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1.
Am J Physiol Heart Circ Physiol ; 322(2): H285-H295, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34919457

RESUMO

Preeclampsia is a hypertensive pregnancy disorder with no treatment beyond management of symptoms and delivery of the fetus and placenta. Chronic hypertension increases the risk of developing superimposed preeclampsia. Previous reports showed that 1,3-butanediol attenuates hypertension in rodents; however, the therapeutic potential of 1,3-butanediol for the prevention of preeclampsia has not been investigated. This study tested the hypothesis that attenuating hypertension before pregnancy and through the placentation period via 1,3-butanediol prevents the onset of preeclampsia in female Dahl salt-sensitive (SS/Jr) rats. Female Dahl SS/Jr rats were divided into two groups: 1,3-butanediol treated (20% via drinking water) and control (ad libitum water). Both groups were maintained on low-salt rodent chow (Teklad 7034, 0.3% NaCl; n = 8/group). Animals were treated with 1,3-butanediol for 7 wk (baseline), mated, and treated through day 12 of pregnancy. 1,3-Butanediol treatment increased plasma ß-hydroxybutyrate (metabolite of 1,3-butanediol) that negatively correlated with maternal body weight in late pregnancy. Mean arterial pressure was lower in the treated group at baseline, early, and mid pregnancy, but no difference was observed in late pregnancy after treatment ended. Uterine artery resistance index (UARI) was reduced in the treated dams. No adverse fetal effects were observed, and there were no differences in pup weight or length. Placentas from treated dams had decreased vascular endothelial growth factor levels as well as decreased placental basal zone thickness and increased labyrinth zone thickness. These findings support the therapeutic role of physiological ketosis via 1,3-butanediol as a potential therapeutic approach for managing chronic hypertension, thereby preventing and mitigating adverse pregnancy outcomes associated with preeclampsia.NEW & NOTEWORTHY A ketogenic diet or increased ß-hydroxybutyrate levels can reduce hypertension, but the potential of 1,3-butanediol, a ß-hydroxybutyrate precursor, for treatment of preeclampsia is unknown. We hypothesized that attenuating hypertension before and during pregnancy via 1,3-butanediol prevents preeclampsia in Dahl Salt-sensitive rats. 1,3-Butanediol significantly lowered blood pressure and improved uterine artery resistance with no observable adverse fetal effects. Physiological ketosis via 1,3-butanediol may be a potential therapeutic approach for managing hypertension and mitigating adverse pregnancy outcomes.


Assuntos
Butileno Glicóis/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Ácido 3-Hidroxibutírico/sangue , Animais , Peso Corporal , Butileno Glicóis/administração & dosagem , Butileno Glicóis/efeitos adversos , Suplementos Nutricionais , Feminino , Cetose , Fenótipo , Placenta/metabolismo , Pré-Eclâmpsia/prevenção & controle , Gravidez , Ratos , Ratos Endogâmicos Dahl , Fator A de Crescimento do Endotélio Vascular/metabolismo
2.
FASEB J ; 33(2): 2409-2421, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30303740

RESUMO

The dietary R-3-hydroxybutyrate- R-1,3-butanediol monoester increases resting energy expenditure (REE) and markers of brown and white adipose thermogenesis in lean mice. The purpose of this investigation was to determine whether the ketone ester, R, S-1,3-butanediol diacetoacetate (BD-AcAc2), increases energy expenditure and markers of adipose tissue thermogenesis in the context of high-fat diet (HFD)-induced obesity. Thirty-five-week-old male C57BL/6J mice were placed on an ad libitum HFD (45% kcal) for 10 wk. The mice were then randomized to 1 of 3 groups ( n = 10 per group) for an additional 12 wk: 1) control (Con), continuous HFD, 2) pair-fed (PF) to ketone ester (KE); and 3) KE: HFD+30% energy from BD-AcAc2. Mean energy intake throughout the study was ∼26% lower in the KE compared to the Con group (8.2 ± 0.5 vs. 11.2 ± 0.7 kcal/d; P < 0.05). Final body weight (26.8 ± 3.6 vs. 34.9 ± 4.8 g; P < 0.001) and fat mass (5.2 ± 1.2 vs. 11.3 ± 4.5 g; P < 0.001) of the KE group was significantly lower than PF, despite being matched for energy provisions. Differences in body weight and adiposity were accompanied by higher REE and total energy expenditure in the KE group compared to PF after adjustment for lean body mass and fat-mass ( P = 0.001 and 0.007, respectively). Coupled or uncoupled mitochondrial respiratory rates in skeletal muscle were not different among groups, but markers of mitochondrial uncoupling and thermogenesis (uncoupling protein-1, deiodinase-2, and peroxisome proliferator-activated receptor γ coactivator-1α) were higher in interscapular brown adipose tissue (BAT) of mice receiving the KE diet. The absence of mitochondrial uncoupling in skeletal muscle and increased markers of mitochondrial uncoupling in BAT suggest that BD-AcAc2 initiates a transcriptional signature consistent with BAT thermogenesis in the context of HFD-induced obesity.-Davis, R. A. H., Deemer, S. E., Bergeron, J. M., Little, J. T., Warren, J. L., Fisher, G., Smith, D. L., Jr., Fontaine, K. R., Dickinson, S. L., Allison, D. B., Plaisance, E. P. Dietary R, S-1,3-butanediol diacetoacetate reduces body weight and adiposity in obese mice fed a high-fat diet.


Assuntos
Acetoacetatos/administração & dosagem , Adiposidade/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Butileno Glicóis/administração & dosagem , Dieta Hiperlipídica/efeitos adversos , Metabolismo Energético/efeitos dos fármacos , Obesidade/prevenção & controle , Tecido Adiposo Marrom/efeitos dos fármacos , Tecido Adiposo Branco/efeitos dos fármacos , Animais , Composição Corporal , Ingestão de Energia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Obesos , Obesidade/fisiopatologia
3.
Breast Cancer Res Treat ; 173(3): 545-557, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30367332

RESUMO

PURPOSE: Exposure to the polyphenolic plant lignan secoisolariciresinol diglucoside (SDG) and its metabolite enterolactone (ENL) has been associated with reduced breast cancer progression, particularly for estrogen receptor alpha (ERα)-negative disease, and decreased preclinical mammary tumor growth. However, while preclinical studies have established that SDG and ENL affect measures of progression in models of triple-negative breast cancer (TNBC, a subset of ERα-negative disease), the molecular mechanisms underlying these effects remain unclear. METHODS: C57BL/6 mice were fed a control diet (control, 10% kcal from fat) or control diet + SDG (SDG, 100 mg/kg diet) for 8 weeks, then orthotopically injected with syngeneic E0771 mammary tumor cells (a model of TNBC); tumor growth was monitored for 3 weeks. The role of reduced NF-κB signaling in SDG's anti-tumor effects was explored in vitro via treatment with the bioactive SDG metabolite ENL. In addition to the murine E0771 cells, the in vitro studies utilized MDA-MB-231 and MCF-7 cells, two human cell lines which model the triple-negative and luminal A breast cancer subtypes, respectively. RESULTS: SDG supplementation in the mice significantly reduced tumor volume and expression of phospho-p65 and NF-κB target genes (P < 0.05). Markers of macrophage infiltration were decreased in the distal-to-tumor mammary fat pad of mice supplemented with SDG relative to control mice (P < 0.05). In vitro, ENL treatment inhibited viability, survival, and NF-κB activity and target gene expression in E0771, MDA-MB-231, and MCF-7 cells (P < 0.05). Overexpression of Rela attenuated ENL's inhibition of E0771 cell viability and survival. CONCLUSIONS: SDG reduces tumor growth in the E0771 model of TNBC, likely via a mechanism involving inhibition of NF-κB activity. SDG could serve as a practical and effective adjuvant treatment to reduce recurrence, but greater understanding of its effects is needed to inform the development of more targeted recommendations for its use.


Assuntos
Anti-Inflamatórios/farmacologia , Butileno Glicóis/farmacologia , Linho/química , Glucosídeos/farmacologia , Neoplasias Mamárias Animais/metabolismo , NF-kappa B/metabolismo , Transdução de Sinais/efeitos dos fármacos , 4-Butirolactona/análogos & derivados , 4-Butirolactona/sangue , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/química , Biomarcadores , Butileno Glicóis/administração & dosagem , Butileno Glicóis/química , Linhagem Celular Tumoral , Sobrevivência Celular , Citocinas/sangue , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Feminino , Perfilação da Expressão Gênica , Glucosídeos/administração & dosagem , Glucosídeos/química , Imuno-Histoquímica , Lignanas/sangue , Neoplasias Mamárias Animais/tratamento farmacológico , Neoplasias Mamárias Animais/genética , Neoplasias Mamárias Animais/patologia , Camundongos
4.
Int J Sport Nutr Exerc Metab ; 29(5): 466-473, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30632425

RESUMO

This study investigated the effect of the racemic ß-hydroxybutyrate (ßHB) precursor, R,S-1,3-butanediol (BD), on time-trial (TT) performance and tolerability. A repeated-measures, randomized, crossover study was conducted in nine trained male cyclists (age, 26.7 ± 5.2 years; body mass, 69.6 ± 8.4 kg; height, 1.82 ± 0.09 m; body mass index, 21.2 ± 1.5 kg/m2; VO2peak,63.9 ± 2.5 ml·kg-1·min-1; Wmax, 389.3 ± 50.4 W). Participants ingested 0.35 g/kg of BD or placebo 30 min before and 60 min during 85 min of steady-state exercise, which preceded a ∼25- to 35-min TT (i.e., 7 kJ/kg). The ingestion of BD increased blood D-ßHB concentration throughout exercise (0.44-0.79 mmol/L) compared with placebo (0.11-0.16 mmol/L; all p < .001), which peaked 1 hr following the TT (1.38 ± 0.35 vs. 0.34 ± 0.24 mmol/L; p < .001). Serum glucose and blood lactate concentrations were not different between trials (all p > .05). BD ingestion increased oxygen consumption and carbon dioxide production after 20 min of steady-state exercise (p = .002 and p = .032, respectively); however, no further effects on cardiorespiratory parameters were observed. Within the BD trial, moderate to severe gastrointestinal symptoms were reported in five participants, and low levels of dizziness, nausea, and euphoria were reported in two participants. However, this had no effect on TT duration (placebo, 28.5 ± 3.6 min; BD, 28.7 ± 3.2 min; p = .62) and average power output (placebo, 290.1 ± 53.7 W; BD, 286.4 ± 45.9 W; p = .50). These results suggest that BD has no benefit for endurance performance.


Assuntos
Desempenho Atlético/fisiologia , Ciclismo/fisiologia , Butileno Glicóis/administração & dosagem , Ácido 3-Hidroxibutírico/sangue , Adulto , Glicemia/análise , Estudos Cross-Over , Humanos , Ácido Láctico/sangue , Masculino , Consumo de Oxigênio , Substâncias para Melhoria do Desempenho/administração & dosagem , Adulto Jovem
5.
Nutr Cancer ; 70(2): 306-315, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29303360

RESUMO

Systemic cytotoxic chemotherapy remains the mainstay of metastatic breast cancer; however, prognosis and overall survival is unfavorable due to inadequate treatment response and/or unacceptable toxicity. Natural compounds and their active metabolites receive increasing attention as possible adjuvant therapy with cancer chemotherapeutics to improve treatment response, survival rates, and quality of life of breast cancer patients. This study investigated the combination of flaxseed lignans (Secoisolariciresinol and Enterolactone) with classic chemotherapeutic agents (Docetaxel, Doxorubicin, and Carboplatin) with different mechanisms of action to determine whether flaxseed lignans could enhance the cytotoxic effect of such drugs in the metastatic breast cancer cell lines, SKBR3 and MDA-MB-231. The experimental data suggests that flaxseed lignans significantly enhanced the ability of chemotherapeutic agents to cause cytotoxicity in SKBR3 and MDA-MB-231 breast cancer cells. A three compound combination study found that enterolactone and metformin together in combination with relatively low concentrations of chemotherapeutic drugs were able to significantly decrease cancer cell viability, compared to low concentrations of the individual chemotherapeutic drug alone. Our in vitro evaluation suggests a future direction in improving chemotherapeutic efficacy in breast cancer by adjuvant therapy with the flaxseed lignans.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Neoplasias da Mama/tratamento farmacológico , Linho/química , Lignanas/farmacologia , 4-Butirolactona/administração & dosagem , 4-Butirolactona/análogos & derivados , Neoplasias da Mama/patologia , Butileno Glicóis/administração & dosagem , Carboplatina/administração & dosagem , Linhagem Celular Tumoral , Suplementos Nutricionais , Docetaxel/administração & dosagem , Doxorrubicina/administração & dosagem , Ensaios de Seleção de Medicamentos Antitumorais , Feminino , Humanos , Concentração Inibidora 50 , Lignanas/administração & dosagem , Metformina/administração & dosagem
6.
J Med Assoc Thai ; 100(1): 70-7, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29911772

RESUMO

Background: 5% minoxidil solution is approved for the treatment of male androgenetic alopecia (AGA). However, there have been occasional reports of adverse events that were caused mostly by propylene glycol sensitivity. As an alternative treatment, Siriraj hair team developed a proprietary preparation referred to as "minoxidil milky lotion" that uses butylene glycol as a substitute for propylene glycol. Objective: To compare the efficacy and safety of 5% minoxidil solution with 5% minoxidil milky lotion in the treatment of male AGA. Materials and Method: Twenty males with AGA were recruited for this prospective randomized study. Subjects were randomly treated with 5% minoxidil solution or 5% minoxidil milky lotion. Clinical outcomes and adverse events were recorded at 8, 16, and 24 weeks. Results: The mean age of subjects was 43.5±12.5 years (range, 26-65 years). Percentage increase in hair density at 8 weeks after receiving 5% minoxidil solution and 5% minoxidil milky lotion was 8.8% and 37.4%, respectively (p = 0.01). However, there was no statistically significant difference between the two preparations at the 16 and 24 week visits. Mild irritation was reported in 1 case in the 5% minoxidil milky lotion group. Study limitation: Small sample size. Conclusion: Both formulations were found to be effective and safe in the treatment of male AGA. 5% minoxidil milky lotion may be an alternative treatment in propylene glycol-sensitive patients, with efficacy that is comparable to that of 5% minoxidil solution.


Assuntos
Alopecia/tratamento farmacológico , Minoxidil/uso terapêutico , Administração Tópica , Adulto , Idoso , Butileno Glicóis/administração & dosagem , Butileno Glicóis/efeitos adversos , Butileno Glicóis/uso terapêutico , Emolientes/administração & dosagem , Emolientes/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Minoxidil/administração & dosagem , Minoxidil/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento , Vasodilatadores/administração & dosagem , Vasodilatadores/efeitos adversos , Vasodilatadores/uso terapêutico
7.
Carcinogenesis ; 37(2): 177-87, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26678224

RESUMO

Malignant mesothelioma (MM), linked to asbestos exposure, is a highly lethal form of thoracic cancer with a long latency period, high mortality and poor treatment options. Chronic inflammation and oxidative tissue damage caused by asbestos fibers are linked to MM development. Flaxseed lignans, enriched in secoisolariciresinol diglucoside (SDG), have antioxidant, anti-inflammatory and cancer chemopreventive properties. As a prelude to chronic chemoprevention studies for MM development, we tested the ability of flaxseed lignan component (FLC) to prevent acute asbestos-induced inflammation in MM-prone Nf2(+/mu) mice. Mice (n = 16-17 per group) were placed on control (CTL) or FLC-supplemented diets initiated 7 days prior to a single intraperitoneal bolus of 400 µg of crocidolite asbestos. Three days post asbestos exposure, mice were evaluated for abdominal inflammation, proinflammatory/profibrogenic cytokine release, WBC gene expression changes and oxidative and nitrosative stress in peritoneal lavage fluid (PLF). Asbestos-exposed mice fed CTL diet developed acute inflammation, with significant (P < 0.0001) elevations in WBCs and proinflammatory/profibrogenic cytokines (IL-1ß, IL-6, TNFα, HMGB1 and active TGFß1) relative to baseline (BL) levels. Alternatively, asbestos-exposed FLC-fed mice had a significant (P < 0.0001) decrease in PLF WBCs and proinflammatory/profibrogenic cytokine levels relative to CTL-fed mice. Importantly, PLF WBC gene expression of cytokines (IL-1ß, IL-6, TNFα, HMGB1 and TGFß1) and cytokine receptors (TNFαR1 and TGFßR1) were also downregulated by FLC. FLC also significantly (P < 0.0001) blunted asbestos-induced nitrosative and oxidative stress. FLC reduces acute asbestos-induced peritoneal inflammation, nitrosative and oxidative stress and may thus prove to be a promising agent in the chemoprevention of MM.


Assuntos
Asbesto Crocidolita/toxicidade , Butileno Glicóis/administração & dosagem , Glucosídeos/administração & dosagem , Inflamação/patologia , Lignanas/administração & dosagem , Peritônio/patologia , Animais , Antioxidantes/farmacologia , Cromatografia Líquida , Dieta , Suplementos Nutricionais , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Linho , Mesotelioma/patologia , Camundongos , Camundongos Mutantes , Estresse Oxidativo/efeitos dos fármacos , Lavagem Peritoneal , Peritônio/efeitos dos fármacos , Lesões Pré-Cancerosas/tratamento farmacológico , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sementes , Espectrometria de Massas em Tandem , Transcriptoma
8.
Br J Nutr ; 113(5): 749-57, 2015 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-25716060

RESUMO

Consumption of flaxseed lignans is associated with various health benefits; however, little is known about the bioavailability of purified lignans in flaxseed. Data on their bioavailability and hence pharmacokinetics (PK) are necessary to better understand their role in putative health benefits. In the present study, we conducted a comparative PK analysis of the principal lignan of flaxseed, secoisolariciresinol diglucoside (SDG), and its primary metabolites, secoisolariciresinol (SECO), enterodiol (ED) and enterolactone (EL) in rats. Purified lignans were intravenously or orally administered to each male Wistar rat. SDG and its primary metabolites SECO, ED and EL were administered orally at doses of 40, 40, 10 and 10 mg/kg, respectively, and intravenously at doses of 20, 20, 5 and 1 mg/kg, respectively. Blood samples were collected at 0 (pre-dose), 5, 10, 15, 20, 30 and 45 min, and at 1, 2, 4, 6, 8, 12 and 24 h post-dosing, and serum samples were analysed. PK parameters and oral bioavailability of purified lignans were determined by non-compartmental methods. In general, administration of the flaxseed lignans SDG, SECO and ED demonstrated a high systemic clearance, a large volume of distribution and short half-lives, whereas administration of EL at the doses of 1 mg/kg (intravenously) and 10 mg/kg (orally administered) killed the rats within a few hours of dosing, precluding a PK analysis of this lignan. PK parameters of flaxseed lignans exhibited the following order: systemic clearance, SDG < SECO < ED; volume of distribution, SDG < SECO < ED; half-life, SDG < ED < SECO. The percentage of oral bioavailability was 0, 25 and < 1 % for SDG, SECO and ED, respectively.


Assuntos
Estrogênios/metabolismo , Linho/química , Lignanas/metabolismo , Fitoestrógenos/metabolismo , Sementes/química , 4-Butirolactona/administração & dosagem , 4-Butirolactona/efeitos adversos , 4-Butirolactona/análogos & derivados , 4-Butirolactona/metabolismo , 4-Butirolactona/farmacocinética , Administração Oral , Animais , Disponibilidade Biológica , Butileno Glicóis/administração & dosagem , Butileno Glicóis/efeitos adversos , Butileno Glicóis/metabolismo , Butileno Glicóis/farmacocinética , Suplementos Nutricionais/efeitos adversos , Relação Dose-Resposta a Droga , Estrogênios/administração & dosagem , Estrogênios/efeitos adversos , Estrogênios/farmacocinética , Glucosídeos/administração & dosagem , Glucosídeos/efeitos adversos , Glucosídeos/metabolismo , Glucosídeos/farmacocinética , Meia-Vida , Injeções Intravenosas , Absorção Intestinal , Cinética , Lignanas/administração & dosagem , Lignanas/efeitos adversos , Lignanas/farmacocinética , Masculino , Taxa de Depuração Metabólica , Fitoestrógenos/administração & dosagem , Fitoestrógenos/efeitos adversos , Fitoestrógenos/farmacocinética , Distribuição Aleatória , Ratos Wistar
9.
J Biomed Sci ; 21: 15, 2014 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-24548760

RESUMO

BACKGROUND: Stroke is one of the leading causes of neuronal death. Sesamin is known for neuroprotection by its antioxidant and anti-inflammatory properties but it lacks blood-brain barrier (BBB) activity. A panel of sesamin derivatives was screened and 3-bis (3-methoxybenzyl) butane-1,4-diol (BBD) was selected for high BBB activity and tested for its neuroprotective effect. METHODS: The focal cerebral ischemia of Sprague-Dawley rats and hypoxia models of murine BV-2 microglia or PC12 cells under oxygen/glucose deprivation were used for in vivo and in vitro test, respectively. Lipid peroxidation and superoxide dismutase (SOD) activity from the ischemic brain were tested and reactive oxygen species (ROS), cytokine production, prostaglandin (PGE2) and related signaling pathways from hypoxic cells were examined by ELISA or Western blot assay, respectively. RESULTS: BBD showed a protective effect when given 90 min after the focal cerebral ischemia. It also reduced lipid peroxidation and preserved SOD activity from the ischemic brain. The mechanism of BBD was further confirmed by attenuating ROS, cytokine production, and PGE2 release from hypoxic BV-2 or PC12 cells. BBD significantly reduced hypoxia-induced c-Jun N-terminal kinases (JNK) and modulated AKT-1 and caspase-3 (survival and apoptotic pathways) in BV-2 cells, and inhibited hypoxia-induced JNK and cyclooxygenase-2 activation in PC12 cells. CONCLUSIONS: The neuroprotective effect of BBD on ischemia/hypoxia models was involved with antioxidant and anti-inflammatory effects. The result would help the development of new CNS drug for protection of ischemia/hypoxia injury.


Assuntos
Antioxidantes/administração & dosagem , Isquemia Encefálica/tratamento farmacológico , Butileno Glicóis/administração & dosagem , Dioxóis/administração & dosagem , Lignanas/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/química , Antioxidantes/química , Antioxidantes/metabolismo , Barreira Hematoencefálica/efeitos dos fármacos , Isquemia Encefálica/patologia , Hipóxia Celular/efeitos dos fármacos , Dioxóis/química , Humanos , Lignanas/química , Peroxidação de Lipídeos/efeitos dos fármacos , Camundongos , Microglia/efeitos dos fármacos , Microglia/patologia , Neurônios/efeitos dos fármacos , Neurônios/patologia , Fármacos Neuroprotetores/química , Ratos , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacos , Superóxido Dismutase/biossíntese
10.
J Nutr Health Aging ; 28(9): 100329, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39137624

RESUMO

OBJECTIVES: Ketone bodies are endogenous metabolites produced during fasting or a ketogenic diet that have pleiotropic effects on aging pathways. Ketone esters (KEs) are compounds that induce ketosis without dietary changes, but KEs have not been studied in an older adult population. The primary objective of this trial was to assess the tolerability and safety of KE ingestion in a cohort of older adults. DESIGN: Randomized, placebo-controlled, double-blinded, parallel-arm trial (NCT05585762). SETTING: General community, Northern California, USA. PARTICIPANTS: Community-dwelling older adults, independent in activities of daily living, with no unstable acute medical conditions (n = 30; M = 15, F = 15; age = 76 y, range 65-90 y) were randomized and n = 23 (M = 14, F = 9) completed the protocol. INTERVENTION: Participants were randomly allocated to consume either KE (25 g bis-octanoyl (R)-1,3-butanediol) or a taste, appearance, and calorie-matched placebo (PLA) containing canola oil daily for 12 weeks. MEASUREMENTS: Tolerability was assessed using a composite score from a daily log for 2-weeks, and then via a bi-weekly phone interview. Safety was assessed by vital signs and lab tests at screening and weeks 0, 4 and 12, along with tabulation of adverse events. RESULTS: There was no difference in the prespecified primary outcome of proportion of participants reporting moderate or severe nausea, headache, or dizziness on more than one day in a two-week reporting period (KE n = 2 (14.3% [90% CI = 2.6-38.5]); PLA n = 1 (7.1% [90% CI = 0.4-29.7]). Dropouts numbered four in the PLA group and two in the KE group. A greater number of symptoms were reported in both groups during the first two weeks; symptoms were reported less frequently between 2 and 12 weeks. There were no clinically relevant changes in safety labs or vital signs in either group. CONCLUSIONS: This KE was safe and well-tolerated in this study of healthy older adults. These results provide an initial foundation for use of KEs in clinical research with older adults.


Assuntos
Butileno Glicóis , Humanos , Idoso , Método Duplo-Cego , Masculino , Feminino , Idoso de 80 Anos ou mais , Projetos Piloto , Butileno Glicóis/administração & dosagem , Butileno Glicóis/efeitos adversos , Butileno Glicóis/farmacologia , Dieta Cetogênica/efeitos adversos , Dieta Cetogênica/métodos , Cetonas/efeitos adversos , Cetonas/administração & dosagem , Corpos Cetônicos , Cetose , Ésteres/administração & dosagem
11.
Am J Epidemiol ; 178(3): 434-40, 2013 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-23752918

RESUMO

Experimental data indicate that gestational exposures to estrogenic compounds impact risk of hypospadias. We examined whether risk of hypospadias (i.e., a congenital malformation in which the opening of the penile urethra occurs on the ventral side of the penis) was associated with maternal intake of phytoestrogens, given their potential impact on estrogen metabolism. The analysis included data on mothers of 1,250 hypospadias cases and 3,118 controls who delivered their infants from 1997 to 2005 and participated in the National Birth Defects Prevention Study, a multistate, population-based, case-control study. After adjustment for several covariates, high intakes of daidzein, genistein, glycetin, secoisolariciresinol, total isoflavones, total lignans, and total phytoestrogens were associated with reduced risks; odds ratios comparing intakes ≥90th percentile with intakes between the 11th and 89th percentiles ranged from 0.6 to 0.8. For example, the odds ratio for total phytoestrogen intake was 0.7 (95% confidence interval: 0.5, 1.0). This study represents the first large-scale analysis of phytoestrogen intake and hypospadias. The observed associations merit investigation in additional populations before firm conclusions can be reached.


Assuntos
Dieta Vegetariana , Hipospadia/epidemiologia , Fitoestrógenos/administração & dosagem , Efeitos Tardios da Exposição Pré-Natal , Adulto , Butileno Glicóis/administração & dosagem , Butileno Glicóis/efeitos adversos , Estudos de Casos e Controles , Dieta Vegetariana/efeitos adversos , Feminino , Genisteína/administração & dosagem , Genisteína/efeitos adversos , Humanos , Hipospadia/induzido quimicamente , Recém-Nascido , Isoflavonas/administração & dosagem , Isoflavonas/efeitos adversos , Lignanas/administração & dosagem , Lignanas/efeitos adversos , Masculino , Razão de Chances , Fitoestrógenos/efeitos adversos , Gravidez , Medição de Risco , Fatores de Risco , Inquéritos e Questionários
12.
BMC Cancer ; 13: 179, 2013 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-23557217

RESUMO

BACKGROUND: Wholegrain flaxseed (FS), and its lignan component (FLC) consisting mainly of secoisolariciresinol diglucoside (SDG), have potent lung radioprotective properties while not abrogating the efficacy of radiotherapy. However, while the whole grain was recently shown to also have potent mitigating properties in a thoracic radiation pneumonopathy model, the bioactive component in the grain responsible for the mitigation of lung damage was never identified. Lungs may be exposed to radiation therapeutically for thoracic malignancies or incidentally following detonation of a radiological dispersion device. This could potentially lead to pulmonary inflammation, oxidative tissue injury, and fibrosis. This study aimed to evaluate the radiation mitigating effects of FLC in a mouse model of radiation pneumonopathy. METHODS: We evaluated FLC-supplemented diets containing SDG lignan levels comparable to those in 10% and 20% whole grain diets. 10% or 20% FLC diets as compared to an isocaloric control diet (0% FLC) were given to mice (C57/BL6) (n=15-30 mice/group) at 24, 48, or 72-hours after single-dose (13.5 Gy) thoracic x-ray treatment (XRT). Mice were evaluated 4 months post-XRT for blood oxygenation, lung inflammation, fibrosis, cytokine and oxidative damage levels, and survival. RESULTS: FLC significantly mitigated radiation-related animal death. Specifically, mice fed 0% FLC demonstrated 36.7% survival 4 months post-XRT compared to 60-73.3% survival in mice fed 10%-20% FLC initiated 24-72 hours post-XRT. FLC also mitigated radiation-induced lung fibrosis whereby 10% FLC initiated 24-hours post-XRT significantly decreased fibrosis as compared to mice fed control diet while the corresponding TGF-beta1 levels detected immunohistochemically were also decreased. Additionally, 10-20% FLC initiated at any time point post radiation exposure, mitigated radiation-induced lung injury evidenced by decreased bronchoalveolar lavage (BAL) protein and inflammatory cytokine/chemokine release at 16 weeks post-XRT. Importantly, neutrophilic and overall inflammatory cell infiltrate in airways and levels of nitrotyrosine and malondialdehyde (protein and lipid oxidation, respectively) were also mitigated by the lignan diet. CONCLUSIONS: Dietary FLC given early post-XRT mitigated radiation effects by decreasing inflammation, lung injury and eventual fibrosis while improving survival. FLC may be a useful agent, mitigating adverse effects of radiation in individuals exposed to incidental radiation, inhaled radioisotopes or even after the initiation of radiation therapy to treat malignancy.


Assuntos
Butileno Glicóis/administração & dosagem , Citocinas/metabolismo , Linho , Glucosídeos/administração & dosagem , Lesão Pulmonar/prevenção & controle , Fitoterapia , Lesões Experimentais por Radiação/prevenção & controle , Protetores contra Radiação/administração & dosagem , Sementes , Ração Animal , Animais , Líquido da Lavagem Broncoalveolar , Feminino , Fibrose/etiologia , Fibrose/prevenção & controle , Estimativa de Kaplan-Meier , Lignanas/administração & dosagem , Pulmão/metabolismo , Pulmão/patologia , Pulmão/efeitos da radiação , Lesão Pulmonar/complicações , Lesão Pulmonar/metabolismo , Malondialdeído/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Neutrófilos , Oxigênio/sangue , Lesões Experimentais por Radiação/complicações , Lesões Experimentais por Radiação/metabolismo , Pneumonite por Radiação/etiologia , Pneumonite por Radiação/patologia , Taxa de Sobrevida , Fatores de Tempo , Fator de Crescimento Transformador beta1/metabolismo , Tirosina/análogos & derivados , Tirosina/metabolismo
13.
Int J Food Sci Nutr ; 64(5): 535-43, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23373826

RESUMO

Higher intake of lignans, diphenolic plant compounds, may reduce the risk of certain types of cancer and cardiovascular diseases. We assessed the dietary intake of four lignans: matairesinol, secoisolariciresinol, lariciresinol and pinoresinol. Furthermore, for the breads we supplemented the data with two more lignans: syringaresinol and medioresinol. Study subjects were 172 men and 97 women aged 40-75 years, residing in Riga, the capital of Latvia, all living at home, eating habitual food. Median total lignan intake was 2259 (range 1169-5759) µg/day. Secoisolariciresinol contributed 58% and syringaresinol 22% of lignan intake. Bread was the major food source of lignans in men (86%), whereas in women it was bread (57%) and flaxseed (35%).


Assuntos
Pão , Dieta , Linho/química , Lignanas/administração & dosagem , Fenóis/administração & dosagem , Fitoestrógenos/administração & dosagem , Extratos Vegetais/administração & dosagem , Adulto , Idoso , Butileno Glicóis/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Comportamento Alimentar , Feminino , Furanos/administração & dosagem , Humanos , Letônia , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Fatores Sexuais
14.
Zhong Yao Cai ; 35(2): 248-53, 2012 Feb.
Artigo em Zh | MEDLINE | ID: mdl-22822672

RESUMO

OBJECTIVE: To study the influence of Secoisolariciresinol Diglucoside (SDG) combined with Bortezomib on induction of apoptosis in lung cancer cell line A549 and its relative mechanisms. METHODS: The effect on proliferation was evaluated by MTT assay. The cell apoptosis was studied by flow cytometry and Hoechst 33342 staining. Colorimetric method was used to detect the activity of Caspase-3. Real time PCR was used to detect the expression of Caspase-3, BCL-2 and BAX mRNA. Western blot was used to determine the change of p-JNK, BCL-2 and BAX protein expression in A549 cells. RESULTS: The cell growth was significantly slowed down and the cell apoptosis was induced after the combined treatment. Meanwhile the Caspase-3 activity and the expression of Caspase-3 mRNA were obviously increased, the expression of BCL-2 mRNA and protein were significantly down regulated and the expression of BAX. p-JNK mRNA and protein were significantly up regulated after the combined treatment. CONCLUSION: The results demonstrate that SDG combined with Bortezomib can significantly induce apoptosis of A549 cells, its mechanisms may be involved in activation of the JNK pathway.


Assuntos
Antineoplásicos/farmacologia , Apoptose/efeitos dos fármacos , Ácidos Borônicos/farmacologia , Butileno Glicóis/farmacologia , Glucosídeos/farmacologia , Neoplasias Pulmonares/patologia , Inibidores de Proteases/farmacologia , Pirazinas/farmacologia , Antineoplásicos/administração & dosagem , Ácidos Borônicos/administração & dosagem , Bortezomib , Butileno Glicóis/administração & dosagem , Caspase 3/genética , Caspase 3/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Quimioterapia Combinada , Citometria de Fluxo , Glucosídeos/administração & dosagem , Humanos , Inibidores de Proteases/administração & dosagem , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Pirazinas/administração & dosagem , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Proteína X Associada a bcl-2/genética , Proteína X Associada a bcl-2/metabolismo
15.
Rev Prat ; 62(5): 669-72, 2012 May.
Artigo em Francês | MEDLINE | ID: mdl-22730800

RESUMO

Gamma-hydroxybutyric acid (GHB) is an old anaesthetic drug which was misused in the 80-90's as an anabolic agent (bodybuilding), recreational drug (drunkenness, euphoric, disinhibiting and aphrodisiac effects) and as a date rape drug (disinhibiting, hypnotic and amnesic effects). Its use in the general population is low, and mainly concerns gay population in nightclubs and young people in parties. The intoxications, above all with alcohol combination, can be severe, with coma and breathing depression, or even fatal. Chronic use leads to psychic and physical dependence; withdrawal syndrome can be severe, with agitation and delirium. In 1999, GHB classification as a narcotic resulted in the increased use of GHB prodrugs gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD), which were easily commercially available as solvent and cleaning products. Like GHB, they have a narrow window of use, and share similar toxicity. Their increased cases of recreational use and of severe drug intoxication, abuse and dependence, led the French Ministry of Health in 2011 to prohibit their sale and transfer to the public.


Assuntos
4-Butirolactona , Butileno Glicóis , Hidroxibutiratos , Drogas Ilícitas/farmacologia , 4-Butirolactona/administração & dosagem , 4-Butirolactona/química , 4-Butirolactona/farmacocinética , 4-Butirolactona/toxicidade , Butileno Glicóis/administração & dosagem , Butileno Glicóis/química , Butileno Glicóis/farmacocinética , Butileno Glicóis/toxicidade , Humanos , Hidroxibutiratos/administração & dosagem , Hidroxibutiratos/química , Hidroxibutiratos/farmacocinética , Hidroxibutiratos/toxicidade , Drogas Ilícitas/química , Drogas Ilícitas/toxicidade , Conhecimento , Modelos Biológicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Transtornos Relacionados ao Uso de Substâncias/mortalidade
16.
J Dairy Res ; 78(1): 111-7, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21214967

RESUMO

Nutritional value is a priority in new product development. Using vegetable or marine oils, rich in polyunsaturated fatty acids, in dairy beverage formulations is an option to provide the consumers with healthier products. However, these formulations are prone to oxidation, which is responsible for rapid flavour degradation and the development of potentially toxic reaction products during storage. Flaxseed lignans, secoisolariciresinol diglucoside (SDG), and its mammalian metabolites have antioxidant activity and could be used in beverage formulations to prevent oxidation. Commercially available SDG extract was added to the formulation of dairy beverages enriched with flaxseed oil. As an alternative approach, dairy beverages were produced from milk naturally rich in SDG metabolites obtained through the alteration of cow diet. Resistance to oxidation was determined from the kinetics of hexanal and propanal production during heat and light exposure treatments. Increasing SDG concentration in dairy beverage slightly reduced redox potential but had no effect on oxygen consumption during oxidation treatments. The presence of SDG in dairy beverage significantly improved resistance to heat- and light-induced oxidation. However, purified enterolactone, a mammalian metabolite from SDG, prevented oxidation at much lower concentrations. The use of milk from dairy cow fed flaxseed meal did not improve resistance to oxidation in dairy beverage. Enterolactone concentration in milk was increased by the experimental diet but it remained too low to observe any significant effect on dairy beverage oxidation.


Assuntos
Antioxidantes/administração & dosagem , Ácidos Graxos Insaturados/química , Linho/química , Alimentos Fortificados , Lignanas/administração & dosagem , Leite/química , 4-Butirolactona/análogos & derivados , 4-Butirolactona/análise , 4-Butirolactona/metabolismo , 4-Butirolactona/farmacologia , Animais , Butileno Glicóis/administração & dosagem , Butileno Glicóis/metabolismo , Bovinos , Dieta , Feminino , Glucosídeos/administração & dosagem , Glucosídeos/metabolismo , Temperatura Alta , Lignanas/análise , Lignanas/metabolismo , Lignanas/farmacologia , Oxirredução , Estresse Oxidativo , Processos Fotoquímicos
17.
Nutrients ; 13(6)2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34208742

RESUMO

Nutritional ketosis is a state of mildly elevated blood ketone concentrations resulting from dietary changes (e.g., fasting or reduced carbohydrate intake) or exogenous ketone consumption. In this study, we determined the tolerability and safety of a novel exogenous ketone diester, bis-hexanoyl-(R)-1,3-butanediol (BH-BD), in a 28-day, randomized, double-blind, placebo-controlled, parallel trial (NCT04707989). Healthy adults (n = 59, mean (SD), age: 42.8 (13.4) y, body mass index: 27.8 (3.9) kg/m2) were randomized to consume a beverage containing 12.5 g (Days 0-7) and 25 g (Days 7-28) of BH-BD or a taste-matched placebo daily with breakfast. Tolerability, stimulation, and sedation were assessed daily by standardized questionnaires, and blood and urine samples were collected at Days 0, 7, 14, and 28 for safety assessment. There were no differences in at-home composite systemic and gastrointestinal tolerability scores between BH-BD and placebo at any time in the study, or in acute tolerability measured 1-h post-consumption in-clinic. Weekly at-home composite tolerability scores did not change when BH-BD servings were doubled. At-home scores for stimulation and sedation did not differ between groups. BH-BD significantly increased blood ketone concentrations 1-h post-consumption. No clinically meaningful changes in safety measures including vital signs and clinical laboratory measurements were detected within or between groups. These results support the overall tolerability and safety of consumption of up to 25 g/day BH-BD.


Assuntos
Butileno Glicóis/farmacologia , Cetose/induzido quimicamente , Adulto , Bebidas , Glicemia/análise , Butileno Glicóis/administração & dosagem , Butileno Glicóis/efeitos adversos , Butileno Glicóis/sangue , Método Duplo-Cego , Feminino , Humanos , Corpos Cetônicos/sangue , Masculino , Inquéritos e Questionários
18.
Microbiologyopen ; 10(2): e1185, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33970540

RESUMO

LGM2605 is a synthetic version of the naturally occurring flaxseed lignan secoisolariciresinol diglucoside (SDG), with known anti-inflammatory and antioxidant properties; however, its effects on gut microbial composition have not previously been evaluated. In the present study, we sought to determine how the 10-day oral administration of LGM2605 alters the gut microbiota of mice. Eight-week-old female C57BL/6 mice were treated with either LGM2605 or saline, administered daily via oral gavage over a 10-day treatment period. Upon termination of treatment, mouse cecums (n = 31) were collected, and cecal DNA was isolated. 16S rRNA genes were sequenced and analyzed in Mothur to identify changes in gut microbial composition induced by LGM2605 treatment (v. saline control). We then assessed community composition, performed indicator taxa analysis, and measured alpha and beta diversity. Overall, LGM2605 significantly altered the gut microbiota of mice; we reported alterations in 3 bacterial phyla and 22 genera as a result of treatment. The study here identifies for the first time significant alterations in the gut microbiota of mice following oral administration of LGM2605, in general shifting toward a more anti-inflammatory composition. These findings lay the foundation for future investigations utilizing LGM2605 to control gut dysbiosis and, by extension, systemic inflammation.


Assuntos
Anti-Infecciosos/farmacologia , Butileno Glicóis/farmacologia , Linho/química , Microbioma Gastrointestinal/efeitos dos fármacos , Glucosídeos/farmacologia , Administração Oral , Animais , Anti-Infecciosos/administração & dosagem , Biodiversidade , Butileno Glicóis/administração & dosagem , Ceco/microbiologia , Biologia Computacional/métodos , Disbiose/microbiologia , Feminino , Glucosídeos/administração & dosagem , Lignanas/administração & dosagem , Lignanas/farmacologia , Camundongos , Camundongos Endogâmicos C57BL , RNA Ribossômico 16S , Sementes/química
19.
Br J Nutr ; 104(6): 833-41, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20388250

RESUMO

Limited information is available on lignan metabolism and tissue distribution between sexes and the effects of prolonged lignan exposure on tissue concentrations. In the present study, excretion and tissue distribution of lignans were compared after 1 d and 7 d administration of flaxseed lignan secoisolariciresinol diglycoside (SDG) in male and female rats. Sprague-Dawley rats were daily gavaged per os with 3H-SDG (3.7 kBq/g body weight (bwt)) and unlabelled SDG (5.3 microg/g bwt). Urine, faeces, serum and tissues (liver, kidneys, bladder, spleen, lungs, brain, thymus, heart, muscle, adipose, mammary gland, ovaries, vagina, uterus, testis, seminal vesicles, coagulating glands and ventral prostate) were collected at 0, 12 and 24 h after a single lignan dose or after the last dose of 7 d exposure. The sample total lignan content was measured as radioactivity by liquid scintillation counting. In both sexes, majority of radioactivity was excreted in faeces (40-83%) and urine (1.2-5.2%). 3H-SDG administration increased radioactivity in all tissues at all time points, and the levels were further increased after prolonged SDG exposure. Liver contained majority of the tissue lignans (48-56%) in both sexes after both exposure regimens. After prolonged SDG exposure, the serum lignan concentrations had reached a plateau which was approximately 4-fold of that of acute exposure, whereas in both sexes, concentrations in skin and kidneys still increased, indicating tissue accumulation. After prolonged exposure, females had higher lignan concentrations in heart and thymus at all time points, demonstrating sex-related differences in lignan tissue distribution and the possibility for sex-specific treatment responses. These findings facilitate identification of target tissues for local lignan actions in vivo.


Assuntos
Butileno Glicóis/farmacocinética , Linho/química , Glicosídeos/farmacocinética , Lignanas/farmacocinética , Animais , Butileno Glicóis/administração & dosagem , Fezes/química , Feminino , Glicosídeos/administração & dosagem , Lignanas/administração & dosagem , Masculino , Ratos , Ratos Sprague-Dawley , Sementes , Fatores Sexuais , Fatores de Tempo , Distribuição Tecidual , Urina/química
20.
Nutr Metab Cardiovasc Dis ; 20(1): 64-71, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19361969

RESUMO

BACKGROUND AND AIMS: It has been suggested that lignan intake may decrease the risk for cardiovascular disease (CVD) by modifying traditional risk factors as well as aortic stiffness. However, the role of dietary lignans on the vascular system is largely unknown. The objective was to investigate whether dietary intake of plant lignans in a free-living population was associated with markers of vascular inflammation and function. METHODS AND RESULTS: We performed a cross-sectional study in 242 (151 males) men and post-menopausal women. Anthropometric characteristics and lignan intake were evaluated. Soluble intercellular adhesion molecule-1 (sICAM-1), insulin, high-sensitive C-reactive protein, glucose, total cholesterol, HDL-cholesterol and triacylglycerols were measured in fasting blood samples. Brachial flow-mediated dilation (FMD) measurements were available for 101 subjects (56 males). Median (interquartile range) daily intake of matairesinol (MAT), secoisolariciresinol (SECO), pinoresinol (PINO), lariciresinol (LARI), and total lignans was 20.9 microg (17.4), 335.3 microg (289.1), 96.7 microg (91.1), 175.7 microg (135.8), and 665.5 microg (413.7), respectively, as assessed by 3-day weighed food record. Plasma concentrations of sICAM-1 (whole sample) significantly decreased (mean (95%CI) = 358 microg/L (320-401), 276 microg/L (252-303), 298 microg/L (271-326), and 269 microg/L (239-303), P per trend 0.013) and FMD values (FMD sub-group) significantly increased (4.1% (2.2-6.0), 5.7% (4.3-7.2), 6.4% (4.9-7.8), and 8.1% (6.3-10.0), P per trend 0.016) across quartiles of energy-adjusted MAT intake, even after adjustment for relevant clinical and dietary variables. Intake of SECO was also inversely related to plasma sICAM-1 (P per trend 0.018), but not to FMD values. No relationship between intake of PINO, LARI or total lignans and either sICAM-1 or FMD values was observed. CONCLUSIONS: Higher MAT intakes in the context of a typical Northern Italian diet are associated to lower vascular inflammation and endothelial dysfunction, which could have some implications in CVD prevention.


Assuntos
Dieta , Endotélio Vascular/fisiopatologia , Inflamação/fisiopatologia , Lignanas/administração & dosagem , Fitoestrógenos/administração & dosagem , Doenças Vasculares/fisiopatologia , Idoso , Biomarcadores/sangue , Butileno Glicóis/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Estudos Transversais , Registros de Dieta , Dieta Mediterrânea/estatística & dados numéricos , Feminino , Furanos/administração & dosagem , Hemodinâmica , Humanos , Inflamação/sangue , Inflamação/prevenção & controle , Itália , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Doenças Vasculares/sangue , Doenças Vasculares/prevenção & controle
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