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Original article
Effect of resveratrol on seric vascular endothelial growth factor concentrations during atherosclerosis
Efecto del resveratrol sobre las concentraciones séricas del factor de crecimiento endotelial vascular durante la aterosclerosis
Leticia Figueiraa,
Corresponding author
figueiraleticia@gmail.com

Corresponding author.
, Julio César Gonzáleza,b
a School of Bioanalysis, Laboratorio de Investigación y Postgrado de la Escuela de Bioanálisis (LIPEB) [Research and Postgraduate Laboratory of the School of Bioanalysis], Faculty of Health Sciences, Universidad de Carabobo, Naguanagua, Carabobo, Venezuela
b Laboratorio Clínico Julio César González, Valencia, Carabobo, Venezuela
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        "titulo" => "Efecto del resveratrol sobre las concentraciones s&#233;ricas del factor de crecimiento endotelial vascular durante la aterosclerosis"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Effect of resveratrol on the serum concentrations of VEGF in the experimentation rabbits in weeks 0&#44; 6 and 12&#46; The results are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12 baseline and week 6&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6 at week 12&#41;&#46; &#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 <span class="elsevierStyleItalic">vs</span>&#46; control &#40;group 1&#41;&#46; <span class="elsevierStyleSup">&#35;</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0010 <span class="elsevierStyleItalic">vs</span>&#46; control resveratrol &#40;group 3&#41;&#46; <span class="elsevierStyleSup">&#948;</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0051 <span class="elsevierStyleItalic">vs</span>&#46; group 2&#46; <span class="elsevierStyleSup">¿</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 <span class="elsevierStyleItalic">vs</span>&#46; baseline value&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Resveratrol &#40;3&#44;5&#44;4&#8242;-trihydroxystilbene&#41; is a polyphenolic compound found in grapes and red wine&#44; described as having antioxidant&#44; anti-inflammatory&#44; antiproliferative and antiangiogenic properties&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2</span></a> It has been proven beneficial in preventing the onset and progression of atherosclerosis&#44; as it inhibits the oxidation of low-density lipoproteins &#40;LDL&#41;&#44; suppresses platelet aggregation&#44; inhibits the proliferation of vascular smooth muscle cells <span class="elsevierStyleItalic">in vitro</span>&#44; reduces endothelial cell damage and attenuates thickening of the intima media&#46; It also reduces the size of atherosclerotic lesions&#44; modulates the production of nitric oxide &#40;NO&#41;&#44; inhibits the production of chemokines and reactive oxygen species &#40;ROS&#41; and controls plasma cholesterol levels&#59; all of the above being important factors in atherogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Inflammation and angiogenesis are involved in the pathophysiology of atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> Vascular endothelial growth factor &#40;VEGF&#41; is a powerful growth factor produced by different cells such as endothelial and smooth muscle cells&#44; platelets and macrophages&#46; VEGF plays a determining role in the rate and extent of vascular remodelling&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> Its role in atherosclerosis&#44; however&#44; is still not fully understood&#46; VEGF exerts dual actions and induces both beneficial and harmful effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;6</span></a> It can protect endothelial cells by inducing the expression of antiapoptotic proteins and the production of NO&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> but it also has pro-atherogenic effects&#44; as it stimulates the proliferation and growth of endothelial cells&#44; induces angiogenesis&#44; and increases the permeability of the endothelium and the expression of cell adhesion proteins&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Evidence has been found of an increase in serum VEGF levels in patients with coronary heart disease&#44; myocardial infarction and atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">4&#44;8</span></a> An increase has also been detected in the expression of VEGF in atherosclerotic plaques in the coronary and carotid arteries&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a> primarily in the deep portions of the intima of affected vessels&#44; associated with intraplaque haemorrhage&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a> suggesting that VEGF is involved in the pathogenesis of atherosclerosis&#46; However&#44; the effect of resveratrol on serum VEGF levels during the development and progression of atherosclerosis remains unclear&#44; and even less is known about the relationship between VEGF and inflammation and how this evolves over the course of the atherogenic process&#46; We therefore decided to conduct a study to analyse the effect of resveratrol on serum levels of VEGF and how they evolve over time in rabbits fed a diet enriched with cholesterol&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We used 48 male 12-week-old New Zealand strain rabbits &#40;Laboratory Animal Facility of the Instituto de Higiene Rafael Rangel&#44; Caracas&#44; Venezuela&#41; weighing from 1200 to 1300<span class="elsevierStyleHsp" style=""></span>g&#46; The animals were kept in cages under controlled light and dark &#40;L&#58;D&#44; 12&#58;12&#41; and temperature &#40;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; conditions&#46; After a week of acclimatisation at the Laboratory Animal Facility&#44; Universidad de Carabobo &#40;Valencia&#44; Venezuela&#41;&#44; the rabbits were randomly divided into four groups of 12&#58; group 1 &#40;control&#41;&#44; fed daily with standard diet &#40;commercial rabbit food from Protinal&#44; Venezuela&#41;&#59; group 2&#44; fed daily with a standard diet enriched with 0&#46;5&#37; &#40;w&#47;w&#41; cholesterol&#59; group 3 &#40;control resveratrol&#41;&#44; fed daily with standard diet and supplemented with resveratrol in the food &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg body weight&#44; oral&#41;&#59; group 4&#58; fed daily with standard diet&#44; enriched with 0&#46;5&#37; &#40;w&#47;w&#41; of cholesterol and resveratrol mixed in the food &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg body weight&#44; oral&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The cholesterol was administered by enriching the standard diet with cholesterol dissolved in ethyl ether and absolute ethanol&#46; The grains of rabbit feed were covered with the cholesterol solution at a ratio of 0&#46;5<span class="elsevierStyleHsp" style=""></span>g of cholesterol per 100<span class="elsevierStyleHsp" style=""></span>g of feed and the solvent was removed by evaporation for 24<span class="elsevierStyleHsp" style=""></span>h&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> The resveratrol concentration was selected based on <span class="elsevierStyleItalic">in vivo</span> studies in rabbits<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> and tests performed in our laboratory&#44; in which resveratrol was found to have biological effects at a dose of 2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg orally&#46; The resveratrol &#40;3&#44;5&#44;4&#8242;-trihydroxystilbene&#41; administered to the rabbits was of natural origin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All the rabbits had free access to drinking water&#46; The experimental period lasted 12 weeks&#46; The rabbits were weighed before&#44; during and after the experimentation&#46; The experiments were approved by the Bioethics Committee and conducted in line with the National Institutes of Health Guide for the Care and Use of Laboratory Animals &#40;NIH Publications No&#46; 8023&#44; revised 1978&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Experimental procedure</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Biochemical measurements</span><p id="par0035" class="elsevierStylePara elsevierViewall">The blood samples were extracted from all the rabbits by intracardiac puncture&#44; after fasting for 14<span class="elsevierStyleHsp" style=""></span>h&#44; at the start and weeks 6 and 12&#44; using tubes without anticoagulant&#46; After being cold-stored&#44; the samples were centrifuged at 3000<span class="elsevierStyleHsp" style=""></span>rpm for 15<span class="elsevierStyleHsp" style=""></span>min and the serum obtained was then stored frozen at &#8722;70<span class="elsevierStyleHsp" style=""></span>&#176;C until processing&#46; Enzymatic methods &#40;Linear Chemicals&#44; Spain&#41; were used to measure serum total cholesterol &#40;TC&#41; and triglycerides &#40;TG&#41;&#46; High-density lipoprotein cholesterol &#40;HDL-C&#41; and low-density lipoprotein cholesterol &#40;LDL-C&#41; were measured by precipitation and subsequent enzymatic determination &#40;Linear Chemicals&#44; Spain&#41;&#46; C-reactive protein &#40;CRP&#41; was measured quantitatively using the immunoturbidimetric method &#40;Alpco&#44; USA&#41;&#46; Serum concentrations of VEGF were determined by immunoenzyme assay &#40;NeoBiolab&#44; Cambridge&#44; Massachusetts&#44; USA&#41;&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Killing of the animals</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Tissue preparation and histological typing of atherosclerotic lesions</span><p id="par0040" class="elsevierStylePara elsevierViewall">At week 6 and at the end of the study&#44; half the animals in each group were killed by dislocation of the neck&#46; Once the post-mortem examination had been performed&#44; the aortic artery was dissected for histological study&#46; The extracted tissue samples were fixed in 10&#37; formaldehyde in PBS for 24<span class="elsevierStyleHsp" style=""></span>h and processed according to the routine technique and then stained with haematoxylin-eosin&#44; to be studied by optical microscopy&#46; The lesions were classified according to the American Heart Association classification system&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Data analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Mean and standard deviation were calculated for the variables studied&#46; We performed the Shapiro&#8211;Wilk&#44; Kolmogorov&#8211;Smirnov and Jarque&#8211;Bera normality tests&#46; The Kruskall&#8211;Wallis analysis was used with <span class="elsevierStyleItalic">post hoc</span> analysis&#44; applying the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test to each pair of groups&#46; We used the Spearman correlation to relate VEGF to the study variables&#46; A <span class="elsevierStyleItalic">p</span> value &#60;0&#46;05 was considered significant&#46; The programme GraphPad Prism version 5 was used&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Lipid profile of the rabbits</span><p id="par0050" class="elsevierStylePara elsevierViewall">The rabbits&#8217; serum lipid concentrations are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; No statistically significant differences were found in serum concentrations of TC&#44; HDL-C&#44; LDL-C or TG among the groups of rabbits&#46; There were no significant changes in TC&#44; HDL-C&#44; LDL-C or TG over the course of the study in groups 1 and 3&#46; In weeks 6 and 12 of the experiment&#44; however&#44; there was a significant increase in the concentrations of TC&#44; HDL-C&#44; LDL-C and TG in groups 2 and 4 compared to their respective controls &#40;groups 1 and 3&#44; respectively&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; There were changes in serum lipid concentrations between the beginning and the end of the experiment in groups 2 and 4 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; but no statistically significant differences were found between the two groups in the serum concentrations of TC&#44; HDL-C&#44; LDL-C or TG over the course of the study &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Serum concentrations of inflammatory markers</span><p id="par0055" class="elsevierStylePara elsevierViewall">As can be seen in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#44; no statistically significant differences were found among the groups of rabbits in the baseline serum concentrations of VEGF or CRP&#46; The VEGF and CRP in groups 1 and 3 remained unchanged throughout the experiment&#46; There were changes&#44; however&#44; in the levels of VEGF and CRP in groups 2 and 4 over the course of the study &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; In week 6 and at the end of the experiment&#44; serum concentrations of VEGF and CRP increased in group 2 compared to group 1 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0010&#41;&#44; and in group 4 compared to group 3 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0010&#41;&#46; However&#44; in week 12 a significant decrease in VEGF and CRP levels was found in group 4 compared to group 2 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0049&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows Spearman&#39;s correlations between VEGF concentration&#44; lipid profile and CRP&#44; with a significant positive correlation being found between VEGF and the lipid profile and CRP &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Histological analysis of the aorta</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the distribution of the rabbits according to the maximum degree of atheroma found in the aorta sections&#44; with none of the rabbits from groups 1 or 3 having atherosclerotic lesions over the course of the study&#46; The rabbits in group 2 did develop lesions of variable degrees over the course of the study&#46; In group 4&#44; some rabbits had no lesions at all and others had lesions of variable degrees &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">We found evidence in our study to suggest that VEGF and CRP may be non-invasive early markers of atherosclerosis&#46; The administration of a diet enriched with cholesterol caused intermediate and advanced atherosclerotic lesions and an increase in serum concentrations of VEGF and CRP from week 6 of the study&#44; suggesting involvement of these molecules in atherosclerosis from the early stages&#46; Other studies have shown an increase in plasma levels of VEGF in patients with coronary heart disease&#44; myocardial infarction and atherosclerosis&#44; which can reflect the severity of the lesion&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">8&#44;13</span></a> In fact&#44; a number of studies support the pro-atherogenic role of VEGF&#46; It has been reported that treatment with recombinant human VEGF causes an increase in the density of macrophages in the plaque&#44; and an increase in plaque growth and neovascularisation&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> all of which points to the importance of VEGF and its involvement in the growth and extent of inflammation in the atherosclerotic plaque&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">However&#44; the role of VEGF in low-intensity inflammatory processes is still under debate because of its dual action&#46; On the one hand&#44; VEGF-A can increase endothelial permeability and expression of cell adhesion proteins and chemotactic factors&#44; promoting the adhesion of monocytes&#44; their transendothelial migration and activation&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a> but&#44; on the other&#44; it protects endothelial cells by inducing anti-apoptotic proteins and increasing the expression of endothelial nitric oxide synthase &#40;eNOS&#41; and NO synthesis&#44; and it can act as a mitogen that promotes re-endothelialisation&#44; preventing or repairing the endothelial damage begun by the atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The increase in VEGF concentrations found in this study could be a result of the hypoxia and inflammation conditions that exist in atherosclerosis&#59; the rabbits developed intermediate and advanced atherosclerotic lesions&#46; Other authors have reported that during atherosclerosis the thickening of the intima causes a decrease in oxygen supplementation to the arterial wall&#44; which in turn causes the release of angiogenesis-stimulating factors such as VEGF&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a> promoting neovascularisation&#46; This could allow nutrient supplementation&#44; in addition to macrophage infiltration&#44; wall thickening&#44; lipid deposition&#44; inflammation and progression of the atherosclerotic lesion&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Therefore&#44; the increase in VEGF and CRP concentrations found in our study suggests the existence of an inflammatory state induced by the diet enriched with cholesterol&#44; which caused intermediate and advanced atherosclerotic lesions&#46; It is thought that the increase in the expression of cell adhesion molecules and cytokines promoted by hyperlipidaemia&#44; with the consequent accumulation of monocytes in the intima&#44; may be involved in the development of these atherosclerotic lesions&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a> given that inflammation plays an important role in the pathophysiology of atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In fact&#44; CRP is the most studied marker of inflammation related to cardiovascular prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">19&#8211;21</span></a> Different authors have detected CRP in atherosclerotic lesions in humans and animals&#44; and suggested that it may have a direct effect on atherogenesis because it is synthesised in the macrophages of the lipid nucleus and is associated with the thickness of the fibrous cap&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a> The increase in serum CRP levels we found after week 6 of our experiment in the groups given a cholesterol-enriched diet therefore suggests that it is a systemic marker of inflammation which increases early on&#44; as found in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;22&#8211;27</span></a> as it is involved from the initial phase of atherosclerosis&#44; promoting the increase in the expression of cell adhesion molecules&#44; increasing the adhesion and migration of monocytes&#44; determining the synthesis of chemotactic factors and inducing the endothelial secretion of other pro-inflammatory factors such as nuclear factor-kappa B &#40;NF-&#954;B&#41;&#44; interleukin 6 &#40;IL-6&#41; and IL-8&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> Additionally&#44; epidemiological and clinical studies have shown that elevated serum levels of CRP are a risk factor as well as a marker of cardiovascular disease&#44; as CRP is a predictor of risk of myocardial infarction and peripheral arterial disease&#44; even in apparently healthy individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Our findings showed a positive association between VEGF and the lipid profile and CRP&#44; in line with other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">29&#44;30</span></a> suggesting that the increase in the serum lipid concentration may help trigger the systemic inflammatory process&#44; which is then accompanied by the increase in VEGF and CRP and contributes to the atherosclerotic process&#46; These data also suggest that serum VEGF may be a marker of risk and of atherosclerosis&#44; as the increase in serum lipids is accompanied by an increase in the inflammatory state&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In vivo</span> and <span class="elsevierStyleItalic">in vitro</span> studies have shown resveratrol to have an effect on atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2&#44;11</span></a> Resveratrol is a phytoalexin with cardioprotective effects&#46; These effects are due to its antioxidant properties&#44; as it is capable of inhibiting oxidative damage by acting on the superoxide anion and hydroxyl radicals&#44; inhibiting ROS production and lipid peroxidation&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a> Resveratrol also has anti-inflammatory effects&#44; inhibiting activation of transcription factors associated with inflammation such as NF-&#954;B and reducing serum levels of pro-inflammatory cytokines such as chemokine ligand 3&#44; interleukin 1 beta &#40;IL-1&#946;&#41; and tumour necrosis factor alpha &#40;TNF-&#945;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2&#44;11&#44;31</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Our study showed that resveratrol has an anti-inflammatory and anti-atherogenic effect&#59; in the rabbits supplemented with resveratrol and given a cholesterol-enriched diet&#44; serum VEGF and CRP levels had decreased in week 12 and we found a decrease in the formation of atherosclerotic lesions&#46; We demonstrated for the first time <span class="elsevierStyleItalic">in vivo</span> the effect of resveratrol on serum concentrations of VEGF in atherosclerosis&#46; Resveratrol can regulate the expression of VEGF in various cells&#59; it reduces the levels of VEGF in gingival fibroblasts&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a> in squamous cell carcinoma of the tongue and in human hepatoma cells&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">It has also been shown to reduce the increase in VEGF expression and secretion and cellular hyperpermeability induced by high glucose in culture of monolayers of aorta endothelial cells&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a> Additionally&#44; resveratrol prevents up-regulation of VEGF in macrophages incubated with 1-oxo cholesterol&#44; reinforcing its potential therapeutic role in counteracting the pro-atherogenic signalling of the oxysterols within the atherosclerotic plaque&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a> Considering that resveratrol was able to reduce serum concentrations of VEGF&#44; which has been shown to stimulate migration&#44; permeability and endothelial proliferation&#44; we can conclude that one of resveratrol&#39;s anti-atherogenic effects comes from reducing VEGF secretion <span class="elsevierStyleItalic">in vivo</span> during the atherosclerosis process&#44; which may contribute to decreasing endothelial permeability&#46; It is important to point out that the effect of resveratrol on VEGF and CRP levels was observed in rabbits with atherosclerosis induced by a hypercholesterolaemic diet&#44; suggesting the need for a &#8220;stimulated&#8221; or inflamed environment&#44; just as previously seen <span class="elsevierStyleItalic">in vitro</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Also of great relevance is the fact that resveratrol was able to reduce serum concentrations of CRP&#44; an important acute-phase protein and cardiovascular risk marker&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a> This confirms resveratrol&#39;s anti-inflammatory properties&#44; as reported by other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;31&#44;36</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Although the evidence suggests that resveratrol has lipid-lowering properties&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a> we did not detect this effect in our study&#59; as also reported in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;37</span></a> with the suggestion that it may have been due to the short experimental period&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> However&#44; our data and the evidence suggest that the absence of the lipid-lowering effect in our experimental model may be a result of the accumulation of exogenous lipids from their diet&#44; as they were not able to increase the excretion of sterols&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Nevertheless&#44; despite the fact that resveratrol supplementation had no effect on serum lipids&#44; it was able to reduce the formation and progression of atherosclerosis induced by the hypercholesterolaemic diet from week 6 of the study&#44; as has previously been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;11</span></a> A decrease was also reported in the expression of pro-inflammatory proteins in the aorta&#44; such as vascular cell adhesion molecule-1 &#40;VCAM-1&#41;&#44; monocyte chemoattractant protein-1 &#40;MCP-1&#41; and IL-6&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> and of factor NF-&#954;B&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a> Resveratrol has also been described as having a preventive effect on the development of atherosclerotic lesions&#44; possibly through inhibition of LDL oxidation&#44; platelet aggregation and proliferation of vascular smooth muscle cells&#44; and by inhibiting the expression of pro-inflammatory and pro-atherogenic genes&#44; such as factor NF-&#954;B and activating protein-1 &#40;AP-1&#41;&#44; in endothelial cells&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a> However&#44; <span class="elsevierStyleItalic">in vitro</span> studies have also found that the antioxidant effects mediate the anti-atherogenic action of resveratrol&#59; pre-treatment with resveratrol in a macrophage cell line was able to inhibit the formation of foam cells and lipopolysaccharide-induced ROS production by inhibiting the expression of nicotinamide adenine dinucleotide phosphate oxidase &#40;NADPH oxidase&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a> We would therefore suggest that the anti-atherogenic effect of resveratrol observed in this study could be partly due to its anti-inflammatory effect&#44; indicating that it may act as a preventive agent in the development of atherosclerotic lesions&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; our results suggest that serum VEGF and CRP are non-invasive early markers of inflammation and atherosclerosis&#46; Concentrations of both VEGF and CRP increased from week 6 of the study onwards&#44; confirming their role in the pathophysiology of atherosclerosis&#46; We therefore believe that quantification of VEGF and CRP in blood could be useful for providing diagnostic information about atherosclerosis&#46; We found oral resveratrol supplementation to have anti-inflammatory and anti-atherosclerotic effects&#44; as it decreased serum concentrations of VEGF and CRP and reduced the formation and progression of atherosclerotic lesions&#44; suggesting that administration of this polyphenol could be beneficial in preventing atherosclerosis&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">This study was made possible thanks to the funding received from Distribuidora Gonzalab&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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              "titulo" => "Lipid profile of the rabbits"
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              "titulo" => "Serum concentrations of inflammatory markers"
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              "titulo" => "Histological analysis of the aorta"
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    "fechaRecibido" => "2018-03-10"
    "fechaAceptado" => "2018-04-13"
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            0 => "Resveratrol"
            1 => "Vascular endothelial growth factor"
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            1 => "Factor de crecimiento endotelial vascular"
            2 => "Prote&#237;na C reactiva"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although it is known that resveratrol has anti-inflammatory and anti-atherogenic actions&#44; its effect on vascular endothelial growth factor &#40;VEGF&#41; in atherosclerosis is unknown&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate the effect of resveratrol on serum concentrations of VEGF during the progression and evolution of atherosclerosis&#44; as well as and its evolution over time in rabbits fed with a cholesterol diet&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 48 New Zealand white male rabbits were randomly divided into four groups of 12 rabbits&#58; group 1 &#40;control&#41;&#58; standard diet &#40;commercial rabbit food&#41;&#59; group 2&#58; cholesterol diet &#40;0&#46;5&#37; cholesterol&#41;&#59; group 3 &#40;control resveratrol&#41;&#58; standard diet &#40;commercial rabbit food&#41; and resveratrol &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#41;&#59; group 4&#58; cholesterol diet &#40;0&#46;5&#37; cholesterol&#41; and resveratrol &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#41;&#44; for 12<span class="elsevierStyleHsp" style=""></span>weeks&#46; Blood samples of overnight-fasted rabbits were collected at baseline and the sixth and twelfth weeks&#44; and the lipid profile&#44; VEGF&#44; and C-reactive protein &#40;CRP&#41; levels were determined&#46; Half of the animals were sacrificed on the sixth or twelfth week&#44; and the aorta was dissected for histological studies&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">VEGF and CRP levels were significantly higher in groups 2 and 4 than in groups 1 and 3&#44; respectively&#44; from the 6th week &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; VEGF and CRP were significantly lower in group 4 than in group 2 on 12th week &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; Supplementation of resveratrol reduced the formation of atherosclerotic lesions&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Serum VEGF and CRP levels are early markers of atherosclerosis&#46; Oral supplementation of resveratrol exerts anti-inflammatory and anti-atherosclerotic effects&#44; decreasing serum concentrations of VEGF and CRP and the formation and evolution of atherosclerotic lesions&#46;</p></span>"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Materials and methods"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El resveratrol tiene propiedades antiinflamatorias y antiaterog&#233;nicas&#59; sin embargo&#44; se desconoce su efecto sobre el factor de crecimiento endotelial vascular &#40;VEGF&#41; en la aterosclerosis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar el efecto del resveratrol sobre las concentraciones s&#233;ricas del VEGF durante la progresi&#243;n y evoluci&#243;n de la aterosclerosis y su evoluci&#243;n en el tiempo en conejos alimentados con dieta enriquecida con colesterol&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Cuarenta y ocho conejos machos divididos en cuatro grupos de 12 conejos recibieron&#58; grupo 1 &#40;control&#41;&#58; conejarina&#59; grupo 2&#58; conejarina suplementada con 0&#44;5&#37; colesterol&#59; grupo 3 &#40;control resveratrol&#41;&#58; conejarina y resveratrol &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#41;&#59; grupo 4&#58; conejarina suplementada con 0&#44;5&#37; colesterol y resveratrol&#44; durante 12 semanas&#46; Se realizaron determinaciones s&#233;ricas de triglic&#233;ridos&#44; colesterol y sus fracciones&#44; VEGF y prote&#237;na <span class="elsevierStyleSmallCaps">C</span> reactiva &#40;PCR&#41; al inicio&#44; a la 6&#46;<span class="elsevierStyleSup">a</span> y a la 12&#46;<span class="elsevierStyleSup">a</span> semana de experimentaci&#243;n&#46; La mitad de los conejos fueron sacrificados a la 6&#46;<span class="elsevierStyleSup">a</span> y a la 12&#46;<span class="elsevierStyleSup">a</span> semana y se realiz&#243; estudio histol&#243;gico de su aorta&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El VEGF y la PCR aumentaron en los grupos 2 y 4 desde la 6&#46;<span class="elsevierStyleSup">a</span> semana de experimentaci&#243;n con respecto a los grupos 1 y 3&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En la duod&#233;cima semana se observ&#243; una disminuci&#243;n de los niveles de VEGF y PCR en el grupo<span class="elsevierStyleHsp" style=""></span>4 con respecto al grupo 2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; El tratamiento con resveratrol disminuy&#243; la formaci&#243;n de ateromas&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El VEGF y la PCR s&#233;ricos constituyen marcadores tempranos no invasivos de inflamaci&#243;n y aterosclerosis&#46; La suplementaci&#243;n oral de resveratrol ejerce efectos antiinflamatorios y antiateroscler&#243;ticos&#44; disminuyendo las concentraciones s&#233;ricas de VEGF y PCR&#44; y la formaci&#243;n y evoluci&#243;n de las lesiones ateroscler&#243;ticas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Figueira L&#44; Gonz&#225;lez JC&#46; Efecto del resveratrol sobre las concentraciones s&#233;ricas del factor de crecimiento endotelial vascular durante la aterosclerosis&#46; Clin Invest Arterioscler&#46; 2018&#59;30&#58;209&#8211;216&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Histological sections of rabbit aortas at the end of the study&#46; Type IV lesion &#40;panel A&#41;&#46; Intracellular and extracellular lipid clusters can be seen to a greater extent in the arterial intima in a rabbit belonging to group 2&#46; Type II lesion &#40;panel B&#41;&#46; Intracellular lipid clusters can be seen in the arterial intima of a rabbit belonging to group 4&#46; Haematoxylin-eosin staining&#44; 50&#215;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">HDL-C&#58; cholesterol combined with high-density lipoproteins&#59; LDL-C&#58; cholesterol combined with low-density lipoproteins&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The results are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; Significance&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TC &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDL-C &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HDL-C &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TG &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Baseline</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Week 6</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">739<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>104<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">590<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>69<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">721<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>111<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">702<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>125<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">591<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">716<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>90<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Week 12</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1184<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>201<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">879<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>82<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1103<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>315<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1345<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>179<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">867<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>79<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1136<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>226<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">p values</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9436&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9890&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3843&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6896&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;4564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3449&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Group 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Week 6&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Week 12&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "El resveratrol&#46; Papel en enfermedades cardiovasculares y c&#225;ncer"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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              "identificador" => "bib0200"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resveratrol protects against diet-induced atherosclerosis by reducing low-density lipoprotein cholesterol and inhibiting inflammation in apolipoprotein E-deficient mice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Chang"
                            1 => "P&#46; Chen"
                            2 => "P&#46; Hou"
                            3 => "F&#46; Mao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Iran J Basic Med Sci"
                        "fecha" => "2015"
                        "volumen" => "18"
                        "paginaInicial" => "1063"
                        "paginaFinal" => "1071"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26949492"
                            "web" => "Medline"
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              "identificador" => "bib0205"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuevos mediadores implicados en la g&#233;nesis de la aterosclerosis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Lorenzo"
                            1 => "L&#46; Blanco"
                            2 => "J&#46; Mart&#237;n"
                            3 => "E&#46; S&#225;nchez"
                            4 => "S&#46; Ares"
                            5 => "I&#46; Zubiri"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Invest Arterioscl"
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                        "volumen" => "21"
                        "paginaInicial" => "25"
                        "paginaFinal" => "33"
                      ]
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            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular endothelial growth factor and its receptor Flt-1&#44; in the plasma of patients with coronary or peripheral atherosclerosis&#44; or type II diabetes"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            2 => "C&#46; Mccollum"
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                            4 => "P&#46; Lin"
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                        ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Sci"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos