Synthesis and stability studies of bicyclo[6.1.0]nonyne scaffolds for automated solid-phase oligonucleotide synthesis.

Two novel bicyclo[6.1.0]nonyne (BCN) linker derivatives, which can be directly incorporated into oligonucleotide sequences during standard automated solid-phase synthesis, are reported. Stabilities of BCN-carbinol and two BCN-oligonucleotides are evaluated under acidic conditions. In addition, derivatized BCN linkers (non-acidic and acid treated) are evaluated for strain-promoted alkyne-azide cycloaddition (SPAAC).

Tiña por Nannizzia nana: caso clínico y revisión bibliográfica / Ringworm by Nannizzia nana: Clinical case and literature review

Introducción Las dermatofitosis humanas son el grupo más extendido de infecciones causadas por hongos. Estos son capaces de invadir los tejidos que contienen queratina de los animales. Nannizzia nana (N. nana) puede causar tiña en cerdos y que de manera excepcional puede producir infecciones en humanos. Métodos Realizamos una búsqueda en PubMed de artículos publicados desde el 1 de enero de 1990 hasta el 31 de marzo del 2022 para identificar casos adicionales. Los términos de búsqueda empleados fueron «Microsporum nanum» y «Nannizzia nana». Resultados Tras la revisión bibliográfica identificamos un total 16 casos de dermatofitosis por N. nana desde 1990. En la mayoría de los pacientes, el diagnóstico clínico fue tinea corporis y los antifúngicos más utilizados fueron terbinafina y griseofulvina. Conclusión N. nana es una especie de dermatofito aislada infrecuentemente en humanos, pero que representa una fuente potencial de dermatofitosis en personas que entran en contacto directo o indirecto con animales y con el suelo (AU)

Introduction Human dermatophytoses are the most widespread infections caused by fungi. These are capable of invading the keratin-containing tissues of animals. Nannizzia nana (N. nana) can cause ringworm in pigs and rarely cause infections in humans. Methods We conducted a search using PubMed for articles published from January 1, 1990 to March 31, 2022 to identify additional cases. The search terms used were “Microsporum nanum” and “Nannizzia nana”. Results After reviewing the literature, we identified a total of 16 cases of dermatophytosis due to N. nana since 1990. In most of the patients, the clinical diagnosis was tinea corporis and the most widely used antifungals were: terbinafine and griseofulvin. Conclusion N. nana is a dermatophyte species isolated infrequently in humans, but it represents a potential source of dermatophytosis in people who come into direct or indirect contact with animals and soil (AU)

Ringworm by Nannizzia nana: Clinical case and literature review.

INTRODUCTION: Human dermatophytoses are the most widespread infections caused by fungi. These are capable of invading the keratin-containing tissues of animals. Nannizzia nana (N. nana) can cause ringworm in pigs and rarely cause infections in humans. METHODS: We conducted a search using PUBMED for articles published from January 1, 1990 to March 31, 2022 to identify additional cases. The search terms used were "Microsporum nanum" and "Nannizzia nana". RESULTS: After reviewing the literature, we identified a total of 16 cases of dermatophytosis due to N. nana since 1990. In most of the patients, the clinical diagnosis was tinea corporis and the most widely used antifungals were: terbinafine and griseofulvin. CONCLUSION: N. nana is a dermatophyte species isolated infrequently in humans, but it represents a potential source of dermatophytosis in people who come into direct or indirect contact with animals and soil.

Análise quantitativa de frenectomias realizadas no contexto do SUS após obrigatoriedade do teste da linguinha / Quantitative analysis of frenectomies performed in the context of the SUS after mandatory tongue test

RESUMO Buscou-se investigar e conhecer a frequência e a distribuição de frenotomias e fenectomias realizadas no Sistema Único de Saúde (SUS) após os dispositivos legais que instituíram o teste da linguinha, bem como entender quais profissionais estão realizando o procedimento cirúrgico. Estudo descritivo analítico, retrospectivo, com dados secundários, disponíveis no Sistema de Informações Ambulatoriais do DataSUS, extraídos por meio do TabWin. Observou-se um aumento considerável no número de procedimentos, porém, com flutuações nos anos seguintes. Das frenectomias registradas no SUS, no período, 33% foram realizadas por dentistas na atenção primária. Os resultados apontaram que houve um aumento substancial no número de procedimentos cirúrgicos em dois momentos, em 2014 e em 2017, possivelmente em decorrência da publicação da Lei nº 13.002/2014 e da Nota Técnica (NT) nº 09/2016. A NT nº 35/2018 deslocou o diagnóstico e o tratamento para a média complexidade, possivelmente resultando em filas, principalmente em se tratando de cirurgias que poderiam ser realizadas na atenção primária. Apesar de não haver unanimidade quanto à correlação anquiloglossia e desmame, não parece haver um monitoramento para evitar cirurgias desnecessárias, uma vez que a ordenha pode não ser afetada e o acompanhamento ser realizado para confirmar ou não essa necessidade.

ABSTRACT This study sought to investigate and to know the frequency and the distribution of frenotomies and frenectomies performed in the Unified Health System (SUS) after the legal provisions that instituted the tong test, and to understand which professionals are performing the surgical procedure. This is an analytical, descriptive, retrospective study, with secondary data, available in the DATASUS Information System. It was observed that a considerable increase in the number of procedures, but with fluctuations in the following years. Out of the frenectomies registered in the SUS in the period, 33% were performed by dentists in primary care. The results showed that there was a substantial increase in the number of surgical procedures in two moments, in 2014 and in 2017, possibly as a result of the publication of Ordinance nº 13.002/2014 and Technical Note (NT) No. 09/2016. NT No. 35/2018 shifted diagnosis and treatment to medium complexity, possibly resulting in queues, especially in the case of surgeries that could be performed in primary care. Although there is no unanimity regarding the correlation between ankyloglossia and weaning, there seems to be no monitoring to avoid unnecessary surgeries, since milking may not be affected and follow-up is carried out to confirm or not this need.

Saliva molecular testing bypassing RNA extraction is suitable for monitoring and diagnosing SARS-CoV-2 infection in children.

BACKGROUND: Adults are being vaccinated against SARS-CoV-2 worldwide, but the longitudinal protection of these vaccines is uncertain, given the ongoing appearance of SARS-CoV-2 variants. Children remain largely unvaccinated and are susceptible to infection, with studies reporting that they actively transmit the virus even when asymptomatic, thus affecting the community. METHODS: We investigated if saliva is an effective sample for detecting SARS-CoV-2 RNA and antibodies in children, and associated viral RNA levels to infectivity. For that, we used a saliva-based SARS-CoV-2 RT-qPCR test, preceded or not by RNA extraction, in 85 children aged 10 years and under, admitted to the hospital regardless of COVID-19 symptomatology. Amongst these, 29 (63.0%) presented at least one COVID-19 symptom, 46 (54.1%) were positive for SARS-CoV-2 infection, 28 (32.9%) were under the age of 1, and the mean (SD) age was 3.8 (3.4) years. Saliva samples were collected up to 48 h after a nasopharyngeal swab-RT-qPCR test. RESULTS: In children aged 10 years and under, the sensitivity, specificity, and accuracy of saliva-RT-qPCR tests compared to NP swab-RT-qPCR were, respectively, 84.8% (71.8%-92.4%), 100% (91.0%-100%), and 91.8% (84.0%-96.6%) with RNA extraction, and 81.8% (68.0%-90.5%), 100% (91.0%-100%), and 90.4% (82.1%-95.0%) without RNA extraction. Rescue of infectious particles from saliva was limited to CT values below 26. In addition, we found significant IgM positive responses to SARS-CoV-2 in children positive for SARS-CoV-2 by NP swab and negative by saliva compared to other groups, indicating late infection onset (>7-10 days). CONCLUSIONS: Saliva is a suitable sample type for diagnosing children aged 10 years and under, including infants aged <1 year, even bypassing RNA extraction methods. Importantly, the detected viral RNA levels were significantly above the infectivity threshold in several samples. Further investigation is required to correlate SARS-CoV-2 RNA levels to viral transmission.

Morbimortality and Six-Month Survival Among Elderly Patients Treated With Noninvasive Mechanical Ventilation in an Intermediate Care Unit: A Retrospective Evaluation.

BACKGROUND: Noninvasive mechanical ventilation (NIMV) has been established as a successful therapeutic option for patients with acute respiratory failure (ARF) with a specific etiology. OBJECTIVES: This study evaluated the morbimortality of patients with ARF treated with NIMV in a medical intermediate care unit (UCINT) to identify factors associated with higher in-hospital mortality, six-month mortality, and three- and six-month hospital readmission rates. METHODS: This retrospective cohort study included elderly patients admitted for ARF and treated with NIMV in the UCINT between 2015 and 2019. RESULTS: In the sample of 102 patients, the median age was 84.2 (±5.5) years, and 57% were women. In total, 28% were on long-term oxygen therapy, and 68% had a do-not-resuscitate order. At admission, the median Charlson comorbidity index and Barthel index of activities of daily living were 7 [6; 8] and 30 [20; 57,5], respectively. The simplified acute physiology score II was 39.1±10.7, and 92% of patients had type 2 ARF. Median days on NIMV and days in UCINT were 10 [6; 16] and 6 [3; 10], respectively. The main conditions requiring UCINT admission for NIMV were heart failure, pneumonia, and exacerbation of the chronic obstructive pulmonary disease. The NIMV failure rate was 7%. At discharge, the average Barthel index was 35 [10; 55]. The in-hospital mortality rate was 23%. DISCUSSION:  Older age, higher simplified acute physiology score II, higher Charlson comorbidity index, and higher number of days on NIMV were associated with higher in-hospital mortality. Long-term oxygen therapy was associated with higher three-month mortality. A higher Barthel index at the time of hospital discharge was associated with a higher six-month readmission rate. CONCLUSION: NIMV can be used successfully in elderly patients and less studied ARF etiologies, such as pneumonia.

Can a pharyngeal bulb prosthesis eliminate hypernasal speech in individuals with hypodynamic velopharynx?

ABSTRACT Purpose: to investigate the effectiveness of a pharyngeal bulb prosthesis to eliminate hypernasality in patients with operated cleft palate presenting with diagnosis of hypodynamic velopharynx. Methods: twenty patients with cleft palate, ages 11-40 years, presenting hypodynamic velopharynx participated in the study. Patients had their speech audio recorded twice, with and without prosthesis, simultaneously with nasometry. Three speech-pathologists rated the presence and absence of hypernasality. Perceptual and nasometric data without and with prosthesis were compared, using the McNemar Test (p<0.05). Results: three (15%) patients presented hypernasality without prosthesis and normal resonance with prosthesis, 3 (15%), normal resonance without prosthesis and hypernasality with prosthesis, 9 (45%), hypernasality without and with prosthesis, and 5 (25%), normal resonance in both conditions. Nasometry (≤27% cut off): 1 (5%), presented scores >27% without prosthesis and <27% with prosthesis, 2 (10%), scores <27% without prosthesis and >27% with prosthesis, 17 (85%), scores >27% in both conditions, and 1(5%), scores <27% in both conditions. The comparisons between the results were not significant (p=1.000). Conclusion: the pharyngeal bulb prosthesis alone is insufficient to eliminate hypernasality of patients presented with hypodynamic velopharynx. To this purpose, the combination between the prosthesis and speech therapy is required.

Signatures in SARS-CoV-2 spike protein conferring escape to neutralizing antibodies.

Understanding SARS-CoV-2 evolution and host immunity is critical to control COVID-19 pandemics. At the core is an arms-race between SARS-CoV-2 antibody and angiotensin-converting enzyme 2 (ACE2) recognition, a function of the viral protein spike. Mutations in spike impacting antibody and/or ACE2 binding are appearing worldwide, imposing the need to monitor SARS-CoV2 evolution and dynamics in the population. Determining signatures in SARS-CoV-2 that render the virus resistant to neutralizing antibodies is critical. We engineered 25 spike-pseudotyped lentiviruses containing individual and combined mutations in the spike protein, including all defining mutations in the variants of concern, to identify the effect of single and synergic amino acid substitutions in promoting immune escape. We confirmed that E484K evades antibody neutralization elicited by infection or vaccination, a capacity augmented when complemented by K417N and N501Y mutations. In silico analysis provided an explanation for E484K immune evasion. E484 frequently engages in interactions with antibodies but not with ACE2. Importantly, we identified a novel amino acid of concern, S494, which shares a similar pattern. Using the already circulating mutation S494P, we found that it reduces antibody neutralization of convalescent and post-immunization sera, particularly when combined with E484K and with mutations able to increase binding to ACE2, such as N501Y. Our analysis of synergic mutations provides a signature for hotspots for immune evasion and for targets of therapies, vaccines and diagnostics.

Antioxidant films and coatings based on starch and phenolics from Spondias purpurea L.

The objective of this study was to prepare, for the first time, active films and coatings from fruit starch (SPFS) and phenolic stem bark extract (SBPE) from Spondias purpurea L. Starch film formulations were prepared with different SBPE contents (5-20 wt% on starch), then cast and dried into films. SBPE showed higher antioxidant activity and antimicrobial activity against both Gram-negative and Gram-positive bacteria. Chemical, morphological, thermal, optical, mechanical, and barrier properties were studied for SPFS-SBPE films. In general, the phenolic extract caused significant changes in starch films (especially when in excess), such as gradual reduction of elastic modulus and tensile strength, increased elongation, opacity, and thermal properties (e.g. glass transition and melting enthalpy). On the other hand, SBPE provided the films with active properties (antioxidant and UV-absorbing). Coatings were applied to minimally processed mangoes (MPM), which were stored for 10 days at 12 °C. SBPE-containing coatings provided better protective action, reducing the total color difference (∆E⁎) and delaying the browning index (BI) during storage as well as reducing fungus attack. The active SPFS-SBPE films showed great potential as environmentally friendly active films and coatings.

The lingual enamel morphology and bracket shear bond strength influenced by Nd:YAG laser and aluminum oxide sandblasting preconditioning.

OBJECTIVES: This study aimed to investigate the influence of Nd:YAG laser and aluminum oxide sandblasting on the shear bond strength (SBS) of lingual brackets and to optically analyze the behavior of the enamel morphology. MATERIALS AND METHODS: Thirty-five bovines' incisors teeth were divided into 5 groups (n = 7), according to the surface preconditioning: G1, control group; G2, Nd:YAG laser; G3, laser + aluminum oxide sandblasting (Al2O3); G4, Al2O3; and G5, Al2O3 + laser. All groups had lingual brackets bonded and shear debonded after 72 h. SBS values were analyzed, and the enamel morphology was evaluated by optical coherence tomography (OCT) and scanning electron microscope (SEM), before and after preconditioning surface. The optical attenuation coefficient (α) analysis was obtained from OCT images. Data analysis used the ANOVA test, followed by post hoc Tukey, Kruskal Wallis, and post hoc Dunn tests (significance of 5%). RESULTS: The SBS values presented similarly among groups, but the value of α showed statistical difference (p-value = 0.0124) between G3 and G5 with the others. Optical analyses indicated a melting on the enamel that suffered laser irradiation for G2 and G5 and crystal surface disorganization for G4. Sandblasting partially removes the melting of the laser effect (G3). CONCLUSION: The sandblasting is a dispensable step for bonding lingual brackets, and the melting of the enamel after laser irradiation does not compromise the bracket adhesive resistance. CLINICAL RELEVANCE: The Nd:YAG laser became an interesting tool to prevent caries and decrease prevalence of white spot lesions in orthodontic treatments, without systemic effects in patients with genetic high risks of caries.

Effect of pulsed light on postharvest disease control-related metabolomic variation in melon (Cucumis melo) artificially inoculated with Fusarium pallidoroseum.

Pulsed light, as a postharvest technology, is an alternative to traditional fungicides, and can be used on a wide variety of fruit and vegetables for sanitization or pathogen control. In addition to these applications, other effects also are detected in vegetal cells, including changes in metabolism and secondary metabolite production, which directly affect disease control response mechanisms. This study aimed to evaluate pulsed ultraviolet light in controlling postharvest rot, caused by Fusarium pallidoroseum in 'Spanish' melon, in natura, and its implications in disease control as a function of metabolomic variation to fungicidal or fungistatic effects. The dose of pulsed light (PL) that inhibited F. pallidoroseum growth in melons (Cucumis melo var. Spanish) was 9 KJ m-2. Ultra-performance liquid chromatography (UPLC) coupled to a quadrupole-time-of-flight (QTOF) mass analyzer identified 12 compounds based on tandem mass spectrometry (MS/MS) fragmentation patterns. Chemometric analysis by Principal Components Analysis (PCA) and Orthogonal Partial Least Squared Discriminant Analysis (OPLS-DA) and corresponding S-Plot were used to evaluate the changes in fruit metabolism. PL technology provided protection against postharvest disease in melons, directly inhibiting the growth of F. pallidoroseum through the upregulation of specific fruit biomarkers such as pipecolic acid (11), saponarin (7), and orientin (3), which acted as major markers for the defense system against pathogens. PL can thus be proposed as a postharvest technology to prevent chemical fungicides and may be applied to reduce the decay of melon quality during its export and storage.

Synthetic Approaches to A Challenging and Unusual Structure-An Amino-Pyrrolidine Guanine Core.

The synthesis of an unreported 2-aminopyrrolidine-1-carboxamidine unit is here described for the first time. This unusual and promising structure was attained through the oxidative decarboxylation of amino acids using the pair of reagents, silver(I)/peroxydisulfate (Ag(I)/S2O82-) followed by intermolecular (in the case of l-proline derivative) and intramolecular trapping (in the case of acyl l-arginine) by N-nucleophiles. The l-proline approach has a broader scope for the synthesis of 2-aminopyrrolidine-1-carboxamidine derivatives, whereas the intramolecular cyclization afforded by the l-acylarginines, when applied, results in higher yields. The former allowed the first synthesis of cernumidine, a natural alkaloid isolated in 2011 from Solanum cernuum Vell, as its racemic form.

Xenon lamps used for fruit surface sterilization can increase the content of total flavonols in leaves of Lactuca sativa L. without any negative effect on net photosynthesis.

One (1P), two (2P), three (3P) or four (4P) pulses of light supplied by a xenon lamp, were applied to young lettuce plants grown in pots. The lamp used in the trial was similar to those used for fruit surface sterilization. Total flavonols were measured in leaves using the Dualex method. In a first trial conducted in greenhouse conditions, 6 days after the pulsed light (PL) treatment, flavonols were increased by 312% and 525% in the 3P and 4P treatments, respectively, in comparison to the those in the untreated control. Changes in the chlorophyll fluorescence parameters suggest that the PL treatment may induce limited and transient damage to the photosynthetic machinery and that the damage increases with the increasing number of pulses. The performance parameters were not significantly affected by PL and recovered fully by 6 days after the treatments. The 1P and the 2P treatments 6 days after the treatment showed a 28.6% and a 32.5% increase, respectively, in net photosynthetic assimilation, when compared to that of the control. However, 8 days after the treatment, there was no longer a difference between the treatments and the control in net photosynthetic assimilation. Eight days after the light treatment, the 3P treatment showed a 38.4% increase in maximal net photosynthetic assimilation over that of the control, which is an indication of positive long-term adaptation of photosynthetic capacity. As a whole, our observations suggest that PL could be used on field or greenhouse crops to increase their phytochemical content. No long-lasting or strong negative effects on photosynthesis were associated with PL within the range of doses we tested; some observations even suggest that certain treatments could result in an additional positive effect. This conclusion is supported by a second trial conducted in phytotrons. More studies are required to better understand the roles of the different wavelengths supplied by PL and their interactions.

Factors associated with vocal health and quality of life in teachers/professors / Fatores associados à saúde vocal e a qualidade de vida em professores

ABSTRACT Purpose: to analyze the association of self-reported vocal symptoms with personal, occupational and clinical aspects and relate them to the quality of life of teachers/professors of the federal network of vocational and technological education. Methods: study carried out with 157 teachers from a federal public institution of vocational and technological education, who answered the World Health Organization Quality of Life questionnaire (WHOQOL-bref), Quality of Life in the Voice (V-RQOL) questionnaire and a data form (on social information, health conditions, vocal symptoms, habits, organization and working environment). Statistical analysis was performed using the Chi-square test. Results: 29% of the teachers presented vocal symptoms. The prevalent complaints were dry throat (38.2%), cough (37.6%) and hoarseness (30.6%). There was a higher prevalence of symptoms in females. For the WHOQOL-bref, the average was 71.3 points, which is considered regular. The domain with the highest score was the psychological one with 75.3. Regarding V-RQOL, the average score in the global domain was 92.5 points, and the physical score was the most compromised one. 90.5% of teachers showed low voice impact on quality of life. Conclusion: although these teachers present vocal complaints, they do not reflect in the limitation of the quality of life.

RESUMO Objetivo: analisar a associação de sintomas vocais autorreferidos com aspectos pessoais, ocupacionais, clínicos e relacionar com a qualidade de vida de professores da rede federal de ensino profissional e tecnológico. Métodos: estudo com 157 docentes de uma instituição pública federal de educação profissional e tecnológica, que responderam aos questionários World Health Organization Quality Of Life/bref (WHOQOL-bref), Qualidade de Vida em Voz (QVV) e o formulário de dados (sociais, condições de saúde, sintomas vocais, hábitos, organização e ambiente de trabalho). A análise estatística foi realizada por meio do teste Qui-quadrado. Resultados: 29% dos professores apresentaram sintomas vocais. As queixas prevalentes foram garganta seca (38,2%), tosse (37,6%) e rouquidão (30,6%). Houve maior prevalência dos sintomas no sexo feminino. Para o WHOQOL-bref, a média foi 71,3 pontos, considerada regular. O domínio com maior pontuação foi o psicológico com 75,3. Quanto ao QVV, o escore médio no domínio global foi de 92,5 pontos, sendo o físico o mais comprometido. 90,5% dos docentes apresentaram baixo impacto da voz na qualidade de vida. Conclusão: embora os docentes apresentem queixas vocais, elas não se refletem na limitação da qualidade de vida.

Enhancing storage stability of guava with tannic acid-crosslinked zein coatings.

The quality of zein (Z)- and zein-tannic acid (ZTA)-coated guavas was monitored throughout 12 days of storage. Coated fruit showed lower changes in terms of visual appearance, chlorophyll contents and color. Weight loss, softening, and changes in soluble solids were also decreased by the coatings. The respiration peak as well as H2O2 and superoxide dismutase activity peaks were delayed by the coatings, and the ethylene production was reduced. So, the results were consistent with a slowed down ripening of guavas by the coatings, which was probably related to lowered oxygen permeability of guava skin. ZTA coating was more effective than Z to reduce weight loss, softening, color changes, ethylene production, and oxidative stress. The higher efficiency of ZTA coating was ascribed to zein crosslinking, which probably resulted in decreased gas permeability, promoting lower respiration rates and lower ROS production, slowing down the ripening process, and extending guava stability.

Bioaccumulation Study of Produced Water Discharges from Southeastern Brazilian Offshore Petroleum Industry Using Feral Fishes.

The main effluent of oil and gas production is the discharge of produced water (PW). Despite the potential environmental impact, the structure of oil and gas platforms can act as artificial reefs. Two species of fish, Caranx crysos and Tylosurus acus, were captured under two discharging platforms at Campos Basin, P19 and P40. A nondischarging platform, P25, was taken as reference. The highest median concentration of PAH in muscle tissue was observed for C. Crysos at P40 (219.38 ng g-1) followed by P19 (68.26 ng g-1). For T. acus, the highest median concentrations were 40.07 and 42.21 ng g-1 from P19 and P40 respectively. P25 presented the smallest recorded concentrations. The results of PAH in the muscle tissue of C. crysos enabled to distinguish the platforms with PW discharge from the platform without discharge. Trace elements concentrations reflected the background levels and were not influenced by the PW release.

A Ortodontia Lingual e a contribuição efetiva do corredor bucal na estética do sorriso ­ relato de caso / Lingual Orthodontics and the effective contribution of buccal corridor to the smile aesthetics ­ case report

Um sorriso atraente ajuda as pessoas a se sentirem mais confiantes e a parecerem mais jovens, podendo influenciar inclusive no desempenho das relações profissionais e pessoais, além de impactar no desenvolvimento da personalidade. Dentre as características estudadas e consideradas importantes para um sorriso estético, está o corredor bucal. Atributo que pode ser definido como a diferença entre a largura da dentição maxilar visível e a largura da comissura interna. A influência negativa da presença do corredor bucal excessivo sobre a estética do sorriso é um tema controverso e que abrange uma gama de trabalhos na literatura, podendo ser incluído na lista de problemas ortodônticos durante o diagnóstico e planejamento do tratamento. Considerando esse contexto, o presente trabalho tem o objetivo de relatar um caso clínico tratado com Ortodontia lingual, em que foram alcançados resultados estéticos favoráveis com a diminuição do corredor bucal.(AU)

An attractive smile helps people to feel more confident and look younger and could have influence on professional performance and personal relationships, as well as it may have impact on personality development. Among the characteristics studied and considered important for smile aesthetic is the buccal corridor. It can be defined as the difference between the width of the visible maxillary dentition and the width of the inner commissure. The negative influence of excessive buccal corridor presence in the smiling aesthetics is a controversial subject that is covered in a range of literature works; it can be included in the list of orthodontic problems during the diagnosis and treatment planning. Considering this context, the present work aims to report a clinical case treated with lingual orthodontics, in which favorable aesthetic results were obtained with reduction of the buccal corridor. (AU)

The process of implementation of emergency care units in Brazil.

OBJECTIVE: To analyze the process of implementation of emergency care units in Brazil. METHODS: We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS: Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS: The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.