Artificial neural networks optimize the establishment of a Brazilian germplasm core collection of winter squash (Cucurbita moschata D.).

With widespread cultivation, Cucurbita moschata stands out for the carotenoid content of its fruits such as ß and α-carotene, components with pronounced provitamin A function and antioxidant activity. C. moschata seed oil has a high monounsaturated fatty acid content and vitamin E, constituting a lipid source of high chemical-nutritional quality. The present study evaluates the agronomic and chemical-nutritional aspects of 91 accessions of C. moschata kept at the BGH-UFV and propose the establishment of a core collection based on multivariate approaches and on the implementation of Artificial Neural Networks (ANNs). ANNs was more efficient in identifying similarity patterns and in organizing the distance between the genotypes in the groups. The averages and variances of traits in the CC formed using a 15% sampling of accessions, were closer to those of the complete collection, particularly for accumulated degree days for flowering, the mass of seeds per fruit, and seed and oil productivity. Establishing the 15% CC, based on the broad characterization of this germplasm, will be crucial to optimize the evaluation and use of promising accessions from this collection in C. moschata breeding programs, especially for traits of high chemical-nutritional importance such as the carotenoid content and the fatty acid profile.

ATP sulfurylase atypical leucine zipper interacts with Cys3 and calcineurin A in the regulation of sulfur amino acid biosynthesis in Cryptococcus neoformans.

Fungal pathogens are a major cause of death, especially among immunocompromised patients. Therapies against invasive fungal infections are restricted to a few antifungals; therefore, novel therapies are necessary. Nutritional signaling and regulation are important for pathogen establishment in the host. In Cryptococcus neoformans, the causal agent of fungal meningitis, amino acid uptake and biosynthesis are major aspects of nutritional adaptation. Disruptions in these pathways lead to virulence attenuation in an animal model of infection, especially for sulfur uptake and sulfur amino acid biosynthesis. Deletion of Cys3, the main transcription factor that controls these pathways, is the most deleterious gene knockout in vitro and in vivo, making it an important target for further application. Previously, we demonstrated that Cys3 is part of a protein complex, including calcineurin, which is necessary to maintain high Cys3 protein levels during sulfur uptake and sulfur amino acid biosynthesis. In the current study, other aspects of Cys3 regulation are explored. Two lines of evidence suggest that C. neoformans Cys3 does not interact with the F-box WD40 protein annotated as Met30, indicating another protein mediates Cys3 ubiquitin degradation. However, we found another level of Cys3 regulation, which involves protein interactions between Cys3 and ATP sulfurylase (MET3 gene). We show that an atypical leucine zipper at the N-terminus of ATP sulfurylase is essential for physical interaction with Cys3 and calcineurin. Our data suggests that Cys3 and ATP sulfurylase interact to regulate Cys3 transcriptional activity. This work evidences the complexity involved in the regulation of a transcription factor essential for the sulfur metabolism, which is a biological process important to nutritional adaptation, oxidative stress response, nucleic acid stability, and methylation. This information may be useful in designing novel therapies against fungal infections.

Biomechanical analysis of narrow dental implants for maxillary anterior rehabilitation / Análise biomecânica de implantes de diâmetro reduzido para reabilitação da região anterior da maxila

Introdução: O conhecimento da biomecânica de implantes de diâmetro reduzido indica dimensões seguras para uso clínico. Objetivo: O objetivo do presente estudo foi comparar biomecanicamente implantes de diâmetro regular e reduzido para suporte de próteses implantossuportadas unitárias na região anterior da maxila por meio de análise de elementos finitos 3D (3D-FEA). Material e método: Quatro modelos 3D-FEA foram desenvolvidos a partir de recomposição de tomografia computadorizada e dados da literatura: um bloco ósseo na região incisiva lateral superior direita com implante e coroa. M1: 3,75 x 13 mm, M2: 3,75 x 8,5 mm, M3: 2,9 x 13 mm e M4: 2,9 x 8,5 mm. Foi aplicada carga de 178 N nos ângulos 0, 30 e 60 graus em relação ao longo eixo do implante. Foram avaliados mapas de tensão de Von Mises, tensão principal máxima e microdeformação. Resultado: M3 e M4 apresentaram maiores valores de tensão e microdeformação que M1 e M2, principalmente quando foram aplicadas forças inclinadas. Porém, M3 apresentou comportamento biomecânico melhor do que M4. Conclusão: Pode-se concluir que reduzir o diâmetro dos implantes pode prejudicar a biomecânica durante a aplicação de forças, mas a distribuição e intensidade das tensões, bem como os valores de microdeformação podem ser melhorados se o comprimento do implante for aumentado

Introduction: Narrow diameter implants biomechanics knowledge indicates safe dimensions for clinical use. Objective: Purpose of the present study was biomechanically to compare regular and narrow diameter implants to support single implant-supported prosthesis in the anterior region of the maxilla by 3D finite element analysis (3D-FEA). Material and method: Four 3D-FEA models were developed form CT scan recompositing and literature data: a bone block in the right upper lateral incisive region with implant and crown. M1: 3.75 x 13 mm, M2: 3.75 x 8.5 mm, M3: 2.9 x 13 mm and M4: 2.9 x 8.5 mm. It was applied load was of 178 N at 0, 30 and 60 degrees in relation to implant long axis. Von Mises stress, maximum principal stress and microdeformation maps were evaluated. Result: M3 and M4 did show higher tension and higher microdeformation values than M1 and M2, especially when inclined forces were applied. However, M3 presented enhanced biomechanical behavior than M4. Conclusion: It can be concluded that reduce the diameter of the implants can disadvantage to the biomechanics during the application of forces, but the distribution and intensity of the stresses, as well as the micro deformation values can be improved if the length of the implant is increased

Assistência de enfermagem nos cuidados ao paciente oncológico em fase terminal / Nursing care in the care of oncological patients in the terminal stage / La atención de enfermería en la atención de pacientes oncológicos en etapa terminal

Objetivo: Identificar os desafios da equipe de Enfermagem frente ao paciente com câncer, bem como dificuldades enfrentadas no que se diz respeito a terminalidade e cuidados paliativos utilizados Metodologia: Foi realizada a revisão integrativa com base na literatura recente. A pesquisa foi realizada entre abril e maio de 2023, tendo como base de dados a MEDLINE, BDENF e LILACS, onde foram selecionados artigos completos nos idiomas português, inglês e espanhol publicados nos últimos cinco anos. Resultados: Foram encontrados 122.880 artigos validados nas bases de dados, onde após utilizar critérios de inclusão e exclusão, e leitura de título e resumo foram selecionados 12 artigos para o estudo, onde foram encontradas evidências que retratam as dificuldades vivenciadas pela equipe de enfermagem no que se diz respeito a vivência na área da oncologia terminal e a importância dos cuidados paliativos. Conclusões: Pode-se concluir a importância da presença da família no âmbito hospitalar e/ou domiciliar, bem como a necessidade de um aprofundamento na terapêutica paliativa ainda na graduação, tendo em vista os desafios vivenciados pela equipe de enfermagem frente a finitude da vida dos pacientes oncológicos terminais.

Objective: To identify the challenges of the nursing team facing the patient with cancer in its terminal phase, as well as the difficulties faced with regard to terminality and palliative care used Methodology: Na integrative review was carried out based on recent literature. The research was carried out bet ween april and may 2023, using MEDLINE, BDENF and LILACS as a database, where full articles were selected in Portuguese, English and Spanish, published in the last five years. Results: 122,880 validated articles were found in the databases, where after using inclusion and exclusion criteria, and reading the title and abstract, 12 were selected for the study where evidence was found that portrays the difficulties experienced by the nursing team regarding the experience in the area of terminal oncology and the importance of palliative care. Conclusions: It can be concluded the importance of the presence of the family in the hospital and/or home environment, as well as the need for a deepening of palliative therapy during graduation, in view of the challenges experienced by the nursing team in the face of the terminality of life of terminal cancer patients.

Objetivo: Identificar los desafíos del equipo de Enfermería frente al paciente con cáncer en su fase terminal, así como las dificultades enfrentadas con respecto a la terminalidad y los cuidados paliativos utilizados. Metodología: Se realizó una revisión integradora basada en literatura reciente. La investigación se realizó entre abril y junio de 2023, utilizando como base de datos MEDLINE, BDENF y LILACS, donde se seleccionaron artículos completos en portugués, inglés y español, publicados en los últimos cinco anos. Resultados: se encontraron 122.880 artículos validados en las bases de datos, donde luego de aplicar criterios de inclusión y exclusión, lectura del título y resumen, se seleccionaron 12 para el estudio. Donde se encontró evidencia que retrata las dificultades vividas por el equipo de enfermería en cuanto a la experiencia en el área de oncología terminal y la importancia de los cuidados paliativos. Conclusiones: Se puede concluir la importancia de la presencia de la familia en el hospital y/o ambiente domiciliario, así como la necesidad de una profundización de la terapia paliativa durante la graduación, frente a los desafíos vividos por el equipo de enfermería frente a la terminalidad de la vida de los pacientes oncológicos terminales

Stress distribution in lower second molar mesialization using mini-implants: a pilot study using 3D finite element analysis / Distribuição de tensões na mesialização do segundo molar inferior usando mini-implantes: um estudo piloto usando análise de elementos finitos 3D

Objective: to analyze the stress distribution in a 3D model that simulates second molar mesialization using two different types of mini-implants. Material and Methods: a mandible bone model was obtained by recomposing a computed tomography performed by a software program. The cortical and trabecular bone, a lower second molar, periodontal ligament, orthodontic tube, resin cement and the mini-implants were designed and modeled using the Rhinoceros 4.0 software program. The characteristics of self-drilling orthodontic mini-implants were: one with 7 mm length, 1 mm transmucosal neck section and 1.6 mm diameter and another with 5 mm length and 1.5 mm diameter. A total of 235.161 and 224.505 elements were used for the mesh. These models were inserted into the bone block and then subjected to loads of 200 cN (centinewton). The results were calculated and analyzed by the Ansys 17.0 software program for qualitative verification through displacement and maximum principal stress maps. Results: it was possible to observe that the periodontal ligament presented low displacement and stress values. However, the physiological values presented are among those capable to provide orthodontic movement, with compression and tensile area visualization staggered between 0.1 and -0.1 MPa (megapascal). Conclusion: within the limitations of the study, the mini-implants tested showed similar results where the load on the tooth allowed dental displacement (molar mesialization), with a tendency to rotate it, theoretically allowing the second molar to take the location of the first molar. (AU)

Objetivo: analisar a distribuição de tensões em um modelo 3D que simula a mesialização do segundo molar usando dois tipos diferentes de mini-implantes. Material e Métodos: um modelo de osso mandibular foi obtido por recomposição de uma tomografia computadorizada realizada por um software. O osso cortical e trabecular, um segundo molar inferior, ligamento periodontal, tubo ortodôntico, cimento resinoso e os mini-implantes foram projetados e modelados no software Rhinoceros 4.0. As características dos mini-implantes ortodônticos auto perfurantes foram: um com 7 mm de comprimento, 1 mm de secção transmucosa e 1,6 mm de diâmetro e outro com 5 mm de comprimento e 1,5 mm de diâmetro. Para a malha, foram utilizados 235.161 e 224.505 elementos. Esses modelos foram inseridos no bloco ósseo e então submetidos a cargas de 200 cN (centinewton). Os resultados foram calculados e analisados pelo software Ansys 17.0 para verificação qualitativa por meio de mapas de deslocamento e tensões máximas principais. Resultados: foi possível observar que o ligamento periodontal apresentou baixos valores de deslocamento e tensões. Porém, os valores fisiológicos apresentados são capazes de proporcionar movimentação ortodôntica, com visualização da área de compressão e tração escalonada entre 0,1 e -0,1 MPa (megapascal). Conclusão: dentro das limitações do estudo, os mini-implantes testados apresentaram resultados semelhantes onde a carga sobre o dente permitiu o deslocamento dentário (mesialização do molar), com tendência a girá-lo, permitindo teoricamente que o segundo molar ocupe do lugar do primeiro molar (AU)

Heterologous Expression, Purification, and Immunomodulatory Effects of Recombinant Lipoprotein GUDIV-103 Isolated from Ureaplasma diversum.

Ureaplasma diversum is a bacterial pathogen that infects cattle and can cause severe inflammation of the genital and reproductive systems. Lipid-associated membrane proteins (LAMPs), including GUDIV-103, are the main virulence factors in this bacterium. In this study, we heterologously expressed recombinant GUDIV-103 (rGUDIV-103) in Escherichia coli, purified it, and evaluated its immunological reactivity and immunomodulatory effects in bovine peripheral blood mononuclear cells (PBMCs). Samples from rabbits inoculated with purified rGUDIV-103 were analysed using indirect enzyme-linked immunosorbent assay and dot blotting to confirm polyclonal antibody production and assess kinetics, respectively. The expression of this lipoprotein in field isolates was confirmed via Western blotting with anti-rGUDIV-103 serum and hydrophobic or hydrophilic proteins from 42 U. diversum strains. Moreover, the antibodies produced against the U. diversum ATCC 49783 strain recognised rGUDIV-103. The mitogenic potential of rGUDIV-103 was evaluated using a lymphoproliferation assay in 5(6)-carboxyfluorescein diacetate succinimidyl ester−labelled bovine PBMCs, where it induced lymphocyte proliferation. Quantitative polymerase chain reaction analysis revealed that the expression of interleukin-1ß, toll-like receptor (TLR)-α, TLR2, TLR4, inducible nitric oxide synthase, and caspase-3−encoding genes increased more in rGUDIV-103−treated PBMCs than in untreated cells (p < 0.05). Treating PBMCs with rGUDIV-103 increased nitric oxide and hydrogen peroxide levels. The antigenic and immunogenic properties of rGUDIV-103 suggested its suitability for immunobiological application.

Clinical comparison between crestal and subcrestal dental implants: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: How the performance of dental implants is related to their occlusogingival placement, crestal or subcrestal, is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate marginal bone loss, implant survival rate, and peri-implant soft tissue parameters between implants placed at the crestal and subcrestal bone level. MATERIAL AND METHODS: Two independent reviewers searched the PubMed/MEDLINE, Embase, and Cochrane Library databases for randomized clinical trials published up to September 2020. The meta-analysis was based on the Mantel-Haenszel and the inverse variance methods (α=.05). RESULTS: The search identified 928 references, and 10 studies met the eligibility criteria. A total of 393 participants received 709 implants, 351 at crestal bone levels and 358 at subcrestal bone levels. Meta-analysis indicated that crestal bone level implants showed similar marginal bone loss to that seen with subcrestal bone level implants (mm) (P=.79), independent of the subcrestal level (P=.05) and healing protocol (P=.24). The bone level implant placement did not affect the implant survival rate (P=.76), keratinized tissue (mm) (P=.91), probing depth (mm) (P=.70), or plaque index (%) (P=.92). CONCLUSIONS: The evidence suggests that both approaches of implant placement are clinically acceptable in terms of peri-implant tissue parameters and implant-supported restoration survival.

Biomechanical Evaluation of Different Implant-Abutment Connections, Retention Systems, and Restorative Materials in the Implant-Supported Single Crowns Using 3D Finite Element Analysis.

This is an in silico study aimed to evaluate the biomechanical influence of different implant-abutment interfaces (external hexagon and Morse taper implants), retention systems (cement and screw retained), and restorative crowns (metal-ceramic and monolithic) using 3-dimensional finite element analysis (3D-FEA). Eight 3D models were simulated for the maxillary first molar area using InVesalius, Rhinoceros, and SolidWorks and processed using Femap and NEi Nastran software. Axial and oblique forces of 200 and 100 N, respectively, were applied on the occlusal surface of the prostheses. Microstrain and von Mises stress maps were used to evaluate the deformation (cortical bone tissue) and stress (implants/fixation screws/crowns), respectively, for each model. For both loadings, Morse taper implants had lower microstrain values than the external hexagon implants. The retention system did not affect microstrain on the cortical bone tissue under both loadings. However, the cemented prosthesis displayed higher stress with the fixation screw than the external hexagon implants. No difference was observed between the metal-ceramic and zirconia monolithic crowns in terms of microstrain and stress distribution on the cortical bone, implants, or components. Morse taper implants can be considered as a good alternative for dental implant rehabilitation because they demonstrated better biomechanical behavior for the bone and fixation screw as compared to external hexagon implants. Cement-retained prosthesis increased the stress on the fixation screw of the external hexagon implants, thereby increasing the risk of screw loosening/fracture in the posterior maxillary area. The use of metal-ceramic or monolithic crowns did not affect the biomechanical behavior of the evaluated structures.

Effect of bone quality and bone loss level around internal and external connection implants: A finite element analysis study.

STATEMENT OF PROBLEM: A consensus regarding the biomechanical effects of vertical bone loss in normal and osteoporotic bone tissue according to different implant-abutment interfaces is lacking. PURPOSE: The purpose of this finite element analysis study was to evaluate the effect of vertical bone loss (without bone loss; with 1.5-mm bone loss; with 3-mm bone loss; and with 4.5-mm bone loss) in normal and osteoporotic bone that received a Ø4×10-mm implant with different implant-abutment connections (external connection [external hexagon] and internal connection [Morse taper]) by using 3D finite element analysis. MATERIAL AND METHODS: Sixteen 3D models were simulated. Axial and oblique forces of 200 N and 100 N, respectively, were applied on the occlusal surfaces of the prostheses. Maximum principal stress and microstrain were determined from the bone tissue of each model. von Mises stress analysis was used to evaluate the stress distribution in implants and prosthetic components (fixation screws, abutment, and crown). RESULTS: The results showed higher stress concentrations in models with bone loss as increased vertical bone loss contributed to higher stress and microstrain in the bone tissue, regardless of the quality of bone and implant-abutment connection. Osteoporotic bone contributed to increase in microstrain in the trabecular bone. The internal connection showed lower stress than the external connection implants only in models without marginal bone loss. Furthermore, higher stress concentrations were observed in the implants and fixation screws in models with increased bone loss and external connection implants, mainly under oblique loading. Osteoporotic bone did not affect stress distribution in the implants and prosthetic components. CONCLUSIONS: Progressive bone loss contributed to higher stress in the bone tissue, implants, and prosthetic components. The osteoporotic bone affects only the microstrain in the trabecular bone, but not the stress in the implants and prosthetic components. The internal connection implants showed lower stress in the cortical bone only in models without bone loss, while external connection implants exhibited higher stress in the implants and screws under oblique loading.

Immunoinformatics and analysis of antigen distribution of Ureaplasma diversum strains isolated from different Brazilian states.

BACKGROUND: Ureaplasma diversum has numerous virulence factors that contribute to pathogenesis in cattle, including Lipid-associated membrane proteins (LAMPs). Therefore, the objectives of this study were to evaluate in silico important characteristics for immunobiological applications and for heterologous expression of 36 LAMPs of U. diversum (UdLAMPs) and, also, to verify by conventional PCR the distribution of these antigens in strains of Brazilian states (Bahia, Minas Gerais, São Paulo, and Mato Grosso do Sul). The Manatee database was used to obtain the gene and peptide sequences of the antigens. Similarity and identity studies were performed using BLASTp and direct antigenicity was evaluated by the VaxiJen v2.0 server. Epitope prediction for B lymphocytes was performed on the BepiPred v2.0 and CBTOPE v1.0 servers. NetBoLApan v1.0 was used to predict CD8+ T lymphocyte epitopes. Subcellular location and presence of transmembrane regions were verified by the software PSORTb v3.0.2 and TMHMM v2.2 respectively. SignalP v5.0, SecretomeP v2.0, and DOLOP servers were used to predict the extracellular excretion signal. Physico-chemical properties were evaluated by the web-software ProtParam, Solpro, and Protein-sol. RESULTS: In silico analysis revealed that many UdLAMPs have desirable properties for immunobiological applications and heterologous expression. The proteins gudiv_61, gudiv_103, gudiv_517, and gudiv_681 were most promising. Strains from the 4 states were PCR positive for antigens predicted with immunogenic and/or with good characteristics for expression in a heterologous system. CONCLUSION: These works contribute to a better understanding of the immunobiological properties of the UdLAMPs and provide a profile of the distribution of these antigens in different Brazilian states.

Brazilian germplasm of winter squash (Cucurbita moschata D.) displays vast genetic variability, allowing identification of promising genotypes for agro-morphological traits.

Winter squash fruits (Cucurbita moschata D.) are among the best sources of vitamin A precursors and constitute sources of bioactive components such as phenolic compounds and flavonoids. Approximately 70% of C. moschata seed oil is made up of unsaturated fatty acids, with high levels of monounsaturated fatty acids and components such as vitamin E and carotenoids, which represent a promising nutritional aspect in the production of this vegetable. C. moschata germplasm expresses high genetic variability, especially in Brazil. We assessed 91 C. moschata accessions, from different regions of Brazil, and maintained at the Federal University of Viçosa (UFV) Vegetable Germplasm Bank, to identify early-flowering accessions with high levels of carotenoids in the fruit pulp and high yields of seed and seed oil. Results showed that the accessions have high variability in the number and mass of seeds per fruit, number of accumulated degree-days for flowering, total carotenoid content, and fruit productivity, which allowed selection for considerable gains in these characteristics. Analysis of the correlation between these characteristics provided information that will assist in selection to improve this crop. Cluster analysis resulted in the formation of 16 groups, confirming the variability of the accessions. Per se analysis identified accessions BGH-6749, BGH-5639, and BGH-219 as those with the earliest flowering. Accessions BGH-5455A and BGH-5598A had the highest carotenoid content, with averages greater than 170.00 µg g-1 of fresh mass. With a productivity of 0.13 t ha-1, accessions BGH-5485A, BGH-4610A, and BGH-5472A were the most promising for seed oil production. These last two accessions corresponded to those with higher seed productivity, averaging 0.58 and 0.54 t ha-1, respectively. This study confirms the high potential of this germplasm for use in breeding for promotion of earlier flowering and increase in total content of fruit pulp carotenoids and in seed and seed oil productivity.

Fatores associados à interrupção precoce do aleitamento materno exclusivo em prematuros / Associated factors with early interruption of exclusive breastfeeding in preterm infants

Objetivo: Avaliar a prevalência e os fatores associados à interrupção precoce do aleitamento materno exclusivo (AME) em recém-nascidos prematuros. Métodos: Coorte prospectiva com puérperas no pós-parto prematuro e seus respectivos filhos, assistidos em hospital da rede pública de saúde, em Maceió-AL, nos anos de 2016/2017. Dados clínicos e obstétricos do binômio, além de informações sobre a prática de aleitamento materno do recém-nascido após alta hospitalar, foram obtidos por aplicação de questionário padronizado. O acompanhamento foi realizado mensalmente, por seis meses. A descontinuidade do aleitamento materno exclusivo, em qualquer momento do estudo, caracterizou a interrupção precoce. O teste de regressão de Poisson foi utilizado para avaliação dos fatores associados ao desfecho, com resultados expressos por Razão de prevalência (RP) e respectivos intervalos de confiança a 95% (IC 95%) considerando p< 0,05 como significativo. Resultados: Dos 132 recém-nascidos que receberam alta hospitalar em aleitamento materno exclusivo e que foram acompanhados até os 6 meses de vida, 94 (71,2%) deles interromperam a amamentação exclusiva precocemente. Idade materna ≥35 anos foi caracterizada como fator de proteção para a interrupção precoce do aleitamento materno exclusivo [RP: 0,591 (0,350-0,997); p= 0,049] e a via de parto cesariana, como fator de risco [RP: 1,284 (1,010-1,633); p=0,041]. Conclusão: Foi alta a prevalência de interrupção do aleitamento materno exclusivo antes dos 6 meses de vida em recém-nascidos prematuros. Foram fatores associados ao desfecho, a idade materna avançada, como fator de proteção, e parto cesáreo, como fator de risco para a interrupção precoce do aleitamento materno.

Objective: To evaluate the prevalence and associated factors with early discontinuation of exclusive breastfeeding (EBF) in preterm infants. Methods: Prospective cohort with puerperal women in the premature postpartum and their respective children, assisted at a public health hospital in Maceió-AL, in 2016/2017. Clinical and obstetric data from the binomial, as well as information about the breastfeeding practice of the newborn after hospital discharge, were obtained by applying a standardized questionnaire. Follow-up was performed monthly for six months. Discontinuity of exclusive breastfeeding at any time of the study characterized early discontinuation. Poisson regression test was used to assess outcome-associated factors, with results expressed as Prevalence Ratio (PR) and 95% confidence ratios (95% CI), considering p <0.05 as significant. Results: Of the 132 newborns who were discharged from exclusive breastfeeding and who were followed up to 6 months of age, 94 (71.2%) of premature infants stopped early exclusive breastfeeding. Maternal age ≥35 years was characterized as a protective factor for early discontinuation of exclusive breastfeeding [PR: 0.591 (0.350-0.997); p = 0.049] and cesarean section as a risk factor [PR: 1.284 (1.010-1.633); p = 0.041]. Conclusion: The prevalence of exclusive breastfeeding interruption before 6 months of life in premature newborns was high. Factors associated with the outcome were advanced maternal age as a protective factor and cesarean delivery as a risk factor for early interruption of breastfeeding.

Análise biomecânica envolvendo implantes estreitos para reabilitações unitárias na região maxilar anterior / Biomechanical analysis involving narrow implants for unitary rehabilitation in the anterior maxillary region

Proposição: Avaliar biomecanicamente a possibilidade de uso de implantes de diâmetro reduzido em reabilitações unitárias em região maxilar anterior. Foram avaliados biomecanicamente o uso de implantes de diâmetro 2,9 mm com implantes de 3,5 mm instalados a nível ósseo e 1,5 mm infraósseo, variando-se o comprimento dos implantes (7 mm, 8,5 mm, 10 mm, 11,5 mm, 13 mm e 15 mm), por meio da análise dos elementos finitos 3D. Material e métodos: 12 modelos tridimensionais foram simulados com ajuda dos programas Invesalius, Rhinoceros 3D e SolidWorks. Cada modelo possuía um bloco ósseo da região anterior maxilar (osso tipo III) com a presença dos dentes incisivo central e canino, simulando uma reabilitação com coroa unitária metal free cimentada (dente incisivo lateral direito), suportada por um implante de 7 mm, 8,5 mm, 10 mm, 11,5 mm, 13 mm ou 15 mm, variando-se o diâmetro do implante (2,9 mm e 3,5 mm) e a instalação dos implantes no tecido ósseo (ao nível e 1,5 mm infraósseo). Os modelos foram processados pelos programas ANSYS 19.2, utilizando uma força de 178 N em diferentes inclinações (0º, 30º e 60º). Os resultados foram plotados em mapas de Tensão de Von Mises (VM), Tensão Máxima Principal (TMP), Microdeformação (µÎµ) e Deslocamento. Resultados: Na análise de VM houve um aumento da concentração de tensão com o aumento da inclinação da força nos implantes/componentes e tecido ósseo. Foi possível observar maiores concentrações de tensões para os implantes instalados 1,5 mm infraósseo, além disso, os implantes de 2,9 mm de diâmetro apresentaram maiores concentrações de tensões. Sob análise de TMP e µÎµ, o tecido ósseo apresentou maiores concentrações de tensões de tração e microdeformação sob cargas oblíquas (30° e 60°) ao redor do pescoço do implante (tecido ósseo cortical) na técnica de instalação ao infraósseo, além isso, foi possível observar que os implante menor diâmetro apresentaram maiores concentrações de tensões nos implantes/componentes e tecido ósseo e menor tendência de deslocamento na técnica de instalação ao nível ósseo. Conclusão: Os implantes de 3,5 mm de diâmetro foram mais favoráveis biomecanicamente que os implante de 2,5 mm, independentemente do tipo de técnica de instalação utilizadas. A instalação de implantes por técnica ao nível ósseo nas condições do estudo, favoreceu uma diminuição de concentração de tensões no tecido ósseo adjacente ao implante(AU)

Proposition: Biomechanically evaluate the possibility of using small diameter implants in unitary rehabilitation in the anterior maxillary region. Biomechanically evaluated the use of 2.9 mm diameter implants with 3.5 mm implants placement at bone level and 1.5 mm subcrestal, through 3D finite element analysis. Material and methods: 12 three-dimensional models were simulated with the help of the Invesalius, Rhinoceros 3D and SolidWorks programs. Each model had a bone block from the anterior maxillary region (type III bone) with the presence of the central and canine incisor teeth, simulating a rehabilitation with a cemented metal free unitary crown (right lateral incisor tooth), supported by implant the 7 mm, 8,5 mm, 10 mm, 11.5 mm, 13 mm or 15 mm, varying the implant diameter (2.9 mm and 3.5 mm), the placement of the implants in the bone tissue at level 1, 5 mm subcrestal. The models were processed by the ANSYS 19.2 programs, using a force of 178 N at different slopes (0º, 30º and 60º). The results were plotted on Von Mises Stress (VM), Maximum Main Stress (TMP), Microdeformation (µÎµ) and Displacement. Results: In the analysis of VM there was an increase in the concentration of tension with the increase of the inclination of the force in the implants/components and bone tissue. It was possible to observe higher concentrations of stresses for the implants installed in the subcrestal, in addition, the implants of 2.9 mm in diameter presented higher concentrations of stresses. Under analysis of TMP and µÎµ, the bone tissue showed higher concentrations of tensile stresses and microdeformation under oblique loads (30° and 60°) around the implant neck (cortical bone tissue) in the placement the technique at the subcrestal, in addition , it was possible to observe that the smaller diameter implants showed higher concentrations of stress in the implants/components and bone tissue and and less tendency of displacement in the installation technique at the bone level. Conclusion: The 3.5 mm diameter implants were more favorable biomechanically than the 2.5 mm implants, regardless of the type of placement the technique used. The placement of implants by crestal technique under the conditions of the study, favored a decrease of stress concentration in the bone tissue adjacent to the implant(AU)

Systematic review and meta-analysis of welding procedures in one-piece cast implant-supported frameworks.

The objective of this systematic review and meta-analysis was to evaluate the effect of welding techniques on implant-supported prostheses and determine whether they contribute to a better adaptation compared with a one-piece cast. A search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases, and articles published until November 2017 were obtained from these databases. This review followed the PRISMA criteria and is registered on the PROSPERO platform (CRD42017081865). The PICO question was "Do welding procedures in one-piece cast implant-supported frameworks influence implant/abutment-framework marginal misfits?" Eleven studies were selected for a qualitative analysis, and seven studies were selected for a quantitative analysis. A total of 189 specimens were fabricated using different materials (cp-Ti, Ni-Cr, Cr-Co, and noble alloys), and welding techniques such as laser welding, conventional welding, tungsten inert gas, and brazing were applied. A vertical marginal misfit was measured using an optical microscope, a stereomicroscope, and/or a scanning electron microscopy. The qualitative analysis in the studies demonstrated a positive effect of the welding techniques on the adaptation of the infrastructures. The meta-analysis confirmed the results (p < 0.00001; MD: -36.14; 95%CI: -48.69 to -23.59). Within the limitations of this study and regarding the heterogeneity of the samples, we conclude that the soldering point technique is effective for obtaining relatively low values of marginal misfit, with laser welding as the most effective technique. However, additional studies were recommended due to the heterogeneity of different variables (alloys, connection, and misfit evaluation) in the included studies.

Ceramic versus metal-ceramic implant-supported prostheses: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: There is insufficient evidence to recommend the restorative material for implant-supported prostheses. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate studies that compared ceramic and metal-ceramic restorations for implant-supported prostheses (within the same study to avoid indirect comparison) in terms of the mechanical and biological complication rates, prosthesis survival rate, and marginal bone loss. MATERIAL AND METHODS: Two independent reviewers performed a comprehensive search in databases (PubMed/MEDLINE, Web of Science, and Cochrane Library) for articles indexed until March 31, 2018. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and methods were registered in the International Prospective Register of Systematic Reviews (PROSPERO). The focused question was "Do ceramic restorations have mechanical/biological complication rates, prosthesis survival rates, and marginal bone loss similar to those of metal-ceramic restorations?" RESULTS: The search identified 949 references. The interinvestigator agreement using kappa values was 0.87 for PubMed/MEDLINE, 0.93 for Scopus, and 1.0 for the Cochrane Library. After analysis, 12 studies were selected for qualitative and quantitative analysis. The mechanical complication rate did not differ between ceramic and metal-ceramic restorations (P=.89), independent of the type of prostheses (single crown: P=.63; fixed partial denture: P=.65). The biological complication rate was also not significantly different between ceramic and metal-ceramic restorations (P=.21). The prosthesis survival rate showed no significant differences between the 2 types of restorations (P=.56). Marginal bone loss was also similar for both types of restorations (P=.12). CONCLUSIONS: This systematic review indicated that ceramic and metal-ceramic implant-supported prostheses have similar mechanical and biological complication rates, prosthesis survival rates, and marginal bone loss. Thus, both treatments are appropriate options for long-term rehabilitation treatment.

Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis.

This study compared the survival rate of dental implants, amount of marginal bone loss, and rates of complications (biological and prosthetic) between short implants and long implants placed after maxillary sinus augmentation. This systematic review has been registered at PROSPERO under the number (CRD42017073929). Two reviewers searched the PubMed/MEDLINE, Embase, LILACS, and Cochrane Library databases. Eligibility criteria included randomized controlled trials, comparisons between short implants and long implants placed after maxillary sinus augmentation in the same study, and follow-up for >6 months. The Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used to assess the quality and risk of bias of the included studies. The search identified 1366 references. After applying the inclusion criteria, 11 trials including 420 patients who received 911 dental implants were considered eligible. No significant difference was observed in the survival rate [p = 0.86; risk ratio (RR): 1.08; 95% confidence interval (CI): 0.46-2.52] or in the amount of marginal bone loss (p = 0.08; RR: -0.05; 95%CI: -0.10 to 0.01). However, higher rates of biological complications for long implants associated with maxillary sinus augmentation were observed (p < 0.00001; RR: 0.21; 95%CI: 0.10-0.41), whereas a higher prosthetic complication rate for short implants was noted (p = 0.010; RR: 3.15; 95%CI: 1.32-7.51). Short implant placement is an effective alternative because of fewer biological complications and similar survival and marginal bone loss than long implant placement with maxillary sinus augmentation. However, the risk of mechanical complications associated with the prostheses fitted on short implants should be considered.

Outcomes comparison of different surgical strategies for the management of severe aortic valve stenosis: study protocol of a prospective multicentre European registry (E-AVR registry).

INTRODUCTION: Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size. A prospective multicentre registry including all patients referred for a surgical treatment of SAVS (traditional, through full sternotomy; minimally invasive; or transcatheter; with both 'sutured' and 'sutureless' valves) will provide a 'real-world' picture of available results of current surgical options and will help to clarify the 'grey zones' of current guidelines. METHODS AND ANALYSIS: European Aortic Valve Registry is a prospective observational open registry designed to collect all data from patients admitted for SAVS, with or without coronary artery disease, in 16 cardiac surgery centres located in six countries (France, Germany, Italy, Spain, Switzerland and UK). Patients will be enrolled over a 2-year period and followed up for a minimum of 5 years to a maximum of 10 years after enrolment. Outcome definitions are concordant with Valve Academic Research Consortium-2 criteria and established guidelines. Primary outcome is 5-year all-cause mortality. Secondary outcomes aim at establishing 'early' 30-day all-cause and cardiovascular mortality, as well as major morbidity, and 'late' cardiovascular mortality, major morbidity, structural and non-structural valve complications, quality of life and echocardiographic results. ETHICS AND DISSEMINATION: The study protocol is approved by local ethics committees. Any formal presentation or publication of data will be considered as a joint publication by the participating physician(s) and will follow the recommendations of the International Committee of Medical Journal Editors for authorship. TRIAL REGISTRATION NUMBER: NCT03143361; Pre-results.

Comparison of the Use of Titanium-Zirconium Alloy and Titanium Alloy in Dental Implants: A Systematic Review and Meta-Analysis.

The aim of this study was to compare the values of bone-implant contact (BIC) and removal torque (RTQ) reported in different animal studies for titanium-zirconium (TiZr) and titanium (Ti) dental implants. This review has been registered at PROSPERO under number CRD42016047745. We undertook an electronic search for data published up until November 2017 using the PubMed/Medline, Embase, and The Cochrane Library databases. Eligibility criteria included in vivo studies, comparisons between Ti and TiZr implants in the same study, and studies published in English that evaluated BIC and RTQ. After inclusion criteria, 8 studies were assessed for eligibility. Of the 8 studies, 7 analyzed BIC outcome and 3 analyzed RTQ outcome. Among such studies, 6 studies were considered for meta-analysis of quantitative for BIC and 2 studies for RTQ. There was no significant difference for BIC analysis ( P = .89; random ration [RR]: -0.21; 95% confidence interval [CI]: -3.14 to 2.72). The heterogeneity of the primary outcome studies was considered low (7.19; P = .21; I 2 : 30%). However, the RTQ analysis showed different results favoring the TiZr dental implants ( P = .001; RR: 23.62; 95%CI: 9.15 to 38.10). Low heterogeneity was observed for RTQ (χ2: 1.25; P = .26; I 2 : 20%). Within the limitations of this study, there was no difference between TiZr and Ti alloys implants in terms of BIC. However, TiZr implants had higher RTQ than Ti alloys.

Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis

Abstract This study compared the survival rate of dental implants, amount of marginal bone loss, and rates of complications (biological and prosthetic) between short implants and long implants placed after maxillary sinus augmentation. This systematic review has been registered at PROSPERO under the number (CRD42017073929). Two reviewers searched the PubMed/MEDLINE, Embase, LILACS, and Cochrane Library databases. Eligibility criteria included randomized controlled trials, comparisons between short implants and long implants placed after maxillary sinus augmentation in the same study, and follow-up for >6 months. The Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used to assess the quality and risk of bias of the included studies. The search identified 1366 references. After applying the inclusion criteria, 11 trials including 420 patients who received 911 dental implants were considered eligible. No significant difference was observed in the survival rate [p = 0.86; risk ratio (RR): 1.08; 95% confidence interval (CI): 0.46-2.52] or in the amount of marginal bone loss (p = 0.08; RR: −0.05; 95%CI: −0.10 to 0.01). However, higher rates of biological complications for long implants associated with maxillary sinus augmentation were observed (p < 0.00001; RR: 0.21; 95%CI: 0.10-0.41), whereas a higher prosthetic complication rate for short implants was noted (p = 0.010; RR: 3.15; 95%CI: 1.32-7.51). Short implant placement is an effective alternative because of fewer biological complications and similar survival and marginal bone loss than long implant placement with maxillary sinus augmentation. However, the risk of mechanical complications associated with the prostheses fitted on short implants should be considered.

Three-dimensional finite element analysis of glass fiber and cast metal posts with different alloys for reconstruction of teeth without ferrule.

The aim of this study was to evaluate different materials for restoration of teeth without ferrule by three-dimensional (3D) finite element analysis (FEA). Five models simulating the maxillary central incisor and surrounding bone were simulated according to the type of post: glass fibre post (GFP) or cast metal post (CMP) with different alloys such as gold (Au), silver-palladium (AgPd), copper-aluminum (CuAl) and nickel-chromium (NiCr). Models were designed using Invesalius and Rhinoceros. FEAs were made using FEMAP and NeiNastran, with an applied axial force of 100 N and oblique occlusal load at 45°. Stress distribution among groups was analysed by two-way analysis of variance (ANOVA), followed by post-hoc Tukey's test. The GFP showed the best stress distribution in the post, followed by CMP with Au, AgPd, CuAl and NiCr alloys, respectively (p < .001). No statistically significant difference in the stress distribution in teeth was found under application of axial load (p > .05). Under oblique load, the GFP generated the highest values of tension among the models, followed by the CMP with NiCr alloy than other models (p < .001). The use of GFP resulted in a lower stress concentration in the post, but increased stress in the tooth without ferrule. The CMP with NiCr alloy exhibited the highest stress distribution among other CMP. To avoid higher stress in teeth, alloys of Au, AgPd and CuAl, respectively, are recommended.