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"Latar belakang : Anemia akut sering terjadi pada anak sakit kritis yang dirawat diPICU, memiliki konsekuensi hipoksia global yang dapat mengakibatkan disfungsimiokardium. Transfusi PRC masih menjadi salah satu pilihan dalam rangkamemperbaiki oksigenasi dan kinerja jantung saat terjadi anemia. Bukti-bukti pengaruhtransfusi pada perbaikan performa jantung masih terbatas.Tujuan : Mengevaluasi kadar NT-proBNP, pasokan oksigen, indeks inotropi dan rasioenergi potensial:energi gerak pada jantung sebelum dan sesudah transfusi PRC padaanak sakit kritis yang mengalami anemia akut.Metode : Penelitian analitik observasional potong lintang sejak April sampai Agustus2019 pada anak usia 1 bulan-18 tahun dengan sakit kritis yang dirawat di PICURSUPN Dr. Cipto Mangunkusumo. Penilaian hemodinamik menggunakan USCOM.Hasil : Penelitian ini melibatkan 31 subyek dengan median umur 3,6 tahun (rentang0,1-17,5 tahun). Kadar Hb naik sebesar 29,1±15,9% setelah mendapat transfusi PRC9±3,3 mL/KgBB. Rerata kadar hemoglobin sebelum dan sesudah transfusi adalah7,94±1,46 dan 10,17±1,92 g/dL (p<0,000 IK 95%: 1,80-2,64). Kadar NT-proBNPmeningkat tak bermakna sebesar 12% (-77,0-199) setelah transfusi dari 4214±6678menjadi 5182±8327 pg/mL (p=0,186 IK 95%: -493-2428). Tidak terdapat korelasiantara persen perubahan Hb dan NT-proBNP (Spearman correlation r=0,124; p=0,505).Terdapat kenaikan pasokan oksigen pasca transfusi sebesar 20,7±38,9% dan berkorelasidengan kanaikan hemoglobin (Pearson correlation r=0,39; p=0,029). Uji Chi-squaremenunjukkan adanya hubungan bermakna antara kelompok yang mengalami kenaikanDO dengan perbaikan indeks inotropi (uji Chi square, p=0,031) dan perbaikan PKR(p=0,008), namun tak ada hubungan dengan perubahan NT-proBNP (p=0,511).Simpulan : Tidak terdapat perubahan bermakna kadar NT-proBNP sebelum dansesudah transfusi PRC pada anak sakit kritis yang mengalami anemia akut. Peningkatanpasokan oksigen pasca transfusi PRC berkorelasi dengan peningkatan indeks inotropi(Smith-Madigan Inotropy Index) dan perbaikan potensial to kinetic ratio (PKR)

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Background: Acute anemia often occurs in critically ill children in PICU, which hasglobal hypoxic consequences resulting myocardial dysfunction. Transfusion of PRC isstill choosen in order to improve oxygenation and cardiac performance during anemia.Evidence of the effect of transfusion on improving cardiac performance is still limited.Objective: To evaluate NT-proBNP levels, delivery oxygen (DO2), inotropy index andthe potential to kinetic energy ratio (PKR) of heart before and after PRC transfusion incritically ill children with acute anemia.Methods: A cross-sectional observational analytic study conducted from April toAugust 2019 in children aged 1 month-18 years cared in PICU Dr. CiptoMangunkusumo Hospital. Hemodynamic assessment using USCOM.Results: This study involved 31 subjects with a median age of 3.6 years (range 0.1-17.5years). Hb levels increased by 29.1±15.9% after receiving a 9±3.3 mL / KgBBtransfusion PRC. The mean hemoglobin levels before and after the transfusion were7.94±1.46 and 10.17±1.92 g / dL (p <0.000; CI 95%: 1.80-2.64). NT-proBNP levelsslight increased but not statistically sgnificant by 12%(-77.0 - 199) after PRCtransfusion from 4214±6678 to 5182±8327 pg/mL (p = 0.186; CI 95%: -493 - 2428).There was no correlation between percent change in Hb and NT-proBNP (Spearmancorrelation r=0.124; p=0.505). There was increasing in DO2 after transfusion by20.7±38.9% and correlated with increased hemogolobin (Pearson correlation r=0.39;p=0.029). Chi-square test showed a significant relationship between groups thatexperienced an increase in DO2 with an improvement in the inotropy index (Chi squaretest, p=0.031) and improvement in PKR (p=0.008), but there was no relationship withNT-proBNP changes (p=0.511) .Conclusions: There was no significant change in NT-proBNP levels before and afterPRC transfusion in critically ill children who had acute anemia. Increased DO2 afterPRC transfusion correlates with an increase in the inotropy index (Smith-MadiganInotropy Index) and improvement in potential to kinetic ratio (PKR)."

"Latar Belakang: Meningkatnya angka kejadian stroke dan beratnya disabilitas dari penderita stroke yang bertahan hidup, menjadikan diperlukannya terapi yang optimal untuk restorasi paska stroke. Neurorestorasi dengan transplantasi sel punca menjanjikan perbaikan luaran fungsional yang baik pada pasien stroke iskemik. Penelitian ini dibuat untuk mengamati efek transplantasi Stem Cell from Human Exfoliated Deciduous Teeth SHED pada luaran klinis dan rasio sel neuron mati pada model stroke iskemik, untuk mendapatkan terapi yang optimal untuk stroke iskemik.Metode: Pembuatan tikus model stroke iskemik dilakukan dengan oklusi arteri cerebri media (MCAO). Pada 48 jam setelah MCAO, dilakukan transplantasi sel mesenkimal asal SHED secara intravena, dengan dosis 2x106/kgBB. Dilakukan evaluasi fungsional tikus secara neurobehaviour dengan tes Y Maze, dan evaluasi sensorimotor tikus dengan tes silinder. Evaluasi rasio neuron mati dilakukan dengan pewarnaan Hematoksilin dan Eosin.Hasil: Terdapat perbaikan evaluasi neurobehaviour dengan Y Maze (p=0,04) dan evaluasi sensorimotor dengan tes silinder (p=0,04) pada 14 hari setelah transplantasi pada kelompok tikus yang ditransplantasi SHED dibandingkan kontrol. Terdapat pengurangan rasio sel neuron mati (p=0,0) pada tikus yang ditransplantasi SHED pada 21 hari setelah MCAO.Kesimpulan: Transplantasi SHED pada tikus model stroke iskemik pada fase akut stroke menunjukkan perbaikan klinis dan terdapat pengurangan rasio neuron mati pada otak tikus model stroke iskemik yang di transplantasi dengan sel mesenkimal asal SHED.

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Background: The incidence of stroke reaches 15 million cases worldwide, and 5 million stroke survivors suffered permanent disability. Ischemic stroke causes a burden on health problems particularly in Indonesia. The prevalence of stroke in Indonesia in 2013 is 7 per 1000 population. The optimal stroke restoration therapy required, and neurorestoration with stem cell transplantation is a promising therapy that provides functional improvements for ischemic stroke. This research was conducted to observe the effects of Stem Cell from Human Exfoliated Deciduous Teeth (SHED) transplantation on the clinical improvement and neuron death ratio in the brain of rats models with ischemic stroke.Methods: One group of normal rats and two groups (n=5) of male wistar rats undergone permenents Middle Cerebral Artery Occlusion (MCAO). SHED transplantation performed 48 hours after MCAO, by intravenous injection with a dose of 2x106 cells/kg. Functional evaluation conducted in rats with Y Maze and cylinder Test. Evaluation of the death neurons ratio in brain cortex area done by Hematoksilin and Eosin staining.Results : The functional evaluation using Y Maze and Cylinder Test was significantly improved in the treatment group compared to the control stroke group p < 0,05 14 days after MCAO. There was a reduction in the neuron death ratio p = 0.0 in rats transplanted with SHED.Conclusion : SHED transplantation in acute stroke showed clinical improvement and reduction in the neuron death ratio in the brain of rat models with ischemic stroke. Keywords: Cell transplantation, Ischemic Stroke, MCAO, SHED"

"Latar Belakang. Transfusi packed red cell (PRC) sering ditemui pada anak sakit kritis, dengan kemungkinan efek samping yang tidak sedikit. Beberapa laporan terakhir merekomendasikan ambang batas transfusi yang lebih rendah yaitu hemoglobin (Hb) 7 g/dL, namun data karakteristik serta pedoman transfusi PRC anak sakit kritis di Indonesia belum diketahui.Metode. Studi dilakukan terhadap pasien yang dirawat di unit perawatan intensif anak (PICU) Rumah Sakit Cipto Mangunkusumo (RSCM) dan diputuskan untuk mendapat transfusi PRC. Kadar Hb, saturasi vena sentral (ScvO2), rasio ekstraksi oksigen (O2ER), oxygen delivery (DO2), indeks kardiak (CI), dan indeks inotropik (INO) diukur/dihitung sebelum dan sesudah transfusi.Hasil. Dari 92 pasien yang masuk perawatan PICU, 25 anak (27,5%) menjalani transfusi PRC dengan total 38 episode transfusi selama bulan Oktober hingga Desember 2015. Tiga episode dieksklusi dari penelitian sehingga 35 episode transfusi PRC diikutsertakan dalam analisis. Sebagian besar pasien adalah anak lelaki (77,1%) berusia 1 bulan hingga 1 tahun (45,7%), dengan median usia 2,1 (rentang 0,2 ? 16,2) tahun. Rerata Hb pre- dan pascatransfusi adalah 7,7 + 1,46 dan 10,2 + 1,97 g/dL. Rerata ScvO2 dan O2ER pretransfusi normal, yaitu 73,8 + 6,46 % dan 0,25 + 0,070, dengan rerata pascatransfusi tidak berbeda bermakna untuk keduanya, yaitu 79,0 + 5,92 % dan 0,19 + 0,056. Perbedaan rerata DO2, CI, dan INO pre- dan pascatransfusi juga tidak bermakna secara klinis maupun statistik. Analisis subgrup yang menunjukkan perbedaan bermakna secara klinis adalah pada anak dengan ScvO2 pretransfusi < 70%. Subgrup ini menunjukkan rerata Hb pretransfusi 7,2 + 1,69 g/dL, dengan nilai ScvO2 pre- dan pascatransfusi sebesar 64,1 + 4,71 % (nilai p 0,181) serta O2ER pre- dan pascatransfusi 0,34 + 0,055 dan 0,21 + 0,080 (nilai p 0,152).Simpulan. Studi terhadap praktek transfusi PRC di PICU RSCM tidak menunjukkan perubahan hemodinamik yang bermakna. Analisis lebih lanjut pada anak sakit kritis dengan nilai ScvO2 < 70% sebelum mendapatkan transfusi PRC cenderung menunjukkan perbaikan hemodinamik. Penelitian lebih lanjut mengenai ambang batas Hb atau ScvO2 untuk memutuskan pemberian transfusi PRC perlu dilakukan.

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Background. Transfusion of packed red cells (PRC) often found in critically ill children, with the possibility of side effects is not uncommon. Later reports recommended a lower hemoglobin (Hb) for transfusion threshold, nevertheless the characteristics and transfusion guidelines PRC critically ill children in Indonesia is yet unknown.

Methods. This study was conducted on patients admitted to the pediatric intensive care unit (PICU) Cipto Mangunkusumo Hospital (RSCM) and underwent PRC transfusion. Hemoglobin level, central venous saturation (ScvO2), oxygen extraction ratio (O2ER), oxygen delivery (DO2), cardiac index (CI), and inotropic index (INO) were measured/calculated before and after transfusion.

Results Of the 92 patients admitted to the PICU, 25 children (27.5%) were given PRC transfusion with a total of 38 episodes of transfusion during October to December 2015. Three episodes were excluded from the study that 35 episodes of PRC transfusion were included in the analysis. Most patients were boys (77.1%) aged 1 month to 1 year (45.7%), with a median of age 2.1 (range 0.2 to 16.2) yearold. Mean Hb pre- and post transfusion were 7.7 + 1.46 and 10.2 + 1.97 g/dL. The average ScvO2 and O2ER before transfusion were still in normal range, i.e. 73.8 + 6.46 % and 0.25 + 0.070, without significantly different levels after transfusion, i.e. 79.0 + 5.92% and 0.19 + 0.056. The mean differences of DO2, CI, and INO pre- and post transfusion were neither clinically nor statistically significant. Subgroup analysis that revealed clinically significant difference was children with pretransfusion ScvO2 <70%. This subgroup mean pretransfusion Hb was 7.2 + 1.69 g/dL, with pre/post transfusion ScvO2 values of 64.1 + 4.71% (p-value 0.181) and pre/post post transfusion O2ER 0.34 + 0.055 and 0.21 + 0.080 (p-value 0.152).

Conclusions. Study on PRC transfusion practice in PICU RSCM showed no significant hemodynamic changes. Subgroup analysis of critically ill children with ScvO2 <70% before PRC transfusion indicated hemodynamic improvement. Further research on optimal transfusion thresholds, e.g. hemoglobin level or ScvO2, for PRC transfusion decision-making need to be done."

"This volume aims to cover important aspects of the various facets of organ transplantation and regenerative medicine."

"Latar belakang: Transfusi komponen Packed Red Cell (PRC) dengan metode pengurangan sel darah putih (PRC leukodepleted) mulai banyak digunakan untuk terapi pasien karena mampu mengurangi kejadian pasca transfusi yang tidak diinginkan. Jumlah perokok aktif di Indonesia yang cukup tinggi sehingga berpotensi besar menjadi pendonor darah karena belum ada regulasi yang mengaturnya. PRC leukodepleted pada perokok aktif beresiko besar mengalami kerusakan membran sel darah merah dan hemolisis akibat stres oksidatif yang terjadi karena akumulasi radikal bebas pada perokok aktif. Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh stres oksidatif terhadap ketahanan membran PRC leukodepleted donor perokok aktif selama penyimpanan. Metode: PRC leukodepleted diproduksi dari pendonor yang dikelompokkan menjadi kelompok pendonor non perokok (NP), pendonor perokok ringan (PR) dan pendonor perokok sedang (PS). Sampel penelitian dibagi menjadi 6 aliquot untuk diperiksa kadar malondialdehid (MDA), aktivitas enzim superoksida dismutase (SOD), uji fragilitas osmotik (osmotic fragility test, OFT) dan hemolisis pada hari ke 0, 7, 14, 21, 28 dan 35. Hasil: Berdasarkan uji Kruskal Wallis ketiga kelompok menunjukkan perbedaan bermakna antara H0, H7, H14, H21, H28 dan H35 pada parameter MDA, SOD, OFT dan hemolisis yaitu dengan p<0,05. Dalam larutan NaCl 0,54 % pada uji OFT, terjadi hemolisis kelompok NP sebesar 17,53+12,16% pada H35; kelompok PR sebesar 34,10+7,92% pada H28; dan kelompok PS sebesar 30,92+5,98% pada H0. Kesimpulan: Penyimpanan PRC leukodepleted selama 35 hari meningkatkan stres oksidatif. Stres oksidatif paling tinggi terjadi pada kelompok perokok sedang. Terdapat korelasi antara stres oksidatif dengan ketahanan membran sel darah merah.

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Background: Packed Red Cell (PRC) transfusion without the leukocyte (leukodepleted PRC) method has begun to be widely used for patient therapy because it can reduce unexpected post-transfusion effects. The number of active smokers in Indonesia is quite high so they have a great opportunity to become blood donors, since there is no regulation yet. Leukodepleted PRC in active smokers are at great risk for red blood cell membran damage and hemolysis due to oxidative stress that occurs caused by accumulation of free radicals in active smokers. Objective: This study aim to determine the effect of oxidative stress on red blood cells membrane resistance of leukodepleted PRC in active smokers donors during storage. Methods: Leukodepleted PRC was produced from donors who were grouped into non-smoker donors (NP), light smoker donors (PR) and moderate smoking donors (PS). The research sample was divided into 6 aliquots to be examined for the malondialdehyde (MDA) level, activity of superoxide dismutase (SOD) enzyme, osmotic fragility test (OFT) and hemolysis on 0, 7, 14, 21, 28 and 35 days of storage. Results: The three groups showed significant differences between D0, D7, D14, D21, D28 and D35 on the parameters of MDA, SOD, OFT and hemolysis (p<0.05, Kruskal-Wallis test). In 0.54% NaCl solution of OFT test, NP group hemolysis was 17.53+12.16% on D35; PR group was 34.10+7.92% on D28; and the PS group was 30.92+5.98% on D0. Conclusion: Storage for 35 days increased the oxidative stress of leukodepleted PRC. The highest oxidative stress occurred in the moderate smoker (PS) group. Oxidative stress has correlation with red blood cell membrane resistance."

"Advances in stem cell research discusses recent advances in stem cell science, including therapeutic applications. This volume covers such topics as biomanufacturing iPS cells for therapeutic applications, techniques for controlling stem cell fate decisions, as well as current basic research in such areas as germ line stem cells, genomics and proteomics in stem cell research. "

"ABSTRACTPenelitian ini menganalisis kemampuan Human Serum Albumin (HSA), Umbilical cord blood (UCB) serum dan Fetal Bovine Serum (FBS) dalam menjaga stabilitas ekspansi ex vivo kultur sel punca hematopoetik (SPH). Sel yang digunakan adalah sel mononuklear dan sel CD34+ dari darah tali pusat yang disimpan beku dalam lingkungan nitrogen. Medium basal kultur yang digunakan adalah RPMI 1640 Biowest dan Stemspan. Jumlah sel hidup dihitung menggunakan metode eksklusi tryphan blue dan fenotipe sel CD34+ dianalisis menggunakan flow cytometry. Pewarnaan Giemsa dilakukan pada sel-sel yang dipanen pada hari ketujuh kultur untuk menganalisis morfologi sel. Besar sampel dalam penelitian ini adalah tiga dan jumlah pengulangan adalah dua kali. Penelitian ini menunjukkan bahwa kultur dengan suplementasi HSA menghasilkan jumlah sel yang lebih rendah namun memiliki persentase CD34+ yang lebih tinggi dibandingkan UCB serum dan FBS. Pewarnaan Giemsa menunjukkan sel-sel darah yang terdiferensiasi paling sedikit ditemukan pada HSA. Hasil tersebut menunjukkan bahwa, medium dengan suplementasi HSA lebih unggul dari UCB serum dan FBS dalam mempertahankan kepuncaan sel punca hematopoetik.

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ABSTRACTThis study analyzed the ability of serum Human Serum Albumin (HSA), Umbilical cord blood (UCB) and Fetal Bovine Serum (FBS) to maintain the stability of ex vivo expansion of hematopoietic stem cell (SPH) cultures. The cells used are mononuclear cells and CD34 + cells from cord blood which are frozen in a nitrogen environment. The basal culture medium used was RPMI 1640 Biowest and Stemspan. The number of living cells was calculated using the tryphan blue exclusion method and the CD34 + cell phenotype was analyzed using flow cytometry. Giemsa staining was carried out on cells harvested on the seventh day of culture to analyze cell morphology. The sample size in this study was three and the number of repetitions was twice. This study shows that culture with HSA supplementation results in lower cell counts but has a higher CD34 + percentage compared to serum UCB and FBS. Giemsa staining shows the least differentiated blood cells are found in HSA. These results indicate that, medium with HSA supplementation is superior to serum UCB and FBS in maintaining hematopoietic stem cell stem cells."

"Latar belakang: Transplantasi ginjal dapat memperbaiki fungsi endotel. Berbagai penelitian membuktikan bahwa peningkatan kadar eritropoietin (Epo) dapat mengaktifasi dan memobilisasi Endothelial Progenitor Cell (EPC) sehingga mampu memperbaiki fungsi endotel melalui proses angiogenesis dan neovaskularisasi. Membaiknya fungsi endotel akan menurunkan angka kesakitan dan kematian akibat penyakit kardiovaskular pada penderita PGK. Tujuan: Untuk mengetahui hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel pada penderita gagal ginjal 3 bulan setelah transplantasi ginjal. Metode Penelitian: Potong lintang sebelum dengan 3 bulan setelah transplantasi ginjal pada penderita gagal ginjal yang menjalani transplantasi ginjal di RSCM. Jumlah subyek 21 orang yang dikumpulkan dalam kurun waktu Juli 2013 - Februari 2014. Pengambilan sampel darah untuk memeriksa kadar Epo, jumlah EPC CD34+ dan CD133+ dan kadar asimetrik dimetilarginin (ADMA) dilakukan sebelum dan 3 bulan setelah transplantasi ginjal. Analisis statistik dengan uji korelasi Pearson atau Spearman. Hasil: Penelitian ini menunjukkan adanya peningkatan kadar Epo tetapi tidak bermakna secara statistik (p>0.05), sedangkan jumlah EPC CD34+ dan CD133+ meningkat (p<0.05), serta kadar ADMA menurun yang bermakna secara statistik (p<0.05). Tiga bulan setelah transplantasi ada korelasi bermakna antara peningkatan kadar Epo dengan jumlah EPC CD34+ (r = 0.466 ; p < 0.05). Tidak ada hubungan peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel 3 bulan setelah transplantasi ginjal. Kesimpulan: Tiga bulan setelah transplantasi ginjal didapatkan adanya peningkatan kadar Epo, jumlah EPC CD34+ dan CD133+ serta penurunan kadar ADMA. Tetapi tidak ada korelasi peningkatan kadar Epo dan jumlah EPC CD34+ serta CD133+ dengan perbaikan fungsi endotel dalam rentang 3 bulan setelah transplantasi ginjal.

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Background: Kidney transplantation improved endothelial function. Various studies have shown that elevated level of erythropoietin (Epo) could activate and mobilize Endothelial Progenitor Cell (EPC), thus would improve endothelial function through the process of angiogenesis and neovascularization. The improvement of endothelial function will decrease morbidity and mortality from cardiovascular disease in patients with CKD.

Aim: To determine association between elevated level of Epo and the numbers of EPC CD34+ - CD133+ with the improvement of endothelial function in patients three months after kidney transplantation.

Methods: cross sectional study prior and 3 months after kidney transplantation in patients with renal failure who underwent kidney transplantation in RSCM. The study included 21 subjects who enrolled from July 2013 to February 2014. Blood samples prior and 3 months after kidney transplantation were collected to evaluate the level of Epo, numbers of EPC CD34+ and CD133+ and level of assymetric dimethylarginine (ADMA). Statistical analysis was performed using Pearson or Spearman correlation test.

Resulys: The results of the study showed that prior to kidney transplantation, level of Epo was increased but not statistically significant (p>0.05). The EPC numbers of CD34+ and CD133+ were significantly increased (p<0.05), whereas the ADMA level was significantly decreased (p<0.05). Three months after transplantation showed a significant association between elevated level of Epo and the numbers of EPC CD34+ (r = 0.466, p > 0.05). There was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function three months after kidney transplantation.

Conclusion: Three months after kidney transplantation showed an elevated level of Epo, the numbers of EPC CD34+ and CD133+ and the decreased level of ADMA. However, there was no association between the elevated level of Epo and the numbers of EPC CD34+ and CD133+ with the improvement of endothelial function in patients 3 months after kidney transplantation."