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Abstrak :
Latar Belakang: Celah langit-langit merupakan salah satu kelainan bawaan yang banyak terjadi. Alpha-smooth muscle actin (ASMA) adalah actin isoform yang dominan di dalam sel-sel otot halus dan berperan penting dalam proses fibrogenesis. Diferensiasi fibroblast menjadi myofibroblast merupakan proses kunci dalam penyembuhan luka dan repair jaringan, namun berbahaya untuk fungsi jaringan apabila berlebihan seperti hypertrophic scars (jaringan parut). Dalam kesembuhan luka Angiogenesis sangat penting untuk penyediaan oksigen dan nutrisi ke sel jaringan yang terluka dan membaginya sel tumor yang memiliki kebutuhan metabolik tinggi, angiogenesis dirangsang oleh vascular endothelial growth factor (VEGF). Faktor aktivitas ASMA dan VEGF yang mempengaruhi pembentukan jaringan parut pasca tindakan yang dapat menyebabkan gangguan perkembangan maksila. Tujuan: Dapat Mengetahui ekpresi ASMA dan VEGF pada pasien celah langit langit inkomplit, unilateral  dan bilateral non sindromik. Metode: Pada penelitian ini dilakukan studi deksripstif laboratorik Ekpresi ASMA dan VEGF dengan pemeriksaan imunohistokimia ASMA dan VEGF terhadap jaringan mukosa pasien langit – langit inkomplit, unilateral dan bilateral serta dilakukan pemeriksaan foto klinis pada minggu pertama, ketiga dan keempat dimana pengambilan jaringan dilakukan unit Celah Bibir dan Langit-Langit RSAB Harapan. Hasil: Dilakukan pengambilan jaringan pasien 4 pasien celah langit – langit non sindromik. Satu pasien celah langit – langit bilateral non sindromik, satu pasein celah langit – langit inkomplit non sindromik dan dua pasien celah langit – langit unilateral non sindromik. Hasil pemeriksaan imunohistokimia pada pasien  celah langit – langit bilateral non sindromik lebih tinggi dibandingkan dengan pasien celah langit – langit unilateral dan inkomplit. Pada pemeriksaan foto klinis didapatkan kesembuhan luka pada keempat pasien tercapai dalam waktu empat minggu. Kesimpulan: Terdapat perbedaan ekspresi gen ASMA dan VEGF di jarigan mukosa palatum pada kasus pasien celah langit – langit inkompilt, unilateral dan bilateral non sindromik yang berpengaruh terhadap kecepatan kesembuhan luka pasca operasi palatoplasti primer. Peningkatan ekspresi asma akan menyebabkan peningkatan luasan terjadi gagalan fusi antara prosessus palatinus. ......Background: Cleft palate is one of the many congenital abnormalities that occur. Alpha-smooth muscle actin (ASMA) is the dominant actin of isoform in the smooth muscle cells and plays an important role in the process of fibrogenesis. Differentiation of fibroblasts into myofibroblasts is a key process in wound healing and tissue repair, but is harmful to tissue function when overuse such as hypertrophic scars. In wound healing Angiogenesis is essential for the supply of oxygen and nutrients to injured tissue cells and dividing tumor cells that have high metabolic requirements, angiogenesis stimulated by vascular endothelial growth factor (VEGF). ASMA and VEGF activity factors that influence the formation of post-action scarring which may cause impairment of maxillary development. Objectives: Can be known for ASMA and VEGF expression in incomplete, unilateral and non-syndromic bilateral cleft palate patients. Methods: In this study a laboratory deksripstif study of ASMA and VEGF expression was performed with ASMA and VEGF immunohistochemistry examination of mucosal tissue of incomplete, unilateral and bilateral cleft palate patients as well as clinical photo examination in the first, third and fourth week where tissue taking was performed at Celah Bibir dan Langit-Langit RSAB Harapan kita. Results: Conducted tissue retrieval patients 4 patients cleft palate non-syndrome. One patient had a non syndromic bilateral cleft palate, one patient non syndromic incomplete cleft palate and two non syndromic unilateral cleft palate patients. Immunohistochemical examination results in non-syndromic bilateral cleft palate  higher than with unilateral and incomplete cleft palate patients. At the clinical photo examination, the wound healing in all four patients was achieved within four weeks. Conclussion: There is a difference in ASMA and VEGF gene expression in the palatum mucosa in the case of incomplete, unilateral and bilateral non syndromic cleft patients affecting the rate of wound healing following primary palatoplasty surgery. Increased expression of asthma will cause an increase in the extent of fusion failure between the palatinus process.

Abstrak :
Latar Belakang: Kanker nasofaring (KNF) endemik di Indonesia dan kebanyakan datang dengan stadium lokal lanjut. Angka rekurensi KNF stadium lokal lanjut hingga kini masih cukup tinggi. Berbagai variabel terkait klinis dan patologis yang ada saat ini belum sepenuhnya mampu menstratifikasi pasien yang akan mendapatkan manfaat jika diberikan kemoterapi ajuvan terutama pada pasien yang tercapai objective respons rateberupa remisi lengkap dan parsial.Perkembangan mekanisme petanda molekuler yang terlibat pada jalur onkogenesis KNF berkembang pesat hingga saat ini, di antaranya Vascular Endothelial Growth Factor(VEGF) dan osteopontin (OPN). Beberapa studi sebelumnya menunjukkan VEGF dan OPN berkorelasi dengan progresifitas dan luaran klinis tumor padat, termasuk KNF. Tujuan: Mengetahui progression-free survival (PFS)3 tahun pasien KNF stadium lokal lanjut pasca kemoradiasi berbasis platinum serta hubungannya dengan ekspresi VEGF dan OPN. Metode: Penelitian ini menggunakan disain kohort retrospektif dengan subyek merupakan pasien KNF stadium lokal lanjut yang berobat di RSCM pada periode 2015-2017. Penelusuran data klinis dilakukan bersamaan dengan pewarnaan imunohistokimia VEGF dan OPN masing-masing menggunakan antibodi monoklonal Santa Cruz® sc-7267 dan Akm2A1. Intensitas pewarnaan dihitung dengan histoscore menggunakan piranti imageJ. Penilaian PFS dilakukan dengan analisis kesintasan Kaplan Meier. Analisis hubungan VEGF dan OPN terhadap PFS 3 tahun menggunakan kurva Kaplan Meier dan uji dengan log rankdengan batas kemaknaan p<0,05. Hasil:Angka PFS 3 tahun pada subyek sebesar 39% dengan median 23 bulan. Ekspresi VEGF dideteksi pada 113 (72,9%) subyek, dan ekspresi OPN positif pada 99 (63,8%) subyek. Kurva Kaplan-Meier menunjukkan PFS 3 tahun untuk VEGF (+) dan (-) berturut-turut yaitu 40% (SE 5%) dan 36% (SE 8%), log rank p=0,584. PFS untuk OPN (+) dan (-) berturut-turut yaitu 41% (SE 6%) dan 35% (SE 7%), log rank p=0,747.Analisis subgrup pasien dengan stadium IVB dan ukuran tumor N3, ekspresi VEGF dan OPN yang positif berhubungan dengan PFS 3 tahun yang lebih baik dibandingkan ekspresi negatif. Untuk subgrup pasien yang mendapatkan kemoterapi neoajuvan, ekspresi VEGF yang positif memberikan PFS 3 tahun yang lebih baik dibandingkan ekpresi negatif. Simpulan: Penelitian ini menunjukkan PFS 3 tahun KNS stadium lokal lanjut yang maih cukup rendah, dan tidak terdapat hubungan antara ekspresi VEGF dan OPN dengan PFS 3 tahun. ......Background: Nasopharyngeal carcinoma (NPC) is endemic in Indonesia and most patients were admitted to hospital when they already in locally advanced stage.The recurrence rate of locally advanced NPC is still quite high. Various clinical and pathological variables that exist today are not fully capable of stratifying patients who will benefit if adjuvant chemotherapy is given, especially in patients whom are complete and partial remission.To date,the development of molecular marker mechanismsinvolved in the oncogenesis pathway of NPC has grown rapidly, including Vascular Endothelial Growth Factor (VEGF) and Osteopontin (OPN). Previous studies have shown VEGF and OPN to be correlated with the progression and clinical outcome of solid tumors, including nasopharyngeal cancer. Objective: This study aimed to determine 3-years progression-free survival (PFS) of locally advanced nasopharyngeal carcinoma after platinum-based concurrent chemoradiation and its association with VEGF and OPN. Methods: A retrospective cohort study was conducted in subjects of NPC patients at Cipto Mangunkusumo Hospital from 2015 until 2017. Clinical data was collected from hospital registries, and immunohistochemistry staining of VEGF and OPN was perfomed by using monoclonal antibodySanta Cruz® sc-7267 and Akm2A1, respectively.We calculated H-score according to Allred criteria with computer software imageJ. We determined PFS byKaplan Meier survival analysis. Association of VEGF and OPN with 3 years-PFS was analyzed using Kaplan Meier with log-rank test p<0.05. Results: The 3-years PFS rate in subjects was 39% with a median of 23 months. VEGF expression was detected in 113 (72.9%) samples, and positive OPN expression in 99 (63.8%) samples. The Kaplan-Meier curve shown the 3-years PFS for VEGF (+) and (-) were 40% (SE 5%) and 36% (SE 8%), respectively with log rank p=0.584. While 3-years PFS for OPN (+) and (-) were 41% (SE 6%) and 35% (SE 7%), respectively with log rank p=0.747. Subgroup analysis of patients with stage IVB and tumor size N3 showed that positive VEGF and OPN expression were associated with better3-years PFS than negative expression. For the subgroup of patients receiving neoadjuvant chemotherapy, positive VEGF expression showed better 3-years PFS than negative expression. Conclusions: This study showed that the 3-years PFS of locally advanced NPC was quite low, and there was no relationship between VEGF and OPN expression with 3-years PFS.

Abstrak :
Kanker kolorektal merupakan kanker penyebab kematian kedua tertinggi di dunia. Pengobatan kanker kolorektal memiliki kelemahan dari segi biaya, toksisitas, dan efektivitas. Lunasin mampu menghambat kanker secara in vitro sehingga lunasin dapat menjadi solusi terapi yang efektif biaya untuk kanker kolorektal. Penelitian ini menyelidiki pengaruh ekstrak kedelai kaya lunasin (EKKL) pada ekspresi vascular endothelial growth factor (VEGF) yang berperan dalam proses angiogenesis pada kanker kolorektal. Tiga puluh mencit Swiss Webster dibagi menjadi enam kelompok. Semua kelompok kecuali kelompok normal diinduksi dengan azoxymethane (AOM) dan dextran sodium sulfate (DSS). Kelompok kontrol negatif diberikan larutan garam fisiologis, sedangkan kelompok kontrol positif diberi aspirin. EKKL diberikan kepada ketiga kelompok percobaan dengan dosis yang berbeda (250 mg/KgBB, 300 mg/KgBB, dan 350 mg/KgBB). Pada minggu kelima, setelah mencit diterminasi, jaringan kolon distal mencit diambil dan diwarnai imunohistokimia, kemudian diamati di bawah mikroskop dan dianalisis menggunakan IHC profiler pada ImageJ. Indeks yang diperoleh dari IHC profiler dihitung untuk mendapatkan indeks H-score. Ekspresi VEGF menurun secara signifikan pada kelompok EKKL dosis 300 mg/KgBB (p=0,031) dengan penurunan rata-rata skor 33,202% dan 350 mg/KgBB (p=0,003) dengan penurunan rata-rata skor 43,334%. Namun, tidak ditemukan adanya perbedaan yang signifikan secara statistik antara kedua kelompok tersebut. ......Colorectal cancer is the world’s second highest cause of cancer death. Current treatments for colorectal cancer lack in cost, toxicity, and effectivity. Lunasin has the effect of inhibiting cancer in vitro, hence lunasin might offer the solution of cost-effective therapy for colorectal cancer. We investigate the effect of lunasin-rich soybean extract (LSRE) on vascular endothelial growth factor (VEGF) expression which is responsible for angiogenesis in colorectal cancer. Thirty Swiss Webster mice were divided into six groups. All groups except the normal group were induced by azoxymethane (AOM) and dextran sodium sulfate (DSS). Negative control group received normal saline solution, whereas positive control group were treated with aspirin. LSRE were given to three experimental groups, each with different dosing (250 mg/KgBW, 300 mg/KgBW, and 350 mg/KgBW). On the fifth week, after the mice were terminated, the distal colon tissues were obtained and received immunohistochemistry staining, then observed under a microscope and analyzed using IHC profiler in ImageJ. Index acquired from IHC profiler were calculated to achieve H-score. VEGF expression was significantly decreased in 300 mg/KgBW (p=0.031) and 350 mg/KgBW (p=0.003) of EKKL by an average reduction of 33.202% and 43.334% respectively. However, there was no statistically significant difference between both groups.

Abstrak :
Tujuan: Membandingkan kadar vascular endothelial growth factor VEGF dan placental growth factor PlGF plasma dan vitreus pada tikus diabetes dengan kontrol gula darah GD buruk, dengan perbaikan kontrol gula darah, dan tikus nondiabetes, dan melihat pengaruh perbaikan kontrol gula darah terhadap kadar VEGF dan PlGF. Metode: Penelitian ini merupakan uji eksperimental pada hewan coba tikus strain Sprague Dawley. Sebanyak 18 ekor tikus disertakan dalam penelitian dan secara acak dibagi ke dalam kelompok perlakuan n=14 dan kontrol n=4 . Kelompok perlakuan diberikan injeksi Streptozotocin untuk menginduksi diabetes. Tikus dengan kadar GD 72 jam pasca induksi lebih dari 300 mg/dL didiagnosis diabetes. Kadar GD diperiksa secara berkala pada seluruh subyek. Setelah 4 mingu, kelompok perlakuan dibagi ke dalam kelompok I untuk terminasi dan kelompok II untuk perbaikan kontrol GD dengan injeksi insulin selama 4 minggu berikutnya, begitu pula dengan kelompok kontrol. Saat terminasi, sampel plasma darah dan vitreus diambil untuk analisis kadar VEGF dan PlGF melalui pemeriksaan enzyme-linked immunosorbent assay ELISA. Hasil: Sebanyak 17 ekor tikus bertahan hidup hingga akhir penelitian dengan 1 ekor tikus mati dari kelompok perlakuan. Kadar GD kelompok perlakuan II menurun drastis dan mencapai normoglikemia. Pemeriksaan ELISA bulan pertama menunjukkan kadar VEGF vitreus kelompok perlakuan I cenderung lebih tinggi dibandingkan kontrol I, yakni 196,36 65,24 pg/dL dan 123,64 44,99 pg/dL p=0,20 . Pemeriksaan ELISA bulan kedua menunjukkan kadar PlGF vitreus kelompok perlakuan II lebih tinggi dibandingkan kontrol II, yakni 59,04 2,48 dan 51,93 3,15 p=0,01. Kadar VEGF vitreus dan plasma kelompok perlakuan I dan II tidak berbeda bermakna, sedangkan kadar PlGF vitreus dan plasma lebih tinggi pada bulan kedua. Kesimpulan: Kadar VEGF dan PlGF vitreus mengalami peningkatan pada kelompok tikus diabetes dibandingkan nondiabetes, dan perbaikan kontrol gula darah selama 1 bulan belum dapat menurunkan kadar VEGF dan PlGF.

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Aim: To compare plasma and vitreous level of vascular endothelial growth factor VEGF and placental growth factor PlGF in diabetic rats with poor blood glucose BG control, reconstitution of good BG control, and nondiabetic rats, and to investigate the effect of reconstitution of good BG control to VEGF and PlGF plasma and vitreous level. Methods: This is an experimental study using Sprague Dawley rats. Eighteen rats were divided into intervention group n 14 and control group n 4. Intervention group were given Streptozotocin STZ injection to induce diabetes. Rats with BG level more than 300 mg dL at 72 hours after injection were considered diabetes and successful models. BG levels were monitored periodically in all subjects. After 4 weeks, intervention group was randomly divided into group I for termination and group II for reconstitution of good BG control with insulin for following 4 weeks, and so was the control group. Plasma and vitreous samples were taken. VEGF and PlGF levels were detected with enzyme linked immunosorbent assay ELISA. Results: Seventeen rats survived and one rat died in intervention group. BG level of intervention group II decreased dramatically to normoglycemia. ELISA at month 1 showed that VEGF vitreous level tend to be higher in intervention group I compared to control I, 196.36 65.24 pg dL and 123.64 44.99, respectively p 0.20. ELISA at month 2 showed that PlGF vitreous level of intervention group I were significantly higher compared to control I, 59.04 2.48 and 51.93 3.15, respectively p 0.01. Vitreous and plasma VEGF of intervention group I and II were not different, while vitreous and plasma PlGF were significantly higher in group II. Conclusions: Vitreous levels of VEGF and PlGF were increased in diabetic rats compared to nondiabetic, and reconstitution of good BG control for 1 month were unable to reduce VEGF and PlGF levels.

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ABSTRAK
Latar 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. ...... 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.

Abstrak :
Latar Belakang: Saat ini, injeksi intravitreal anti-VEGF merupakan tatalaksana medikamentosa lini pertama pada DME. Namun monoterapi bevacizumab dinilai kurang efektif dalam mengobati DME derajat sedang-berat, sehingga meningkatkan jumlah re-injeksi. Selain VEGF, mediator inflamasi juga berperan penting dalam pathogenesis DME. Sehingga diperlukan terapi adjuvant pada kasus dengan respon suboptimal. Tujuan: Mengetahui perbedaan perubahan sensitivitas retina, ketebalan makula sentral (CMT) dan BCVA sesudah dilakukan injeksi intravitreal Bevacizumab dengan kombinasi Triamsinolon Asetonid (TA)  dibandingkan dengan monoterapi Bevacizumab pada pasien dengan edema makula diabetik derajat sedang-berat. Metodologi: Pada studi eksperimental lengan ganda dengan randomisasi blok ini didapatkan sejumlah 28 subjek dengan CMT > 400 mm dibagi menjadi dua kelompok. Subjek pada kelompok intervensi diberikan injeksi kombinasi Bevacizumab 1,25 mg dan TA 2 mg intravitreal, sedangkan subjek kelompok kontrol hanya diberikan injeksi Bevacizumab 1,25 mg. Evaluasi BCVA dan CMT dilakukan pada 1 minggu dan 1 bulan pasca injeksi, evaluasi sensitivitas retina pada 1 bulan pasca injeks, serta peningkatan TIO dan efek samping. Hasil: Pasca 1 bulan injeksi didapatkan penurunan CMT yang lebih besar yang bermakna pada kelompok intervensi (-269,1 (170-413) mm vs -133,6 (50-218) mm, p< 0,001), begitu juga dengan peningkatan sensitivitas retina yang lebih baik pada kelompok intervensi (2,4 (0,02-7,1) dB vs 1,3 (0,16-3,5) dB, p = 0,035). Tidak didapatkan perbedaan bermakna pada luaran BCVA logMAR antar kedua kelompok (0.2 (0-0.5) vs 0.15 (0-0.5)). Kesimpulan: Terapi kombinasi bevacizumab dan TA ini terbukti efektif dan cost-effective sebagai dalam menurunkan edema makula segera dan memperbaiki sensitivitas retina pada pasien DME derajat sedang-berat dan DME persisten. ......Backgrounds: Intravitreal bevacizumab (IVB) monotherapy is less effective in treating moderate-to-severe diabetic macular edema (DME), potentially increasing the number of injections and the risk of permanent vision loss. In addition to VEGF, inflammatory mediators also play an important role in the pathogenesis of DME. Therefore, there is a need for additional treatment options for DME cases with suboptimal response to anti-VEGF therapy. Objectives: To compare the efficacy and safety of the combination of IVB and triamcinolone acetonide (TA) with IVB monotherapy in treating moderate to severe DME. Methods: In this double-arm randomized controlled trial study, a total of 28 DME patients with central macular thickness (CMT) >400 mm were assigned into two groups according to the therapeutic method: 1,25 mg of  bevacizumab combined with 2 mg of  TA as the intervention group and 1,25 mg of IVB as the control group. BCVA and CMT were observed at 1 week and 1 month follow-up, retinal sensitivity was observed at 1 month follow-up, as well as increased IOP and other side effects. Results: CMT reduction after 1 month were higher in the intervention group with statistically significant different (-269,1 mm vs -133,6 mm, p< 0,001) as well as retinal sensitivity improvement also better in the intervention group (2,4 dB vs 1,3 dB, p = 0,035). But there was no statistically different in BCVA changes after 1 month follow-up (0,2 vs 0,15, p= 0,874) between the groups, even though 35,7% of the intervention group has gained more than 10 BCVA letters. No significant increase in IOP were observed at the end of the follow-up. Conclusions: It is effective and cost-effective to treat moderate-to-severe or persistent DME by utilizing TA as an adjunct to anti-VEGF.

Abstrak :
Latar Belakang: Ulkus diabetik merupakan komplikasi diabetes melitus yang menjadi salah satu masalah utama di bidang kesehatan. Di Indonesia, angka mortalitas ulkus diabetik mencapai 17-30%, dengan laju amputasi sekitar 15-30%. Pemberian terapi oksigen hiperbarik (TOHB) dapat meningkatkan oksigenasi endotel dan merangsang produksi vascular endothelial growth factor (VEGF) yang merupakan faktor pertumbuhan paling spesifik dan poten untuk proses angiogenesis sehingga dapat mempercepat proses penyembuhan luka. Tujuan: Penelitian ini bertujuan untuk mengetahui apakah TOHB berpengaruh terhadap peningkatan kadar VEGF pasien ulkus diabetik. Metode: Dilakukan penelitian uji ktinis eksperimental dari bulan Februari 2006 sampai April 2006 terhadap 12 pasien ulkus diabetik yang mendapat TOHB 3 X 30 menit per hari selama 5 hari (kelompok TOHB) dan 10 pasien ulkus diabetik yang tidak mendapat TOHB (kelompok non-TOHB, kelompok kontrol). Kadar VEGF pada kedua kelompok diukur pada hari pertama dan hari kelima. Hasil: Pada kelompok TOHB kadar VEGF hari pertama menunjukkan nilai rerata 1241,325 + 237,6533 pg/ml dan setelah 5 hari nilat rerata menjadi 1244,458 + 264,5641 pg/ml, (p = 0,583). Sedangkan pada kelompok non-TOHB kadar VEGF hari pertama menunjukkan nilai rerata 1262,350 + 227,9603 pg/ml kemudian pada hari ke-5 nilai rerata menjadi 1112,460 + 220,3795 pg/ml, (p = 0,093). Tidak didapatkan perbedaan yang bermakna nilai rerata kadar VEGF antara kelompok TOHB dan kelompok nonTOHB pada hari pertama (p= 1) maupun hari kelima (p = 0,872). Kesimpulan: Terapi oksigen hiperbarik selama 5 hari tidak meningkatkan kadar VEGF pada pasien ulkus diabetik. ......Background: Diabetic ulcer is a complication of diabetes mellitus which one of the main health problem. In Indonesia the mortality rate of diabetic ulcer is about 17-30%, while the amputation rate is about 15-30%. Hyperbaric oxygen therapy (TOHB) increase endothelial oxygenation and stimulates vascular endothelial growth factor (VEGF) as the most specific and potent growth factor for angiogenesis and increases wound heating process. Aim of the study: The aim of the study is to know if TOHB can increase the level of VEGF in diabetic ulcer patients. Methods: Clinical experimental study was conducted from February 2006 until April 2006 of 12 diabetic ulcer patients who received TOHB 30 minutes, 3 times a day for 5 days (TOHB group) and 10 diabetic ulcer patients as a control group who did not receive TOHB (non-TOHB group). The VEGF level in both groups was measured on days 1 and 5. Results: In TOHB group the mean level of VEGF on day 1 was 1241.325 + 237.6533 pg/ml and became 1244.458 + 264.5641 pg/ml (p = 0.583) on day 5, while in non-TOHB group the mean level of VEGF on day | was 1262.350 + 227.9603 pg/ml and became 1112.460 + 220.3795 pg/ml (p = 0.093) on day 5. There were no significant differentiation of VEGF level between TOHB group and non-TOHB, group both on day 1 (p = 1) and day 5 (p = 0.872). Conclusion: Hyperbaric oxygen therapy for 5 days did not increase the VEGF level of diabetic ulcer patients.

Abstrak :
Untuk hemodialisis pasien Penyakit Ginjal Tahap Akhir (PGTA) akses vaskular terpilih adalah pembuatan fistula arteriovenosa (FAV) native, namun FAV memiliki angka kegagalan maturitas yang relatif tinggi. Primary balloon angioplasty (PBA) merupakan salah satu teknik dilatasi untuk membantu maturitas FAV. Teknik konstruksi FAV yang traumatik dan peregangan diameter lumen vena dengan balon dapat menyebabkan cedera fokal pada endotelium vena dan memberikan respons hiperplasia intima serta memengaruhi kadar NO, VEGF dan EMP yang dapat berdampak negatif pada maturitas FAV. Penelitian ini bertujuan untuk mengetahui efek PBA terhadap hiperplasia intima, kadar NO, VEGF, EMP serta maturitas FAV pada pasien dengan PGTA. Desain penelitian adalah uji klinis tersamar acak tunggal di RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok pada bulan Desember 2019 sampai Februari 2022; dengan subjek penelitian 112 pasien. Setelah randomisasi sampel terstratifikasi, 48 pasien menjalani konstruksi FAV dengan PBA (intervensi) dan 64 pasien menjalani konstruksi FAV tanpa PBA (kontrol). Pengukuran meliputi intimal medial thickness (IMT) jukstaanastomosis, VF dan PSV draining vein 1, 2 dan 6 minggu pascaoperasi; kadar NO, kadar VEGF, kadar EMP pascaoperasi dan 2 minggu pascaoperasi serta maturitas FAV yang dievaluasi 6 minggu pascaoperasi. Terkait pandemi COVID-19, 32 pasien lost to follow-up dan 5 pasien kontrol dieksklusi karena trombus pada FAV sehingga subjek yang dianalisis 36 pasien intervensi dan 39 pasien kontrol. Terdapat perbedaan bermakna antara grup kontrol dan intervensi pada maturitas, VF dan PSV draining vein 6 minggu pascaoperasi; kadar EMP 2 minggu pascaoperasi pada pasien PGTA yang menjalani operasi konstruksi FAV (Uji Mann Whitney U, p < 0,05). Tidak didapatkan perbedaan bermakna IMT jukstaanastomosis serta kadar NO dan VEGF antara kelompok kontrol dan intervensi (Uji Mann Whitney U, p > 0,05). Simpulan: PBA meningkatkan maturitas FAV pada pasien PGTA yang menjalani operasi konstruksi FAV yang ditandai dengan peningkatan VF dan PSV draining vein hingga 6 minggu pascaoperasi tanpa memengaruhi ketebalan intima pada daerah jukstaanastomosis, kadar NO dan kadar VEGF. Terdapat peningkatan kadar EMP 2 minggu pascaoperasi pada FAV dengan PBA. ......The preferred vascular access for hemodialysis for patients with end-stage renal disease (ESRD) is through the creation of a native arteriovenous fistula (AVF). The weakness of AVF is the relatively high maturation failure rate. Primary balloon angioplasty (PBA) is a dilation technique to assist AVF maturation. Traumatic AVF construction technique and diameter stretching of the vein lumen with balloons can cause focal injury to the venous endothelium which will eventually affect intimal hyperplasia and NO, VEGF and EMP levels which can negatively impact AVF maturation. This study aimed to determine the effect of PBA on intimal hyperplasia, levels of NO, VEGF, EMP and AVF maturation in patients with ESRD who underwent AVF construction surgery. This study used a single-blind randomized clinical trial design at RSUPN Cipto Mangunkusumo, RSUPN Fatmawati, RSUD Kabupaten Tangerang, dan RS Hermina Depok in December 2019 until February 2022 with 112 subjects. With stratified sample randomization method, 48 patients underwent AVF construction with PBA (intervention), 64 patients underwent AVF construction without PBA (control). Measurements included jukstaanastomosis intimal medial thickness (IMT), VF and peak systolic value (PSV) draining veins 1, 2 and 6 weeks postoperatively; NO, VEGF, EMP levels postoperative and 2 weeks postoperative; and AVF maturation evaluated 6 weeks postoperatively. Regarding the COVID-19 pandemic, 32 patients lost to follow-up and 5 control patients were excluded because of thrombus in the AVF so that analysis was carried out on 75 subjects (36 intervention patients and 39 control patients). There were significant differences between control and intervention groups in maturity, VF and PSV draining vein 6 weeks postoperatively; EMP levels 2 weeks postoperatively in ESRD patients undergoing AVF construction (Mann Whitney U, p < 0,05). There were no significant differences in jukstaanastomosis IMT; NO and VEGF levels between control and intervention groups (Mann Whitney U, p > 0.05). Conclusion: PBA increases the maturity of the arteriovenous fistula in ESRD patients undergoing AVF construction surgery which is characterized by an increase in VF and PSV draining veins up to 6 weeks postoperatively without affecting the IMT in jukstaanastomosis area, NO and VEGF levels. There was an increase in EMP levels 2 weeks postoperatively in AVF with PBA.

Abstrak :
Background: living kidney donation is a safe medical procedure. Kidney function after donation is crucial for donors’ health and quality of life. Kidney hyperfiltration is a compensatory mechanism, which will preserve kidney function after unilateral nephrectomy. The number of studies regarding hyperfiltration in living kidney donors is limited. Our study aimed to explain kidney hyperfiltration mechanism and evaluate its effect on the kidney function within 30 days after surgery. Methods: our study was a prospective cohort study with 46 living-kidney donors participating in the study between April and December 2019. We evaluated main outcomes, the 30-day post-surgery kidney function, which was evaluated by calculating estimated glomerular filtration rate (eGFR) and Urinary Albumin to Creatinine Ratio (ACR). The subjects were categorized into two groups based on their 30-day outcomes, which were the adaptive (eGFR > 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) and maladaptive (eGFR < 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) groups. A series of evaluation including calculating the renal arterial resistive index (RI) and measuring urinary vascular endothelial growth factor (VEGF), neutrophil gelatinase-associated lipocalin (NGAL), and heparan sulfate (HS) levels were performed before surgery and serially until 30 days after surgery. Multivariate analysis with adjustments for confounding factors was done. Results: forty donors were included and mostly were female (67.5%). The average age and body mass index (BMI) were 45.85 (SD 9.74) years old and 24.36 (SD 3.73) kg/m2 , respectively. Nineteen donors (47.5%) had maladaptive hyperfiltration outcomes. The hyperfiltration process was demonstrated by significant changes in renal arterial RI, urinary VEGF, NGAL, and HS levels (p<0.005). There was no significant difference regarding RI, urinary VEGF, NGAL, and HS levels between both groups. Several confounding factors (BMI over 25 kg/m2 , familial relationship, age over 40 years old, and arterial stiffness) were significantly influenced by kidney hyperfiltration and outcomes (p<0.05). Conclusion: the hyperfiltration process does not affect the 30-day post-nephrectomy kidney function of the donors. Several other factors may influence the hyperfiltration process and kidney function. Further study is necessary to evaluate kidney function and its other related variables with a longer period of time study duration.