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1.
Eur J Neurosci ; 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33608957

RESUMO

Chronic hyperglycemia induces activation of the polyol-sorbitol pathway, which is a major contributor to microvascular complications like stroke. The current study was designed to elucidate the therapeutic role of α-glucose inhibitor in chronic hyperglycemia-induced impaired polyol pathway and associated micro-complications. Male albino-Wistar rats (200-250g) were treated with voglibose 10 mg/kg/day/p.o for two weeks before middle cerebral artery occlusion; 72 hours after surgery neurological score was evaluated and blood was collected for the assessment of various serum biochemical parameters like CRP, CK-MB, LDH, lipid profile, blood glucose levels. In the end, brain samples were excised for determination of brain infarct volume, brain hemisphere weight difference, Na+-K+ ATPase activity oxidative stress-related parameters, aldose reductase activity and gene expression studies. Results from the present study indicate, pre-treatment with voglibose showed significant improvement in lipid parameters but did not impact glucose levels. Voglibose has shown a statistically significant (p<0.05) reduction in neurological score, brain infarct volume, the difference in brain hemisphere weight as compared to the disease control group. Voglibose significantly (p<0.05) improve all biochemical parameters and reduced Na+-K+ ATPase and aldose reductase activity. Moreover, voglibose produced a significant reduction in oxidative stress and down-regulation of TNF-α and BCl-2 gene expression which reduces the risk of factors related to stroke. In conclusion, the pleiotropic effect of voglibose on cerebrovascular complications may be due to inhibition of aldose reductase-or anti-inflammatory pathways.

2.
J Gastrointest Surg ; 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33443687
3.
Hosp Pediatr ; 11(1): 79-87, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33386296

RESUMO

OBJECTIVES: Understanding the risk factors, predictors, and clinical presentation of coronavirus disease 2019 (COVID-19) in pediatric patients with severe disease. METHODS: We conducted a retrospective chart review of pediatric patients admitted between March 1, 2020, and May 31, 2020, to a large health network in New Jersey with positive test results for severe acute respiratory syndrome coronavirus 2 on reverse transcriptase polymerase chain reaction, rapid testing, or serum immunoglobulin G testing; we included demographic characteristics, clinical features, and outcomes. RESULTS: A total of 81 patients ≤21 years old were admitted with positive test results for severe acute respiratory syndrome coronavirus 2 on reverse transcriptase polymerase chain reaction and/or serum immunoglobulin testing. Sixty-seven patients (82.7%) were admitted for management of acute COVID-19 infection, whereas 14 (17.3%) were admitted for management of multisystem inflammatory syndrome in children (MIS-C). Of the 81 hospitalized patients, 28 (34.6%) required intensive care. A majority of patients (42 [51.9%]) admitted for both acute COVID-19 infection and MIS-C were Hispanic. Underlying chronic health conditions were not present in most patients. Obesity (mean BMI of 41.1) was noted in the patients with MIS-C requiring ICU care, although not statistically significant. Absolute lymphopenia and elevated levels of inflammatory markers were statistically significant in the patients with MIS-C treated in the ICU. CONCLUSIONS: This study adds to the growing literature of potential risk factors for severe disease in pediatric patients due to COVID-19 infection and MIS-C. Patients of Hispanic ethnicity represented the majority of patients with both acute COVID-19 infection and MIS-C, despite only representing 10% to 20% of the population our hospitals serve. Infants and patients with chronic health conditions were not at increased risk for severe disease. Absolute lymphopenia and elevated levels of inflammatory markers were associated with more severe disease.


Assuntos
/diagnóstico , /terapia , Adolescente , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Masculino , New Jersey , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
4.
Eye (Lond) ; 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514899

RESUMO

A review of literature was performed, focused on the etiopathogenesis of aggressive posterior retinopathy of prematurity (APROP), the characteristic and atypical clinical features, management strategies, anatomical and visual outcomes. Characteristically APROP has zone I/posterior zone II involvement with prominent plus disease, featureless junction, large vascular loops, flat extra-retinal fibrovascular proliferation, and a rapidly progressive course. The risk factors for APROP are extreme prematurity (birth weight ≤1000 gram and/or gestational age ≤28 weeks), dysregulated oxygen supplementation, intrauterine growth retardation, sepsis, and thrombocytopenia. The uncommon presentations include small zone I disease, a hybrid disease with additional ridge tissue, and APROP in bigger babies with birth weight greater than 1500 g. Laser photocoagulation role is limited by the resultant visual field loss and high refractive error. Although anti-vascular endothelial growth factor injection allows peripheral retinal vascularization; reactivation of disease, systemic absorption of the drug and long-term safety are the chief concerns. Early vitrectomy is required when tractional retinal detachment develops. The visual outcome depends upon the morphology and vascular development of the macula. With the limited yet emerging new understanding of the pathophysiology, a multifaceted rational and individualized treatment strategy is suggested for APROP. Best practices in neonatal intensive care may prevent the occurrence of APROP. Further studies need to be performed for the prevention and safe, effective management of APROP.

5.
Cells ; 9(12)2020 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-33322834

RESUMO

Biomarker-driven targeted therapies are lacking for head and neck squamous cell carcinoma (HNSCC), which is common and lethal. Efforts to develop such therapies are hindered by a genomic landscape dominated by the loss of tumor suppressor function, including NOTCH1 that is frequently mutated in HNSCC. Clearer understanding of NOTCH1 signaling in HNSCCs is crucial to clinically targeting this pathway. Structural characterization of NOTCH1 mutations in HNSCC demonstrates that most are predicted to cause loss of function, in agreement with NOTCH1's role as a tumor suppressor in this cancer. Experimental manipulation of NOTCH1 signaling in HNSCC cell lines harboring either mutant or wild-type NOTCH1 further supports a tumor suppressor function. Additionally, the loss of NOTCH1 signaling can drive HNSCC tumorigenesis and clinical aggressiveness. Our recent data suggest that NOTCH1 controls genes involved in early differentiation that could have different phenotypic consequences depending on the cancer's genetic background, including acquisition of pseudo-stem cell-like properties. The presence of NOTCH1 mutations may predict response to treatment with an immune checkpoint or phosphatidylinositol 3-kinase inhibitors. The latter is being tested in a clinical trial, and if validated, it may lead to the development of the first biomarker-driven targeted therapy for HNSCC.

6.
iScience ; 23(11): 101714, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33196031

RESUMO

Microbial communities display behavioral changes in response to variable environmental conditions. In some bacteria, motility increases as a function of cell density, allowing for population dispersal before the onset of nutrient scarcity. Utilizing automated particle tracking, we now report on a population-dependent increase in the swimming speeds of the photosynthetic unicellular eukaryotes Chlamydomonas reinhardtii and C. moewussi. Our findings confirm that this acceleration in swimming speed arises as a function of culture density, rather than with age and/or nutrient availability. Furthermore, this phenomenon depends on the synthesis and detection of a low-molecular-weight compound which can be transferred between cultures and stimulates comparable effects across both species, supporting the existence of a conserved phenomenon, not unlike bacterial quorum sensing, among members of this genus. The potential expansion of density-dependent phenomena to a new group of unicellular eukaryotes provides important insight into how microbial populations evolve and regulate "social" behaviors.

7.
Cureus ; 12(10): e10942, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33200056

RESUMO

Cardiovascular disease is the leading cause of death in the United States of America due to elevated triglyceride levels. High triglyceride levels lead to higher risks of ischemic events. There are multiple pieces of research and analyses on statin therapy and its ability to reduce the prevalence of heart complications. Heart ailments can reduce through the use of icosapent ethyl in the form of statin therapy. This literature review will explain the reduction of cardiovascular risks with icosapent ethyl. Though some genetic conditions can cause some of these ailments, the rest of the predisposing conditions revolve around cholesterol, lipoproteins, and triglycerides.

8.
Child Abuse Negl ; : 104803, 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33220945

RESUMO

BACKGROUND: The leading causes of street involvement worldwide are poverty, family conflict, and abuse. A common misconception is that street involvement is due to delinquency, a belief leading to social exclusion and social inequality for children in street situations (CSS). Exploring community perceptions of CSS and the reproduction of social difference and inequalities can help reduce stigma and discrimination. OBJECTIVE: To explore how stigma and discrimination of CSS was produced and reproduced in specific contexts of culture and power. PARTICIPANTS AND SETTING: Social actors including CSS, healthcare providers, children's officers, and police officers in western Kenya. METHODS: Using a sociological conceptualization of stigma, this qualitative study explored the stigmatization processes that take shape in specific contexts of culture and power. We conducted 41 in-depth interviews and 7 focus group discussions with a total of 100 participants. RESULTS: CSS were often labeled "chokoraa" or garbage picker, a label linked to undesirable characteristics constituting "evils" in society and stereotyped beliefs that they were "delinquents," reinforcing their "otherness" and devalued social status. CSS experienced individual and structural discrimination leading to exclusion from social and economic life. CONCLUSION: CSS were stigmatized when labeled, set apart, and linked to negative characteristics leading to their experience of status loss and discrimination. CSS's differentness and devalued status served to limit their access to societal resources and deemed them unworthy of equal rights. Interventions involving various social actors are needed to challenge negative stereotypes, reduce stigma, and uphold CSS's human rights.

9.
Curr Gene Ther ; 20(3): 223-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33054705

RESUMO

BACKGROUND: Postprandial hyperglycemia considered to be a major risk factor for cerebrovascular complications. OBJECTIVE: The current study was designed to elucidate the beneficial role of voglibose via in-silico in vitro to in-vivo studies in improving the postprandial glycaemic state by protection against strokeprone type 2 diabetes. MATERIALS AND METHODS: In-Silico molecular docking and virtual screening were carried out with the help of iGEMDOCK+ Pymol+docking software and Protein Drug Bank database (PDB). Based on the results of docking studies, in-vivo investigation was carried out for possible neuroprotective action. T2DM was induced by a single injection of streptozotocin (90mg/kg, i.v.) to neonates. Six weeks after induction, voglibose was administered at the dose of 10mg/kg p.o. for two weeks. After eight weeks, diabetic rats were subjected to middle cerebral artery occlusion, and after 72 hours of surgery, neurological deficits were determined. The blood was collected for the determination of serum glucose, CK-MB, LDH and lipid levels. Brains were excised for determination of brain infarct volume, brain hemisphere weight difference, Na+-K+ ATPase activity, ROS parameters, NO levels, and aldose reductase activity. RESULTS: In-silico docking studies showed good docking binding score for stroke associated proteins, which possibly hypotheses neuroprotective action of voglibose in stroke. In the present in-vivo study, pre-treatment with voglibose showed a significant decrease (p<0.05) in serum glucose and lipid levels. Voglibose has shown significant (p<0.05) reduction in neurological score, brain infarct volume, the difference in brain hemisphere weight. On biochemical evaluation, treatment with voglibose produced significant (p<0.05) decrease in CK-MB, LDH, and NO levels in blood and reduction in Na+-K+ ATPase, oxidative stress, and aldose reductase activity in brain homogenate. CONCLUSION: In-silico molecular docking and virtual screening studies and in-vivo studies in MCAo induced stroke, animal model outcomes support the strong anti-stroke signature for possible neuroprotective therapeutics.

10.
J Pediatr Ophthalmol Strabismus ; 57: e71-e73, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33090229

RESUMO

A preterm neonate with type 1 retinopathy of prematurity in posterior zone II presented with hemorrhage in Berger's space immediately after intravitreal bevacizumab injection. The authors report a rare case of successful self-resolution and discuss the need for proper injection technique to prevent this complication. [J Pediatr Ophthalmol Strabismus. 2020;57:e71-e73.].

11.
Case Rep Oncol ; 13(3): 1131-1135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33082759

RESUMO

Follicular dendritic cell sarcoma (FDCS) is a rare sarcoma, which commonly presents as a slow-growing, painless mass. There are only a few hundred reported FDCS cases, and the role for adjuvant chemo- or radiation therapy has not been established. Choosing an appropriate therapy in disseminated disease can therefore be challenging. A 26-year-old patient with FDCS was admitted with dyspnea, fever, and night sweats. He was found to have a large right hemothorax with compressive atelectasis on initial imaging. CT of the chest revealed multiple bilateral lung and pleural nodules with associated bilateral hilar adenopathy, a hypodense mass within the right hemithorax, and necrotic right external iliac and inguinal nodes. Inguinal node biopsy diagnosed FDCS. The patient was initially treated with cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. Gemcitabine/Taxotere was given as second-line therapy and pembrolizumab as third-line therapy, with continued disease progression after 2 cycles of both regimens. The patient was switched to fourth-line therapy with pazopanib and had a partial response for 9 months. This case illustrates a successful FDCS treatment with pazopanib. Due to the rarity of FDCS, where large studies comparing treatment approaches are not available, recommendations for optimal treatment are not well defined. This case is in support of growing evidence suggesting that FDCS responds to systemic therapies that are used for soft tissue sarcoma, such as pazopanib.

12.
J Pediatr Pharmacol Ther ; 25(7): 636-641, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33041719

RESUMO

OBJECTIVES: Guidelines by the AAP for the use of palivizumab prophylaxis for respiratory syncytial virus (RSV) recommend administration within 72 hours prior to discharge for selected high-risk patient populations. Our institution historically administered palivizumab on a fixed-day schedule of Mondays and Thursdays, but adjusted the practice in fall 2017 to a pharmacist-driven flex-schedule based on anticipated discharge date. This review evaluated the effect of pharmacist-driven palivizumab ordering on the appropriateness of palivizumab administrations, based on AAP and institutional recommendations. Additionally, this review evaluated for effects on institutional cost. METHODS: This was a retrospective single-center evaluation including patients for whom palivizumab was ordered between July 1, 2016, and June 30, 2018. Patients in the 2016-2017 RSV season were in the fixed-day group, while patients in the 2017-2018 RSV season were in the flex-schedule group. RESULTS: A total of 142 palivizumab doses were evaluated. Overall, 97% of administrations were for an appropriate indication. All doses administered inappropriately (n = 4) occurred in the fixed-day group. In the fixed-day group, 48.6% of doses were given within 72 hours prior to discharge, which increased to 70.1% in the flex-schedule group (p = 0.01). The amount of drug saved by batching was 1 vial for every 4.9 patients in the fixed-day group, and 1 vial for every 4.8 patients in the flex-schedule group. CONCLUSIONS: There was a statistically significant improvement in compliance with AAP recommendations following the implementation of pharmacist-driven flex-schedule for palivizumab, compared to a fixed-day batching schedule. There was no significant difference in cost.

13.
J Pediatr Pharmacol Ther ; 25(5): 390-400, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32641909

RESUMO

Experiential education conducted in the pediatric practice setting provides student pharmacists the opportunity to learn about a unique patient population. For many students, experiential rotations may be the only form of pediatric education they receive in pharmacy school. Providing quality pediatric experiences is essential to stimulate students' interest in this practice area and train those with goals to become pediatric pharmacists. It is also important to ensure graduating pharmacists have exposure to fundamental pediatric pharmacy concepts. Although pediatric practice areas and institutions differ in patient populations and services, a well-rounded rotation experience should be provided for the pharmacy student. Preceptors must decide what concepts to teach and what activities students should be incorporated into during this experiential period. This article provides goals and activities for student pharmacists that can be included in newly designed introductory pharmacy practice experiences and advanced pharmacy practice experiences within various pediatric settings.

14.
World J Surg ; 44(10): 3268-3276, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32524159

RESUMO

BACKGROUND: Half of the global population is at risk for catastrophic health expenditure (CHE) in the event that they require surgery. Universal health coverage fundamentally requires protection from CHE, particularly in low- and middle-income countries (LMICs). Financial risk protection reports in LMICs covering surgical care are limited. We explored the relationship between financial risk protection and hospital admission among injured patients in Cameroon to understand the role of health insurance in addressing unmet need for surgery in LMICs. METHODS: The Cameroon National Trauma Registry, a database of all injured patients presenting to the emergency departments (ED) of three Cameroonian hospitals, was retrospectively reviewed between 2015 and 2017. Multivariate regression analysis identified predictors of hospital admission after injury and of patient report of cost inhibiting their care. RESULTS: Of the 7603 injured patients, 95.7% paid out-of-pocket to finance ED care. Less than two percent (1.42%) utilized private insurance, and more than half (54.7%) reported that cost inhibited their care. In multivariate analysis, private insurance coverage was a predictor of hospital admission (OR 2.17, 95% CI: 1.26, 3.74) and decreased likelihood of cost inhibiting care (OR 0.34, 95% CI: 0.20, 0.60) when compared to individuals paying out-of-pocket. CONCLUSION: The prevalence of out-of-pocket spending among injured patients in Cameroon highlights the need for financial risk protection that encompasses surgical care. Patients with private insurance were more likely to be admitted to the hospital, and less likely to report that cost inhibited care, supporting private health insurance as a potential financing strategy.

15.
J Patient Saf ; 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32168273

RESUMO

OBJECTIVES: Medications often require manipulations to measure and administer the correct dose for pediatric patients. These manipulations pose medication safety risks. The objective of this study was to determine the frequency of drug formulation manipulations in the pediatric inpatient population and compare the findings to a parallel adult inpatient population. METHODS: Observations were conducted at four sites with 1 day of data collection per week by a randomized schedule for 5 weeks. All pediatric inpatients at each study site were included as well as an equivalent number of medication orders from adult inpatients with similar levels of care. The percentage of medication orders requiring a manipulation were evaluated and compared between pediatric and adult patients. RESULTS: A total of 15,722 medication orders were analyzed. Drug formulation manipulation was required in 3925 (49.9%) of 7861 pediatric orders versus 1301 of 7861 adult orders (16.6%) (P < 0.05). By pediatric service, drug manipulations were required most frequently (71.5% of orders) in the neonatal intensive care unit. The most common dosage forms requiring manipulation for pediatric patients were oral liquids (45.7% of orders) and intravenous medications (44.6% of orders). By pediatric patient age, drug manipulation was required most often in patients aged 1 to 12 months (69.8% of orders). CONCLUSIONS: Drug formulation manipulation was three times more common in pediatric inpatient practice compared with adult inpatient practice in this study. This study demonstrated a statistically significant difference in the prevalence of drug formulation manipulation between pediatric and adult inpatients.

16.
Indian J Ophthalmol ; 68(3): 494-499, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32057011

RESUMO

Purpose: To evaluate age-related changes in macular vessels and their perfusion densities using optical coherence tomography angiography (OCTA). Methods: A total of 108 eyes of 54 healthy subjects between the age group of 11 to 60 years having unaided visual acuity of 20/20 were studied on spectral domain OCTS using 3 * 3 mm macula protocol. These subjects were divided into 5 groups; Group 1: 11-20 years, Group 2: 21-30 years, Group 3: 31-40 years, Group 4: 41-50 years, and Group 5: 51-60 years. An early treatment diabetic retinopathy study (ETDRS) grid overlay at the macula was used to calculate changes in different quadrants of the superficial retinal plexus. Results: A total of 98 eyes of 49 patients were considered for the final analysis. The vessel density values decreased from the second to the sixth decade in all four quadrants (except the third decade, where a slight increase was noted). The total vessel density decreased from 168 ± 78 mm-1 (group 1) to 131.47 ± 18.32 mm-1 (group 5). A similar reduction pattern in perfusion density was seen in each quadrant from the second to the sixth decade. The total perfusion density reduced from 309 ± 15.63% (group 1) to 283.05 ± 45.23% (group 5). The foveal avascular zone area was 0.18 ± 0.09 mm2 in group 1, 0.33 ± 0.13 mm2 in group 2, 0.30 ± 0.10 mm2 in group 3, 0.38 ± 0.05 mm2 in group 4, and 0.46 ± 0.06 mm2 in group 5. Conclusion: In our population, macular vessel density appears to decrease noticeably from the fourth decade onwards but a statistically significant decrease was observed only from the fifth decade onwards. However, it was not uniform along with all the quadrants. Similarly, the percentage of perfusion density dropped from the fourth decade but these values also varied among the different quadrants.

17.
J Indian Prosthodont Soc ; 20(1): 11-16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32089594

RESUMO

Aim: The aim of this study is to assess the influence of different implant placement techniques to improve primary implant stability (PIS) in the low-density bone. Materials and Methods: Citations published in English and those available in full text were searched from electronic databases (PubMed and Google Scholar) from the year 2000-2017 by which 75 manuscripts were revealed. After applying inclusion and exclusion criteria, seven were selected for the present review. The whole process was conducted by the following preferred reporting items for systematic reviews and meta-analyses guidelines. Results: The measurement of primary stability showed significant correlations with different bone densities and with implant outcome; however, these two parameters have not been investigated at the same time frequently. Of the seven manuscripts, three discussed standard drilling protocol, two used undersized drilling, one used guided drilling, and one compared standard drilling with undersized drilling. Several intraoperative methods of jaw bone-density assessment were reported, and resonance frequency analysis, periotest, and insertion torque values were used to quantify PIS. Conclusion: The use of undersized drilling has proven advantageous for increasing initial implant stability in the low-density bone. Although the PIS may be lower, the secondary implant stability is found to be correlated to acceptable values.

19.
J Prosthet Dent ; 123(2): 299-304, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31227235

RESUMO

STATEMENT OF PROBLEM: The optimal procedure for the transfer of the sagittal inclination of the occlusal plane (OP) to semiadjustable and fully adjustable articulators is unclear. PURPOSE: The purpose of this clinical study was to evaluate and compare the sagittal inclination of the OP with the Frankfort horizontal plane (FHP) on a facebow transfer to semiadjustable and fully adjustable articulators. MATERIAL AND METHODS: Facebow transfers (Hanau Spring-Bow; Whip Mix Corp) of 30 participants were recorded and transferred to a semiadjustable articulator (Hanau Wide-Vue; Whip Mix Corp) using the indirect method. Another set of facebow transfers from the same set of 30 participants using another facebow (Denar Slidematic Facebow; Whip Mix Corp) was recorded and transferred to a fully adjustable articulator (Denar D5A; Whip Mix Corp). The angle between the OP of the mounted cast and the upper member of the articulator was measured in each participant with a digital protractor on both articulators. Standardized lateral cephalograms of each participant were made as a control. The FHP and OP were traced on each standardized lateral cephalogram. The angle on the cephalogram between the FHP and OP was measured. These values were compared with previously measured values for the Hanau Wide-Vue and the Denar D5A articulators. The data were analyzed using ANOVA. Intergroup comparisons between and among the Hanau Wide-Vue, Denar D5A, and lateral cephalograms were performed using the independent t test. RESULTS: No statistically significant difference was found between the Hanau Wide-Vue and Denar D5A articulators compared with the lateral cephalograms (P=.06). In the intergroup comparison, no statistically significant differences were found between the Hanau Wide-Vue and Denar D5A articulators (P=.18). No statistically significant differences were found between the values obtained on the Hanau Wide-Vue and lateral cephalograms (P=.06). When the Denar D5A articulator was compared with the lateral cephalograms, there was a statistically significant difference (P=.02). CONCLUSIONS: The Hanau Wide-Vue articulator most closely replicated the inclination of the OP. Regarding the sagittal inclination of the OP, the semiadjustable articulator can provide more accurate results than a fully adjustable articulator and thus eliminates occlusal errors.


Assuntos
Articuladores Dentários , Oclusão Dentária , Aparelhos de Tração Extrabucal , Cabeça , Humanos , Registro da Relação Maxilomandibular
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