1
|
Iser-Bem PN, Lobato TB, Alecrim-Zeza AL, Dos Santos de Oliveira LC, Passos MEP, Manuel R, Diniz VLS, Correa IS, de Oliveira SP, Silva EBD, Almeida MMD, Dias BB, Gritte RB, Levada-Pires AC, Masi LN, Hatanaka E, Pithon-Curi TC, Hirabara SM, Fabi JP, Curi R, Gorjao R. Ganoderma lucidum dry extract supplementation modulates T lymphocyte function in older women. Br J Nutr 2024:1-11. [PMID: 38800991 DOI: 10.1017/s0007114524001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Ganoderma lucidum (a mushroom used in traditional Chinese medicine) compounds may attenuate ageing-related physiological changes and restore normal immunity. However, studies on the physiological effects of Ganoderma lucidum dry extract food supplements are few. Therefore, here, we aimed to investigate the effects of Ganoderma lucidum dry extract food supplement on the lymphocyte function of older women. This was a double-blind clinical trial (n 60) with a final 39 older volunteers, divided into two groups Ganoderma lucidum (n 23) and placebo (n 16). The Ganoderma lucidum group received 2000 mg/d of Ganoderma lucidum dry extract for 8 weeks. We used flow cytometry to determine the lymphocyte profile. CD4+ lymphocyte gene expression was evaluated by real-time polymerase chain reaction. We observed that in the Ganoderma lucidum group, concanavalin A stimulation increased lymphocyte proliferation. Further, we observed an increase in expression of Forkhead box P3, transforming growth factor-beta, IL-10, IL-6, retinoic acid receptor-related orphan receptor gamma, GATA-binding protein 3 and interferon gamma genes in the Ganoderma lucidum group. Furthermore, in the Ganoderma lucidum group, ionomycin and phorbol 12-myristate 13-acetate stimulation led to decrease in Th17+ cells and increase in Th2+ cells. Thus, in older women, Ganoderma lucidum regulates T lymphocyte function leading to a predominant anti-inflammatory action but does not induce T lymphocyte proliferation through CD28 signalling pathway.
Collapse
Affiliation(s)
- Patricia Nancy Iser-Bem
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
- National Commercial Learning Service (SENAC), São Paulo, Brazil
| | - Tiago Bertola Lobato
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Amanda Lins Alecrim-Zeza
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | | | | | - Richelieau Manuel
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | | | - Ilana Souza Correa
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Sarah Poma de Oliveira
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Eliane Borges da Silva
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Mariana Mendes de Almeida
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Beatriz Belmiro Dias
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Raquel Bragante Gritte
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | | | - Laureane Nunes Masi
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
- Multicenter Graduate Program in Physiological Sciences, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Elaine Hatanaka
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Tania Cristina Pithon-Curi
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Sandro Massao Hirabara
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - João Paulo Fabi
- Department of Food Science and Experimental Nutrition, School of Pharmaceutical Sciences - Food Research Center (FoRC) - University of São Paulo, São Paulo, Brazil
| | - Rui Curi
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
- Butantan Institute, Sao Paulo, Brazil
| | - Renata Gorjao
- Interdisciplinary Post-graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| |
Collapse
|
2
|
Zhou Z, Guan H, Xiu M, Wu F. Dance/movement therapy for improving metabolic parameters in long-term veterans with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:23. [PMID: 38388554 PMCID: PMC10884034 DOI: 10.1038/s41537-024-00435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
Accumulating evidence has supported the implementation of dance/movement therapy (DMT) as a promising intervention for patients with schizophrenia (SCZ). However, its effect on body weight and metabolic profile in SCZ remains unclear. This study aimed to evaluate the outcome of a 12-week DMT session on weight and lipid profile in patients with SCZ using a randomized, single-blinded, controlled trial design. This study encompassed two groups of long-term hospitalized patients with SCZ, who were randomly assigned to the DMT intervention (n = 30) or the treatment as usual (TAU) group (n = 30). Metabolic markers, including weight, body mass index (BMI), fasting glucose, triglycerides, and total cholesterol were measured in both groups at two measurement points (at baseline and the end of the 12-week treatment). We found that DMT intervention significantly decreased body weight (F = 5.5, p = 0.02) and BMI (F = 5.7, p = 0.02) as compared to the TAU group. However, no significance was observed in other metabolic markers, including fasting glucose, triglycerides, and total cholesterol after treatment (all p > 0.05). Our study indicates that a 12-week, 24-session DMT program may be effective in decreasing body weight and BMI in long-term hospitalized patients with SCZ. DMT intervention may be a promising treatment strategy for long-term inpatients in the psychiatric department.
Collapse
Affiliation(s)
| | | | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.
| | - Fengchun Wu
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
- Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
3
|
Lopez-Nieves I, Jakobsche CE. Biomolecular Effects of Dance and Dance/Movement Therapy: A Review. AMERICAN JOURNAL OF DANCE THERAPY 2022. [DOI: 10.1007/s10465-022-09368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractThe positive health impacts of dance and dance/movement therapy can be seen all the way down to the molecular level. This narrative-style review illustrates this connection by presenting a collection of clinical and preclinical studies that evaluate the effects of dance activities on hormones and other small-molecule metabolites within the human body. The results of these studies show that dance activities can increase levels of nitric oxide, serotonin, estrogen hormones, and HDL cholesterol, while they can decrease levels of dopamine, serum glucose, serum triglycerides, and LDL cholesterol. Levels of cortisol can either be increased or decreased, depending on the type of dance. Many of these results parallel the biomolecular effects of traditional (non-dance) exercise activities, although some contrasting results can also be seen. The concentrations of these molecules and their distributions throughout the body impact health and a wide variety of disease states. This connection to the molecular level provides a perspective for understanding how it is that dance activities are able to affect larger-scale physiological and psychological responses and lead to the positive health outcomes that are observed in many situations.
Collapse
|
4
|
Gennari-Felipe M, Borges L, Dermargos A, Weimann E, Curi R, Pithon-Curi TC, Hatanaka E. Hypertonic Solution in Severe COVID-19 Patient: A Potential Adjuvant Therapy. Front Med (Lausanne) 2022; 9:917008. [PMID: 35801207 PMCID: PMC9253300 DOI: 10.3389/fmed.2022.917008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) features hyper-inflammation, cytokine storm, neutrophil function changes, and sodium chloride (NaCl) homeostasis disruption, while the treatment with NaCl hypertonic solutions (HS) controls electrolytic body homeostasis and cell functions. HS treatment is a simple, popular, economic, and feasible therapy to regulate leukocyte function with a robust anti-inflammatory effect in many inflammatory diseases. The purpose of this narrative review is to highlight the knowledge on the use of HS approaches against viral infection over the past years and to describe the mechanisms involved in the release of neutrophil extracellular traps (NETs) and production of cytokine in severe lung diseases, such as COVID-19. We reported the consequences of hyponatremia in COVID-19 patients, and the immunomodulatory effects of HS, either in vitro or in vivo. We also described the relationship between electrolyte disturbances and COVID-19 infection. Although there is still a lack of clinical trials, hypertonic NaCl solutions have marked effects on neutrophil function and NETs formation, emerging as a promising adjuvant therapy in COVID-19.
Collapse
Affiliation(s)
- Matheus Gennari-Felipe
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul, São Paulo, Brazil
| | - Leandro Borges
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul, São Paulo, Brazil
| | - Alexandre Dermargos
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul, São Paulo, Brazil
| | - Eleine Weimann
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul, São Paulo, Brazil
| | - Rui Curi
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul, São Paulo, Brazil
- Seção de Produção de Imunobiológicos, Centro Bioindustrial, Instituto Butantan, São Paulo, Brazil
| | | | - Elaine Hatanaka
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul, São Paulo, Brazil
- *Correspondence: Elaine Hatanaka,
| |
Collapse
|
5
|
Cheng Y, Yu W, Zhou Y, Zhang T, Chi H, Xu C. Novel predictor of the occurrence of DKA in T1DM patients without infection: A combination of neutrophil/lymphocyte ratio and white blood cells. Open Life Sci 2022; 16:1365-1376. [PMID: 35071771 PMCID: PMC8760182 DOI: 10.1515/biol-2021-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/24/2021] [Accepted: 11/12/2021] [Indexed: 12/28/2022] Open
Abstract
The role of inflammation has been identified in the pathogenesis of diabetic ketoacidosis (DKA). The neutrophil/lymphocyte ratio (NLR) and white blood cells (WBC) can be used to predict a systemic inflammatory response. Changes in NLR and WBC levels have never been explored in type 1 diabetes mellitus (T1DM) patients with DKA and an uninfected state. This retrospective study included a total of 644 participants. NLR and WBC were measured in the control group (n = 316) and in T1DM patients with mild-DKA (n = 92), severe-DKA (n = 52), and non-DKA (n = 184) in an uninfected state. Then, we assessed the independent predictors of DKA occurrence in T1DM patients in an uninfected state. The diagnostic performance of variables was determined by receiver operating characteristic curve analysis. Serum NLR of T1DM patients is significantly higher than that of normal controls, and if DKA occurs, NLR increases further and increases with the severity of DKA. In addition to diastolic blood pressure, blood urea nitrogen, glycated hemoglobin (HbA1c), and WBC, NLR was also independently associated with DKA in T1DM patients with an uninfected state (OR = 1.386, 95% CI: 1.127-1.705, p = 0.002). Furthermore, the diagnosis analysis showed that except for NLR and WBC, the area under the curve (AUC) of indicators with a statistical difference in patients with and without DKA were 0.747 for DKA diagnosis, and after the addition of NLR and WBC, the AUC was 0.806. The increased NLR level represents a low-cost and highly accessible predictor for DKA in T1DM patients with an uninfected state. The addition of inflammation indicators can play a statistically significant role in the prediction model of the DKA occurrence.
Collapse
Affiliation(s)
- Yiping Cheng
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324, Jing 5 Road, Jinan 250021, Shandong, China.,Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Road, Jinan 250021, Shandong, China.,Department of Endocrinology and Metabolism, Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan 250021, Shandong, China.,Department of Endocrinology and Metabolism, Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan 250021, Shandong, China
| | - Wenhao Yu
- Department of Biostatistics, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China
| | - Yuping Zhou
- Department of Endocrinology and Metabolism, Weihai Municipal Hospital, 70, Heping Road, Weihai, 264299, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China
| | - Haiyan Chi
- Department of Endocrinology and Metabolism, Weihai Municipal Hospital, 70, Heping Road, Weihai, 264299, China
| | - Chao Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324, Jing 5 Road, Jinan 250021, Shandong, China.,Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Road, Jinan 250021, Shandong, China.,Department of Endocrinology and Metabolism, Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan 250021, Shandong, China.,Department of Endocrinology and Metabolism, Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan 250021, Shandong, China
| |
Collapse
|
6
|
Galán B, Serdan T, Rodrigues L, Manoel R, Gorjão R, Masi L, Pithon-Curi T, Curi R, Hirabara S. Reviewing physical exercise in non-obese diabetic Goto-Kakizaki rats. Braz J Med Biol Res 2022; 55:e11795. [PMID: 35648976 PMCID: PMC9150428 DOI: 10.1590/1414-431x2022e11795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
There is a high incidence of non-obese type 2 diabetes mellitus (non-obese-T2DM) cases, particularly in Asian countries, for which the pathogenesis remains mainly unclear. Interestingly, Goto-Kakizaki (GK) rats spontaneously develop insulin resistance (IR) and non-obese-T2DM, making them a lean diabetes model. Physical exercise is a non-pharmacological therapeutic approach to reduce adipose tissue mass, improving peripheral IR, glycemic control, and quality of life in obese animals or humans with T2DM. In this narrative review, we selected and analyzed the published literature on the effects of physical exercise on the metabolic features associated with non-obese-T2DM. Only randomized controlled trials with regular physical exercise training, freely executed physical activity, or skeletal muscle stimulation protocols in GK rats published after 2008 were included. The results indicated that exercise reduces plasma insulin levels, increases skeletal muscle glycogen content, improves exercise tolerance, protects renal and myocardial function, and enhances blood oxygen flow in GK rats.
Collapse
Affiliation(s)
- B.S.M. Galán
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil
| | - T.D.A. Serdan
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil; New York University, USA
| | - L.E. Rodrigues
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil
| | - R. Manoel
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil
| | - R. Gorjão
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil
| | - L.N. Masi
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil
| | - T.C. Pithon-Curi
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil
| | - R. Curi
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil; Instituto Butantan, Brasil
| | - S.M. Hirabara
- Instituto de Atividade Física e Esportes, Universidade Cruzeiro do Sul, Brasil
| |
Collapse
|
7
|
Machado OAS, Diniz VLS, Passos MEP, de Oliveira HH, Santos-Oliveira LC, Alecrim AL, Bertola Lobato T, Manoel R, Correa I, Silva EB, de Oliveira Poma S, Mendes de Almeida M, Pithon-Curi TC, Diniz S, Levada-Pires AC, Curi R, Masi LN, Hirabara SM, Gorjão R. Physical exercise increases global and gene-specific (interleukin-17 and interferon-γ) DNA methylation in lymphocytes from aged women. Exp Physiol 2021; 106:1878-1885. [PMID: 34229361 DOI: 10.1113/ep089673] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 12/22/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is lymphocyte DNA methylation differentially modulated by resistance training and aerobic exercise in older women? What is the main finding and its importance? The practice of resistance training led to an increased global DNA methylation in lymphocytes. The exercise-induced increase of inflammatory genes methylation may be associated with immune function impairment during ageing. ABSTRACT Ageing-induced increase in inflammatory gene expression through a reduction in DNA methylation might contribute to chronic diseases. Regular physical exercise practices, in turn, are associated with a decrease in the incidence of inflammatory diseases. We herein evaluated the effects of three exercise modalities on lymphocyte global and gene-specific (interferon γ (IFN-γ) and interleukin 17A (IL-17A) DNA methylation in aged women (68 ± 7.5 years). This cross-sectional study included 86 women, divided into four groups according to the physical exercise practice: 20 were practicing resistance training (RT); 24 were practicing water aerobics exercise (W); 22 were practicing water aerobics and resistance exercise (RWT), and 20 did not practice any physical exercise (CON). We evaluated volunteer functional capability using the Timed Up and Go (TUG) test, global lymphocyte DNA methylation by enzyme-linked immunosorbent assay, IFN-γ and IL-17A methylation by qPCR and CD4+ IFN-γ+ and CD4+ IL-17+ cell percentage by flow cytometry. The three physically exercised groups performed functional capability tests in a shorter period and showed a higher global lymphocyte DNA methylation and methylated CpGs of IL-17A and IFN-γ promoter regions than the control group. The practice of resistance training (RT and RWT groups) lead to high global DNA methylation. The combination of resistance training and aerobic exercise led to the increase of lymphocyte IL-17A and IFN-γ gene methylation induced by each separately. However, the percentage of IFN-γ+ and IL-17+ cells was lower only in the RT group. The exercise-induced increase of inflammatory-gene methylation may be associated with gene expression changes and immune function impairment during ageing.
Collapse
Affiliation(s)
- Otávio A S Machado
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil.,Physiology and Metabolism Study Center, Physical Education Faculty of Sorocaba YMCA, Sorocaba, Brazil
| | - Vinicius L S Diniz
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Maria E P Passos
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Heloisa H de Oliveira
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Laiane C Santos-Oliveira
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Amanda L Alecrim
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Tiago Bertola Lobato
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Richelieau Manoel
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Ilana Correa
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Eliane B Silva
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Sarah de Oliveira Poma
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Mariana Mendes de Almeida
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Tania C Pithon-Curi
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | | | - Adriana C Levada-Pires
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Rui Curi
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Laureane Nunes Masi
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Sandro M Hirabara
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| | - Renata Gorjão
- Interdisciplinary Post-Graduate Program in Health Sciences, Health Sciences department, Cruzeiro do Sul University, São Paulo, Brazil
| |
Collapse
|