Genetic diversity of Trypanosoma cruzi strains isolated from chronic chagasic patients and non-human hosts in the state of São Paulo, Brazil.

BACKGROUND: Trypanosoma cruzi shows an exuberant genetic diversity. Currently, seven phylogenetic lineages, called discrete typing units (DTUs), are recognised: TcI-TcVI and Tcbat. Despite advances in studies on T. cruzi and its populations, there is no consensus regarding its heterogeneity. OBJECTIVES: This study aimed to perform molecular characterisation of T. cruzi strains, isolated in the state of São Paulo, to identify the DTUs involved and evaluate their genetic diversity. METHODS: T. cruzi strains were isolated from biological samples of chronic chagasic patients, marsupials and triatomines through culture techniques and subjected to molecular characterisation using the fluorescent fragment length barcoding (FFLB) technique. Subsequently, the results were correlated with complementary information to enable better discrimination between the identified DTUs. FINDINGS: It was possible to identify TcI in two humans and two triatomines; TcII/VI in 19 humans, two marsupials and one triatomine; and TcIII in one human host, an individual that also presented a result for TcI, which indicated the possibility of a mixed infection. Regarding the strains characterised by the TcII/VI profile, the correlation with complementary information allowed to suggest that, in general, these parasite populations indeed correspond to the TcII genotype. MAIN CONCLUSIONS: The TcII/VI profile, associated with domestic cycles and patients with chronic Chagas disease, was the most prevalent among the identified DTUs. Furthermore, the correlation of the study results with complementary information made it possible to suggest that TcII is the predominant lineage of this work.

Effect of sintering process on microstructure, 4-point flexural strength, and grain size of yttria-stabilized tetragonal zirconia polycrystal for use in monolithic dental restorations.

STATEMENT OF PROBLEM: Modifications have been made in the microstructure and sintering parameters of monolithic zirconia to improve esthetics qualities and avoid chipping of 2-layer restorations. However, how these modifications affect the physical and mechanical properties of zirconia is unclear. PURPOSE: The purpose of this in vitro study was to compare the influence of different sintering parameters on the microstructure, 4-point flexural strength, density, and grain size of 2 commercially available zirconia advocated for the fabrication of monolithic dental prostheses and 1 commercially available zirconia for use as a core material. MATERIAL AND METHODS: Three presintered blocks (Ceramill Zolid, Prettau, and IPS e.max ZirCAD) were used. Specimens were cut and sintered as per the manufacturer's recommendation or as per a modified heating protocol. Ceramill Zolid (Z1450) was sintered at 1450 °C, Prettau (P1600) was sintered at 1600 °C, and IPS e.max ZirCAD (I1530) was sintered at 1530 °C by following the manufacturer's heating protocol. Groups Ceramill Zolid Z1530 and Z1600 were sintered at temperatures higher than the manufacturer's recommendation. Specimens from each group (n=13) were analyzed with X-ray diffraction (XRD), density calculus, average grain size measurement, and 4-point flexural tests. Data were compared by using ANOVA (α=.05). RESULTS: XRD analysis showed the presence of a tetragonal metastable phase in all groups before and after sintering. No significant differences were found in relative density values for the 3 Ceramill groups (5.98 g/cm3). Groups I1530 (6.03 g/cm3) and P1600 (6.03 g/cm3) had similar density results greater than 6.00 g/cm3. The average grain size of all groups remained lower than 1 µm. P1600 had the highest grain size (0.817 µm), and Z1450 presented the lowest grain size (0.465 µm). P1600 showed the most homogeneous flexural strength and the highest Weibull modulus (m=8.22). Z1530 presented the lowest Weibull modulus (m=4.58). IPS e.max ZirCAD (I1530) had the highest flexural strength (1057.41 ±150.54 MPa), and Ceramill Zolid Z1450 had the lowest (621.01 ±138.08 MPa). CONCLUSIONS: The flexural strength, microstructure, crystal phase, and grain size of the analyzed zirconia varied as per the sintering processing. The IPS e.max ZirCAD had the highest flexural strength (1057.41 ±150.54 MPa), followed by Prettau zirconia (864.18 ±118.21), with a statistically significant difference (P<.05). The Ceramill Zolid zirconia presented the lowest flexural strength, as well as the lowest reliability for all sintering parameters used (Z1450: 621.01 ±138.08 MPa and m=5.42; Z1530: 713.10 ±175.44 MPa and m=4.58; Z1600: 630.15 ±112.08 MPa and m=6.87). At a lower heating rate (8 °C/min), the final density increased and excessive grain growth in group Z1530 was prevented.

Indication of CPAP without a sleep study in patients with high pretest probability of obstructive sleep apnea.

OBJECTIVE: To evaluate the performance of clinical criteria (CC) for diagnosis and initiation of empirical treatment with continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea (OSA) compared with the treatment decision based on sleep studies (polysomnography or respiratory polygraphy), guidelines, and experience of participating physicians. METHODS: This was a simulated intention-to-treat study in a retrospective (G1) and prospective (G2) cohort. Four observers (two per group) called CC1 and CC2 reviewed the sleep questionnaires and indicated CPAP if the patients presented snoring, frequent apneas (≥ 3-4/week), body mass index (BMI) > 25 kg/m2, sleepiness (Epworth > 11), or tiredness (at least 3-4 times per week) and some comorbidity (hypertension, coronary/cerebrovascular event, diabetes). Ten independent observers formed two groups of five (FD1 and FD2) and were blinded to each other's opinion. These observers in FD1 and FD2 decided CPAP treatment based on guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) or guidelines of the American Academy of Sleep Medicine (AASM) and factored in their own opinion. Sensitivity (S), specificity (Sp), and positive/negative likelihood ratios (LR+/-) were calculated with the test method: CC1/2, and the reference method: majority decision of FD1/2. RESULTS: A total of 653 patients (264 women, 40%) were studied. Median age was 54 years, BMI 28 kg/m2, and apnea hypopnea index (AHI) 16.5 events/h. S ranged from 21 to 25% (p 0.60), Sp 96.1 to 97.6% (p 0.39), and LR+ of clinical criteria 6.4 to 8.9 (p 0.52). CONCLUSION: CPAP indication without a previous sleep study showed a low sensitivity (≅ 22%) but a specificity greater than 95% in patients with high pretest probability for OSA (snoring, report of frequent apneas, BMI > 25 kg/m2 and sleepiness or tiredness plus comorbidity).

Biocompatibility of bioabsorbable Mg-Ca alloys with rare earth elements addition.

The objectives were to investigate the mechanical strength and biocompatibility of Mg2Ca2Gd and Mg1Ca2Nd (wt%) alloys developed for biomedical application as implantable bioabsorbable devices. Samples were implanted in New-Zealand rabbits tibia for 3, 6 and 8 weeks and compatibility analysis involved whole blood test, biochemistry, histopathology, histology, and radiographs. Refinement in grains were observed in Mg2Ca2Gd alloy; and Mg5Gd, Mg41Nd5, α-Mg and Mg2Ca phases were identified. Polarization curves revealed easier oxidation of Mg2Ca2Gd alloy, smaller values of corrosion rate and a higher polarization resistance of Mg1Ca2Nd. Adequate compatibility of both alloys was identified with pre-osteoblast stem cells. Red and white cells stayed compatible with reference ranges. Enzymes from liver and kidneys stayed at regular values and samples from kidneys and liver tissues presented similar organization to control animals. Histological displays from implantation sites disclosed well-structured tissues with evidences of bone cells activities compatible with the new bone tissues observed. Radiographs from tibias did not revealed relevant gas pockets. Mg2Ca2Gd alloy demonstrated faster degradation. Adequate biocompatibility was observed in Mg-Ca alloys with RE addition, being potential candidates for development of metallic implantable bioabsorbable devices.

Evaluation of the Effect of Air Polishing With Different Abrasive Powders on the Roughness of Implant Abutment Surface: An In Vitro Study.

The aim of this in vitro study was to evaluate the effect of air polishing on the implant abutment surface using different abrasive powders: sodium bicarbonate and amino acid glycine. Fifteen grade III machined surface titanium disks with 8-mm diameter and 2-mm thickness were divided in 3 groups of 5 samples each and subjected to air polishing for 20 seconds with an Ultrajet Flex air-abrasive device and a distinct prophylaxis protocol: air and water (G1); air, water, and sodium bicarbonate (G2); and air, water; and amino acid glycine (G3). After the air polishing, the average roughness (Ra) of the samples was measured using an optical profilometer, and the obtained data were statistically analyzed. We found that G1 and G3 had similar Ra, while Ra values for G2 were significantly higher. This study demonstrated that air-polishing powders containing glycine had less of an effect on the roughness of the surface of titanium disks compared with sodium bicarbonate powders. Future in vivo studies will be conducted to investigate the clinical relevance of the present results.

Evaluation of Whole-Genome Sequencing for Mycobacterial Species Identification and Drug Susceptibility Testing in a Clinical Setting: a Large-Scale Prospective Assessment of Performance against Line Probe Assays and Phenotyping.

Use of whole-genome sequencing (WGS) for routine mycobacterial species identification and drug susceptibility testing (DST) is becoming a reality. We compared the performances of WGS and standard laboratory workflows prospectively, by parallel processing at a major mycobacterial reference service over the course of 1 year, for species identification, first-line Mycobacterium tuberculosis resistance prediction, and turnaround time. Among 2,039 isolates with line probe assay results for species identification, 74 (3.6%) failed sequencing or WGS species identification. Excluding these isolates, clinically important species were identified for 1,902 isolates, of which 1,825 (96.0%) were identified as the same species by WGS and the line probe assay. A total of 2,157 line probe test results for detection of resistance to the first-line drugs isoniazid and rifampin were available for 728 M. tuberculosis complex isolates. Excluding 216 (10.0%) cases where there were insufficient sequencing data for WGS to make a prediction, overall concordance was 99.3% (95% confidence interval [CI], 98.9 to 99.6%), sensitivity was 97.6% (91.7 to 99.7%), and specificity was 99.5% (99.0 to 99.7%). A total of 2,982 phenotypic DST results were available for 777 M. tuberculosis complex isolates. Of these, 356 (11.9%) had no WGS comparator due to insufficient sequencing data, and in 154 (5.2%) cases the WGS prediction was indeterminate due to discovery of novel, previously uncharacterized mutations. Excluding these data, overall concordance was 99.2% (98.7 to 99.5%), sensitivity was 94.2% (88.4 to 97.6%), and specificity was 99.4% (99.0 to 99.7%). Median processing times for the routine laboratory tests versus WGS were similar overall, i.e., 20 days (interquartile range [IQR], 15 to 31 days) and 21 days (15 to 29 days), respectively (P = 0.41). In conclusion, WGS predicts species and drug susceptibility with great accuracy, but work is needed to increase the proportion of predictions made.

SUMOylation represses SnRK1 signaling in Arabidopsis.

The SnRK1 protein kinase balances cellular energy levels in accordance with extracellular conditions and is thereby key for plant stress tolerance. In addition, SnRK1 has been implicated in numerous growth and developmental processes from seed filling and maturation to flowering and senescence. Despite its importance, the mechanisms that regulate SnRK1 activity are poorly understood. Here, we demonstrate that the SnRK1 complex is SUMOylated on multiple subunits and identify SIZ1 as the E3 Small Ubiquitin-like Modifier (SUMO) ligase responsible for this modification. We further show that SnRK1 is ubiquitinated in a SIZ1-dependent manner, causing its degradation through the proteasome. In consequence, SnRK1 degradation is deficient in siz1-2 mutants, leading to its accumulation and hyperactivation of SnRK1 signaling. Finally, SnRK1 degradation is strictly dependent on its activity, as inactive SnRK1 variants are aberrantly stable but recover normal degradation when expressed as SUMO mimetics. Altogether, our data suggest that active SnRK1 triggers its own SUMOylation and degradation, establishing a negative feedback loop that attenuates SnRK1 signaling and prevents detrimental hyperactivation of stress responses.

Insidious Risk of Severe Mycobacterium chimaera Infection in Cardiac Surgery Patients.

BACKGROUND: An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands. METHODS: Parallel investigations were pursued: (1) identification of cardiopulmonary bypass-associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates. RESULTS: Eighteen probable cases of cardiopulmonary bypass-associated M. chimaera infection were identified; all except one occurred in adults. Patients had undergone valve replacement in 11 hospitals between 2007 and 2015, a median of 19 months prior to onset (range, 3 months to 5 years). Risk to patients increased after 2010 from <0.2 to 1.65 per 10000 person-years in 2013, a 9-fold rise for infections within 2 years of surgery (rate ratio, 9.08 [95% CI, 1.81-87.76]). Endocarditis was the most common presentation (n = 11). To date, 9 patients have died. Investigations identified aerosol release through breaches in heater-cooler tanks. Mycobacterium chimaera and other pathogens were recovered from water and air samples. Phylogenetic analysis found close clustering of strains from probable cases. CONCLUSIONS: We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection.

Same-Day Diagnostic and Surveillance Data for Tuberculosis via Whole-Genome Sequencing of Direct Respiratory Samples.

Routine full characterization of Mycobacterium tuberculosis is culture based, taking many weeks. Whole-genome sequencing (WGS) can generate antibiotic susceptibility profiles to inform treatment, augmented with strain information for global surveillance; such data could be transformative if provided at or near the point of care. We demonstrate a low-cost method of DNA extraction directly from patient samples for M. tuberculosis WGS. We initially evaluated the method by using the Illumina MiSeq sequencer (40 smear-positive respiratory samples obtained after routine clinical testing and 27 matched liquid cultures). M. tuberculosis was identified in all 39 samples from which DNA was successfully extracted. Sufficient data for antibiotic susceptibility prediction were obtained from 24 (62%) samples; all results were concordant with reference laboratory phenotypes. Phylogenetic placement was concordant between direct and cultured samples. With Illumina MiSeq/MiniSeq, the workflow from patient sample to results can be completed in 44/16 h at a reagent cost of £96/£198 per sample. We then employed a nonspecific PCR-based library preparation method for sequencing on an Oxford Nanopore Technologies MinION sequencer. We applied this to cultured Mycobacterium bovis strain BCG DNA and to combined culture-negative sputum DNA and BCG DNA. For flow cell version R9.4, the estimated turnaround time from patient to identification of BCG, detection of pyrazinamide resistance, and phylogenetic placement was 7.5 h, with full susceptibility results 5 h later. Antibiotic susceptibility predictions were fully concordant. A critical advantage of MinION is the ability to continue sequencing until sufficient coverage is obtained, providing a potential solution to the problem of variable amounts of M. tuberculosis DNA in direct samples.

Influence of acid treatment on surface properties and in vivo performance of Ti6Al4V alloy for biomedical applications.

The purpose of this work was to investigate the influence of acid treatment on the surface properties and in vivo performance of titanium grade 5 (Ti6Al4V) alloy. Mini-implants with surface treatment were inserted into New Zealand rabbit tibia for 1, 4 and 8 weeks. SEM analysis showed intercommunicated micropores in acid treated samples. AFM showed micron and sub-micron roughness. The thickness of the titanium oxide layer increased with surface treatment, with a significant reduction of Al and V concentration. Acid treated implant removal torque was larger than without treatment. The implants/bone interface of acid treated implants showed dense adhered Ca/P particles with spreading osteoblasts after 4 weeks and newly formed bone trabeculae after 8 weeks. Analysis of rabbit blood that received treated implant showed lower Al and V contents at all times. Acid treatment improved surface morphology and mechanical stability, which allowed initial events of osseointegration, while Al-V ion release was reduced. GRAPHICAL ABTSRACT.

In vitro analysis of the microbiological sealing of tapered implants after mechanical cycling.

OBJECTIVE: The aim of this in vitro study was to evaluate the mechanical behavior and bacterial microleakage at the implant/abutment-tapered interface following mechanical cycling. MATERIALS AND METHODS: Two groups of screwless (Morse taper) implants (G1 and G2) and two groups of prosthetic screwed implants (G3 and G4) were tested. One group from each model (G2 and G4) were submitted to mechanical cycling, 500,000 cycles per sample, at a load of 120 N at 2 Hz prior to analysis. Microbiological analysis was performed via immersion of all samples in an Escherichia coli-containing suspension, incubated at 37 °C. After 14 days, the abutments were removed from their respective implants, registering the removal force (G1 and G2) or reverse torque (G3 and G4), and the presence of bacterial leakage was evaluated. Scanning electron microscopy (SEM) was performed to analyze the tapered surfaces of the selected samples. The Student t, binomial, and G tests were used for statistical analysis at a 5 % significance level. RESULTS: The results showed no significant difference between removal force, reverse torque, and contamination values when comparing implants of the same type. However, when the four groups were compared, contamination differed significantly (p = 0.044), with G1 having the least number of contaminated samples (8.3 %). SEM analysis showed superficial defects and damage. CONCLUSIONS: The abutment removal force or torque was not affected by mechanical cycling. Bacterial sealing of the implant/abutment tapered interface was not effective for any condition analyzed. Imprecise machining of implant parts does not allow a sufficient contact area between surfaces to provide effective sealing and prevent bacterial leakage. CLINICAL RELEVANCE: The microscopic gap caused by unsatisfactory implant/abutment adaptation, surface irregularities, and plastic deformation of all parts enabled bacterial contamination of the oral implants.

Surface analysis of 2 orthodontic mini-implants after clinical use.

INTRODUCTION: The purpose of this study was to analyze the design and surface morphology of 2 brands of mini-implants before and after 12 to 18 months of clinical use. METHODS: We studied 22 mini-implants sold in the Brazilian market by 2 companies (Forestadent, Pforzheim, Germany; and Dental Morelli, Sorocaba, São Paulo, Brazil). The surface morphology of the mini-implants was analyzed by scanning electron microscopy before and after insertion in the oral environment to aid orthodontic movement. RESULTS: The Forestadent and the Morelli mini-implants showed different shapes (size, screw thread design), and the surface morphology changed after clinical use. The most important surface morphology alterations after clinical use were strain in several parts and fracture of the active thread part of some mini-implants. CONCLUSIONS: The results of the analyses showed that the screw threads of the mini-implants differ in pitch, angle, and length. The mini-implants also showed differences in body design, active tip, and taper. These differences affect the performance of the mini-implants. After clinical use, all mini-implants showed surface degradation, plastic deformation, and some fractures.

Mycobacterial DNA extraction for whole-genome sequencing from early positive liquid (MGIT) cultures.

We developed a low-cost and reliable method of DNA extraction from as little as 1 ml of early positive mycobacterial growth indicator tube (MGIT) cultures that is suitable for whole-genome sequencing to identify mycobacterial species and predict antibiotic resistance in clinical samples. The DNA extraction method is based on ethanol precipitation supplemented by pretreatment steps with a MolYsis kit or saline wash for the removal of human DNA and a final DNA cleanup step with solid-phase reversible immobilization beads. The protocol yielded ≥0.2 ng/µl of DNA for 90% (MolYsis kit) and 83% (saline wash) of positive MGIT cultures. A total of 144 (94%) of the 154 samples sequenced on the MiSeq platform (Illumina) achieved the target of 1 million reads, with <5% of reads derived from human or nasopharyngeal flora for 88% and 91% of samples, respectively. A total of 59 (98%) of 60 samples that were identified by the national mycobacterial reference laboratory (NMRL) as Mycobacterium tuberculosis were successfully mapped to the H37Rv reference, with >90% coverage achieved. The DNA extraction protocol, therefore, will facilitate fast and accurate identification of mycobacterial species and resistance using a range of bioinformatics tools.

Colonization with Enterobacteriaceae producing ESBLs in children attending pre-school childcare facilities in the Lao People's Democratic Republic.

OBJECTIVES: Intestinal carriage constitutes an important reservoir of antimicrobial-resistant bacteria, with some of the highest rates reported from Asia. Antibiotic resistance has been little studied in Laos, where some antibiotics are available without restriction, but others such as carbapenems are not available. PATIENTS AND METHODS: We collected stools from 397 healthy children in 12 randomly selected pre-school childcare facilities in and around Vientiane. Colonization with ESBL-producing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) was detected using a disc diffusion screening test and ESBLE were characterized using WGS. Risk factor data were collected by questionnaire. RESULTS: Ninety-two children (23%) were colonized with ESBLE, mainly Escherichia coli carrying blaCTX-M and Klebsiella pneumoniae carrying blaSHV or blaCTX-M, which were frequently resistant to multiple antibiotic classes. Although residence in Vientiane Capital, foreign travel, higher maternal level of education, antibiotic use in the preceding 3 months and attending a childcare facility with a 'good' level of hygiene were all associated with ESBLE colonization on univariable analysis, a significant association remained only for antibiotic use when a stepwise approach was used with a multivariate random-effects model. WGS analysis suggested transmission in both childcare facilities and community settings. CONCLUSIONS: The high prevalence of paediatric colonization with ESBLE in Laos, one of the highest reported in Asia, is probably the result of inappropriate antibiotic use. Paediatric colonization with CPE was not identified in this study, but it is important to continue to monitor the spread of antibiotic-resistant Enterobacteriaceae in Laos.

Whole-genome sequencing demonstrates that fidaxomicin is superior to vancomycin for preventing reinfection and relapse of infection with Clostridium difficile.

Whole-genome sequencing was used to determine whether the reductions in recurrence of Clostridium difficile infection observed with fidaxomicin in pivotal phase 3 trials occurred by preventing relapse of the same infection, by preventing reinfection with a new strain, or by preventing both outcomes. Paired isolates of C. difficile were available from 93 of 199 participants with recurrences (28 were treated with fidaxomicin, and 65 were treated with vancomycin). Given C. difficile evolutionary rates, paired samples ≤2 single-nucleotide variants (SNVs) apart were considered relapses, paired samples >10 SNVs apart were considered reinfection, and those 3-10 SNVs apart (or without whole-genome sequences) were considered indeterminate in a competing risks survival analysis. Fidaxomicin reduced the risk of both relapse (competing risks hazard ratio [HR], 0.40 [95% confidence interval {CI}, .25-.66]; P = .0003) and reinfection (competing risks HR, 0.33 [95% CI, 0.11-1.01]; P = .05).

Assessment of exogenous pigmentation in colourless elastic ligatures.

INTRODUCTION: The aim of this study was to evaluate colour alteration of transparent elastic ligatures submitted to exogenous pigmentation. METHODS: Forty test specimens were divided into eight groups corresponding to one commercial brand with five test specimens in each group. The test specimens were immersed into coffee and black tea solutions with the purpose of assessing colour alteration using a portable digital spectrophotometer (Vita Easyshade Compact). The surfaces of the ligatures under scanning electron microscope (SEM) at ×30, ×150 and ×20,000 magnification were evaluated with the purpose of observing the differences in porosity of the ligatures. The Kolmogorov-Smirnov test for normality was applied followed by the one-way analysis of variance (one-way ANOVA) and the level of significance adopted was 95%. RESULTS: All the groups showed modified initial colour that was perceptible to the human eye. The brand that showed greater colour alteration, in comparison with its initial colour, was the American® pearl elastic ligature and the ligatures that presented the smallest colour variation were the Ortho-Organizer®. The surface evaluations of the ligatures showed differences with regard to the topography evidencing more porosity in the ligatures that showed greater staining. CONCLUSION: The group that changed colour significantly was the one that presented the highest porosity, and the brand that was the least altered was the one that showed the lowest porosity.

Spatial patterns of prematurity and its determinants in the metropolitan region of São Paulo, Brazil, 2010-2019.

OBJECTIVE: To analyze spatial distribution of preterm births and their association with maternal, social, and health services indicators in the metropolitan region of São Paulo, Brazil, 2010-2019. METHODS: Ecological study using data on preterm newborns from 39 municipalities in the metropolitan region of São Paulo. Univariate global Moran's index (Im) was used to evaluate spatial association of prematurity, and univariate local Moran's index by using the cluster map (LISA) to identify spatial patterns and clusters. Bivariate global Moran's index was also used to analyze spatial autocorrelation with maternal, social, and health services indicators. RESULTS: A total of 3,103,898 live births were registered in period 2010-2019, of which 331,174 (10.7%) were preterm. The global Moran's index showed spatial independence (Im=0.05; p-value=0.233) of the proportion of preterm births between municipalities. However, in the local spatial analysis it was possible to identify a statistically significant spatial cluster between the municipalities of Biritiba Mirim, Guararema and Salesópolis, with high proportions of preterm births. In the bivariate analysis, a significant positive spatial association was identified with proportions of mothers under 20 years old (Im=0.17; p-value=0.024) and mothers with low schooling (Im=0.17; p-value=0.020), and a significant negative spatial association with HDI (Im=-0.14; p-value=0.039). CONCLUSIONS: The local spatial approach identified a spatial cluster located in the far east of the metropolitan region of São Paulo, where actions by health managers are needed to minimize occurrence of preterm births.

Cross-section dimensions and mechanical properties of esthetic orthodontic coated archwires.

INTRODUCTION: There has been continuing interest in the development and use of esthetic and effective orthodontic archwires. The aims of this study were to evaluate the inner alloy core dimensions of 4 brands of as-received esthetic coated wires and their mechanical properties before and after 21 days of oral exposure, compared with conventional stainless steel and nickel titanium wires. METHODS: Four groups (Ortho Organizers, Carlsbad, Calif; TP Orthodontics, LaPorte, Ind; Orthometric, Beijing, China; and Trianeiro, Rio Claro, São Paulo, Brazil) of orthodontic archwires were tested. Five properties were evaluated: inner wire dimensions, modulus of elasticity, modulus of resilience, maximum deflection force, and load deflection curve characteristics. Images of the transverse sections from the specimens were made with a stereoscope. The inner alloy core dimensions of each wire were measured by using Image Pro Plus software (version 4.5; Media Cybernetics, Silver Spring, Md). All specimens were tested in a universal testing machine in a 3-point bending test. RESULTS: Coated wires of the Ortho Organizers and Trianeiro groups showed greater reductions in their inner alloy core dimensions and produced lower loading and unloading forces and lower modulus of elasticity, modulus of resilience, and maximum deflection force values than did their control wires. Inner alloy core dimensions and the mechanical behavior of coated wires practically did not differ from the control wires in the TP Orthodontics and Orthometric groups. CONCLUSIONS: The reduction on the inner alloy core dimensions to compensate for the coating thickness seems to be the variable responsible for greater changes in the mechanical properties of esthetic coated wires.

Populism, cyberdemocracy and disinformation: analysis of the social media strategies of the French extreme right in the 2014 and 2019 European elections.

Since the European elections in 2014, the populist formations had been increasing the shares of power that their masses finally claimed in the May 2019 elections. In the case of France, this rise of the Rassemblement National has even given rise to a new political regime: the Europeanism of Macron vs. the Euroscepticism of Le Pen. This paper aims to delve into the communication strategy of the latter formation, to see how it has been able to shift the party's fascist image towards that of a protector of national sovereignty and interests (against the European ones). To this end, the 1256 tweets posted on its official Twitter profile during the fortnight of the 2014 and 2019 European election campaigns have been qualitatively analysed. The results point to a whitening of its image, in order to present itself as a potential voting option for the majority of the French electorate while retaining a certain populist essence.