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Introduction and Objective: Previous studies indicate that miltefosine (MFS) may be an alternative as an antifungal agent; however, it presents several adverse effects. Thus, the aim of this study was to produce miltefosine-loaded alginate nanoparticles (MFS.Alg) for toxicity reduction to be used as an alternative for the treatment of cryptococcosis and candidiasis., Methods: Alginate nanoparticles were produced using the external emulsification/gelation method, and their physicochemical and morphological characteristics were analyzed. MFS encapsulation efficiency, release assay and toxicity on red blood cells and on Galleria mellonella larvae were assessed. The antifungal activity was evaluated using in vitro and in vivo larval models of G. mellonella infected with Candida albicans (SC5314 and IAL-40), Cryptococcus neoformans H99 and Cryptococcus gattii ATCC 56990. The treatment efficacy was evaluated by survival curve, colony forming unit (CFU) counting and histopathological analysis., Results: MFS.Alg nanoparticles presented a mean size of 279.1±56.7 nm, a polydispersity index of 0.42±0.15 and a zeta potential of -39.7±5.2 mV. The encapsulation efficiency of MFS was 81.70±6.64%, and its release from the nanoparticles occurred in a sustained manner. MFS in alginate nanoparticles presented no hemolytic effect and no toxicity in G. mellonella larvae. Treatment with MFS.Alg extended the survival time of larvae infected with C. albicans and C. gattii . In addition, the fungal burden reduction was confirmed by CFU and histopathological data for all groups treated with 200 mg/Kg of MFS.Alg., Conclusion: These results support the use of alginate-based drug delivery systems as carriers for MFS for drug toxicity reduction and control of the fungal infection in the in vivo model of G. mellonella ., Competing Interests: Dr Cristina de Castro Spadari and Dr Fernanda Walt Mendes da Silva de Bastiani were participants of the fellowship program from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Dr Cristina de Castro Spadari reports a patent BR 10 2017 018011 5 pending; Dr Fernanda Walt Mendes da Silva de Bastiani reports a patent BR 10 2017 018011 5 pending; Dr Luciana Biagini Lopes reports a patent BR 10 2017 018011 5 pending and Dr Kelly Ishida reports a patent BR 10 2017 018011 5 pending. Dr Luciana Biagini Lopes reports grants from São Paulo Research Foundation, during the conduct of the study and non-financial support from Abitech, outside the submitted work. The authors report no other conflicts of interest in this work.

Background: Individuals diagnosed with a rare genetic disease that affects skeletal development often have physical limitations and orofacial problems that exert an impact on oral health. The aim of the present study was to analyze the possible vulnerability to dental caries in individuals with rare genetic diseases that affect skeletal development., Methods: A paired cross-sectional study was carried out with a sample of 140 individuals [70 with rare genetic diseases affecting skeletal development: mucopolysaccharidosis (MPS) (n = 29) and osteogenesis imperfecta (OI) (n = 41) and 70 without rare diseases] and their parents/caregivers. The participants in the first group were recruited from two reference hospitals specialized in rare genetic diseases in the city of Belo Horizonte, Brazil. All participants were examined for the evaluation of breathing type, malocclusion, dental anomalies, oral hygiene and dental caries. The parents/caregivers answered a structured questionnaire addressing the individual/behavioral characteristics and medical/dental history of the participants. Statistical analysis involved the chi-square test and multiple logistic regression analysis for the dependent variable (dental caries) (α = 5%). This study received approval from the Human Research Ethics Committee of the Universidade Federal de Minas Gerais., Results: The mean age of the individuals was 10.34 ± 6.55 years (median: 9.50 years). Individuals with inadequate oral hygiene were 4.70-fold more likely to have dental caries (95% CI: 2.13-10.40) and those with the rare genetic diseases (MPS/OI) were 2.92-fold more likely to have dental caries (95% CI: 1.38-6.17)., Conclusion: Individuals with inadequate oral hygiene and those with MPS and OI had a greater chance of belonging to the group with dental caries. Based on the present findings, individuals with the rare genetic diseases may be considered vulnerable to caries.

Peripheral inflammatory stimuli increase proinflammatory cytokines in the bloodstream and central nervous system and activate microglial cells. Here we tested the hypothesis that contrasting environments mimicking sedentary and active lives would be associated with differential microglial morphological responses, inflammatory cytokines concentration, and virus load in the peripheral blood. For this, mice were maintained either in standard (standard environment) or enriched cages (enriched environment) and then subjected to a single (DENV1) serotype infection. Blood samples from infected animals showed higher viral loads and higher tumor necrosis factor-α (TNFα) mRNA concentrations than control subjects. Using an unbiased stereological sampling approach, we selected 544 microglia from lateral septum for microscopic 3D reconstruction. Morphological complexity contributed most to cluster formation. Infected groups exhibited significant increase in the microglia morphological complexity and number, despite the absence of dengue virus antigens in the brain. Two microglial phenotypes (type I with lower and type II with higher morphological complexity) were found in both infected and control groups. However, microglia from infected mice maintained in enriched environment showed only one morphological phenotype. Two-way ANOVA revealed that environmental changes and infection influenced type-I and II microglial morphologies and number. Environmental enrichment and infection interactions may contribute to microglial morphological change to a point that type-I and II morphological phenotypes could no longer be distinguished in infected mice from enriched environment. Significant linear correlation was found between morphological complexity and TNFα peripheral blood. Our findings demonstrated that sedentary-like and active murine models exhibited differential microglial responses and peripheral inflammation to systemic non-neurotropic infections with DENV1 virus.

Background: The 17DD-yellow fever (YF) vaccine induces a long-lasting protective immunity, resulting from humoral and cellular immunological memory. The treatment of rheumatoid arthritis (RA) patients with disease-modifying anti-rheumatic drugs (DMARD) may affect pre-existing 17DD-vaccine protective immunity and increase the risk of acquiring YF infection. Our goal was to determine whether DMARD would affect the duration of YF-specific protective immunity in RA patients., Methods: A total of 122 RA patients, previously immunized with the 17DD-YF vaccine (1-5, 5-9, and ≥ 10 years) and currently under DMARD therapy, were enrolled in the present investigation. Immunomodulatory therapy encompasses the use of conventional synthetic DMARD alone (csDMARD) or combines with biological DMARD (cs+bDMARD). A total of 226 healthy subjects were recruited as a control group (CONT). Neutralizing antibody responses were measured by a plaque-reduction neutralization test (PRNT), and cellular immunity was evaluated by an in vitro 17DD-YF-specific peripheral blood lymphoproliferative assay., Results: The data demonstrated that csDMARD therapy did not affect the duration of protective immunity induced by the 17DD-YF vaccine compared to that of CONT, as both presented a significant time-dependent decline at 10 years after vaccination. Conversely, cs+bDMARD therapy induced a premature depletion in the main determinants of the vaccine protective response, with diminished PRNT seropositivity levels between 5 and 9 years and impaired effector memory in CD8 + T cells as early as 1-5 years after 17DD-YF vaccination., Conclusions: These findings could support changing the vaccination schedule of this population, with the possibility of a planned booster dose upon the suspension of bDMARD in cases where this is allowed, even before 10 years following 17DD-YF vaccination. The benefit of a planned booster dose should be evaluated in further studies., Trial Registration: RBR-946bv5 . Date of registration: March 05, 2018. Retrospectively registered.

Objectives: To perform a systematic review of test methodologies on conventional restorative glass-ionomer cement (GIC) materials for mechanical and optical properties to compare the results between different GICs., Material and Methods: Screening of titles and abstracts, data extraction, and quality assessments of full-texts were conducted in search for in vitro studies on conventional GICs that follow the relevant specifications of ISO standards regarding the following mechanical and optical properties: compressive strength, flexural strength, color, opacity and radiopacity., Sources: The Latin American and Caribbean Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO) databases from Latin-American and Caribbean System on Health Sciences Information (BIREME) and PubMed/Medline (US National Library of Medicine - National Institutes of Health) databases were searched regardless of language. Altogether, 1146 in vitro studies were selected. Two reviewers independently selected and assessed the articles according to pre-established inclusion/exclusion criteria. Among all the properties investigated, only one study was classified as being of fair quality that tested compressive strength and was included. It was observed that many authors had not strictly followed ISO recommendations and that, for some properties (diametral tensile strength and microhardness), there are no guidelines provided., Conclusions: It was not possible to compare the results for the mechanical and optical properties of conventional restorative GICs due to the lack of standardization of studies.

A decade after the first health app became available, the field of digital health has produced a range of health behavior insights and an expanding product portfolio. Despite sustained interest and growth fueled by academic and industry interests, the impact of digital health on health behavior change and related outcomes has been limited. This underperformance relative to expectations may be partially attributed to a gap between industry and academia in which both seek to develop technology-driven solutions but fail to converge around respective, unique strengths. An opportunity exists for new and improved collaborative models of research, innovation, and care delivery that disrupt the field of behavioral medicine and benefit academic and industry interests. For those partnerships to thrive, recognizing key differences between academic and industry roles may help smooth the path. Here we speak specifically to concerns particular to academics and offer suggestions for how to navigate related challenges.

Objective: The aim of this study was to systematically review the scientific efficacy of infrared thermography (IT) on the diagnosis of temporomandibular joint disorders (TMDs)., Study Design: An electronic search was performed in 8 databases for publications up to May 2018. Additionally, a hand search of the reference lists was conducted. There were no restrictions on language or on year of publication. Two independent reviewers selected the studies, reviewed the abstract information, and assessed the quality. The methodology of the included articles was evaluated by using the QUADAS-2 tool., Results: Nine studies fulfilled the eligibility criteria and were included in the systematic review. Four studies concluded that IT presents low accuracy or is not an accurate instrument for TMD diagnosis, but there was substantial variation in sensitivity, specificity, and receiver operating characteristic curve values. Five studies concluded that IT appears to be promising or may be a complementary diagnostic aid in the evaluation of TMDs. These studies presented sensitivity values ranging from 70% to 90% and specificity values ranging from 62% to 92%. All studies were judged as being "at risk of bias" and as having "concerns regarding applicability.", Conclusions: The literature is still lacking in sufficient number of studies regarding the reliability of IT for the diagnosis of TMDs., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To evaluate the impact of repeat surgery for recurrence on the long-term survival after 2-stage hepatectomy (TSH) for extensive colorectal liver metastases (CRLM)., Background: Although TSH is now deemed effective for selected patients with extensive bilobar CRLM, disease recurrence after TSH is very frequent because of the extensive tumor load., Methods: Among a total cohort of 1235 patients who underwent hepatectomy for CRLM between 1992 and 2012, 139 with extensive bilobar CRLM were scheduled for TSH. Of these, 93 patients had completion of TSH and were enrolled in this study., Results: The 5-year overall survival (OS) rate after TSH was 41.3%. Twenty-two patients (23.7%) had a concomitant extrahepatic disease (EHD), and curative resection of concomitant EHD was achieved in 13 patients. Among the 81 patients who achieved complete tumor removal for primary, CRLM, and concomitant EHD, 62 (76.5%) had recurrence. Repeat surgery was performed in 38 patients; 35 for recurrence after curative surgery and 3 for liver recurrence with unresected concomitant EHD or primary tumor. Of these 38 patients, 31 were salvaged. The patients who underwent repeat surgery had a significantly longer OS than those who did not (45.8% vs 26.3%; P = 0.0041). A multivariate analysis revealed that repeat surgery was an independent prognostic factor of the OS after TSH (hazard ratio 0.31, P = 0.0012)., Conclusions: Repeat surgery for recurrence after TSH may be crucial for the long-term survival in patients with extensive bilobar CRLM. Intensive oncosurgical surveillance is essential to avoid missing the chance for repeat surgery after TSH.

Objective: To evaluate the effects of auricular acupuncture on pain intensity, its impact on daily activities, the relief provided by the intervention, and the pain threshold in people with back musculoskeletal disorders., Methods: Randomized clinical trial carried out with people randomly allocated into three groups: treatment, placebo, and control. Evaluations were performed using the Brief Pain Inventory and a digital algometer before (initial) and after (final) the treatment and after a 15-day follow-up period., Results: The sample was 110 people. There was a decrease in pain intensity in the treatment and placebo groups as revealed by the comparison between the initial and final evaluations (p<0.05), and in the treatment group in the comparison between the initial and follow-up evaluations (p<0.05). A decreased impact of pain on daily activities in the treatment and placebo groups over time was found (p<0.05). At the final evaluation, the impact of pain was lower in the treatment group (p<0.05). Auricular acupuncture did not increase the pain threshold., Conclusion: Auricular acupuncture presented positive effects by reducing the chronic pain intensity and its impact on daily activities in people with back musculoskeletal disorders. Brazilian Clinical Trials Registry: RBR-5X69X2.

Babesiosis is a tick-borne hemolytic disease caused by intraerythrocytic protozoan parasites of the genus Babesia. The present study describes epidemiological, clinical, and pathological features of cases of bovine babesiosis diagnosed over the last two decades in the state of Mato Grosso do Sul in central-western Brazil. Examination of a total of 5298 bovine samples resulted in a definitive or presumptive diagnosis of babesiosis in 41 cases from 33 outbreaks. Babesia bovis was the most common causal agent of bovine babesiosis, and animals of all ages were affected. Zebu cattle, which are more frequent in the study region than are taurine cattle, were the cattle most often affected. Although zebu cattle have been claimed to be highly tolerant, the present findings show that they can develop severe illness and die due to Babesia spp. infection. The disease was diagnosed almost every year over the time period covered in this study (1995-2017). However, the number of cases of bovine babesiosis diagnosed was low compared to the total number of cases reviewed. Veterinary practitioners that work on cattle farms should to be able to diagnose the disease in its early stages so that treatment can be initiated promptly and economic losses can be minimized., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Objective: To quantify Enterococcus faecalis density in root canal dentin after chemomechanical preparation (CMP) using alternated irrigating regimen., Methodology: Root canals (RC) were contaminated with E. faecalis (ATCC 19433) for 3 weeks and evident biofilms were obtained. After initial sampling (S1), the CMP was aided by irrigants: saline solution (control; n=12), a conventional regimen (CR) (group 1; n=12) using 5.25% NaOCl and a final rinse with 17% EDTA, and an alternating regimen (AR) of intercalated use of NaOCl and EDTA (group 2, n=12), followed by a second sampling (S2). After 2 weeks, S3 was obtained. Two roots were analyzed by scanning electron microscopy. Each root was divided into cervical, mild, and apical segments and sampling of the superficial (n=90) and deep (n=90) dentin layers was obtained using Gates-Glidden burs. The E. faecalis density (CFU/mg) in log 10 was categorized as residual (0 > 0.2), moderate (0.2 ≥ 0.5), or elevated (> 0.5). The prevalence of positive samples in BHI and BHI-A was analyzed by Pearson's chi-square test. The data were normalized by a log 10 transformation of CFU and were analyzed by one-way ANOVA and Tukey's tests., Results: Biofilms were observed only in the control root canal walls. Topographically, the controls and CR showed similar distributions of E. faecalis in the dentin. Microbiologically positive root canals harbored much E. faecalis in the adjacent dentin ( p < 0.05). Irrigating saline provided moderate density of E. faecalis in the dentin while CR and AR resulted in a residual density of microorganisms ( p < 0.05)., Conclusions: The Enterococcus faecalis density in dentin was influenced by the irrigating regimen and the microbiological status of the root canal. The CMP aided by the alternating regimen interfered with the recolonization of the root canal and topographic distribution of Enterococcus in root dentin.

Loss and fragmentation of native vegetation negatively affect crop pollinators and productivity of several crop species. The yellow passion fruit is an excellent model to investigate this issue, because its main pollinators are sensitive to deforestation. Seasonality also influences fruit set of crop species that are pollinated by bees. Climate determines plant flowering patterns and consequently affects pollinator activity. Little is known on effects of pollinators on crop quality in general, and particularly of many tropical fruits that have multiple fruiting seasons throughout the year, such as passion fruit. Our hypothesis is that the distance to the native vegetation and climate seasonality affect the pollination and fruit production of cultivated, hermaphrodite, self-incompatible, protandrous species that depend on large-sized bees to set fruit. We observed flowers of the yellow passion fruit in eight areas at different distances (600-4,000 m) from a dry seasonal forest (Caatinga). We compared the frequency of the main floral visitor (pollinators and robbers) visits and fruit set among areas at the beginning and end of the dry and rainy seasons. Xylocopa species were pollinators, and Apis mellifera, Trigona spinipes and a hummingbird were robbers. Xylocopa visits diminished with increasing distance to native remnants, converse to what was observed for the robbers at the beginning of the dry season. Fruit set was higher at the beginning of the dry season. The distance to the forest affected quality of fruits in terms of length, diameter and skin thickness, which all decreased with increase in remnant distance. Our results show that insect pollination is higher in the dry season, increasing profitability and reducing labour costs for the producer. Considering the influence of distance to native vegetation on pollination, robbery and fruit quality, our study reinforces the necessity for conservation of native vegetation remnants., (© 2018 German Society for Plant Sciences and The Royal Botanical Society of the Netherlands.)

Background: The avian infectious bronchitis virus (IBV) remains a significant source of loss in the poultry industry and early diagnosis is required to prevent the disease from spreading. This study examined the combined use of an ELISA and Western blot (WB) to detect antibodies against the nucleocapsid protein (N) of IBV. The coding sequence for N was amplified by RT-PCR and expressed in Escherichia coli. A soluble recombinant N protein (rN) of approximately 50 kDa was obtained. A total of 389 sera were tested against the rN in ELISA and the results were compared with those of the commercial IDEXX IBV Ab test. ELISA-rN achieved a 90.34% sensitivity and 90.16% specificity. WB confirmed all false negative sera in ELISA-rN or IDEXX test as truly positive. The current study indicate that the combined use of rN in ELISA and WB is a powerful tool for the immunodiagnosis of avian infectious bronchitis., Methods: Constructed recombinant pAE/n expression vectors were used to transform E. coli BL21(DE3) Star competent cells (Invitrogen). The rN of infectious bronchitis virus was purified by affinity chromatography using HisTrap HP 1 mL columns pre-packed with pre-charged Ni Sepharose in the ÄKTAprime Automated Liquid Chromatography system (GE Healthcare). A total of 389 serum samples from chickens were used to develop and evaluate the ELISA-rN test. To standardize the indirect ELISA development, serum dilutions (1:100, 1:200 and 1:400) and different concentrations of purified rN antigen (50, 100 and 200 ng/well) were tested. Positive and negative sera for IBV were used as controls. The results were compared with those obtained from a commercial kit. Serum samples scored as negative with the commercial kit but as positive with the ELISA-rN were further analysed by Western blot analyses using the rN protein as an antigen. The results of the ELISA-rN were compared to the commercial kit results using receiver-operating characteristics curves, area under the curve, and confidence intervals with the software GraphPad Prism version 6.0 for Windows (GraphPad Software, USA)., Results: The expected cDNA fragment of approximately 1240 bp was successfully amplified by PCR using primers designed to select for the coding region of the N protein. The rN was expressed as a soluble protein to avoid the refolding steps and, after purification a yield of 10 mg/L of rN was obtained. The SDS-PAGE results demonstrated the presence of two distinct bands that had a molecular mass of approximately 45 and 50 KDa. Out of 244 sera that scored positive in the commercial ELISA IDEXX IBV Ab Test, 220 were also positive in the ELISA-rN, yielding an ELISA-rN test sensitivity of 90.16%. Out of 145 sera that scored negative in the IDEXX IBV Ab Test, 131 also scored negative in the ELISA-rN, indicating a specificity of 90.34%. Sera that tested negative in the ELISA-rN and positive in the commercial test also reacted with the rN protein in Western blot., Conclusions: The association between the ELISA and Western blot techniques developed in this study with a subunit of IBV (rN) were able to detect antibodies that the commercial ELISA did not detect suggesting that the ELISA-rN has greater sensitivity.

Objectives: The aim of this systematic review was to evaluate human gingival crevicular fluid (GCF) tumor necrosis factor-alpha (TNF-α) as a potential biomarker for diagnosis of periodontal disease (International prospective register of systematic reviews [PROSPERO] number: CRD42015020199)., Methods: An electronic search for TNF-α in human GCF was conducted until May 17, 2018. Data from systemically healthy patients with healthy periodontium or periodontal disease were incorporated. Risk bias was assessed by Newcastle-Ottawa Scale for case-control studies and Jadad scale for clinical trials., Results: Twenty-six studies were included (12 case-control studies, 7 clinical trials, and 7 randomized controlled trials). Most case-control studies showed increased TNF-α concentration in GCF of patients with periodontal disease. The clinical trials and randomized controlled trials demonstrated no consistent modification of TNF-α level after periodontal intervention., Conclusion: The present data support the use of TNF-α in GCF as a potential biomarker for diagnosis of periodontal disease but not to monitor the healing after therapy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Childhood consumption of added sugars, such as sucrose, has been associated to increased risk of metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD). Although the mechanisms underlying NAFLD onset are incompletely defined, recent evidence has proposed a role for the endoplasmic reticulum (ER) stress. Thus, the present study sought to investigate the metabolic outcomes of high-sucrose intake on weaned Swiss mice fed a 25% sucrose diet for 30, 60 and 90 days in comparison to regular chow-fed controls. High-sucrose feeding promoted progressive metabolic and oxidative disturbances, starting from fasting and fed hyperglycemia, hyperinsulinemia, glucose intolerance and increased adiposity at 30-days; passing by insulin resistance, hypertriglyceridemia and NAFLD onset at 60 days; until late hepatic oxidative damage at 90 days. In parallel, assessment of transcriptional and/or translational levels of de novo lipogenesis (DNL) and ER stress markers showed up-regulation of both fatty acid synthesis (ChREBP and SCD1) and oxidation (PPARα and CPT-1α), as well as overexpression of unfolded protein response sensors (IRE1α, PERK and ATF6), chaperones (GRP78 and PDIA1) and antioxidant defense (NRF2) genes at 30 days. At 60 days, fatty acid oxidation genes were down-regulated, and ER stress switched over toward a proapoptotic pattern via up-regulation of BAK protein and CHOP gene levels. Finally, down-regulation of both NRF2 and CPT-1α protein levels led to late up-regulation of SREBP-1c and exponential raise of fatty acids synthesis. In conclusion, our study originally demonstrates a temporal relationship between DNL and ER stress pathways toward MetS and NAFLD development on weaned rats fed a high-sucrose diet., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the scientific evidence from observational studies concerning the risk of peri-implantitis development in periodontally-compromised patients., Source: The search was carried out in Medline, via PubMed, and the Cochrane Library up to March 2018., Study Selection: Clinical studies reporting data on periodontitis and peri-implantitis, with confirmed diagnosis of peri-implantitis based on specific parameters (peri-implant probing depth and peri-implant bleeding on probing) and with evaluations of implants with at least 1 year of function were selected., Data: Nineteen articles were included; only two did not show any association between periodontitis and peri-implantitis. Quality analysis of the articles revealed a low risk of bias in most of the studies. Meta-analyses by study design on patient data showed that patients with periodontitis had a 2.29 higher risk of peri-implantitis than patients without periodontitis (95%CI: 1.34-3.24). However, the effect estimate was OR 5.15 (95%CI: -3.35; 13.65; I2: 0%, p = 0.887) for cohort studies. A subgroup analysis showed a significant association between peri-implantitis and chronic periodontitis (patient based data: OR = 2.89, 95% CI: 1.79-4.00). Meta-analysis by study design on implant data showed that implants in individuals with periodontitis had 2.15 higher chances of having peri-implantitis (95%CI: 1.10; 3.21). However, the effect estimate was OR 3.24 (95%CI: -0.05; 6.53) for cohort studies., Conclusions: This systematic review showed that diagnosis or history of periodontitis was associated with the occurrence of peri-implantitis. However, this association was not observed when only the cohort studies were analyzed. Results should be evaluated with caution due to heterogeneity among the included primary studies. Registration number CRD42015009518., Clinical Significance: Peri-implantitis is a prevalent condition and and present an uncertain prognosis. Determining the potential factors associated with peri-implantitis is fundamental for preventive strategies., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To describe and discuss events associated with the latest review of the national primary health care (PHC) policy in Brazil ( Política Nacional de Atenção Básica , PNAB) so as to highlight narratives that may contribute to future analyses focusing on the formulation, implementation, and assessment of this policy., Method: Participant observation report of the PNAB review process, based on content and document analyses., Results: The review process of PNAB, which took place between 2015 and 2017, was strongly marked by technical and political dispute among the Ministry of Health and authorities representing municipal and state health departments. The main changes introduced by the new version of PNAB are the financing of other PHC organizational models in addition to the Family Health Strategy; attribution of additional responsibilities to community health agents; introduction of a national set of core and extended PHC services and actions; and introduction of a manager role as part of PHC teams., Conclusions: Implementation of the revised PNAB, which was the result of interfederation dispute, will depend on the convergence of interests in a PHC that is accessible and effective, strengthening the Unified Health System. This will substantially require societal engagement and leadership in the fight for the right to health in Brazil., Competing Interests: Conflitos de interesse. Os autores declaram a existência de conflito de interesses, visto serem técnicos do quadro de trabalhadores do Departamento de Atenção Básica/Ministério de Saúde - Brasil e participantes do processo de revisão da Política Nacional de Atenção Básica.

The bark and the latex of plants constitute non-timber forest products (NTFPs) of medicinal and economic value that are widely harvested throughout the world. Bark and latex harvesting impacts on plant reproduction are controversial in the literature. Some species are negatively impacted, some do not show any response, and others may exhibit higher flower and fruit production after harvesting. In areas of rainforests and cerrado (tropical savanna) in northeastern Brazil, local people intensely remove the bark of Himatanthus drasticus (for latex collection) and Stryphnodendron rotundifolium for medicinal purposes. We aimed to investigate the short-term impact of harvesting upon reproductive effort of tree species, using those species as models. We assumed that bark harvesting negatively interferes in the reproductive capacity of plant species. Individuals of both species were harvested 2 months before blooming (treated) and the production of reproductive structures, physical characteristics of fruits and seeds, and the pre-emergent reproductive success were compared between treated and control (intact) individuals. All parameters of H. drasticus declined after bark removal, except pollen and ovule production. The only reproductive parameters of S. rotundifolium that were negatively affected were pollen and ovule production, and the pre-emergent reproductive success was higher in treatment individuals. We discuss the differences found between the species regarding responses to harvesting. Our results show that harvesting have short-term effects upon reproduction and may impair gene flow by affecting pollination and seed dispersal of tree species.

Objectives: to evaluate the evidence from the literature regarding the effects of cupping therapy on chronic back pain in adults, the most used outcomes to evaluate this condition, the protocol used to apply the intervention and to investigate the effectiveness of cupping therapy on the intensity of chronic back pain., Method: systematic review and meta-analysis carried out by two independent researchers in national and international databases. Reference lists of systematic reviews were also explored. The quality of evidence was assessed according to the Jadad scale., Results: 611 studies were identified, of which 16 were included in the qualitative analysis and 10 in the quantitative analysis. Cupping therapy has shown positive results on chronic back pain. There is no standardization in the treatment protocol. The main assessed outcomes were pain intensity, physical incapacity, quality of life and nociceptive threshold before the mechanical stimulus. There was a significant reduction in the pain intensity score through the use of cupping therapy (p = 0.001)., Conclusion: cupping therapy is a promising method for the treatment of chronic back pain in adults. There is the need to establish standardized application protocols for this intervention.

Objective: The aim of the present study was to evaluate association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old preschool children., Materials and Methods: A cross-sectional study was conducted with 764 pairs of children and parents/caregivers in preschools. The parents/caregivers answered questionnaires addressing oral health-related quality of life (OHRQoL), sense of coherence, locus of control, oral habits and socio-demographic characteristics. The children answered a self-report questionnaire addressing OHRQoL and were submitted to a clinical examination for the anterior open bite by examiners. Descriptive analysis was conducted, followed by Poisson's regression analysis., Results: The prevalence of anterior open bite was 15.2%. The following variables remained significantly associated with anterior open bite: pacifier use (PR = 7.09; 95% CI: 4.06-12.39), attending a public preschool (PR = 2.40; 95% CI: 1.68-3.43), digit sucking (PR = 2.15; 95% CI: 1.27-3.62), greater number of residents in the home (PR = 1.67; 95% CI: 1.18-2.36) and impact on OHRQoL according to child's report (PR = 1.56; 95% CI: 1.11-2.20)., Conclusions: Anterior open bite was associated with OHRQoL according to the children's reports. Moreover, attending a public preschool, a greater number of residents in the home, digit sucking and pacifier sucking were associated with this type of malocclusion.

Background: The Breastfeeding Self-Efficacy Scale-Short Form is a reliable instrument to measure mother's confidence in her ability to breastfeed. The Breastfeeding Self-Efficacy Scale-Short Form has traditionally been used postnatally, but evidence suggests that it can be used antenatally to identify mothers at-risk of requiring additional support to improve breastfeeding outcomes., Objective: The aim of this study was to examine the psychometric characteristics of an antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form, among pregnant Portuguese women., Design: Methodological prospective study to examine the psychometric characteristics of the antenatal Portuguese version of the Breastfeeding Self-Efficacy Scale-Short Form., Settings: Two public hospital units in the Northern Portugal., Participants: The sample was comprised of 373 pregnant women recruited at 30-34 gestational weeks., Methods: The original English version of the antenatal Breastfeeding Self-Efficacy Scale-Short Form was translated into Portuguese and the Portuguese antenatal version of the scale was tested in a sample of 373 pregnant women. To examine the psychometric characteristics of the Portuguese antenatal version of the scale, the maternal demographic variables and the depressive and anxiety symptomatology of the participants were examined. The predictive validity of the Portuguese antenatal version of the scale was studied according to infant feeding method at one, three, and six months postpartum., Results: The Cronbach's alpha coefficient was 0.92. The antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form scores were found to be associated with women's parity, educational level, occupational status, time they intend to breastfeed, and previous breastfeeding experience. Also, the antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form scores significantly predicted exclusive breastfeeding at 1 month postpartum., Conclusions: Results provided evidence that the antenatal Portuguese version of the Breastfeeding Self-Efficacy Scale-Short Form is a valid and reliable measure to assess breastfeeding self-efficacy in pregnant women. The antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form could be a useful tool to assist Portuguese health professionals during routine prenatal care appointments to screen women with lower antenatal breastfeeding self-efficacy and, consequently, those that could be at risk for not initiating or early breastfeeding cessation., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

A pentafluorobenzamide stationary phase was synthesized by an easy method with no intermediate purification steps. Physicochemical characterization (elemental analysis, fourier transform infrared spectroscopy, 29 Si and 13 C nuclear magnetic resonance spectroscopy) confirmed the presence of pentafluorobenzamide functionalization on the surface of the silica particles. The pentafluorobenzamide stationary phase proved to be quite versatile as it can be used in two different modes in liquid chromatography: reversed phase and hydrophilic interaction liquid chromatography. Chromatographic characterizations in both modes confirmed the multiple interactions established by the new stationary phase, such as hydrogen bonding and π-π and ion-exchange interactions. The pentafluorobenzamide stationary phase was successfully employed for the separation of nucleosides and antihypertensive drugs under hydrophilic interaction liquid chromatography conditions, as well as pesticides and benzodiazepine using reversed phase conditions. The stationary phase showed significant potential when compared with commercial columns., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Objectives: to assess the action of ear acupuncture on disability and tissue temperature in people with chronic pain in the spinal column., Method: a clinical trial with a sample of 110 people, randomized into three groups: Treatment, Placebo and Control. The assessment instruments were the Rolland Morris Disability Questionnaire (RMDQ) and a thermographic camera, administered before the first treatment session, one week after and 15 days after (follow-up) the fifth session of ear acupuncture. In the analysis of the data, the Kruskal Wallis, Student-Newman Keuls and Wilcoxon tests were applied., Results: there was a significant reduction in disability in the Treatment and Placebo groups between the initial and final assessments (p<0.05) and between the initial assessments and follow-up (p<0.05). In the final assessment, the Treatment group presented improvement of disability when compared with the Placebo and Control groups (p<0.05). There was an increase in mean tissue temperature of the dorsal region between the initial and follow-up assessments in Treatment and Control groups (p<0.05), and between the final assessments and follow-up in the Treatment and Placebo groups (p<0.05)., Conclusion: ear acupuncture was efficacious in reducing disability and increasing tissue temperature in people with chronic pain in the spinal column. Brazilian Register of Clinical Trials (RBR-5X69X2).

Purpose: The aim of the present study was to perform a systematic review of the literature for scientific evidence regarding the association between a sense of coherence (SOC) and oral health-related of quality of life (OHRQoL)., Methods: Electronic searches were performed in five databases. Manual searches were also performed. To be included, studies needed to address the relationship between SOC and OHRQoL. The risk of bias was evaluated using the Newcastle-Ottawa scales for cross-sectional and cohort studies and the Physiotherapy Evidence Database scale for clinical trials., Results: Seven cross-sectional studies, four cohort studies, and one clinical trial were included in the present review. Two independent reviewers selected the studies, extracted that data, and performed the evaluations of methodological quality based on the standardized scales. The majority of authors found a significant association between a weak SOC and greater impact on OHRQoL, but some methodological flaws were found in the execution of the studies., Conclusion: Based on the analysis of the studies included in the present systematic review, there is scientific evidence that a sense of coherence exerts an influence on oral health-related quality of life, but further population-based studies are needed to confirm such evidence.

Cryptococcus spp. are common opportunistic fungal pathogens, particularly in HIV patients. The approved drug miltefosine (MFS) has potential as an alternative antifungal against cryptococcosis; however, the mechanism of action of MFS in Cryptococcus is poorly understood. Here, we examined the effects of MFS on C. neoformans and C. gattii yeasts (planktonic and biofilm lifestyles) to clarify its mechanism of action. MFS presented inhibitory and fungicidal effects against planktonic Cryptococcus cells, with similar activities against dispersion biofilm cells, while sessile biofilm cells were less sensitive to MFS. Interestingly, MFS had postantifungal effect on Cryptococcus , with a proliferation delay of up to 8.15 h after a short exposure to fungicidal doses. MFS at fungicidal concentrations increased the plasma membrane permeability, likely due to a direct interaction with ergosterol, as suggested by competition assays with exogenous ergosterol. Moreover, MFS reduced the mitochondrial membrane potential, increased reactive oxygen species (ROS) production, and induced DNA fragmentation and condensation, all of which are hallmarks of apoptosis. Transmission electron microscopy analysis showed that MFS-treated yeasts had a reduced mucopolysaccharide capsule (confirmed by morphometry with light microscopy), plasma membrane irregularities, mitochondrial swelling, and a less conspicuous cell wall. Our results suggest that MFS increases the plasma membrane permeability in Cryptococcus via an interaction with ergosterol and also affects the mitochondrial membrane, eventually leading to apoptosis, in line with its fungicidal activity. These findings confirm the potential of MFS as an antifungal against C. neoformans and C. gattii and warrant further studies to establish clinical protocols for MFS use against cryptococcosis., (Copyright © 2018 American Society for Microbiology.)

Background: The scientific evidence regarding the association between parental oral health literacy (OHL) and children's oral health is unclear., Aim: To evaluate the scientific evidence concerning the association between parental OHL and children's oral health outcomes., Design: Eight databases were searched. Studies that evaluated oral health outcomes among children and measured parental OHL through a validated tool were included. Two independent reviewers selected studies, extracted data and analysed the risk of bias., Results: Eleven studies were included. Most (n = 6) had a high risk of bias. Most studies evaluating dental caries found association between lower parental OHL and higher prevalence/experience of dental caries. Poor oral health-related quality of life was associated with decreased parental OHL (P < 0.05). Studies diverged on the association between OHL and the number of filled, extracted teeth, and dental visits. There was no association between children's tooth brushing frequency, use of toothpaste, oral health claim, oral health expenditures and parental OHL. The literature was inconclusive regarding the association between night bottle feeding, negative parental perception of the child's oral health and OHL., Conclusion: Low parental OHL was associated with dental caries among their children. It is too soon to assume an association between OHL and the remaining outcomes., (© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The authors systematically reviewed the scientific evidence of an association between periodontal disease and Down syndrome (DS)., Types of Studies Reviewed: In this systematic review, the authors included observational studies in which the investigators assessed the prevalence, incidence, or experience of periodontal disease in patients with DS compared with that in healthy patients. The authors used the Population, Exposure, Comparison, Outcome structure. The population was patients of any age, the exposure was the presence of DS, the comparison was the absence of DS, and the outcome was the presence of periodontal disease. The authors conducted an electronic search in 5 databases through March 2017. Two independent reviewers assessed the risk of bias by using the Fowkes and Fulton scale. The authors performed a meta-analysis to compare periodontal disease among patients with DS and those without DS. The authors calculated a summary effect measure-standard mean difference-when evaluating the means of the oral hygiene index. The authors assessed the strength of evidence from the selected studies by using a modified Grading of Recommendations Assessment, Development and Evaluation system., Results: The authors included 23 case-control studies in the systematic review and submitted 3 to meta-analysis. In the qualitative analysis, results from most studies showed that the prevalence of some periodontal parameters was higher among patients with DS than among those without DS. Evaluations of the Fowkes and Fulton scale point to many methodological problems in the studies evaluated. Results of the meta-analysis revealed no differences between groups with regard to the oral hygiene index (standard mean difference, 0.05; 95% confidence interval, -0.55 to 0.65; I 2  = 0.0%)., Conclusions and Practical Implications: Further research is required, in particular well-designed studies that avoid the deficiencies identified in the studies in this review., (Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Introduction  Several studies show correlations between congenital toxoplasmosis and hearing loss, with a broad diversity of levels of hearing loss and specifications of hearing disorders. Objective  To describe the studies found in the literature regarding hearing disorders in congenital toxoplasmosis. Data Synthesis  A literature review was conducted on the Lilacs, SciELO, PubMed and Scopus databases by combining the following keywords: congenital toxoplasmosis and hearing . Based on this search strategy, 152 papers were found, the majority published on the Scopus and PubMed databases from 1958 to 2015. After the application of the inclusion criteria, 8 articles published between 1980 and 2015 were included in the present study. Conclusion  This review showed a moderate evidence of the association between hearing disorders and congenital toxoplasmosis, which is characterized by sensorineural hearing loss. However, there are gaps in the description of the specific characteristics of the type and level of hearing loss, or of other possible disorders involved in the auditory processing.

The immaturity of born to preterm infants may predispose to sucking difficulties. This research aimed to evaluate if pacifier use is associated with preterm birth and influenced in type of infant feeding. This comparative cross-sectional study was conducted in Belo Horizonte, Brazil and evaluated 250 children aged 3 to 5 years. As a sample, two groups were established: the normal term children group (n=125) was selected at a day-care centre and the group of preterm children (125) was identified at a public university hospital with a preterm care project from birth to seven years of age. To collect data, a pre-tested questionnaire regarding information on gestational age, infant development, infant feeding and non-nutritive sucking habits was used for both groups. Bivariate and multivariate Poisson regression was used for the statistical analysis. Pacifier use was more prevalent in the preterm group (PR=1.20, 95% CI=1.02-1.42) who used the bottle (PR=1.38, 95% CI=1.15-1.64) and were breastfed for less than six months (PR=1.19, 95% CI=1.01-1.41). The majority of breastfed infants were of normal term birth (PR=1.14, 95% CI=1.04-1.20) and had monthly family income greater than USD 450.28 (RP= 1.10, 95% CI=1.01-1.20). In this study, pacifier use was more prevalent among preterm infants and associated with less than six months of breastfeeding and used of bottle. Monthly family income was associated with a prevalence of breastfeeding.

Monomorphic enantiostylous species produce flowers with a displacement of the style to the left (L) or right (R) on the same individual, and may exhibit different dynamics for the production of these floral types, which may influence levels of selfing. We investigated the production dynamics of L and R floral types in seven species and a variety of monomorphic enantiostylous species of the genera Senna and Chamaecrista. Our hypothesis was that most species present similar proportions of floral morphs each day. Individuals were classified daily over a period of 7 days according to the functional status, i.e. the proportion of floral morphs as functionally L, R or reciprocal (REC, i.e. similar proportions of the two floral morphs), and also according to the number of consecutive days in which they exhibited the same functional status. All species presented low daily flower production. Most species had individuals classified as functionally R, L and REC, and tend to repeat the same functional status over a few days, although they may change functional status during the flowering period. All species exhibited individuals that were classified as functionally reciprocal when both the daily and total number of flowers produced over 7 days was considered. The occurrence of different functional status has not yet been reported in the literature for enantiostylous species. The distinct strategies observed in the dynamics of floral morph production seemed likely to minimise geitonogamy and to favour cross-pollination between individuals (xenogamy)., (© 2018 German Society for Plant Sciences and The Royal Botanical Society of the Netherlands.)

Objectives: To conduct a systematic review and meta-analysis regarding the association of oral health literacy (OHL) with oral health behaviors, perception, knowledge, and dental treatment related outcomes., Methods: Eight electronic databases were searched up until June 2017. Studies regarding the aforementioned outcomes measuring OHL through a validated instrument and in which OHL was an explanatory variable were included. Two independent reviewers selected studies, extracted data, and analyzed the risk of bias of the studies. Meta-analysis using random effect modeling was undertaken. Pooled estimates were calculated with 95 percent confidence interval (CI) and odds ratios (OR)., Results: Twenty-five studies were included in the systematic review and three in the meta-analysis. Most studies were cross-sectional (n = 21) and had a high risk of bias (n = 17). The meta-analysis showed no association between OHL and frequency of visit to the dentist for adults, either through bivariate analysis (OR = 1.25; 95 percent CI: 0.95-1.63) or multivariate analysis (OR = 1.90; 95 percent CI: 0.77-4.84). Dental anxiety and night bottle-feeding were associated with low OHL (P < 0.05). Most studies regarding tooth brushing frequency found no association with OHL. Most studies regarding oral health knowledge related outcomes reported an association with higher OHL. The literature was inconclusive regarding the association between OHL and dental treatment outcomes, oral health behaviors, and oral health perception., Conclusions: The current scientific evidence suggests that no association exists between OHL and any of the outcomes investigated. Further prospective studies with a higher methodological quality are necessary to confirm the evidence., (© 2018 American Association of Public Health Dentistry.)

Purpose: The aim of this meta-analysis was to determine which characteristics of mandibular third molars (MTMs) are more often associated with an increase in the prevalence/incidence of caries on the distal surface of mandibular second molars (MSMs)., Methods: Three electronic databases were analyzed: PubMed; OVID and the Virtual Health Library. Observational studies were included, and the risk of bias was assessed using The Newcastle-Ottawa Scale. The Comprehensive Meta-Analysis software program was used for meta-analysis., Results: Fifteen studies were included in this systematic review, and five were included in the meta-analysis. The distal surface of MSMs were more likely to exhibit caries in the following scenarios: when MTMs were found in the A position, rather than the C position (OR: 3.45, 95% CI: 2.28-5.22, p<0.001); when the horizontal position was compared with the vertical (OR: 8.12, 95% CI: 3.75-17.58, p<0.001) and distoangular (OR: 9.75, 95% CI: 3.49 - 27.25, p<0.001) positions; and when the mesioangular position was compared with the vertical (OR: 7.25, 95% CI: 3.48-15.10, p<0.001) and distoangular (OR: 9.54, 95% CI: 3.47 - 26.21, p<0.001) positions., Conclusion: The results of this study suggest that the presence of MTMs increases the incidence of caries on the distal surface of MSMs. Furthermore, caries on the distal surface of MSMs is more commonly associated with position A and horizontal and mesioangular mandibular molars.

Introduction: Previous diagnosis and intervention in patients with sleep-disordered breathing involves several health professionals. Speech-Language and Hearing Sciences (SLHS) performance has been solidified through scientific production., Objective: To describe the inclusion of Brazilian Speech-Language Pathologists (SLP) in the field of sleep disorders, through the description of studies, scientific publications and participation in scientific events., Data Synthesis: A search and an analysis of the Brazilian SLP publications in the field of sleep disorders were carried out, including articles, monographs, dissertations, thesis and abstracts published in annals of events. The databases Lilacs, SciELO, Pubmed, Google Scholar tool and Lattes platform were accessed, with final search in January 2018. The analysis consisted of a description of the year of publication, type of publication, area of the SLHS, place of publication and/or event. 40 articles were found in national and international journals, from 1999 to 2017. In relation to publications in books, one book about the subject was published in 2009 and eight chapters of books were published. In the monograph format, 21 studies were carried out, there are 13 dissertations and eight thesis. A total of 151 abstracts were published in annals of scientific events, from 2001 to 2017 and 63 lectures were conducted by SLP., Conclusion: The inclusion of Brazilian SLP in the area of sleep disorders has been supported by scientific publications in the format of articles in national and international journals, monographs, thesis, dissertations, books and publications in event annals.

Aim: To examine foot posture changes during the three trimesters of pregnancy and to determine whether there is a relationship between these changes and the pain experienced in this period., Methods: The study sample consisted of 62 pregnant women who attended the Gynaecology Service at Hospital ​Santa María del Puerto (Cádiz, Spain), between January 2013 and May 2014. In their first visit, the following sociodemographic and anthropometric data were recorded: age, weight, height and foot size. In addition, information was obtained regarding pain in the lower back, knees, ankles and feet. In this first visit, too, the Foot Posture Index (FPI) was assessed, and three subsequent controls were performed during the first, second and third months of pregnancy (termed Stages 1, 2 and 3, respectively)., Results: In Stage 1, the average foot size (i.e., shoe size) was 38.3 (SD 1.5). This size did not change between Stages 1, 2 and 3. However, body weight and BMI did present statistically significant changes during this period (p<0.0001). The FPI varied during pregnancy but no relation was observed between these changes and the onset of pain., Conclusions: During pregnancy, pronation increases but this does not appear to influence the onset of pain in the lower limbs., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: This study aimed to evaluate if in patients with dentin hypersensitivity (DH), the DH treatments are able to improve individuals' oral health related quality of life (OHRQoL)., Data and Sources: A systematic review was performed based on PRISMA guidelines (PROSPERO CRD42016050864). Clinical trials reporting OHRQoL before and after DH treatment were included. The search was performed in the PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, LILACS, EMBASE and Scielo databases until May 2017. Hand searches and grey literature were included. Three researches independently selected the studies, extracted data, and assessed the methodological quality. The risk of bias was estimated based on the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was performed by I 2 test. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE)., Study Selection: Six clinical trials were included. DH was assessed by evaporative, cold, and tactile stimuli. OHRQoL was evaluated by OHIP-14 and DHEQ questionnaires. In-home and in-office desensitizing agents for DH treatment were used. The revised studies reported statistically significant reduction of DH and significant improvement in quality of life after treatment (p<0.05). Two studies were judged as high risk of bias. The studies presented high heterogeneity (I 2 =0.8407). The evidence was very low to moderate., Conclusions: The studies indicated decreasing of DH and improving of OHRQoL after DH treatment, although, they presented low to moderate methodological quality., Clinical Significance: The Oral Health Relate Quality of Life of whom complaint of DH can be improved after DH treatment., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Histone demethylase KDM4A is involved in H3K9me3 and H3K36me3 demethylation, which are epigenetic modifications associated with gene silencing and RNA Polymerase II elongation, respectively. KDM4A is abnormally expressed in cancer, affecting the expression of multiple targets, such as the CHD5 gene. This enzyme localizes at the first intron of CHD5 , and the dissociation of KDM4A increases gene expression. In vitro assays showed that KDM4A-mediated demethylation is enhanced in the presence of CTCF, suggesting that CTCF could increase its enzymatic activity in vivo, however the specific mechanism by which CTCF and KDM4A might be involved in the CHD5 gene repression is poorly understood. Here, we show that CTCF and KDM4A form a protein complex, which is recruited into the first intron of CHD5 . This is related to a decrease in H3K36me3/2 histone marks and is associated with its transcriptional downregulation. Depletion of CTCF or KDM4A by siRNA, triggered the reactivation of CHD5 expression, suggesting that both proteins are involved in the negative regulation of this gene. Furthermore, the knockout of KDM4A restored the CHD5 expression and H3K36me3 and H3K36me2 histone marks. Such mechanism acts independently of CHD5 promoter DNA methylation. Our findings support a novel mechanism of epigenetic repression at the gene body that does not involve promoter silencing., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflicts of interests.

Objectives: This study proposed a version of the Children's Sleep Habits Questionnaire for infants under 12 months (CSHQ-I)., Methods: The sample was comprised of 299 infants, aged between 2 weeks and 12 months., Results: Exploratory factor analysis revealed four subscales: Bedtime Resistance, Sleep Anxiety, Positive Sleep Habits, and Daytime Sleepiness. The CSHQ-I total scale presented good test-retest reliability and internal consistency. The CSHQ-I also showed good concurrent validity, with significant associations found between the CSHQ-I total scale and subscales and a measure of infant sleep-wake behaviors., Conclusions: The present study suggested the CSHQ-I as a reliable instrument to assess sleep problems in infants during the first year of life., (Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Obtaining accurate and reproducible estimates of internal shell volume is a vital requirement for studies into the ecology of a range of shell-occupying organisms, including hermit crabs. Shell internal volume is usually estimated by filling the shell cavity with water or sand, however, there has been no systematic assessment of the reliability of these methods and moreover no comparison with modern alternatives, e.g., computed tomography (CT). This study undertakes the first assessment of the measurement reproducibility of three contrasting approaches across a spectrum of shell architectures and sizes. While our results suggested a certain level of variability inherent for all methods, we conclude that a single measure using sand/water is likely to be sufficient for the majority of studies. However, care must be taken as precision may decline with increasing shell size and structural complexity. CT provided less variation between repeat measures but volume estimates were consistently lower compared to sand/water and will need methodological improvements before it can be used as an alternative. CT indicated volume may be also underestimated using sand/water due to the presence of air spaces visible in filled shells scanned by CT. Lastly, we encourage authors to clearly describe how volume estimates were obtained.

The aim of the present study was to evaluate the influence of the severity/activity of dental caries as well as sense of coherence (SOC) and locus of control (LOC) on oral health-related quality of life (OHRQoL) among 5-year-old children. A cross-sectional study was conducted involving 769 children at schools in a city in northeast Brazil. Parents/caregivers answered validated questionnaires addressing SOC and LOC. The children and parents/caregivers answered their respective modules of the Brazilian version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). Data were also collected on sociodemographic characteristics, visits to the dentist, and the occurrence of toothache. Clinical examinations were performed by 2 trained examiners. A directed acyclic graph was used to select covariates for statistical adjustment, and logistic regression for complex samples was used to test associations between the dependent and independent variables (α = 5%). For parents/caregivers, the variables associated with a negative impact on OHRQoL were the occurrence of toothache (odds ratio, OR: 10.53; 95% confidence interval, CI: 6.34-17.51; p < 0.001) and a low SOC (OR: 2.17; 95% CI: 1.37-3.43; p = 0.001). According to the children's perceptions, the following variables were associated with a negative impact on OHRQoL: toothache (OR: 3.58; 95% CI: 2.30-5.55; p < 0.001), caries activity (OR: 1.97; 95% CI: 1.07-3.62; p = 0.028), and traumatic dental injury (OR: 1.71; 95% CI: 1.15-2.53; p = 0.007). Among parents/caregivers, a low SOC led to poorer OHRQoL. For the children, however, neither psychological aspect affected OHRQoL. In the perception of both the parents/caregivers and children, toothache was the oral condition that exerted a negative impact on OHRQoL., (© 2018 S. Karger AG, Basel.)

Introduction: Approximately seven to eight million people worldwide have Chagas disease. In Brazil, benznidazole is the most commonly used active drug against Trypanosoma cruzi; however, its efficacy is limited, and side effects are frequent. Recent studies suggest that amiodarone may be beneficial in the treatment of this disease, by exerting anti-T. cruzi action. This study evaluated changes in T. cruzi cell count in in vitro cultures subjected to different doses of benznidazole, amiodarone, and their combination., Methods: T. cruzi (Y strain) cultures containing approximately 100,000 cells were treated with either 100mg, 50mg, 25mg, 12.5mg, or 10mg of benznidazole, amiodarone, or their combination. On the 4th day, cell count was compared to the baseline data., Results: On the 4th day, no parasites were observed in any of the treated cultures., Conclusions: Benznidazole and amiodarone were equally effective in eliminating T. cruzi in culture. The combination of the two drugs was also equally effective, but our data cannot demonstrate synergism, as similar results were obtained when the drugs were tested individually or in combination. It is suggested that this study be repeated with other T. cruzi strains to determine whether similar results can be obtained again.

Introduction: The yellow fever vaccine is a live attenuated virus vaccine that is considered one of the most efficient vaccines produced to date. The original 17D strain generated the substrains 17D-204 and 17DD, which are used for the current production of vaccines against yellow fever. The 17D-204 and 17DD substrains present subtle differences in their nucleotide compositions, which can potentially lead to variations in immunogenicity and reactogenicity. We will address the main changes in the immune responses induced by the 17D-204 and 17DD yellow fever vaccines and report similarities and differences between these vaccines in cellular and humoral immunity . This is a relevant issue in view of the re-emergence of yellow fever in Uganda in 2016 and in Brazil in the beginning of 2017., Areas Covered: This article will be divided into 8 sections that will analyze the innate immune response, adaptive immune response, humoral response, production of cytokines, immunity in children, immunity in the elderly, gene expression and adverse reactions., Expert Commentary: The 17D-204 and 17DD yellow fever vaccines present similar immunogenicity, with strong activation of the cellular and humoral immune responses. Additionally, both vaccines have similar adverse effects, which are mostly mild and thus are considered safe.

Background: Labiaplasty is one of the aesthetic procedures that has shown the greatest increase in the number of operations in recent years, although the absolute number of these procedures is still very low. Labia minora hypertrophy causes not only functional discomfort and sexual difficulties, but also embarrassment and aesthetic concern. The aim of this study was to assess the impact of labiaplasty on the patient's quality of life, self-esteem, and sexual function., Methods: Twenty-four consecutive sexually active patients, who expressed the desire to undergo labiaplasty, were divided into two groups of 12 patients each: the intervention group that underwent labiaplasty immediately after responding the first questionnaires, and the control group that received no intervention during the study period. All patients were assessed for health-related quality of life, self-esteem, and sexual function using the Brazilian Portuguese versions of the Medical Outcomes Study 36-Item Short Form Health Survey, the Brazilian version of the Rosenberg Self-Esteem scale, and the Female Sexual Function Questionnaire, respectively. The questionnaires were administered at inclusion and at 3 and 6 months later in both groups. Comparisons within and between groups were performed. Statistical analysis was performed at a significance level of p < 0.05., Results: No significant differences in Rosenberg Self-Esteem scale or Medical Outcomes Study 36-Item Short Form Health Survey score were found in either group during the study period. However, a significant improvement was found in the Female Sexual Function Questionnaire total score in the pain and enjoyment domains., Conclusion: Labiaplasty had a positive impact on sexual functioning of the study population.

Background: The practice of evidence-based medicine in plastic surgery is no longer a trend but a reality, with a growing number of studies published in recent years using evidence-based medicine as an assessment tool., Objective: The aim of this study was to verify whether the number of citations to articles with a high level of evidence is greater than articles with low level of evidence., Methods: A search was conducted in the 4 main international journals of plastic surgery. All original articles published in 2011 were analyzed, selected, and classified based on the study design. The articles were then divided into 2 groups: group 1, high level of evidence; and group 2, low level of evidence. Next, Scopus was searched for the number of citations of each article in the 2 subsequent years. The proportion of the number of citations received by articles in groups 1 and 2 was statistically compared., Results: The articles with the highest level of evidence were the most cited among original articles, with 48.6% of them being cited more than 10 times over 2 years, whereas only 18.4% of articles in group 2 were cited with the same frequency. The mean number of citations was 12.6 citations per article in group 1 and 6.56 citations in group 2, with a significant difference between groups (P < 0.0001)., Conclusions: The articles with a higher level of evidence are, on average, cited more often than those with low levels of evidence in the leading journals of plastic surgery.

The AAA+ adenosine triphosphatase (ATPase) Thorase plays a critical role in controlling synaptic plasticity by regulating the expression of surface α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs). Bidirectional sequencing of exons of ATAD1 , the gene encoding Thorase, in a cohort of patients with schizophrenia and healthy controls revealed rare Thorase variants. These variants caused defects in glutamatergic signaling by impairing AMPAR internalization and recycling in mouse primary cortical neurons. This contributed to increased surface expression of the AMPAR subunit GluA2 and enhanced synaptic transmission. Heterozygous Thorase-deficient mice engineered to express these Thorase variants showed altered synaptic transmission and several behavioral deficits compared to heterozygous Thorase-deficient mice expressing wild-type Thorase. These behavioral impairments were rescued by the competitive AMPAR antagonist Perampanel, a U.S. Food and Drug Administration-approved drug. These findings suggest that Perampanel may be useful for treating disorders involving compromised AMPAR-mediated glutamatergic neurotransmission., (Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Background/aim: Traumatic dental injuries occur frequently among young children. The aim of this study was to evaluate the impact of traumatic dental injuries on oral health-related quality of life (OHRQoL) in preschool children using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)., Materials and Methods: This study involved 769 five-year-old children enrolled at public and private preschools. Two examiners underwent a training process which involved the determination of interexaminer and intra-examiner agreement (Kappa statistic) for all clinical conditions (K > 0.82). Descriptive statistics were performed, followed by Poisson regression analysis (α = 5%)., Results: The prevalence of the impact of oral problems on OHRQoL was 32.9% and 42.2% according to the parents/caregivers and children, respectively. Based on the children's self-reports, the occurrence of two or more injured teeth (PR = 1.30; 95% CI: 1.04-1.64), toothache (PR = 1.68; 95% CI: 1.35-2.09), and a low level of parent's schooling (PR = 1.54; 95% CI: 1.24-1.91) exerted impacts on OHRQoL. For the reports of parents/caregivers, the occurrence of non-complicated TDI (PR = 0.66; 95% CI: 0.44-0.98), toothache (PR = 8.03; 95% CI: 5.92-10.88), and a low level of parent's schooling (PR = 1.60; 95% CI: 1.17-2.17) remained associated with the final model., Conclusions: The impact of oral problems on the OHRQoL of the preschool children was high. A greater number of injured teeth, the presence of toothache, and socioeconomic factors were associated with poorer OHRQoL, based on the reports of both the parents/caregivers and the children. The occurrence of non-complicated TDI was a protective factor for OHRQoL., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To characterize patients with syndromic craniosynostosis with respect to their neuropsycholinguistic abilities and to present these findings together with the brain abnormalities., Methods: Eighteen patients with a diagnosis of syndromic craniosynostosis were studied. Eight patients had Apert syndrome and 10 had Crouzon syndrome. They were submitted to phonological evaluation, neuropsychological evaluation and magnetic resonance imaging of the brain. The phonological evaluation was done by behavioral observation of the language, the Peabody test, Token test and a school achievement test. The neuropsychological evaluation included the WISC III and WAIS tests., Results: Abnormalities in language abilities were observed and the school achievement test showed abnormalities in 66.67% of the patients. A normal intelligence quotient was observed in 39.3% of the patients, and congenital abnormalities of the central nervous system were observed in 46.4% of the patients., Conclusion: Abnormalities of language abilities were observed in the majority of patients with syndromic craniosynostosis, and low cognitive performance was also observed.

Chagas disease, caused by Trypanosoma cruzi affects about 6-8 million people worldwide. Although transmission by triatomine insects has been controlled, other means of transmission maintain the infection. These forms of transmission are responsible for introducing Chagas disease in other non-endemic countries of the world. Thus, Chagas disease, nowadays is a worldwide health problem. In Brazil, acai pulp and sugarcane juice have been associated with Chagas disease outbreaks. The difficulties in isolation of the parasite from foods are hampering source tracking which could allow the confirmation of an implicated food commodity in these outbreak investigations. To address this scientific gap, we evaluated the performance of real-time PCR (qPCR) for detecting T. cruzi in acai pulp and sugarcane juice. All experiments were performed with acai pulp and sugarcane juice samples contaminated with different concentrations of T. cruzi. In assays with qPCR, the results showed that the ideal procedure for T. cruzi identification in acai pulp and sugarcane juice consisted of: i. centrifugation; ii. DNA extraction with a commercial kit for stool matrix; and iii. qPCR using a specific molecular marker for T. cruzi. The seeding in LIT medium of experimentally contaminated foods was effective in detecting the parasitic load by qPCR. The efficacy of qPCR was also verified testing food samples crushed with infected Triatomines. In conclusion, this methodology can be used to perform rapid diagnosis in outbreaks, facilitating measures in disease control., (Copyright © 2017 Elsevier B.V. All rights reserved.)