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1.
Biofabrication ; 16(2)2024 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-38331416

RESUMO

Fabrication of a biohybrid actuator requires muscle cells anisotropically aligned in a line, curve, or combination of lines and curves (similar to the microstructure of living muscle tissue) to replicate lifelike movements, in addition to considering the arrangement of skeletal structure or muscular structure with anisotropic straight patterns. Here, we report a UV laser-processed microstructure for freely directing cellular alignment to engineer a biohybrid actuator composed of poly(styrene-block-butadiene-block-styrene triblock copolymer) (SBS) thin film with tailor-made microgrooves (MGs) and skeletal myotubes aligned along these MGs. Specifically, straight, circular, or curved MGs were transferred to SBS thin films from a UV laser-processed template, allowing for the successful alignment of myotubes along MGs. The biohybrid actuator, composed of anisotropically aligned myotubes on a curved microgrooved SBS thin film, was contracted by electrical stimulation. Contraction of biohybrid actuators with curved aligned myotubes permits twisted-like behavior, unlike straight microgrooved films. Therefore, the UV laser-ablation system is a unique maskless and rapid microfabrication technique that provides intriguing opportunities for omni-directional microgrooved structures to achieve the complex motion of living organisms.


Assuntos
Butadienos , Fibras Musculares Esqueléticas , Poliestirenos , Anisotropia , Lasers
2.
Artigo em Inglês | MEDLINE | ID: mdl-37976002

RESUMO

BACKGROUND: The prognosis of gastric cancer has gradually improved as treatments have evolved. However, curative treatments might be difficult when gastric cancer is detected in the elderly or individuals with multiple comorbidities. This study investigated the prognosis of elderly patients with gastric cancer who received best supportive care (BSC). METHODS: This single-center observational study retrospectively reviewed medical records from elderly patients (>65 years-old) diagnosed with gastric cancer between 2014 and 2019 who received BSC. RESULTS: Data were obtained from 39 patients with a median age of 90 years. Median follow-up period was 207 days. Median survival time for all causes was 508 days for stage 0, 1026 days for stage I, 319 days for stage II, 317 days for stage III, and 43 days for stage IV. Median survival time for cancer-specific deaths was 1987 days for stage 0, 1280 days for stage I, 331 days for stage II, 371 days for stage III, and 43 days for stage IV. Univariate analyses identified 'stage' and performance status as risk factors for both overall and cancer-specific mortality. In multivariate analyses, 'stage' was an independent risk factor predicting overall mortality (HR=3.71, 95%CI=1.73-7.98, P < 0.001) and both 'stage' and performance status were independent risk factors predicting cancer-specific mortality (HR=4.06 and 8.95, 95%CI=1.13-14.51 and 3.00-26.67, P = 0.031 and P < 0.001, respectively). CONCLUSION: This result will help clarify the natural history of elderly patients with gastric cancer and provide useful information when choosing treatments in the future.

4.
Gan To Kagaku Ryoho ; 48(2): 215-218, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597362

RESUMO

A male patient in his 70s underwent a right lobectomy because of a hepatocellular carcinoma(HCC)located in the right lobe(S6)of his liver. Eleven months after surgery, contrast-enhanced CT showed multiple masses in the residual liver, which were diagnosed as HCC recurrence. He was then treated with hepatic arterial infusion chemotherapy(HAIC). Ten months after the recurrence, the liver tumors progressed. Therefore, treatment was switched to sorafenib(400 mg/day orally)and HAIC(low-dose FP: 5-FU 250 mg plus CDDP 5 mg 5 days/week 4 weeks)sequential therapy. The patient received 2 cycles of sorafenib-HAIC sequential therapy for 11 months, and his liver tumors shrunk considerably. Unfortunately, 24 months after the recurrence of HCC, he died of respiratory failure. The cause of his death was officially determined to be primary lung cancer. An autopsy revealed that most tissues were necrotic, and only a small number of viable tumor cells were present in the liver tumors. This suggests that sorafenib-HAIC sequential therapy was significantly effective in targeting the multiple HCCs in this case.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/cirurgia , Artéria Hepática , Humanos , Infusões Intra-Arteriais , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Sorafenibe/uso terapêutico , Resultado do Tratamento
5.
Intern Med ; 60(8): 1211-1215, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33229807

RESUMO

We herein report a rare case of intraductal papillary mucinous neoplasm with a pancreatogastric fistula in an elderly Japanese man admitted to our hospital. The pancreatogastric fistula was confirmed using endoscopic retrograde pancreatography via a cannulated guidewire placed in the stomach. Six months after admission, the patient was diagnosed with intraductal papillary mucinous carcinoma. A pancreatogastric fistula is generally a rare complication of intraductal papillary mucinous neoplasm. It was caused by mechanical penetration in this case. Interestingly, we also observed endoscopic and histochemical mucosal changes in the fistula.


Assuntos
Adenocarcinoma Mucinoso , Adenocarcinoma Papilar , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Adenocarcinoma Mucinoso/complicações , Adenocarcinoma Mucinoso/diagnóstico , Idoso , Carcinoma Ductal Pancreático/complicações , Carcinoma Ductal Pancreático/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico
6.
Clin J Gastroenterol ; 14(1): 63-70, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32996111

RESUMO

We report a rare case of undifferentiated-type intramucosal gastric cancer that occurred in the fornix of the stomach without Helicobacter pylori infection, which consisted mainly of poorly differentiated adenocarcinoma. A 49-year-old man visited our hospital for a follow-up endoscopic examination of a small depressed lesion of the gastric fornix detected by surveillance esophagogastroduodenoscopy. On magnifying endoscopy with blue laser imaging, the depressed lesion (approximately 10 mm in diameter) was regarded as undifferentiated-type early gastric cancer that proved to be a poorly differentiated adenocarcinoma by histological examination of biopsied specimens. The cancerous lesion was successfully treated with endoscopic submucosal dissection and microscopically showed an intramucosal cancer that invaded the whole mucosal layer with predominant growth of a poorly differentiated adenocarcinoma component. The patient status was verified as Helicobacter pylori-naïve according to the strict diagnostic criteria, thereby confirming this case as an undifferentiated-type Helicobacter pylori-uninfected gastric cancer. Helicobacter pylori-uninfected intramucosal poorly differentiated adenocarcinoma occurring in the gastric fornix has not been previously reported.


Assuntos
Adenocarcinoma , Infecções por Helicobacter , Helicobacter pylori , Neoplasias Gástricas , Adenocarcinoma/cirurgia , Mucosa Gástrica , Infecções por Helicobacter/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/cirurgia
8.
Nihon Shokakibyo Gakkai Zasshi ; 117(6): 532-541, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32565511

RESUMO

IgG4-related autoimmune hepatitis (IgG4-AIH) is characterized by hepatic inflammation and is considered an IgG4-related disease. Several inflammatory pseudotumors (IPTs) are also considered as IgG4-related diseases;however, there have been no reports of cases wherein both diseases occurred concurrently. An older adult with liver dysfunction was admitted to the hospital and was diagnosed with IgG4-AIH following a liver biopsy;IgG4-positive plasma cell infiltration in the portal tract and high serum IgG4 concentration were detected. A few months following biopsy, imaging studies revealed two IPTs in the liver. The patient was diagnosed with cryptogenic organized pneumonia several months after imaging and was treated with steroids in a different hospital. Her liver dysfunction improved, and one of the two IPTs disappeared in response to steroid treatment. The following is an account of a rare case of IgG4-AIH with IPTs of the liver.


Assuntos
Doenças Autoimunes , Granuloma de Células Plasmáticas , Hepatite Autoimune , Hepatopatias , Idoso , Feminino , Humanos , Imunoglobulina G
9.
Intern Med ; 58(22): 3305-3311, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31366794

RESUMO

A rare case of lung cancer with the simultaneous production of granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) is reported. A 79-year-old man was admitted to our hospital due to cachectic symptoms and an increased inflammatory response. Laboratory tests and imaging studies suggested metastatic lung cancer with high serum levels of G-CSF and IL-6. He died of progressive disease, and an autopsy showed that the lung tumor had positive protein expression of both cytokines and a solid growth of large-cell carcinoma with sarcomatoid changes, possibly resulting from the epithelial-mesenchymal transition mediated by IL-6 and leading to widespread metastases.


Assuntos
Carcinoma de Células Grandes/patologia , Transição Epitelial-Mesenquimal/fisiologia , Neoplasias Pulmonares/patologia , Idoso , Autopsia , Fator Estimulador de Colônias de Granulócitos/metabolismo , Humanos , Interleucina-6/metabolismo , Masculino , Sarcoma/patologia
11.
Mol Clin Oncol ; 10(1): 10-16, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30655972

RESUMO

Paraganglioma and pheochromocytoma are rare neuroendocrine neoplasms that originate from chromaffin cells. In many of these tumors, several mutations are reported to occur in the genes of germline and/or somatic cells. A case of paraganglioma in the posterior mediastinum with highly malignant potential is reported. The patient had a rapid clinical course, and it was difficult to reach the final diagnosis. The initial diagnosis on fine-needle aspiration biopsy was a gastrointestinal stromal tumor (GIST) arising from the esophagus. Although radiation therapy was effective for the main tumor, the lung metastases did not respond sufficiently to several tyrosine kinase inhibitors. Autopsy and immunohistochemical examination using a battery of different markers resulted in a final diagnosis of malignant paraganglioma. Next-generation sequencing revealed several gene mutations and copy number variations, including of fumarate hydratase (FH), neurofibromatosis type-1 (NF1) and RET. Those gene alterations may contribute to the pathogenesis of this malignant phenotype to a certain extent. To confirm this, further cases and studies are required. In addition, it should be noted that histological examination of a small piece of tumor might have sampling bias and could cause misdiagnosis.

12.
Intern Med ; 56(23): 3183-3188, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29021473

RESUMO

We herein report the case of a 78-year-old woman with an intraductal tumor with scant mucin production in a moderately dilated main pancreatic duct that resembled an intraductal tubulopapillary neoplasm (ITPN) on imaging. An endoscopic transpapillary forceps biopsy enabled an accurate preoperative diagnosis of the tumor as an oncocytic type intraductal papillary mucinous neoplasm (IPMN) of the pancreas microscopically showing papillary growth consisting of oncocytic cells with a typical mucin expression profile, although with few intraepithelial lumina containing mucin. This is the first case of an oncocytic type IPMN mimicking an ITPN that was able to be diagnosed preoperatively.


Assuntos
Adenoma Oxífilo/diagnóstico , Mucinas/metabolismo , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma Mucinoso/patologia , Adenoma Oxífilo/patologia , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia
13.
J Clin Gastroenterol ; 50(9): 727-32, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26756107

RESUMO

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is the most common method of enteral nutrition in patients who require long-term tube feeding. According to meta-analyses, administration of systemic prophylactic antibiotics for PEG reduces peristomal infection. However, with several recent developments in the procedure and instruments, the risk of infection might have been reduced. The aim of this study was to evaluate the use of systemic antibiotic prophylaxis for a modified introducer method of PEG. METHODS: This prospective, randomized, double-blind trial assessed 278 patients undergoing PEG for inclusion. Ninety-one patients with an indication for PEG who gave informed consent to participate were randomized. Forty-six patients received prophylactic ampicillin and 45 patients received a placebo. A modified introducer method of PEG using a Seldinger PEG kit was performed. The primary outcome was the occurrence of clinically evident wound infection within 3 days after PEG. RESULTS: Wound infection within 3 days was observed in none in the prophylaxis group and in 1 patient in the control group (P=0.4945). There was no significant difference between 2 groups in the other parameters, including peristomal infection within 7 days, overall infection, white blood cell counts, C-reactive protein level, and successive rate of finishing antibiotics. CONCLUSIONS: For wound infection within 3 days, noninferiority of the placebo group to the antibiotics group was preliminarily suggested with our criteria, but not for peristomal infection within 7 days. More strict criteria for noninferiority should be examined in a further large sample study.


Assuntos
Ampicilina/administração & dosagem , Antibioticoprofilaxia , Nutrição Enteral , Estenose Esofágica/cirurgia , Idoso , Método Duplo-Cego , Feminino , Gastroscopia/métodos , Gastrostomia/métodos , Humanos , Japão , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Infecção da Ferida Cirúrgica , Resultado do Tratamento
14.
Intern Med ; 54(23): 3017-22, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26631885

RESUMO

Anaplastic carcinoma is a rare pancreatic cancer, and the malignant transformation of a heterotopic pancreas is also rare. We herein report a case of an elderly woman with a mass of unknown origin in the abdominal cavity. Computed tomography identified the extent of the tumor but not the organ of origin. The abdominal tumor eventually metastasized to the liver and lung. An autopsy and immunohistochemical examination revealed an anaplastic carcinoma possibly originating in an ectopic pancreas.


Assuntos
Carcinoma/diagnóstico , Neoplasias Hepáticas/patologia , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Idoso , Autopsia , Transformação Celular Neoplásica/patologia , Evolução Fatal , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X
15.
Intern Med ; 54(12): 1531-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26073245

RESUMO

Extragonadal yolk sac tumors (YSTs) are rare. We herein report the case of a 66-year-old man with mediastinal, lung and liver tumors. The largest mass was located in the liver and contained a high concentration of protein induced by vitamin K absence or antagonist-II (PIVKA-II) and alpha-fetoprotein. Therefore, the lesion was difficult to distinguish from hepatocellular carcinoma. Finally, YST was diagnosed based on the results of a liver biopsy. Although chemotherapy was effective, the patient died of respiratory failure. The autopsy revealed primary mediastinal YST. In the current report, we describe this case of PIVKA-II-producing YST and review previous cases of PIVKA-II-producing tumors other than hepatoma.


Assuntos
Biomarcadores Tumorais/análise , Biomarcadores/análise , Tumor do Seio Endodérmico/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias do Mediastino/diagnóstico , Precursores de Proteínas/análise , Protrombina/análise , Vitamina K/análise , alfa-Fetoproteínas/análise , Idoso , Autopsia , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Tumor do Seio Endodérmico/química , Evolução Fatal , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/química , Neoplasias Pulmonares/química , Masculino , Neoplasias do Mediastino/química
17.
Hepatobiliary Pancreat Dis Int ; 12(1): 103-5, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23392807

RESUMO

BACKGROUND: Hepatic portal venous gas (HPVG) is a rare entity commonly associated with intestinal necrosis and fatal outcome, and various underlying diseases have been reported. Pancreatic solitary metastasis without local extension is also rare in esophageal squamous cell carcinoma. METHODS: This report describes an interesting and unusual case of HPVG arising from pancreatic tumor. Autopsy revealed pathogenesis of HPVG and synchronous tumors of the esophagus and pancreas. RESULTS: A 73-year-old man developed synchronous double tumor in the esophagus and pancreas several months before acute abdomen and his death, which were generated by HPVG. Autopsy revealed that HPVG was caused by gastric wall infarction owing to expansion of an isolated pancreatic metastasis from esophageal squamous cell carcinoma. CONCLUSIONS: This is the first case of HPVG that was derived from pancreatic tumor infiltration. If he had been diagnosed with solitary pancreatic metastasis from esophageal squamous cell carcinoma in the first time, he might have an option for chemotherapy, which could let him live longer.


Assuntos
Carcinoma de Células Escamosas/secundário , Embolia Aérea/patologia , Neoplasias Esofágicas/patologia , Gases , Neoplasias Pancreáticas/secundário , Veia Porta/patologia , Idoso , Carcinoma de Células Escamosas/complicações , Embolia Aérea/etiologia , Neoplasias Esofágicas/complicações , Evolução Fatal , Humanos , Masculino , Neoplasias Pancreáticas/complicações
18.
Dig Endosc ; 24(4): 275-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22725115

RESUMO

Ménétrier's disease (MD) is a rare, acquired, premalignant disorder of the stomach characterized by enlarged gastric folds with foveolar hyperplasia, the phenotype of antralization of gastric glands, hypochlorhydria and hypoproteinemia. The etiology of MD is unknown, but both increased signaling by transforming growth factor-α and infection with Helicobacter pylori (H. pylori) have been implicated. Here, a case involving 70-year-old man who lost weight after developing anorexia and diarrhea is reported. He was diagnosed as MD without H. pylori infection, and in spite of intensive care, he died 40 days after admission. An autopsy confirmed MD. Immunohistochemistry revealed overexpression of transforming growth factor-α in the foveolar region of the gastric mucosa. The autopsy also distinguished this H. pylori-negative MD from hyperplastic polyp of the stomach, which is important in clarifying the entity of H. pylori-negative MD.


Assuntos
Mucosa Gástrica/metabolismo , Gastrite Hipertrófica/etiologia , Fator de Crescimento Transformador alfa/metabolismo , Idoso , Ciclo-Oxigenase 2/metabolismo , Dilatação Patológica , Endossonografia , Evolução Fatal , Mucosa Gástrica/patologia , Gastrite Hipertrófica/epidemiologia , Gastrite Hipertrófica/metabolismo , Gastrite Hipertrófica/terapia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Humanos , Imuno-Histoquímica , Insuflação , Masculino , Transdução de Sinais/fisiologia
19.
J Biol Chem ; 287(16): 12975-84, 2012 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-22337872

RESUMO

The mitotic checkpoint gene CHFR (checkpoint with forkhead-associated (FHA) and RING finger domains) is silenced by promoter hypermethylation or mutated in various human cancers, suggesting that CHFR is an important tumor suppressor. Recent studies have reported that CHFR functions as an E3 ubiquitin ligase, resulting in the degradation of target proteins. To better understand how CHFR suppresses cell cycle progression and tumorigenesis, we sought to identify CHFR-interacting proteins using affinity purification combined with mass spectrometry. Here we show poly(ADP-ribose) polymerase 1 (PARP-1) to be a novel CHFR-interacting protein. In CHFR-expressing cells, mitotic stress induced the autoPARylation of PARP-1, resulting in an enhanced interaction between CHFR and PARP-1 and an increase in the polyubiquitination/degradation of PARP-1. The decrease in PARP-1 protein levels promoted cell cycle arrest at prophase, supporting that the cells expressing CHFR were resistant to microtubule inhibitors. In contrast, in CHFR-silenced cells, polyubiquitination was not induced in response to mitotic stress. Thus, PARP-1 protein levels did not decrease, and cells progressed into mitosis under mitotic stress, suggesting that CHFR-silenced cancer cells were sensitized to microtubule inhibitors. Furthermore, we found that cells from Chfr knockout mice and CHFR-silenced primary gastric cancer tissues expressed higher levels of PARP-1 protein, strongly supporting our data that the interaction between CHFR and PARP-1 plays an important role in cell cycle regulation and cancer therapeutic strategies. On the basis of our studies, we demonstrate a significant advantage for use of combinational chemotherapy with PARP inhibitors for cancer cells resistant to microtubule inhibitors.


Assuntos
Pontos de Checagem da Fase M do Ciclo Celular/fisiologia , Neoplasias/patologia , Poli(ADP-Ribose) Polimerases/metabolismo , Proteínas Supressoras de Tumor/genética , Proteínas Supressoras de Tumor/metabolismo , Ubiquitina-Proteína Ligases/genética , Ubiquitina-Proteína Ligases/metabolismo , Ubiquitinação/fisiologia , Animais , Neoplasias da Mama , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Pontos de Checagem do Ciclo Celular/fisiologia , Desenho de Fármacos , Feminino , Genes Supressores de Tumor/fisiologia , Células HEK293 , Células HeLa , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Microtúbulos/efeitos dos fármacos , Microtúbulos/fisiologia , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/metabolismo , Neoplasias Bucais/patologia , Neoplasias/tratamento farmacológico , Neoplasias/metabolismo , Neoplasias de Células Escamosas/tratamento farmacológico , Neoplasias de Células Escamosas/metabolismo , Neoplasias de Células Escamosas/patologia , Poli(ADP-Ribose) Polimerase-1 , Proteínas de Ligação a Poli-ADP-Ribose , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia
20.
Intern Med ; 49(20): 2229-33, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20962441

RESUMO

An 84-year-old woman under warfarin therapy, who had undergone mechanical valve replacement 29 months previously, developed coagulation abnormalities after antibiotic treatment for pyelonephritis. Laboratory findings included PT at 47.6 sec, activated thromboplastin time (APTT) at 147 sec, factor V (FV) activity of 4% and FV inhibitor of 8 BU. Although overt bleeding was not observed, administration of prednisolone was started. Her coagulation abnormalities were rapidly normalized. It was later determined that the patient had received bovine thrombin at surgery. The presence of a FV inhibitor should be considered in the differential diagnosis in patients demonstrating an unexpected prolongation of PT under warfarin therapy following surgery.


Assuntos
Anticoagulantes/uso terapêutico , Valva Aórtica , Fator V/imunologia , Próteses Valvulares Cardíacas , Transtornos Hemorrágicos/etiologia , Complicações Pós-Operatórias/etiologia , Trombina/efeitos adversos , Varfarina/uso terapêutico , Idoso de 80 Anos ou mais , Animais , Antibacterianos/uso terapêutico , Estenose da Valva Aórtica/cirurgia , Bovinos , Ceftriaxona/uso terapêutico , Feminino , Transtornos Hemorrágicos/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Tempo de Tromboplastina Parcial , Complicações Pós-Operatórias/tratamento farmacológico , Prednisolona/uso terapêutico , Tempo de Protrombina , Pielonefrite/complicações , Pielonefrite/tratamento farmacológico , Especificidade da Espécie , Trombina/imunologia
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