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1.
Phys Rev Lett ; 120(3): 031101, 2018 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-29400499

RESUMO

We analyze the Sun's shadow observed with the Tibet-III air shower array and find that the shadow's center deviates northward (southward) from the optical solar disk center in the "away" ("toward") interplanetary magnetic field (IMF) sector. By comparing with numerical simulations based on the solar magnetic field model, we find that the average IMF strength in the away (toward) sector is 1.54±0.21_{stat}±0.20_{syst} (1.62±0.15_{stat}±0.22_{syst}) times larger than the model prediction. These demonstrate that the observed Sun's shadow is a useful tool for the quantitative evaluation of the average solar magnetic field.

3.
Scand J Surg ; 106(3): 249-254, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27557983

RESUMO

BACKGROUND AND AIMS: Peripheral artery disease in dialysis cases is more prone to critical limb ischemia compared to non-dialysis cases, with a significantly high rate of major amputation of the lower limbs. Lesions are distributed on the more distal side in dialysis critical limb ischemia cases. The aim of this study was to investigate the usefulness of indocyanine green angiography to determine differences in the regional circulation in the foot between dialysis and non-dialysis patients. MATERIALS AND METHODS: The subjects included 62 cases, among which 20 were dialysis patients and 42 were non-dialysis patients. We compared the indocyanine green angiography parameters for regions of interest in the dialysis and non-dialysis groups, which included the magnitude of intensity from indocyanine green onset to maximum intensity (Imax), the time from indocyanine green onset to maximum intensity (Tmax), the time elapsed from the fluorescence onset to half the maximum intensity (T1/2), and the time from maximum intensity to declining to 90% of the maximum intensity (Td90%). These indocyanine green angiography parameters were measured at region of interest 1 (the Chopart joint), region of interest 2 (the Lisfranc joint), and region of interest 3 (the distal region of the first metatarsal bone). RESULTS: In the comparison between the dialysis and non-dialysis groups, a significant difference was observed regarding Tmax, T1/2, and Td90%, especially in region of interest 3. CONCLUSION: In this study, we show that regional tissue perfusion is more deteriorated in dialysis patients compared with non-dialysis patients using indocyanine green angiography. Tmax, T1/2, and Td90% could be useful clinical parameters to compare ischemic severity of the lower limb between dialysis and non-dialysis patients.


Assuntos
Angiofluoresceinografia/métodos , Corantes Fluorescentes , Pé/irrigação sanguínea , Verde de Indocianina , Isquemia/diagnóstico por imagem , Falência Renal Crônica/complicações , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Pé/diagnóstico por imagem , Monitorização Hemodinâmica , Humanos , Isquemia/etiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional
4.
AJNR Am J Neuroradiol ; 38(1): 77-83, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27633805

RESUMO

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia is a rare neurodegenerative disease resulting from mutations in the colony stimulating factor 1 receptor gene. Accurate diagnosis can be difficult because the associated clinical and MR imaging findings are nonspecific. We present 9 cases with intracranial calcifications distributed in 2 brain regions: the frontal white matter adjacent to the anterior horns of the lateral ventricles and the parietal subcortical white matter. Thin-section (1-mm) CT scans are particularly helpful in detection due to the small size of the calcifications. These calcifications had a symmetric "stepping stone appearance" in the frontal pericallosal regions, which was clearly visible on reconstructed sagittal CT images. Intrafamilial variability was seen in 2 of the families, and calcifications were seen at birth in a single individual. These characteristic calcification patterns may assist in making a correct diagnosis and may contribute to understanding of the pathogenesis of leukoencephalopathy.


Assuntos
Calcinose/diagnóstico por imagem , Leucoencefalopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Axônios , Calcinose/patologia , Feminino , Humanos , Leucoencefalopatias/patologia , Masculino , Neuroglia
5.
Eur J Neurol ; 24(1): 37-45, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27680516

RESUMO

BACKGROUND AND PURPOSE: The clinical characteristics of colony stimulating factor 1 receptor (CSF1R) related adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) have been only partially elucidated. METHODS: Clinical data from CSF1R mutation carriers who had been seen at our institutions or reported elsewhere were collected and analysed using a specific investigation sheet to standardize the data. RESULTS: In all, 122 cases from 90 families with CSF1R mutations were identified. The mean age of onset was 43 years (range 18-78 years), the mean age at death was 53 years (range 23-84 years) and the mean disease duration was 6.8 years (range 1-29 years). Women had a significantly younger age of onset than men (40 vs. 47 years, P = 0.0006, 95% confidence interval 3.158-11.177). There was an age-dependent penetrance that was significantly different between the sexes (P = 0.0013). Motor dysfunctions were the most frequent initial symptom in women whose diseases began in their 20s. Thinning of the corpus callosum, abnormal signalling in pyramidal tracts, diffusion-restricted lesions and calcifications in the white matter were characteristic imaging findings of ALSP. The calcifications were more frequently reported in our case series than in the literature (54% vs. 3%). Seventy-nine per cent of the mutations were located in the distal part of the tyrosine kinase domain of CSF1R (102 cases). There were no apparent phenotype-genotype correlations. CONCLUSIONS: The characteristics of ALSP were clarified. The phenotype of ALSP caused by CSF1R mutations is affected by sex.


Assuntos
Leucoencefalopatias/genética , Leucoencefalopatias/patologia , Receptores de Fator Estimulador das Colônias de Granulócitos e Macrófagos/genética , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Axônios/patologia , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Feminino , Heterozigoto , Humanos , Leucoencefalopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Mutação/genética , Neuroglia/patologia , Penetrância , Tratos Piramidais/diagnóstico por imagem , Tratos Piramidais/patologia , Caracteres Sexuais , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Adulto Jovem
6.
Phys Rev Lett ; 111(1): 011101, 2013 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-24027782

RESUMO

We report on a clear solar-cycle variation of the Sun's shadow in the 10 TeV cosmic-ray flux observed by the Tibet air shower array during a full solar cycle from 1996 to 2009. In order to clarify the physical implications of the observed solar cycle variation, we develop numerical simulations of the Sun's shadow, using the potential field source surface model and the current sheet source surface (CSSS) model for the coronal magnetic field. We find that the intensity deficit in the simulated Sun's shadow is very sensitive to the coronal magnetic field structure, and the observed variation of the Sun's shadow is better reproduced by the CSSS model. This is the first successful attempt to evaluate the coronal magnetic field models by using the Sun's shadow observed in the TeV cosmic-ray flux.

8.
Transplant Proc ; 44(4): 1107-9, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22564637

RESUMO

AIM: To investigate whether mouse bone marrow mesenchymal stem cells (BMC) stimulate liver regeneration after partial hepatectomy. METHODS: Isolated BMCs were purified by density gradient centrifugation. We performed a 70% hepatectomy in male BALB/c mice followed by injection of BMCs into the portal vein (PV-BMC group), or the tail vein (IV-BMC group), or of saline into the portal vein (control group). RESULTS: The wet weight of the liver remnant increased significantly in the PV-BMC group at 3 and 5 days after hepatectomy compared with the IV-BMC and control groups. The Ki-67 labeling index revealed that the increase to result from stimulation of DNA synthesis. The constitutive interleukin-6 and hepatocyte growth factor mRNAs in the remnant liver tended to increase in the PV-BMC group at 3 days after hepatectomy. CONCLUSIONS: These results demonstrated that BMC injection into the portal vein enhanced liver growth after partial hepatectomy in mice.


Assuntos
Transplante de Medula Óssea , Hepatectomia , Regeneração Hepática , Fígado/cirurgia , Transplante de Células-Tronco Mesenquimais , Veia Porta , Animais , Proliferação de Células , Replicação do DNA , Fator de Crescimento de Hepatócito/genética , Injeções Intravenosas , Interleucina-6/genética , Antígeno Ki-67/metabolismo , Fígado/irrigação sanguínea , Fígado/metabolismo , Fígado/patologia , Fígado/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , RNA Mensageiro/metabolismo , Fatores de Tempo , Regulação para Cima
9.
Eur Surg Res ; 47(4): 274-83, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22076046

RESUMO

BACKGROUND/AIMS: Excess production of nitric oxide (NO) by inducible nitric oxide synthase (iNOS) has been implicated as proinflammatory biomarker in liver injury. The application of active hexose correlated compound (AHCC) as a functional food in complementary and alternative medicine has increased. The possibility that AHCC might inhibit iNOS induction was investigated as a potential liver-protective effect. METHODS: Hepatocytes were isolated from rats by collagenase perfusion and cultured. Primary cultured hepatocytes were treated with interleukin-1ß in the presence or absence of AHCC-sugar fraction (AHCC-SF). RESULTS AND CONCLUSION: AHCC-SF inhibited the production of NO and reduced expressions of iNOS mRNA and its protein. AHCC-SF had no effects on either IκB degradation or nuclear factor-κB (NF-κB) activation. In contrast, AHCC-SF inhibited the upregulation of type I interleukin-1 receptor (IL-1RI) through the inhibition of Akt phosphorylation. Transfection experiments with iNOS promoter-luciferase constructs revealed that AHCC-SF reduced the levels of iNOS mRNA at both promoter transactivation and mRNA stabilization steps. AHCC-SF inhibited the expression of iNOS gene antisense transcript, which is involved in iNOS mRNA stabilization. These findings demonstrate that AHCC-SF suppresses iNOS gene expression through a IκB/NF-κB-independent but Akt/IL-1RI-dependent pathway, resulting in the reduction of NO production. AHCC-SF may have therapeutic potential for various liver injuries.


Assuntos
Hepatócitos/efeitos dos fármacos , Óxido Nítrico Sintase Tipo II/metabolismo , Polissacarídeos/farmacologia , Animais , Biomarcadores/metabolismo , Expressão Gênica/efeitos dos fármacos , Humanos , Proteínas I-kappa B/metabolismo , Interleucina-1beta , Masculino , NF-kappa B/metabolismo , Ratos , Ratos Wistar , Regulação para Cima
13.
J Neurol Neurosurg Psychiatry ; 81(11): 1253-5, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20571046

RESUMO

OBJECTIVE: This study aimed to determine the spectrum of pathological involvement of the striatonigral (StrN) and olivopontocerebellar (OPC) systems in Japanese patients with multiple system atrophy (MSA). This study also aimed to compare the pathological spectrum of Japanese MSA patients with the previously reported results in British MSA patients. METHODS: A semiquantitative pathological analysis of 50 MSA patients' brains that were referred to the Brain Research Institute, Niigata University, Japan, was performed. The severity of neuronal cell loss was determined as previously described by the study from the Queen Square Brain Bank (QSBB), UK. RESULTS: The mean neuronal cell loss score was significantly higher in the OPC area than in the basal ganglia sites examined, except the dorsolateral putamen. The relative prevalence of pathological phenotypes showed that 40% of cases had OPC-predominant pathology, 18% had StrN-predominant pathology and the remaining (42%) had equivalent StrN and OPC pathology. None of the MSA cases had coexistent Lewy bodies in the dorsal motor nucleus of the vagus and the substantia nigra. CONCLUSIONS: In contrast to the previously reported results involving British patients' brains from the QSBB (OPC-predominant pathology 17%, StrN-predominant pathology 34%, equivalent StrN and OPC pathology 49%), the results of the present study showed more pathological involvement of the OPC system than of the StrN system. The rarity of Lewy bodies may underlie the phenotypic expression of Japanese MSA. The present observations reflect the disequilibrium in the phenotype distribution between the two populations.


Assuntos
Povo Asiático/estatística & dados numéricos , Encéfalo/patologia , Atrofia de Múltiplos Sistemas/etnologia , Atrofia de Múltiplos Sistemas/patologia , Adulto , Idoso , Contagem de Células , Cerebelo/patologia , Feminino , Humanos , Japão/epidemiologia , Corpos de Lewy/patologia , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/genética , Núcleo Olivar/patologia , Fenótipo , Prevalência , Substância Negra/patologia , Nervo Vago/patologia
15.
Arq. bras. med. vet. zootec ; 62(2): 293-301, abr. 2010. ilus
Artigo em Português | LILACS | ID: lil-551855

RESUMO

Avaliaram-se o comprimento do infundíbulo, do magno, do istmo, do útero e da vagina e o número de pregas do magno e do istmo do oviduto de 20 marrecas Ana boschas na fase reprodutiva. O infundíbulo apresenta mucosa com pregas longitudinais e baixas, revestidas por epitélio pseudoestratificado cilíndrico ciliado, com células caliciformes. O magno, compartimento mais longo do oviduto, 25,38cm±3,20, encontra-se constituído por uma camada mucosa com pregas altas e espessas revestidas por células cilíndricas ciliadas e abundantes células caliciformes. O istmo é formado por uma mucosa com pregas estreitas e curtas e numerosas glândulas tubulares que se estendem para o interior da lâmina própria. O útero, região curta do oviduto, 5,25cm±1,26, apresenta parede com pregas e cristas baixas e numerosas glândulas tubulares enoveladas, dirigidas para o interior da lâmina própria. A vagina, um estreito tubo muscular, está constituído por oito anéis circulares, em média, e uma camada muscular altamente desenvolvida e espessa. A morfologia do oviduto da marreca apresenta características morfológicas e histológicas distintas dos galiniformes, observando-se que a vagina e a porção cranial do infundíbulo apresentam pregas e células caliciformes, respectivamente, sendo estas últimas estruturas ausentes nos galiniformes.


The length of infundibulum, magnum, isthmus, uterus, vagina, and the number of oviduct, magnum, and isthmus folds were evaluated in 20 Ana boschas female ducks in the reproductive phase. The infundibulum presented mucous membrane with longitudinal and short folds, covered by ciliated columnar pseudostratified epithelium, with goblet cells. Magnum, the longest oviduct compartment, 25.38cm±3.20, is constituted by mucous membrane with high and thick folds that are covered by ciliated columnar cells and many goblet cells. Isthmus is formed by mucous membrane with narrow and short folds, and many tubular glands that extend inside lamina propria. Uterus, an oviduct short region, 5.25cm±1.26, presented surface with short folds and crests, and numerous reeled tubular glands, that are directed inside lamina propria. Vagina, a strait muscular tube, is constituted by, approximately, eight circular rings, and a very developed and thick muscular layer. The oviduct morphology of female ducks presented different morphological and histological characteristics from Galliformes, because vagina and infundibulum cranial portion present folds and goblet cells, respectively, and the last cited structures are absent in Galliformes.


Assuntos
Animais , Adulto , Aves/anatomia & histologia , Aves/fisiologia , Genitália Feminina/anatomia & histologia , Genitália Feminina/fisiologia , Laparotomia/métodos , Laparotomia/veterinária
16.
Neurology ; 73(20): 1628-37, 2009 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-19917985

RESUMO

BACKGROUND: Neuromyelitis optica (NMO) is a demyelinating syndrome characterized by myelitis and optic neuritis. Detection of anti-NMO immunoglobulin G antibody that binds to aquaporin-4 (AQP4) water channels allows the diagnosis of a limited form of NMO in the early stage with myelitis, but not optic neuritis. However, the detailed clinicopathologic features and long-term course of this limited form remain elusive. METHODS: We investigated 8 patients with the limited form of NMO with myelitis in comparison with 9 patients with the definite form. RESULT: All patients with limited and definite form showed uniform relapsing-remitting courses, with no secondary progressive courses. Pathologic findings of biopsy specimens from the limited form were identical to those of autopsy from the definite form, demonstrating extremely active demyelination of plaques, extensive loss of AQP4 immunoreactivity in plaques, and diffuse infiltration by macrophages containing myelin basic proteins with thickened hyalinized blood vessels. Moreover, the definite form at the nadir of relapses displayed significantly higher amounts of the inflammatory cytokines interleukin (IL)-1beta and IL-6 in CSF than the limited form and multiple sclerosis. CONCLUSION: This consistency of pathologic findings and uniformity of courses indicates that aquaporin 4-specific autoantibodies as the initiator of the neuromyelitis optica (NMO) lesion consistently play an important common role in the pathogenicity through the entire course, consisting of both limited and definite forms, and NMO continuously displays homogeneity of pathogenic effector immune mechanisms through terminal stages, whereas multiple sclerosis should be recognized as the heterogeneous 2-stage disease that could switch from inflammatory to degenerative phase. This report is a significant description comparing the pathologic and immunologic data of limited NMO with those of definite NMO.


Assuntos
Mielite/imunologia , Mielite/patologia , Neuromielite Óptica/imunologia , Neuromielite Óptica/patologia , Adulto , Aquaporina 4/imunologia , Aquaporina 4/metabolismo , Autoanticorpos/metabolismo , Vasos Sanguíneos/imunologia , Vasos Sanguíneos/metabolismo , Vasos Sanguíneos/patologia , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Macrófagos/imunologia , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Proteína Básica da Mielina/metabolismo , Bainha de Mielina/imunologia , Bainha de Mielina/metabolismo , Bainha de Mielina/patologia , Mielite/metabolismo , Neuromielite Óptica/metabolismo , Recidiva , Estudos Retrospectivos , Medula Espinal/imunologia , Medula Espinal/metabolismo , Medula Espinal/patologia , Adulto Jovem
17.
J Neurol Neurosurg Psychiatry ; 80(9): 1050-2, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19684239

RESUMO

BACKGROUND: The occurrence of duplications of the amyloid precursor protein gene (APP) has been described in European families with early-onset familial Alzheimer disease (EO-FAD) and cerebral amyloid angiopathy. However, the contribution of APP duplication to the development of AD in other ethnic populations remains undetermined. METHODS: The occurrence of APP duplication in probands from 25 families with FAD and 11 sporadic EO-AD cases in the Japanese population was examined by quantitative PCR and microarray-based comparative genomic hybridisation analyses. APP expression level was determined by real-time quantitative reverse-transcription (RT) PCR analysis using mRNA extracted from the peripheral blood of the patients. RESULTS: We identified APP locus duplications in two unrelated EO-FAD families. The duplicated genomic regions in two patients of these families differed from each other. No APP duplication was found in the late-onset FAD families or sporadic EO-AD patients. The patients with APP duplication developed insidious memory disturbance in their fifties without intracerebral haemorrhage and epilepsy. Quantitative RT-PCR analysis showed the increased APP mRNA expression levels in these patients compared with those in age- and sex-matched controls. CONCLUSIONS: Our results suggest that APP duplication should be considered in patients with EO-FAD in various ethnic groups, and that increased APP mRNA expression level owing to APP duplication contributes to AD development.


Assuntos
Doença de Alzheimer/genética , Precursor de Proteína beta-Amiloide/genética , Duplicação Gênica , Idade de Início , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/patologia , Apolipoproteínas E/genética , Atrofia , Encéfalo/patologia , Estudos de Coortes , DNA/genética , Feminino , Dosagem de Genes , Humanos , Japão/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Linhagem , RNA Mensageiro/sangue , Proteínas tau/líquido cefalorraquidiano
18.
J Neuroimmunol ; 211(1-2): 110-3, 2009 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-19410301

RESUMO

OBJECTIVE: Anti-aquaporin 4 antibodies (AQP4-Ab) are specifically detected in patients with neuromyelitis optica. To investigate the role of AQP4-Ab, we examined the antibody binding epitope using human and mouse mutant AQP4. METHODS: We constructed human and mouse amino acid substitution AQP4 mutants and compared the reactivity with wild-form of human, mouse and rat AQP4. RESULTS: The decreased intensity of AQP4-Ab staining with mouse AQP4 was recovered to that of human AQP4 with the mouse mutant A228E for 9 of the 10 sera. CONCLUSIONS: The third extracellular loop of AQP4 is considered to be the major epitope for AQP4-Ab in NMO.


Assuntos
Aquaporina 4/imunologia , Autoanticorpos/imunologia , Sítios de Ligação de Anticorpos/imunologia , Neuromielite Óptica/imunologia , Sequência de Aminoácidos , Animais , Aquaporina 4/química , Aquaporina 4/genética , Autoanticorpos/química , Autoanticorpos/genética , Sítios de Ligação de Anticorpos/genética , Epitopos/imunologia , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imuno-Histoquímica , Camundongos , Dados de Sequência Molecular , Ratos , Transfecção
19.
J Biomech ; 42(7): 838-43, 2009 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-19268948

RESUMO

We investigated the behavior of red blood cells (RBCs) in a microchannel with stenosis using a confocal micro-PTV system. Individual trajectories of RBCs in a concentrated suspension of up to 20% hematocrit (Hct) were measured successfully. Results indicated that the trajectories of healthy RBCs became asymmetric before and after the stenosis, while the trajectories of tracer particles in pure water were almost symmetric. The asymmetry was greater in 10% Hct than in 20% Hct. We also investigated the effect of deformability of RBCs on the cell-free layer thickness by hardening RBCs using a glutaraldehyde treatment. The results indicated that deformability is the key factor in the asymmetry of cell-free layer thickness. Therefore, the motions of RBCs are influenced strongly by the Hct, the deformability, and the channel geometry. These results give fundamental knowledge for a better understanding of blood flow in microcirculation and biomedical microdevices.


Assuntos
Eritrócitos , Velocidade do Fluxo Sanguíneo , Constrição Patológica , Saúde , Hematócrito , Humanos , Masculino , Microcirculação , Reologia , Água , Adulto Jovem
20.
J Neurol ; 255(10): 1483-5, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18670800

RESUMO

Sudden death has been reported in patients with multiple system atrophy (MSA), although the frequency of this event has not been well delineated. We investigated the frequency and potential causes of sudden death in patients with MSA. During the 5-year observation period, 10 of 45 patients with probable MSA died. The causes of death included sudden death of unknown etiology (seven patients), aspiration pneumonia (one patient), asphyxia after vomiting (one patient), and lung cancer (one patient). The mean survival time of patients with sudden death was 63.0 +/- 24.7 months (range, 39-116 months). Among seven patients who experienced sudden death, six were found to have died during sleep. Among these patients, two had been treated with tracheostomy and three with continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) during sleep, suggesting that these treatments do not always prevent sudden death in patients with MSA. Nocturnal sudden death should be recognized as the most common mechanism of death in patients with MSA.


Assuntos
Morte Súbita , Atrofia de Múltiplos Sistemas/mortalidade , Adulto , Idoso , Causas de Morte , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/fisiopatologia , Respiração com Pressão Positiva , Sono , Taxa de Sobrevida , Traqueostomia
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