The HPV vaccination was associated with higher knowledge and appropriately lower perception of HPV risk. Despite the vaccination, most of the adolescents continued to perceive a need for safer sexual behavior. All adolescent girls should receive HPV vaccination in order to reduce cervical cancer burden in the future.

Objective To determine the predictive accuracy of the combined panels of serum human tissue kallikreins (hKs) and CA-125 for the detection of epithelial ovarian cancer. Methods Serum specimens collected from 5 Indonesian centers and 1 Vietnamese center were analyzed for CA-125, hK6, and hK10 levels. A total of 375 specimens from patients presenting with ovarian tumors, which include 156 benign cysts, 172 epithelial ovarian cancers (stage I/II, n=72; stage III/IV, n=100), 36 germ cell tumors and 11 borderline tumors, were included in the study analysis. Receiver operating characteristic analysis were performed to determine the cutoffs for age, CA-125, hK6, and hK10. Sensitivity, specificity, negative, and positive predictive values were determined for various combinations of the biomarkers. Results The levels of hK6 and hK10 were significantly elevated in ovarian cancer cases compared to benign cysts. Combination of 3 markers, age/CA-125/hk6 or CA-125/hk6/hk10, showed improved specificity (100%) and positive predictive value (100%) for prediction of ovarian cancer, when compared to the performance of single markers having 80-92% specificity and 74-87% positive predictive value. Four-marker combination, age/CA-125/hK6/hK10 also showed 100% specificity and 100% positive predictive value, although it demonstrated low sensitivity (11.9%) and negative predictive value (52.8%). Conclusion The combination of human tissue kallikreins and CA-125 showed potential for improving prediction of epithelial ovarian cancer in patients presenting with ovarian tumors.

Objective To determine the role of caspase-3, apoptosis-inducing factor (AIF), and B-cell lymphoma-2 (Bcl-2) expressions in term premature rupture of membrane (PROM). Methods An analytic observational study with case-control design was conducted, involving 52 subjects (37–42 weeks of gestation) who were divided into 2 groups: 26 cases of term delivery with PROM, and 26 controls of term delivery without PROM. The expressions of caspase-3, AIF, and Bcl-2 in the amniotic membrane were determined by immunohistochemistry. Data were analyzed using the chi-squared test. The risk of PROM was expressed by odds ratio (OR). Results There were no significant differences in age, parity and body mass index between the two groups (p > 0.05). High caspase-3 and AIF expressions increased the risk of PROM 17.64 times (OR = 17.64; 95% CI = 4.44–70.07; p = 0.001) and 9.45 times (OR = 9.45; 95% CI= 2.62–34.07; p = 0.001), respectively, while low Bcl-2 expression increased 10.39 times (OR = 10.39; 95% CI = 2.73–39.56; p = 0.001)the risk of PROM . Conclusion High caspase-3 and AIF expressions and low Bcl-2 expression were risk factors for term PROM. Caspase-dependent and independent pathways of apoptosis were involved in the mechanism of PROM in term pregnancy.

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Abstrak: Insiden kanker serviks di Bali sangat tinggi (0,8%), dimana lebih dari 70% kasus terdeteksi saat sudah stadium lanjut (di atas 2B), sehingga sulit diobati. Upaya pencegahan masih rendah dan Kabupaten Badung hanya membiayai vaksinasi dengan cakupan 17,8% (1567 dari 8784) siswa sekolah menengah umum. Vaksinasi membutuhkan dana yang besar, keberlangsungan subsidi pemerintah daerah belum dipastikan, sehingga dibutuhkan partisipasi masyarakat untuk keberlanjutan dan cakupan yang lebih luas. Penelitian crossectional ini bertujuan untuk mengetahui hubungan antara variabel perceived susceptibility, perceived severity, perceived benefits, perceived barriers, pendidikan dan pekerjaan, dengan kesediaan orang tua membayar biaya vaksinasi. Sampel penelitian adalah 196 dari 595 populasi dipilih secara random, terdiri dari ibu siswi Kelas 1 SMU 1 Petang, SMU 2 Mengwi dan SMU 1 Kuta Utara. Data dikumpulkan dengan self administered questionnaires.  Perceived benefits dan severity diukur dengan menilai jawaban dari pertanyaan terbuka dan  pre-coded. Analisis data menggunakan chi square dan regresi logistik. Kesediaan orang tua membayar masih rendah 43% dengan 70% responden sanggup membayar dibawah Rp. 237.500,-. untuk tiga dosis. Hasil analisa bivariat menunjukkan perceived susceptibility [RP 1,31; 95%CI 1,04-1,67], perceived severity [RP 1,57; 95%CI 1,20-2,05], perceived benefits [RP 1,84; 95%CI 1,39-2,45], pendidikan [RP 1,64; 95%CI 1,05-2,57], perceived barriers [RP 0,89; 95%CI 0,70-1,15] dan pekerjaan [RP=1,18; 95%CI 0,87-1,60]. Dari hasil penelitian dapat disimpulkan bahwa perceived susceptibility, perceived severity, perceived benefits dan pendidikan berhubungan dengan kesediaan orang tua membayar vaksin. Faktor dominan yang berhubungan adalah perceived benefits. Disarankan promosi kesehatan lebih menekankan pada manfaat vaksinasi serta tingkat keganasan penyakit untuk meningkatkan kesediaan masyarakat membayar.

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Objective: To characterize HPV16 E6/E7 mutation and its association with p53 expression among Indonesian women with cervical cancer. Methods: This is a cross-sectional study involving 31 Indonesian women with pathologically proven cervical cancer and HPV16 infection. Data about the clinical characteristics of the study population were obtained from the medical records. Biopsy specimen of the cervical cancer mass from each study participant was obtained for DNA isolation. The ORFs of E6 and E7 genes were amplified using specific primer designed according to K02718/HPV16R gene sequence obtained from GenBank. Sequencing was performed using software program MEGA10. HPV16 E6 and E7 prototype sequences for nucleotide alignment (HPv16. P, GenBank Access code: NC_001526) was selected from European variant. The sequence of nucleotide and amino acid was aligned using software program BioEdit. p53 expression was evaluated through immunohistochemistry and quantified using immunoreactivity score (IRS). Results: Twelve subjects (38.7%) present with E6 and E7 mutation. Median age, parity, stage and histologic type of the tumour did not associate with E6/E7 mutation. E6 and E7 mutation rate was 25.8% (8/31) and 12.9% (4/31), respectively. Seven single nucleotide changes were identified within the E6 and E7 oncogenes, including four non-synonymous and three synonymous mutations. E6 T27C was the most prevalent mutation (16.1%). Nonsynonymous mutations were more prevalent within E7 gene (9.6%) (N29T, N29S, and R77C). Median IRS did not differ between HPV16-E6/E7 variants and wildtype (p value = 0.990). There was no association between E6/E7 mutations and p53 expression in Indonesian women with cervical cancer (PR 1.4, 95% CI: 0.29-6.77, p value = 0.704). Conclusions: HPV16 E6 mutation was more prevalent than E7 mutation among Indonesian women. There was no association between E6/E7 mutation and p53 expression level.

IntroductionInsulin-like growth factor-binding protein 2 (IGFBP2) plays an important role in the pathogenesis of ovarian cancer. The most prominent effects of IGFBP2 include promoting proliferation, driving invasion, and suppressing apoptosis. This study aimed to determine the diagnostic accuracy of serum IGFBP2 in differentiating between benign and malignant ovarian neoplasms.MethodsPreoperative serum IGFBP2 level was evaluated from 76 women with primary ovarian tumor who underwent exploratory laparotomy at Sanglah General Hospital, Denpasar, Bali, Indonesia. The optimal threshold value of IGFBP2 for the diagnosis of ovarian cancer was determined from the receiver 0perating characteristic (ROC) curve. The diagnosis was confirmed by histopathologic analysis of resected ovarian specimens.ResultsForty-six (60.5%) patients were diagnosed with ovarian cancer. The area under the ROC curve (AUC) of IGFBP2 in detecting ovarian cancer was 0.815 (95% CI: 0.721 to 0.910, P<0.001). For a given specificity larger than 95%, the optimal sensitivity was 63%. The optimal threshold value of IGFBP2 for the diagnosis of ovarian cancer was 804 ng/mL [sensitivity 63%, specificity 96.7%, positive predictive value (PPV) 96.7%, negative predictive value (NPV) 63%, accuracy 76.3%, and diagnostic odd ratio (DOR) 49.5 (95% CI 6.1 to 396.5)]. In a subgroup analysis, IGFBP2 showed excellence performance in diagnosing advanced ovarian cancer (AUC 0.904 [95% CI: 0.806 to 1.000], sensitivity 83.3%, specificity 96.7%, PPV 95.2%, NPV 87.9%, accuracy 90.7%, and DOR 145.0 [95% CI 15.0 to 1395.3]).ConclusionIGFBP2 is a novel and potentially promising biomarker for detecting ovarian cancer. Further studies are needed to confirm its diagnostic performance in premenopausal women and for detecting early stage ovarian cancer.