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1.
J Paediatr Child Health ; 59(2): 411, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36722445

Assuntos
Face , Boca , Recém-Nascido , Humanos
2.
AANA J ; 91(1): 55-60, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36722784

RESUMO

Patients with Treacher Collins syndrome have a known difficult airway particularly if intubation is required. In most institutions that perform full mouth dental restoration (FMDR) procedures the patient is nasally intubated to protect the airway from debris and irrigation fluid. For patients with Treacher Collins syndrome the actual intubation and securing the airway can be more difficult and traumatic than the actual dental restoration itself. However, there is an airway technique using nasopharyngeal airways combined with a dental technique called "dry prepping" that can provide those patients a safe way of receiving an FMDR without intubation. A recent case report of a 29-month-old child with Treacher Collins syndrome received an FMDR without intubation.


Assuntos
Disostose Mandibulofacial , Criança , Humanos , Pré-Escolar , Boca , Intubação Intratraqueal
3.
Int J Mol Sci ; 24(2)2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36674962

RESUMO

Yeast acquisition begins at birth; however, the contribution of the mother on yeast transmission to the offspring and associated resistance is yet to be clarified. The aim of this study was to explore the vertical transmission of yeasts and their antifungal susceptibility profile in early life. Oral, fecal, and breastmilk samples were collected from 73 mother-child pairs four to twelve weeks after delivery and cultured on Sabouraud dextrose agar with chloramphenicol. The isolates were identified by MALDI-TOF MS. The vertical transmission was studied by microsatellite genotyping. Antifungal susceptibility was determined for fluconazole, voriconazole, miconazole, anidulafungin, and nystatin by broth microdilution assay, following CLSI-M60 guidelines. A total of 129 isolates were identified from 53% mother-child pairs. We verified the vertical transmission of Candida albicans (n = three mother-child pairs) and Candida parapsilosis (n = one mother-child pair) strains, including an antifungal resistant strain transmitted from breastmilk to the gut of a child. Most isolates were susceptible to the tested antifungals, with the exception of four C. albicans isolates and one R. mucilaginosa isolate. The vertical transmission of yeasts happens in early life. This is the first work that demonstrated the role of the mother as a source of transmission of antifungal-resistant yeasts to the child.


Assuntos
Antifúngicos , Leite Humano , Recém-Nascido , Humanos , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida , Leveduras , Boca , Relações Mãe-Filho , Testes de Sensibilidade Microbiana , Farmacorresistência Fúngica
4.
In Vivo ; 37(1): 366-370, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593008

RESUMO

BACKGROUND/AIM: Vascular malformations are congenital abnormalities that result from disturbances in the embryologic development of the vascular system. A retrospective study at a single institution was performed to determine the localization and treatment patterns for vascular malformations in children. PATIENTS AND METHODS: A total of 198 pediatric patients were identified. Age at diagnosis and presentation, sex, localization, diagnostics, and therapy were described. RESULTS: The most common diagnosis was lymphatic malformation (LM, 58.6%), followed by venous (VM, 31.8%) and arteriovenous malformation (AVM, 4.5%). The mean age at diagnosis was 2.2 years, while the mean age at presentation at our hospital was 7.2 years. The sex ratio showed a female predominance (1.44:1), which was most evident in children with AVM. The neck, cheek/parotid gland and oral cavity were the most predominant locations. Half of the patients required at least one intervention at our hospital. Especially, CM and LM were managed by watch-and wait, whereas lymphovenous malformation (LVM) and AVM were most often treated. Treatment differed between the various malformation types, the most common used treatment was conventional surgery followed by laser therapy. In case of treatment, the average number of procedures in our hospital was 1.58 for VM, 1.53 for LM, 1.33 for AVM, and 1.0 for LVM. CONCLUSION: In children with vascular malformations interventional treatment is often necessary, in many cases more than one treatment step is needed. Correct identification of the malformation type is important for optimal treatment and appropriate care of patients with vascular malformations.


Assuntos
Malformações Arteriovenosas , Malformações Vasculares , Humanos , Criança , Feminino , Pré-Escolar , Masculino , Estudos Retrospectivos , Malformações Vasculares/diagnóstico , Malformações Vasculares/epidemiologia , Malformações Vasculares/terapia , Pescoço/irrigação sanguínea , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/epidemiologia , Malformações Arteriovenosas/terapia , Boca
5.
Langmuir ; 39(4): 1677-1685, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36649661

RESUMO

Silica is widely used in the oral care formulations to act as an abrasive and to give the products its distinct physical properties. In this study, silica particles were synthesized using a co-condensation of tetraethyl orthosilicate with a series of functional silane compounds [(3-mercaptopropyl)trimethoxysilane, (3-glycidyloxypropyl)trimethoxysilane, and (3-acryloxypropyl)trimethoxysilane)]. The surface of the particles based on tetraethyl orthosilicate and (3-glycidyloxypropyl)trimethoxysilane was then further modified with 3-aminophenylboronic acid. Commercial Aerosil R972 Pharma silica particles were also coated with chitosan. Additionally, commercially available (3-maleimido)propyl-functionalized silica particles were used in this study. All these functionalized silica particles were incorporated into toothpaste formulations, and their retentive properties were tested on ex vivo sheep tongue mucosa models using fluorescent microscopy-based flow-through techniques. Those surfaces with chitosan, phenylboronic acid, and acryloyl groups were shown to provide a significant improvement in the retention of the oral care formulations during the retention testing. The retention of toothpastes containing silica functionalized with maleimide and thiol groups was also superior compared to that of unmodified silica particles. This study synthesized and tested a range of silica particles and demonstrated that the functionalized silica incorporated into toothpastes can significantly improve the retention of these formulations on oral mucosal surfaces.


Assuntos
Quitosana , Cremes Dentais , Animais , Ovinos , Adesivos , Dióxido de Silício , Boca
6.
BMJ Case Rep ; 16(1)2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36599490

RESUMO

Oral soft-tissue myxomas of the oral cavity have been sparsely cited in the medical literature worldwide. This could be due to other clinically and/or histologically similar lesions requiring accurate differential diagnosis by experienced physicians and pathologists. Although myxomas are benign and do not metastasise, they have higher rates of recurrence and deserve proper attention and to be reported as well. Soft-tissue myxomas of the oral cavity are extremely rare and very few cases have been reported in the literature. The article describes a soft-tissue myxoma in a male patient in his 40s and review of published cases.


Assuntos
Boca , Mixoma , Humanos , Masculino , Boca/patologia , Mixoma/diagnóstico por imagem , Mixoma/cirurgia
7.
IEEE J Transl Eng Health Med ; 11: 107-115, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36619906

RESUMO

Infant breastfeeding diagnostics remain subjective due to the absence of instrumentation to objectively measure and understand infant oral motor skills and suckling characteristics. Qualitative diagnostic exams, such as the digital suck assessment which relies upon a clinician's gloved finger inserted into the infant's mouth, produce a diversity of diagnoses and intervention pathways due to their subjective nature. In this paper, we report on the design of a non-nutritive suckling (NNS) system which quantifies and analyzes quantitative intraoral vacuum and sucking patterns of full-term neonates in real time. In our study, we evaluate thirty neonate suckling profiles to demonstrate the technical and clinical feasibility of the system. We successfully extract the mean suck vacuum, maximum suck vacuum, frequency, burst duration, number of sucks per burst, number of sucks per minute, and number of bursts per minute. In addition, we highlight the discovery of three intraoral vacuum profile shapes that are found to be correlated to different levels of suckling characteristics. These results establish a framework for future studies to evaluate oromotor dysfunction that affect the appearance of these signals based on established normal profiles. Ultimately, with the ability to easily and quickly capture intraoral vacuum data, clinicians can more accurately perform suckling assessments to provide timely intervention and assist mothers and infants towards successful breastfeeding outcomes.


Assuntos
Ingestão de Alimentos , Comportamento de Sucção , Feminino , Humanos , Lactente , Recém-Nascido , Aleitamento Materno , Boca , Vácuo , Chupetas
8.
Sensors (Basel) ; 23(2)2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36679385

RESUMO

Technological advancements are enabling new applications within biomedical engineering. As a connection point between the outer environment and the human system, the oral cavity offers unique opportunities for sensing technologies. This paper systematically reviews the performance of measurement systems tested in the human oral cavity. Performance was defined by metrics related to accuracy and agreement estimation. A comprehensive search identifying human studies that reported on the accuracy or agreement of intraoral sensors found 85 research papers. Most of the literature (62%) was in dentistry, followed by neurology (21%), and physical medicine and rehabilitation (12%). The remaining papers were on internal medicine, obstetrics, and aerospace medicine. Most of the studies applied force or pressure sensors (32%), while optical and image sensors were applied most widely across fields. The main challenges for future adoption include the lack of large human trials, the maturity of emerging technologies (e.g., biochemical sensors), and the absence of standardization of evaluation in specific fields. New research should aim to employ robust performance metrics to evaluate their systems and incorporate real-world evidence as part of the evaluation process. Oral cavity sensors offer the potential for applications in healthcare and wellbeing, but for many technologies, more research is needed.


Assuntos
Engenharia Biomédica , Gravitação , Gravidez , Feminino , Humanos , Boca
9.
PLoS One ; 18(1): e0279204, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36652464

RESUMO

BACKGROUND: Previous clinical and in vitro investigations have supported the efficacy of a glycerol throat spray containing cold-adapted cod trypsin (ColdZyme) against respiratory viruses causing the common cold bycreating a protective mucosal barrier shown to deactivate common cold virus in vitro and decrease pharyngeal rhinovirus load. METHODS AND FINDINGS: This was a double-blind, randomized, parallel-group, placebo-controlled study conducted at 10 German sites to evaluate the efficacy of the medical device ColdZyme, a glycerol mouth spray containing cold-adapted cod trypsin for a naturally occurring common cold versus placebo spray. Adults experiencing a minimum of three common colds during the previous year, but otherwise healthy, were enrolled to begin treatment with the mouth spray or placebo six times daily at first sign of a common cold. Jackson's symptom scale and the 9-item Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) quality of life (QoL) domain and a sore throat scale were recorded daily by subjects, as well as any use of allowed rescue treatment. Between January and April 2019, 701 subjects were enrolled and randomly assigned to the ColdZyme group (n = 351) or the placebo group (n = 350). Of the 701 subjects, 438 (62.5%) subjects developed symptoms typical of common cold, and all 438 started study treatment (n = 220 in the ColdZyme group and n = 218 in the placebo group). The demographic profile of the treatment groups were comparable with 68.1% female and almost all subjects being Caucasian (98.4%). The age ranged between 18 and 70 years with a mean age of 41.3 (±14.4) years. There were no differences between the groups in primary and major secondary endpoints, however, the assessment using the WURSS-21 QoL domain and Jackson score suggests a slightly faster recovery with ColdZyme as symptoms and complaints affecting the quality of life were shortened by about 1 day. The beneficial effect of ColdZyme was particularly noticeable on the fifth day of the common cold. A positive difference between treatment groups was also seen for the subjects' assessments of global efficacy of the investigational product A robust safety profile for ColdZyme was demonstrated throughout the study. CONCLUSION: The safety and tolerability of ColdZyme have been confirmed in a large study population and further establishes evidence of a faster recovery from common cold symptoms. Early self-diagnosis and early use of ColdZyme mouth spray is a safe alternative for treatment of naturally occurring colds.


Assuntos
Resfriado Comum , Adulto , Humanos , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Masculino , Resfriado Comum/diagnóstico , Resfriado Comum/tratamento farmacológico , Resfriado Comum/complicações , Qualidade de Vida , Sprays Orais , Glicerol/uso terapêutico , Tripsina , Método Duplo-Cego , Rhinovirus , Boca
10.
Sci Data ; 10(1): 48, 2023 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-36681671

RESUMO

There is evidence linking hand, foot and mouth disease (HFMD) to gut microbiota dysbiosis, and this relationship was corroborated in a large HFMD patient population in our previous study. Here, we present a bacterial 16S rRNA gene dataset from faecal samples of 713 individuals (254 HFMD patients, 459 healthy controls) aged 2 to 7 years residing in Heyuan and Jiangmen counties, Guangdong Province, southern China. Microbiome analysis indicated a significant increase in genus Prevotella, Cetobacterium, and Megamonas was observed in patients with HFMD, whereas a large increase in genus Bacteroides, Ruminococcus, and Faecalibacterium were seen in the control group. We also share the bioinformatic analytical pipeline for this analysis, from data preprocessing to data filtering and amplicon sequence variant (ASV) table generation. We expect that the dataset will be reprocessed, evaluated and fully analysed with various analysis methods to further elucidate the role of the gut microbiota in HFMD development.


Assuntos
Doença de Mão, Pé e Boca , RNA Ribossômico 16S , Humanos , Fezes/microbiologia , Genes de RNAr , Doença de Mão, Pé e Boca/genética , Boca , RNA Ribossômico 16S/genética
11.
BMJ Case Rep ; 16(1)2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36669786

RESUMO

Odontoma is the most common benign odontogenic hamartoma. Odontomas are of two types, such as viz compound and complex odontoma. The complex type is a conglomeration of hard tissues of dental origin. They are primarily intraosseous and usually present in the second decade of life. Most odontomas are asymptomatic, but those erupting in the oral cavity may cause severe infection. They are often associated with impacted teeth and are present with the anterior maxilla showing the highest propensity.The present case report is of a male patient in his early 60s with a substantial solitary sclerotic odontoma of the middle and posterior segments of the maxilla erupted into the oral cavity communicating with the right maxillary sinus. The delayed presentation, size, location and active suppuration can misguide clinicians.


Assuntos
Odontoma , Osteomielite , Dente Impactado , Humanos , Masculino , Odontoma/diagnóstico por imagem , Odontoma/cirurgia , Maxila , Boca , Osteomielite/diagnóstico por imagem , Osteomielite/complicações
12.
PeerJ ; 11: e14746, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36718448

RESUMO

In this study, we used escape location underneath the trawl to understand groundfish herding behaviour at the trawl mouth. Three collecting bags (port, center, starboard) were mounted under the trawl and behind the footgear to collect escapees. The escape-at-length of species that escaped into the center bag were compared to the two wing bags to infer fish response behaviour, herding behaviour, and swimming capacity at the trawl mouth. For roundfish, smaller-sized individuals escaped more in the center for both Atlantic cod (Gadus morhua) and haddock (Melanogrammus aeglefinus), <20 and 11 cm, respectively, indicating that larger-sized fish were to a greater extent seeking to escape under the trawl at the wings, vs small fish being herded to the center and likely overrun due to reduced swimming capacity. For flatfish and monkfish (Lophius piscatorius), results varied. European plaice (Pleuronectes platessa), American plaice (Hippoglossoides platessoides), and monkfish were caught most often in the wings, though not significantly for American plaice. Catches of dab (Limanda limanda) between 18 and 27 cm were significantly higher in the center, with no difference for smaller and larger individuals. The differences between fish escape location likely result from a combination of varying herding behaviour, size, and swimming capacity. Here, we were able to show how these size-dependent behaviours relate to fish response behaviour, escape behaviour, size, and likely swimming capacity.


Assuntos
Linguado , Gadiformes , Gadus morhua , Animais , Peixes/fisiologia , Gadiformes/fisiologia , Linguado/fisiologia , Boca
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 55(1): 120-123, 2023 Feb 18.
Artigo em Chinês | MEDLINE | ID: mdl-36718699

RESUMO

OBJECTIVE: To preliminarily explore the applicable scenarios of an intraoral camera to assist oral anatomical landmarks recognition, so as to improve the clinical diagnosis and treatment mode, cultivate the concept of caring for patients, strengthen doctor-patient communication, assist experts to teach, and improve the clinical diagnosis and efficacy rate. METHODS: A new type of an intraoral camera was applied in the recognition of oral anatomy landmarks and four application scenarios were developed, namely: (1) clinical diagnosis and treatment scenarios, in which doctors used intraoral camera to conduct a comprehensive examination of patients in the mouth and take videos and photos; (2) doctor-patient communication scenarios, when the doctor told the patient about the treatment plan, the video or photo taken by the intraoral camera was displayed to the patient; (3) expert teaching scenarios, when the expert used an intraoral camera to teach in the patient's mouth, and the young doctor learned oral anatomical signs on the projection screen, with the study of theoretical lessons; (4) difficult case recording scenarios, in the process of clinical diagnosis and treatment, when encountering difficult cases, you could use intraoral camera to record and take photos for young doctors to discuss, and experts to comment and guide. RESULTS: The application of intraoral camera could: (1) improve the clinical diagnosis and treatment mode and raise the clinical diagnosis and efficacy rate; (2) stimulate young doctors' interest in learning, use intraoral camera in assessments, and skillfully combine theoretical knowledge of anatomical landmarks with clinical practice, so as to improve the teaching effect; (3) cultivate, through self or mutual use, the concept of caring for patients and reinforce the importance of gentle operation; (4) strengthen doctor-patient communication. Doctors could communicate with patients more visually, so that the patients could better understand their own situation, and strengthen the patients' trust in the doctors. CONCLUSION: Intraoral camera can assist oral clinical diagnosis and treatment, such as the recognition of oral anatomical landmarks. It plays a certain role in promoting the improvement of clinical diagnosis and treatment mode, stimulating learning interest, cultivating the concept of caring for patients, and enhancing doctor-patient communication.


Assuntos
Relações Médico-Paciente , Médicos , Humanos , Comunicação , Boca , Aprendizagem
15.
Chem Res Toxicol ; 36(1): 43-52, 2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36598842

RESUMO

Little filtered cigars are tobacco products with many cigarette-like characteristics. However, despite cigars falling under the U.S. Food and Drug Administration regulatory authority, characterizing flavors, which are still allowed in little filtered cigars, and filter design may influence how people use the products and the resulting exposure to harmful and potentially harmful constituents. We estimated nicotine mouth level intake (MLI) from analyses of little cigar filter butt solanesol levels, brand characteristics, carbon monoxide boost, and puff volume in 48 dual cigarette/cigar users during two repeat bouts of ad lib smoking of three little filtered cigar brands. Mean nicotine MLI for the three brands was significantly different with Swisher Sweets (0.1% ventilation) Cherry at 1.20 mg nicotine, Cheyenne Menthol (1.5%) at 0.63 mg, and Santa Fe unflavored (49%) at 0.94 mg. The association between nicotine MLI and puff volume was the same between Cheyenne Menthol and Santa Fe unflavored. However, these were different from Swisher Sweets Cherry. At least five main factors─flavor, ventilation, filter design, nicotine delivery related to tar, and user puff volume─may directly or indirectly impact MLI and its association with other measures. We found that users of little filtered cigars that have different filter ventilation and flavor draw dissimilar amounts of nicotine from the product, which may be accompanied by differences in exposure to other harmful smoke constituents.


Assuntos
Nicotina , Produtos do Tabaco , Adulto , Humanos , Nicotina/análise , Mentol , Produtos do Tabaco/análise , Fumar , Tabaco , Boca/química
17.
Sci Rep ; 13(1): 677, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36635354

RESUMO

Orthodontic tooth movement (OTM) occurs through proteolytic remodelling within the periodontium following the application of external force to the tooth. This study describes the first characterization of the salivary peptidome and protease profile during the alignment stage of fixed appliance orthodontic treatment. Unstimulated whole mouth saliva from 16 orthodontic patients (10 males, 6 females, mean (SD) age 15.2 (1.6) years) was collected prior to fixed appliance placement (T1), 1-h (T2), 1-week (T3) following fixed appliance placement and on completion of mandibular arch alignment (T4). Salivary peptides were extracted using filtration followed by mass spectrometry to identify amino acid sequences. Protease prediction was carried out in silico using Proteasix and validated with gelatin zymography and enzyme-linked immunosorbent assay. A total of 2852 naturally-occurring peptides were detected, originating from 436 different proteins. Both collagen and statherin-derived peptide levels were increased at T2. Proteasix predicted 73 proteases potentially involved in generating these peptides, including metalloproteinases, calpains and cathepsins. Changes in predicted activity of proteases over time were also observed, with most metalloproteinases showing increased predicted activity at T2-T3. Increased gelatinolytic activity and MMP8/MMP9 levels were detected at T3. Collectively, multiple protein targets and changes in protease-predicted activity during OTM have been identified.


Assuntos
Endopeptidases , Peptídeo Hidrolases , Técnicas de Movimentação Dentária , Adolescente , Feminino , Humanos , Masculino , Endopeptidases/metabolismo , Boca/metabolismo , Aparelhos Ortodônticos Fixos , Peptídeo Hidrolases/metabolismo , Saliva/metabolismo
18.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 54(1): 1-6, 2023 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-36647635

RESUMO

As one of the most diverse microbial communities within the human body, the oral microbiome is an important component that contributes to the maintenance of human health. The microbial composition of different sites in the oral cavity varies significantly and a dynamic equilibrium is maintained through communications with the environment and oral and distal organs of the host. It has been reported that there is significant correlation between dysbiotic oral microbiome and the occurrence or progression of a variety of systemic diseases. In this review, we summarized recent advances in research on the relationship between oral microbiome and systemic health, focusing on the interaction and pathological mechanisms between oral microbiome and systemic health and hoping to provide new avenues for the early prevention and clinical diagnosis and treatment of systemic diseases.


Assuntos
Microbiota , Humanos , Boca , Disbiose
19.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 54(1): 14-19, 2023 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-36647637

RESUMO

Nicotinamide (NAM) is the amide form of niacin and one of the precursors of nicotinamide adenine dinucleotide (NAD +). NAM can be used as a dietary supplement or clinical therapeutic drug to replenish NAD + levels in the human body and participate in key bodily functions such as cellular metabolism and DNA repair. NAM has the advantage of low cost, wide availability, and sound biosafety. It also has multiple biological functions, including antibacterial effect, anti-inflammatory effect, and modulation of cellular immunity, producing significant ameliorative effects on skin and neurodegenerative diseases. However, most studies on NAM are still at the laboratory stage. Herein we reviewed the role and mechanism of NAM in the prevention and treatment of oral and systemic diseases, explored its potential as clinical therapeutic medication, provided some basis and references for the clinical application of nicotinamide in the prevention and treatment of various diseases, and discussed its prospects for future research and application.


Assuntos
NAD , Niacinamida , Humanos , Niacinamida/farmacologia , Niacinamida/uso terapêutico , NAD/metabolismo , Pele/metabolismo , Boca/metabolismo , Face
20.
Methods Mol Biol ; 2588: 61-73, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36418682

RESUMO

Culture-independent nucleic acid technologies have been extensively applied to the analysis of oral bacterial communities associated with healthy and diseased conditions. These methods have confirmed and substantially expanded the findings from culture studies to reveal the oral microbial inhabitants and candidate pathogens associated with the major oral diseases. Over 1000 bacterial distinct species-level taxa have been identified in the oral cavity and studies using next-generation DNA sequencing approaches indicate that the breadth of bacterial diversity is even much larger. Nucleic acid technologies have also been helpful in profiling bacterial communities and identifying disease-related patterns. This chapter provides an overview of the diversity and taxonomy of oral bacteria associated with health and disease.


Assuntos
Microbiota , Ácidos Nucleicos , Microbiota/genética , Boca , Sequenciamento de Nucleotídeos em Larga Escala , Nível de Saúde
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