Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Introduction: This study aims to know the performance of the Vascular – Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (V-POSSUM) score as a predictor of 30-day mortality after the Endovascular Aortic Aneurysm Repair (EVAR) – Thoracic Endovascular Aortic Repair (TEVAR) procedure in Abdominal Aortic Aneurysms (AAA) and Thoracic Aortic Aneurysms (TAA) patients in Cipto Mangunkusumo Hospital. Method: This was a retrospective cohort study using data from medical records. Data were taken according to the variables contained in the V-POSSUM scoring system in the patient who undergone EVAR – TEVAR procedure, on the period of 2013 to July 2018. Results: The study involved 85 patients who met the study requirements. It was known that physiological scores, morbidity risk, and mortality risk could be used as a model to predict mortality outcomes because they had good accuracy and discrimination performance, while the severity of the operation score cannot. The result of the goodness of fit model’s physiological score, morbidity risk, and mortality risk was significant (p <0.001), while the severity score of the operation was 0.18 (p >0.05). The Area Under the Curve (AUC) was 94%, 93%, 93%, with the cut points at 31, 68.8, and 10.6 for the physiological score, morbidity risk, and mortality risk, respectively. Conclusion: The V-POSSUM score had good accuracy and discrimination for the physiological score, morbidity risk, and mortality risk.

Abstrak :
PURPOSE: To evaluate and compare the clinical outcomes and hospital costs of using sutureless aortic valves vs conventional stented aortic valves.

METHODS: Between 2007 and 2011, 52 elderly patients undergoing aortic valve replacement for aortic stenosis in our center had a sutureless valve inserted. From among 180 patients who had a stented valve inserted during the same period, 52 patients were matched to the sutureless group, based on age, gender, and operation type. We compared clinical outcomes and hospital costs between the two groups.

RESULTS: The sutureless group had a higher Euroscore (logistic Euroscore I) risk (12,8 vs 9,7; p = 0,02), with significantly shorter aortic cross-clamp (ACC) time (p<0,01), cardiopulmonary bypass (CPB) time (p<0,01), intensive care unit stay (p<0,01), intubation time (p<0,01), and overall hospital stay (p=0.05). The sutureless group also revealed a significant hospital cost saving of approximately 8200 (p=0,01).

CONCLUSIONS: The clinical and hemodynamic outcomes of using the sutureless bioprosthesis were excellent. The reduced ACC and CPB times had a favorable effect on the duration of intubation and intensive care stay, resulting not only in faster recovery and discharge home, but also in a significant hospital cost reduction.

Abstrak :

Latar belakang: Operasi modifikasi Bentall merupakan pilihan utama terhadap tatalaksana penyakit aorta diseksi dan nondiseksi yang membutuhkan perbaikan pangkal aorta. Kerusakan ginjal akut (KGA) pascaoperasi modifikasi Bentall merupakan kejadian yang cukup sering ditemukan. Metode: Desain penelitian ini adalah kohort analitik retrospektif. Pasien dengan penyakit aorta diseksi tipe A dan nondiseksi aorta yang telah menjalani prosedur modifikasi Bentall (Januari 2015 sampai Desember 2018), dilakukan analisis faktor risiko preoperasi dan intraoperasi terhadap kejadian KGA pascaoperasi. Uji statistik dengan melakukan analisis bivariat dan multivariat. Hasil: Total subjek penelitian 82 pasien (43 pasien diseksi, dan 39 pasien nondiseksi). KGA tampak lebih besar pada kelompok diseksi (79,1% vs 39%, p = 0,001). Onset dini KGA pascaoperasi banyak ditemukan pada grup diseksi (p <0,05). Riwayat merokok (OR 4,130; p = 0,01) dan lama MHCA (OR 1,054; p = 0,001) merupakan faktor risiko yang paling memengaruhi kejadian KGA pascaoperasi tanpa membedakan stadium KGA. Simpulan: AKI pascaoperasi modifikasi Bentall ditemukan lebih banyak pada grup diseksi aorta. Riwayat merokok dan lama MHCA merupakan faktor risiko yang paling memengaruhi kejadian KGA pascaoperasi modifikasi Bentall tanpa membedakan stadium KGA. Onset kejadian KGA pascaoperasi dini didominasi oleh pasien pada grup diseksi aorta. 

---

Introduction: the Bentall modification procedure is considered the gold standard in treatment of patients with various aortic dissease requiring aortic root replacement. Postoperative acute kidney injury (AKI) are common among patients undergoing Bentall modification procedure. Methods: study design was retrospective cohort analytic. From January 2015 - December 2018, patients with type A aortic dissection and nondissection aortic who had undergone Bentall modification procedure was analize to find the correlation of preoperative and intraoperative risk factors with postoperative AKI. Bivariate and multivariate statistical analysis was perform. Results: 82 patients included, devided in to aortic dissection group (N = 43) and nondissection group (N = 39). Incidence of postoperative AKI found greater in aortic dissection group (79,1% vs 39%). early onset of postoperative AKI found greater in aortic dissection group (p < 0,05). History of smoking (OR 4,130; p = 0,01), and MHCA time (OR 1,054; p = 0,001) were associate with postoperative AKI. Conclusions: postoperative AKI after Bentall modification procedure found greater in aortic dissection. History of smoking and MHCA time associated with postoperative AKI after Bentall modification procedure. early onset of postoperative AKI dominated by patients in aortic dissection. 

Abstrak :
ABSTRAK
Latar belakang. Pada pasien SA fraksi ejeksi ventrikel kiri dapat normal bahkan supra normal untuk jangka waktu yang lama walaupun proses remodeling ventrikel kiri sudah mulai terjadi.. Ekokardiografi speckle tracking dua dimensi (EST) mempunyai kelebihan untuk digunakan dalam menilai penurunan fungsi kontraktilitas miokard subklinis, dimana keadaan tersebut dapat mempengaruhi prognosis pasien SA. sST2 merupakan biomarker yang relatif baru, dapat meningkat pada regangan otot jantung (myocardial stretch), fibrosis, inflamasi, dan injuri miokard, apakah berhubungan dengan disfungsi dini ventrikel kiri masih belum diketahui. Tujuan. Mengetahui korelasi sST2 terhadap nilai GLS EST pada pasien SA berat dengan FEVK normal Metode. Merupakan studi potong lintang. Evaluasi dilakukan pada 29 pasien stenosis aorta berat dengan fraksi ejeksi normal yang datang ke poliklinik RS Jantung Harapan Kita periode Februari 2015 sampai November 2015. Dilakukan pengambilan figur ekokardiografi untuk menilai severitas SA dan untuk perhitungan nilai global longitudinal strain speckle tracking kemudian dilakukan pengambilan sampel darah di laboratorium RS Jantung Harapan Kita untuk menilai sST2. Hasil Penelitian. Dua puluh sembilan subjek ikut dalam penelitian ini dengan rerata usia adalah 59.7±12.1 tahun. Fungsi intrinsik ventrikel kiri pasien SA berat pada penelitian ini mengalami penurunan dengan nilai rerata GLS -11±4.5%. Hasil uji korelasi menunjukan terdapat korelasi positif dengan kekuatan korelasi sedang yang bermakna (r=0.429, p=0.02). Analisis multivariat tetap menunjukkan adanya hubungan antara kadar sST2 dengan nilai GLS EST (r=0,282 p=0.036). Kesimpulan. Terdapat korelasi sST2 dengan global longitudinal strain speckle tracking pada pasien SA berat dengan fraksi ejeksi normal.ABSTRACT
Background. In severe aortic stenosis (AS), cardiac performance measured at the ventricular chamber is typically normal or supranormal, whereas Global Longitudinal Strain providing comprehensive information on LV myocardial contractility and is superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation, and myocardial injury. Whether sST2 is increased in relation to the subclinical LV dysfunction assessed by GLS in AS is unknown. Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe Methods. This is a correlation study with cross sectional design. The subject was aortic stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A comprehensive transthoracic echocardiography was performed to evaluate severity of aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line subsequent GLS analysis. sST2 measurements were drawn after echocardiography. Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1 years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%. A Pearson correlate revealed significant positive correlation between sST2 and GLS (r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still showed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation between sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe aortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at the ventricular chamber is typically normal or supranormal, whereas Global Longitudinal Strain providing comprehensive information on LV myocardial contractility and is superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation, and myocardial injury. Whether sST2 is increased in relation to the subclinical LV dysfunction assessed by GLS in AS is unknown. Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe Methods. This is a correlation study with cross sectional design. The subject was aortic stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A comprehensive transthoracic echocardiography was performed to evaluate severity of aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line subsequent GLS analysis. sST2 measurements were drawn after echocardiography. Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1 years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%. A Pearson correlate revealed significant positive correlation between sST2 and GLS (r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still showed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation between sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe aortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at the ventricular chamber is typically normal or supranormal, whereas Global Longitudinal Strain providing comprehensive information on LV myocardial contractility and is superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation, and myocardial injury. Whether sST2 is increased in relation to the subclinical LV dysfunction assessed by GLS in AS is unknown. Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe Methods. This is a correlation study with cross sectional design. The subject was aortic stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A comprehensive transthoracic echocardiography was performed to evaluate severity of aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line subsequent GLS analysis. sST2 measurements were drawn after echocardiography. Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1 years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%. A Pearson correlate revealed significant positive correlation between sST2 and GLS (r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still showed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation between sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe aortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at the ventricular chamber is typically normal or supranormal, whereas Global Longitudinal Strain providing comprehensive information on LV myocardial contractility and is superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation, and myocardial injury. Whether sST2 is increased in relation to the subclinical LV dysfunction assessed by GLS in AS is unknown. Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe Methods. This is a correlation study with cross sectional design. The subject was aortic stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A comprehensive transthoracic echocardiography was performed to evaluate severity of aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line subsequent GLS analysis. sST2 measurements were drawn after echocardiography. Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1 years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%. A Pearson correlate revealed significant positive correlation between sST2 and GLS (r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still showed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation between sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe aortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at the ventricular chamber is typically normal or supranormal, whereas Global Longitudinal Strain providing comprehensive information on LV myocardial contractility and is superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation, and myocardial injury. Whether sST2 is increased in relation to the subclinical LV dysfunction assessed by GLS in AS is unknown. Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe Methods. This is a correlation study with cross sectional design. The subject was aortic stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A comprehensive transthoracic echocardiography was performed to evaluate severity of aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line subsequent GLS analysis. sST2 measurements were drawn after echocardiography. Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1 years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%. A Pearson correlate revealed significant positive correlation between sST2 and GLS (r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still showed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation between sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe aortic stenosis with preserved EF.

Abstrak :
Praktik Residensi Ners Spesialis Keperawatan Medikal Bedah, Peminatan Keperawatan Kardiovaskular dilaksanakan di RS Jantung dan Pembuluh Darah Harapan Kita Jakarta selama dua semester bertujuan untuk mengaplikasikan peran ners spesialis dalam mengelola pasien gangguan kardiovaskular dengan menggunakan teori keperawatan Orem. Peran sebagai pemberi asuhan keperawatan dicapai dengan target mengelola 30 kasus resume dan 1 kasus kelolaan utama pasien dengan Post operasi Bentall dan MV repair pada Aneurisma aorta. Peran ners spesialis sebagai peneliti dicapai dengan penyusunan proposal penerapan intervensi keperawatan berbasis bukti (evidence based nursing practice), dengan topik akurasi penimbangan berat badan tiap hari dibandingkan dengan pencatatan keseimbangan cairan harian dalam menilai status hidrasi pasien gagal jantung. Peran sebagai inovator dilaksanakan secara kelompok berupa penerapan serah terima pasien terstruktur dengan metoda MDS-ECHO (Minimum Data Set for Effective Clinical HandOver). Hasil praktik residensi menunjukkan bahwa teori Orem efektif digunakan pada pasien dengan gangguan kardiovaskular dan metoda MDS-ECHO mendapatkan respon positif untuk dapat diterapkan di RS Jantung dan Pembuluh Darah Harapan Kita Jakarta. Proposal EBN tidak dapat dilaksanakan karena terkendala pandemi COVID 19. ......Medical Surgical Nursing Specialist Residency practice in Cardiovascular Nursing specialization is held at The National Cardiovascular Center Harapan Kita Hospital for two semester aiming to apply the role of specialist nurse in managing patients with cardiovascular disorders using Orem’s nursing theory. The role as a nursing care provider is achieved with the target of managing 30 resume cases and 1 main managed case of patient with Post Bentall surgery and MV repair on aortic aneurysm. The role of specialist nurse as researcher is achieved by preparing proposals for the application of evidence- based nursing practice, with the topic of the accuracy of weighing daily body weight compared to recording fluid balance in assessing the hydration status of heart failure patient. The role as an innovator is carried out in groups in the form of implementing structured patient handover using the MDS-ECHO (Minimum Data Set for Effective Clinical HandOver). The results of the residency practice show that Orem’s theory is effectively used in patient with cardiovascular disorders and the MDS-ECHO method gets a positive response to be applied at Harapan Kita Hospital. The EBN proposal could not be implemented due to the COVID 19 pandemic.

Abstrak :
Tesis ini membahas mengenai performa skor V-POSSUM sebagai prediktor mortalitas 30 hari pasca tindakan EVAR TEVAR pada pasien AAA dan TAA di RSUPN Cipto Mangunkusumo.Penelitian ini merupakan studi kohort retrospektif menggunakan data dari rekam medis. Data yang diambil sesuai variabel yang terdapat dalam sistem skoring dalam bentuk kategorik lalu diolah secara statistik untuk menguji validitas skor V-POSSUM. Hasil penelitian melibatkan 85 pasien yang memenuhi syarat penerimaan penelitian. Dari pengolahan data statistik diketahui bahwa skor fisiologis, risiko morbiditas, dan risiko mortalitas dapat digunakan sebagai model untuk memprediksi luaran kematian karena memiliki performa akurasi dan diskriminasi yang baik, sedangkan skor kepelikan operasi tidak dapat digunakan karena secara statistik tidak menunjukkan hal yang sama. Nilai P hasil perhitungan 'Goodnes of Fit Model' skor fisiologis, risiko morbiditas, risiko mortalitas masing-masing adalah 0.00, sedangkan skor kepelikan operasi 0.18 (>0.05). 'Area Under the Curve' (AUC) masing-masing adalah 94%, 93%, 93%, dengan titik potong masing-masing berada di angka 31, 68.8, dan 10.6. Sebagai kesimpulan adalah bahwa skor V-POSSUM memiliki akurasi dan diskriminasi yang baik bukan hanya pada skor risiko mortalitasnya saja, namun pada skor fisiologis dan skor risiko morbiditasnya. ...... This thesis discusses the performance of V-POSSUM score as a predictor of 30 days mortality after EVAR TEVAR in AAA and TAA patients at Cipto Mangunkusumo Hospital. This study is a retrospective cohort method using data from medical records. Data taken according to the variables contained in the scoring system in categorical form then processed statistically to test the validity of the V-POSSUM score. The results of the study involved 85 patients who met the research acceptance requirements. From the processing of statistical data it is known that physiological scores, morbidity risk, and mortality risk can be used as a model to predict the outcome of death because it has good performance in accuracy and discrimination, while the severity score of surgery cannot be used because it does not show the same result statistically. The P value calculated by the Goodnes of Fit Model physiological score, the morbidity risk, the mortality risk of each was 0.00, while the severity score of the operation was 0.18 (> 0.05). Area Under the Curve (AUC) are 94%, 93%, 93%, respectively, with points 31, 68.8 and 10.6. The conclusion is that the V-POSSUM score has good accuracy and discrimination not only on the mortality risk score, but also on the physiological score and the morbidity risk score.

Abstrak :
Pada organisme aerob, oksigen direduksi sempurna menjadi air di akhir rantai pernafasan di mitokondria yang menyediakan energi untuk menjaga fungsi normal set. Tetapi di dalam mitokondria ada molekul oksigen yang direduksi sebagian membentuk superoksida. Superoksida adalah radikal bebas, senyawa kimia yang mempunyai elektron tidak berpasangan. Radikal bebas sangat penting untuk banyak proses biologi seperti untuk melawan mikroorganisme yang patogen. Namun radikal bebas dapat merusak bila tidak dikontrol dan menyebabkan stres oksidatif. Stres oksidatif terjadi pula di jantung saat direoksigenasi setelah hipoksia, cedera yang terjadi disebut reperfusion injury. Jantung akan kehilangan fungsinya terutama kontraktilitasnya. Penelitian ini bertujuan untuk mengetahui efek kurkumin pada cedera reperfusi. Kurkumin adalah antioksidan yang mempunyai 2 cincin fenol. Kurkumin diduga' dapat mencegah ceders reperfusi setelah hipoksia jantung yang dilakukan pads model the isolated working heart. Penelitian ini menggunakan marmut jantan yang terbagi menjadi 3 kelompok, yaitu kelompok kontrol, kelompok kurkumin 0,25 1.tM, clan kelompok kurkumin 0,5 µM. Efek proteksi kurkumin dilihat dengan mengukur aliran darah koroner, aliran darah aorta, tekanan sistolik dan pengamatan histopatologi jantung. Aliran darah koroner meningkat selama reoksigenasi setelah 60 menit hipoksia, dengan kurkumin aliran darah koroner cenderung menurun. Aliran darah aorta dan tekanan sistolik menurun selama reoksigenasi setelah hipoksia 60 menu, dan cenderung meningkat setelah pemberian kurkumin. Histopatologi jantung yang direoksigenasi setelah hipoksia 60 menit memperlihatkan perubahan pada sel jantung. Kurkumin dosis 0,25 p.M cenderung iebih balk clan pada dosis 0,5 p.M dalam memproteksi jantung selama reoksigenasi setelah hipoksia 60 menit.

---

The Effect of Curcumin Toward Coronary Flow, Aortic Flow, And Systolic Pressure in Hypoxia and Reoxygenation Isolated Working Heart Guinea PigIn aerobic organisms oxygen is converted to water at the end of the respiratory chain in mitochondria which provide the energy needed to maintain normal body function and metabolism. However, in the same mitochondrial respiratory chain, oxygen is "partially reduced" to form super oxide. Super oxide is a free radical, a chemical species with an unpaired electron. Free radicals are essential for many normal biological processes, i.e., they are essential in the response of tissue to invading microorganisms. However, they can be destructive if they are not tightly controlled. The oxidative stress also changes the heart in reoxygenation after hypoxia, which is called as reperfusion injury. The heart loses its function, especially contractility. The present study was conducted to find out the effect of curcumin in reoxygenation injury. Curcumin is an antioxidant, a symmetrical compound with two phenyl rings. It is hypothesized that curcumin is active to reduce reperfusion injury after hypoxia in the heart, assayed by the working guinea pig heart model. Three groups of male guinea pigs were used in this study, consisting of control group, curcumin 0, 25 µM, and curcumin 0,5 pM groups. The protective effect of curcumin was investigated by measuring coronary flow, aortic flow and systolic pressure, and by observing the histopathology of the heart. Reoxygenation of the heart after 60 minutes of hypoxia resulted in increased coronary flow, and curcumin decreased the coronary flow. Aortic flow and systolic pressure decreased during reoxygenation after 60 minutes of hypoxia, and curcumin increased aortic flow and systolic pressure. histopathology of the heart after reoxygenation and 60 minutes of hypoxia showed changes of the myocardium. Curcumin 0,25 µM was better than curcumin 0,50 p.M as a protective agent during reoxygenation after 60 minutes of hypoxia.

Abstrak :
Kesemek (Diospyros kaki L.) merupakan tanaman tradisional Korea yang tumbuh di Indonesia dan secara empiris digunakan untuk kesehatan maternal. Penelitian dilakukan untuk mengetahui efek antioksidan yang dapat digunakan untuk mengurangi oksidasi LDL dan berpotensi sebagai antiaterosklerosis pada tikus putih jantan galur Sprague-Dawley yang di induksi dengan diet kolesterol. Uji antioksidan dengan metode DPPH menghasilkan nilai IC50 44,07 ± 15,06 mg/ mL. Hasil ANAVA satu arah (P= 0,05) menunjukkan penurunan nilai kolesterol total, trigliserida, dan LDL melalui perhitungan dan kenaikan HDL secara bermakna terhadap kelompok normal dan kontrol (-) serta penurunan tebal aorta dan jumlah sel busa . Sehingga disimpulkan ekstrak kesemek dapat mencegah aterosklerosis. ...... Persimmon fruits (Diospyros kaki L.) is a traditional plant in Korea and can be growth in Indonesia that has been used empirically to promote maternal health. The research has been done to figure out the antioxidant effect can use to prevent oxidation LDL and potential to the antiatherosclerosis on rats strain Sprague- Dawley previously induced by cholesterol diet. The scavenging activity against DPPH (1,1-diphenyl-2-picrylhydrazyl) radicals of the ethanol extracts of these plants were investigated. The extract of D. kaki was found to be the most potent, with an IC50 value of 44,07 ± 15,06 mg/ mL. One way ANOVA (P=0,05) of study showed reduction total cholesterol, triglycerides, LDL, and raise HDL were significantly amoung normal groups and control (-) along with relieve aortic sel foam. Result reflecting the protective effect of persimmon against atherosclerosis.

Abstrak :
Latar Belakang: Endovascular repair of abdominal aortic aneurysms (EVAR) menggunakan stent graft merupakan terapi utama pada pasien dengan aneurisma aorta abdominal. Aplikasi klinis EVAR dihadapkan dengan tingginya variasi anatomik aneurisma yang menyebabkan ketidaksesuaian ukuran stent yang dapat menyebabkan komplikasi berupa endoleak. Pembuatan instructions for use (IFU) merupakan upaya standardisasi dari produsen stent sehingga dapat sesuai dengan kondisi anatomik pasien dan menghindari komplikasi. Belum adanya penelitian mengenai kesesuaian IFU pada EVAR dan keluaran operasinya khususnya endoleak pasca-EVAR. Penelitian ini ditujukan untuk melihat hubungan kesesuaian IFU pada EVAR dengan kejadian endoleak pasca-EVAR. Metode: Studi dilakukan secara kohort retrospektif yang menilai hubungan kesesuaian IFU pada EVAR dengan kejadian endoleak pasca-EVAR. Penelitian akan dilakukan dari bulan Desember 2018-Februari 2019 di Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Pengambilan subjek dilakukan dengan pengambilan subjek total. Hasil: Pada pengambilan subjek didapatkan 39 subjek yang menjalani prosedur EVAR. Pada penelitian ini didapatkan 27 subjek (69.2%) menjalani EVAR sesuai dengan IFU dan 12 subjek (30.8%) tidak sesuai dengan IFU. Pada penelitian ini didapatkan 3 subjek penelitian (7.7%) mengalami endoleak pasca-EVAR. Pada analisis data, ditujukan bahwa kesesuaian IFU dalam menjalani EVAR tidak menunjukan hubungan yang bermakna dengan kejadian endoleak pasca-EVAR (p=0.539). Pada penelitian ini didapatkan bahwa seluruh pasien yang mengalami endoleak pasca-EVAR berasal dari kelompok yang menjalankan IFU yang sesuai. Analisis data panjang, sudut, dan diameter leher juga tidak menunjukan hubungan yang bermakna dengan kejadian endoleak pasca-EVAR. Kesimpulan: Tidak terdapat adanya hubungan antara kesesuaian IFU dalam menjalani EVAR dengan kejadian endoleak pasca-EVAR.

---

Background: Endovascular repair of abdominal aortic aneurysms (EVAR) with stent-graft is the main treatment for patients with abdominal aortic aneurysm. Clinical application of EVAR is faced with the wide anatomic variety of aneurysm that could lead to incompatibility of stent size that could cause complications like endoleak. Instruction of use (IFU) is a standardization effort from the producer of the stent so that it would be more suitable for the patients anatomical condition thus avoiding the complications. Up until now, there has not been a research that studied the use of IFU on EVAR and its post-surgical outcome, especially post-EVAR endoleak. The objective of this study is to see the association between IFU accordance in EVAR with post-EVAR endoleak. Method: The study was conducted by cohort-retrospective which assesses the association between IFU accordance in EVAR with post-EVAR endoleak. This study was done from December 2018 to February 2019 at vascular surgery out-patient clinic in Cipto Mangunkusumo Hospital. Total sampling was conducted to obtain subjects by collecting all patients treated by EVAR. Results: There were 39 subjects selected in this study. We found 27 subjects (69.2%) underwent EVAR appropriately according to IFU and 12 subjects (30.8%) that did not. Three of the subjects (7.7%) had post-EVAR endoleak. In the data analysis, IFU accordance in EVAR did not have a significant association with post-EVAR endoleak incidence (p=0.539). This study also found that every single subject with post-EVAR endoleak was from the IFU appropriate EVAR group. Data analysis on neck length, angle, and diameter also did not show any significant association with post-EVAR endoleak incidence (p>0.05). Conclusion: There is no association between IFU accordance in EVAR with post-EVAR endoleak. Another study with larger sample size is needed to show association between IFU accordance with post-EVAR endoleak more accurately.

Abstrak :
Latar Belakang: Penyakit AAA sebagian besar berlokasi pada infrarenal. Mortalitas meningkat dengan ruptur. Faktor risiko utama ruptur adalah diameter aneurisma dan hipertensi. Analisis computational fluid dynamic (CFD) pada aliran darah memungkinkan untuk mengetahui predileksi area tempat terjadinya ruptur. Wall shear stress (WSS) dan tekanan dinding merupakan parameter yang bisa dianalisis melalui CFD untuk melihat potensi ruptur pada AAA. Tujuan: Mengetahui morfologi aneurisma AAA infrarenal beserta sebaran nilai WSS dan tekanan dinding aneurisma berdasarkan CFD untuk memprediksi ruptur aneurisma. Metode: Studi cross-sectional dengan analisis CT angiogram pasien AAA infrarenal di Divisi Vaskular dan Endovaskular-Departemen Bedah dan Departemen Radiologi RSUPN Dr. Cipto Mangunkusumo pada bulan Juli–Desember 2022. Data CT angiografi diolah dengan Radiant Viewer untuk dijadikan model 3D. Dari keseluruhan sampel, dikelompokkan menjadi 5 tipe aneurisma. Kemudian masing-masing model dilakukan proses pembuatan solid vessel dengan Meshmixer. Proses selanjutnya adalah geometri, meshing, setup parameter CFD, dan solution untuk menghasilkan kontur WSS dan tekanan dinding pada berbagai kecepatan dan tekanan darah dengan program ANSYS 2022 R2 Academic Student. Hasil visual pada tiap tipe dianalisis dan dibandingkan. Uji statistik non-parametrik WSS dan tekanan dinding pada tiap tipe dan antar grup menggunakan SPSS 25.0 dengan nilai p dianggap bermakna jika p<0,05. Hasil: Dari 93 CT angiogram, setelah eksklusi didapatkan 40 sampel. Median usia 67 (47-76 th), dengan 90% adalah laki-laki. Sebanyak 25% sampel memiliki komponen sakular. Hasil analisis visual, terdapat korelasi area antara WSS terendah dengan tekanan dinding tertinggi. Perubahan kecepatan dan tekanan darah inisial juga mengubah nilai dan luas area pada kontur WSS dan tekanan dinding aorta, meskipun pusat perubahan kontur masih berada pada area yang relatif sama. Terdapat perbedaan bermakna pada WSS dan tekanan dinding (p=0,038 dan p<0,001). Kesimpulan: Area WSS terendah berkaitan dengan lokasi tekanan dinding tertinggi. Berubahnya kecepatan dan tekanan darah, mempengaruhi luas dan nilai dari WSS dan tekanan dinding. ......Background: AAA disease is mostly located in infrarenal. Mortality increases with rupture. The main risk factors for rupture are diameter sac and hypertension. Computational fluid dynamic (CFD) analysis of blood flow allows for a detection where rupture area will occur. Wall shear stress (WSS) and wall pressure are parameters that can be analyzed through CFD to see the potential location for rupture in AAA. Objective: Knowing the morphology of infrarenal AAA along with the distribution of WSS values ​​and aneurysmal wall pressure based on CFD to predict aneurysm rupture. Method: Cross-sectional study with CT angiogram analysis of infrarenal AAA patients in the Vascular and Endovascular Division-Department of Surgery and the Department of Radiology RSUPN Dr. Cipto Mangunkusumo in July–December 2022. CT angiography data was processed with Radiant Viewer to be used as a 3D model. From the whole sample, grouped into 5 types of aneurysms. Then for each model the process of making a solid vessel is carried out with the Meshmixer. The next process is geometry, meshing, CFD parameter setup, and solutions to produce WSS and wall pressure contours at various speeds and blood pressures with the ANSYS 2022 R2 Academic Student program. Visual results for each type were analyzed and compared. WSS and wall pressure non-parametric statistical test were performed for each type and between groups using SPSS 25.0 with a p-value considered significant if p <0.05. Results: Of the 93 CT angiograms, after exclusion, 40 samples were obtained. Median age 67 (47-76 years), with 90% were men. As much as 25% of the sample had a saccular component. The results of the visual analysis showed that there was an area correlation between the lowest WSS and the highest wall pressure. Changes in velocity and initial blood pressure also changed the value and area of ​​the WSS and the aortic wall pressure contours, although the center of the contour change was still in the relatively same area. There was a significant difference in WSS and wall pressure (p=0.038 and p<0.001). Conclusion: The area of ​​lowest WSS corresponds to the location of the highest wall pressure. Changes in blood velocity and pressure affect the area and value of WSS and wall pressure.