Center Of General Hospital Research Articles

Effect of hypnotherapy on paediatric cancer pain management in Indonesia: A quasi-experimental study

Background: Paediatric cancer patients often experience pain related to their condition and treatment. Hypnotherapy, a non-pharmacological intervention, has shown promise in pain management. This study aimed to investigate the effects of hospital-based hypnotherapy on pain reduction in paediatric cancer patients.Methods: A pretest-posttest experimental design without a control group was done with 60 paediatric cancer patients (ages 6–12) at Central General Hospital, Dr. Kariadi Semarang, Indonesia, from February to May 2024. Pain levels were assessed using the visual analogue scale (scores from 0 to 10) at the baseline, after two follow-up sessions at a week interval. Pain scores were recorded starting from 0 to 10. These were categorised as no score 0, mild (1–3), moderate (4–6) and severe (7–10) pain. Pain scores were compared using ANCOVA, but pain categories were compared using the chi-square test.Results: The mean age of the subjects was 8.8 (standard deviation, 4.2) years; 60% were boys. Hypnotherapy significantly reduced pain scores from a baseline mean score of 4.7 to 0.7 at the second assessment (P<0.001). Severe pain (13.3%) declined to 0%, and conversely, no pain category (0%) increased to 51.7% (P<0.001).Conclusion: Hypnotherapy at hospital significantly reduces pain in paediatric cancer patients. Therefore, hypnotherapy could be a valuable adjunct to conventional pain management strategies in paediatric oncology.

Exploration of rituximab treatment strategies for membranous nephropathy adapted to the Chinese healthcare environment

PurposeThis study aimed to explore the specific efficacy of rituximab (RTX) in the treatment of membranous nephropathy (MN) and compare and analyze the differences in effectiveness among various treatment regimens, with the objective of identifying the optimal treatment protocol suitable for the medical environment in China.Patients and methodsThis retrospective study focused on patients with MN who were treated with RTX and hospitalized at the First Medical Center of PLA General Hospital between January 1, 2019, and December 30, 2022. These patients were followed up for more than one year. We collected clinical data from these patients and categorized them into three groups on the basis of their RTX treatment background: the combined glucocorticoids (GCs) and/or immunosuppressants (IMS) and RTX monotherapy treatment groups, the initial and non-initial treatment groups, and the standard RTX and non-standard RTX treatment groups. The study evaluated the comprehensive outcomes of complete or partial remission during follow-up, as well as relapses after remission. Additionally, Cox regression analysis was conducted to identify risk factors influencing patient remission and relapse.ResultsA total of 126 patients were enrolled in this study, with an average age of 49.0 ± 13.4 years. Among them, males accounted for up to 77.8%, with an average BMI of 26.7 ± 4.0. Among these patients, 59.5% (75/126) received RTX combined with GCs and/or IMS. Statistical results revealed that the combined use of GCs and/or the IMS had no significant effect on renal remission (P = 0.439), but it accelerated the process of renal remission (P = 0.010). A total of 34.9% (42/126) of patients chose RTX as the initial treatment. Compared with the non-initial treatment group, this choice did not significantly differ in terms of efficacy or faster remission speed (all P > 0.05). On the other hand, 39.7% (50/126) of patients received the standard RTX treatment regimen. Compared with the non-standard group, the standard RTX treatment group presented a better remission rate (P < 0.001) and a faster remission speed (P = 0.027). During 13.0 (12.0, 20.0) months of follow-up, the cumulative remission rate reached 73% (92/126), including 47.6% (60/126) of patients with partial remission (PR) and 25.4% (32/126) of patients with complete remission (CR). The cumulative relapse rate was 20.7% (26/126). In addition, 17.5% (22/126) of patients experienced adverse reactions. Multivariate Cox regression analysis revealed that the standard RTX treatment regimen was associated with a better remission rate, whereas comorbid diabetes reduced the remission rate. Older age and higher white blood cell counts may lead to a higher relapse rate.ConclusionThis study revealed that RTX treatment has a high remission rate and a low relapse rate in MN patients. The standard RTX treatment regimen can provide better benefits. However, our experience is limited by its retrospective design and relatively small sample size, and further large-scale randomized controlled studies are needed to confirm our preliminary findings.

Profile of Degenerative Spine Diseases at Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar in 2022-2023

Background: Degenerative spine disease is a chronic condition with an increasing prevalence as age and life expectancy. There are approximately 266 million cases annually, with the highest incidence reported in Southeast Asia. In Indonesia, there is a lack of specific data on this disease. The Basic Health Research (Riskesdas) in 2018 only reported data on joint diseases in individuals aged ≥15 years, while the Ministry of Health Center for Data and Information (Pusdatin)’s publication in 2016 focused solely on osteoporosis. This study, conducted at Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar, aims to determine the profile of degenerative spine disease at Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar in 2022–2023 based on age, sex, BMI, occupation, and pathoanatomical location. Methods: This descriptive study included 164 samples collected from the Medical Records Department of Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar over six months in 2024. Results: Among 164 medical records meeting the inclusion criteria, 55.5% of patients were classified as old age (65–90 years), and 50.6% were male. Approximately 29.3% of patients had obesity (BMI 25.0–29.9) and a normal BMI (18.5–22.9). Regarding occupation, 61% of patients had sedentary jobs, and 87.2% had degenerative spine disease primarily in the lumbar region. Conclusion: Most patients with degenerative spine disease were old age, predominantly male, with obesity and a normal BMI, engaged in sedentary occupations, and predominantly affected in the lumbar region. Keywords: Profile, degenerative spine disease, degenerative disease

Prenatal diagnosis and genetic counseling of 20 fetuses with 15q11.2 BP1-BP2 microdeletion syndrome

To explore the clinical phenotype, pregnancy outcome and follow-up of fetuses with 15q11.2BP1-BP2 microdeletions in order to provide a basis for prenatal and reproductive consultation. From March 2019 to December 2023, 20 fetuses who were diagnosed with 15q11.2BP1-BP2 microdeletion syndrome at the Prenatal Diagnosis Center of General Hospital of Ningxia Medical University were selected as the study subjects. Results of genetic testing and ultrasound examination, outcome of pregnancy, and postnatal follow-up were retrospectively analyzed. This study has been approved by the Ethics Committee of General Hospital of Ningxia Medical University ([2020]0520B). None of the 20 fetuses was found to have chromosomal abnormality, whilst all were found to harbor a 15q11.2 BP1-BP2 microdeletion by low-depth whole genome sequencing (CNV-seq). The range of deletions was determined as 0.26 ~ 0.87 Mb, and all were rated as pathogenic CNVs. Three fetuses had abnormal ultrasound findings, including 1 with widened renal pelvis, 1 with agenesis of corpus callosum, and 1 with nuchal fold thickening. Parental verification in 10 couples verified that two fetal deletions were de novo, whilst the remaining eight were inherited from a phenotypically normal parent. Following genetic counseling, three couples had opted to terminate the pregnancy, whilst the remaining 17 had continued with the pregnancy until delivery. The 17 liveborns were followed up for 2 months to 5 years, with no obvious abnormality in growth and development noted. CNV-seq plays an important role in the prenatal diagnosis of 15q11.2 BP1-BP2 microdeletions. Such deletions may not always lead to disease phenotypes. Individualized consultation and long-term follow-up, in combination with intrauterine ultrasound and parental verification are necessary.

Robotic-assisted Kasai portoenterostomy for child biliary atresia.

The Kasai procedure (KPE) is an important treatment for biliary atresia (BA), the most common cause of neonatal obstructive jaundice. To investigate the efficacy of robotic-assisted Kasai portoenterostomy (RAKPE) in patients with BA. Clinical data of 10 patients with BA who underwent RAKPE at the Seventh Medical Center of the People's Liberation Army General Hospital between December 2018 and December 2021 were retrospectively analyzed. One patient underwent Open Kasai portoenterostomy (OKPE) due to intraoperative bleeding. Consequently, nine patients were included in this study. Fifty-two patients who underwent OKPE during the same period served as the control group. Preoperative and postoperative biochemical indexes, surgery-related indexes, and postoperative clearance of jaundice (CJ) were recorded and statistically analyzed. RAKPE was successfully completed in all nine patients, with an average total operative time of 352.2 minutes (including intraoperative cholangiography). Milk feeding resumed on an average 9.89 days postoperatively, and the average time of drainage tube removal was 18.11 days. All patients were followed up for 6 months to 2 years. The liver function indicators and bilirubin levels in 8 patients returned to normal within 3 months after surgery. Three patients developed recurrent cholangitis after discharge, with elevated white blood cell counts, liver function indicators, and bilirubin levels, requiring hospitalization for intravenous antibiotic treatment. The duration of cholangitis ranged from 5 to 8 months post-surgery. To date, no subsequent cases of cholangitis have occurred. All patients have normal liver function and bilirubin levels, with no intrahepatic bile duct dilatation on ultrasonography. Statistical analysis comparing these indicators with those of patients who underwent OKPE showed that the RAKPE group had longer operative times and postoperative drainage tube removal durations. However, there were no significant differences in intraoperative blood loss, postoperative oral milk intake resumption, postoperative hospital stay, or CJ at 3 months post-surgery. RAKPE is technically feasible, safe, and effective for treating BA. Once the technique is mastered, RAKPE may achieve CJ outcomes comparable to those of OKPE.

COVID-19 Treatment Patterns in Patients with Acute Respiratory Failure at Dr. Hasan Sadikin General Hospital Bandung in 2021–2022

Acute respiratory failure is the most common complication and cause of death in COVID-19 patients. The COVID-19 medication has yet to be discovered. COVID-19 treatment guidelines are constantly being updated. This study aims to determine the COVID-19 treatment patterns in patients with acute respiratory failure at Dr. Hasan Sadikin General Hospital Bandung in 2021–2022. This retrospective, descriptive study used systematic random sampling to examine medical records of COVID-19 patients with acute respiratory failure at Dr. Hasan Sadikin Central General Hospital between June 2021 and June 2022. Gender, age, length of stay, outcome, comorbidities, and pharmacological and non-pharmacological treatment data were analyzed by SPSS software. This study included 120 COVID-19 patients with acute respiratory failure, with the majority of patients are male (55.83%), 30–60 years old (55.83%), length of stay of 1–3 days (52.5%), and have disease severity at severe condition (43.33%) and one comorbidity (37.5%). Patients mostly received non-rebreathing oxygen mask (54.2%), antiviral remdesivir (83.3%), corticosteroid dexamethasone (76.7%), enoxaparin anticoagulants (61.7%), a combination of vitamin C, vitamin D, and multivitamins (45.8%), and two antibiotics (33.3%). Additional treatments include tocilizumab (0.8%), intravenous immunoglobulin (2.5%), and convalescent plasma (0.8%). Statistical analysis shows that patients who stay at the hospital longer, have less or no comorbidities, and are given oxygen therapy have a significant possibility of recovering. Treatments commonly prescribed to COVID-19 patients with acute respiratory failure are antivirals, corticosteroids, anticoagulants, vitamins, and antibiotics, while the administration of oxygen therapy has a significant probability of recovery.

Correlation Between Clinical Indicators and Liver Pathology in Children with Chronic Hepatitis B.

Background: Chronic hepatitis B (CHB) in children presents a significant global health challenge, with liver inflammation and fibrosis being critical concerns for disease progression and long-term outcomes. Methods: This retrospective study analyzed 1629 pediatric CHB patients from the Fifth Medical Center of Chinese PLA General Hospital, spanning from January 2000 to December 2021. Liver biopsies were performed to assess the severity of liver inflammation and fibrosis, which were graded using the Scheuer scoring system. Key clinical indicators, including age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT), were evaluated for their predictive value in determining disease severity using restricted cubic spline regression models. Results: Significant nonlinear associations were found between the clinical indicators and liver pathology. Older age was strongly associated with increased risks of moderate to severe inflammation (OR 2.21, 95% CI: 1.34-3.63, p = 0.002) and significant fibrosis (OR 2.22, 95% CI: 1.31-3.77, p = 0.003). Elevated ALT levels (≥80 U/L) were correlated with a higher likelihood of moderate to severe inflammation (OR 1.82, 95% CI: 1.05-3.15, p = 0.033), while higher GGT levels (≥50 U/L) were significantly associated with advanced fibrosis (OR 2.62, 95% CI: 1.72-3.99, p < 0.001). Conclusions: Regular monitoring of clinical indicators such as ALT, AST, and GGT levels plays a critical role in identifying pediatric CHB patients at higher risk of moderate to severe inflammation and significant fibrosis. Our findings highlight the value of integrating age and key biochemical markers into non-invasive diagnostic algorithms for the early detection and management of liver pathology in children.

Characteristics of Hysterosalphingography Findings in Infertile Patients at Prof. Dr. I.G.N.G Ngoerah Central Hospital at Periode of January 2021 to June 2024

Introduction: Infertility is the inability to achieve pregnancy after 12 months of regular unprotected intercourse, affecting millions globally. In Indonesia, it affects 10-15% of reproductive-aged couples. Infertility can be classified as primary (no prior pregnancies) or secondary (previous pregnancies). HSG is commonly used to assess uterine and tubal abnormalities, key contributors to infertility. Methodes: Descriptive qualitative study are done to examine correlation of age, uterine abnormalities, and fallopian tube abnormalities from HSG findings with the prevalence of infertility from patients in Radiology Department from Prof. Dr. I.G.N.G. Ngoerah Central General Hospital, covering the period from January 2021 to June 2024.Results: 66 patients were collected as samples. 47 patients (71.21%) have primary infertility, while 19 patients (28.79%) have secondary infertility. 9 patients (13.63%) have uterus abnormalities, while 21 patients (31.81%) have fallopian tube abnormalities.Discussion: Hysterosalpingography (HSG) is a key diagnostic tool in evaluating infertile patients, providing insights into uterine and fallopian tube morphology and patency. It detects structural abnormalities like retroflexed uterus, didelphys, or blocked tubes, which can hinder sperm-egg interaction, embryo implantation, or cause recurrent miscarriages, affecting fertility. Keywords: Abnormalities, Fallopian tube, Hysterosalphyngography, Infertiliy, uterus

Evaluation of risk factors in diabetic foot infections with systemic inflammatory response syndrome

Objective: To explore the risk factors of systemic inflammatory response syndrome (SIRS) in diabetes foot infection (DFI). Methods: A retrospective analysis was conducted on the clinical data of 301 patients admitted to the Ninth Medical Center of the People's Liberation Army General Hospital for DFI from January 2021 to December 2023, including 223 males and 78 females with the age of (63.3±12.0) years. The study population was divided into SIRS group (n=32) and non-SIRS group (n=269) based on whether SIRS occurred. Multivariate logistic regression model was used to analyze the risk factors of DFI combined with SIRS. Results: Compared with non-SIRS group, patients in SIRS group were younger [(60.3±8.5) vs (63.7±12.3) years, P=0.047], with lower serum albumin [M(Q1, Q3)] [32.7(29.3, 37.3) vs 36.2(33.6, 39.2) g/L, P=0.003] and hemoglobin [116.0(99.8, 125.3) vs 121.0(111.0, 136.0) g/L, P=0.022], and higher glycosylated hemoglobin [9.8%(8.7%, 11.6%) vs 8.7%(7.4%, 10.6%), P=0.007]; positive rate of diabetes foot history was lower [25.0%(8/32) vs 46.8% (123/269), P=0.019] and the proportion of combined osteomyelitis was higher [90.6% (29/32) vs 46.7% (168/269), P=0.002] in SIRS group. Multivariate logistic regression analysis showed that elevated glycosylated hemoglobin (OR=1.27,95%CI:1.03-1.58) and osteomyelitis (OR=4.5,95%CI:1.20-16.86)were risk factors for SIRS. Conclusion: Poor blood glucose control and osteomyelitis are risk factors for DFI complicated with SIRS.

Technique imagination guided to decline painful response on patient fracture at dr. central general hospital Wahidin Sudirohusodo Makassar

Painful can caused from the triggering factors from something stress response, where response This will influence all body systems . Patient And member team health tend For looking drug as the only one method For remove painful. However Lots action nursing non pharmacological can help in remove painful like technique imagination guided by those who have very risky low For shorten the duration of the pain episode only a number of second or minute . Objective study This is For know influence technique imagination guided to decline response painful on patient fracture. Design research used in study This is is Pre-experiment One Group Pre test posttest Design. Taking sample study This use total sampling technique with amount sample as many as 15 respondents . Respondent selected previous done pretest Then done action technique imagination guided Then done posttest for evaluate decline response pain, then the data was analyzed with Wilcoxon test in SPSS version 12.00. Based on results test statistics obtained that There is difference decline response painful between before done action and after done action technique imagination guided, where obtained level meaning that is between p = 0.002 (p&lt;0.005). Conclusion study This is There is influence giving technique imagination guided to decline response painful on patient fracture . Suggestions for power health at home sick to get it teach technique imagination guided with Correct to use lower response the pain experienced beside action pharmacological.

Hybrid Vision Transformer and Convolutional Neural Network for Multi-Class and Multi-Label Classification of Tuberculosis Anomalies on Chest X-Ray

Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a leading cause of global mortality. While TB detection can be performed through chest X-ray (CXR) analysis, numerous studies have leveraged AI to automate and enhance the diagnostic process. However, existing approaches often focus on partial or incomplete lesion detection, lacking comprehensive multi-class and multi-label solutions for the full range of TB-related anomalies. To address this, we present a hybrid AI model combining vision transformer (ViT) and convolutional neural network (CNN) architectures for efficient multi-class and multi-label classification of 14 TB-related anomalies. Using 133 CXR images from Dr. Cipto Mangunkusumo National Central General Hospital and 214 images from the NIH datasets, we tackled data imbalance with augmentation, class weighting, and focal loss. The model achieved an accuracy of 0.911, a loss of 0.285, and an AUC of 0.510. Given the complexity of handling not only multi-class but also multi-label data with imbalanced and limited samples, the AUC score reflects the challenging nature of the task rather than any shortcoming of the model itself. By classifying the most distinct TB-related labels in a single AI study, this research highlights the potential of AI to enhance both the accuracy and efficiency of detecting TB-related anomalies, offering valuable advancements in combating this global health burden.

Evaluasi Nilai Diagnostic Reference Level (DRL) pada Pemeriksaan CT Scan Abdomen 3 Fase di Rumah Sakit Umum Pusat Persahabatan

Background: Diagnostic Reference Levels (DRL) are stated in CTDI and DLP hence due to an accurate parameter selection, good control practices and the use of appropriate DRL, they will significantly reduce the radiation dose to the patient by more than 50%. In addition to DRL, the value of estimated effective dose and estimated cancer risk is as additional information to assist in several aspects of justification and optimization as well as to become an educational device that increases the awareness of the risk of cancer. This research also aims to obtain DRL value for a 3-phase abdominal CT scan because Indonesia does not yet have a DRL for a 3-phase abdominal CT scan. Methods: This research uses an observational approach with descriptive quantitative methods using secondary data. As for the data analyzed herein, they involve the patient information and the radiation dose received during a 3-phase abdominal CT scan obtained from the dose report on the CT Scan machine workstation. Meanwhile, the research population included all the patients who underwent a 3-phase abdominal CT scan undertaken at Radiology Installation of Persahabatan Central General Hospital starting from January up to March 2024 with a total population of 40 patients. The number of samples used was 30 samples. The collected data are processed and analyzed using a descriptive frequency test and then compared with DRLs from the other countries and Abdominal I-DRL, AbdoPelvis and Whole Abdomen. Furthermore, it is then calculated to obtain the estimated effective dose and cancer risk which is presented in tabular form. Results The results of this research suggests that DRL value at CTDI Persahabatan Central General Hospital is lower than that in the other countries and below Abdominal I-DRL, AbdoPelvis and Whole Abdomen, and DLP value is much higher than that in the other countries and above Abdominal I-DRL DLP, AbdoPelvis and Whole Abdomen.

Urine Periostin Level and Renal Function in Malignancy Patients Treated with High-Dose Cisplatine

Cisplatin has been used extensively as a cancer treatment. Nephrotoxicity, which is assessed by blood urea levels, blood creatinine, and estimated glomerular filtration rate (eGFR), is caused by cisplatin metabolites that build up in the kidneys. Because of these indicators' numerous flaws, optimal biological markers are required. One of the key mediators of inflammatory processes, such as kidney fibrosis and inflammation, is periostin. In cancer patients undergoing high-dose cisplatin therapy, the purpose of this study is to ascertain how urine periostin changes and how it relates to kidney function. This cross-sectional study was carried out at the National Center General Hospital of Cipto Mangunkusumo's medical hematology-oncology outer clinic and medical hematology-oncology ward on the eighth floor starting in November 2019 and ending when the minimum sample was obtained through consecutive sampling. Data was analyzed by IBM SPSS Statistics for Windows version 23.0 based on the research objective. Of the 37 responders, 70.3% were men, 29.7% were between the ages of 41 and 50, 78.4% were married, 59.5% had completed high school, 37.8% were employed, 59.5% had NPC, and 64.9% had a Karnofsky score of 80. Between before and one week following chemotherapy II, the respondents' blood creatinine and urea levels rose. The eGFR value has also decreased. Periostin levels, on the other hand, tended to rise one week following treatment III after declining during chemotherapy I and II (p value&gt;0.05). Urine periostin levels and other kidney function indicators did not significantly correlate (p&gt;0.05), according to the correlation test, and several domains had negative directions. The correlation coefficient values were modest (r = 0.017-0.254). There is a changing of urine periostin level of malignant patients receiving high dose cisplatin therapy which increase after the third chemotherapy. No significant correlation was found between periostin levels and kidney function in malignant patients with high-dose cisplatin therapy.

A FLAP MODALITY FOR RESURFACING FOLLOWING EXTERNAL GENITALIA TUMOR ABLATION: A CONSECUTIVE CASE SERIES

Introduction : External genitalia defect may result from various cases such as vulvar cancer, cervical cancer, tumor metastases, etc. Female genitalia is challenging for reconstruction due to many complex anatomical structure like urethra, vagina, anus, and its a highly mobile region. It is need to reconstruct with high successful rate and low morbidity procedure. The aim of this paper is to report various flaps for resurfacing following external genitalia defect. Method : From September 2017 - April 2022, 7 patients referred by Obstetric Gynecology Department to Plastic Surgery Division at Muhammad Hoesin Central General Hospital. The data was reviewed retrospectively to evaluate demographic, diagnosis, choice of flap reconstruction, functional and anatomical long term evaluation. Result : The ages of the patients ranged from 29 - 67 year-old, diagnosed with cervical cancer with tumor metastases to vulva in 16% (n=1) and vulvar carcinoma 84% (n=5). Flaps performed: Antero-lateral Thigh (ALT) flap in 14,5% (n=1), gracilis flap in 28,5% (n= 2), rotation flap in 28,5% (n= 2), keystone flap in 28,5% (n=1). A major dehiscence and need required reoperation for abscess in 16% (n=1). Flap selection based on size, region, and anatomical structure defect. ALT was chosen for wide and bilateral vulvar and perineal defect, gracilis for unilateral vulvar and perineal defect, Keystone flap for half of vulvar and perineal defect, rotation flap for defect on mons region. Conclusion: Flap selection in genitalia external reconstruction must be consider on the anatomical loss structure and defect size to achive durable tissue for acceptable functional and mobilisation. The algorithm may help to choose for flap based on loss area.

Clinicopathological and molecular genetic features of POLE-mutated endometrioid carcinoma

Objective: To investigate the clinicopathological and molecular genetic features of POLE mutant endometrioid carcinoma. Methods: Genetic test data of 230 cases of endometrial carcinoma that underwent surgical resection and molecular typing by next generation sequencing in the First Medical Center of Chinese PLA General Hospital from January 2021 to June 2023 were retrospectively analyzed. Seventeen cases of endometrioid carcinoma with POLE mutation were selected. Clinical and prognostic information was collected. The paraffin-embedded tissue and immunohistochemical sections were reviewed, and the gene detection data were analyzed. Results: In the 17 cases of endometrioid carcinoma with POLE mutations, 16 cases (16/230, 6.9%) had mutations at known pathogenic sites, and 1 case had a mutation site (S459Y) that had not been reported, which was inferred to be pathogenic based on clinical prognosis. The 17 patients aged from 48 to 79 years (median 56 years, mean 58 years). All cases had typical histological features of endometrioid carcinoma, including 7 cases (7/17) of poorly-differentiated, 4 cases (4/17) of moderately-differentiated and 6 cases (6/17) of well-differentiated. Squamous differentiation was noted, mucous differentiation was less commonly found and often accompanied by superficial muscle infiltration. The number of stromal lymphocyte infiltration was variable. Lymph-vascular embolus was found in 6 cases, and lymph node metastasis was only detected in 1 case. According to the FIGO staging system for endometrial cancer in 2023, all the cases were in FIGO stage ⅠAm-POLEmut except for one case in FIGO stage ⅢC1. There were 8 cases with genetic co-mutation, 5 cases with TP53 mutation (immunohistochemically subclonal expression pattern), 1 case with MSI-H, and 2 cases with both TP53 mutation and MSI-H. Five of 7 patients with POLE mutation (poorly-differentiated) received postoperative chemotherapy and/or radiotherapy, 4 patients received endocrine therapy, and 8 patients had no treatment after surgery. One of the stage ⅠAm-POLEmut tumor patients was found to have pelvic recurrence one year after surgery, and the other 16 patients were followed up for 10-38 months without recurrence or metastasis. Conclusions: POLE mutant endometrioid carcinoma may have different differentiation, and most patients have good prognosis. Correct interpretation of molecular results, accurate identification and classification are important for predicting prognosis and avoiding overtreatment. However, a small number of cases may have recurrence and metastasis, and therefore it is necessary to make a reasonable treatment plan based on the comprehensive judgment of other high risk factors.

Pengaruh Lingkungan Kerja Fisik dan Lingkungan Kerja Non Fisik Terhadap Kepuasan Kerja Pegawai

This study aims to determine whether there is an influence of the physical and non-physical work environments on employee job satisfaction at Dr. Tadjuddin Chalid Central General Hospital Makassar. This research is quantitative in nature with a descriptive approach and is population-based. The sample for this study consists of 78 nurses from the inpatient ward of Dr. Tadjuddin Chalid Central General Hospital Makassar. Hypothesis testing in this study utilizes multiple linear regression analysis and yields the following results: Based on the hypothesis testing results using multiple linear regression analysis, it is indicated that both the physical and non-physical work environment variables simultaneously affect employee job satisfaction at Dr. Tadjuddin Chalid Central General Hospital Makassar. The hypothesis testing results also demonstrate that the physical work environment partially affects employee job satisfaction at Dr. Tadjuddin Chalid Central General Hospital Makassar, and the non-physical work environment partially affects employee job satisfaction at Dr. Tadjuddin Chalid Central General Hospital Makassar.

Analysis of perioperative complications of flow-diverter devices in the treatment of unruptured intracranial aneurysms

Objective: To investigate the perioperative adverse events and complications of flow-diverter devices in the treatment of unruptured intracranial aneurysms. Methods: This is a retrospective case series study. The clinical and imaging data of 174 patients with unruptured intracranial aneurysms treated with flow-diverter devices in the Department of Neurointervention, Department of Neurology, the First Medical Center of Chinese People's Liberation Army General Hospital from January 2020 to January 2024 were retrospectively analyzed. There were 63 males and 111 females, with an age of (53.9±11.4) years (range:23 to 76 years).The occurrence, development and outcome of perioperative complications and related adverse events during treatment were collected and analyzed. The degree of aneurysm embolization was evaluated using the O'Kelly-Marotta (OKM) grading system,with OKM grade C and D as successful occlusion. Results: A total of 187 flow-diverter devices (from 7 different brands) were implanted in 174 patients (with 294 aneurysms). Of these, 151 cases involved standalone stent embolization, 26 cases involved stent embolization combined with coil assistance, and 5 cases involved the use of two flow-diverter devices simultaneously. Twenty-nine cases (16.7%,29/174) suffered intraoperative adverse events, including 10 cases of poor stents deployment, 3 cases of stents migration into the aneurysm sac, 1 cases of abnormal guidewire movement, 4 cases of ischemic events. Complications occurred in 10 patients (5.7%, 10/174), and neurological deficits occurred in 5 patients (2.9%, 5/174). A total of 129 patients completed follow-up for more than 12 months after surgery. There were 117 aneurysms with OKM grade D and 22 with OKM grade C, showing a satisfactory healing rate of 77.7% (139/179). Conclusion: The effect of flow-diverter devices in the treatment of intracranial aneurysms is satisfactory, but complications and adverse events cannot be ignored, especially the relatively high incidence of perioperative adverse events, which requires neurointerventional physicians to be vigilant.

Anti-Retroviral Treatment in dr. Sardjito Central General Hospital Yogyakarta

Anti-Retroviral Treatment in dr. Sardjito Central General Hospital Yogyakarta

Relationship Between Service Performance And Financial Performanceon The Level Of Financial Independence At The Central General Hospital H. Adam Malik Medan

The intention of these researchers is to study the relationship between economic performance and service performance at the level of independence at H. Adam Malik Central General Hospital. Secondary data is used in this research, which is a quantitative approach. Order of population members based. The sample for study is financial reporting data and services at RSUP H. Adam Malik Medan for the years 2018 - 2022. From the results of this study, it appears that there is a link between economic performance, measured by the correlation of Fixed Asset Turnover (PAT) and service performance, measured by mean length of stay (AVLOS), and the degree of autonomy of the public There are hospitals. 2018 - 2022 Center H. Adam Malik

Differences in Effective Duration of Cold Compress Administration on Reducing Pain Intensity in Fracture Patients

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Fracture is one of the problems in health care centers around the world. The condition of the tissue around the fracture will experience damage to its integrity so that it can cause pain, trauma, joint stiffness, and musculoskeletal disorders. Pain is a sensory or emotional experience related to tissue damage. Sharp and stabbing pain is felt due to bone infection due to muscle spasms or pressure on sensory nerves. Non-pharmacological therapies include cold compresses that can reduce pain, reduce inflammatory responses, and reduce blood flow and reduce edema. This therapy is more effectiveand easy to do independently by patients. Cold pack for compresses are also useful for reducing muscle tension and reducing swelling so that patients are more comfortable and relaxed. This study aims to assess the difference in the duration of cold compresses using cold packs on reducing the intensity of acute pain in fracture patients at the Haji Adam Malik Central General Hospital. The research method is Quasi-Experimental with a pretest, posttest group design approach. Sampling using the consecutive sampling technique so that 66 respondents were obtained. The research instrument used the Numeric Rating Scale. The data were analyzed using the Wilcoxon and Mann Whitney U tests. The results showed that the mean value for the 20 minute compress group was 23.85, while the mean value for the 30 minute compress group was 43.15 with a p value &amp;lt;0.05. It can be concluded that giving a cold compress for 30 minutes is much more effective than giving a cold compress for 20 minutes. It is hoped that nurses in providing nursing care can apply a cold compress for 30 minutes using a cold pack as an independent nursing action in managing fracture pain in the hospital.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;strong&gt;&lt;em&gt;Keywords: Cold Pack, Pain, Fracture&lt;/em&gt;&lt;/strong&gt;