Ekspresi CD44 (Penanda Sel Punca Kanker) sebagai Faktor Prognostik Kekambuhan pada Kanker Ovarium Tipe Epitel Stadium III

Epithelial ovarian cancer is a deadly cancer, cancer recurrence and resistance post surgical staging and chemotherapy are major problems which will eventually occur in most advanced stage ovarian cancer. Recent investigations have unravelled the role of CSC/ Cancer Stem Cell in the cancer recurrence and therapy resistance, CD44 has been reported as a CSC marker in ovarian cancer, investigator wanted to analyse CD44 expression as recurrence prognostic factor in stage III epithelial ovarian cancer. Purpose: to analyse the role of CD44 expression as recurrence prognostic factor in stage III epithelial ovarian cancer. Metode: Hystorical Cohort, ICH CD44 examination was performed on the pathological ovarian cancer sample which diagnosed with platinum resistant recurrence (study sample) and platinum sensitive recurrence (control sample). CD44 expression was measured, the role as recurrence prognostic factor evaluated, influence of CD44 expression increasetowards earlier recurrence analysed, and the CD44 expression differences between 2 groups based on grade; pathological type; and stadium were measured and analysed. Results: 40 research subjects were involved in the research, with 20 among them were platinum resistant and the other 20 were platinum sensitive. Mean CD44 expression in the platinum resistant group was 36,80+29,54; while in the resistant platinum was 7,05+9,58. There was a significant difference of CD44 expression between 2 groups (p=0,000). There was a strong correlation between CD44 expression with the timing of recurrence (p=0,894). With the cut off of12,5; 85% platinum resistant subject had CD44>12,5; 85% platinum sensitive subject had CD44<12,5; with 85% sensitivity and 85% specificity as a good recurrence prognostic factor. Relative Risk (RR) of CD44 Expression is 5,667, RRof tumor residue post surgical staging is 2,513. Through logistic regression analysis, it was concluded that high expression of CD44 and tumor residue are risk factors for recurrences, patient with CD44 expression of ≥ 12,50 has possibility of earlier recurrence (< 6 months) 48,487 times compared with patient with CD44 expression of < 12,50 and patient with tumor residue of < 1cm has possibility of earlier recurrence 13,013 times compared with patient without macroscopic residue.Conclusion: This research found that CD44 expression can be used as recurrence prognostic factor in stage III epithelial ovarian cancer, CD44 expression was significantly higher in the platinum resistant group, there was negative correlationbetween CD44 expression with the timing of recurrence. CD44 expression as recurrence prognostic factor was not influenced with grade and pathologic type, but influenced by stage. Expression of CD44 and tumor residue post surgical staging are good predictors for recurrence timing

Psychological Respons (Anxiety and Depression) and Biological Respons (Cortisol, Ifn-γ and Tnf-α) in Ischemic Stroke Patients by Home Care Holistic Model Approach

Introduction: The patient with stroke often experience on psychological disorder such as anxiety and depression that lead to biologycal aspects such as on cytokin. The objective of the study was to analyse the corelation between psychological respons (anxiety and depression) and biological respons (cortisol, ifn-γ dan tnf-α) in ischemic stroke patients by home care holistic model approach. Method: This study applied an experimental research with quasy experimental design. The study was conducted in the area of Surabaya by selecting ischemic stroke patients after being hospitalised at ”A-Seruni room, Medic IRNA, Dr. Soetomo hospital”. A sample of size 40 was patients divided equally into two groups, control andtreatment groups. The treatment and control groups respectively received holistic home care and home care. The depression and anxiety level were measured by using questionnaires and observation technique, while Cortisol level, IFN-γ and TNF-α levels were measured by using ELISA quantitative technique. The data was analyzed by using Levene\u27s test for homogeneity of variance, t-test and correlation test. Result: The statistical analysis shows there was a significant difference between psychological response in control group after intervension with p = 0.000 for anxiety, and p = 0.000 for depression. For biological response, there is a significant difference p = 0.007 for cortisol and p = 0.000 for TNF-α. However, there is no significant difference in IFN-γ with p = 0.425. The correlation test result shows there was signi fi cant correlations between anxiety and biological responses such as Cortisol with r = 0.724 and p = 0.038; IFN-γ with r = 0.475 and p = 0.034; TNF-α with r = 0.592 and p = 0.006. Furthermore, there was positive correlation between depression and biological responses such as Cortisol with r = 0.705 and p = 0.033; IFN-γ with r = 0.454 and p = 0.044, TNF-α with r = 0.561 and p = 0.010. Discussion: Holistic home care could improve the psychological responses by decreasing anxiety and depression level and also could improve biological responses by decreasing Cortisol, IFN-γ and TNF-α level in ischemic stroke patients