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Veronica Galih Gunarsih
"Latar belakang : Hipoksia merupakan bahaya potensial dalam penerbangan. Waktu sadar efektif (WSE) merupakan waktu ketika seorang penerbang atau awak pesawat mulai terpajan hipoksia sampai sebelum mengalami inkapasitansi. Selama rentang waktu tersebut seorang penerbang dapat membuat keputusan atau tindakan yang tepat. Hemoglobin sangat berpengaruh terhadap saturasi O2 yang menentukan oksigenasi jaringan tubuh. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi WSE yaitu pada calon dan awak pesawat militer di Indonesia.
Metode: Desain penelitian dengan potong lintang, pengambilan sampel secara purposif. Data diambil dari hasil pelaksanaan Indoktrinasi Latihan Aerofisiologi (ILA) di Lakespra Saryanto selama Januari-Mei 2014. Subyek penelitian adalah calon dan awak pesawat militer. Lama WSE diperoleh dengan demonstrasi hipoksia dalam ruang udara bertekanan rendah (RUBR) pada simulasi ketinggian 25000 kaki. Nilai kesamaptaan jasmani ditentukan dengan VO2maks. Analisis regresi linier digunakan untuk mengidentifikasi faktor risiko WSE.
Hasil: Calon dan awak pesawat militer yang melaksanakan ILA sebanyak 183 orang. Duapuluh lima subyek dikeluarkan karena tidak melaksanakan demonstrasi hipoksia di RUBR atau uji latih jantung, 158 subyek memenuhi kriteria inklusi. Faktor dominan yang memperpanjang WSE adalah Hb, sedangkan yang mempersingkat adalah IMT dan umur. Setiap 1 g/dL Hb menambah WSE 14,7 detik [koefisien regresi (β) = 14,677 ; p = 0,010].
Simpulan: Kenaikan IMT 1 kg/m2 mengurangi WSE 3,3 detik [β = -3,274; 95% interval kepercayaan (CI) = -8,287;1,738 ; p = 0,199]. Penambahan umur 1 tahun mengurangi WSE 3,9 detik (β = -3,917; p = 0,000).

Background: Hypoxia is potential hazard in aviation. Time of useful consciousness (TUC) is time during when a pilot or aircrew exposed hypoxia before experiencing incapacitation. During the span of time, a pilot can make the right decision or action. Haemoglobin (Hb) influences the oxygen saturation that determines oxygenation of the body tissue. This study aims to identify the factors affect WSE on candidates and military aircrew in Indonesia.
Methods: Study designed was cross sectional with purposive sampling. Data taken from the result of Indoktrinasi Latihan Aerofisiologi (ILA) in Lakespra Saryanto Jakarta during January to May 2014. Research subjects were candidates and military aircrews. Time of useful consciousness was obtained from hypoxia demonstration in hypobaric Chambers at 25000 feet altitude simulation. The value of physical fitness was determined by VO2max. Linear regression analysis was used to identify risk factors of TUC.
Results: Candidates and military aircrew carried out the ILA were 183 persons. Twenty-five subjects were excluded because of not carried out hypoxia demonstration in hypobaric chamber or treadmill test. The dominant factors that extend TUC were Hb. while shortening were BMI and age. Each 1 g/dL Hb extend TUC 14.7 seconds [regression coefficient (β) = 14.677 ; p = 0.010]. Increasing BMI of 1 kg/m2 shorten TUC 3.3 seconds [(β) = -3.274; 95% confidence interval (CI) = -8.287;1.738 ; p = 0.199]. Addition of age 1 year shorten TUC 3.3 seconds (β= -3.917 ; p = 0.000).
Conclusion: Increasing Hb extends TUC, while gain BMI and addition age shorten TUC.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Himmi Marsiati
"Pendahuluan: Penelitian dilakukan untuk mengetahui peran senyawa flavonoid mangiferin dalam meningkatkan ekspresi mRNA HIF-1α dan sebagai pencekal besi dalam menstabilkan HIF-1α pada lini sel HepG2 dan menganalisis interaksi mangiferin dengan prolil hidroksilase (PHD2) secara simulasi docking.
Metode: Sel HepG2 dikultur hingga >80% konfluen dan selanjutnya diberikan mangiferin konsentrasi 25-200μM. Kuersetin digunakan sebagai pembanding flavonoid mangiferin yang bekerja di dalam inti sel, sedangkan DFO dan CuCl2 digunakan sebagai pembanding daya ikat terhadap besi. Ekspresi mRNA HIF-1α ditentukan dengan real time RT- PCR/q-PCR, dan stabilisasi protein HIF-1α ditentukan mengunakan teknik ELISA. Simulasi docking dilakukan terhadap protein PHD2 dengan mangiferin, CuCl2, deferoksamin (DFO), dan campuran mangiferin+ kuersetin.
Hasil: Uji viabilitas sel menggunakan metode MTS dengan pemberian mangiferin, kuersetin, campuran mangiferin-kuersetin, DFO dan CuCl2 (25-200μM) memperlihatkan hasil diatas 85%. Ekspresi mRNA HIF-1α dengan mangiferin, kuersetin, mangiferin+kuersetin, dan DFO menunjukkan hasil sedikit lebih tinggi dibanding kontrol. Konsentrasi protein HIF-1α pada pemberian mangiferin, kuersetin, mangiferin-kuersetin, DFO dan CuCl2 lebih tinggi dibanding kontrol. Simulasi docking mangiferin terhadap PHD2 memperlihatkan ΔG= -16,22, dan DFO menunjukkan ΔG= -17,15. Terdapat interaksi antara mangiferin, dan DFO dengan besi dan asam amino pada situs katalitik domain PHD2, sedangkan CuCl2 tidak berinteraksi dengan residu asam amino pada domain PHD2, tetapi langsung menggantikan Fe. Efek penghambatan terhadap PHD2 oleh mangiferin dan kuersetin disebabkan oleh delokalisasi elektron melalui kompleks transfer elektron.
Kesimpulan: Mangiferin dapat meningkatkan ekspresi mRNA HIF-1α dan meningkatkan protein HIF-1α, menurun protein PHD2 dan menurunkan protein HO-HIF-1α pada lini sel HepG2 secara in vitro. Analisis docking terdapat interaksi antara mangiferin, dan DFO dengan besi dan asam amino PHD2. Mangiferin memiliki stabilitas pengkikatan dengan besi yang berdekatan dengan DFO.

Introduction: This research was conducted to determine the role of flavanoid mangiferin to increase expression HIF-1α mRNA, and as an iron chelator to stabilize protein HIF-1α in cell line HepG2 and analyzes the interaction of mangiferin with prolil hidroksilase (PHD2) by docking simulation.
Methods: HepG2 cells were cultured and treated by mangiferin with concentration between 25-200μM. Quercetin is used as a comparison mangiferin flavonoid that works in the nucleus and DFO, CuCl2 is used as a comparison to iron-binding. HIF- 1α mRNA expression was determined by real time RT-PCR/q-PCR, and the stability HIF-1α protein were measured by the increase in HIF-1α protein, decreased PHD2 protein and decreased HO-HIF-1α using ELISA. Docking simulation was conducted between PHD2 protein and mangiferin, CuCl2, desferoxamine (DFO), and quercetin.
Results: Cell viability with MTS assay showed that cell exposure with 25μM-200μM concentrations of mangiferin, quercetin, mangiferin+quercetin mixture, DFO, and CuCl2 is above 85%. HIF-1α mRNA expression was slightly higher than in controls with mangiferin, quercetin, mangiferin quercetin mixture and DFO. HIF-1α protein concentration and ratios vs untreated controls were above 1 with mangiferin, quercetin, mangiferin quercetin mixture, DFO, and CuCl2. Docking simulation mangiferin with PHD2 showed ΔG= -16,22. Docking simulation with DFO showed ΔG= -17,15, and interact mangiferin, and DFO with iron in the catalytic site of PHD2 and with amino acid residues, whereas CuCl2 does not react with amino acid residues in the PHD2 domain, but directly replaces Fe. The inhibitory effect to PHD2 by mangiferin and quercetin is considered by electron delocalisation through an electron transfer complex.
Conclusion: Mangiferin can increase HIF-1α mRNA expression and HIF-1α protein levels in HepG2 cell line by in vitro. Binding interaction with iron and PHD2 amino acids occurs by mangiferin and DFO. Mangiferin has stability iron binding a similar with DFO.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
D-Pdf
UI - Disertasi Membership  Universitas Indonesia Library
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Prinka Diaz Adyta
"Pendahuluan: Malnutrisi dan hipoksia merupakan faktor yang mempengaruhi kegagalan terapi pada KNF stadium lokal lanjut. Kadar albumin merupakan salah satu pemeriksaan status nutrisi. Hipoksia menyebabkan radioresistensi terhadap radiasi.Tujuan dari penelitian ini adalah mengetahui korelasi antara kadar albumin praradiasi, hipoksia terhadap respon radiasi.
Metode penelitian: Penelitian ini merupakan studi kohort retrospektif menggunakan data sekunder terhadap 40 pasien kanker nasofaring stadium lokal lanjut yang memenuhi kriteria inklusi di Departemen Radioterapi dan Departemen Patologi Anatomi RSUP Dr Cipto Mangunkusumo dari Desember 2012 sampai Agustus 2013. Dilakukan pencatatan kadar albumin praradiasi, berat badan serta CT scan sebelum dan sesudah radiasi. Kemudian dilakukan analisa HIF1α dengan pulasan imunohistokimia. Sel yang positif hipoksia dihitung per 10 lapang pandang besar. Setelah itu, dilakukan penilaian respon radiasi berdasarkan kriteria Recist.
Hasil: Rerata kadar albumin praradiasi sebesar 3,9 +/- 0,5 g/dL, dan median persentase hipoksia sel yaitu 24,7(1-100)%. Tidak terdapat hubungan yang bermakna antara kadar albumin praradiasi terhadap respon radiasi (p≥0,05). Terdapat hubungan yang bermakna anatara hipoksia terhadap respon radiasi (p<0,05). Korelasi antara kadar albumin praradiasi dan hipoksia menunujukkan korelasi yang lemah dan tidak bermakna (r=-0,24, p=0,324).
Kesimpulan: Hasil penelitian ini memperlihatkan bahwa albumin praradiasi tidak berhubungan dengan respon radiasi pada KNF stadium lokal lanjut. Terbukti bahwa hipoksia meningkatkan radioresistensi dan menurunkan respon radiasi. Tidak terdapat korelasi antara albumin praradiasi dan hipoksia.

Introduction: Malnutrion and hypoxia had been shown to cause irradiation failure. Albumin is one of the nutritional status examination. Hypoxia caused radioresistance to irradiation. The purpose of this study was to evaluate the correlation of albumin, hypoxia towards radiation response in locally advanced nasopharyngeal carcinoma.
Methods: This is a retrospective cohort study using secondary data from Departement of Radiotheraphy and Departement of Pathology Cipto Mangunkusomo hospital of 40 patients locally advanced nasopharyngeal cancer who meet the inclusion criteria from December 2012 to August 2013. Albumin preirradiation, body weight and CT scan before and after radiation were recorded. We examined the expression of HIF1 α by immunohistochemistry staining. Hypoxia cell was asessed by cell counting. Radiation response was determined by Recist criteria.
Results: The mean of serum albumin is 3.9 + / - 0.5 g /dL, and the median percentage of hypoxia was 24,7(1-100)%. There was no statistically significant relationship between albumin and radiation response (p≥0.05). There was a statistically significant relationship between hypoxia and radiation response (p<0,05). There were no correlation between albumin and hypoxia (r=-0,24, p=0,324).
Conclusion: This study showed that there was no correlation between albumin preirradiation and response in locally advanced nasopharyngeal cancer. It was proven that hypoxia increased radioresistance in locally advanced nasopharyngeal cancer. There was no correlation between albumin preirradiation and hypoxia.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T59152
UI - Tesis Membership  Universitas Indonesia Library
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Ninik Mudjihartini
"[ABSTRAK
Hipoksia berperan penting pada patofisiologi berbagai penyakit utama penyebab kematian seperti, penyakit jantung iskemia, strok, kanker, penyakit paru kronik, dan gagal jantung kongestif. Kedua protein golongan globin di otak, yaitu neuroglobin (Ngb) dan sitoglobin (Cygb) diduga berperan dalam suplai oksigen ke mitokondria dan melindungi jaringan otak dari kerusakan akibat hipoksia (neuroprotektan). Perubahan ekspresi protein merupakan salah satu bentuk adaptasi biokimia yang penting terhadap perubahan homeostasis. Oleh karena itu timbul pertanyaan bagaimana pola ekspresi Ngb dan Cygb serta peran neuroprotektan kedua protein tersebut di otak pada keadaan hipoksia sistemik kronik (HSK). Penelitian bertujuan manganalisis perbedaan pola ekspresi Ngb dan Cygb serta kaitannya dengan apoptosis pada HSK. Parameter yang diukur adalah Ngb, Cygb, sitokrom c, MDA, GSH dan HIF-lα. Rancangan penelitian yang digunakan adalah studi eksperimental in vivo model HSK pada tikus. Tikus sebagai hewan coba dibagi secara acak dalam 6 kelompok perlakuan, yaitu kelompok I adalah kelompok kontrol atau tanpa perlakuan hipoksia, sedangkan kelompok II, III, IV, V, dan VI mendapat perlakuan hipoksia dengan lama waktu hipoksia selama 1, 3, 5, 7, dan 14 hari. Parameter yang diperiksa meliputi ekspresi Ngb dan Cygb dengan teknik real time-RT PCR, ELISA dan imunofluoresen FITC, stres oksidatif, HIF-1α sebagai penanda hipoksia, dan sitokrom c sebagai penanda apoptosis. Hasil yang diperoleh HSK meningkatkan ekspresi mRNA Ngb pada hipoksia 3, 5, dan 7 hari, namun ekspresi proteinnya menurun pada hipoksia 1, 3, 5, 7, dan 14 hari dibanding dengan kontrol. Berbeda dengan ekspresi mRNA Cygb yang menurun selama hipoksia 1, 3, 5, 7, dan 14 hari, namun protein Cygb meningkat pada hipoksia 1, 3, 5, 7, dan 14 hari dibandingkan dengan kontrol. Korelasi Ngb dengan sitokrom c lemah tidak signifikan, sedangkan Cygb sangat lemah dan tidak signifikan. HSK menginduksi ekspresi HIF-lα yang meningkat tertinggi pada hipoksia 7 hari, dan menyebabkan stres oksidatif yang ditandai dengan meningkatnya MDA pada hipoksia 1, 3 dan 5 hari, serta menurunnya GSH pada hipoksia 1, 3, dan 5 hari. Penelitian ini membuktikan bahwa terdapat perbedaan pola ekspresi Ngb dan Cygb pada HSK. Ekspresi Ngb sebagai respons adaptasi terjadi lebih awal dan lebih dipengaruhi oleh lama waktu hipoksia dibandingkan dengan ekspresi Cygb. Meskipun lemah, Ngb cenderung mempunyai peran menghambat apoptosis dibandingkan dengan protein Cygb.;

ABSTRACT
Hypoxia has an important role in the pathophysiology of high mortality diseases, such as ischemic cardiovascular disease, stroke, cancer, chronic lung disease, and congestive heart failure. The proteins belonged to globin protein group, included neuroglobin (Ngb) and cytoglobin (Cygb), have been presumed to play a role in regulating the oxygen supply into the mitochondria and protecting the brain tissues from damage due to hypoxia (neuroprotectant). An alteration in protein expression due to a homeostatic shift is an important adaptation process in biochemistry. Therefore, the expression pattern of Ngb and Cygb as well as their protein roles in brain during a chronic systemic hypoxia condition (CSH) remain unclear. This study aim to analyse the differences of the Ngb and Cygb expression patterns, and correlation of both protein to apoptosis in chronic systemic hypoxic condition. Ngb, Cygb, Cytochrome c, MDA, GSH, and HIF-1 α. were examined. An in vivo experimental model of CSH was carried out using rat. The experimental rats were randomly divided into 6 treatment groups, i.e. group I was a control group or without hypoxic condition, groups II, III, IV, V, and VI were treated by hypoxic condition for 1, 3, 5, 7, and 14 days, respectively. The Ngb and Cygb expressions were analysed using real time-RTPCR, ELISA, immunofluorescence with FITC, and the measurement of stress oxidative biomarkers, included HIF-1α as a biomarker of hypoxic condition and cytochrome c as a biomarker of apoptosis. The CSH was increased the mRNA expression of Ngb at 3, 5, and 7 days hypoxic groups, while the protein expression was decreased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The mRNA expression of Cygb was decreased at 1, 3, 5, 7, and 14 days hypoxic groups, whereas the Cygb protein expression was increased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The correlation between Ngb with cytochrome c was weakly statistically insignificant, and Cygb with cytochrome c was statistically insignificant. The CSH induced the HIFlα, which was shown by a high increase at 7 days hypoxic group, as well as stress oxidative which was represented by MDA at 1, 3, and 5 days hypoxic groups, and decreased GSH at 1, 3, and 5 days hypoxic groups. There are differences in expression pattern of Ngb and Cygb in CSH. The expression of Ngb, as an adaptive response, occurs earlier and is more influenced by the duration of hypoxic condition compared to Cygb. Although the correlation is weak, the Ngb seems more likely to inhibit apoptosis compared to Cygb protein;Hypoxia has an important role in the pathophysiology of high mortality diseases, such as ischemic cardiovascular disease, stroke, cancer, chronic lung disease, and congestive heart failure. The proteins belonged to globin protein group, included neuroglobin (Ngb) and cytoglobin (Cygb), have been presumed to play a role in regulating the oxygen supply into the mitochondria and protecting the brain tissues from damage due to hypoxia (neuroprotectant). An alteration in protein expression due to a homeostatic shift is an important adaptation process in biochemistry. Therefore, the expression pattern of Ngb and Cygb as well as their protein roles in brain during a chronic systemic hypoxia condition (CSH) remain unclear. This study aim to analyse the differences of the Ngb and Cygb expression patterns, and correlation of both protein to apoptosis in chronic systemic hypoxic condition. Ngb, Cygb, Cytochrome c, MDA, GSH, and HIF-1 α. were examined. An in vivo experimental model of CSH was carried out using rat. The experimental rats were randomly divided into 6 treatment groups, i.e. group I was a control group or without hypoxic condition, groups II, III, IV, V, and VI were treated by hypoxic condition for 1, 3, 5, 7, and 14 days, respectively. The Ngb and Cygb expressions were analysed using real time-RTPCR, ELISA, immunofluorescence with FITC, and the measurement of stress oxidative biomarkers, included HIF-1α as a biomarker of hypoxic condition and cytochrome c as a biomarker of apoptosis. The CSH was increased the mRNA expression of Ngb at 3, 5, and 7 days hypoxic groups, while the protein expression was decreased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The mRNA expression of Cygb was decreased at 1, 3, 5, 7, and 14 days hypoxic groups, whereas the Cygb protein expression was increased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The correlation between Ngb with cytochrome c was weakly statistically insignificant, and Cygb with cytochrome c was statistically insignificant. The CSH induced the HIFlα, which was shown by a high increase at 7 days hypoxic group, as well as stress oxidative which was represented by MDA at 1, 3, and 5 days hypoxic groups, and decreased GSH at 1, 3, and 5 days hypoxic groups. There are differences in expression pattern of Ngb and Cygb in CSH. The expression of Ngb, as an adaptive response, occurs earlier and is more influenced by the duration of hypoxic condition compared to Cygb. Although the correlation is weak, the Ngb seems more likely to inhibit apoptosis compared to Cygb protein;Hypoxia has an important role in the pathophysiology of high mortality diseases, such as ischemic cardiovascular disease, stroke, cancer, chronic lung disease, and congestive heart failure. The proteins belonged to globin protein group, included neuroglobin (Ngb) and cytoglobin (Cygb), have been presumed to play a role in regulating the oxygen supply into the mitochondria and protecting the brain tissues from damage due to hypoxia (neuroprotectant). An alteration in protein expression due to a homeostatic shift is an important adaptation process in biochemistry. Therefore, the expression pattern of Ngb and Cygb as well as their protein roles in brain during a chronic systemic hypoxia condition (CSH) remain unclear. This study aim to analyse the differences of the Ngb and Cygb expression patterns, and correlation of both protein to apoptosis in chronic systemic hypoxic condition. Ngb, Cygb, Cytochrome c, MDA, GSH, and HIF-1 α. were examined. An in vivo experimental model of CSH was carried out using rat. The experimental rats were randomly divided into 6 treatment groups, i.e. group I was a control group or without hypoxic condition, groups II, III, IV, V, and VI were treated by hypoxic condition for 1, 3, 5, 7, and 14 days, respectively. The Ngb and Cygb expressions were analysed using real time-RTPCR, ELISA, immunofluorescence with FITC, and the measurement of stress oxidative biomarkers, included HIF-1α as a biomarker of hypoxic condition and cytochrome c as a biomarker of apoptosis. The CSH was increased the mRNA expression of Ngb at 3, 5, and 7 days hypoxic groups, while the protein expression was decreased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The mRNA expression of Cygb was decreased at 1, 3, 5, 7, and 14 days hypoxic groups, whereas the Cygb protein expression was increased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The correlation between Ngb with cytochrome c was weakly statistically insignificant, and Cygb with cytochrome c was statistically insignificant. The CSH induced the HIFlα, which was shown by a high increase at 7 days hypoxic group, as well as stress oxidative which was represented by MDA at 1, 3, and 5 days hypoxic groups, and decreased GSH at 1, 3, and 5 days hypoxic groups. There are differences in expression pattern of Ngb and Cygb in CSH. The expression of Ngb, as an adaptive response, occurs earlier and is more influenced by the duration of hypoxic condition compared to Cygb. Although the correlation is weak, the Ngb seems more likely to inhibit apoptosis compared to Cygb protein;Hypoxia has an important role in the pathophysiology of high mortality diseases, such as ischemic cardiovascular disease, stroke, cancer, chronic lung disease, and congestive heart failure. The proteins belonged to globin protein group, included neuroglobin (Ngb) and cytoglobin (Cygb), have been presumed to play a role in regulating the oxygen supply into the mitochondria and protecting the brain tissues from damage due to hypoxia (neuroprotectant). An alteration in protein expression due to a homeostatic shift is an important adaptation process in biochemistry. Therefore, the expression pattern of Ngb and Cygb as well as their protein roles in brain during a chronic systemic hypoxia condition (CSH) remain unclear. This study aim to analyse the differences of the Ngb and Cygb expression patterns, and correlation of both protein to apoptosis in chronic systemic hypoxic condition. Ngb, Cygb, Cytochrome c, MDA, GSH, and HIF-1 α. were examined. An in vivo experimental model of CSH was carried out using rat. The experimental rats were randomly divided into 6 treatment groups, i.e. group I was a control group or without hypoxic condition, groups II, III, IV, V, and VI were treated by hypoxic condition for 1, 3, 5, 7, and 14 days, respectively. The Ngb and Cygb expressions were analysed using real time-RTPCR, ELISA, immunofluorescence with FITC, and the measurement of stress oxidative biomarkers, included HIF-1α as a biomarker of hypoxic condition and cytochrome c as a biomarker of apoptosis. The CSH was increased the mRNA expression of Ngb at 3, 5, and 7 days hypoxic groups, while the protein expression was decreased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The mRNA expression of Cygb was decreased at 1, 3, 5, 7, and 14 days hypoxic groups, whereas the Cygb protein expression was increased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The correlation between Ngb with cytochrome c was weakly statistically insignificant, and Cygb with cytochrome c was statistically insignificant. The CSH induced the HIFlα, which was shown by a high increase at 7 days hypoxic group, as well as stress oxidative which was represented by MDA at 1, 3, and 5 days hypoxic groups, and decreased GSH at 1, 3, and 5 days hypoxic groups. There are differences in expression pattern of Ngb and Cygb in CSH. The expression of Ngb, as an adaptive response, occurs earlier and is more influenced by the duration of hypoxic condition compared to Cygb. Although the correlation is weak, the Ngb seems more likely to inhibit apoptosis compared to Cygb protein, Hypoxia has an important role in the pathophysiology of high mortality diseases, such as ischemic cardiovascular disease, stroke, cancer, chronic lung disease, and congestive heart failure. The proteins belonged to globin protein group, included neuroglobin (Ngb) and cytoglobin (Cygb), have been presumed to play a role in regulating the oxygen supply into the mitochondria and protecting the brain tissues from damage due to hypoxia (neuroprotectant). An alteration in protein expression due to a homeostatic shift is an important adaptation process in biochemistry. Therefore, the expression pattern of Ngb and Cygb as well as their protein roles in brain during a chronic systemic hypoxia condition (CSH) remain unclear. This study aim to analyse the differences of the Ngb and Cygb expression patterns, and correlation of both protein to apoptosis in chronic systemic hypoxic condition. Ngb, Cygb, Cytochrome c, MDA, GSH, and HIF-1 α. were examined. An in vivo experimental model of CSH was carried out using rat. The experimental rats were randomly divided into 6 treatment groups, i.e. group I was a control group or without hypoxic condition, groups II, III, IV, V, and VI were treated by hypoxic condition for 1, 3, 5, 7, and 14 days, respectively. The Ngb and Cygb expressions were analysed using real time-RTPCR, ELISA, immunofluorescence with FITC, and the measurement of stress oxidative biomarkers, included HIF-1α as a biomarker of hypoxic condition and cytochrome c as a biomarker of apoptosis. The CSH was increased the mRNA expression of Ngb at 3, 5, and 7 days hypoxic groups, while the protein expression was decreased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The mRNA expression of Cygb was decreased at 1, 3, 5, 7, and 14 days hypoxic groups, whereas the Cygb protein expression was increased at 1, 3, 5, 7, and 14 days hypoxic groups compared to control group. The correlation between Ngb with cytochrome c was weakly statistically insignificant, and Cygb with cytochrome c was statistically insignificant. The CSH induced the HIFlα, which was shown by a high increase at 7 days hypoxic group, as well as stress oxidative which was represented by MDA at 1, 3, and 5 days hypoxic groups, and decreased GSH at 1, 3, and 5 days hypoxic groups. There are differences in expression pattern of Ngb and Cygb in CSH. The expression of Ngb, as an adaptive response, occurs earlier and is more influenced by the duration of hypoxic condition compared to Cygb. Although the correlation is weak, the Ngb seems more likely to inhibit apoptosis compared to Cygb protein]"
2015
D-Pdf
UI - Disertasi Membership  Universitas Indonesia Library
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Endah Wulandari
"Latar belakang: Sitoglobin (Cygb) adalah protein pengangkut O2 yang diekspresikan oleh fibroblas dan fibroblast like cells aktif. Keperluan O2 dan energi meningkat pada fibrosis akibat proliferasi fibroblas dan sintesis kolagen. Pada fibrosis terjadi hipoksia yang ditandai oleh stabilisasi hypoxia inducible factor-1α (HIF-1α), yang kemudian membentuk HIF-1 yang merupakan faktor transkripsi untuk ekspresi protein adaptasi (termasuk Cygb). Diduga Cygb berperan dalam suplai O2 pada fibrosis. Tujuan penelitian ini adalah untuk memperoleh informasi mengenai peran Cygb pada hipoksia jaringan fibrosis dengan keloid sebagai model.
Metode: Penelitian bersifat observasional deskriptif. Sampel keloid diperoleh melalui biopsi, sedangkan kontrol preputium diperoleh melalui sirkumsisi, masing-masing 10 sampel jaringan. Pengukuran ekspresi mRNA Cygb, HIF-1α, kolagen I dan III dilakukan dengan real time RT-PCR; kadar protein Cygb dan HIF-1α dengan ELISA; dan ekspresi protein Cygb, HIF-1α, FGF, kolagen I dan III di lapisan dermis dengan imunohistokimia (IHK). Pengukuran kadar MDA dan GSH (tingkat stres oksidatif) serta kadar hidroksiprolin (untuk pematangan kolagen) dengan spektrofotometri, sedangkan pengukuran kepadatan kolagen dengan pewarnaan Van Gieson. Data dianalisis secara statistik menggunakan uji-t.
Hasil: Pada keloid dibandingkan preputium, ekspresi mRNA Cygb meningkat 8,7 kali, protein Cygb meningkat bermakna (1,196 Vs 0,779 ng/mg protein dan 95% Vs 63% ; p <0,05). Ekspresi mRNA HIF-1α meningkat 5,1 kali, protein HIF-1α meningkat bermakna (0,201 Vs 0,122 ng/mg protein dan 80% Vs 38%; p <0,05). Terdapat korelasi kuat antara ekspresi protein HIF-1α dan mRNA Cygb (Pearson; R = 0,649; p <0,01). Ekspresi protein FGF keloid meningkat bermakna (78% Vs 41%; p <0,05). Demikian pula ekspresi mRNA prokolagen I dan III keloid meningkat bermakna (35 kali dan 27,1 kali), serta ekspresi protein kolagen I dan III (61% Vs 37% dan 39% Vs. 16%; p <0,05). Juga terdapat korelasi kuat antara protein HIF-1α dengan FGF, prokolagen I dan III (Pearson; R= 0,878; R=0,960; dan R=0884; p<0,01). Kadar hiroksiprolin lebih tinggi pada keloid (0,297 Vs 276 ng/mg protein; p >0,05) dan pematangan kolagen lebih tinggi bermakna (1,2 kali; p <0,05). Cygb berkorelasi kuat dengan pematangan kolagen (kadar hidroksiprolin) (Pearson; R = 0,790; p <0,001).
Kesimpulan: Cygb berperan pada hipoksia jaringan fibrosis yang ditandai dengan peningkatan ekspresinya. Peran Cygb terkait dengan ekspresi HIF-1α yang berkorelasi dengan peningkatan FGF, pro/kolagen I dan III yang merupakan faktor penting pada fibrosis. Cygb juga berperan pada pematangan kolagen.

Background: Cytoglobin (Cygb) is an O2 carrier protein expressed by fibroblasts and active fibroblast like cells. O2 and energy demand increased in fibrosis due to proliferation of fibroblasts and synthesis of collagen. In fibrosis hypoxia occurred which is characterized by stabilization of hypoxia inducible factor-1α (HIF-1α), which later forming the HIF-1, a transcription factor for the expression of adaptation protein (including Cygb). Cygb alleged role in the supply of O2 in fibrosis. The purpose of this study was to obtain information about Cygb role in fibrosis hypoxia with keloid tissue as a model.
Methods: This was an observational descriptive study. Keloid samples were obtained from biopsy, while the preputium as control were obtained from circumcision, 10 tissue samples each. Measurement of Cygb, HIF-1α, collagen I and III mRNA expression were carried out by real time RT?PCR. Cygb and HIF-1α protein level were measured by ELISA; while Cygb, HIF-1α, FGF, and collagen I and III protein expressions in the dermis layer by immunohistochemistry (IHC). Measurement of MDA and GSH levels (oxidative stress) and hydroxyprolin concentration (marker of mature collagen) by spectrophotometry, while the collagen density measurement with van Gieson staining. Data were analyzed statistically using t-test.
Results: In keloid compared preputium, Cygb mRNA expression increased 8.7 times compared to preputium, Cygb protein increased significantly (1.196 Vs 0.779 ng/mg protein and 95% Vs 63%, p <0.05). HIF-1α mRNA expression increased by 5.1 times in keloid tissue, and protein HIF-1α increased significantly (0.201 Vs 0.122 ng/mg protein and 80% Vs 38%, p <0.05). There is a strong correlation between the expression of HIF-1α protein and Cygb mRNA (Pearson; R = 0.649, p <0.01). Keloid FGF protein expression increased significantly (78% Vs 41%; p <0.05). Similarly, mRNA expression of procollagen I and III keloid increased significantly (35 times and 27.1 times), and protein expression of collagen I and III (61% Vs 37% and 39% Vs 16%, p <0.05). There is also a strong correlation between HIF-1α protein with FGF, procollagen I and III (Pearson, R = 0.878, R = 0.960; and R = 0.884, p <0.01). Hydroxyprolin concentration were higher in keloid (0.297 Vs 0.276 ng/mg protein; p >0.05) and collagen maturation was significantly higher (1.2 times, p <0.05). Cygb is correlated with maturation of collagen (hydroxyproline levels) (Pearson, R = 0.790, p <0.001).
Conclusion: Cygb play role in fibrosis hypoxia which is characterized by its increased expression. Cygb role is associated with the expression of HIF-1α which are correlated with increased FGF, pro/collagen I and III, which are important factor in fibrosis. Cygb also play a role in the maturation of collagen."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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Maria Ekawati
"Pendahuluan: Hipoksia plasenta pada bayi prematur menyebabkan stres oksidatif yang merusak protein penaut endotel kapiler plasenta. Kerusakan pada kapiler plasenta diharapkan dapat menggambarkan perubahan permeabiltas kapiler otak yang menyebabkan perdarahan intraventrikel.
Metode: Penelitian observasional potong lintang terhadap 58 sampel plasenta bayi prematur. Hipoksia dinilai dari saturasi vena umbilikal, respon jaringan terhadap hipoksia dari kadar HIF-1α, stres oksidatif dari kadar malondialdehid (MDA) dan glutation (GSH). Integritas lapisan endotel dinilai dengan histomorfologi, ekspresi protein N-kaderin dan okludin dengan imunohistokimia, Glial fibrillary acidic protein (GFAP) sebagai petanda kerusakan perivaskular astrosit dan perdarahan intraventrikel dinilai dengan ultrasonografi kepala.
Hasil: Kadar HIF-1α lebih tinggi tidak bermakna pada kelompok hipoksia dibandingkan kelompok non hipoksia (uji t tidak berpasangan, p = 0,122); Kadar MDA jaringan plasenta lebih tinggi tidak bermakna sedangkan GSH lebih rendah tidak bermakna (Mann Whitney, p = 0,414 dan p = 0,810). Gambaran histomorfologi lebih tidak utuh tidak bermakna (Chi-square, p = 0,066), sedangkan ekspresi N-kaderin dan okludin lebih rendah bermakna (Chi-square, p = 0,001). Kadar GFAP serum lebih tinggi bermakna (Mann Whitney, p = 0,05). Korelasi tidak bermakna antara ekspresi N-kaderin dan okludin dengan perdarahan intraventrikel (Spearman?s rho, p = 0,869 dan p = 0,341).
Kesimpulan: Hipoksia pada plasenta menyebabkan perubahan ekspresi protein penaut endotel kapiler plasenta, secara molekuler sudah menyebabkan perubahan permeabilitas lapisan endotel kapiler plasenta tetapi secara struktural belum. Perubahan ekspresi protein penaut endotel kapiler plasenta tidak berhubungan dengan perdarahan intraventrikel.

Introduction: Plasental hypoxia in premature infants causes oxidative stress which inflicts damage to endothelial protein junction of placental capillary. It is expected that damaged of placental capillary can demonstate permeability changes in brain capillary that can cause intraventricular hemorrage.
Method:.a cross sectional observational study conducted on 58 placenta of premature infants. Hypoxia is determined by umbilical venous saturation. Tissue response to hypoxia determined by the level of HIF-1α, stress oxidative by the level of malondialdehide (MDA) and glutation (GSH). Endothelial layer integtrity by histomorfologi overview, N-cadherine and occludin by immunohistochemistry. Glial fibrillary acidic protein (GFAP) as perivascular astrocyte disruption marker and intraventricular hemorrhage carried by head ultrasound.
Result: The levels of HIF-1α was not significantly higher in hypoxia group compared to non hypoxia group (unpaired t test, p = 0,122); The level of placental MDA was not significantly hingher while GSH was not significantly lower (Mann Whitney, p = 0,414 and p = 0,810). Histomorpological overview was not significantly not intact (Chi-square, p = 0,066), while the expression of N-cadherine and occludin were significantly lower (Chi-square = 0,001). There was not significant correlation between protein junction expression with intravenrticular hemorrhage (Spearman?s rho, p = 0,869 and p = 0,341).
Conclution: Hypoxia causes lower expression of N-cadherin and occludin, moleculary it cause placental endothelial capillary permeability but structurally it does not. Protein expression changes does not correlate with intraventricular hemorrhage.
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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Aleida Nugraha
"Latar Belakang: Walaupun pesawat terbang telah dilengkapi dengan perangkat oksigen dan kabin bertekanan, kemungkinan hipoksia masih ada apabila terjadi kegagalan dari kedua sistem tersebut. Pengetahuan mengenai rentang waktu terjadinya hipoksia awal dan faktor-faktor kardiorespirasi yang berkorelasi dengan rentang waktu hipoksia awal perlu diketahui dan diteliti.
Metodologi: Studi eksperimental dilakukan pada 130 calon siswa Sekolah Penerbang TNI AU berusia 21-26 tahun; pada keadaan permukaan bumi diukur kadar hemoglobin, saturasi oksigen, fungsi faali kardiorespirasi dan kadar gula darah. Dalam ruang udara bertekanan rendah subyek dipajankan pada kondisi hipobarik dengan ketinggian setara 18.000 kaki. Diukur rentang waktu mulai saat pemajanan sampai terjadi saturasi oksigen 85 % dengan alat pulse oksimeter.
Hasil: Pada penelitian ini ditemukan rerata waktu terjadinya hipoksia awal 199,65 detik ; (95 % CI:192,64 - 206,66 detik). Faktor-faktor yang berkorelasi positif secara bermakna adalah kadar hemoglobin (r = 0,3396 ; p = 0,000) dan kadar gula darah (r = 0,4108 p = 0,000). Sedangkan frekuensi denyut nadi mempunyai korelasi negatif kuat (r = -0,4324 ; p=0,000). Model regresi yang sesuai untuk prediksi rentang waktu hipoksia awal terdiri dari faktor-faktor kadar hemoglobin frekuensi denyut nadi dan kadar gula darah.
Kesimpulan: Dengan mengetahui kadar hemoglobin, frekuensi denyut nadi dan kadar gula darah dapat diprediksi rentang waktu terjadinya hipoksia awal.

Elapsed Time To Early Hypoxia At Simulated Altitude 18.000 Feet In Hypobaric Chamber Indicated By 85% Oxyhaemoglobin Saturation And Its Influencing Factors Among Indonesian Air Force Flight Cadets.Background. Although aeroplanes are equipped with oxygen equipment and cabin pressurization, possibilities of hypoxia incidence still exists if there are system's failure. Information on elapsed time to early hypoxia should be available, and its correlation with cardiorespiratory factors should be investigated.
Methods. An experimental study on 130 Indonesian Air Force Flight Cadets age 21-26 years was conducted. Haemoglobin, oxyhaemoglobin saturation, cardiorespiratory function and blood sugar at ground level was measured In hypobaric chamber subjects were exposed to simulated altitude 18.000 feet environment. Elapsed time between the beginning of hypobaric exposure to early sign of hypoxia indicated by 85% oxyhaemoglobin satin-lion was measured.
Result. Average elapsed time to early hypoxia was 199, 65 seconds; (95 % CI:192,64 - 206,66 seconds). Significant positive correlation was found to haemoglobin (r = 0,3396 ; p = 0,000) and blood sugar levels (r = 0,4108 ; p = 0,000). Pulse rate showed negative correlation with elapsed time to early hypoxia (r = -0,4324 ; p = 0,000). The suitable regression model for estimating elapsed time to early hypoxia include haemoglobin,pulse rate, and blood sugar levels.
Conclusion. Predicted elapsed time to early hypoxia could be estimated by using haemoglobin, pulse rate, and blood sugar levels.
"
Depok: Universitas Indonesia, 1997
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Felix Sangkalia
"ABSTRAK
Latar belakang:
Penelitian terdahulu mengenai pengaruh hipoksia terhadap penglihatan warna masih kontroversial. Penglihatan warna penting dalam penerbangan. Tujuan penelitian ini adalah untuk mengetahui pengaruh hipoksia setara 18.000 kaki melalui ruang udara bertekanan rendah terhadap penglihatan warna. Studi dilakukan di Lakespra Saryanto Jakarta pada bulan Desember 1996. Sampel terdiri dari 101 orang laki-laki, calon penerbang sipil PLP Curug, berusia 17-23 tahun dan tamat SLTA. Disain penelitian kuasi eksperimen pre dan post test. Diperiksa faktor-faktor faali seperti: nadi, tekanan darah sistolik dan diastolik, rib dan kadar saturasi oksigen darah. Digunakan buku Ishihara 38 lembar untuk pemeriksaan penglihatan warna dengan cara menilai waktu baca lembar 1-38 (detik) dan kebenaran baca lembar 1-21 (9i).
Hasil penelitian :
Melalui uji t berpasangan, ditemukan perbedaan bermakna (p<0,05) antara: saturasi 02 darah, nadi, waktu baca dan kebenaran baca pada permukaan tanah dibanding pada 18.000 kaki. Pada 18.000 kaki: kadar saturasi 02 darah 68,17 % ±2,92 lebih rendah dibanding pada permukaan tanah; nadi 116,32 ±12,21 permenit lebih tinggi dibanding pada permukaan tanah; waktu baca 72,18 ± 15,05 detik rata-rata lebih lama 15,52 detik dibanding pada permukaan tanah; kebenaran baca 97,43 ± 3,36% lebih rendah dibanding pada permukaan tanah. Studi ini menunjukkan bahwa waktu baca dan kebenaran baca buku Ishihara pada permukaan tanah maupun pada 18.000 kaki masih dalam batas normal. Analisa multiple regression dan simple regression menunjukkan bahwa diramalkan waktu baca lebih singkat apabila tekanan diastolik lebih besar pada permukaan tanah diramalkan waktu baca lebih singkat apabila denyut nadi meningkat.
Kesimpulan
Studi penjajagan ini menunjukkan bahwa hipoksia setara 18.000 kaki meningkatkan waktu baca dan meningkatkan skor kesalahan baca tetapi tidak menyebabkan defisiensi penglihatan warna. Dibutuhkan penelitian lanjut dengan alat pemeriksaan warna yang lain untuk membandingkan studi ini.

ABSTRACT
Back ground :
Related previous studies indicated the controversial result on the relationship between hypoxia and color vision. Color vision is one of the major individual factors for pilots which relates to many aircraft accidents especially in hypoxia condition. This study aimed to identify the relationship between color vision and the hypoxic hypoxia among pilot candidates in a hypobaric chamber at the cruising altitude of 18.000 ft (FL 180). The number of samples collection are 101 pilot candidates from PLP Curug, ages 17-23 yr. The design of study was a pre and post test and Ishihara plates were used to measure color vision.
Results .
A t-paired test analysis showed the significant differences (p< 0,05) among variables : pulse, oxygen saturation levels, reading time and error scores at ground level (GL) and at flight level of 18.000 ft (FL180). At 18.000 ft, study results reported : increased of pulse rate (mean 116 ± 12,21 per minutes), increased of SaO2 (mean 68,17% ± 2,92%), increased of reading time (72,18 } 15.05 seconds) and increased of error scores {41,58%). Multiple regression and simple regression analysis showed that increasing of diastolic at GL would decrease reading time and increases of pulse rate. At FL 180 would decrease reading time.
Conclusions:
This preliminary study indicated, that there was an increase of reading time and increase of error scores by using Ishihara plates at FL 180 but these results had not made a deficiency of color vision. Advanced study with any other device to examine color vision are needed to compare the result of preliminary study.
"
Depok: Universitas Indonesia, 1997
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Carla Handayani
"Penelitian ini membahas tentang kadar karbonil sebagai penanda dari stress oksidatif di jantung akibat pajanan hipoksia hipobarik. Pada penerbang (pilot) sering mengalami keadaan hipoksia hipobarik karena mereka selalu menemui kondisi tersebut. Jantung, sebagai salah satu organ penting di tubuh sangat rentan terhadap paparan stres oksidatif yang disebabkan oleh hipoksia hipobarik. Pada penelitian ini, teknik penelitian yang dipilih adalah teknik eksperimental. Sampel jaringan yang dipakai adalah jaringan jantung tikus jantan galur winstar. Sampel ini lalu diklasifikasikan ke dalam empat perlakuan dengan perbedaan frekuensi pajanan hipoksia hipobarik dari hypoxia chamber dengan satu kelompok kontrol. Teknik yang digunakan untuk mengukur tingkat karbonil adalah teknik yang digunakan oleh Cayman's Protein Carbonyl Assay dan dimodifikasi oleh departemen biokimia di Fakultas Kedokteran Universitas Indonesia. Hasil penelitian menunjukkan adanya perbedaan tingkat karbonil yang bermakna antara grup perlakuan dan grup kontrol (p<0.05). Penelitian ini menggambarkan adanya peningkatan stress oksidatif yang bermakna pada keadaan hipoksia hipobarik di jaringan jantung tikus.

This research describes about the level of carbonyl concentration as marker of stress oxidative in the heart because of the exposure of hypobaric hypoxia. Hypobaric hypoxia is vulnerable in aviator (pilot) who usually meets this situation. Heart, as one of important organ in the body is vulnerable to the exposure of stress oxidative because of hypobaric hypoxia state. The technique chosen in this study is experimental method. The sample selected is heart tissue from male rats winstar. This sample then classified into four different exposed clusters with different hypobaric hypoxia frequency in hypoxia chamber and one control group. The technique used to quantify carbonyl concentration is the technique from Cayman's Protein Carbonyl Assay Procedure which then altered by biochemistry department in Universitas Indonesia. The result of this experiment demonstrated that there is a significant difference of carbonyl concentration among exposed and control group (p<0.05). This project illustrates that there is marked increase of stress oxidative in hypobaric hypoxia setting in heart tissue."
Depok: Fakultas Kedokteran Universitas Indonesia, 2023
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Luhur Pribadi
"Latar belakang: Kondisi hipoksia masih merupakan potensi paling berbahaya pada saat terbang, dan berhubungan dengan angka kejadian kecelakaan pesawat baik saat latihan atau tugas operasi. Deteksi dini terhadap efek fisiologis hipoksia sangat penting untuk mencegah bencana dalam penerbangan sipil dan militer.1Saat ini ada beberapa penelitian mengenai efek fisiologi pada hipobarik hipoksia terutama di bidang vascular. Fungsi endotel perifer vaskular dapat dinilai melalui pengukuran fungsi vasomotor. Tes non-invasif untuk menilainya dapat menggunakan pemeriksaan flow mediated dilation (FMD). Sejauh belum ada penelitian yang mencari hubungan antara fungsi endotel pembuluh darah perifer terhadap hipoksia sebagai acuan awal deteksi dini faktor risiko terjadinya hipoksia hipobarik pada awak pesawat.
Tujuan: Untuk mengetahui manfaat pemeriksaan disfungsi endotel terhadap hipoksia hipobarik
Metode: Sebanyak 59 awak pesawat TNI AU yang melakukan pemeriksaan kesehatan berkala dan latihan uji latih hipoksia d LAKESPRA SARYANTO dilakukan pemeriksaan FMD kemudian dihubungkan dengan menggunakan uji statisik antara WSE dan FMD.
Hasil: Didapatkan proporsi yang mengalami disfungsi endotel sebesar 23.7 %. Sedangkan proporsi subjek dengan WSE yang tidak normal sebesar 32%.Tidak terdapat hubungan bermakna antara disfungsi endotel dengan WSE (p=0,357) dan nilai r = 0,111.
Kesimpulan: Tidak terdapat hubungan bermakna antara disfungsi endotel dengan WSE.

Background: Hypoxia is still the most dangerous potential during flight, and is associated with the incidence of aircraft accidents both during training or operating duty. Early detection of physiological effects of hypoxia is very important to prevent mishap in civil and military flights. Currently there are several studies on the physiological effects of hypobaric hypoxia especially in the vascular. Vascular peripheral endothelial function can be assessed through measurement of vasomotor function. Non-invasive tests to assess can use flow mediated dilation (FMD). As far as there has been no research looking for a relationship between peripheral vascular endothelial function and hypoxia as an initial reference to early detection of risk factors for hypobaric hypoxia in aircrew
Objective: To determine the relationship between endothelial dysfunction examined by FMD against hypoxia with time of useful consciousness (TUC) parameters.
Methods: A total of 59 Indonesian Air Force crews conducting periodic medical examinations and hypoxic training in LAKESPRA SARYANTO were performed FMD examination and analyzed by correlation statistics between FMD and TUC.
Results: There was a proportion of 23.7% endothelial dysfunction. While the proportion of subjects with abnormal TUC was 32%. There was no significant relationship between endothelial dysfunction and TUC (p = 0.357) and r value = 0.111
Conclusion: There is no significant relationship between endothelial dysfunction and time of useful consciousness
"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T58739
UI - Tesis Membership  Universitas Indonesia Library
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