jawaban simulasi PA 1.Verrucae 2.leimyoma uteri 3.reactive hiperplasia 4.TBC 5.DCIS 6.Retinoblastoma 7.Keloid 8.Seminoma 9.Fatty change 10.

Hidropic 11.Ca nasopharynx 12.Hiperplasi 13.Veruccae 14.Haschimoto 15.Gout 16.Adenocarninoma 17.Hemangioma 18.Pleumorfik adenoma 19.Melanoma 20.Transisional 21.Lipoma 22.Swanoma 23.Jaringan granulasi 24.Degenerasi hyalin 25.Teratoma immature 26.Jar.granulasi 27.Atrofi 28.Lipoma 29.Pleumorfik adenoma 30.Meningoma 31.Adenocarcinoma prostat 32.Fatty change 33.Papila adeno 34.Infark 35.Osteosarcoma 36.TBC 37.SCC 38.Degenerasi hyalin 39.Folikular lipoma 40.Rhabdomiosarcoma

Ginkgo Biloba for Prevention of Cognitive Decline

In a well-conducted clinical trial, G. biloba was ineffective in preventing cognitive decline in nondemented elders. Ginkgo biloba is one of the most heavily marketed herbalsupplements for cognitive enhancement and dementiaprevention. The G. biloba Evaluation of Memory (GEM) study was a randomized, double-blind, placebo-controlled clinical trial assessing the efficacy of G. biloba in preventing dementia and cognitive decline in elders with normal cognition or mild cognitive impairment at baseline. The authors previously reported that G. biloba was ineffective in preventing Alzheimer disease ordementia (JAMA 2008; 300:2253). Now, they report the effect ofG. biloba on rates of decline in global cognition, memory, attention, executive function, language, and visuospatial function. The researchers randomized 3069 community-dwelling elders (mean age, 79) with normal cognition or mild cognitive impairment at baseline to receive 120 mg of G. bilobasupplements or placebo twice daily. Every 6 to 12 months, for a total of 6 years, participants underwent comprehensive neuropsychological evaluations and cognitive testing. After analyses were adjusted for age, sex, race, education, and apolipoprotein E 4 status, and for mild cognitive impairment and depression at baseline, the treatment groups did not differ significantly in rates of change in global or specific cognitive domains. Comment: Unlike medications, supplements are not regulated by the Food and Drug Administration, and manufacturers are not required to provide compelling clinical trial evidence of their efficacy. However, G. biloba has been assessed in several clinical trials for different indications. In a small clinical trial, G. biloba was modestly effective in the shortterm treatment ofdementia (Pharmacopsychiatry 2003; 36:297), but results have been equivocal at best regarding prevention of dementia and slowing of cognitive decline in elders. The current study is the largest and longest clinical trial assessing the efficacy of G. biloba in the reduction of cognitive decline and prevention of dementia in nondemented elders. The results are disappointing, demonstrating lack of efficacy on all accounts. This study teaches us an important lesson: Well-designed trials are critical in determining the potential benefit of supplements in primary and secondary prevention of dementiaand, for that matter, in the prevention or treatment of any condition. Gad A. Marshall, MD Dr. Marshall is Instructor in Neurology, Harvard Medical School, and Associate Neurologist, Center for Alzheimer Research andTreatment, Brigham and Women's Hospital, Boston. Published in Journal Watch Neurology April 6, 2010

CITATION(S):
Snitz BE et al. Ginkgo biloba for preventing cognitive decline in older adults: A randomized trial. JAMA 2009 Dec 23/30; 302:2663.

Exercise as a Treatment to Enhance Sleep

1. Matthew P. Buman, PhD 1. Department of Medicine, Stanford University School of Medicine, Stanford, California, mbuman@stanford.edu 1. Abby C. King, PhD 1. Department of Health Research and Policy Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California

Abstract
The prevalence of sleep-related complaints and the limited efficacy of pharmacological treatments make nonpharmacological alternatives essential. Physical exercise is one such alternative that is inexpensive and affects numerous health systems simultaneously. This article reviews putative mechanisms that have guided exercise and sleep research, including exercises antidepressant effects, restorative functions, and circadian effects, and concludes that a number of mechanisms are plausible and likely active in explaining the effects of exercise on sleep. The empirical literature is reviewed, with special emphasis given to randomized controlled trials and experimental studies that help to inform for whom (eg, age, fitness characteristics), under what conditions (eg, light exposure, time of day), and by what means (eg, type, intensity, duration) exercise optimally affects sleep. The review also includes the emerging research using exercise as a treatment of obstructive sleep apnea and restless legs syndrome. The current literature indicates that moderate amounts of exercise, which can be obtained through a variety of means such as brisk walking and resistance training, are sufficient to improve sleep quality. Additional research is warranted in this area, particularly randomized controlled trials that target subgroups at risk for poor sleep such as older adults and persons with sleep disorders.