Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos

Detalhes bibliográficos
Autor(a) principal: Moraes, Oscar Albuquerque de
Data de Publicação: 2013
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da Uninove
Texto Completo: http://bibliotecatede.uninove.br/handle/tede/1146
Resumo: Introduction: It is known that diabetes is associated with autonomic dysfunction and this is a severe complication that increases the risk of cardiovascular mortality. The non-obese diabetic mice (NOD) is an experimental model of type 1 diabetes which develops insulitis at the 4th week and diabetes between the 14th and the 20th week of life. However, data about autonomic function in these mice remain scarce. Objective: To investigate the cardiovascular autonomic profile of NOD mice. Methods: Female mice (24-28 week old) were divided in two groups: NOD (n=6) and control (n=6, swiss mice). NOD mice with glycemia ???300 mg/dl were used in this study. Heart rate variability (HRV) was evaluated in time and frequency domains and also through symbolic analysis. Were also analyzed the variability of the blood pressure, and baroreflex sensitivity by means of the bradycardic and tachycardic responses induced by infusion of phenylephrine and sodium nitroprusside. Student t test for independent samples and Pearson's correlation coefficient were used for statistical analyses. The data were described as means and standard error. Results: The heart rate and arterial pressure were similar between the groups, however HRV (total variance of RR interval: NOD = 21.07 ?? 3.75 vs. C = 42.02 ?? 6.54 ms2) and RMSSD (NOD = 4.01 ?? 0.32 vs. C = 8.28 ?? 0.97 ms), a vagal modulation index, were lower in NOD group when compared to control group. Moreover, the low frequency component was higher in NOD group (normalized LF: NOD = 61.0 ?? 4.0 vs. C = 20.0 ?? 4.0%), while the high frequency of HR component was lower in NOD compared with the control group (normalized HF: NOD = 39.0 ?? 4.0% vs. C = 80.0 ?? 4.0%). Similarly, the 0V pattern of symbolic analysis, indicative of sympathetic activity, was increased in NOD group when compared to the control group (NOD = 11.9 ?? 1.4 vs. C = 6.06 ?? 0.90%) and the 2LV pattern, indicative of parasympathetic activity, was reduced in the NOD group (NOD = 7.98 ?? 1.3 vs. C = 21.2 ?? 3.36%). Both responses to arterial pressure changes, tachycardic (NOD = 3.01 ?? 0.72 vs. C = 4.54 ?? 0.36 bpm/mmHg) and bradycardic (NOD = 2.49 ?? 0.31 vs. C = 3.43 ?? 0.33 bpm/mmHg) were lower in NOD when compared to the control group. A negative correlation between the indices of vagal modulation (RMSSD, normalized high frequency component and 2LV pattern of symbolic analysis) and blood glucose levels was also observed. Conclusions: The NOD mice present cardiovascular autonomic dysfunction and that is probably associated with glycemic levels.
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spelling Irigoyen, Maria Claudia Costahttp://lattes.cnpq.br/8049184468038869Rodrigues, Brunohttp://lattes.cnpq.br/3247986175082808Angelis, K??tia dehttp://lattes.cnpq.br/429934481050996581849877068http://lattes.cnpq.br/7393338113597275Moraes, Oscar Albuquerque de2015-07-27T13:30:56Z2013-12-10Moraes, Oscar Albuquerque de. Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos. 2013. 63 f. Disserta????o( Programa de Mestrado em Medicina) - Universidade Nove de Julho, S??o Paulo .http://bibliotecatede.uninove.br/handle/tede/1146Introduction: It is known that diabetes is associated with autonomic dysfunction and this is a severe complication that increases the risk of cardiovascular mortality. The non-obese diabetic mice (NOD) is an experimental model of type 1 diabetes which develops insulitis at the 4th week and diabetes between the 14th and the 20th week of life. However, data about autonomic function in these mice remain scarce. Objective: To investigate the cardiovascular autonomic profile of NOD mice. Methods: Female mice (24-28 week old) were divided in two groups: NOD (n=6) and control (n=6, swiss mice). NOD mice with glycemia ???300 mg/dl were used in this study. Heart rate variability (HRV) was evaluated in time and frequency domains and also through symbolic analysis. Were also analyzed the variability of the blood pressure, and baroreflex sensitivity by means of the bradycardic and tachycardic responses induced by infusion of phenylephrine and sodium nitroprusside. Student t test for independent samples and Pearson's correlation coefficient were used for statistical analyses. The data were described as means and standard error. Results: The heart rate and arterial pressure were similar between the groups, however HRV (total variance of RR interval: NOD = 21.07 ?? 3.75 vs. C = 42.02 ?? 6.54 ms2) and RMSSD (NOD = 4.01 ?? 0.32 vs. C = 8.28 ?? 0.97 ms), a vagal modulation index, were lower in NOD group when compared to control group. Moreover, the low frequency component was higher in NOD group (normalized LF: NOD = 61.0 ?? 4.0 vs. C = 20.0 ?? 4.0%), while the high frequency of HR component was lower in NOD compared with the control group (normalized HF: NOD = 39.0 ?? 4.0% vs. C = 80.0 ?? 4.0%). Similarly, the 0V pattern of symbolic analysis, indicative of sympathetic activity, was increased in NOD group when compared to the control group (NOD = 11.9 ?? 1.4 vs. C = 6.06 ?? 0.90%) and the 2LV pattern, indicative of parasympathetic activity, was reduced in the NOD group (NOD = 7.98 ?? 1.3 vs. C = 21.2 ?? 3.36%). Both responses to arterial pressure changes, tachycardic (NOD = 3.01 ?? 0.72 vs. C = 4.54 ?? 0.36 bpm/mmHg) and bradycardic (NOD = 2.49 ?? 0.31 vs. C = 3.43 ?? 0.33 bpm/mmHg) were lower in NOD when compared to the control group. A negative correlation between the indices of vagal modulation (RMSSD, normalized high frequency component and 2LV pattern of symbolic analysis) and blood glucose levels was also observed. Conclusions: The NOD mice present cardiovascular autonomic dysfunction and that is probably associated with glycemic levels.Introdu????o: O diabetes est?? associado com disfun????o auton??mica e esta ?? uma grave complica????o que eleva o risco de mortalidade cardiovascular. O camundongo n??o obeso diab??tico (NOD) ?? um modelo experimental de diabetes tipo 1 que desenvolve insulinite na quarta semana de vida e diabetes entre a 14?? e 20?? semana de vida. Contudo, dados sobre a fun????o auton??mica cardiovascular em camundongos NOD permanecem escassos. Objetivos: Investigar a fun????o auton??mica cardiovascular do camundongo NOD. M??todos: Camundongos f??meas (24-28 semanas de vida) foram divididas em dois grupos: NOD (n = 6) e controle (C, camundongo sui??o, n=6). Foram inclu??dos no grupo NOD animais com glicemia igual ou superior a 300 mg/dl. Foi avaliada a variabilidade da frequ??ncia card??aca no dom??nio do tempo e da frequ??ncia e tamb??m por meio de an??lise simb??lica. Al??m disso, foram avaliados a variabilidade da press??o arterial, bem como a sensibilidade barorreflexa, por meio das respostas bradic??rdicas e taquic??rdicas induzidas pela infus??o de fenilefrina e nitroprussiato de s??dio. Para an??lise estat??stica foi utilizado o teste t de Student para amostras independentes e o coeficiente de correla????o de Pearson. Os dados foram descritos como m??dia e erro padr??o. Resultados: A frequ??ncia card??aca e a press??o arterial foram similares entre os grupos, no entanto a variabilidade da frequ??ncia card??aca (vari??ncia do intervalo de pulso: NOD = 21,07 ?? 3,75 vs. C = 42,02 ?? 6,54 ms2) e o RMSSD (NOD = 4,01 ?? 0,32 vs. C = 8,28 ?? 0,97 ms), um ??ndice de modula????o vagal, foram menores no grupo NOD quando comparados ao grupo controle. Al??m disso, o componente de baixa frequ??ncia foi maior no grupo NOD (BF normalizado: NOD = 61,0 ?? 4,0 vs. C = 20,0 ?? 4,0%), enquanto que o componente de alta frequ??ncia foi menor no grupo NOD quando comparado com o grupo controle (AF normalizado: NOD = 39,0 ?? 4,0% vs. C = 80,0 ?? 4,0%). De forma semelhante, na an??lise simb??lica o padr??o 0V, indicativo da atividade simp??tica, estava aumentado no grupo NOD em compara????o com o grupo controle (NOD= 11,9 ?? 1,4 vs. C = 6,06 ?? 0,90%) e o padr??o 2LV, indicativo da atividade parassimp??tica, estava reduzido no grupo NOD (NOD = 7,98 ?? 1,3 vs. C = 21,2 ?? 3,36%). Ambas as respostas reflexas comandadas pelos barorreceptores, taquic??rdica (NOD = 3,01 ?? 0,72 vs. C = 4,54 ?? 0,36 bpm/mmHg) e bradic??rdica (NOD = 2,49 ?? 0,31 vs. C = 3,43 ?? 0,33 bpm/mmHg) foram menores no grupo NOD quando comparadas com o grupo controle. Ainda, observamos uma correla????o negativa entre os ??ndices de modula????o vagal (RMSSD, componente de alta frequ??ncia normalizado e padr??o 2LV da an??lise simb??lica) e os n??veis glic??micos. Conclus??o: Os camundongos NOD apresentam disfun????o auton??mica cardiovascular e essa disautonomia est?? associada com os n??veis glic??micos.Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-27T13:30:56Z No. of bitstreams: 1 Oscar Albuquerque de Moraes.pdf: 5700519 bytes, checksum: 9bc35ce1df2c3e4a35600d5a4b8579a6 (MD5)Made available in DSpace on 2015-07-27T13:30:56Z (GMT). No. of bitstreams: 1 Oscar Albuquerque de Moraes.pdf: 5700519 bytes, checksum: 9bc35ce1df2c3e4a35600d5a4b8579a6 (MD5) Previous issue date: 2013-12-10application/pdfporUniversidade Nove de JulhoPrograma de Mestrado em MedicinaUNINOVEBrasilSa??dediabetes mellitussistema nervoso aut??nomobarorreflexocamundongo nodbaroreflexinbred noddiabetes mellitusautonomic nervous systemmiceCIENCIAS DA SAUDEAvalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesis8765449414823306929600info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da Uninoveinstname:Universidade Nove de Julho (UNINOVE)instacron:UNINOVEORIGINALOscar Albuquerque de Moraes.pdfOscar Albuquerque de Moraes.pdfapplication/pdf5700519http://localhost:8080/tede/bitstream/tede/1146/2/Oscar+Albuquerque+de+Moraes.pdf9bc35ce1df2c3e4a35600d5a4b8579a6MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82089http://localhost:8080/tede/bitstream/tede/1146/1/license.txt7b5ba3d2445355f386edab96125d42b7MD51tede/11462015-07-27 10:30:56.367oai:localhost:tede/1146Tk9UQTogQ09MT1FVRSBBUVVJIEEgU1VBIFBSP1BSSUEgTElDRU4/QQpFc3RhIGxpY2VuP2EgZGUgZXhlbXBsbyA/IGZvcm5lY2lkYSBhcGVuYXMgcGFyYSBmaW5zIGluZm9ybWF0aXZvcy4KCkxJQ0VOP0EgREUgRElTVFJJQlVJPz9PIE4/Ty1FWENMVVNJVkEKCkNvbSBhIGFwcmVzZW50YT8/byBkZXN0YSBsaWNlbj9hLCB2b2M/IChvIGF1dG9yIChlcykgb3UgbyB0aXR1bGFyIGRvcyBkaXJlaXRvcyBkZSBhdXRvcikgY29uY2VkZSA/IFVuaXZlcnNpZGFkZSAKWFhYIChTaWdsYSBkYSBVbml2ZXJzaWRhZGUpIG8gZGlyZWl0byBuP28tZXhjbHVzaXZvIGRlIHJlcHJvZHV6aXIsICB0cmFkdXppciAoY29uZm9ybWUgZGVmaW5pZG8gYWJhaXhvKSwgZS9vdSAKZGlzdHJpYnVpciBhIHN1YSB0ZXNlIG91IGRpc3NlcnRhPz9vIChpbmNsdWluZG8gbyByZXN1bW8pIHBvciB0b2RvIG8gbXVuZG8gbm8gZm9ybWF0byBpbXByZXNzbyBlIGVsZXRyP25pY28gZSAKZW0gcXVhbHF1ZXIgbWVpbywgaW5jbHVpbmRvIG9zIGZvcm1hdG9zID91ZGlvIG91IHY/ZGVvLgoKVm9jPyBjb25jb3JkYSBxdWUgYSBTaWdsYSBkZSBVbml2ZXJzaWRhZGUgcG9kZSwgc2VtIGFsdGVyYXIgbyBjb250ZT9kbywgdHJhbnNwb3IgYSBzdWEgdGVzZSBvdSBkaXNzZXJ0YT8/byAKcGFyYSBxdWFscXVlciBtZWlvIG91IGZvcm1hdG8gcGFyYSBmaW5zIGRlIHByZXNlcnZhPz9vLgoKVm9jPyB0YW1iP20gY29uY29yZGEgcXVlIGEgU2lnbGEgZGUgVW5pdmVyc2lkYWRlIHBvZGUgbWFudGVyIG1haXMgZGUgdW1hIGM/cGlhIGEgc3VhIHRlc2Ugb3UgCmRpc3NlcnRhPz9vIHBhcmEgZmlucyBkZSBzZWd1cmFuP2EsIGJhY2stdXAgZSBwcmVzZXJ2YT8/by4KClZvYz8gZGVjbGFyYSBxdWUgYSBzdWEgdGVzZSBvdSBkaXNzZXJ0YT8/byA/IG9yaWdpbmFsIGUgcXVlIHZvYz8gdGVtIG8gcG9kZXIgZGUgY29uY2VkZXIgb3MgZGlyZWl0b3MgY29udGlkb3MgCm5lc3RhIGxpY2VuP2EuIFZvYz8gdGFtYj9tIGRlY2xhcmEgcXVlIG8gZGVwP3NpdG8gZGEgc3VhIHRlc2Ugb3UgZGlzc2VydGE/P28gbj9vLCBxdWUgc2VqYSBkZSBzZXUgCmNvbmhlY2ltZW50bywgaW5mcmluZ2UgZGlyZWl0b3MgYXV0b3JhaXMgZGUgbmluZ3U/bS4KCkNhc28gYSBzdWEgdGVzZSBvdSBkaXNzZXJ0YT8/byBjb250ZW5oYSBtYXRlcmlhbCBxdWUgdm9jPyBuP28gcG9zc3VpIGEgdGl0dWxhcmlkYWRlIGRvcyBkaXJlaXRvcyBhdXRvcmFpcywgdm9jPyAKZGVjbGFyYSBxdWUgb2J0ZXZlIGEgcGVybWlzcz9vIGlycmVzdHJpdGEgZG8gZGV0ZW50b3IgZG9zIGRpcmVpdG9zIGF1dG9yYWlzIHBhcmEgY29uY2VkZXIgPyBTaWdsYSBkZSBVbml2ZXJzaWRhZGUgCm9zIGRpcmVpdG9zIGFwcmVzZW50YWRvcyBuZXN0YSBsaWNlbj9hLCBlIHF1ZSBlc3NlIG1hdGVyaWFsIGRlIHByb3ByaWVkYWRlIGRlIHRlcmNlaXJvcyBlc3Q/IGNsYXJhbWVudGUgCmlkZW50aWZpY2FkbyBlIHJlY29uaGVjaWRvIG5vIHRleHRvIG91IG5vIGNvbnRlP2RvIGRhIHRlc2Ugb3UgZGlzc2VydGE/P28gb3JhIGRlcG9zaXRhZGEuCgpDQVNPIEEgVEVTRSBPVSBESVNTRVJUQT8/TyBPUkEgREVQT1NJVEFEQSBURU5IQSBTSURPIFJFU1VMVEFETyBERSBVTSBQQVRST0M/TklPIE9VIApBUE9JTyBERSBVTUEgQUc/TkNJQSBERSBGT01FTlRPIE9VIE9VVFJPIE9SR0FOSVNNTyBRVUUgTj9PIFNFSkEgQSBTSUdMQSBERSAKVU5JVkVSU0lEQURFLCBWT0M/IERFQ0xBUkEgUVVFIFJFU1BFSVRPVSBUT0RPUyBFIFFVQUlTUVVFUiBESVJFSVRPUyBERSBSRVZJUz9PIENPTU8gClRBTUI/TSBBUyBERU1BSVMgT0JSSUdBPz9FUyBFWElHSURBUyBQT1IgQ09OVFJBVE8gT1UgQUNPUkRPLgoKQSBTaWdsYSBkZSBVbml2ZXJzaWRhZGUgc2UgY29tcHJvbWV0ZSBhIGlkZW50aWZpY2FyIGNsYXJhbWVudGUgbyBzZXUgbm9tZSAocykgb3UgbyhzKSBub21lKHMpIGRvKHMpIApkZXRlbnRvcihlcykgZG9zIGRpcmVpdG9zIGF1dG9yYWlzIGRhIHRlc2Ugb3UgZGlzc2VydGE/P28sIGUgbj9vIGZhcj8gcXVhbHF1ZXIgYWx0ZXJhPz9vLCBhbD9tIGRhcXVlbGFzIApjb25jZWRpZGFzIHBvciBlc3RhIGxpY2VuP2EuCg==Biblioteca Digital de Teses e Dissertaçõeshttp://bibliotecatede.uninove.br/PRIhttp://bibliotecatede.uninove.br/oai/requestbibliotecatede@uninove.br||bibliotecatede@uninove.bropendoar:2015-07-27T13:30:56Biblioteca Digital de Teses e Dissertações da Uninove - Universidade Nove de Julho (UNINOVE)false
dc.title.por.fl_str_mv Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
title Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
spellingShingle Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
Moraes, Oscar Albuquerque de
diabetes mellitus
sistema nervoso aut??nomo
barorreflexo
camundongo nod
baroreflex
inbred nod
diabetes mellitus
autonomic nervous system
mice
CIENCIAS DA SAUDE
title_short Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
title_full Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
title_fullStr Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
title_full_unstemmed Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
title_sort Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos
author Moraes, Oscar Albuquerque de
author_facet Moraes, Oscar Albuquerque de
author_role author
dc.contributor.advisor1.fl_str_mv Irigoyen, Maria Claudia Costa
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/8049184468038869
dc.contributor.referee1.fl_str_mv Rodrigues, Bruno
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/3247986175082808
dc.contributor.referee2.fl_str_mv Angelis, K??tia de
dc.contributor.referee2Lattes.fl_str_mv http://lattes.cnpq.br/4299344810509965
dc.contributor.authorID.fl_str_mv 81849877068
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/7393338113597275
dc.contributor.author.fl_str_mv Moraes, Oscar Albuquerque de
contributor_str_mv Irigoyen, Maria Claudia Costa
Rodrigues, Bruno
Angelis, K??tia de
dc.subject.por.fl_str_mv diabetes mellitus
sistema nervoso aut??nomo
barorreflexo
camundongo nod
baroreflex
inbred nod
topic diabetes mellitus
sistema nervoso aut??nomo
barorreflexo
camundongo nod
baroreflex
inbred nod
diabetes mellitus
autonomic nervous system
mice
CIENCIAS DA SAUDE
dc.subject.eng.fl_str_mv diabetes mellitus
autonomic nervous system
mice
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE
description Introduction: It is known that diabetes is associated with autonomic dysfunction and this is a severe complication that increases the risk of cardiovascular mortality. The non-obese diabetic mice (NOD) is an experimental model of type 1 diabetes which develops insulitis at the 4th week and diabetes between the 14th and the 20th week of life. However, data about autonomic function in these mice remain scarce. Objective: To investigate the cardiovascular autonomic profile of NOD mice. Methods: Female mice (24-28 week old) were divided in two groups: NOD (n=6) and control (n=6, swiss mice). NOD mice with glycemia ???300 mg/dl were used in this study. Heart rate variability (HRV) was evaluated in time and frequency domains and also through symbolic analysis. Were also analyzed the variability of the blood pressure, and baroreflex sensitivity by means of the bradycardic and tachycardic responses induced by infusion of phenylephrine and sodium nitroprusside. Student t test for independent samples and Pearson's correlation coefficient were used for statistical analyses. The data were described as means and standard error. Results: The heart rate and arterial pressure were similar between the groups, however HRV (total variance of RR interval: NOD = 21.07 ?? 3.75 vs. C = 42.02 ?? 6.54 ms2) and RMSSD (NOD = 4.01 ?? 0.32 vs. C = 8.28 ?? 0.97 ms), a vagal modulation index, were lower in NOD group when compared to control group. Moreover, the low frequency component was higher in NOD group (normalized LF: NOD = 61.0 ?? 4.0 vs. C = 20.0 ?? 4.0%), while the high frequency of HR component was lower in NOD compared with the control group (normalized HF: NOD = 39.0 ?? 4.0% vs. C = 80.0 ?? 4.0%). Similarly, the 0V pattern of symbolic analysis, indicative of sympathetic activity, was increased in NOD group when compared to the control group (NOD = 11.9 ?? 1.4 vs. C = 6.06 ?? 0.90%) and the 2LV pattern, indicative of parasympathetic activity, was reduced in the NOD group (NOD = 7.98 ?? 1.3 vs. C = 21.2 ?? 3.36%). Both responses to arterial pressure changes, tachycardic (NOD = 3.01 ?? 0.72 vs. C = 4.54 ?? 0.36 bpm/mmHg) and bradycardic (NOD = 2.49 ?? 0.31 vs. C = 3.43 ?? 0.33 bpm/mmHg) were lower in NOD when compared to the control group. A negative correlation between the indices of vagal modulation (RMSSD, normalized high frequency component and 2LV pattern of symbolic analysis) and blood glucose levels was also observed. Conclusions: The NOD mice present cardiovascular autonomic dysfunction and that is probably associated with glycemic levels.
publishDate 2013
dc.date.issued.fl_str_mv 2013-12-10
dc.date.accessioned.fl_str_mv 2015-07-27T13:30:56Z
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dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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dc.identifier.citation.fl_str_mv Moraes, Oscar Albuquerque de. Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos. 2013. 63 f. Disserta????o( Programa de Mestrado em Medicina) - Universidade Nove de Julho, S??o Paulo .
dc.identifier.uri.fl_str_mv http://bibliotecatede.uninove.br/handle/tede/1146
identifier_str_mv Moraes, Oscar Albuquerque de. Avalia????o da modula????o auton??mica cardiovascular de camundongos diab??ticos n??o obesos. 2013. 63 f. Disserta????o( Programa de Mestrado em Medicina) - Universidade Nove de Julho, S??o Paulo .
url http://bibliotecatede.uninove.br/handle/tede/1146
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dc.publisher.none.fl_str_mv Universidade Nove de Julho
dc.publisher.program.fl_str_mv Programa de Mestrado em Medicina
dc.publisher.initials.fl_str_mv UNINOVE
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv Sa??de
publisher.none.fl_str_mv Universidade Nove de Julho
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