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1.
Hand (N Y) ; : 15589447211065075, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996302

RESUMO

Background: Enhanced Recovery After Surgery (ERAS) is a standardized approach to care of the surgical patient. Postoperative patient instructions, an aspect of ERAS protocols, are difficult to standardize in hand surgery because of the diversity of procedures. The aim of this study was to determine the effect of standardized hand surgery postoperative instructions on the number of unscheduled postoperative patient encounters. Methods: The study was an institutional review board-approved prospective cohort in which all hand surgery patients from 6 surgeons at a single, hospital-based academic institution were included. For a 6-month period, both before and after establishing a standardized postoperative instructional handout, data were collected on unscheduled postoperative encounters within 14 days of surgery. Results: There were 330 patients in the control group versus 282 who received standardized postoperative instructions. Trauma comprised 24.6% of cases in comparison to 75.4% elective. Individual surgeons did not significantly influence whether patients had an encounter. Overall, patients who received standardized instructions were just as likely as the control group to have unscheduled encounters (41.5% vs 43.9%, respectively). Notably, elective patients were significantly more likely to have encounters (46%) versus trauma patients (33.1%; P = .007); however, the standardized instructions did not influence the number of encounters for either group. Conclusions: This study did not demonstrate a difference in unscheduled postoperative encounters after initiation of standardized postoperative instructions for hand surgery patients. These findings may help providers save time and resources by tailoring the use of ERAS in this distinct patient population.

2.
Clin Plast Surg ; 49(1): 191-195, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782136

RESUMO

Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplasty plastic surgeon.


Assuntos
Rinoplastia , Humanos , Isquemia , Nariz/cirurgia
3.
Clin Plast Surg ; 49(1): 71-79, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782141
4.
AIDS Behav ; 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34783938

RESUMO

Suppressing HIV viral loads to undetectable levels is essential for ending the HIV/AIDS epidemic. We evaluated randomized controlled trials aimed to increase antiretroviral medication adherence and promote undetectable viral loads among people living with HIV through November 22, 2019. We extracted data from 51 eligible interventions and analyzed the results using random effects models to compare intervention effects between groups within each intervention and across interventions. We also evaluated the relation between publication date and treatment effects. Only five interventions increased undetectable viral loads significantly. As a whole, the analyzed interventions were superior to Standard of Care in promoting undetectable viral loads. Interventions published more recently were not more effective in promoting undetectable viral loads. No treatment category consistently produced significant increases in undetectable viral loads. To end the HIV/AIDS epidemic, we should use interventions that can suppress HIV viral loads to undetectable levels.

5.
Drug Alcohol Depend ; 226: 108907, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34311206

RESUMO

BACKGROUND: Unemployment is a common problem among adults who have substance use disorder that often persists during treatment and recovery. We identified patient characteristics that were associated with obtaining employment among unemployed adults in opioid use disorder treatment. METHODS: This analysis used data from participants (N = 91) who were enrolled in a randomized controlled trial evaluating the effectiveness of a therapeutic workplace in promoting drug abstinence and employment. After a 3-month training period (Phase 1), participants were randomly assigned to a study group and could work for 12 months with an employment specialist who assisted participants in obtaining employment (Phase 2). A logistic regression model was used to identify patient characteristics that were associated with obtaining employment. RESULTS: Of the 91 participants, 39 (42.9 %) obtained employment. Compared to participants who did not obtain employment, participants who obtained employment worked more days in the therapeutic workplace during the training period (Phase 1) [OR (95 % CI) = 1.072 (1.015-1.132), p = .014], provided more opiate- and cocaine-negative urine samples while seeking employment [OR (95 % CI) = 1.015 (1.002-1.027), p = .025], and reported not usually being unemployed at study intake [OR (95 % CI) = 0.229 (0.080-0.652), p = .007]. CONCLUSIONS: Our analyses suggest that among unemployed adults in opioid use disorder treatment, those with the lowest rates of therapeutic workplace attendance, lowest rates of drug abstinence while seeking employment, and relatively long histories of unemployment are the least likely to obtain employment. These relations are potentially addressable at a practical level, and future research could build on these findings to improve the effectiveness of employment-based interventions.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Local de Trabalho , Adulto , Analgésicos Opioides/uso terapêutico , Emprego , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Desemprego
6.
Psychol Addict Behav ; 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34323526

RESUMO

OBJECTIVE: To evaluate the feasibility and potential efficacy of a technology-assisted education program in teaching adults at a high risk of opioid overdose about opioids; opioid overdose; and opioid use disorder medications. METHOD: A within-subject, repeated-measures design was used to evaluate effects of the novel technology-assisted education program. Participants (N = 40) were out-of-treatment adults with opioid use disorder, recruited in Baltimore, Maryland from May 2019 to January 2020. The education program was self-paced and contained three courses. Each course presented information and required answers to multiple-choice questions. The education program was evaluated using a 50-item test, delivered before and after participants completed each course. Tests were divided into three subtests that contained questions from each course. We measured accuracy on each subtest before and after completion of each course and used a mixed-effects model to analyze changes in accuracy across tests. RESULTS: The technology-assisted education program required a median time of 91 min of activity to complete. Most participants completed the program in a single day. Accuracy on each subtest increased only after completion of the course that corresponded to that subtest, and learning comparisons were significant at the p < .001 level for all subtests. Accuracy on each subtest was unchanged before completion of the relevant course, and increases in accuracy were retained across subsequent tests. Learning occurred similarly independent of participant education, employment, and poverty. CONCLUSIONS: Technology-assisted education programs can provide at-risk adults with access to effective education on opioids, opioid overdose, and opioid use disorder medications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

7.
Drug Alcohol Depend ; 225: 108786, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34087746

RESUMO

BACKGROUND: Opioid overdose remains a leading cause of death. Office-based buprenorphine could expand access to treatment to the many opioid users who are not in treatment and who are at risk for opioid overdose. However, many people in need of buprenorphine treatment do not enroll in treatment. This randomized pilot trial evaluated efficacy of a remotely delivered incentive intervention in promoting engagement in buprenorphine treatment in out-of-treatment adults with opioid use disorder. METHODS: Participants (N = 41) were offered referrals to buprenorphine treatment and randomly assigned to Control or Incentive groups for 6 months. Incentive participants were offered incentives for enrolling in buprenorphine treatment, verified by providing documentation showing that they received a buprenorphine prescription, and providing videos taking daily buprenorphine doses. Participants used a smartphone application to record and submit a video of their buprenorphine prescription and daily buprenorphine administration. Incentive earnings were added remotely to reloadable credit cards. RESULTS: Incentive participants were significantly more likely to enroll in treatment compared to control participants (71.4 % versus 30.0 % of participants; OR [95 % CI]: 6.24 [1.46-26.72], p = .014). Few participants in either group adhered to buprenorphine treatment, and the two groups continued to use opioids, including fentanyl at high and comparable rates. The two groups did not differ in the percentage of urine samples that were positive for buprenorphine, opiates, fentanyl, or methadone at monthly assessments conducted during the 6-month intervention. CONCLUSIONS: Remotely delivered incentives can connect out-of-treatment adults with opioid use disorder to treatment, but additional supports are needed to promote buprenorphine adherence.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Adulto , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Humanos , Metadona/uso terapêutico , Motivação , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
8.
Plast Reconstr Surg Glob Open ; 8(3): e2668, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32537332

RESUMO

Immediate fat grafting to the pedicled myocutaneous latissimus dorsi (LD) flap has recently gained in popularity as a means to supplement volume for breast reconstruction. The aim of this study is to compare complication rates of the immediately fat-grafted LD to free tissue transfer in the obese population. Methods: In this retrospective cohort, 82 patients (149 breasts) from 2015 to 2019 were included. Patients underwent either unilateral or bilateral breast reconstruction with either LD with immediate fat grafting or abdominal-based free tissue transfer. Included patients had a body mass index ≥ 30 kg/m2 at the time of surgery. Complication data were recorded as minor, major, and medical complications. Procedure characteristics and postoperative data were also studied. Results: Minor complication rates between the LD with immediate fat grafting and free tissue transfer cases were similar (26.9% versus 26%, respectively). The free tissue transfer group had a significantly higher rate of major complications (20.3% versus 3.8%; P = 0.048) and medical complications (10.6% versus zero). Finally, the LD with immediate fat grafting group had significantly shorter operating room times, hospital length of stay, and fewer donor-site revisions. Conclusions: LD with immediate fat grafting offers the benefit of a totally autologous reconstruction without the risks of abdominal-based microvascular free tissue transfer or an implant. Favorable complication rates, shorter operative times, and shorter hospital length of stay make this reconstructive option a safe alternative to free tissue transfer in the obese population.

9.
Behav Anal Pract ; 13(1): 11-21, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32231963

RESUMO

Privacy has been identified as a primary concern among stakeholders (i.e., service recipients, advocates, administrators, family) when using technology to provide residential services to individuals in need. This paper summarizes a study that distributed a survey to agencies that provide services (e.g., clinical, recreational) and resources (e.g., advocacy groups) to people with various types of disabilities (e.g., physical, sensory, intellectual, developmental) across the United States. The results led to several recommendations about how smart-home service providers can use technology in a way that promotes client privacy. In addition, we make several suggestions for how remote staff (i.e., individuals monitoring the information gathered by technology) can assist in the process of ensuring client privacy.

10.
J Appl Behav Anal ; 53(1): 449-464, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301072

RESUMO

This experiment used a pyramidal training model to evaluate the effects of behavioral skills training (BST), delivered in a 1-time group-training format, on the extent to which 25 human service staff implemented BST when training others how to implement behavioral procedures. Results indicated that (a) the training workshop increased BST integrity to mastery levels for the majority of participants with varying levels of education, organizational positions, and training experience, (b) the training effects generalized to teaching an untrained skill, and (c) high levels of BST integrity maintained at follow-up 4 to 6 weeks after training for all 3 participants with whom probes were conducted. Moreover, participants indicated high levels of satisfaction with both the training workshop and BST as a training procedure.


Assuntos
Capacitação em Serviço , Capacitação de Professores , Adulto , Feminino , Processos Grupais , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Adulto Jovem
11.
J Exp Anal Behav ; 113(1): 172-186, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858608

RESUMO

Organizational settings are replete with changing stimulus contexts and contingencies, which makes relapse a particularly relevant framework for understanding the ways in which controlling stimuli influence employee responding. The purpose of the current study was to develop a translational model to assess renewal of desirable behavior in a simulated workplace with neurotypical adults. Experiment 1 assessed renewal of desirable behavior using a computerized check processing task. Experiment 2 extended the findings and the translational utility of the experimental arrangement to implementation of a behavior-analytic teaching procedure. Results across both experiments demonstrated renewal of desirable behavior. Overall, the current methodology and findings extend the human operant literature on renewal and demonstrate a translational model that brings together operant renewal and organizational behavior management.


Assuntos
Condicionamento Operante , Modelos Psicológicos , Local de Trabalho/psicologia , Adolescente , Extinção Psicológica , Feminino , Humanos , Masculino , Reforço Psicológico , Adulto Jovem
12.
J Appl Behav Anal ; 52(4): 1021-1033, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31642524

RESUMO

Autism spectrum disorder (ASD) is marked by deficits in social communication and the presence of restrictive and/or repetitive behaviors or interests. Motor stereotypy is a form of repetitive behavior that is common in ASD. Response Interruption and Redirection (RIRD) and response blocking (RB) are two interventions found to be efficacious in reducing motor stereotypy. However, the current literature presents with inconsistencies regarding the relative efficacy of these two procedures. Thus, we sought to replicate and extend previous literature by evaluating the efficacy of both interventions on reducing motor stereotypy among 3 individuals with ASD. We also sought to evaluate how variations in data analysis affected the interpretation of treatment outcomes. Results indicated that both interventions were equally efficacious at reducing stereotypy when analyzing data exclusive of treatment-implementation time. However, when analyzing total session time data, RB produced greater and more sustained reductions in stereotypy across all participants. These results emphasize the importance of data analysis decision-making in evaluating intervention outcomes.


Assuntos
Transtorno do Espectro Autista/complicações , Terapia Comportamental/métodos , Comportamento Estereotipado/efeitos da radiação , Transtorno de Movimento Estereotipado/terapia , Atenção , Criança , Humanos , Masculino , Reforço Psicológico , Comportamento Estereotipado/fisiologia , Transtorno de Movimento Estereotipado/etiologia , Resultado do Tratamento , Adulto Jovem
13.
Cardiovasc Revasc Med ; 20(1): 29-37, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30757995

RESUMO

BACKGROUND: The optimal preventive strategy for contrast induced acute kidney injury (CIAKI) in patients undergoing cardiac catheterization remains uncertain. OBJECTIVE: We conducted Bayesian network meta-analysis (NMA) to compare different preventive strategies for CIAKI in these cohorts. METHODS: Forty-nine randomized controlled trials were extracted using MEDLINE, EMBASE and CENTRAL data bases (inception-1st December 2017). We calculated median of the odds ratio (OR) with the corresponding 95% credible interval (CrI). The ranking probability of each treatment was based on SUCRA (surface under the cumulative ranking curve). RESULTS: In NMA of 28,063 patients [normal saline (NS: 9716 patients), sodium bicarbonate (NaHCO3: 4484 patients), statin (2542 patients), N-acetylcysteine (NAC: 3006 patients), NAC + NaHCO3 (774 patients), NS + NAC (3807 patients), NS + NaHCO3 (135 patients) and placebo (3599 patients)], statins reduced the relative risk of CIAKI compared with NS (OR: 0.50; 95% CrI, 0.25-0.99), and placebo (OR: 0.44; 95% CrI, 0.24-0.83). Subgroup analyses showed that in patients receiving low osmolar contrast, statins reduced the relative risk of CIAKI by 58% versus NS, and 51% versus placebo. There were no significant differences across all the treatments in terms of risk of hemodialysis or all-cause mortality. Statins had the highest probability for reducing the risk of CIAKI (SUCRA, 0.86), risk of hemodialysis (SUCRA, 0.88) and all-cause mortality (SUCRA, 0.81). CONCLUSION: Statins were the superior preventive strategy for reducing the risk of CIAKI compared with NS alone and placebo.


Assuntos
Injúria Renal Aguda/prevenção & controle , Cateterismo Cardíaco/efeitos adversos , Meios de Contraste/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Acetilcisteína/uso terapêutico , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Idoso , Teorema de Bayes , Cateterismo Cardíaco/mortalidade , Meios de Contraste/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal , Medição de Risco , Fatores de Risco , Bicarbonato de Sódio/uso terapêutico
14.
Perspect Behav Sci ; 42(4): 955-972, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31976469

RESUMO

The science of behavior has effectively addressed many areas of social importance, including the performance management of staff working in human-service settings. Evidence-based performance management entails initial preservice training and ongoing staff support. Initial training reflects a critical first training component and is necessary for staff to work independently within an organization. However, investment in staff must not end once preservice training is complete. Ongoing staff support should follow preservice training and involves continued coaching and feedback. The purpose of this article is to bridge the research-to-practice gap by outlining research-supported initial training and ongoing staff support procedures within human-serving settings, presenting practice guidelines, and sharing information about easy-to-implement ways practitioners may stay abreast of current research.

15.
Cureus ; 10(8): e3150, 2018 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30345206

RESUMO

Steroid is usually indicated in patients with post-streptococcal glomerulonephritis (PSGN) with more than 30% crescents on renal biopsy. The role of steroids in patients without crescentic glomerulonephritis is not clear. We present a 19-year-old male patient who was diagnosed with PSGN three weeks after a sore throat infection. He developed acute renal and respiratory failure requiring hemodialysis and mechanical ventilation. The renal biopsy confirmed PSGN, but did not show severe histological features such as crescents formation. Due to lack of clinical improvement, trials of pulse dose methylprednisolone were initiated with prompt improvement in renal and respiratory function. Our case suggested the potential role of high dose steroids in select patients of PSGN with progressive renal failure, development of multi-organ system deterioration, and failed conservative management irrespective of histological findings.

16.
Cureus ; 10(1): e2020, 2018 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-29531873

RESUMO

A 65-year-old man, with a history of hypertension and hyperlipidemia, presented with intractable lower back pain, shortness of breath, and decreasing urine output at the emergency room and was admitted after he was found to have elevated creatinine kinase levels of greater than 160,000 U/L. We discontinued all his home medications, which included atorvastatin and amlodipine. We trended his creatine phosphokinase (CPK) level daily and noticed it decreasing significantly off these meds. We hydrated him with normal saline and monitored his kidney functions. By the time he was ready for discharge, his CPK levels were back to normal. This case report summarizes the drug-drug interactions of atorvastatin and amlodipine.

17.
Am J Emerg Med ; 36(6): 983-987, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29122373

RESUMO

INTRODUCTION: At many mass gathering events (MGEs), emergency medical services decrease the number of patient transfers to the hospital; however, little information is known regarding the characteristics of attendees presenting to or requiring transfer to the emergency department (ED). The purpose of this study is to describe the characteristics of patients presenting from MGEs to the ED. A secondary aim of this study is to describe ED resources utilized by these patients. METHODS: This was a single-center, retrospective review evaluating patients attending MGEs who presented to the ED. Electronic medical records of patients seen in the ED of a tertiary academic medical center between October 13, 2013 and December 31, 2015 were reviewed and a descriptive analysis performed. RESULTS: We reviewed and included 209 patients. The majority of patients presenting to the ED were from large outdoor concerts (n=186, 89%), young (median age 20years), single (n=156, 87%) and had no past medical history (n=114, 63%). Alcohol use was reported in a majority (n=140, 78%) and polysubstance use in over a quarter of patients (n=55, 31%). The most frequently administered medications were intravenous fluids (n=94, 52%) and antiemetics (n=59, 33%). The majority of patients (n=161, 89%) were discharged directly from the ED, and median length of stay in the ED was 3.3h [IQR 2.3 to 5.3]. CONCLUSION: Patients presenting to the ED from MGEs generally required minimal medical care beyond supportive management with low rates of hospital admission. Further controlled studies are needed to confirm these findings.


Assuntos
Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Incidentes com Feridos em Massa/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Illinois , Masculino , Estudos Retrospectivos , Adulto Jovem
18.
J Appl Behav Anal ; 48(4): 860-4, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26373351

RESUMO

The current study replicated and extended previous research on the use of a rapid assessment to identify effective arm-splint rigidity with 2 participants who had been diagnosed with autism and who engaged in self-injurious behavior (SIB). We varied rigidity levels within a multielement design across several adaptive tasks and identified the most effective rigidity level in terms of reductions in SIB and levels of compliance.


Assuntos
Adaptação Psicológica/fisiologia , Braço , Terapia Comportamental/métodos , Comportamento Autodestrutivo/reabilitação , Contenções , Adolescente , Transtorno Autístico/complicações , Criança , Humanos , Masculino , Comportamento Autodestrutivo/etiologia , Resultado do Tratamento
19.
J Diabetes Sci Technol ; 9(5): 993-8, 2015 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-26134832

RESUMO

For implantable sensors to become a more viable option for continuous glucose monitoring strategies, they must be able to persist in vivo for periods longer than the 3- to 7-day window that is the current industry standard. Recent studies have attributed such limited performance to tissue reactions resulting from implantation. While in vivo biocompatibility studies have provided much in the way of understanding histology surrounding an implanted sensor, little is known about how each constituent of the foreign body response affects sensor function. Due to the ordered composition and geometry of implant-associated tissue reactions, their effects on sensor function may be computationally modeled and analyzed in a way that would be prohibitive using in vivo studies. This review both explains how physiologically accurate computational models of implant-associated tissue reaction can be designed and shows how they have been utilized thus far. Going forward, these in silico models of implanted sensor behavior may soon complement in vivo studies to provide valuable information for improved sensor designs.


Assuntos
Técnicas Biossensoriais/instrumentação , Glicemia/análise , Próteses e Implantes/efeitos adversos , Técnicas Biossensoriais/métodos , Reação a Corpo Estranho/etiologia , Humanos , Sistemas de Infusão de Insulina , Modelos Teóricos
20.
Biomaterials ; 35(36): 9563-72, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25175597

RESUMO

The erroneous and unpredictable behavior of percutaneous glucose sensors just days following implantation has limited their clinical utility for diabetes management. Recent research has implicated the presence of adherent inflammatory cells as the key mitigating factor limiting sensor functionality in this period of days post-implantation. Here we present a novel in vitro platform to mimic the cell-embedded provisional matrix that forms adjacent to the sensor immediately after implantation for the focused investigation of the effects of early stage tissue response on sensor function. This biomimetic surrogate is formed by imbibing fibrin-based gels with physiological densities of inflammatory RAW 264.7 macrophages. When surrounding functional sensors, macrophage-embedded fibrin gels contribute to sensor signal declines that are similar in both shape and magnitude to those observed in previous whole blood and small animal studies. Signal decline in the presence of gels is both metabolically-mediated and sensitive to cell type and activation. Computational modeling of the experimental setup is also presented to validate the design by showing that the cellular glucose uptake parameters necessary to achieve such experimental declines align well with literature values. Together, these data suggest this in vitro provisional matrix surrogate may serve as an effective screening tool for testing the biocompatibility of future glucose sensor designs.


Assuntos
Técnicas Biossensoriais , Glicemia/análise , Fibrina/química , Géis/química , Inflamação/etiologia , Macrófagos/imunologia , Próteses e Implantes/efeitos adversos , Células 3T3 , Animais , Materiais Biocompatíveis/química , Técnicas Biossensoriais/instrumentação , Linhagem Celular , Células Imobilizadas/citologia , Células Imobilizadas/imunologia , Inflamação/imunologia , Macrófagos/citologia , Camundongos
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