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"Inflamasi kronik adalah proses yang penting dalam patofisiologi adenokarsinoma duktal pankreas (PDAC). Beberapa studi telah meneliti potensi enzim siklooksigenase-2 (COX-2) sebagai faktor prognostik PDAC, dengan hasil yang kontradiktif. Nuclear factor kappa−B (NF−?B), specificity protein 1 (Sp1), dan c−Jun adalah faktor transkripsi gen COX2. Penelitian ini adalah studi observasional eksploratori yang bertujuan untuk mengidentifikasi asosiasi ekspresi protein NF−?B (RelA/ p65), COX−2, Sp1, dan c−Jun dengan kesintasan pasien PDAC. Ekspresi protein tersebut dinilai di jaringan pasien PDAC menggunakan metode imunohistokimia. Diidentifikasi ekspresi keempat protein tersebut dengan overall survival (OS) dan karakteristik klinikopatologis pasien PDAC. Sebanyak 53 jaringan PDAC dari biopsi atau reseksi kanker diikutkan dalam penelitian. Hasilnya terdapat korelasi antara keempat protein di jaringan kanker. Ekspresi NF−?B sitoplasmik (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) atau nuklear (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) berhubungan secara independen dengan prognosis pasien yang lebih baik. Protein lainnya tidak berhubungan dengan kesintasan pasien. Hal ini menunjukkan bahwa peran inflamasi di PDAC lebih kompleks dari yang diperkirakan sebelumnya.

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Chronic inflammation is a crucial driver of carcinogenesis in pancreatic ductal adenocarcinoma (PDAC). Several studies have investigated the prognostic significance of cyclooxygenase−2 (COX−2) expression in PDAC patients, obtaining conflicting results. Nuclear factor kappa−B (NF−?B), specificity protein 1 (Sp1), and c−Jun are known as the transcription factors of the COX2 gene. This exploratory observational study investigated the association of the NF−?B, COX−2, Sp1, and c−Jun expressions with patient survival in PDAC. We used the immunohistochemical method to detect the PDAC tissue expressions of NF−?B (RelA/p65), COX−2, Sp1, and c−Jun. The expressions of these proteins were correlated with the overall survival (OS) and other clinicopathological characteristics of PDAC patients. We obtained 53 PDAC specimens from resections and biopsies. There were significant correlations between the four proteins’ expressions in the PDAC tissues. The expression of the cytoplasmic (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) or nuclear NF−?B (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) was independently associated with a better prognosis in the PDAC patients. COX−2, Sp1, and c−Jun showed no significant association with a prognosis in the PDAC patients. The PDAC patients who expressed NF−?B had a better prognosis than the other patients, which suggests that the role of inflammation in PDAC is more complex than previously thought."

"Latar Belakang: Malnutrisi meningkatkan morbiditas dan mortalitas dan menurunkan kualitas hidup pasien sirosis hati. Untuk memperbaiki status gizi, dianjurkan pemberian late night snack (LNS) dengan 50 gram karbohidrat. Santan mengandung banyak middle chain triacylglicerol, sehingga berpotensi menjadi sumber gizi yang lebih baik dan aman bagi pasien sirosis. Tujuan: Mengetahui manfaat santan untuk memperbaiki status gizi pasien sirosis hati. Metode: Dilakukan uji klinik dengan desain paralel. Subjek adalah pasien sirosis hati Child Pugh A dan B, yang mengalami malnutrisi berdasarkan kriteria IMT modifikasi Campillo, atau mengalami unintentional weight loss. Pasien dibagi menjadi 2 kelompok, kelompok I mendapat LNS berupa 25 gram gula ditambah 50 cc santan, sedangkan kelompok II mendapat LNS berupa 50 gram gula. Status gizi dinilai dari parameter triceps skinfold thickness (TSF), mid arm muscle circumference (MAMC), indeks massa tubuh (IMT), massa lemak tubuh (MLT), kadar prealbumin dan kadar albumin serum. Hasil Penelitian: Terdapat 18 subjek pada kelompok I, dan 17 subjek pada kelompok II yang menyelesaikan penelitian. Kedua kelompok setara dalam proporsi gender, CP A dan B, dan penyebab sirosis. Meskipun rerata usia kelompok II lebih tua dibandingkan kelompok I, namun tidak terdapat korelasi antara usia dengan semua parameter status gizi yang diukur. Didapatkan peningkatan status gizi lebih baik pada kelompok I bila dilihat dari parameter MAMC, MLT dan kadar albumin serum. Pengukuran TSF meningkat setelah pemberian LNS, namun tidak menunjukkan beda perubahan bermakna antara kedua kelompok, Pengukuran IMT dan kadar prealbumin serum tidak dapat mencerminkan perubahan status gizi dengan baik. Kesimpulan: Pemberian LNS dengan kombinasi karbohidrat dan santan lebih unggul dibandingkan LNS dengan karbohidrat saja dalam memperbaiki status gizi pasien sirosis hati, dilihat dari parameter MAMC, MLT dan kadar albumin serum, sedangkan parameter TSF, IMT dan kadar prealbumin serum tidak menunjukkan beda perubahan yang bermakna antara kedua kelompok.

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Background: Malnutrition caused a decline in quality of life, increased morbidity and mortality in patients with cirrhosis of the liver. It is recommended to give late night snack (LNS) with 50 grams of carbohydrates to improve their nutritional status. Coconut milk contains a lot of middle chain triacylglycerol, it is potentially act as a source of safe, and better nutrition for patients with cirrhosis.

Aim: To see the benefit of coconut milk to improve the nutritional status of chirrotic patients.

Methods: This study is a clinical trial with parallel design. Subjects were cirrhotic patients with Child-Pugh A and B, who suffered malnutrition using Campillo?s modification of BMI criteria or experience unintentional weight loss. Subjects were devided into 2 groups, groups I received 25 gram of sugar and 50 cc of coconut milk as LNS, group II received received 50 gram sugar as LNS. Nutritional status assessed from triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), body mass index (BMI), body fat mass (BFM), serum prealbumin and serum albumin levels.

Results: There were 18 subjects in group I and 17 subjects in group II. Both groups were similar in proportion of gender, CP A and B, and the cause of cirrhosis. Although the mean age of group II older than group I, but there were no significant correlation found between age and all nutrition parameters. Measurement of MAMC, BFM, and albumin levels showed that cirrhotic patient in group I have improvement of nutritional status better than group II, The TSF was increased after administration of LNS, but no significantly different changes found among both groups,. BMI and serum prealbumin cannot reflect changes in nutritional status well.

Conclusion: Late night snack containing carbohydrate and coconut milk, is superior to improving nutritional status in cirrhotic patients compare to carbohydrates alone, as seen from MAMC, BFM, and serum albumin level parameters, whereas TSF, BMI, and serum prealbumin level did not show any difference between two groups."

"Latar Belakang: Derajat keparahan karsinoma hepatoselular (KHS) yang dinilai dengan klasifikasi Barcelona Clinic Liver Cancer (BCLC) merupakan faktor prognostik utama KHS. Penilaian kadar serum Vascular Endothelial Growth Factor (VEGF) dianggap dapat mencerminkan tingkat keparahan KHS. Namun, belum ada kesepakatan mengenai hubungan tingkat keparahan KHS dengan kadar serum VEGF. Tujuan : Mengetahui hubungan kadar serum VEGF dengan tingkat keparahan KHS dengan menilai perbedaan rerata kadar serum VEGF pada berbagai tingkat keparahan KHS. Metode : Penelitian ini adalah studi potong lintang untuk menentukan hubungan antara kadar serum VEGF dengan tingkat keparahan KHS berdasarkan klasifikasi BCLC. Penelitian ini dilakukan di Rumah Sakit Cipto Mangunkusumo antara bulan Januari 2015 dan Mei 2015. Uji statistik yang digunakan untuk menilai hubungan kadar serum VEGF dengan klasifikasi BCLC ialah analisis one way ANOVA, dan dilanjutkan dengan analisis post hoc Tukey Schaffe. Hasil : Sebanyak 61 subyek KHS diikutkan dalam penelitian ini. Pada penelitian ini tidak ditemukan subyek dengan BCLC stage 0. Rerata kadar serum VEGF BCLC stage A adalah 288,26±156,6 pg/ml; BCLC stage B: 434±164,8 pg/ml; BCLC stage C: 785,57±194,25 pg/ml; BCLC stage D: 1537,97±660,62 pg/ml. Analisis one way ANOVA menunjukkan perbedaan bermakna (P<0,001) antara kadar serum VEGF dengan tingkat keparahan KHS berdasarkan klasifikasi BCLC. Analisis post hoc dengan Tukey Schaffe menunjukkan adanya perbedaan bermakna antara BCLC stage A dan C (p<0,05) serta BCLC stage A dan D (p< 0.001), BCLC stage B dan D (p<0.001), dan BCLC stage C dan D (p<0.001). Tidak ditemukan perbedaan bermakna antara subyek dengan BCLC stage A dan B, dan antara BCLC stage B dan C. Kesimpulan : Didapatkan kadar serum VEGF yang meningkat sesuai dengan tingkat keparahan KHS berdasarkan klasifikasi BCLC terutama untuk BCLC stage B ke atas.

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Background : The severity of Hepatocellular Carcinoma (HCC) stratified by Barcelona Clinic Liver Cancer (BCLC) staging classification has been one of the main prognostic factors of patients with HCC. Serum vascular endothelial growth factor (VEGF) examination can be reflect to predict the severity of HCC. Although, there is no consensus among experts about the severity of HCC staging and serum VEGF levels.

Aim : To determine the association between serum VEGF levels and severity of HCC.

Methods : A cross-sectional study to determine the association between serum VEGF levels and the severity of HCC stratified by BCLC staging classification. The study was conducted at Cipto Mangunkusumo Hospital between January 2015 and May 2015. One way ANOVA analysis was used to assess the association between serum VEGF levels and BCLC classification staging. Post hoc analysis will be done using Tukey Schaffe test.

Results: There were 61 HCC subjects included to this study. There were no subjects with BCLC stage 0. The mean VEGF serum level in patients with BCLC stage A was 288.26 ± 156.6 pg / ml; BCLC stage B: 434 ± 164.8 pg / ml; BCLC stage C: 785.57 ± 194.25 pg/ml; and BCLC stage D: 1537.97 ± 660.62 pg/ml. One way ANOVA showed significant statistical difference (P <0.001) between mean serum VEGF levels and the severity in all BCLC stages. Post hoc analysis using Tukey Schaffe test showed significant stastical difference between BCLC stage A and C (p<0.05), BCLC stage A and D (p<0.001), BCLC stage B and D (p<0.001), and BCLC stage C and D (p<0.001). There were no significant statistical differences between patients with BCLC stage A and B, and between BCLC stage B and C.

Conclusion: We found that increased levels of serum VEGF were associated with the severity of HCC based on BCLC staging classification, especially in patients with BCLC stage B and upwards."