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"Latar Belakang: Sarkopenia mempengaruhi prognosis karsinoma sel hati (KSH). Dalam penilaian klasifikasi Barcelona Clinic Liver Cancer (BCLC) terkandung penilaian status performa Eastern Cooperative Oncology Group (ECOG). Status performa ECOG merupakan penilaian aktivitas fisik terkait sarkopenia. Pemeriksaan baku emas sarkopenia pada KSH mahal dan membutuhkan banyak waktu. Pemeriksaan tebal otot paha dapat digunakan sebagai modalitas yang baru. Studi ini bertujuan untuk menilai hubungan antara status performa ECOG dengan sarkopenia pada KSH, mengetahui perbedaan rerata antara tebal otot paha pasien status performa ECOG rendah dengan status performa ECOG tinggi pada KSH, dan mengetahui perbedaan rerata antara tebal otot paha pasien sarkopenia dengan non sarkopenia pada KSH.Metode: Studi ini dilakukan di RS tersier selama Januari – Oktober 2021. Analisis statistik dilakukan untuk memperoleh hubungan antara status performa ECOG, tebal otot paha, dan status sarkopenik pasien KSH.Hasil: Delapan puluh lima subjek pasien KSH (usia median, 52 tahun) dilakukan analisis. Sarkopenia diamati pada 30,6% pasien KSH. Setelah melalui analisis multivariat, status performa ECOG buruk berhubungan dengan sarkopenia pada KSH (adjusted OR = 6,35, IK 95% 2,06-19,60). Terdapat perbedaan signifikan rerata tebal otot paha pasien status performa ECOG rendah dengan status performa ECOG tinggi pada KSH (p < 0,001). Terdapat juga perbedaan signifikan rerata tebal otot paha pasien sarkopenia dan non sarkopenia (p < 0,001).Kesimpulan: Terdapat hubungan antara status performa ECOG tinggi dengan sarkopenia pada KSH (aOR = 6,35, IK 95% 2,06-19,60). Rerata tebal otot paha pasien status performa ECOG rendah lebih besar dibanding dengan status performa ECOG tinggi pada karsinoma sel hati. Rerata tebal otot paha pasien non sarkopenia lebih besar dibanding dengan sarkopenia pada karsinoma sel hati.

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Background: Sarcopenia affects hepatocellular carcinoma (HCC) prognosis. HCC staging consists of Eastern Cooperative Oncology Group performance status (ECOG-PS). ECOG-PS is an assessment of physical activity related to sarcopenia. Gold standard examinations for sarcopenia in HCC are expensive and time-consuming. Thigh muscle thickness can be used as a new modality. This study was aimed to explore the association between ECOG-PS with sarcopenia, to seek thigh muscle thickness difference between poor and good performance status, and to know thigh muscle thickness difference between sarcopenic and non-sarcopenic patients with HCC.

Methods: The study was conducted in a tertiary hospital during January – October 2021. Statistical analysis was performed to obtain an association between ECOG-PS, thigh muscle thickness, and sarcopenic status of HCC patients.

Results: Eighty-five HCC patients (median age, 52 years) were analyzed. Sarcopenia was observed in 30,6% of HCC patients. On multivariate binary regression analysis, a poor ECOG-PS remained independently associated with sarcopenia in HCC (adjusted OR = 6,35, 95% CI 2,06-19,6, p < 0,001). There was a significant difference in thigh muscle thickness between good and poor performance status (p < 0,001). There was also a significant difference in thigh muscle thickness between sarcopenic and non-sarcopenic patients (p < 0,001).

Conclusion: There were association between ECOG-PS and sarcopenia in HCC (aOR = 6,35, IK 95% 2,06-19,60). Mean thigh muscle thickness was larger in HCC patients with good ECOG-PS than poor ECOG-PS. Mean thigh muscle thickness was larger in non-sarcopenic HCC patients than sarcopenic ones."

"Sarkopenia menyebabkan luaran buruk pada populasi hemodialisis reguler. Panduan diagnosis dan cara pengukuran yang berbeda menyebabkan rentang prevalensi yang besar. Faktor yang berperan terhadap sarkopenia pada hemodialisis reguler belum diketahui. Tujuan: Mengetahui prevalensi dan hubungan fosfat dengan sarkopenia pada hemodialisis reguler. Metode: Studi potong lintang observasional pada 96 pasien hemodialisis reguler, usia ≥18 tahun, lama hemodialisis ≥120 hari di RSCM (Maret-Mei 2022).Uji deskriptif, analisis bivariat, dan regresi logistik mendapatkan prevalensi dan hubungan antara Simplify Creatinine Index, DM type 2, IL-6, status gizi, aktivitas fisik, dan fosfat dengan sarkopenia. Diagnosis sarkopenia menggunakan kriteria AWGS 2019. Hand Grip Strength untuk kekuatan otot, massa otot dengan Bioimpedance Spectroscopy dan performa fisik dengan uji berjalan 6 meter. Hasil: Prevalensi sarkopenia adalah 54,2% dan rerata kadar fosfat 4,08 mg/dL (SB 1,45 mg/dL). Beda rerata kadar fosfat kelompok sarkopenia dengan kelompok tanpa sarkopenia adalah 3,73mg/dL vs 4,5 mg/dL, p=0,008. Faktor lain yang berhubungan dengan sarkopenia adalah SCI (p=0,005), dan aktivitas fisik ringan (p=0,006). Fosfat tidak berhubungan bermakna setelah menambahkan perancu. Kesimpulan: Prevalensi sarkopenia dengan kriteria AWGS 2019 pada populasi hemodialisis reguler adalah 54,2%. Kelompok sarkopenia memiliki rerata fosfat lebih rendah dibandingkan dengan kelompok tanpa sarkopenia, hubungan menjadi tidak bermakna setelah menambahkan variabel perancu.

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Sarcopenia asscociated with worse outcomes in MHD patients. Difference in criteria and methods used to diagnose causing wide range of prevalence. Factors asscociated with sarcopenia in MHD have not been well studied. Objective: to investigate the prevalence and asscociation between phosphate and sarcopenia in MHD. Methods: Observational cross-sectional study in 96 MHD patients ≥18 years old, dialysis vintage ≥120 days in RSCM March-May 2022. Descriptive, bivariate, and logistic regression used to find prevalence and asccociation with Simplify Creatinine Index, type 2 DM, IL-6, nutritional status, physical activity, and phosphate. AWGS 2019 criteria used to diagnose sarcopenia, Hand Grip Strength for muscle strength, Bioimpedance Spectroscopy for muscle mass, and 6-meter walk for physical performance. Results: Sarcopenia prevalence was 54.2% and mean phosphate was 4,08 mg/dL (SD 1,45 mg/dL). Mean difference of phosphate in sarcopenia group compared to non-sarcopenia group is 3,73mg/dL vs 4,5 mg/dL, p=0,008. Factors with significant association were SCI (p=0.005) and low physical activity (p-0.006). Phosphate no longer asscociate significantly with sarcopenia after adjustement. Conclusions: Sarcopenia prevalence in MHD population with AWGS 2019 criteria was 54.2%. Sarcopenia group has significant lower mean phosphate compared to non-sarcopenia group, but the asscociation no longer significant after adjustment with confounding variables."

"Latar Belakang: Sarkopenia dan obesitas sering ditemukan pada populasi lanjut usia (lansia). Kombinasi sarkopenia dan obesitas, yaitu obesitas sarkopenia, memiliki morbiditas dan mortalitas lebih tinggi dibandingkan salah satu entitas saja. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara obesitas perifer dan sentral dengan komponen sarkopenia. Metode: Studi potong-lintang ini memakai data sekunder dari penelitian validasi skor Sarcopenia Quality of Life (SARQoL) terhadap lansia ≥60 tahun di Poliklinik Geriatri Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia, periode April–Juni 2018. Analisis multivariat dilakukan terhadap obesitas (indeks massa tubuh [IMT] dan lingkar pinggang [LP]) dan komponen sarkopenia (kekuatan genggam tangan [KGT], indeks massa otot [appendicular skeletal muscle mass per tinggi badan kuadrat, ASMM/TB2], dan kecepatan berjalan) untuk disesuaikan dengan perancu (usia, diabetes melitus, dan aktivitas fisik). Nilai potong diagnostik masing-masing komponen sarkopenia memakai panduan the Asian Working Group on Sarcopenia (AWGS) 2019. Hasil: Rerata usia dari 120 subjek adalah 71,89 (6,11) tahun, dengan proporsi wanita 61,70%. Seluruh subjek menunjukkan rerata IMT 22,48 (4,60) kg/m2; median LP 91,48 (65,40-113,00) cm; rerata ASMM/TB2 6,88 (0,96) kg/m2; median KGT 20 (10,00-40,00) kg; dan rerata kecepatan berjalan 0,76 (0,23) meter/detik. KGT rendah ditemukan lebih sedikit pada kelompok obesitas perifer dibandingkan nonobesitas perifer (adjusted odds ratio OR 0,419; interval kepercayaan IK 95% 0,183-0,959; p=0,040). ASMM/TB2 rendah lebih sedikit pada kelompok obesitas sentral dibandingkan nonobesitas sentral (adjusted OR 0,087; IK 95% 0,029-0,262; p <0,001). Simpulan: Terdapat efek protektif obesitas perifer dan sentral terhadap sarkopenia, tetapi hubungan ini terbatas pada IMT <30 kg/m2.

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Background: Increasing number of elderly is accompanied by increasing prevalence of sarcopenia and obesity. Combination of sarcopenia and obesity, which is called as sarcopenic obesity, associated with higher morbidity and mortality compared to either obesity or sarcopenia alone. Objectives: This study aimed to determine the association between obesity profiles and sarcopenia components.

Methods: This cross-sectional study was using data from the validation study of Sarcopenia Quality of Life (SARQoL) score, of which conducted in geriatric outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Multivariate analysis between obesity (body mass index [BMI] and waist circumference [WC]) and sarcopenia components (handgrip strength [HGS], muscle mass index [appendicular skeletal muscle mass/ height square, ASMM/h2], and gait speed was adjusted to age, diabetes mellitus, and physical activities.

Results: Out of 120 subjects, there was 61.70% women. All subjects had mean of age 71.89 (6.11) years old; mean of BMI 22.48 (4.60) kg/m2; median of WC 91.48 (65.40-113.00) cm; mean of ASMM/h2 6.88 (0.96) kg/m2; median of HGS 20 (10.00-40.00) kg; and mean of gait speed 0.76 (0.23) meter/second. Low HGS was found statistically significant in lower proportion for peripheral obesity group than non-peripheral obesity group (adjusted odds ratio OR 0.419, 95% confidence interval CI 0.183-0.959, p=0.040); and low muscle mass index was lower in central obesity group than non-central obesity group (adjusted OR 0.087, 95% CI 0.029-0.262, p <0.001).

Conclusion: There were protective effects of peripheral and central obesity against sarcopenia"

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Penurunan massa otot pada usia lanjut menimbulkan sarkopenia,salah satu penyebabnya adalah proses inflamasi. Rasio asam lemak omega-3/omega-6 dapat memengaruhi proses inflamasi, namun hubungannya dengan massa otot masih menunjukkan hasil yang beragam. Penelitian potong lintang ini bertujuan untuk mengeksplorasi korelasi rasio asupan asam lemak omega-3/omega-6 dan kadar asam lemak omega-3 dengan massa otot pada usia lanjut di lima panti wreda yang terdaftar di Kota Tangerang Selatan. Penelitian ini melibatkan 101 usila yang didapatkan menggunakan proportional random sampling. Rasio asupan asam lemak omega-3 dan omega-6 dinilai menggunakan food record 3x24 jam dan food frequency questionnaire semikuantitatif, kadar asam lemak omega-3 membran eritrosit diukur menggunakan gas chromatography-mass spectrometry, dan pemeriksaan massa otot menggunakan bioelectrical impedance analysis. Analisis korelasi menggunakan uji Spearman. Didapatkan rerata usia subjek adalah 75.5 ± 7.6 tahun dengan 73.3% subjek adalah perempuan. Rasio asupan asam lemak omega-3/omega-6 subjek menggunakan food record adalah 0,09 (0,05-0,22) dan 0,08 (0,05-0,23) menggunakan FFQ semikuantitatif. Nilai tengah kadar asam lemak omega-3 membran eritrosit subjek untuk ALA=10,06 (4,9-24,9) µg/mL, EPA=14,6 (5,06-81,02) µg/mL, DHA=115,5 (20,6-275,09) µg/mL, dan total omega-3=144,1 (89,3-332,1) µg/mL. Nilai tengah massa otot subjek adalah 35,5 (22,8-63,5) kg. Hasil penelitian ini menunjukkan tidak terdapat korelasi antara rasio asupan asam lemak omega-3/omega-6 dengan massa otot baik menggunakan food record (r = -0.2, p = 0.07), maupun FFQ semikuantitatif (r = 0.01, p = 0.9), dan tidak terdapat korelasi antara kadar ALA, EPA, DHA, total asam lemak omega-3 membran eritrosit dengan massa otot berturut-turut (r = -0.03, p = 0.8; r = 0.01, p = 0.9; r = -0.06, p = 0.5; dan r = -0.02, p = 0.8).

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The phenomenon of muscle mass deterioration appeared in the elderly called sarcopenia, one of the reasons was the inflammatory process. The ratio of omega-3 and omega-6 fatty acids are known to influence the inflammatory process. However, the relationship of this ratio with muscle mass are still conflicting. This cross-sectional study aimed to explore the correlations of omega-3/omega-6 fatty acids intake ratio and omega-3 fatty acids erythrocyte membrane levels with muscle mass among the elderly in five registered nursing homes in South Tangerang City. This study involved 101 elderly from the proportional random sampling method. The ratio of omega-3 and omega-6 fatty acids intake was assessed using 3-days food records and semi-quantitative food frequency questionnaire (SQ-FFQ). Moreover, omega-3 fatty acid erythrocyte membrane levels were measured using gas chromatography-mass spectrometry and muscle mass were examined using bioelectrical impedance analysis. We used Spearman analysis to investigate the correlation. The mean age of the participants was 75.5 ± 7.6 years and most of the participants were female (73.3%). Furthermore, the median value of omega-3 and omega-6 fatty acid intake ratio was 0.09 (0.05 – 0.22) using 3-days food records and 0.08 (0.05 – 0.23) using SQ-FFQ, the median value of omega-3 erythrocyte membrane levels for ALA = 10.06 (4.9-24.9) µg/mL, EPA = 14.6 (5.06 – 81.02) µg/mL, DHA = 115.5 (20.6 – 275.09) µg/mL, total omega-3 = 144.1 (89.3 – 332.1) µg/mL, and the median value of muscle mass were 35.5 (22.8 – 63.5) kg. We did not find strong correlation between omega-3/omega-6 fatty acids intake ratio and muscle mass using either 3-days food records (r = -0.2, p = 0.07), or SQ-FFQ (r = 0.01, p = 0.9), and no strong correlations found between ALA, EPA, DHA, total omega-3 fatty acids erythrocyte membrane levels and muscle mass (r = -0.03, p = 0.8; r = 0.01, p = 0.9; r = -0.06, p = 0.5; and r = -0.02, p = 0.8), respectively.

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"Latar belakang: Peningkatan usia lanjut menimbulkan dampak kesehatan, diantaranya adalah sarkopenia dan kerapuhan. Kekuatan genggam tangan merupakan komponensarkopenia, fenotip sindrom kerapuhan, dan bersifat dinamis. Berbagai studi potonglintang menilai hubungan kekuataan genggam tangan dengan usia, jenis kelamin, statusnutrisi, status fungsional, status mental, dan komorbiditas namun temuan masihberagam. Selain itu, belum ada studi longitudinal untuk mengetahui hubunganperubahan kekuatan genggam tangan dengan usia, jenis kelamin, status nutrisi, statusfungsional, status mental dan komorbiditas di Indonesia.Tujuan: Mengetahui hubungan antara usia, jenis kelamin, status nutrisi, statusfungsional, status mental dan komorbiditas dengan perubahan kekuatan genggamtangan pada pasien usia lanjut.Metode: Penelitian kohort prospektif menggunakan data sekunder pasien usia lanjutyang kontrol rutin di Poliklinik Geriatri RSCM Jakarta dari register studi longitudinalINA-FRAGILE yang telah diobservasi selama 1 tahun (2013-2014). Uji analisismultivariat regresi logistik digunakan untuk menilai hubungan antara usia, jeniskelamin, status nutrisi (skor MNA), status fungsional (skor ADL), status mental (skorGDS-SF), indeks komorbiditas (skor CIRS) dengan perubahan kekuatan genggamtangan.Hasil: Dalam 1 tahun pengamatan dari 162 subjek, didapatkan rerata usia 72,9 (SB 5,9)tahun, jenis kelamin terbanyak perempuan (57,41%), memiliki nutrisi baik (83,9%),mandiri (median ADL 9–20), tidak depresi (median GDS-SF 0–11), rerata indekskomorbiditas 11,8 (SB 3,7), dan 53,1% mengalami penurunan kekuatan genggamtangan. Status nutrisi (OR=2,7; p=0,033) dan indeks komorbiditas (OR 0,3; p<0,002)berhubungan dengan kekuatan genggam tangan.Simpulan: Status nutrisi dan komorbiditas memengaruhi perubahan kekuatan genggamtangan pada pasien usia lanjut dalam 1 tahun di rawat jalan.

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Background: Increasing elderly population throughout the world has been related to

increased prevalence of sarcopenia and frailty. Handgrip strength is a component of

sarcopenia, one of frailty syndrome phenotypes, and a dynamic process. Previous

cross-sectional studies have assessed association of age, sex, nutritional status,

functional status, mental status and comorbodity but the results were varied. That being

said, there was no longitudinal study has been done to determine the correlation of

handgrip strength changes with age, sex, nutritional status, functional status, mental

status, and comorbidity in Indonesia.

Objective: To examine correlation between age, sex, nutritional status, functional

status, depressive symptopms, comorbidity, and handgrip strength changes in elderly

patients.

Methods: A prospective cohort study using secondary data of elderly patients whom

routinely visiting Geriatric Out-Patients Clinic at Cipto Mangunkusumo Hospital,

Jakarta from INA-FRAGILE register that have been observed for 1 year (2013-2014).

The multivariate logistic regression analysis was used to assess correlation between

sex, age, nutrional status (MNA score), functional status (ADL score), depressive

symptoms (GDS-SF score), comorbidities (CIRS score) and handgrip strength changes.

Results: From 162 subjects which were included in the study, the mean age was 72.9

(SB 5.9) years, predominantly female (57.41%), with good nutrition (83.9%),

independent (median 9- 20), not depressed (median 0-11), has average comorbidity

index 11.8 (SB 3.7), and 53.1% experienced decreased handgrip strength. Nutritional

status (OR = 2.7, p = 0.033) and comorbidity index (OR 0.3, p <0.002) correlated with

handgrip strength changes.

Conclusion: Nutritional status and comorbidity correlates with handgrip strength

changes in out-patients elderly within 1 year."

"Latar Belakang: Sarkopenia merupakan salah satu sindrom geriatri yang dapat menyebabkan luaran yang buruk. Dibutuhkan pemeriksaan yang lebih sederhana dibandingkan Bioelectrical Impedance Analysis (BIA) atau Dual energy X- ray Absorptiometry (DXA) untuk mengukur massa otot sebagai komponen penting sarkopenia. Namun, belum ada studi di Indonesia yang meneliti perannya dalam memprediksi massa otot pada pasien usia 60 tahun atau lebih. Tujuan: Mengetahui performa diagnostik lingkar betis untuk estimasi massa otot sebagai komponen sarkopenia pada pasien usia 60 tahun atau lebih. Metode: Penelitian ini merupakan suatu uji diagnostik menggunakan desain uji potong lintang yang dilakukan di poliklinik geriatri Departemen Ilmu Penyakit Dalam FKUI-RSCM selama bulan April-Juni 2018. Pengukuran massa otot menggunakan DXA dan penentuan titik potong berdasarkan Asian Working Group of Sarcopenia (AWGS). Hasil: Dari 120 subjek didapatkan 46 lelaki (38,3%) dan 74 perempuan (61,7%). Didapatkan titik potong lingkar betis kelompok lelaki dibawah 34 cm (sensitivitas 64.7%, spesifitas 79.3%, NDP 64.7%, NDN 79.3%, AUC 73.1%) dan 29 cm untuk perempuan (sensitivitas 71.4%, spesifitas 95.5%, NDP 62.5%, NDN 97.0%, AUC 96.4%). Simpulan: Akurasi diagnostik lingkar betis cukup baik sebagai prediktor massa otot pada pasien perempuan usia 60 tahun atau lebih.

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Background: Sarcopenia is one of the geriatric syndromes that lead to poor outcomes. A simpler method than Bioelectrical Impedance Analysis (BIA) or Dual energy X- ray Absorptiometry (DXA) is needed to measure muscle mass as essential component of sarcopenia. Previous studies have shown calf circumference (CC) as surrogate marker of muscle mass. However there has been no study on the role of CC in predicting muscle mass in both gender of elderly outpatient. Objectives: To investigate the diagnostic performance of CC to estimate muscle mass in elderly outpatient. Methods: A cross sectional study was conducted at Geriatric Outpatient Clinic of Cipto Mangunkusumo Hospital Jakarta during April-June 2018, using DXA as a reference test for measuring muscle mass. Asian Working Group of Sarcopenia (AWGS) criteria was used to classify muscle mass as normal or low. Results: Of the 120 subjects, 46 subjects were male (38.3%) and 74 were female (61.7%).The optimal Cut-off for CC that indicate low muscle mass was 34 cm for (sensitivity 64.7%, specificity 79.3%, PPV 64.7%, NPV 79.3%, AUC 73.1%) and 29 cm for female (sensitivity 71.4%, specificity 95.5%, PPV 62.5%, NPV 97.0%, AUC 96.4%). Conclusion: CC can be used to estimate muscle mass in female elderly outpatient, with good diagnostic performance."

"Latar Belakang: Dengan kesintasan lima tahun sebesar 18%, menempatkan karsinoma sel hati (KSH) sebagai kanker paling mematikan setelah kanker pankreas. Salah satu faktor yang diperkirakan berperan dalam menentukan prognosis KSH adalah kompsosisi tubuh pasien. Namun demikian, berbagai studi yang menilai sarkopenia sebagai faktor prognostik pasien KSH memberikan hasil yang inkonsisten. Tujuan: Menilai peran sarkopenia terhadap kesintasan dan kekambuhan pasien KSH. Sumber Data: Pencarian utama dilakukan pada basis data PubMed, ProQuest, EBSCOhost, Embase, dan Scopus hingga 1 September 2020. Pencarian sekunder dilakukan secara snowballing pada sitasi studi terkait dan perpustakaan elektronik serta pengumpulan informasi melalui Perhimpunan Peneliti Hati Indonesia. Seleksi Studi: Studi kohort yang menilai prognosis dengan melaporkan perbandingan kesintasan, mortalitas, dan/atau periode bebas penyakit pasien KSH berdasarkan ada atau tidak adanya sarkopenia serta periode observasi minimal tiga bulan akan diikutsertakan. Tidak ada batasan terhadap tahun publikasi dan bahasa. Penilaian terhadap judul, abstrak, dan studi dilakukan oleh dua peninjau independen. Dari 990 studi, 44 di antaranya memenuhi kriteria eligibilitas. Ekstraksi Data: Ekstraksi data dilakukan oleh kedua peninjau. Konfirmasi data studi dilakukan dengan menghubungi peneliti. Tidak ada data tambahan yang didapatkan.Hasil: Studi yang melaporkan kesintasan kumulatif dirangkum secara kualitatif. Studi yang melaporkan Cox proportional hazard ratio (HR) dimasukkan ke dalam meta-analisis. Hasil meta-analisis menggunakan random-effects model dari 39 studi menunjukkan sarkopenia berhubungan dengan kesintasan yang lebih rendah (HR 1.74, IK 95% 1.49-2.02) dibandingkan pasien KSH non-sarkopenia pada seluruh stadium. Sarkopenia juga berhubungan dengan kekambuhan yang lebih tinggi (HR 1.42, IK 95% 1.15-1.76) dibandingkan pasien KSH non-sarkopenia yang menjalani terapi kuratif. Analisis subgrup berdasarkan tujuan terapi (kuratif dan paliatif), jenis intervensi yang diberikan, serta parameter diagnostik yang digunakan tidak memengaruhi arah hasil luaran. Kesimpulan: Sarkopenia berhubungan dengan kesintasan pasien KSH yang lebih rendah dan periode bebas penyakit yang lebih singkat pada pasien yang menjalani terapi kuratif.

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Background: With overall 5-year survival of 18%, HCC is the second most lethal cancer after pancreatic cancer. One of the factors compromising prognosis in HCC patients is body composition. Nonetheless, studies evaluating sarcopenia as prognostic factor in HCC show inconsistent results. Objective: To assess the role of sarcopenia in overall survival and disease-free survival of HCC patients. Data Source: We searched PubMed, ProQuest, EBSCOhost, Embase and Scopus through September 1, 2020. Secondary searching was done by snowballing method including references of qualifying articles and manual searching through e-library and information gathering through Indonesian Association for the Study of Liver. Study Selection: Cohort studies evaluating prognosis and reporting comparation of overall survival, all-cause mortality, and/or disease-free survival of HCC patients with and without pre-existing sarcopenia and minimum observation period of three months were included. No restriction regarding year of publication and language. Titles, abstracts, and articles were reviewed by two independent reviewer. Of 990 studies identified in our original search, 44 articles met our eligibility criteria. Data extraction: Data extraction was done by two reviewer. We contacted authors for data confirmation and no additional information were obtained.Result: Studies reporting cumulative survival were summarized qualitatively. Studies reporting Cox proportional hazard ratio (HR) were combined in a metaanalysis. A random-effects model meta-analysis of 35 studies showed that sarcopenia was associated with an reduced overall survival HR of 1.59 (95% CI 1.42-1.77) and increased recurrence with HR of 1.10 (95% CI 1.03-1.17) after curative treatment compared with non-sarcopenic HCC patients through all stages. Subgroup analyses showed aim of treatment (curative vs palliative), type of interventions, and parameter used to define sarcopenia did not modify both clinical outcomes. Conclusion: Sarcopenia is associated with reduced overall survival and shorter disease-free survival in HCC patients."

"Latar belakang: Karsinoma sel hati (KSH) merupakan salah satu kanker dan penyebab kematian akibat kanker tersering. Magnetic resonance imaging (MRI) abdomen multifase adalah modalitas pilihan untuk diagnosis KSH, karena dapat menggambarkan perubahan patofisiologi selama hepatokarsinogenesis melalui sekuens dynamic contrast enhanced (DCE), T1-weighted imaging (T1WI) dengan chemical shift imaging, T2- weighted imaging (T2WI), diffusion-weighted imaging (DWI), peta apparent diffusion coefficient (ADC), serta fase hepatobilier. Alpha fetoprotein (AFP) sebagai penanda serologis KSH terkait surveilans, diagnostik, dan prognostik, juga berperan dalam hepatokarsinogenesis dengan menunjukkan perbedaan agresivitas tumor. Penelitian ini bertujuan menganalisis hubungan antara temuan morfologi dan karakteristik KSH pada MRI dengan kadar serum AFP.Metode: Studi retrospektif ini dilakukan pada pasien KSH yang menjalani MRI abdomen multifase kontras spesifik hepatobilier dan kadar serum AFP di RSUPN dr. Cipto Mangunkusumo, serta belum menjalani prosedur pengobatan apapun. Dilakukan analisis menggunakan uji Chi Square atau uji Mutlak Fisher antara temuan morfologis dan karakteristik KSH pada MRI, serta menggunakan uji Mann-Whitney antara nilai rerata apparent diffusion coefficient (ADC) dengan kadar serum AFP.Hasil: Diperoleh 82 subyek dengan usia rerata subyek 58 tahun, diameter tumor >5cm (58,5%) dan tumor multipel (59,8%) paling banyak ditemukan, serta memiliki perbedaan proporsi yang bermakna dengan kadar serum AFP (nilai p = 0,030 dan p = 0,000). Vaskularisasi tumor, kapsul tumor, lemak intratumoral, tumor hiperintens T2, restriksi difusi, dan tumor hipointens fase hepatobilier lebih banyak ditemukan pada kadar serum AFP ≥ 100ng/mL, namun tidak ditemukan perbedaan proporsi bermakna. Terdapat perbedaan bermakna nilai rerata ADC antara 39 subyek dengan kadar serum AFP < 100ng/mL dan 43 subyek dengan AFP ³ 100ng/mL. Median nilai rerata ADC 1,19 (0,71 – 2,20) pada subyek dengan kadar serum AFP < 100ng/mL, median 0,97 (0,72 – 1,77) pada subyek dengan AFP ≥ 100ng/mL, dan nilai p = 0,003.Simpulan: Proporsi tumor berdiameter > 5cm dan tumor multipel pada subyek dengan AFP ≥ 100ng/mL secara bermakna lebih tinggi dibandingkan pada subyek dengan AFP < 100ng/mL. Nilai rerata ADC pada subyek dengan AFP ≥ 100ng/mL secara bermakna lebih rendah dibandingkan AFP < 100ng/mL. Sehingga nilai rerata ADC dapat membantu memprediksi kadar serum AFP pada pasien KSH.

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Background: Hepatocellular carcinoma (HCC) is one of the most common cancers and cancer-related death. Multiphase contrast-enhanced abdominal magnetic resonance imaging (MRI) is the modality of choice for the diagnosis of KSH, as it can depict pathophysiologic changes during hepatocarcinogenesis through sequences: dynamic contrast enhanced (DCE), T1-weighted imaging (T1WI) with chemical shift imaging, T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, and hepatobiliary phase. Alpha fetoprotein (AFP) as a serological marker of HCC related to surveillance, diagnostics, and prognostics, also plays a role in hepatocarcinogenesis by showing differences in tumor aggressiveness. This study aims to analyze the relationship between morphological findings and characteristics of HCC on MRI with serum AFP levels.

Methods: This retrospective study was conducted on HCC patients who underwent hepatobiliary-specific contrast-enhanced multiphase abdominal MRI and serum AFP levels at Dr. Cipto Mangunkusumo Hospital, had not undergone any treatment procedures. Chi Square or Fisher's exact test between morphological findings and characteristics of HCC on MRI, and Mann-Whitney test between mean apparent diffusion coefficient (ADC) values and serum AFP levels were analyzed.

Results: There were 82 subjects with a mean age of 58 years, tumor size >5cm (58.5%) and multiple tumors (59.8%) were more common, had a significant difference in proportion with AFP serum levels (p value = 0.030 and p = 0.000). Tumor vascularization, tumor capsule, intratumoral fat, T2 hyperintense tumor, diffusion restriction, and hepatobiliary phase hypointense tumor were more common in serum AFP level ≥ 100ng/mL, but there was no significant difference in proportion. There was a significant difference in mean ADC between 39 subjects with serum AFP level < 100ng/mL and 43 subjects with AFP 100ng/mL. The median ADC score was 1.19 (0.71 – 2.20) in subjects with serum AFP level < 100ng/mL, median 0.97 (0.72 – 1.77) in subjects with AFP ≥ 100ng/mL, and p value is 0.003.

Conclusion: The proportion of tumors > 5cm in diameter and multiple tumors in subjects with AFP ≥ 100ng/mL was significantly higher than that in subjects with AFP < 100ng/mL. The mean value of ADC in subjects with AFP ≥ 100ng/mL was significantly lower than AFP < 100ng/mL. So that the mean value of ADC can help predict serum AFP levels in patients with HCC."

"Tesis ini disusun untuk mengetahui hubungan antara tingkat aktivitas fisik dan performa fisik dengan keadaan sarkopenia pada penderita obesitas usia lanjut di komunitas. Penelitian ini merupakan studi deskriptif analitik potong-lintang dengan teknik pengambilan secara konsekutif. Kriteria inklusi diantaranya adalah subjek berusia ≥ 60 tahun, indeks massa tubuh ≥ 25 Kg / m2, mampu berjalan minimal 10 meter dan fungsi kognitif baik, Subjek yang menggunakan alat pacu jantung, terdapat implant metal di dalam tubuh, memiliki riwayat penyakit kanker, gangguan kardiovaskular dan respirasi akut, deformitas atau nyeri pada ekstremitas dan mendapatkan latihan terapeutik atau olahraga teratur dieksklusi dari penelitian ini. Pengukuran tingkat aktivitas fisik menggunakan kuesioner Physical Activity Scale for Elderly (PASE) dan performa fisik menggunakan uji kecepatan berjalan 6 meter dan uji timed up and go test (TUG). Penegakkan sarkopenia berdasarkan kriteria Asian Working Group of Sarcopenia 2019 dengan pengukuran komposisi tubuh menggunakan Bioelectric Impedance Analysis (BIA). Pada penelitian ini, didapatkan proporsi sarkopenia pada keseluruhan subjek (n = 119) adalah 23,5% dengan 71,4% berjenis kelamin perempuan. Hasil analisis menunjukkan bahwa tidak ada hubungan yang signifikan pada variabel tingkat aktivitas fisik (p > 0,05) dan hubungan yang signifikan pada variabel kecepatan berjalan dan uji TUG (p < 0,05). Kesimpulan pada penelitian adalah terdapat hubungan yang signifikan antara performa fisik dengan kondisi sarkopenia pada penderita obesitas usia lanjut di komunitas.

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This thesis was aimed to determine the association between physical activity level and physical performance with sarcopenia in elderly obese patient in community. The research design is a cross sectional study with consecutive sampling. Inclusion criteria included subjects with age ≥ 60 years old, body mass index ≥ 25 Kg / m2, able to walk at least 10 meters, and has a good cognitive function. Subjects with pacemaker, have metal implants, history of cancer, acute cardiovascular and respiratory disorders, deformities or pain in extremities and receive regular therapeutic exercise were excluded from this research. Measurement of physical activity level using Physical Activity Scale for Elderly (PASE) questionnaire and physical performance using 6meter walking speed test and timed up and go test (TUG). Sarcopenia is based on criteria from Asian Working Group of Sarcopenia 2019 with body composition assessment using Bioelectric Impedance Analysis (BIA). In this research, the proportion of sarcopenia in all subjects (n = 119) was 23,5% with 71,4% was female. The results showed that there was no significant association on physical activity level (p > 0,05) and a significant association on walking speed and TUG test (p < 0,05). This research concluded that there is a significant association between physical performance with sarcopenia in elderly obese patient in the community."