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"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.

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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."

"Konversi luka bakar merupakan perubahan zona kedalaman dari dangkal menjadi dalam pada 3–7 hari pasca luka bakar. Saat ini, proses autofagi, inflamasi, iskemia, infeksi, dan reactive oxygen species dianggap berperan dalam patogenesis konversi luka bakar. Penelitian ini bertujuan untuk mengkaji faktor risiko terjadinya konversi luka bakar pada pasien dewasa dan mengembangkan sistem skor untuk memprediksi kejadian konversi luka bakar sebagai acuan tatalaksana konservatif dan operatif. Penelitian dilaksanakan dengan metode nested case control pada pasien luka bakar dewasa yang dirawat di Unit Luka Bakar RSUPN Dr. Cipto Mangunkusumo dan RS Islam Jakarta Cempaka Putih. Subjek direkrut dengan metode consecutive sampling pada Februari 2019–Agustus 2020. Faktor risiko yang diteliti adalah karakteristik klinis, pemeriksaan klinis lokal, dan pemeriksaan klinis sistemik. Faktor risiko dianalisis secara bivariat dan multivariat regresi logistik.Terdapat 40 subjek kelompok kasus dan 20 subjek kelompok kontrol. Luka bakar di regio trunkus (OR = 3,67; p = 0,028), regio tungkai (OR = 6,93; p = 0,001), luas luka bakar yang dihitung dengan ImageJ ³ 9,49 %TBSA (OR = 32,11 p < 0,001), suhu permukaan luka yang diukur dengan termografi FLIR ONE® ≤ -1,55 oC (OR = 13,78; p < 0,001), kadar prokalsitonin ≥ 0,075 ng/mL (OR = 12; p < 0,001), dan kadar laktat darah ≥ 1,75 mmol/L (OR = 7; p = 0,001) memiliki hubungan bermakna dengan konversi luka bakar. Dikembangkan 3 model konversi luka bakar dari variabel bermakna. Model 1 diterapkan di fasilitas kesehatan tersier dengan sensitivitas dan spesifisitas sebesar 92,5% dan 85% (IK95% 0,835–1,00; p < 0,001). Model 2 dan 3 dapat diterapkan di fasilitas kesehatan primer dan sekunder dengan model 2 memiliki sensitivitas dan spesifisitas sebesar 95% dan 70% (IK95% 0,830– 1,00; p < 0,001) dan model 3 memiliki sensitivitas dan spesifisitas sebesar 92,5% dan 85% (IK95% 0,832–1,00; p < 0,001). Model skor yang dibuat dapat dipertimbangkan digunakan dalam praktek seharihari terutama sebagai acuan tatalaksana konservatif dan operatif.

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Burns are a global public health problem with high morbidity and mortality rates. Burn wound conversion describes the process by which superficial-partial thickness burns convert into deeper burns within 3–7 days after the burn. Currently, autophagy, inflammation, ischemia, infection, and reactive oxygen species are thought to play a role in the pathogenesis of burn wound conversion. This study aims to assess risk factors for burn wound conversion and develop a scoring system to predict burn conversion as a reference for burn wound management.

The study was conducted using the nested case control method, in adult burn patients who were treated at Dr. Cipto Mangunkusumo and Jakarta Islamic Hospital Cempaka Putih. Subjects were recruited by consecutive sampling method in February 2019–August 2020. The role of clinical characteristics, local clinical examination, and systemic examination as predictors of burn wound conversion were assessed. The risk factors were analyzed using bivariate and logistic regression multivariate analysis.

There were 40 subjects in case group and 20 subjects in control group. Involvement of trunk (OR = 3.67; p = 0.028), limbs (OR = 6.93; p = 0.001), burn extent measured using ImageJ ³ 9.49 %TBSA (OR = 32.11 p < 0.001), wound surface temperature measured using FLIR ONE® thermography ≤ -1.55 oC (OR = 13.78; p < 0.001), procalsitonin level ≥ 0.075 ng/mL (OR = 12; p < 0.001), dan blood lactate level ≥ 1.75 mmol/L (OR = 7; p = 0.001) had significant relationship with burn wound conversion. Three scoring models were developed based on the significant variables with model 1 to be applied in tertiary health facilities and model 2 and 3 to be applied in primary and secondary health facilities with sensitivity and specificity of 92.5% and 85% (95% CI 0.835–1,00; p < 0.001)), 95% and 70% (95% CI 0.830–1.00; p < 0.001) and 92,5% and 85% (95% CI 0.832–1.00; p < 0.001), respectively).

The scoring models can be considered to be used in daily practice, especially as a reference for conservative and operative management."

"Luka diabetes merupakan komplikasi mikrovaskular yang sering dikeluhkan oleh pasien diabetes melitus (DM) tipe 2. Vaskularisasi berperan penting dalam penyembuhan luka, yang aktivitasnya diperantarai aktivitas hypoxia-inducible factor 1-alpha (HIF-1α) dan vascular endothelial growth factor (VEGF). Belum ada studi klinis yang mengevaluasi aktivitas HIF-1α dan VEGF pada manusia, khususnya pasien DM tipe 2 yang mengalami luka kaki diabetes. Tujuan penelitian adalah untuk mengevaluasi vaskularisasi jaringan, HIF-1α, dan VEGF pada luka kaki diabetes yang menjalani amputasi dan non-amputasi.Studi potong lintang dilakukan di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSCM) pada tahun 2020–2021. Subjek penelitian adalah pasien luka kaki diabetik yang dilakukan debridemen/amputasi. Kemudian diambil jaringan viabel tepi luka untuk diperiksa vaskularisasi jaringan (densitas mikrovaskular), ekspresi VEGF, serta area granulasi, di Departemen Patologi Anatomi FKUI-RSCM. Konsentrasi HIF-1α jaringan dikuantifikasi di Departemen Biokimia dan Biologi Molekuler FKUI-RSCM. Data numerik yang diperoleh diuji normalitasnya dengan uji Saphiro-Wilk. Data distribusi normal dianalisis dengan uji t tidak berpasangan. Dilakukan uji regresi logistik bila terdapat > 2 variabel independen dengan nilai p < 0,25.Dari 67 subjek terdapat 30 pasien amputasi dan 34 pasien debridemen yang dianalisis. Proporsi subjek laki-laki pada kelompok amputasi lebih tinggi dibandingkan kelompok debridemen (p = 0,041). Tidak terdapat perbedaan bermakna pada status gizi, usia, kejadian hipertensi, gagal ginjal, dan status merokok antar kedua kelompok. Profil glikemik, hematologi rutin, penanda inflamasi, kadar elektrolit, penanda fungsi hati, fungsi ginjal tidak berhubungan dengan tindakan pasien, kecuali kadar albumin. Pada analisis bivariat, kadar albumin lebih tinggi pada kelompok debridemen 2,53/0,49 dibandingkan amputasi 2,94/0,51, p = 0,002. Kelompok amputasi memiliki nilai median HIF-1α 5,77 (0,55–53,47) pg/mg protein yang jauh lebih rendah dibandingkan kelompok debridemen 26,56 (2,23–211,12) pg/mg protein (p = 0,001). Hal serupa juga ditemukan pada nilai VEGF (p < 0,001). Pasien dengan HIF-1α < 8,8065 pg/mg protein, MVD < 68,7%, VEGF < 30,443%, dan area granulasi < 33,2802% memiliki aOR 11,116 (IK 95% 1,441–85,752), 10,934 (IK 95% 1,604–74,55), 7,973 (IK 95% 1,301–48,86), 15,589 (IK 95% 1,39–174,867) untuk mengalami amputasi. Kepadatan mikrovaskular, konsentrasi HIF-1α, ekspresi VEGF, dan area jaringan granulasi lebih banyak pada pasien non-amputasi. Pasien dengan penurunan jumlah parameter tersebut memiliki risiko lebih tinggi untuk mendapat tindakan amputasi.

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Diabetic wounds are microvascular complications often complained by people with type 2 diabetes mellitus (DM). Tissue vascularization plays an essential role in wound healing, whose activity is mediated by the activity of hypoxia-inducible factor 1-alpha (HIF-1α) and vascular endothelial growth factor (VEGF). However, no clinical studies evaluate its activity in humans, especially in type 2 diabetes mellitus patients who have diabetic foot ulcers. This study attempts to evaluate whether there are differences in tissue vascularization, HIF-1 α, and VEGF in diabetic foot wounds that received amputation and non-amputation procedures.

A cross-sectional study was conducted at the Cipto Mangunkusumo National Central General Hospital (RSCM) in 2020–2021. Diabetic foot wound patients who received debridement/amputation were included in this study. Viable tissue at the wound edges was taken. The expression of VEGF, microvascular density, and area of granulated tissue were evaluated in the Department of Pathology and Anatomy, FKUI-RSCM. HIF-1 levels in tissue were quantified at the Department of Biochemistry and Molecular Biology FKUI-RSCM. All numerical data were tested for normality by the Shapiro-Wilk test. Variables with normally distributed data were analyzed by unpaired t-test. A logistic regression test was performed if there were more than two independent variables with a p-value < 0.25.

This study included 67 patients. There were 30 amputees, and 34 debridement patients included in the data analysis. The proportion of male patients in the amputation group was found to be higher than the debridement group (p = 0.041). There were no differences in nutritional status, age, the incidence of hypertension, kidney failure, and smoking status between the two groups. The glycemic profile, routine haematological findings, markers of inflammation, electrolyte levels, markers of liver function, and markers of kidney function were not found to be related to the patient's condition, except for albumin levels. In bivariate analysis, albumin levels were found to be higher in the debridement group [2.53 (0.49)] than in the amputee [2.94 (0.51)], p = 0.002. The amputee group had a median HIF-1α value of 5,77 (0,55–53,47) pg/mg protein, which was much lower than the debridement group of 26,56 (2,23–211,12) pg/mg protein (p = 0.001). Similar condition was also found in the VEGF value (p < 0.001). Patients with HIF-1α < 8.8065 pg/mg protein, MVD < 68.7%, VEGF < 30.443%, and granulation area < 33.2802% had risk odds of 11.116 (95% CI 1.441–85.752), 10.934 (95% CI 1.604–74.55), 7,973 (95% CI 1.301–48.86), 15.589 (95% CI 1.39–174.867) for amputation. Microvascular density, HIF-1α levels, VEGF expression, and granulation tissue area were higher in non-amputated patients. Patients with a decrease in these parameters have a higher risk of amputation."