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1.
Cell Biochem Biophys ; 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38388989

RESUMO

While acute inflammation is an essential physical response to harmful external influences, the transition to chronic inflammation is problematic and associated with the development and worsening of many deadly diseases. Until now, established pharmaceutical agents have had many side effects when used for long periods. In this study, a possible anti-inflammatory effect of the sesquiterpene α-humulene on lipopolysaccharide (LPS) induction was tested. Herein, human THP-1-derived macrophages were used and their pro-inflammatory interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1ß (IL-1ß) cytokine release was measured by means of enzyme-linked immunosorbent assay. A dose-dependent effect of α-humulene on IL-6 release was observed at 0.5 and 100 µM α-humulene, with a maximum IL-6 inhibition of 60% compared to the LPS reference value after the addition of 100 µM α-humulene. TNF-α as well as IL-1ß cytokine concentrations were not reduced by the addition of 0.5 and 100 µM α-humulene. This study suggests that α-humulene has potential as a promising natural alternative to established pharmaceuticals for the treatment of elevated IL-6 levels and chronic inflammation in humans.

2.
Bioengineering (Basel) ; 10(10)2023 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-37892924

RESUMO

Cupriavidus necator is a facultative chemolithotrophic organism that grows under both heterotrophic and autotrophic conditions. It is becoming increasingly important due to its ability to convert CO2 into industrially valuable chemicals. To translate the potential of C. necator into technical applications, it is necessary to optimize and scale up production processes. A previous proof-of-principle study showed that C. necator can be used for the de novo production of the terpene α-humulene from CO2 up to concentrations of 11 mg L-1 in septum flasks. However, an increase in final product titer and space-time yield will be necessary to establish an economically viable industrial process. To ensure optimized growth and production conditions, the application of an improved process design in a gas bioreactor with the control of pH, dissolved oxygen and temperature including a controlled gas supply was investigated. In the controlled gas bioreactor, the concentration of α-humulene was improved by a factor of 6.6 and the space-time yield was improved by a factor of 13.2. These results represent an important step toward the autotrophic production of high-value chemicals from CO2. In addition, the in situ product removal of α-humulene was investigated and important indications of the critical logP value were obtained, which was in the range of 3.0-4.2.

3.
Am J Physiol Cell Physiol ; 325(1): C332-C343, 2023 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-37335025

RESUMO

Cardiomyopathies are associated with fibrotic remodeling of the heart, which is characterized by the excessive accumulation of collagen type I (COL I) due to chronic inflammation and suspected epigenetic influences. Despite the severity and high mortality rate of cardiac fibrosis, current treatment options are often inadequate, underscoring the importance of gaining a deeper understanding of the disease's underlying molecular and cellular mechanisms. In this study, the extracellular matrix (ECM) and nuclei in fibrotic areas of different cardiomyopathies were molecularly characterized by Raman microspectroscopy and imaging and compared with the control myocardium. Patient samples were obtained from heart tissue affected by ischemia, hypertrophy, and dilated cardiomyopathy and analyzed for fibrosis through conventional histology and marker-independent Raman microspectroscopy (RMS). Prominent differences between control myocardium and cardiomyopathies were revealed by spectral deconvolution of COL I Raman spectra. Statistically significant differences were identified in the amide I region of spectral subpeak at 1,608 cm-1, which is a representative endogenous marker for alterations in the structural conformation of COL I fibers. Moreover, epigenetic 5mC DNA modification was identified within cell nuclei by multivariate analysis. A statistically significant increase in signal intensities of spectral features indicative of DNA methylation was detected in cardiomyopathies in accordance with immunofluorescence 5mC staining. Overall, RMS is a versatile technology in the discrimination of cardiomyopathies based on molecular evaluation of COL I and nuclei while providing insights into the pathogenesis of the diseases.NEW & NOTEWORTHY Cardiomyopathies are associated with severe fibrotic remodeling of the heart, which is characterized by the excessive accumulation of collagen type I (COL I). In this study, we used marker-independent Raman microspectroscopy (RMS) to gain a deeper understanding of the disease's underlying molecular and cellular mechanisms.


Assuntos
Cardiomiopatias , Metilação de DNA , Humanos , Colágeno Tipo I/metabolismo , Cardiomiopatias/patologia , Epigênese Genética , Fibrose
4.
Acta Biomater ; 162: 278-291, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36931422

RESUMO

Fibrosis is a consequence of the pathological remodeling of extracellular matrix (ECM) structures in the connective tissue of an organ. It is often caused by chronic inflammation, which over time, progressively leads to an excess deposition of collagen type I (COL I) that replaces healthy tissue structures, in many cases leaving a stiff scar. Increasing fibrosis can lead to organ failure and death; therefore, developing methods that potentially allow real-time monitoring of early onset or progression of fibrosis are highly valuable. In this study, the ECM structures of diseased and healthy human tissue from multiple organs were investigated for the presence of fibrosis using routine histology and marker-independent Raman microspectroscopy and Raman imaging. Spectral deconvolution of COL I Raman spectra allowed the discrimination of fibrotic and non-fibrotic COL I fibers. Statistically significant differences were identified in the amide I region of the spectral subpeak at 1608 cm-1, which was deemed to be representative for structural changes in COL I fibers in all examined fibrotic tissues. Raman spectroscopy-based methods in combination with this newly discovered spectroscopic biomarker potentially offer a diagnostic approach to non-invasively track and monitor the progression of fibrosis. STATEMENT OF SIGNIFICANCE: Current diagnosis of fibrosis still relies on histopathological examination with invasive biopsy procedures. Although, several non-invasive imaging techniques such as positron emission tomography, single-photon emission computed tomography and second harmonic generation are gradually employed in preclinical or clinical studies, these techniques are limited in spatial resolution and the morphological interpretation highly relies on individual experience and knowledge. In this study, we propose a non-destructive technique, Raman microspectroscopy, to discriminate fibrotic changes of collagen type I based on a molecular biomarker. The changes of the secondary structure of collagen type I can be identified by spectral deconvolution, which potentially can provide an automatic diagnosis for fibrotic tissues in the clinical applicaion.


Assuntos
Colágeno Tipo I , Matriz Extracelular , Humanos , Análise Espectral Raman/métodos , Cicatriz , Biomarcadores
5.
Trends Biotechnol ; 41(8): 1013-1026, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36959084

RESUMO

The robustness of bioprocesses is becoming increasingly important. The main driving forces of this development are, in particular, increasing demands on product purities as well as economic aspects. In general, bioprocesses exhibit extremely high complexity and variability. Biological systems often have a much higher intrinsic variability compared with chemical processes, which makes the development and characterization of robust processes tedious task. To predict and control robustness, a clear understanding of interactions between input and output variables is necessary. Robust bioprocesses can be realized, for example, by using advanced control strategies for the different unit operations. In this review, we discuss the different biological, technical, and mathematical tools for the analysis and control of bioprocess robustness.


Assuntos
Reatores Biológicos
6.
Int J Mol Sci ; 23(13)2022 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-35805961

RESUMO

Three-dimensional (3D) organoid culture recapitulating patient-specific histopathological and molecular diversity offers great promise for precision medicine in cancer. In this study, we established label-free imaging procedures, including Raman microspectroscopy (RMS) and fluorescence lifetime imaging microscopy (FLIM), for in situ cellular analysis and metabolic monitoring of drug treatment efficacy. Primary tumor and urine specimens were utilized to generate bladder cancer organoids, which were further treated with various concentrations of pharmaceutical agents relevant for the treatment of bladder cancer (i.e., cisplatin, venetoclax). Direct cellular response upon drug treatment was monitored by RMS. Raman spectra of treated and untreated bladder cancer organoids were compared using multivariate data analysis to monitor the impact of drugs on subcellular structures such as nuclei and mitochondria based on shifts and intensity changes of specific molecular vibrations. The effects of different drugs on cell metabolism were assessed by the local autofluorophore environment of NADH and FAD, determined by multiexponential fitting of lifetime decays. Data-driven neural network and data validation analyses (k-means clustering) were performed to retrieve additional and non-biased biomarkers for the classification of drug-specific responsiveness. Together, FLIM and RMS allowed for non-invasive and molecular-sensitive monitoring of tumor-drug interactions, providing the potential to determine and optimize patient-specific treatment efficacy.


Assuntos
Organoides , Neoplasias da Bexiga Urinária , Biomarcadores/metabolismo , Cisplatino/farmacologia , Humanos , Organoides/metabolismo , Medicina de Precisão , Neoplasias da Bexiga Urinária/metabolismo
7.
Biomedicines ; 10(4)2022 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-35453677

RESUMO

Postoperative abdominal adhesions are responsible for serious clinical disorders. Administration of plasma-activated media (PAM) to cell type-specific modulated proliferation and protein biosynthesis is a promising therapeutic strategy to prevent pathological cell responses in the context of wound healing disorders. We analyzed PAM as a therapeutic option based on cell type-specific anti-adhesive responses. Primary human peritoneal fibroblasts and mesothelial cells were isolated, characterized and exposed to different PAM dosages. Cell type-specific PAM effects on different cell components were identified by contact- and marker-independent Raman imaging, followed by thorough validation by specific molecular biological methods. The investigation revealed cell type-specific molecular responses after PAM treatment, including significant cell growth retardation in peritoneal fibroblasts due to transient DNA damage, cell cycle arrest and apoptosis. We identified a therapeutic dose window wherein specifically pro-adhesive peritoneal fibroblasts were targeted, whereas peritoneal mesothelial cells retained their anti-adhesive potential of epithelial wound closure. Finally, we demonstrate that PAM treatment of peritoneal fibroblasts reduced the expression and secretion of pro-adhesive cytokines and extracellular matrix proteins. Altogether, we provide insights into biochemical PAM mechanisms which lead to cell type-specific pro-therapeutic cell responses. This may open the door for the prevention of pro-adhesive clinical disorders.

8.
Cancers (Basel) ; 13(22)2021 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-34830837

RESUMO

Hurdles for effective tumor therapy are delayed detection and limited effectiveness of systemic drug therapies by patient-specific multidrug resistance. Non-invasive bioimaging tools such as fluorescence lifetime imaging microscopy (FLIM) and Raman-microspectroscopy have evolved over the last decade, providing the potential to be translated into clinics for early-stage disease detection, in vitro drug screening, and drug efficacy studies in personalized medicine. Accessing tissue- and cell-specific spectral signatures, Raman microspectroscopy has emerged as a diagnostic tool to identify precancerous lesions, cancer stages, or cell malignancy. In vivo Raman measurements have been enabled by recent technological advances in Raman endoscopy and signal-enhancing setups such as coherent anti-stokes Raman spectroscopy or surface-enhanced Raman spectroscopy. FLIM enables in situ investigations of metabolic processes such as glycolysis, oxidative stress, or mitochondrial activity by using the autofluorescence of co-enzymes NADH and FAD, which are associated with intrinsic proteins as a direct measure of tumor metabolism, cell death stages and drug efficacy. The combination of non-invasive and molecular-sensitive in situ techniques and advanced 3D tumor models such as patient-derived organoids or microtumors allows the recapitulation of tumor physiology and metabolism in vitro and facilitates the screening for patient-individualized drug treatment options.

9.
Radiol Oncol ; 55(3): 274-283, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34384013

RESUMO

INTRODUCTION: Radiation-induced cavernomas (RIC) after cranial radiotherapy have an unknown risk of hemorrhage. Zabramski magnetic resonance imaging (MRI) classification is touted as being able to indicate non-radiation-induced cavernomas hemorrhage risk. The aim of our study was to assess the hemorrhage risk of RIC during long-term follow-up of childhood cancer survivors based on brain MRI examinations. PATIENTS AND METHODS: We analyzed retrospectively long-term follow-up data of 36 childhood cancer survivors after initial diagnosis with acute leukemia (n = 18) or brain tumor (n = 18), all treated with cranial radiotherapy. Detected RIC in long-term follow-up brain MRI (1.5 or 3 Tesla) were classified following the Zabramski MRI classification and were categorized into "high" (Zabramski type I, II or V) or "low" (type III or IV) risk of hemorrhage. RESULTS: 18 patients (50%) showed RIC with a significant relation to the original tumor entity (p = 0.023) and the cumulative radiation dose to the brain (p = 0.016): all 9 childhood cancer survivors diagnosed with medulloblastoma developed RIC. We classified RIC in only 3/36 childhood cancer survivors (8%) (1 patient with acute lymphoblastic leukemia [Zabramski type II] and 2 patients with medulloblastoma [type I and type II]) as high risk for hemorrhage, the remaining RIC were classified as Zabramski type IV with low risk for hemorrhage. None of the childhood cancer survivors with RIC showed symptomatic hemorrhages. CONCLUSIONS: RIC are common late effects in childhood cancer survivors treated with cranial radiotherapy affecting half of these patients. However, only a few RIC (occurring in 8% of all reviewed childhood cancer survivors) were classified as high risk for hemorrhage and none of the childhood cancer survivors with RIC developed symptomatic hemorrhages. Thus, we conclude that RIC are low-risk findings in brain MRI and the course is mainly benign.


Assuntos
Sobreviventes de Câncer , Irradiação Craniana/efeitos adversos , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Doença Aguda , Adolescente , Neoplasias Encefálicas/radioterapia , Hemorragia Cerebral/classificação , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Hemangioma Cavernoso do Sistema Nervoso Central/classificação , Hemangioma Cavernoso do Sistema Nervoso Central/etiologia , Humanos , Lactente , Leucemia Mieloide Aguda/radioterapia , Masculino , Meduloblastoma/radioterapia , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/etiologia , Meningioma/diagnóstico por imagem , Meningioma/etiologia , Neoplasias Induzidas por Radiação/classificação , Neoplasias Induzidas por Radiação/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Doses de Radiação , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
10.
Biomedicines ; 9(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33578986

RESUMO

Peritoneal mucosa of mesothelial cells line the abdominal cavity, surround intestinal organs and the female reproductive organs and are responsible for immunological integrity, organ functionality and regeneration. Peritoneal diseases range from inflammation, adhesions, endometriosis, and cancer. Efficient technologies to isolate and cultivate healthy patient-derived mesothelial cells with maximal purity enable the generation of capable 2D and 3D as well as in vivo-like microfluidic cell culture models to investigate pathomechanisms and treatment strategies. Here, we describe a new and easily reproducible technique for the isolation and culture of primary human mesothelial cells from laparoscopic peritoneal wash cytology. We established a protocol containing multiple washing and centrifugation steps, followed by cell culture at the highest purity and over multiple passages. Isolated peritoneal mesothelial cells were characterized in detail, utilizing brightfield and immunofluorescence microscopy, flow cytometry as well as Raman microspectroscopy and multivariate data analysis. Thereby, cytokeratin expression enabled specific discrimination from primary peritoneal human fibroblasts. Raman microspectroscopy and imaging were used to study morphology and biochemical properties of primary mesothelial cell culture compared to cryo-fixed and cryo-sectioned peritoneal tissue.

11.
Tissue Eng Part A ; 27(13-14): 977-991, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33023407

RESUMO

The use of biomaterials and biomaterial functionalization is a promising approach to support pancreatic islet viability posttransplantation in an effort to reduce insulin dependence for patients afflicted with diabetes mellitus type 1. Extracellular matrix (ECM) proteins are known to impact numerous reparative functions in the body. Assessing how endogenously expressed pancreatic ECM proteins are affected by posttransplant-like hypoxic conditions may provide significant insights toward the development of tissue-engineered therapeutic strategies to positively influence ß-cell survival, proliferation, and functionality. Here, we investigated the expression of three relevant groups of pancreatic ECM proteins in human native tissue, including basement membrane (BM) proteins (collagen type 4 [COL4], laminins [LAM]), proteoglycans (decorin [DCN], nidogen-1 [NID1]), and fibril-forming proteins (fibronectin [FN], collagen type 1 [COL1]). In an in vitro hypoxia model, we identified that ECM proteins were differently affected by hypoxic conditions, contributing to an overall loss of ß-cell functionality. The use of a COL1 hydrogel as carrier material demonstrated a protective effect on ß-cells mitigating the effect of hypoxia on proteoglycans as well as fibril-forming protein expression, supporting ß-cell functionality in hypoxia. We further showed that providing endothelial cells (ECs) into the COL1 hydrogel improves ß-cell response as well as the expression of relevant BM proteins. Our data show that ß-cells benefit from a microenvironment composed of structure-providing COL1 with the incorporation of ECs to withstand the harsh conditions of hypoxia. Such hydrogels support ß-cell survival and can serve as an initial source of ECM proteins to allow cell engraftment while preserving cell functionality posttransplantation. Impact statement Expression analysis identifies hypoxia-induced pathological changes in extracellular matrix (ECM) homeostasis as potential targets to support ß-cell transplants by encapsulation in biomaterials for the treatment of diabetes mellitus. A collagen-1 hydrogel is shown to attenuate the effect of hypoxia on ß-cells and their ECM expression. The functionalization of the hydrogel with endothelial cells increases the ß-cell response to glucose and rescues essential basement membrane proteins.


Assuntos
Células Endoteliais , Matriz Extracelular , Técnicas de Cocultura , Colágeno , Proteínas da Matriz Extracelular , Humanos , Laminina
12.
Arq Bras Cardiol ; 94(1): 41-5, 2010 Jan.
Artigo em Português | MEDLINE | ID: mdl-20414525

RESUMO

BACKGROUND: Oral anticoagulants are broadly used in cardiology. However, it is still necessary to evaluate their use in clinical practice. OBJECTIVES: To describe the differences in the maintenance of anticoagulation control, as well as the incidence of hemorrhagic and thromboembolic events among users of warfarin and phenprocoumon. METHODS: Non-concurrent cohort study of 127 patients using oral anticoagulation. RESULTS: Phenprocoumon was the most frequently used anticoagulant in 60% of the patients. The prevalence of RNI<2 at the last medical appointment was higher among warfarin users (46% vs. 19.5%; p<0.001). During the follow-up, Phenprocoumon users were within the therapeutic range during 60.7% of the period, in comparison with 45.6% of warfarin users (OR:1.84; 95%CI:1.59-2.13; P<0.001). The incidence of bleeding was 5.3/100 patients/year in the phenprocoumon group versus 18.8/100 patients/year in the warfarin group (RR: 3.5; 95%CI: 1.87-6.48; P<0.001). CONCLUSION: Patients that used Warfarin remained at subtherapeutic levels for a longer period; however, they also presented more hemorrhagic events. Phenprocoumon users were younger and had been using oral anticoagulation for longer periods, presenting fewer drug-related adverse events.


Assuntos
Anticoagulantes/efeitos adversos , Femprocumona/efeitos adversos , Varfarina/efeitos adversos , Administração Oral , Instituições de Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Femprocumona/uso terapêutico , Protrombina/metabolismo , Fatores de Tempo , Resultado do Tratamento , Varfarina/uso terapêutico
13.
Arq. bras. cardiol ; 94(1): 41-45, jan. 2010. graf, tab
Artigo em Inglês, Espanhol, Português | LILACS | ID: lil-543858

RESUMO

Fundamento: Os anticoagulantes orais são amplamente utilizados na cardiologia. Contudo, uma avaliação sobre o seu uso na prática clínica ainda é necessária. Objetivos: Descrever as diferenças na manutenção do controle da anticoagulação, bem como a incidência de eventos hemorrágicos e tromboembólicos entre os usuários de varfarina e femprocumona. Métodos: Estudo de coorte não concorrente de 127 pacientes em uso de anticoagulação oral. Resultados: A femprocumona foi o anticoagulante mais utilizado em 60 por cento dos pacientes. A prevalência de INR<2 na última consulta era maior entre os usuários de varfarina (46 por cento vs. 19,5 por cento; p<0,001). Durante o seguimento, os usuários da femprocumona estiveram dentro dos níveis terapêuticos em 60,7 por cento do período em comparação com 45,6 por cento dos usuários da Varfarina (OR:1,84;CI95 por cento:1,59-2,13;p<0,001). A incidência de sangramentos foi de 5,3/100 pacientes/ano no grupo da femprocumona contra 18,8/100 pacientes/anos no grupo varfarina (RR:3,5;CI95 por cento:1,87-6,48;p<0,001). Conclusão: Pacientes que faziam uso da varfarina permaneceram em níveis subterapêuticos por um maior período, contudo também apresentaram mais eventos hemorrágicos. Usuários da femprocumona eram mais jovens e estavam utilizando a anticoagulação oral por um período maior, tendo apresentado menos efeitos adversos dessas medicações.


Background: Oral anticoagulants are broadly used in cardiology. However, it is still necessary to evaluate their use in clinical practice. Objectives: To describe the differences in the maintenance of anticoagulation control, as well as the incidence of hemorrhagic and thromboembolic events among users of warfarin and phenprocoumon. Methods: Non-concurrent cohort study of 127 patients using oral anticoagulation. Results: Phenprocoumon was the most frequently used anticoagulant in 60 percent of the patients. The prevalence of RNI<2 at the last medical appointment was higher among warfarin users (46 percent vs. 19.5 percent; p<0.001). During the follow-up, Phenprocoumon users were within the therapeutic range during 60.7 percent of the period, in comparison with 45.6 percent of warfarin users (OR:1.84; 95 percentCI:1.59-2.13; P<0.001). The incidence of bleeding was 5.3/100 patients/year in the phenprocoumon group versus 18.8/100 patients/year in the warfarin group (RR: 3.5; 95 percentCI: 1.87-6.48; P<0.001). Conclusion: Patients that used Warfarin remained at subtherapeutic levels for a longer period; however, they also presented more hemorrhagic events. Phenprocoumon users were younger and had been using oral anticoagulation for longer periods, presenting fewer drug-related adverse events.


Fundamento: Los anticoagulantes orales son ampliamente utilizados en la cardiología. Con todo, una evaluación acerca de su utilización en la práctica clínica es necesaria todavía. Objetivo: Describir las diferencias en el mantenimiento del control de la anticoagulación, así como la incidencia de eventos hemorrágicos y tromboembólicos entre sus usuarios de warfarina y femprocumona. Métodos: Estudio de cohorte no concurrente de 127 pacientes en tratamiento con anticoagulación oral. Resultados: La femprocumona fue el anticoagulante más utilizado en el 60 por ciento de los pacientes. La prevalencia de INR<2 en la última consulta era mayor entre los usuarios de warfarina (46 por ciento vs 19,5 por ciento; P<0,001). Durante el seguimiento, los usuarios de la femprocumona estuvieron dentro de los niveles terapéuticos en el 60,7 por ciento del período en comparación con el 45,6 por ciento de los usuarios de la warfarina (OR:1,84;CI95 por ciento:1,59-2,13;P<0,001). La incidencia de sangrados fue de 5,3/100 pacientes/año en el grupo de la femprocumona contra 18,8/100 pacientes/años en el grupo warfarina (RR:3,5;CI95 por ciento:1,87-6,48;P<0,001). Conclusión: Pacientes que hacían uso de la warfarina permanecieron en niveles subterapéuticos por un mayor período, sin embargo presentaron también más eventos hemorrágicos. Los usuarios de la femprocumona eran más jóvenes y estaban utilizando la anticoagulación oral por un período mayor, habiendo presentado menos efectos adversos de estas medicaciones.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anticoagulantes/efeitos adversos , Femprocumona/efeitos adversos , Varfarina/efeitos adversos , Administração Oral , Instituições de Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Brasil/epidemiologia , Métodos Epidemiológicos , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Femprocumona/uso terapêutico , Protrombina/metabolismo , Fatores de Tempo , Resultado do Tratamento , Varfarina/uso terapêutico
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