formulir_etik_uji_hewan.doc

7/24/2019 Formulir_Etik_Uji_Hewan.doc

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KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

FAKULTAS KEDOKTERAN UNIVERSITAS PADJADJARAN

KOMISI ETIK PENELITIAN KESEHATAN

HEALTH RESEARCH ETHICS COMMITTEEJl. Prof. Eijkman No. 38 Bandung 40161

Telp. & Fa. 0!!"!0386#$ email% kepk.fk.unpadgmail.'om

FL/04-06

Formulir Hewan Coba

No. Register: 0 4 1 5 0 6 0 5 6 8

A. Informasi Umum

1. eneliti !tama "gelar #an nama$ %mran &s'a (a)utra* #rg

+ea,lian/()esialisasi e#a, ulut

abatan/+e#u#u'an Resi#en (

2el). Ruma,: H.: 08138434545 2obassamet,gmail.7om

. &sal %nstansi F'g un)a# 2el). +antor* Fa.* e-mail

()onsor -

Clinical Monitor -embimbing/eneliti Lain: R.antra Nan#ini.*#rg

()."+$.&R(

&n#ri Her#ianto #rg.*

()..*.*,

9etnia, uniantito*

#r,.,.*& 9et

3. u#ul enelitian:erban#ingan ;u'an 'e

+omite ;ti' Lain

o=a oiterima oitola'

ila a* lam)ir


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1. Ring'asan usulan )enelitian men7a'u) alasan/motiDasi #ila'u'anna )enelitian* tu>uan/ob>e'tiuan enelitian emanawab/a,li ,ewan )er7obaan:

o 2i#a' Ya apaka! ada rekomendasi dari "PPH #bila ada lampirkan$

5. ata Hewan ang &'an iguna'an:

()esies ,ewan:ti'us !mur: 8 minggu

(train/alur:s)rague #awle erat a#an: 300-400 gr enis 'elamin: >antan umla,: @

&sal/#i)erole, #ari: in#o animal lab bogor

6. +eterangan engenai rose#ur ang &'an ila'u'an 2er,a#a) Hewan:

a. emeli,araan ,ewan 7oba:

" emeli,araan ,ewan 7oba sebelum interDensiCara )erla'uan )a#a ti'us :

1. a'anan : ma'anan stan#ar ti'us (rague awle ang su#a, #iatur sesuai

stan#ar u>i 'linis ,ewan

. +an#ang : tem)at ti'us stan#ar ti'us (rague awle untu' )enelitian ang
mailto:[email protected]:[email protected]


3/15






su#a, #iatur sesuai stan#ar u>i 'linis ,ewan

umla, 'an#ang #an )ola ma'an binatang )er7obaan :

1. 2i'us ()rague awle ber>umla, 30 e'or #item)at'an #i 'an#ang #an ruangan ',usus

ang tela, #iatur su,u #an 'elembaban ruanganna*u'uran 'an#ang ti'us ()rague

awle 307m 407m

. a'anan ti'us ()rague awle beru)a )elet tera)ung sebagai ma'anan stan#ar ti'us

untu' )er7obaan.+om)osisi nutrisi beru)a Cru#e )rotein 30E*7ru#e Fat 4E*7ru#e


4/15






oemane'

o (ebelum membu'a ber'as )enelitian* )etugas ,arus menan#atangani )ersetu>uan untu'

men>aga 'era,asiaan #o'umen

o &)abila memung'in'an* in#enti


5/15






an#ung* 1A uni 015

*en)eta!ui

"a. 'epartemen(Prodi Peneliti Utama

R. ;n#ang (>amsu#in #rg.* () #rg. %mran &s'a (a)utra

"etua Tim Pembimbin)

R. antra Nan#ini*.#rg.*()"+$.*&R(

Pembimbin) I Pembimbin) II

&n#ri Har#ianto.*#rg.().*.*, 9etnia, uniantito*#r,.,.*& 9et

BI+ 'ATA PE,E-ITI UTA*A

Nama leng'a) : %mran &s'a (a)utra* #rg

N.%.. : 16011100010
mailto:[email protected]:[email protected]


6/15






2em)at/tgl. la,ir : ogor*6 &gustus 1A81

enis +elamin : la'i-la'i&lamat ? No. 2el). : >ln.unga a'ung raa No A " 08138434545 $

Pendidikan"#ari (ar>ana u#a/ ang se#era>at 'eatas$

2em)at en#i#i'an +ota/Negara 2a,un

Lulus

i#ang (tu#i

F+ !N& an#ung/%n#onesia 006 o'ter igi

Pen)alaman Penelitian

u#ul enelitian 2a,un

erban#ingan e


7/15






N.%.. : 1A505161A@804 001

2em)at/tgl. la,ir : an#ung* 16 ei 1A5enis +elamin :erem)uan

&lamat ? No. 2el). : l. Ciumbuleuit No. 60 an#ung

H. 081648@4580



Lulus

i#ang (tu#i

F+ !N&

F+ !N&

F+ !%

F+ !N&

an#ung

an#ung

a'arta

an#ung

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1A88

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se'arang

+e#o'teran igi

()esialis e#a, ulut

&R(

as7a (ar>ana

Pen)alaman Penelitian

u#ul enelitian 2a,un

engaru, e#a, +ore'si 2e'ni' ,arngeal

Fla)I )a#a e#a, Re'onstru'si 2e'ni' us,-

a7'I ter,a#a) Fungsi i7ara )a#a &na' !sia

(e'ola,

&nalisis erbe#aan +ista Ra#i'uler #engan +istaFoli'uler ber#asar'an +linis* Ra#iologis* #an

Histo)atologis

&nalisis erban#ingan +eber,asilan eto#e

)erasi Cela, ibir 2e'ni' Le esurier #engan

2e'ni' nisu'a #i bawa, &nestesi Lo'al

&nalisis +asus 2rans)lantasi igi #i agian

e#a, ulut #an a'silo


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&nalisis engelolaan #ontoma #i agian

e#a, ulut #an a'silo


9/15






engaru, 2rans)lantasi &utologous

esen7,mal (m),isis an#ibula Combine#

wit, (nt,eti7 Carbon &)atite* #an r,-ter,a#a) a) one Healing melalui

Re'onstru'si #an erawatan rto#onti-

rosto#onti )a#a &lDeolar Cle


10/15






2em)at/tgl. la,ir : a'arta* 3 'tober 1A@3

enis +elamin : La'i-la'i&lamat ? No. 2el). : Resort ago a'ar Forest Hills ;-1 an#ung

H. 081136055



Lulus

i#ang (tu#i

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!niD. (,ang,ai iao

2ong

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an#ung

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11/15






9essel


12/15






enis +elamin : La'i-la'i

&lamat ? No. 2el). : >l &gat,is +am)us % ramaga*'abu)aten ogor H. 0815388158



Lulus

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4. Bi>esun#era ++*/uniantito 0* olbar

H* Fu>isawa +*2ana'a *%7,i'awa C*%awa

2* +uwamura* * Yamate /.;)ressions o< %ba1an# gale7tin-3 "al-3$ in t,ioa7etami#e "2&&$-

in#u7e# a7ute rat liDer lesions. ;) 2oi7ol

at,ol 013M 65: @AA-808.

5. olbar H*%awa 2* %7,i'awa C* 2ana'a

* /uniantito 0*(awamoto *+uwamura

* Yamate /. (lowl )rogressiDe

7,olangio


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10./uniantito 0* %awa 2* =uasa 2* %7,i'awa C*

=ano R* +uwamura * Yamate /.

%mmuno),enot)i7al 7,ara7teriation o


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* %to (* Yamate /. astrointestinal 7an#i#iasis

in an &l#abra giant tortoise "Geochelone

gigantea$. 9et e# (7i 00AM @1: 16A-1@.

18./uniantito 0* raseto F. &'tiDitas se#iaan gel

#ari e'stra' li#a, buaa "(loe )ar)adensisill.$

)a#a )roses )ersembu,an lu'a. %lmu ertanian

%n#onesia 006M 11: 18-3 "%n %n#onesian$.

1A.riosoeranto *Huminto H.* &gung)riono

R* Han#,arani ;*;stuningsi, (*Harlina ;*

Binarsi, B* /uniantito 0.&n outbrea' o< aDian

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formulir_etik_uji_hewan.doc

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