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Teratomas are the most prevalent type of germ cell tumors and usually display benign characteristics. Mature cystic teratomas consist of a varied mixture of mature tissue types that originate from squamous epithelium and skin adnexal structures. It is most commonly found in female gonads. A mature teratoma located in the abdomen of an adult male patient is exceptionally uncommon. In this case, we report a rare case of intra-abdominal mature cystic teratoma in an adult male.

Lipoblastoma is a benign soft tissue tumor that originates from embryonic white fat. Lipoblastoma presents as a slow-growing mass that commonly occurs in the extremities of young children. Histological examination remains the gold standard in confirming lipoblastoma; however, radiology examination can help identify and evaluate the extent and characterization of the mass prior to the excision. Here, we report a 7-year-old male patient who presented with a painless mass in the right popliteal extending to the proximal cruris areas, and the imaging modalities suggested the presence of fat within the mass. The patient then underwent complete excision, and histopathology examination revealed lipoblastoma. This study highlights the possibility of lipoblastoma in older children and the role of imaging examinations in the diagnosis.

Eva Krishna Sutedja,1 Endang Sutedja,1 Kartika Ruchiatan,1 Yogi Faldian,1 Yuri Yogya,1 Risa Miliawati Nurul Hidayah,1 Rafithia Anandita,1 Yohana Azhar,2 Anglita Yantisetiasti,3 Bethy Suryawathy Hernowo,3 Yovan Rivanzah1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Department of Surgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 3Department of Pathological Anatomy, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Eva Krishna Sutedja, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +628122014300 ext. 3449, Fax +62222032426, Email eva.krishna@unpad.ac.idAbstract: Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor involving the dermis and subcutaneous fat that rarely occurs in children, manifested as a slowly growing firm plaque on the trunk. A 12-year-old girl patient presented with dark patch on the nasal root after finishing 25 sessions of radiotherapy. Initially, patient came to Oncology Surgery Clinic at Hasan Sadikin General Hospital Bandung with the chief complaint of a large exophytic mass located in the nasal area, which was neither itchy nor painful. A large, firm, painless mass with no sign of localized heat or redness was found on physical examination. There were no palpable cervical or axillary lymph nodes. Wide local excision and frontal flap procedure were performed by Oncology Surgery Department leaving a pedicle with 2× 1.5× 1 cm on size was observed. Upon histopathological examination, tumor mass was found in the subepithelium and consisted of oval to spindle-shaped cells that were hyperplastic, compacted, diffuse, forming fasciculus, whorled, and cartwheel. Cell nuclei were pleomorphic (oval to wavy), hyperchromatic, with clear nucleolus, and occasion mitotic figures. Hyalinisation was seen between the tumor masses. On immunohistochemical stains, there were diffuse positivity for epithelial membrane antigen (EMA) and vimentin. Based on the histological and immunohistochemical findings, the diagnosis of stage II DFSP was made. Until now, there is no established algorithm for treatment of DFSP. Wide local excision and radiotherapy for 25 sessions was performed on this patient, resulting in complete tumor mass removal. After three months of observation, the second surgery was done to remove a pedicle; however, there is no recurrence of tumor growth. Despite its rarity, DFSP should be considered as a differential diagnosis to avoid underdiagnosis or misdiagnosis.Keywords: dermatofibrosarcoma protuberans, radiotherapy, wide local excision

Abstract Background Classical Hodgkin Lymphomas (HL) are a unique malignant growth with an excellent initial prognosis. However, 10–30% of patients will still relapse after remission. One primary cellular function that has been the focus of tumor progression is autophagy. This process can preserve cellular homeostasis under stressful conditions. Several studies have shown that autophagy may play a role in developing HL. Therefore, this review aimed to explore chemotherapy’s effect on autophagy in HL, and the effects of autophagy on HL. Methods A scoping review in line with the published PRISMA extension for scoping reviews (PRISMA-ScR) was conducted. A literature search was conducted on the MEDLINE database and the Cochrane Central Register of Controlled Trials (CENTRAL). All results were retrieved and screened, and the resulting articles were synthesized narratively. Results The results showed that some cancer chemotherapy also induces autophagic flux. Although the data on HL is limited, since the mechanisms of action of these drugs are similar, we can infer a similar relationship. However, this increased autophagy activity may reflect a mechanism for increasing tumor growth or a cellular compensation to inhibit its growth. Although evidence supports both views, we argued that autophagy allowed cancer cells to resist cell death, mainly due to DNA damage caused by cytotoxic drugs. Conclusion Autophagy reflects the cell’s adaptation to survive and explains why chemotherapy generally induces autophagy functions. However, further research on autophagy inhibition is needed as it presents a viable treatment strategy, especially against drug-resistant populations that may arise from HL chemotherapy regimens.

Metal soap pyrolysis is an attractive route for green gasoline fuel production because it is a straightforward process with no hydrogen supply needed and is operated under a pressure atmosphere. Pyrolysis of soap made from oleic acid is carried out via the catalytic route in a Py-GC reactor. Bivalent metals such as Zn, are evaluated as catalysts in pyrolysis. The preparation of a mixture of oleic acid: NaOH: Zn metal was studied at a concentration of 1:1:1. Thermal stability analysis of pyrolysis was studied at a temperature of 250oC with a heating rate of 10, 20, 40oC/min. This research aimed to figure out the characteristics of the relationship between raw materials, metal soap, and the bio-hydrocarbon products produced. Experimental results show that Zn metal can supply good temperature stability during the pyrolysis heat degradation process. Zn metal also can act as a catalyst, helping the decarboxylation reaction of oleic acid to become short-chain bio-hydrocarbons. The yield of short-chain bio-hydrocarbons C9-C18 was 0.04-7.33%w/w, meanwhile, long-chain bio-hydrocarbons reached 48.07%w/w. The presence of oxygenate compounds is due to the low quality of the raw materials. A decrease in the quality of raw materials can be caused by poor handling and storage of oleic acid as evaluated by large saponification, acid, and peroxide numbers.

المخلص: أهداف البحث: لدى مستقبلات فيتامين د أدوار كمضاد للسرطان لأنواع مختلفة من السرطانات. الهدف من هذه الدراسة هو تحديد الفروق في مستويات مستقبلات فيتامين د بين الورم الحويصلي المائي وورم النسيج الترويفي الحملي. طرق البحث: هذه دراسة مقارنة شملت ستة وستين نسيجا تم جمعها من الورم الحويصلي المائي وورم النسيج الترويفي الحملي. تم إجراء اختبار ''تي'' واختبار ''مان ويتني'' لمقارنة التعبير المناعي لمستقبلات فيتامين د، بما في ذلك شدة مستقبلات فيتامين د، توزيع مستقبلات فيتامين د، والتقدير التاريخي بين الورم الحويصلي المائي وورم النسيج الترويفي الحملي. النتائج: تم تضمين ما مجموعه ستة وستين عينة من الأنسجة في هذه الدراسة، تتألف من سبعة وثلاثين نسيجا تم تشخيصها بالورم الحويصلي المائي وأربعة وعشرين نسيجا تم تشخيصها بورم النسيج الترويفي الحملي. تمت المقارنة بين العمر والأعداد بين المرضى الذين يعانون من الورم الحويصلي المائي والمرضى الذين يعانون من ورم النسيج الترويفي الحملي، ولم يلاحظ وجود فروقات كبيرة في كلا المجموعتين. بالنسبة لحالات ورم النسيج الترويفي الحملي، كانت شدة مستقبلات فيتامين د أقل بشكل ملحوظ من شدة مستقبلات فيتامين د في نسيج الورم الحويصلي المائي. بالإضافة إلى ذلك، كان التقدير التاريخي في نسيج ورم النسيج الترويفي الحملي أقل بشكل ملحوظ من التقدير التاريخي في نسيج الورم الحويصلي المائي. ومع ذلك، لم يكن هناك فروقات كبيرة في توزيع مستقبلات فيتامين د بين نسيج ورم النسيج الترويفي الحملي ونسيج الورم الحويصلي المائي. الاستنتاجات: كان التعبير المنخفض لمستقبلات فيتامين د مرتبطا بورم النسيج الترويفي الحملي. بالمقابل، كان التعبيرالعالي لمستقبلات فيتامين د مرتبطا بالورم الحويصلي المائي. تشير هذه النتائج إلى أن مستويات مستقبلات فيتامين د قد تلعب دورا في شدة مرض النسيج الترويفي الحملي. Abstract: Objective: Vitamin D receptor (VDR) exerts anti-cancer properties in a variety of cancers. The purpose of this study was to investigate the expression of VDR in patients with hydatidiform mole (HM) and gestational trophoblastic neoplasia (GTN). Methods: This is a cross-sectional study involved 61 specimens of HM (n = 37, 60.7%) and GTN (n = 24, 39.3%) was collected from the biopsy. An immunohistochemistry was used to asses the VDR expression. Student's t-test and Mann–Whitney test were used to compare the expression of VDR, including VDR staining intensity, VDR distribution, and histoscore, between HM and GTN tissue specimens. Results: No significant differences in age and parity were noted between patients with HM or GTN (p > 0.05). The VDR staining intensity of GTN tissue specimens was significantly lower than that of HM tissue specimens (2.3 ± 0.8 vs. 2.8 ± 0.5, p = 0.008). In addition, the histoscore for GTN tissues was significantly lower than that for HM tissues (7.3 ± 3.2 vs. 9.4 ± 28, p = 0.016). However, no significant differences in VDR distribution between GTN and HM tissues were observed (3.3 ± 0.8 vs. 3.3 ± 1.0, p = 0.525). Conclusion: Low VDR expression is associated with GTN, whereas high VDR expression is associated with HM, suggesting that the expression of VDR may regulate the severity of gestational trophoblastic disease.

Sawkar Vijay Pramod,1 Ferry Safriadi,1 Bethy S Hernowo,2 Reiva Farah Dwiyana,3 Nurvita Trianasari,4 Shin Egawa5 1Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin Academic Medical Center, Bandung, Indonesia; 2Department of Pathology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin Academic Medical Center, Bandung, Indonesia; 3Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia; 4Economics and Business School, Telkom University, Bandung, West Java, Indonesia; 5Department of Urology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-ku, Tokyo, JapanCorrespondence: Sawkar Vijay Pramod, Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin Academic Medical Center, Bandung, Indonesia, Email doktervj@yahoo.co.idPurpose: To the best of our knowledge, Androgen receptor (AR) and cluster of differentiation 24 (CD24) expression in bladder urothelial carcinoma (UC) has not yet been reported in our population. The aim of this study was to evaluate the expression of both markers in UCB using immunohistochemistry.Materials and Methods: Data from 60 patients with UCB were obtained between 2009 and 2018. The samples were divided into four groups based on their smoking history. Group 1 included non-smokers, group 2 smoked < 20 cigarettes/day for 30 years, group 3 smoked for 31– 40 years, and group 4 smoked for > 40 years. Each group then divided into Non muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) subgroups. The smear was stained with hematoxylin and eosin (HE) - immunohistochemistry of CD24 and RA, followed by histoscore assessment.Results: The male to female smoking rates was 1.8. Based on gender, in the NMIBC group there were 85.7% men and 14.3% were women while in MIBC 74.4% men and 25.6% women. The mean age of the NMIBC and MIBC groups was 56.3 years and 54.5 years, respectively. There was no significant relationship between smoking status in group 2 (OR 0.31, CI 95% CI, p=0,39), group 3 (OR 013, CI 95% CI, p=0,05), and group 4 (OR 0.23, CI 95% CI, p=0215) to the UCB invasiveness. A significant relationship was observed between cytoplasmic AR expression and UCB invasiveness (OR 0.14[0,04; 0.47], CI 95%, p=0.001). There was no significant relationship between RA in the nucleus and UCB invasion (OR 1.09[0,18; 6.48] CI 95%, p=1000). No significant relationship was observed between CD24 expression and UCB invasiveness (OR 0.81[0,27– 2,45] CI 95%, p=0712).Conclusion: Cytoplasmic AR expression is associated with UCB invasiveness. Smoking history and CD24 expression were not associated with UCB invasion.Keywords: androgen receptor, CD24, immunohistochemistry, smoking, urothelial carcinoma of the bladder

This paper conducts a comprehensive literature review on the administration of intradialytic parenteral nutrition (IDPN) for patients undergoing hemodialysis (HD) in Indonesia. The objective is to assess the current status and challenges associated with IDPN in the country and propose potential strategies for enhancement. The review, encompassing articles published between 2013 and 2023 from databases such as PubMed, Scopus, and Google Scholar, exposes significant risks and the prevalence of malnutrition, particularly protein-energy wasting (PEW), among patients undergoing HD. This patient cohort often necessitates nutritional therapy, and IDPN emerges as a viable option for both prevention and definitive treatment. However, detailed data on malnutrition among HD patients in Indonesia are limited. Challenges include a shortage of nutrition experts in kidney care, low patient adherence to dietary advice, and the inability of Indonesian hospitals to provide IDPN to malnourished hemodialysis patients. The non-uniform cost coverage by the National Health Insurance further complicates matters, despite consumable costs for HD being uniform across all hospitals. The payment system by BPJS does not accommodate the provision of parenteral IDPN with varying prices, as listed in the e-catalog by the national public procurement agency. To offer IDPN to patients, hospitals must achieve cost-efficiency within their HD units, or they risk financial losses. Currently, IDPN is exclusively administered to HD patients with acute conditions in an inpatient setting. A recommendation for policymakers is to explore the adoption of distinct tariffs for HD patients undergoing outpatient care, particularly those managing complex conditions such as PEW. This approach can contribute to improved nutritional support for hemodialysis patients in Indonesia.

B-cell non-Hodgkin lymphoma (B-NHL) is a lymphoid malignancy derived from B-cells that remains difficult to treat. Moreover, relapses and refractory cases are common. Abnormalities in epigenetic mechanisms, such as imbalanced histone acetylation affecting certain genes, contribute to relapses and refractory cases. Chidamide (tucidinostat) is a novel histone deacetylase inhibitor that can reverse this epigenetic imbalance and has been approved for the treatment of T-cell malignancies. However, the use of chidamide for B-NHL remains limited, and the lack of relevant literature exacerbates this limitation. We conducted this review to summarize the anticancer activity of chidamide against B-NHL and its clinical applications to overcome drug resistance. This systematic review was conducted according to the PRISMA 2020 guidelines, using some keyword combinations from MEDLINE and EBSCO. The inclusion and exclusion criteria were also defined. Of the 131 records retrieved from databases, 16 were included in the review. Nine articles revealed that chidamide limited tumor progression by modifying the tumor microenvironment, stopping the cell cycle, inducing apoptosis and autophagy, and enhancing complement-dependent and antibody-dependent cell-mediated cytotoxicities.According to seven other studies, administering chidamide in combination with another existing therapeutic regimen may benefit not only patients with relapsed/refractory B-NHL, but also those with newly diagnosed B-NHL. Chidamide plays many important roles in limiting B-NHL progression through epigenetic modifications. Thus, combining chidamide with other anticancer drugs may be more beneficial for patients with newly diagnosed and relapsed/refractory B-NHL.

Purpose: This study aimed to determine survival rate and clinical characteristics of testicular tumor patients with a history of scrotal violation. Materials and Methods: This study was a retrospective cohort; we reviewed medical records from 2017 to 2021 with testicular tumors who had a history of scrotal violation. We evaluate clinical characteristics and survival up to 5 years. We used the KaplanMeier survival analysis and log-rank test. Results: There are 27 patients with testicular tumor who had a history of scrotal violation. Based on histopathological findings, the most common type was seminoma testis. While based on TNMS staging of the testicular tumor, the most common presentation is T2; Nx; Mx; and S3. Furthermore, based on the prognostic group for testicular tumor we found 5 patients with stage IB, 15 patients with stage IS, 2 patients with stage II, and 5 patients with stage III. Clinical manifestations of scrotal violation were residual tumor found in scrotal region in 2 patients, inguinal and abdominal region in 3 patients. Using the Kaplan-Meier survival curve, the 5-year survival rate was 44% from Statistical test in log-rank test, a significant result is obtained. Conclusion: Survival rate of testicular tumors who had a history of scrotal violation were lower and influenced by ECOG Performance Status Scale. Prognosis of a scrotal breach in the late stage may have a higher mortality rate. In contrast, there was a significant difference in outcome if the scrotal violation had been known at the early stages.

Low birth weight (LBW) babies are closely related to infant morbidity, stunted growth and cognitive development, and chronic diseases. Placenta accreta spectrum (PAS) is a condition that complicates pregnancy and is closely related to low birth weight. Objectives: To determined the incidence of LBW in mothers with SPA at the hospital Dr. Hasan Sadikin Bandung. Methods: A descriptive observational study involving 71 cases of SPA in hospitals Dr. Hasan Sadikin Bandung, period 2016-2020, which has met the inclusion and exclusion criteria. SPA cases were divided into three groups: placenta accreta, increta, and percreta. In each SPA group, the incidence of LBW was evaluated. Results: 46.5% (33/71 cases of PAS) had low birth weight, while 53.5% (38/71 cases of PAS) had normal birth weight babies. The placenta accreta and percreta groups were dominated by normal birth weight infants [(18/31 cases), (5/9 cases)], while the placenta increta group was dominated by low birth weight infants (16/31 cases). The LBW category is divided into Extremely Low Birth Weight (ELBW), Very Low Birth Weight (VLBW), and LBW. In placenta accreta, there were 2 ELBW and VLBW infants, and 9 LBW infants. In the placenta increta, there are 3 ELBW and VLBW, and 10 LBW. In the placenta percreta, there were 1 ELBW and 3 LBW, while VLBW was not found in the placenta percreta. Conclusion: The incidence of LBW is found in almost half the population of SPA cases in hospitals. DR. Hasan Sadikin in the 2016-2020 period. Keywords: low birth weight, placenta accreta spectrum

BACKGROUND: Interaction between estrogen and estrogen receptor (ER) takes part in the regulation and differentiation of breast tumorigenesis. Some ERα polymorphisms, including ERα rs3798577, are reported to be associated with the risk and aggressiveness of breast carcinoma since the site was reported to be targeted by microRNA, which can further modulate the ERα expression. Hence, this study was conducted to disclose the possible role of ERα SNP rs3798577 on breast carcinoma patients. METHODS: Samples were taken from the post-mastectomy breast carcinoma tissues of female patients and screened based on the completeness of medical and histopathological records. DNA isolation was proceeded using real time-polymerase chain reaction (RT-PCR) then analyzed for high resolution melting (HRM). The nucleotide base sequence was then analyzed based on rs3798577 ERα polymorphism. ER immunohistochemistry test was carried out and counted quantitatively based on the staining intensity and the percentage of the stained cells. RESULTS: Out of 65 samples, there were 33 samples as wild type and 32 samples as variant type. Most variant and wild type had >80% ERα percentage. Most variant type had middle ERα intensity, while wild type had strong ERα intensity. Higher percentage of variant type (52.2%) was found with weak ERα histoscore, meanwhile higher percentage of wild type (52.4%) was found with strong ERα histoscore, but not significant (p=0.725). CONCLUSION: ERα rs3798577 variant type had a lower ERα intensity and weaker ERα histoscore compared to the wild type, suggesting that ERα rs3798577 polymorphism might play a role in breast carcinoma risk determination. KEYWORDS: breast cancer, ERα, rs3798577, polymorphism, immunoexpression

Stress is a global phenomenon that has become a part of everyday life. Stress can be triggered by the presence of stressors. In Indonesia, the prevalence of psychological stress keeps increasing. This study aims to analyze the perceived restoration effect of green open parks on the stress levels of Bogor Botanical Gardens visitors. A survey of 100 visitors of Bogor Botanical Garden was conducted based on the Perceived Stress Scale. Data on respondent characteristics and stress levels were analyzed using descriptive analysis, the visitor's characteristics that affected their stress levels were analyzed using stepwise linear regression and analysis of variance, and the effect of having a garden and the proximity to open green space on the visitor's stress levels were identified using analysis of variance. The respondents who felt low, medium, and high-stress levels, were 22%, 73%, and 5% respectively. The majority of the respondents perceived Bogor Botanical Garden as restorative. Factors that significantly affect the stress level of respondents are age and purpose of visit. The older the respondent, the lower their stress level tends to be. Visitors who visit for exercise/health activities have significantly lower stress levels than for other visits. In this study, no significant relationship was found between garden ownership and proximity to green parks on the stress level of the respondents.

Background: Bladder tumors are the most common neoplasm of the lower urinary tract. Bladder carcinoma arising from a suprapubic cystostomy tract is a relatively rare. Some patients with bladder tumors have difficult urethral access for urinary retention due to inaccessible urethra. Most people think cystostomy in patient with bladder cancer can cause seeding and upstaging to suprapubic cystostomy tract. This study aim of suprapubic cystostomy can cause seeding and upstaging of bladder cancer. Methods: Literature obtained from the search results of Pubmed, Medscape, Science Direct, Scopus, Cochrane Library, and Google Scholar electronic databases with the keywords used are “suprapubic catheter and bladder cancer”, “suprapubic catheter and bladder tumor”, “suprapubic catheter and bladder carcinoma”, “suprapubic cystotomy and bladder carcinoma”, and “suprapubic catheter and bladder cancer upstaging” with no time limits. Results: Eighty two articles were obtained from the electronic database. Following all the inclusion and exclusion criteria, the final selection considered 5 literature with 16 patient eligible for this literature review. The five literature involved a total of 16 bladder cancer patients with a suprapubic catheter. The duration of suprapubic catheter insertion was between 1 to 3 months. As long as it is within the specified time and from the location of cancer, literature result there will be no seeding and upgrading in the suprapubic cystostomy tract. In our case report we have patient with duration suprapubic cystostomy 1 months wih no seeding and upgrading cancer. Conclusion: Although SPC is an effective, inexpensive, easy mode of access for bladder tumors with difficult urethral access for urinary retention due to inaccessible urethra, it also presents a risk of SPC tract bladder cancer, mostly SCC and TCC. It is important to be aware of any suspicious signs and symptoms, duration time of use suprapubic cystostomy and location of the cancer.

Diagnosis of nodular red lesions is challenging. The differential diagnosis includes dermal nevus, angioma, pyogenic granuloma, amelanotic melanoma, eccrine poroma, Kaposi’s sarcoma, skin malignancy or metastasis. Erythema nodosum is one of the common consideration of the red skin nodules, however fully work up should be done to find the right diagnosis. A 60 years old female admitted to our hospital due to pain dark reddish skin nodules since one month. She had continuously high grade fever of 39 Celsius accompanied by arthralgia and fatigue since two months prior to admission and she lost 6 kg of weight in 2 months. On admission, physical examination revealed slight fever, pale conjunctiva, mild hepatosplenomegaly, tender dark red nodules 0.3 to 2 cm, firm edge, at her cheek, abdominal area and both lower extremities. No lymph nodes enlargement was noticed. Her laboratory test showed haemoglobin 9,1 g/dl, WBC 3,040/mL, PLT 149,000/mL, SGOT 48 U/L, SGPT 43 U/L, urea 12.5 mg/dL, creatinine 0.67 mg/dL. She was found to be non-reactive for HBsAg, HCV, and HIV antigens. Urine routine and microscopic examination was unremarkable. Her histopathology of left foot nodule biopsy revealed cutaneous lymphoma. The immunohistochemical (IHC) stain of CD45, CD20, and CD10 were positive, Ki67 were also positive with >70% tumor cells, while CD3,CD56, CD30, and Granzyme were negative. Her final diagnosed was Cutaneous Diffuse large B cell lymphoma. Primary cutaneous lymphomas of B-cells occur less frequently than primary cutaneous T-cells lymphomas. Primary extra-nodal diffuse large B-Cell lymphoma (DLBCL) can be seen in up to 40% of cases. However skin involvement is less common and in a large cohort of DLBCL cases, skin involvement at presentation was seen only in 3.3% of cases.It characterized by few lesions, in general showing nodules or infiltrations of relatively fast growth and have no itching. The diagnosis is made by the immunohistochemical findings, clinicopathological correlation, and molecular pathology. The lymphomas have different clinical behaviours despite being identical in morphological appearance. The primary lymphomas presents with local recurrence in up to 68% of the cases and with rare extra-cutaneous dissemination, with an average rate of 5-year survival varying from 89 to 96%. Cutaneous lymphoma should be always become one of considered diagnosed of skin red nodules even it is rare.

Stress can be defined as psychological and physical tension caused by physical, emotional, social, economic, and occupational, events, or experiences that are difficult to manage or endure. Bird sounds can be a potential solution to reduce stress levels. This study aimed to analyze the effect of bird sounds as a stress restorative on Bogor Botanical Garden visitors. A survey of 100 visitors of Bogor Botanical Garden was conducted based on the Perceived Stress Scale and Perceived Restorativeness Soundscape Scale. Data on respondent characteristics were analyzed using descriptive analysis, the relationship between stress levels and perceived stress restorative effect of bird sound was analyzed using Pearson correlation analysis. The analysis showed that 78% of respondents had moderate to high perceived stress levels and 98% of respondents rated the degree of restoration from bird sounds to be moderate to high. The correlation analysis revealed a negative relationship between the stress level and bird sounds' perceived restorative effect. The older the respondents and the more frequently they visited Bogor Botanical Garden, the higher the perceived stress restorative effect from bird sound.

The decline in the Maleo population due to the decrease in suitable nesting sites caused the need for Maleo conservation activities such as protecting Maleo’s nesting site and their eggs. This study aims to analyze aspects of Maleo chicks captive management and assess Maleo chicks welfare levels in Hungayono Sanctuary. The method used is direct observation, interviews, and literature studies. Data analysis was carried out by describing the welfare assessment. The results showed that welfare management in Hungayono includes the management of cages, feed, and health. Management activities for the aspects of cages, feed, and overall health are still lacking. This is because several important aspects had not been fulfilled in management, such as the quantity and quality of the cages, feed and water given, also medical personnel and facilities. Maleo chick’s welfare level in Hungayono had a value of 49.73, which was categorized as low. The aspect of freedom from pain, injury, and disease had the lowest score, which was 1.92. In conclusion, the overall management of maleo chick's in Hungayono was still lacking and needed to be improved. The welfare level of Maleo chick’s was low, with freedom from pain, injury, and disease having the lowest score. Hungayono managers need to add medical personnel and increase the quality and quantity of their medical facilities to improve the aspects of freedom from pain, injury, and disease.

Ganglioneuroma is a rare, differentiated, and benign neurogenic tumor that could grow into a huge size with minimal or no symptoms at all. Ganglioneuroma is typically found in older children or adults and is commonly detected within the posterior mediastinum (other than retroperitoneal). Here, we present a case of a 3-year-old patient with shortness of breath, and radiological examination showed a giant mediastinal tumor which proved to be a ganglioneuroma after histopathological examination. This study highlights the possibility of ganglioneuroma occurring in younger children and the role of imaging in assessing ganglioneuroma as a posterior mediastinal tumor.

Bali starling (Leucopsar rothschildi) is categorized as an endangered species based on the International Union for Conservation of Nature and Natural Resources (IUCN) red list. Thus, preventing this species from extinction becomes very crucial. One of the most important activities for this purpose is a soft release method to avoid birds’ mortality, which has been done in West Bali National Park (WBNP). However, this method creates the dependency of birds to the artificial treatment and may affect the distribution of Bali starling. Therefore, this study aimed to analyze the population and habitat and create a habitat suitability index model for Bali starling in WBNP. Data were obtained by surveying the Bali starling population, including the number of individuals, distribution, age structure, sex ratio, natality, and mortality. Vegetation analysis was also conducted to determine habitat conditions. Finally, map interpretation data was used to develop a suitable habitat model for Bali starling in WBNP. The results showed that 63 Bali starling were found near the resort office, bird release sites, and binding bird cages. It indicated that the habitat of Bali starling has shifted from the soft release site. The habitat suitability index model of Bali starling in WBNP was Y = 17.145 + 6.640PC1 - 4.055PC2, showing the selected variables only give a moderate determination coefficient (R2 = 40.9%). The artificial treatment created by the WBNP authority seems to be another great factor influencing the existence and distribution of Bali starling in WBNP. It was also indicated that Bali starling could breed in the WBNP, but it tends to have a shifting habitat in the wild. Keywords: Bali starling, Geographic information system, Habitat suitability, Population

Purpose: Around 75% of all bladder cancers are classified into nonmuscle invasive bladder cancer (NMIBC). The NMIBC's high recurrence and progressivity rate are most commonly found in tumors invading the lamina propria (LP), classified as staged pT1 when it extended to the LP with a heterogeneous recurrence and progression. This study aimed to correlate the measurement of tumor depth and width to lymphovascular invasion (LVI) in NMIBC. Materials and Methods: A 5-year retrospective analytical study (2015–2019) was conducted in a tertiary hospital in Indonesia. We reassessed and analyzed the tumor depth and width of 64 patients with pT1 bladder cancer based on histopathological reports and analyzed the correlation of tumors and LVI. The depth was reassessed by measuring the transitional urothelium with the LP as an initial marking point, up to the tumor's edge in the LP, and tumor's width by measuring the largest width of one tumor focus in the LP, along with the presence of LVI by histopathological exams. Data were analyzed using the Mann − Whitney test. Results: The participants were 64 patients with pT1 bladder cancer. The mean tumor pT1 invasion depth was 2.03 ± 0.918 mm. The non-LVI group's mean tumor invasion depth was 1.72 ± 0.721 mm, whereas the LVI group was 2.21 ± 0.980 mm. The tumor invasion depth was a significant factor for LVI, whereas the tumor maximum diameter was not. Conclusion: The tumor invasion's depth was significantly associated with the LVI. The pT1 tumor invasion depth measurement might serve as a predictive variable of tumor recurrence and progressivity.

One way of conventional medicine in Indonesia is the herbal medicinal plant tobacco which is a controversial plant. However, currently, many types of businesses offer health services using alternative medicine using traditional medicine. Of course, this is contrary to the anti-tobacco campaign launched by the government and the regulations on tobacco contained in various laws and regulations. Therefore, this study aims to examine how the legal system regarding tobacco is related to conflicts of interest in tobacco use for treatment. This research is normative juridical research. Through a statutory and conceptual approach, the aim is to understand the importance of using tobacco as alternative medicine. The results of this study are that the government should make tobacco a priority for traditional medicine media and provide legality to community therapy houses because it is proven that tobacco can make a positive contribution to improving health.

The population of the Javan langur (Trachypithecus auratus) is currently decreasing, so the threat to the preservation of the Javan langur requires conservation efforts that are beneficial for conservation in nature. One of the conservation efforts is carried out ex-situ, such as the one at the research station at the Javan Langur Center. This study aims to determine the Rehabilitation management of Javan langurs at the Javan Langur Center. The method used in this research is the interview, field observation, and literature study. The use of strategic factor analysis (SWOT) is carried out in the management of Javan Langur rehabilitation which includes analysis of internal factors and external factors. The first rehabilitation management, namely the development strategy at the research site, is carried out through a rehabilitation program strategy. The second utilizes and maintains good support from the government. Third, utilize experienced human resources. Fourth, increase the number of health workers who are still lacking. Fifth, improve the quality and quantity of facilities and infrastructure. Sixth, add experienced human resources. Seventh, improving the quality and quantity of facilities at the Javan Langur Center.

Organic fertilizers contain a lot of residual organic matter that has been decomposed and is ready for consumption by plants. The raw materials for organic liquid fertilizer used in this study were market waste, dry leaves, and the addition of three bio activators (tofu wastewater, Stardec, and EM4). The selection of tofu liquid waste is done because it is easy to obtain, cheap, and reduces environmental pollution. Therefore, the purpose of this study was to analyze the quality and quality of the manufacture of liquid fertilizer using the tofu industry's liquid waste bio activator compared to other bio activators. The method used in this research is the experimental manufacture of liquid fertilizer with anaerobic fermentation, which is then applied to the growth of kale. The results of this study are the quality and quality of the manufacture of liquid fertilizer using a liquid waste bio activator tofu industry is quite good, although it still does not meet the minimum Technical Requirements for Organic Fertilizer standards issued by the Decree of the Minister of Agriculture of the Republic of Indonesia Number 261/KPTS/SR.310/M /4/2019. This can be seen from the average height of the kale plant which is not much different from the use of popular bio activators on the market (EM4 and Stardec), where the average height yield is 6.72 cm on the seventh day.

Fauzan Ali Zainal Abidin, Hermin Aminah Usman, Sri Suryanti, Bethy S Hernowo Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Hermin Aminah UsmanDepartment of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Jl Pasteur No. 39, Bandung, West Java, 40161, IndonesiaTel +62 22-2031447Fax +62 22-2551126Email hermin@unpad.ac.idBackground: Acral melanoma (AM) is a malignancy that originates from melanocytes, located in an anatomical area without sun exposure, aggressive, resistant to chemotherapy, and quickly metastasize. The invasion capability of tumor cells is the main factor for metastasis in malignancy. E-cadherin is a marker of tumor progressivity that has an important role in the process of invasion. The responsibility of E-cadherin in the invasion process of AM is not well known. CD103 is an immune component found in the tumor microenvironment that contributes to melanoma progression control, whereas E-cadherin is the ligand for CD103.Purpose: The objective of this research was to see if there was an association between E-cadherin and CD103 immunoexpression and the thickness of invasion in AM.Materials and Methods: This is observational cross-sectional research. Formalin-fixed paraffin-embedded (FFPE) acral melanoma tissue samples were collected during 2014– 2020 at the Department of Anatomic Pathology, Dr. Hasan Sadikin Hospital, Bandung. A total of 40 samples were collected, including 20 cases of invasive melanoma less than 4 mm thickness and 20 cases of invasive melanoma greater than 4 mm thickness. All samples were immunostained with E-cadherin and CD103. Chi-Square test was used to examine the association concerning E-cadherin and CD103 with the thickness of invasion, respectively. The p-value of 0.05 was chosen as the significance level.Results: This study showed an insignificant association between E-cadherin immunoexpression and the thickness of invasion on AM (p = 0.4272). CD103 immunoexpression had a significant association with the thickness of invasion on AM (p = 0.0001).Conclusion: The findings revealed that CD103 in AM is associated with the thickness of invasion, and it may play important functions throughout the invasion process despite the uninvolvement of E-cadherin.Keywords: CD103, E-cadherin, acral melanoma, invasion

Giant renal cell carcinoma is a rare case. We reported six cases of giant renal cell carcinoma, which required surgical resection of the tumor, including a 9.900 cm3 of encapsulated neoplasm removal. To our knowledge, this is the largest giant clear cell RCC ever reported in Asia. Cytoreductive nephrectomy without targeted therapy was performed in all cases. The most common type in all cases was clear cell carcinoma. From six cases, four patients died during follow-up of more than 6 months. The number of cases that died in our case was related to poor preoperative status performance, while one of the patients had a histopathological sarcomatoid cell result with a poor prognosis. We should consider performing cytoreductive nephrectomy in younger patients, clear-cell histology, good performance status, limited metastatic burden, 3 or less International Metastatic RCC Database Consortium (IMDC) risk factors, responding to presurgical therapy, preferably in high-volume centers. Cytoreductive nephrectomy is not for every patient, and it’s associated with longer survival in well-selected patients.

Endocrine therapy resistance in Luminal Breast Cancer is a significant issue to be tackled, but currently, no specific biomarker could be used to anticipate this event. p53 mutation is widely known as one of Breast Cancer’s most prominent genetic alterations. Its mutation could generate various effects in Estrogen Receptor and Progesterone Receptor molecular works, tangled in events leading to the aggravation of endocrine therapy resistance. Hence the possibility of p53 mutation utilization as an endocrine therapy resistance predictive biomarker is plausible. The purpose of this review is to explore the latest knowledge of p53 role in Estrogen Receptor and Progesterone Receptor molecular actions, thus aggravating the Endocrine Therapy resistance in Luminal Breast Cancer, from which we could define possibilities and limitations to utilize p53 as the predictive biomarker of endocrine therapy resistance in Luminal Breast Cancer.

Maleo population is decreasing due to the decline in suitable breeding site. The establishment of a maleo sanctuary in Hungayono aims to increase maleo population by protecting its eggs and increasing the success rate of eggs hatched. This study aims to analyze the characteristics of maleo nesting habitats, to describe the semi-natural maleo egg hatching management in the sanctuary, and analyze the success rate of maleo egg hatching in Hungayono. The results showed that the Maleo nesting sites are clean of bushes and shrubs, but there was still shades from trees or bamboo. The nesting sites are close to rivers and geothermal sources with mixed soil structure. The natural egg burrows has an average depth of 92.8 cm, width of 82.7 cm, temperature of 32.5 oC, and humidity of 90%. Hungayono has seven hatcheries that utilized geothermal heat to hatch Maleo egg semi-naturally. The burrows size in the hatcheries were made according to the size of Maleo eggs, with an average depth of 32 cm and width of 10 cm, the average temperature is 32.5 oC and humidity is 90.8%. The incubation period for the semi-natural hatcheries is 60-80 days. Maleo egg hatching success rate reached 60.18% in which is medium category.

Background:The aim of this study was to create a simplistic taxonomy to improve transparency and consistency in, and reduce complexity of, interpreting diffusion tensor imaging (DTI) profiles in white matter disruption. Using a novel strategy of a periodic table of DTI elements, we examined if DTI profiles could demonstrate neural properties of disruption sufficient to characterize white matter changes specific for hydrocephalus vs. non-hydrocephalus, and to distinguish between cohorts of neural injury by their differing potential for reversibility.MethodsDTI datasets from three clinical cohorts representing pathological milestones from reversible to irreversible brain injury were compared to those of healthy controls at baseline, over time and with interventions. The final dataset comprised patients vs. controls in the following groupings: mild traumatic brain injury (mTBI), n = 24 vs. 27, normal pressure hydrocephalus (NPH), n = 16 vs. 9 and Alzheimer's disease (AD), n = 27 vs. 47. We generated DTI profiles from fractional anisotropy (FA) and mean, axial and radial diffusivity measures (MD, L1 and L2 and 3 respectively), and constructed an algorithm to map changes consistently to a periodic table of elements, which fully described their diffusivity and neural properties.ResultsMapping tissue signatures to a periodic table of DTI elements rapidly characterized cohorts by their differing patterns of injury. At baseline, patients with mTBI displayed the most preserved tracts. In NPH, the magnitude of changes was dependent on “familial” DTI neuroanatomy, i.e., potential for neural distortion from risk of ventriculomegaly. With time, patients with Alzheimer's disease were significantly different to controls across multiple measures. By contrast, patients with mTBI showed both loss of integrity and pathophysiological processes of neural repair. In NPH, some patterns of injury, such as “stretch/compression” and “compression” were more reversible following intervention than others; these neural profile properties suggested “microstructural resilience” to injury.ConclusionUsing the novel strategy of a periodic table of DTI elements, our study has demonstrated it is possible to distinguish between different cohorts along the spectrum of brain injury by describing neural profile properties of white matter disruption. Further work to contribute datasets of disease toward this proposed taxonomic framework would enhance the translatability of DTI profiles to the clinical-research interface.

Objective The aim of this study was to evaluate the efficacy and cardiotoxicity profile, and to reduce the extend of breast cancer surgery in primary systemic therapy (PST) HER2/neu–positive operable breast cancer patients. Materials and Methods A total of 152 patients diagnosed from 2010 to 2015 were included in the study. The PST consisted of a sequential regimen of taxanes and anthracyclines plus trastuzumab. The clinical and pathological responses and the type of breast cancer surgery were evaluated and correlated with clinical and biological factors. The cardiotoxicity profile and long-term benefits were analyzed. Results The median patient age was 47 (37–67) years, with T2 and T3 67 (44.1%) and 85 (55.9%), respectively. Axillary lymph node breast cancer at diagnosis N0 was 104 (68.4%) and N1 and N2 were 28.9% and 2.6%, respectively. A total of 95.7% of patients had nonspecific type of breast cancer, 67% of tumors were hormonal receptor–negative, 75.5% were grade III, 100% Ki67 > 20%, and 90% of tumors were confirmed to be HER2/neu–positive through immunohistochemistry. Following PST, pathological complete response (pCR) rate was achieved in 44.7% evaluable patients. The pCR rate was higher in HR-negative (93.1% vs. 6.9%) cancer and in grade III (86.2%) than in grade I and II (13.8%) cancer; only 75.5% of complete response (CR) on ultrasound and magnetic resonance imaging were also CR on pathology results. Breast conserving surgery was performed in 41.4%. Regarding type of chemotherapy, there were no significant differences between chemotherapy with anthracycline backbone or taxanes to achieved pathological complete response. Despite that, we were unable to demonstrate an association between pCR and better DFS with p = 0.096; HR 5.7 95.0% CI (0.73–45.52). Patients who are hormonal receptor positive tend to have lower disease-free survival (DFS) than those who are hormonal receptor negative; HR = 6.34, 95.0% CI (1.54–26.00) and p = 0.010. Five years DFS was higher for those who achieved pCR compare with those who did not. Even in this research we failed to show it is statistically significant. Conclusion A sequential regimen of taxanes and anthracyclines plus trastuzumab was effective with high pCR rates and increases the possibility to do breast conservation surgery and had tolerable cardiotoxicity profile.

Nastassa Gipsyianti, Afiati Aziz, Bethy S Hernowo, Hermin A Usman Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Hermin A UsmanDepartment of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaEmail hermin.seroja@gmail.comIntroduction: Acral melanoma (AM) has a poor prognosis since it is easily metastatic and resistant to chemo and immunotherapy. Cyclooxygenase-2 (COX-2) is an enzyme that plays a role in the carcinogenesis process. The increased expression of COX-2 has an impact on increasing levels of Myeloid-Derived Suppressor Cell (MDSC), which is a key regulator of immune. The increase in MDSC produces Transforming Growth Factor β 1 (TGF-β 1), which will suppress Natural Killer (NK) cells and Dendritic Cells (DC) function so that tumor cells are spared from the immune systems and are easier to invade surrounding tissues.Purpose: This study aimed to determine the role of COX-2 and TGF-β 1 on the depth of invasion on AM.Materials and Methods: This study was a cross-sectional observational study on 40 paraffin blocks of AM cases during 2014– 2019 in the Department of Pathology Anatomy, Faculty of Medicine, Dr. Hasan Sadikin General Hospital, Bandung. The depth of invasion of all samples was measured by dotSlide imaging software and the immunohistochemical staining of COX-2 and TGF-β 1 was performed. The association between COX-2 and TGF-β 1 expression and AM depth of invasion were analyzed using Mann Whitney.Results: The result showed a significant association between COX-2 and TGF-β 1 expression and depth of invasion on AM. COX-2 expression had a significant association with TGF-β 1 expression (0.0001). Through multivariate analysis, it was found that COX-2 had the greatest association with the depth of invasion (p=0.0001).Conclusion: The findings showed that increasing expression of COX-2 in AM is associated with the depth of invasion by increasing TGF-β 1 and it might play important roles during the invasion process of AM.Keywords: acral melanoma, COX-2, depth of invasion, TGF-β 1

Introduction: Dental implants have become a more desirable treatment for replacing missing teeth. The mechanical properties and biocompatibility of titanium and zirconia are excellent, but they are less bioactive. The chemical composition of the carbonate apatite is similar to enamel and dentin. Geopolymers are inorganic polymers, and they are similar to ceramics. They have excellent mechanical properties, bioactivity, biocompatibility. The purpose of this study was to assess histomorphological evaluation of geopolymer-carbonated apatite nanocomposites implanted on rabbit tibia at early bone healing in vivo. Methods: Geopolymer-CHA nanocomposites with a diameter of 3 mm and length of 6 mm was placed in the tibia of eight male New Zealand White rabbit whose body weight is 3 to 3.5 kg and six-month ages. Experimental subjects were randomly assigned to 2 groups for assessing the bone healing capability around samples to 14 and 28 days histomorphologically. Wilcoxon test was performed, and p

Luminal B HER2-negative breast cancer (BC) is the most common type in Indonesian BC patients, and frequently manifests with locally advanced staging. Recurrence often occurs within two years of the endocrine therapy course (primary endocrine therapy (ET) resistance). p53 mutation often exists in luminal B HER2-negative BC, but its application as an ET resistance predictor in those populations is still limited. The primary purpose of this research is to evaluate p53 expression and its association with primary ET resistance in luminal B HER2-negative BC. This cross-sectional study compiled 67 luminal B HER2-negative patients’ clinical data during their pre-treatment period until they completed a two-year course of endocrine therapy. They were divided into two groups: 29 patients with primary ET resistance and 38 without primary ET resistance. Pre-treatment paraffin blocks from each patient were retrieved, and the p53 expression difference between the two groups was analyzed. Positive p53 expression was significantly higher in patients with primary ET resistance [odds ratio (OR) of 11.78 (95% CI: 3.72–37.37, p-value < 0.0001)]. We conclude that p53 expression could be a beneficial marker for primary ET resistance in locally advanced luminal B HER2-negative BC.

Computational fluid dynamics (CFD) is a powerful tool to provide information on detailed turbulent flow in unit processes. For that reason, this study intends to reveal the flow structures in the horizontal pipe and biomass combustor. The simulation was aided by ANSYS Fluent employing standard k$$ k $$‐ε$$ \upvarepsilon $$ model. The results show that a greater Reynolds number generates more turbulence. The pressure drop inside the pipe is also found steeper for small pipe diameters following Fanning's correlation. The fully developed flow for the laminar regime is found in locations where the ratio of entrance length to pipe diameter complies with Hagen–Poiseuille's rule. The sucking phenomenon in jet flow is also similar to the working principle of ejector. For the biomass combustor, the average combustion temperature is 356–696°C, and the maximum flame temperature is 1587–1697°C. Subsequently, air initially flows through the burner area and then moves to the outlet when enters the combustor chamber. Not so for particle flow, the particle experiences sedimentation in the burner area and then falls as it enters the combustor chamber. This study also convinces that secondary air supply can produce more circulating effects in the combustor. [ABSTRACT FROM AUTHOR]