RESUMO
PURPOSE: Radiation therapy (RT) for muscle invasive bladder cancer (MIBC) is challenging, with observed variations in bladder shape and size resulting in inappropriate coverage of the target volumes (CTV). Large margins were historically applied around the CTV, increasing the dose delivered to organs at risk (OAR). With repositioning imaging and visualization of soft tissues during image guided RT, an opportunity to consider these movements and deformations appeared possible with an adaptive RT approach (ART). MATERIALS AND METHODS: A bibliographic search on the PubMed database has been done in January 2019. Studies focusing on patients with MIBC, treating on ART, with the objectives of feasibility, clinical and/or dosimetric evaluation and comparison with a standard irradiation technique were eligible. The purpose of this review was to define the different ART techniques used in clinical practice, to discuss their advantages compared to conventional RT in terms of target volume's coverage and OAR dose and to describe their feasibility in clinical practice. RESULTS: A total of 30 studies were selected. The strategies known as "composite offline", "plan of the day" not individualized or individualized, and "re-optimization" have been identified. All the studies have shown a significant benefit of ART in target coverage and dose of OAR, especially the rectum and small bowel. All ART plans produced are not used during RT sessions. Inter-observer variability for the selection of these plans can be observed. The practical implementation within a department required staff education and training, and increases the duration of treatment preparation. The "A-POLO" approach seems to be the most suitable for practice. CONCLUSION: ART is the technique of choice for bladder cancer RT. The "plan of the day" approach, individualized according to the A-POLO methodology, seems to be the most effective. The emergence of daily re-optimization, especially using MRI-Linac, is promising. The correlation between dosimetric benefits and clinical efficacy and safety results should be demonstrated into future trials.
Assuntos
Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/métodos , Neoplasias da Bexiga Urinária/radioterapia , Estudos de Viabilidade , Humanos , Movimentos dos Órgãos , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/prevenção & controle , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias da Bexiga Urinária/patologiaRESUMO
From oleoresin of Aucoumea klaineana Pierre, five triterpenes are isolated; one pentacyclic triterpene: alpha-amyrin and four tetracyclic triterpenes: masticadienediol which seems to be new in this family, 3alpha-hydroxytirucalla-8,24-dien-21-oic acid, 3 alpha-hydroxytirucalla-7,24-dien-21-oic acid which have been already isolated in some Burseraceae and 3-oxotirucalla-7,24-dien-21-oic acid which seems to be a new triterpene.
RESUMO
From roots of Rubia cordifolia L. four anthraquinones are isolated: 1-hydroxy 2-methoxy anthraquinone; 1,4-dihydroxy 2-methyl 5-methoxy anthraquinone or 1,4-dihydroxy 2-methyl 8-methoxy anthraquinone; 1,3-dimethoxy 2-carboxy anthraquinone and rubiadin.
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From roots of Rubia cordifolia L. two anthraquinones are isolated: 1,4-dihydroxy 2-methylanthraquinone and 1,5-dihydroxy 2-methylanthraquinone and 3-prenyl methoxy 1,4-naphthoquinone.
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From roots of Rubia cordifolia L. four anthraquinones are isolated: 1-hydroxy 2-methylanthraquinone and nordamnacanthal which have been already isolated in some Rubiaceae, physcion which seems to be new in this family and 1,4-dihydroxy 6-methyl-anthraquinone which seems to be a new quinizarin.
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This new method of myocardial protection was used to prevent complications of cardiac ischaemia during clamping of the aorta. 4 litres of Ringer lactate at 4 degrees C are used to perfuse the coronary arteries and produce a total, uniform and deep fall of all the pericardial and myocardial system. This results in a flat electrocardiogram, i.e. the interruption of electrical activity of the cardiac cells. This effect persists until the aortic clamp is released which results in reoxygenation, a rise in temperature and the restoration of function. The method has been used in more than 250 operations with extracorporeal circulation (valves, bypass procedures, transplants). Up until the present, it has proved superior to techniques of coronary perfusion or hypothermia obtained using Shumway's technique.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Circulação Extracorpórea , Hipotermia Induzida , HumanosRESUMO
The authors present a cucurbitacins' review (distribution in plants, structure and pharmacologic activity). They relate the isolation of these tetracyclic triterpens from Euphorbiacées (Maprounea and Spondianthus genus) for the first time, and their toxicity and cytotoxicity (Hela, Allium, and Lepidium tests).