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"ABSTRAKPada clubfoot idiopatik, skor pirani mempunyai nilai prediksi terhadap beberapa aspek. Skor pirani dapat berhubungan dengan besar koreksi ekuinus pasca tenotomi tendon achilles perkutaneus teknik Ponseti.Didapatkan 16 pasien dengan 23 kaki clubfoot yang dapat dievaluasi. Dilakukan pengambilan data skor pirani awal serta besar koreksi ekuinus pasca tenotomi tendon Achilles perkutaneus yang didapatkan. Dilakukan uji korelasi. Ekspektasi nilai r adalah 0,5. Hasilnya tidak didapatkan hubungan yang bermakna secara klinis antara skor Pirani awal dengan besar koreksi ekuinus pasca tenotomi Achilles (p 0,04; r -0,36).

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ABSTRACTIdiopathic clubfoot is common musculosceletal disorder in children. The Ponseti technique will avoid extensive surgery and give a good result. Pirani score is a simple scoring system to use that can have a predictive value of the prognosis of clubfoot. We evaluate 16 patient with 23 clubfeet at the clinic. We collect the Pirani score and the degree of correction of equinus post percutaneus achilles tenotomy. Correlation test was performed with the relationship expectation r 0,5. The result we founded that no clinical relationship between the initial pirani score with the amount of correction post percutaneus achilles tenotomy (p 0,04; r -0,36)."

"Pendahuluan. Congenital Talipes Equino Varus (CTEV, clubfoot) merupakan salah satu kelainan kaki bawaan yang paling sering ditemui di dunia. Jika tidak ditangani, clubfoot akan mempengaruhi kualitas hidup secara signifikan. Teknik Ponseti telah diterima secara universal sebagai metode terapi dengan hasil yang sangat memuaskan. Tujuan. Mengetahui korelasi antara parameter antropometri kaki dengan skor Dimeglio pasca Ponseti. Metode Penelitian. Penelitian analitik observasional dilakukan dengan desain cross sectional terhadap pasien clubfoot unilateral yang datang ke RSCM 2008-2013. Selain pencatatan data dasar dan jenis tatalaksana yang dilakukan, diukur juga panjang kaki, lebar kaki dan lingkar betis kedua kaki, serta penilaian skor Dimeglio. Uji t digunakan untuk menganalisis perbedaan rerata panjang kaki, lebar kaki dan lingkar betis kaki ctev dengan kaki normal. Sedangkan Uji korelasi Pearson digunakan untuk menganalisis korelasi antara selisih antropometri dengan Skor Dimeglio. Temuan dan Diskusi Penelitian. Rerata skor Dimeglio pasca terapi adalah 4,8. Uji t satu arah ditemukan panjang kaki, lebar kaki dan lingkar betis kaki CTEV lebih kecil signifikan dari kaki normal (t0>t, CI 95%). Korelasi selisih panjang kaki dengan Skor Dimeglio 0,694. Korelasi selisih lebar kaki dengan skor Dimeglio 0,367. Korelasi selisih lingkar betis dengan skor Dimeglio 0,305. Uji Korelasi Pearson ditemukan korelasi bermakna antara selisih panjang kaki dengan skor Dimeglio (P<0,01). Sedangkan tidak ditemukan korelasi antara lebar kaki dan lingkar betis dengan skor Dimeglio (P>0,01). Kesimpulan. Luaran metoda Ponseti dengan skor Dimeglio pada clubfoot unilateral adalah baik. Rerata panjang, lebar, dan lingkar betis kaki CTEV lebih rendah dari kaki normal. Terdapat korelasi antara selisih panjang kaki dengan skor Dimeglio pasca terapi.

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Introduction. Clubfoot is one of the most common congenital foot deformity in the world which affect the quality of life. Ponseti technique has been universaly accepted as the method with a very satisfactory result.

Objective. This study aims to find any correlation between Dimeglio score post Ponseti-treated clubfoot with anthropometric parameter of the foot.

Method. This is an observational analytic study with cross sectional design. Unilateral clubfoot patients who came to Cipto Mangunkusumo Hospital from 2008 until 2013 were recruited. Measurement of foot length, foot width, and calf circumference of both feet and Dimeglio score assessment was done. T-test was used to analyze the differences of foot length, foot width, and calf circumference between both feet. Pearson correlation test was used to analyze the correlation between anthropometric differences and severity of clubfoot.

Result and Discussion. The mean of post-treatment Dimeglio score was 4.8. One-way t-test found that the foot length, foot width and calf circumference of clubfeet were significantly smaller than the normal feet (t0>t, CI 95%). The correlation of difference in foot length, foot width, and calf circumference with Dimeglio score was 0.694, 0.367 and 0.305, respectively. Pearson correlation test found significant correlation between the difference in foot length and Dimeglio score (p<0.01).

Conclusion. The outcome of Ponsetti technique for unilateral clubfoot using Dimeglio score is good. The means of foot length, foot width, and calf circumference for clubfoot were found to be less than normal foot. There were correlation between differences of foot length and post treatment Dimeglio score."

"ABSTRAKSebagian besar peneliti menyatakan pasien dengan clubfoot idiopatik yang ditatalaksana dengan metode Ponseti memberikan hasil baik. Kekurangan metode Ponseti adalah angka rekurensi yang relatif tinggi. Penelitian ini merupakan penelitian kohort retrospektif yang dilakukan di Poliklinik Orthopaedi Rumah Sakit Ciptomangunkusumo pada tahun 2007 - 2010. Studi ini menunjukkan hanya variabel wilayah tempat tinggal yang mempengaruhi luaran skor Pirani dengan nilai OR 21,60 (95% IK 2,39 – 195,29). Jarak yang jauh dari tempat penyedia fasilitas kesehatan, membuat orang tua pasien mengalami keberatan untuk kontrol rutin. Hal tersebut menyebabkan penatalaksanaan yang tidak optimal sehingga menyebabkan hasil akhir yang kurang baik. Jarak tempat tinggal terhadap tempat layanan kesehatan, berpengaruh terhadap luaran penatalaksanaan Ponseti pada kasus clubfoot di RSCM.

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ABSTRACTMost of the researchers said that patients with idiopathic clubfoot treated by the Ponseti method give good results. However, this method has the disadvantage which is a relatively high recurrence rate which influenced by cultural factors. The study design is retrospective cohort study conducted at the outpatient setting in Ciptomangunkusumo Hospital from 2007 to 2010. This study showed that only the residential distance to the health facility that influence the value of Pirani score outcome OR 21.60 (95% CI 2.39 to 195.29). Patients living far from health facility, tend to miss routine control. This leads to sub-optimal management causing unfavorable outcome. The residential distance to the health service, influence the outcome of the Ponseti treatment of clubfoot cases in the hospital."

"ABSTRAK Latar Belakang: Simple bone cyst (SBC) adalah tumor tulang jinak, berisi cairan.Tujuan utama terapi SBC adalah mendapatkan penyembuhan tulang, mencegahfraktur patologis, dan manajemen gejala khususnya nyeri. Terdapat berbagaimetode pengobatan SBC, namun saat ini masih kontroversial karena angkakesembuhan dan tingkat invasi operasi. Terapi injeksi perkutaneus steroidmerupakan metode operasi dengan tingkat invasi rendah sehingga penyembuhantulang dan luaran fungsional lebih baik. Metode: Total terdapat 10 pasien (6 laki-laki, 4 perempuan, rerata usia13 tahun)SBC yang terbagi dalam dua kelompok. 5 pasien (proksimal femur 3; proksimalhumerus 1; calcaneus 1) dilakukan terapi injeksi perkutaneus steroid dan 5 pasien(proksimal femur 2; proksimal humerus 2, radius 1) terapi kurease denganhidroksiapatit. Injeksi perkutaneus steroid dilakukan sebanyak tiga kali denganinterval waktu tiap satu bulan. Rerata follow up adalah 12-26 bulan. Evaluasipenyembuhan tulang dinilai secara radiologi dengan kriteria Chang dkk. Luaranfungsional dinilai berdasarkan skor MSTS.Hasil: Penyembuhan tulang komplit didapatkan pada kedua kelompok, namunsolid union lebih cepat terjadi pada kelompok terapi injeksi perkutaneus steroid. Luaran fungsional didapatkan nilai yang lebih baik pada kelompok injeksiperkutaneus steroid terutama pada bulan ke-3 (55%) dan ke-6 (84%) pasca operasiberdasarkan skor MSTS dibandingkan terapi kuretase dengan hidroksiapatit(bulan ke-3 47% dan ke-6 69,3%). Simpulan: Terapi injeksi perkutaneus steroid masih tetap menjadi pilihan utamametode terapi SBC dengan solid union lebih cepat, tingkat prosedur operasi invasi rendah, lebih mudah, efektif, dan aman.ABSTRACT Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe."

"CTEV idiopatik memiliki tingkat keberhasilan koreksi awal yang tinggi menggunakan metode Ponseti (90%), namun angka rekurensi tetap signifikan (3,7%–67,3%), terutama akibat ketidakpatuhan terhadap penggunaan foot abduction orthosis (FAO). FAO direkomendasikan digunakan selama 4 tahun, tetapi penelitian Iowa menunjukkan pemakaian selama 2 tahun menghasilkan angka rekurensi 56%, artinya 44% pasien tidak mengalami rekurensi meskipun hanya menggunakan FAO selama 2 tahun. Penelitian ini bertujuan menganalisis skala maturasi medial malleolus, talus dan kalkaneus pada pasien CTEV idiopatik yang menjalani tahap pemeliharaan protokol Ponseti. Penelitian dilakukan dengan desain potong lintang pada 20 pasien usia 2 dan 4 tahun di RSUPN Cipto Mangunkusumo (2018-2023) menggunakan ultrasonografi. Hasil menunjukkan skala maturasi medial malleolus (108,1%) dan talus (93,6%) lebih tinggi pada usia 2 tahun dibanding usia 4 tahun (99,9% dan 75,7%), sedangkan kalkaneus lebih tinggi pada usia 4 tahun (111,9%) dibanding usia 2 tahun (95,8%). Perbedaan ini tidak signifikan secara statistik (p>0,05). Faktor jenis kelamin menunjukkan hubungan signifikan (p<0,05), di mana laki-laki memiliki skala maturasi medial malleolus lebih tinggi dibanding perempuan. Kesimpulannya, tidak terdapat perbedaan bermakna pada skala maturasi antar kelompok usia, tetapi jenis kelamin memengaruhi skala maturasi medial malleolus

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Idiopathic CTEV has a high initial correction success rate using the Ponseti method (90%), but recurrence rates remain significant (3.7%–67.3%), primarily due to noncompliance with Foot Abduction Orthosis (FAO) usage. FAO is recommended for 4 years, but a study in Iowa found that 2 years of FAO usage resulted in a recurrence rate of 56%, indicating that 44% of patients did not experience recurrence despite using FAO for only 2 years. This study aims to analyze the maturation scale of the medial malleolus, calcaneus, and talus in idiopathic CTEV patients undergoing the maintenance stage of the Ponseti protocol with FAO. This cross-sectional study included 20 patients aged 2 and 4 years at RSUPN Cipto Mangunkusumo (2018–2023) using ultrasonographic examinations. Results showed that the medial malleolus (108.1%) and talus (93.6%) maturation scales were higher in the 2-year age group compared to the 4-year group (99.9% and 75.7%), while the calcaneus maturation scale was higher in the 4-year group (111.9%) than the 2-year group (95.8%). These differences were not statistically significant (p>0.05). Among analyzed factors, only gender showed a significant relationship (p<0.05), with males having a higher medial malleolus maturation scale than females. In conclusion, there were no significant differences in maturation scales between age groups, but gender influenced the medial malleolus maturation scale."

"ABSTRAKFluoroquinolon memiliki efek terhadap mekanisme penyembuhan ruptur tendon Achilles. Penelitian ini dilakukan untuk menilai efek siprofloksasin terhadap proses penyembuhan tendon in vivo. Efek obat diperiksa terhadap biomekanik dan histopatologik tendon Achilles tikus. Uji eksperimental ini menggunakan siprofloksasin selama 2 kali/hari selama 15 dan 35 hari berturut-turut. Asesmen pada tendon Achilles mencakup pengukuran ultimate tensile force (UTF) dan skor histopatologik Bonar. Rerata UTF dan skor proliferasi tenosit pada grup kontrol signifikan dibandingkan grup perlakuan pada protokol 15 hari p<0.004 dan p<0,002. Tidak ada perbedaan bermakna pada skor kolagen, ground substance, dan vaskularisasi. Berdasarkan penelitian ini, siprofloksasin terbukti menurunkan kekuatan biomekanik, metabolisme tenosit, kolagen, dan matriks selama proses penyembuhan tendon Achilles model tikus.

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ABSTRACTFluoroquinolon has a side effect on the healing process of Achilles tendon rupture. The purpose of this experimental research is to evaluate ciprofloxacin towards tendon healing (in vivo) in respect to biomechanic and histopathologic of Achilles tendon. Ciprofloxacin is administered 2 times per day within 15 and 35 days follow-up. After that, Achilles tendon is measured for ultimate tensile force (UTF) and Bonar histopathologic score. According to this research, the mean of UTF and tenocyte proliferation score is significant in control group compared to intervention group on day-15 (p<0.004 and p<0.002 consecutively). The statistical significance is narrow in collagen score, ground substance, and vascularization. Based on those foundings, ciprofloxacin has been proven to reduce biomechanical force, tenocyte metabolism, collagen, and matrix during the healing process of Achilles tendon in rat model."

"Achilles tendinopathy merupakan sebuah penyakit degeneratif yang dapat disebabkan oleh diabetes mellitus tipe 2 (DMT2). Penyakit ini disebabkan oleh akumulasi dari advanced glycation end products (AGEs). Akumulasi AGEs pada tendon dapat menyebabkan mekanisme cross-link dengan kolagen dan aktivasi jalur persinyalan receptor of advanced glycation end products (RAGE) yang menyebabkan struktur kolagen menjadi tidak teratur. Pembuatan model DMT2 dilakukan dengan hewan model tikus dengan metode high fat diet dan induksi streptozotocin (STZ) pada galur tikus Sprague Dawley. Studi pendahuluan yang dilakukan menunjukkan pada dosis STZ 30 mg/Kg tidak menunjukkan hewan model DMT2. Oleh karena itu, tujuan pada penelitian ini adalah untuk melakukan studi histologis achilles tendinopathy yang disebabkan oleh DMT2 pada ketiga dosis (30 mg/Kg, 40 mg/Kg dan 65 mg/Kg) dan dilanjutkan dengan studi ekspresi gen efek gen RAGE. Studi ini menggunakan sampel tendon achilles tikus yang sudah dibuat model DMT2 dengan metode high fat diet dan induksi streptozotocin (STZ) pada galur tikus Sprague Dawley yang telah dibentuk dalam blok parafin. Terdapat tiga kelompok perlakuan diabetes dengan induksi streptozotocin yang berbeda, yakni dosis STZ 30 mg/Kg, 40 mg/Kg, dan 65 mg/Kg. Metode yang digunakan untuk membuat preparat histologis adalah dengan metode parafin dengan dua pewarnaan, yakni hematoksilin dan eosin Harris dan masson trichrome untuk melihat struktur kolagen. Untuk identifikasi ekspresi gen RAGE menggunakan metode quantitative real time polymerase chain reaction. Hasil penelitian menunjukkan bahwa achilles tendinopathy yang disebabkan oleh diabetes memberikan hasil gambaran histologis dengan terjadinya kerusakan jaringan tendon yang ditandai dengan disorganisasi kolagen yang terlihat pada dosis STZ 65 mg/Kg. PaPada dosis STZ 30 mg/Kg dan 40 mg/Kg, kondisi kolagen masih dalam kolagen yang mirip dengan tendon sehat dengan beberapa daerah mulai mengalami disorganisasi kolagen. Ekspresi gen RAGE dengan menggunakan qRT-PCR menghasilkan tingkat ekspresi gen RAGE yang meningkat sebanyak 2,71 kali pada kelompok perlakuan diabetes dibandingkan dengan kelompok normal. Kesimpulan yang didapatkan pada penelitian ini adalah model tikus DMT2 menunjukkan perubahan dan disorganisasi tendon. Pada sampel tikus dosis STZ 65 mg/Kg menghasilkan disorganisasi tendon paling parah dibandingkan dengan dosis injeksi STZ 30 mg/Kg dan 40 mg/Kg. Selain itu, pada tendon perlakuan diabetes didapatkan tingkat ekspresi gen RAGE yang meningkat sebanyak 2,71 kali dibandingkan dengan tendon normal.

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Achilles tendinopathy is a degenerative condition that can be caused by type 2 diabetes mellitus (DMT2). This disease is caused by the accumulation of advanced glycation end products (AGEs). The buildup of AGEs in the tendon can lead to cross-linking mechanisms with collagen and activation of the receptor for advanced glycation end products (RAGE) signaling pathway, resulting in irregular collagen structure. The disease model was created using a rat model with a high-fat diet and streptozotocin (STZ) induction in Sprague Dawley rats. Preliminary studies showed that the STZ dose of 30 mg/kg did not result in a DMT2 model. Therefore, the aim of this research was to conduct a histological study of Achilles tendinopathy caused by DMT2 at three different doses (30 mg/kg, 40 mg/kg, and 65 mg/kg), followed by studying the gene expression of RAGE-related genes.The study used Achilles tendon samples from rats that were induced with DMT2 using a high-fat diet and STZ induction in Sprague Dawley rats, which were then embedded in paraffin blocks. There were three diabetes treatment groups with different STZ induction doses: 30 mg/kg, 40 mg/kg, and 65 mg/kg. Histological preparations were made using the paraffin method with two staining techniques, namely Harris hematoxylin and eosin staining and Masson trichrome staining to visualize collagen structure. The quantitative real-time polymerase chain reaction (qRT-PCR) method was used to identify RAGE gene expression. The results showed that Achilles tendinopathy caused by diabetes resulted in histological changes in the tendon tissue, characterized by collagen disorganization, particularly evident at the STZ dose of 65 mg/kg. At doses of STZ 30 mg/kg and 40 mg/kg, collagen appeared similar to that of a healthy tendon, but some areas showed signs of collagen disorganization. The qRT-PCR analysis revealed that RAGE gene expression was 2.71 times higher in the diabetes treatment group compared to the normal group.In conclusion, the DMT2 rat model exhibited changes and disorganization in the tendon. The 65 mg/kg STZ injection in rat samples resulted in the most severe tendon disorganization compared to the 30 mg/kg and 40 mg/kg STZ injection doses. Additionally, diabetes treatment of the tendon showed a 2.71-fold increase in RAGE gene expression compared to the normal tendon."

"Pendahuluan: Efek hiperglikemik dan produk Advanced Glycation Endproduct (AGE) dari diabetes mellitus (DM) sering dikaitkan dengan komplikasi muskuloskeletal seperti neuropati perifer dan tendinopati Achilles pada regio pergelangan kaki. Hal ini beresiko menimbulkan efek lanjutan berupa perubahan struktur berjalan, kekakuan sendi hingga luka tukak telapak kaki. Tatalaksana tendinopati DM hingga saat ini terbatas pada pengurangan gejala lanjutan tanpa meningkatkan proses regenerasi tendon, sehingga dibutuhkan penelitian untuk menilai efek terapi dari sekretom dan eksosom SPM dalam hal perbaikan struktur tendon. Hal ini diwakili oleh penggunaan hewan coba tikus SD yang telah terinduksi menjadi tendinopati DM. Metode: Studi ini melibatkan fase studi pilot pertama, kedua, dan penelitian utama. Tikus SD diperoleh dan diberikan diet tinggi lemak (HFD) dan pemberian larutan fruktosa 55% selama delapan minggu. Diabetes diinduksi menggunakan injeksi streptozotocin (STZ) intraperitoneal berbagai dosis. Studi pilot pertama bertujuan untuk menentukan volume cairan yang dapat diinjeksikan ke area peritendon. Sementara itu, studi pilot kedua bertujuan untuk mengidentifikasi dosis STZ yang efektif. Dalam fase penelitian utama, tikus diabetes menerima injeksi lokal eksosom, sekretom, atau kombinasinya. Setelah perawatan, tikus dieutanasia, dan tendon Achilles dianalisis secara histopatologi dan imunohistokimia. Hasil dan Diskusi: Studi pilot pertama menyimpulkan bahwa 0,8 ml merupakan volume cairan optimal yang dapat diinjeksikan ke area peritendon. Sementara itu, studi pilot kedua menunjukkan bahwa setelah 8 minggu HFD, pemberian fruktosa, dan injeksi STZ, kelompok STZ 26 mg/kg memiliki kadar glukosa 220,54 ± 9,11 mg/dL, dan kelompok STZ 30mg/kg memiliki 213,88 ± 8,99 mg/dL dengan perbedaan paling signifikan dalam skor Bonar diamati di kelompok STZ 30mg/kg, hal ini menunjukkan keberhasilan induksi hewan coba. Pada penelitian utama setelah pemberian sekretom, eksosom, atau kombinasi, kadar TGF-β dan IL-6 dan skor Bonar tidak menunjukkan perbedaan signifikan antar kelompok. Analisis pasca intervensi mengungkapkan perbedaan signifikan dalam kadar IL-6 dan Col-1, dimana pada kelompok perlakuan terdapat penurunan IL-6 yang signifikan pada hari ke-14 dan peningkatan Col-1 yang signifikan pada hari ke-21 dibandingkan dengan kelompok kontrol. Kesimpulan: Penelitian ini menunjukkan bahwa kombinasi diet HFD, pemberian fruktosa, dan dosis injeksi STZ 30 mg/kg efektif menciptakan hewan model tendinopati DM. Skor Bonar yang tinggi pada kelompok STZ mengindikasikan kerusakan tendon signifikan. TGF-β dan IL-6 tidak menunjukkan perbedaan signifikan antar kelompok, namun IL-6 meningkat pada hari ke-14 dan Col-1 pada hari ke-21 pada kelompok intervensi secara signifikan, menunjukkan potensi terapi eksosom dan sekretom pada penyembuhan tendon.

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Introduction: The hyperglycemic effects and Advanced Glycation Endproduct (AGE) of diabetes mellitus (DM) are often associated with musculoskeletal complications such as peripheral neuropathy and Achilles tendinopathy in the region of the legs and ankles. It is one of the risks of developing advanced negative effects such as changes in walking structure, stiffness of the joints to ulcer wounds on the the ankle. The management of DM tendinopathy to date is limited to reducing advanced symptoms without enhancing tendon regeneration process, therefore, further research is needed to assess the therapeutic effects of MSC secretomes and exosomes in terms of tendon structure improvement. It is represented by the use of SD rats induced into DM

tendinopathy.

Methods: This study involves two pilot study phases and the main research. SD mice were obtained and given a high-fat diet (HFD) and given 55% fructose solution foreight weeks. Diabetes is induced by injection of streptozotocin (STZ). The first phase of the pilot study aims to determine the volume of liquid injected into the peritendon area, and the second phase aims to identify an effective dose of STZ to induce DM. In the main study, diabetic mice received local injections of exosomes, secretomes, or a combination of them. After treatment, the rats were euthanazied, and the Achilles tendon was analysed histopathologically and immunohistochemically.

Results and Discussion: The first pilot study concluded that 0.8 ml was the optimal fluid volume that could be injected into the peritendon area. Meanwhile, the second pilot study showed that after 8 weeks of HFD, fructose administration, and injection of STZ, the STZ 26 mg/kg group had a glucose level of 220.54 ± 9.11 mg/dL, and the STZ 30 mg/kg group had 213.88 ± 8.99 mg/dL with the most significant difference in Bonar score was observed in the STZ 30mg/kg group, this indicates successful induction of experimental animals. In the main study after administering secretome, exosome, or a combination of the two, the levels of TGF-β and IL-6 and the Bonar score did not show significant differences between groups. Post-intervention analysis revealed significant differences in IL-6 and Col-1 levels, in which the treatment group there was a significant decrease in IL-6 on day 14 and a significant increase in Col-1 on day 21 compared to the control group.

Conclusion: This study shows that a combination of HFD, fructose administration, and STZ 30mg/kg are effective in creating animal model for diabetic Achilles tendinopathy. A high Bonar score in the STZ group indicates significant tendon damage. TGF-β and IL-6 did not show significant differences between the groups, but IL-6 increased on day 14 and Col-1 on day 21 in the intervention groups significantly, indicating the potential for exosome and secretome therapy on tendon healing.

Keyword: diabetic Achilles tendinopathy, Sprague Dawley rats, exosome and secretome combination, bone marrow mesenchymal stem cel"

"Pendahuluan: Kejadian ruptur tendon Achilles meningkat dalam beberapa dekade terakhir dengan insiden tertinggi didapatkan pada kelompok usia 30-39 tahun. Penanganan terkini untuk ruptur tendon Achilles adalah pembedahan dengan penjahitan primer, serta dapat juga secara konservatif pada kondisi-kondisi tertentu. Karena komplikasi adhesi dan gliding tendon sering terjadi pasca tindakan pembedahan, para peneliti berusaha menemukan bahan yang secara efektif mampu memperbaiki proses penyembuhan tendon. Platelet-rich plasma (PRP) dan membran amnion merupakan bahan yang dinyatakan memiliki potensi dalam memperbaiki proses penyembuhan tendon, mencegah adhesi dan gliding tendon. Namun, penelitian mengenai efek kombinasi keduanya masih belum pernah dilakukan.Metode: Model ruptur tendon Achilles dilakukan pada 24 ekor kelinci putih New Zealand yang terbagi dalam 4 kelompok perlakuan, yaitu kelompok kontrol, kelompok dengan pemberian membran amnion, kelompok dengan pemberian PRP dan kelompok dengan pemberian kombinasi membran amnion dan PRP. Evaluasi dilakukan pada 6 minggu setelah tindakan pembedahan berdasarkan penilaian terhadap pemeriksaan gliding tendon dengan USG, Tang score gambaran makroskopis adhesi tendon, grading adhesi secara makroskopis, Tang score gambaran histopatologis adhesi, grading adhesi secara histopatologis, serta Tensile strength tendon dengan uji tarik. Data yang didapatkan diuji secara statistik dengan jenis data dan jumlah kelompoknya.Hasil: Kelompok perlakuan membran amnion serta kelompok kombinasi membran amnion dan PRP memiliki perbedaan bermakna terhadap dalam hal gliding tendon secara USG, Tang score makroskopis dan histopatologis serta grading adhesi makroskopis dan histopatologis. Kelompok perlakuan PRP dan kombinasi membran amnion dan PRP menunjukkan perbedaan bermakna terhadap kelompok kontrol dalam hal nilai tensile strength test.

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Background: The incidence of Achilles tendon rupture has increased in the last few decades with the highest incidence found in the 30-39 years of age group. The current treatment for Achilles tendon rupture is surgery with primary suturing, and can also be conservative under certain conditions. Because adhesion complications and gliding tendons often occur after surgery, the researchers tried to find a material that is able to effectively improve the tendon healing process. Platelet-rich plasma (PRP) and amniotic membrane are substances that have the potential to improve tendon healing processes, prevent adhesion and gliding tendons. However, research on the effects of the combination of both has never been done.

Methods: The Achilles tendon rupture model was carried out in 24 New Zealand white rabbits, which were divided into 4 treatment groups, namely the control group, the group with the administration of amniotic membrane, the group with the administration of PRP and the group with the combination of amniotic membrane and PRP. The evaluation was carried out at 6 weeks after surgery based on an assessment of gliding tendon examination with ultrasound, Tang score macroscopic image of tendon adhesion, macroscopic adhesion grading, Tang score histopathological adhesion, histopathological adhesion grading, and Tensile strength tendon with the tensile test. The data obtained were tested statistically with the type of data and the number of groups.

Results: Amniotic membrane treatment group and combined amniotic membrane and PRP treatment group had significant differences in terms of gliding tendon by ultrasound, macroscopic and histopathological Tang scores and macroscopic and histopathological adhesion grading. The PRP treatment group and combined amniotic membrane and PRP treatment group showed significant differences compared to the control group in terms of tensile strength test values.

Conclusion: The administration of amniotic membrane can reduce the formed paratenon adhesion, however, it does not have statistical significance in influencing tendon strength. Giving Platelet-rich Plasma (PRP) does not affect the formation of paratenon adhesion statistically, but it affects the increase in tendon strength. The combination of amniotic membrane and PRP has a significant effect in reducing paratenon adhesion and increasing tendon strength."

"Pasien uveitis tanpa etiologi yang jelas (idiopatik) dengan kriteria klinis peradangan yang tidak spesifik namun memiliki status IGRA positif kerap menyebabkan dilema dalam pengobatan. Kelompok pasien tersebut diterapi sebagai kelompok suspek ekstrapulmonari TB dan mendapatkan pengobatan Obat Anti Tuberkulosis (OAT). Berbagai penelitian menunjukan bahwa profil ekspresi transkriptomik Interferon-stimulated Genes (ISG) tipe 1 ditemukan meningkat pada pasien aktif TB dan diketahui berpotensi sebagai biomarker diagnosa dan monitoring efikasi terapi. Selain itu level protein C1q ditemukan meningkat pada pasien TB aktif dibandingkan kelompok kontrol sehat serta kadarnnya menurun signifikan seiring dengan durasi pengobatan OAT. Pada penelitian ini dilakukan pemeriksaan ekspresi mRNA menggunakan RT-qPCR terhadap Interferon Stimulated Genes (ISG) tipe 1 (MyD88, FCG1R1B, IL1B, IFIT2, GBP1, IRF7, TLR8, STAT1, SERPING1, UBE2L6) dan protein C1q menggunakan ELISA pada pasien uveitis idiopatik dengan IGRA positif dari 20 pasien dengan time-point follow up pada minggu ke-0 (M0) dan minggu ke-2 (M2). Ekspresi gen GBP1 (p=0,001), UBE2L6 (p=0,0012) dan SERPING1 (p=0,03) berbeda bermakna pada kelompok perbaikan okular, dengan 8/10 gen menunjukan tren penurunan ekspresi pada M2. Hanya GBP1 (p=0,03) yang ekspresinya berbeda bermakna pada kelompok tanpa perbaikan okular, dengan 9/10 menunjukan tren peningkatan ekspresi gen pada M2. Perubahan ekspresi gen (M0-M2) MyD88, FCGR1B, GBP1, TLR8, STAT1 berkorelasi dengan outcome okular. Perubahan ekspresi gen GBP1 dan TLR8 berbeda bermakna sebagai biomarker diagnosis dengan AUC 88,1% dan 90,5%. Pada penelitian ini, level C1q sebelum dan setelah pengobatan ditemukan tidak berbeda bermakna (p=0,87) dan tidak terdapat hubungan berbeda bermakna antara perubahan klinis okular dengan level C1q.

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Uveitis patients without a clear etiology (idiopathic) with non-specific inflammation clinical criteria but who have a positive IGRA status often cause dilemmas in treatment. This group of patients was treated as a group of suspected extrapulmonary TB and received anti-tuberculosis drug (ATT) treatment. Various studies have shown that the transcriptomic expression profile of type 1 Interferon Stimulated Genes (ISG) was found to be increased in active TB patients and is known to have potential as a diagnostic biomarker and monitoring of therapy efficacy. In addition, the C1q protein level was found to be increased in active TB patients compared to the healthy control group and its levels decreased significantly with the duration of OAT treatment. In this study, mRNA expression was examined using RT-qPCR on Interferon Stimulated Genes (ISG) type 1 (MyD88, FCG1R1B, IL1B, IFIT2, GBP1, IRF7, TLR8, STAT1, SERPING1, UBE2L6) and C1q protein using ELISA in idiopathic uveitis patients. with positive IGRA of 20 patients with time-point follow-up at week 0 (W0) and week 2 (W2). GBP1 (p=0.001), UBE2L6 (p=0.0012), and SERPING1 (p=0.03) genes differentially expressed significantly in the group with ocular improvement, which 8/10 genes were downregulated in W2. In the non-improvement ocular group, only the GBP1 gene was significantly expressed differentially (p=0.03), with 9/10 genes expression upregulated in W2. Changes in expression of the MyD88, FCGR1B, GBP1, TLR8, and STAT1 genes correlated with ocular improvement. Changes in GBP1 and TLR8 gene expression were significantly different as a biomarker diagnosis with AUC of 88.1% and 90.5%. In this study, C1q levels before and after treatment were not significantly different (p=0.87) and there was no significant correlation between ocular clinical changes and C1q levels."