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3.
Nat Commun ; 8(1): 1719, 2017 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-29170512

RESUMO

Animal fetuses and embryos may have applications in the generation of human organs. Progenitor cells may be an appropriate cell source for regenerative organs because of their safety and availability. However, regenerative organs derived from exogenous lineage progenitors in developing animal fetuses have not yet been obtained. Here, we established a combination system through which donor cells could be precisely injected into the nephrogenic zone and native nephron progenitor cells (NPCs) could be eliminated in a time- and tissue-specific manner. We successfully achieved removal of Six2+ NPCs within the nephrogenic niche and complete replacement of transplanted NPCs with donor cells. These NPCs developed into mature glomeruli and renal tubules, and blood flow was observed following transplantation in vivo. Furthermore, this artificial nephron could be obtained using NPCs from different species. Thus, this technique enables in vivo differentiation from progenitor cells into nephrons, providing insights into nephrogenesis and organ regeneration.


Assuntos
Néfrons/metabolismo , Transplante de Células-Tronco/métodos , Células-Tronco/metabolismo , Quimeras de Transplante , Animais , Diferenciação Celular , Feminino , Masculino , Mesoderma/citologia , Mesoderma/embriologia , Mesoderma/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Néfrons/citologia , Néfrons/embriologia , Organogênese , Ratos Sprague-Dawley , Ratos Transgênicos , Especificidade da Espécie , Células-Tronco/citologia
4.
Clin Pharmacol Ther ; 95(5): 542-9, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24281222

RESUMO

Although it is well known that there are differences in approved doses between Japan and the United States, there has been no comprehensive research into the causes thereof. This study furthers the discussion of our previous investigation in 2010, with particular focus on pharmaceutical industry strategy and regulatory policy, among drugs approved in Japan between 2001 and 2009. Dose differences were observed in 73 of 190 drugs. Non-Japanese firms were more likely to have a similar dose approved between Japan and the United States, the association being more pronounced when limiting the analysis to drugs for which a Japanese dose-finding study was not conducted. Furthermore, dose differences were less frequent when non-Japanese efficacy data were included in the application data package. No relation between potential intrinsic ethnic difference and dose difference could be identified. The results suggest that the pathway of drug development is more strongly associated with dose difference than are drug characteristics.


Assuntos
Aprovação de Drogas , Indústria Farmacêutica , Preparações Farmacêuticas/administração & dosagem , Relação Dose-Resposta a Droga , Desenho de Fármacos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Humanos , Japão , Estados Unidos
5.
Gene Ther ; 19(8): 828-35, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21918548

RESUMO

The intranuclear disposition of plasmid DNA is extremely important for transgene expression. The interactions between the plasmid DNA and the histone proteins are one of the keys for controlling the disposition. In this study, the effects of a left-handedly curved sequence (20-40 repeated A•T tracts) on transgene expression from a plasmid were examined in vivo. A naked luciferase plasmid with the curved sequence was delivered into mouse liver by a hydrodynamics-based injection, and the luciferase activities were quantitated at various time points. Interestingly, transgene expression was markedly increased by the addition of the curved sequence. An analysis of the nucleosome positions near the left-handedly curved sequence suggested that the sequence functions as an acceptor of the histone core and allows nucleosome sliding, resulting in transcriptional activation. These results suggested that the designed curved DNA sequences could control transgene expression from plasmid DNAs in vivo.


Assuntos
Sequência de Bases , Expressão Gênica , Fígado/metabolismo , Plasmídeos/genética , Transgenes , Animais , Núcleo Celular/metabolismo , Histonas/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Nucleossomos/genética
6.
Eur J Vasc Endovasc Surg ; 42(2): 178-84, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21514186

RESUMO

OBJECTIVES: The objective of this study was to evaluate and compare our perioperative outcomes for open abdominal aortic aneurysm (AAA) between the pre-endovascular aneurysm repair (pre-EVAR) and EVAR eras and to analyse whether the AAA that was excluded from EVAR could affect the perioperative outcome. MATERIALS AND METHODS: The Kurume University Hospital vascular registry was reviewed to identify all patients undergoing an elective open AAA repair from January 2004 through November 2006 (pre-EVAR era, n = 99) and from December 2006 through June 2010 (EVAR era, n = 125). The early clinical outcomes between the two groups were compared. RESULTS: In the EVAR era, the proportion of EVAR in all elective AAA repairs was 43.4%. The EVAR era had a significantly higher proportion of very elderly patients over 80 years of age (23.2% vs. 11.1%, P = 0.0391). The morbidity rates were similar between the two groups (22.3% vs. 24,8%) and the mortality rate was 0% for both. CONCLUSION: Despite the increased complexity of OAR in the EVAR era, we believe that OAR remains a valid procedure for AAA repair.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/efeitos adversos , Distribuição de Qui-Quadrado , Procedimentos Cirúrgicos Eletivos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
J Appl Microbiol ; 105(6): 1851-7, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19120633

RESUMO

AIMS: Copper is a critical metal of modern industry, and is the most widespread heavy metal contaminant in wastewater. Therefore, isolation of copper-tolerant microbes having the potential as biosorbent is fascinating not only from an environmental microbiology, but also from a biotechnology view point. In this study, we attempted to isolate highly copper-tolerant microbes from soil samples of the Nabanobori copper mine, the oldest mine in Japan. METHODS AND RESULTS: As a result of an enrichment culture, two fungal strains were isolated from soil of the smelter remains. The isolates could grow in a maximum of 200 mmol l(-l) Cu(2+), and grew under a wide pH range. The Cu(2+)-binding capacity of nontreated biomass of the isolates was around 35 mg Cu(2+) g(-1)-biomass. Analysis of 18S rDNA suggested that the isolates belong to the Aspergillus/Penicillium clade, but they represented a distinct lineage against known neighbours. CONCLUSION: The isolates were highly copper-tolerant, and their Cu(2+)-binding capacity was comparable to well-studied fungal sorbents. The isolates were implied as novel species. Soil of the historic old mine under weather-beaten conditions might be a suitable source for metal-tolerant microbes. SIGNIFICANCE AND IMPACT OF THE STUDY: The present results advance our understanding of metal-tolerant microbes, and offer a new tool for both environmental control and metal recovery operations.


Assuntos
Cobre/farmacologia , Fungos/efeitos dos fármacos , Biomassa , Meios de Cultura , Fungos/classificação , Fungos/fisiologia , Japão , Mineração , RNA Ribossômico 18S/análise
9.
Oncology ; 71(3-4): 204-11, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17641542

RESUMO

OBJECTIVES: Lymph node metastasis is one of the determining factors of a poor prognosis for colorectal cancer. Recent studies have reported that cancer cells can promote lymphangiogenesis and that chemokine receptors expressed by cancer cells might play a role in metastasis. In this study, we examined the correlation between the expression of vascular endothelial growth factor (VEGF) C, the chemokine receptor CXCR4 and lymph node metastasis in colorectal cancer. METHODS: One hundred and sixty-one consecutive patients who underwent resection at our department were studied. Lymph node metastasis was observed in 69 cases (43%) and lymphatic involvement was present in 105 cases (65%). Immunohistochemical staining was performed using antibodies for VEGF-C and CXCR4. Moreover, lymphatic vessel density (LVD) was evaluated within the tumor by immunostaining with a D2-40 antibody. RESULTS: VEGF-C expression was found in 81 cases (50%) and CXCR4 expression in 87 cases (54%). Regarding the correlation between nodal metastasis and the expression of CXCR4 and VEGF-C, the incidence of nodal metastasis was significantly (p < 0.01) higher in patients with CXCR4-positive tumors than in those with CXCR4-negative tumors. In addition, a significant correlation was observed between CXCR4 and VEGF-C expression and lymphatic invasion (p < 0.01). LVD was significantly higher in VEGF-C-positive tumors compared with VEGF-C-negative tumors. However, there was no significant correlation between LVD and CXCR4 expression. Using multivariate analysis, VEGF-C, CXCR4, lymphatic invasion and wall invasion were found to be independent risk factors for lymph node metastasis. CONCLUSIONS: This study suggests that although the mechanism that promoted lymph node metastasis was different between VEGF-C and CXCR4, both VEGF-C and CXCR4 contributed to lymphatic involvement and nodal metastasis in colorectal cancer.


Assuntos
Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , Receptores CXCR4/metabolismo , Fator C de Crescimento do Endotélio Vascular/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Vasos Linfáticos/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico
10.
Neuroscience ; 135(4): 1017-23, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16165299

RESUMO

Classical eyeblink conditioning has been known to depend critically on the cerebellum. Apparently consistent with this, glutamate receptor subunit delta2 null mutant mice, which have serious morphological and functional deficiencies in the cerebellar cortex, are severely impaired in delay paradigm. However, these mutant mice successfully learn in trace paradigm, even in '0-trace paradigm,' in which the unconditioned stimulus starts just after the conditioned stimulus terminates. Our previous studies revealed that the hippocampus and the muscarinic acetylcholine receptors play crucial roles in 0-trace paradigm in glutamate receptor subunit delta2 null mutant mice unlike in wild-type mice, suggesting a large contribution of the forebrain to 0-trace conditioning in this type of mutant mice. In the present study, we investigated the role of N-methyl-D-aspartate receptors in 0-trace eyeblink conditioning in glutamate receptor subunit delta2 null mutant mice. Mice were injected intraperitoneally with the noncompetitive N-methyl-d-aspartate receptor antagonist (+)MK-801 (0.1mg/kg) or saline, and conditioned with 350-ms tone conditioned stimulus followed by 100-ms periorbital shock unconditioned stimulus. Glutamate receptor subunit delta2 null mutant mice that received (+)MK-801 injection exhibited a severe impairment in acquisition of the conditioned response, compared with the saline-injected glutamate receptor subunit delta2 null mutant mice. In contrast, wild-type mice were not impaired in acquisition of 0-trace conditioned response by (+)MK-801 injection. After the injection solution was changed from (+)MK-801 to saline, glutamate receptor subunit delta2 null mutant mice showed a rapid and partial recovery of performance of the conditioned response. On the other hand, when the injection solution was changed from saline to (+)MK-801, glutamate receptor subunit delta2 null mutant mice showed a marked impairment in expression of the pre-acquired conditioned response, whereas impairment of the expression was small in wild-type mice. Injection of (+)MK-801 had no significant effects on spontaneous eyeblink frequency or startle eyeblink frequency to the tone conditioned stimulus in either glutamate receptor subunit delta2 null mutant mice or wild-type mice. These results suggest that N-methyl-D-aspartate receptors play critical roles both in acquisition and expression of the conditioned response in 0-trace eyeblink conditioning in glutamate receptor subunit delta2 null mutant mice.


Assuntos
Piscadela/fisiologia , Encéfalo/fisiologia , Condicionamento Palpebral/fisiologia , Receptores de Glutamato/deficiência , Receptores de N-Metil-D-Aspartato/metabolismo , Animais , Encéfalo/efeitos dos fármacos , Condicionamento Palpebral/efeitos dos fármacos , Maleato de Dizocilpina/farmacologia , Antagonistas de Aminoácidos Excitatórios/farmacologia , Camundongos , Camundongos Mutantes , Receptores de Glutamato/genética , Receptores de N-Metil-D-Aspartato/efeitos dos fármacos
11.
Int J Cosmet Sci ; 27(2): 101-6, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18492159

RESUMO

The cell biological properties of collagen, gelatin and collagen hydrolysate (<15 000 Da) were studied using murine keratinocytes. Keratinocyte culture experiments demonstrated that only collagen had significant effects on cell attachment and proliferation, but the results of cells cultured on gelatin and collagen hydrolysate showed the rates of adhesion and proliferation were similar to those of cells cultured on plastic as a control. It is concluded that collagen has better physiological effects than those of gelatin and collagen hydrolysate as skin-care cosmetic materials.

12.
Conf Proc IEEE Eng Med Biol Soc ; 2004: 4815-7, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-17271388

RESUMO

This study assessed the changes in blood flow volume in elderly hemiplegic patients before and after rehabilitation training. Total hemoglobin accumulation (blood flow volume) was measured using near-infrared spectroscopy (NIRS) in both the affected and unaffected gastrocnemius muscles before and after walking. In the gastrocnemius on the affected side, the blood flow volume was larger during the recovery period than during the rest period, and the blood flow volume did not decrease during the recovery period after the subjects walked a corridor. By contrast, the blood flow volume recovered faster on the unaffected side than on the affected side. After the subjects walked the stairs, the blood flow volume increased in the gastrocnemius muscles on both sides. These results suggested that the level of training involved in walking a corridor was too light for the unaffected side, although it was effective for the affected side. In our subjects, walking the stairs was effective rehabilitation training for both the unaffected and affected sides. Our results suggested that NIRS was an objective tool useful for planning rehabilitation training.

13.
Pediatr Surg Int ; 19(1-2): 112-4, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12721741

RESUMO

Both Beckwith-Wiedemann syndrome (BWS) and hemihypertrophy (HH) have been recognized to be overgrowth syndromes associated with an increased risk of cancer. We report an infant with hepatoblastoma associated with both BWS and HH in whom high serum alpha-fetoprotein (AFP) levels persisted even after complete tumor resection with no tumor recurrence. This phenomenon might be partly due to the nature of the proliferative disease. It is important to recognize that in some infants with BWS prolonged high serum AFP levels mimic the existence of a tumor, and that treatment should be based not only on AFP measurement, but also on repeated radiologic imaging.


Assuntos
Síndrome de Beckwith-Wiedemann/complicações , Hepatoblastoma/complicações , Neoplasias Hepáticas/complicações , Hepatoblastoma/patologia , Hepatoblastoma/cirurgia , Humanos , Hipertrofia/complicações , Hipertrofia/congênito , Lactente , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino
14.
J Cardiovasc Surg (Torino) ; 43(5): 581-7, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12386567

RESUMO

BACKGROUND: We reviewed our clinical experience with primary cardiac tumors, attempting to clarify the surgical management of these rare entities. METHODS: Between October 1978 and November 1999, we experienced 60 surgical cases of primary cardiac tumors. There were 23 male and 37 female patients (age range, 7 months to 84 years). Tumors included the following 3 groups: myxomas (n=49), nonmyxoma benign tumors (n=3), and malignant tumors (n=8). We reviewed the presenting symptoms, diagnostic data, anatomical findings, and surgical techniques, and evaluated the surgical RESULTS. Late follow-up was 95% complete (mean follow-up, 7.7+/-7.1 years). RESULTS: Tumors produced obstructive, embolic, and/or constitutional symptoms in most cases. Generally, echocardiography alone gave sufficient information for operation. Full-thickness excision was performed in 42 patients with myxoma. Complete excision was achieved in all of the nonmyxoma benign tumors and in none of the malignancies. Early mortalities in the 3 groups were 8.2% (4/49), 0% (0/3), and 12.5% (1/8), respectively. Late mortalities were 9.5% (4/42), 0% (0/3), and 100% (7/7), respectively. One patient with myxoma had recurrence, the cause of which was likely to be inadequate resection. The late deaths in patients with malignancies were due to metastasis or local recurrence. CONCLUSIONS: Benign tumors are generally curable if surgically excised. Preoperative refractory cardiac dysfunction or embolism should be avoided by the accurate evaluation on echocardiography. The prognosis of malignant tumors is poor if they are only debulked. However, aggressive surgery that can palliate obstruction and allow time for adjuvant therapy should be carried out.


Assuntos
Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem , Estudos Retrospectivos , Rabdomiossarcoma/diagnóstico por imagem , Rabdomiossarcoma/cirurgia , Resultado do Tratamento , Ultrassonografia
15.
Cardiovasc Surg ; 10(4): 339-44, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12359404

RESUMO

Between 1995 and 2000, 8 patients with St. Jude Medical (SJM) valves in the aortic position required 9 redo valve replacement for prosthetic valve obstruction. Obstruction of the prosthetic valve was diagnosed by simultaneous echocardiography and cineradiography, and process of restricted leaflet movement that progressed to hemodynamic impairment was observed by serial studies in three recent patients. An oral anticoagulation was considered to be adequate in all patients except one patient who had withdrawal of warfrain. Pannus was the sole cause of valve obstruction in seven events in 6 patients, and both thrombus and pannus in 2 patients. Pannus overgrowth was found on the inflow aspect of the SJM valve, and involved the ends of the straight edge of the leaflets over pivot guards. These results suggest that pannus might play the primary role in development of obstruction of aortic SJM valves in patients on adequate oral anticoagulation.


Assuntos
Estenose da Valva Aórtica/etiologia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias , Idoso , Estenose da Valva Aórtica/diagnóstico , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Desenho de Prótese , Falha de Prótese , Reoperação
16.
Kyobu Geka ; 55(8 Suppl): 628-32, 2002 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-12174647

RESUMO

Between January 1974 and December 2000, aortic root replacement was performed for 46 patients with Marfan syndrome. The hospital mortality rate amounts to 8.6% (4 patients out of 46). Fifteen (35.7% of survivor) of 42 survivor died during the period of follow-up. Eighteen of 42 survivor were developed cardiovascular events of 21 times and 11 patients had to be reoperated on at least once for a total of 12 reoperations. Nine of 15 late death patient died in relation to aortic dissection and pseudoaneurysm of distal anastomosis and coronary anastomosis. Actuarial survival rate was satisfactory for 10 years after aortic root replacement, but sharply decreased after postoperative 10 years. The use of non-sealed graft, classical Bentall method, reoperation and inclusion technique were risk factors for the late death.


Assuntos
Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/mortalidade , Síndrome de Marfan/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
17.
Pediatr Surg Int ; 18(4): 284-6, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12021981

RESUMO

Postoperative intussusception of the appendiceal stump is a rare complication of appendicectomy. We report an infant who developed an intussusception of the appendiceal stump 2 days following an appendicectomy performed during a right inguinal herniotomy as a day case. The intussusception was diagnosed on ultrasonography and was to be treated laparoscopically, but spontaneous reduction occurred during induction of general anesthesia.


Assuntos
Apendicectomia/efeitos adversos , Apendicite/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Abdome/diagnóstico por imagem , Hérnia Inguinal/diagnóstico por imagem , Humanos , Lactente , Masculino , Ultrassonografia
18.
Ann Hematol ; 80(10): 617-9, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11732876

RESUMO

A 61-year-old male with non-Hodgkin's lymphoma (peripheral T-cell lymphoma, unspecified, clinical stage IVb) received autologous peripheral blood stem cell transplantation (PBSCT) during first remission. He was seropositive for cytomegalovirus (CMV) prior to autologous PBSCT. His posttransplant clinical course was complicated by refractory CMV enteritis, which manifested persistent abdominal pain, diarrhea, and bloody stool. Generally, gastrointestinal CMV disease is relatively rare after autologous PBSCT. However, our case indicates that CMV infection must be considered as a differential diagnosis in cases of unexplained hemorrhagic enteritis following autologous PBSCT.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Enterite/virologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Linfoma de Células T/terapia , Dor Abdominal , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Diagnóstico Diferencial , Diarreia , Hemorragia Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Transplante Autólogo
19.
J Oral Pathol Med ; 30(8): 494-8, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11545241

RESUMO

A peripheral ameloblastoma with atypical features occurring on the left maxillary alveolar ridge of 40-year-old man is described, along with an immunohistochemical profile of its cytokeratin (CK). The lesion apparently originated from the surface gingival epithelium. The tumor nests or strands were highly cellular with a variable degree of squamous differentiation and microcyst formation. Occasional mitotic figures and dystrophic calcification, both of which are not seen in conventional ameloblastomas, were also observed. The tumor infiltrated deep into the alveolar mucosa, including the periodontal ligament, and showed histological and topographical evidence of atypism, resulting in resorption of the underlying alveolar bone. On the CK immunohistochemistry, CK19 was demonstrated in all the types of neoplastic epithelia, including microcyst-forming cells, densely packed round or spindle cells within the tumor nests, cells with squamous metaplasia, and peripheral tall columnar cells. The CK immunohistochemical findings suggest the lesion's cell of odontogenic origin; they may reflect an immature phenotypic expression of cell differentiation in the odontogenic epithelia during the tumor growth in the gingival mucosa.


Assuntos
Ameloblastoma/patologia , Neoplasias Gengivais/patologia , Queratinas/análise , Adulto , Perda do Osso Alveolar/patologia , Calcinose/patologia , Diferenciação Celular , Epitélio/patologia , Humanos , Imuno-Histoquímica , Masculino , Metaplasia , Mitose , Mucosa Bucal/patologia , Ligamento Periodontal/patologia , Fenótipo
20.
Jpn Circ J ; 65(6): 581-3, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11407746

RESUMO

Rupture of the posterior wall of the left ventricle after mitral valve replacement is a dire complication associated with a very high mortality. This study reports a successful repair of type I left ventricular rupture, which occurred after mitral valve replacement concomitant with a left atrial reduction procedure, by combination of an intracardiac patch and an extracardiac buttress suture. In a case such as this, in which hemostasis is quite difficult to establish, this combination technique is particularly effective.


Assuntos
Ruptura Cardíaca/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Feminino , Átrios do Coração/cirurgia , Ruptura Cardíaca/etiologia , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Humanos , Pessoa de Meia-Idade , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Suturas
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