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"ABSTRACTPancreatic complex deep injury extending to the main pancreatic duct (MPD), caused by strong external forces such as traffic accidents, is lethal without emergency surgery. However, the best surgical procedure for this serious injury has not been established. The Bracey procedure is a relatively simple reconstructive technique involving pancreaticogastrostomy, but it is often followed by postoperative complications, such as dilatation of the MPD caused by anastomotic stenosis, as well as subsequent serious sequela such as repetitive pancreatitis and new-onset pancreatic diabetes. It is possible that the combination of ductal mucosal pancreaticogastrostomy (DMPG) and an internal stent might prevent anastomotic stenosis of the MPD. We found that the Bracey procedure was a safe and effective reconstructive procedure for five patients who suffered a pancreatic complex deep injury with MPD involvement. In three of these patients, postoperative dilatation of the MPD was prevented by combining the Bracey procedure with DMPG including an internal stent. Our experience suggests that this procedure is one of the best techniques for treating pancreatic complex deep injury extending to the MPD."

"PurposePancreatic ductal adenocarcinoma (PDAC) is a lethal disease; however, the frequency of recurrence can be reduced if curative surgery following adjuvant chemotherapy is applied. At present, adjuvant chemotherapy is uniformly performed in all patients, as it is unclear which tumor types are controlled best or worst. We investigated patients with recurrence to establish the optimum treatment strategy.MethodsOf 138 patients who underwent curative surgery for PDAC, 85 developed recurrence. Comprehensive clinicopathological factors were investigated for their association with the survival time after recurrence (SAR).ResultsThe median SAR was 12.6 months. Treatments for recurrence included best supportive care, GEM-based therapy and S-1. The performance status [hazard ratio (HR) 0.12, P < 0.001], histological invasion of lymph vessels (HR 0.27, P < 0.001), kind of treatment for recurrence (HR 5.0, P < 0.001) and initial recurrence site (HR 2.9, P < 0.001) were independent significant risk factors for the SAR. The initial recurrence sites were the liver (n = 21, median SAR 8.8 months), lung (n = 10, 14.9 months), peritoneum (n = 6, 1.7 months), lymph nodes (n = 6, 14.7 months), local site (n = 17, 13.9 months) and multiple sites (n = 25, 10.1 months). A shorter recurrence-free survival (< 1 year) and higher postoperative CA19-9 level were significantly associated with critical recurrence (peritoneal/liver).ConclusionsSeveral risk factors for SAR were detected in this study. Further investigations are needed to individualize the adjuvant chemotherapy for each patient with PDAC."

"Keganasan pankreas merupakan keganasan dengan angka kematian yang tinggi, dengan Adenokarsinoma Duktal Pankreas/Pancreatic Ductal Adenocarcinoma (PDAC) mencakup 85-90% kasus. PDAC memiliki perjalanan penyakit yang sangat agresif, dan seringkali baru terdiagnosis pada stadium lanjut. Penegakan diagnosis pasti PDAC seringkali hanya dapat dilakukan melalui sediaan terbatas baik berupa biopsi maupun endoscopic ultrasound-guided fine-needle aspiration/EUS-FNA. Salah satu tantangannya adalah membedakan PDAC dari jaringan pankreas non-neoplastik/reaktif. Penelitian ini akan membahas mengenai peran von Hippel-Lindau gene product/pVHL dalam membedakan PDAC dengan jaringan pankreas non-neoplastik, serta hubungannya dengan profil klinikopatologiradira PDAC. Penelitian ini merupakan penelitian observasional analitik dengan desain cross-sectional pada kasus PDAC dan jaringan pankreas non-neoplastik yang dilakukan di RSCM pada sampel yang diperoleh pada bulan Januari 2012 hingga September 2023. Sampel penelitian dibagi menjadi 2 kelompok besar, yaitu kelompok PDAC dan pankreas non-neoplastik. Pemilihan sampel dilakukan dengan menggunakan simple random sampling dari kasus-kasus yang memenuhi kriteria inklusi dan tidak termasuk dalam kriteria eksklusi. Dilakukan pulasan imunohistokimia pVHL dan perhitungan Histoscore/H-score serta penentuan cut-offnya untuk membagi ekspresi pVHL menjadi tinggi dan rendah dan hubungannya dengan PDAC dan non-neoplastik, serta profil klinikopatologi pada kelompok PDAC. Penelitian ini menunjukkan tidak terdapat perbedaan ekspresi pVHL pada kelompok PDAC dan non-neoplastik, dan staging pN memiliki hubungan bermakna dengan ekspresi pVHL pada PDAC. Ekspresi pVHL yang rendah lebih banyak ditemukan pada PDAC berdiferensiasi sedang, tidak ditemukan invasi limfovaskular maupun invasi perineural, memiliki batas sayatan yang tidak bebas, memiliki staging pT2, pN0, M0, dan kesintasan > 7 bulan. Sebaliknya, ekspresi pVHL yang tinggi juga lebih banyak ditemukan pada PDAC berdiferensiasi sedang, ditemukan invasi limfovaskular, tidak ditemukan invasi perineural, status batas sayatan yang bebas, staging pT2 dan pT3, pN1 dan pN2, M0, dengan kesintasan ≤ 7 bulan. Temuan ini berbeda dengan penelitian sebelumnya yang mendapati hilangnya ekspresi pVHL pada tumor PDAC, dan sebaliknya pada duktus pankreas non-neoplastik. Hal ini kemungkinan disebabkan oleh perbedaan klon antibodi yang digunakan pada penelitian ini dibandingkan dengan penelitian sebelumnya. Klon antibodi yang digunakan adalah VHL40, sedangkan penelitian-penelitian sebelumnya menggunakan klon FL-181 yang berikatan dengan asam amino yang berbeda dan memiliki klonalitas yang berbeda pula. Selain itu, pada PDAC dapat terjadi mutasi pada gen VHL yang menghasilkan protein VHL yang non-fungsional yang kemungkinan masih dapat terdeteksi dengan ikatan antigen-antibodi pada penelitian ini. 

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Pancreatic malignancy is a malignancy with a high mortality rate, with Pancreatic Ductal Adenocarcinoma (PDAC) accounting for 85-90% of cases. PDAC has a very aggressive disease course, and is often only diagnosed at an advanced stage. Establishing a definite diagnosis of PDAC can often only be done through limited sample from biopsy or endoscopic ultrasound-guided fine-needle aspiration/EUS-FNA. In such limited sample, differentiating PDAC from non-neoplastic/reactive pancreatic tissue can be challenging. This research will discuss the role of von Hippel-Lindau gene product/pVHL in PDAC and non-neoplastic pancreatic tissue, as well as their relationship with PDAC pathological factors. This research is an analytical observational study with a cross-sectional design on cases of PDAC and non-neoplastic pancreatic tissue conducted at RSCM on samples obtained from January 2012 to September 2023. The research samples were divided into 2 large groups, namely the PDAC and non-neoplastic pancreatic groups. Sample selection was carried out using simple random sampling from cases that met the inclusion criteria and were not included in the exclusion criteria. Immunohistochemistry of pVHL was performed along with calculation of Histoscore/H-score and determination of cut-offs to divide pVHL expression into high and low and its relationship with PDAC and non-neoplastic, as well as pathological factors in the PDAC group. This study shows that there is no difference in pVHL expression in the PDAC and non-neoplastic groups, and pN staging has a significant relationship with pVHL expression in PDAC. Low pVHL expression is more often found in moderately differentiated PDAC, no lymphovascular invasion or perineural invasion, non-free incision margins, staging pT2, pN0, M0, and survival > 7 months. In contrast, high pVHL expression was also found more frequently in moderately differentiated PDAC, lymphovascular invasion was found, no perineural invasion was found, free incision margin status, pT2 and pT3 staging, pN1 and pN2, M0, with survival ≤ 7 months. This finding is different from previous studies which found loss of pVHL expression in PDAC tumors, and vice versa. This difference in results is likely due to differences in the antibody clones used in this study compared to previous studies. The antibody clone used was VHL40, whereas previous studies used the FL-181 clone which binds to different amino acids and has different clonality. In addition, in PDAC there is a mutation in the VHL gene which may produce a non-functional VHL protein that still be detectable by antigen-antibody binding in this study."

"Inflamasi kronik adalah proses yang penting dalam patofisiologi adenokarsinoma duktal pankreas (PDAC). Beberapa studi telah meneliti potensi enzim siklooksigenase-2 (COX-2) sebagai faktor prognostik PDAC, dengan hasil yang kontradiktif. Nuclear factor kappa−B (NF−?B), specificity protein 1 (Sp1), dan c−Jun adalah faktor transkripsi gen COX2. Penelitian ini adalah studi observasional eksploratori yang bertujuan untuk mengidentifikasi asosiasi ekspresi protein NF−?B (RelA/ p65), COX−2, Sp1, dan c−Jun dengan kesintasan pasien PDAC. Ekspresi protein tersebut dinilai di jaringan pasien PDAC menggunakan metode imunohistokimia. Diidentifikasi ekspresi keempat protein tersebut dengan overall survival (OS) dan karakteristik klinikopatologis pasien PDAC. Sebanyak 53 jaringan PDAC dari biopsi atau reseksi kanker diikutkan dalam penelitian. Hasilnya terdapat korelasi antara keempat protein di jaringan kanker. Ekspresi NF−?B sitoplasmik (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) atau nuklear (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) berhubungan secara independen dengan prognosis pasien yang lebih baik. Protein lainnya tidak berhubungan dengan kesintasan pasien. Hal ini menunjukkan bahwa peran inflamasi di PDAC lebih kompleks dari yang diperkirakan sebelumnya.

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Chronic inflammation is a crucial driver of carcinogenesis in pancreatic ductal adenocarcinoma (PDAC). Several studies have investigated the prognostic significance of cyclooxygenase−2 (COX−2) expression in PDAC patients, obtaining conflicting results. Nuclear factor kappa−B (NF−?B), specificity protein 1 (Sp1), and c−Jun are known as the transcription factors of the COX2 gene. This exploratory observational study investigated the association of the NF−?B, COX−2, Sp1, and c−Jun expressions with patient survival in PDAC. We used the immunohistochemical method to detect the PDAC tissue expressions of NF−?B (RelA/p65), COX−2, Sp1, and c−Jun. The expressions of these proteins were correlated with the overall survival (OS) and other clinicopathological characteristics of PDAC patients. We obtained 53 PDAC specimens from resections and biopsies. There were significant correlations between the four proteins’ expressions in the PDAC tissues. The expression of the cytoplasmic (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) or nuclear NF−?B (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) was independently associated with a better prognosis in the PDAC patients. COX−2, Sp1, and c−Jun showed no significant association with a prognosis in the PDAC patients. The PDAC patients who expressed NF−?B had a better prognosis than the other patients, which suggests that the role of inflammation in PDAC is more complex than previously thought."

"Latar Belakang : Terdapat dua modalitas terapi paliatif pada populasi pasien penyakit jantung bawaan biru pulmonary duct dependent yaitu intervensi kateterisasi dengan PDA stent dan pembedahan dengan mBTT shunt. Sampai saat ini belum ada penelitian yang membandingkan luaran kedua tindakan paliatif ini pada usia yang lebih tua.Tujuan: Mengetahui luaran tindakan PDA stent dibandingkan dengan mBTT shunt sebagai terapi paliatif pada pasien penyakit jantung bawaan sianotik dengan pulmonary duct dependent.Metode : Dilakukan studi kohort retrospektif menggunakan data sekunder terhadap 143 pasien yang menjalani terapi paliatif PDA stent dan mBTT shunt pada periode Agustus 2016 sampai Agustus 2022 di RS Pusat Jantung Harapan Kita. Dilakukan pemantauan selama perawatan hingga 30 hari pasca tindakan. Hasil: Total 143 pasien yang dimasukkan ke dalam analisis luaran primer dan sekunder; 43 pasien menjalani PDA stent dan 100 pasien menjalani mBTT shunt dengan median usia kelompok PDA stent 110 (31-1498) hari dan kelompok mBTTshunt 174.5 (30-1651) hari. Komposit luaran primer tidak bermakna pada kedua kelompok meliputi mortalitas 30 hari (6(14%) vs 14 (14%), p=1,000), reintervensi (1(2,3%) vs 7 (7%),p = 0,436) , dan rehospitalisasi 30 hari (0(0%) vs 2(2%),p=0,319). Analisis luaran sekunder didapatkan angka lama rawat inap ICU lebih pendek pada kelompok PDA stent(2 (0-16) hari vs 4 (1-63) hari, p =0,002).Kesimpulan: PDA stent memiliki luaran yang tidak berbeda dengan tindakan mBTT shunt pada komposit luaran meliputi mortalitas 30 hari, reintervensi, dan rehospitalisasi 30 hari namun berbeda bermakna pada lama rawat ICU.

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Background: There are two modalities of palliative therapy in the population of patient with pulmonary duct dependent which is catheterization intervention with PDA stent and surgery with BTT shunt. To date, there have been no studies that have compared the outcomes of these two palliative strategy in older age.

Objectives: To determine the outcome of PDA stent compared to mBTT shunt as palliative therapy in patients with pulmonary duct dependent congenital heart disease.

Methods: A retrospective cohort study was conducted using secondary data on 143 patients undergoing palliative therapy for PDA stents and mBTT shunts from August 2016 to August 2022 at National Cardiovascular Center Harapan Kita. Monitoring was carried out during treatment up to 30 days after the procedure.

Results : A total of 143 patients were included in the primary and secondary outcome analysis; 43 patients underwent PDA stent and 100 patients underwent mBTT shunt with median age of PDA stent group 110 (31-1498) days and mBTT shunt group 174.5 (30-1651) days. Primary outcome composite was not significant in both groups including 30 days mortality (6(14%) vs 14(14%), p=1.000), reintervention (1(2.3%) vs 7(7%),p=0.436) , and 30 days rehospitalization (0(0%) vs 2(2%),p=0.319). Secondary outcome analysis showed shorter ICU length of stay in the PDA stent group (2 (0-16) days vs 4 (1-63) days, p = 0.002).

Conclusion: PDA stent has an outcome that is not different from the mBTT shunt procedure in the composite outcome including 30 days mortality, reintervention, and 30 days rehospitalization but significantly different in ICU length of stay."

"Laporan magang ini membahas evaluasi prosedur audit internal atas pendapatan dengan standar audit internal Sawyer yang dilakukan oleh Departemen Internal Audit PT ABC kepada anak usahanya, yaitu PT XYZ untuk periode 1 Januari hingga 30 September 2021. PT XYZ merupakan perusahaan yang bergerak di bidang pariwisata dengan mengelola hotel, villa, dan kawasan pariwisata. Terdapat tiga jenis pendapatan pada PT XYZ, yaitu Residensial, Infrastruktur, dan Jasa. Dari bulan Januari hingga September 2021, Pendapatan Jasa berkontribusi sekitar 90% dari total pendapatan sehingga siklus pendapatan yang dibahas dipusatkan pada Pendapatan Jasa. Evaluasi difokuskan pada prosedur vouching dan pembuatan draft laporan internal audit. Vouching bertujuan untuk mengumpulkan dan mendapatkan bukti-bukti audit dan draft laporan internal audit bertujuan untuk melaporkan hasil audit. Berdasarkan evaluasi yang telah dilakukan, didapat bahwa prosedur audit internal sudah sesuai dengan standar yang berlaku. Selain itu, pada laporan magang juga dibahas mengenai refleksi diri dari pengalaman atas kegiatan magang. Hasil evaluasi menyimpulkan bahwa kemampuan pengoperasian Microsoft Excel dan pengetahuan dasar audit dalam menjalankan aktivitas magang sudah baik. Adapun hal yang belum berjalan baik, yaitu pengetahuan audit secara praktikal dan kemampuan berkomunikasi. Laporan magang ini juga membahas mengenai rencana tindak lanjut dari refleksi diri yang telah dilakukan.

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This internship report discusses the evaluation of internal audit procedures on income with Sawyer's internal audit standards carried out by the Internal Audit Department of PT ABC to its subsidiary, namely PT XYZ for the period January 1 to September 30, 2021. PT XYZ is a company engaged in the tourism sector by managing hotels, villas, and tourism areas. There are three types of income at PT XYZ, namely Residential, Infrastructure, and Services. From January to September 2021, Service Revenues contributed about 90% of total revenue so that the revenue cycle discussed is centered on Service Revenues. The evaluation focused on the vouching procedure and drafting of the internal audit report. Vouching aims to collect and obtain audit evidence and the draft internal audit report aims to report audit results. Based on the evaluation that has been done, it is found that the internal audit procedures are in accordance with applicable standards. In addition, the internship report also discusses self-reflection from the experience of internship activities. The evaluation results concluded that the ability to operate Microsoft Excel and basic audit knowledge in carrying out internship activities was good. The things that have not gone well are practical audit knowledge and communication skills. This internship report also discusses the follow-up plan of the self-reflection that has been done."

"Gastroduodenal mucosat integrity has important role in the pathogenesis of gastroduodenal ulcer. It depends on imbalance between aggressive and defensive factors. However, many experts believe that defensive factors has more dominant role. Maintenance of gastrointestinal endothelial integrity appears to define the "cytoprotection" phenomenon and, as discussed below, is a critical component of NSAID-induced GI injury and a potential target for therapeutic intervention,"

"ABSTRAKInternet telah menjadi bentuk komunikasi yang terpopuler dan digunakan di berbagai tempat di dunia dan banyak digunakan oleh anak muda. Selain internet biasa, ada bagian dari internet yang tidak dapat diakses menggunakan indeks biasa yang disebut deep web. Deep Web sering dikaitkan dengan aktifitas ilegal terutama karena misinformasi yang digambarkan di budaya populer seperti film / televisi dan situs internet. Salah satu kelompok yang paling terpengaruh oleh budaya populer adalah anak muda dikarenakan konsumsi budaya populer mereka yang tinggi. Karya Ilmiah ini dibuat untuk meneliti hubungan antara anak muda dan budaya populer yang menghasilkan informasi yang salah tentang deep web dengan menganalisa data, penelitian dan berita tentang subyek tersebut. Untuk memberikan pengertian yang lebih baik tentang hubungan tersebut, karya ilmiah ini akan menghubungkan permasalahan penelitian dengan dua teori komunikasi, yaitu Teori Sociocultural dan Teori Social Cognitive. Dengan menganalisa profil anak muda di intenet, yang mencakup perilaku, pilihan dan kebiasaan mereka, dan juga menganalisa budaya populer termasuk tipe dari budaya populer, profil pengguna dan bagaimana budaya populer mempengaruhi pengguna mereka, maka kita bisa mengerti bagaimana anak muda mendapat informasi yang salah tentang deep web melalui budaya popular, Penelitian ini juga bertujuan untuk meningkatkan kesadaran tentang perilaku daring anak muda berdasarkan pengaruh budaya popular dan mecegah penyebaran informasi yang salah tentang deep web diantara mereka.

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ABSTRACTInternet has been one of the most used forms of communication around the world and being used in majority by young people. Beyond the regular internet there is part of internet that is inaccessible using regular index called deep web. Deep web is often associated with illegal activities primarily because of misinformation by popular cultures such as movie television and internet sites. Among those who are most influenced by popular culture is the young people due to their high consumption of popular culture. This paper is created to examine the connection between young people and popular culture that resulted in misinformation of deep web by analyzing data, research and news regarding the subject. To better understand the connection, this paper will connect the research problem with two communication theories which are Sociocultural Theory and Social Cognitive Theory. By examining young people rsquo s profile online, which cover their behavior, preference and habits and by examining the popular culture including the type of popular culture, their audience profile and how they influence their respective audience, we can understand how young people get misinformed about deep web through popular culture. This research also aims at raising awareness of young people regarding their online behavior which is influenced by popular culture and at preventing misinformation about deep web among them."

"The year of 1997s witnessed a depreciation of domestic currency in many countries in Asia, including Indonesia. Finally in 1998, Indonesia got debt repayment ability problems and the economic crisis at the same time. Some economists found that the economic crisis caused by shocks in 1997 has been the major cause of the debt repayment inability. Meanwhile others argue that the debt problems in Indonesia have been the major cause of the economic. This invites question: Which of these contrary hypotheses are relevant for Indonesia case? Furthermore, how do Internal and External Shocks Effect Debt Crisis? For the case of Indonesia, this study found that shocks in exchange rate, domestic income and foreign income influence the loan demand and loan supply of Indonesia that finally caused the debt crisis. Defining Debt Crisis as a condition of excess demand (Loan Demand > Loan Supply) and use a rescheduling under duress as the working definition, this paper try to see what factors determined the loan demand and supply. Using Balance of Payments equation, this paper found identity equations determine loan demand. Any shocks over the variables determined these factors will finally be transmitted to loan demand and cause pressure to debt crisis. Using Vector Autoregression Model, this paper found significant relationship among the exchange rate, domestic income and foreign income and Export of goods and services, import of goods and services and direct foreign investment. The Impulse Response Function (IRF) provides further evidence that pressure for loan demand actually increased when depreciation occurred. It was caused trough its effect to export of goods and services, import of goods and services and direct foreign investment. The econometric results also show that there was a significant negative relationship between foreign income and loan demand, suggesting that an increase of foreign currency led to a lessening in pressure for debt crisis trough an increase in loan supply and a decrease in loan demand. Another finding is that an increase in domestic income will create pressure on debt repayment ability. This conclusion is supported by the positive relationship between domestic income and import showed by Impulse Response Function."

"Laporan magang ini membahas mengenai pemutakhiran standard operating procedure proses budgeting pada PT XYZ yang disertai dengan analisis pengendalian internal. Hal ini bertujuan untuk memberikan informasi terbaru kepada para karyawan PT XYZ mengenai prosedur dalam menjalankan aktivitas bisnis dan memberikan kesamaan interpretasi dalam pelaksanaan proses budgeting. Selain itu, hal ini juga bertujuan untuk meningkatkan efektifitas pengendalian internal pada standard operating procedure. Proses pemutakhiran dan analisis dilakukan dengan wawancara dan penelusuran atas dokumen yang dimiliki oleh PT XYZ.

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This Internship Report discusses about the update of the standard operating procedure on budgeting of PT XYZ together with the analysis of internal control. The update was intended to provide the latest information to the employees of PT XYZ about the procedure in conducting business activities and to ensure similarity of understanding in the implementation of the budgeting process. In addition, it also aims to improve the effectiveness of internal control within the standard operating procedure. The update process and analysis was done by interviewing relevant officers and tracking of PT XYZ documents."