Background: Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor in adultswith dismal prognosis due to the unavailability of an effective therapy. Up to now, there had been no definitive studies published on EGFR inhibition therapy as a chemosensitizer for GBM therapy using Temozolomide (TMZ). This study aims to reveal the most effective method and timing to administer TMZ-anti EGFR targeted therapy which causes maximal DNA damage on GBM cells.

Methods: Various regimens of anti EGFR monoclonal antibody Nimotuzumab (NMZ) was administered in different combinations with TMZ, performed on U87MG MGMT(+) EGFR(+) cells. The effectiveness of the combinations were evaluated by measuring yH2AX levels which reflects the degree of DNA damage. One-way Anova and LSD tests were performed to determine the effects of each treatment with p<0.05. Results and discussion: the mean SD of yH2AX of each treatment was: 11,90±1,25 for the control group; 29.33±1.91 for NMZ alone; 28.13±1.58 for TMZ alone; 41.53±3.51 for concurrent use; 35.67 ±2.65 for NMZ after 24 hours TMZ; 31.87±2.94 for NMZ after 48 hours TMZ; 39.57±4.2 for TMZ after 24 hours NMZ; and 35.93 ±3.56 for TMZ after 48 hours NMZ. The administration of TMZ concurrent with or after 24 hours NMZ gives the highest amount of DNA damage to GBM cells. Conclusion: The administration of Nimotuzumab targeted therapy up to 24 hours before Temozolomide chemotherapy has been proven to be effective in maximizing the amount of DNA damage done to GBM cells in vitro. 

Background: Until recently, cervical cancer is one of the major problem in women’s health issue related to its high incidence and mortality rate. The etiology of cervical cancer is the high risk oncogenic group of Human Papillomavirus (HPV), especially HPV-16 and 18 and its phylogenies. Meanwhile in Bali, more than 50% of infection are caused by HPV-16 infection. The main objective of this study was to investigate the role of LMP-2, LMP-7, TAP-1 and TAP-2 gene polymorphism as the risk factor in the cervical cancer carcinogenesis that is caused by HPV-16 infection. Method: A nested non-paired case-control study was conducted at Obstetric and Gynecologic Department Sanglah General Hospital, Bali-Indonesia from March 1 until August 31, 2013. Laboratory testing was carried out at Laboratory of Histopathology Leiden University Medical Centre, Netherlands,. Results: A total of 40 samples were collected, consist of 20epithelial cervical cancer patients with positive HPV-16 infection as the case group and 20 non-cervical cancer patients with positive HPV-16 infection as the control group. Women infected by HPV-16 with LMP-7 gene polymorphism had a higher risk (OR=7.36, CI 95%=1.38-40.55, p=0.013) to be diagnosed with cervical cancer. Balinese women who were infected by HPV-16 with TAP-2 gene polymorphism had a higher risk (OR= 9.33, CI 95%=2.18-39.96, p=0.001) to be diagnosed with cervical cancer. Meanwhile, Balinese women who were infected by HPV-16 with LMP-7 and TAP-2 genes polymorphism had a higher risk (OR=12.67, CI 95%=1.40-114.42, p=0.020) to be diagnosed with cervical cancer. As the result, it was shown that both of this gene polymorphism was working synergistically. Conclusion: TAP-2 and LMP-7 genes polymorphism play a role in the carcinogenesis mechanism of cervical cancer that is caused by HPV-16 infection in Bali. Meanwhile, LMP-2 and TAP-1 genes polymorphism were not found to play a role in the immunology pathway of cervical cancer that is caused by HPV-16 infection. 

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Background: Good quality of semen is required for artificial insemination technology in ex-situ conservation efforts of green jungle fowl. This study was aimed to investigate semen quality of green jungle fowl during storage at 5^oC for 48 hours with the addition of combination lactose-astaxanthin in egg yolk phosphate dilution. Method: The semen used in the study was collected from eight healthy male green jungle fowls by using massage techniques. The semen quality was analyzed with macroscopic and microscopic examinations.  The semen was diluted with egg yolk phosphate with the addition of 0.6% lactose, 0,004% astaxanthin and combination 0.6% Laktose-0,004% astaxanthin, and was stored at 5^oC for 48 hours. Following 48-hour treatment, the semen quality was evaluated based on its progressive motility, and DNA fragmentation. Data were firstly analyzed by using analysis of variance (ANOVA), and were then proceeded by using Duncan Multiple Range test. Results: The results showed that the progressive motilities of semen diluted in 0.6% lactose combined with astaxanthin 0.004% %, (79,66 + 1.50%) was significantly higher than those diluted in 0.6% lactose (66,77 + 2.16%,) and in astaxanthin 0.004% (68,11 + 3.01 %). The DNA fragmentation of semen diluted inn 0.6% lactose combined with astaxanthin 0.004% %, (7,55 + 1,66%) was significantly lower than those diluted in 0.6% lactose (12,33 + 1,93%) and in astaxanthin 0.004% (13,55 + 1,81%).  Conclusions: In conclusion, the combination of l 0.6% lactose -astaxanthin 0.004% showed the best results for progressive motility, and DNA fragmentation. 

Background: This was a retrospective study of 10 cervical spinal cord injury (CSCI), concomitant with ossification of posterior longitudinal ligament (OPLL), that were treated by the author at Sanglah General Hospital-Bali during 2013-2014. The purpose of this study was to evaluate the efficacy of combination technique of laminoplasty with lateral mass screw fusion for canal compression due to OPLL in CSCI. There were 9 male patients of 10, average age was 58,3 years old. American Spinal Cord Injury Association (ASIA) scale preoperative was average in C scale and ASIA scale postoperative was in D. Mean JOA score preoperative was 9,5 and mean Japan orthopedic association (JOA) score postoperative was 13,3. Improvement after surgery using improvement formula of JOA was achieved by mean of 19,16%. All patients survived and improved neurologically, there was no surgical complication and implant failure in this series. No kyphotic deformity was observed in follow up cervical spine x-ray after 6 months. The author present a combination technique of 10 consecutive patients who underwent laminoplasty fusion for OPLL in CSCI with better result.

We read the exceedingly rare case study recently described by Hota et al. about giant ovarian cyst in term pregnancy¹. The patient was a 25-year-old woman undergoing therapy for hypothyroidism, with history of three previous deliveries (P1L1A1). USG of abdomen and pelvis was normal with respect to gestational age in the second trimester, and ovarian cyst was not seen. However, the USG of control done on the third trimester revealed a left ovarian cyst (21x18 cm), with normal obstetric features. The weight of removed cyst of 29x20 cm was 4.9 kg, and the histopathology diagnosis was ovarian mucinous cystadenoma¹. The authors emphasized the rarity of concomitat pregnancy and ovarian cyst, and 15% of these mucinous cysts are malignant¹. Huge ovarian cysts are more often benign, and less frequently they are diagnosed in association with normal pregnancies¹. Major concerns in this setting should be the early diagnosis, close follow-up of the cyst growing, and appropriate intervention¹. Interestingly, in the case herein commented the ovarian cyst was not detected by USG in the first two trimesters of pregnancy. 

We read the exceedingly rare case study recently described by Hota et al. about giant ovarian cyst in term pregnancy¹. The patient was a 25-year-old woman undergoing therapy for hypothyroidism, with history of three previous deliveries (P1L1A1). USG of abdomen and pelvis was normal with respect to gestational age in the second trimester, and ovarian cyst was not seen. However, the USG of control done on the third trimester revealed a left ovarian cyst (21x18 cm), with normal obstetric features. The weight of removed cyst of 29x20 cm was 4.9 kg, and the histopathology diagnosis was ovarian mucinous cystadenoma¹. The authors emphasized the rarity of concomitat pregnancy and ovarian cyst, and 15% of these mucinous cysts are malignant¹. Huge ovarian cysts are more often benign, and less frequently they are diagnosed in association with normal pregnancies¹. Major concerns in this setting should be the early diagnosis, close follow-up of the cyst growing, and appropriate intervention¹. Interestingly, in the case herein commented the ovarian cyst was not detected by USG in the first two trimesters of pregnancy.