Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: does early diagnosis alter risk for gestational trophoblastic neoplasia?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estudo das limitações impostas ao amortecimento de oscilações eletromecânicas pelos zeros da FTMA de controladores suplementares

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Pole placement by coordinated tuning of Power System Stabilizers and FACTS-POD stabilizers

This work presents the application of the Decentralized Modal Control method for pole placement in multimachine power systems utilizing FACTS (Flexible AC Transmission Systems), STATCOM (Static Synchronous Compensator) and UPFC (Unified Power Flow Controller) devices. For this, these devices are equipped with supplementary damping controllers, denominated POD ( Power Oscillation Damping), achieving a coordinated project with local controllers (Power System Stabilizers - PSS). Comparative analysis on the function of damping of the FACTS, STATCOM and UPFC is performed using the New England System that has 10 generators, 39 buses and 46 transmission lines. (c) 2011 Elsevier Ltd. All rights reserved.

Molar Pregnancy in Adolescents

OBJECTIVE: To describe the clinical presentation of hydatidiform molar pregnancy in women under the age of 20 years. In addition, we sought to understand if this adolescent population manifests differences in clinical factors compared to an adult population that may affect outcome.STUDY DESIGN: We used a database from the New England Trophoblastic Disease Center to analyze clinical data from all women followed for molar pregnancy between 1970 and 2009 with complete follow-up information. This population was stratified by age and clinical parameters including presenting signs, molar histology and development of gestational trophoblastic neoplasia (GTN). Univariable and multivariable logistic regression was employed to discern clinical factors that associated with adolescent age. The Partners Human Research Committee approved this study.RESULTS: We identified 1,494 women diagnosed with hydatidiform mole (HM), of which 220 (14.7%) were adolescents defined as age <20 years. The most common presenting clinical signs were vaginal bleeding and an enlarged uterus compared to dates. Median gestational age at diagnosis was 13.4 weeks, not different from that in the adult population. Similarly, no difference in presenting human chorionic gonadotropin was observed between the adult and adolescent populations. Adolescents presented with a significant overrepresentation of complete mole (86% vs. 75%, p < 0.001) compared to adults. Complete mole was associated with a heightened risk of developing GTN (OR 2.6, 95% CI 1.9-3.5), and despite the association of complete mole with young maternal age, univariable analysis showed no difference in the rate of GTN observed between adolescents and adults (24% vs. 30%, p = 0.08). Multivariable analysis controlling for molar histology demonstrated that adolescent age was associated with a decreased risk of GTN (hazard ratio 0.67, 95% CI 0.48 0.93).CONCLUSION: Adolescents account for a substantial proportion of the population with HM. They commonly present with vaginal bleeding. Though this population develops a complete mole with a higher frequency than adults, adolescents appear to have a significantly decreased risk of developing GTN. (J Reprod Med 2012; 57:225-230)

Fluxo de carga continuado considerando o controle de intercâmbio entre áreas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo dos efeitos da compensação série no desempenho transitório dos sistemas de energia elétrica sob o enfoque da energia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Utilização de redes neurais artificiais no ajuste de controladores suplementares e dispositivo FACTS STATCOM para a melhoria da estabilidade a pequenas perturbações do sistema elétrico de potência

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise dos zeros da FTMA e ajuste de parâmetros de controladores suplementares de amortecimento acoplado ao dispositivo FACTS UPFC

Pós-graduação em Engenharia Elétrica - FEIS

Controle coordenado de múltiplos dipositivos facts com vistas à estabilidade transitória de SEE

Pós-graduação em Engenharia Elétrica - FEIS

Métodos de otimização aplicados no ajuste de ESPS e controladores de amortecimento inseridos no FACTS TCSC em sistemas elétricos de potência

Pós-graduação em Engenharia Elétrica - FEIS

Response to Chemotherapy in Overweight/Obese Patients With Low-Risk Gestational Trophoblastic Neoplasia

Objective Despite rising global obesity rates, the impact of obesity on gestational trophoblastic neoplasia (GTN) remains uninvestigated. This study aimed at investigating whether overweight/obesity relates to response to chemotherapy in low-risk GTN patients.Methods This nonconcurrent cohort study included 300 patients with International Federation of Gynecology and Obstetrics-defined postmolar low-risk GTN treated with a single-agent chemotherapymethotrexate or actinomycin-D (actD)between 1973 and 2012 at the New England Trophoblastic Disease Center. Chemotherapy dosing was based on actual body weight regardless of obesity status, except for 5-day courses or pulse regimens of actD. Patients were classified as overweight/obese (body mass index [BMI] 25 kg/m(2)) or non-overweight/obese (BMI <25 kg/m(2)). Information on patient characteristics and response to chemotherapy (need for second-line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles, need for combination chemotherapy, and time to human chorionic gonadotropin remission) was obtained.Results Of 300 low-risk GTN patients, 81 (27%) were overweight/obese. Overweight/obese patients were older than the non-overweight/obese patients (median age: 30 vs 28 years, P = 0.004). First-line therapy using actD was more frequent in overweight/obese patients (6.2% vs 1.4%, P = 0.036). Resistance and toxicity were similar between groups. No significant difference in the number of chemotherapy cycles needed for remission or time required to achieve remission was found between groups.Conclusions No association between overweight/obesity and low-risk GTN outcomes was found. Current chemotherapy dosing using BMI seems to be appropriate for overweight/obese patients with low-risk GTN.

Relationship between race and clinical characteristics, extent of disease, and response to chemotherapy in patients with low-risk gestational trophoblastic neoplasia

Objective. To evaluate the potential effects of race on clinical characteristics, extent of disease, and response to chemotherapy in women with postmolar low-risk gestational trophoblastic neoplasia (GTN).Methods. This non-concurrent cohort study was undertaken including patients with FIGO-defined postmolar low-risk GTN treated with comparable doses and schedules of chemotherapy at the New England Trophoblastic Disease Center (NETDC) between 1973 and 2012. Racial groups investigated included whites, African American and Asians. Information on patient characteristics and response to chemotherapy (need for second line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles/regimens, need for combination chemotherapy, and time to hCG remission) was obtained.Results. Of 316 women, 274 (86.7%) were white, 19 (6%) African American, and 23 (7.3%) Asian. African Americans were significantly younger than white and Asian women (p = 0.008). Disease presentation, and extent of disease, including antecedent molar histology, median time to persistence, median hCG level at persistence, rate of D&C at persistence, presence of metastatic disease, and FIGO stage and risk score were similar among races. Need for second line chemotherapy (p = 0.023), and median number of regimens (p = 0.035) were greater in Asian women than in other races.Conclusions. Low-risk GTN was more aggressive in Asian women, who were significantly more likely to need second line chemotherapy and a higher number of chemotherapy regimens to achieve complete remission than women of African American and Asian descent. Further studies involving racial differences related to clinical, biological and environmental characteristics are needed. (C) 2015 Published by Elsevier Inc.

Comparação dos resultados da gravidez molar entre adolescentes da América do Norte e da América do Sul

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB