The median lingual foramen in the era of orthognathic virtual surgical planning.

The median lingual foramen (MLF), which contains neurovascular bundles, is located in an area commonly considered safe for surgical procedures. However, published reports of severe complications after interventions in the mandibular symphysis area indicate the need for caution when approaching this region surgically. The aim of this study was to evaluate the vertical location of the MLF and the median lingual canal (MLC) by measuring the distances of these landmarks to the root apex of the lower central incisors (LCI) and to the menton cephalometric point (Me) on pre-orthognathic surgery cone beam computed tomography scans (N = 100). The results were analyzed in relation to the patients' type of deformity, age, sex, and number of foramina (single vs multiple). The median MLF-LCI and MLF-Me distances were 5.9 mm and 15.0 mm, respectively, while the mean MLC-LCI and MLC-Me distances were 9.7 mm and 11.6 mm, respectively. The mean LCI-Me distance was 21.3 mm, while the mean MLC length was 3.4 mm. Apart from the length of the MLC, the distances were all significantly greater in the male patients than in the female patients. The MLC-Me distance and MLC length differed significantly according to the number of foramina. In preoperative planning, the vertical locations of the MLF and respective MLC appear to be relevant for avoiding neurovascular complications.

Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society.

INTRODUCTION: Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking. OBJECTIVE: To establish recommendations for CTD-ILD screening based on the current evidence. METHOD: Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD. RESULTS: The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous. CONCLUSIONS: Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.

Bioprospecting essential oils of exotic species as potential mitigations of ruminant enteric methanogenesis.

The inclusion of essential oils (EOs) in the diet of ruminants is one of the strategies used to alter ruminal microbial fermentation, improving feed efficiency, while simultaneously reducing enteric methane (CH4) production. This study aimed to evaluate the effects of three new EOs from plants exotic to the Azores, Pittosporum undulatum (PU), Hedychium gardnerianum (HG), and Cryptomeria japonica (CJ), on biogas production kinetics and in vitro CH4 production. Three levels of EOs (40, 80, and 120 µL/g dry matter (DM) were added to the basal diet to evaluate ruminal fermentation using the in vitro gas production technique. Added 800 mL of rumen inoculum with 5 g DM of the basal diet (BD) to all experimental units for 96 h, except for the blanks, to which only the inoculum was added. The total gas and CH4 produced by treatment incubation were recorded every hour after incubation until 96 h. The results showed that the gas production decreased significantly (P < 0.001) at 24 and 96 h after incubation, in the medium and high levels, with the essential oils PU, CJ, and HG treatment, when compared to the control treatment. The same significant differences (P < 0.001) were observed in in vitro CH4 production. The greatest reduction was noted with the addition of PUEO at the highest concentration (120 µL), which allowed a reduction in CH4 production at 24 h of 47% (P < 0.01). There was an interaction effect between EOs and concentration levels for all variables (P < 0.001). A decrease in total volatile fat acid (VFA) concentration (P < 0.05) was recorded compared to control, as well as the insoluble fraction and the potential degradation of the BD when EOs were included in the diet. In conclusion, the addition of EOs to the BD effectively reduced total enteric gas emissions and mitigated CH4 production. The most significant reduction of CH4 (47% in 24 h of incubation) occurs when 120 µL PUEO is added to each gram DM. The inclusion of OEs in the BD also affected the gas production kinetics and fermentation parameters.

Are we able to predict airway dimensional changes in isolated mandibular setback?

The goal of this study was to determine whether a relationship exists between the amount of mandibular setback and the amount of airway dimensional changes. Records and cone beam computed tomography (CBCT) of patients who had undergone isolated bilateral sagittal split osteotomy setback between January 1, 2013 and March 16, 2020 at a single institution were reviewed retrospectively. The primary outcome variable was upper airway volume dimension change, and the predictor variable was the magnitude of mandibular setback as measured by six different methods. Thirty-one patients were included in the study, with a mean mandibular setback ranging from 1.41 mm to 6.11 mm. None of the predictor variables showed an association with oropharyngeal (P = 0.54) or hypopharyngeal (P = 0.33) volume. Stepwise regression analysis failed to show any significant relationships. Similarly, there was no statistically significant association between any of the predictor variables and oropharyngeal (P = 0.44) or hypopharyngeal (P = 0.74) minimum axial area. The results showed that no correlation exists between the magnitude of mandibular setback and the amount of static airway dimensional changes; therefore, it may not be possible to predict whether obstructive sleep apnea will develop following mild to moderate mandibular setback based upon CBCT measurements.

Multimodality imaging in connective tissue disease-related interstitial lung disease.

Interstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Early detection and characterisation are paramount for adequate patient management and require a multidisciplinary approach, in which imaging plays a vital role. Computed tomography is currently the imaging method of choice; however, other imaging techniques have recently been investigated, namely ultrasound, magnetic resonance imaging, and positron-emission tomography, with promising results. The aim of this review is to describe the imaging findings of connective tissue disease-related interstitial lung disease and explain the role of each imaging technique in diagnosis and disease characterisation.

Controlling the transport of active matter in disordered lattices of asymmetrical obstacles.

We investigate the transport of active matter in the presence of a disordered square lattice of asymmetric obstacles, which is built by removing a fraction of them from the initial full lattice. We obtain a spontaneous inversion of the net particle current, compared to the usual sense of such a current as a function of the fraction of removed obstacles and particle density. We observed that the negative current regime is the consequence of trapping of particles among the obstacles which favors that more particles move in the negative current direction. The same reasoning applies to the positive current regime as well. We show a calculation that partially reproduces our numerical results, based on the argument that the mean current is given by the product of the mean speed and the mean number of travelers in each direction; the breakdown of this assumption is responsible for the failure of our calculation to reproduce the initial negative current regime.

Does a learning curve exist for accuracy in three-dimensional planning for maxillary positioning in bimaxillary orthognathic surgery?

The purpose of this study was to investigate the influence of time, and experience, on the accuracy of maxillary repositioning in bimaxillary orthognathic surgery performed using virtual surgical planning (VSP). Patients who had undergone bimaxillary orthognathic surgery were reviewed. Maxillary position on pre- and postoperative computed tomography scans was compared. The patients were divided into groups according to the year in which VSP was performed and surgery completed. Linear distances between upper jaw reference landmarks were measured in all three planes of space to determine accuracy between the preoperative VSP and the surgical outcome at various time points. One hundred subjects met the eligibility criteria for assessment and were allocated to groups: 2013 (n=10), 2014 (n=17), 2015 (n=39), 2016 (n=20), and 2017 (n=14). Overall, the results demonstrated improved precision in maxillary position over the years, with more accurate results in patients who underwent surgery in 2015, 2016, and 2017. Mean linear differences between planned and obtained results demonstrated more accurate results in the horizontal direction, followed by transverse and vertical directions. An overall average difference within 1mm was observed for 51.3% of the measurements included in the sample group. Time, and surgeon experience, can influence the accuracy of maxillary positioning in bimaxillary orthognathic surgery.

Idiopathic pulmonary fibrosis in the era of antifibrotic therapy: Searching for new opportunities grounded in evidence.

Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease that up to now has been associated with a poor prognosis. However, the results of the INPULSIS and ASCEND trials and the approval of nintedanib and pirfenidone have marked the beginning of a new era for IPF patients. Questions remain, however. Should these drugs be used earlier? What effect will they have on more severe disease? Will their effects last beyond the trial period? This manuscript is the outcome of a multidisciplinary meeting between pulmonology, radiology, and pathology clinicians on the use of antifibrotic agents in IPF. In our opinion, the existing data show that pirfenidone and nintedanib slow functional decline in early stages of disease. These drugs also appear to result in therapeutic benefits when administered to patients with advanced disease at diagnosis and maintain effective over time. The data also suggest that continuing antifibrotic therapy after disease progression may confer benefits, but more evidence is needed. Early diagnosis and treatment are crucial for reducing functional decline, slowing disease progression, and improving quality of life.

Methylsilsesquioxane-Based Aerogel Systems-Insights into the Role of the Formation of Molecular Clusters.

Condensed clusters of hydrolyzed methyltrimethoxysilane (MTMS) were studied using two complementary approaches: (i) Fourier transform infrared (FTIR) spectroscopy was applied along with the hydrolysis and condensation stages of a sol-gel process from the condensation of colloidal suspension of nanoparticles to the solid phase of bulk material; (ii) density functional theory calculations of energies, structural and vibrational data of pertinent MTMS hydrolysis products, specifically, methylsilanetriol-based species with different number of silicon atoms (from two to eight atoms) and different structures/conformations (linear, cyclic, and cage, in a total of 13 structures), were performed at B3LYP/6-311+G(d,p) level of theory. The calculated infrared spectra show two distinct Si-O-Si stretch vibration bands for models of caged structures. The higher-frequency IR band at ca. 1120 cm(-1) is derived from the antisymmetric Si-O-Si stretch vibration mode, while the lower-frequency band at 1035 cm(-1) is due to the symmetric Si-O-Si stretch and is characteristic of the cyclic clusters, being absent in highly symmetric cage structures. The calculated versus the experimental FTIR spectra of poly(methylsilsesquioxane) (PMSQ) dried aerogel in KBr pellet show that cage/cyclic-like structures prevail over ladder structures (linear) in actual PMSQ.

Mandible-first sequence in bimaxillary orthognathic surgery: a systematic review.

The sequencing of bimaxillary orthognathic surgery remains controversial, although the traditional maxilla-first approach is performed routinely. The goal of this study was to present a systematic review of the mandible-first sequence in bimaxillary orthognathic surgery, to provide data that may assist in the decision as to which jaw should undergo osteotomy first in bimaxillary orthognathic surgery cases. A literature search was conducted for articles published in the English language, reporting the use of the altered sequence for bimaxillary orthognathic surgery (mandible-first), using the following descriptors: 'orthognathic' and 'double-jaw', 'orthognathic' and 'two-jaw', 'orthognathic' and 'mandible-first', 'orthognathic' and 'bimaxillary'. Eight hundred eighty-seven abstracts were initially identified and were evaluated for inclusion according to the proposed inclusion criteria. After evaluation of these abstracts and relevant references, six publications met the criteria for consideration. Performing mandible-first surgery in bimaxillary orthognathic cases dates back to the 1970s; however the decision regarding the jaw to be operated on first seems to rely on accurate preoperative planning based upon the surgeon's experience and preference. While there appear to be significant theoretical advantages to support the use of the altered orthognathic sequence (mandible-first), future prospective studies on its reliability, accuracy, and short- and long-term outcomes are required.

Structure and photochemistry of a saccharyl thiotetrazole.

The molecular structure and photochemistry of 5-thiosaccharyl-1-methyltetrazole (TSMT) were studied by means of matrix-isolation FTIR spectroscopy, X-ray crystallography, and theoretical calculations. The calculations predicted two conformers of TSMT that differ in energy by more than 15 kJ mol(-1). The infrared spectrum of TSMT isolated in solid argon was fully assigned on the basis of the spectrum calculated (O3LYP/6-311++G(3df,3pd)) for the most stable conformer. In the crystal, TSMT molecules were found to assume the same conformation as for the isolated molecule, with each molecule forming four hydrogen bonds with three neighboring molecules, leading to a network of TSMT oligomers. Upon UV (λ = 265 nm) irradiation of the matrix-isolated TSMT, two photodegradation pathways were observed, both arising from cleavage of the tetrazolyl ring. Pathway a involves cleavage of the N1-N2 and N3-N4 bonds with extrusion of N2, leading to photostable diazirine and thiocarbodiimide derivatives. The photostability of the photoproduced diazirine under the conditions used precluded its rearrangement to the nitrile imine, as reported for 5-phenyltetrazole by Bégué et al. ( J. Am. Chem. Soc. 2012 , 134 , 5339 ). Pathway b involves cleavage of the C5-N1 and N4-N3 bonds, leading to a thiocyanate and methyl azide, the latter undergoing subsequent fragmentation to give CNH.

Evaluation of PCR in the diagnosis of canine leishmaniasis in two different epidemiological regions: Campinas (SP) and Teresina (PI), Brazil.

SUMMARY Using the polymerase chain reaction (PCR) test for diagnosis of canine leishmaniasis has greater sensitivity and specificity than culture and visualization of the parasite. This study compares PCR for the diagnosis of the genus and species of Leishmania with serological techniques used for the control of canine visceral leishmaniasis (CVL) in Brazil, considering two regions. We analysed peripheral blood samples collected from 195 dogs in the Campinas (SP) and Teresina (PI) regions. ELISA was performed as a serological method and PCR was performed using specific primers for the genus Leishmania spp. and the species Leishmania chagasi. In Campinas, a greater sensitivity of PCR (88.24%) (P = 0.0455) compared to Teresina (14.71%) (P < 0.0001) was observed, and an agreement was observed for Cohen's kappa index (0.9096). Both PCR and ELISA showed discordance for sensitivity (Campinas 100%, Teresina 21.74%), specificity (Campinas 30.77%, Teresina 100%), positive predictive value (Campinas 68.97%, Teresina 100%), negative predictive value (Campinas 100%, Teresina 37.94%) and Cohen's kappa index (0.1238). This study confirms the importance of PCR in analysis of the canine reservoir, and as an effective method for the detection of active and recent infection.

Accuracy of perioperative mandibular positions in orthognathic surgery.

Mandibular position is an important parameter used for the diagnosis of dentofacial deformities, as well as for orthognathic surgery planning and execution. Centric relation (anterior and superior relationship of the mandibular condyles interposed by the thinnest portion of their disks against the articular eminencies), centric occlusion (when lower teeth contact upper teeth at centric relation), and maximal intercuspation (complete interdigitation of lower and upper teeth) are not often addressed as factors that influence the results of orthognathic surgery, although these relationships are critical to ensure accuracy during the surgery. The present study assessed occlusal measurements taken before and after the induction of general anaesthesia from consecutive orthognathic surgery subjects. The variables assessed included the differences between these occlusal measurements, patient age, gender, type of deformity, and type of proposed orthognathic surgical procedure. The results demonstrated statistically significant differences for mandibular retrusion from maximal intercuspation to centric occlusion position, whereas the mandible appeared not to change significantly from centric occlusion after the induction of general anaesthesia. Patient age and the type of deformity appeared to influence the results. While in most instances centric occlusion can be adequately reproduced under general anaesthesia, for some specific orthognathic cases more accurate results might be obtained if the mandible-first sequence is used.

Is there consistency in cephalometric landmark identification amongst oral and maxillofacial surgeons?

There may be significant variation amongst oral and maxillofacial surgeons (OMFS) in the identification and placement of cephalometric landmarks for orthognathic surgery, and this could impact upon the surgical plan and final treatment outcome. In an effort to assess this variability, 10 lateral cephalometric radiographs were selected for evaluation by 16 OMFS with different levels of surgical knowledge and experience, and the position of 21 commonly used cephalometric landmarks were identified on radiographs displayed on a computer screen using a computer mouse on a pen tablet. The database consisted of real position measurements (x, y) to determine the consistency of landmark identification between surgeons and within individual surgeons. Inter-examiner analysis demonstrated that most landmark points had excellent reliability (intra-class correlation coefficient >0.90). Regardless of the level of surgeon experience, certain landmarks presented consistently poor reliability, and intra-examiner reliability analysis demonstrated that some locations had a higher average difference for both x and y axes. In particular, porion, condylion, and gonion showed poor agreement and reliability between examiners. The identification of most landmarks showed some inconsistencies within different parameters of evaluation. Such variability among surgeons may be addressed by the consistent use of high-quality images, and also by periodic surgeon education of the definition of the specific landmarks.

Amino→imino tautomerization upon in vacuo sublimation of 2-methyltetrazole-saccharinate as probed by matrix isolation infrared spectroscopy.

The amino-imino tautomerization of the nitrogen-linked conjugate 2-methyltetrazole-saccharinate (2MTS) was observed upon sublimation of the compound in vacuo. As shown previously by X-ray diffraction [Ismael, A.; Paixão, J. A.; Fausto, R.; Cristiano, M. L. S. J. Mol. Struct., 2011, 1023, 128-142], in the crystalline phase the compound exists in an amino-bridged tautomeric form. Infrared spectroscopic investigation of a cryogenic matrix prepared after sublimation of a crystalline sample of 2MTS and deposition of the sublimate together with argon (in ~1:1000 molar ratio) onto an IR-transparent cold (15 K) substrate, revealed that the form of 2MTS present in the matrix corresponds to the theoretically predicted most stable imino-bridged tautomer. In this tautomer, the labile hydrogen atom is connected to the saccharine nitrogen, and the two heterocyclic fragments are linked by an imino moiety in which the double-bond is established with the carbon atom belonging to the saccharyl fragment. The observed isomeric form of this tautomer is characterized by a zusammen (Z) arrangement of the two rings around the C═N bond of the bridging group and an intramolecular NH···N hydrogen bond. The experimental IR spectrum of the matrix-isolated 2MTS has been fully assigned based on the calculated spectra for the two most stable conformers of this tautomer. A mechanism for the conversion of the tautomeric form existing in the crystal into that present in the gas phase is proposed. As a basis for the interpretation of the experimental results, a detailed theoretical [at the DFT(B3LYP) level of approximation with the 6-31++G(d,p) and 6-311++G(3df,3pd)] study of the potential energy surface of the compound was performed.

Relationship between exposure to cement and the incidence of respiratory diseases in children: a preventive perspective.

Respiratory disease in childhood is a factor of concern to health professionals, resulting in a primary determinant of lung function in adulthood. Studies indicate that people placed in areas with established industries, are exposed to pollutants from many industrial processes, thus increasing the risk of diseases. The aim was to examine the connection between exposure to cement and the incidence of respiratory diseases in the Jardins Community. It was a field study, descriptive, conducted in a community in the city of Cabedelo- PB, and result in a qualitative-quantitative approach. The sample comprised 51 children aged between 1 to 12 years who have symptoms or diagnosis of respiratory disease. The survey data was obtained by applying a semistructured interview, and analysed using chi-square, MacNemar and Mann-Whitney tests for statistical analysis. A high number of complaints about environmental pollution, small houses and subdued, lack of paving and sanitation, a high frequency of respiratory symptoms and especially the occurrence of the onset of symptoms after arrival in the community were found. There is a correlation between environmental exposure and the incidence of respiratory diseases in children; therefore the community requires specific actions to reduce the exposure.

Keratocystic odontogenic tumors and Carnoy's solution: results and complications assessment.

OBJECTIVE: Keratocystic odontogenic tumors (KOTs) can be treated with Carnoy's solution, although this treatment modality is not free from complications. It is important to verify the incidence of complications after the use of Carnoy's solution and compare these with the literature. MATERIALS AND METHODS: This study verified the effects of a complementary treatment for KOTs and assessed the incidence of such complications as recurrence, infection, sequestrum formation, mandibular fracture, dehiscence, and neuropathy. RESULTS: Twenty-two KOTs treated with Carnoy's solution combined with peripheral ostectomy were included, and the follow-up period varied from 12 to 78months with a mean of 42.9months. Complications included recurrence (4.5%), dehiscence (22.7%), infection (4.5%), and paresthesia (18.2%). No difference was found among lesions associated (9.1%) or not (0%) with nevoid basal cell carcinoma syndrome (P>0.05). Dehiscence was influenced by marsupialization (P<0.05), and paresthesia was observed exclusively in cases of mandibular canal fenestration (P<0.01). CONCLUSIONS: Complementary treatment with Carnoy's solution and peripheral ostectomy appear to provide efficient treatment for KOTs. Complications originating from the use of the solution are less frequent and less serious than complications associated with cryotherapy. Neuropathy seems to be related to direct contact between the solution and the epineurium.

Internal carotid bifurcation aneurysm in childhood: a case report and literature review.

Childhood aneurysms are rare pathological findings. They present with a low incidence and have characteristic features. When occurred in the first year of life or when giant-sized, survival and recovery may be worst. Nevertheless outcomes are generally better than in adults. A surgical case of an eleven year old boy with excellent outcome is reported, with a subsequent review on the subject. Patients may present with classical subarachnoidal hemorrhage, but also with compressive signs with bigger and unruptured lesions. Initial management of these cases is basically the same of older patients, considering their age, weight and special intensive care for infants. Surgical principles, outcomes and etiology are analyzed.

Effects of plasma urea nitrogen levels on the bovine oocyte ability to develop after in vitro fertilization.

The overall aim of the present study was to evaluate in vitro development ability of oocytes recovered from 56 Holstein Frisian heifers with low [group 1 (G1): <13 mg /dl], moderate [group 2 (G2): 13-16 mg /dl] and high [group 3 (G3): >16 mg /dl] plasma urea nitrogen (PUN) concentrations, to determine whether PUN concentrations affect the competence of oocytes to progress to blastocysts after in vitro fertilization. In vitro oocyte and embryo development was assessed by blastocyst rates, embryo total cell numbers and apoptosis. Blood samples for the determination of PUN were collected 24 h prior to collection of the ovaries at the slaughter. A total of 112 ovaries were collected at a local abattoir and oocytes (n = 697) were aspirated, in vitro matured and fertilized. On day 8, blastocysts were assigned to the terminal dUTP nick end labelling assay. Cleavage rates were significantly higher (p < 0.001) for groups 1 and 2 than for group 3 (i.e. 72.5% and 72.2% vs 61.7%, respectively). The proportion of fertilized oocytes that developed into blastocysts was higher (p < 0.05) for group 1 than for group 3 (34.0% vs 23.0%, respectively). Day 8 blastocysts showed higher total cell counts (p < 0.05) for group 1 than for group 3 (123.7 vs 76.3), and a higher (p < 0.05) total apoptotic cell rate was found in group 3 (25.9 and 19.0 vs 43.2 for G1, G2 and G3, respectively). In conclusion, the ability of oocytes from heifers with increased levels of PUN to develop to the blastocyst stage was significantly reduced when standard routines for in vitro maturation, fertilization and culture were followed. These detrimental effects can be mediated in part through direct effect of urea and/or by the metabolic products on the process of follicle-enclosed oocyte nuclear and cytoplasmic development.

Effects of grass silage and soybean meal supplementation on milk production and milk fatty acid profiles of grazing dairy cows.

The effects of supplementation with grass silage and replacement of some corn in the concentrate with soybean meal (SBM) on milk production, and milk fatty acid (FA) profiles were evaluated in a replicated 4 x 4 Latin square study using 16 dairy cows grazing pasture composed of ryegrass, Kentucky bluegrass, and white clover. Each experimental period lasted for 3 wk. The 4 dietary treatments were PC, 20 h of access to grazing pasture, supplemented with 6 kg/d of corn-based concentrate mixture (96% corn; C); PCSB, 20 h of access to grazing pasture, supplemented with 6 kg/d of corn- and SBM-based concentrate mixture (78% corn and 18% SBM; CSB); SC, 7 h of access to grazing pasture during the day and 13 h of ad libitum access to grass silage at night, supplemented with 6 kg/d of C concentrate; and SCSB, 7 h of access to grazing pasture during the day and 13 h of ad libitum access to grass silage at night, supplemented with 6 kg/d of CSB concentrate. The concentrate mixtures were offered twice each day in the milking parlor and were consumed completely. Grass silage supplementation reduced dietary crude protein and concentration of total sugars, and dietary SBM inclusion increased dietary crude protein concentration and decreased dietary starch concentration. Milk yield and energy-corrected milk were increased by SBM supplementation of cows with access to grass silage. Milk protein concentration was lower in cows offered grass silage, regardless of whether SBM was fed. Dietary SBM inclusion tended to increase milk fat concentration. Plasma urea N was reduced by silage feeding and increased by SBM supplementation. Supplementation with grass silage overnight could represent a useful strategy for periods of lower pasture availability. Dietary inclusion of SBM in solely grazing cows had no effects on milk production and composition, exacerbated the inefficient capture of dietary N, and increased diet cost. Grass silage supplementation affected milk FA profiles, increasing both the FA derived from de novo synthesis and those derived from rumen microbial biomass, and decreasing the sum of C18 FA (mostly derived from diet or from mobilization of adipose tissue reserves). Milk fat concentrations of conjugated linoleic acid cis-9, trans-11, vaccenic acid (18:1 trans-11), and linolenic acid (18:3n-3) were unaffected by grass silage supplementation, suggesting that partial replacement of pasture by unwilted grass silage does not compromise the dietary quality of milk fat for humans.