KESIMPULAN SARAN KESIMPULAN DAN SARAN

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BAB 5 KESIMPULAN DAN SARAN

5.1. KESIMPULAN

1. Pemberian ekstrak daun dan batang Scurrulla atropurpurea per-oral dengan dosis 1,5gkgBBhari selama 3 minggu bersamaan dengan inokulasi kanker terinduksi benzoalphapyrene menunjukkan kecenderungan penurunan aktivitas proliferasi sel tumor payudara tikus, meskipun tak bermakna p0,05. 2. Efek inhibisi aktivitas proliferasi sel tumor dengan pemberian ekstrak daun dan batang Scurrulla atropurpurea jika diberikan setelah tumbuhnya massa tumor payudara tikus Wistar lebih baik jika diberikan pada dosis bertingkat 3gkgBBharioral dibandingkan dengan dosis rendah 1,5gkgBBharioral.

5.2. SARAN

1. Penelitian in vitro atau kultur jaringan mungkin lebih baik digunakan untuk mencegah faktor immune surveillance host. 2. Perlu dilakukan penelitian lebih lanjut untuk mencari dosis kuratif yang tepat, baik dengan dosis bertingkat maupun interval waktu yang lebih lama dengan mempertimbangkan dose-effect relationship terhadap Scurrulla atropurpurea. Universitas Sumatera Utara 50 DAFTAR RUJUKAN 1. Direktorat Jenderal Pelayanan Medik Depkes RI, Badan Registrasi Kanker Perhimpunan Dokter Spesialis patologi Indonesia. Data Histopatologik.Yayasan Kanker Indonesia, 2001. 2. Jwrt, Stanley J. Breast cancer overview, incidence and prevalence .available from http:www.oncologychannel.combreastcancerindex.shtml:Des;2007 3. Mark JR, Humphrey PA, Wu K, et al. Overexpression of p53 and Her-2neu proteins as prognostic markers in early stage breast cancer. Annals of Surgery. 1994;219:332-341. 4. Lester, Susan C. The breast. In : kumar V, Abbas AK, fausto N, editors. Robbins and Cotran Pathologic Basis of Disease. 7 th edition. Elsevier;2005:1119-1151. 5. Cell cycle related proteins in hyperplasia of usual type in breast specimens of patients with and without breast cancer : cited 2011 jan 15. Available from : hhtp:www.biomedcentral.com147-2121729. 6. Schluter C, Duchrow M, Wohlenberg C, Becker MHG, Key G, Flad HD, et al. The cell proliferation-associated antigen of antibody Ki-67: a very large, ubiquitous nuclear protein with numerous repeated alements, representing a new kind of cell cycle-maintaining protins. J cell boil 1993 Nov; 1233:p 513-522. 7. Puay HT, Boon HB, Yip G, Selvarajan S, tan P, Wu J, et al. Immunohistochemical detection of Ki67 in breast cancer correlates with transcriptional regulation of genes related to apoptosis and cell death. Modern pathol 2005 18 2004 Nov 19:374-381. 8. Ellis.IO, Schnitt SJ. Invasive breast carcinoma. In: Tavassoli FA, Devilee P. WHO Classification ot Tumours Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003. p.13-103. 9. Mahardini T, Renawati, Yulistia A. Parameter Polycyclic Aromatic Hydrocarbons PAHs dalam Standarisasi Produk Pangan. Balai Besar Industri Agro Deprin, Bogor. 10. Agency for Toxic Subtances and Desease Regstry ATSDR, 1995, ToxicologicalProfile for Polycyclic Aromatic Hydrocarbons PAHs. Atlanta, GA: U.S.Departement of Health and Human Services, Public Health Services. 11. Elisabeth, dkk., Polycyclic Aromatic Hydrocarbon PAH: Kaitannya dengan minyak sawit dan kesehatan, dalam warta PPKS Pusat Penelitian KelapaSawit, Medan. 2000. Universitas Sumatera Utara 51 12. Juliyarsi I, Melia S. Dadih susu sapi mutan lactococcus lactis sebagai food healthy dalam menghambat kanker. Artikel Penelitian. Fakultas Peternakan Universitas Andalas, Padang. 2007. hal:1-25. 13. Rosai J. Rosai and Ackerman’s Surgical Pathology : Breast. 9 th edition. Mosby; 2004.1764-1835. 14. Rosmarilin H. Anti-cancer activity of local alpinia galangal L SW rhizome extracts on cancer cell line of human and mice transplanted with primary tumor cell. USU reporitary 2006 cited 2007 feb 14. Available from: http:library.usu.ac.iddownloadfpD0300608.pdf 15. Ohashi K, Winarno H, Mukai M. Indonesian medicinal plants XXV: cancer cell invasion inhibitory effects of chemical constituents in the parasitic plant Scurrula artropurpurea Loranthaceae. Chem Pharm. Bull 2003;51:343-5. 16. Muwarni R. Indonesian tea mistletoe Scurrula oortiana stem extract increases tumor cell sensitivity to tumour necrosis factor alpha TNF alpha. Phytotherapy Research. Phytother. Res 2003:17:407-9. [cited June 17, 2005]. Available from URL : http:www.interscience.wiley.com . 17. Matsunaga K. Legionella pneumophila replication in macrophages inhibited by selective immunomodulatory effects on cytokines formation by epigallocathecin gallate, a major substance from of tea cathecin. Infect and Immunity 2001;696:3947-3953. 18. Noreen Y, Serrano G, Perera P, Bohlin L. Flavan-3-ols isolated from some medicinal plants inhibiting COX-1 and COX-2catalyzed prostaglandin biosynthesis. 1998.[cited June 17, 2005]. Available from URL:http:www.fkogserver. bmc.uu.seinfop1998.html 19. Sulistyo H. Inhibisi aktivitas proliferasi sel dan perubahan histopatologik epithelial mukosa nasofaring mencit C 3 H dengan pemberian ekstrak benalu teh. Tesis Program pasca sarjana Universitas Diponegoro. Semarang. 2008. 20. Anonymus. Kanker Payudara. Farmasia.2008. Available at: farmasiaunfari.blogspot.com. cited 10 September 2012 21. Anderson. Female Reproductive System. Volume 6. Churchill Livingstone. 1991: 208-218. 22. The global burden of cancer: Available from: http:www.global.iarc.fr . cited 2011jan12. Universitas Sumatera Utara 52 23. Benzoalphapyrene. Wikipedia.Available from: cited 12 Januari 2012 http:en.wikipedia.orgwikiBenzoapyrene . 24. Public health goal for benzoapyrene in drinking water, December 1977:1-42 25. Caussens, L.M. and Werb, Z. Inflammation and Cancer. Nature 420, 2002:860- 867. 26. Sachs, R.K., Chan, M., Hlatky, L., and Hahnfeldt, P. Modeling Intercellular Interactions during Carcinogenesis. Radiat. Res. 2005;164:324-331. 27. Edsell. RD. Benzoapyrene Regulated with Coal Tar PitchVolatiles.Occupational Safety and Health Administration ASHA, US Dept. Of labor.1986. http:www.osha-sle.govOsh.DocInterp_data119860407.html . cited: 12 Juni 2011.

28. Lamson DW, Brignall MS. Antioxidants and cancer III: quercetin. Altern Med

Rev. 2000;53:196-208. 29. Fernandez T, cerda Z. immunobiological features of the galactoside lectin L-Lc isolated from the Argentine mistletoe ligaria cuneifolia. 2003. Available from : http:www.nchi.nlm.nih.goventrezquery.fcgi?pubmedcmd?Displaydopt?pub medpubmedfromuid:12576206 30. Hargono D. Inhibisi aktivitas biologik infusum benalu teh Scurrulla atropurpurea bl danser terhadap aktivitas system imun pada mencit. 1998. Available from : http:digilib.litbang.depkes.go.idgo.phpid=jkpkb cited: Agustus 2011. 31. Davehat L, tomasi s, Fontanel D, boustie J. flavonols from Scurrulla ferruginea danser loranthaceae.2002. Available from : http:www.nchi.nlm.nih.goventrezquery.fcgi?db=pubmedcmd+Displaydopt pubmed_pubmedfrom_uid:12562100 cited: September 2011. 32. Kresno SB. Imunologi: diagnosis dan prosedur laboratorium.Ed 4.Jakarta: Balai Penerbit Fakultas Kedokteran Universitas Indonesia. 2001:14-101. 33. Abbas AK, Lichtman AH, Fober JS. Cellular and molecular immunology,4 th ed. Philadelphia: Saunders.2000:384-403. 34. Brakenhielm, Ebba. Angiogenesis in obesity and cancer. 2003. Available from : http:www.diss.kib.ki.se200391-7349-578-6 cited: Juli 2011 35. Ki-67 biology. From Wikipedia, the free encyclopedia. From : http:en.wikipedia.orgwikiKi-67_Biology cited: Februari 2012. Universitas Sumatera Utara 53 36. Urruticoechea A, Smith I.E, Dowsett M. Proliferation marker Ki-67 in early breast cancer. Journal of Clinical Oncology. 2005;2328:7212-7220. 37. Sudigdo S, Sofyan I. Dasar-dasar metodologi penelitian klinis. Edisi 3. Jakarta. ISBN. 2008. 38. Federer, W.Y. Experimental design, theory and application. New York, Mac.Millan. 1963. p:544. 39. Jonat W, Arnold N. Is the ki-67 labelling index ready for clinical use?. Annals of Oncology. 2011:223:500-502. 40. Santoso, S. Buku Latihan SPSS Statistik Non Parametrik. Penerbit PT Elex Media Komputindo Kelompok Gramedia. Jakarta.2001:127-135. 41. Sulaiman, W. Statistik Non Parametrik Contoh Kasus dan Pemecahannya dengan SPSS. Edisi Pertama. Penerbit ANDI, Yogyakarta.2003: 29. 42. Swann B.J and Smyth J.M. Immune surveillance of tumors. The Journal of Clinical Investigation.2007;1175:1137-1146. 43. Urruticoechea A. Smith I.A and Dowsett M. Proliferation marker Ki-67 in early breast cancer. Journal of Clinical Oncology.2005;2328:7212-7220. Universitas Sumatera Utara 54 LAMPIRAN 1 Universitas Sumatera Utara 55 LAMPIRAN 2 HASIL PEMERIKSAAN Menerangkan bahwa mahasiswapeneliti yang namanya di bawah ini: Peneliti : dr. Dwi Rita Anggraini, M.Kes. Nama Instansi : Departemen Anatomi Fak. Kedokteran USU Pada pemeriksaan karakterisasi simplisiaekstrak Benalu Teh diperoleh hasil sebagai berikut: No. Pemeriksaan Hasil Rujukan Metode Biaya Rp 1 Alkaloid MMI 120.000 Reagen Meyer End. Putih + Reagen Dragendorff End. Coklat; lar. Kuning + Reagen Bouchardat End. Coklat; lar. Coklat + 2 Glikosida MMI 160.000 Reagen Fehling A + B Lar. Merah + Reagen Lieberman-Bouchard ungu + 3 Sianogenik : as. pikrat - MMI 45.000 4 Antrakinon : amonia - MMI 110.000 5 Tanin: FeCl 3 4,5 Hijau biru + MMI 20.000 6 TriterpenSteroid: as. Asetat anhidrat + as. Sulfat p Hijau menjadi ungu + triterpen 35.000 7 Flavonoid MMI 105.000 ZnHCl p kuning + MgHCl p Merah jingga + 8 Saponin : uji busa + HCl buih mantap + MMI 25.000 Ket. MMI Materia Medika Indonesia Jilid V Universitas Sumatera Utara 56 LAMPIRAN 3 Data baku penelitian Kelompok Waktu Intervensi BB awal BB akhir Berat massa Ki-67 labelling index K1- M1 3 mgg 152 174 1.37 1 K1-M2 3 mgg 150 183 3.09 3 K1-M3 3 mgg 157 168 0.76 1 K1-H1 3 mgg 169 188 0.1 1 K1-H2 3 mgg 143 147 0.42 1 P1-M1 3 mgg Benalu teh 1.5gkgBB 148 153 0.22 1 P1-M2 3 mgg Benalu teh 1.5gkgBB 147 145 0.55 3 P1-M3 3 mgg Benalu teh 1.5gkgBB 128 186 0.09 P1-H1 3 mgg Benalu teh 1.5gkgBB 156 176 0.38 1 P1-H2 3 mgg Benalu teh 1.5gkgBB 161 179 0.34 K2-M1 6 mgg 137 155 0.68 1 K2-M2 6 mgg 139 152 0.26 K2-H1 6 mgg 151 164 0.37 3 K2-H2 6 mgg 116 134 0.29 1 K2-H3 6 mgg 172 180 0.32 1 P2-M1 6 mgg 3 mgg 0 3 mgg Benalu teh 1.5gkgBB 143 196 0.31 1 P2-M2 6 mgg 3 mgg 0 3 mgg Benalu teh 1.5gkgBB 174 161 0.21 1 P2-M3 6 mgg 3 mgg 0 3 mgg Benalu teh 1.5gkgBB 146 167 0.64 P2-M4 6 mgg 3 mgg 0 3 mgg Benalu teh 1.5gkgBB 145 160 0.26 P2-H3 6 mgg 3 mgg 0 3 mgg Benalu teh 1.5gkgBB 164 204 0.37 1 P3-M1 6 mgg 3 mgg 0 3 mgg Benalu teh 3gkgBB 145 158 0.32 P3-M2 6 mgg 3 mgg 0 3 mgg Benalu teh 3gkgBB 125 139 0.15 P3-M3 6 mgg 3 mgg 0 3 mgg Benalu teh 3gkgBB 180 206 0.24 1 P3-H1 6 mgg 3 mgg 0 3 mgg Benalu teh 3gkgBB 156 175 0.14 1 P3-H3 6 mgg 3 mgg 0 3 mgg Benalu teh 3gkgBB 131 168 0.16 Keterangan : 0 = tak ada 1 = lemah 2 = sedang 3 = kuat Universitas Sumatera Utara 57 LAMPIRAN 4 Explore Uji normalitas seluruh kelompok Descriptives Statistic Std. Error BM Mean 481.60 121.415 95 Confidence Interval for Mean Lower Bound 231.01 Upper Bound 732.19 5 Trimmed Mean 377.44 Median 320.00 Variance 3.685E5 Std. Deviation 607.074 Minimum 90 Maximum 3090 Range 3000 Interquartile Range 270 Skewness 3.675 .464 Kurtosis 15.117 .902 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic df Sig. Statistic df Sig. BM .300 25 .000 .542 25 .000 a. Lilliefors Significance Correction kesimpulan : distribusi tidak normal Universitas Sumatera Utara 58 Explore UJi noormalitas 1 dan 2 BM Mean 732.00 287.707 95 Confidence Interval for Mean Lower Bound 81.16 Upper Bound 1382.84 5 Trimmed Mean 636.67 Median 400.00 Variance 8.278E5 Std. Deviation 909.808 Minimum 90 Maximum 3090 Range 3000 Interquartile Range 722 Skewness 2.320 .687 Kurtosis 5.704 1.334 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic df Sig. Statistic df Sig. BM .288 10 .019 .699 10 .001 a. Lilliefors Significance Correction kesimpulan : distribusi tidak normal Universitas Sumatera Utara 59 Explore Uji Normalitas kelompok 3, 4, dan 5 Descriptives Statistic Std. Error BM Mean 314.67 40.835 95 Confidence Interval for Mean Lower Bound 227.08 Upper Bound 402.25 5 Trimmed Mean 304.07 Median 290.00 Variance 2.501E4 Std. Deviation 158.153 Minimum 140 Maximum 680 Range 540 Interquartile Range 160 Skewness 1.420 .580 Kurtosis 1.754 1.121 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic df Sig. Statistic df Sig. BM .230 15 .032 .835 15 .011 a. Lilliefors Significance Correction kesimpulan: p value alpha Ho di tolakdistribusi tidak normal Universitas Sumatera Utara 60 Kruskal-Wallis Test Ranks Kelompok N Mean Rank BM 6 minggu tanpa intervensi 5 10.50 6mg,3mg benalu teh 1,5