Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review.

Introduction Obstructive sleep apnea (OSA) is defined as intermittent partial or complete collapse of the upper airway during sleep. It is a common condition in childhood, with an incidence ranging from 1.2% to 5.7%, and it can harm several aspects of children's life, such as cognitive, metabolic and cardiovascular functions, among others. There are treatment options, such as adenotonsillectomy, myofunctional therapy, mandibular advancement appliances (MAAs), rapid maxillary expansion, and positive airway pressure devices, but there is still doubt about which method is more suitable for the treatment of OSA in children. Objective To analyze the effectiveness of MAAs in the treatment of pediatric OSA. Materials and Methods The search was conducted in August 2021 in different electronic databases, such as PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS, Ovid, SciELO, Web of Science, EMBASE BIREME, BBO BIREME, and the Cochrane Library. Results Only three systematic reviews and two meta-analyses were included in the present study. All studies showed improvement in the score on the apnea-hypopnea index after using MAAs in the treatment of pediatric OSA. Conclusion Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.

Fatores associados ao baixo apgar em recém-nascidos angolanos / Factors associated with low apgar in angolan newborn / Factores asociados con apgar bajo en recién nacidos angolanos

Objetivo:avaliar os fatores associados ao baixo Apgar em recém-nascidos de Angola. Método:estudo analíticoe transversal, quali-quantitativo, em umHospital Geral de Luanda, Angola, entre março e maio de 2021. Realizou-se entrevistas em sala de observação e consulta aos prontuários das parturientes. Os dados foram analisados pelo teste qui-quadrado (X2) e regressão logística. Resultados:prevaleceu parturientes entre 19-35 anos (70,0%), 7º-9º ano (57,5%), multíparas (75%), multigestas (75,0%), sem histórico de aborto (72,5%), idade gestacional de 40 semanas (60,0%), usuárias de bebidas alcoólicas (77,5%), baixa frequência de consultas pré-natais (52,5%), com parto natural (82,5%) e recém-nascidos com peso normal (52,5%). Mulheres de região periurbana [OR:6,85 (95% CI:0.65-71,2), p=0,108] e rural [OR:4,47 (95% CI:0.47-48,4), p=0,184] apresentaram maior chance de terem recém-nascidos com baixo Apgar, assim como as usuárias de álcool [OR:3,28 (95% CI:0,58-18,3), p=0,176] e recém-nascidos que nasceram com peso normal [OR:1,75 (95% CI:0,49­6,22), p=0,387]. Não houve associação estatística entre os dados sociodemográficos e maternos. Conclusão:a faixa etária, local de residência, consumo de álcool materno e peso do recém-nascido podem implicar em baixo Apgar.

Objective: to evaluate the factors associated with low Apgar in newborns in Angola. Method:analytical and cross-sectional, quali-quantitative study, in a General Hospital in Luanda, Angola, between March and May 2021. Interviews were carried out in an observation room and consultation of the parturients' medical records. Data were analyzed using the chi-square test (X2) and logistic regression.Results: pregnant women aged 19-35 years (70.0%), 7th-9th year(57.5%), multiparous (75%), multiparous (75.0%), without a history of abortion (72.5%), prevailed. gestational age of 40 weeks (60.0%), users of alcoholic beverages (77.5%), low frequency of prenatal consultations (52.5%), with natural childbirth (82.5%) and newborns with normal weight (52.5%). Women from peri-urban regions [OR:6.85 (95% CI:0.65-71.2), p=0.108] and rural [OR:4.47 (95% CI:0.47-48.4), p=0.184] were more likely to have low Apgar newborns, as well as alcohol users [OR:3.28 (95% CI:0.58-18.3), p=0.176] and newborns who were born with normal [OR:1.75 (95% CI:0.49­6.22), p=0.387]. There was no statistical association between sociodemographic and maternal data.Conclusion: age group, place of residence, maternal alcohol consumption and newborn weight may imply low Apgar.

Objetivo: evaluar los factores asociados al Apgar bajo en recién nacidos en Angola.Método: estudio analítico y transversal, cuali-cuantitativo, en un Hospital General de Luanda, Angola, entre marzo y mayo de 2021. Se realizaron entrevistas en sala de observación y consulta de las historias clínicas de las parturientas. Los datos se analizaron mediante la prueba de chi-cuadrado (X2) y regresión logística. Resultados: gestantes de 19 a 35 años (70,0%), de 7° a 9° año (57,5%), multíparas (75%), multíparas (75,0%), sin antecedente de aborto (72,5%), predominó la edad gestacional de 40 semanas (60,0%), usuarias de bebidas alcohólicas (77,5%), baja frecuencia de consultas prenatales (52,5%), con parto natural (82,5%) y recién nacidos con normopeso (52,5%). Las mujeres de regiones periurbanas [OR:6,85 (IC 95%:0,65-71,2), p=0,108] y rurales [OR:4,47 (IC 95%:0,47-48,4), p=0,184] tenían más probabilidades de tener bajo Recién nacidos Apgar, así como consumidores de alcohol [OR:3,28 (IC 95%:0,58-18,3), p=0,176] y recién nacidos que nacieron con normalidad [OR:1,75 (IC 95%:0,49-6,22), p=0,387]. No hubo asociación estadística entre datos sociodemográficos y maternos. Conclusión: el grupo de edad, el lugar de residencia, el consumo materno de alcohol y el peso del recién nacido pueden implicar un Apgar bajo.

The Law of Minimum Vertical Dimension: Evidence for Improvement of Dental Occlusion.

The law of minimum vertical dimension (MVD) states that "when the mandible moves to reach the maximum intercuspal position, this always involves bringing the mandible and maxilla as close together as possible." Therefore, after the first occlusal contact is made, the MIP will be reached through reduction of the vertical dimension. Our objective of this study, through an integrative review of the literature review, was to determine whether ignoring this law is a factor that contributes to malocclusion, temporomandibular joint dysfunction, and recurrences of functional orthodontic and orthopedic treatments.We conducted a search of the literature in five of the main electronic scientific databases. The following medical subject heading terms were used in our search: centric relation, dental occlusion, malocclusion, vertical dimension, and mastication. We cross-referenced the descriptors in the following four groups: centric relation and maximum intercuspation; occlusal plane and malocclusion; neuro-occlusal rehabilitation; and vertical dimension and unilateral chewing. From this, we selected 277 potentially eligible articles. Out of these, 209 were excluded in accordance with the exclusion criteria already described. Thus, 65 studies were included in the qualitative synthesis.The articles were also classified according to their impact factor and degree of recommendation, in conformity with the table of the Oxford Centre for Evidence-Based Medicine. The scientific interest in the scope of the articles was also assessed by using three charts developed according to year and country of publication and the percentage of publication. Unilateral chewing creates a vicious cycle of damage that leads to an ever-increasing masticatory deficiency. Most of the articles chosen for this review confirmed that noncompliance with law of MVD was a predisposing factor in cases of relapse, in functional orthodontic and orthopedic treatments, as well as a causal factor in malocclusion and in functional and morphological TMJ dysfunctions.

Tecnologias educacionais para promoção de experiência de parto positiva: revisão integrativa / Tecnologías educativas para promover la experiencia positiva del parto: revisión integradora / Educational technologies for the promotion of positive childbirth experiences: an integrative review

RESUMO Objetivo: Identificar as evidências acerca das tecnologias educacionais utilizadas durante a gestação com mulheres e acompanhantes para promoção de experiência de parto positiva. Métodos: Trata-se de uma revisão integrativa, realizada nas bases de dados eletrônicas LILACS, Scopus e Web of Science em outubro de 2022, em que foram localizadas 5.553 produções, das quais 32 foram incluídas no estudo para análise. Resultados: As tecnologias incluíram orientações educacionais, grupos de pré-natal, planos de parto, panfletos, livretos e orientações individualizadas que possibilitaram experiências positivas, como início do trabalho de parto espontâneo, controle no processo de parto, alívio da dor, redução de intervenções, participação ativa do acompanhante, partos assistidos em locais e por profissionais qualificados. Conclusão: As tecnologias são um fator promotor de experiências de parto positivas, pois apresentam repercussões favoráveis à aplicação de métodos não farmacológicos para alívio da dor, redução da taxa de indução do parto, aumento do número de partos vaginais e ampliação da participação da mulher e seu acompanhante na tomada de decisões no processo de parto e no nascimento do bebê.

RESUMEN Objetivo: identificar las evidencias acerca de las tecnologías educativas utilizadas durante la gestación con mujeres y acompañantes para la promoción de experiencia de parto positiva. Método: se trata de una revisión integradora, realizada en las bases de datos electrónicas LILACS, Scopus y Web of Science en octubre de 2022, en las que fueron localizadas 5.553 producciones, de las cuales 32 fueron incluidas en el estudio para el análisis. Resultados: las tecnologías incluyeron orientaciones educativas, grupos de prenatal, planificaciones de parto, prospectos, folletos y orientaciones individualizadas que posibilitaron experiencias positivas, como inicio del trabajo de parto espontáneo, control en el proceso de parto, alivio del dolor, reducción de intervenciones, participación activa del acompañante, partos asistidos en locales y por profesionales calificados. Conclusión: las tecnologías son un factor promotor de experiencias de parto positivas, pues presentan repercusiones favorables a la aplicación de métodos no farmacológicos para alivio del dolor, reducción de la tasa de inducción del parto, aumento del número de partos vaginales y ampliación de la participación de la mujer y su acompañante en la toma de decisiones en el proceso de parto y en el nacimiento del bebé.

ABSTRACT Objective: To identify the evidence about educational technologies used during pregnancy with women and companions to promote positive childbirth experiences. Methods: This is an integrative review conducted in LILACS, Scopus and Web of Science electronic databases in October 2022, where 5,553 productions were found, of which 32 were included in the study for analysis. Results: The technologies included educational guidance, prenatal support groups, birth plans, pamphlets, booklets, and individualized guidance that enabled positive experiences, such as spontaneous onset of labor, control in the childbirth process, pain relief, reduction of interventions, active participation of the companion, and births assisted in appropriate places and by skilled professionals. Conclusion: The technologies promote positive childbirth experiences, as they present favorable repercussions on the application of non-pharmacological pain relief methods, lower rates of labor induction, higher number of vaginal births, and greater participation of the woman and her companion in decision-making during labor and delivery.

Dipeptidyl peptidase-IV inhibitory peptides generated by tryptic hydrolysis of a whey protein concentrate rich in ß-lactoglobulin.

Dipeptidyl peptidase-IV (DPP-IV) is a serine protease involved in the degradation and inactivation of incretin hormones that act by stimulating glucose-dependent insulin secretion after meal ingestion. DPP-IV inhibitors have emerged as new and promising oral agents for the treatment of type 2 diabetes. The purpose of this study was to investigate the potential of ß-lactoglobulin as natural source of DPP-IV inhibitory peptides. A whey protein concentrate rich in ß-lactoglobulin was hydrolysed with trypsin and fractionated using a chromatographic separation at semipreparative scale. Two of the six collected fractions showed notable DPP-IV inhibitory activity. These fractions were analysed by HPLC coupled to tandem mass spectrometry (HPLC-MS/MS) to identify peptides responsible for the observed activity. The most potent fragment (IPAVF) corresponded to ß-lactoglobulin f(78-82) which IC50 value was 44.7µM. The results suggest that peptides derived from ß-lactoglobulin would be beneficial ingredients of foods against type 2 diabetes.

Immobilization of keratinolytic metalloprotease from Chryseobacterium sp. strain kr6 on glutaraldehyde-activated chitosan.

Keratinases are exciting keratin-degrading enzymes; however, there have been relatively few studies on their immobilization. A keratinolytic protease from Chryseobacterium sp. kr6 was purified and its partial sequence determined using mass spectrometry. No significant homology to other microbial peptides in the NCBI database was observed. Certain parameters for immobilization of the purified keratinase on chitosan beads were investigated. The production of the chitosan beads was optimized using factorial design and surface response techniques. The optimum chitosan bead production for protease immobilization was a 20 g/l chitosan solution in acetic acid [1.5% (v/v)], glutaraldehyde ranging from 34 g to 56 g/l, and an activation time between 6 and 10 h. Under these conditions, above 80% of the enzyme was immobilized on the support. The behavior of the keratinase loading on the chitosan beads surface was well described using the Langmuir model. The maximum capacity of the support (qm) and dissociation constant (Kd) were estimated as 58.8 U/g and 0.245 U/ml, respectively. The thermal stability of the immobilized enzyme was also improved around 2-fold, when compared with that of the free enzyme, after 30 min at 65 degrees C. In addition, the activity of the immobilized enzyme remained at 63.4% after it was reused five times. Thus, the immobilized enzyme exhibited an improved thermal stability and remained active after several uses.

A psychrotrophic Burkholderia cepacia strain isolated from refrigerated raw milk showing proteolytic activity and adhesion to stainless steel.

The proteolytic activity of a psychrotrophic strain of Burkholderia cepacia isolated from refrigerated raw milk was characterized. Bur. cepacia produced proteolytic activity during growth at refrigeration temperature, with maximum activity at pH 6-7. The enzyme showed relative thermal stability in the range 40-50°C during 25 min, and maintained 80% its initial activity at 76°C/30 s. Milk coagulation assay showed that the crude protease from Bur. cepacia caused coagulation from day 2 for skimmed milk, whereas coagulation was observed from day 5 for whole milk. The adherence of this strain to stainless steel was evaluated, and the substrata had around 107 CFU/cm2 after 15 to 60 min incubation. Results on biofilm development suggest that this bacterium could adhere and to form biofilms even at refrigeration temperatures. These results indicate that Bur. cepacia may represent a potential hazardous to milk and dairy products.

Thermodynamics and kinetics of heat inactivation of a novel keratinase from Chryseobacterium sp. strain kr6.

A novel keratinase from Chryseobacterium sp. strain kr6 was purified to homogeneity by (NH(4))(2)SO(4) precipitation, gel permeation on Sephadex G-100, and Q-Sepharose Fast Flow anion-exchange chromatography. The molecular weight of the purified enzyme was around 20 kDa. Kinetic and thermodynamic parameters for thermal inactivation were determined. The influence of Ca(2+) and Mg(2+) ions and purification degree on the enzyme stability was evaluated in the range of 50 to 60 degrees C. The results showed that first-order kinetics explained well the thermal denaturation of the keratinase in this temperature interval. The presence of Ca(2+) increases significantly the enzyme stability. Compared with the controls, the half-life of the purified enzyme after two purification steps in the presence of Ca(2+) increased 7.3, 20.2, and 9.8 fold at 50, 55, and 60 degrees C, respectively. Thermodynamics parameters for thermal inactivation were also determined.

Production of cellulolytic enzymes by Aspergillus phoenicis in grape waste using response surface methodology.

The production of cellulolytic enzymes by the fungus Aspergillus phoenicis was investigated. Grape waste from the winemaking industry was chosen as the growth substrate among several agro-industrial byproducts. A 2 x 2 central composite design was performed, utilizing the amount of grape waste and peptone as independent variables. The fungus was cultivated in submerged fermentation at 30 degrees C and 120 rpm for 120 h, and the activities of total cellulases, endoglucanases, and beta-glucosidases were measured. Total cellulases were positively influenced by the linear increase of peptone concentration and decrease at axial concentrations of grape waste and peptone. Maximum activity of endoglucanase was observed by a linear increase of both grape waste and peptone concentrations. Concentrations of grape waste between 5 and 15 g/L had a positive effect on the production of beta-glucosidase; peptone had no significant effects. The optimum production of the three cellulolytic activities was observed at values near the central point. A. phoenicis has the potential for the production of cellulases utilizing grape waste as the growth substrate.

Separation of phycocyanin from Spirulina platensis using ion exchange chromatography.

This paper presents the evaluation of some important parameters for the purification of phycocyanin using ion exchange chromatography. The influences of pH and temperature on the equilibrium partition coefficient were investigated to establish the best conditions for phycocyanin adsorption. The equilibrium isotherm for the phycocyanin-resin system was also determined. The separation of phycocyanin using the Q-Sepharose ion exchange resin was evaluated in terms of the pH and elution volume that improved the increase in purity and recovery. The highest partition coefficients were obtained in the pH range from 7.5 to 8.0 at 25 degrees C. Under these conditions the equilibrium isotherm for phycocyanin adsorption was well described by the Langmuir model, attaining a Q (m) of 22.7 mg/mL and K (d) of 3.1 x 10(-2) mg/mL. The best conditions for phycocyanin purification using the ion exchange column were at pH 7.5 with an elution volume of 36 mL, obtaining 77.3% recovery and a 3.4-fold increase in purity.

Optimization of glucoamylase production by Aspergillus niger in solid-state fermentation.

Glucoamylase production by Aspergillus niger in solid-state fermentation was optimized using factorial design and response surface techniques. The variables evaluated were pH and bed thickness in tray, having as response enzyme production and productivity. The bed thickness in tray was the most significant variable for both responses. The highest values for glucoamylase production occurred using pH 4.5 and bed thickness in the inferior limits at 2.0-4.2 cm. For productivity, the optimal conditions were at pH 4.5 as well and bed thickness from 4.4 to 7.5 cm. The optimal conditions for glucoamylase production while obtaining high activity without loss of productivity were pH 4.5 and bed thickness in tray from 4.0 to 4.5 cm, which resulted in an enzyme production of 695 U/g and productivity of 5791 U/h.

Análise comparativa de duas linhas de tratamento para pacientes portadores de disfunçäo vestibular periférica com idade superior a sessenta anos / Comparative analysis of two management protocols for patients with peripheral vestibular dysfunction in age over 60 years old

Objetivo: Comparar duas linhas de tratamento, os exercícios de Cawthorne e Cooksey e os exercícios seletivos de tronco, segundo Davies. Método: Vinte e seis pacientes, com idade igual ou superior a sessenta anos, submeteram-se ao exame vestibular com vectoeletronistagmografia (VENG) e ao questionário de handicap para tontura (QHT) no período pré e pós tratamento. Os participantes foram distribuídos em três grupos: o grupo A com 9 componentes, o grupo B com 10 e o grupo C com 7. Durante dez semanas consecutivas, o grupo A submeteu-se ao tratamento fisioterapêutico, por meio dos exercícios seletivos de tronco; o grupo B, por meio de exercícios de Cawthorne & Cooksey; e o grupo C (controle), näo efetuou nenhuma forma de tratamento, porque se recusaram a participar do programa de reabilitaçäo vestibular. Resultados: Foram encontradas vinte e quatro hipóteses diagnósticas de síndrome vestibular periférica irritativa e dois exames com síndrome vestibular deficitária à esquerda. O QHT demonstrou amplo handicap para esta populaçäo, sendo que as variáveis física e funcional mostraram-se mais comprometidas. Na avaliaçäo final, a VENG apresentou onze exames vestibulares normais, quatorze exames com a hipótese diagnóstica de síndrome vestibular periférica irritativa e um exame com síndrome vestibular periférica deficitária à esquerda. O QHT revelou que os grupos A e B apresentaram uma reduçäo estatisticamente significante do handicap, provocado pelas alteraçöes vestibulares, tanto na pontuaçäo total como nas variáveis física, funcional e emocional. O grupo C manteve inalterado o seu handicap. A análise estatística para dados independentes entre os grupos A e B, mostrou diferença significante para a escala física do grupo A. Os resultados da VENG, em média e em proporçäo, evidenciaram que as duas formas de tratamento auxiliam no processo de compensaçäo vestibular. Conclusöes: As duas linhas de tratamento promovem melhora na qualidade de vida dos idosos e auxiliam no processo de compensaçäo vestibular.