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"Dispepsia merupakan sindrom penyakit pada regio gastroduodenal yang berpengaruh besar terhadap kualitas hidup penderitanya baik secara fisik maupun mental. Berbagai terapi farmakologis telah dikembangkan, namun efektivitasnya masih belum maksimal. Akupunktur merupakan salah satu modalitas terapi yang telah terbukti efektif dalam mengatasi gejala-gejala dispepsia. Elektroakupunktur (EA) pada titik ST 36 Zusanli merupakan metode perangsangan dan titik akupunktur yang paling sering digunakan dalam penelitian untuk mengatasi masalah lambung melalui mekanisme yang melibatkan nitrit oksida (NO). Penelitian ini bertujuan untuk mengetahui efektivitas metode terapi elektroakupunktur dibandingkan dengan akupunktur manual pada ST 36 Zusanli terhadap peningkatan kadar NO serum pada penderita dispepsia. Uji klinis acak tersamar ganda dengan pembanding dilakukan terhadap 40 pasien dispepsia yang dibagi ke dalam kelompok elektroakupunktur (EA) dan kelompok akupunktur manual (AM). Hasil penelitian menunjukkan terdapat perbedaan bermakna rerata peningkatan kadar NO serum pada kelompok elektroakupunktur dibandingkan dengan kelompok akupunktur manual (p = 0,026). Kesimpulan penelitian ini yaitu tindakan elektroakupunktur pada ST 36 Zusanli lebihefektif meningkatkan kadar NO serum dibandingkan tindakan akupunktur manual pada pasien dispepsia (p < 0,05).

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Dyspepsia is a syndrome in gastroduodenal region which affect the quality of life ofpatients both physically and mentally Various pharmacological therapies have beendeveloped but its effectiveness is unsatisfying Acupuncture is a modality that hasbeen proven effective in addressing the symptoms of dyspepsia Electroacupuncture EA at ST 36 Zusanli is the method of stimulation and acupuncture points whichmost frequently used in research to overcome the problem of the stomach through amechanism involving nitric oxide NO

The aim of this study was to determine theeffectiveness of electroacupuncture treatment method compared to manualacupuncture at ST 36 Zusanli to increase serum levels of NO in patients withdyspepsia A double blind randomized controlled trial involved 40 patients withdyspepsia randomly allocated into groups of electroacupuncture EA and manualacupuncture MA

The results showed there were significant differences in themean serum levels of NO in the EA group compared to the MA group p 0 026 The results suggested that electroacupuncture at ST 36 Zusanli is more effectivethan manual acupuncture in increasing the serum levels of NO in patients withdyspepsia p 0 05"

"Latar belakang: Skor MSOFA telah dikembangkan sebagai critical care triage pada rumah sakit dengan sumber daya terbatas. Di Indonesia telah diteliti performa MSOFA sebagai prediktor mortalitas terhadap pasien penyakit kritis namun terbatas pada pasien bedah. Hasil evaluasi prediksi mortalitas MSOFA menunjukkan kemampuan prediksi mortalitas yang cenderung rendah. Penambahan variabel lain pada skor MSOFA untuk meningkatkan prediksi mortalitas perlu diteliti lebih lanjut. Hiperglikemia pada penyakit kritis tanpa riwayat diabetes melitus (hiperglikemia akibat stres) berdasarkan penelitian merupakan faktor risiko independen terhadap mortalitas.Tujuan: Melakukan validasi MSOFA serta nilai tambah kadar glukosa darah sebagai prediktor mortalitas pasien penyakit kritis tanpa riwayat diabetes melitus.Metode penelitian: Penelitian prospektif kohort pada pasien penyakit kritis medis maupun bedah di RSUPN Cipto Mangunkusumo selama periode Agustus hingga Desember 2013. Pasien dilakukan anamnesis, pemeriksaan fisik, saturasi oksigen perifer, glasgow coma scale, pemeriksaan laboratorium kadar kreatinin, pemeriksaan glukosa darah sewaktu serta A1C dalam 24 jam pertama perawatan. Outcome penelitian ini adalah mortalitas dalam 28 hari. Analisis statistik menggunakan tes Hosmer-Lemeshow, plot kalibrasi serta kurva ROC.Hasil: Subjek penelitian sebanyak 150 pasien. Mortalitas terjadi pada 52 pasien (34,67%) dengan sepsis sebagai masalah terbanyak. Kalibrasi MSOFA menunjukkan Hosmer-Lemeshow x2=13,748(p=0,056). Diskriminasi MSOFA menunjukkan AUC 0,83 (IK 95% 0,76-0,89). Hiperglikemia terjadi pada 79 pasien (52,67%). Penambahan kadar glukosa darah pada MSOFA tidak menunjukkan peningkatan AUC.Simpulan: Validasi MSOFA menunjukkan kalibrasi dan diskriminasi yang baik pada pasien penyakit kritis baik medis maupun bedah. Penambahan kadar glukosa darah pada skor MSOFA tidak meningkatkan kemampuan prediksi mortalitas.

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Background: MSOFA, a simple scoring system, has been developed as a critical care triage in centers with limited resources. Previous study have evaluated MSOFA’s performance but limited only in surgical critically ill patients which showed a low precision in predicting mortality. Addition of another variable to improve MSOFA’s performance merits further investigation. Hyperglycemia in critically ill patients without previous history of diabetes (stress hyperglycemia) has been shown to be an independent risk factor of mortality.

Objective: to evaluate MSOFA scoring system’s performance and addition of admission blood glucose test to predict mortality in critically ill patient without previous history of diabetes.

Methods: This was a prospective cohort study recruiting medical and surgical critically ill patients admitted to Cipto Mangunkusomo Hospital during a period of August to December 2013. History taking, physical examination, peripheral oxygen saturation, Glasgow Coma Scale, creatinine, blood glucose and A1C were obtained within 24 hour of admission. The outcome was mortality within 28 days. Performance of MSOFA was evaluated with the Hosmer-Lemeshow goodness of fit test and measuring the AUC.

Results: 150 patients completed the study protocols. Mortality was observed in 52 patients (34,67%) with sepsis being the most prevalent diagnosis. Calibration of MSOFA showed a Hosmer-Lemeshow test x2=13.748 (p = 0.056). Receiver Operating Curve (ROC) of MSOFA showed an AUC of 0,83 (95% CI 0,76-0,89). Stress hyperglycemia was evident in 79 patients (52,67%) recruited in this study. Addition of blood glucose to MSOFA scoring system did not show improvement in MSOFA’s performance.

Conclusion: We have validated MSOFA in this study which showed good calibration and discrimination in both medical and surgical critically ill patients. Adding blood glucose to MSOFA scoring system did not improve MSOFA’s performance."

"Latar Belakang: Dalam dekade terakhir terjadi peningkatan bakterimia Multi-Drug Resistant (MDR) Gram negatif. Bakterimia MDR Gram negatif tidak hanya meningkatkan angka kematian, tetapi juga dapat dikaitkan dengan peningkatan morbiditas pasien, lama perawatan dan biaya perawatan rumah sakit. Faktor-faktor risiko terjadinya bakterimia MDR Gram negatif di ruang rawat inap penting untuk diketahui sehingga dapat dilakukan upaya pencegahan dan pengendalian terhadap faktor-faktor risiko tersebut dan menurunkan kejadian bakterimia MDR Gram negatif pada pasien rawat inap. Tujuan: Mengetahui faktor-faktor risiko yang berhubungan dengan terjadinya bakterimia MDR Gram negatif pada pasien rawat inap. Metode: Faktor risiko diidentifikasi menggunakan studi kasus kontrol. Data dikumpulkan dari catatan rekam medis pasien rawat inap RSCM yang memiliki kultur darah positif tumbuh bakteri patogen Gram negatif. Kelompok kasus adalah subjek dengan bakterimia MDR Gram negatif, kelompok kontrol adalah subjek dengan bakterimia non-MDR Gram negatif. Kedua kelompok kasus dan kontrol diambil secara konsekutif dikarenakan kurangnya sampel. Analisis bivariat dilakukan pada variabel bebas yaitu riwayat antibiotik sebelumnya, pemberian antibiotik kombinasi, fokus infeksi, riwayat hospitalisasi, lama perawatan, Charlson index >2, pemberian kemoterapi, kortikosteroid, keganasan, kolonisasi, absolute neutrophile count (ANC) <500, perawatan di ICU/HCU, prosedur medis invasif, hipoalbuminemia. Semua variabel yang mempunyai nilai p <0,25 pada analisis bivariat dimasukkan ke dalam analisis multivariat dengan regresi logistik. Hasil: Selama periode penelitian didapatkan 131 pasien yang memenuhi kriteria, 42 pasien dengan bakterimia MDR Gram negatif (kasus), dan 89 pasien dengan bakterimia non-MDR Gram negatif (kontrol). Berdasarkan hasil analisis bivariat didapatkan 2 variabel yang memiliki kemaknaan secara statistik yaitu riwayat ICU/HCU (p= 0.003) dan riwayat ventilator (p=0.030). Pada analisa multivariat lebih lanjut terdapat satu varibel bermakna secara statistik, yaitu riwayat ICU/HCU (OR: 3.118; IK 95% : 1.443 – 6.736; p=0,004). Simpulan: Riwayat ICU/HCU merupakan faktor risiko terjadinya bakterimia MDR Gram negatif pada pasien rawat inap.

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Background: Over the past decade, the numbers of bloodstream infections caused by multidrug-resistant (MDR) Gram-negative bacteria have risen sharply. MDR Gramnegative bacteremia increases not only mortality, but may also be associated with increased patient morbidity, length of treatment and hospitalization costs. It is important to identify risk factors of MDR Gram-negative bacteremia among hospitalized patients in order to prevent and to control these risk factors and thus to lower the incidence of MDR Gram-negative infections among hospitalized patients.

Aim: To identify the risk factors associated with the occurrence of MDR Gramnegative bacteremia among hospitalized patients.

Method: Risk factors were identified by a case-control study. Data was collected from inpatients medical record that had positive blood cultures of Gram negative bacterial pathogens. Both case and control samples were collected consecutively due to lack of samples available. The case group was subjects who had MDR Gram-negative bacteremia, and the control group was subjects who had non-MDR Gram negative bacteremia. Bivariate analysis was performed on several independent variables, which were previous antibiotic history, antibiotic combination, source of infection, history of hospitalization, duration of hospitalization, Charlson index> 2, administration of chemotherapy, use of corticosteroid, malignancy, colonization, ANC <500, history of treatment in ICU / HCU, invasive medical procedures and hypoalbuminemia. All variables that had a value of p <0.25 on bivariate analysis were included in multivariate analysis using logistic regression.

Result: During the study period, there were 131 patients fulfilled the criteria, which consisted of 42 patients who had MDR Gram-negative pathogen bacteremia (case) and 89 patients who had non-MDR Gram-negative pathogen bacteremia patients (control group). Based on the bivariate analysis, there were two variables statistically significance, which were history of treatment in ICU / HCU (p=0.003) and history of ventilator (p=0.030). Further multivariate analysis showed that there was one variable statistically significance, which was history of treatment in ICU / HCU (OR: 3.118; CI 95% : 1.443 – 6.736; p=0,004).

Conclusion: History of treatment in ICU / HCU was risk factor of MDR Gram negative bacteremia among hospitalized patients."

"ABSTRACTBackground: the aging process causes decreasing in the function of various organs. Skletal muscle is one of the organs affected by aging process. It is known as sarcopenia. Sarcopenia is defined as a syndrome characterized by progressive loss of muscle mass and strength. The handgrip strength examination is often applied as a sarcopenia filtering technique. This study aimed to determine the relationship between age, nutritional status, and chronic diseases such as stroke, hypertension (HT), diabetes mellitus (DM), coronary heart disease (CHD), and chronic obstructive pulmonary disease (COPD) with handgrip strength. Methods: a cross-sectional study to determine factors related to the handgrip strength in elderly patients was conducted in Geriatric outpatient clinic of Cipto Mangunkusumo Hospital and Mohammad Hoesin Hospital from August to October 2015. There were 352 eligible subjects in this study recruited with consecutive sampling. The independent variables in the study consisted of age, sex, nutritional status, chronic disease (stroke, hypertension (HT), diabetes mellitus (DM), coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD)), waist circumference while the dependent variable was handgrip strength. Results: age of more than 75 years old and malnutriton were risk factors that affected hangrip strength. Age of >75 years increase the risk for having low handgrip strength by 2,3-fold. Malnutrition increased risk for low handgrip strength for 1,9-fold. Conclusion: ages of >75 years old and malnutrition will increase the risk of low handgrip strength in elderly patients."

"Artritis reumatoid AR adalah penyakit autoimun yang saat ini telah diketahui menunjukkan manifestasi klinis bukan hanya intraartikular, tetapi juga ekstraartikular. Kejadian kardiovaskular baik subklinis maupun klinis ditemukan lebih tinggi pada penderita AR. Mediator inflamasi aterogenik pada AR seperti interleukin-6 IL-6 diduga menjadi salah satu faktor risiko nontradisional kardiovaskular yang berkontribusi meningkatkan penanda disfungsi endotel seperti E-Selectin. Penelitian ini bertujuan mengetahui peran mediator inflamasi dalam kejadian disfungsi endotel, khususnya korelasi IL-6 dan E-selectin, pada pasien artritis reumatoid tanpa faktor risiko kardiovaskular. Studi potong-lintang dilakukan pada 40 pasien AR di Poliklinik Reumatologi RSUPN Dr. Cipto Mangunkusumo, Indonesia, pada bulan September-November 2017. Pemeriksaan IL-6 dan E-Selectin dilakukan dengan teknik enzyme-linked immunosorbent assay ELISA. Analisis korelasi bivariat dilakukan untuk menemukan korelasi kedua penanda tersebut. Rerata usia subjek penelitian ini adalah 44,9 13,1 tahun dan median durasi sakit adalah 36 bulan. Korelasi kadar IL-6 dengan kadar E-Selectin memiliki kekuatan korelasi lemah tetapi tidak bermakna secara statistik r = 0.232, p=0,149. Tidak terdapat korelasi antara IL-6 dengan E-Selectin pada pasien AR tanpa faktor risiko tradisional kardiovaskular.

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Rheumatoid arthritis RA is an autoimmune disease which has recently been recognized to manifest as not only intraarticular but also extraarticular symptoms. Cardiovascular events, presented either subclinically or clinically, were discovered more in AR patients. Atherogenic inflammatory mediator in AR including interleukin-6 IL-6 was thought to be one of nontraditional cardiovascular risk factor contributing to increase the endothelial dysfunction biomarker such as E-Selectin. This study was purposed to determine the correlation between inflammatory mediator and endothelial dysfunction event, especially between IL-6 and E-Selectin, in RA patient without traditional cardiovascular risk factor. A cross-sectional study was performed to 40 RA patients of Rheumatology Clinic of Cipto Mangunkusumo National General Hospital, Indonesia from September to November 2017. Measurement of the level of IL-6 and E-Selectin were performed using enzyme-linked immunosorbent assay ELISA. Bivariate correlation analysis was performed to determine the correlation between those two biomarkers. The mean age of this study subjects was 44.9 13.1 years and median of disease duration was 36 months. This study showed weak correlation between IL-6 and E-Selectin level, but not statistically significant.232, p=0.149 . There is no correlation between IL-6 and sE-Selectin in rheumatoid arthritis patient without traditional risk factor cardiovascular."

"Latar Belakang: Ikterus obstruktif merupakan salah satu komplikasi tersering keganasan sistem bilier. Keadaan ini akan memicu pelepasan sitokin proinflamasi. Terdapat kontroversi mengenai pengaruh drainase bilier terhadap perubahan kadar sitokin proinflamasi pada penderita kanker pankreatobilier.Tujuan: Untuk mengetahui kadar Tumor Necrosis Faktor alfa (TNF-alfa) dan Interleukin 6 (IL6) sebelum dan sesudah Endoscopic Retrograde Cholangio Pancreatography (ERCP) atau Percutaneus Transhepatic Biliary Drainage (PTBD) pada penderita ikterus obstruksi etiologi kanker pankreatobilier.Metode: Desain penelitian adalah one group before after study. Pemilihan sampel secara consecutive sampling. Sampel darah diambil sebelum dan lima hari sesudah ERCP atau PTBD. Pengukuran kadar TNF-alfa dan IL-6 dengan cara Enzyme Linked Immunosorbed Assay (ELISA).Hasil: Terdapat 40 orang responden yang diikutsertakan dalam penelitian ini, 22 laki laki dan 18 perempuan dengan usia rata rata 55,3 tahun. Berdasarkan imaging dan endoskopi, ditegakkan diagnosis kolangiokarsinoma sebanyak 22 orang, tumor ampula Vateri 10 orang, dan tumor pankreas 8 orang. Kadar rata-rata TNF- alfa sebelum tindakan 4,81 (2,91) pg/ml dan sesudah tindakan 8,05 (6,7) pg/ml, terdapat peningkatan yang bermakna setelah tindakan drainase bilier (p:0,02). Kadar rata-rata IL-6 sebelum tindakan 7,79 (1,57) pg/ml dan sesudah tindakan 7,75 (1,76) pg/ml, tidak terdapat perbedaan yang bermakna setelah tindakan drainase bilier (p:0.52). Kadar rata-rata bilirubin sebelum tindakan 15,5 mg% dan sesudah tindakan 11,3 mg%.Simpulan: Terjadi peningkatan kadar rata-rata TNF-alfa secara bermakna setelah drainase. Tidak ada penurunan yang bermakna kadar rata-rata IL-6.

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Background: Obstructive jaundice represents the most common complication of biliary tract malignancy. Obstructive jaundice causes releases of proinflammatory cytokine. There has been controversy about effect of biliary drainage on the change in proinflammatory cytokine level in pancreatobiliary cancer patients.Objective: The present study was designed to determine levels of Tumor Necrosis Factor Alpha (TNF-Alpha) and Interleukin 6 (IL-6) in preprocedure of either Endoscopic Retrograde Cholangio Pancreatography (ERCP) or Percutaneus Transhepatic Biliary Drainage (PTBD) and postprocedure of them in obstructive jaundice patient caused by pancreatobiliary cancer.Methods : The study method is before- and- after case study design with consecutive sampling. Blood was collected five days prior to either Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure or Percutaneus Transhepatic Biliary Drainage (PTBD) procedure and five days after either of them. Enzyme Linked Immunosorbed Assay (ELISA) was used to determine TNF-Alpha and IL-6.Results: Forty subjects were included in this study which consisted of 22 men and 18 women. The mean age was 55.3 years old. According to the results of imaging and endoscopy procedure, twenty two (22) people were diagnosed cholangi carcinoma, ten (10) people were diagnosed ampulla varteri and eigth (8) people were diagnosed pancreatic tumor. In preprocedure, the mean of TNF-Alpha concentration was 4.81 (2.91) pg/mL, the mean of IL-6 concentration was 7.79 (1.57) pg/mL and the mean of bilirubin concentration was 15.5 mg%. In postprocedure, the mean of TNF-Alpha concentration was 8.05 (6.7) pg/mL, there was significant increase in TNF-Alpha concentration (p:0.02). However, the mean of IL-6 concentration was 7.75 (1.76) pg/mL, there was not any significant chance in IL-6 concentration (p:0.52). The mean of bilirubin concentration was 11.3 mg%.Conclusions: On one hand, there was significant increase in mean concentration value of TNF-Alpha after biliary drainage procedure. On the other hand there was not any significant decrease in mean concentration value of IL-6 after biliary drainage procedure."

"ABSTRAKKanker kolorektal merupakan salah satu jenis kanker yang paling banyakmenyebabkan kematian di dunia dan berada di peringkat tiga terbanyak setelahkanker paru dan kanker payudara. Inflamasi merupakan predisposisi kankerkolorektal melalui berbagai mediator proinflamasi dan antiinflamasi yang dihasilkansel-sel inflamasi. Pengobatan kanker kolorektal secara konvensional dengan terapibedah, kemoterapi maupun radioterapi belum dapat memberikan hasil yangmemuaskan karena angka kekambuhan kanker yang tinggi dan terjadinya inflamasiakibat terapi. Annona muricata Linn. (AML), atau sirsak memiliki zat aktifasetogenin,yang selain bersifat anti-oksidan, antiinflamasi juga memiliki efeksitotoksik karena mampu menginduksi apoptosis dengan mengurangi kadar cAMPdan cGMP pada sel-sel kanker manusia. Dua puluh lima subyek penderita kankerkolorektal yang sudah direseksi dibagi menjadi dua kelompok dan mendapatkantambahan terapi berupa ekstrak etanol daun AML atau maltosa selama 8 minggu, dandilakukan pemeriksaan kadar TNF-α, IL-10, IFN-γ, COX-2 serta cleaved caspaseCK18 melalui serum subyek sebelum dan setelah terapi selesai dilakukan. Pemberianekstrak etanol AML tidak menimbulkan perubahan signifikan dari kelima parameterdibandingkan antara kelompok perlakuan dan kontrol. Terdapat korelasi bersifatpositif yang signifikan antara mediator proinflamasi TNF-α dan IL-10 setelahperlakuan yaitu 0,641 (p = 0,009) dan juga korelasi positif antara TNF-α dan ccCK18yaitu 0,817 (p = 0,002). Berdasarkan hasil di atas ekstrak etanol AML memiliki peranuntuk meregulasi homeostasis proinflamasi dan antiinflamasi serta berperan dalamproses apoptosis.

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ABSTRACTColorectal cancer is one type of cancer which causes the most deaths in the world andis the third highest after lung cancer and breast cancer. Inflammation is one ofcolorectal cancer predispotition, mediated by a variety of inflammatory cytokineproduced by inflammatory cells. Treatment of colorectal cancer include surgicaltherapy, chemotherapy or radiotherapy had not given a satisfactory result for the highrecurrence rate of cancer, even resulted inflammation as a side effect of therapy.Annona muricata Linn. (AML), or soursop has asetogenin as one of its activesubstances, which have antioxidant potency, anti-inflammatory and cytotoxic effectbecause it can induce apoptosis by reducing levels of cAMP and cGMP in humancancer cells. Twenty-five post-resection colorectal cancer patients divided into twogroups and get ethanol fraction of leaves of AML or maltose as an additional therapyfor 8 weeks. Levels of TNF-α, IL-10, IFN-γ, COX-2 and caspase cleaved CK18serum subjects before and after treatment was examined. Ethanol fraction of AMLdid not make a significant change from the five parameters which were comparedbetween treatment and kontrol groups. TNF-α and IL-10 serum after treatment had apositive correlation with R= 0,641 (p = 0.009). TNF-α and ccCK18 also had positivecorrelation with R = 0.817 (p = 0.002). Based on results the ethanol fraction of AMLplays a role to homeostasis of proinflammatory and antiinflammatory as well asapoptosis regulation."

"Gastroesophageal reflux disease (GERD) adalah suatu kondisi kembalinya cairan lambung ke esofagus. Terapi akupunktur tanam benang telah menjadi salah satu terapi yang digunakan untuk alternatif terapi. Penelitian ini bertujuan untuk mengetahui perubahan kadar Nitrit Oksida (NO) serum setelah terapi akupunktur tanam benang dan medikamentosa. Uji acak tersamar tunggal dilakukan pada 50 responden dengan GERD yang di bagi kepada kelompok akupunktur tanam benang dan medikamentosa dibandingkan dengan kelompok akupunktur sham dan medikamentosa. Pemeriksaan kadar NO menjadi parameter yang dinilai pada saat sebelum perlakuan dan 30 hari setelah 2 kali terapi dengan durasi 15 hari sekali.Hasil penelitian menunjukkan terjadi kenaikan kadar NO pada kelompok perlakuan dibandingkan kelompok sham namun tidak ada perbedaan bermakna antara kedua kelompok. Kesimpulan penelitian ini akupunktur tanam benang belum terbukti secara statistik mempengaruhi kadar NO pada pasien GERD.

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OksidaGastroesophageal reflux disease (GERD ) is a condition that causes the return of gastric fluid into the esophagus. Catgut embedding acupuncture has become one of the therapies used for alternative therapies. This study aimed to determine changes in serum Nitric Oxide (NO) levels after catgut embedding acupuncture therapy and conventional medicine. Single -blind randomized trials is used on 50 respondents with GERD were divided to group catgut embedding acupuncture therapy and conventional medicine compared with sham acupuncture group and medicine. The level of NO into the parameters assessed at the time before treatment and 30 days after treatment with 2 times the duration of 15 days.

The results showed increased levels of NO in catgut embedding acupuncture therapy and conventional medicine group compared with sham acupuncture group and medicine but there was no significant difference between the two groups. The conclusion of this study catgut embedding acupuncture has not been proven statistically in influencing the levels of NO in patients with GERD."

"Epithelial Mesenchymal Transition (EMT) adalah salah satu mekanisme resistensi Sorafenib pada kanker hepatoseluler. Alfa Mangostin diketahui dapat menurunkan aktifitas jalur TGF-βpada hepatic stellate cells. Penelitian ini dilakukan untuk mengetahui pengaruh Alfa Mangostin pada Epithelial Mesenchymal Transition (EMT), HepG2 yang tahan terhadap Sorafenib melalui jalur TGF-β/SMAD. Sel lestari kanker hati, HepG2 dibagi menjadi enam kelompok perlakuan, yaitu kelompok DMSO 0,01%, Alfa Mangostin20μM, Sorafenib10μM, Sorafenib10μM+Sorafenib10μM, Sorafenib10μM-Alfa Mangostin20μM, dan Sorafenib10μM +Sorafenib10μM - Alfa Mangostin20μMselama 24 jam. Sel dihitung menggunakan trypan blue exclusion method. Kadar TGF-β medium diukur menggunakan ELISA. Ekspresi TGF-β,TGF-βRI, SMAD3, SMAD7, E-cadherin dan Vimentin diukur dengan qRT-PCR. Pemberian Alfa Mangostin pada sel HepG2 yang tahan terhadap Sorafenib dapat menurunkan jumlah sel hidup. Namun terdapat peningkatan ekspresi TGF-β, kadar TGF-β1 aktif, TGF-βRI, SMAD3, dan Vimentin serta penurunan ekspresi SMAD7 dan E-cadherin setelah pemberian Sorafenib dan Alfa Mangostin. Alfa Mangostin menurunkan jumlah sel hidup namun tidak menghambat EMT melalui jalur TGF-β/SMAD pada sel HepG2 yang tahan terhadap Sorafenib. Epithelial Mesenchymal Transition (EMT) is one of resistance mechanism through Sorafenib in hepatocellular carcinoma. Alpha Mangosteen is known to have reduced TGF-β/SMAD pathway in hepatic stellate cells. This research purpose is to explore the effect of Alpha Mangosteen on Epithelial Mesenchymal Transition (EMT) on human hepatoceluller carcinoma HepG2 cells surviving Sorafenib via TGF-β/SMAD pathways. Immortalized HCC cell line, HepG2 cells, were divided into 6 groups: DMSO0,01% group, Alpha Mangosteen 20μMgroup, Sorafenib10μM group, Sorafenib 10μM-Sorafenib10μM group, Sorafenib10μM +  Alpha Mangosteen 20μM group, dan Sorafenib10μM + Sorafenib10μM - Alpha Mangosteen 20μMgroup for 24 h. Cells were harvested and counted by trypan blue exclusion method. TGF-β medium concentration was evaluated by ELISA. Expression of TGF-β,TGF-βRI, SMAD3, SMAD7, E-cadherinand Vimentin measured by qRT-PCR. Alpha Mangosteen administration on HepG2 surviving Sorafenib cells reduced mean live cells. However, the expression of TGF-β, TGF-β1 active concentration, TGF-βR, SMAD3, and Vimentin were elevated. Alpha Mangosteen also decreased SMAD7 dan E-cadherin expression. Alpha Mangosteen reduced live cells but did not have effect on preventing EMT activation through TGF-β/SMAD pathways on HepG2 surviving Sorafenib cells. "

"Pendahuluan : GERD dapat menurunkan kualitas hidup yang dapat dipicu dan dieksaserbasi dengan stres. Tujuan penelitian ini adalah untuk mengetahui hubungan antara stres kerja dengan kejadian GERD. Metode : Penelitian ini merupakan penelitian potong lintang pada Januari hingga April 2021 terhadap 100 guru SD di Cipondoh, Kota Tangerang yang dipilih melalui metode multistage cluster random sample. Para guru mengisi kuesioner melalui google form. Kuesioner GERDQ digunakan untuk mendiagnosis GERD, sementara stres kerja dinilai menggunakan Teacher Stress Inventory (TSI). Seluruh faktor risiko yang mungkin ada dianalisa. Data yang didapat diolah dengan menggunakan analisis bivariat. Hasil : Mayoritas guru adalah perempuan, berusia dibawah 40 tahun, mengajar sekolah swasta, dan memiliki pengalaman mengajar lebih dari lima tahun. Guru yang mengalami stres rendah sebanyak 77% dengan beban kerja sebagai stresor utama. Prevalensi GERD didapatkan sebanyak 23%. Dari hasil penelitian ini, tidak didapatkan hubungan yang bermakna antara stres kerja pada guru dengan kejadian GERD (p=0,69). Faktor resiko yang bermakna secara statistik ialah merokok (p = 0,037; OR : 11,4). Karakteristik guru, obesitas, diet tinggi lemak, kafein serta peristiwa hidup yang stressful bukan merupakan faktor resiko yang bermakna. Kesimpulan : Tidak terdapat hubungan yang bermakna antara stres kerja dengan GERD.

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GERD can reduce the quality of life and it can triggered and exacerbated by stress. The aim of this study is to find a relationship between occupational stress and GERD.

Method: This is a cross-sectional study, held in September 2020-July 2021. This study were involving 100 elementary teacher in Cipondoh, Kota Tangerang, whom selected by multistage cluster random sample method, and completing the questionnaire using google form application. The GERDQ Questioner were used to diagnose GERD, while occupational stress assessed using the Teacher Stress Inventory (TSI). All possible risk factors were analysed. Results were analysed using bivariate analysis.

Results: Most of the subject were female, under 40 years old, work in private school, and have more than five years experiences of teaching. They are having a low occupational stress (77%), workload being the most stressor. The prevalence of GERD was 23%. The result of this study failed to indicate a significant relationship between occupational stress among the teachers and GERD (p = 0,69). We found that the statistically significant risk factors of GERD is smoking (p = 0,037; OR = 11,4). Characteristic subject, obesity, fat dietary, caffein, and (stressful) life events were not a significant risk factors of GERD.

Conclusion: We didn’t find any significant relationship between teacher stress and GERD."