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Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

World Journal of Clinical Oncology 2019年第2期10卷 28-37页

作者： Antonio Braga Paulo Mora Andréia Cristina de Melo Angélica Nogueira-Rodrigues joffre amim-junior Jorge Rezende-Filho Michael J Seckl Postgraduate Program of Medical Sciences Fluminense Federal University Department of Gynecology and Obstetrics Faculty of Medicine Rio de Janeiro Federal University Postgraduate Program of Perinatal Health Maternity School Brazilian National Cancer Hospital do Cancer 2 Department of Internal Medicine Faculty of Medicine Minas Gerais Federal University Department of Medical Oncology Charing Cross Gestational Trophoblastic Disease Centre Charing Cross Hospital Imperial College London

Gestational trophoblastic neoplasia(GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma(CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor(PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic *** diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics(FIGO)2000 criteria: four or more plateaued human chorionic gonadotropin(hCG)concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However,the latter reason for treatment is no longer used by many centers. In addition,GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate(MTX) or Actinomycin-D(Act-D), can cure about 70% of patients with FIGO/World Health Organization(WHO) prognosis risk score ≤ 6(low risk), reserving multiple agent chemotherapy, such as EMA/CO(Etoposide,MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7(high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death,allow the healing and maintenance of the reproductive potential of these women.

关键词： Gestational trophoblastic neoplasia Chemotherapy Chorionic gonadotropin Invasive mole Choriocarcinoma Placental site trophoblastic tumor Epithelioid trophoblastic tumor

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Nutritional Status and Total Phenols of Passiflora Genotypes Related to Nitrogen Fertilization

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American Journal of Plant Sciences 2015年第5期6卷 685-692页

作者： Renata Vianna Lima Almy junior Cordeiro de Carvalho Paulo Cesar Santos Jalille amim Altoé Freitas Mírian Peixoto Soares da Silva Silvio de Jesus Freitas Marta Simone Mendonca Freitas Universidade Estadual do Norte Fluminense Darcy Ribeiro Campos dos GoytacazesBrazil

This paper was developed in order to verify the influence of nitrogen fertilization and different genotypes in the nutritional aspect and in the production of total phenols in passifloraceae. The experimental design was randomized blocks in a 5 × 2 × 2 factorial scheme, being five genotypes of Passiflora (three genotypes of Passiflora edulis, a genotype of Passiflora alata and a genotype of Passiflora ligularis), two levels of cow manure (with and without) and two doses of N (20 and 80 g), with four replicates. At 120 days after sowing, levels of foliar nutrient and total phenols were determined. Foliar N content varied depending on N doses, organic fertilization and the genotypes used. Foliar levels of P and K were higher when all genotypes received organic fertilization, while the levels of Fe and Mn were similar regardless of this fertilization. The levels of Ca and Mg were higher related to organic fertilization and the genotypes, in isolation. But the foliar contents of S, Zn and Cu increased only in relation to the used genotypes, and the average foliar content of total phenols found was 19.4 g·kg-1, ranging from 13.1 to 23.2 g·kg-1, being the lowest value observed in Passiflora alata without fertilization with cow manure. It is concluded that the nutritional requirement for N is greater for genotypes of the species Passiflora edulis in relation to the species Passiflora alata and Passiflora ligulares, and that the organic fertilization influences positively in the production of total phenols only for the genotype of sweet passion fruit.

关键词： Fertilization Nitrogen Secondary Metabolites Nutrients

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