Cervical cancer remains a major cause of morbidity and mortality, with most cases in Indonesia diagnosed at a locally advanced stage. Although concurrent chemoradiotherapy is the standard treatment, response varies. Dysregulation of microRNAs (miRNAs), particularly oncogenic miR-92a and tumor suppressor miR-125b, may contribute to treatment resistance. This study aimed to evaluate the association between miR-92a and miR-125b expression and chemoradiotherapy response in locally advanced cervical cancer. This single-center retrospective cohort study included patients with stage IB3-IVA cervical cancer treated with chemoradiotherapy between 2019 and 2025. miRNA expression levels were measured from pretreatment tumor biopsy specimens. Poor response was defined as incomplete response or disease progression after treatment. Appropriate comparative, predictive, and survival analyses were performed. Sixty-eight patients were included. Poor response was significantly associated with underweight body mass index, elevated miR-92a, and reduced miR-125b expression (p < 0.05). High miR-92a and low miR-125b expression were also associated with shorter overall survival (p < 0.001). A combined model incorporating BMI, miR-92a, and miR-125b showed good predictive performance. Elevated miR-92a and reduced miR-125b are associated with poor treatment response and worse survival. These miRNAs may support risk stratification and treatment personalization in locally advanced cervical cancer.

Cervical cancer remains one of the most lethal cancers affecting women, with infection by high-risk Human Papillomavirus (HR-HPV), especially HPV-16, recognized as a primary cause. Phyllanthus urinaria, a plant that grows in Indonesia, has demonstrated notable both antiviral and anticancer properties. This study aimed to investigate the potential of P. urinaria as both an antiviral and anti-cervical cancer agent. The HPV-16 E6 protein was modeled using homology modelling, with model accuracy verified through torsional angle assessment and identification of conserved regions. Molecular docking was performed to examine E6-p53 interactions. Fraction of n-hexane compounds of P. urinaria were further evaluated for their interaction with E6 by molecular docking and molecular dynamics simulation. Additionally, in vitro cytotoxicity assays were conducted using HaCaT (normal keratinocyte) and HeLa (cervical cancer) cell lines. Compounds from P. urinaria were found to interact with E6 within conserved regions and these interactions were more stable conformationally than those observed for p53. In vitro assay demonstrated that P. urinaria exhibited moderate cytotoxicity against HeLa cells but had limited toxicity toward HaCaT cells. The n-hexane fraction of P. urinaria leaves exhibits anti-cervical cancer activity by inhibiting HPV-16 E6 and eliminating cervical cancer cells.

Introduction:Endometrial thickness is a crucial indicator for reproductive health evaluation and initial detection of abnormalities. This study aims to comprehensively characterize and evaluate the endometrium in normal and cancer of Indonesian women using ultrasonography. Methods:This retrospective investigation analyzed ultrasound data from three hospitals during 2021-2024 in women who met predefined inclusion criteria. Subjects were classified according to age, ethnicity, menopausal status, and ultrasound-based examination category. Results and Discussion:Endometrial thickness was quantified in 170 women with normal gynecological result and 82 women with histopathologically confirmed endometrial cancer. The average age of the normal group was 40.63 ± 0.91 years while the cancer group had an average age of 52.28 ± 1.33 years, significantly indicating that cancer subjects were generally of greater age. Endometrial thickness significantly decreased with advancing age, with the reduces values in women over 50 years (post-menopausal). There was a significant difference in endometrial thickness between normal and cancer cases, with optimal diagnostic cut-off values of 12.85 mm (AUC 0.89, sensitivity 0.83, specificity 0.94) for women aged ≤50 years and 10.20 mm (AUC 0.99, sensitivity 0.97, specificity 1.00) for women aged >50 years. These results underscore the robust relationship between age, menopausal status, and endometrial pathology, and support the clinical utility of ultrasound as a non-invasive method for early detection and risk profiling of endometrial abnormalities.

Purpose:Vulvar cancer (VC) is a rare malignancy with limited data in Southeast Asia. This 6-year retrospective cohort study aims to characterize temporal trends in VC cases in Indonesia, describe patients' sociodemographic, obstetric, and clinicopathological features, and identify predictors of advanced stage and distant metastasis (DM). Patients and Methods:We analyzed 86 VC cases diagnosed between 2015 and 2020 at a tertiary hospital in Indonesia. Patients' sociodemographic and obstetric characteristics were described, and clinicopathological and treatment-related features were compared by stage and DM status. Temporal trends were assessed using Joinpoint regression, expressed as annual percentage change (APC). Subgroup analyses were conducted by age (<60 vs ≥60 years), residential status (rural vs urban), and DM presence (negative vs positive). Univariate and multivariate logistic regression identified predictors of advanced-stage VC and DM, with model performance evaluated using the area under the receiver operating characteristic curve (AUC). Results:The number of VC cases increased significantly over six years (APC +21.43%, p=0.034), with the highest growth observed among older patients, rural residents, and cases without DM (+25.53% vs +19.61%; +22.25% vs +19.08%; +30.50% vs +9.95%, respectively). Multivariate analysis identified urban residence (OR 5.12), right-sided lesion (OR 7.93), bilateral lesions (OR 10.25), and tumor volume ≥70 cm³ (OR 10.88) as independent predictors of advanced-stage VC (AUC 0.81, p<0.001). Predictors of DM included normal/underweight nutritional status (OR 5.50), presence of pain (OR 4.88), right-sided lesion (OR 13.80), and non-keratinized tumor subtype (OR 5.72) (AUC 0.80, p<0.001). Conclusion:The experience from an Indonesian referral hospital shows that the number of VC cases treated is rising, particularly among older adults, rural populations, and patients without DM. Specific clinicopathological features, including tumor laterality, bilaterality, volume, nutritional status, pain, and histological subtype, predict adverse outcomes, providing a foundation for improved risk stratification, early detection, and targeted management in underrepresented populations.

Abstract Introduction: In 2020, cervical cancer ranked as the fourth most common cancer in women globally, with an incidence of 604,000 cases. In Indonesia, cervical cancer holds the second position among the most prevalent cancers in women. This study aims to evaluate the relationship between age and the occurrence of advanced-stage cervical cancer as a step towards effective prevention, early detection, and management. Methods: This research adopts a retrospective study design based on the Cancer Registration database of RSUPN Cipto Mangunkusumo, focusing on cervical cancer patients from 2019 to 2022. Multivariate analysis was conducted with age as the primary independent variable, considering parity and employment status in the analysis. The FIGO classification of cervical cancer stages was used to categorize patients into early and advanced stages. Results: Out of 512 cervical cancer cases, 492 were included in this study. The distribution of cervical cancer stages and the age distribution of patients is depicted in Figure 1 and Figure 2. The analysis of the relationship between cervical cancer stage, age, parity, and employment status is presented in Table 2. The association between age and cervical cancer stage is statistically significant (p<0.05) with an odds ratio of 2.13, particularly in individuals aged >54 years. Conclusion: Age over 54 years is a significant risk factor for advanced-stage cervical cancer. Although there is no significant association with parity and employment history, these findings support preventive and early detection efforts in the older population. Increased screening programs and education are expected to reduce cases of advanced-stage cervical cancer in the future.

Objective:This research seeks to establish comprehensive baseline data on the normal anatomical features of the uterus and ovaries in a cohort of healthy Indonesian subjects. Methods:This research was a retrospective study employing 500 ultrasonography results from various gynecological examinations conducted between 2021 and 2024. The ultrasound record serves as a basis for diagnosis and the definition of inclusion criteria. A morphometric analysis will be performed on the uterus and ovaries of the subject. Results:The study sample comprised 121 healthy women from reproductive age to menopause, examined using ultrasonography. Significant differences in uterine volume (p < 0.05) were observed between the 21-30 age group and the 31-40, 41-50, 51-60, and >60 age groups. Furthermore, differences in ovarian volume were observed between the right and left ovaries, as well as between women of reproductive age and those who are menopausal. Conclusion:This study on ovarian and uterine volumes in Indonesian women offers significant insights into reproductive health, highlighting age-related changes and prospective improvements in diagnostic accuracy.

Cervical cancer is the fourth most prevalent cancer among women globally. Protein concentrations of Large Tumor Suppressor Kinase-1 (LATS1) and Nuclear Factor Kappa-B (NF-κB) have been identified as prospective biomarkers of radioresistance in cervical cancer. This preliminary study aimed to investigate the effectiveness of LATS1 and NF-κB levels as a biomarker for radioresistance and evaluate their response to radiation in cervical cancer patients. A comprehensive cross-sectional study was conducted involving 114 subjects diagnosed with advanced stages cervical cancer (stage IIIB and IVA) who underwent definitive radiotherapy. The concentrations of LATS1 and NF-κB were measured using ELISA from biopsy samples taken prior to the initiation of radiotherapy. This study’s finding included 114 subjects, with a median age of 53 years. A total of 85 (74.5%) subjects had stage IIIB, while 29 (25.4%) subjects had stage IVA. The cut-offs for LATS1 and NF-κB were 0.02765 ng/mg and 192.42 pg/mg, respectively. Subjects with a higher expression of LATS1 were found to be unresponsive to radiation therapy (p ≤ 0.001; AUC = 32.7%), and subjects with a lower expression of NF-κB were found to be unresponsive to radiation therapy (p = 0.009; AUC = 61%). This study suggests that elevated LATS1 expression may inversely predict radioresistance, while NF-κB expression shows a weak correlation with resistance to radiation therapy.

Background: Ovarian cancer remains a leading cause of gynecological cancer mortality due to its typically late-stage diagnosis. Current diagnostic methods include ultrasonography (USG) and computed tomography (CT), with CT generally favored for its higher sensitivity and specificity. However, CT's limited availability in resource-poor settings raises the need to assess USG’s diagnostic viability in detecting advanced ovarian malignancies. This study aims to compare the diagnostic accuracy of USG and CT in detecting adnexal masses, ascites, lymph node involvement, omental cake, and distant metastasis in advanced-stage ovarian cancer.Method: A cross-sectional comparative study was conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from January 2021 to December 2023. The study included 70 patients with histologically confirmed advanced ovarian cancer (FIGO stages III and IV) who underwent both USG and CT before surgical intervention. Diagnostic performance measures, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for each modality, using surgical findings as the gold standard. Statistical analysis was performed using SPSS software, with significance set at p 0.05.Results: Both imaging methods demonstrated high specificity (100%) and PPV for adnexal mass detection, indicating reliability in confirming positive cases. However, CT showed superior sensitivity and accuracy across most parameters, particularly for ascites (sensitivity: 93.94%), lymph node involvement (56%), and distant metastases (36.67%). In comparison, USG had lower sensitivity, especially for distant metastases (6.67%), but maintained high specificity. These findings suggest that while USG is effective for initial assessment, CT is preferred for detailed staging.Conclusion: This study confirms CT’s superiority over USG in comprehensive ovarian cancer staging, particularly for detecting metastatic indicators. However, USG’s accessibility and affordability support its role as an initial diagnostic tool, especially in resource-limited settings. A multimodal approach, integrating USG for preliminary screening with CT for confirmation, may optimize diagnostic outcomes. Further research should focus on enhancing USG’s sensitivity to bridge the diagnostic gap in underserved regions.

OBJECTIVE:Ovarian cancer is one of the most common cancers with a high mortality rate worldwide. Despite optimal surgical therapy and chemotherapy, recurrence is still common. Cancer stem cells expressing CD44 and CD24 are thought to be contributing factors in recurrence.METHODS:A cohort retrospective study with survival analysis was carried out on advanced ovarian cancer patients who underwent optimal debulking surgery followed by 6 cycles of chemotherapy at Cipto Mangunkusumo General Hospital and Fatmawati General Hospital from January 2019 to March 2023. Immunohistochemical examination was performed on tumor tissue with CD44 and CD24 expression were assessed using the H-Score method then determined the cut off-point expression level using the ROC curve. Furthermore, the relationship between these expression levels with the disease-free survival was assessed using the survival curve.RESULTS:There were 48 subjects who were included in the study. There were high expression levels of CD44 in 47.9% and CD24 in 50% of cases. High CD44 expression had mean and median survival of 13.2 ± 1.8 and 11 months (HR 5.05, 95% CI 1.84- 13.85). High CD24 expression had mean and median survival of 13.5 ± 2.4 and 7 months (HR 7.73, 95% CI 2.58 - 23.15). The combination of the two high expressions had mean and median survival of 10.44 ± 1.88 and 7 months.CONCLUSION:High expression of CD44 and CD24 will shorten the disease-free survival of patients with advanced ovarian cancer.

Abstract This research aims to describe the profile of students’ creative thinking abilities using problem-solving-based creative thinking ability assessment instruments. Creative thinking skills tend to train students to come up with ideas and express themselves in the learning process. The instrument for targeting student profiles is in the form of an essay referring to the creative thinking indicators of fluency, elaboration, originality and flexibility. Using quantitative descriptive to analyze student profiles. The data collection technique uses a creative thinking ability test. The results of the implementation of the instrument showed that the level of creative thinking ability or student profile was obtained, and it was known that students’ abilities were categorized in each creative thinking indicator; the highest and lowest scores were respectively described in the specified aspects of creativity. The results of the analysis of students’ creative thinking abilities on renewable energy material were 68.0% in the creative category, 32.0% quite creative, and the average obtained for each indicator was 52.0%. Based on the data and analysis, it can be concluded that creative thinking abilities show the creative category and are creative enough so that physics learning is needed, which can further foster and increase student creativity.

Radioresistance poses a significant challenge in the effective treatment of cervical cancer, often leading to poor patient outcomes. MicroRNA-21 (miR-21) and MicroRNA-145 (miR-145) are oncogenic micro-RNAs associated with various cancers, including cervical cancer, but their potential as predictive biomarkers for radioresistance remains underexplored. This study aimed to investigate the association between miR-21 and miR-145 expressions and the response to radiation therapy in cervical cancer patients. An analytical cross-sectional study was conducted on 140 subjects with cervical cancer stages IIIB and IVA who received definitive radiotherapy. miR-21 and miR-145 expressions were measured using real-time reverse transcriptase–polymerase chain reaction (RT-qPCR). A total of 102 subjects (72.9%) were classified as having stage III cervical cancer, and 38 subjects (27.1%) were classified as having stage IV cervical cancer. Disease progression occurred in 60.7% of subjects. The cut-off value for miR-21 expression was 0.00088 nmol/(mg/mL) (AUC 0.676, sensitivity 70.8%, specificity 50.8%), and a higher expression was significantly associated with radioresistance (p = 0.010). miR-145, with a cut-off of 0.0239 nmol/(mg/mL) (AUC 0.612, sensitivity 67.5%, specificity 45.5%), showed no significant association with treatment response (p = 0.132). Combining miR-21 and miR-145 (AUC 0.639, sensitivity 68.6%, specificity 46.9%, p = 0.063) did not significantly improve the predictive accuracy. This study suggests that an elevated miR-21 expression is significantly associated with radioresistance in cervical cancer patients, while miR-145 expression shows no significant correlation with treatment response. Additionally, combining miR-21 and miR-145 does not enhance the predictive power.

Hiperplasia endometrium dan kanker endometrium adalah kondisi yang memengaruhi kesuburan wanita. Tujuan dari tinjauan sistematis dan meta-analisis ini adalah untuk mengevaluasi faktor-faktor yang berhubungan dengan tingkat kehamilan pada pasien dengan kondisi tersebut. Pencarian dilakukan di lima database utama: PubMed, Science Direct, Scopus, Embase, dan Cochrane Library. Dari 2.742 studi yang awalnya ditemukan, 7 studi memenuhi kriteria inklusi dan dianalisis lebih lanjut. Meta-analisis dilakukan untuk mengevaluasi efek terapi kombinasi Levonorgestrel-Releasing Intrauterine System (LNG-IUS) dengan progestin dan pengaruh indeks massa tubuh (BMI) terhadap tingkat kehamilan. Analisis gabungan dari dua studi yang membandingkan kombinasi LNG-IUS dengan progestin terhadap LNG-IUS saja menghasilkan Odds Ratio (OR) sebesar 1,54 [95% CI: 0,74–3,24], tanpa signifikansi statistik (p = 0,25). Untuk BMI, gabungan dua studi memberikan Risk Ratio (RR) sebesar 1,40 [95% CI: 0,93–2,10], juga tidak signifikan (p = 0,11). Heterogenitas yang rendah (I² = 0%) pada analisis terapi dan sedang (I² = 53%) pada analisis BMI menunjukkan konsistensi antarstudi. Meskipun ada tren peningkatan angka kehamilan dengan terapi kombinasi LNG-IUS dan progestin serta BMI ≥ 25, hasil meta-analisis ini belum menunjukkan signifikansi statistik. Penelitian lebih lanjut diperlukan untuk memperjelas faktor-faktor yang berhubungan dengan kehamilan pada pasien dengan hiperplasia dan kanker endometrium.

Objective: This diagnostic study aims to determine the expression of salivary IEX-1 as a predictor of malignancy in epithelial ovarian tumors. Methods: Samples were obtained from ovarian cancer patients who were scheduled for elective surgery. Patients' saliva was collected before surgery and used as the study's research material. Research subjects who met the inclusion and exclusion criteria were divided into two groups based on the post-operative histopathological results, benign and malignant epithelial ovarian tumors. The salivary IEX-1 expression was examined using the Real Time qPCR method. We compared and analyzed the salivary IEX-1 expression ​​in benign and malignant epithelial ovarian tumors. Results: The results of this study were obtained from 47 epithelial ovarian tumors subjects, 22 malignant tumors and 27 benign tumors. The mean salivary IEX-1 expression in benign epithelial ovarian tumors was higher (1.976) than the malignant tumors (0.554) (p<0.001). The AUC value of IEX-1 expression was 0.949 (95% CI 0.894-1,000), cut off point of salivary IEX-1 is ≥ 0,9115 with sensitivity 84%, specificity 86,4%, positive predictive value 82.6% and negative predictive value 87.5%. There was a significant correlation between salivary IEX-1 expression and malignant epithelial ovarian tumors with an OR 5.031 (95% CI 2.039-12.4; p<0,001) Conclusion: Salivary IEX-1 expression declines in tandem with the development of malignant epithelial ovarian tumors, providing a very sensitive and specific indicator of the presence of these malignant tumors. Keywords: Expression of IEX-1, Malignant epithelial ovarian tumor, Salivary IEX-1, Tumor Marker.

Introduction: Sexually transmitted infections (STIs), an emerging public health burden, are increasing due to a lack of understanding about their prevention. Objective: To understand the association between STI-related knowledge, attitudes, and practices (KAP) among women of reproductive age in an urban community health centre in Jakarta, Indonesia. Material and Methods: A cross-sectional study and consecutive sampling technique were employed on 50 women using a structured, self-administered questionnaire. All data were analysed using Spearman’s rank correlation, χ 2 , or Fisher’s exact test to test the hypothesis. Results: Encountered women had an average age of 26.80 ± 4.64 years, were married (74%), primiparous (46%), and with a high level of education (88%). The median scores for attitude and knowledge were 76.90 and 79.20, respectively, and there was a moderate correlation between these scores (ρ=0.482, p<0.001). Overall, 84% of individuals had good knowledge, and 88% of respondents had a positive attitude. Practical insight was moderate, with the rate of abstinence, using condoms, suggesting condoms, and stigmatising persons with HIV/AIDS being 54%, 32%, 2%, and 36%, respectively. Education level was a significant predictor of knowledge, and women’s attitudes toward STIs were associated with their knowledge (OR 7.80, p=0.044). There was no relationship between socio-demographic profiles and the KAP of STIs. Knowledge and attitude did not contribute significantly towards abstinence, using condoms, suggesting condoms, and HIV/AIDS-related stigmatisation due to the complexity of practice actualisation related to theories of planned behaviour. Conclusion: STI-related knowledge and attitude correlate well, but this study found that neither predicts STI-related practice.

AIM: The worrisome prognosis of advanced-stage epithelial ovarian cancer (EOC) needs a new perspective from developing countries. Thus, we attempted to study the 5-year overall survival (OS) of advanced-stage EOC patients who underwent debulking surgery in an Indonesian tertiary hospital. METHODS: A retrospective study recruited forty-eight subjects between 2013 and 2015. We conducted multiple logistic regression analyses to predict risk factors leading to unwanted disease outcomes. The OS was evaluated through the Kaplan–Meier curve and Log-rank test. Cox proportional hazards regression examined prognostic factors of patients. RESULTS: Prominent characteristics of our patients were middle age (mean: 51.9 ± 8.9 years), obese, with normal menarche onset, multiparous, not using contraception, premenopausal, with serous EOC, and FIGO stage IIIC. The subjects mainly underwent primary debulking surgery (66.8%), with 47.9% of all individuals acquiring optimal results, 77.1% of patients treated had the residual disease (RD), and 52.1% got adjuvant chemotherapy. The risk factor for serous EOC was menopause (odds ratio [OR] = 4.82). The predictors of suboptimal surgery were serous EOC (OR = 8.25) and FIGO stage IV (OR = 11.13). The different OS and median survival were observed exclusively in RD, making it an independent prognostic factor (hazard ratio = 3.50). 5-year A five year OS and median survival for patients with advanced-stage EOC who underwent debulking surgery was 37.5% and 32 months, respectively. Optimal versus suboptimal debulking surgery yielded OS 43.5% versus 32% and median survival of 39 versus 29 months. Both optimal and suboptimal debulking surgery followed with chemotherapy demonstrated an OS 40% lower than those not administered (46.2% and 20%, respectively). The highest 5-year OS was in serous EOC (50%). Meanwhile, the most extended median survival was with mucinous EOC (45 months). CONCLUSION: Chemotherapy following optimal and suboptimal debulking surgery has the best OS among approaches researched in this study. RD is a significant prognostic factor among advanced-stage EOC. Suboptimal surgery outcomes can be predicted by stage and histological subtype.

Background: Ovarian cancer is one of the leading cancers in women. Seventy percent were founded in the advanced stage, with a 5-year survival rate of only 46%. The current treatment modality is cytoreduction with platinum-based adjuvant chemotherapy as the first line. The effectiveness of chemotherapy is only 60% in the advanced stage, later developing into recurrent. Therefore, additional types of therapy are required based on agents that work specifically in cancer cells and synergize with current standard treatments. This study aimed to know the anti-proliferation effect and apoptosis effect of combination cisplatin with nanocurcumin on SKOV3 cells. Methods: This experimental study was conducted in vitro using the biological cell line SKOV3 to determine the anti-proliferation effect (expression Ki67) and the apoptosis effect (caspase 3 and 8) of combination cisplatin with combination with cisplatin nanocurcumin on the cell. The data were analyzed with unpaired T when regular distribution / Mann Whitney test when the distribution is abnormal and using Graph Pad Prism. Results: Based on this result, 50cc of nanocurcumin is 67 μm, and 50cc of cisplatin is 54 μm, using the MTT Assay method. The viability of the cells in this study decreased according to the dose-dependent, whereas the combined dose of 134 μm nanocurcumin with 108 μm cisplatin found the lowest life cell, 24.3% (p <0.001). Ki67 expression was low in the SKOV3 cells post-exposure to cisplatin, but increased post-exposure to nanocurcumin, suspected nanocurcumin at certain doses of pro-oxidant properties that triggered proliferation. Caspase 3 and 8 cannot be detected in this cell by the ELISA method. Conclusions: Nanocurcumin has a potential effect on chemosensitive cells. However, our study shows no healing effect in chemoresistance cells, particularly SKOV3.

Background: Risk of ovarian malignancy algorithm (ROMA) and risk of malignancy index (RMI) are two scoring systems that are commonly used to predict ovarian tumor malignancy.Literature shows different cutoff points for a different population.Objective: This study aims to validate and compare the performance of ROMA and RMI and also validate the cutoff points for Indonesian population.Methods: This is a retrospective study conducted at Dr Cipto Mangunkusumo Hospital (CMH).Medical records of patients with epithelial ovarian cancer who underwent surgery in our institution during 2010-2014 were collected.The diagnostic values of ROMA and RMI were calculated.Results: From the analysis of 213 subjects included in this study, ROMA was statistically better than RMI [AUC (area under the curve) in all groups: 87.00% > 81.30%, p ≤0.001; postmenopausal group: AUC 91.47% > 88.97%, p ≤0.001].RMI had values of sensitivity: 85.3%, specificity: 66.3%, positive predictive value (PPV): 79.7%, negative predictive value (NPV): 74.3%, positive likelihood ratio (LR): 2.53, negative LR: 0.22, and accuracy: 0.77.ROMA had values of sensitivity: 95