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2.
Microbiome ; 11(1): 140, 2023 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-37394428

RESUMO

BACKGROUND: Most interactions between the host and its microbiota occur at the gut barrier, and primary colonizers are essential in the gut barrier maturation in the early life. The mother-offspring transmission of microorganisms is the most important factor influencing microbial colonization in mammals, and C-section delivery (CSD) is an important disruptive factor of this transfer. Recently, the deregulation of symbiotic host-microbe interactions in early life has been shown to alter the maturation of the immune system, predisposing the host to gut barrier dysfunction and inflammation. The main goal of this study is to decipher the role of the early-life gut microbiota-barrier alterations and its links with later-life risks of intestinal inflammation in a murine model of CSD. RESULTS: The higher sensitivity to chemically induced inflammation in CSD mice is related to excessive exposure to a too diverse microbiota too early in life. This early microbial stimulus has short-term consequences on the host homeostasis. It switches the pup's immune response to an inflammatory context and alters the epithelium structure and the mucus-producing cells, disrupting gut homeostasis. This presence of a too diverse microbiota in the very early life involves a disproportionate short-chain fatty acids ratio and an excessive antigen exposure across the vulnerable gut barrier in the first days of life, before the gut closure. Besides, as shown by microbiota transfer experiments, the microbiota is causal in the high sensitivity of CSD mice to chemical-induced colitis and in most of the phenotypical parameters found altered in early life. Finally, supplementation with lactobacilli, the main bacterial group impacted by CSD in mice, reverts the higher sensitivity to inflammation in ex-germ-free mice colonized by CSD pups' microbiota. CONCLUSIONS: Early-life gut microbiota-host crosstalk alterations related to CSD could be the linchpin behind the phenotypic effects that lead to increased susceptibility to an induced inflammation later in life in mice. Video Abstract.


Assuntos
Colite , Microbioma Gastrointestinal , Microbiota , Camundongos , Animais , Microbioma Gastrointestinal/fisiologia , Modelos Animais de Doenças , Inflamação , Colite/induzido quimicamente , Mamíferos
3.
Sci Rep ; 13(1): 6114, 2023 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-37059733

RESUMO

Most lactobacilli produce extracellular polysaccharides that are considered to contribute to the probiotic effect of many strains. Lacticaseibacillus rhamnosus CNCM I-3690 is an anti-inflammatory strain able to counterbalance gut barrier dysfunction. In this study ten spontaneous variants of CNCM I-3690 with different EPS-production were generated and characterized by their ropy phenotype, the quantification of the secreted EPS and genetic analysis. Amongst them, two were further analysed in vitro and in vivo: an EPS over-producer (7292) and a low-producer derivative of 7292 (7358, with similar EPS levels than the wild type (WT) strain). Our results showed that 7292 does not have anti-inflammatory profile in vitro, and lost the capacity to adhere to the colonic epithelial cells as well as the protective effect on the permeability. Finally, 7292 lost the protective effects of the WT strain in a murine model of gut dysfunction. Notably, strain 7292 was unable to stimulate goblet cell mucus production and colonic IL-10 production, all key features for the beneficial effect of the WT strain. Furthermore, transcriptome analysis of colonic samples from 7292-treated mice showed a down-regulation of anti-inflammatory genes. Altogether, our results point out that the increase of EPS production in CNCM I-3690 impairs its protective effects and highlight the importance of the correct EPS synthesis for the beneficial effects of this strain.


Assuntos
Lacticaseibacillus rhamnosus , Probióticos , Animais , Camundongos , Lacticaseibacillus , Lactobacillus , Células Caliciformes , Anti-Inflamatórios , Polissacarídeos Bacterianos/farmacologia
4.
Neuropsychopharmacology ; 46(3): 579-602, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32781459

RESUMO

Maternal immune activation (MIA) and poor maternal nutritional habits are risk factors for the occurrence of neurodevelopmental disorders (NDD). Human studies show the deleterious impact of prenatal inflammation and low n-3 polyunsaturated fatty acid (PUFA) intake on neurodevelopment with long-lasting consequences on behavior. However, the mechanisms linking maternal nutritional status to MIA are still unclear, despite their relevance to the etiology of NDD. We demonstrate here that low maternal n-3 PUFA intake worsens MIA-induced early gut dysfunction, including modification of gut microbiota composition and higher local inflammatory reactivity. These deficits correlate with alterations of microglia-neuron crosstalk pathways and have long-lasting effects, both at transcriptional and behavioral levels. This work highlights the perinatal period as a critical time window, especially regarding the role of the gut-brain axis in neurodevelopment, elucidating the link between MIA, poor nutritional habits, and NDD.


Assuntos
Ácidos Graxos Ômega-3 , Efeitos Tardios da Exposição Pré-Natal , Animais , Comportamento Animal , Encéfalo , Feminino , Humanos , Inflamação , Microglia , Gravidez
5.
Benef Microbes ; 9(1): 87-100, 2018 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-29022382

RESUMO

Beneficial bacteria represent potential sources of therapy, particularly in the battle against antibiotic-resistant pathogens. The Gram-negative bacillus Klebsiella pneumoniae is not only a paradigm of multi-resistant opportunistic pathogen, but it is also able to colonise the human intestine and displays a high capacity to form biofilm. In this study, the anti-biofilm activity of 140 neutralised Lactobacillus supernatants was assessed against K. pneumoniae. Among the 13 strains whose supernatant significantly impaired biofilm formation, Lactobacillus plantarum CIRM653 was selected because it was also able to impair K. pneumoniae preformed biofilm, independently of a bactericidal effect. Mixed K. pneumoniae/L. plantarum CIRM653 biofilms had reduced tridimensional structures associated with a significant decrease in K. pneumoniae biomass. Further investigation showed that L. plantarum CIRM653 supernatant induced transcriptional modifications of K. pneumoniae biofilm-related genes, including down-regulation of the quorum sensing-related lsr operons and over-expression of type 3 pili structure genes. Increased production of type 3 pili was validated by Western-blot, hemagglutination and adhesion assays. L. plantarum CIRM653 activity against K. pneumoniae was also assessed in a murine intestinal colonisation model: a constant faecal pathogen burden was observed, as against a gradual decrease in the control group. These results reveal that an in vitro a priori attracting anti-biofilm activity of Lactobacillus might be counterbalanced by an in vivo behaviour in a complex microbiota environment with potential deleterious dispersal of highly adherent K. pneumoniae cells, raising the question of the accuracy of in vitro assays in screening of beneficial microbes.


Assuntos
Antibiose , Biofilmes/crescimento & desenvolvimento , Trato Gastrointestinal/microbiologia , Klebsiella pneumoniae/crescimento & desenvolvimento , Lactobacillus plantarum/fisiologia , Animais , Aderência Bacteriana/genética , Proteínas de Bactérias/genética , Técnicas de Cocultura , Fímbrias Bacterianas/genética , Klebsiella pneumoniae/genética , Lactobacillus/classificação , Lactobacillus/crescimento & desenvolvimento , Lactobacillus/fisiologia , Lactobacillus plantarum/crescimento & desenvolvimento , Lactobacillus plantarum/metabolismo , Camundongos , Percepção de Quorum/genética , Transcrição Gênica
6.
Zygote ; 25(1): 10-16, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27806737

RESUMO

Sesquiterpene lactones (STLs) are a large and structurally diverse group of plant metabolites generally found in the Asteraceae family. STLs exhibit a wide spectrum of biological activities and it is generally accepted that their major mechanism of action is the alkylation of the thiol groups of biological molecules. The guaianolides is one of various groups of STLs. Anti-tumour and anti-migraine effects, an allergenic agent, an inhibitor of smooth muscle cells and of meristematic cell proliferation are only a few of the most commonly reported activities of STLs. In amphibians, fully grown ovarian oocytes are arrested at the beginning of meiosis I. Under stimulus with progesterone, this meiotic arrest is released and meiosis progresses to metaphase II, a process known as oocyte maturation. There are previous records of the inhibitory effect of dehydroleucodin (DhL), a guaianolide lactone, on the progression of meiosis. It has been also shown that DhL and its 11,13-dihydroderivative (2H-DhL; a mixture of epimers at C-11) act as blockers of the resumption of meiosis in fully grown ovarian oocytes from the amphibian Rhinella arenarum (formerly classified as Bufo arenarum). The aim of this study was to analyze the effect of four closely related guaianolides, i.e., DhL, achillin, desacetoxymatricarin and estafietin as possible inhibitors of meiosis in oocytes of amphibians in vitro and discuss some structure-activity relationships. It was found that the inhibitory effect on meiosis resumption is greater when the lactone has two potentially reactive centres, either a α,ß-α',ß'-diunsaturated cyclopentanone moiety or an epoxide group plus an exo-methylene-γ-lactone function.


Assuntos
Meiose/efeitos dos fármacos , Oócitos/efeitos dos fármacos , Oócitos/fisiologia , Sesquiterpenos/farmacologia , Animais , Bufo arenarum , Células Cultivadas , Feminino , Lactonas/química , Lactonas/farmacologia , Espectroscopia de Ressonância Magnética , Estrutura Molecular , Progesterona/farmacologia , Sesquiterpenos/química , Sesquiterpenos de Guaiano/farmacologia , Relação Estrutura-Atividade
7.
Gut ; 65(3): 415-425, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26045134

RESUMO

BACKGROUND: Crohn's disease (CD)-associated dysbiosis is characterised by a loss of Faecalibacterium prausnitzii, whose culture supernatant exerts an anti-inflammatory effect both in vitro and in vivo. However, the chemical nature of the anti-inflammatory compounds has not yet been determined. METHODS: Peptidomic analysis using mass spectrometry was applied to F. prausnitzii supernatant. Anti-inflammatory effects of identified peptides were tested in vitro directly on intestinal epithelial cell lines and on cell lines transfected with a plasmid construction coding for the candidate protein encompassing these peptides. In vivo, the cDNA of the candidate protein was delivered to the gut by recombinant lactic acid bacteria to prevent dinitrobenzene sulfonic acid (DNBS)-colitis in mice. RESULTS: The seven peptides, identified in the F. prausnitzii culture supernatants, derived from a single microbial anti-inflammatory molecule (MAM), a protein of 15 kDa, and comprising 53% of non-polar residues. This last feature prevented the direct characterisation of the putative anti-inflammatory activity of MAM-derived peptides. Transfection of MAM cDNA in epithelial cells led to a significant decrease in the activation of the nuclear factor (NF)-κB pathway with a dose-dependent effect. Finally, the use of a food-grade bacterium, Lactococcus lactis, delivering a plasmid encoding MAM was able to alleviate DNBS-induced colitis in mice. CONCLUSIONS: A 15 kDa protein with anti-inflammatory properties is produced by F. prausnitzii, a commensal bacterium involved in CD pathogenesis. This protein is able to inhibit the NF-κB pathway in intestinal epithelial cells and to prevent colitis in an animal model.


Assuntos
Proteínas de Bactérias/metabolismo , Clostridiales/metabolismo , Doença de Crohn/microbiologia , Disbiose/microbiologia , Mucosa Intestinal/microbiologia , Sequência de Aminoácidos , Animais , Anti-Inflamatórios/uso terapêutico , Proteínas de Bactérias/química , Proteínas de Bactérias/isolamento & purificação , Proteínas de Bactérias/uso terapêutico , Biomarcadores/metabolismo , Linhagem Celular , Colite/induzido quimicamente , Colite/metabolismo , Colite/prevenção & controle , Doença de Crohn/metabolismo , Doença de Crohn/patologia , Disbiose/metabolismo , Disbiose/patologia , Humanos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , NF-kappa B/metabolismo , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
8.
Gut Microbes ; 6(1): 1-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25517879

RESUMO

Impaired gut barrier function has been reported in a wide range of diseases and syndromes and in some functional gastrointestinal disorders. In addition, there is increasing evidence that suggests the gut microbiota tightly regulates gut barrier function and recent studies demonstrate that probiotic bacteria can enhance barrier integrity. Here, we aimed to investigate the effects of Lactobacillus rhamnosus CNCM I-3690 on intestinal barrier function. In vitro results using a Caco-2 monolayer cells stimulated with TNF-α confirmed the anti-inflammatory nature of the strain CNCM I-3690 and pointed out a putative role for the protection of the epithelial function. Next, we tested the protective effects of L. rhamnosus CNCM I-3690 in a mouse model of increased colonic permeability. Most importantly, we compared its performance to that of the well-known beneficial human commensal bacterium Faecalibacterium prauznitzii A2-165. Increased colonic permeability was normalized by both strains to a similar degree. Modulation of apical tight junction proteins expression was then analyzed to decipher the mechanism underlying this effect. We showed that CNCM I-3690 partially restored the function of the intestinal barrier and increased the levels of tight junction proteins Occludin and E-cadherin. The results indicate L. rhamnosus CNCM I-3690 is as effective as the commensal anti-inflammatory bacterium F. prausnitzii to treat functional barrier abnormalities.


Assuntos
Anti-Inflamatórios/administração & dosagem , Clostridium/fisiologia , Mucosa Intestinal/fisiologia , Lacticaseibacillus rhamnosus/fisiologia , Permeabilidade/efeitos dos fármacos , Probióticos/administração & dosagem , Experimentação Animal , Animais , Células CACO-2 , Clostridium/crescimento & desenvolvimento , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/microbiologia , Perfilação da Expressão Gênica , Humanos , Mucosa Intestinal/efeitos dos fármacos , Lacticaseibacillus rhamnosus/crescimento & desenvolvimento , Masculino , Camundongos Endogâmicos C57BL , Proteínas de Junções Íntimas/biossíntese , Resultado do Tratamento , Fator de Necrose Tumoral alfa/metabolismo
9.
Mol Plant Microbe Interact ; 22(11): 1323-30, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19810802

RESUMO

The supply of soluble silicon (Si) to plants has been associated with many benefits that remain poorly explained and often contested. In this work, the effect of Si was studied on wheat plants under both control and pathogen stress (Blumeria graminis f. sp. tritici) conditions by conducting a large transcriptomic analysis (55,000 unigenes) aimed at comparing the differential response of plants under four treatments. The response to the supply of Si on control (uninfected) plants was limited to 47 genes of diverse functions providing little evidence of regulation of a specific metabolic process. Plants reacted to inoculation with B. graminis f. sp. tritici by an upregulation of many genes linked to stress and metabolic processes and a downregulation of genes linked to photosynthesis. Supplying Si to inoculated plants largely prevented disease development, a phenotypic response that translated into a nearly perfect reversal of genes regulated by the effect of B. graminis f. sp. tritici alone. These results suggest that Si plays a limited role on a plant's transcriptome in the absence of stress, even in the case of a high-Si-accumulating monocot such as wheat. On the other hand, the benefits of Si in the form of biotic stress alleviation were remarkably aligned with a counter-response to transcriptomic changes induced by the pathogen B. graminis f. sp. tritici.


Assuntos
Perfilação da Expressão Gênica , Regulação da Expressão Gênica de Plantas/fisiologia , Doenças das Plantas/microbiologia , Silício/farmacologia , Triticum/efeitos dos fármacos , Triticum/crescimento & desenvolvimento , Ascomicetos/fisiologia , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismo , Análise Serial de Proteínas , Estresse Fisiológico
10.
Phytopathology ; 99(10): 1142-9, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19740027

RESUMO

Flocculosin is an antifungal cellobiose lipid linked to the biocontrol activity of Pseudozyma flocculosa and whose structure is very similar to that of ustilagic acid produced by Ustilago maydis. In this work, homologs of the U. maydis cyp1 gene, involved in the biosynthesis of ustilagic acid, were isolated and sequenced from P. flocculosa and P. fusiformata, the latter species being also known to produce ustilagic acid. Interestingly, no homologs were found in four other closely related Pseudozyma spp. from which no evidence of ustilagic acid production has ever been obtained, thus supporting the specificity of cyp1 with ustilagic acid synthesis. In addition, a homolog of the U. maydis uat1 gene involved in the acetylation of the molecule and located next to the cyp1 gene was partially sequenced from P. flocculosa. All three newly sequenced genes showed strong sequence similarity to their counterparts in U. maydis. Cyp1 expression was monitored in conditions that were either conducive or repressive to flocculosin production. Expression increased markedly (>100x) when P. flocculosa was inoculated in a growth medium conducive to flocculosin production but was rapidly downregulated in a repressive medium (in vitro) or on powdery mildew-infected cucumber leaves (in vivo). This suggests that the molecule was preferentially synthesized early in the process of searching for a growth substrate. This study provides the first identification of genes involved in the production of flocculosin, a molecule potentially associated with the biocontrol properties of P. flocculosa.


Assuntos
Genes Fúngicos , Controle Biológico de Vetores , Ustilaginales/genética , Sequência de Aminoácidos , Sequência de Bases , Southern Blotting , Celobiose/análogos & derivados , Celobiose/biossíntese , Celobiose/química , Clonagem Molecular , Proteínas Fúngicas/química , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Regulação Fúngica da Expressão Gênica , Glicolipídeos/biossíntese , Glicolipídeos/química , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Alinhamento de Sequência , Análise de Sequência de DNA
12.
Neurology ; 47(6): 1504-11, 1996 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8960735

RESUMO

We examined mechanisms of recovery from aphasia in seven nonfluent aphasic patients, who were successfully treated with melodic intonation therapy (MIT) after a lengthy absence of spontaneous recovery. We measured changes in relative cerebral blood flow (CBF) with positron emission tomography (PET) during hearing and repetition of simple words, and during repetition of MIT-loaded words. Without MIT, language tasks abnormally activated right hemisphere regions, homotopic to those activated in the normal subject, and deactivated left hemisphere language zones. In contrast, repeating words with MIT reactivated Broca's area and the left prefrontal cortex, while deactivating the counterpart of Wernicke's area in the right hemisphere. The recovery process induced by MIT in these patients probably coincides with this reactivation of left prefrontal structures. In contrast, the right hemisphere regions abnormally activated during simple language tasks seem to be associated with the initial persistence of the aphasia. This study supports the idea that abnormal activation patterns in the lesioned brain are not necessarily related to the recovery process.


Assuntos
Afasia/diagnóstico por imagem , Afasia/terapia , Musicoterapia , Adulto , Encéfalo/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão
13.
Rev Neurol (Paris) ; 150(1): 70-2, 1994.
Artigo em Francês | MEDLINE | ID: mdl-7801045

RESUMO

We report axial myoclonic jerks causing flexion of the trunk, neck, left shoulder, hips and knees in a 28-years-old HIV positive patient. The clinical and electromyographic features of the jerks were consistent with a spinal origin and corresponded to the new concept of propriospinal myoclonus. No structural lesion was identified in this patient. Neurological examination was otherwise normal. HIV specific antibodies were detected in CSF, suggesting central nervous system infection. Spinal myoclonus should be considered an unusual and early manifestation of central nervous system HIV infection.


Assuntos
Soropositividade para HIV/complicações , Mioclonia/etiologia , Medula Espinal/fisiopatologia , Adulto , Eletromiografia , Humanos , Masculino , Mioclonia/fisiopatologia
15.
Rev Neurol (Paris) ; 147(5): 368-75, 1991.
Artigo em Francês | MEDLINE | ID: mdl-1649487

RESUMO

A 51 year old woman presented with cerebellar ataxia and paralysis of conjugate lateral movement of the eyes. She had xerophtalmia and xerostomia. Biopsy of minor salivary glands showed mononuclear infiltrates typical of Sjögren's syndrome. Peripheral neuropathy was of the axonal type, and nerve biopsy showed a vasculitis made of a mononuclear infiltrate with only a few polymorphonuclears. The patient deteriorated despite corticosteroid therapy, plasma exchange and cyclophosphamide. Ciclosporin seemed to be transitorily beneficial. Epileptic seizures (auditory hallucinations) occurred. MRI showed hypersignal in the right temporal lobe. At post-mortem examination, a small ischaemic lesion with a large lymphocytic infiltrate was present in the left putamen. Neuronal loss and gliosis with some rod cells and glial stars were found in the brainstem, dentate nucleus and internal part of the right temporal lobe. Inflammatory changes were limited. The posterior columns of the spinal cord were pale, and some residual nodules of Nageotte were present in the spinal ganglia. These lesions were similar to those seen in encephalomyelitic syndromes associated with carcinoma. Lesions of the peripheral nerves were associated with vasculitis but changes in the central nervous system were morphologically similar to those observed as remote effects of carcinoma.


Assuntos
Doenças do Sistema Nervoso/etiologia , Síndrome de Sjogren/complicações , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/patologia
17.
Neurology ; 39(6): 777-81, 1989 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-2725871

RESUMO

A manic-like state occurred in a 44-year-old right-handed woman with bilateral orbitofrontal and right temporoparietal traumatic contusions. In a brief trial, we assessed the effect of clonidine, carbamazepine, dopa therapy, and placebo on manic symptoms and cognitive functions. Clonidine rapidly reversed the manic syndrome. The patient's behavior did not change with carbamazepine and worsened with levodopa. We suggest that the manic-like syndrome was related to noradrenergic overactivity secondary to the fronto-orbital lesions.


Assuntos
Transtorno Bipolar/etiologia , Clonidina/uso terapêutico , Lobo Frontal/lesões , Órbita/lesões , Lobo Parietal/lesões , Lobo Temporal/lesões , Adulto , Comportamento/efeitos dos fármacos , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Encéfalo/diagnóstico por imagem , Carbamazepina/uso terapêutico , Cognição/efeitos dos fármacos , Feminino , Humanos , Levodopa/uso terapêutico , Tomografia Computadorizada por Raios X
18.
J Neurol Neurosurg Psychiatry ; 52(5): 656-8, 1989 May.
Artigo em Inglês | MEDLINE | ID: mdl-2732738

RESUMO

The visually evoked P 300 wave and related reaction times (RTs) were studied in 25 patients with progressive supranuclear palsy (PSP). Both the P 300 wave latency and the RTs were significantly increased compared with 14 control subjects, and were correlated with an intellectual deterioration index calculated from neuropsychological scores. It is suggested that the study of wave P 300 may contribute to the diagnosis of cognitive disorders in PSP.


Assuntos
Potenciais Evocados Visuais , Tempo de Reação , Paralisia Supranuclear Progressiva/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade
19.
Neurology ; 39(4): 512-5, 1989 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-2927675

RESUMO

A 35-year-old woman with 3 weeks of cervical pain developed ischemia in the basilar artery territory following cervical manipulation. At autopsy, there was a dissecting aneurysm within the third segment of the right vertebral artery. The pathologic changes in the lower and the upper part of the dissecting aneurysm were different, indicating recurring bleeding. Cervical manipulation could have accounted for one recent dissection, but not for another, which was a few weeks old. This suggests that cervical pain, which prompted the manipulation, may have been the first symptom of the dissection, and manipulation of the neck precipitated the stroke by inducing bleeding within the dissecting aneurysm.


Assuntos
Dissecção Aórtica/patologia , Vértebras Cervicais , Manipulação Ortopédica/efeitos adversos , Artéria Vertebral/patologia , Adulto , Autopsia , Feminino , Humanos , Trombose/patologia
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