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1.
Animals (Basel) ; 11(10)2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34679792

RESUMO

In patients with solid tumors, circulating tumor cells (CTCs) spread in their blood and function as a seed for metastases. However, the study of CTCs has been limited by their rarity, low frequency, and heterogeneity. The efficient collection of CTCs will contribute to further research of metastatic cancers. Apheresis is a process in which the whole blood of an individual is passed through a machine that isolates a particular constituent and returns the remainder to the circulation. In the present study, we investigated the safety and feasibility of apheresis to separate peripheral blood monocytes (PBMCs), whose density is closely similar to that of CTCs, and to capture intravenously administered human breast cancer cells, MCF7s, from the dogs. No life-threatening events were observed in dogs during the apheresis process. The changes in the hemogram were transient and recovered gradually within a few days after apheresis. During apheresis, 50 mL of PBMCs could be collected from each dog. Notably, a thrombus was formed along the circuit wall during apheresis, which decreased the blood collection pressure. MCF7 cells were successfully captured by the apheresis machine. The captured cells were regrown in vitro and characterized compared with the original cells. In conclusion, apheresis could be safely performed in dogs to isolate CTCs with precautions to maintain hemodynamic stability.

2.
Transplantation ; 98(3): 267-76, 2014 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-24992357

RESUMO

BACKGROUND: Blocking the CD40-CD154 signal pathway has previously shown promise as a strategy to prevent allograft rejection. In this study, the efficacy of a novel fully human anti-CD40 monoclonal antibody-ASKP1240, administered as a monotherapy or combination therapy (subtherapeutic dose of tacrolimus or mycophenolate mofetil), on the prevention of renal allograft rejection was evaluated in Cynomolgus monkeys. METHODS: Heterotopic kidney transplants were performed in ABO-compatible, stimulation index 2.5 or higher in the two-way mixed lymphocyte reaction monkey pairs. Animals were divided into 12 groups and observed for a maximum of 180 days. Histopathologic, hematology, and biochemistry analyses were conducted in all groups. Cytokine release (interleukin [IL]-2, IL-4, IL-5, IL-6, tumor necrosis factor, and interferon-γ) was investigated in several groups. RESULTS: ASKP1240 prolonged renal allograft survival in a dose-dependent manner in monotherapy. Low-dose (2 mg/kg) or high-dose (5 mg/kg) ASKP1240, in combination with mycophenolate mofetil (15 mg/kg) or tacrolimus (1 mg/kg), showed a significantly longer allograft survival time compared with monotherapy groups. No obvious side effects including drug-related thromboembolic complications were found. Cytokine release was not induced by ASKP1240 administration. CONCLUSION: The present study indicates that ASKP1240, alone or in combination with other immunosuppressive drugs, could be a promising antirejection agent in organ transplantation.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/administração & dosagem , Transplante de Rim , Ácido Micofenólico/análogos & derivados , Tacrolimo/administração & dosagem , Aloenxertos , Animais , Anticorpos Monoclonais/sangue , Anticorpos Monoclonais Humanizados , Antígenos CD40/imunologia , Ligante de CD40/imunologia , Citocinas/sangue , Quimioterapia Combinada , Rim/patologia , Macaca fascicularis , Masculino , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/sangue , Tacrolimo/sangue
3.
J Vet Med Sci ; 76(6): 917-21, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24584083

RESUMO

The anesthetic effect of a combination of medetomidine, midazolam and butorphanol (Me-Mi-Bu) was evaluated in healthy cynomolgus monkeys. The Me-Mi-Bu combination was intramuscularly administered as follows: Dose 1, Me 0.015 mg/kg-Mi 0.1 mg/kg-Bu 0.15 mg/kg; Dose 2, Me 0.02 mg/kg-Mi 0.15 mg/kg-Bu 0.2 mg/kg; and Dose 3, Me 0.04 mg/kg-Mi 0.3 mg/kg-Bu 0.4 mg/kg. The combination rapidly induced immobilization, and lateral recumbency was reached within 15 min. The duration of anesthesia for each dose administered was follows: Dose 1, 47 ± 27 min; Dose 2, 113 ± 31 min; and Dose 3, 190 ± 24 min. The anesthetic effect of the combination was abolished by the α2-adrenoceptor antagonist atipamezole. No marked changes in the levels of hematologic or serum biochemical parameters were noted in cynomolgus monkeys administered the combination plus atipamezole. Taken together, these results suggest that the Me-Mi-Bu combination exhibits reversible anesthetic effect and may be useful for studies involving cynomolgus monkeys.


Assuntos
Anestesia/veterinária , Anestésicos Combinados/farmacologia , Anestésicos/farmacologia , Butorfanol/farmacologia , Macaca fascicularis/fisiologia , Medetomidina/farmacologia , Midazolam/farmacologia , Anestésicos Combinados/administração & dosagem , Animais , Butorfanol/administração & dosagem , Relação Dose-Resposta a Droga , Injeções Intramusculares/veterinária , Medetomidina/administração & dosagem , Midazolam/administração & dosagem , Fatores de Tempo
4.
Exp Anim ; 62(4): 329-32, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24172197

RESUMO

Here, to determine the effects of transport stress on blood parameters in dogs, we investigated the changes in hematologic and serum chemical parameters in healthy beagle dogs transported from Beijing, China, to Osaka, Japan, to obtain the background data. Only the activity of serum alkaline phosphatase increased clearly upon arrival, a change attributed to transport stress, but the activity gradually reduced afterward. No marked changes in levels of other blood parameters were noted. Our findings here suggest that alkaline phosphatase is a useful tool for studying transport stress.


Assuntos
Fosfatase Alcalina/sangue , Cães , Estresse Fisiológico/fisiologia , Estresse Psicológico/sangue , Meios de Transporte , Animais , China , Japão , Masculino , Fatores de Tempo
5.
Transpl Immunol ; 23(1-2): 18-23, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20206695

RESUMO

Acute rejection following renal transplantation has become manageable with the introduction of calcineurin inhibitors, FK506 and cyclosporine A. However, chronic allograft dysfunction accompanied by renal interstitial fibrosis, which induces graft loss, remains unresolved. Here, we evaluated the effect of FR276457, a pan-histone deacetylase (HDAC) inhibitor, on interstitial fibrosis in the injured kidneys of a rat model of unilateral ureteral obstruction. The injured kidneys, harvested on Day 14 following the operation, showed progression of interstitial fibrosis, increases of hydroxyproline contents, and mRNA expression of collagen type Ialpha1 and monocyte chemotactic protein 1 (MCP-1). However, these changes were found to be prevented with daily oral administration of FR276457. In addition, given that MCP-1 is believed to contribute to progressive fibrosis, we investigated the direct effect of FR276457 on MCP-1 production by activated THP-1 cells in vitro. Results showed that FR276457 administration decreased MCP-1 production in these cells in a concentration-dependent manner. Findings from the present study suggested that a pan-HDAC inhibitor may exert a prophylactic effect against renal interstitial fibrosis by inhibiting MCP-1 production.


Assuntos
Fibrose/prevenção & controle , Inibidores de Histona Desacetilases/uso terapêutico , Ácidos Hidroxâmicos/uso terapêutico , Nefrite Intersticial/prevenção & controle , Obstrução Ureteral/tratamento farmacológico , Animais , Linhagem Celular Tumoral , Quimiocina CCL2/antagonistas & inibidores , Quimiocina CCL2/metabolismo , Modelos Animais de Doenças , Rim/patologia , Transplante de Rim , Masculino , Ratos , Ratos Sprague-Dawley
6.
Microsurgery ; 30(4): 327-31, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20049911

RESUMO

Surgical complications are important causes of graft loss in the nonhuman primate kidney transplantation model. We reviewed the incidence and intervention methods in 182 kidney transplantations performed in our lab recently 2 years in Cynomolgus monkeys. There were six renal artery thromboses (3.3%), eight urine leakages (4.4%), and five ureteral stenoses (2.7%). All renal artery thrombosis cases were found within 3 days after surgery. Urine leakage appeared from the 5th to 12th day after surgery and all cases were caused by ureter rupture. Reexploration was performed in five cases to reanastomose ureter with stent. Four cases reached long-term survival. The rest one died of graft rejection. Ureteral stenoses were found in long-term survival cases. Ureter reanastomoses with stent were performed in two cases. The postoperative renal functions of these two monkeys recovered to normal and they survived until study termination. From this large number of study, our experience indicated that kidney transplantation in the nonhuman primate is a safe procedure with low complications. Reexploration is recommended for salvage of the graft with urine leakage and ureteral stenosis.


Assuntos
Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Obstrução Ureteral/etiologia , Incontinência Urinária/etiologia , Animais , Modelos Animais de Doenças , Rejeição de Enxerto , Sobrevivência de Enxerto , Haplorrinos , Transplante de Rim/mortalidade , Masculino , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Distribuição Aleatória , Reoperação/métodos , Fatores de Risco , Taxa de Sobrevida , Obstrução Ureteral/cirurgia , Incontinência Urinária/cirurgia
7.
Transpl Immunol ; 21(4): 198-202, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19409992

RESUMO

The histone deacetylase (HDAC) inhibitor FR276457, a hydroxamic derivative, was identified during chemical library screening and was found to exhibit potent inhibitory effects on the activity of mammalian HDACs. It has been shown that FR276457 exhibited marked immunosuppressive effects in a rat heterotopic cardiac transplant model. To predict clinical efficacy of FR276457, we investigated the inhibitory effect of the proliferation of Jurkat cells in vitro and immunosuppressive effect of orally administered FR276457 on allograft rejection as a monotherapy or in combination with tacrolimus (0.04 mg/kg) injected intramuscularly (i.m.) in a canine renal transplant model. Animal survival, the plasma creatinine level, and histopathology were evaluated. FR276457 inhibited the proliferation of Jurkat cells probably by targeting activity of NF-kappaB. FR276457 prolonged the median survival time (MST) of transplanted grafts from 11.5 days (untreated group) to 29.0 days (FR276457-treated group). FR276457 administered 1 mg/kg twice a day in combination with tacrolimus prevented allograft rejection. In addition, a dose of 1.5 mg/kg twice a day or 5.0 mg/kg once a day prolonged the MST from 18 days (control group) to >73 or >90 days, respectively. Histopathological analysis showed that FR276457 suppressed the score for mononuclear cell infiltration and vasculitis. In conclusion, the HDAC inhibitor FR276457 inhibited the proliferation of T cell line established from human in vitro. And more, FR276457 clinically prolonged allograft survival when administered as a monotherapy, and had additive or synergistic effects when combined with tacrolimus with the canine renal transplant model. These results showed HDAC inhibitor is a promising biological target for treatment in transplant field.


Assuntos
Rejeição de Enxerto/imunologia , Histona Desacetilases/metabolismo , Ácidos Hidroxâmicos/administração & dosagem , Imunossupressores/administração & dosagem , Linfócitos T/efeitos dos fármacos , Administração Oral , Animais , Cães , Quimioterapia Combinada , Rejeição de Enxerto/patologia , Rejeição de Enxerto/fisiopatologia , Rejeição de Enxerto/prevenção & controle , Humanos , Terapia de Imunossupressão , Células Jurkat , Transplante de Rim , Linfócitos T/imunologia , Linfócitos T/metabolismo , Linfócitos T/patologia , Tacrolimo/administração & dosagem , Vasculite/prevenção & controle
8.
Biol Pharm Bull ; 31(9): 1723-6, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18758066

RESUMO

Histone deacetylase (HDAC) is a known modulator of gene transcription, and the immunosuppressive activity of HDAC inhibitors has been demonstrated in recent several reports. In this study, the HDAC inhibitor FR276457, a hydroxamic derivative, was found to have a similar inhibitory effect on all mammalian HDACs tested, but no isozyme selectivity. Both FR276457 and tacrolimus exerted an immunosuppressive effect on in vitro rat splenocyte proliferation stimulated with Concanavalin A. Next, the effect of FR276457 on allograft rejection when administered either as a monotherapy or in combination with tacrolimus was investigated in a rat heterotopic cardiac transplant model. Orally administered FR276457 prolonged the median survival times (MST) of the transplanted grafts in the vehicle group from 6 d to 17 or 21 d at doses of 20 or 40 mg/kg, respectively. Histopathological analysis showed the structures of the myocardium were not affected, but interstitial cellular infiltration could not be suppressed completely. Tacrolimus (0.032 mg/kg) prolonged allograft MST to 16 d. FR276457, when combined with tacrolimus, prevented allograft rejection at a dose lower than that of the monotherapy. The combination dose prolonged the MST in the groups treated with 10 and 20 mg/kg to >28 d, and cellular infiltration was suppressed completely. In conclusion, this study demonstrated that the oral administration of HDAC inhibitor FR276457 can prevent allograft rejection as a monotherapy, and has additive or synergistic effects when combined with tacrolimus.


Assuntos
Transplante de Coração/imunologia , Inibidores de Histona Desacetilases , Ácidos Hidroxâmicos/farmacologia , Imunossupressores/farmacologia , Animais , Proliferação de Células/efeitos dos fármacos , Feminino , Rejeição de Enxerto/patologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Histona Desacetilases/genética , Humanos , Isoenzimas/antagonistas & inibidores , Isoenzimas/genética , Miocárdio/patologia , Ratos , Ratos Endogâmicos Lew , Linfócitos T/efeitos dos fármacos , Tacrolimo/farmacologia
9.
Transplantation ; 81(4): 627-31, 2006 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-16495814

RESUMO

Cytotoxic nitric oxide (NO) is produced during ischemia/reperfusion (I/R) injury by the expression of inducible NO synthase (iNOS). Therefore, continuous iNOS inhibition might prevent early graft dysfunction. FR260330, a potent and selective inhibitor of iNOS activity, impedes the dimmerization of iNOS monomer. In this study, the effect of FR260330 in the prevention of renal I/R injury was evaluated in the model of one kidney ischemia in Vervet monkeys. A total of 18 male Vervet monkeys were randomly assigned to two equal groups (n=9). Transient (60 min) left renal ischemia was produced by simultaneous contralateral nephrectomy in treated (FR260330 20 mg/kg/day) and placebo control groups. Renal function and other biochemical parameters as well as FR260330 concentrations were studies until day 15 after I/R injury. All monkeys survived after 60 min I/R injury until sacrifice on day 15. Serum creatinine in the untreated controls increased significantly in comparison to the FR260330-treated group on days 2, 3, 4, and 7 (P<0.05). Plasma FR260330 concentration after oral administration showed that C(max) was 3.251+/-2.526 microg/ml, and T(max) was 4 hr. This study thus finds that FR260330, as a selective iNOS inhibitor, effectively prevents renal I/R injury in Vervet monkeys.


Assuntos
Inibidores Enzimáticos/farmacologia , Rim/irrigação sanguínea , Óxido Nítrico Sintase Tipo II/antagonistas & inibidores , Piperidinas/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Animais , Chlorocebus aethiops , Masculino , Modelos Animais
10.
Transplantation ; 79(11): 1537-44, 2005 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-15940043

RESUMO

BACKGROUND: PG490-88 is a water soluble, semisynthetic derivative of a novel compound PG490 (triptolide) purified from the Chinese herb Tripterygium Wilfordii Hook F. In this study, we evaluated the immunosuppressive effect of PG490-88 alone or combined with FK506 in a dog renal transplantation model. METHODS: Recipient and donor male beagle dogs were obtained from different breeders to ensure MHC mismatching. PG490-88 and/or FK506 were administered orally based on protocol design. RESULTS: All dogs in the untreated group developed acute vascular rejection with a median survival time of 6 days. The grafts from this group presented with massive hemorrhage, IgM, IgG, and C4c deposition. Administration of PG490-88 0.06 mg/kg/day significantly prolonged graft survival to a median survival time of 11 days (P=0.038, vs. control). Treatment with FK506 0.3 mg/kg/day did not prolong graft survival with a median survival time of 9 days. Although FK506 0.6 mg/kg/day significantly prolonged survival, this dose was not tolerated by the dogs. The combination of PG 0.06 mg/kg/day and FK506 0.3 mg/kg/day significantly prolonged survival to a median survival time of 15 days (P=0.017, vs. control). Compared to the untreated control group, the pattern of acute humoral rejection was attenuated in renal allografts treated with PG490-88 and/or FK506. C4c deposition was significantly decreased in renal allografts treated with PG490-88 monotherapy and combination therapy. CONCLUSIONS: PG490-88 alone and combined with low dose FK506 significantly prolonged renal allograft survival in a dog model. This agent attenuated acute humoral rejection by inhibiting complement activation and T-cell infiltration.


Assuntos
Diterpenos/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Tacrolimo/uso terapêutico , Animais , Creatinina/sangue , Cães , Quimioterapia Combinada , Monitorização Fisiológica/métodos , Análise de Sobrevida , Fatores de Tempo , Transplante Homólogo/imunologia , Pamoato de Triptorrelina/uso terapêutico
11.
Transplantation ; 79(10): 1386-92, 2005 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-15912108

RESUMO

BACKGROUND: Cytotoxic nitric oxide (NO) is produced during ischemia-reperfusion injury and acute and chronic rejection in allografts by expression of inducible (i) NO synthase (NOS). Therefore, continuous inhibition of iNOS may prevent early graft dysfunction and immune injury (rejection) and consequently improve graft survival. FR260330 is a potent and selective inhibitor of iNOS activity that works by preventing iNOS monomers from dimerization. In this study, the authors evaluated the effect of FR260330 in prevention of chronic rejection in a model of rat aortic allografts. METHODS: Male Lewis (LEW, RT1l) rats received male ACI (RT1a) aorta allografts or LEW aorta isografts. Fourteen groups (n > or = 6) were involved in this study. FR260330, tacrolimus, or both were administered orally for 14 or 90 days, according to protocol. The degree of intimal proliferation of graft aorta was determined by a computerized image system. RESULTS: Both low and high doses of FR260330- or tacrolimus-treated grafts showed significantly decreased intima/(intima+media) ratios at day 90 compared with placebo controls. Combination therapy of low-dose FR260330 with low-dose tacrolimus produced a significant decrease of intima/(intima+media) ratios with intact endothelium compared with placebo controls. Anti-alpha-actin immunohistochemical staining demonstrated that one of the mechanisms of intimal proliferation is related to migration of vascular smooth muscle cells. CONCLUSIONS: A selective inhibitor of NOS, FR260330 plays a protective role in chronic aortic allograft rejection in the rat. Combination therapy of low-dose FR260330 with tacrolimus produces significant protection of immune injury and may serve to improve long-term graft survival and function.


Assuntos
Aorta/transplante , Inibidores Enzimáticos/farmacologia , Rejeição de Enxerto/prevenção & controle , Óxido Nítrico Sintase/antagonistas & inibidores , Piperidinas/farmacologia , Túnica Íntima/patologia , Actinas/metabolismo , Animais , Aorta/patologia , Peso Corporal/efeitos dos fármacos , Doença Crônica , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Inibidores Enzimáticos/administração & dosagem , Sobrevivência de Enxerto/efeitos dos fármacos , Hiperplasia , Imunossupressores/farmacologia , Masculino , Músculo Liso Vascular/citologia , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , Óxido Nítrico Sintase Tipo II , Piperidinas/administração & dosagem , Ratos , Ratos Endogâmicos ACI , Ratos Endogâmicos Lew , Tacrolimo/farmacologia , Transplante Homólogo , Túnica Média/patologia
12.
Eur J Pharmacol ; 509(1): 71-6, 2005 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-15713431

RESUMO

In this study, we examined effects of a newly synthesized chemical compound, FR260330, (2E)-3-(4-chlorophenyl)-N-[(1S)-2-oxo-2-{[2-oxo-2-(4-{[6-(trifluoromethyl)-4-pyrimidinyl]oxy}-1-piperidinyl)ethyl]amino}-1-(2-pyridinylmethyl)ethyl]acrylamide on nitric oxide (NO) production in rat splenocytes and human colon cancer cell line, DLD-1 cells. FR260330 inhibited NOx production dose dependently in both cells. In lipopolysaccharide (LPS) and interferon-gamma (IFN-gamma) treated murine macrophage cell line, RAW264.7, Western blot analysis with gel filtration chromatography revealed FR260330 might prevent dimerization of inducible nitric oxide synthase (iNOS), but had no effect on the expression of iNOS protein. Furthermore, oral administration of FR260330 reduced NOx production dose dependently in plasma from rats exposed to LPS (IC50=1.6 mg/kg). Meanwhile, higher dose (100 mg/kg) of oral administration of FR260330 did not change mean arterial blood pressure in rats. These results suggest that FR260330 might be a useful therapeutical approach to various inflammatory diseases, in which superoxide or peroxynitrite formed from iNOS-derived NO are involved.


Assuntos
Administração Oral , Inibidores Enzimáticos/farmacologia , Piperidinas/farmacologia , Animais , Pressão Sanguínea/fisiologia , Western Blotting/métodos , Linhagem Celular Tumoral , Cromatografia em Gel/métodos , Dimerização , Relação Dose-Resposta a Droga , Inibidores Enzimáticos/administração & dosagem , Humanos , Interferon gama/farmacologia , Interleucina-1/farmacologia , Macrófagos/efeitos dos fármacos , Camundongos , NG-Nitroarginina Metil Éster/farmacologia , Nitratos/sangue , Óxido Nítrico/antagonistas & inibidores , Óxido Nítrico/metabolismo , Nitritos/sangue , Piperidinas/administração & dosagem , Piperidinas/química , Polissacarídeos Bacterianos/farmacologia , Ratos , Baço/efeitos dos fármacos , Baço/metabolismo , Baço/patologia , Fator de Necrose Tumoral alfa/farmacologia
13.
ASAIO J ; 48(3): 320-5, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12059009

RESUMO

In hemodialysis (HD) patients, the diameter of the inferior vena cava (IVC) serves for evaluation of the amount of body fluid. IVC measurement is usually performed immediately before and/or after an HD session. In the present study, we examined the validity of IVC diameter in the interdialysis period (interdialytic IVC) for dry weight (DW) optimization. In 100 HD patients, interdialytic IVC was measured ultrasonographically. The average maximum IVC diameter during quiet expiration (IVCe) was 14.2+/-3.8 mm. In 32 patients with volume dependent hypertension, the interdialytic IVCe was > 16 mm in 29 of 32. Thus, we defined an interdialytic IVCe > 16 mm as a hypervolemic state. Next, by screening 306 HD patients ultrasonographically, 31 patients with left ventricular volume overload were chosen based on criteria of an interdialytic IVCe > 16 mm, together with a left ventricular ejection fraction (EF) < 55%. After the DW was lowered to obtain an interdialytic IVCe < 16 mm, 25 of the 31 patients had a significant increase in EF, decrease in diastolic left ventricular dimension, and amelioration of hypertension. In conclusion, interdialytic IVCe is considered to be a useful parameter for DW optimization. In hypervolemic patients with IVCe > 16 mm, reduction in DW is expected to improve volume overload and cardiac function.


Assuntos
Líquidos Corporais/metabolismo , Coração/fisiopatologia , Diálise Renal , Veia Cava Inferior/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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