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1.
Circulation ; 149(21): 1650-1666, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38344825

RESUMO

BACKGROUND: Much of our knowledge of organ rejection after transplantation is derived from rodent models. METHODS: We used single-nucleus RNA sequencing to investigate the inflammatory myocardial microenvironment in human pediatric cardiac allografts at different stages after transplantation. We distinguished donor- from recipient-derived cells using naturally occurring genetic variants embedded in single-nucleus RNA sequencing data. RESULTS: Donor-derived tissue resident macrophages, which accompany the allograft into the recipient, are lost over time after transplantation. In contrast, monocyte-derived macrophages from the recipient populate the heart within days after transplantation and form 2 macrophage populations: recipient MP1 and recipient MP2. Recipient MP2s have cell signatures similar to donor-derived resident macrophages; however, they lack signatures of pro-reparative phagocytic activity typical of donor-derived resident macrophages and instead express profibrotic genes. In contrast, recipient MP1s express genes consistent with hallmarks of cellular rejection. Our data suggest that recipient MP1s activate a subset of natural killer cells, turning them into a cytotoxic cell population through feed-forward signaling between recipient MP1s and natural killer cells. CONCLUSIONS: Our findings reveal an imbalance of donor-derived and recipient-derived macrophages in the pediatric cardiac allograft that contributes to allograft failure.


Assuntos
Aloenxertos , Rejeição de Enxerto , Transplante de Coração , Macrófagos , Humanos , Transplante de Coração/efeitos adversos , Macrófagos/metabolismo , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/genética , Masculino , Feminino , Criança , Pré-Escolar , Miocárdio/patologia , Sobrevivência de Enxerto , Lactente , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Adolescente
2.
Circulation ; 146(22): 1694-1711, 2022 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-36317529

RESUMO

BACKGROUND: The sinoatrial node (SAN) functions as the pacemaker of the heart, initiating rhythmic heartbeats. Despite its importance, the SAN is one of the most poorly understood cardiac entities because of its small size and complex composition and function. The Hippo signaling pathway is a molecular signaling pathway fundamental to heart development and regeneration. Although abnormalities of the Hippo pathway are associated with cardiac arrhythmias in human patients, the role of this pathway in the SAN is unknown. METHODS: We investigated key regulators of the Hippo pathway in SAN pacemaker cells by conditionally inactivating the Hippo signaling kinases Lats1 and Lats2 using the tamoxifen-inducible, cardiac conduction system-specific Cre driver Hcn4CreERT2 with Lats1 and Lats2 conditional knockout alleles. In addition, the Hippo-signaling effectors Yap and Taz were conditionally inactivated in the SAN. To determine the function of Hippo signaling in the SAN and other cardiac conduction system components, we conducted a series of physiological and molecular experiments, including telemetry ECG recording, echocardiography, Masson Trichrome staining, calcium imaging, immunostaining, RNAscope, cleavage under targets and tagmentation sequencing using antibodies against Yap1 or H3K4me3, quantitative real-time polymerase chain reaction, and Western blotting. We also performed comprehensive bioinformatics analyses of various datasets. RESULTS: We found that Lats1/2 inactivation caused severe sinus node dysfunction. Compared with the controls, Lats1/2 conditional knockout mutants exhibited dysregulated calcium handling and increased fibrosis in the SAN, indicating that Lats1/2 function through both cell-autonomous and non-cell-autonomous mechanisms. It is notable that the Lats1/2 conditional knockout phenotype was rescued by genetic deletion of Yap and Taz in the cardiac conduction system. These rescued mice had normal sinus rhythm and reduced fibrosis of the SAN, indicating that Lats1/2 function through Yap and Taz. Cleavage Under Targets and Tagmentation sequencing data showed that Yap potentially regulates genes critical for calcium homeostasis such as Ryr2 and genes encoding paracrine factors important in intercellular communication and fibrosis induction such as Tgfb1 and Tgfb3. Consistent with this, Lats1/2 conditional knockout mutants had decreased Ryr2 expression and increased Tgfb1 and Tgfb3 expression compared with control mice. CONCLUSIONS: We reveal, for the first time to our knowledge, that the canonical Hippo-Yap pathway plays a pivotal role in maintaining SAN homeostasis.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal , Proteínas de Ciclo Celular , Humanos , Camundongos , Animais , Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Proteínas de Ciclo Celular/metabolismo , Fator de Crescimento Transformador beta3/metabolismo , Fosfoproteínas/genética , Fosfoproteínas/metabolismo , Nó Sinoatrial/metabolismo , Cálcio/metabolismo , Canal de Liberação de Cálcio do Receptor de Rianodina , Proteínas Serina-Treonina Quinases/genética , Homeostase , Fibrose , Proliferação de Células , Proteínas Supressoras de Tumor
3.
Phys Rev Lett ; 130(5): 051803, 2023 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-36800477

RESUMO

The COHERENT Collaboration searched for scalar dark matter particles produced at the Spallation Neutron Source with masses between 1 and 220 MeV/c^{2} using a CsI[Na] scintillation detector sensitive to nuclear recoils above 9 keV_{nr}. No evidence for dark matter is found and we thus place limits on allowed parameter space. With this low-threshold detector, we are sensitive to coherent elastic scattering between dark matter and nuclei. The cross section for this process is orders of magnitude higher than for other processes historically used for accelerator-based direct-detection searches so that our small, 14.6 kg detector significantly improves on past constraints. At peak sensitivity, we reject the flux consistent with the cosmologically observed dark-matter concentration for all coupling constants α_{D}<0.64, assuming a scalar dark-matter particle. We also calculate the sensitivity of future COHERENT detectors to dark-matter signals which will ambitiously test multiple dark-matter spin scenarios.

4.
J Org Chem ; 84(14): 9196-9214, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31264876

RESUMO

The development of a π-stacking-based approach for increased stereoselectivity in Sharpless asymmetric and diastereomeric dihydroxylation of cis-enynes is disclosed. The use of neighboring, electron-rich benzoate esters proved key to the success of this process. Density functional theory study suggests that the substrate benzoate ester group rigidifies the dihydroxylation transition states by forming a favorable π-stacking interaction in both Major-TS and Minor-TS. The energetic preference for the Major-TS was found in part because of the favorable eclipsing conformation of the alkene substituent as opposed to the disfavored bisecting conformation found in the Minor-TS. The application to a second-generation synthesis of the C15-C24 northern portion of mandelalide A is demonstrated.

5.
Angew Chem Int Ed Engl ; 58(3): 681-694, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30378226

RESUMO

This Minireview is focused on an in-depth discussion of comparative strategies to construct the gelsemine and gelsedine classes of the gelsemium alkaloids. This document highlights the diversity of strategies used to access specific motifs found within these targets: a) the fused "[3.2.1]bicycle" (in gelsemine) and "oxabicycle" (in gelsedine class); b) the "piroxindole" moiety with C7 quaternary center; c) the "N-heterocycles" and d) the "THP" moiety with C20 quaternary center (in gelsemine).


Assuntos
Alcaloides/síntese química , Técnicas de Química Sintética/métodos , Gelsemium/química , Oxindóis/síntese química , Compostos Policíclicos/síntese química , Alcaloides/química , Produtos Biológicos/síntese química , Produtos Biológicos/química , Compostos Bicíclicos com Pontes/síntese química , Compostos Bicíclicos com Pontes/química , Oxindóis/química , Compostos Policíclicos/química
6.
Angew Chem Int Ed Engl ; 57(29): 9117-9121, 2018 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-29920904

RESUMO

The efficient, 12-14 step (LLS) total synthesis of (-)-halenaquinone has been achieved. Key steps in the synthetic sequence include: (a) proline sulfonamide-catalyzed, Yamada-Otani reaction to establish the C6 all-carbon quaternary stereocenter, (b) multiple, novel palladium-mediated oxidative cyclizations to introduce the furan moiety, and (c) oxidative Bergman cyclization to form the final quinone ring.

7.
J Am Chem Soc ; 139(37): 13031-13037, 2017 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-28823162

RESUMO

We report that crystalline 3,4,9,10-perylenetetracarboxylic dianhydride (PTCDA), an organic solid, is highly amenable to host divalent metal ions, i.e., Mg2+ and Ca2+, in aqueous electrolytes, where the van der Waals structure is intrinsically superior in hosting charge-dense ions. We observe that the divalent nature of Mg2+ causes unique squeezing deformation of the electrode structure, where it contracts and expands in different crystallographic directions when hosting the inserted Mg-ions. This phenomenon is revealed experimentally by ex situ X-ray diffraction and transmission electron microscopy, and is investigated theoretically by first-principles calculations. Interestingly, hosting one Mg2+ ion requires the coordination from three PTCDA molecules in adjacent columns of stacked molecules, which rotates the columns, thus reducing the (011) spacing but increasing the (021) spacing. We demonstrate that a PTCDA Mg-ion electrode delivers a reversible capacity of 125 mA h g-1, which may include a minor contribution of hydronium storage, a good rate capability by retaining 75 mA h g-1 at 500 mA g-1 (or 3.7 C), and a stable cycle life. We also report Ca2+ storage in PTCDA, where a reversible capacity of over 80 mA h g-1 is delivered.

8.
Angew Chem Int Ed Engl ; 56(7): 1704-1718, 2017 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-28097748

RESUMO

Since the pioneering days of total synthesis and retrosynthetic analysis, the community has embraced guiding principles for planning synthetic approaches towards complex natural products. These guideposts have enabled the community to synthesize ever more complex compounds by applying prior knowledge gained in new settings. The recently isolated schinortriterpenoid family of natural products has attracted considerable synthetic attention and provided a rich opportunity to evaluate the lessons learned in the construction of complex, polycyclic scaffolds. In this Minireview, a detailed discussion of the synthetic work within this family is provided, including the six reported total syntheses, as well as a comparative analysis of the approaches utilized in their construction.

9.
J Am Chem Soc ; 138(3): 770-3, 2016 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-26759923

RESUMO

The total synthesis of mandelalide A and its ring-expanded macrolide isomer isomandelalide A has been achieved. Unexpected high levels of cytotoxicity were observed with the ring-expanded isomandelalide A with a rank order of potency: mandelalide A > isomandelalide A > mandelalide B. Key aspects of the synthesis include Ag-catalyzed cyclizations (AgCC's) to construct both the THF and THP rings present in the macrocycle, diastereoselective Sharpless dihydroylation of a cis-enyne, and lithium acetylide coupling with a chiral epoxide.


Assuntos
Antineoplásicos Fitogênicos/síntese química , Antineoplásicos Fitogênicos/farmacologia , Descoberta de Drogas , Macrolídeos/síntese química , Antineoplásicos Fitogênicos/química , Catálise , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Ciclização , Ensaios de Seleção de Medicamentos Antitumorais , Células HeLa , Humanos , Macrolídeos/química , Macrolídeos/farmacologia , Conformação Molecular , Prata/química , Estereoisomerismo
10.
J Org Chem ; 81(14): 5963-80, 2016 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-27353498

RESUMO

The pronounced impact of the C10 stereochemistry on the successful construction of a polycyclic Lycopodium alkaloid scaffold has been explored. A wide range of reaction conditions and functionality were investigated to control a keto sulfone Michael addition to construct the C7-C12 linkage. An unexpected, overriding impact of the C10 stereochemistry in stereoselectivity and reaction rate in the Michael addition was observed. Furthermore, divergent reactivity of a conformationally accelerated, intramolecular Mannich cyclization based on the C10 stereochemistry was discovered. The successful execution of this synthetic route resulted in the total synthesis of all three known 10-oxygenated Lycopodium alkaloids: 10-hydroxylycopodine, paniculine, and deacetylpaniculine.


Assuntos
Alcaloides/química , Lycopodium/química , Oxigênio/química , Catálise , Cristalografia por Raios X , Ciclização , Cetonas/química , Estrutura Molecular , Quinolizinas/química , Estereoisomerismo , Sulfonas/química
11.
J Org Chem ; 81(9): 3629-37, 2016 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-27095132

RESUMO

The mechanistic exploration and an expanded experimental discussion of the organocatalyzed, asymmetric Pfau-d'Angelo reaction by exploiting a bifunctional 1° amine thiourea catalyst system is disclosed. Notable breadth in substrate scope has been demonstrated on both the cyclic ketone moiety and the α,ß-unsaturated electrophile. Exploration into the matched and mismatched selectivity of this process with a ketone containing pre-existing stereocenters has been demonstrated. Computational analyses of the reaction mechanism are reported. In concert with kinetic isotope effect (KIE) experiments, these computational results provide a detailed understanding of the likely mechanism, including the aspects of the organocatalyst scaffold that are critical for stereoselectivity.

12.
Org Biomol Chem ; 14(24): 5826-31, 2016 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-27152741

RESUMO

The effectiveness of computational tools in determining relative configurations of complex molecules is investigated, using natural products mandelalides A-D and coibamide A, towards a generalized recipe for the scientific community at large. Ultimately, continuing efforts in this vein will accelerate and strengthen relative structure elucidation of complex molecules, such as natural products. Molecular mechanics conformational search, quantum mechanical NMR chemical shift predictions, and DP4 analyses led to confirmation of the revised structures of mandelalides A-D and coibamide A. All chiral centers in the northern hemisphere of mandelalides A-D are inverted with respect to the originally proposed structures, in agreement with recent total syntheses of mandelalide A by Ye, Fürstner & Carter. In the case of coibamide A, it was found that Fang & Su's revision, in which both the macrocycle [MeAla(11)] and the side chain [HIV(2)] residues are inverted from l to d, was consistent with the authentic natural product and computations.


Assuntos
Produtos Biológicos/química , Depsipeptídeos/química , Macrolídeos/química , Simulação de Dinâmica Molecular , Conformação Molecular
13.
Environ Sci Technol ; 48(1): 412-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24350894

RESUMO

The heterogeneous reactions of benzo[a]pyrene-d12 (BaP-d12), benzo[k]fluoranthene-d12 (BkF-d12), benzo[ghi]perylene-d12 (BghiP-d12), dibenzo[a,i]pyrene-d14 (DaiP-d14), and dibenzo[a,l]pyrene (DalP) with NO2, NO3/N2O5, and OH radicals were investigated at room temperature and atmospheric pressure in an indoor Teflon chamber and novel mono-NO2-DaiP and mono-NO2-DalP products were identified. Quartz fiber filters (QFF) were used as a reaction surface and the filter extracts were analyzed by GC/MS for nitrated-PAHs (NPAHs) and tested in the Salmonella mutagenicity assay, using Salmonella typhimurium strain TA98 (with and without metabolic activation). In parallel to the laboratory experiments, a theoretical study was conducted to rationalize the formation of NPAH isomers based on the thermodynamic stability of OH-PAH intermediates, formed from OH-radical-initiated reactions. NO2 and NO3/N2O5 were effective oxidizing agents in transforming PAHs to NPAHs, with BaP-d12 being the most readily nitrated. Reaction of BaP-d12, BkF-d12, and BghiP-d12 with NO2 and NO3/N2O5 resulted in the formation of more than one mononitro isomer product, while the reaction of DaiP-d14 and DalP resulted in the formation of only one mononitro isomer product. The direct-acting mutagenicity increased the most after NO3/N2O5 exposure, particularly for BkF-d12 in which di-NO2-BkF-d10 isomers were measured. The deuterium isotope effect study suggested that substitution of deuterium for hydrogen lowered both the direct and indirect acting mutagenicity of NPAHs and may result in an underestimation of the mutagencity of the novel NPAHs identified in this study.


Assuntos
Mutagênicos/química , Óxidos de Nitrogênio/química , Hidrocarbonetos Policíclicos Aromáticos/química , Mutagênicos/toxicidade , Hidrocarbonetos Policíclicos Aromáticos/toxicidade , Salmonella typhimurium/efeitos dos fármacos , Salmonella typhimurium/genética
14.
J Am Chem Soc ; 135(29): 10792-803, 2013 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-23845005

RESUMO

The total synthesis of amphidinolide C and a second-generation synthesis of amphidinolide F have been accomplished through the use of a common intermediate to access both the C1-C8 and the C18-C25 sections. The development of a Ag-catalyzed cyclization of a propargyl benzoate diol is described to access both trans-tetrahydrofuran rings. The evolution of a Felkin-controlled, 2-lithio-1,3-dienyl addition strategy to incorporate C9-C11 diene as well as C8 stereocenter is detailed. Key controlling aspects in the sulfone alkylation/oxidative desulfurization to join the major subunits, including the exploration of the optimum masking group for the C18 carbonyl motif, are discussed. A Trost asymmetric alkynylation and a stereoselective cuprate addition to an alkynoate have been developed for the rapid construction of the C26-C34 subunit. A Tamura/Vedejs olefination to introduce the C26 side arm of amphidnolides C and F is employed. The late-stage incorporation of the C15, C18 diketone motif proved critical to the successful competition of the total syntheses.


Assuntos
Produtos Biológicos/síntese química , Macrolídeos/síntese química , Benzoatos/química , Ciclização , Furanos/química , Prata/química
15.
J Org Chem ; 78(6): 2213-47, 2013 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-23406192

RESUMO

The total syntheses of amphidinolide B1 and the proposed structure of amphidinolide B2 have been accomplished. Key aspects of this work include the development of a practical, non-transition-metal-mediated method for the construction of the C13-C15 diene, the identification of α-chelation and dipole minimization models for diastereoselective methyl ketone aldol reactions, the discovery of a spontaneous Horner-Wadsworth-Emmons macrocyclization strategy, and the development of a novel late stage method for construction of an allylic epoxide moiety. The originally proposed structure for amphidinolide B2 and diastereomers thereof display potent antitumor activities with IC50 values ranging from 3.3 to 94.5 nM against human solid and blood tumor cells. Of the different stereoisomers, the proposed structure of amphidinolide B2 is over 12-fold more potent than the C8,9-epimer and C18-epimer in human DU145 prostate cancer cells. These data suggest that the epoxide stereochemistry is a significant factor for anticancer activity.


Assuntos
Antineoplásicos/síntese química , Antineoplásicos/farmacologia , Compostos de Epóxi/química , Compostos de Epóxi/farmacologia , Macrolídeos/síntese química , Macrolídeos/farmacologia , Linhagem Celular Tumoral , Humanos , Concentração Inibidora 50 , Macrolídeos/química , Estrutura Molecular , Estereoisomerismo
16.
J Org Chem ; 78(10): 4779-800, 2013 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-23627426

RESUMO

The formal syntheses of C5-epi-senepodine G and C5-epi-cermizine C have been accomplished through a novel diastereoselective, intramolecular amide Michael addition process. The total synthesis of cermizine D has been achieved through use of an organocatalyzed, heteroatom Michael addition to access a common intermediate. Additional key steps of this sequence include a matched, diastereoselective alkylation with an iodomethylphenyl sulfide and sulfone-aldehyde coupling/reductive desulfurization sequence to combine the major subunits. The utility of a Hartwig-style C-N coupling has been explored on functionally dense coupling partners. Diastereoselective conjugate additions to α,ß-unsaturated sulfones have been investigated, which provided the key sulfone intermediate in just six steps from commercially available starting materials. The formal syntheses of senepodine G and cermizine C have been accomplished through an intramolecular cyclization process of a N-Boc-protected piperidine sulfone.


Assuntos
Compostos Heterocíclicos com 2 Anéis/síntese química , Quinolizidinas/síntese química , Compostos Heterocíclicos com 2 Anéis/química , Estrutura Molecular , Quinolizidinas/química , Estereoisomerismo
17.
Nat Genet ; 2(1): 66-74, 1992 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1303253

RESUMO

Patients with glucocorticoid-remediable aldosteronism (GRA) from 12 kindreds possess chimaeric gene duplications arising from unequal crossing-over, fusing regulatory sequences of steroid 11 beta-hydroxylase to coding sequences of aldosterone synthase. These chimaeric genes are specific for GRA and explain the biochemistry, physiology and genetics of this form of hypertension. Sites of crossing over range from intron 2 to intron 4. Most mutations have arisen independently from either sister or non-sister chromatid exchange between these genes, which are only 45 kilobases apart. The possibility of a susceptibility allele for GRA of Irish origin is suggested. These findings indicate the utility of a direct genetic test for this disorder.


Assuntos
Quimera/genética , Sistema Enzimático do Citocromo P-450/genética , Hipertensão/genética , Família Multigênica , Esteroide Hidroxilases/genética , Alelos , Sequência de Bases , Troca Genética , Citocromo P-450 CYP11B2 , DNA/genética , Feminino , Expressão Gênica , Haplótipos/genética , Humanos , Desequilíbrio de Ligação , Masculino , Dados de Sequência Molecular , Linhagem , Esteroide 11-beta-Hidroxilase/genética
19.
Cell Mol Bioeng ; 16(3): 181-185, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37456787

RESUMO

Promotion and tenure (P&T) remain the central tenets of academia. The criteria for P&T both create and reflect the mission of an institution. The discipline of biomedical engineering is built upon the invention and translation of tools to address unmet clinical needs. 'Broadening the bar' for P&T to include efforts in innovation, entrepreneurship, and technology-based transfer (I/E/T) will require establishing the criteria and communication of methodology for their evaluation. We surveyed the department chairs across the fields of biomedical and bioengineering to understand the state-of-the-art in incorporation, evaluation, and definition of I/E/T as applied to the P&T process. The survey results reflected a commitment to increasing and respecting I/E/T activities as part of the P&T criteria. This was balanced by an equally strong desire for improving the education and policy for evaluating I/E/T internally as well as externally. The potential for 'broadening the bar' for P&T to include I/E/T activities in biomedical engineering may serve as an example for other fields in engineering and applied sciences, and a template for potential inclusion of additional efforts such as diversity, equity, and inclusion (DEI) into the pillars of scholarship, education, and service.

20.
Epidemics ; 43: 100676, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36913804

RESUMO

In an emergency epidemic response, data providers supply data on a best-faith effort to modellers and analysts who are typically the end user of data collected for other primary purposes such as to inform patient care. Thus, modellers who analyse secondary data have limited ability to influence what is captured. During an emergency response, models themselves are often under constant development and require both stability in their data inputs and flexibility to incorporate new inputs as novel data sources become available. This dynamic landscape is challenging to work with. Here we outline a data pipeline used in the ongoing COVID-19 response in the UK that aims to address these issues. A data pipeline is a sequence of steps to carry the raw data through to a processed and useable model input, along with the appropriate metadata and context. In ours, each data type had an individual processing report, designed to produce outputs that could be easily combined and used downstream. Automated checks were in-built and added as new pathologies emerged. These cleaned outputs were collated at different geographic levels to provide standardised datasets. Finally, a human validation step was an essential component of the analysis pathway and permitted more nuanced issues to be captured. This framework allowed the pipeline to grow in complexity and volume and facilitated the diverse range of modelling approaches employed by researchers. Additionally, every report or modelling output could be traced back to the specific data version that informed it ensuring reproducibility of results. Our approach has been used to facilitate fast-paced analysis and has evolved over time. Our framework and its aspirations are applicable to many settings beyond COVID-19 data, for example for other outbreaks such as Ebola, or where routine and regular analyses are required.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Saúde Pública , Reprodutibilidade dos Testes , Surtos de Doenças
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