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1.
Climacteric ; 25(4): 369-375, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34694941

RESUMO

OBJECTIVE: The aim of this study is to analyze the association between coronary artery vitamin D receptor (VDR) expression and systemic coronary artery atherosclerosis (CAA) risk factors. METHODS: Female cynomolgus monkeys (n = 39) consumed atherogenic diets containing the women's equivalent of 1000 IU/day of vitamin D3. After 32 months consuming the diets, each monkey underwent surgical menopause. After 32 postmenopausal months, CAA and VDR expression were quantified in the left anterior descending coronary artery. Plasma 25OHD3, lipid profiles and serum monocyte chemotactic protein-1 (MCP-1) were measured. RESULTS: In postmenopausal monkeys receiving atherogenic diets, serum MCP-1 was significantly elevated compared with baseline (482.2 ± 174.2 pg/ml vs. 349.1 ± 163.2 pg/ml, respectively; p < 0.001; d = 0.79) and at the start of menopause (363.4 ± 117.2 pg/ml; p < 0.001; d = 0.80). Coronary VDR expression was inversely correlated with serum MCP-1 (p = 0.042). Additionally, the change of postmenopausal MCP-1 (from baseline to necropsy) was significantly reduced in the group with higher, compared to below the median, VDR expression (p = 0.038). The combination of plasma 25OHD3 and total plasma cholesterol/high-density lipoprotein cholesterol was subsequently broken into low-risk, moderate-risk and high-risk groups; as the risk increased, the VDR quantity decreased (p = 0.04). CAA was not associated with various atherogenic diets. CONCLUSION: Coronary artery VDR expression was inversely correlated with markers of CAA risk and inflammation, including MCP-1, suggesting that systemic and perhaps local inflammation in the artery may be associated with reduced arterial VDR expression.


Assuntos
Aterosclerose , Doença da Artéria Coronariana , Receptores de Calcitriol/metabolismo , Aterosclerose/complicações , Doença da Artéria Coronariana/etiologia , Feminino , Humanos , Inflamação , Fatores de Risco , Vitamina D
3.
J Hosp Infect ; 114: 117-125, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33930487

RESUMO

BACKGROUND: Healthcare workers (HCWs) are at the front line of the ongoing coronavirus 2019 (COVID-19) pandemic. Comprehensive evaluation of the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) among HCWs in a large healthcare system could help to identify the impact of epidemiological factors and the presence of symptoms on the immune response to the infection over time. AIM: To determine the seroprevalence of SARS-CoV-2-specific antibodies among HCWs, identify associated epidemiological factors and study antibody kinetics. METHODS: A longitudinal evaluation of the seroprevalence and epidemiology of SARS-CoV-2-specific antibodies was undertaken in approximately 30,000 HCWs in the largest healthcare system in Connecticut, USA. FINDINGS: At baseline, the prevalence of SARS-CoV-2 antibody among 6863 HCWs was 6.3% [95% confidence interval (CI) 5.7-6.9%], and was highest among patient care support (16.7%), medical assistants (9.1%) and nurses (8.2%), and lower for physicians (3.8%) and advanced practice providers (4.5%). Seroprevalence was significantly higher among African Americans [odds ratio (OR) 3.26 compared with Caucasians, 95% CI 1.77-5.99], in participants with at least one symptom of COVID-19 (OR 3.00, 95% CI 1.92-4.68), and in those reporting prior quarantine (OR 3.83, 95% CI 2.57-5.70). No symptoms were reported in 24% of seropositive participants. Among the 47% of participants who returned for a follow-up serological test, the seroreversion rate was 39.5% and the seroconversion rate was 2.2%. The incidence of re-infection in the seropositive group was zero. CONCLUSION: Although there is a decline in the immunoglobulin G antibody signal over time, 60.5% of seropositive HCWs had maintained their seroconversion status after a median of 5.5 months.


Assuntos
Anticorpos Antivirais/sangue , COVID-19 , SARS-CoV-2 , Adulto , COVID-19/imunologia , Connecticut/epidemiologia , Feminino , Pessoal de Saúde , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/imunologia , Estudos Soroepidemiológicos
6.
Br J Cancer ; 111(10): 1932-44, 2014 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-25290091

RESUMO

BACKGROUND: Two strategies to interrogate the insulin growth factor 1 receptor (IGF-1R) pathway were investigated: vertical inhibition with dalotuzumab and MK-2206 or ridaforolimus to potentiate PI3K pathway targeting and horizontal cross-talk inhibition with dalotuzumab and MK-0752 to exert effects against cellular proliferation, angiogenesis, and stem cell propagation. METHODS: A phase I, multi-cohort dose escalation study was conducted in patients with advanced solid tumours. Patients received dalotuzumab (10 mg kg(-1)) and escalating doses of MK-2206 (90-200 mg) or escalating doses of dalotuzumab (7.5-10 mg kg(-1)) and MK-0752 (1800 mg) weekly. Upon maximum tolerated dose determination, patients with low-RAS signature, high-IGF1 expression ovarian cancer were randomised to dalotuzumab/MK-2206 versus dalotuzumab/ridaforolimus, whereas patients with high IGF1/low IGF2 expression colorectal cancer received dalotuzumab/MK-0752. RESULTS: A total of 47 patients were enrolled: 29 in part A (18 in the dalotuzumab/MK-2206 arm and 11 in the dalotuzumab/MK-0752 arm) and 18 in part B (6 in each arm). Dose-limiting toxicities (DLTs) for dalotuzumab/MK-2206 included grade 4 neutropenia and grade 3 serum sickness-like reaction, maculopapular rash, and gastrointestinal inflammation. For dalotuzumab/MK-0752, DLTs included grade 3 dehydration, rash, and diarrhoea. Seven patients remained on study for >4 cycles. CONCLUSIONS: Dalotuzumab/MK-2206 and dalotuzumab/MK-0752 combinations were tolerable. Further developments of prospectively validated predictive biomarkers to aid in patient selection for anti-IGF-1R therapies are needed.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Derivados de Benzeno/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Neoplasias/tratamento farmacológico , Propionatos/uso terapêutico , Sirolimo/análogos & derivados , Sulfonas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/farmacocinética , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica , Derivados de Benzeno/farmacocinética , Biomarcadores Tumorais/metabolismo , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Estudos de Coortes , Feminino , Seguimentos , Compostos Heterocíclicos com 3 Anéis/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/metabolismo , Neoplasias/patologia , Prognóstico , Propionatos/farmacocinética , Proteínas Proto-Oncogênicas c-akt/antagonistas & inibidores , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptor IGF Tipo 1/antagonistas & inibidores , Receptores Notch/antagonistas & inibidores , Sirolimo/farmacocinética , Sirolimo/uso terapêutico , Sulfonas/farmacocinética , Serina-Treonina Quinases TOR/antagonistas & inibidores , Distribuição Tecidual
7.
Biol Sport ; 30(1): 51-5, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24744466

RESUMO

The axe kick, in Olympic style taekwondo, has been identified as the most popular scoring technique aimed to the head during full contact competition. The first purpose of this study was to identify and investigate design issues with the current World Taekwondo Federation approved chest protector. A secondary purpose was to develop a novel chest protector addressing the identified design issues and to conduct a biomechanical analysis. Fifteen male elite Taekwondo players were selected to perform three different styles of the axe kick, i.e., front, in-out, and out-in axe kick five times each for a total of 45 kicks. Two-way repeated measures ANOVA showed significant differences between the novel and existing chest protector conditions for vertical height of the toe, downward kicking foot speed, hip flexion angle and ipsilateral shoulder flexion extension range of motion (ROM) (p < 0.05). There were no significant differences between the control condition (no chest protector) and the novel chest protector condition for these variables (p > 0.05). These results indicate that the novel chest protector interferes less with both the lower and upper limbs during the performance of the axe kick and provides a more natural, free-moving alternative to the current equipment used.

8.
Int J Clin Pract ; 65(6): 674-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21564440

RESUMO

Acid suppressive therapy, in the form of proton pump inhibitor (PPI), is widely used in cirrhotic patients, often in indications which are not clearly justified. PPI facilitates enteric bacterial colonisation, overgrowth and translocation, which might predispose to spontaneous bacterial peritonitis. However, observational studies evaluating the association of PPI and SBP in cirrhotic patients have yielded inconsistent results. We therefore conducted a meta-analysis of relevant clinical studies to determine the nature of this association. Observational studies assessing the association between SBP and PPI in cirrhosis, conducted in adult population and published in all languages, were identified through systematic search in the MEDLINE, EMBASE and manual reviews of all major gastroenterology meeting proceedings up to May 2010. The relevant studies were pooled using traditional meta-analytic techniques with a random-effects model. Four studies were identified and included in the meta-analysis. The pooled analysis, involving a total of 772 patients, found a significant association between the use of PPI and the development of SBP (OR 2.77, 95% CI 1.82-4.23). There was very little degree of heterogeneity as reflected by an I(2) value of 22% and the visual inspection of the funnel plot. There is a potential association between use of PPI and development of SBP. Therefore, PPIs should be used judiciously and only when clearly indicated in cirrhotics. Further studies are essential to clarify this relationship and elucidate the underlying mechanisms.


Assuntos
Infecções Bacterianas/induzido quimicamente , Cirrose Hepática/complicações , Peritonite/induzido quimicamente , Inibidores da Bomba de Prótons/efeitos adversos , Adulto , Idoso , Antiácidos/efeitos adversos , Gastroenteropatias/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
J Antimicrob Chemother ; 62(6): 1199-202, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18799471

RESUMO

OBJECTIVES: To investigate how the SOS response, an error-prone DNA repair pathway, is expressed following subinhibitory quinolone treatment of Mycobacterium tuberculosis. METHODS: Genome-wide expression profiling followed by quantitative RT (qRT)-PCR was used to study the effect of ciprofloxacin on M. tuberculosis gene expression. RESULTS: Microarray analysis showed that 16/110 genes involved in DNA protection, repair and recombination were up-regulated. There appeared to be a lack of downstream genes involved in the SOS response. qRT-PCR detected an induction of lexA and recA after 4 h and of dnaE2 after 24 h of subinhibitory treatment. CONCLUSIONS: The pattern of gene expression observed following subinhibitory quinolone treatment differed from that induced after other DNA-damaging agents (e.g. mitomycin C). The expression of the DnaE2 polymerase response was significantly delayed following subinhibitory quinolone exposure.


Assuntos
Antituberculosos/farmacologia , Ciprofloxacina/farmacologia , Reparo do DNA , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/fisiologia , Perfilação da Expressão Gênica , Regulação Bacteriana da Expressão Gênica , Genes Bacterianos , Análise de Sequência com Séries de Oligonucleotídeos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Resposta SOS em Genética
11.
J Antimicrob Chemother ; 62(4): 709-12, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18577539

RESUMO

OBJECTIVES: To determine the effect of oxidative stress on isoniazid-resistant Mycobacterium tuberculosis deficient in catalase/peroxidase activity to varying degrees through mutation in katG. METHODS: The mutation rate was determined for a set of isogenic strains with different katG alleles giving different catalase and/or peroxidase activities following exposure to the oxidizing agent, hydrogen peroxide. Mutants were selected on rifampicin, and the location and nature of the mutation were identified by sequencing the rpoB gene. RESULTS: No evidence was found to suggest that strains that had impaired catalase/peroxidase activity were hypermutable, and the presence of excess hydrogen peroxide had no effect on the mutation rate. An unusual pattern of mutations in rpoB was observed in catalase-deficient strains with only 3 of 66 having mutations within the rifampicin resistance-determining region. CONCLUSIONS: The mutation rate of M. tuberculosis in response to oxidative stress is not increased in strains with significant deficits in catalase and peroxidase activity. Our data suggest that isoniazid-resistant strains compensate for their reduced ability to detoxify oxidative stress effectively. Interestingly, mutations were found in unusual locations at positions similar to those found in clinical isoniazid-resistant strains.


Assuntos
Proteínas de Bactérias/genética , Catalase/genética , Mutação , Mycobacterium tuberculosis/enzimologia , Mycobacterium tuberculosis/genética , Estresse Oxidativo , Antibacterianos/farmacologia , Análise Mutacional de DNA , DNA Bacteriano/química , DNA Bacteriano/genética , RNA Polimerases Dirigidas por DNA/genética , Farmacorresistência Bacteriana , Genótipo , Peróxido de Hidrogênio/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Oxidantes/farmacologia , Rifampina/farmacologia , Análise de Sequência de DNA
12.
Vaccine ; 25(49): 8203-5, 2007 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-17980937

RESUMO

Quantitation of bacterial load in tissues is essential for experimental investigation of Mycobacterium tuberculosis infection and immunity. We have used an automated liquid culture system to determine the number of colony forming units (CFU) in murine tissues and compared the results to those obtained by conventional plating on Middlebrook agar. There is an overall good correlation between results obtained by the two methods. Although less consistency and more contamination was observed in the automated liquid culture, the method is more sensitive, less labour intensive and allows the processing of large numbers of samples.


Assuntos
Meios de Cultura , Modelos Animais de Doenças , Pulmão/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Baço/microbiologia , Tuberculose Pulmonar/microbiologia , Ágar , Animais , Técnicas Bacteriológicas , Contagem de Colônia Microbiana , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Sensibilidade e Especificidade
13.
Biochem Pharmacol ; 72(1): 11-8, 2006 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-16678798

RESUMO

The role of topoisomerase (topo) II in DNA repair has yet to be fully elucidated. Current evidence suggesting a role for topo II in the repair of DNA damage has been obtained by using in vitro model systems or inferred from correlative data in drug resistant cell lines. In this study we directly examined the role of topo IIalpha and beta in mediating the repair of melphalan-induced crosslinks in cellular DNA. To accomplish this, we used siRNA technology to knock down either topo IIalpha or beta in human chronic myelogenous leukemia K562 and histiocytic lymphoma U937 cell line. Our data demonstrate that topo IIbeta levels, (but not alpha), are a determinant of melphalan-induced crosslinks and sensitivity to melphalan. Furthermore, we show that knocking down topo IIbeta inhibits the repair of melphalan-induced crosslinks in K562 cells. These studies represent the first direct evidence that topo IIbeta participates in the repair of DNA damage induced by an alkylating agent in cellular DNA. Finally, these results suggest non-redundant roles for these two isoforms in mediating repair of DNA crosslinks.


Assuntos
Antineoplásicos Alquilantes/farmacologia , Reagentes de Ligações Cruzadas/farmacologia , DNA Topoisomerases Tipo II/metabolismo , Proteínas de Ligação a DNA/metabolismo , DNA/efeitos dos fármacos , Melfalan/farmacologia , Antígenos de Neoplasias/genética , Antígenos de Neoplasias/metabolismo , Apoptose/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Dano ao DNA , Reparo do DNA/efeitos dos fármacos , DNA Topoisomerases Tipo II/genética , Proteínas de Ligação a DNA/antagonistas & inibidores , Proteínas de Ligação a DNA/genética , Humanos , Células K562/efeitos dos fármacos , Células K562/enzimologia , RNA Interferente Pequeno/genética , RNA Interferente Pequeno/metabolismo , RNA Interferente Pequeno/farmacologia , Inibidores da Topoisomerase II , Transfecção , Células U937/efeitos dos fármacos , Células U937/enzimologia
14.
Bioresour Technol ; 96(13): 1499-504, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15939278

RESUMO

Direct application of yard trimmings to agricultural land can benefit soils and crop production, while providing an outlet for handling high volumes of materials at compost facilities. Variability in the composition of yard trimmings can make it difficult to determine appropriate application rates. Our objective was to characterize the chemical composition and variability of yard trimmings generated throughout the spring and summer season at facilities in the Puget Sound region of Washington State. Yard trimmings were sampled from four composting facilities on five dates between April and August 1999. One material contained mostly grass clippings and had higher mean total N (3.2%) than mixed grass and woody materials (1.5-2%). Mean C:N was lower in the grass-rich material (12:1 vs. 15 to 21:1), while mean ammonium concentrations were similar (0.18-0.28%). Variation among facilities was greater than variation over time. The amount of variation observed with other nutrients, pH, EC, or trace elements would not affect use of the yard trimmings in agriculture. Our results suggest that it is possible to characterize yard trimmings adequately for agricultural use.


Assuntos
Agricultura/métodos , Folhas de Planta/química , Poaceae/química , Eliminação de Resíduos/métodos , Estações do Ano , Análise de Variância , Carbono/análise , Concentração de Íons de Hidrogênio , Nitrogênio/análise , Washington
15.
16.
Blood ; 98(6): 1897-903, 2001 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-11535527

RESUMO

We previously showed that adhesion of myeloma cells to fibronectin (FN) by means of beta1 integrins causes resistance to certain cytotoxic drugs. The study described here found that adhesion of U937 human histiocytic lymphoma cells to FN provides a survival advantage with respect to damage induced by the topoisomerase (topo) II inhibitors mitoxantrone, doxorubicin, and etoposide. Apoptosis induced by a topo II inhibitor is thought to be initiated by DNA damage. The neutral comet assay was used to determine whether initial drug-induced DNA damage correlated with cellular-adhesion-mediated drug resistance. Cellular adhesion by means of beta1 integrins resulted in a 40% to 60% reduction in mitoxantrone- and etoposide-induced DNA double-strand breaks. When the mechanisms regulating the initial drug-induced DNA damage were examined, a beta1 integrin-mediated reduction in drug-induced DNA double-strand breaks was found to correlate with reduced topo II activity and decreased salt-extractable nuclear topo IIbeta protein levels. Confocal studies showed changes in the nuclear localization of topo IIbeta; however, alterations in the nuclear-to-cytoplasmic ratio of topo IIbeta in FN-adhered cells were not significantly different. Furthermore, after a high level of salt extraction of nuclear proteins, higher levels of topo IIbeta-associated DNA binding were observed in FN-adhered cells than in cells in suspension. Together, these data suggest that topo IIbeta is more tightly bound to the nucleus of FN-adhered cells. Thus, FN adhesion by means of beta1 integrins appears to protect U937 cells from initial drug-induced DNA damage by reducing topo II activity secondarily to alterations in the nuclear distribution of topo IIbeta.


Assuntos
Antineoplásicos/farmacologia , Adesão Celular , Dano ao DNA , Resistencia a Medicamentos Antineoplásicos , Integrina beta1/fisiologia , Apoptose , Núcleo Celular/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Ensaio Cometa , DNA Topoisomerases Tipo II/metabolismo , Proteínas de Ligação a DNA , Doxorrubicina/farmacologia , Etoposídeo/farmacologia , Fibronectinas/metabolismo , Humanos , Mitoxantrona/farmacologia , Receptores de Fibronectina/fisiologia , Inibidores da Topoisomerase II , Células U937
17.
J Appl Physiol (1985) ; 90(5): 1648-56, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11299251

RESUMO

Cardiac dysfunction has been documented in vivo after acute massive pulmonary embolism (AMPE). The present study tests whether intrinsic ventricular dysfunction occurs in rat hearts isolated after AMPE. AMPE was induced in spontaneously breathing ketamine-xylazine-anesthetized rats by thrombus infusion until mean arterial blood pressure (MAP) was approximately 40% of basal measurement. A hypotensive control group underwent controlled blood withdrawal to produce MAP approximately 40% of basal levels. Shams underwent identical surgical and anesthesia preparation but without pulmonary embolization. Hearts were perfused in isovolumetric mode, and simultaneous right ventricular (RV) and left ventricular (LV) pressures were measured. AMPE caused arterial hypotension with hypoxemia (PO(2) = 50 +/- 14 Torr), acidemia (pH = 7.26 +/- 0.11), and high lactate concentration (6.9 +/- 1.7 mM). Starling curves from both ventricles demonstrated that AMPE significantly reduced ex vivo systolic contractile function in the RV (P = 0.031) and LV (P = 0.008) compared with both the hypotensive control and sham hearts. AMPE did not alter coronary flow or compliance in either ventricle. Soluble tumor necrosis factor-alpha decreased in the RV (P = 0.043) and LV (P = 0.005) tissue. These data support the hypothesis that AMPE produces intrinsic biventricular dysfunction and suggest that arterial hypotension is not the principal mechanism of this dysfunction.


Assuntos
Coração/fisiopatologia , Embolia Pulmonar/fisiopatologia , Disfunção Ventricular/fisiopatologia , Animais , Pressão Sanguínea , Dióxido de Carbono/sangue , Hipotensão/etiologia , Hipotensão/fisiopatologia , Técnicas In Vitro , Masculino , Contração Miocárdica , Oxigênio/sangue , Pressão Parcial , Embolia Pulmonar/complicações , Ratos , Ratos Sprague-Dawley , Sístole , Fatores de Tempo , Disfunção Ventricular/etiologia , Função Ventricular Esquerda , Função Ventricular Direita
19.
J Environ Qual ; 30(6): 2188-94, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11790031

RESUMO

Repeated applications of municipal wastewater biosolids is cost effective for biosolids managers, but may lead to undesirable accumulations of nutrients or contaminants. We evaluated the effects of seven years of biosolids applications on tall fescue (Festuca arundinacea Schreb.) production and nutrient availability. We compared two types of Class A biosolids applied to tall fescue on a sandy loam in western Washington. Mean annual biosolids rates of 290, 580, and 870 kg total N ha(-1) yr(-1) were compared with inorganic N and zero-N controls using a randomized complete block design. We measured yield and N uptake for each forage harvest, plant tissue metals at selected harvests, soil nitrate each fall, diethylenetriaminepentaacetic acid (DTPA)-extractable metals after five years of applications, and soil pH, available P, and organic C after seven years. Forage yields increased with biosolids rate. Apparent nitrogen recovery (ANR) for biosolids averaged 18% in 1993 (Year 1), 35% in 1994, and 46% in 1999. The ANR for inorganic N averaged 62% from 1994-1999. Residual soil nitrate was less than 25 kg ha(-1) for all treatments through 1995, but increased beginning in 1996 for the high biosolids rate. Biosolids increased soil organic C levels by 2 to 5 g kg(-1) and Bray-1 P levels by 300 to 600 mg kg(-1) (0-15 cm depth). Plant tissue Zn increased from 24 to 66 mg kg(-1) at the highest application rate. Nearly all of the DTPA-extractable metals remained in the 0- to 8-cm soil depth.


Assuntos
Monitoramento Ambiental , Eutrofização , Nitrogênio/análise , Poaceae , Eliminação de Resíduos/métodos , Quelantes/química , Conservação dos Recursos Naturais , Ácido Pentético/química , Poluentes do Solo/análise , Distribuição Tecidual
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