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Abstrak :
Astrositoma ialah tumor primer pada bagian intrakranial yang muncul dari sel astrosite otak. Penelitian ini menggunakan metodologi studi retrospective cohort yang bertujuan untuk mengetahui hubungan antara usia dan indeks proliferasi AgNOR pada pasien astrositoma. Dengan menganalisa data dari 48 pasien pada penelitian ini, dan menggunakan metodologi Spearman’s rho test, data data tersebut dianalisa. Hasil dari penelitian ini menunjukan bahwa indeks proliferasi AgNOR dan usia menunjukan korelasi satu sama lain (p < 0.01). Akan tetapi hubungan antara 2 variabel tersebut tidak kuat (koefisien korelasi = 0.504). Insiden tersering untuk kasus astrositoma ialah pada pasien pasien yang berusia diantara 41-50 tahun. ......Astrocytoma is a primary intracranial tumor arised from astrocytes cells of the brain and is the most common infiltrating glioma. The research design in this study is retrospective cohort study that aim is about finding relationship of Age and prognostic factor of astrocytoma. There were 48 participants included in this study, and by using Spearman’s rho correlation test statistical analysis, the data were analyzed. The result showed that both AgNOR proliferation index and age in astrocytoma patients showed a significant correlation each other (p <0.01). However, the relation between both variables was not strong (correlation coefficient = 0.504). Further, the most common incidence for astrocytoma case is in 41-50 age group patients.

Abstrak :
Dari pemeriksaan MRI, diperoleh gambar jaringan otak, yang akan digunakan oleh proton MRS untuk menentukan konsentrasi metabolit otak pada jaringan yang didiagnosa astrocytoma, seperti metabolit NAA, choline, creatine, Lipid, Lactate, Myoinositol, dan Glutamine-glutamate. Dari hasil MRS ini, astrocytoma dapat diklasifikasi berdasarkan derajat keganasannya (grade), yaitu high grade dan low grade. Proses klasifikasi astrocytoma, biasa dilakukan secara manual oleh ahli patologi atau secara statistik. Dalam skripsi ini, akan dibahas proses klasifikasi astrocytoma menjadi tiga kelas derajat keganasan dengan menggunakan metode Principal Component Analysis (PCA) dan Spherical K-Means terhadap data MRS. Algoritma Spherical K-Means merupakan algoritma K- Means dengan cosine similarity. Sedangkan PCA merupakan teknik yang digunakan untuk mencari vektor-vektor basis subruang tiap kelas (grade). Vektor-vektor basis ini akan membangun Principal Component yang akan digunakan dalam pengidentifikasian grade suatu data MRS. Data yang digunakan dalam skripsi ini adalah data yang berasal dari laboratorium radiologi Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta. Hasil penelitian yang dilakukan pada skripsi ini, diketahui bahwa PCA dapat mengklasifikasi astrocytoma dengan akurasi tertinggi, yaitu 85%. Selain itu, dari penelitian ini dihasilkan perangkat lunak yang dapat digunakan untuk membantu pengambilan keputusan yang terkait dengan klasifikasi astrocytoma menjadi high grade, low grade, dan normal. ......MRI gives information in form of brain tissue image, which will be used by MRS proton to determine the concentration of brain metabolites on the astrocytoma diagnosed tissue, such as NAA, choline (Cho), creatine (Cr), Lipid (Lip), Lactate (Lac), Myoinositol (MI), and Glutamine-glutamate (Glx). From that result, astrocytoma could be classified to high grade and low grade. This classifying could be processed manually by pathologist, or be processed statistically. On this essay, astrocytoma would be classified into three class of astrocytoma grades with the Principal Component Analysis (PCA) and Spherical K-Means of the MRS data. Spherical K-Means algorithm is a K-Means algorithm with cosine similarity. At the same time, PCA is a technique which used to find the basis vectors of each class (grade) subspace. These basis vectors would build Principal Component which would be used in identifying a grade of a MRS data. The data used in this essay is resourced from radiology laboratory of Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta. From this research, note that PCA can classify astrocytoma with the highest accuracy, ie 85%. In addition, this research produce software that can be used to assist decision making related to the classification of astrocytoma to high grade, low grade, and normal

Abstrak :
Magnetic Resonance Spectroscopy (MRS) membantu ahli radiologi untuk mengetahui tingkat keganasan dari kanker otak (astrocytoma). Dalam tugas akhir ini akan dibahas proses klasifikasi terhadap data hasil MRS untuk mengetahui tingkat keganasan dari astrocytoma yang terdiri dari Tingkat rendah (Low Grade), Tingkat tinggi (High Grade), dan Normal. Data yang digunakan dalam tugas akhir ini berasal dari RSU Pusat Nasional Dr. Cipto Mangunkusumo, Jakarta. Metode yang digunakan untuk klasifikasi adalah metode Independent Component Analysis dan metode Possibilistic C-Means. Hasil percobaan yang dilakukan menunjukkan bahwa metode Independent Component Analysis mempunyai nilai akurasi 96,67% sementara nilai akurasi dari metode Possibilistic C-Means mencapai 90,91%. Dalam tugas akhir ini, akan dibuat sebuah perangkat lunak untuk pendukung keputusan yang membantu memberikan informasi mengenai tingkat keganasan dari astrocytoma. ......Magnetic Resonance Spectroscopy (MRS) helps radiologists to determine the level of malignancy of brain cancer (astrocytoma). In this final project, we will discuss the classification process of MRS data to determine the level of malignancy of astrocytoma consisting of low grade, high grade, and normal. The data used in this final project comes from the National Central Hospital Dr. Cipto Mangunkusumo, Jakarta. The methods used for classification are the Independent Component Analysis method and the Possibilistic C-Means method. The experimental results show that the Independent Component Analysis method has an accuracy value of 96.67% while the accuracy value of the Possibilistic C-Means method reaches 90.91%. In this final project, a decision support software will be made to help provide information about the level of malignancy of astrocytoma.

Abstrak :
Analisis praktik residensi keperawatan medikal bedah merupakan karya ilmiah akhir Ners Spesialis. Bertujuan untuk memberikan gambaran secara umum proses pelaksanaan praktik residensi keperawatan medikal bedah yang dilaksanakan dalam dua semester. Analisis ini terdiri dari kasus kelolaan utama pada gangguan sistem neurologi dengan kasus astrositoma dan 30 kasus resum menggunakan pendekatan model adaptasi Roy, penerapan evidence based nursing (EBN) dan proyek inovasi. pada kasus kelolaan masalah masalah ketidakefektifan perfusi cerebral teratasi dan pada 30 kasus resum diagnosa terbanyak yaitu risiko jatuh dan ketidakefektifan perfusi cerebral. untuk peneraan evidence based nursing tentang Tongue stretching exercises (TSE) pada pasien stroke dengan gangguan menelan dan terbukti dapat meningkatan gerakan lidah dalam proses menelan. Untuk proyek inovasi melakukan tatalaksana perawatan pasca stroke terkini. Banyak manfaat yang didapatkan selama proses praktik residensi diantaranya melatihan berpikir kritis dalam mengelola kasus sulit, melatih keterampilan praktik, dan menerapkan intervensi berdasarkan bukti ilmiah. Diharapkan bagi bagi perawat untuk memberikan intervensi keperawatan berdasarkan bukti ilmiah dan selalu berlatih dalam berpikir kritis agar memiliki tingkat sensitifitas dalam melihat fenomena masalah pada pasien.

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Analysis of practice medical surgical nursing residency is the final scientific work of Specialist Nursing. The aim is to provide an overview of the process of implementing medical surgical nursing residency practices that got in two semesters. This analysis consists of cases of major management in neurological system disorders with astrocytoma cases and 30 cases of rums using Roy's adaptation model approach, application of evidence based nursing (EBN) and innovation projects. The case of managed cerebral perfusion problems the problem is managed and in 30 cases the most common diagnoses are the risk of falls and the ineffectiveness of cerebral perfusion. For evidence based nursing information about Tongue stretching exercises (TSE) in stroke patients with swallowing disorders and is proven to increase tongue movement in the swallowing process. Innovation projects carry out the latest post-stroke care management. Many benefits got during the residency practice process include training critical thinking in managing difficult cases, practicing practical skills, and implementing interventions based on scientific evidence. Hope is expected for nurses to provide nursing interventions based on scientific evidence and always practice critical thinking in order to have a sensitivity level in seeing the phenomenon of problems in patients.

Abstrak :
[Latar belakang—Metilasi dari gen promoter O6-methylguanine-DNA methyltransferase (MGMT) adalah salah satu faktor yang berperan pada karsinogenesis dan berkembang menjadi marker dalam menilai progresivisitas dan respons terapi astrositoma. Tujuan—Untuk mendapatkan gambaran frekuensi status metilasi gen promoter MGMT pada pasien astrositoma menggunakan methylation specific polymerase chain reaction (MS-PCR) dan methylation specific high resolution melting (MS-HRM). Metode—Dilakukan pengumpulan data klinis, imajing dan blok parafin jaringan astrositoma di RSCM dalam kurun waktu 2008-2012. Status metilasi gen promoter MGMT dianalisis menggunakan MS-PCR dan MS-HRM serta dihubungkan dengan berbagai faktor prognostik klinis. Penelitian ini adalah penelitian potong-lintang. Hasil— Didapatkan 13 sampel yang terdiri dari 7 astrositoma derajat rendah dan 6 astrositoma derajat tinggi. Metilasi gen promoter MGMT didapatkan pada 1/13 sampel astrositoma dengan MS-PCR dan 4/13 sampel dengan MS-HRM yang seluruhnya adalah astrositoma derajat rendah. Terdapat perbedaan yang bermakna antara status metilasi gen promoter MGMT dengan derajat keganasan astrositoma yaitu astrositoma derajat rendah 4/7 sampel, tanpa ditemukan pada astrositoma derajat tinggi (p=0.049) sedangkan faktor lain seperti usia, jenis kelamin, karnofsky performance scale (KPS), lokasi astrositoma dan derajat WHO tidak terdapat perbedaan yang bermakna (p= 1,000; p= 0,657; p= 0,354; p= 0,538). Simpulan—Penelitian saat ini menunjukkan frekuensi status metilasi gen promoter MGMT pada astrositoma sedikit berbeda dengan berbagai penelitian lain sebelumnya yaitu hipermetilasi hanya terjadi pada astrositoma derajat rendah. Penelitian ini merupakan penelitian pertama di Indonesia yang melaporkan gambaran status metilasi gen promoter MGMT pada pasien astrositoma. ......Background—Astrocytoma is the most common primary central nervous system tumor with difficult management as it requires a combination of surgery, chemotherapy and radiotherapy. This multimodal approach increases patients survival rate significantly, however chemotherapy resistance is now commonly seen. One of the potential causes of chemotherapy resistance is the epigenetic factors from O6 methylguanine-DNAmethyltransferase (MGMT) gene. MGMT gene has role in DNA repair and also have a protective effect against exyogen and endogeneous alkylating agent. The methylation of MGMT gene promoter leads to the decrease of MGMT protein, attenuating its function. Therefore, the methylation status of MGMT gene promoter can act as an indicator for astrocytomas progresivity and treatment aggressiveness. Objective—To determine the frequency of MGMT gene promoter methylation among patients with astrocytomas using methylation specific polymerase chain reaction (MS-PCR) and methylation sensitive high resolution melting (MS-HRM). Methods—Clinical data, imaging and parafin blocks from astrocytoma patients were collected in RSCM from 2008-2012. The methylation status of MGMT gene promoter was confirmed using MS-PCR and MS-HRM. This is cross-sectional study. Results—The total of 13 samples collected including 7 low-grade and 6 high-grade astrocytomas. The MGMT gene promoter was methylated in 1/13 cases using MS-PCR and 4/13 cases using MS-HRM. All methylated cases were low-grade astrocytoma. There was significant association between methylation status of MGMT gene promoter with degree of malignancy which is 4/7 samples hypermethylated in low-grade with no hypermethylation in high-grade astrocytomas (p=0.049). While other factors like age, sex, KPS and astrocytomas location have no significant association (p= 1,000; p= 0,657; p= 0,354; p= 0,538). Conclusions— The present study showed difference of methylation of MGMT gene promoter in astrocytomas with others studies which is hypermethylated MGMT only found in low grade astrocytomas. Our study was the first to report the frequency of MGMT promoter methylation among Indonesian astrocytoma patients., Background—Astrocytoma is the most common primary central nervous system tumor with difficult management as it requires a combination of surgery, chemotherapy and radiotherapy. This multimodal approach increases patients survival rate significantly, however chemotherapy resistance is now commonly seen. One of the potential causes of chemotherapy resistance is the epigenetic factors from O6 methylguanine-DNAmethyltransferase (MGMT) gene. MGMT gene has role in DNA repair and also have a protective effect against exyogen and endogeneous alkylating agent. The methylation of MGMT gene promoter leads to the decrease of MGMT protein, attenuating its function. Therefore, the methylation status of MGMT gene promoter can act as an indicator for astrocytomas progresivity and treatment aggressiveness. Objective—To determine the frequency of MGMT gene promoter methylation among patients with astrocytomas using methylation specific polymerase chain reaction (MS-PCR) and methylation sensitive high resolution melting (MS-HRM). Methods—Clinical data, imaging and parafin blocks from astrocytoma patients were collected in RSCM from 2008-2012. The methylation status of MGMT gene promoter was confirmed using MS-PCR and MS-HRM. This is cross-sectional study. Results—The total of 13 samples collected including 7 low-grade and 6 high-grade astrocytomas. The MGMT gene promoter was methylated in 1/13 cases using MS-PCR and 4/13 cases using MS-HRM. All methylated cases were low-grade astrocytoma. There was significant association between methylation status of MGMT gene promoter with degree of malignancy which is 4/7 samples hypermethylated in low-grade with no hypermethylation in high-grade astrocytomas (p=0.049). While other factors like age, sex, KPS and astrocytomas location have no significant association (p= 1,000; p= 0,657; p= 0,354; p= 0,538). Conclusions— The present study showed difference of methylation of MGMT gene promoter in astrocytomas with others studies which is hypermethylated MGMT only found in low grade astrocytomas. Our study was the first to report the frequency of MGMT promoter methylation among Indonesian astrocytoma patients.]