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"Penyakit Dekompresi (DCS) merupakan keadaan patologis yang mempengaruhi penyelam, astronot, pilot dan pekerja udara terkompresi akibat dari gelembung yang timbul dalam tubuh selama atau setelah penurunan tekanan ambien. Divers Alert Network melaporkan kasus DCS pada penyelam rekreasi sebanyak 651kejadian (23%) dari 2,866. Chichi Wahab, dkk melaporkan sebanyak 62 orang (53%) dari 117 menderita Penyakit Dekompresi pada penyelam tradisional. Reaksi Inflamasi merupakan salah satu penyebab DCS. Di Indonesia belum ada penelitian tentang pengaruh penyelaman dekompresi terhadap perubahan fungsi endotel sebagai pemicu terjadinya DCS.Penelitian ini menggunakan desain eksperimental rancangan pola silang. Data subjek adalah data primer yang di dapat melalui kuesioner, pemeriksaan fisik dan laboratorium. Sampel dipilih dengan cara random sistematik, diambil 20 orang sebagai subjek penelitian dan dibagi menjadi dua kelompok secara random. Kelompok A diberi perlakuan dengan tekanan 280 kPa pada hari pertama dan pada hari kedua diberi perlakuan masuk RUBT tanpa tekanan. Kelompok B yang diberi perlakuan tanpa tekanan pada hari pertama dan diberi perlakuan dengan tekanan 280 kPa pada hari berikutnya. Tiap Subjek Penelitian dilakukan pemeriksaan Interleukin-1α dengan menggunakan ELISA sandwich teknik kuantitatif sebanyak 3x yaitu sebelum diberikan perlakuan, setelah diberikan perlakuan dengan tekanan 280 kPa dan setelah perlakuan tanpa tekanan.Hasil penelitian menunjukkan bahwa terjadi peningkatan ekspresi Interleukin-1α baik setelah mendapatkan perlakuan dengan tekanan, maupun perlakuan tanpa tekanan, namun kenaikan ekspresi Interleukin-1α lebih besar setelah mendapat perlakuan dengan tekanan. Rerata kenaikan ekspresi Interleukin-1α setelah diberikan perlakuan dengan tekanan sebesar 0.01±0.01 pg/ml.Kesimpulan dan Saran: Dibuktikannya peningkatan ekspresi Interleukin-1α yang bermakna pada subjek penelitian setelah diberikan perlakuan dengan tekanan 280 kPa.

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Decompression Illness (DCS) is a pathological condition that affects divers, astronauts, pilots and workers who work in compressed air, as a result of bubbles arising in the body during or after drop in ambient pressure. Divers Alert Network reported cases of DCS in recreational divers as many as 651 events (23%) of 2.8663. Chichi Wahab et al reported 62 people (53%) of 117 suffered from decompression illness in traditional divers. Inflammatory reaction is one of many causes of DCS. In Indonesia, there is no research on the effects of decompression dives to changes in endothelial function as a trigger of DCS.

This study used experimental study design with Cross Over. Primary data was collected through questionnaires, physical examination and laboratory. Samples were selected, systematic randomly 20 people as research subjects each for two groups. The subjects were randomly assigned to a group. Group A was treated with a pressure of 280 kPa on the first day and on the second day entered the RUBT without pressure. Group B were treated with no pressure on the first day and was treated with pressure of 280 kPa on the next day. Each study subject was examined Interleukin-1α using ELISA sandwich quantitative techniques 3 times: before the study, after being given treatment with a pressure of 280 kPa and after treatment without pressure.

The results showed that an increase expression of Interleukin-1α better after getting treatment with pressure, or treatment without pressure, but the increase expression of Interleukin-1α larger after being treated with pressure. The mean increase e expression of Interleukin-1α after being treated with pressure is 0:01 ± 0.01 pg/ml.

Conclusions and Recommendations : Good evidence increasing expression of Interleukin-1α meaningful research on the subject after being given treatment with pressure of 280 kPa."

"Latar Belakang : Decompression sickness (DCS) masih menjadi masalah, walaupun dekompresi telah dilakukan sesuai dengan prosedur[1,2,3] Insiden pada recreational diving 2-4 per 10.000 penyelaman[1]. Patofisiologi terjadinya DCS tidak hanya terjadi akibat mekanisme obstruksi dari gelembung gas[3,4], namun dikaitkan dengan gangguan terhadap fungsi fisiologis NO[2,3,4,5]. Metode : Penelitian ini merupakan studi eksperimental dengan desain cross over pada 16 orang penyelam laki-laki Dislambair Koarmatim TNI AL. Data diperoleh melalui kuesioner, pemeriksaan fisik dan laboratorium ekspresi eNOS menggunakan teknik kuantitatif ELISA sandwich, yang diberi perlakuan penyelaman tunggal dekompresi US Navy 280 kPa dalam RUBT. Hasil : Terdapat penurunan ekspresi eNOS yang bermakna pada kelompok hiperbarik (p<0,001) dan perbedaan selisih ekspresi eNOS antara kelompok normobarik dan hiperbarik yang bermakna (p=0,01). Korelasi IMT dengan ekspresi eNOS sebelum dan sesudah perlakuan pada kelompok hiperbarik dan sebelum perlakuan pada kelompok normobarik berlawanan arah. Korelasi antara kebiasaan merokok dengan ekspresi eNOS sebelum dan sesudah perlakuan pada kelompok normobarik adalah sedang. Kesimpulan dan Saran: Penurunan ekspresi eNOS pada kelompok hiperbarik (p<0,001) dan selisih rerata ekspresi eNOS antara kelompok normobarik dan hiperbarik (p=0,001). Memperhatikan faktor individu, yaitu IMT dan kebiasaan merokok pada prosedur penyelaman dan diperlukan kajian medik langkah preconditioning sebelum penyelaman.

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Background : Decompression sickness (DCS) is still a problem, even though decompression has been performed in accordance with the procedures[1,2,3] recreational diving incident at 2-4 per 10,000 dives[1]. Path physiology of DCS not only occur due to obstruction mechanism of gas bubbles[3,4], but is associated with disruption of physiological functions NO[2,3,4,5].

Methods : This study is an experimental study with cross-over design in 16 male divers Dislambair Koarmatim Navy. Data obtained through questionnaires , physical examination and laboratory eNOS expression using quantitative techniques sandwich ELISA, which treated single dive decompression US Navy 280 kPa in hyperbaric chamber.

Results : Significant reduction in eNOS expression in the hyperbaric group(p<0.001) and the difference in eNOS expression differences between groups normobaric and hyperbaric(p=0.01). IMT correlation with the eNOS expression before and after treatment in the hyperbaric group and before treatment in group normobaric opposite direction. The correlation between smoking and eNOS expression before and after treatment in group normobaric is being.

Conclusions and Recommendations : A reduction in eNOS expression in the hyperbaric group(p< 0.001) and the mean difference between groups normobaric eNOS expression and hyperbaric(p = 0.001) . Attention to individual factors , namely BMI and smoking habits on the procedures required dives and medical studies preconditioning step prior to the dive."

"Latar Belakang: Penurunan eNOS secara signifikan terjadi pada penyelam terlatih yang melakukan penyelaman dekompresi. Latihan fisik submaksimal akut diperkirakan dapat mencegah terjadinya penurunan eNOS pada penyelaman dekompresi. Penelitian ini bertujuan membuktikan pengaruh pemberian latihan fisik submaksimal akut prapenyelaman tunggal dekompresi dalam mencegah penurunan kadar eNOS pada kelompok perlakuan dan kontrol. Metode: Penelitian menggunakan studi eksperimental murni. Kadar eNOS diperiksa pada awal penelitian, sebelum penyelaman dan setelah penyelaman. Kelompok perlakuan melakukan latihan fisik submaksimal akut 70 frekuensi kardiak maksimal dengan ergocycle putaran 60 rpm 24 jam sebelum penyelaman 280 kPa selama 80 menit. Subjek penelitian adalah penyelam laki-laki terlatih. Hasil: Latihan fisik submaksimal akut dapat mencegah penurunan ekspresi eNOS setelah penyelaman tunggal dekompresi pada kelompok perlakuan dengan kadar eNOS awal penelitian 2.7 2.07 - 20.76 dan kadar eNOS sesudah penyelaman dekompresi 2.7 1.81 - 34.77 serta terdapat perbedaan perubahan rerata ekspresi eNOS bermakna antara kelompok perlakuan dan kelompok kontrol dengan perbedaan rerata 0.00 -6.66 ndash; 29.27 pada keleompok perlakuan dan -0.39 -122.03 - 0.84 pada kelompok kontrol. Kesimpulan dan Saran: Latihan fisik submaksimal akut dapat mencegah terjadinya penurunan ekspresi eNOS setelah penyelaman tunggal dekompresi. Terdapat perbedaan perubahan rerata ekspresi eNOS bermakna antara kelompok perlakuan dan kontrol. Kajian lebih lanjut diperlukan mengenai manfaat secara klinis dan subjek penelitian selain penyelam laki-laki terlatih.

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Background: eNOS decreased significantly in trained divers who do decompression dives. Acute Submaximal exercise can prevent a decrease of eNOS in decompression dives. This study aims to prove the effect of exercise before a single decompression dive in preventing reduction of eNOS levels in the treatment group and control.

Methods: This research uses true experimental study design. eNOS levels were checked at the beginning, before and after dive. The experiment group performed acute submaximal exercise 70 of maximum cardiac frequency with ergocycle 60 rpm 24 hours before dive 280 kPa for 80 minutes. The control group did not do ergocycle before dive. Subjects were male trained divers.

Result: In experiment group, acute submaximal exercise can prevent a decrease of eNOS levels after a single decompression dive with baseline levels of eNOS 2.7 2.07 20.76 and eNOS levels after decompression dives 2.7 1.81 34.77 , and there are differences in changes of the mean levels of eNOS significantly between experiment group and control with mean difference 0.00 6.66 ndash 29.27 on experiment group and 0.39 122.03 ndash 0.84 in control group.

Conclusion and Recommendation: Acute submaximal exercise can prevent a decrease of eNOS levels after single decompression dive. There are significant differences between treatment group and control. Further study is needed on the clinical benefits and the research subject other than a male trained diver. "

"Latar Belakang: Pelepasan gelembung gas inert akibat supersaturasi jaringan dengan perubahan tekanan dipercaya sebagai penyebab decompression sickness. Gelembung gas dapat dideteksi melalui USG Doppler tetapi sensitivitas dan spesifisitas terhadap decompression sickness dipertanyakan. Perubahan fisiologis tubuh berupa peningkatan agregasi trombosit diduga berperan dalam terjadinya decompression sickness. Peningkatan agregasi trombosit terbukti pada penyelaman 60 msw. Tujuan: untuk membuktikan penyelaman tunggal dekompresi 280 kPa dapat mengakibatkan peningkatan agregasi trombosit. Metode: Penelitian eksperimental desain cross over dengan melibatkan delapan belas penyelam laki-laki dislambair. Semua penyelam akan melakukan penyelaman kering dengan udara pada tekanan 280 kPa selama 80 menit dengan kontrol masuk ke dalam RUBT tanpa ditekan pada periode pertama. Pada periode kedua kelompok perlakuan dan kontrol ditukar. Prosedur dekompresi disesuaikan dengan prosedur tabel dekompresi US Navy Revisi 6. Pengambilan darah dilakukan sebelum perlakuan, setelah periode pertama, dan setelah periode kedua. Pemeriksaan agregasi trombosit menggunakan induktor ADP, kolagen dan epinefrin. Hasil: Setelah penyelaman tunggal dekompresi 280 kPa selama 80 menit secara signifikan meningkatkan persentase agregasi maksimal trombosit dengan induktor ADP dari 86.94 ± 4.11 menjadi 90.46 ± 3.41, dengan induktor kolagen dari 91.94 ± 2.62 menjadi 94.69 ± 2.25, dan induktor epinefrin dari 86.65 (22.10-93.8) menjadi 90.25 (31-95.9) pada kelompok sebelum perlakuan dan setelah perlakuan. Tidak ditemukan peningkatan signifikan persentase agregasi maksimal trombosit pada kelompok sebelum perlakuan dengan kontrol. Kesimpulan: Penyelaman tunggal dekompresi 280 kPa selama 80 menit meningkatkan persentase agregasi maksimal trombosit dengan induktor ADP, kolagen, dan epinefrin.

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Background: The release of inert gas bubbles due to changes in tissue?s supersaturating with pressure change is believed to be the cause of decompression sickness. Gas bubbles can be detected by Doppler ultrasonography but sensitivity and specificity is poorly defined. Increased of platelet aggregation is estimated have a role in DCS. Increasing platelet aggregation has been proved in dive with depth 60 MSW.

Aim: To prove that a single decompression dives 280 kPa can lead to increased platelet aggregation.

Methods: Experimental studies with a cross-over design involving eighteen male dislambair divers. All divers will dive in air compression chamber at a pressure of 280 kPa for 80 minutes with control entry into air compression chamber without pressure in the first period. In the second period, treatment and control group exchanged. Decompression procedures adapted to the US Navy decompression tables procedures 6th Revision. Taking blood performed before the intervention, after first period, and after second period. Examination of platelet aggregation using inductors ADP, collagen and epinephrine.

Result: A single decompression dive 280 kPa for 80 minutes significantly increased the percentage of maximal platelet aggregation with ADP inductor from 86.94±4.11 to 90.46±3.41, with a collagen inductor from 91.94±2.62 to 94.69±2.25, and epinephrine inductor from 86.65 (22.10-93.8) to 90.25 (31-95.9) in before and after treatment group. Increasing percentage of maximal platelet aggregation was not significant in the before treatment group and control group.

Conclusion: A single decompression dive 280 kPa for 80 minutes can lead to increase the percentage of maximal platelet aggregation with ADP, collagen, and epinephrine inductors."

"ABSTRAKLatar Belakang. Tindakan pembedahan radikal pada pasien dengan kanker seringkali menyebabkan komplikasi limfedema. Limfedema dapat diatasi dengan operasi transfer jaringan atau rekonstruksi limfatik. Penelitian ini bertujuan untuk membuktikan adanya pembentukan pembuluh limfe baru dengan penambahan flap jaringan pasca diseksi kelenjar limfe, dilihat dari peningkatan ekspresi VEGF-C, infiltrasi makrofag, dan pembentukan fibrosis.Metode. Penelitian ini merupakan penelitian eksperimental pada 20 ekor tikus Sprague Clawley jantan berumur 8-12 minggu, yang dibagi rata kedalam tiap kelompok perlakuan, di Animal House Skill Lab Fakultas Kedokteran Universitas Indonesia pada Januari-Maret 2018. Tiap tikus akan menjalani diseksi, kemudian diacak untuk menerima flap jaringan maupun hanya diseksi inguinal, dan dievaluasi setelah 2 bulan. Pemeriksaan histopatologi dilakukan pada akhir penelitian untuk menilai pembentukan fibrosis dan dilanjutkan pemeriksaan immunohistokimia. Analisis data dilakukan dengan program SPSS 20.0.Hasil. Sebanyak 8 tikus 88.9 yang menerima flap jaringan menunjukkan hasil positif pada tes methylene blue dibandingkan 2 tikus 22.2 pada kelompok kontrol p < 0.05 . Pada 18 tikus tersebut, pewarnaan HE juga menunjukkan adanya pembentukan jaringan ikat pembuluh yang lebih lebar pada tikus yang diberi perlakuan, meski tidak signifikan secara statistik. Pemeriksaan immunohistokimia juga menunjukkan ekspresi VEGF-C yang lebih jelas dengan dominasi warna coklat pada tikus perlakuan p < 0.05 . Ekspresi protein CD68 juga lebih jelas pada tikus perlakuan meski perbedaannya tidak signifikan.Kesimpulan. Penambahan flap jaringan dapat membantu memperbaiki aliran limfa yang dibuktikan dengan peningkatan aliran limfe dan ekspresi VEGF-C.

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ABSTRACT

Background. Radical surgeries for patients with cancer often cause lymphedema complications. Lymphedema may be solved with tissue transfer or lymphatic reconstruction surgery. This research aims to prove new formations of lymphatic vessels by the addition of tissue flap post dissection of lymphatic vessels, marked by increased expression of VEGF-C, macrophage infiltration, and fibrosis formation.Methods. This is an experimental study on 20 male Sprague Clawley mice aged 8-12 weeks, divided evenly for each experiment group, at Animal House Skill Lab Faculty of Medicine Universitas Indonesia from January-March 2018. Each mouse underwent dissection, randomized for flap addition or only inguinal dissection, and evaluated after 2 months. Histopathologic assessment was conducted at the end of study period to evaluate fibrosis formation and followed by immunohistochemistry analysis. Data analysis was conducted with statistical program SPSS 20.0Results. 8 mice 88.9 , which received tissue flap showed positive results on methylene blue test compared to 2 mice 22.2 from control group p < 0.05 . From the 18 mice, HE staining also showed wider formation of lymphatic connective tissue on flap-receiver mice, although it was not statistically significant. Immunohistochemistry analysis also showed clearer VEGF-C formation showed by brown coloration in flap-receiver mice p < 0.05 . Expression of CD68 protein was also clearer in flap-receiver mice although the difference was not significant.Conclusion. Addition of tissue flap may help improve lymphatic circulation proven by increased lymphatic circulation and VEGF-C expression."

"Artritis reumatoid AR adalah penyakit autoimun yang saat ini telah diketahui menunjukkan manifestasi klinis bukan hanya intraartikular, tetapi juga ekstraartikular. Kejadian kardiovaskular baik subklinis maupun klinis ditemukan lebih tinggi pada penderita AR. Mediator inflamasi aterogenik pada AR seperti interleukin-6 IL-6 diduga menjadi salah satu faktor risiko nontradisional kardiovaskular yang berkontribusi meningkatkan penanda disfungsi endotel seperti E-Selectin. Penelitian ini bertujuan mengetahui peran mediator inflamasi dalam kejadian disfungsi endotel, khususnya korelasi IL-6 dan E-selectin, pada pasien artritis reumatoid tanpa faktor risiko kardiovaskular. Studi potong-lintang dilakukan pada 40 pasien AR di Poliklinik Reumatologi RSUPN Dr. Cipto Mangunkusumo, Indonesia, pada bulan September-November 2017. Pemeriksaan IL-6 dan E-Selectin dilakukan dengan teknik enzyme-linked immunosorbent assay ELISA. Analisis korelasi bivariat dilakukan untuk menemukan korelasi kedua penanda tersebut. Rerata usia subjek penelitian ini adalah 44,9 13,1 tahun dan median durasi sakit adalah 36 bulan. Korelasi kadar IL-6 dengan kadar E-Selectin memiliki kekuatan korelasi lemah tetapi tidak bermakna secara statistik r = 0.232, p=0,149. Tidak terdapat korelasi antara IL-6 dengan E-Selectin pada pasien AR tanpa faktor risiko tradisional kardiovaskular.

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Rheumatoid arthritis RA is an autoimmune disease which has recently been recognized to manifest as not only intraarticular but also extraarticular symptoms. Cardiovascular events, presented either subclinically or clinically, were discovered more in AR patients. Atherogenic inflammatory mediator in AR including interleukin-6 IL-6 was thought to be one of nontraditional cardiovascular risk factor contributing to increase the endothelial dysfunction biomarker such as E-Selectin. This study was purposed to determine the correlation between inflammatory mediator and endothelial dysfunction event, especially between IL-6 and E-Selectin, in RA patient without traditional cardiovascular risk factor. A cross-sectional study was performed to 40 RA patients of Rheumatology Clinic of Cipto Mangunkusumo National General Hospital, Indonesia from September to November 2017. Measurement of the level of IL-6 and E-Selectin were performed using enzyme-linked immunosorbent assay ELISA. Bivariate correlation analysis was performed to determine the correlation between those two biomarkers. The mean age of this study subjects was 44.9 13.1 years and median of disease duration was 36 months. This study showed weak correlation between IL-6 and E-Selectin level, but not statistically significant.232, p=0.149 . There is no correlation between IL-6 and sE-Selectin in rheumatoid arthritis patient without traditional risk factor cardiovascular."

"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."

"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. "

"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."

"ABSTRACTBackground: Tadalafil is a PDE5I which has been licensed for the treatment of erectile dysfunction (ED) since 2003, is effective from 30 minutes after administration and its efficacy is maintained for up to 36 hours. More recently, it is also given OAD in a lower dose to allow spontaneous sexual activities. However, whether OAD administration is more effective than PRN administration in improving the EF is yet to be established. This study aimed to evaluate whether OAD administration of tadalafil leads to a better improvement of erectile function (EF) in patients with erectile dysfunction (ED) compared to PRN administration. Methods: literature search of electronic database was performed through Medline, Scopus, Cochrane Library, and CINAHL databases. Cochrane Risk of Bias Tool was then employed to assess the risk of bias in each study. Results: initial literature search resulted in 231 hits, but only four studies were included in final selection. Based on our judgements, the study by Kang et al. was the most applicable in our clinical setting. This study showed that subjects who received tadalafil OAD had statistically significant higher increases of mean IIEF-EF (6,5 (SD 4,5) vs 4,9 (SD 4,2), p=0,032), proportion of yes responses to SEP-2 (81,8% vs 64,7%, p=0,025), and proportion of yes responses to SEP-3 (77,3% vs 60,3%, p= 0,034). Conclusion: administration of tadalafil OAD leads to a better improvement of EF compared to PRN administration."