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Metastatic colon cancer mimics HELLP syndrome in pregnancy
( Soohyun Oh ),( Hyo Jeong Ahn ),( Byoung Jae Kim ),( Kyu Ri Hwang ),( Taek Sang Lee ),( Hye Won Jeon ),( Sun Min Kim ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Colorectal cancer(CRC) is rare in pregnant women. Common symptoms include bleeding, abdominal pain, nausea, constipation, and anemia. These symptoms are commonly seen in pregnancy and confused with physiologic changes of pregnancy. This makes early diagnosis of CRC difficult and cancer to spread. We present a 34-year-old pregnant woman who was revealed to have advanced CRC with hepatic metastasis. She was referred to our clinic due to right upper quadrant (RUQ) pain with dichorionic diamniotic twin fetuses at 27+6 weeks of gestation. Her blood pressure 123/91 mmHg. Estimated fetal weight (EFW) of F1 was 1258 g, which was close to average, but EFW of F2 was 773 g (5th percentile=789) and suitable for fetal growth restriction. Umbilical artery Doppler of F2 showed absent of end-diastolic flow. She was hospitalized for maternal and fetal surveillance and workup for preeclampsia. Laboratory testing showed anemia, elevated liver enzyme and LDH, and proteinuria (Hb 9.5g/dL, AST 87 IU/L, LDH 1660 IU/L, random urine protein/creatinine ratio 0.32). She was presumed to have severe preeclampsia, also known as HELLP syndrome. After admission, her diastolic blood pressure was maintained at a level not exceeding 100 mmHg and there were no headache or blurred vision symptoms, but she complained of continuous stabbing RUQ pain, of which NRS scale was 2-5 points. She underwent liver ultrasonography and it showed multiple hyperechoic masses, considered as multinodular hepatocellular carcinoma or multiple metastasis. For further evaluation and management of maternal malignancy, she delivered twin female infants at 28+2 weeks of gestation on March 15th. After delivery, abdominopelvic computed tomography and colonoscopic biopsy revealed colon cancer with multiple metastasis, consistent with stage IV. Now She is under palliative chemotherapy.
Soohyun Oh,Hye-Young Lee,Ye-Eun Seo,Doil Choi 한국원예학회 2021 한국원예학회 학술발표요지 Vol.2021 No.10
Nonhost resistance (NHR) is a robust plant immune response against non-adapted pathogen species. To date, a few nucleotide-binding leucine-rich repeats (NLR) proteins derived from nonhost plants have been identified to recognize effectors of non-adapted pathogen and confer resistance in susceptible host plants. However, how and whether these NLRs contribute to the intrinsic durability of NHR is still elusive. Here, we screened 57 core effectors of potato late blight pathogen Phytophthora infestans (Pi) on nonhost pepper (Capsicum annuum), tested them against 436 genome-wide cloned pepper NLRs, and identified multiple functional NLRs that recognize Pi effectors and confer resistance in host species. These NLRs were homologous to known NLRs derived from wild potatoes, and recognize the same Pi avirulence effectors such as Avr2, Avrblb1, Avrblb2, and Avrvnt1. We focused on two of these NLRs, Rpi-can1 and Rpi-can2, that recognize multiple members of the conserved AVRblb2 effectors. While Rpi-can1 and Rpi-can2 are homologs of Rpi-blb2, they only function through the pepper-specific helper NLR-required for cell death (NRC). Notably, Rpi-can1 and pepper NRC-mediated HR and resistance were less susceptible to suppression of P. infestans than Rpi-blb2 and NRC from the host species, respectively. We propose that multiple effector recognitions mediated by the NLR network of pepper underlie the robust NHR against P. infestans. Our findings suggest how NLRs from evolutionarily diverged nonhost plants could durably function to fend off non-adapted pathogens. Further understanding of the NLR network architecture and other components of NHR could enable us to develop durable resistant crops against fast-evolving pathogens.