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1.
J Dent Res ; 90(3): 325-30, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21297015

RESUMO

Therapeutic vaccination with Streptococcus sobrinus recombinant enolase (rEnolase) protects rats from dental caries. Here, we investigated the effect that maternal rEnolase vaccination before pregnancy had on the offspring's immune response to S. sobrinus oral infection and dental caries progression. Female Wistar rats were immunized by intranasal and subcutaneous routes with rEnolase adsorbed onto aluminum hydroxide as adjuvant or similarly treated with the adjuvant alone (sham-immunized). Ten days after the last administration, the immunized females were paired with a male rat. The oral immune responses to S. sobrinus infection and dental caries in the offspring were evaluated. The results showed that pups born from rEnolase-immunized mothers had higher levels of rEnolase-specific salivary IgA and IgG antibodies (indicating a placental antibody transfer) and lower sulcal and proximal enamel caries scores than rats born from sham-immunized mothers. In conclusion, rEnolase maternal immunization before pregnancy provides offspring with protection against S. sobrinus-induced dental caries.


Assuntos
Cárie Dentária/prevenção & controle , Imunidade Materno-Adquirida , Fosfopiruvato Hidratase/uso terapêutico , Vacinas Estreptocócicas/uso terapêutico , Streptococcus sobrinus/imunologia , Animais , Cárie Dentária/imunologia , Cárie Dentária/microbiologia , Feminino , Imunoglobulina A Secretora/análise , Imunoglobulina G/análise , Masculino , Gravidez , Ratos , Ratos Wistar , Proteínas Recombinantes/uso terapêutico , Saliva/imunologia , Streptococcus sobrinus/enzimologia
2.
Eur J Clin Microbiol Infect Dis ; 30(4): 555-9, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21207091

RESUMO

The purpose of this study was to evaluate the influence of adding Lactobacillus acidophilus to a triple regimen for Helicobacter pylori eradication in untreated patients with peptic ulcers or ulcer-scars. This was a pre-randomized, single-blind, interventional, treatment-efficacy study with active controls and parallel-assignment, set in Coimbra, Portugal, on 62 consecutive H. pylori-positive untreated adults with peptic ulcers or ulcer-scars, diagnosed by gastroduodenoscopy, with pre-treatment direct Gram-staining and culture of gastric biopsies. The first 31 patients received esomeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg (EAC), all b.i.d., for 8 days. The remaining 31 added L. acidophilus, 5 × 10(9) organisms per capsule, 3 + 2 i.d. for 8 days (EACL). The main outcome measure was (13)C urea breath test (UBT), ≥6 weeks after completion of therapy. Successful eradication (UBT-negativity after treatment), was similar in both groups (EAC = 80.6%; EACL = 83.9%, p = 0.740) by both intention-to-treat and per-protocol analysis. The non-eradicated strains were susceptible in vitro to both antibiotics. Adding L. acidophilus to EAC triple therapy did not increase H. pylori eradication rates. Considering the cost and the burden of ingesting five extra capsules daily, supplementing the EAC therapy with L. acidophilus, at this dose, shows no benefit. Further studies with different dosages and duration of treatment, and other probiotics or probiotic combinations are required to improve eradication.


Assuntos
Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Esomeprazol/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Lactobacillus acidophilus , Probióticos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Testes Respiratórios , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Terapia Combinada , Quimioterapia Combinada , Esomeprazol/administração & dosagem , Feminino , Infecções por Helicobacter/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/microbiologia , Probióticos/administração & dosagem , Método Simples-Cego , Resultado do Tratamento , Ureia , Adulto Jovem
3.
Fundam Clin Pharmacol ; 23(6): 747-55, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19656206

RESUMO

Indomethacin (IM) is a non-steroidal anti-inflammatory drug which inhibits prostaglandin biosynthesis. It is practically insoluble in water and has the capacity to induce gastric injury. Hydroxypropyl-beta-cyclodextrin (HP-beta-CD) is an alkylated derivative of beta-CD with the capacity to form inclusion complexes with suitable molecules. IM is considered to form partial inclusion complexes with HP-beta-CD by enclosure of the p-chlorobenzoic part of the molecule in the cyclodextrin channel, reducing the adverse effects. The aim of this paper is to evaluate the gastric damage induced by the IM inclusion complex prepared by freeze-drying and spray-drying. A total of 135 Wistar rats weighing 224.4 +/- 62.5 g were put into 10 groups. They were allowed free access to water but were maintained fasted for 18 h before the first administration until the end of the experiment. IM acid-form, IM trihydrated-sodium-salt and IM-HP-beta-CD spray and freeze-dried, at normal and toxic doses, were administered through gastric cannula once/day for 3 days. Seventy-two hours after the first administration, the animals were sacrificed and the stomachs collected and prepared for morphological study by using the haematoxylin-eosin technique. Lesion indexes (rated 0/4) were developed and the type of injury was scored according to the severity of damage and the incidence of microscopic evidence of harm. Microscopic assessment demonstrated levels of injury with index one on 10-25%. The type of complexation method had different incidence but the same degree. The results show that IM inclusion complexation protects against gastric injury, reducing the incidence and the maximum degree of severity from 4 to 1, with a better performance of the spray-dried complex.


Assuntos
Anti-Inflamatórios não Esteroides/toxicidade , Mucosa Gástrica/efeitos dos fármacos , Indometacina/toxicidade , Úlcera Gástrica/patologia , beta-Ciclodextrinas/química , 2-Hidroxipropil-beta-Ciclodextrina , Ácidos , Animais , Anti-Inflamatórios não Esteroides/química , Composição de Medicamentos , Avaliação Pré-Clínica de Medicamentos , Feminino , Liofilização , Mucosa Gástrica/patologia , Indometacina/química , Masculino , Ratos , Ratos Wistar , Sais , Solubilidade , Úlcera Gástrica/induzido quimicamente
4.
Tumori ; 95(2): 227-32, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19579870

RESUMO

GOALS: Expression of GLUT-1 and transglutaminase 2 is increased in aggressive breast cancer, whereas claudin-1, which is expressed in normal tissues, is absent in such tumors. This experimental study was undertaken to establish the aggressiveness and prognosis of DMBA-induced mammary tumors in female Wistar rats based on the assessment of these markers. MATERIALS AND METHODS: The rats were divided into two groups, a control group (n = 70) and a chemoprevention group (n = 70). Breast tumors were induced in both groups by administration of 7,12-dimethylbenz[a] anthracene (DMBA). The chemoprevention group also received alpha-tocopherol and a solution of micronutrients containing ascorbic acid and selenium. Neoplastic lesions of both groups were randomly selected for immunohistochemical assessment of the expression of GLUT-1, transglutaminase 2 and claudin-1. RESULTS: A higher proportion of mammary tumors expressed GLUT-1 and transglutaminase 2 in the chemoprevention group. Claudin-1 expression was absent in all tumors of both groups. CONCLUSIONS: These results are suggestive of increased aggressiveness of tumors not susceptible to chemoprevention by the agents used in this study.


Assuntos
Anticarcinógenos/farmacologia , Antioxidantes/farmacologia , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/enzimologia , Neoplasias da Mama/prevenção & controle , Proteínas de Ligação ao GTP/efeitos dos fármacos , Transportador de Glucose Tipo 1/efeitos dos fármacos , Transglutaminases/efeitos dos fármacos , 9,10-Dimetil-1,2-benzantraceno , Animais , Anticarcinógenos/administração & dosagem , Antioxidantes/administração & dosagem , Ácido Ascórbico/farmacologia , Neoplasias da Mama/induzido quimicamente , Carcinógenos , Feminino , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Imuno-Histoquímica , Proteína 2 Glutamina gama-Glutamiltransferase , Distribuição Aleatória , Ratos , Ratos Wistar , Compostos de Selênio/farmacologia , Falha de Tratamento , alfa-Tocoferol/farmacologia
5.
J Mater Sci Mater Med ; 20(3): 725-31, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18987948

RESUMO

Glass-reinforced hydroxyapatite composites (GR-HA) are bone regenerative materials that are characterized by their increased mechanical properties, when compared to synthetic hydroxyapatite. Bonelike is a GR-HA that is a result of the addition of a CaO-P(2)O(5) based glass to a HA matrix. This biomaterial has been successfully applied in clinical bone regenerative applications. This work aims to evaluate the ability of Bonelike to support the adhesion, proliferation and phenotypic expression of human endothelial cells, aiming to establish new bone tissue engineering pre-endothelialization strategies. Bonelike discs, regardless of being submitted to a pre-immersion treatment with culture medium, were seeded with first passage human umbilical vein endothelial cells, and characterized regarding proliferation and differentiation events. Pre-immersed Bonelike allowed the adhesion, proliferation and phenotype expression of endothelial cells. Seeded materials presented positive immunofluorescent staining for PECAM-1 and a tendency for the formation of cord-like arrangements under angiogenesis-stimulating conditions, although, compared to standard culture plates, a slight decreased cell growth was observed. In this way, Bonelike may be a suitable candidate for pre-endothelialization approaches in bone tissue engineering applications.


Assuntos
Substitutos Ósseos/química , Durapatita/química , Células Endoteliais/citologia , Células Endoteliais/metabolismo , Adesão Celular , Diferenciação Celular , Proliferação de Células , Células Cultivadas , Vidro , Humanos , Teste de Materiais , Neovascularização Fisiológica , Fenótipo , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Engenharia Tecidual
6.
Toxicol Appl Pharmacol ; 224(2): 163-73, 2007 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-17692352

RESUMO

Hexavalent chromium [Cr(VI)] exposure is commonly associated with lung cancer. Although other adverse health effects have been reported, some authors, on assuming that orally ingested Cr(VI) is efficiently detoxified upon reduction by body fluids, believe that Cr(VI) do not target cells other than respiratory tract cells. In rodents, ingested Cr(VI)-contaminated water was reported to induce, in the liver, increases in TGF-beta transcripts. As TGF-beta dependent signaling pathways are closely associated with hepatic injury, the present study was undertaken addressing two specific issues: the effects of ingestion of water contaminated with high levels of Cr(VI) in rat liver structure and function; and the role of the TGF-beta pathway in Cr(VI)-induced liver injury. Examination of Wistar rats exposed to 20 ppm Cr(VI)-contaminated water for 10 weeks showed increased serum glucose and alanine aminotransferase (ALT) levels. Liver histological examination revealed hepatocellular apoptosis, further confirmed by immunohystochemical study of Caspase 3 expression. Liver gene expression analysis revealed increased expression of Smad2/Smad4 and Dapk, suggesting the involvement of the TGF-beta pathway in the apoptotic process. Since no changes in Smad3 expression were observed it appears apoptosis is using a Smad3-independent pathway. Increased expression of both Caspase 8 and Daxx genes suggests also the involvement of the Fas pathway. Gene expression analysis also revealed that a p160(ROCK)-Rho-independent pathway operates, leading to cell contraction and membrane blebbing, characteristic apoptotic features. These findings suggest that either the amount of Cr(VI) ingested overwhelmed the body fluids reductive capacity or some Cr(VI) escapes the reductive protection barrier, thus targeting the liver and inducing apoptosis.


Assuntos
Apoptose/efeitos dos fármacos , Cromo/toxicidade , Regulação da Expressão Gênica/efeitos dos fármacos , Fator de Crescimento Transformador beta/efeitos dos fármacos , Poluentes Químicos da Água/toxicidade , Alanina Transaminase/efeitos dos fármacos , Alanina Transaminase/metabolismo , Animais , Glicemia/efeitos dos fármacos , Carcinógenos Ambientais/toxicidade , Caspase 3/efeitos dos fármacos , Caspase 3/metabolismo , Imuno-Histoquímica , Fígado/metabolismo , Fígado/patologia , Masculino , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Fator de Crescimento Transformador beta/metabolismo
7.
Transplant Proc ; 37(6): 2802-4, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16182814

RESUMO

Morselized bone allografts have been used for the treatment of bone stock loss in orthopedic revision surgery with encouraging results. However, several parameters can influence the graft incorporation including the processing treatments. This experimental work used a cavitary bone defect in 90 rabbits to evaluate the sequence of incorporation of three different kinds of morselized bone allografts: uncryopreserved cancellous bone, freeze-dried cancellous bone, and totally demineralized cortical bone each of which were prepared in accordance with our rigid protocol. Revascularization and remodeling of the transplanted bone grafts were evident upon histological evaluation. Bone apposition and bone resorption resulted in a mixture of graft and new bone. Mineralized cancellous grafts showed great osteoconductive capacity, whereas demineralized cortical grafts showed an intense osteoinductive capacity and a weak osteoconductive capacity. In a general evaluation, cryopreserved cancellous bone grafts showed superior biological efficacy for reconstruction of experimental bone defects, closely followed by freeze-dried cancellous bone grafts, and, finally, by demineralized cortical bone grafts. These results validate our protocol for the processing and preservation of these three kinds of bone grafts.


Assuntos
Transplante Ósseo/métodos , Animais , Doenças Ósseas/cirurgia , Transplante Ósseo/fisiologia , Osso e Ossos/irrigação sanguínea , Osso e Ossos/cirurgia , Fêmur , Masculino , Modelos Animais , Neovascularização Fisiológica , Coelhos , Tíbia , Transplante Homólogo
8.
J Dent Res ; 83(4): 354-8, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15044513

RESUMO

Streptococcus sobrinus produces a virulence-associated immunomodulatory protein (VIP) which suppresses the host-specific immune response and induces the early production of IL-10. In this study, we evaluated the effects of therapeutic immunization with this VIP on the incidence of caries in S. sobrinus-infected rats. Groups of Wistar rats were orally infected with S. sobrinus and fed with sucrose-sweetened drinking water ad libitum. Five days later, rats were immunized intranasally with active or heat-inactivated VIP plus alum as adjuvant or PBS plus adjuvant (sham-immunized). After 3 wks, all rats were re-immunized as above. Evaluation of dental caries showed that VIP-immunized animals had significantly fewer enamel sulcal and proximal caries lesions than did the sham-immunized animals (p < 0.001). The protective effects following therapeutic VIP immunization were attributed to the induced salivary immunoglobulin A specific to the VIP. These results offer a promising and safe strategy for the development of a vaccine against dental caries.


Assuntos
Proteínas de Bactérias/imunologia , Vacinas Bacterianas/imunologia , Cárie Dentária/imunologia , Cárie Dentária/prevenção & controle , Streptococcus sobrinus/imunologia , Fatores de Virulência/imunologia , Análise de Variância , Animais , Vacinas Bacterianas/uso terapêutico , Modelos Animais de Doenças , Feminino , Imunização , Imunoglobulina A/análise , Masculino , Ratos , Ratos Wistar , Saliva/química , Saliva/imunologia
9.
s.l; s.n; 2003. 5 p. ilus.
Não convencional em Inglês | Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-1242561

RESUMO

The search for good conduits for brindings nerve defects is a major challenge of today's tissue engineering research. In this paper we repor on a laser confocal microscope study on early nerve regeneration inside a tissue engineered graft made by a poly (DLLA-e-CL) conduit enriched with fresh skeletal muscle. The same biodegradable tubes filled with PBS solution were used as controls. The conduits were placed to bridge unilateral 1-cm-long rat sciatic nerve defects and analysed 10 days after surgery. Results showed that inside the muscle-enriched tubes axon regeneration was detectable along control tubes. In addition, a-GFAP (glial fibrillar acid protein) immuno-labelling of Schwann cells showed that progression inside muscle-enriched tubes, especially from the distal nerve stump, was much more evident than in control conduits. These results suggest that enrichment of synthesis tubes with fresh skeletal muscle promotes axon regeneration and Schwann cell migration in early nerve repair stages


Assuntos
Animais , Engenharia Tecidual , Engenharia Tecidual/métodos , Engenharia Tecidual/tendências , Nervo Isquiático/cirurgia , Nervo Isquiático/imunologia , Nervo Isquiático/lesões , Nervo Isquiático/metabolismo , Nervo Isquiático/patologia , Tecido Nervoso/cirurgia , Tecido Nervoso/lesões , Tecido Nervoso/metabolismo , Tecido Nervoso/patologia , Regeneração Nervosa/fisiologia
10.
J Invest Surg ; 15(4): 237-43, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12217188

RESUMO

This study analyzes an experimental model for the study of reactions from gastric tissue exposed to enteric environment. Morphological studies were performed by histological, histochemical and immunohistochemical methods, using formalin-fixed biopsies of full-wall-thickness gastric implants in a whole-wall jejunal defect. These grafts suffered severe lesions, characterized by chronic atrophic gastritis, foveolar hyperplasia, glandular cystic transformation, and intestinal metaplasia. Increase in acidic mucins was also observed. There was no proliferating cell nuclear antigen (PCNA) overexpression. The results suggest that this model can be useful to investigate the heterotopic grastropathy and can be applied in further research studies.


Assuntos
Coristoma/patologia , Modelos Animais de Doenças , Enteropatias/patologia , Ratos Wistar , Estômago , Animais , Enterite/patologia , Feminino , Seguimentos , Ratos
11.
J Neurosci Methods ; 108(1): 1-9, 2001 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-11459612

RESUMO

The experimental model of choice for many peripheral nerve investigators is the rat. Walking track analysis is a useful tool in the evaluation of functional peripheral nerve recovery in the rat. This quantitative method of analyzing hind limbs performance by examining footprints, known as the sciatic function index (SFI), has been widely used to quantify functional recovery from sciatic nerve injury in a number of different injury models, although some limitations of the SFI has been questioned by several authors. This article is designed to offer the peripheral nerve investigator a noninvasive method to evaluate quantitatively the integrated motor recovery in experimental studies.


Assuntos
Marcha/fisiologia , Regeneração Nervosa/fisiologia , Nervos Periféricos/cirurgia , Recuperação de Função Fisiológica/fisiologia , Animais , Avaliação da Deficiência , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Traumatismos dos Nervos Periféricos , Nervos Periféricos/fisiopatologia , Ratos/lesões , Ratos/fisiologia , Ratos/cirurgia
12.
Microsurgery ; 21(8): 383-8, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11757066

RESUMO

Computerized rat gait analysis has become an invaluable technique of functional evaluation for some peripheral nerve investigators, comparing the normal and the pathological kinematic data. Appropriate selection of the methods to evaluate the functional outcome should be sensitive enough to moderate changes. By combining kinematic data and traditional methods in regeneration studies, it is possible to achieve better documentation of functional changes with the passage of time. A review of the three commonly kinematic parameters used in nerve regeneration studies, such as the calculation of sciatic function index, stance factor, and ankle angle, will provide the reader with detailed information about this accurate and consistent means of evaluating peripheral nerve function after nerve injury and repair. This study aims to review the different methods and potentialities of the rat gait kinematics as a noninvasive evaluation during regeneration, allowing for measurement of the rate of functional recovery in experimental studies.


Assuntos
Marcha , Regeneração Nervosa , Animais , Fenômenos Biomecânicos , Membro Posterior/fisiologia , Ratos
13.
Pediatr Surg Int ; 16(5-6): 364-9, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10955563

RESUMO

Adult intestinal allografts have demonstrated high immunogenicity in human transplantation, making the search for new and more favorable grafts an actual problem. Accepting that fetal and newborn immune systems are relatively immature, their intestines could be ideal sources for organ donation. The purpose of this study was to compare the immunogenicity of fetal, newborn, and adult intestine for selection of the least antigenic. Using a bidirectional rat model for immunologic responses, 116 small-bowel transplantations were done: 36 fetal, 40 newborn, and 40 adult grafts. Two histocompatibility barriers and different immunosuppression regimes were used. For fetal and newborn intestines, free grafts into the omentum of adult recipients were done; for adult intestines, accessory grafts in adult recipients of the same age, using vascular anastomoses. The diagnosis of graft rejection and graft-versus-host disease (GVHD) was based on histology of hematoxylin and eosin-stained biopsies from target organs. Recipients of fetal and newborn grafts did not show signs of GVHD, while 12% of the adult group did (P < 0.05). Rejection was less severe in fetal and adult (P > 0.05) than in newborn (P < 0.05) intestinal transplantation. Treatment with 10 mg/kg per day cyclosporine prevented rejection in 70% of fetal and 75% of adult grafts, while all newborn grafts were rejected. Under no immunosuppression, or with low doses of cyclosporine (2 mg/kg per day), all groups showed histologic signs of rejection in almost all cases, the fetal intestine being the least affected. Concerning histocompatibility barriers, grafts were usually less damaged in the weaker transplantation subgroups. Our data indicate that fetal intestine is the least immunogenic of the three grafts studied, suggesting that it will be the most suitable tissue for organ donation.


Assuntos
Animais Recém-Nascidos , Modelos Animais de Doenças , Feto , Jejuno/transplante , Transplante Homólogo/imunologia , Transplante Homólogo/métodos , Fatores Etários , Animais , Biópsia , Ciclosporinas/uso terapêutico , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/imunologia , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/imunologia , Teste de Histocompatibilidade , Imunossupressores/uso terapêutico , Ratos , Ratos Sprague-Dawley , Ratos Wistar , Obtenção de Tecidos e Órgãos , Transplante Homólogo/efeitos adversos
14.
Microsurgery ; 18(7): 424-9, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9880159

RESUMO

Two surgical models of intestinal transplantation in the rat are described. One is the implantation of fetal and newborn intestine as free grafts into the omentum of adult recipients, the other the adult intestine transplantation as an accessory graft using vascular anastomoses. A hundred and sixteen small-bowel transplantations were done; 36 of which were fetal intestine (group I), 40 of newborn intestine (group II), and 40 of adult intestine (group III). In the fetal and newborn intestinal transplantation, we emphasize the practices that allowed us to avoid ischemic and traumatic injury to the graft. In the adult intestine transplantation with vascular anastomoses, we heighten the modifications in the surgical technique that made the operation easier and the strategies used to prevent hypothermia and hypovolemic shock. Once experienced with the two chosen surgical techniques, transplantation using an avascular segment became much easier and quicker than transplantation with vascular anastomoses.


Assuntos
Intestino Delgado/transplante , Microcirurgia/métodos , Transplante de Tecidos/métodos , Anastomose Cirúrgica/métodos , Animais , Ciclosporinas/administração & dosagem , Modelos Animais de Doenças , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/efeitos dos fármacos , Sobrevivência de Enxerto/imunologia , Masculino , Ratos , Ratos Sprague-Dawley , Ratos Wistar , Resultado do Tratamento
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