, behavior, COVID-19, knowledge, social distancing.

The antioxidant activity (AA), total phenolic content (TPC), and total flavonoid content (TFC) of selected Indonesian Zingiberaceae herbs were determined. An optimization extraction procedure was conducted by using Taguchi L16 orthogonal array. Four chemical assays were applied, including 2,2-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity assay, H2O2 scavenging activity assay, Folin–Ciocalteau (F–C) assay, and NaNO2-AlCl3-NaOH assay, which revealed remarkable differences in AA, TPC, and TFC. The result indicated the diversity of AA composition among the herbs, and C. longa exhibited the highest AA. HPLC-PAD analysis revealed that curcumin was present in five high antioxidant herbs, and the highest amount was in C. longa. Pearson correlation analysis indicated that the identified TPC and TFC were significant contributors to AA, and curcumin was likely the main contributing antioxidant compound. Our approach concluded that C. longa is the greatest source of natural antioxidants among 12 Indonesian indigenous Zingiberaceae herbs. The use of a mixed-method approach to augment the findings of solitary methods might facilitate future researchers to uncover deeper and hidden meanings.

BACKGROUND: Data on readmission as well as the potential impact of length of stay (LOS) after colectomy for colon cancer remain poorly defined. The objective of the current study was to evaluate risk factors associated with readmission among a nationwide cohort of patients after colorectal surgery. STUDY DESIGN: We identified 149,622 unique individuals from the Surveillance, Epidemiology, and End Results-Medicare dataset with a diagnosis of primary colorectal cancer who underwent colectomy between 1986 and 2005. In-hospital morbidity, mortality, LOS, and 30-day readmission were examined using univariate and multivariate logistic regression models. RESULTS: Primary surgical treatment consisted of right (37.4%), transverse (4.9%), left (10.5%), sigmoid (22.8%), abdominoperineal resection (7.3%), low anterior resection (5.6%), total colectomy (1.2%), or other/unspecified (10.3%). Mean patient age was 76.5 years and more patients were female (52.9%). The number of patients with multiple preoperative comorbidities increased over time (Charlson comorbidity score ≥3: 1986 to 1990, 52.5% vs 2001 to 2005, 63.1%; p < 0.001). Mean LOS was 11.7 days and morbidity and mortality were 36.5% and 4.2%, respectively. LOS decreased over time (1986 to 1990, 14.0 days; 1991 to 1995, 12.0 days; 1996 to 2000, 10.4 days; 2001 to 2005, 10.6 days; p < 0.001). In contrast, 30-day readmission rates increased (1986 to 1990, 10.2%; 1991 to 1995, 10.9%; 1996 to 2000, 12.4%; 2001 to 2005, 13.7%; p < 0.001). Factors associated with increased risk of readmission included LOS (odds ratio = 1.02), Charlson comorbidities ≥3 (odds ratio = 1.27), and postoperative complications (odds ratio = 1.17) (all p < 0.01). CONCLUSIONS: Readmission rates after colectomies have increased during the past 2 decades and mean LOS after this operation has declined. More research is needed to understand the balance and possible trade off between these hospital performance measures for all surgical procedures.

Abstract This study used a systematic review and meta-analysis as a method to investigate whether STEM enactment in Asia effectively enhances students’ learning outcomes. Verifiable examples of science, technology, engineering, and mathematics (STEM) education, effectively being applied in Asia, are presented in this study. The study involved 4768 students from 54 studies. Learning outcomes focused on the students’ academic learning achievement, higher-order thinking skills (HOTS), and motivation. The analysis results of effect sizes showed that the STEM enactments in Asia were effective at a moderate level (0.69 [0.58, 0.81 of 95% CI]) of improving students’ learning outcomes. Sequentially, the effectiveness of STEM enactment starts from students’ higher-order thinking skills, moves to students’ academic learning achievement, and ends with the motivation. In addition, STEM enactments in Asia were carried out with several variations where STEM integrated with project-based learning was preferred. The recommendations of this study include a combination of the learning approach, learning orientation, and duration of instruction, all of which contribute to the STEM enactment effectiveness and maximize results in STEM education. Some practical implications, such as the central role of the teacher during the STEM enactment, are extensively discussed. This study supports that STEM education is a universally crucial tool which effectively prepares students from various national and cultural backgrounds, across Asia, toward improved learning outcomes.

OBJECTIVE: To determine the long-term efficacy of percutaneous radiofrequency medial branch neurotomy in the treatment of chronic neck pain. METHODS: Between 1991 and 1996, radiofrequency neurotomy was performed in 28 patients diagnosed as having cervical zygapophysial joint pain on the basis of controlled diagnostic blocks. The procedure was repeated in patients whose pain recurred. Outcome measures were the proportion of patients who responded to the initial procedure and the duration of relief subsequently obtained. Outcome was correlated with the operator performing the procedure, the type of electrode used, litigation status, and the type of diagnostic blocks used to establish the diagnosis. RESULTS: Complete relief of pain was obtained in 71% of patients after an initial procedure. No patient who failed to respond to a first procedure responded to a repeat procedure, but if pain returned after a successful initial procedure, relief could be reinstated by a repeat procedure. The median duration of relief after a first procedure was 219 days when failures are included but 422 days when only successful cases are considered. The median duration of relief after repeat procedures was at least 219 days; several patients had ongoing relief at the time of follow-up. Outcome did not differ according to the operator, the type of electrode used, litigation status, or the type of diagnostic block used. CONCLUSION: Radiofrequency neurotomy provides clinically significant and satisfying periods of freedom from pain, and its effects can be reinstated if pain recurs.

There has been much effort to provide eco-friendly and biodegradable materials for the next generation of composite products owing to global environmental concerns and increased awareness of renewable green resources. This review article uniquely highlights the use of green composites from natural fiber, particularly with regard to the development and characterization of chitosan, natural-fiber-reinforced chitosan biopolymer, chitosan blends, and chitosan nanocomposites. Natural fiber composites have a number of advantages such as durability, low cost, low weight, high specific strength, non-abrasiveness, equitably good mechanical properties, environmental friendliness, and biodegradability. Findings revealed that chitosan is a natural fiber that falls to the animal fiber category. As it has a biomaterial form, chitosan can be presented as hydrogels, sponges, film, and porous membrane. There are different processing methods in the preparation of chitosan composites such as solution and solvent casting, dipping and spray coating, freeze casting and drying, layer-by-layer preparation, and extrusion. It was also reported that the developed chitosan-based composites possess high thermal stability, as well as good chemical and physical properties. In these regards, chitosan-based "green" composites have wide applicability and potential in the industry of biomedicine, cosmetology, papermaking, wastewater treatment, agriculture, and pharmaceuticals.

Incidental durotomy is a frequent complication of lumbar spinal surgery. The number and complexity of spinal procedures is increasing, leading to a greater prevalence of dural tears; therefore, it is imperative that spine surgeons be familiar with safe and effective closure techniques. Occasionally, a tear may not be recognized during the procedure, so that one must recognize the signs and symptoms of a cerebrospinal fluid leak postoperatively. Several newer treatment concepts show promise. The current study represents an extensive review of the recent literature on the prevalence, mechanism, diagnosis, treatment, and outcomes of dural tears. The authors provide an overview of the problem, an update on current treatment strategies, and describe the senior author's technique of repair, which is easy to do and is effective in stopping additional leakage of cerebrospinal fluid.

Sugar palm (Arenga pinnata) fibres and starches are considered as agro-industrial residue in the agricultural industry. This paper aims to investigate the effect of different concentrations (0–1.0 wt%) of sugar palm nanofibrillated cellulose (SPNFCs) reinforced sugar palm starch (SPS) on morphological, mechanical and physical properties of the bionanocomposites film. The SPNFCs, having a diameter of 5.5 ± 0.99 nm and length of several micrometres, were prepared from sugar palm fibres via a high-pressure homogenisation process. FESEM investigation of casting solution displayed good miscibility between SPS and SPNFCs. The FTIR analysis revealed good compatibility between the SPS and SPNFCs, and there were existence of intermolecular hydrogen bonds between them. The SPS/sPNFCs with 1.0 wt% had undergone an increment in both the tensile strength and Young’s modulus when compared with the SPS film, from 4.80 MPa to 10.68 MPa and 53.97 MPa to 121.26 MPa, respectively. The enhancement in water barrier resistance was led by reinforcing SPNFCs into the matrix, which resulted in bionanocomposites. The properties of bionanocomposites will be enhanced for short-life applications, such as recyclable container and plastic packaging through the incorporation of SPNFCs within the SPS bionanocomposites.

The monolayer of cells forming the human corneal endothelium is critical to the maintenance of corneal transparency and is not known to regenerate in vivo. Thus, dysfunction of these cells constitutes the most often cited reasons for the 150,000 or so corneal transplants performed yearly. Although current corneal transplantation is more than 90% successful at 1 year, longer term results are not as encouraging with approximately 70% success at 5 years. Nonimmunologic graft failure and allograft endothelial rejection are the main problems. Furthermore, the global shortage of donor corneas greatly restricts several corneal transplantations performed. With advances in understanding corneal endothelial cell biology, it is now possible to cultivate human corneal endothelial cells (HCECs) in vitro, thus providing new opportunities to develop novel tissue-engineered human corneal endothelium. This review will provide an overview of (a) the characteristics of human corneal endothelium; (b) past and present HCECs isolation and culture protocols; (c) various potential carriers for the generation of tissue-engineered corneal endothelium, together with some of the functional studies reported in various animal models; and (d) the current rapid advancements in surgical techniques for keratoplasty. A successful combination of tissue-engineered human corneal endothelium coupled with innovative and groundbreaking surgical procedures will bridge basic research involving cultured HCECs, bringing it from bench to bedside.