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Utz Melere M, Sanha V, Farina M, da Silva CS, Nader L, Trein C, Lucchese AM, Ferreira C, Kalil AN, Feier FH. Primary liver transplantation vs transplant after Kasai portoenterostomy in children with biliary atresia: A retrospective Brazilian single-center cohort. World J Transplant 2024; 14:88734. [PMID: 38576759 PMCID: PMC10989469 DOI: 10.5500/wjt.v14.i1.88734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Biliary atresia (BA) is the most common indication for pediatric liver trans plantation, although portoenterostomy is usually performed first. However, due to the high failure rate of portoenterostomy, liver transplantation has been advocated as the primary procedure for patients with BA. It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes. AIM To investigate the effect of prior portoenterostomy in infants un dergoing liver transplantation for BA. METHODS This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil. Patients with BA were divided into two groups: Those under going primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy. Continuous variables were compared using the Student's t-test or the Kruskal-Wallis test, and categorical variables were compared using the χ2 or Fisher's exact test, as appropriate. Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis. Patient and graft survival analyses were conducted with the Kaplan-Meier product-limit estimator, and patient subgroups were compared using the two-sided log-rank test. RESULTS Forty-two patients were included in the study (25 [60%] girls), 23 undergoing liver transplantation without prior portoenterostomy, and 19 undergoing liver transplantation with prior portoenterostomy. Patients with prior portoenterostomy were older (12 vs 8 months; P = 0.02) at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores (13.2 vs 21.4; P = 0.01). The majority of the patients (35/42, 83%) underwent living-donor liver transplantation. The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis (39 vs 11%), but this result did not reach statistical significance. Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation, graft-to-recipient weight ratio, and use of vascular grafts. Finally, the groups did not significantly differ in terms of post-transplant survival. CONCLUSION In our study, prior portoenterostomy did not significantly affect the outcomes of liver transplantation.
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Affiliation(s)
- Melina Utz Melere
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
| | - Valberto Sanha
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
| | - Marco Farina
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
| | - Carolina Soares da Silva
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
| | - Luiza Nader
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
| | - Cristine Trein
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
| | - Angelica Maria Lucchese
- Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Cristina Ferreira
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
| | - Antonio Nocchi Kalil
- Department of Surgical Oncology, Santa Rita Hospital/Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Flavia Heinz Feier
- Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
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Machry M, Ferreira LF, Lucchese AM, Kalil AN, Feier FH. Liver volumetric and anatomic assessment in living donor liver transplantation: The role of modern imaging and artificial intelligence. World J Transplant 2023; 13:290-298. [PMID: 38174151 PMCID: PMC10758682 DOI: 10.5500/wjt.v13.i6.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 10/17/2023] [Indexed: 12/15/2023] Open
Abstract
The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation. Living-donor liver transplantation (LDLT) has emerged as a viable option, expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes. An accurate evaluation of the donor liver's volumetry (LV) and anatomical study is crucial to ensure adequate future liver remnant, graft volume and precise liver resection. Thus, ensuring donor safety and an appropriate graft-to-recipient weight ratio. Manual LV (MLV) using computed tomography has traditionally been considered the gold standard for assessing liver volume. However, the method has been limited by cost, subjectivity, and variability. Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility, reduced variability, and enhanced efficiency compared to manual measurements. However, the accuracy of automated LV requires further investigation. The study provides a comprehensive review of traditional and emerging LV methods, including semi-automated image processing, automated LV techniques, and machine learning-based approaches. Additionally, the study discusses the respective strengths and weaknesses of each of the aforementioned techniques. The use of artificial intelligence (AI) technologies, including machine learning and deep learning, is expected to become a routine part of surgical planning in the near future. The implementation of AI is expected to enable faster and more accurate image study interpretations, improve workflow efficiency, and enhance the safety, speed, and cost-effectiveness of the procedures. Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT. MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions. Moreover, AI has tremendous potential for LV and segmentation; however, its widespread use is hindered by cost and availability. Therefore, the integration of multiple specialties is necessary to embrace technology and explore its possibilities, ranging from patient counseling to intraoperative decision-making through automation and AI.
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Affiliation(s)
- Mayara Machry
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Luis Fernando Ferreira
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Angelica Maria Lucchese
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Antonio Nocchi Kalil
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Flavia Heinz Feier
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
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Torres OJM, Coelho FF, Kalil AN, Belotto M, Ramos EJB, Lucchese AM, Moraes-Junior JMA, Amaral PCG, Fonseca GM, Herman P. Surgical resection for non-Asian intrahepatic lithiasis: The Brazilian experience. Asian J Surg 2020; 44:553-559. [PMID: 33323316 DOI: 10.1016/j.asjsur.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intrahepatic lithiasis (IHL) is a rare disease in the western world. Complications associated with IHL include acute cholangitis, liver atrophy, secondary biliary cirrhosis, and risk for intrahepatic cholangiocarcinoma. Liver resection is considered the treatment of choice for IHL. The objective of this study was to analyze patients who underwent liver resection for non-Asian hepatolithiasis. METHODS 127 patients with symptomatic non-Asian hepatolithiasis underwent resection in six institutions. Demographic data, clinical presentation, diagnosis, classification according to stone location, presence of atrophy, bile duct stricture, biliary cirrhosis, incidence of cholangiocarcinoma, treatment and postoperative course were evaluated. RESULTS 52 patients (40.9%) were male and the mean age was 46.1 years. Sixty-six patients (51.9%) presented with history of cholangitis. Stones were located in the left lobe in 63 (49.6%), and right lobe in 28 patients (22.0%). Atrophy was observed in 31 patients (24.4%) and biliary stenosis in 18 patients (14.1%). The most common procedure performed was left lateral sectionectomy in 63 (49.6%) patients, followed by left hepatectomy in 36 (28.3%), right hepatectomy in 19 (15.0%), and associated hepaticojejunostomy in 28 (22.0%). Forty-two patients (33.0%) presented postoperative complications and the most common were biliary fistula (13.3%) and surgical site infection (7.0%). Postoperative mortality was 0.7%. Intrahepatic cholangiocarcinoma was observed in 2 patients (1.5%). Recurrence was identified in 10 patients (7.8%), mostly with bilateral stones and/or hepaticojejunostomy. CONCLUSION Liver resection is the standard treatment for symptomatic unilateral or complicated IHL with good operative results. Risk of cholangiocarcinoma was low in non-Asian patients.
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Affiliation(s)
- Orlando Jorge M Torres
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: Federal University of Maranhão, São Luís, MA, Brazil.
| | - Fabricio Ferreira Coelho
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Antonio Nocchi Kalil
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: Santa Casa de Porto Alegre, RS, Brazil
| | - Marcos Belotto
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: Sirio Libanês and Osvaldo Cruz Hospital, São Paulo, SP, Brazil
| | - Eduardo José B Ramos
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: NS das Graças Hospital, Curitiba, PR, Brazil
| | - Angelica Maria Lucchese
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: Santa Casa de Porto Alegre, RS, Brazil
| | - José Maria A Moraes-Junior
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: Federal University of Maranhão, São Luís, MA, Brazil
| | - Paulo Cezar G Amaral
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: Hospital São Raphael, Salvador, BA, Brazil
| | - Gilton Marques Fonseca
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Paulo Herman
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit: University of São Paulo Medical School, São Paulo, SP, Brazil
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Torres OJM, Linhares MM, Ramos EJB, Amaral PCG, Belotto M, Lucchese AM, Neiva RF, Freitas TM, Santana R, Vieira JP, Freire JS, Torres CCS, Kalil AN. LIVER RESECTION FOR NON-ORIENTAL HEPATOLITHIASIS. ACTA ACUST UNITED AC 2019; 32:e1463. [PMID: 31859916 PMCID: PMC6918752 DOI: 10.1590/0102-672020190001e1463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
Background: Primary intrahepatic lithiasis is defined when the stones are formed in the liver and associated with local dilatation and biliary stricture. Liver resection is the ideal procedure. Aim: To evaluate the results of liver resection in the treatment of non-oriental intrahepatic lithiasis. Methods: Fifty-one patients with symptomatic benign non-oriental hepatolithiasis underwent surgical resection in six institutions in Brazil. Demography data, clinical symptoms, classification, diagnosis, management and postoperative course were analyzed. Results: Of the 51 patients, 28 were male (54.9%), with a mean age of 49.3 years. History of cholangitis was observed in 15 (29.4%). The types of intrahepatic lithiasis were type I in 39 (76.5%) and type IIb in 12 (23.5%), with additional type Ea in six (11.8%). Liver function test were normal in 42 patients (82.4%). Segmental atrophy was observed in 12 (23.5%). Treatments included left lateral sectionectomy in 24 (47.1%), left hepatectomy in 14 (27.5%) and right hepatectomy in eight (15.7%), with associated hepaticojejunostomy in four (7.8%). Laparoscopic liver resection was performed in eight (15.7%). Postoperative complications were observed in 20 (39.2%) with no mortality. Conclusion: Liver resection in patients with hepatolithiasis is the ideal procedure as it removes stones, stricture, atrophic parenchyma, and minimizes the risk of cholangiocarcinoma.
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Affiliation(s)
- Orlando Jorge Martins Torres
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luís, MA, Brazil
| | - Marcelo Moura Linhares
- Department of Gastrointestinal Surgery, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Eduardo José B Ramos
- Department of Gastrointestinal Surgery, NS das Graças Hospital, Curitiba, PR, Brazil
| | - Paulo Cezar G Amaral
- Department of Gastrointestinal Surgery, Hospital São Raphael, Salvador, BA, Brazil
| | - Marcos Belotto
- Department of Gastrointestinal Surgery, Santa Casa de São Paulo, SP, Brazil
| | | | - Romerito Fonseca Neiva
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luís, MA, Brazil
| | - Theago Medeiros Freitas
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luís, MA, Brazil
| | - Rodolfo Santana
- Department of Gastrointestinal Surgery, Santa Casa de São Paulo, SP, Brazil
| | - Josiel Paiva Vieira
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luís, MA, Brazil
| | - Jaldo Santos Freire
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luís, MA, Brazil
| | - Camila Cristina S Torres
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luís, MA, Brazil
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Lucchese AM, Kalil AN, Ruiz A, Karam V, Ciacio O, Pittau G, Castaing D, Cherqui D, Sa Cunha A, Vibert E, Adam R. Neoadjuvant chemotherapy response influences outcomes in non-colorectal, non-neuroendocrine liver metastases. Br J Surg 2018; 105:1665-1670. [PMID: 29893476 DOI: 10.1002/bjs.10884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/31/2018] [Accepted: 04/04/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Indications for surgical resection of non-colorectal, non-neuroendocrine (NCNNE) liver metastases are unclear. This study analysed the influence of response to neoadjuvant chemotherapy and the presence of extrahepatic disease (EHD) on outcomes. METHODS Patients who underwent hepatic resection for NCNNE liver metastases and who received neoadjuvant chemotherapy at a single centre between 1982 and 2016 were analysed retrospectively. Patients were classified as having no EHD, controlled EHD or non-controlled EHD. RESULTS Hepatic resection was performed in 199 patients (81·2 per cent) after partial or complete response to chemotherapy or disease stabilization, and 46 patients (18·8 per cent) after tumour progression. Patients with progressive disease after chemotherapy had worse overall survival than those without (23 versus 50·4 per cent at 5 years; P = 0·004). Median survival was 63·6 (range 31·1-94·8) months for patients without EHD, 34·8 (19·2-49·2) months for those with controlled EHD and 7·2 (1·2-13·2) months for patients with non-controlled EHD (P = 0·004). In multivariable analysis, EHD (P = 0·004), response to chemotherapy (P = 0·004) and resection margins (P = 0·002) were all independent predictors of overall survival, regardless of primary tumour site. CONCLUSION The prognosis of patients with NCNNE liver metastases is influenced by preoperative chemotherapy and resectability.
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Affiliation(s)
- A M Lucchese
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France.,Department of Surgical Oncology, Santa Rita Hospital/Santa Casa de Misericórdia de Porto Alegre, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - A N Kalil
- Department of Surgical Oncology, Santa Rita Hospital/Santa Casa de Misericórdia de Porto Alegre, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - A Ruiz
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - V Karam
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - O Ciacio
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - G Pittau
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - D Castaing
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - D Cherqui
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - E Vibert
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
| | - R Adam
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U935 and U1193, Villejuif, France
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Juiz PJL, Lucchese AM, Gambari R, Piva R, Penolazzi L, Di Ciano M, Uetanabaro APT, Silva F, Avila-Campos MJ. Essential oils and isolated compounds from Lippia alba leaves and flowers: antimicrobial activity and osteoclast apoptosis. Int J Mol Med 2014; 35:211-7. [PMID: 25384405 DOI: 10.3892/ijmm.2014.1995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/24/2014] [Indexed: 11/05/2022] Open
Abstract
In the present study, essential oils extracted from the leaves and flowers of Lippia alba (Mill.) N.E.Br. (L. alba) were analyzed for their antimicrobial activity and their effects on osteoclasts. The periodontal pathogens, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans; ATCC 43717), Fusobacterium nucleatum (F. nucleatum; ATCC 25586) and Porphyromonas gingivalis (P. gingivalis); ATCC 33277) were used in antimicrobial activity assays for determining the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC), whereas Bacteroides fragilis (B. fragilis; ATCC 25285) was used as the control microorganism. Osteoclast (OC) apoptosis was assessed by TUNEL assay and Fas receptor expression was detected by immunocytochemistry. The analysis of antimicrobial activity revealed that P. gingivalis had the lowest MIC values, whereas A. actinomycetemcomitans had the highest. L. alba essential oils were found to be toxic to human cells, although the compounds, carvone, limonene and citral, were non-toxic and induced apoptosis in the OCs. This study demonstrates that L. alba has potential biotechnological application in dentistry. In fact periodontal disease has a multifactorial etiology, and the immune response to microbial challenge leads to osteoclast activation and the resorption of the alveolar bone, resulting in tooth loss.
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Affiliation(s)
- Paulo José Lima Juiz
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Cajueiro, 44570-000 Santo Antônio de Jesus, Bahia, Brazil
| | - Angelica Maria Lucchese
- Department of Mathematical Sciences, Area of Chemistry, State University of Feira de Santana, 44031-460 Feira de Santana, Bahia, Brazil
| | - Roberto Gambari
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy
| | - Roberta Piva
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Letizia Penolazzi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Martina Di Ciano
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Ana Paula Trovatti Uetanabaro
- Department of Biological Sciences - UESC, State University of Santa Cruz, Salobrinho, 45662900 Ilheus, Bahia, Brazil
| | - Franceli Silva
- Center for Agricultural, Environmental and Biological Sciences, Federal University of Recôncavo da Bahia, 44380-000 Cruz das Almas, Bahia, Brazil
| | - Mario Julio Avila-Campos
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 Butantan, São Paulo, Brazil
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