Clinical relevance of double heterozygosity revealed by next-generation sequencing of homologous recombination repair pathway genes in South African breast cancer patients.

PURPOSE: Genetically predisposed breast cancer (BC) patients represent a minor but clinically meaningful subgroup of the disease, with 25% of all cases associated with actionable variants in BRCA1/2. Diagnostic implementation of next-generation sequencing (NGS) resulted in the rare identification of BC patients with double heterozygosity for deleterious variants in genes partaking in homologous recombination repair of DNA. As clinical heterogeneity poses challenges for genetic counseling, this study focused on the occurrence and clinical relevance of double heterozygous BC in South Africa. METHODS: DNA samples were diagnostically screened using the NGS-based Oncomine™ BRCA Expanded Research Assay. Data was generated on the Ion GeneStudio S5 system and analyzed using the Torrent Suite™ and reporter software. The clinical significance of the variants detected was determined using international variant classification guidelines and treatment implications. RESULTS: Six of 1600 BC patients (0.375%) tested were identified as being bi-allelic for two germline likely pathogenic or pathogenic variants. Most of the variants were present in BRCA1/2, including two founder-related small deletions in three cases, with family-specific variants detected in ATM, BARD1, FANCD2, NBN, and TP53. The scientific interpretation and clinical relevance were based on the clinical and tumor characteristics of each case. CONCLUSION: This study increased current knowledge of the risk implications associated with the co-occurrence of more than one pathogenic variant in the BC susceptibility genes, confirmed to be a rare condition in South Africa. Further molecular pathology-based studies are warranted to determine whether clinical decision-making is affected by the detection of a second pathogenic variant in BRCA1/2 and TP53 carriers.

Patient perception of orthodontists with different stereotypes: development, psychometric properties, and application of an assessment instrument.

INTRODUCTION: This research aimed to develop and validate a questionnaire that considers social judgments and, through its application, assesses whether the presence of piercings, tattoos, beards, and loose hair visible in the face and neck region reflect on the patient perception regarding characteristics of the orthodontist's professional scope. METHODS: The developed questionnaire had its psychometric properties evaluated and was applied to 220 young people and adults, aged 18-70 years, who responded according to their perception of 12 manipulated images of orthodontists with different stereotypes, considering the following items: hygiene, care, punctuality, experience and knowledge in orthodontics. RESULTS: The developed questionnaire showed high acceptability, confirmed reliability and validity of the construct, and satisfactory internal consistency. The stereotype interfered with the perception of professionalism (P <0.01), in which the orthodontist with combined characteristics (beard/loose hair, piercing, earrings, and tattoo) obtained the lowest mean scores, both for each item of the questionnaire individually (P <0.01) and in total (P <0.01). Health professional (P = 0.427) and educational level (P = 0.285) status did not influence the perception; however, there was a significant difference for the age groups (P = 0.041). CONCLUSIONS: The developed questionnaire proved to be valid and reliable for application. Orthodontists with piercings and tattoos on the face and neck were considered less professional. Being a health professional and educational level status did not influence the perception. However, older subjects (aged 51-70 years) were more critical in judging stereotypes than younger subjects (aged 18-30 years).

Deformation of the circummaxillary sutures during acute micro-implant assisted rapid palatal expansion and tooth-supported expansion: An ex vivo study.

INTRODUCTION: This study aimed to assess and compare the deformation that develops in the circummaxillary sutures during activation of micro-implant assisted rapid palatal expander (MARPE) and tooth-supported expander (Hyrax) s, in the rapid maxillary expansion. SETTINGS AND SAMPLE: 7 pigs Sus Scrofa received custom-made MARPE (n = 3) and Hyrax (n = 4) appliances. MATERIAL AND METHODS: The devices were activated 25 times with strain readings captured by strain gauges attached to the following regions: posterior midpalatal suture (MPS), maxilla-premaxilla suture (MPM), maxilla-zygomatic suture (MZ) and maxilla pterygoid-process suture (MPP). The intermolar distance and suture width were measured immediately before activation and at the 20th and 25th activation. ANOVA and Kruskal-Wallis test was applied. RESULTS: The MARPE group presented greater MPS displacement in all measured regions, and one of the devices produced a significant opening (1.7 mm) in the posterior region. The accumulated tension in the MPS was higher compared to the other sutures (P < .05). A MARPE animal presented higher median tension in the MPS region (294.77µÎµ) compared to all other animals except one Hyrax animal (P < .05). Regarding the median tensions of the different activation intervals, the median tension measured during the 16th to 25th activation interval in the Hyrax group was lower than that measured during the first 8 activations, in both the MPS and MZ (P < .05). CONCLUSIONS: MARPE expanders developed more constant tensions during all activations (MPS and MZ), while Hyrax showed lower tension in the 16th to 25th activation.

Maternal-child exposure to metals during pregnancy in Rio de Janeiro city, Brazil: The Rio Birth Cohort Study of Environmental Exposure and Childhood Development (PIPA project).

BACKGROUND: Environmental metal exposure during pregnancy can affect intrauterine growth and disrupt child development. Metal exposure in urban areas can occur through the air, water and food routes. The city of Rio de Janeiro is the second more populous of Brazil and the sixth most populous in the American continent and is characterized by a significant social-economic inequality and a large range of urban organization problems. OBJECTIVES: To evaluate environmental heavy metal (arsenic, cadmium, lead and mercury) exposure in mother-newborns pairs in an urban area in Rio de Janeiro, Brazil. METHODS: All pregnant women, over 16 years of age, who came to the University Maternity School for newborn delivery orientation, between October and November 2017, were invited to participate in the project. Socioeconomic, cultural, leisure, and living conditions data of from the parents were collected via questionnaire; whole maternal blood and umbilical cord blood samples were also collected. RESULTS: Of the 209 eligible pregnant women 142 (68%) accepted the invitation to participate in the study. A total of 131 (92.3%) mothers delivered live born children, and maternal blood and umbilical cord blood were collected from 117 mother-newborn pairs. Metal concentrations above the detection limit were detected in all maternal and cord blood samples. Strong correlations of arsenic, cadmium, lead and mercury concentrations between maternal and umbilical cord blood were observed. Median lead and arsenic concentrations in maternal and umbilical cord blood were higher than values reported in other studies conducted in Brazil and worldwide. Lead concentrations in 25% of the umbilical cord blood samples were near of 5 µg/dL (P75 = 4.92 µg/dL). CONCLUSION: The results reported herein indicate the need for the establishment of health surveillance programs in Brazil, in order to investigate and monitor the health effects of environmental heavy metal exposure in children since the gestation period.

Toxicological, chemopreventive, and cytotoxic potentialities of rare vegetal species and supporting findings for the Brazilian Unified Health System (SUS).

Caatinga flora which are found in a poor Brazilian region contain a substantial number of endemic taxa with biomedical and social importance for regional communities. This study examined the antioxidant and cytotoxic potential of 35 samples (extracts/fractions) from 12 Caatinga species and determined the antiproliferative and genotoxic action of dichloromethane fraction from Mimosa caesalpiniifolia stem bark (DC-Mca) on human and vegetal cells. Samples were assessed for chemopreventive ability, toxic effects on Artemia salina shrimp as well as cytotoxicity on tumor cell lines and erythrocytes. DC-Mca was also tested with respect to antiproliferative and genotoxic effects upon normal leukocytes and meristematic cells from A. cepa roots. Some extracts reduced free radical levels >95% and 7 samples exhibited a lethal concentration (LC) 50 < 100 µg/ml upon Artemia salina larvae. Eight samples displayed in vitro antitumor effects and three produced hemolysis. Data also demonstrated the pharmacological significance of bioactive extracts from Brazilian semi-arid region. There was no significant relationship between antioxidant, toxic, and antiproliferative activities, and that these properties were dependent upon the extractant. DC-Mca contained betulinic acid as main compound (approximately 70%), which showed higher (1) cytotoxic activity on cancer cell lines and dividing leukocytes, (2) reduced mitotic index of Allium cepa roots, and (3) induced cell cycle arrest and chromosomal bridges, thereby providing native promising sources for phytotherapy development. ABBREVIATIONS: ABTS: 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid); AcOH: ethyl acetate; ANOVA: analysis of variance; SUS: Brazilian Unified Health System; DC-Mca: dichloromethane fraction from Mimosa caesalpiniifolia stem bark; DMSO: dimethylsulfoxide; DPPH: 1,1-diphenyl-2-picrylhydrazyl; EC50: effective concentration 50%; EtOAc: ethyl acetate; FDA: Food and Drug Administration; GC-Qms: gas chromatograph quadrupole mass spectrometer; GI: genotoxic index; HCT-116: colon carcinoma line; HL-60: promyelocytic leukemia line; HPLC: high-performance liquid chromatography; HRAPCIMS: high resolution atmospheric pressure chemical ionization mass spectrum; IC50: inhibitory concentration 50%; LC50: lethal concentration 50%; MeOH = methyl alcohol; MI: mitotic index; MTT: 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide; MutI: mutagenic index; OVCAR-8 = ovarian carcinoma line; PBMC: peripheral blood mononuclear cells; RPMI-1640: Roswell Park Memorial Institute medium; SF-295: glioblastoma line; TEAC: trolox equivalent antioxidant capacity; TLC: thin-layer chromatography; Trolox: 6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid.

Possible association between craniofacial dimensions and genetic markers in ESR1 and ESR2.

OBJECTIVE: To investigate the association of genetic markers in ESR1 and ESR2 with craniofacial measurements. DESIGN: Cross-sectional study. SETTING: School of Dentistry of Ribeirão Preto, University of São Paulo. PARTICIPANTS: A total of 146 biologically unrelated, self-reported Caucasian Brazilians with no syndromic conditions were included. METHODS: Sagittal and vertical measurements (ANB, S-N, Ptm'-A', Co-Gn, Go-Pg, N-Me, ANS-Me, S-Go and Co-Go) from lateral cephalograms were examined for craniofacial evaluation. DNA was extracted from saliva and genetic markers in ESR1 (rs2234693 and rs9340799) and in ESR2 (rs1256049 and rs4986938) were analysed by real-time polymerase chain reaction. Hardy-Weinberg equilibrium was evaluated using the Chi-square test within each marker. The associations between craniofacial dimensions and genotypes were analysed by linear regression and adjusted by sex and age. The established alpha was 5%. RESULTS: Individuals carrying CC in ESR1 rs2234693 had a decrease of -3.146 mm in ANS-Me (P = 0.044). In addition, rs4986938 in ESR2 was associated with S-N measurement (P = 0.009/ ß = -3.465). This marker was also associated with Go-Pg measurement, in which the CC genotype had a decrease of -3.925 mm in the length of the mandibular body (P = 0.043). CONCLUSION: The present study suggests that in ESR1 and ESR2 are markers for variations in the craniofacial dimensions. However, further research should confirm the results.

Combined maxillary and mandibular distraction osteogenesis in patients with hemifacial microsomia.

INTRODUCTION: Hemifacial microsomia is a deformity of variable expressivity with unilateral hypoplasia of the mandible and the ear. In this study, we evaluated skeletal soft tissue changes after bimaxillary unilateral vertical distraction. METHODS: Eight patients (4 preadolescents 4 adolescents) each with a grade II mandibular deformity underwent a LeFort I osteotomy and an ipsilateral horizontal mandibular ramus osteotomy. A semiburied distraction device was placed over the ramus, and intermaxillary fixation was applied. Anteroposterior cephalometric and frontal photographic analyses were conducted before and after distraction. Statistics were used to analyze the preoperative and postoperative changes. RESULTS: Cephalometrically, the nasal floor and the occlusal and gonial plane angles decreased. The ratios of affected-unaffected ramus and gonial angle heights improved by 15% and 20%, respectively. The position of menton moved toward the midline. The photographic analysis showed a decrease of the nasal and commissure plane angles, and the chin moved to the unaffected side. The parallelism between the horizontal skeletal and soft tissue planes improved, with an increase in the affected side ramus height and correction of the chin point toward the midline. CONCLUSIONS: Simultaneous maxillary and mandibular distraction improved facial balance and symmetry. Patients in the permanent dentition with fixed orthodontic appliances and well-aligned dental arches responded well to this intervention.

Prediction of 3-dimensional pharyngeal airway changes after orthognathic surgery: a preliminary study.

INTRODUCTION: Recent studies have shown some contradictory results when evaluating the consequences of orthodontic-surgical treatments on the pharyngeal airway. Therefore, the purpose of this study was to correlate the amount of jaw displacement with the volume variation and the minimal cross-sectional area of the pharyngeal airway. A comparison was made between the correlations with the percentage and the absolute values of the measurement variations. METHODS: Forty-two patients were divided into 2 groups according to the kind of orthognathic surgery that they had undergone. Group 1 had 22 subjects who had undergone maxillary advancement associated with mandibular setback, and group 2 had 20 patients who had undergone maxillomandibular advancement. The pharyngeal airway was divided into the upper segment and the lower segment, and the sum of these volumetric measures resulted in the total volume. The maxillary and mandibular displacements were assessed using closest point iteration after a voxel-wise cone-beam computed tomography superimposition. Hence, jaw displacements were correlated, using Pearson's correlation and linear regression analysis, to the volume variations of the pharyngeal airway (first time separately and then both groups together) and to the minimal cross-sectional area variation. RESULTS: The strongest correlation found was between maxillary displacement and the upper segment in group 2 (r = 0.898, R(2) = 0.888; P ≤0.001). With the groups' data combined, the variables mandibular displacement and the lower segment showed a linear correlation (r = 0.921, R(2) = 0.914; P ≤0.001). Maxillary displacement showed a strong positive correlation with the minimal cross-sectional area variation in group 2 (r = 0.710, R(2) = 0.604; P ≤0.01). CONCLUSIONS: Correlations with the percentage values were substantially stronger than the correlations with the absolute values. Stronger positive correlations were found between the jaw's displacement and the volume variation of the volume segment that was closer to it in both kinds of surgeries. Only the maxillary displacement is a reliable predictor of the minimal cross-sectional area variation after maxillomandibular advancement.

BMP2 rs1005464 is associated with mandibular condyle size variation.

This study aimed to evaluate the association between single nucleotide polymorphisms (SNPs) in endochondral development-related genes and mandibular condyle shape, size, volume, and symmetry traits. Cone-beam Computed Tomographies and genomic DNA from 118 individuals were evaluated (age range: 15-66 years). Data from twelve 3D landmarks on mandibular condyles were submitted to morphometric analyses including Procrustes fit, principal component analysis, and estimation of centroid sizes and fluctuating asymmetry scores. Condylar volumes were additionally measured. Seven SNPs across BMP2, BMP4, RUNX2 and SMAD6 were genotyped. Linear models were fit to evaluate the effect of the SNPs on the mandibular condyles' quantitative traits. Only the association between BMP2 rs1005464 and centroid size remained significant after adjusting to account for the false discovery rate due to multiple testing. Individuals carrying at least one A allele for this SNP showed larger condylar size than common homozygotes GG (ß = 0.043; 95% CI: 0.014-0.071; P value = 0.028). The model including BMP2 rs1005464, age and sex of the participants explained 17% of the variation in condylar size. Shape, volume, and symmetry were not associated with the evaluated SNPs. These results suggest that BMP2 rs1005464 might be associated with variation in the mandibular condyles size.

Root repair after contact with mini-implants: systematic review of the literature.

This systematic review identified and qualified the current evidence of dental root damage and repair after contact with mini-implants. The electronic databases Cochrane library, Ovid, Scirus, Scopus, and Virtual Health Library were used to search original articles from 1980 to December 2011. The inclusion criteria to select the articles were 1. randomized controlled trials and prospective clinical studies based on trials involving humans, 2. randomized controlled studies in animals, 3. use of mini-implants with a diameter less than 2.5 mm, and 4. root contact evaluation associated with the use of orthodontic mini-implants. Two authors independently reviewed and extracted data from the selected studies and a methodological quality assessment process was used to rank the studies classifying them as low moderate or high quality. The searches retrieved 579 citations. After initial selection, 17 studies were considered eligible and their full texts were assessed. Four of those were excluded because root damage was not evaluated and two were excluded because of overlapping samples. Eleven articles, nine in animals and two in humans, fulfilled the inclusion criteria. From these, two studies were ranked as presenting high methodological quality, eight were judged to be of moderate, and one of low quality. The evidence found suggested that the quality of root repair depends on the amount of damage caused by the mini-implant. When the damage is limited to the cementum or dentin, healing and almost complete and repair of the periodontal structure can occur. Mini-implants that injured the pulp were less likely to result in complete repair of the periodontal tissues.

COVID-19 and Hypertensive Disorders of Pregnancy (HDP): A Portuguese Multicentric Retrospective Cohort Study of HDP in SARS-CoV-2 Infected Patients.

BACKGROUND:  An increased incidence of hypertensive disorders of pregnancy (HDP) has been reported among pregnant women infected by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the pathogen behind coronavirus disease-19 (COVID-19). Although it is primarily a respiratory infection, the extra-pulmonary manifestations of COVID-19 mimic those found in preeclampsia (PE). Moreover, the two conditions share common risk factors and pathological mechanisms, hindering the ability to understand the interaction between them. Current literature on this topic is controversial and as there is an overlap of clinical and laboratory findings, HDP can be an overreported outcome in pregnant women with COVID-19. The aim of our study is to assess whether there is an association between maternal SARS-CoV-2 infection and HDP. METHODS: We designed a multicenter retrospective cohort study with data collected from five maternity hospitals in Almada, Porto, Lisboa, Penafiel and Coimbra, Portugal, between March 2020 and March 2021. We obtained a sample of 789 pregnant women who were followed up or delivered their babies in one of the participating centers. Each pregnant woman who tested positive for SARS-CoV-2 on a real-time polymerase chain reaction test -- exposure group (n= 263), was paired with two negative pregnant women (1:2), who received the same antenatal care and had similar gestational age and parity -- control group (n=526). Data were collected on maternal characteristics, medical history, obstetric outcomes, and delivery.  Outcomes: The primary outcome of our study is to assess the incidence of HDP in pregnant women infected and not infected by SARS-CoV-2. The secondary outcomes of our study are to assess the incidence of HDP across all COVID-19 severity subgroups and to assess whether SARS-CoV-2 infection in pregnancy modified the odds of a set of risk factors developing HDP.  Results: There was a slightly increased, but not statistically significant, incidence of PE (relative risk, RR, 1.33; 95% confidence interval, CI 0.68-2.57) in the SARS-CoV-2 positive group. There was no statistically significant association between having COVID-19 in pregnancy and developing PE/eclampsia/ hemolysis, elevated liver enzymes, and low platelets, HELLP syndrome [X2(1) = 0.732; p = 0.392] as well as developing gestational hypertension (GH) [X2(1) = 0.039; p = 1]. There was no statistically significant association [X2(2) = 0.402; p = 0.875), [X2(2) = 1.529; p = 0.435] between COVID-19 severity and incidence of HDP. The SARS-CoV-2 infection did not modify the odds of each maternal risk factor causing HDP.  Conclusion: Our study did not demonstrate an association between maternal COVID-19 and HDP. We did not observe a significantly increased incidence of HDP in pregnant women infected by SARS-CoV-2. As current literature is controversial on this topic, clinicians should be aware that HDP is a possible complication of maternal SARS-CoV-2 infection and further research studies urge to better assess the association between COVID-19 in pregnancy and HDP.

[Communication strategies used by health care professionals in providing palliative care to patients]. / Estratégias de comunicação utilizadas por profissionais de saúde na atenção à pacientes sob cuidados paliativos.

The objective of this study is to verify the relevance and utilization of communication strategies in palliative care. This is a multicenter qualitative study using a questionnaire, performed from August of 2008 to July of 2009 with 303 health care professionals who worked with patients receiving palliative care. Data were subjected to descriptive statistical analysis. Most participants (57.7%) were unable to state at least one verbal communication strategy, and only 15.2% were able to describe five signs or non-verbal communication strategies. The verbal strategies most commonly mentioned were those related to answering questions about the disease/treatment. Among the non-verbal strategies used, the most common were affective touch, looking, smiling, physical proximity, and careful listening. Though professionals have assigned a high degree of importance to communication in palliative care, they showed poor knowledge regarding communication strategies. Final considerations include the necessity of training professionals to communicate effectively in palliative care.

Communication strategies used by adolescents with autism spectrum disorder and health professionals during treatment.

Background: Autism spectrum disorder (ASD) is a developmental disorder, which affects social communicative capabilities. The research study has shown that ASD studies are focused on young children, excluding adolescents and adults: and it is understudied in the context of South Africa. Objective: This study examined the interactional communication strategies of adolescents with ASD and health professionals during different treatment consultations to identify the interactional styles and communication strategies utilised by adolescents with ASD and their respective healthcare professionals in a variety of scenarios in order to generate management strategies for future healthcare professional communication training. Method: A multi-case study design with a qualitative research approach has been used. Four adolescents with a moderate form of ASD and four health practitioners were interviewed. Participants were chosen by purpose and snowball sampling. Semi-structured, open-ended interviews were used for health professionals to collect information on the various interaction types and communication methods used, as well as their interpretations of these methods. Conversely, adapted face-to-face interviews were used to collect similar knowledge from adolescents themselves. The findings were qualitatively analysed on a case-by-case and cross-case basis by thematic analysis techniques. Results: The findings indicated that ASD adolescents have interaction types that influence intervention to various degrees. In comparison to motor therapies such as occupational therapy and physiotherapy, interaction types have a greater impact on psychiatry and psychology, which depend mainly on verbal communication. Intuitively, to promote contact with these teens, all health practitioners changed their own interaction styles. They used techniques of clarification and repair. The therapists shared the intention to learn a range of successful ways to strengthen future experiences with ASD between themselves and adolescents. Conclusion: The findings indicate that practitioners can benefit from altering their interaction styles, and that approaches for promoting successful interactions and in establishing rapport could be shared with other professionals in the future.

Collagen membrane and distraction osteogenesis for correcting alveolar bone defects: An animal pilot study.

BACKGROUND: The objective of this study was to evaluate the applicability of distraction osteogenesis with or without collagen membrane coverage to approximate the bone surfaces surrounding alveolar defects in pigs. METHODS: The sample comprised six pigs. One animal was control, and in the other five, alveolar bone defects were created and distraction osteogenesis was carried out to approximate adjacent bone surfaces in the defect site. Resorbable membranes were placed to cover the alveolar defects on one palatal side of the experimental animals. Radiographs were taken, and the histology was studied in each bone defect site at the 2nd, 9th, 16th, 23rd, and 46th days of healing. RESULTS: The radiographs showed that the alveolar bone defects were successfully corrected. Initial osteogenesis was delayed, but bone bridge formation was complete in the membrane-covered samples at the 46th day of healing. In the other group, bone bridge formation was incomplete at the end of the study. CONCLUSIONS: Distraction osteogenesis was effective in approximating transported bones to host bones. The resorbable membranes produced complete bone bridges in the approximation sites.

Emoji as promising tools for emotional evaluation in orthodontics.

BACKGROUND: Emoji are pictograms frequently used in social networks capable of expressing emotions. These tools can provide insights into people's behavior that could not be obtained with the use of textual communication. Recently, emoji have been introduced to various research fields as successful alternatives to word-based questionnaires for measure emotional responses. The objective of this study was to preliminarily evaluate the discriminating ability and relationship of these tools with different occlusal conditions/malocclusions. METHODS: Online surveys were applied to adult individuals (n = 201; mean age = 27.4 ± 5.7; 37.3% males, 62.7% females). Subjects issued acceptance scores (10-point scale) and expressed their emotional status using a 30-emoji list in relation to nine occlusal conditions: C1-crowding, C2-anterior open bite, C3-interincisal diastema, C4-increased overjet + deep bite (Class II div. 1), C5-anterior crossbite (Class III), C6-ideal occlusion, C7-unilateral posterior crossbite, C8-anterior open bite plus bilateral posterior crossbite plus crowding, and C9-deep bite (Class II div. 2). Cochran's Q and McNemar tests were used to compare the frequencies of choice of emoji between conditions. Correspondence analyses were applied to assess the association between occlusal conditions and emoji. Kendall's correlation coefficient was calculated to evaluate the relationship between mean acceptance scores and frequency counts of each emoji. RESULTS: The frequency of choice between conditions showed a significant difference for 25 of the 30 emoji (P < 0.05), indicating an adequate discriminating ability of these tools. Emoji were grouped predominantly based on their emotional valence (positive/negative) and arousal/activation (high/low). Positive emoji were associated with the most accepted conditions (i.e., C6, C3), while negative emoji with the most rejected ones (i.e., C8, C1, C2). Although only weak, positive correlations between acceptance and positively valenced emoji, and negative correlations between acceptance and negatively valenced emoji were observed (P < 0.05). CONCLUSIONS: Emoji have an adequate discriminatory ability and would allow determining emotional profiles in the face of different occlusal conditions. Further research is necessary to consolidate the use of these tools in an instrument that allows measuring emotional responses.

Prenatal Exposure to Metals and Neurodevelopment in Infants at Six Months: Rio Birth Cohort Study of Environmental Exposure and Childhood Development (PIPA Project).

The PIPA Project is a prospective birth cohort study based in Rio de Janeiro, Brazil, whose pilot study was carried out between October 2017 and August 2018. Arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) concentrations were determined in maternal (n = 49) and umbilical cord blood (n = 46). The Denver Developmental Screening Test II (DDST-II) was applied in 50 six-month-old infants. Metals were detected in 100% of the mother and newborn samples above the limits of detection. Maternal blood lead concentrations were higher in premature newborns (GM: 5.72 µg/dL; p = 0.05). One-third of the infants (n = 17-35.4%) exhibited at least one fail in the neurodevelopment evaluation (fail group). Maternal blood arsenic concentrations were significantly (p = 0.03) higher in the "fail group" (GM: 11.85 µg/L) compared to infants who did not fail (not fail group) (GM: 8.47 µg/L). Maternal and umbilical cord blood arsenic concentrations were higher in all Denver Test's domains in the "fail group", albeit non-statistically significant, showing a tendency for the gross motor domain and maternal blood (p = 0.07). These findings indicate the need to further investigate the toxic effects of prenatal exposure to metals on infant neurodevelopment.

Does rapid maxillary expansion have long-term effects on airway dimensions and breathing?

INTRODUCTION: In this systematic review, we identified and qualified the evidence of long-term reports on the effects of rapid maxillary expansion (RME) on airway dimensions and functions. METHODS: Electronic databases (Ovid, Scirus, Scopus, Virtual Health Library, and Cochrane Library) were searched from 1900 to September 2010. Clinical trials that assessed airway changes at least 6 months after RME in growing children with rhinomanometry, acoustic rhinometry, computed tomography, or posteroanterior and lateral radiographs were selected. Studies that used surgically assisted RME and evaluated other simultaneous treatments during expansion, systemically compromised subjects, or cleft patients were excluded. A methodologic-quality scoring process was used to identify which studies would be most valuable. RESULTS: Fifteen articles fulfilled the inclusion criteria, and full texts were assessed. Three were excluded, and 12 were assessed for eligibility. Four articles with low methodologic quality were not considered. The remaining 8 were qualified as moderate. The posteroanterior radiographs showed that nasal cavity width increases; in the lateral radiographs, decreased craniocervical angulation was associated with increases of posterior nasal space. Cone-beam computed tomography did not show significant increases of nasal cavity volume. Rhinomanometry showed reduction of nasal airway resistance and increase of total nasal flow, and acoustic rhinometry detected increases of minimal cross-sectional area and nasal cavity volume. CONCLUSIONS: There is moderate evidence that changes after RME in growing children improve the conditions for nasal breathing and the results can be expected to be stable for at least 11 months after therapy.

Orthodontic camouflage as a treatment alternative for skeletal Class III.

INTRODUCTION: Skeletal Class III malocclusion is a deformity of complex treatment, with few intervention alternatives, which are further limited in nongrowing patients. In most cases, orthognathic surgery is the ideal treatment for adults, an option often refused by patients. Mild to moderate skeletal Class III malocclusions and acceptable facial esthetics can benefit from a course of treatment in which dental movements are used to compensate for the skeletal discrepancy. OBJECTIVE: This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications and expected results.

Chromatic analysis of orthodontic resin bonding agents exposed to different antiseptic mouthrinses.

OBJECTIVE: To assess the color of different orthodontic resin bonding agents exposed to three antiseptic mouthrinses for a prolonged time interval (10-year aging simulation). METHODS: 160 specimens were distributed into four groups, according to the orthodontic resin bond agent (Concise, Transbond XT, Transbond Plus Color Change, and Natural Ortho). Each group was exposed to different antiseptic mouthrinses: alcohol-based (Listerine®), alcohol-free (Oral-B®), chlorhexidine (Periogard®) and distilled water as the control. Specimens were submitted to two cycles of staining and artificial aging. Color was evaluated by means of a digital spectrophotometer at the beginning of the experiment and after every cycle. The system used to assess color changes was the CIE L*a*b*. Data was analyzed using the ANOVA and Tukey post-hoc test. RESULTS: After simulation of 10 years of aging, Transbond XT and Natural Ortho composites presented no statistically significant differences in ∆E when exposed to different mouthrinses. The Concise composite specimens exposed to alcohol-free mouthrinse presented a significant difference when compared with specimens from the same group exposed to other antiseptic mouthrinses. Transbond Plus Color Change specimens exposed to chlorhexidine mouthrinse and to alcohol-containing mouthrinse presented a significant difference when compared with the specimens from the group exposed to water and alcohol-free antiseptic. CONCLUSION: All orthodontic resin bonding agents tested presented clinically perceptible color changes when exposed to at least one of the mouthrinses, except for the Natural Ortho composite. The Concise composite exposed to the alcohol-free solution was the resin that presented the highest color change values.