Sustained Tau Phosphorylation and Microglial Activation Following Repetitive Traumatic Brain Injury

BACKGROUND: Repetitive traumatic brain injury (TBI), even without acute sequela, can induce a delayed neurodegenerative with overexpression of phosphorylated tau (p-tau) as hallmark, caused by chronic inflammation mediated in part by microglial activation. AIM: The aim of this study was to examine the dynamics of p-tau accumulation and microglial activation following repetitive TBI. MATERIALS AND METHODS: Thirty Sprague–Dawley rats were randomized into a sham control group and two treatment groups receiving three successive closed-skull impacts (TBI model) from a 40-g mass dropped from a 1-m height on alternating days (days 0, 1, 3, and 7). The first treatment group was sacrificed on the last day of trauma and the second treatment group after 7 days of no trauma. The expression level of p-tau was evaluated by AT-8 antibody immunostaining and microglial activation by anti-CD-68 immunostaining. RESULTS: Immunoexpression of AT-8 was significantly elevated 7 days after TBI compared to the last day of trauma and compared to the sham control group, while CD-68 expression was significantly higher than sham controls on the last day of trauma and remained elevated for 7 days without trauma. CONCLUSION: The study showed that brain trauma can induce p-tau overexpression and microglial activation that is sustained during the non-trauma period

SINOPSIS ILMU BEDAH SARAF

xiii,234 hlm.; 17x24,5 c

Pancreatic Cancer Early Detection Using Twin Support Vector Machine Based on Kernel

Early detection of pancreatic cancer is difficult, and thus many cases of pancreatic cancer are diagnosed late. When pancreatic cancer is detected, the cancer is usually well developed. Machine learning is an approach that is part of artificial intelligence and can detect pancreatic cancer early. This paper proposes a machine learning approach with the twin support vector machine (TWSVM) method as a new approach to detecting pancreatic cancer early. TWSVM aims to find two symmetry planes such that each plane has a distance close to one data class and as far as possible from another data class. TWSVM is fast in building a model and has good generalizations. However, TWSVM requires kernel functions to operate in the feature space. The kernel functions commonly used are the linear kernel, polynomial kernel, and radial basis function (RBF) kernel. This paper uses the TWSVM method with these kernels and compares the best kernel for use by TWSVM to detect pancreatic cancer early. In this paper, the TWSVM model with each kernel is evaluated using a 10-fold cross validation. The results obtained are that TWSVM based on the kernel is able to detect pancreatic cancer with good performance. However, the best kernel obtained is the RBF kernel, which produces an accuracy of 98%, a sensitivity of 97%, a specificity of 100%, and a running time of around 1.3408 s

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

Background. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

Background. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries

New Predictor of In-Hospital Mortality of The Surgically Treated Haemorrhagic Stroke: Subanalysis

At present there are no specific limits on the level of inflammatory markers which can be used as a boundary between excessive or non-inflammatory responses. We investigate the leukocytes count at hospital admission of spontaneous intracerebral haemorrhage patients to be proposed as a boundary between excessive inflammation and not excessive. This is a subanalysis from the study of the neuroprotective effect of tigecycline on brain injury due to spontaneous intracerebral haemorrhage supratentorial who underwent evacuation of the hematoma. Leukocytosis defined as a leukocyte count ≥ 11.000 cells/mL. The primary outcome was inhospital mortality and the secondary outcome was length of hospital stay (LOS). Statistical analysis conducted by chi-square or Fisher’s exact test and logistic regression. Seventy patients were included. Approximately 79% of the patients had leucocytosis. Leucocytosis was not associated with inhospital mortality or LOS of 15 days or longer. However, a leucocyte count of 20,000 mm3 or higher was associated with in-hospital mortality (odds ratio, 9.09; 95% confidence interval, 1.97 to 42.06; P = 0.005). A leucocyte count of 20,000/mm3 or higher can be proposed as a boundary of the excessive inflammation on spontaneous intracerebral haemorrhage. Prediktor Baru Kematian di Rumah Sakit untuk Pasien Stroke Hemoragik yang Dilakukan Operasi: Hasil Subanalisis Saat ini belum ada penanda khusus untuk menilai suatu respons inflamasi yang berlebihan atau tidak. Penelitian ini bermaksud mengungkap jumlah leukosit tertentu sebagai penanda inflamasi yang berlebihan pada pasien perdarahan otak spontan yang dilakukan operasi evakuasi hematoma intracranial. Penelitian Ini adalah subanalisis dari studi efek neuroprotektif tigecycline pada cedera otak akibat perdarahan intraserebral spontan yang menjalani evakuasi hematoma. Leukositosis didefinisikan sebagai jumlah leukosit ≥ 11.000 sel / mL. Luaran utamanya adalah kematian di rumah sakit dan luaran sekundernya adalah lama perawatan di rumah sakit (LOS= length of stay). Analisis statistik dilakukan dengan chi-square atau uji eksak Fisher dan regresi logistik. Hasil: 70 pasien dilibatkan. Sekitar 79% dari pasien memiliki leukositosis. Leucocytosis tidak berhubungan dengan kematian di rumah sakit atau LOS 15 hari atau lebih. Namun, jumlah leukosit 20.000 mm3 atau lebih tinggi berhubungan dengan kematian di rumah sakit (rasio odds, 9,09; interval kepercayaan 95%, 1,97 hingga 42,06; P = 0,005). Jumlah leukosit 20.000 / mm3 atau lebih tinggi dapat diusulkan sebagai batas peradangan berlebihan pada perdarahan intraserebral spontan.&nbsp

In retrospective, the gentle learning curve of unilateral laminectomy promotes favorable clinical outcomes

Background: The learning curve in implementing a new surgical procedure is often time-consuming and potentially comes with the additional risk of injury associated with an unusual surgical procedure, which may harm the patient. Aim: Evaluate intraoperative burden and neurologic recovery of spinal tumor resection following unilateral laminectomy procedures. Methods: Medical records of patients undergoing surgery for intradural spinal tumors from January 2015 to June 2020 were retrospectively reviewed. Preoperative and postoperative data were collected from medical records and interviews. The intraoperative burden was assessed by duration of surgery, estimated intraoperative blood loss (EIBL), and postoperative leukocyte count. Short-term and long-term outcomes were recorded. Data analysis was performed using descriptive statistics and Fisher's exact test. The neurological recovery rate is calculated by the Hirabayashi method, where a 75–100% score indicates an excellent neurological recovery. Results: Twenty-six records were included in this study. The mean duration of surgery was 180 (120–540) minutes, the mean EIBL was 175 (50 – 1,200) mL, and mean increase in postoperative leukocyte count was 5,670 (2,210 – 13,250) cells/mL, and the mean LOS was 6.5 (4 – 42) days. In 20 of 26 (76.9%) patients, gross total resection was achieved. An excellent neurological recovery rate was achieved in 81% of patients. Conclusion: Unilateral laminectomy procedures are adaptable without additional disadvantages, resulting in satisfactory clinical results

Status Koagulasi Pasien Cedera Kepala Sedang Berdasarkan Tromboelastografi dan Hemostasis Konvensional

 Pasien cedera kepala paling banyak di RSUPN dr. Cipto Mangunkusumo (RSCM), Jakarta adalah cedera kepala sedang (CKS) dan kelainan koagulasi dapat memperburuk luaran pasien cedera kepala. Untuk mengetahui status koagulasi dan luaran pada pasien CKS di RSCM dilakukan studi kohort prospektif pada bulan Oktober 2019 – Januari 2020 dengan subjek 20 pasien CKS. Dilakukan pemeriksaan hemostasis konvensional (trombosit, PT, APTT) dan viskoelastisitas darah menggunakan tromboelastografi (TEG). Dari pemeriksaan konvensional didapatkan gangguan koagulasi pada 5% pasien sedangkan dari pemeriksaan TEG diperoleh 60% subjek dengan gangguan koagulasi (55% hiperkoagulasi dan 5% hipokoagulasi). Median lama rawat inap adalah 7 (3-27) hari dan tidak didapatkan mortalitas. Tidak didapatkan perbedaan bermakna antara pemeriksaan hemostasis konvensional dengan TEG (uji Fisher, p>0,999) serta antara status TEG dengan lama rawat inap (Uji Mann-Whitney, p=0,243). Dari parameter TEG (R time, K time, alpha angle, dan MA) tidak didapatkan perbedaan bermakna dengan lama rawat (uji Mann Whitney dan korelasi Spearman). Terdapat perbedaan bermakna antara parameter TEG, yaitu R time (p<0,001) dan alpha angle (p=0,028) dengan hasil CT scan. Disimpulkan, hiperkoagulasi merupakan kelainan koagulasi yang paling sering pada pasien CKS.   Coagulation Status of Patients with Moderate Traumatic Brain Injury Based on Thromboelastography and Conventional Haemostasis Test   It is known that the majority of traumatic brain injury (TBI) patients in Cipto Mangunkusumo Hospital, Jakarta (RSCM) are comprised of moderate TBI. This prospective cohort study was done in RSCM to evaluate the coagulation status profile of 20 patients with moderate TBI using conventional hemostatic test (platelet count, PT, APTT) and blood viscoelasticity using thromboelastography (TEG) from October 2019 – January 2020. From conventional test, coagulopathy were detected in 5% patients, while from the TEG, coagulopathy were detected in 60% patients (55% hypercoagulopathy and 5% hypocoagulopathy). The outcome of the patients were evaluate using length of stay (LOS) which is 7 days (3-27 days) and mortality (no mortality found in this study). From statistical analysis, the conventional test result and TEG test are not significantly correlated (p>0.999). Thromboelastography test result are not significantly correlated with LOS (p=0.243). From each parameter of TEG (R time, K time, alpha angle, and MA) are not correlated with LOS (Mann Whitney test and Spearman’s correlation test). We found that 2 parameters of TEG, R time (p<0,001) and alpha angle (p=0,028) are significantly correlated with CT scan. In conclusion, hypercoagulopathy is the most coagulation abnormality that occurred in moderate TBI.  &nbsp

Status Koagulasi Pasien Cedera Kepala Sedang Berdasarkan Tromboelastografi dan Hemostasis Konvensional

 Pasien cedera kepala paling banyak di RSUPN dr. Cipto Mangunkusumo (RSCM), Jakarta adalah cedera kepala sedang (CKS) dan kelainan koagulasi dapat memperburuk luaran pasien cedera kepala. Untuk mengetahui status koagulasi dan luaran pada pasien CKS di RSCM dilakukan studi kohort prospektif pada bulan Oktober 2019 – Januari 2020 dengan subjek 20 pasien CKS. Dilakukan pemeriksaan hemostasis konvensional (trombosit, PT, APTT) dan viskoelastisitas darah menggunakan tromboelastografi (TEG). Dari pemeriksaan konvensional didapatkan gangguan koagulasi pada 5% pasien sedangkan dari pemeriksaan TEG diperoleh 60% subjek dengan gangguan koagulasi (55% hiperkoagulasi dan 5% hipokoagulasi). Median lama rawat inap adalah 7 (3-27) hari dan tidak didapatkan mortalitas. Tidak didapatkan perbedaan bermakna antara pemeriksaan hemostasis konvensional dengan TEG (uji Fisher, p>0,999) serta antara status TEG dengan lama rawat inap (Uji Mann-Whitney, p=0,243). Dari parameter TEG (R time, K time, alpha angle, dan MA) tidak didapatkan perbedaan bermakna dengan lama rawat (uji Mann Whitney dan korelasi Spearman). Terdapat perbedaan bermakna antara parameter TEG, yaitu R time (p<0,001) dan alpha angle (p=0,028) dengan hasil CT scan. Disimpulkan, hiperkoagulasi merupakan kelainan koagulasi yang paling sering pada pasien CKS.   Coagulation Status of Patients with Moderate Traumatic Brain Injury Based on Thromboelastography and Conventional Haemostasis Test   It is known that the majority of traumatic brain injury (TBI) patients in Cipto Mangunkusumo Hospital, Jakarta (RSCM) are comprised of moderate TBI. This prospective cohort study was done in RSCM to evaluate the coagulation status profile of 20 patients with moderate TBI using conventional hemostatic test (platelet count, PT, APTT) and blood viscoelasticity using thromboelastography (TEG) from October 2019 – January 2020. From conventional test, coagulopathy were detected in 5% patients, while from the TEG, coagulopathy were detected in 60% patients (55% hypercoagulopathy and 5% hypocoagulopathy). The outcome of the patients were evaluate using length of stay (LOS) which is 7 days (3-27 days) and mortality (no mortality found in this study). From statistical analysis, the conventional test result and TEG test are not significantly correlated (p>0.999). Thromboelastography test result are not significantly correlated with LOS (p=0.243). From each parameter of TEG (R time, K time, alpha angle, and MA) are not correlated with LOS (Mann Whitney test and Spearman’s correlation test). We found that 2 parameters of TEG, R time (p<0,001) and alpha angle (p=0,028) are significantly correlated with CT scan. In conclusion, hypercoagulopathy is the most coagulation abnormality that occurred in moderate TBI.  &nbsp