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1.
Folia Morphol (Warsz) ; 78(1): 91-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30106463

RESUMO

BACKGROUND: Red grape juice (RGJ) and dark raisins (DR) are rich in polyphenols and antioxidants. This study aimed to assess the efficacy of RGJ and DR in protec- ting the renal tubules against hypercholesteraemic-induced pathological changes. MATERIALS AND METHODS: Forty albino rats divided into four groups (n = 10) were utilised in this study. They included the control, high cholesterol diet (HCD)-fed, HCD+RGJ-fed, and HCD+DR-fed groups. Body weight gain, food and water in- take, blood and insulin levels, lipid profile and kidney functions were assessed at the start of the experiment and after 12 weeks. The right kidney was dissected out and processed for both light and electron microscopic examination. Desmin and cytokeratin antibodies were utilised as histologic markers to assess the integrity of the proximal (PTs) and distal tubules (DTs) of the kidney. RESULTS: Administration of HCD resulted in hypercholesterolaemia in rats as evi- denced by the lipid profile. The PTs of hypercholesteraemic rats appeared dilated with hyaline casts and mitochondria in most of the tubular cells were affected. Immunohistochemical assessment revealed affection of both PTs and DTs. Both RGJ and DR, when administered along with the HCD for 12 weeks, improved the lipid profile, kidney functions as well as the histologic and cellular changes-induced by hypercholesterolaemia in the rats. The effect of raisins was superior to RGJ which might be due to its high contents of fibres and proteins. CONCLUSIONS: This study highlighted the importance of supplementation of red grape and raisins in protection against the harmful effects induced by deposition of fat on the renal tubules' structure and function.


Assuntos
Hipercolesterolemia/complicações , Túbulos Renais/patologia , Vitis , Animais , Antioxidantes/farmacologia , Dieta , Dieta Hiperlipídica/efeitos adversos , Masculino , Ratos , Ratos Wistar
2.
Bone Joint Res ; 7(6): 397-405, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30034793

RESUMO

Objectives: Bone fracture healing is regulated by a series of complex physicochemical and biochemical processes. One of these processes is bone mineralization, which is vital for normal bone development. Phosphatase, orphan 1 (PHOSPHO1), a skeletal tissue-specific phosphatase, has been shown to be involved in the mineralization of the extracellular matrix and to maintain the structural integrity of bone. In this study, we examined how PHOSPHO1 deficiency might affect the healing and quality of fracture callus in mice. Methods: Tibial fractures were created and then stabilized in control wild-type (WT) and Phospho1-/- mice (n = 16 for each group; mixed gender, each group carrying equal number of male and female mice) at eight weeks of age. Fractures were allowed to heal for four weeks and then the mice were euthanized and their tibias analyzed using radiographs, micro-CT (µCT), histology, histomorphometry and three-point bending tests. Results: The µCT and radiographic analyses revealed a mild reduction of bone volume in Phospho1-/- callus, although it was not statistically significant. An increase in trabecular number and a decrease in trabecular thickness and separation were observed in Phospho1-/- callus in comparison with the WT callus. Histomorphometric analyses showed that there was a marked increase of osteoid volume over bone volume in the Phospho1-/- callus. The three-point bending test showed that Phospho1-/- fractured bone had more of an elastic characteristic than the WT bone. Conclusion: Our work suggests that PHOSPHO1 plays an integral role during bone fracture repair and may be a therapeutic target to improve the fracture healing process.Cite this article: M. W. Morcos, H. Al-Jallad, J. Li, C. Farquharson, J. L. Millán, R. C. Hamdy, M. Murshed. PHOSPHO1 is essential for normal bone fracture healing: An Animal Study. Bone Joint Res 2018;7:397-405. DOI: 10.1302/2046-3758.76.BJR-2017-0140.R2.

3.
Gerontol Geriatr Med ; 4: 2333721418777086, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29872665

RESUMO

Visual well-formed hallucinations, fluctuations in the level of cognition, and alertness and extrapyramidal signs are core features of dementia with Lewy bodies. Some patients realize that what they are seeing or hearing are just hallucinations and learn to accept them. Others, however experience these hallucinations as quite real and cannot be dissuaded from the firm belief that they are. In fact, efforts to dissuade them often serve only to confirm the often associated paranoid delusions and this may lead to a catastrophic ending. Hence, it is best not to contradict the patient. Instead, attempts should be made to distract the patient and change the focus of her or his attention. In this case scenario, we present a 68-year-old man who has been diagnosed with dementia with Lewy bodies. He lives with his daughter. He has visual hallucinations and paranoid delusions that worsen at night: He thinks there are people outside the house plotting to kill him. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted.

4.
Gerontol Geriatr Med ; 4: 2333721418777085, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29900187

RESUMO

Driving is a symbol of autonomy and independence, eagerly awaited during adolescence, cherished during adulthood and reluctantly rescinded during old age. It is nevertheless an individual's privilege, not right, especially as driving may affect other drivers and pedestrians on the road. It is therefore not only the individual patient who is at stake but essentially the entire community. In this case scenario, we describe the situation that arose when a patient with multi-infarct dementia wanted to go for a drive and his son and grandson tried to convince him that he could no longer drive. What went wrong in the caregivers/patient interaction is presented. The futility of arguing with patients who have dementia is highlighted as well as the suspiciousness it may generate. Alternate actions that can be useful to avoid/avert the situation from escalating and having a catastrophic ending are discussed. Testing/evaluating patients with dementia for fitness to drive is also reviewed and a list of select resources is included.

5.
Gerontol Geriatr Med ; 4: 2333721418778419, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29900188

RESUMO

Patients with dementia, particularly Alzheimer's disease, may not recognize that their clothes are dirty. They may see the food stains and discoloration of the clothes and yet because of their agnosia are unable to integrate these observations and deduce that their clothes are dirty and need to be changed. They will, therefore, resist attempts to get them to change clothes, especially if these clothes happen to be their favorite ones. This often causes caregivers to become frustrated, especially, if it represents a change in the patient's previous habits of only wearing clean clothes. In this case study, we present a 72-year-old woman with moderate Alzheimer's disease who lives with her daughter, who adamantly refuses to change the clothes she has been wearing for a few days and which are now clearly dirty. We report the interaction, highlight what went wrong in the patient-daughter interaction, and discuss how the catastrophic ending could have been avoided or averted.

6.
Gerontol Geriatr Med ; 4: 2333721418778421, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29900189

RESUMO

Insomnia is a common problem in older people, especially in patients with mild cognitive impairment (MCI) whose circadian rhythm is often compromised. Insomnia exerts such a toll on caregivers that it is frequently the primary reason for seeking to institutionalize their loved ones. Three different types of insomnia are recognized: sleep-onset or initial insomnia, sleep maintenance or middle insomnia, and early morning awakening or late insomnia. Nocturnal hypoglycemia, as a cause of middle insomnia, is the main focus of this case study. Other types of insomnia are also briefly reviewed. The management of insomnia is then discussed including sleep hygiene, the usefulness and potential drawbacks of dietary supplements, nonprescription over-the-counter preparations and prescription hypnotics. Sleep architecture is then briefly reviewed, emphasizing the importance of its integrity and the role of each sleep stage.

7.
Gerontol Geriatr Med ; 4: 2333721417740190, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29468186

RESUMO

Repetitive questioning is a major problem for caregivers, particularly taxing if they are unable to recognize and understand the reasons why their loved one keeps asking the same question over and over again. Caregivers may be tempted to believe that the patient does not even try to remember the answer given or is just getting obnoxious. This is incorrect. Repetitive questioning is due to the underlying disease: The patient's short term memory is impaired and he is unable to register, encode, retain and retrieve the answer. If he is concerned about a particular topic, he will keep asking the same question over and over again. To the patient each time she asks the question, it is as if she asked it for the first time. Just answering repetitive questioning by providing repeatedly the same answer is not sufficient. Caregivers should try to identify the underlying cause for this repetitive questioning. In an earlier case study, the patient was concerned about her and her family's safety and kept asking whether the doors are locked. In this present case study, the patient does not know how to handle the awkward situation he finds himself in. He just does not know what to do. He is not able to adjust to the new unexpected situation. So he repeatedly wants to reassure himself that he is not intruding by asking the same question over and over again. We discuss how the patient's son-in-law could have avoided this situation and averted the catastrophic ending.

8.
Osteoporos Int ; 29(4): 947-952, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29397409

RESUMO

The FRAX algorithm assesses the patient's probability of sustaining an osteoporotic fracture and can be calculated with or without densitometric data. This study seeks to determine whether in men, FRAX scores calculated without BMD, correctly identify patients with BMD-defined osteoporosis. INTRODUCTION: The diagnosis of osteoporosis is based on densitometric data, the presence of a fragility fracture or increased fracture risk. The FRAX algorithm estimates the patient's 10-year probability of sustaining an osteoporotic fracture and can be calculated with or without BMD data. The purpose of this study is to determine whether in men, FRAX calculated without BMD, can correctly identify patients with BMD-defined osteoporosis. METHODS: Retrospectively retrieved data from 726 consecutive Caucasian males, 50 to 70 years old referred to our Osteoporosis Center. RESULTS: In the population studied, 11.8 and 25.3% had BMD-defined osteoporosis when female and male reference populations were used respectively. When the National Osteoporosis Foundation thresholds to initiate treatment are used, only 27% of patients with BMD-defined osteoporosis, but 4% with normal BMD reached/exceeded these thresholds. Lowering the threshold increased sensitivity, but decreased specificity. CONCLUSIONS: Our results suggest that FRAX without BMD is not sensitive/specific enough to be used to identify Caucasian men 50 to 70 years old with BMD-defined osteoporosis.


Assuntos
Densidade Óssea/fisiologia , Osteoporose/diagnóstico , Idoso , Algoritmos , Densitometria , Colo do Fêmur/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoporose/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/prevenção & controle , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos
9.
Gerontol Geriatr Med ; 4: 2333721417738915, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29349099

RESUMO

Repetitive questioning is due to an impaired episodic memory and is a frequent, often presenting, problem in patients with Alzheimer's disease (amnestic type). It is due to the patients' difficulties learning new information, retaining it, and recalling it, and is often aggravated by a poor attention span and easy distractibility. A number of factors may trigger and maintain repetitive questioning. Caregivers should try to identify and address these triggers. In the case discussion presented, it is due to the patient's concerns about her and her family's safety triggered by watching a particularly violent movie aired on TV. What went wrong in the patient/caregiver interaction and how it could have been avoided or averted are explored. Also reviewed are the impact of repetitive questioning, the challenges it raises for caregivers, and some effective intervention strategies that may be useful to diffuse the angst that caregivers experience with repetitive questioning.

10.
Gerontol Geriatr Med ; 4: 2333721418777057, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31799336

RESUMO

Diabetes mellitus is common among older people. Hypoglycemia is a sign of poorly controlled diabetes mellitus and may lead to irritability, agitation, anxiety, hunger, and an excessive food intake, which in turn may make the control of diabetes more difficult. Excessive, inappropriate food intake is also a sign of Fronto-Temporal Dementia (behavioral variant: bvFTD). In this case study, we describe the events leading to an altercation that developed between an older diabetic patient with bvFTD and the staff in an Assisted Living Facility. His first dose of insulin was given early that morning while he was still asleep. He, subsequently, woke up feeling hungry, agitated, and irritable. This, in turn, exacerbated the hyperorality associated with bvFTD. We examine what went wrong in the patient/caregiver interaction and how this potentially catastrophic situation could have been avoided or defused.

11.
Gerontol Geriatr Med ; 3: 2333721417735938, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29242811

RESUMO

Mild cognitive impairment (MCI) is the middle ground between normal, age-appropriate memory impairment, and dementia. Whereas patients with MCI are able to cope with the memory deficit, those with dementia are not: Their memory impairment and other cognitive deficits are of sufficient magnitude to interfere with the patients' ability to cope independently with daily activities. In both MCI and dementia, there is evidence of declining cognitive functions from a previously higher level of functioning. In both the conditions, there is also an evidence of dysfunction in one or more cognitive domains. There are two subtypes of MCI depending on whether memory is predominantly affected: amnestic type and nonamnestic/behavioral type. Not all patients with MCI transition to dementia, some recover. In this case scenario, we present a 68-year-old man with MCI who lives with his wife. They are getting ready to host dinner. His wife asks him to vacuum the dining room while she runs an urgent errand. We describe how this simple task vacuuming a room ended in a catastrophe with the patient spending the night in jail and his wife hospitalized. We discuss what went wrong in the patient/wife interaction and how the catastrophic ending could have been avoided. Objectives: At the end of this case discussion readers will know the following:The differences between mild cognitive impairment (MCI), normal aging, and dementia.MCI is often a precursor of dementia and has an amnestic or nonamnestic/behavioral presentation. However, not all patients with MCI develop dementia, some even recover.MCI is an opportunity to discuss with the patient various issues that may arise, should it progress to dementia such as preparing a will, transitioning from driver to passenger, and addressing various financial and legal issues including end-of-life issues and selecting someone to have power of attorney.Patients with MCI should be regularly followed up to determine whether and when they will transition to dementia as this changes the level of care needed.Patients with MCI are at an increased risk of triggering accidents because of their cognitive impairment and often impaired judgment.It may be hazardous to leave patients with MCI alone, without supervision.The importance of support groups, social media, and cameras when providing care to patients with MCI and dementias.

12.
Gerontol Geriatr Med ; 3: 2333721417721108, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29164172

RESUMO

In this case study, we present a patient with preexistent posttraumatic stress disorder and psychosis who has been recently diagnosed with Dementia with Lewy Bodies. He is experiencing vivid hallucinations. What went wrong between him and his wife as a result of these hallucinations is presented. Alternative actions that could have been used are suggested. Objectives: At the end of this case study, readers will know the following:The characteristic clinical features of Dementia with Lewy Bodies (DLB).Patients experiencing hallucinations should not be contradicted, to them, these hallucinations are real.Easy distractibility and short attention span can be exploited to avert or defuse potentially catastrophic situations.Patients with dementia should not have access to loaded guns.

13.
Heliyon ; 3(11): e00450, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29167826

RESUMO

Several types of serious bone defects would not heal without invasive clinical intervention. One approach to such defects is to enhance the capacity of bone-formation cells. Exogenous bone morphogenetic proteins (BMP) have been utilized to positively regulate matrix mineralization and osteoblastogenesis, however, numerous adverse effects are associated with this approach. Noggin, a potent antagonist of BMPs, is an ideal candidate to target and decrease the need for supraphysiological doses of BMPs. In the current research we report a novel siRNA-mediated gene knock-down strategy to down-regulate Noggin. We utilized a lipid nanoparticle (LNP) delivery strategy in pre-osteoblastic rat cells. In vitro LNP-siRNA treatment caused inconsequential cell toxicity and transfection was achieved in over 85% of cells. Noggin siRNA treatment successfully down-regulated cellular Noggin protein levels and enhanced BMP signal activity which in turn resulted in significantly increased osteoblast differentiation and extracellular matrix mineralization evidenced by histological assessments. Gene expression analysis showed that targeting Noggin specifically in bone cells would not lead to a compensatory effect from other BMP negative regulators such as Gremlin and Chordin. The results from this study support the notion that novel therapeutics targeting Noggin have the clinically relevant potential to enhance bone formation without the need for toxic doses of exogenous BMPs. Such treatments will undeniably provide safe and economical treatments for individuals whose poor bone repair results in permanent morbidity and disability.

14.
Gerontol Geriatr Med ; 3: 2333721417734684, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29051913

RESUMO

Patients with dementia, especially Alzheimer's disease and particularly those in early stages, are susceptible to become victims of predators: Their agnosia (see Case 1) prevents them from detecting and accurately interpreting subtle signals that otherwise would have alerted them that they are about to fall for a scam. Furthermore, their judgment is impaired very early in the disease process, often before other symptoms manifest themselves and usually before a diagnosis is made. Patients with early stages of dementia are therefore prime targets for unscrupulous predators, and it behooves caregivers and health care professionals to ensure the integrity of these patients. In this case study, we discuss how a man with mild Alzheimer's disease was about to fall for a scam were it not for his vigilant wife. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted.

15.
Gerontol Geriatr Med ; 3: 2333721417720585, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28904992

RESUMO

Choices are often difficult to make by patients with Alzheimer Dementia. They often become acutely confused when faced with too many options because they are not able to retain in their working memory enough information about the various individual choices available. In this case study, we describe how an essentially simple benign task (choosing a dress to wear) can rapidly escalate and result in a catastrophic outcome. We examine what went wrong in the patient/caregiver interaction and how that potentially catastrophic situation could have been avoided or defused.

16.
Int J Oral Maxillofac Surg ; 46(9): 1178-1187, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28476313

RESUMO

Maxillary sinus pneumatization limits implant placement in the edentulous posterior maxilla. Grafted sinus floor augmentation through Schneiderian membrane elevation and space obliteration with autogenous bone grafts, bone substitutes, or a combination of the two has often been used to resolve this problem. More recently, non-grafted sinus floor elevation has been established. This is based on the concept of membrane elevation and support either by tenting technique or using space-maintaining mesh. The aim of this study was to evaluate the predictability of new bone formation after sinus floor elevation using space-maintaining mesh without graft material and to illustrate the difference between the use of bioresorbable and titanium meshes. Eight patients with bilateral sinus pneumatization were selected for implant placement in the edentulous posterior maxilla. Pneumatized sinuses were approached through the lateral window technique; these were elevated and maintained with resorbable or titanium meshes. All patients were evaluated clinically and radiographically immediately and at 6 months postoperative. At 6 months, a core bone biopsy was obtained from the planned implant position using a trephine drill, and the bone formed was examined histologically. Healing was uneventful in all patients, and radiographic, clinical, and histological evidence of new bone formation was seen in both groups. Titanium and resorbable meshes were found to be reliable and predictable as space-maintaining devices.


Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis/farmacologia , Levantamento do Assoalho do Seio Maxilar/instrumentação , Telas Cirúrgicas , Titânio/farmacologia , Adulto , Regeneração Óssea/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Panorâmica , Resultado do Tratamento
18.
J Musculoskelet Neuronal Interact ; 14(1): 124-30, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24583547

RESUMO

Distraction osteogenesis (DO) is a successful technique for bone lengthening, but one problem is the need to keep an external fixator in place until bone completely regenerates. We hypothesized that the systemic administration of sclerostin antibodies (Scl-Ab) can accelerate bone regeneration in a mouse model of DO. A total of 110 mice were randomized to receive one intravenous injection per week of either Scl-Ab (100 mg per kg body weight) or saline after DO surgery. Mice were sacrificed on day 11, 17, 34 or 51 post-surgery. Microcomputed tomography showed that bone volume per tissue volume of the Scl-Ab treated group was significantly higher on day 11 (P=0.009). Histological examinations indicated that chondrocytes and fibrocartilage predominated in the Scl-Ab group at day 11. The radiographic score of bone healing was also higher in Scl-Ab treated animals at day 11. There was a trend towards higher ultimate force and work to failure in Scl-Ab treated groups on day 34 and 51 (P>0.05). These data suggest the potential utility of Scl-Ab to reduce the time during DO when an external fixator is required.


Assuntos
Anticorpos/farmacologia , Regeneração Óssea/efeitos dos fármacos , Glicoproteínas/antagonistas & inibidores , Osteogênese por Distração/métodos , Proteínas Adaptadoras de Transdução de Sinal , Animais , Modelos Animais de Doenças , Peptídeos e Proteínas de Sinalização Intercelular , Masculino , Camundongos
19.
J Sports Med Phys Fitness ; 49(4): 464-73, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20087308

RESUMO

AIM: Bone changes in size and density in response to different levels of stress. Alterations to bone mineral density (BMD) appear to occur in a site specific manner. Even though BMD has been examined in many populations there is a paucity of data looking at strength-power athletes, such as throwers. Therefore, the purpose of this study was to examine the BMD of a group of USA Division I collegiate throwers (e.g. shot put, discus, etc.). METHODS: Seven throwers (4 males; 3 females) who were 19.0 + or - 0.9 years had their BMD compared to an age matched control group (n = 14; 8 women and 6 men) and normative data. BMD was measured with dual X-ray absorptometry. Potential right/left side and sex difference in BMD were also examined. Maximal isometric strength was assessed using a mid-thigh pull while standing on a forceplate which generated force-time curves. Peak force (PF) and normalized peak force (PFa) were then correlated with BMDs. RESULTS: Generally, throwers had denser bones with male throwers tending to have a greater total BMD (P < or = 0.05). The dominant arm BMD was slightly greater when compared to non-dominant arm (P < or = 0.05). Furthermore, total body BMD was related to PF (r = 0.68, r(2) = 0.46) and PFa (r = 0.56, r(2) = 0.31). CONCLUSIONS: Throwers have greater BMDs than non-athletes and most other athletes. However, throwers only showed a small indication of sidedness. It is likely that the BMDs observed in this study stem from the training intervention (e.g. whole body heavy lifting) undertaken by this population.


Assuntos
Densidade Óssea/fisiologia , Contração Isométrica/fisiologia , Força Muscular/fisiologia , Atletismo/fisiologia , Absorciometria de Fóton , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Músculo Esquelético/fisiologia , Comportamento Sedentário , Estatística como Assunto , Adulto Jovem
20.
J AOAC Int ; 92(6): 1815-20, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20166600

RESUMO

A sensitive and selective indirect competitive ELISA was developed for the detection of deltamethrin bound residues on cotton texture. Cross-reactivity studies with the main deltamethrin photodegradation products showed high specificity of deltamethrin polyclonal antibody to the parent compound. No cross-reactivity was measured with deltamethrin photodegradtion products derived from the alcohol moiety (3-phenoxybenzaldhyde, phenoxybenzyl alcohol, cyanohydrin, and 3-phenoxybenzoic acid), and lesser amounts were observed with the acid moiety (deltamethric acid). The dot-blot immunoassay was performed on cotton fabric discs spiked with deltamethrin and irradiated to assess the suitability of this system to detect bound residue. The dot-blot immunoassay results revealed that the bound form of deltamethrin has binding affinity with deltamethrin antibody similar to the parent compound. In addition, the test system was used to detect bound and free residues of deltamethrin on cotton samples exposed to three cycles of simulated sunlight and water wash. The results obtained suggest that the competitive ELISA format can be used as a tool for monitoring free and bound residues of deltamethrin impregnated on cotton targets.


Assuntos
Fibra de Algodão , Inseticidas/análise , Nitrilas/análise , Resíduos de Praguicidas/análise , Piretrinas/análise , Têxteis/análise , Especificidade de Anticorpos , Reações Cruzadas , Ensaio de Imunoadsorção Enzimática , Lavanderia , Fotoquímica , Padrões de Referência , Têxteis/efeitos da radiação , Raios Ultravioleta , Água/análise
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