Articles de revues sur le sujet « Di Oster »

Lack care of childs personal hygiene can cause some health problems such as diarrhea, worms, scabies, and others. Parenting contribute on the p ersonal hygiene behaviour. The aim of this study was to described childs personal hygiene based on parenting perception of children in UPTD Kampung Anak Negeri Surabaya. This study was a descriptive cross sectional study with quantitative approach. The sample was 30 f oster children with determining the sample by random sampling. Data were taking with questionnaires and interview. Instrument used in this study was questionnaires and interview guideline. Data analysis were conducted with descriptive analysis. The results was most of the foster children were 12-16 years old. Most of the foster children was in the road more than 7 months. The majority of foster children was schoolless. Most of the foster children was entered the UPTD because singing in the road. Most of the foster children had a good personal hygiene. Most of the foster children had democratic perception on parenting. The conclusion of this study is foster children that have otoriter, democratic, as well as permissive perception on parenting have good perception on personal hygiene.

Viene presentato il caso di una paziente di 4 anni, giunta ad osservazione per ritardo psico-motorio ed arresto dello sviluppo del linguaggio. Figurava nell'anamnesi la comparsa di irrequietezza, insonnia e pianto frequente; la deambulazione senza appoggio, iniziata a 3 anni, era condotta su base allargata. Le indagini di routine, la ricerca di mucopolisaccaridi ed enzimi lisosomiali, EMG, potenziali evocati del tronco encefalico e cariotipo risultarono nella norma; l'EEG mostrò anomalie non specifiche. L'obiettività rivelò macrocrania, ipertelorismo, iper-refles- sia osteo-tendinea. La TC evidenziò grave riduzione di densità della sostanza bianca e discreta dilatazione ventricolare. La RM rivelò parimenti gravi segni di sofferenza della sostanza bianca cerebrale e cerebellare, con integrit della capsula interna e dello splenio del corpo calloso.

La giunzione occipito-cervicale, regione di transizione tra cranio e colonna vertebrale, possiede caratteristiche uniche per la struttura osteo-ligamentosa di cui è costituita e per le importanti formazioni neuro-vascolari con cui contrae rapporti di contiguità. Questa particolare regione può essere interessata da una serie di differenti entità patologiche: essa è infatti sede di particolari anomalie congenite, di patologie infiammatorie o degenerative, di gravi lesioni traumatiche e di lesioni espansive di differente natura. L'instabilità della giunzione conseguente a tali patologie o le diverse lesioni espansive determinano come conseguenza fondamentale la compressione del midollo cervicale superiore; altri effetti secondari sono rappresentati dalla compressione delle strutture vascolari e dall'ostacolo alla circolazione liquorale. La tomografia computerizzata e la risonanza magnetica rappresentano le metodiche neuroradiologiche di elezione per lo studio della giunzione occipito-cervicale. La TC è in grado di definire con maggiore accuratezza le alterazioni osteo-strutturali e le fini calcificazioni. Malgrado tali prerogative, la RM è la metodica di scelta grazie alla possibilità di uno studio multiplanare, dell'elevata risoluzione di contrasto e dell'assenza di artefatti legati alla vicinanza di strutture ossee; un ulteriore vantaggio è costituito dalla possibilità di studio delle strutture vascolari del basicranio mediante angio-RM. La radiologia tradizionale conserva un ruolo complementare, utile soprattutto in fase di screening nello studio della patologia ossea malformativa o traumatica. Un'accurata conoscenza delle caratteristiche anatomiche e della semeiotica neuroradiologica è essenziale per affrontare uno studio corretto delle patologie della cerniera occipito-cervicale.

L’utilizzo della pianificazione virtuale in chirurgia testa e collo è in forte crescita. In letteratura, la validità del metodo dal punto di vista dell’acuratezza e l’utilità clinica sono stati ampiamente documentati, in modo particolare per il rimodellamento osseo del lembo. Al giorno d’oggi, l’aumentato utilizzo della programmazione virtuale in chirurgia oncologica testa-collo e, conseguentemente, la maggiore necessità di ricostruzioni sia ossee che dei tessuti molli, rendono importante realizzare il programma virtuale considerando non solo la ricostruzione ossea, ma anche tutti gli aspetti relativi alla ricostruzione dei tessuti molli con lembi compositi. Descriviamo nel seguente articolo il nostro approccio alla pianificazione virtuale nel caso di lembi compositi. Lo studio riporta sei pazienti consecutivi con malattia maligna programmati mediante ricostruzione mandibolare computer assistita e lembi osteo-fascio-cutanei di perone. In tutti i sei pazienti, la resezione e la ricostruzione sono state progettate concentrandosi sulla posizione dei vasi perforanti cutanei, al fine di programmare la posizione più corretta delle guide di taglio a livello del perone in funzione della posizione dei vasi perforanti stessi. La tecnica descritta ci ha permesso di programmare lembi osteo-fascio-cutanei di perone nella ricostruzione mandibolare computer assistita, con buona precisione della posizione del segmento osseo rispetto alla padella cutanea, importante per la ricostruzione dei tessuti molli. Nonostante il numero limitato di casi, i risultati preliminari dello studio suggeriscono che questo protocollo è utile nella programmazione virtuale. Sono necessarie ulteriori indagini.

Descriviamo un interessante caso di compressione midollare anteriore a livello D11-D12 da ernia del disco calcificata in trasformazione osteo-condromatosa, operata per via postero-laterale mediante l'osteotomo Sumisonic ME-2400 ad ultrasuoni. Viene discussa l'eziopatogenesi di questa rara affezione in riferimento ai princìpi di fisiopatologia del circolo ematico midollare. Si sottolinea l'importanza delle moderne metodiche neuroradiologiche che consentono di ottenere una esatta definizione morfologica e di livello della noxa compressiva, chiarendone al contempo i rapporti con le varie strutture mielo-radicolari. L'impiego dell'osteotomo ultrasonico, oltre a rendere più agevole l'intervento chirurgico, ha consentito di salvaguardare le strutture nervose, preservandole dalle complicanze iatrogene ischemiche che in passato caratterizzavano frequentemente il decorso post-operatorio

La sindrome da neuropatia periferica canalicolare non traumatica è un'affezione relativamente frequente e può rappresentare il risultato di numerose noxe che direttamente o indirettamente agiscono su segmenti di nervo che percorrono canali osteo-fibrosi. In tali strettoie il nervo, struttura più vulnerabile, può subire fenomeni meccanici di frizione o di pressione che, agendo sui vasa nervorum possono produrre ipossia, anossia, ischemia del nervo. Viene riportato lo studio di 31 pazienti affetti da sindromi canalicolari spontanee non traumatiche degli arti superiori. Viene sottolineato il ruolo svolto dalla RM nell'analisi morfologica dei singoli casi, i cui risultati correlati ai reperti clinici ed elettrofisiologici, possono essere utilizzati quale parametro di gravità nella valutazione prognostica e nella programmazione terapeutica della sindrome.

Rumah Sakit Umum Daerah Dungus merupakan salah satu rumah sakit yang terletak di kota Madiun. Pasien yang berkunjung ke rumah sakit, terutama pada poli fisioterapi banyak dari kalangan lanjut usia, seperti yang kita ketahui proses degeneratif akan membuat seseorang mengalami kemunduran terutapa pada fungsi fisik, salah satunya permasalahan pada musculoskeletal seperti osteoarthritis knee (nyeri lutut). Dengan adanya kasus tersebut maka dilakukanlah penyuluhan tentang osteoarthritis knee dilakukan bertujuan untuk mengetahui apa yang dimaksud dengan osteoatrhitis knee, apa saja tanda-tanda ketika terkena osteoarthritis knee dan bagaimana penanganan dirumah yang bisa dilaukan untuk mengurangi nyeri yang dialami. Metode yang digunakan yaitu dengan memberikan penyuluhan kepada masyarakat, berupa promosi kesehatan tentang osteoarthritis knee, dengan menggunakan leaflet sebagai media, guna memudahkan pemahaman masyarakat, melakukan tanya jawab yang berguna untuk menggali informasi tentang keluhan yang dialami masyarakat, dan mengedukasi dengan latihan-latihan dan penanganan yang bisa dilakukan dirumah untuk mengurangi keluhan. Proses penyuluhan berjalan dengan lancar, masyarakat mulai memahami terkait latihan-latihan yang telah diajarkan untuk dilakukan dirumah, dengan tujuan untuk mendapatkan pemahaman masyarakat dari 0% hingga 100% setelah penyuluhan dilakukan. Sehingga terjadinya penurunan tingkat nyeri yang dialami masyarak setelah melakukan latihan dirumah. Dengan adanya kegitan penyuluhan yang dilakukan kepada masyarakat, dapat meningkatkan pengetahuan masyarakat tentang osteoarthritis knee, bagaimana penanganan dirumah dan dapat menurunkan nyeri yang dialami.

Tujuan dalam penelitian ini adalah untuk melihat apakah self-efficacy memiliki pengaruh positif terhadap sikap guru inklusi. Menggunakan populasi 11 sekolah inklusi yang berada di Kota Mataram baik yang milik swasta maupun negeri. Instrumen menggunakan attitudes toward inclusive education scale (MATIES) untuk sikap guru terhadap inklusi sedangkan self-efficacy menggunakan Teacher’s sense of efficacy scale (OSTES). Hasil menunjukkan adanya pengaruh yang postif antara self-efficacy dengan sikap guru terhadap inklusi.

Lo studio ha riguardato la caratterizzazione fenotipica di 56 soggetti (tra 2 e 30 anni di età) riconducibili alla popolazione asinina Calabrese, allevati in 23 aziende. Su ciascun soggetto sono stati eseguiti i più significativi rilievi morfometrici mediante l’impiego di un sistema di analisi d’immagine computerizzato. Tali dati sono stati successi-vamente utilizzati per il calcolo dei più significativi indici biometrici. Inoltre sono stati presi in considerazione il colore e le eventuali particolarità del mantello. Gli indici biometrici ricavati ci hanno permesso di inquadrare questa popolazione asinina nel tipo dolicomorfo, come evidenziato dai valori dell’Indice di conformazione laterale del corpo (97,78), dell’Indice toracico di profilo (44,85), dell’Indice di Compattezza (90,80), dell’Indice lunghezza torace (100,79) e dell’Indice di ossatura (12,82). Il colore del mantello è risultato essere principalmente morello (75 %) anche se si è osser-vata la presenza di soggetti baio scuro (20 %) e grigio (5 %). Il colore dell’addome costantemente bianco come anche il muso e le occhiaie. Il colore dell’ano, vulva e mammella è costantemente nero.

Il gold standard nella ricostruzione dei mascellari nelle atrofie severe, siano esse di natura idiopatica o iatrogena, come nei casi di chirurgia resettiva oncologica, deve essere incentrato verso tecniche di ricostruzione immediata che consentano un veloce recupero funzionale ed estetico. I pazienti considerati in questo studio sono stati trattati durante un periodo di 5 anni (2010-2014) con ricostruzione immediata del deficit dei mascellari, eseguito per mezzo di lembo libero di fibula osteo-periosteo. Sono stati pertanto selezionati 14 pazienti sottoposti a ricostruzione con tale tecnica, senza riportare complicanze a medio e lungo termine. Il principale vantaggio di questo tipo di ricostruzione va ricercato nella formazione di gengiva cheratinizzata sovrastante il lembo libero che consente la migliori condizione possibile per una ricostruzione implantoprotesica. L’unico svantaggio di questa tecnica è da imputare alla necessità di lasciare che la ferita chirurgica intraorale guarisca per seconda intenzione in modo da promuovere la formazione di gengiva cheratinizzata dai bordi della ferita stessa, per tale ragione però il pazente necessita di un rigido follow up per il primo mese dopo l’intervento. Lo scopo di questo lavoro è valutare l’efficacia di tale tecnica nelle ricostruzioni ossee dei mascellari.

The article presents the clinical case of retro- and prospective observation of 12 patients with oste-omyelitis and features the use of a synthetic analogue of microorganism products — muramyl di-peptide (developed at the M. M. Shemyakin and Yu. A. Institute of Bioorganic Chemistry Ovchini-kova, RAS). Parameters of the clinical and laboratory efficacy of a domestic immunocorrection drug are given.

Facendo proprie le riflessioni della scrittrice iraniana Azar Nafisi (“La Repubblica dell’immaginazione”, 2015), secondo la quale la conoscenza immaginativa pragmatica e ispirandosi al grande medico William Osler (1849- 1919), bibliofilo appassionato, che stil una lista di testi classici che ogni futuro medico avrebbe dovuto leggere – la c.d. bedside library –, gli Autori sottolineano l’importanza dei libri classici per la crescita personale dei medici e per la loro competenza clinica. Anche Italo Calvino affermava che ci sono cose che solo la letteratura pu dare con i suoi mezzi specifici (Lezioni americane, 1988). La grande letteratura un ponte che consente il dialogo a prescindere dai reciproci mondi di appartenenza (universalit ); luogo dell’immedesimazione (empatia); porta alla luce gli archetipi del comportamento umano (risonanza etica). Su questi presupposti si basa l’idea di stimolare la lettura dei classici sin dal primo anno della formazione degli studenti di medicina nell’ambito delle Medical Humanities.

La patologia della colonna dell'anziano, intendendo arbitrariamente con questo termine soggetti di età superiore ai 60 anni, è costituita per lo più da lesioni degenerative osteo-disco-articolari, dalla osteoporosi e dalle sue complicanze. Dalla revisione di 1.000 esami di tomografia computerizzata della colonna in pazienti di età superiore a 60 anni gli Autori infatti hanno posto diagnosi in 808 casi di malattia degenerativa e di osteoporosi e in 192 casi hanno ritrovato altre patologie che, pur non essendo di esclusiva pertinenza dell'anziano, mostrano una netta predilezione per questa fascia di età. In 27 pazienti fu posta diagnosi di metastasi ed il dato, epidemiologicamente non significativo, è da porsi in relazione al carattere monospecialistico degli Istituti Ortopedici Rizzoli. In 93 casi fu posta diagnosi di tumore osseo primitivo benigno rappresentato dall'emangioma nelle sue varietà asintomatica e compressiva; i 43 casi di tumori ossei primitivi maligni sono da ascrivere in ordine decrescente al mieloma, al cordoma, ai linfomi e a rarissimi casi di emangioendotelioma. In 21 pazienti fu posta diagnosi di spondilodiscite e in 8 di malattia di Paget. Gli autori descrivono le caratteristiche clinico-radiologiche di queste lesioni enfatizzando il ruolo della tomografia computerizzata e della risonanza magnetica non solo nella individuazione e precisazione della lesione ma anche nel bilancio loco-regionale ed infine sottolineano la difficoltà della diagnosi differenziale tra metastasi, tumori primitivi maligni talora con le spondilodisciti e la malattia di Paget per cui spesso è indispensabile il ricorso alla biopsia TC-guidata.

Efikasi diri guru merupakan salah satu aspek yang penting untuk dimiliki oleh setiap guru. Semakin tinggi efikasi diri guru dalam mengajar maka akan memberikan efek yang positif terhadap diri guru, kualitas mengajar guru, dan prestasi akademik siswa. Pengabdian kepada masyarakat ini bertujuan untuk meningkatkan efikasi diri guru sekolah menengah pertama islam terpadu (SMPIT) melalui pemberian pelatihan Uiversal Design for Learning (UDL). Untuk mengukur efektivitas pelatihan tersebut digunakan metode kuasi eksperimen dengan pendekatan one-group pretest-posttest design. Partisipan dalam pelatihan ini sebanyak 11 orang guru SMPIT, pengukuran efikasi diri guru dilakukan dengan menggunakan Ohio State Teacher Efficacy Scale (OSTES), dan data hasil pengukuran dianalisis menggunakan Wilcoxon signed rank test. Berdasarkan hasil pengukuran dan evaluasi dapat disimpulkan bahwa pelatihan UDL dapat meningkatkan efikasi diri guru SMPIT dalam mengajar (p = 0,008, p < 0,01), pelatihan UDL bermanfaat bagi pekerjaan para guru di SMPIT, pelatihan UDL dapat diterapkan dalam kegiatan belajar mengajar di SMPIT, dan pelatihan UDL dapat membantu para guru SMPIT untuk bekerja lebih baik.

Sebagian besar anggota group senam ling tien kung, didapatkan tingkat pengetahuan mengenai osteo arthritis lutut kurang. Ada beberapa gerakan senam ling tien kung berpengaruh pada sendi lutut terutama pada lansia dengan keluhan nyeri di lutut akibat OA lutut. Penyuluhan ini diharapkan anggota senam yang sudah terkena OA lutut bisa tahu gerakan yang mana yang harus di hindari supaya tidak memperparah keluhan nyeri akibat OA lutut. Kegiatan pengabdian masyarakat dilakukan pada bulan September 2021dengan mengadakan penyuluhan secara langsung dengan media poster dan leaflet dengan penerapan protokol kesehatan. Seluruh proses kegiatan ini dilakukan selama 1 (satu) bulan. Sebelum dilakukan proses pendidikan kesehatan didapatkan tingkat pengetahuan anggota senam tentang OA lutut adalah 4 orang (16%) mempunyai tingkat pengetahuan baik, 10 orang (40%) mempunyai tingkat pengetahuan sedang dan 11 orang (44%) mempunyai tingkat pengetahuan kurang. Sedangkan setelah mengikuti pendidikan kesehatan didapatkan bahwa: 2 orang (8%) mempunyai tingkat pengetahuan sedang dan 23 orang (92%) mempunyai tingkat pengetahuan baik. Berdasarkan kegiatan tersebut menunjukkan bahwa pendidikan kesehatan dapat meningkatkan pengetahuan responden mengenai OA lutut.

Water-soluble gold(i) complexes, [Au(Ipr)(L)]PF₆ where L = thiourea (Tu) 1 and N,N′-dimethylthiourea (Me₂Tu) 2, were synthesized from the parent 1,3-bis(2,6-di-isopropylphenyl)imidazol-2-ylidenechloridogold(i) [(Ipr)AuCl] (0).

Penyakit artrhitis atau sering dikenal dengan nama rematik merupakan penyakit yang menyerang sendi dan struktur atau jaringan penunjang sekitar sendi. Jenis penyakit rematik memiliki lebih dari 150 jenis, tetapi di indonesia ada 3 jenis penyakit paling sering diderita masyarakat diantaranya Gout Arthritis, Rheumatoid Arthritis, dan Osteo Arthritis. Gejala pada jenis penyakit rematik sering tidak disadari oleh masyarakat, karena umumnya memiliki gejala yang mirip satu sama lain. Salah satu solusi yang dapat digunakan masyarakat untuk melakukan diagnosis dini jenis penyakit rematik adalah sistem pakar. Sistem pakar adalah sebuah sistem yang mengadopsi pengetahuan pakar sehingga dapat melakukan seperti yang dilakukan pakar. Penelitian ini mengembangkan sistem pakar diagnosis penyakit rematik menggunakan inferensi forward chaining berbasis prolog. Metode inferensi forward chaining digunakan untuk menarik kesimpulan jenis penyakit rematik yang diderita berdasarkan gejala-gejala yang dirasakan. Berdasarkan pengujian yang telah dilakukan bahwa metode inferensi forward chaining dapat melakukan diagnosis jenis penyakit rematik..

Abstract: Leaders are a significant factor in realizing a productive church. It is demonstrated through the discipleship in small groups aimed at giving birth to new leaders. But the problem is, not all leaders give birth to a new leader. Therefore, this paper examines the role of the leader to see his role in Holy Word Christian Church Pekanbaru. Richard Robert Osmer's four practical theological tasks is used to refine analysis because it offers methodological novelty, practicality and is comprehensive in understanding or changing contexts. Therefore, a case study approach is used to produce research depth. The data collection process accomplishes through observation, interviews, and documentation. The results showed that the role of leaders in Holy Word Christian Church Pekanbaru is significant in realizing a productive church and giving birth to new leaders. So the discipleship system must lead to the goal of birth to new leaders through small groups that have already been forming. Keywords: role, leader, discipleship, case study, reproductive, small group. Abstrak: Pemimpin merupakan faktor penting dalam mewujudkan jemaat yang reproduktif. Hal tersebut ditunjukkan melalui pemuridan dalam kelompok kecil dengan tujuan melahirkan para pemimpin baru. Tetapi persoalannya, tidak semua pemimpin melahirkan pemimpin baru. Oleh karena itu, artikel ini mengkaji tentang peran pemimpin untuk melihat perannya dalam gereja pemuridan di Gereja Kristen Kalam Kudus (selanjutnya disebut GKKK) Pekanbaru. Empat tugas teologi praktika Richard Robert Osmer digunakan untuk mempertajam analisis karena menawarkan kebaruan metodologi, kepraktisan dan komprehensif dalam memahami atau menggali konteks. Oleh karena itu, pendekatan studi kasus digunakan untuk menghasilkan kedalaman. Proses pengumpulan data dilakukan melalui observasi, wawancara dan dokumentasi. Hasilnya menunjukkan bahwa peran pemimpin di GKKK Pekanbaru signifikan dalam mewujudkan gereja yang reproduktif dan melahirkan pemimpin baru. Jadi, sistem pemuridan harus mengarah pada tujuan untuk melahirkan para pemimpin baru melalui kelompok-kelompok kecil yang sudah terbentuk. Kata-kata kunci: peran, pemimpin, pemuridan, studi kasus, reproduktif, kelompok kecil.

Abstract Hemogenic stem cells (HSC) emerge at distinct allocation territories during ontogenesis. They irrigate freely the whole body by the blood stream, but the adult HSC expand and differentiate exclusively in the bone marrow (BM). This implies that stem cells are not autonomous units of development; rather, tissue specific niches control their destiny. We investigated the spatio-temporal emergence of stem cells and nest-forming cells, and basic mechanisms by which they shape together the functional-proliferative units in the liver and BM during ontogenesis. Video microscopy in gut/liver primordium cultures provided direct evidence for intrinsic emergence of a primitive vasculo-hemogenic meshwork guided by pulsative, cardiomyogenic cells around nascent hepatic cords in E8.75-E10 mouse embryos. Gain-of-competence and development of hepatic units required firm aggregation of cholangio-hepatic (CK19+/CK18+), hemogenic (CAFC) and vasculogenic stem/progenitor cells and nest-forming cells into compact 3-D structures, similarly to BM hematons. Colonization and expansion of HSC in the mouse liver at E12, then in the BM at postnatal d2, numerically correlated with the increase in isolatable niches/hematons. Time-lapse video microscopy, quantitative colony assays, FACS and immunocytochemistry analyses of the adult human BM showed that the hematon is enriched in mesenchymal stem cells, preadipocytes/adipocytes, contractile myogenic cells, a vascular meshwork, guardian macrophages and hemopoietic stem/progenitor cells (Sca-1/c-kit/CD34/Thy-1/CD31+). A hematon module plays the role of an organizing center that emits growth signalling factors and accumulates morphogen/differenciator factors, retinoids and 1,25-di(OH)-vitaminD3. The physical attachment of many hematons to spongy bone suggests that they form the basic structural-functional units in the ultimate, fully competent BM. We suggest designating these units osteo-hematons. A comparative analysis of BM aspirates from healthy donors (n=75) and patients (n=210) revealed the disorganization of osteo-hematon modules in AML prior to therapy and in CML during all stages of the disease.

The author was reproached with the need for the ingot of frequent application of forceps after the operation he preached. In fact, the forceps, according to M.'s opinion, are far from the necessary addition to the symphysisotomy.

TÓM TẮTThông động tĩnh mạch phổi (Pulmonary arteriovenous malformations (PAVM)) là dị dạng mạch máu ở phổi hiếm gặp, trong đó có sự nối thông bất thường giữa động mạch và tĩnh mạch phổi. Theo y văn và các trường hợp báo cáo, khoảng 75% các trường hợp gặp trong bệnh cảnh Rendu-Osler hay hội chứng giãn mao mạch xuất huyết di truyền (hereditary haemorrhagictelangiectasia) [1]. Mặc dù bệnh nhân có thể không có triệu chứng, tuy nhiên, triệu chứng hay gặp là khó thở, có thể có tím do luồng shuntphải – trái, gây ra tình trạng giảm oxy máu mãn tính. Các biến chứng tổn thương thần kinh trung ương như đột quỵ hay abcess não có thể xảy ra do huyết khối ngược dòng từ động mạch phổi vào tĩnh mạch phổi rồi đổ về nhĩ trái. Chụp X-quang ngực và cắt lớp vi tính (CLVT) ngực có tiêm thuốc cản quang là các phương pháp đầu tay để chẩn đoán bệnh, nhưng chụp động mạch phổi số hoá xoá nền vẫn là tiêu chuẩn vàng. Hầu hất các bệnh nhân nên điều trị. Phương pháp điềutrị được lựa chọn gồm can thiệp nút mạch với coil kim loại hoặc bóng hay phẫu thuật. Chúng tôi trình bày một ca lâm sàng ở bệnh nhân nam 33 tuổi, được chẩn đoán AVM phổi lớn, đơn độc ở thuỳ dưới phổi phải bằng chụp Xquang và chụp CLVT. Bệnh nhân được điều trị bằng phương pháp chụp động mạch phổi số hoá xoá nền nútmạch với dụng cụ 2 coil kim loại và dù chẹn động mạch đến, kiểm tra lại sau 6 tháng bằng cộng hưởng từ, chụp cắt lớp vi tính và chụp mạch thấy tắc hoàn toàn luồng thông. Lâm sàng cải thiện rõ, bệnh nhân hết khó thở, đỡ tím, xét nghiệm khí máu trước can thiệp: pO2 64,7mmHg và SatO2 89,9% và 6 tháng sau can thiệp: pO2 91,3mmHg và SatO2 96,2%.

Настоящая работа является первым общим описанием на русском языке двух некрополей Кампокиаро (Кампобассо, Италия) – Виченне и Морионе, датируемых последней третью VII в. – началом VIII в. Культурное содержание некрополей показывает прочные связи с населением центральноазиатского происхождения. Важнейшим признаком некрополей являются захоронения с конем, соответствующие евразийскому кочевому погребальному обряду. Автор поддержал выводы европейских исследователей о том, что с большой долей вероятности некрополи оставлены булгарами дукса–гаштальда Алзеко, зафиксированными Павлом Диаконом в VIII в. на территориях Бояно, Сепино и Изернии. Аналогии некрополей Кампокиаро с погребениями Аварского каганата показывают присутствие в аварском обществе булгар со схожим погребальным обрядом. Из тысяч погребений с конем, оставленных аварским населением, булгарам могла принадлежать большая часть. Авары и булгары составляли основу и правящую верхушку каганата. Народ Алзеко являлся той частью булгар, которая в 631 г. боролась за каганский престол, что указывает на высокое положение булгар и их большое количество. После поражения эта группа булгар мигрировала последовательно в Баварию, Карантанию и Италию. Несколько десятков лет проживания в венедской, а затем в лангобардской и романской среде привели к гетерогенности погребального инвентаря, но не изменили сам обряд. Булгары лангобардского королевства составляли новый военный слой, который представлял из себя профессиональную кавалерию, получивший землю. Эта конная дружина является ранним примером европейского феодального воинского и социального сословия, которое станет называться рыцарством. Библиографические ссылки Акимова М.С. Материалы к антропологии ранних болгар // Генинг В.Ф., Халиков А.Х. Ранние болгары на Волге (Больше–Тарханский могильник). М.: Наука, 1964. С. 177–191. Амброз А.К. Кинжалы VI – VIII вв, с двумя выступами на ножнах // СА. 1986. № 4. С. 53–73. 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BackgroundPsoriatic arthritis (PsA) greatly affects patient-reported health-related quality of life (HRQoL).ObjectivesTo assess the impact of risankizumab (RZB) on patient-reported outcomes (PROs) in patients with high skin burden using integrated efficacy data from two Phase III clinical trials (KEEPsAKE-1 and KEEPsAKE-2).MethodsAdult patients with PsA with inadequate response or intolerance to disease-modifying antirheumatic drugs were randomized 1:1 to receive RZB (150 mg) or placebo (PBO). Improvement from baseline in PROs (Patient’s Global Assessment of Disease Activity [PtGA] by visual analog scale [VAS], Short-Form 36 Health Questionnaire physical and mental component summary scores [SF-36 PCS and MCS], Health Assessment Questionnaire – Disability Index [HAQ-DI], EQ-5D 5-Level questionnaire [EQ-5D-5L] index and by VAS, Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-Fatigue], and pain by VAS) were assessed at Week 24 in patients with high skin burden (body surface area involvement ≥3% and Psoriasis Area Severity Index >10). Least squares mean (LSM) difference (95% confidence interval [CI]) between RZB and PBO groups based on mixed-model repeated measures regression is reported.ResultsRZB- vs PBO-treated patients demonstrated greater improvements in PROs with notable LSM differences (95% CI) between groups (P<0.01) in PtGA (-18.7 [-25.1, -12.2]), SF-36 PCS (6.3 [4.2, 8.4]) and MCS (4.4 [2.3, 6.6]), HAQ-DI (-0.4 [-0.5, -0.3]), EQ-5D-5L index (0.1 [0.1, 0.2]) and VAS (8.2 [2.5,13.9]), FACIT-Fatigue (4.9 [2.7, 7.2]), and pain (-18.9 [-25.1, -12.7]).ConclusionIn patients with PsA with high skin burden, 24 weeks of RZB treatment, as compared with PBO, improved patients’ HRQoL, including fatigue and pain.AcknowledgementsAbbVie funded the study and participated in interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing services were provided by Samantha Francis Stuart (Fishawack Facilitate Ltd) and funded by AbbVie.Disclosure of InterestsKim Papp Speakers bureau: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Consultant of: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Grant/research support from: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Christian Kaufmann Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Douglas White Speakers bureau: AbbVie and Novartis., Consultant of: AbbVie and Novartis., Andrew Ostor Speakers bureau: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Consultant of: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Grant/research support from: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Consultant of: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Grant/research support from: UCB, Novartis, Pfizer, Eli Lilly, Biogen, AbbVie, and Janssen Pharmaceuticals and UCB.

BackgroundBaricitinib (BARI), an oral selective JAK 1/2 inhibitor, is approved for treating adults with moderate to severe active rheumatoid arthritis (RA). RA-BE-REAL is a 3-year, multinational, prospective, observational study of adult patients with RA evaluating time to discontinuation of initial RA treatment for all causes (excluding sustained clinical response) over 24 months (M).ObjectivesThis analysis reports time to discontinuation in the European (France, Germany, Italy, Spain, UK) subgroup, treated with either BARI, biologic (b) disease-modifying anti-rheumatic drugs (DMARDs) or any other targeted synthetic (ts)DMARDs, as well as, the effectiveness of RA treatment, at 12M.MethodsIn the two cohorts, patients were initiated with BARI 2-mg or 4-mg (cohort A), or any bDMARD or tsDMARD (b/tsDMARDs; cohort B). Treatment initiation and changes are at the discretion of the patient or physician. Response rates for remission, low disease activity (LDA), moderate disease activity (MDA) or high disease activity (HDA) were determined using the Clinical Disease Activity Index (CDAI) at 12M. Quality of life using the EQ-5D-5L and patient reported outcome (PRO) measures for pain (pain visual analogue scale; VAS) and physical functioning (Health Assessment Questionnaire Disability Index; HAQ-DI) were also assessed at 12M. This pre-specified interim analysis reports descriptive 12M data using summary statistics, without any inferential testing.ResultsThis analysis involved 1073 adult RA patients with a mean age (standard deviation; SD) of 59.1 (13.2) (cohort A) and 57.0 (13.9) yrs (cohort B), respectively, and a mean disease duration (SD) of 10.0 (9.1) (cohort A) and 8.9 (9.6) yrs (cohort B), respectively. At baseline, 50.9% of patients in cohort A and 31.2% in cohort B initiated treatment as a monotherapy. At 12M, 26.7% of patients in cohort A and 44.1% of patients in cohort B had discontinued treatment. The most common reason for discontinuation in both cohorts was primary non-response. At 12M, 24.1% of patients in cohort A and 16.6% in cohort B achieved CDAI remission (Figure 1). The mean CDAI reduction was -14.5 and -12.0, respectively in cohorts A and B. Mean reductions from baseline in physician global assessment (PhGA) and in patient global assessment (PGA) were -3.4 and -2.5, respectively in cohort A and -3.0 and -2.1, respectively in cohort B. Improvements from baseline in EQ-5D-5L, HAQ-DI, and pain (VAS) were reported in both cohorts at 12M. The mean pain (VAS) reduction from baseline was -24.6 and -19.3 in cohort A and cohort B, respectively.Figure 1.Percentage of pts in cohorts A and B achieving remission and LDA at 12MConclusionThe majority of BARI-treated patients were in remission or had low disease activity and continued treatment at 12M.Table 1.Disease activity and patient reported outcomes at baseline and 12MCohort A BaricitinibCohort B b/tsDMARDsBaseline12MCFBBaseline12MCFBCDAI24.0 (11.7)9.1 (8.2)-14.5 (12.4)23.8 (12.4)10.7 (9.8)-12.0 (12.6)SJC5.2 (4.8)1.3 (2.4)-3.9 (4.8)4.7 (4.9)1.3 (2.8)-3.0 (4.6)TJC7.3 (6.1)2.2 (3.6)-4.7 (6.0)7.8 (6.5)3.0 (4.8)-4.0 (6.1)PhGA5.6 (2.0)2.3 (2.1)-3.4 (2.5)5.5 (2.1)2.5 (2.1)-3.0 (2.6)PGA5.9 (2.3)3.4 (2.5)-2.5 (2.9)5.8 (2.4)3.8 (2.6)-2.1 (3.0)HAQ-DI1.4 (0.7)1.0 (0.8)-0.4 (0.6)1.3 (0.7)1.0 (0.8)-0.3 (0.6)Pain (VAS)59 (23.1)33.2 (26.2)-24.6 (28.7)56.5 (24.3)36.6 (26.5)-19.3 (30.4)EQ-5D-5L0.5 (0.3)0.7 (0.2)0.1 (0.3)0.5 (0.3)0.7 (0.2)0.1 (0.3)Values represent observed mean (SD)b/tsDMARDs; biologic/targeted synthetic disease-modifying anti-rheumatic drugs, CFB; change from baseline, CDAI; clinical disease activity index, SJC; swollen joint count, TJC; tender joint count, P(h)GA; patient (physician) global assessment of disease activity, HAQ-DI; health assessment questionnaire disability index, VAS; visual analogue scale (mm), EQ-5D-5L; European quality of life 5 dimensions 5 levelsDisclosure of InterestsRieke Alten Speakers bureau: Eli Lilly and Company, Pfizer, Galapagos, Consultant of: Eli Lilly and Company, Pfizer, Galapagos, Grant/research support from: Eli Lilly and Company, Pfizer, Galapagos, Gerd Rüdiger Burmester Speakers bureau: Amgen, AbbVie, BMS, Galapagos, Eli Lilly and Company, MSD, Pfizer, Roche, Sanofi, Consultant of: Amgen, AbbVie, BMS, Galapagos, Eli Lilly and Company, MSD, Pfizer, Roche, Sanofi, Marco Matucci Cerinic Speakers bureau: Biogen, Eli Lilly and Company, Grant/research support from: Actelion, Biogen, Novartis, MSD, Andrew Ostor Consultant of: AbbVie, BMS, Roche, Janssen, Eli Lilly and Company, Novartis, Pfizer, UCB, Gilead, Paradigm, Liliana Zaremba-Pechmann: None declared, Marta Herrera Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kathy Gibson Speakers bureau: UCB, Consultant of: Janssen, Novartis, Grant/research support from: Novartis, Employee of: Eli Lilly and Company, Tamas Treuer Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jens Gerwien Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Bruno Fautrel Consultant of: AbbVie, Biogen, BMS, Celgene, Janssen, Eli Lilly and Company, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, SOBI, UCB, Grant/research support from: AbbVie, MSD, Pfizer, Eli Lilly and Company

Background:Psoriatic Arthritis (PsA) treatment should aim to achieve robust improvement of arthritis as well as control of extra-articular manifestations like the skin. SPIRIT-H2H evaluated the efficacy of ixekizumab (IXE) and adalimumab (ADA) in patients with active PsA and psoriasis, and naïve to biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs). At week 24 (W24), IXE showed superiority to ADA in simultaneous achievement of ACR50 and PASI100 as well as significant improvement of treat-to-target and other extra-articular outcomes.Objectives:To examine and to compare PsA efficacy outcomes in patients beyond achievement of the primary endpoint of the SPIRIT-H2H trial at W24, irrespective of treatment allocation.Methods:All patients recruited had active PsA (defined as tender joint count ≥3/68, swollen joint count ≥3/66 and body surface area [BSA] ≥3%), and inadequate response to conventional synthetic (cs)-DMARDs. Patients were randomised 1:1 to open-label, assessor-blinded IXE or ADA. We conducted post-hoc analysis of SPIRIT-H2H (NCT03151551), categorizing patients into four independent groups based on the achievement of the primary outcome (ACR50 & PASI100), ACR50 only, PASI100 only or none of them after 24 weeks of treatment. Statistical analyses consisted of mixed model for repeated measurement and logistic regression models using non-response imputation.Results:At week 24, patients reaching simultaneously ACR50 and PASI100 had a statistically significant higher response in most treat-to-target endpoints than those meeting ACR50 only (p<0.05). In this latter group, a high response rate was observed in ACR70, MDA, DAPSA remission and PASI90 response (48.9%, 60.6%, 35.1%, 36.2%, respectively). In patients that did not achieve either ACR50 or PASI100, up to 1/3 of the patients did achieve ACR20, DAPSA score ≤14, or no physical impairment.Table.Efficacy Endpoints at W24ACR50 & PASI100ACR50 onlyPASI100 onlyNeither ACR50 nor PASI100n=181n=94n=121n=170ACR20100.0b,c100.053.734.7ACR7064.6a,b,c48.90.00.0MDA75.7a,b,c60.623.112.4VLDA32.6a,b,c13.83.31.8DAPSA LDA or Remission (≤14)92.3a,b,c81.943.028.8DAPSA Remission (≤4)44.8b,c35.16.62.4HAQ-DI score ≤0.575.7b,c64.930.627.4PASI75100.0a,c60.6100.037.1PASI90100.0a,c36.2100.014.7SF-36 PCS change from baseline§12.3±0.53b,c12.3±0.745.4±0.664.0±0.55Data are presented as %;§mean±standard error.ap<0.05 vs. ACR50 only;bp<0.05 vs. PASI100only;cp<0.05 vs. Neither ACR50 nor PASI100.ACR, American College of Rheumatology; DAPSA, Disease Activity in Psoriatic Arthritis; HAQ-DI, Health Assessment Questionnaire Disability Index; LDA, Low Disease Activity; MDA, Minimal Disease Activity; PASI, Psoriasis Area Severity Index; VLDA, Very Low Disease Activity.Nine patients with active PsO and BSA≥3% were assessed as PASI=0 at baseline, a medical inconsistency that was resolved using medical judgement. These patients were considered PASI100 responders if PASI=0 and BSA=0 at post baseline visits.Conclusion:Reflecting the complexity of PsA, different degrees of improvement were observed across all treat-to-target outcomes with greater improvements in patients that met ACR50 response regardless of skin resolution. These findings at week 24 need to be confirmed with a longer duration of treatment.Disclosure of Interests:Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Inmaculada De La Torre Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Gabriella Meszaros Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Andrew Ostor Consultant of: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Speakers bureau: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB

Background:In Phase 3 trials, upadacitinib (UPA), an oral JAK1-selective inhibitor, has been assessed as monotherapy vs MTX (SELECT-EARLY1) and in combination with MTX vs adalimumab + MTX (ADA; SELECT-COMPARE2) in RA pts who were MTX naïve or with inadequate responses to MTX (MTX-IR), respectively.Objectives:In this analysis we assessed individual and composite measures of disease activity in SELECT-EARLY and SELECT-COMPARE.Methods:In SELECT-EARLY, MTX-naïve pts received UPA 15 mg or 30 mg monotherapy once daily (QD), or MTX monotherapy, for 12 wks. In SELECT-COMPARE, MTX-IR pts on stable background MTX received UPA 15 mg QD, PBO, or ADA 40 mg every 2 wks for 12 wks. For this analysis, responses at Wk 12 were defined as ≥50% improvement in the 7 components of the ACR response criteria. Among ACR50 responders, the proportions of pts with ≥50% improvement in all 7 components of the ACR criteria was assessed. The proportion of pts achieving TJC68=0 and SJC66=0 was also determined. All analyses were based on observed data without imputation.Results:947 pts were randomized in SELECT-EARLY, and 1629 pts in SELECT-COMPARE. Mean time since RA diagnosis was 2.7 years in SELECT-EARLY (median 6 months) and 8.2 years in SELECT-COMPARE; mean DAS28(CRP) was 5.9 and 5.8, respectively. In SELECT-EARLY, significantly more MTX-naïve pts receiving UPA 15 mg or 30 mg monotherapy achieved ≥50% improvements in all ACR components at Wk 12 compared with MTX (Figure 1a,Figure 1b). In SELECT-COMPARE, significantly more MTX-IR pts on UPA 15 mg + MTX achieved ≥50% improvement in the ACR components vs PBO (all components) and ADA + MTX (all components except SJC and PhGA). Among pts with ACR50 responses at Wk 12, approximately half of the MTX-naïve pts on UPA 15 mg and 30 mg in SELECT-EARLY had ≥50% improvements in all 5 remaining ACR components (pain, PtGA, PhGA, HAQ-DI, hsCRP) compared with 28% with MTX. Corresponding proportions in MTX-IR pts in SELECT-COMPARE were 34% for UPA 15 mg + MTX, 28% for ADA + MTX, and 17% for PBO. UPA treatment also significantly increased the proportions of pts achieving both TJC68=0 and SJC66=0 vs PBO or MTX, and SJC66=0 vs ADA + MTX (Figure 1a,Figure 1b).Conclusion:In MTX-naïve and MTX-IR pts, treatment responses at 12 wks occurred in significantly higher proportions of pts receiving UPA monotherapy vs MTX and UPA + MTX vs PBO for all 7 components of the ACR response criteria, and for 5 of 7 ACR components for UPA + MTX vs ADA + MTX. Favorable outcomes with UPA treatment were evident both in composite and individual parameters.References:[1]van Vollenhoven R, et al. Arthritis Rheumatol 2018;70(Suppl. 10): Abstract 891[2]Fleischmann R, et al. Arthritis Rheumatol 2018;70(Suppl. 10): Abstract 890Disclosure of Interests:Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, Andrew Ostor Consultant of: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Speakers bureau: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Eduardo Mysler Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Roche, Eli Lilly, Novartis, Janssen, Sanofi, and Pfizer., Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Roche, Eli Lilly, Novartis, Janssen, Sanofi, and Pfizer, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, In-Ho Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB

<p><em>P</em><em>oster merupakan istilah umum terhadap bentuk surat tempelan/ plakat. Poster merupakan plakat yang dipasang di tempat umum, berupa pengumuman atau iklan (Kamus Besar Bahasa Indonesia, 1986: 679). </em><em>Poster dapat dimaknai sebagai suatu bentuk karya komunikasi visual untuk khalayak luas dalam format tulisan dan gambar yang umumnya berupa tempelan di dinding dengan jangkauan komunikasi untuk massa.</em> <em>Penelitian ini menganalisis karya-karya poster Naufan Noordiyanto yang meliputi kajian tentang bentuk karya, unsur desain, pesan dan nilai-nilai yang terkandung di dalam karya posternya dengan pendekatan kritik seni. Karya poster Naufan Noordiyanto banyak mengangkat tema-tema sosial dan politik, mengenai identitas, toleransi, kesetaraan, filosofi dan hal –hal yang bersifat kontemporer. Karya-karya tersebut diciptakan sebagai refleksi dari pengalaman-pengalamannya, pemikirannya, dan konflik-konflik yang dihadapi pada saat ini.Seniman Naufan Noordiyanto banyak memunculkan wujud-wujud dengan perubahan bentuk. Banyak bagian-bagian tubuh yang dideformasi dari figur manusia yang diciptakannya terlihat menjadi wujud manusia yang abnormal. Tentunya terdapat pesan yang ingin disampaikan oleh desainer Naufan Noordiyanto melalui karya-karyanya. Seperti pada karyanya Marlina yang menyajikan pengungkapan diri Naufan tentang akibat-akibat yang timbul dari kurangnya kesetaraan atas diri seseorang, dan menjadi terasing kadang lebih disukai daripada untuk dapat dikenali melalui sekumpulan norma dalam suatu sistem yang dapat melukai dan meniadakan. Dalam penelitian ini penulis menggunakan teori mimesis, teori ekspresif, dan teori objektif/pragmatis.</em></p>

Pendidikan profesi dilakukan penilaian pembelajaran melalui student report. Penilaian dilakukan pada stase mayor dan minor. Pada penilaian klinik ditemukan penilaian yang tidak terlaksana sesuai kewajiban. Oleh karena itu, peneliti tertarik mengetahui dan mendeskripsikan kualitas dan kuantitas penilaian klinik pada Program Studi Profesi Dokter di salah satu Fakultas Kedokteran swasta kota Semarang. Metode menggunakan observasional deskriptif menggunakan data sekunder student report. Pengambilan sampel menggunakan teknik cluster random sampling dianalisis menggunakan analisis deskriptif. Total sampel 70. Kuantitas penilaian Mini-CEX paling terpenuhi di Anestesiologi (92,9%), DOPS di Radiologi (100%), CBD di semua stase minor (100%), P-MEX di THT-KL dan Saraf (57,1%), m-OSLER di semua stase (100%). Kualitas penilaian Mini-CEX, DOPS, P-MEX mayoritas kualitas cukup dan kurang. m-OSLER mayoritas kualitas baik di Kulit Kelamin (100%). CBD mayoritas baik di Anestesiologi, Saraf, Kulit Kelamin, THT-KL (100%). Kuantitas penilaian kognitif paling terpenuhi di semua stase minor, psikomotor di Anestesiologi dan Radiologi, afektif di Anestesiologi dan THT-KL, penilaian keseluruhan di semua stase mayor dan minor. Kualitas penilaian kognitif paling baik di Kulit Kelamin dan Saraf. Psikomotor di Kulit Kelamin dan Saraf. Afektif di Radiologi. Penilaian keseluruhan di stase Kulit Kelamin. Kata Kunci`: Penilaian Klinik, Mahasiswa Kedokteran, Kuantitas, Kualitas

A 22-year-old man presented with a 3-week history of increased thirst, polydipsia, and polyuria. He described consuming large volumes of water and waking up multiple times throughout the night to drink and urinate. He also endorsed symptoms of fatigue and frequent headaches. Prior to this, he had been well. There was no history of diuretic use, lithium use, or renal disease. There was no prior head trauma, cranial irradiation, or intracranial pathology. He denied consumption of nutritional or protein supplements. Clinical exam revealed a well appearing young man with normal heart rate and blood pressure. Visual fields and general neurologic exam were grossly normal.Baselines investigations revealed serum sodium ranging from 141–142 mmol/L (reference range 133–145 mmol/L), creatinine 92 umol/L (50–120 umol/L), random glucose 5.4 mmol/L (3.3–11.0 mmol/L), potassium 4.0 (3.3–5.1 mmol/L) and ionized calcium 1.25 mmol/L (1.15–1.35 mmol/L). A 24-hour urine collection was arranged, and returned a urine volume of 5.6L (normal less than 3 litres/24 hours). Further investigations revealed a serum sodium of 142 mmol/L, serum osmolality 306 mmol/kg (280–300 mmol/kg), and urine osmolality of 102 mmol/kg (50–1200 mmol/kg). AM cortisol was 372 nmol/L (200–690 nmol/L).These results demonstrated inability to concentrate the urine, despite the physiologic stimulus of hyperosmolarity. Based on this, a presumptive diagnosis of diabetes insipidus was made. The patient was instructed to drink as much as he needed to satiate his thirst, and to avoid fluid restriction. The patient was started on DDAVP intranasal spray, which provided immediate relief from his symptoms. Magnetic resonance imaging of the brain revealed an unremarkable pituitary gland with abnormal thickening of the pituitary stalk and loss of the posterior pituitary bright spot. This confirmed the diagnosis of central diabetes insipidus, presumed secondary to infiltrative disease affecting the pituitary stalk.IntroductionPolyuria is defined as inappropriately high urine output relative to effective arterial blood volume and serum sodium. In adults, polyuria can be objectively quantified as urine output in excess of 3–3.5 L per day with a low urine osmolality (<300 mmol/kg).2Daily urine output is dependent on 2 major factors. The first is the amount of daily solute excretion, and the second is the urine concentrating capability of the nephron.3 Disturbances in either of these factors can occur by many different mechanisms, and can lead to a diuresis. This diuresis can be driven either by solute (solute diuresis), water (water diuresis) or a combination of these processes.4 A diagnostic algorithm for polyuria is outlined in Figure 1.Figure 1. Diagnostic Approach to Polyuria Solute DiuresisDaily solute intake varies between individuals, but typically averages about 10 mmol/kg or 500–800 mmol/day.2,3 Solute diuresis is the result of a higher solute load that exceeds the usual solute excretion. 4 Higher solute loads can be a consequence of either increased solute intake or increased solute generation through metabolism. High solute intake can occur from intravenous fluids, enteral or parental nutrition, and any other sources of exogenous protein, glucose, bicarbonate, or sugar alcohols.2,4 Metabolic processes leading to increased solute generation include hyperglycemia and azotemia. 2,4 Increased solute excretion drives urine output in a linear fashion.3 Furthermore, solute diuresis impairs the ability of the kidney to concentrate urine. Typically, in a pure solute diuresis, urine concentration is between 300 and 500 mmol/kg.2,4 The specific cause of solute diuresis can be further delineated with estimation of the urine electrolyte solute over 24 hours: 2(urine [Na]+urine [K]) ×24 hours.4 Values greater than 600 mmol/day suggest electrolytes are the solutes driving the diuresis, while values less than 600 mmol/day imply that the diuresis is due to a non-electrolyte solute, typically glucose or urea.Water DiuresisWater diuresis can occur due to excessive amounts of free water consumption (primary polydipsia) or impaired secretion or response to ADH (diabetes insipidus). In both cases, urine osmolality should be less than 100 mmol/kg.2 Primary polydipsia is characterized by excessive water consumption. This can be a result of compulsive water drinking (often observed in psychiatric disorders) or a defect in the thirst centre of the hypothalamus due to an infiltrative disease process.5,6The osmotic threshold for ADH release occurs at 280–290 mmol/kg. Failure to maximally concentrate the urine (1000–1200 mmol/kg in healthy kidneys) when serum osmolality rises above the osmotic threshold suggest diabetes insipidus.3 Diabetes insipidus (DI) can result from either insufficient ADH secretion from the posterior pituitary (central DI) or ADH resistance (nephrogenic DI).1Central DI can be caused by both congenital and acquired conditions known to affect the hypothalamic-neurohypophyseal system7,8 (Table 1). Polyuria occurs when 80% or more of the ADH secreting neurons are damaged 7. Metastatic disease has a predilection for the posterior pituitary, as its blood supply is derived from the systemic circulation, in contrast to the anterior pituitary which is supplied by the hypophyseal portal system.9 Rapid onset of polydipsia and polyuria in a patient older than 50 years of age should therefore raise immediate suspicion for metastatic disease.9 Treatment of adrenal insufficiency may “unmask” or exacerbate central DI, as normalization of blood pressure following glucocorticoid replacement inhibits ADH release.10 In the pregnant state, ADH degradation is increased due to placental production of vasopressinase. Any mechanism of hepatic dysfunction that occurs in pregnancy (pre-eclampsia, HELLP, acute fatty liver) will augment this normal physiology by reducing vasopressinase clearance, and can subsequently lead to transient DI 11In nephrogenic DI, ADH is present but the kidneys are unable to respond appropriately.8 In normal physiology, ADH acts to concentrate the urine via activation of the vasopressin V2 receptor, which leads to insertion of aquaporin-2 water channels in the collecting duct. 3,12 Nephrogenic DI can be primary (genetic) or secondary (acquired). Primary nephrogenic DI occurs as a result of genetic mutations affecting either the vasopressin 2 receptor or aquaporin-2 water channels; typically, such conditions present in infancy.12 Secondary nephrogenic DI can occur by a variety of mechanisms; the most common is chronic lithium administration. Lithium enters the principal cell in the collecting duct via epithelial sodium channels, and is thought to impair urinary concentrating ability via reduction in the number of principal cells and interference in signalling pathways involved in aquaporin. 12,13 Hypercalcemia, hypokalemia, obstructive uropathy, and pregnancy can lead to transient nephrogenic DI. 12,13 Hypercalcemia can lead to nephrogenic DI by causing a renal concentrating defect when calcium levels are persistently above 2.75 mmol/ L.14 Increased hydrostatic pressure from obstructive uropathy may lead to suppression of aquaporin-2 expression, resulting in transient nephrogenic DI.12 Nephrogenic DI can be caused by various renal diseases due to impairment of renal concentrating mechanisms, even before glomerular filtration rate is impaired. Polycystic kidney disease causes anatomic disruption of the medullary architecture. Polyuria in sickle cell disease results from a similar mechanism, as sickling in the vasa recta interferes with the countercurrent exchange mechanisms 16. Infiltrative renal disease including amyloid and Sjogren’s syndrome impair renal tubular function due to amyloid deposition and lymphocytic infiltration.17,18Mixed Water-Solute DiuresisIn some cases, polyuria can be caused by a combination of both mechanisms. The linear relationship between solute excretion and urine output described above is strongly influenced by ADH. In the setting of a solute diuresis, absence or deficiency of ADH can augment the degree of polyuria quite dramatically.14,19 Clinical examples of mixed diuresis include concurrent loading of both water and solute, chronic renal failure or infiltrative renal disease, relief of prolonged urinary obstruction, and partial DI.2,4 Typically in such scenarios, urine osmolality ranges from 100–300 mmol/kg.2 Conclusion Polyuria has a broad range of causes and can be a diagnostic challenge for clinicians. Understanding the pathophysiology that underpins the different mechanisms of polyuria is essential to appropriate workup, diagnosis, and treatment of this condition. If this is a complaint, the first step is to quantitate the 24-hour urine volume. We recommend referral to endocrinology when there is evidence of hypothalamic or pituitary disease, when a water deprivation test is required, or in cases where the diagnosis is unclear. DisclosureFunding sources: None.Conflicts of interest: None. References 1. Leung AK, Robson WL, Halperin ML. Polyuria in childhood. Clin Pediatr (Phila) 1991;30(11):634–40.2. Bhasin B, Velez JC. Evaluation of polyuria: the roles of solute loading and water diuresis. Am J Kidney Dis 2016;67(3):507–11.3. Rennke HG, Denker BM. Renal pathophysiology: the essentials. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014.4. Oster JR, Singer I, Thatte L, Grant-Taylor I, Diego JM. The polyuria of solute diuresis. Arch Intern Med 1997;157(7):721–9.5. Grois N, Fahrner B, Arceci RJ, Henter JI, McClain K, Lassmann H, et al. Central nervous system disease in Langerhans cell histiocytosis. J Pediatr 2010;156(6):873–81, 81.e1.6. Stuart CA, Neelon FA, Lebovitz HE. Disordered control of thirst in hypothalamic-pituitary sarcoidosis. N Engl J Med 1980;303(19):1078–82.7. Di Iorgi N, Napoli F, Allegri AE, Olivieri I, Bertelli E, Gallizia A, et al. Diabetes insipidus--diagnosis and management. Horm Res Paediatr 2012;77(2):69–84.8. Mahzari M, Liu D, Arnaout A, Lochnan H. Immune checkpoint inhibitor therapy associated hypophysitis. Clin Med Ins Endocrin Diabet 2015;8:21–8.9. Hermet M, Delévaux I, Trouillier S, André M, Chazal J, Aumaître O. Diabète insipide révélateur de métastases hypophysaires : quatre observations et revue de la littérature. La Revue de Médecine Interne 2009;30(5):425-9.10. Martin MM. Coexisting anterior pituitary and neurohypophyseal insufficiency: A syndrome with diagnostic implication. Arch Intern Med 1969;123(4):409–16.11. Aleksandrov N, Audibert F, Bedard MJ, Mahone M, Goffinet F, Kadoch IJ. Gestational diabetes insipidus: a review of an underdiagnosed condition. J Obstet Gynaecol Can 2010;32(3):225–31.12. Bockenhauer D, Bichet DG. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat Rev Nephrol 2015;11(10):576–88.13. Grünfeld JP, Rossier BC. Lithium nephrotoxicity revisited. Nat Rev Nephrol 2009;5(5):270.14. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill, Medical Pub. Division; 2001, 754.15. Gabow PA, Kaehny WD, Johnson AM, Duley IT, Manco-Johnson M, Lezotte DC, et al. The clinical utility of renal concentrating capacity in polycystic kidney disease. Kidney Internat 35(2):675–80.16. Hatch FE, Culbertson JW, Diggs LW. Nature of the renal concentrating defect in sickle cell disease. J Clin Invest 1967;46(3):336–4517. Carone FA, Epstein FH. Nephrogenic diabetes insipidus caused by amyloid disease: Evidence in man of the role of the collecting ducts in concentrating urine. Am J Med 1960;29(3):539–44.18. Shearn MA, Tu W-H. Nephrogenic diabetes insipidus and other defects of renal tubular function in Sjögren's syndrome. Am J Med 1965;39(2):312–8.19. Rennke HG, Denker BM. Renal pathophysiology: the essentials. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014. Figure 3.7, effects of ADH and solute excretion on urine volume, 88.

Zusammenfassung Allgemeines Irene Etzersdorfer, Krieg. Eine Einführung in die Theorien bewaffneter Konflikte (Martin Meier) Anthony Pagden, Worlds at war. The 2,500-year struggle between East and West (Michael Fröhlich) Wegweiser zur Geschichte: Naher Osten. Im Auftr. des MGFA hrsg. von Bernhard Chiari und Dieter H. Kollmer unter Mitarb. von Martin Rink (Rolf Steininger) Die Festungspläne des preußischen Kriegsministeriums. Ein Inventar. Bearb. von Winfried Bliß (Stephan Kaiser) Daniel Burger, Festungen in Bayern (Sascha Sabien) Thomas Fuchs, Bibliothek und Militär. Militärische Büchersammlungen in Hannover vom 18. bis zum 20. Jahrhundert (Gabriele Bosch) Manfred Lachmann, Gliederung und Garnisonen der sächsischen Armee vom Aufkommen des stehenden Heeres bis zum Ende der Monarchie (Werner Knoll) Rainer Sippenauer, Leipziger Soldaten. Ein Biographisches Lexikon (Clemens Heitmann) Wolfram Pyta, Hindenburg. Herrschaft zwischen Hohenzollern und Hitler (Benjamin Ziemann) Andreas Toppe, Militär und Kriegsvölkerrecht. Rechtsnorm, Fachdiskurs und Kriegspraxis in Deutschland 1899-1940 (Klaus-Jürgen Bremm) Heinrich Rieker, Nicht schießen, wir schießen auch nicht! Versöhnung von Kriegsgegnern im Niemandsland 1914-1918 und 1939-1945 (Manfred Messerschmidt) Altertum und Mittelalter Luigi Loreto, La grande strategia di Roma nell´ età della Prima guerra punica (ca. 273 ca. 229 a.C.) (Peter Kehne) Bereit zum Konflikt. Strategien und Medien der Konflikterzeugung und Konfliktbewältigung im europäischen Mittelalter. Hrsg. von Oliver Auge [u.a.] (Hiram Kümper)

Abstract: osteoarthritis is derived from greek meaning bone, arthro meaning joint and itis meaning inflammation. Osteoarthritis is a degenerative joint disease that is chronic,progessive runing slow, often inflamed or causes only mild inflammation, and characterized by deterioration and abrasion of articular cartilage as well as by two risk factor are: risk factors that cannot be changed and modifable risk factors. Obesity is a global epidemic in developed countries and developing countries such as Indonesia, particularly in urban strip. This situation is caused by unbalanced energy intake with energy expenditure and excess energy is stored as body fat within a specified period. Objectives: this study aimed to determine the role of risk factor of obesity on the incidence of osteoarthitis of the knee in patients who visit the Rehabilitation Medical Installation BLU Prof. DR. R. D. Kandou Manado. Method: this type of research is descriptive research by taking medical record in medical rehabillitation installation at BLU RSUP Prof. DR. R. D. Kandou Manado. Result: in this study was obtained from descriptive data/medical record(MR) found the number of patients diagnosed with osteoarthritis of the knee by 74 people. Obtained as many as 31 people who have data(weight and height),3 complete lack data because just have weight and 40 people don’t have either weight or height. Research results knee OA patient who come control in the installation of medical rehabillitation only 31are listed the data Body Mass Indeks(weight and height), there are 5 people who have normal BMI, and 26 people who had a BMI of both overweight and obesity excess. Conclusion: from here we may see one of the risk factor for OA knee is obesity Keywords: Knee osteoarthritis, obesity. Abstrak: Osteoartritis (OA) berasal dari bahasa Yunani yaitu osteo yang berarti tulang, arthro yang berarti sendi dan itis yang berarti inflamasi. Osteoartritis adalah penyakit degeneratif sendi yang bersifat kronik, berjalan progresif lambat, seringkali tidak meradang atau hanya menyebabkan inflamasi ringan, dan ditandai dengan adanya deteriorasi dan abrasi rawan sendi serta oleh 2 faktor resiko yaitu: faktor resiko yang tidak dapat diubah dan faktor resiko yang dapat diubah. Obesitas merupakan epidemi global pada negara-negara maju dan negara berkembang seperti di Indonesia, terutama di daerah perkotaan. Keadaan ini diakibatkan karena pemasukan energi tidak seimbang dengan pengeluaran energi dan kelebihan energi ini disimpan dalam bentuk lemak tubuh dalam jangka waktu tertentu. Tujuan: Penelitian ini bertujuan untuk mengetahui peranan faktor resiko obesitas terhadap angka kejadian osteoartritis lutut pada penderita yang berkunjung di Instalasi Rehabilitasi Medik BLU RSUP Prof. DR. R. D. Kandou Manado. Metode: Jenis penelitian ini adalah penelitian deskriptif dengan mengambil data rekam medik di Instalasi Rehabilitasi Medik BLU RSUP Prof. DR. R. D. Kandou Manado. Hasil: Pada penelitian yang didapatkan dari data deskriptif/rekam medik (RM) didapatkan jumlah penderita yang didiagnosis dengan osteoartritis lutut sebanyak 74 orang. Didapatkan sebanyak 31 orang yang memiliki data BB dan TB, 3 data kurang lengkap yaitu hanya terdapat data BB dan 40 data yang tidak mempunyai baik BB maupun TB. Hasil penelitian menyatakan penderita OA lutut yang datang kontrol di Instalasi Rehabilitasi Medik,hanya 31 yang tercantum data IMT (BB&TB),terdapat 5 orang yang memiliki IMT normal,dan 26 orang yang memiliki IMT berlebih baik overweight maupun obesitas. Simpulan: Dari sini kita bisa melihat salah satu faktor resiko OA lutut adalah obesitas. Kata Kunci: Osteoartritis lutut, Obesitas.

: Clinically, the treatment of bone defects remains a significant challenge, as it requires autogenous bone grafts or bone graft substitutes. However, the existing biomaterials often fail to meet the clinical requirements in terms of structural support, bone induction and controllable biodegradability. In the treatment of bone defects, 3D porous scaffolds have at-tracted much attention in the orthopedic field. In terms of appearance and microstructure, complex bone scaffolds created by 3D printing technology are similar to human bone. On this basis, the combination of active substances including cells and growth factors is more conducive to bone tissue reconstruction, which is of great significance for the personalized treatment of bone defects. With the continuous development of 3D printing technology, it has been widely used in bone defect repair as well as diagnosis and rehabilitation, creating an emerging industry with excellent market potential. Meanwhile, the di-verse combination of 3D printing technology with multi-disciplinary fields such as tissue engineering, digital medicine, and materials science has made 3D printing products with good biocompatibility, excellent osteo-inductive capacity and stable mechanical properties. In the clinical application of the repair of bone defects, various biological materials and 3D printing methods have emerged to make patient-specific bioactive scaffolds. The microstructure of 3D printed scaffolds can meet the complex needs of bone defect repair and support the personalized treatment of patients. Some of the new materials and technologies that emerged from the 3D printing industry's advent in the past decade successfully translated into clinical practice. In this article, we first introduced the development and application of different types of materials that were used in 3D bioprinting, including metal, ceramic materials, polymer materials, composite materials, and cell tissue. The combined application of 3D bioprinting and other manufacturing method used for bone tissue engineering are also discussed in this ar-ticle. Finally, we discussed the bottleneck of 3D bioprinting technique and forecasted its research orientation and prospect.