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"The chief complain of chronic peripheral arterial occlusion disease is intermittent clodication, or calf pain during exercise that is relieved by resting. As the disease advances, pain occurs even during resting. The main cause for this disease is atherosclerosis.Clinical evaluation of patients comprise of questionnaire, exploration of atherosclerosis risk factors such as smoking, hyperlipidemia, diabetes mellitus, hypertension, etc. Pulse examination, ankle-brachial pressure index (ABPl) measurements and leg segmenta! blood pressure assessments are integral examinations in such patients. Another important test is functional assessments using the treadmill, or other tests to cause hyperemia.The chief management is to prevent common morbidity and mortality due to atherosclersosis such as coronary heart disease and its complications, as well as cerebrovascular disease and its complications. Management is also targeted towards preventing the progress of peripheral arterial occlusion disease.Specific management for peripheral arterial occlusion disease that is clearly beneficial to improve symptoms is physical exercise. Drugs such as pentoxyphylline, naftidrofuryl, buflomedil, and cilostazol are of little benefit only. Aspirin is useful to prevent cardiovascular, but is useless to improve symptoms.Prior to offering interventional procedures (angiopfasty and for stent insertion) or surgery, the following issues should be contemplated: I) the patient does not respond to physical exercise and risk factor modification, b) there is severe disability, c) there is no longer other disease that limits activity, and d) the morphology of the lesion is in line with the intervention, with a low risk and high probability for initial and long-term success"

"ABSTRACTAtherosclerosis is a chronic inflammatory disorder involving innate and adaptive immunity process. Effector T cell (Teff) responses promote atherosclerotic disease, whereas regulatory T cells (Tregs) have been shown to play a protective role against atherosclerosis by down-regulating inflammatory responses which include multiple mechanisms. Compelling experimental data suggest that shifting the Treg/Teff balance toward Tregs may be a possible therapeutic approach for atherosclerotic disease, although the role of Tregs in human atherosclerotic disease has not been fully elucidated. In this review, we discuss recent advances in our understanding of the roles of Tregs and Teffs in experimental atherosclerosis, as well as human coronary artery disease."

"Aterosklerosis sebagai penyebab terjadinya PJK merupakan proses multifaktorial karena banyak sekali faktor-faktor yang menyebabkannya dengan mekanisme yang saling terkait. Saat ini proses aterosklerosis dianggap sebagai proses inflamasi. Inflamasi terbukti berperan penting pada inisiasi, progresi maupun destabilisasi plak aterosklerosis. High sensitivity C-reactive protein (hs-CRP) merupakan salah satu petanda inflamasi yang penting pada penyakit jantung koroner (PJK) yang berhubungan dengan tingkat keparahan aterosklerosis, iskemi miokardium dan nekrosis miokardium. Tujuan penelitian ini adalah untuk mengetahui dan membandingkan kadar hs-CRP pada pasien sindroma koroner akut (SKA), PJK kronik dan bukan PJK, serta untuk mengetahui apakah terdapat hubungan antara kadar hs-CRP dengan kadar enzim CKMB pada pasien infark miokard akut (IMA). Penelitian bersifat observasional deskriptif dan analitik dengan pendekatan potong lintang. Dilakukan pemeriksaan kadar hs-CRP dengan metode chemiluminescent pada 21 pasien SKA, 20 pasien PJK kronik dan 20 bukan PJK. Didapatkan kadar hs-CRP rerata pada pasien SKA, PJK kronik dan bukan PJK sebesar 8,40 (SD 5,53) mg/l, 2,81 (SD 2,09) mg/l dan 1,07 (SD 0,81) mg/l. Analisis statistik didapatkan perbedaan kadar hs-CRP yang bermakna antara pasien SKA, PJK kronik dan bukan PJK (p 0,000). Kadar hs-CRP mempunyai korelasi positif yang bermakna dengan kadar enzim CKMB pada pasien IMA (p 0,004). Sebagai kesimpulan, kadar hs-CRP pada pasien SKA secara bermakna lebih tinggi dibanding PJK kronik dan bukan PJK. Terdapat hubungan yang bermakna antara peningkatan kadar hs-CRP dengan peningkatan kadar enzim CKMB. (Med J Indones 2004; 13: 102-6)

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Coronary heart disease (CHD) due to atherosclerosis is a multifactorial process with multiple interdependent factors. At present time, atherosclerosis is considered to be an inflammatory process. It has been proven that inflammation plays a mayor role in the initiation, progression as well as the destabilitation of the atherosclerosis plaque. High sensitivity C-reactive protein (hs-CRP) is one of the most important inflammatory marker in CHD and directly related to the extent and severity of atherosclerosis, extent of myocardial ischemia and myocardial necrosis. The purpose of this study is to determine hs-CRP levels in patients with acute coronary syndrome (ACS), chronic CHD and non CHD. And, to determine the correlation between hs-CRP levels and CKMB enzyme level in patients with acute myocardial infarction (AMI). This is a descriptive observational analytic study with cross sectional design. hs-CRP levels were measured by using chemiluminescent method on 21 ACS patients, 20 chronic CHD patients and 20 non CHD patients. The mean hs-CRP level in ACS, chronic CHD and non CHD patients were respectively 8.40 (SD 5.53) mg/l, 2.81 (SD 2.09) mg/l and 1.07 (SD 0.81) mg/l. A statistically significant difference in hs-CRP level was found between ACS, chronic CHD and non CHD (p = 0.000 ). A positive correlation was found between hs-CRP level and CKMB enzyme level in AMI patients (p = 0.004). In conclusion hs-CRP level is consistently higher in patients with ACS compared to patients with chronic CHD and non CHD. A positive correlation was found between the increased level of hs-CRP and CKMB enzyme level. (Med J Indones 2004; 13: 102-6)"

"Salah satu penyakit degeneratif dengan morbiditas dan mortalitas yang tinggi pada lansia adalah penyakit jantung koroner. Bedah arteri pintas koroner merupakan intervensi bedah yang sering dilakukan untuk mengatasi arteri yang tersumbat. Radikal bebas yang terbentuk saat operasi dapat mempengaruhi hasil operasi dan berdampak terhadap lama rawat. Penelitian ini bertujuan untuk mengetahui perubahan parameter stres oksidatif dan penuaan seluler serta kaitannya dengan lama perawatan di ICU. Penelitian ini menggunakan 27 subjek lansia yang menjalani bedah arteri pintas koroner di RS. Pusat Jantung Nasional Harapan Kita. Dilakukan pengambilan sampel darah pra operasi, 24 jam pasca operasi dan 4 hari pasca operasi. Pemeriksaan kadar MDA dengan metode Will’s, TSOD dan TAOC dengan metode colorimetrik, IL-1β dan IL-18 dengan metode bead-based multiplexing, SA-β-Gal dengan metode Fluorometrik. Didapatkan perbedaan yang signifikan pada pengukuran MDA dan IL-18 pada pengambilan sampel 24 jam dan 4 hari pasca operasi dibandingkan dengan kadar MDA dan IL-18 pra operasi. Didapatkan korelasi negatif antara kadar TSOD pra operasi dengan lama rawat di ICU dengan r = -0,417 yang menunjukkan bahwa semakin tinggi kadar TSOD pra operasi akan semakin singkat lama perawatan di ICU.

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One of the degenerative diseases with high morbidity and mortality rates in the elderly is coronary heart disease. Coronary artery bypass surgery is a common surgical intervention to address blocked arteries. Free radicals formed during the surgery can affect the surgical outcomes and impact the length of hospital stay. This study aims to investigate changes in oxidative stress parameters and cellular aging, and their association with the length of ICU stay. The study involved 27 elderly subjects undergoing coronary artery bypass surgery at the National Cardiovascular Center Harapan Kita. Blood samples were taken pre-operatively, 24 hours postoperatively, and 4 days postoperatively. MDA levels were measured using Will's method, TSOD, and TAOC using colorimetric methods, IL-1β and IL-18 using bead-based multiplexing, and SA-β-Gal using fluorometric methods. Significant differences were found in MDA and IL-18 measurements at 24 hours and 4 days post-operatively compared to pre-operative levels. A negative correlation was found between pre-operative TSOD levels and the length of ICU stay, with r = -0.417, indicating that higher pre-operative TSOD levels are associated with a shorter ICU stay."

"ABSTRAKAglaonema simplex is an aquatic plant that has been widely used as ornamental plants. the genus contains polyhydroxy alkaloids that exhibit the glycosidase inhibitor activity. this paper reports a phytochemical screening of in vitro Aglaonema simplex plantlets and the potential compounds as alternatives of SR-B1 ligand that plays a role in reducing atherosclerosis. the phytochemical screening was conducted using Thin Layer Chromatography and Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy on methanol crude extracts of leaves, stems and roots. SR-B1 ligand activities were tested on HepG2 cell line stably transfected with SR-B1 promoter. The results showed that the extracts contained secondary metabolites belonging to the terpenoids, steroids, phenolics, alkaloids and glycosides. Luciferase assay suggested that the stem and root extracts increased the expression of SR-B1 at 1.61- and 1.72-fold higher than the control, respectively. thus, Aglaonema simplex is one of the potential sources of the phytochemicals for the treatment of atherosclerosis. the tissue culture technology may be applicable for sustainable production of the identified compounds from the plant."

"ABSTRAKAterosklerosis merupakan proses terjadinya penyempitan dan pengerasan pembuluh darah yang disebabkan oleh penimbunan lemak, terutama dalam pembuluh darah arteri. Pada tahun 2016, tercatat bahwa 35% kematian di Indonesia disebabkan oleh penyakit yang terjadi karena aterosklerosis. Beberapa alternatif penyembuhan aterosklerosis adalah dengan mengkonsumsi obat antiaterosklerosis. Namun, obat anti-aterosklerosis yang telah beredar di masyrakat luas saat ini memiliki efek samping yang cukup mengganggu saat dikonsumsi. Kombinasi herbal yang terdiri dari daun tanjung, daun belimbing manis dan temulawak dipercaya secara empirik berperan sebagai jamu antiaterosklerosis yang mengandung senyawa fenolik dan flavonoid yang berpotensi sebagai antioksidan, antihiperglikemik, dan antiinflamasi serta meningkatkan aktivitas imunomodulator dalam tubuh. Pengujian aktivitas antihiperglikemik, antiinflamasi dan aktivitas imunomodulator dilakukan masing-masing terhadap 5 kelompok perlakuan tikus putih jantan yaitu kelompok normal (tanpa perlakuan), kontrol positif (diberikan obat antihiperglikemik/antiinflamasi/imboost), dosis 1 ekstrak jamu (13,5 mg/g BB), dosis 2 ekstrak jamu (18 mg/g BB), dan dosis 3 esktrak jamu (22,5 mg/g BB). Melalui pengujian yang dilakukan, dosis jamu anti-aterosklerosis yang menghasilkan aktivitas imunomodulator yang optimum bervariasi antara dosis 2 dan 3. Dapat disimpulkan bahwa formulasi ekstrak jamu anti-aterosklerosis dapat digunakan sebagai imunomodulator yang mampu untuk meningkatkan dan meregulasi sistem kekebalan tubuh karena diketahui adanya aktivitas antihiperglikemik dan antiinflamasi dari jamu antiaterosklerosis.

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ABSTRACT

Atherosclerosis is a process of narrowing and hardening of the arteries caused by accumulation of fat, especially in arteries. In 2016, it was recorded that 35% of deaths in Indonesia were caused by diseases that occur due to atherosclerosis. Some alternatives to cure atherosclerosis are by taking antiaterosclerosis drugs. However, anti-atherosclerosis drugs that have been circulating in the wider community now have side effects that are quite disturbing when consumed. The combination of herbs consisting of tanjung leaves, sweet starfruit leaves and ginger is empirically believed to act as an antiaterosclerosis herbal medicine containing phenolic and flavonoid compounds that have the potential to be antioxidants, antihyperglycemic, and anti-inflammatory and to increase immunomodulatory activity in the body. Testing of antihyperglycemic, anti-inflammatory and immunomodulatory activities was carried out on each of the 5 treatment groups of male white rats namely normal group (without treatment), positive control (given antihyperglycemic/anti-inflammatory / imboost drug), dose 1 of herbal extract (13.5 mg/g BW), dose 2 of herbal extract (18 mg/g BW), and dose 3 of herbal extracts (22.5 mg/g BW). Through testing, the dosage of anti-atherosclerosis herbs that produce optimum immunomodulatory activity varies between doses 2 and 3. It can be concluded that the formulation of anti-atherosclerosis herbal extract can be used as an immunomodulator that is able to enhance and regulate the immune system because of the known antihyperglycemic and anti-inflammatory activity of anti-atherosclerosis herbs."

"In this volume, international experts in the field discuss the pathogenetic, diagnostic, preventive and possible therapeutic relevance of inflammation in atherogenesis. This book is intended for researchers and physicians in the fields of vascular biology, immunology and atherosclerosis."

"ABSTRACTImunomodulator merupakan agen yang dapat meningkatkan fungsi sistem imun tubuhmanusia. Imunomodulator mempunyai fungsi untuk mengembalikan keseimbanganimun. Tumbuhan mengandung berbagai senyawa kimia dengan khasiat yang sebagiantelah diketahui. Penelitian Tristantini dkk. pada tahun 2015 telah membuktikan bahwadaun tanjung Mimusops elengi L. , daun belimbing Averrhoa carambola L. , danrimpang temulawak Curcuma xanthorrhiza L. dapat digabungkan dan diramusebagai jamu anti-aterosklerosis. Ekstrak jamu tersebut diketahui mengandungberbagai senyawa golongan flavonoid dengan aktivitas anti-inflamasi. Dengandemikian, kelompok senyawa tersebut memiliki prospek untuk berfungsi sebagaiimunomodulator dalam tubuh manusia. Formula jamu dapat diolah dalam berbagaiukuran partikel ekstrak yang berbeda, yakni simplisia utuh dan bubuk simplisia yangdiduga dapat mempengaruhi kualitas jamu tersebut. Pengujian aktivitasimunomodulator dilakukan terhadap 5 kelompok perlakuan tikus putih jantan yaitukelompok normal tanpa perlakuan , kontrol positif diberikan obat imunomodulator,Imboost , dosis 1 ekstrak jamu 13,5 mg/g BB , dosis 2 ekstrak jamu 18 mg/g BB ,dan dosis 3 esktrak jamu 22,5 mg/g BB . Data bobot badan diambil setiap mingguselama 28 hari, sedangkan data bobot organ limfoid, total serum protein, albumin, sertahasil histopatologi diambil setelah hari ke-28. Hasil penelitian ini menunjukkan rataratatotal serum protein untuk kelompok normal, kontrol positif, dosis 1, dosis 2, dandosis 3 berturut-turut adalah 8,56; 9,26; 9,71; 9,74;9,74 g/dL. Didapatkan pula jumlahpulpa putih pada organ limpa untuk kelompok normal, kontrol positif, dosis 1, dosis2, dan dosis 3 berturut-turut adalah 29, 27, 26, 27, dan 20. Peningkatan pada totalserum protein dapat mengindikasikan bahwa dihasilkan semakin banyak proteinkekebalan seperti imunoglobulin, dan protein humoral lainnya dengan pemberianekstrak jamu maupun obat imunomodulator. Penurunan jumlah pulpa putih dapatmengindikasikan bahwa terjadi regulasi pada reaksi inflamasi yang terjadi sehinggatidak terjadi secara berlebihan dengan adanya flavonoid, yaitu kuersetin. Pengujianstatistik yang dilakukan juga membuktikan bahwa terdapat perbedaan bermakna padatotal serum protein antara kelompok hewan uji yang diberikan jamu ataupun Imboostdengan yang tidak diberikan perlakuan. Melalui pengujian yang dilakukan, dosis jamuanti-aterosklerosis yang menghasilkan aktivitas imunomodulator yang optimumbervariasi antara dosis 2 dan 3. Dapat disimpulkan bahwa jamu anti-aterosklerosisdapat digunakan sebagai imunomodulator yang mampu untuk meningkatkan danmeregulasi sistem kekebalan tubuh.

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ABSTRACTImmunomodulators are substances which help increase the immune system in thehuman body. Immmunomodulator has a function to restore balance to the immunesystem. Plants contain various chemical substances, where some have been known fortheir function. A research done by Tristantini in 2015 has proven that Tanjung leaf Mimusops elengi L. , starfruit leaf Averrhoa carambola L. , dan Curcuma Curcumaxanthorrhiza L. can be combined and be used as a treatment for atherosclerosis. Theseherbs extract are known to contain various various flavonoids that are proven to haveanti inflammatory activity. Thus, these herbs have a prospect to be used asimmunomodulators. This formulation of herbs can be processed into different particlesizes, which are raw simplisia and powder, that are expected to have some effect toit rsquo s quality. Therefore, a testing is done in this research to see if this formulation ofherbs can be used as immunomodulators, and the particle size of the herbs will affectit rsquo s quality. The study was performed on 5 groups of male white rats which consist ofnormal without treatment , positive control immunomodulatory drug, Imboost , dose1 of herbal extract 13.5 mg g BW , dose 2 of herbal extract 18 mg g BW , and adose of 3 extracts of herbal medicine 22.5 mg g BW . The rats were weighed everyweek for 28 days, while the lymphoid organ weight, total serum protein, albumin, andhistopathology results were taken after the 28th day. The results of this study showedthe mean total serum protein for the normal group, positive control, dose 1, dose 2,and dose 3 were 8.56 9.26 9.71 9.74 9.74 g dL. The number of white pulp in thespleen were also obtained for the normal group, positive control, dose 1, dose 2, anddose 3 were 29, 27, 26, 27, and 20 respectively. The increase in total serum proteinmay indicate that more immune proteins such as immunoglobulins, and other humoralproteins with the provision of herbal extracts and immunomodulatory drugs. Adecrease in the number of white pulp may indicate that there was regulation in theinflammatory reaction that occured so that it did not occur excessively in the presenceof flavonoids, namely quercetin. Statistical testing has also proven a significantdifference of the total protein serum amongst the group given either the herb extractor Imboost and the normal group. Through the study performed, the dosage of an antiatheroscleroticherb that produces the optimum immunomodulatory activity variesbetween doses 2 and 3. It can be concluded that anti atherosclerosis herbs can be usedas immunomodulator, capable of enhancing and regulating the immune system."