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This study aimed to identify the potential use of the ceramic composite ZrO 2 (CeO 2 )-Al 2 O 3 as a dental implant due to its intrinsic geometry and different masticatory loads based on finite element simulations. Ceramic samples were sintered at 1500 °C-2h, and characterized: The mechanical properties of the ceramic composite (hardness, fracture toughness, flexural strength, Young's Modulus, and Poisson ratio) were determined, in addition to the relative density and its structural characteristics. Commercial dental implant designs (incisal and third-molar) on CAD models were used in this study as an initial implant geometry applied in a typical simulated mandible anatomy. Finite element models were generated for implant geometries using CAD and CAE techniques. Loading cases were considered based on different intensities (100-500 N) and orientation angles to the implant axis (0° and 45°) to reproduce human masticatory conditions. For comparison purposes, the numerical predictions were compared with finite element simulations of gold-standard titanium implants. Ce-TZP/Al 2 O 3 sintered ceramics showed flexural strength of 952.6 ± 88 MPa, hardness and fracture toughness of 1427 ± 46 HV and 11.3 ± 0.4 MPa m 1/2 , respectively, beside Young's modulus of 228.3 ± 65 GPa and Poisson ratio of 0.28. For both Ce-TZP/Al 2 O 3 dental implant geometries, the implant prototypes showed adequate mechanical behavior regardless of the masticatory load value or the orientation angle applied in the simulations: All finite element predictions are lower than the values established by Mohr Coulomb's failure criterion, allowing the feasibility, preliminarily, of the proposed ceramics for dental implant applications without fracture risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The Western diet can negatively affect the gut microbiota and is associated with metabolic disorders. Kombucha, a tea fermented by a symbiotic culture of bacteria and yeast (SCOBY), is known for its bioactive properties and has become popular in the last years. In this study, we evaluated the effects of regular kombucha consumption on the gut microbiota and on outcomes related to the intestinal health of Wistar rats fed a high-fat high-fructose diet. After eight weeks receiving a standard diet (AIN-93M) (n = 10) or a high-fat and high-fructose diet (HFHF) (n = 30) to induce metabolic disorders, the animals were subdivided into four groups: AIN-93M (n = 10); HFHF (n = 10); GTK (HFHF + green tea kombucha (n = 10); and BTK (HFHF + black tea kombucha; n = 10) for 10 weeks. Although body composition did not differ among the groups, the HFHF diet was associated with metabolic alterations, and stimulated the growth of gram-negative bacteria such as Proteobacteria and Bacteroides . Kombucha ingestion could somewhat modulate the gut microbiota, attenuating the effects of a Western diet by increasing propionate production and favoring the growth of beneficial bacteria, such as Adlercreutzia in the GTK group. Our results suggest that regular kombucha consumption may be beneficial to intestinal health, which can be mostly attributed to its high content and diversity of phenolic compounds.

This study revisited the forensic literature to compile case-specific characteristics of the tandem-bullet phenomenon (TBP). A systematic review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and The Joanna Briggs Institute's manual. The protocol was registered in Open Science Framework. Ten primary databases and two sources of grey literature were searched, with descriptive studies on TBP, with information about the victim, weapon, ammunition and injuries, being included. From an initial sample of 2360 studies, 13 were eligible. The studies reported 11 male and 2 female victims, with ages between 14 and 63 years (mean = 39.45 ± 14.51 years); seven were victims of suicide (or suicide attempt); most of the victims (69.23%) were shot in the head and neck; and most (84.61%) had an entry and exit wound ratio of 1:0, respectively. The use of image exams to assess injuries and bullets was reported in 12 cases (92.30%). The most frequent reasons for the TBP were the mismatch between weapon and ammunition and the use of defective cartridges (76.92%). Forensic professionals must be aware of the case-specific characteristics of the TBP to overcome confounding factors in wound ballistics and medicolegal examinations., Competing Interests: Declaration of competing interest This study was financed in part by the Coordination of Superior Level Staff Improvement (CAPES), finance code 001, and the National Council for Scientific and Technological Development (CNPq). Luiz Renato Paranhos was the financed author. No other financial association is related to the present study., (Copyright © 2022 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Objectives: This study investigates the simulation of the mechanical behavior of a bioceramic composite based on (Ce,Y)-TZP reinforced with equiaxed Al 2 O 3 and platelet-shaped hexaaluminate (H6A) grains using Finit Element Method (FEM)., Methods: A commercial (Ce, Y)-TZP/Al 2 O 3 ceramic powder was compacted into disc-shaped specimens that were sintered at 1500 °C for 2 h. The sintered samples were further subjected to hydrothermal degradation in an autoclave at 134 °C, 0.2 MPa, for 10 h and characterized according to their phase composition, microstructure, and relative density. Their flexural strength values were determined by the piston-on-three-ball test, and Weibull statistics was used to evaluate the results. Their hardness, fracture toughness and elastic parameters were also measured. Numerical simulations of the biaxial strength test were performed using the ABAQUS finite element code., Results: The sintered ceramic composite material presented relative density >99%, high resistance to hydrothermal degradation, average hardness of 1435 ± 35 HV, fracture toughness K IC of 9.7 ± 0.5 MPa m 1/2 , and average biaxial flexural strength of 952.6 ± 88 MPa. The numerical predictions of the biaxial flexural strength showed a consistently lower average biaxial flexural strength value of 880.9 MPa, ∼10% lower than the average experimental results., Conclusions: The differences observed are attributed to the complex coupled toughness mechanisms of this material, not included in the finite element simulations., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

COVID-19-related in-hospital mortality has been reported at 30.7-47.3% in Brazil, however studies assessing exclusively private hospitals are lacking. This is important because of significant differences existing between the Brazilian private and public healthcare systems. We aimed to determine the COVID-19-related in-hospital mortality and associated risk factors in a Brazilian private network from March/2020 to March/2021. Data were extracted from institutional database and analyzed using Cox regression model. Length of hospitalization and death-related factors were modeled based on available independent variables. In total, 38,937 COVID-19 patients were hospitalized of whom 3058 (7.8%) died. Admission to the intensive care unit occurred in 62.5% of cases, and 11.5% and 3.8% required mechanical ventilation (MV) and renal replacement therapy (RRT), respectively. In the adjusted model, age ≥ 61 years-old, comorbidities, and the need for MV and/or RRT were significantly associated with increased mortality (p < 0.05). Obesity and hypertension were associated with the need for MV and RRT (p < 0.05)., (© 2022. The Author(s).)

Objective: to compare the perception of patient safety culture among health workers from critical and non-critical areas., Method: cross-sectional study with health workers from critical and non-critical areas of a large hospital. Data collection used a characterization instrument and the Safety Attitudes Questionnaire. The analysis was performed in the Predictive Analytics Software Statistic®., Results: a total of 393 workers participated, predominantly women, over 43 years old, nursing technicians, with a partner, and children. Results indicated that the areas have a negative perception of patient safety (66.5%, ±12.7 critical; 63.5%, ±14.4 non-critical). Only job satisfaction had a positive score (83.0%, ±15.9 critical; 80.1%, ±17.5 non-critical). There was a relationship between being a worker in critical areas and having a positive perception of the unit's management (p = 0.041)., Conclusion: both areas have a negative perception of the safety culture. Although critical areas have obtained more positive evaluations, the results did not show statistical significance when compared to non-critical areas.

High-level sport requires analysis of athletes' metabolic conditions in order to improve the training. Raman spectroscopy can be used to assess urinary composition advantageously when compared to conventional methods of urinalysis. In this work, Raman spectroscopy has been employed to detect creatine in urine of professional swimmers before and after training compared to sedentaries. It has been collected urine samples from five swimmers before and immediately after 150 min of swimming and submitted to Raman spectroscopy (830 nm excitation, 350 mW laser power, 20 s integration time) and compared to the urine from a control group (14 sedentary subjects). The Raman spectra of urine from four swimmers after training showed peaks related to creatine at 829, 915, 1049, and 1397 cm -1 , besides peaks referred to urea, creatinine, ketone bodies, and phosphate. A spectral model estimated the concentration of creatine to be from 0.26 to 0.72 g/dL in the urine of these athletes. The presence of this metabolic biomarker in the urine of some swimmers suggests a metabolic profile influenced by the diet, supplementation, individual metabolism, and the self-response to the training. Raman spectroscopy allows a rapid and reliable detection of creatine excreted in the urine of swimming athletes, which may be used to adjust the nutrition/supplementation of each individual as well as the individual response and energy consumption depending on the type and duration of the training.

Raman spectroscopy (RS) is a vibrational technique that is suitable for performing biochemical analyses in human tissues and fluids. This work has investigated the identification of biochemical markers due to physical performance in the urine of swimming athletes. This was achieved by means of the Raman features that were found before and after the swimming training compared to the sedentary control subjects. These particular biochemical marker identifications refer to and infer the physiological status of individuals. The urine samples (single stream) were collected before and after the training (velocity, middle distance and distance) of professional swimmers, as well as from sedentary subjects (control). The urine samples were submitted to RS (830 nm excitation, 350 mW, 400-1800 cm -1 spectral range, 4 cm -1 resolution) and the spectra after the training were compared to the spectra before training, and subsequently, to the control subjects. The principal component analysis (PCA) was employed in order to identify the biochemicals that were responsible for the spectral differences. The Raman features of the urine samples after training showed peaks that were related to common urine metabolites, such as urea and creatinine. PCA analysis also revealed Raman features that were attributed to other metabolites, such as creatine, ketone bodies, phosphate and nitrogenous compounds in the swimmers after training. RS was a rapid and reliable technique for the evaluation of urine metabolites that were related to the physical performance of high-level swimmers, which then allowed for an accurate assessment and a control of their physiological efficiencies., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The respiratory syncytial virus (RSV) is recognized as an important cause of respiratory tract infections. Immunocompromised patients, healthcare workers (HCWs) and children contacts are at increased risk of acquiring the infection. However, the impact of asymptomatic infection in transmission has not been well studied., Objectives: this study evaluated the frequency and viral load (VL) of RSV in nasal swab samples of individuals with different risk factors for acquiring infection in a university hospital in Sao Paulo, Brazil., Methods: We included 196 symptomatic children and their 192 asymptomatic caregivers, 70 symptomatic and 95 asymptomatic HCWs, 43 samples from symptomatic HIV-positive outpatients, and 100 samples of asymptomatic HIV patients in the period of 2009-2013., Results: RSV infection was detected in 10.1% (70/696) of samples, 4.4% (17/387) of asymptomatic patients, and 17.1% (53/309) from symptomatic patients. (P < .0001). The VL of symptomatic patients (4.7 log copies/mL) was significantly higher compared to asymptomatic patients (2.3 log copies/mL). RSV detection among asymptomatic caregivers (6.8%; 13/192) was significantly higher compared to other asymptomatic adults, HIV and HCWs (2.0%; 4/195; P = .0252). A close contact with an infected child at home was an important risk to RSV acquisition [OR 22.6 (95% CI 4.8-106.7)]. Children who possibly transmitted the virus to their asymptomatic contacts had significantly higher viral load than children who probably did not transmit (P < .0001)., Conclusions: According to our results, it is important to know if people circulating inside the hospital have close contact with acute respiratory infected children., (© 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)

Raman spectroscopy is a rapid and non-destructive technique suitable for biological fluids analysis. In this work, dispersive Raman spectroscopy has been employed as a rapid and nondestructive technique to detect the metabolites in urine of physically active subjects before and after vigorous 30min pedaling or running compared to sedentary subjects. For so, urine samples from 9 subjects were obtained before and immediately after physical activities and submitted to Raman spectroscopy (830nm excitation, 250mW laser power, 20s integration time) and compared to urine from 5 sedentary subjects. The Raman spectra of urine from sedentary showed peaks related to urea, creatinine, ketone bodies, phosphate and other nitrogenous compounds. These metabolic biomarkers presented peaks with different intensities in the urine of physically active individuals after exercises compared to before, measured by the intensity of selected peaks the Raman spectra, which means different concentrations after training. These peaks presented different intensity values for each subject before physical activity, also behaving differently compared to the post-training: some subjects presented increase while others decrease the intensity. Raman spectroscopy may allow the development of a rapid and non-destructive test for metabolic evaluation of the physical training in active and trained subjects using urine samples, allowing nutrition adjustment with the sport's performance., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This study assessed the presence of influenza virus among young children and the coverage of vaccination from 2010 to 2012 in São Paulo, Brazil. Our results demonstrated a lower rate of influenza detection and a predominance of influenza B. A decrease of coverage vaccination through the surveillance periods was observed.

Human respiratory syncytial virus (HRSV) causes severe infections among children and immunocompromised patients. We compared HRSV infections among Haematopoietic Stem Cell Transplant program (HSCT) patients and children using direct immunofluorescence (DFA), point-of-care RSV Bio Easy® and a polymerase chain reaction (PCR) assay. Overall, 102 samples from HSCT patients and 128 from children obtained positivity rate of 18.6% and 14.1% respectively. PCR sensitivity was highest mainly on samples collected after five days of symptoms onset. A combination of both DFA and reverse transcriptase-PCR methods for HSCT high-risk patients is the best diagnostic flow for HRSV diagnosis among these patients.

The present study investigated the occurrence of intra-uterine growth retardation (IUGR) in newborn (n=40) and 150-day-old (n=240) pigs of different birthweight ranges (high, HW: 1.8-2.2kg; low, LW: 0.8-1.2kg) from higher-parity commercial sows and its impact on their subsequent development and carcass traits in a Brazilian commercial production system. HW newborn pigs had heavier organs than LW pigs (P<0.01), and all brain:organ weight ratios were higher (P<0.01) in LW compared with HW offspring, providing strong evidence of IUGR in the LW piglets. HW pigs had higher bodyweights and average daily gain (ADG) in all phases of production (P<0.05), but ADG in the finisher phase was similar in both groups. Additionally, LW newborn and 150-day-old pigs showed a lower percentage of muscle fibres and a higher percentage of connective tissue in the semitendinosus muscle, greater fibre number per mm(2) and a lower height of the duodenal mucosa (P<0.05). On the other hand, HW pigs had higher hot carcass weight, meat content in the carcass and yield of ham, shoulder and belly (P<0.01). Hence, lower-birthweight piglets may suffer from IUGR, which impairs their growth performance, muscle accretion, duodenal mucosa morphology and carcass traits.

Background: Rotaviruses are the major cause of diarrhea in children for which a monovalent G1P[8] vaccine has been provided free for all Brazilian infants since March 2006., Objectives: To investigate prevalence and genotypes of rotavirus strains causing diarrhea in children in Triângulo Mineiro, Minas Gerais, during 2007-2010, and to assess local vaccine impact., Study Design: Fecal specimens were analyzed for rotavirus detection and characterization by PAGE, RT-PCR and PCR-genotyping assays., Results: Overall, rotavirus was diagnosed in 12.1% (76/630) cases, accounting for 35.8% of the hospitalizations and 6.5% of outpatient attendance due to diarrhea. A trend in rotavirus disease reduction occurred in both cities (71.8% and 83.4% in Uberaba; 95.3% in Uberlândia) up to 2009, but it reversed in 2010 with increased rotavirus cases in Uberlândia. Short pattern G2P[4] strains were detected in all but three (96%) cases of mixed/P[NT] infections with long electropherotypes., Conclusions: This 4-year follow-up study showed a reduction in rotavirus-related diarrhea and even skipped a rotavirus season, which is consistent with vaccine mediated protection. The 2007-2010 rotavirus epidemic curve reflected the natural cyclic fluctuation of the single G2P[4] genotype, with sharp reduction of cases in 2008 leading to lack of a rotavirus 2009 season (both cases and hospitalizations) followed by its come back in 2010. Diarrhea cases related to either vaccine serotype/genotype (G1 or P[8]) were not detected. Thus, a new scenario emerged with a single epidemic genotype replacing the cocirculation of great diversity of genotypes, thus far, a hallmark of the epidemiology of rotavirus in Brazil., (Copyright © 2012 Elsevier B.V. All rights reserved.)

This study assessed the occurrence of human rhinovirus (HRV) species in outpatient children attending day-care in Sao Paulo, Brazil. HRV reverse transcriptase polymerase chain reaction and amplicon sequencing were done in 120 samples collected in 2008. HRV was detected in 27.5% of samples. HRV C was detected in 60.7% of wheezers, a frequency not different from that observed in nonwheezers (69.6%).

Background: Tuberculosis (TB) has a high prevalence in Brazil. The scenario of liver transplantation (LT) creates challenges: atypical presentation, treatment hepatotoxicity, and increased mortality. The majority of TB cases after transplantation represent reactivation of latent infections; therefore, prophylaxis (PX) plays a major role. The aim of this study was to evaluate the benefits of PX after LT based on a pretransplantation tuberculin test (TT) in an endemic area., Methods: Retrospective analysis of medical data from 376 adult cirrhotic patients undergoing OLT from 2001 to 2009., Results: Among 191 selected patients, 137 (71%) showed a pretransplant TT including 41 (30%) with a TT ≥5 mm. The 17 (40%) of these patients who were prescribed PX did not experience TB. Prophylaxis was discontinued in 5 patients (20%) owing to suspicion of hepatotoxicity (medium serum alanine transaminase 175 U/L). In the group without PX, we diagnosed 1 case of pulmonary TB. The overall prevalence of anergic patients in the cirrhotic phase was 65% and prevalence of TB 1%., Conclusions: The prevalence of TB was similar to that reported in the literature, but positivity to TT was higher (34% vs 25%), possibly because of the endemicity of the area. There was a lower prevalence of extrapulmonary disease and no mortality. No patient undergoing PX with isoniazid, although incomplete due to suspicion of hepatotoxicity displayed TB. One patient without PX was affected by TB. The drug was effective but not always safe., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Rotaviruses are major causes of diarrhea in children for which vaccines were developed and are currently in use., Objectives: To investigate the genotypes of rotavirus strains causing dehydrating diarrhea in children in Uberaba, Triângulo Mineiro region, Minas Gerais, during 2005-2006., Methods: Rotavirus-associated diarrhea was investigated in fecal specimens by PAGE and strains were characterized for their genotype by RT-PCR and PCR-typing assays., Results: Rotavirus was detected in 15% (39/260) of the fecal specimens by PAGE: 64% of the specimens presented short electrophoretic patterns and G2P[4] genotype; and 36% presented long electropherotypes and G1P[8], G9P[8], G4P[9] and two strains with sill undetermined G and P[8] genotype. A change in the dominant electrophoretic pattern was observed, shifting from long to short patterns and coinciding with the highest incidence of diarrheal cases., Conclusions: Those are the first data on rotavirus strains circulating in the Triângulo Mineiro region. They were obtained over a 16-month period that included the first 10 months after the launch of the national rotavirus immunization program that uses a monovalent G1P[8] attenuated vaccine strain. These results should further our understanding of the dynamics of rotavirus strains and help interpreting the significance of the program.

Objectives: The purpose of this study was to prospectively assess the effect of dynamic cardiomyoplasty in patients with symptomatic chronic heart failure., Background: Since the first procedure was performed in 1985, dynamic cardiomyoplasty has been developed for use in patients with chronic heart failure. The aging population in developed countries has made heart failure a growing public health concern. Heart transplantation is appropriate or available for only a small proportion of these patients because of limited donor supply. Effective alternatives to transplantation are needed., Methods: Eight centers in North and South America performed 68 cardiomyoplasty procedures between May 1991 and September 1993. Data were prospectively collected every 6 months and compared with preoperative values using paired t tests, chi-square tests and actuarial survival analyses., Results: Patients had a mean (+/- SD) age of 57 +/- 1 years and were predominantly male (53 [78%] of 68). Heart failure etiology was classified as idiopathic in 47 (69%) of 68 patients and ischemic in 21 (31%). The in-hospital mortality rate was 12% (8 of 68), and the survival rate at 6 and 12 months was 75 +/- 5% and 68 +/- 6%, respectively. Objective improvements were seen at 6 months (n = 49) in left ventricular ejection fraction (23 +/- 1% vs. 25 +/- 1%, p = 0.05), stroke volume (50 +/- 2 vs. 56 +/- 3 ml/beat, p = 0.02) and left ventricular stroke work index (26 +/- 1 vs 30 +/- 2 g/m2 per beat, p = 0.01). Improvements in mean New York Heart Association functional class (3 +/- 0.04 vs. 1.8 +/- 0.1, p = 0.0001) and activity of daily living score (59 +/- 3 vs. 80 +/- 2, p = 0.0001) were also observed. There were no significant changes at 6 months in peak oxygen consumption (15 +/- 1 vs. 16 +/- 1 ml/kg per min), cardiac index (2.26 +/- 0.08 vs. 2.33 +/- 0.08 liters/min per m2), pulmonary capillary wedge pressure (19 +/- 2 vs. 18 +/- 1 mm Hg) or heart rate (87 +/- 2 vs. 82 +/- 3 beats/min)., Conclusions: These data suggest that dynamic cardiomyoplasty improves ventricular systolic function, reduces symptoms of heart failure and improves objective measures of quality of life in patients with congestive heart failure. This improvement occurred without changes in peak exercise capacity, ventricular filling pressure or actuarial survival.