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"[ABSTRAKTujuan: Untuk mengevaluasi perbandingan ketebalan kornea dan morfologi sel endotel penderita miopia sedang dengan pemakaian harian lensa kontak lunak hidrogel konvensional (nelfilcon A) terhadap silikon hidrogel (lotrafilcon B) selama 1 bulan.Metode: Penelitian ini merupakan uji klinis tersamar tunggal pada 17 pasien (34 mata) dengan miopia sedang yang dibagi secara acak untuk memakai lensa kontak lunak nelfilcon A atau Lotrafilcon B. Ketebalan kornea sentral (CCT), Coefficient of variation (CV), dan persentase sel heksagonal (6A) diukur menggunakan mikroskop spekuler non-con robo Konan sebelum penelitian (pre-fitting), 1 minggu serta 1 bulan setelah pemakaian lensa kontak lunak. Pasien juga dievaluasi mengenai adanya efek samping subyektif dan komplikasi selama memakai lensa kontak.Hasil: Terdapat 64,7% subyek dengan riwayat pemakaian lensa kontak lunak sebelumnya, dimana 52,9% diantaranya adalah pemakai hidrogel konvensional yang tidak teratur. Setelah evaluasi 1 bulan, tidak didapatkan perbedaan yang bermakna antara pemakai Nelfilcon A dengan Lotrafilcon B dalam hal: ketebalan kornea sentral (p=0,285; uji Mann Whitney), CV (p=0,587; uji t tidak berpasangan), dan 6A (p=0,353; uji t tidak berpasangan). Analisis general linear model terhadap waktu pengukuran mendapatkan perbedaan yang bermakna pada seluru subyek meliputi penurunan CCT (p=0,001) dan CV (p=0,001), serta peningkatan 6A (p=0,022) pada test within subject effect.Simpulan: Tidak terdapat perbedaan CCT, CV, dan 6A yang bermakna secara statistik antara pada pemakaian harian lensa kontak lunak Lotrafilcon B dan Nelficon A. Pasien dengan riwayat penggunaan lensa kontak sebelumnya mendapatkan manfaat dengan pemakaian nelfilcon A dan lotrafilcon B dalam hal perbaikan hipoksia jaringan berupa: penurunan ketebalan kornea dan perbaikan morfologi sel endotel.

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ABSTRACTObjective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.Methods: This is a prospective, single blind, randomized study. Seventeen (34 eyes) myopic patients were randomly assigned to wearing either nelfilcon A or lotrafilcon B. Central corneal thickness (CCT), Coefficient of variation (CV), and percentage of six-sided cell (6A) were examined using specular microscope non-con robo Konan. Changes in CCT, CV, and 6A were evaluated before contact lenses fitting as well as 1 week and 1 month after the treatment. Patients were also evaluated for any subjective side effects and complications during the treatment period.Results: There were 64,7% subjects with history of contact lens weares and 52,9% of them was hydrogel wearers. After 1 month daily wear of nelfilcon A and lotrafilcon B, no statistically differences changes in CCT (p=0,285; Mann Whitney test), CV (p=0,587; unpaired t test) dan 6A (p=0,353; unpaired t test). General linear model analysis in follow up evaluation with test of within subject effect revealed decreased CCT(p=0,001) and CV (p=0,001), also increased 6A (p=0,022) in all subjects.Conclusions: There were no statistically difference CCT, CV, and 6A between daily wear of nelfilcon A and lotrafilcon B. Subjects with history of contact lens weares gained advantages in oxygen availability, which is decrease in corneal thickness and improvement of endothelial cell morphology., Objective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.Methods: This is a prospective, single blind, randomized study. Seventeen (34 eyes) myopic patients were randomly assigned to wearing either nelfilcon A or lotrafilcon B. Central corneal thickness (CCT), Coefficient of variation (CV), and percentage of six-sided cell (6A) were examined using specular microscope non-con robo Konan. Changes in CCT, CV, and 6A were evaluated before contact lenses fitting as well as 1 week and 1 month after the treatment. Patients were also evaluated for any subjective side effects and complications during the treatment period.Results: There were 64,7% subjects with history of contact lens weares and 52,9% of them was hydrogel wearers. After 1 month daily wear of nelfilcon A and lotrafilcon B, no statistically differences changes in CCT (p=0,285; Mann Whitney test), CV (p=0,587; unpaired t test) dan 6A (p=0,353; unpaired t test). General linear model analysis in follow up evaluation with test of within subject effect revealed decreased CCT(p=0,001) and CV (p=0,001), also increased 6A (p=0,022) in all subjects.Conclusions: There were no statistically difference CCT, CV, and 6A between daily wear of nelfilcon A and lotrafilcon B. Subjects with history of contact lens weares gained advantages in oxygen availability, which is decrease in corneal thickness and improvement of endothelial cell morphology.]"

"Pengaruh Prekondisi dan Hipotermia pada Cedera Iskemia-Reperfusi Terhadap Endotel Pembuluh Darah Perifer pada Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih3 1Program Studi Ilmu Bedah, Fakultas Kedokteran Universitas Indonesia2Departemen Medik Ilmu Bedah, RSUPN Cipto Mangunkusumo Pendahuluan. Cedera iskemia -reperfusi CI/R merupakan masalah serius yang dihadapi pascahipoksia; menyebabkan kerusakan sel yang letaknya remote organ injury. Intervensi prekondisi iskemia-reperfusi PI/R merupakan fenomena jaringan yang diberikan stimulasi hipoksia berulang sebelum mendapatkan keadaan iskemia lama. Keadaan hipotermia iskemia reperfusi HI/R menyebabkan metabolisme sel menurun termasuk respon sel terhadap iskemia. Penelitian ini bertujuan untuk mengetahui efek intervensi PI/R dan HI/R terhadap perubahan morfologi endotel pembuluh darah dan peningkatan kadar malondialdehyde MDA sebagai respon stress oksidatif pada jaringan endotel a/v femoralis komunis distal obstruksi iskemia dan kontralateral CI/R. Metode: Studi eksperimental yang bersifat deskriptif analitik pada Oryctolagus cuniculus, Pada kelompok CI/R dilakukan ligasi arteri femoralis komunis dalam pembiusan selama empat jam untuk menginduksi iskemia. Pada kelompok PI/R dilakukan dengan ligasi berulang arteri femoralis komunis kanan selama dua menit, dilepaskan tiga menit sebanyak dua siklus, kemudian diligasi selama empat jam. Pada kelompok hipotermia, dilakukan ligasi arteri femoralis komunis selama empat jam yang disertai dengan membungkus ekstremitas bawah kanan dengan es dengan target suhu antara 31-33 C, kemudian pada ketiga intervensi ligasi dibuka dan kelinci dibiarkan beraktivitas selama delapan jam. Setelah itu, dilakukan pengambilan sampel a.v yang berasal dari distal dari ligasi ipsilateral dan kontralateral untuk pemeriksaan histopatologi dan biokimia. Pemeriksaan biokimia dilakukan menggunakan malondialdehid MDA. Hasil: Pada pemeriksaan histomorfologi menunjukan perbedaan bermakna antara skoring kerusakan endotel jaringan a.v. ipsilateral pada ketiga sampel intervensi dibanding kontrol dan nilai sampel intervensi preventif lebih baik daripada sampel CI/R p< 0,05 . Pada sampel a.v kontralateral kelompok PI/R dan HIR tidak memiliki perbedaan bermakna dengan kontrol p> 0,05 . Pada evaluasi kadar MDA ditemukan kadar MDA meningkat pada semua intervensi baik pada CIR, PI/R, dan HI/R yang tidak berbeda bermakna dengan kontrol p> 0,05. Konklusi: Keadaan CI/R menyebabkan disfungsi endotel bukan hanya pada daerah iskemik, namun pada organ yang letaknya berjauhan. Kerusakan endhotelial lining dapat dicegah dengan tindakan PI/R dan HI/R dan peningkatan kadar MDA merupakan respon fisiologis jaringan terhadap iskemia dan cedera reperfusi yang terjadi baik pada CI/R, PI/R, dan HI/R.

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The Effect of Preconditioning and Hypothermia in Ischemia Reperfusion Injury to the Endothelial Cells from Peripheral Blood Vessels in Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih31General Surgery Science Study Program, Faculty of Medicine Universitas Indonesia2Department of Surgery, Dr. Cipto Mangunkusumo National General HospitalIntroduction. Ischemia reperfusion injury IRI is a serious problem in the post hypoxia period, which causes remote organ injury. Ischemic preconditioning IPC is a phenomenon where tissues are subjected to repeated hypoxic stimulations to protect against subsequent prolonged period of ischemia. Hypothermia during ischemia reperfusion injury HI decreases metabolism of cells including their response to ischemia. The goal of this study is to investigate the effects of interventions such as IPC and HI on the morphology of endothelial cells in blood vessels and the increased level of malondialdehyde MDA as an oxidative stress response in endothelial tissues of distal common femoral artery and vein obstruction ischemia and its contralateral IRI.

Method: This is a descriptive and analytic experimental study using Oryctolagus cuniculus. In the IRI group, the common femoral artery was ligated during anesthesia for four hours to induce ischemia. In the IPC group, the right common femoral artery was continually ligated for two minutes, which was then released for three minutes for two cycles, and then ligated for four hours. In the hypothermia group, the common femoral artery was ligated for four hours and the right lower extremity was wrapped in ice with the target temperature range between 31 33o C. Then the arteries from the three interventions were unligated and the rabbit was released to observe its activity for eight hours. Next, samples of artery and vein distal from the ligation ipsilateral and its contralateral were obtained for histopathological and biochemical examinations. The biochemical analysis was performed using malondialdehyde MDA.

Results: The histomorphological examination showed significant difference in the injury scores between the endothelial tissues from ipsilateral artery and vein in the three interventional samples compared with control, and the scores for the preventive intervention groups were better than the IRI sample p0.05.

Conclusion: Ischemic reperfusion injury can cause not only endothelial dysfunction in the ischemic area, but also remote organ injury. Endothelial lining injury can be prevented by IPC and HI. The elevated level of MDA is a physiological response of tissue after ischemia reperfusion injury which could be found on IRI, IPC, and HI."

"Panduan resusitasi anak umumnya menganjurkan pemberian cairan dalam jumlah besar. Beberapa penelitian memperlihatkan bahwa penggunaan cairan yang agresif meningkatkan mortalitas. Penelitian pada hewan menunjukkan tekanan vena sentral yang tinggi memicu pelepasan atrial natriuretic peptide ANP , sementara penelitian invitro memperlihatkan ANP meluruhkan glycocalyx endotel vaskular dan meningkatkan permeabilitas endotel. ANP juga memicu vasodilatasi. Hemodilusi berpotensi menurunkan pasokan oksigen tubuh DO2 . Penelitian bertujuan untuk melihat pengaruh resusitasi cairan terhadap kadar ANP serum, peluruhan glycocalyx endotel vaskular, extravascular lung water index ELWI , mean arterial pressure MAP , kadar hemoglobin dan pasokan oksigen. Hewan model renjatan adalah 11 ekor Sus scrofa jantan, usia 6-10 minggu. Renjatan dilakukan dengan metode fixed pressure hemorrhage. Resusitasi pertama dilakukan dengan jumlah cairan sesuai darah yang dikeluarkan resusitasi normovolemik , dilanjutkan dengan 40 mL/kg resusitasi hipervolemik . Pengukuran hemodinamik dilakukan dengan PICCO. Serum ANP dan Syndecan-1, petanda peluruhan glycocalyx, dilakukan dengan teknik ELISA. Hasil penelitian menunjukkan terjadinya peningkatan ANP pasca resusitasi normovolemik p = 0,043 , yang kemudian menurun kembali dalam 30 menit. Peluruhan glycocalyx tidak terjadi. Perbedaan ELWI pada 60 menit pasca resusitasi secara statistik bermakna, dengan perbedaan 0,93 mL/kg 95 IK:0,19 -3,62 . Terdapat korelasi kuat antara SVRI dan CI pasca resusitasi hipervolemik r = -0,587 . Tidak ada perbedaan MAP pasca resusitasi normovolemik dan hipervolemik. Kadar hemoglobin pasca resusitasi hipervolemik lebih rendah daripada pasca resusitasi normovolemik p = 0,009 . Pasokan oksigen tubuh pasca resusitasi hipervolemik lebih tinggi daripada pasca resusitasi normovolemik p = 0,012 . Simpulan: Resusitasi cairan pada renjatan akibat perdarahan tidak mengakibatkan peluruhan glycocalyx endotel vaskular. Peningkatan ELWI amat terbatas. SVRI berkorelasi terbalik dengan CI. Tidak ada perbedaan MAP antara resusitasi normovolemik dan hipervolemik. Resusitasi hipervolemik menyebabkan hemodilusi yang diimbangi dengan peningkatan curah jantung.

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Many pediatric guidelines recommend liberal fluid resuscitation, but recent studies showed that aggressive fluid resuscitation might increase mortality. Animal studies showed that high central venous pressure induced ANP secretion. Invitro studies showed convincing evidence that ANP induced glycocalyx shedding. ANP also induced vasodilatation through cGMP signal transduction pathways. Hemodilution due to a large amount of resuscitation fluid potentially decreasing oxygen delivery.The objectives of this study were investigating the effect of fluid resuscitation, in the animal model, with special concern on serum ANP, glycocalyx shedding indicate by serum Syndecan-1 , changes in extravascular lung water, systemic vascular resirtance and mean arterial pressure, hemoglobin level and oxygen delivery DO2 . The animal models were 11 male domestic pigs, 6 -10 weeks old. The shock was induced with fixed pressure hemorrhage method. Fluid resuscitation was done in 2 phases. On the first attempt, we replaced total numbers of blood that withdrawn normovolemic resuscitation . On the second attempt, we gave 40 mL/kg resuscitation fluids hypervolemic resuscitation . The hemodynamic measurements were done with PICCO. Serum ANP and Syndecan-1 were measure with ELISA method.We found that serum ANP increased after normovolemic resuscitation p = 0.043 and immediately back to base level in 30 minutes. Glycocalyx shedding did not occur. Extravascular lung water index minimally increased. There was a strong correlation between SVRI and CI at hypervolemic resuscitation r = -0.587 . There was no difference in mean arterial pressure between normovolemic and hypervolemic resuscitation. Hemoglobin level after hypervolemic resuscitation was lower than after normovolemic resuscitation p = 0.009 . Oxygen delivery was higher after hypervolemic resuscitation p = 0.012 .Conclusions: Hypervolemic resuscitation in this hemorrhagic shock model did not induce glycocalyx shedding, extravascular lung water index minimally increased. Systemic vascular resistance index negatively correlated to cardiac index. Fluid resuscitation may induce hemodilution, but oxygen delivery can be compensated by increasing cardiac output. "

"Latar Belakang: Hipertensi berkontribusi secara bermakna terhadap morbiditas dan mortalitas kardiovaskular (KV) di dunia. Dua penyebab terpentingnya adalah asupan garam dan disfungsi endotel yang dapat dinilai menggunakan flow-mediated dilatation (FMD). Modifikasi keduanya dapat menurunkan morbiditas dan mortalitas hipertensi. Diet rendah natrium DRN belum diterapkan secara optimal di dunia karena keterbatasan produk garam rendah natrium. Belum ada studi tentang perbandingan efek diet rendah natrium yang bervariasi terhadap perbaikan fungsi endotel yang dinilai melalui FMD pada subjek hipertensi derajat I, khususnya di Indonesia. Metode: Uji klinis ini dilaksanakan di RSJPD Harapan Kita terhadap 52 subjek hipertensi derajat I (26 laki-laki dan 26 perempuan), berusia 25 - 59 tahun, dan berindeks massa tubuh 18,5 - 29,99 kg/m2. Subjek dieksklusi jika berpenyakit atau berfaktor risiko KV, memiliki penyakit liver, kanker, alergi rumput laut, infeksi berat, atau dalam terapi KV, hormonal, steroid, atau terapi herbal rutin. Data primer didapat dari anamnesis dan pemeriksaan fisik. Subjek-subjek dirandomisasi menjadi dua kelompok, yaitu kelompok DRN dengan kadar natrium 21 - 23% dan kelompok DRN dengan kadar natrium 38 - 40%, kedua diet diberikan dalam bentuk kuah. Nilai FMD diukur sebelum intervensi dan 60 menit setelahnya. Hasil: Karakteristik dasar, termasuk diameter arteri brakialis prakompresi dan pascakompresi serta FMD, tidak berbeda bermakna di antara kedua grup. Pada kelompok DRN 38 - 40%, nilai FMD pada menit ke-60 pasca-intervensi menurun dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut tidak bermakna median [kisaran]: 7,92 [0,00 - 17,50]; p>0,05). Pada kelompok DRN 21 - 23%, nilai FMD pada menit ke-60 pasca-intervensi meningkat dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut juga tidak bermakna 7,65 [1,36 - 19,51]; p>0,05). Simpulan: Nilai FMD pasca-intervensi tidak berbeda bermakna antarkelompok. Ketidakbermaknaan perbedaan nilai-nilai FMD dalam penelitian ini mungkin disebabkan oleh aspek-aspek internal subjek yang memengaruhi fungsi endotel dan prosedur evaluasi FMD.

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Background: Hypertension contributes significantly to cardiovascular (CV) morbidity and mortality in the world. Two of its most important causes are salt intake and endothelial dysfunction which can be assessed using flow-mediated dilatation (FMD) test. Modification of both may decrease its morbidity and mortality. Low-sodium diet (LSD) has not been optimally implemented in the world due to the limited low-sodiumsalt products. There has been no study regarding the effects of low-sodium salt with various sodium concentrations on FMD of grade-I-hypertension subjects, especially in Indonesia. Methods: This clinical trial was conducted at the NCC Harapan Kita on 52 grade-Ihypertension subjects 26 men, 26 women , aged 25 - 59 years old, with body mass index of 18.5 - 29.99 kg/m2. Subjects were excluded if they had CVD, CV risk factors, liver disease, cancer, seaweed allergy, severe infection, or on routine CV-, hormonal-, steroid, or herbal-therapy. Primary data were collected from anamnesis and physical examinations. We randomly assigned the subjects into two groups, i.e. the group LSD with natrium concentration of 21 - 23% and the group of LSD with natrium concentration of 38-40% . Both diets were given in a soup form. The FMD values were measured before the intervention and 60 minutes after it. Results: Baseline characteristics, including pre-compression and post-compression brachial artery diameter and baseline FMD, were not significantly different between both groups. At group LSD 38 - 40%, FMD value at 60 minutes post-intervention was decreased compared to its baseline value, but the difference was not significant median [range]: 7.92 [0.00 mdash;17.50]; p>0.05). At group LSD 21 - 23%, FMD value at 60 minutes post-intervention was increased compared to its baseline value, but the difference was also not significant 7.65 [1.36 mdash;19.51]; p>0.05). Conclusion: The post-intervention FMD values were not significantly different between both groups. The non-significant differences between FMD values in this study may be due to the subjects' internal aspects influencing endothelial function and FMD evaluation procedure."

"Latar Belakang. Disfungsi endotel dan aterosklerosis merupakan kondisi yang terjadi secara sistemik. Bila ada aterosklerosis di aorta, maka kemungkinan juga terjadi aterosklerosis di arteri koroner. Kekakuan aorta akibat aterosklerosis tersebut dapat diketahui dari pulse wave velocity (PWV) aorta. Penelitian ini akan menilai hubungan antara PWV aorta dengan keberadaan penyakit arteri koroner (PAK) berdasarkan skor SYNTAX (Synergy between percutaneous coronary intervention with Taxus and cardiac surgery) angiografi koroner. Metode. Penelitian ini merupakan suatu penelitian observasional potong lintang. Evaluasi dilakukan pada 83 pasien yang menjalani angiografi koroner elektif di Pusat Jantung Nasional harapan Kita dan memenuhi kriteria inklusi sejak September hingga November 2013. Hubungan nilai PWV aorta dengan keberadaan PAK berdasarkan skor SYNTAX dinilai dengan analisis regresi logistik. Hasil. Setelah disesuaikan dengan usia, jenis kelamin, indeks massa tubuh, hipertensi, diabetes melitus, dislipidemia, penghambat enzim konverting angiotensin, penyekat reseptor angiotensin, penyekat kanal kalsium, diuretik, dan pasca infark miokard, tidak ditemukan hubungan antara PWV aorta dengan keberadaan PAK (Odds ratio 2,126; IK 95%: 0,744 – 6,072; p= 0,159). Pada kelompok PAK tidak ditemukan korelasi antara nilai PWV aorta dengan skor SYNTAX (r= -0,082; p= 0,539). Uji regresi logistik multinomial antara PWV aorta dengan skor pembuluh juga tidak menunjukkan hubungan yang bermakna. Kesimpulan. PWV aorta tidak memiliki hubungan yang bermakna dengan keberadaan dan beratnya stenosis PAK, tetapi pada kelompok PAK ada kecenderungan terjadi PWV aorta lebih tinggi.

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Background. Endothelial dysfunction and atherosclerosis are conditions that occurs systemically. If atherosclerosis occurred in the aorta, it may also occurred atherosclerosis in coronary artery. Aortic stiffness as a result of atherosclerosis can be known from the pulse wave velocity (PWV) of the aorta. This study will assess the relationship between aortic PWV with the presence of coronary artery disease (CAD) by SYNTAX (Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score from coronary angiography.

Method. This study is a cross-sectional observational study. The evaluation was done on 83 patients who undergoing elective coronary angiography at the Harapan Kita National Heart Centre and met the inclusion criteria since September to November 2013. The relationship between aortic PWV values with the presence of CAD by SYNTAX score was assessed by logistic regression analysis.

Results. After adjusting for age, sex, body mass index, hypertension, diabetes mellitus, dyslipidemia, angiotensin converting enzym inhibitor, angiotensin reseptor blocker, calcium channel blocker, diuretic, and post myocardial infarction, analyses revealed there is no associated between aortic PWV with the presence of CAD (Odds ratio 2,126; IK 95%: 0,744 – 6,072; p= 0,159). In CAD group, there was no associated between aortic PWV value with SYNTAX score. After multinomial logistic regression between aortic PWV with vessel score, there is also no significantly associated.

Conclusion. Aortic PWV has no relation with the presence and severity of CAD, but there is a trend toward high aortic PWV in CAD group."

"ABSTRAKTujuan Untuk mengetahui perbadingan efektivitas dan keamanan antara fakoemulsifikasi torsional dan transversal menggunakan parameter phaco time dan perubahan sel endotel dan ketebalan kornea sentral Metode Penelitian prospektif menggunakan katarak senilis NO 3 4 LOCS III yang dilakukan randomisasi menjadi dua kelompok torsional Ozil IP dan transversal Ellips FX Keluaran primer berupa phaco time sel endotel kornea ketebalan kornea sentral tajam penglihatan terkoreksi pada hari pertama ketujuh dan ke 30 pasca operasi Hasil Penelitian ini menggunakan 61 pasient Karakteristik dasar setara dan dapat dibandingkan Phaco time torsional CDE memiliki nilai kecil hingga hanya 1 3 phaco time transversal EFX Penurunan ECD kelompok torsional 7 9 dan kelompok transversal 8 9 Tidak ada perbedaan bermakna pada perubahan ECD dan CCT antara fakoemulsifikasi torsional dan transversal Simpulan Efektivitas dan keamanan kedua mesin fakoemulsifikasi torsional dan transversal tidak berbeda signifikan.

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ABSTRACT

Purpose To compare the effectivity and safety between torsional and transversal phacoemulsification using intraoperative parameter phaco time and postoperative parameter endothelial cells and central corneal thickness changesMethods This prospective study with senile cataract eyes NO 3 4 LOCS III which randomized to have phacoemulsification using torsional Ozil IP or transversal Ellips FX Primary outcomes were phaco time endothelial cell density ECD central corneal thickness CCT corrected distance visual acuity with 1 7 and 30 days after phacoemulsificationResults The study included 61 patients Baseline characteristic were comparable The phaco time torsional CDE only one third of phaco time transversal EFX The results of the percentage of ECD loss were 7 9 in torsional and 8 9 in transversal No difference in ECD and CCT changes between torsional and transversal statistically Conclusions The effectivity and safety of torsional and transversal phacoemulsification did not differ significantly."

"Latar belakang: Kanker serviks merupakan salah satu kanker yang paling banyak ditemui dengan angka kematian yang tinggi di seluruh dunia. Vascular Endothelial Growth Factor (VEGF) merupakan salah satu biomarker yang berfungsi sebagai faktor prognosis pada kanker serviks. Data ekspresinya terkait berbagai karakteristik kanker serviks yang ditemui pada hasil pemeriksaan Ultrasonografi (USG) dan Magnetic Resonance Imaging (MRI) pada pasien kanker serviks di Indonesia masih terbatas.Tujuan: Untuk mengetahui hubungan antara tingkat ekspresi VEGF, pemeriksaan USG, dan pemeriksaan MRI pada pasien kanker serviks.Metode: Studi diagnostik dengan metode cross-sectional dilakukan pada pasien kanker serviks yang datang ke RSUPN Cipto Mangunkusumo pada bulan September 2021 hingga Agustus 2022. Pasien yang didiagnosis kanker serviks yang belum mendapatkan terapi apapun dilakukan biopsi serviks dan pemeriksaan USG dan MRI. Pasien yang tidak dilakukan pemeriksaan USG dan MRI serta biopsi dikeluarkan dari penelitian. Pemeriksaan VEGF dilakukan pada jaringan serviks dan diinterpretasikan menggunakan H-score. Sensitivitas dan spesifisitas pemeriksaan VEGF dan USG dibandingkan dengan hasil MRI.Hasil: Terdapat 65 subjek yang diikutsertakan dalam penelitian (10 subjek stadium awal dan 55 subjek stadium lanjut). Tidak ada perbedaan ekspresi VEGF di antara pasien kanker serviks dihubungkan dengan stadium, tipe histologi, atau ukuran tumor yang berbeda. Ada interreliabilitas minimum antara pemeriksaan VEGF dan MRI. Ada interreliabilitas yang baik antara pemeriksaan USG dan MRI untuk menentukan stadium kanker, invasi parametrium, invasi kelenjar getah bening dan invasi mukosa vesika urinaria dan rektumKesimpulan: Tidak terdapat perbedaan ekspresi VEGF pada pasien kanker serviks dengan karakteristik yang berbeda. Hasil pemeriksaan USG dan MRI sebanding dalam menentukan stadium klinis pada pasien kanker serviks.

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Background: Cervical cancer is one of the most common cancers with a high mortality rate worldwide. Vascular Endothelial Growth Factor (VEGF) is a biomarker that functions as a prognostic factor in cervical cancer. Expression data related to various characteristics of cervical cancer found on the results of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) examinations in cervical cancer patients in Indonesia are still limited.

Purpose: To determine the relationship between VEGF expression levels, ultrasound examination and MRI examination in cervical cancer patients.

Methods: A diagnostic study using the cross-sectional method was conducted on cervical cancer patients who came to Cipto Mangunkusumo General Hospital from September 2021 to August 2022. Patients diagnosed with cervical cancer who had not received any therapy had cervical biopsies and ultrasound and MRI examinations. Patients who did not undergo ultrasound and MRI examinations and biopsies were excluded from the study. VEGF examination was performed on cervical tissue and interpreted using the H-score. The sensitivity and specificity of VEGF and ultrasound examinations were compared with MRI results.

Results: There were 65 subjects enrolled in the study (10 early-stage subjects and 55 advanced-stage subjects). There were no differences in VEGF expression among cervical cancer patients associated with different stages, histological types, or tumor sizes. There is minimal interreliability between VEGF and MRI examinations. There is good interreliability between ultrasound and MRI examinations for determining the stage of cancer, parametrial invasion, lymph node invasion and mucosal invasion of the bladder and rectum.

Conclusions: There are no differences in VEGF expression in cervical cancer patients with different characteristics. The results of ultrasound and MRI examinations are comparable in determining clinical staging in cervical cancer patients."

"Untuk hemodialisis pasien Penyakit Ginjal Tahap Akhir (PGTA) akses vaskular terpilih adalah pembuatan fistula arteriovenosa (FAV) native, namun FAV memiliki angka kegagalan maturitas yang relatif tinggi. Primary balloon angioplasty (PBA) merupakan salah satu teknik dilatasi untuk membantu maturitas FAV. Teknik konstruksi FAV yang traumatik dan peregangan diameter lumen vena dengan balon dapat menyebabkan cedera fokal pada endotelium vena dan memberikan respons hiperplasia intima serta memengaruhi kadar NO, VEGF dan EMP yang dapat berdampak negatif pada maturitas FAV. Penelitian ini bertujuan untuk mengetahui efek PBA terhadap hiperplasia intima, kadar NO, VEGF, EMP serta maturitas FAV pada pasien dengan PGTA.Desain penelitian adalah uji klinis tersamar acak tunggal di RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok pada bulan Desember 2019 sampai Februari 2022; dengan subjek penelitian 112 pasien. Setelah randomisasi sampel terstratifikasi, 48 pasien menjalani konstruksi FAV dengan PBA (intervensi) dan 64 pasien menjalani konstruksi FAV tanpa PBA (kontrol). Pengukuran meliputi intimal medial thickness (IMT) jukstaanastomosis, VF dan PSV draining vein 1, 2 dan 6 minggu pascaoperasi; kadar NO, kadar VEGF, kadar EMP pascaoperasi dan 2 minggu pascaoperasi serta maturitas FAV yang dievaluasi 6 minggu pascaoperasi. Terkait pandemi COVID-19, 32 pasien lost to follow-up dan 5 pasien kontrol dieksklusi karena trombus pada FAV sehingga subjek yang dianalisis 36 pasien intervensi dan 39 pasien kontrol.Terdapat perbedaan bermakna antara grup kontrol dan intervensi pada maturitas, VF dan PSV draining vein 6 minggu pascaoperasi; kadar EMP 2 minggu pascaoperasi pada pasien PGTA yang menjalani operasi konstruksi FAV (Uji Mann Whitney U, p < 0,05). Tidak didapatkan perbedaan bermakna IMT jukstaanastomosis serta kadar NO dan VEGF antara kelompok kontrol dan intervensi (Uji Mann Whitney U, p > 0,05).Simpulan: PBA meningkatkan maturitas FAV pada pasien PGTA yang menjalani operasi konstruksi FAV yang ditandai dengan peningkatan VF dan PSV draining vein hingga 6 minggu pascaoperasi tanpa memengaruhi ketebalan intima pada daerah jukstaanastomosis, kadar NO dan kadar VEGF. Terdapat peningkatan kadar EMP 2 minggu pascaoperasi pada FAV dengan PBA.

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The preferred vascular access for hemodialysis for patients with end-stage renal disease (ESRD) is through the creation of a native arteriovenous fistula (AVF). The weakness of AVF is the relatively high maturation failure rate. Primary balloon angioplasty (PBA) is a dilation technique to assist AVF maturation. Traumatic AVF construction technique and diameter stretching of the vein lumen with balloons can cause focal injury to the venous endothelium which will eventually affect intimal hyperplasia and NO, VEGF and EMP levels which can negatively impact AVF maturation. This study aimed to determine the effect of PBA on intimal hyperplasia, levels of NO, VEGF, EMP and AVF maturation in patients with ESRD who underwent AVF construction surgery.

This study used a single-blind randomized clinical trial design at RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok in December 2019 until February 2022 with 112 subjects. With stratified sample randomization method, 48 patients underwent AVF construction with PBA (intervention), 64 patients underwent AVF construction without PBA (control). Measurements included jukstaanastomosis intimal medial thickness (IMT), VF and peak systolic value (PSV) draining veins 1, 2 and 6 weeks postoperatively; NO, VEGF, EMP levels postoperative and 2 weeks postoperative; and AVF maturation evaluated 6 weeks postoperatively. Regarding the COVID-19 pandemic, 32 patients lost to follow-up and 5 control patients were excluded because of thrombus in the AVF so that analysis was carried out on 75 subjects (36 intervention patients and 39 control patients).

There were significant differences between control and intervention groups in maturity, VF and PSV draining vein 6 weeks postoperatively; EMP levels 2 weeks postoperatively in ESRD patients undergoing AVF construction (Mann Whitney U, p < 0,05). There were no significant differences in jukstaanastomosis IMT; NO and VEGF levels between control and intervention groups (Mann Whitney U, p > 0.05).

Conclusion: PBA increases the maturity of the arteriovenous fistula in ESRD patients undergoing AVF construction surgery which is characterized by an increase in VF and PSV draining veins up to 6 weeks postoperatively without affecting the IMT in jukstaanastomosis area, NO and VEGF levels. There was an increase in EMP levels 2 weeks postoperatively in AVF with PBA."

"Tujuan: Membandingkan kadar vascular endothelial growth factor VEGF dan placental growth factor PlGF plasma dan vitreus pada tikus diabetes dengan kontrol gula darah GD buruk, dengan perbaikan kontrol gula darah, dan tikus nondiabetes, dan melihat pengaruh perbaikan kontrol gula darah terhadap kadar VEGF dan PlGF. Metode: Penelitian ini merupakan uji eksperimental pada hewan coba tikus strain Sprague Dawley. Sebanyak 18 ekor tikus disertakan dalam penelitian dan secara acak dibagi ke dalam kelompok perlakuan n=14 dan kontrol n=4 . Kelompok perlakuan diberikan injeksi Streptozotocin untuk menginduksi diabetes. Tikus dengan kadar GD 72 jam pasca induksi lebih dari 300 mg/dL didiagnosis diabetes. Kadar GD diperiksa secara berkala pada seluruh subyek. Setelah 4 mingu, kelompok perlakuan dibagi ke dalam kelompok I untuk terminasi dan kelompok II untuk perbaikan kontrol GD dengan injeksi insulin selama 4 minggu berikutnya, begitu pula dengan kelompok kontrol. Saat terminasi, sampel plasma darah dan vitreus diambil untuk analisis kadar VEGF dan PlGF melalui pemeriksaan enzyme-linked immunosorbent assay ELISA. Hasil: Sebanyak 17 ekor tikus bertahan hidup hingga akhir penelitian dengan 1 ekor tikus mati dari kelompok perlakuan. Kadar GD kelompok perlakuan II menurun drastis dan mencapai normoglikemia. Pemeriksaan ELISA bulan pertama menunjukkan kadar VEGF vitreus kelompok perlakuan I cenderung lebih tinggi dibandingkan kontrol I, yakni 196,36 65,24 pg/dL dan 123,64 44,99 pg/dL p=0,20 . Pemeriksaan ELISA bulan kedua menunjukkan kadar PlGF vitreus kelompok perlakuan II lebih tinggi dibandingkan kontrol II, yakni 59,04 2,48 dan 51,93 3,15 p=0,01. Kadar VEGF vitreus dan plasma kelompok perlakuan I dan II tidak berbeda bermakna, sedangkan kadar PlGF vitreus dan plasma lebih tinggi pada bulan kedua. Kesimpulan: Kadar VEGF dan PlGF vitreus mengalami peningkatan pada kelompok tikus diabetes dibandingkan nondiabetes, dan perbaikan kontrol gula darah selama 1 bulan belum dapat menurunkan kadar VEGF dan PlGF.

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Aim: To compare plasma and vitreous level of vascular endothelial growth factor VEGF and placental growth factor PlGF in diabetic rats with poor blood glucose BG control, reconstitution of good BG control, and nondiabetic rats, and to investigate the effect of reconstitution of good BG control to VEGF and PlGF plasma and vitreous level.

Methods: This is an experimental study using Sprague Dawley rats. Eighteen rats were divided into intervention group n 14 and control group n 4. Intervention group were given Streptozotocin STZ injection to induce diabetes. Rats with BG level more than 300 mg dL at 72 hours after injection were considered diabetes and successful models. BG levels were monitored periodically in all subjects. After 4 weeks, intervention group was randomly divided into group I for termination and group II for reconstitution of good BG control with insulin for following 4 weeks, and so was the control group. Plasma and vitreous samples were taken. VEGF and PlGF levels were detected with enzyme linked immunosorbent assay ELISA.

Results: Seventeen rats survived and one rat died in intervention group. BG level of intervention group II decreased dramatically to normoglycemia. ELISA at month 1 showed that VEGF vitreous level tend to be higher in intervention group I compared to control I, 196.36 65.24 pg dL and 123.64 44.99, respectively p 0.20. ELISA at month 2 showed that PlGF vitreous level of intervention group I were significantly higher compared to control I, 59.04 2.48 and 51.93 3.15, respectively p 0.01. Vitreous and plasma VEGF of intervention group I and II were not different, while vitreous and plasma PlGF were significantly higher in group II.

Conclusions: Vitreous levels of VEGF and PlGF were increased in diabetic rats compared to nondiabetic, and reconstitution of good BG control for 1 month were unable to reduce VEGF and PlGF levels. "

"Lupus eritematosus sistemik merupakan penyakit autoimun sistemik yang menghasilkan berbagai autoantibodi yang ditujukan terhadap komponen sel, seperti inti sel, sitoplasma dan membran sel. Salah satu autoantibodi tersebut yaitu antibodi anti ?2GP-1 dihubungkan dengan kejadian aterosklerosis dan penyakit kardiovaskular yang timbul lebih dini pada pasien SLE. Penelitian ini bertujuan untuk mengetahui hubungan antibodi anti ?2GP-1 dengan disfungsi endotel dan aterosklerosis pada pasien SLE dan disfungsi endotel pada HUVEC. Penelitian potong lintang pada pasien SLE yang memenuhi kriteria inklusi menurut ACR 1997 di poliklinik khusus Reumatologi, Alergi Imunologi RSCM dan poliklinik khusus Reumatologi RSUP Dr. M. Djamil dari Maret 2016 sampai dengan Juli 2017. Subjek secara acak dibagi atas 2 kelompok berdasarkan nilai CIMT. Dilakukan pemeriksaan antibodi anti ?2GP-1, ox-LDL, ADMA, ICAM-1, VCAM-1, ET-1. Dilakukan pemajanan antibodi anti ?2GP-1 yang berasal dari kelompok aterosklerosis positif dan kontrol pada HUVEC. Enam puluh enam orang subjek direkrut pada penelitian ini, terdiri atas 33 orang aterosklerosis positif dan 33 orang aterosklerosis negatif dan 6 orang kontrol dengan rentang umur 20-45 tahun. Ditemukan korelasi positif antara antibodi anti ?2GP-1 dengan CIMT,ADMA, ICAM-1, VCAM-1 dan ET-1 dengan nilai r = 0,409, 0,89, 0,36, 0,43, 0,37 dan dengan p < 0,05. Tidak ditemukan korelasi antibodi anti ?2GP-1 dengan ox-LDL dengan r = 0,025 dan p > 0,05. Ditemukan perbedaan bermakna kadar antibodi anti ?2GP-1, ADMA, ICAM-1, VCAM-1 dan ET-1 pada kelompok aterosklerosis positif dengan kelompok aterosklerosis negatif dengan nilai p < 0,05, sedangkan kadar ox-LDL tidak ada perbedaan bermakna pada kedua kelompok tersebut dengan nilai p > 0,05. Hasil pemajanan antibodi anti ?2GP-1 pada HUVEC mendapatkan perbedaan bermakna peningkatan kadar ICAM-1, VCAM-1 dan ET-1 pada kelompok SLE aterosklerosis positif dari kontrol dengan nilai p < 0,05. Antibodi anti ?2GP-1 menimbulkan disfungsi endotel pada pasien SLE.

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Systemic lupus erythematosus SLE is a multi systemic disease characterized by a wide variety of autoantibodies directed to several self molecules found in the nucleus, cytoplasm and cell membrane. One of variety autoantibodies is Antibody anti 2GP 1 which associated with atherosclerosis and premature cardiovascular disease in SLE patients. The purpose of the study is to know the association of antibody anti 2GP 1 with endothelial dysfunction and atherosclerosis in SLE and endothelial dysfunction in HUVEC. Cross sectional study was performed in SLE patients fulfill inclussion criteria according ACR 1997 out patients in Rheumatology and Alergy Immunology polyclinic of Cipto Mangunkusomo Hospital and Dr. M. Djamil Hospital from March 2016 to July 2017. Patients were divided in 2 groups based on CIMT. Examination of antibody anti 2GP 1, ox LDL, ADMA, ICAM 1, VCAM 1 and ET 1 were performed. Purified antibody anti 2GP 1 from positive atherosclerosis and controls groups were exposed to HUVEC. Sixty six patients were enrolled, consists of 33 patients with positive atherosclerosis, 33 patients with negative atherosclerosis and 6 as healthy control with range of age 20 40 year. In this study we found positive correlation between antibody anti 2GP 1 with CIMT, ADMA, ICAM 1, VCAM 1 and ET 1 with r 0.409, 0.89, 0.36, 0.43, 0.43 respectively and p value 0.05. There was no correlation between antibody anti 2GP 1 with ox LDL, r 0.025 and p 0.05. There were significantly different levels of antibody anti 2GP 1, ADMA, ICAM 1, VCAM 1 and ET 1 in positive atherosclerosis compared to negative atherosclerosis group with p 0.05. Level of ox LDL was not different between the two groups with p 0.05. There were significantly different increase of ICAM 1, VCAM 1 and ET 1 levels in HUVEC which was exposed with purified antibody anti 2GP 1 from positive atherosclerosis compared to control with p 0.05. Antibody anti 2GP 1 cause endothelial dysfunction in SLE patients. "