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Abstrak :
Latar Belakang : Pemeriksaan DNA virus Human Papilloma HPV telah digunakan secara luas dalam program deteksi kanker serviks.Pemeriksaan HPV dapat dilakukan melalui pengambilan mandiri sehingga dapat meningkatkan angka cakupan deteksi dini kanker serviks. Namun akurasi klinis dari metode pengambilan mandiri terhadap pengambilan oleh dokter belum banyak dipublikasikan diIndonesia.Tujuan : Untuk mengetahui tingkat akurasi hasil pengambilan sampel mandiri untuk pemeriksaan DNA Hybrid Capture HPVrisiko tinggiterhadap pengambilan sampel oleh dokter dalam deteksi dini lesi pra kanker serviks.Metode : Penelitian uji diagnostikpotong lintangini dilakukan di Poliklinik Kolposkopi Obstetri dan Ginekologi RS Ciptomangunkusumo. Perempuan yang datang kepoliklinik dengan rujukan kelainan sitologi dan hasil inspeksi visual asam asetat positif masuk kedalam perlakuan. Subyek diambil secara konsekutif dan mengambil peran serta dengan melakukan pengambilan sampel apusan vagina secara mandiri dan berikutnya dilakukan pengambilan sampel apusan serviks oleh dokter. Pengambilan sampel menggunakan sikat apusan dari Digene, dan dilakukan pemeriksaanDNA HPV risiko tinggi dengan teknik Hybrid Capture dari Qiagen Lab. Hasil pengambilan sampel oleh dokter dijadikan sebagai standar baku. Dari kedua hasil tersebut dilakukan uji diagnostik kappauntuk menilai kesetaraan dari dua metode pengambilan sampel tersebut.Hasil :Didapatkan 70 subyek dengan kelainan sitologi dan IVA positif, satu diantaranya tidak melanjutkan pemeriksaan karena mengeluh nyeri saat memasukkan sikat apusan. Prevalensi HPV risiko tinggi pada populasi sampel ini adalah 44,9 . Dari hasil analisis kedua pemeriksaan didapatkan nilai kappa cukup baik sebesar 0,76 dengan akurasi hasil pengambilan mandiri sebesar 88,41 . Sensitifitas, spesifisitas, nilai duga positif dan nilai duga negatif metode pengambilan mandiri terhadap pengambilan oleh dokter sebesar 80,65 IK95 ; 63,72-90,81 , 94,74 IK95 ; 82,71-98,54 , 92,59 IK95 ; 76,63-97,94 , 85,71 IK95 ; 72,16-93,28 .Kesimpulan :Penelitian ini menunjukkan bahwa metode pengambilan sampel mandiri dan dokter terhadap HPV DNA risiko tinggi memiliki kesetaraan yang cukup baik. Pengambilan sampel mandiri dapat dijadikan sebagai metode alternatif deteksi dini kanker serviks di Indonesia. Kata kunci: Pengambilan sampel mandiri; Pengambilan sampel dokter; Uji HPV DNA

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Background Human Papilloma Virus HPV DNA detection already widely used in cervical cancer screening program. HPV testing can be done on self taken sampling therefore it offers alternative opportunity to increase cervical cancer screening coverage. However clinical accuracy from self taken sampling methods compare to physician taken sampling has not widely published in Indonesia.Objective To determine the accuracy of Hybrid Capture HPV DNA high risk result from self taken sampling methods to physician taken sampling in cervical cancer screening.Methods This cross sectional diagnostic research conducting in O G Colposcopy polyclinic Ciptomangunkusumo Hospital. All women came with cytology abnormality dan positive VIA were enrolled. Subject was consecutively selected and took place in both vaginal self taken sampling and continued with physician taken sampling. Sample retrieval using Digene cytobrush and high risk HPV DNA test using Hybrid capture DNA II from Qiagen Labs. The sample result taken by physician was taken as gold standard. From those two methods were analyzed and compare with kappa diagnostic test to assess the equality of two methods.Result There were 70 subjects with cytology abnormality and positive VIA, one of them can not finished self examination due to feeling pain while inserting cytobrush. HPV prevalence from this sample population was 44.9 . From analysis result between two methods found kappa value was fairly good at 0.76 with self sampling accuracy was 88.41 . Sensitivity, specificity, positive predictive value and negative predictive value self taken sampling methods to physician taken sampling was 80,65 95 CI 63,72 90,81 , 94,74 95 CI 82,71 98,54 , 92,59 95 CI 76,63 97,94 , 85,71 95 CI 72,16 93,28 .Conclusion This study showed that HPV DNA testing self taken sampling and physician taken sampling had a good equality. HPV testing self sampling can be use as an alternative cervical cancer screening program in Indonesia. Keywords self taken sampling, physician taken sampling, HPV DNA test.

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Latar Belakang : Pasien kanker serviks di Indonesia terbanyak dalam stadium lanjut. Terapi standarnya adalah radiasi. Respons terapi radiasi tidak selalu komplet. MnSOD merupakan garda terdepan melawan radikal bebas yang dihasilkan radiasi. Aktifitas MnSOD dipikirkan dapat digunakan sebagai prediktor respons terapi radiasi. Diperkirakan semakin tinggi aktifitas MnSOD akan semakin buruk respons radiasinya. Tujuan : Menilai aktifitas MnSOD pada biopsi KSS serviks stadium IIIB sebagai prediktor keberhasilan terapi radiasi. Metode : Penelitian potong lintang komparatif ini dilakukan di Divisi Onkologi Ginekologi, Departemen Obstetri dan Ginekologi FKUI, RSCM Jakarta dan Departemen Biokimia dan Biologi Molekuler FKUI. Dilakukan penelusuran data base penelitian sebelumnya untuk mengindentifikasi sampel respons positif dan negatif, dilanjutkan pemeriksaan aktifitas MnSOD dengan sprektrofotometri metode McCord dan Fridovich menggunakan kit RanSOD . Data komparatif yang didapat kemudian di analisis. Hasil : Didapatkan 76 sampel yang memenuhi kriteria inklusi terdiri dari respons positif 47 61,8 negatif 29 38,2 . Dilakukan kategorisasi aktifitas MnSOD dengan titik potong pada nilai 13,126 U/mL. Dengan uji chi-square didapat hubungan bermakna secara statistik antara aktifitas MnSOD pada pasien kanker stadium IIIB dengan respons terapi radiasi. Nilai RR sebesar 1,849 1.075-3.178, IK 95 . Kesintasan dengan analisis bivariat memakai metode Kaplan-Meier: pasien dengan aktifitas MnSOD cutoff < 13,126 U/mL memiliki tingkat kesintasan 1 tahun yang lebih baik 63 dibandingkan dengan pasien kanker serviks IIIB dengan nilai aktifitas MnSOD ge; 14 . Risiko kematian dengan pengujian bivariat metode regresi cox: pasien dengan aktifitas MnSOD cutoff 13,126 U/mL memiliki risiko kematian 1,055 kali IK 95 : 1,003-1,110 dibanding pasien dengan aktifitas MnSOD dibawah nilai cutoff. Dari analisis multivariat terlihat aktifitas MnSOD semakin kuat sebagai prediktor respons terapi radiasi. Kesimpulan : Aktifitas MnSOD tinggi pada jaringan KSS serviks stadium IIIB menghasilkan respons negatif dari terapi radiasi. ......Background: Most of the cervical cancer patients in Indonesia came with advanced stage. Therefore, the choice of treatment is radiotherapy. Although, radiotherapy does not always result in complete response. MnSOD is considered to be one the antioxidant enzyme which has the ability to work against free radicals. Its activity is expected to be acted as response predictor to radiotherapy treatment. It is hypothesized that high MNSOD activity tend to predict poor response of radiotherapy on advanced cervical cancer patients. Objective : To investigate MnSOD activity on cervical SCC stage IIIB as a predictor of radiotherapy response. Methods : It is a comparative cross sectional study conducted in the Gynecology Oncology Division, Obstetrics and Gynecology Department, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine, University of Indonesia. Samples were collected from the tissue bank and research database. They were identified and divided into having positive or negative response to radiotherapy. In vitro experiment was conducted to measure the activity of MnSOD. Manganese superoxide dismutase was isolated using McCord and Fridovich method using RanSOD and the activity was analyzed using spectrophotometry. Data was then analyzed using SPSS.20 for comparative study. Results : Seventy six samples were included in the study 47 61.8 with positive response and 29 38.2 with negative response on radiotherapy. Samples were then divided into having MnSOD activity of 13.126 U mL or 13.126 U mL. Univariate analysis chi square showed that there was statistically significant correlation between MnSOD activity and radiotherapy response in patients with cervical SCC stage IIIB RR 1.849 95 CI 1.075 3.178 . Survival analysis on the first year showed that patients with MnSOD activity 13.126 U mL had better survival than patients with MnSOD activity 13.126 U mL 63 vs 14 , Kaplan Meier study . Hazard ratio for overall survival was 1.055 95 CI 1.003 ndash 1.110 for patients with MnSOD activity of 13.126 U mL. Multivariate analysis showed that MnSOD activity was a strong predictor of radiotherapy response in this study. Conclusion : This in vitro study showed that high activity of MnSOD was associated with poor response of radiotherapy for patients with cervical squamous carcinoma stage IIIB.

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ABSTRAK
Koriokarsinoma merupakan keganasan yang sangat invasive berasal dari villi plasentra dan trofoblas. Mola invasif dan koriokarsinoma sangat reponsif terhadap kemoterapi dengan angka kesembuhan lebih dari 90 , yang memungkinkan tercapainya kesembuhan tanpa mengganggu fungsi reproduksi. Methotrexate MTX merupakan terapi yang sering digunakan pada beberapa keganasan dan merupakan protokol kemoterapi pada koriokarsinoma, namun MTX memiliki banyak efek samping. Berbagai penelitian pada setengah abad terakhir menunjukan fungsi penting nanokurkumin. Penelitian in vitro dan in vivo menujukkan perannya seperti anti inflamasi, pengeluaran sitokin, anti oksidan dan imunomodulator. Namun, sapai saat ini belum ada penelitian mengenai efek antikanker nanokurkumin pada koriokarsinoma. Penelitian eksperimental sederhana ini menggunakan uji Shapiro-Wilk, uji t sampel bebas, dan uji Anova One Way. Pada penelitianini, kami meneliti dan mebandingkan efek pemberian MTX atau kombinasi dengan nanokurkumin pada berbagai jalur sinyal. Pada penelitian ini, 4 kelompok sel BeWo diberikan kombinasi MTX dan nanokurkumin, 1 kelompok sel BeWo diberikan MTX sebagai control positif, dan 1 kelompok sel BeWo sebagai control negatif. Penelitian ini menunjukkan terdapat penurunan ekspresi telomerase, ekspresi NF- B, dan indeks proliferasi BrdU yang signifikan dengan pemberian kombinasi MTX dan nanokurkumin dibandingkan dengan MTX saja ABSTRACT
Choriocarcinoma is a highly invasive malignant tumor arising from the placental villous and extravillous trophoblast. IM and CCA, which make up the majority of these tumors, are highly responsive to chemotherapy with an overall cure rate exceeding 90 , making it usually possible to achieve cure while preserving reproductive function. Methotrexate is a frequently used for the treatment of several malignancies and is part of the chemotherapy protocols used for choriocarcinoma; however, side-effect are common. Extensive research over the last half century has revealed important functions of nanocurcumin. Invitro and in vivoresearch has shown various activities, such as anti-inflammatory, cytokines release, antioxidant, and immunomodulatory. However, to date no study has been carried out to elucidate its anticancer activity of nanocurcumin in choriocarcinoma. In this study, we investigated and compared the effects of methotrexate alone or in combination with nanocurcumin on various signalling pathway. In this simple experiment stury, we used Saphiro-Wilk test, independent sample t test, and Anova One Way test to analize data. To study the potential cooperative effect of both against, 4 BeWo cell lines were treated with the combination of methotrexate and nanocurcumin, 1 BeWO cell line was treated with methotrexate alone as a positive control, and 1 BeWo cell line as a negative control. This study demonstrated significant reduction of telomerase activity, NF- B expression, and proliferation index BrdU of BeWo cell line treated with a combination of nanocurcumin and methotrexate compared with methotrexate alone. It shows that the effect of nanocurcumin and methotrexate are syngergistic suggest potential for the clinical use of methotrexate in combination with curcumin which will allow effective anticancer effect in choriocarcinoma.