Anthropometric measures and obstructive sleep apnea in children and adolescents: a systematic review of the literature and meta-analysis.

BACKGROUND: Anthropometric measurements can be used to identify children at risk of developing obstructive sleep apnea (OSA). The study aimed to assess which anthropometric measurements (AMs) are most associated with an increased predisposition to develop OSA in healthy children and adolescents. METHODS: We performed a systematic review (PROSPERO #CRD42022310572) that searched eight databases and gray literature. RESULTS: In eight studies with low-to-high risk of bias, investigators reported the following AMs: body mass index (BMI), neck circumference, hip circumference, waist-to-hip ratio, neck-to-waist ratio, waist circumference, waist-to-height ratio, and facial AMs. The meta-analysis showed that the OSA group had an average of 1.00 cm greater for the neck circumference (p < 0.001; Cohen's d = 2.26 [0.72, 5.23]), 3.07 cm greater for the waist circumference (p = 0.030; Cohen's d = 0.28 [0.02, 0.53]), 3.96 cm greater for the hip circumference (p = 0.040; Cohen's d = 0.28 [0.02, 0.55]), 5.21° greater for the cervicomental angle (p = 0.020; Cohen's d = 0.31 [0.03, 0.59]), and 1.23° greater for maxillary-mandibular relationship angle (p < 0.001; Cohen's d = 0.47 [0.22, 0.72]) than the control group. The mandibular depth angle had a reduction of 1.86° (p = 0.001; Cohen's d = -0.36° [-0.65, -0.08]) in control than in patients with OSA. The BMI (p = 0.180), waist-to-hip ratio (p = 0.280), neck-to-waist ratio (p = 0.070), maxillary depth angle (p = 0.250), and upper/lower face height ratio (p = 0.070) showed no significant differences between groups. CONCLUSIONS: Compared to the control group, the OSA group exhibited a greater mean difference in neck circumference, the only anthropometric measurement with high certainty of evidence.

Interaction between residual feed intake and thermal environment on performance, nitrogen balance, ingestive behavior and carcass yield of dorper lambs.

Residual feed intake (RFI) is a nutritional variable used in genetic improvement programs, the relationship between the environment and the availability of energy and protein in the diet has not yet been explored. Thus, the aim was to evaluate interactions between RFI and thermal environment on performance, nitrogen balance, ingestive behavior and carcass yield of Dorper lambs receiving diets containing different concentrate levels. Dorper lambs (male, n = 64, 17.83 ± 2.43 kg and 110 ± 10 days of age) were confined individually for 40 days for RFI classification. Lambs were separated into positive RFI (n = 30) and negative RFI (n = 30) and remained confined for another 60 days. The animals were distributed in a randomized block design, with a 2 × 2 × 3 factorial scheme, with 2 confinement environments (full sun or shade), 2 groups of feed efficiency (RFI positive or RFI negative) and three diets containing different concentrate levels (30, 45 and 60%), with 5 replications in each treatment. Isolated effects of concentrate level were observed for dry matter intake and digestibility, feeding, rumination, idle and chewing times, feeding efficiency, ingested, excreted and absorbed nitrogen, and on cooling losses, hot and cold carcass yield (P < 0.05). There was an effect of environment × concentrate interaction on performance, retained nitrogen and nitrogen balance (P < 0.05). There was an effect of RFI × environment interaction on the dry matter rumination efficiency, hot and cold carcass weight (P < 0.05). Under experimental conditions, RFI did not influence the productive performance of Dorper lambs. Interactions between environment and diet indicate better performance for Dorper lamb confined in the shade and receiving a higher proportion of concentrate. Animals with negative RFI show better performance and carcass weight when confined in shade, while animals with positive RFI showed better responses to these variables when confined in full sun.

A roadmap for the conservation of freshwater mussels in Europe.

Europe has a long history of human pressure on freshwater ecosystems. As pressure continues to grow and new threats emerge, there is an urgent need for conservation of freshwater biodiversity and its ecosystem services. However, whilst some taxonomic groups, mainly vertebrates, have received a disproportionate amount of attention and funds, other groups remain largely off the public and scientific radar. Freshwater mussels (Bivalvia, Unionida) are an alarming example of this conservation bias and here we point out six conceptual areas that need immediate and long-term attention: knowledge, threats, socioeconomics, conservation, governance and education. The proposed roadmap aims to advance research, policy and education by identifying the most pressing priorities for the short- and long-term conservation of freshwater mussels across Europe.

Controversies in immunotherapy for anti-NMDA receptor encephalitis: a scoping review with a proposal of operational definitions.

Anti-NMDA receptor encephalitis (NMDARE), an autoimmune encephalitis associated with autoantibodies against the N-methyl-D-aspartate (NMDA) receptor, affects predominantly young women and is associated with psychiatric symptoms, seizures, movement disorders, and autonomic instability. Traditional treatments of anti-NMDA receptor encephalitis involve corticosteroids, intravenous immunoglobulin, plasmapheresis, cyclophosphamide, and rituximab. However, many controversies remain in the treatment for NMDA receptor encephalitis, such as optimal timing and combination of different immunotherapies, the role of newer strategies (e.g., bortezomib or tocilizumab) for severe and refractory patients, and the need or not for long-term immunosuppression. Our goal was to perform a scoping review to discuss the controversial topics of immunotherapy for NMDA receptor encephalitis and propose operational definitions to guide clinical practice and future research in the field.

Methodological parameters for upper airway assessment by cone-beam computed tomography in adults with obstructive sleep apnea: a systematic review of the literature and meta-analysis.

BACKGROUND: A reliable method for analyzing the upper airway (UA) remains a challenge. This study aimed to report the methods for UA assessment using cone-beam computed tomography (CBCT) in adults with obstructive sleep apnea (OSA). METHODS: We performed a systematic review (PROSPERO #CRD42021237490 and PRISMA checklist) that applied a search strategy to seven databases and grey literature. RESULTS: In 29 studies with moderate-to-high risk of bias, investigators mostly reported the body position during CBCT (upright or supine) and hard tissue references, diverging in UA delimitation and terminologies. The meta-analysis showed two subgroups (upright and supine), and no statistical differences were identified (p = 0.18) considering the UA area. The volume in the OSA group was smaller than that in the control group (p < 0.003 and Cohen's d = - 0.81) in the upright position. Patients with OSA showed smaller anteroposterior dimensions than the control group and were not affected by the position during image acquisition (p = 0.02; Cohen's d = - 0.52). The lateral measurements were also lower in the OSA group (supine) (p = 0.002; Cohen's d = - 0.6). CONCLUSIONS: Patients with OSA showed smaller UA measurements in the upright (volume) and supine (lateral dimension) positions. The anteroposterior dimension was also reduced in patients with OSA compared to the control group, regardless of the position during CBCT acquisition.

Effect of spineless cactus [Nopalea cochenillifera (L.) Salm Dyck] on nutrient intake, ingestive behaviour, and performance of lambs.

The objective of this study was to evaluate the effect of increasing levels of spineless cactus (SC) [Nopalea cochenillifera (L.) Salm Dyck] on nutrient intake, ingestive behaviour, and performance of lambs in a feedlot. Thirty-two male (non-castrated) Santa Inês lambs with a mean initial body weight (BW) of 20.4 ± 2.60 kg were distributed across four levels of spineless cactus: zero, 24, 52, and 75% of total diet dry matter (DM). Over 56 days, the animals had their intake and performance monitored. The inclusion of SC influenced (p<0.05) in a quadratic way the dry matter intake and total digestible nutrients, but linearly decreased (p<0.05) the neutral detergent fiber intake. Drinking water intake decreased linearly (p<0.05) with the inclusion of SC in the diet. The inclusion of SC influenced (p<0.05) in a quadratic way the digestibility of organic matter in the diet. The increase in the level of SC in the diet increased linearly (p<0.05) the feeding and rumination efficiencies of the lambs. The maximum daily gain of 0.237 kg/day was achieved with 44% SC in the diet. It is recommended to include up to 40% of spineless cactus in the diet of lambs.

Upper Eyelid Blepharoplasty: Surgical Techniques and Results-Systematic Review and Meta-analysis.

BACKGROUND: Upper eyelid blepharoplasty is a surgical procedure that aims to correct the typical changes that occur with aging to the periorbital area. The outcomes of this surgery are aesthetic, as well as functional. Many studies have described an impact on the cornea, intraocular pressure, dry eye syndrome, and visual quality. The aim of this systematic review is to compare the different surgical techniques and their outcomes. METHODS: The authors performed a literature review through online databases PubMed, Web of Science, Clinicaltrials.gov, and CENTRAL libraries. Information was collected about the surgery techniques and the functional and aesthetic outcomes as well as complications of the interventions. Six types of upper blepharoplasty surgery were studied. Data were analyzed using Cochrane RevMan. RESULTS: Twenty studies were included in our systematic review and nine in our meta-analysis. We presented results about intraocular pressure, central corneal thickness, flattest keratometry, steepest keratometry, corneal astigmatism, visual acuity, Schirmer test 1 and 2, tear film break-up time and the ocular surface disease index questionnaire, according to type of surgery. Our meta-analysis showed no significant results. CONCLUSIONS: No significant results were found; however, many studies reported an impact of upper blepharoplasty surgery in the outcomes studied. Only a small number of complications were reported, and patients were satisfied with the aesthetic outcomes. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Direct-to-Implant Subcutaneous Breast Reconstruction: A Systematic Review of Complications and Patient's Quality of Life.

BACKGROUND: The use of direct-to-implant subcutaneous breast reconstruction has increased over the last years. The goal of this systematic review is to deliver an updated review of the safety of this technique and its impact on quality of life. We also compare subcutaneous vs submuscular complications, through meta-analysis. METHODS: Literature review through PubMed and Cochrane Library databases were performed by PRISMA criteria. Thirty-nine studies met inclusion criteria for subcutaneous review and 15 studies met inclusion criteria for meta-analysis. All included studies were evaluated for complications and answers to the BREAST-Q. Data were analysed using Microsoft Excel, IBM SPSS, and Cochrane RevMan. RESULTS: In 2863 patients and 3988 breasts that undergone direct to implant subcutaneous breast reconstruction, 8,21% had rippling, 5,64% seroma, 1,74% hematoma, 3,40% infection, 3,01% wound dehiscence, 3,93% skin necrosis, 3,34% nipple-areolar-complex (NAC) necrosis, 3,07% capsular contracture, 0,00% animation deformity, and 3,83% an implant removal. Meta-analysis showed a statistically significant decrease in the odds ratio of animation deformity, a but statistically significant higher odds ratio of rippling. Subcutaneous and submuscular reconstructions had similar BREAST-Q scores. CONCLUSIONS: Direct-to-implant subcutaneous breast reconstruction does not harm the patient's quality of life, comparatively with submuscular, saving the pectoral muscle from dissection and preventing animation deformity, but increasing the risk of rippling. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Supplementation of feedlot lambs with cactus cladodes as strategy to improve testicular function.

The aim of this study was to evaluate the effects of diets containing cactus cladodes genotypes on plasma testosterone levels, testicular histopathological and histomorphometric parameters, and oxidative stress markers in lambs. Thirty-six male, intact Santa Inês lambs (22.0 ± 2.9 kg initial body weight), were to feedlot for 86 days. A completely randomized design was used with three dietary treatments (control diet with Tifton-85 hay as the only roughage; and two more diets with Miúda or OEM cactus cladodes partially replacing hay) and twelve replicates. There was no influence of the diets on the testicular weight (P = 0.414) and gonadosomatic index (P = 0.384) of lambs. The testosterone serum concentrations were almost twice as higher in lambs fed Miúda cactus cladodes compared to control treatment. There was greater incidence and severity of lesions in the testicular parenchyma of animals that received control diet: loosening of germ cell epithelium, germ cell desquamation and vacuolization of Sertoli cells. The seminiferous tubule diameter and height of the seminiferous epithelium were higher in lambs fed OEM cactus cladodes (P = 0.003). The tubular volume and Leydig cells volume were higher in animals fed with cactus cladodes (P < 0.05). The levels of malondialdehyde were higher in the lambs of control group compared to OEM group (P = 0.039) and the testicular concentration of nitric oxide was higher in control group (P = 0.009). The diet containing OEM cactus cladodes increased the levels of superoxide dismutase. Our results indicate that diets containing cactus cladodes promote antioxidant protection to the testicular parenchyma and preserve the spermatogenic process of lambs.

Dwarf and tall elephant grass silages: intake, nutrient digestibility, nitrogen balance, ruminal fermentation, and ingestive behavior in sheep.

The objective of this study was to evaluate the exclusive supply of dwarf or tall elephant grass silages, harvested at 60 days of growth, without wilting or the use of additives, on intake, apparent digestibility, nitrogen balance, rumen parameters, and ingestive behavior of sheep. Eight castrated male crossbred sheep (57.6 ± 5.25 kg body weight), fistulated in the rumen, were distributed in two 4 × 4 Latin squares with four treatments and eight animals per treatment and four periods. The treatments consisted of four elephant grass genotype silages (Mott, Taiwan A-146 2.37, IRI-381, or Elephant B). There was no effect of silages (P > 0.05) on dry matter, neutral detergent fiber, and total digestible nutrient intake. The dwarf-sized elephant grass silages provided higher crude protein intake (P = 0.047) and N intake (P = 0.047), while the IRI-381 genotype silage provided higher non-fibrous carbohydrate intake compared to Mott (P = 0.042), without differing from Taiwan A-146 2.37 and Elephant B silages. There were no differences (P > 0.05) among the digestibility coefficients of the evaluated silages. It was observed that silages produced with Mott and IRI-381 genotypes caused a slight decrease in ruminal pH (P = 0.013), and the propionic acid concentration was higher in the rumen fluid of the animals fed with Mott silage (P = 0.021). Therefore, dwarf or tall elephant grass silages, produced with cut genotypes at 60 days of growth and without the use of additives or wilting process, can be used in sheep feeding.

Biorecognition of hydrogen peroxide using a novel electrochemical platform designed with Glossoscolex paulistus giant hemoglobin.

The giant extracellular hemoglobin of the annelid Glossoscolex paulistus (HbGp; 3.6 MDa) is a valuable and underexplored supramolecular hemoprotein system for the biorecognition of reactive oxygen species. In this work, an efficient and simple electrochemical platform was designed for analyzing H2O2, using HbGp covalently immobilized on Nafion®-modified glassy carbon electrode, named as HbGp/Nafion/GCE. Voltammetric and spectroscopic studies revealed the importance of prior modification of the electrodic support with the conducting polymer to obtain satisfactory hemoglobin electroactivity, as well as a biocompatible microenvironment for its immobilization. In terms of biological activity, it was observed a greater reactivity of the biomolecule in acidic medium, enabling the detection of the analyte by a quasi-reversible mechanism, whose kinetics was limited by analyte diffusion. In the presence of H2O2, the native structure of hemoglobin (oxy-HbGp (Fe2+)) oxidizes to ferryl-HbGp (Fe4+) and this redox reaction can be monitored on HbGp/Nafion/GCE with a detection limit of 8.5 × 10‒7  mol L-1. In addition to high sensitivity, the electrochemical biosensor also provided reproducible, consistent, and accurate measurements. The electroanalytical method showed an appropriate performance to quantify different levels of H2O2 in milk samples, proving the potential of HbGp/Nafion/GCE for this purpose.

Carcass characteristics and meat quality of goats fed increasing levels of crude glycerin.

Crude glycerin is a byproduct of the biodiesel industry and has been widely used in ruminant diets as a source of energy, usually in place of corn, primarily during periods of drought in tropical regions. The objective of this study was to evaluate the effect of including levels of the crude glycerin of low purity (0, 6, 12 and 18%) replacing corn in the diets of goats on the carcass characteristics, tissue composition, meat cuts yield and physicochemical parameters of meat. Forty males castrated without defined racial pattern goats an initial average weight of 19.70 ± 2.30 kg were slaughtered after 86 days. Diets content 0 and 6% crude glycerin promoted similar responses to the analyzed variables, except for pH and breast weight. No differences were observed to total digestible nutrients, slaughter body weight, commercial cut yield leg tissue composition and physicochemical parameters of meat. Crude glycerin can be included up to 12% without losses on carcass weight and meat cuts, leg composition, and meat quality. The inclusion of crude glycerin containing 63.06% glycerol and 45.57% lipids could be effective in partial replacement of corn in diets for confined goats in tropical areas.

Nasal Reconstruction: Reconstruction of a Nasal Tip, Columella and Middle Crura Defect After Human Bite with a Turn Down Flap Associated With Conchal Graft and Interpolated Melolabial Flap.

ABSTRACT: Nasal reconstruction is one of the most difficult procedures in plastic surgery due to its complex anatomy and function. A 31-year male was sent to our evaluation after an acquired nasal defect caused by a human bite 2 years before. The defect encompassed the nasal tip, columella, and both middle crura. After a detailed evaluation, the inner lining was reconstructed with a turndown flap of the released scar. In the same operative time, a shaped conchal cartilage graft was anchored to the remnants of both lateral crura and covered with a melolabial interpolated flap. Division, debulking, and final in setting of the flap was done after 5 weeks. Although simple steps were used, a good aesthetic reconstruction was achieved with minimal donor site morbidity.This case proves that a good planning is a cornerstone of a good reconstruction.

Diets containing cactus cladodes on serum and liver levels of microminerals in sheep and goats.

Two experiments were performed to evaluate the effects of partial replacement of Tifton hay by Miúda cactus cladodes (Nopalea) or Orelha de Elefante Mexicana (O.E.M.) cactus cladodes (Opuntia) on serum and liver concentrations of iron (Fe), copper (Cu), zinc (Zn), and manganese (Mn) in feedlot small ruminants. The experiment 1 (Exp. 1) lasted 86 days, and thirty-six male Santa Inês lambs (22.0 ± 2.9 kg initial body weight-IBW) were used. In experiment 2 (Exp. 2), lasting 100 days, thirty-six male goats of undefined breed (19.0 ± 2.8 kg IBW) were used. In both studies, the animals were distributed in a completely randomized design, with three treatments (diet control-without cactus; and diets with hay partially replaced by Miúda or O.E.M. cactus cladodes) and twelve replicates. Blood samples were collected to quantify serum micromineral levels, and at the end of the feedlot periods, sheep and goats were slaughtered and liver fragments were collected for micromineral dosage. In Exp. 1, lambs fed Nopalea cactus cladodes diet showed greater hepatic Cu accumulation (441.87 mg/kg DM; P = 0.027). The diets containing cactus cladodes tended to increase serum levels of Cu (P = 0.075) and Zn (P = 0.058). In Exp. 2, goats fed diet containing Opuntia cactus cladodes presented higher serum levels of Fe (P = 0.024) and Cu (P = 0.012). In conclusion, the partial replacement of Tifton hay by cactus cladodes increases hepatic concentrations of Cu in lambs and serum levels of Fe and Cu in goats.

Performance and ruminal and intestinal morphometry of Santa Inês sheep submitted to feed restriction and refeeding.

A study was carried out to evaluate the performance and ruminal and intestinal morphology of Santa Inês sheep subjected to feed restriction followed by refeeding. A total of 40 uncastrated lambs with an approximate age of 120 ± 15 days and mean body weight (BW) of 17.04 ± 1.18 kg were randomly divided into two groups of BW (20 and 25 kg of BW), which were subjected to different levels of feed restriction (0%, 25%, and 40% of feed restriction). For performance variables, six treatments were considered (0, 25%, and 40% of feed restriction for both groups (20 and 25 kg of BW)) and five treatments for morphometric variables (ad libitum, 25% and 40% for both groups (20 and 25 kg of BW)). All animals were slaughtered with 14 weeks of experimentation. During the feed restriction phase, the dry matter intake (DMI), feed efficiency (FE), and average daily gain (ADG) decreased (P < 0.05) as the level of restriction increased. During the refeeding phase, lambs with 20 kg of body weight subjected to restriction presented lower (P < 0.05) DMI in the ad libitum treatment. However, lambs with 25 kg of body weight under feed restriction presented DMI, FE, and ADG similar (P > 0.05) to the group ad libitum. The final body weight of restricted lambs after refeeding (both groups 20 and 25 kg of body weight) was lower (P < 0.05) than lambs feed ad libitum. In relation to morphology, restricted lambs showed greater height ruminal papillae and larger (P < 0.05) area of ruminal absorption and intestinal absorption, especially the lambs under treatment 40% of feed restriction. The feed restriction followed by refeeding in sheep provided partial compensatory gain, in addition, caused morphological changes in the rumen and intestine that allowed greater absorption and possibly compensatory gain in periods of greater refeeding.

Coconut fruit pulp by-product in the diet of sheep.

This study aimed to evaluate the effect of the inclusion of coconut fruit pulp by-product (CPB) on the intake, apparent digestibility, nitrogen balance, and ruminal parameters of sheep. Five intact, male, non-descript lambs with a mean initial body weight of 25.5 ± 1.68 kg were assigned to a Latin square design (5 × 5) of five treatments consisting of CPB inclusion levels, in five proportions of 0%, 5%, 10%, 15%, and 20% dry matter (DM), in diets consisting of sugarcane bagasse as forage, with corn and soybean meal. Each period lasted 15 days for adaptation followed by 6 days for data collection. The inclusion of CPB linearly decreased (P < 0.05) the intake of DM, crude protein, non-fibre carbohydrates, neutral detergent fibre (NDF), and DM digestibility. The inclusion of CPB linearly increased (P < 0.05) the ether extract digestibility, but did not influence (P > 0.05) the NDF digestibility. There was a linear reduction (P < 0.05) in the absorbed nitrogen (N) and retained N (g/day); however, a quadratic increase (P < 0.05) for N absorbed (% consumed) as well as ammonia nitrogen was observed. There was a quadratic increase (P < 0.05) for propionate (mMol/L and %) and the ratio of acetate, propionate and butyrate (mMol/L and %) with the inclusion of CPB in the diet. Based on these findings, it was recommended to incorporate CPB up to the level of 5% in the diet of sheep.

Kidney changes in lambs fed cactus pear varieties resistant to Dactylopius opuntiae as the only roughage.

This study aimed to evaluate the effects of four varieties of cactus pear resistant to carmine cochineal as exclusive roughage for lambs on the biochemical, histopathological, and histomorphometric parameters of kidneys. Twenty-four castrated male crossbred lambs at eight months of age and an initial body weight of 21.0 ± 0.5 kg were distributed in a completely randomized design, with four treatments and six repetitions. The experimental treatments consisted of four diets containing Miúda cactus pear, IPA-Sertânia cactus pear, IPA-F21 cactus pear, or Orelha de Elefante Mexicana (OEM) cactus pear as the only roughage. Blood samples were collected every two weeks (14 d, 28 d, 42 d, and 56 d) to quantify serum urea and creatinine levels. After 72 days of the introduction of the tested diets, the animals were slaughtered and fragments of the kidneys were collected for histological analysis. The serum urea level was higher in animals fed a diet based on the Miúda variety (49.38 mg dL-1), and the serum creatinine levels were lower in the last two collections (P = 0.009). The most frequent histopathological findings in the kidneys were calcification, congestion, glomerular atrophy, presence of luminal cellular debris, and nephrosis, regardless of the cactus pear variety. The Miúda cactus pear and OEM cactus pear varieties caused more severe damage to the nephron components, while the varieties IPA F-21 and IPA-Sertânia caused less significant injuries. The use of IPA-Sertânia and IPA F-21 cactus pear varieties is suggested in lamb's diets, due to the lower impact on the renal parenchyma. However, there was no expressive impairment of renal function, and there was no difference between the cactus pear varieties tested in this study on the weight gain of the animals, and they can all be used to feed feedlot sheep.

The Use of Surgical Splints in Orthognathic Surgery: A Bibliometric Study.

Introduction Orthognathic surgeries require the use of surgical splints (SS) to stabilize the occlusion and the segments fixed with plates and screws. Technological advances in the field of computing and the possibility of generating three-dimensional (3D) images have brought different possibilities for making SS, which has generated greater predictability and customization of surgical plans. The bibliometric study can have a qualitative character through the scope of articles in a certain area of knowledge. It is a selection process that can track a topic or scientific production. Methods The present study aimed to carry out a bibliometric literature review, in order to assess the evolution of the use of SS and the different planning protocols in orthognathic surgery. The Scopus database was used, with the terms "splint" and "orthognathic surgery." Results A total of 331 articles were found. These were exported to Rayyan for application of the inclusion and exclusion criteria and selection of articles. A total of 76 references were selected and exported to the VOSviewer application for the analysis of bibliometric data. Conclusions Orthognathic surgery was initially not associated with any computerized technological resource; however, it underwent updates between the years 2010 to 2012. These advances allowed surgical planning to become faster, cheaper, and more accurate.

The influence of race on cervical length in pregnant women in Brazil.

OBJECTIVES: Short cervical length is a predictor of preterm birth. We evaluated if there were racial differences in variables associated with cervical length in pregnant Brazilian women. METHODS: Cervical length was determined by vaginal ultrasound in 414 women at 21 weeks gestation. All women were seen at the same clinic and analyzed by the same investigators. Women found to have a short cervix (≤25 mm) received vaginal progesterone throughout gestation. Composition of the vaginal microbiome was determined by analysis of the V1-V3 region of the gene coding for bacterial 16S ribosomal RNA. Demographic, clinical and outcome variables were determined by chart review. Subjects were 53.4% White, 37.2% mixed race and 9.4% Black. RESULTS: Pregnancy, medical history and education level were similar in all groups. Mean cervical length was shorter in Black women (28.4 mm) than in White (32.4 mm) or mixed race (32.8 mm) women (p≤0.016) as was the percentage of women with a short cervix (23.1, 12.2, 7.8% in Black, White, mixed race respectively) (p≤0.026). Mean cervical length increased with maternal age in White (p=0.001) and mixed race (p=0.045) women but not Black women. There were no differences in bacterial dominance in the vaginal microbiota between groups. Most women with a short cervix delivered at term. CONCLUSIONS: We conclude that Black women in Brazil have a shorter cervical length than White or mixed race women independent of maternal age, pregnancy and demographic history or composition of the vaginal microbiome.