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"[ABSTRAKLatar belakang: Hipertensi dan aterosklerosis berkaitan dengan disfungsi endotel yang ditandai oleh pengurangan produksi nitric oxide (NO) dan penurunan NO bioavailability. Disfungsi endotel dapat terjadi sejak usia anak-anak dan inaktivitas fisik menjadi faktor risiko penyakit kardiovaskular. Namun belum banyak penelitian mengenai perbedaan pengaruh latihan fisik aerobik pada juvenil dibandingkan dengan dewasa terhadap fungsi vaskular. Penelitian ini bertujuan untuk mengetahui pengaruh usia latihan fisik terhadap kadar NO, MDA dan aktivitas spesifik enzim SOD pada aorta abdominal dengan lama latihan yang sama.Metode: Subjek penelitian adalah tikus usia juvenil dan dewasa muda yang dibagi dalam kelompok latihan dan kontrol. Latihan aerobik selama 8 minggu menggunakan treadmill dengan kecepatan disesuaikan dengan usia tikus selama 20 menit intermitten, 5x seminggu. Analisis kadar NO, MDA dan aktivitas SOD aorta abdominal menggunakan uji t-test independen (data berdistribusi normal dan homogen) atau uji U-Mann Whitney (data tidak normal).Hasil: Kadar NO dan aktivitas spesisfik SOD lebih tinggi pada kelompok latihan dibandingkan kontrol, baik pada kelompok juvenil maupun dewasa muda. Namun hanya pada kelompok dewasa muda yang perbedaannya bermakna. Tidak terdapat perbedaan bermakna kadar MDA antara kelompok latihan dan kontrol pada kedua usia. Kadar MDA pada kelompok juvenil meningkat dan menurun pada kelompok dewasa muda akibat latihan aerobik selama 8 minggu.Kesimpulan: Latihan aerobik dapat meningkatkan produksi NO dan NO bioavailability pada kelompok juvenil maupun dewasa muda. Peningkatan NO bioavailability terjadi melalui aktivitas spesifik enzim SOD. Diduga tingginya kadar MDA pada kelompok latihan dan kontrol juvenil terkait dengan usia dan stres fisik. Belum diketahui apakah peningkatan kadar MDA pada kelompok juvenil masih dalam kisaran normal atau tidak. Oleh karena itu, masih terdapat beberapa pertanyaan terkait manfaat latihan pada juvenil.

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ABSTRACTBackground: Hypertension and atherosclerosis are related to endothelial dysfunction, that characterized with decrease of NO production and bioavailability. Physical inactivity has contribute to endothelial dysfunction that can occur since childhood. However, until now, there were only few studies about the difference effect of aerobic training to vascular function in juvenile and young-adult rats. Therefore, this study aimed to know the effect of age related- exercise training to level of NO, MDA and specific SOD activity in abdominal aorta.Methode: Subjects were juvenile and young adult male wistar rats divided into 2 group: control and aerobic training. Aerobic training performed in 8 weeks with animal treadmill with age-dependent speed for 20 minutes intermittent exercise, 5x per week. Analysis of NO, MDA level, and SOD activity of abdominal aorta used t-test independent (normal distribution and homogen) or U-Mann Whitney (not normal distribution)Results: NO level and SOD specific activity in training group were higher than control group, in both juvenile and young adult group. But, only in young adult group that had significant result. There was no significant different of MDA level in training group compared to control group in both juvenile and young-adult group, but MDA level increased in juvenile group and decreased in young-adult group because of aerobic training for 8 weeks.Conclussion: Aerobic training can increase NO production and bioavaibility both in juvenile and young adult group. Increase of NO bioavailability was considered to the increase of SOD specific activity. We considered that the increase of MDA level in training and control juvenile group were related to age and physical stress. We didn?t know yet the increased level of MDA in juvenile group was still in normal range level or not. Therefore is still any question if training in juvenile rat was benefit or not.;Background: Hypertension and atherosclerosis are related to endothelial dysfunction, that characterized with decrease of NO production and bioavailability. Physical inactivity has contribute to endothelial dysfunction that can occur since childhood. However, until now, there were only few studies about the difference effect of aerobic training to vascular function in juvenile and young-adult rats. Therefore, this study aimed to know the effect of age related- exercise training to level of NO, MDA and specific SOD activity in abdominal aorta.Methode: Subjects were juvenile and young adult male wistar rats divided into 2 group: control and aerobic training. Aerobic training performed in 8 weeks with animal treadmill with age-dependent speed for 20 minutes intermittent exercise, 5x per week. Analysis of NO, MDA level, and SOD activity of abdominal aorta used t-test independent (normal distribution and homogen) or U-Mann Whitney (not normal distribution)Results: NO level and SOD specific activity in training group were higher than control group, in both juvenile and young adult group. But, only in young adult group that had significant result. There was no significant different of MDA level in training group compared to control group in both juvenile and young-adult group, but MDA level increased in juvenile group and decreased in young-adult group because of aerobic training for 8 weeks.Conclussion: Aerobic training can increase NO production and bioavaibility both in juvenile and young adult group. Increase of NO bioavailability was considered to the increase of SOD specific activity. We considered that the increase of MDA level in training and control juvenile group were related to age and physical stress. We didn’t know yet the increased level of MDA in juvenile group was still in normal range level or not. Therefore is still any question if training in juvenile rat was benefit or not., Background: Hypertension and atherosclerosis are related to endothelial dysfunction, that characterized with decrease of NO production and bioavailability. Physical inactivity has contribute to endothelial dysfunction that can occur since childhood. However, until now, there were only few studies about the difference effect of aerobic training to vascular function in juvenile and young-adult rats. Therefore, this study aimed to know the effect of age related- exercise training to level of NO, MDA and specific SOD activity in abdominal aorta.Methode: Subjects were juvenile and young adult male wistar rats divided into 2 group: control and aerobic training. Aerobic training performed in 8 weeks with animal treadmill with age-dependent speed for 20 minutes intermittent exercise, 5x per week. Analysis of NO, MDA level, and SOD activity of abdominal aorta used t-test independent (normal distribution and homogen) or U-Mann Whitney (not normal distribution)Results: NO level and SOD specific activity in training group were higher than control group, in both juvenile and young adult group. But, only in young adult group that had significant result. There was no significant different of MDA level in training group compared to control group in both juvenile and young-adult group, but MDA level increased in juvenile group and decreased in young-adult group because of aerobic training for 8 weeks.Conclussion: Aerobic training can increase NO production and bioavaibility both in juvenile and young adult group. Increase of NO bioavailability was considered to the increase of SOD specific activity. We considered that the increase of MDA level in training and control juvenile group were related to age and physical stress. We didn’t know yet the increased level of MDA in juvenile group was still in normal range level or not. Therefore is still any question if training in juvenile rat was benefit or not.]"

"[ABSTRAKLatar belakang. Pada stenosis mitral sering timbul komplikasi hipertensi pulmoner dan disfungsi ventikel kanan. Belum ada penelitian yang menghubungkan antara resistensi vaskular paru sebelum operasi dengan fungsi jantung kanan saat pasca operasi serta perubahannya pasca operasi stenosis mitral rematik.Metode. Studi ini merupakan studi kohort prospektif pada 31 pasien stenosis mitral rematik yang menjalani operasi katup mitral di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita sejak April 2014 sampai Maret 2015. Pasien menjalani pemeriksaan ekokardiografi sebelum operasi, sebelum pulang perawatan pasca operasi serta saat follow up mid term di poliklinik. Dilakukan analisa statistik untuk melihat hubungan antara resistensi vaskular paru (RVP) pra operasi dengan strain longitudinal ventrikel kanan saat follow up mid term serta perubahan strain longitudinal ventrikel kanan pasca operasi (delta strain).Hasil. Tidak terdapat korelasi antara RVP pra operasi dengan strain longitudinal speckle tracking ventrikel kanan saat follow up mid term pasca operasi (r 0,199 p 0,264) serta dengan perubahan strain longitudinal ventrikel kanan pasca operasi atau delta strain (r 0,174 p 0,350).Kesimpulan. Resistensi vaskular paru pra operasi tidak berhubungan dengan strain longitudinal speckle tracking ventrikel kanan saat follow up mid term pasca operasi serta dengan perubahan strain longitudinal ventrikel kanan pasca operasi atau delta strain.

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ABSTRACTBackground. In MS right ventikel (RV) dysfunction and pulmonary hypertension often occur as complication. There is no research that connects the pulmonary vascular resistance before surgery with RV function and its changes in the case of rheumatic mitral stenosis who underwent mitral valve surgery.Methods. This study is a prospective cohort study which involves 31 patients with rheumatic mitral stenosis who underwent surgery at National Cardiovaskular Center Harapan Kita Hospital from April 2014 to March 2015. Patients underwent echocardiography before surgery, after surgery pre-hospital discharge and mid-term follow-up at clinic. Statistical analysis was performed to see the relationship between preoperative pulmonary vascular resistance (PVR) with RV function at mid term follow up, which is assessed using echocardiographic parameters right ventricular longitudinal speckle strain, and also with right ventricle longitudinal speckle strain postoperative changes (delta strain).Results. There is no correlation between pre operative PVR with RV longitudinal speckle strain at mid term follow-up (r 0,199 p 0,264), and post operative changes or delta strain (r 0.174 p 0.350).Conclusion. RVP before surgery is not associated with right ventricle longitudinal speckle strain at follow up mid term and post operative changes or delta strain., Background. Acute rheumatic fever and rheumatic heart disease is still regarded as animportant public health problem especially in developing countries. Mitral stenosis (MS) is asequale of rheumatic fever which are most commonly found. In MS right ventikel (RV)dysfunction and pulmonary hypertension often occur as complication. The right ventricle hasa smaller muscle mass so it is more sensitive to changes in pressure loads. There is noresearch that connects the pulmonary vaskular resistance before surgery with RV functionand also changes in the case of rheumatic mitral stenosis who underwent mitral valvesurgery.Methods. This study is a prospective cohort study which involves 31 patients with rheumaticmitral stenosis who underwent surgery at National Cardiovaskular Center Harapan Kita Hospital from April 2014 to March 2015. Patients underwent echocardiography before surgery, after surgery pre-hospital discharge and mid-term follow-up at clinic. Statisticalanalysis was performed to see changes in RV function with longitudinal speckle strain, aftersurgery pre-hospital discharge and mid-term follow-up at clinic. Analysis also performed tosee the relationship between preoperative pulmonary vascular resistance (PVR) with RVfunction at mid term follow up, which is assessed using echocardiographic parameters rightventricular longitudinal speckle strain, and also with right ventricle longitudinal specklestrain postoperative changes (delta strain). Results. Right ventricular function after surgery seen with longitudinal speckle strainimproved from -12.94 ± 3.63 preoperatively into -13.06 ± 3.63 after surgery pre hospitaldischarge, and -15.25 ± 3.75 at follow-up evaluation (p 0.007). There is no correlationbetween pre operative PVR with longitudinal speckle strain at mid term follow-up (r 0,199 p0,264), and RV longitudinal speckle strain post operative changes or delta strain (r 0.174 p0.350). Conclusion. After mitral valve surgery, right ventricle longitudinal speckle strain improves.RVP before surgery is not associated with right ventricle longitudinal speckle strain at follow up mid term and right ventricle longitudinal speckle strain post operative changes or deltastrain. ]"

"Latar Belakang : Peningkatan resistensi vaskular paru (RVP) pasien stenosis mitral (SM) disebabkan oleh proses reaktif hipertensi pulmoner (HP) sehingga mempengaruhi luaran klinis pascabedah katup mitral. Endotelin-1 (ET-1) sebagai mediator vasoaktif berperan penting pada HP reaktif. Belum ada penelitian yang menghubungkan kadar ET-1 vena pulmoner (VP) dengan RVP. Tujuan Penelitian : Menilai korelasi kadar ET-1 VP terhadap RVP sebelum dan sesudah pembedahan katup mitral pada pasien SM dengan HP. Metode : Penelitian ini merupakan studi potong lintang pada 28 pasien SM berat dengan HP sedang dan berat yang menjalani pembedahan katup mitral di Pusat Jantung Nasional Harapan Kita dari bulan April hingga November 2014. Dilakukan analisa statistik untuk mencari korelasi antara kadar ET-1 VP dengan RVP sebelum dan sesudah pembedahan katup mitral. Hasil Penelitian : Terdapat korelasi antara kadar ET-1 VP dengan RVP prabedah (r=0,49, p=0,008), sedangkan dengan RVP pascabedah tidak berkorelasi bermakna (r=0,204, p=0,32). Analisa regresi linear antara kadar ET-1 VP dengan RVP prabedah setelah disesuaikan dengan variabel perancu hipertensi, diabetes melitus tipe 2, fibrilasi atrial, penggunaan penyakat beta dan diuretik didapatkan r=0,5 koefisien β 1,04 dengan interval kepercayaan (IK) 95% (0,401-1,691) p=0,003, sedangkan dengan RVP pascabedah setelah disesuaikan dengan variabel perancu hipertensi, penghambat ACE/ARB, penyakat beta, vasodilator, waktu cross clamp didapatkan r=-0,08 koefisien β -0,2 dengan IK 95 % (-0,99-0,5) p=0,5. Kesimpulan : Terdapat korelasi positif bermakna dengan kekuatan sedang antara kadar ET-1 VP dengan RVP prabedah, Peningkatan kadar ET-1 VP sebesar 1 pg/ml, akan meningkatkan RVP prabedah sebasar 1,04 WU. Kadar ET-1 VP tidak memiliki korelasi bermakna terhadap RVP pascabedah.

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Background : The increased of Pulmonary Vascular Resistance (PVR) in mitral stenosis (MS) patient occurs in reactive pulmonary hypertension, and it affects clinical outcome after mitral valve surgery. Endothelin-1 (ET-1) as vasoconstrictive agent have important role in reactive pulmonary hypertension so far there is no study that corelate pulmonary vein (PV) ET-1 with PVR in MS.

Objectives : To study the correlation of PV ET-1 level with PVR measured by echo before and after mitral valve surgery in patient MS with pulmonary hypertension.

Methods : Twenty eight MS patients with moderate and severe pulmonary hypertension who underwent mitral valve surgery at National Cardiovascular Centre Harapan Kita from April to November 2014. Statistical analysis was done to see the correlation of PV ET-1 level with PVR before and after mitral valve surgery. Blood sample was taken from VP in the operating room and analyzed with Quantikine® ELISA ET-1 Immunoassay. PVR was measured by PVR-AMS formula by echocardiography.

Result : There was a correlation between PV ET-1 and PVR pre surgery (r=0,49, p=0,008), whereas, there was no significant correlation with PVR post surgery (r=0,204, p=0,32). Linear regression analysis was performed, PV ET-1 and PVR pre surgery were adjusted to confounding variables hypertension, diabetes mellitus, atrial fibilation, use of beta blocker and diuretic; r=0,5 β coefisien level 1,04 with confidance interval (CI) 95 % (0,401-1,691), p=0,003. PVR post surgery was adjusted to confounding variables hypertension, dislipidemia, use of ACE-I/ARB, beta blocker, vasodilator, cross clamp time, r=-0,08 β coefisien level -0,2 with CI 95 % (-0,99-0,5), p=0,5.

Conclusion : There was a moderate positive correlation between PV ET-1 with PVR pre surgery, the increased of PV ET-1 level 1 pg/ml, would increase PVR level 1,04 WU. There was no significant correlation between PV ET-1 with PVR post surgery."

"Latar belakang: USG Doppler kerap dipakai untuk skrining awal Chronic Limb Threatening Ischemia (CLTI) dan dapat juga memantau respons terapi selama follow-up. Di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM), sebagai pusat rujukan nasional dan Pusat Pendidikan Subspesialis Bedah Vaskular Endovaskular, Trainee bedah vaskular-endovaskular menjalani pendidikan mereka. Penting bagi Trainee Bedah Vaskular untuk mengkorelasikan temuan klinis dengan hasil USG Doppler, sehingga supervisi  semester 4 terhadap semester 1 menjadi krusial. Namun, dampak pengalaman terhadap akurasi USG Doppler, terutama pada pasien Chronic Limb-Threatening Ischemia (CLTI), antara Trainee semester 1 dan 4 masih belum ada, termasuk kekurangan data dan SOP terkait durasi supervisi.

Metode: Penelitian ini menggunakan metode potong lintang untuk menguji diagnosis CLTI melalui USG oleh trainee semester 1 dan 4, dibandingkan dengan CT Angiografi (CTA) sebagai standar.

Hasil: Total ada 31 pasien (62 tungkai) yang dibagi ke dalam dua kelompok dan diamati menggunakan USG oleh trainee dari kedua semester tersebut. Hasil penelitian menunjukkan bahwa kesesuaian temuan oklusi arteri berdasarkan USG dibandingkan dengan CTA lebih tinggi pada trainee semester 4. Selain itu, korelasi dalam penentuan derajat stenosis antara USG dan CTA lebih kuat pada semester 4. Hasil uji diagnosis menunjukkan bahwa secara keseluruhan trainee semester 4 memiliki akurasi diagnosis USG yang lebih tinggi dibandingkan trainee semester 1 di semua segmen arteri tungkai bawah.

Kesimpulan: Terdapat perbedaan keluaran , akurasi USG oleh semester 1 dan 4 dengan angka yang tidak jauh berbeda dalam mendiagnosis CLTI, Pada Penelitian ini peneliti juga menyarankan perlunya supervisi antara semester 1 dan 4 agar ada transfer ilmu dan patient safety

 

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Conclusion: There are differences in the output and accuracy of ultrasound user in fourth dan first semester trainees which are not much different result in diagnosing CLTI,  in this study researchers also suggest the need for supervision between semesters first and fourth so that there will be a knowledge transfer and patient safety."