jurnal medscape

8/12/2019 jurnal medscape

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Two Hot Treatment Approaches Show

Promise in Ovarian Cancer

Nick Mulcahy

WASHINGTON, DC Two of the hottest treatmet a!!roaches i ocolo"y

immuothera!y a# ati$o#y%#ru" co&u"ates offer the !romise of im!ro'e# outcomes i

#ifficult(to(treat a#'ace# o'aria cacer, accor#i" to ) stu#ies !resetatios here at the

America Associatio for Cacer *esearch +-th Aual Meeti".

The immuothera!y for o'aria cacer is actually a )(ste! !rocess, which, for the first time

e'er, com$ies #e#ritic cell 'acciatio a# a#o!ti'e T(cell thera!y, sai# /aa 0a#alaft,

1harmD, 1hD, from the O'aria Cacer *esearch Ceter i the 1erelma School of Me#icie

at the 2i'ersity of 1esyl'aia i 1hila#el!hia.

I a !hase + trial, ) of 3+ !atiets 45567 with sta"e III8I9 o'aria cacer who were treate#

with the first ste! 4'accie aloe7 ha# either sta$le #isease 4 : +;7 or !artial res!ose 4 :

37. !a# these immue cells, which are the rei&ecte# ito

the !atiet.

I the )(ste! !rocess, the #e#ritic cells act as s!ies a# collect iformatio a$out tar"ets.

The s!ies retur to the lym!h o#es the hea#uarters where they iform the T(cells the sol#iers which the "o a# com$at the tumor, Dr. 0a#alaft e>!laie#.


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I effect, the seco# ste! of the !rocess, the a#o!ti'e trasfer of T(cells, am!lifies the

atitumor immue res!ose. This is e>!lais why there were more !atiets with sta$le

#isease8res!o#ers i the "rou! that u#erwet $oth ste!s tha i the "rou! that u#erwet

oly the first ste! 4;36 's 5567.

AntibodyDrug Conjugate for Patinum!"esistant Disease

At the same !ress $riefi", aother i'esti"ator !resete# results from a !hase + stu#y of a

e>!erimetal a"et that tar"ets o'aria tumors e>!ressi" the M2C+5 !rotei.

Ei"hty !ercet of all o'aria cacers e>!ress the M2C+5 !rotei, sai# lea# author Foyce B.

/iu, MD, M1H, from the Daa(Bar$er Cacer Istitute a# Har'ar# Me#ical School i

i. The ati$o#y i#etifies a

!rotei, M2C+5, which is hi"hly e>!resse# i o'aria cacers, a# tar"ets the to>i to killthe cacer cells. The ati$o#y%#ru" co&u"ate releases the to>i with relati'e selecti'ity to

M2C+5(!ositi'e cacer cells. This allows #eli'ery of #ru"s that woul# otherwise $e too to>ic

for treatmet, accor#i" to Dr. /iu.

If the acti'ity of this #ru" is cofirme# i a##itioal trials, this will re!reset a o'el ty!e of

thera!y for o'aria cacer that is uite #ifficult to treat, she ote#.

Curret thera!ies for !latium(resistat o'aria cacer are limite# i their effecti'eess a#

ty!ically short li'e#, she tol# re!orters.

The wome i the trial were hea'ily !retreate#? they recei'e# a a'era"e of ; !re'iouschemothera!y treatmets.

The a"et has a acce!ta$le safety !rofile, sai# Dr. /iu.

Duri" the stu#y, ) #ose(limiti" to>icities occurre# + case of "ra#e - eutro!eia a# +

case of "ra#e - uric aci# icrease, which occurre# at the ma>imum a#miistere# #ose of

3.) m"8k". Gra#e 3 a#'erse e'ets iclu#e# fati"ue i 6 of !atiets a# eutro!eia i 6

of !atiets.

Bati"ue was the most commo "ra#e 38- a#'erse e'et at all #ose le'els. O'erall, fati"ue

occurre# i @;6 of !atiets. Other commoly re!orte# a#'erse e'ets were ausea, 'omiti",#ecrease# a!!etite, #iarrhea, a# !eri!heral euro!athy.


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How #o you fi# time to $alace school with a $usy ursi" career

Our ursi" alumi $alace# school, work, a# family.

Bi# out how our accre#ite# !ro"rams fit your sche#ule

Iformatio from I#ustry

The results see with DM2C@;@-A #emostrate that ati$o#y%#ru" co&u"ates are the real#eal as a class of #ru", a# that T(DM+ is ot a oe(off e>am!le of a #ru" that works, sai#

/ouis Weier, MD, from the Geor"etow /om$ar#i Com!rehesi'e Cacer Ceter i

Washi"to, DC, who mo#erate# the !ress $riefi".

This is a thera!eutic coce!t that matters a# makes sese. Jou ca take a ati$o#y that

will tar"et a im!ortat ati"e o a tumor cell surface. Jou ca #eli'er a cytoto>ic !oiso to

the iterior of that cell...kill it, a# make !eo!les cacers "et $etter, he sai#.

Dr. Kandalaft 's immunotherapy study was funded by a National ancer !nstitute "varian

#peciali$ed %ro&ram of Research Ecellence &rant( the National !nstitutes of Health( and the

"varian ancer !mmunotherapy !nitiative. Dr. Kandalaft and Dr. )iu have disclosed norelevant financial relationships.

America Associatio for Cacer *esearch 4AAC*7 +-th Aual Meeti" A$stracts /


4/12

#inorities $ait %onger for &reast Cancer

Surgery

A!r )-, )+3


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Our healthcare system #oes ot allow for access to healthcare $y all !eo!le i the same

maer, she tol# *euters Health. Without ha'i" a real sta#ar# of care 4for ty!e of

treatmet a# time to treatmet7 that the healthcare system is accouta$le for, you will see

those #iffereces.

I aother stu#y !u$lishe# cocurretly i FAMA Sur"ery, researchers from the 2i'ersity ofTole#o Me#ical Ceter fou# wome with early(sta"e $reast cacer ha# lar"er tumors at

#ia"osis, a# were more likely to u#er"o mastectomy, if they were co'ere# $y Me#icai#.

What ca you #o to further your e#ucatioal "oals as a urse

/o" o a# lear critical lea#ershi! skills ee#e# to ehace your ursi" career.

Disco'er how our "ra#uate #e"ree !ro"rams ca hel! you meet your e#ucatioal "oals

Iformatio from I#ustry

Si>ty !ercet of those wome ha# a mastectomy, com!are# to 36 of !atiets with !ri'ate

isurace. The Natioal Istitutes of Health e#orses $reast(coser'i" sur"ery ( rather tha

mastectomy ( for early(sta"e $reast cacer, the team le# $y Dr. /i#a A#e!o&u ote#.

The stu#ies are cosistet with !rior research which has show, for e>am!le, that $lack

wome are more likely to #ie of $reast cacer ( i !art #ue to se"re"atio a# lower

ei"h$orhoo# a# family icomes 4see *euters Health story of March )+, )+)7.

Howe'er, with so may uestios a$out the !otetial causes $ehi# #is!arities i cacer

treatmet a# outcomes, its har# to kow where to "o e>t, Har!er ote#.

It really shoul# !ush us to try to "et at some of those uestios for u#ersta#i" how much

of these #iffereces may $e #ue to #iscrimiatio, or where !eo!le li'e a# access totreatmet he sai#.

SO2*CES htt!88$it.ly8++lt2oa# htt!88$it.ly8++lt2o

FAMA Sur"ery )+3.
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6/12

The &road Scope of Heath 'ffects (rom

Chronic Arsenic ')posure

Update on a Worldwide Public Health Problem

Abstract and Introduction

Abstract

&ac*ground+Cocers for arseic e>!osure are ot limite# to to>ic waste sites a# massi'e

!oisoi" e'ets. Chroic e>!osure cotiues to $e a ma&or !u$lic health !ro$lem

worl#wi#e, affecti" hu#re#s of millios of !ersos.

Objectives+We re'iewe# recet iformatio o worl#wi#e cocers for arseic e>!osuresa# !u$lic health to hei"hte awareess of the curret sco!e of arseic e>!osure a# health

outcomes a# the im!ortace of re#uci" e>!osure, !articularly #uri" !re"acy a# early

life.

#ethods+We sythesi=e# the lar"e $o#y of curret research !ertaii" to arseic e>!osure

a# health outcomes with a em!hasis o recet !u$licatios.

Discussion+/ocatios of hi"h arseic e>!osure 'ia #riki" water s!a from imum cotamiat le'el 4MC/7 i #riki" water is + L"8/? howe'er, cocetratios of

3, L"8/ ha'e $ee fou# i wells i the 2ite# States. I a##itio, e>!osure throu"h#iet is of "rowi" cocer. 0owle#"e of the sco!e of arseic(associate# health effects has

$roa#ee#? arseic lea'es essetially o $o#ily system utouche#. Arseic is a kow

carcio"e associate# with ski, lu", $la##er, ki#ey, a# li'er cacer. Dermatolo"ical,

#e'elo!metal, eurolo"ical, res!iratory, car#io'ascular, immuolo"ical, a# e#ocrie

effects are also e'i#et. Most remarka$ly, early(life e>!osure may $e relate# to icrease#

risks for se'eral ty!es of cacer a# other #iseases #uri" a#ulthoo#.

Concusions+These #ata call for hei"htee# awareess of arseic(relate# !atholo"ies i

$roa#er cote>ts tha !re'iously !ercei'e#. Testi" foo#s a# #riki" water for arseic,

iclu#i" i#i'i#ual !ri'ate wells, shoul# $e a to! !riority to re#uce e>!osure, !articularly

for !re"at wome a# chil#re, "i'e the !otetial for life(lo" effects of #e'elo!metal

e>!osure.

Introduction

O"oi" e>!osures to to>ic chemicals such as arseic cotiue to !ose a si"ificat threat to

!u$lic health. The Worl# Health Or"ai=atio 4WHO7 estimates that ) millio !ersos

worl#wi#e mi"ht $e chroically e>!ose# to arseic i #riki" water at cocetratios a$o'e

the WHO safety sta#ar# of + L"8/ 4WHO )K7 4 Ta$le +7. Arseic is a metalloi# elemet

that is ecoutere# !rimarily as arseical com!ou#s. Withi these com!ou#s, arseic

occurs i #ifferet 'alece states, the most commo of which are AsIII

4arseites7 a# As9

4arseates7. Arseic i #riki" water is ty!ically fou# i the ior"aic form, either as As III


7/12

or As9, whereas arseic i foo# is fou# i the or"aic a# ior"aic forms, #e!e#i" o the

s!ecific foo# A"ecy for To>ic Su$staces a# Disease *e"istry 4ATSD*7 );? Euro!ea

Boo# Safety Authority 4EBSA7 ) Sources of arseic cotamiatio iclu#e atural

#e!osits as well as athro!o"eic sources such as mii" a# electroics maufacturi"

!rocesses a# metal smelti" 4ATSD* );7.

Arseic hol#s the hi"hest raki" o the curret 2.S. ATSD* )++ su$stace !riority list

4ATSD* )++$7 4 Ta$le )7. ATSD* raks chemicals usi" a al"orithm that traslates

!otetial !u$lic health ha=ar#s ito a !oits(scale# system $ase# o the freuecy of

occurrece at Natioal 1riority /ist 4N1/7 Su!erfu# sites as well as to>icity a# !otetial

for huma e>!osure. Arseic to!s the list i s!ite of the fact that this raki" #oes ot iclu#e

full cosi#eratio of e>!osure from #riki" water, #iet, co!!er(chromate# arseic(treate#

woo#, coal( a# woo#($uri" sto'es, arseical !estici#es, a# homeo!athic reme#ies

4ATSD* );, )++$? Akter et al. )@? EBSA )? *ose et al. );7. Therefore, the threat

to huma health !ose# $y arseic is e'e "reater tha its to! ATSD* raki" woul# su""est.

I re"ar# to to>icity, the Iteratioal A"ecy for *esearch o Cacer 4IA*C7 #efies arseic

as a Grou! I kow huma carcio"e that also i#uces a wi#e array of other ocacereffects, lea'i" essetially o $o#ily system free from !otetial harm 4ATSD* );? IA*C

)+)? Natioal *esearch Coucil )+? WHO )K7.

Here we sythesi=e the lar"e $o#y of curret research !ertaii" to arseic e>!osure a#

health effects a# em!hasi=e the $roa#ei" sco!e of !re#icte# a# o$ser'e# im!acts of

arseic o !u$lic health. 2#ersta#i" the wi#e ra"e of these im!acts #ri'es home the

im!ortace of testi" #riki"(water sources a# moitori" foo#s for arseic. Whereas

muici!alities test !u$lic #riki"(water sources, !ri'ate wells ca "o uteste#. *ecet #ata

also raise cocers for arseic e>!osure 'ia foo#s iclu#i" rice a# or"aic $row rice syru!

Da'is et al. )+)? EBSA )? Boo# a# Dru" A#miistratio 4BDA7 )+)? Gil$ert(

Diamo# et al. )++? Fackso et al. )+) as well as chicke feather meal !ro#ucts that are

use# i the huma foo# system 4Nachma et al. )+)7.

E'e as assessmets of #ietary e>!osure cotiue to ufol#, #riki" water remais a ma&or

cocer for arseic e>!osure. There are kow, lar"e(scale #riki"(water cotamiatio

!ro$lems i coutries such as


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ski lesios a# ski cacer 4ATSD* )++a? Se"u!ta et al. )K? Smith et al. )a7,

eurolo"ical, res!iratory, car#io'ascular, a# #e'elo!metal effects a# more are like# to

chroic arseic e>!osure 4 Ta$le 37 4Ar"os et al. )+)? Smith a# Steimaus )? States et

al. )++7. Acute !oisoi"s still occur $ut are ucommo 4icity 'ia umerous mechaisms Arseic is "eoto>ic a# has multi!le effects

o cellular si"ali", cellular !roliferatio, DNA structure, e!i"eetic re"ulatio, a#a!o!tosis 4Blora )++? *e et al. )++? States et al. )++7.

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$nformation from $ndustry

A wealth of #ata comes from o"oi" e!i#emiolo"ical stu#ies of lar"e !o!ulatios e>!ose#

to a wi#e ra"e of arseic le'els i #riki" water i re"ios such as Taiwa, !ose# to arseic 'ia #riki" water sice the +s Che CF et al. +KK$,

+)? Gi$$ et al. )++? Tse" +;;? 2.S. E'irometal 1rotectio A"ecy 4E1A7 )+? Wu

et al. +K. I !ose# to hi"h cocetratios of

arseic for a #efie#, limite# !erio# of time 4+@K%+;+7, at which !oit, systems were

istalle# to remo'e arseic from #riki" water 4


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(actors Associated $ith "esiience or

,unerabiity to Hot (ushes and -ight

Sweats During the #enopausa TransitionOoa"h 0. Duffy, 1hD, /isa I'erse, 1hD, /ora Aucott, 1hD, 1hili! C. Haafor#, MD

Disclosures

Abstract and Introduction

Abstract

Objective. The aim of this stu#y was to e>!lore factors associate# with resiliece a#

'ulera$ility to hot flushes a# i"ht sweats.

#ethods. A total of -,-; wome a"e# -@ to @- years who were recruite# from family

!ractices i ortheast Scotla# res!o#e# to a !ostal uestioaire. Amo" res!o#ets

re!orti" hi"h(freuecy hot flushes 4 : 5)K7 or i"ht sweats 4 : 5)K7, we com!are# those

with low le'els of $other 4resiliet7 with the rest. Similarly, amo" wome re!orti" low(

freuecy hot flushes 4 : -@7 or i"ht sweats 4 : -@7, those with hi"h $other

4'ulera$le7 were com!are# with the rest. Borwar# ste!wise lo"istic re"ressio e>amie#

social, !sycholo"ical, a# !hysical factors associate# with resiliece or 'ulera$ility to each

sym!tom.

"esuts. Wome resiliet to hot flushes were those who ha# !re'iously ot $ee $othere# $ytheir mestrual !erio#s? were ot e>!erieci" somatic sym!toms or i"ht sweats? a#

!ercei'e# their sym!toms as ha'i" low coseueces o their li'es. Those 'ulera$le to hot

flushes ha# chil#re? ha# a hi"h $o#y mass i#e>? re!orte# i"ht sweats? a# !ercei'e# their

sym!toms as ha'i" hi"h life coseueces. Wome resiliet to i"ht sweats were

osmokers? were ot e>!erieci" slee! #ifficulties? were ot usi" !sycholo"ical sym!tom

maa"emet strate"ies? a# !ercei'e# their meo!ausal sym!toms as ha'i" low life

coseueces. Those 'ulera$le to i"ht sweats ha# low e#ucatioal attaimet? ha#

!re'iously $ee $othere# $y their mestrual !erio#s? ha# $elow(a'era"e !hysical health?

re!orte# musculoskeletal sym!toms a# hot flushes? a# !ercei'e# their meo!ausal

sym!toms as ha'i" hi"h life coseueces.

Concusions. Bactors associate# with resiliece or 'ulera$ility #iffer $y sym!tom stu#ie#,

althou"h relatioshi!s with illess !erce!tios e>ist i all mo#els. Our results su""est that a

si"le a!!roach to maa"i" these sym!toms is likely to $e usuccessful.

Introduction

So far, most research ito meo!ausal sym!toms has focuse# o the freuecy of 'arious

sym!toms e>!eriece# $y wome #uri" each sta"e of the meo!ausal trasitio, associate#

le'els of $other, a# use of #ifferet sym!tom maa"emet strate"ies. There is ofte

!articular em!hasis o those e>!erieci" a hi"h freuecy of sym!toms or those usi"!articular forms of health care 4such as hormoe thera!y HT7. There is, howe'er, "rowi"


10/12

iterest i u#ersta#i" why some wome seem to $e utrou$le# $y their sym!toms or

re!ort ha'i" a "oo# uality of life #uri" the meo!ausal trasitio.+A $etter

u#ersta#i" of the !sycholo"ical, !hysical, a# social factors associate# with a!!aret

resiliece to sym!toms may hel! i#etify ew iter'etios for wome ee#i" hel!.

*esiliece is a !sycholo"ical coce!t that has $ee #escri$e# as !atters or !rocesses of!ositi'e a#a!tatio a# #e'elo!met i the cote>t of si"ificat threats to a i#i'i#uals life

or fuctio.)Althou"h few woul# ar"ue that the meo!ausal trasitio is a si"ificat

threat to a womas life, it is a time whe may wome re!ort $othersome sym!toms, 3

which !ersist for a um$er of years -a# are associate# with health(relate# uality of life.@,5

The Stu#y of Womes Health Across the Natio 4SWAN7 use# #ata from the se'eth aual

iter'iew of !artici!ati" wome to e>amie factors associate# with #iscre!acies $etwee

re!orte# freuecy of, a# $other from, hot flushes or i"ht sweats.;Wome who re!orte#

freuet hot flushes a# low le'els of $other were more likely to $e marrie# a# less likely to

ha'e e"ati'e affect tha those re!orti" a similar freuecy of hot flushes a# hi"h le'els of

$other. Wome who re!orte# a hi"h freuecy of i"ht sweats $ut low le'els of $other weremore likely to $e marrie#, less likely to re!ort slee! #ifficulties, a# less likely to $e late

!erimeo!ausal tha wome re!orti" a hi"h freuecy of i"ht sweats a# hi"h le'els of

$other. I cotrast, wome who re!orte# a low freuecy of hot flushes a# hi"h le'els of

$other were more likely to $e Africa America 4com!are# with white wome7, more likely

to re!ort their self(rate# health as !oor, a# more likely to ha'e a lower le'el of e#ucatioal

attaimet. Wome re!orti" a low freuecy of i"ht sweats $ut hi"h le'els of $other were

also more likely to re!ort !oor self(rate# health. These results su""est that it may $e !ossi$le

to i#etify wome who are resiliet or 'ulera$le to the im!act of meo!ausal

sym!toms. A recet stu#y of Ecua#oria wome fou# that lower scores o the Wa"il# a#

Jou" *esiliece Scale 4i#icati" less resiliece7 correlate# with more se'ere hot flushes.K

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$nformation from $ndustry

*utter!oite# out that resiliece is likely to resi#e i the social cote>t as much as withi

the i#i'i#ual. Thus, social circumstaces a# su!!ort, self(esteem, a# self(efficacy arelikely to $e im!ortat #etermiats of resiliece. Other iflueces amo" wome

trasitioi" throu"h meo!ause may $e attitu#es towar# meo!ause+a# illess

!erce!tios or re!resetatios++of meo!ausal sym!toms. The aim of this stu#y was to

#etermie factors associate# with resiliece a# 'ulera$ility to meo!ausal sym!toms, usi"

#ata from a lar"e commuity($ase# stu#y of wome li'i" i the 20. Our hy!othesis was

that wome who are a!!aretly resiliet to meo!ausal sym!toms 4ie, those e>!erieci" a

hi"h freuecy of hot flushes or i"ht sweats $ut re!orti" low le'els of associate# $other7

woul# ha'e !ositi'e attitu#es towar# meo!ause, low le'els of a>iety or #e!ressio, hi"h

le'els of social su!!ort, a# !ositi'e illess !erce!tios. Co'ersely, it was hy!othesi=e# that

a!!aretly 'ulera$le wome 4ie, those re!orti" a low freuecy of sym!toms $ut hi"h

le'els of $other7 woul# ha'e results for these characteristics i the o!!osite #irectio.
http://as.webmd.com/event.ng/Type=click&FlightID=448940&AdID=764426&TargetID=100801&Values=60,72,81,93,145,150,205,208,222,229,234,249,308,309,343,424,533,844,1469,1966,1990,2439,3175,3187,3221,3436,3438,3443,6831,7176,13842,13858,14129,14130,18257,20184,20835,25586,26513,26575,27979,28705,31795,31912,43128,49066,49544,50686,53317,53875&Redirect=http:/www.medscape.com/infosite/phoenixnursing/article-7?src=ad_txthttp://as.webmd.com/event.ng/Type=click&FlightID=448940&AdID=764426&TargetID=100801&Values=60,72,81,93,145,150,205,208,222,229,234,249,308,309,343,424,533,844,1469,1966,1990,2439,3175,3187,3221,3436,3438,3443,6831,7176,13842,13858,14129,14130,18257,20184,20835,25586,26513,26575,27979,28705,31795,31912,43128,49066,49544,50686,53317,53875&Redirect=http:/www.medscape.com/infosite/phoenixnursing/article-7?src=ad_txthttp://as.webmd.com/event.ng/Type=click&FlightID=448940&AdID=764426&TargetID=100801&Values=60,72,81,93,145,150,205,208,222,229,234,249,308,309,343,424,533,844,1469,1966,1990,2439,3175,3187,3221,3436,3438,3443,6831,7176,13842,13858,14129,14130,18257,20184,20835,25586,26513,26575,27979,28705,31795,31912,43128,49066,49544,50686,53317,53875&Redirect=http:/www.medscape.com/infosite/phoenixnursing/article-7?src=ad_txthttp://as.webmd.com/event.ng/Type=click&FlightID=448940&AdID=764426&TargetID=100801&Values=60,72,81,93,145,150,205,208,222,229,234,249,308,309,343,424,533,844,1469,1966,1990,2439,3175,3187,3221,3436,3438,3443,6831,7176,13842,13858,14129,14130,18257,20184,20835,25586,26513,26575,27979,28705,31795,31912,43128,49066,49544,50686,53317,53875&Redirect=http:/www.medscape.com/infosite/phoenixnursing/article-7?src=ad_txt


11/12

Prenata #icronutrient Suppementation

and Postpartum Depressive Symptoms in aPregnancy Cohort


12/12

3.), @6 CI : +.@@ ( ;.+, ! : .- a# O* : -.)5, @6 CI : ).@ ( K.K@, ! P .+,

res!ecti'ely7, while !reatal su!!lemetal seleium 4!er + mc", O* : .;5, @6 CI : .;- (

.;K, ! : .+7 a# !ostatal social su!!ort 4O* : .K;, @6 CI : .;K ( .;, ! : .+@7

were !rotecti'e.

ConcusionsMulti!le factors, iclu#i" su!!lemetary seleium itake, are associate# withthe risk of !ost!artum #e!ressi'e sym!toms. Buture research o #ietary su!!lemetatio i

!re"acy with s!ecial attetio to seleium itake is warrate#.

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