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Chew RJJ, Tan KS, Chen T, Al-Hebshi NN, Goh CE. Quantifying periodontitis-associated oral dysbiosis in tongue and saliva microbiomes-An integrated data analysis. J Periodontol 2024. [PMID: 39007741 DOI: 10.1002/jper.24-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Periodontitis is primarily driven by subgingival biofilm dysbiosis. However, the quantification and impact of this periodontal dysbiosis on other oral microbial niches remain unclear. This study seeks to quantify the dysbiotic changes in tongue and salivary microbiomes resulting from periodontitis by applying a clinically relevant dysbiosis index to an integrated data analysis. METHODS The National Center for Biotechnology Information (NCBI) database was searched to identify BioProjects with published studies on salivary and tongue microbiomes of healthy and periodontitis subjects. Raw sequence datasets were processed using a standardized bioinformatic pipeline and categorized by their ecological niche and periodontal status. The subgingival microbial dysbiosis index (SMDI), a dysbiosis index originally developed using the subgingival microbiome, was computed at species and genus levels and customized for each niche. Its diagnostic accuracy for periodontitis was evaluated using receiver operating characteristic curves. RESULTS Four studies, contributing 328 microbiome samples, were included. At both species and genus levels, periodontitis samples had a higher SMDI, but the differences were only significant for subgingival biofilm and saliva (p < 0.001). However, SMDI showed good diagnostic accuracy for periodontitis status for all three niches (area under curve ranging from 0.76 to 0.90, p < 0.05). The dysbiosis index of subgingival biofilm was positively correlated with saliva consistently (p < 0.001) and with the tongue at the genus level (p = 0.036). CONCLUSIONS While the impact on the tongue microbiome requires further investigation, periodontitis-associated dysbiosis affects the salivary microbiome and is quantifiable using the dysbiosis index. The diagnostic potential of salivary microbial dysbiosis as a convenient periodontal biomarker for assessing periodontal status has potential public health and clinical applications. PLAIN LANGUAGE SUMMARY Periodontitis, a severe inflammation of the gums which causes bone loss, is a disease caused by an imbalance of good and bad bacteria under the gums. However, it is unclear how this bacterial imbalance in the gums affects the bacterial balance of other distinct parts of the mouth, such as the saliva and tongue. This study uses bacteria datasets of four previously published studies, contributing a total of 328 bacterial samples. The data were processed using a uniform data analysis workflow, and a bacterial score, the subgingival microbial dysbiosis index (SMDI), previously shown to capture periodontitis-associated bacteria imbalance, was calculated separately for samples from under the gums, the saliva, and the tongue. The SMDI was able to distinguish between health and periodontitis within each oral location, and in general, the scores were higher for periodontitis samples, though this difference was significant only for bacteria under the gums and in saliva. Saliva scores were also consistently correlated with bacteria under the gums. This study shows that periodontitis-associated bacterial imbalances are observed in oral locations beyond just under the gums, particularly the saliva. Thus, saliva bacteria may be used as a convenient biomarker for assessing gum disease, allowing for potential public health and clinical applications.
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Affiliation(s)
- Ren Jie Jacob Chew
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Kai Soo Tan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Tsute Chen
- The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Nezar Noor Al-Hebshi
- Oral Microbiome Research Laboratory, Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Charlene Enhui Goh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Miao X, Yang W, Wang S, Tang J, Luo X, Chen T. Lung abscess caused by the anaerobic pathogen Tannerella forsythia. Respirol Case Rep 2024; 12:e01391. [PMID: 38831800 PMCID: PMC11147646 DOI: 10.1002/rcr2.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/10/2024] [Indexed: 06/05/2024] Open
Abstract
Odontogenic infections can spread to the respiratory tract. Despite the known role of Tannerella forsythia as the primary pathogen in periodontitis, the association between T. forsythia infection and risk of pneumonia or lung abscess remains unknown. In this report, we present a case of lung abscess caused by T. forsythia infection. The pathogen was detected by metagenomic next-generation sequencing (mNGS) in the bronchoalveolar lavage fluid of the patient. The clinical characteristics and possible mechanisms of the infection are discussed. T. forsythia is a conditional pathogen that can cause lung abscess in the presence of helper bacteria and reduced host immune status. The course of treatment should be personalized and might be longer than 3 months.
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Affiliation(s)
- XiaYi Miao
- Department of Respiratory MedicinePutuo Hospital, Shanghai University of Traditional Chinese MedicineShanghaiPeople's Republic of China
| | - Wei Yang
- Department of Respiratory MedicinePutuo Hospital, Shanghai University of Traditional Chinese MedicineShanghaiPeople's Republic of China
| | - Shiqiang Wang
- Department of Respiratory MedicinePutuo Hospital, Shanghai University of Traditional Chinese MedicineShanghaiPeople's Republic of China
| | - Jihong Tang
- Department of Respiratory MedicinePutuo Hospital, Shanghai University of Traditional Chinese MedicineShanghaiPeople's Republic of China
| | - XuMing Luo
- Department of Respiratory MedicinePutuo Hospital, Shanghai University of Traditional Chinese MedicineShanghaiPeople's Republic of China
| | - Teng Chen
- Department of Respiratory MedicinePutuo Hospital, Shanghai University of Traditional Chinese MedicineShanghaiPeople's Republic of China
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Causey C, El Karim I, Blackwood B, McAuley DF, Lundy FT. Quantitative oral health assessments in mechanically ventilated patients: A scoping review. Nurs Crit Care 2023; 28:756-772. [PMID: 35771584 DOI: 10.1111/nicc.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral health is a key contributor to a person's overall health. Previous studies indicate that oral health deteriorates throughout ventilation and may contribute to the development of ventilator-associated pneumonia (VAP). Oral health at the time of initial ventilation may impact on this deterioration. AIMS To determine the quantitative clinical assessment methods used to measure oral health and what is currently known regarding the oral health of patients at the time of initial ventilation. STUDY DESIGN A systematic literature search using electronic bibliographic databases MEDLINE/PubMed, Embase, CINAHL, and the Cochrane Library was undertaken for this scoping review. Studies were included if patients were >18 years old and mechanically ventilated for <48 h at the time of the first oral assessment. RESULTS In total, 12 studies were included. The review demonstrates a limited understanding of clinical oral health at the time of initial ventilation. Significant variation in both assessment methods and reporting of oral health makes comparison of results difficult resulting in a poor overall understanding of oral health at the time of intubation. CONCLUSION Standardized assessment and reporting methods may improve clinical application of findings and help direct future research. We suggest developing a core outcome set to ensure consistent use of assessment tools as well as standardized reporting of results. RELEVANCE TO CLINICAL PRACTICE It is essential that a good understanding of oral health at the time of initial ventilation is gained so that patients receive more targeted oral hygiene intervention in ICU, potentially leading to improved patient outcomes.
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Affiliation(s)
- Christine Causey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Ikhlas El Karim
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Fionnuala T Lundy
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
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Bregaint S, Boyer E, Fong SB, Meuric V, Bonnaure-Mallet M, Jolivet-Gougeon A. Porphyromonas gingivalis outside the oral cavity. Odontology 2021; 110:1-19. [PMID: 34410562 DOI: 10.1007/s10266-021-00647-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 07/31/2021] [Indexed: 12/14/2022]
Abstract
Porphyromonas gingivalis, a Gram-negative anaerobic bacillus present in periodontal disease, is considered one of the major pathogens in periodontitis. A literature search for English original studies, case series and review articles published up to December 2019 was performed using the MEDLINE, PubMed and GoogleScholar databases, with the search terms "Porphyromonas gingivalis" AND the potentially associated condition or systemic disease Abstracts and full text articles were used to make a review of published research literature on P. gingivalis outside the oral cavity. The main points of interest of this narrative review were: (i) a potential direct action of the bacterium and not the systemic effects of the inflammatory acute-phase response induced by the periodontitis, (ii) the presence of the bacterium (viable or not) in the organ, or (iii) the presence of its virulence factors. Virulence factors (gingipains, capsule, fimbriae, hemagglutinins, lipopolysaccharide, hemolysin, iron uptake transporters, toxic outer membrane blebs/vesicles, and DNA) associated with P. gingivalis can deregulate certain functions in humans, particularly host immune systems, and cause various local and systemic pathologies. The most recent studies linking P. gingivalis to systemic diseases were discussed, remembering particularly the molecular mechanisms involved in different infections, including cerebral, cardiovascular, pulmonary, bone, digestive and peri-natal infections. Recent involvement of P. gingivalis in neurological diseases has been demonstrated. P. gingivalis modulates cellular homeostasis and increases markers of inflammation. It is also a factor in the oxidative stress involved in beta-amyloid production.
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Affiliation(s)
- Steeve Bregaint
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Emile Boyer
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France.,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Shao Bing Fong
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Vincent Meuric
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France.,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Martine Bonnaure-Mallet
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France.,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Anne Jolivet-Gougeon
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France. .,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France.
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Araújo MM, Albuquerque BN, Cota LOM, Cortelli SC, Cortelli JR, Costa FO. Periodontitis and Periodontopathogens in Individuals Hospitalized in the Intensive Care Unit: A Case-Control Study. Braz Dent J 2019; 30:342-349. [PMID: 31340223 DOI: 10.1590/0103-6440201902480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/13/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to compare periodontal conditions between intensive care unit (ICU) in-patients and non-ICU patients through clinical and microbiological periodontal parameters. This case-control study included 88 individuals hospitalized in ICU and 176 non-hospitalized controls. All individuals underwent a complete periodontal examination and microbiological sampling. The total bacterial load and counts of Porphyromonas gingivalis, Treponema denticola and Aggregatibacter actinomycetemcomitans were evaluated using qPCR. Data were analyzed through the Chi-square, Fisher exact, and t-Student tests, and the Spearman correlation, as appropriate. The prevalence of periodontitis was 39.7% among controls and 59.0% among ICU in-patients (OR=2.18; p=0.002). ICU in-patients had a significantly higher occurrence of cardiovascular disease (p=0.002; OR=2.20) and history of periodontal disease (p=0.031; OR=1.92) than controls. Bacterial counts of A. actinomycetemcomitans, T. denticola and P. gingivalis were significantly higher in ICU in-patients with periodontitis than in controls. The correlation between periodontal parameters and microbiological findings among cases and controls showed a significant and positive correlation between: total bacteria load and % of sites with probing depth (PD) ≥ 4 mm (cases: r=0.22 and controls: r=0.13) and P. gingivalis and % sites with bleeding on probing (BOP) (cases: r=0.22 and controls: r=0.23). Thus, ICU in-patients presented a higher prevalence of periodontitis and worse periodontal condition (higher mean plaque index, BOP, clinical attachment level ≥3 mm, and sites with PD 4 to 6 mm).
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Affiliation(s)
- Milena Moreira Araújo
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Luís Otávio Miranda Cota
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sheila Cavalca Cortelli
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - José Roberto Cortelli
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fernando Oliveira Costa
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Chen Y, Zhou R, Yi Z, Li Y, Fu Y, Zhang Y, Li P, Li X, Pan Y. Porphyromonas gingivalis induced inflammatory responses and promoted apoptosis in lung epithelial cells infected with H1N1 via the Bcl‑2/Bax/Caspase‑3 signaling pathway. Mol Med Rep 2018; 18:97-104. [PMID: 29750299 PMCID: PMC6059728 DOI: 10.3892/mmr.2018.8983] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to investigate the effects of Porphyromonas gingivalis (P. gingivalis) on inflammatory cytokine and nitic oxide (NO) production in lung epithelial cells infected with H1N1, and the underlying mechanisms. Lung epithelial cells were co-infected with P. gingivalis and H1N1. The concentrations of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6 were detected via an ELISA, and the concentration of NO was detected by the nitrate reductive enzymatic method at 4, 8, 12 and 24 h following infection. The expression levels of inducible NO synthase (iNOS) was detected by western blotting. The apoptotic rate of lung epithelial cells was detected by flow cytometry. The relative protein expression levels of B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax) and caspase-3 in lung epithelial cells were detected by western blotting. Compared with the control group, the concentration of the inflammatory cytokines TNF-α, IL-1β and IL-6 exhibited a significant increase (P<0.05) in the viral-infected, bacterial-infected and co-infected groups. The concentration of NO also increased significantly (P<0.05), along with the rise in the expression levels of iNOS (P<0.05) and the increase in the apoptosis rate of lung epithelial cells (P<0.05). The relative expression levels of caspase-3 and Bax proteins were increased significantly in the viral- and bacterial-infected groups when compared with the control. The relative expression levels of Bcl-2 protein exhibited a significant decrease in lung epithelial cells following the co-infection with P. gingivalis and H1N1 compared with the control (P<0.05). The results of the present study revealed that the combination of P. gingivalis and H1N1 infection in lung epithelial cells may promote the production of inflammatory cytokines and increase NO production, leading to increased levels of apoptosis in lung epithelial cells via the Bcl-2/Bax/caspase-3 signaling pathway.
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Affiliation(s)
- Yongju Chen
- School of Stomatology, Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Rui Zhou
- Department of Stomatology, The Second Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Zhe Yi
- Department of Stomatology, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, P.R. China
| | - Yonggang Li
- Department of Pathogeny Biology, Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Ying Fu
- Department of Stomatology, The Second Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Yibo Zhang
- Department of Pathogeny Biology, Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Ping Li
- School of Stomatology, Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Xin Li
- School of Stomatology, Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Yaping Pan
- Department of Stomatology, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, P.R. China
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You J, Yang YJ, Liu LY, Hu C. [Prior periodontal intervention lowers incidence of lower respiratory infection in patients receiving oral and maxillofacial tumor surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1256-1260. [PMID: 28951372 PMCID: PMC6765502 DOI: 10.3969/j.issn.1673-4254.2017.09.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate whether periodontal infection is a risk factor for lower respiratory infection patients receiving oral and maxillofacial tumor surgery. METHODS Patients undergoing oral and maxillofacial surgery for tumors with concurrent periodontal disease between January, 2012 and December, 2016 were randomized into periodontal intervention group and control group (treated with gargle solution containing chlorhexidine gluconate). The one-time periodontal intervention was completed within 24 h in the intervention group and two-week mouthwash was prescribed in the control group before oral and maxillofacial tumor surgery. Five periodontal indexes were examined at baseline and at 6 weeks after the treatment. The clinical symptoms and incidence of lower respiratory infections were compared between the two groups at 6 weeks. RESULTS The PLI, BOP, PPD, and CAL were significantly lower and GR was higher in the intervention group than in the control group (P<0.01). The periodontal status was significantly improved in the intervention group. The incidence of lower respiratory infection was significantly lower in the intervention group than in the control group (2.22% vs 7.11%, P<0.01). The incidences of cough and expectoration in the intervention group were significantly lower than those in control group (P<0.01). CONCLUSIONS Periodontal infection is one of the risk factors for lower respiratory infection after oral and maxillofacial tumor surgery. The periodontal status can be effectively controlled and improved by periodontal intervention. Compared with mouthwash, periodontal intervention can significantly reduce the incidences of cough and expectoration and lower the incidence of lower respiratory infections.
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Affiliation(s)
- Jie You
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.E-mail:
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Da Collina GA, Tempestini-Horliana ACR, da Silva DDFT, Longo PL, Makabe MLF, Pavani C. Oral hygiene in intensive care unit patients with photodynamic therapy: study protocol for randomised controlled trial. Trials 2017; 18:385. [PMID: 28830529 PMCID: PMC5568342 DOI: 10.1186/s13063-017-2133-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/03/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In intensive care units (ICUs), nosocomial infections are prevalent conditions and they have been related to high mortality indexes. Some studies have suggested that inefficient oral hygiene and ventilator-associated pneumonia (VAP) are related. Nowadays, in the Brazilian public health system there is no well-defined protocol for oral hygiene in an ICU. Due to the drawbacks of the use of antibiotics, photodynamic therapy (PDT) has emerged as an interesting technique in order to reduce antimicrobial-resistant pathogens. Methylene blue (MB) is the most common chemical agent for PDT in Brazil. However, new formulations for improved effectiveness are still lacking. The objective of this study is to evaluate the use of an MB mouthwash as an effective oral-hygiene procedure in an ICU and to show that oral hygiene using PDT with MB mouthwash may reduce VAP frequency to rates similar to, or higher than, chlorhexidine. METHODS Phase 1 will evaluate the most effective cleaning procedure, while phase 2 will correlate oral hygiene to VAP incidence. At the start of phase 1, the ICU patients will be randomly allocated into three different groups (10 patients/group): the efficacy of chlorhexidine, classical MB-PDT, and mouthwash MB-PDT will all be measured for the quantification of viable bacteria, both pre- and post-treatment, by a Reverse Transcription Polymerase Chain Reaction (RT-PCR). In phase 2, the most effective procedure found in phase 1 and a mechanical cleaning with filtered water will be carried out daily, once a day, over 5 days, with a total of 52 ICU patients randomly allocated into the two groups. The clinical records will be evaluated in order to find any pneumonic diagnoses. DISCUSSION Since a variety of bacterial species are related to VAP, a universal primer for bacteria will be used in order to quantify the total bacteria count in the participants' samples. In order to quantify only the living bacteria before DNA extraction, the samples will be treated with propidium monoazide. This will infiltrate the dead bacteria and will intercalate the DNA bases, avoiding their DNA amplification. This will be the first trial to evaluate MB-PDT in a mouthwash formula that can increase the effectiveness due to the control of MB aggregation. The results of this study will be able to generate an easy and low-cost protocol to be used in an ICU for the Brazilian public health system. TRIAL REGISTRATION This protocol was approved by the Research Ethics Committee of the Conjunto Hospitalar do Mandaqui (1.317.834, CAAE: 49273515.9.3001.5551) and it was registered in Registro Brasileiro de Ensaios Clínicos (ReBEC number: RBR-94bvrc;). First received: 12 July 2015; 1st version 6 June 2016. Data will be published in a peer-reviewed journal.
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Affiliation(s)
- Gabriela Alves Da Collina
- Biophotonics Applied to Health Sciences Postgraduation Program, Universidade Nove de Julho – UNINOVE, R. Vergueiro, 235/249, CEP 01504-001 São Paulo, Brazil
| | - Anna Carolina Ratto Tempestini-Horliana
- Biophotonics Applied to Health Sciences Postgraduation Program, Universidade Nove de Julho – UNINOVE, R. Vergueiro, 235/249, CEP 01504-001 São Paulo, Brazil
| | - Daniela de Fátima Teixeira da Silva
- Biophotonics Applied to Health Sciences Postgraduation Program, Universidade Nove de Julho – UNINOVE, R. Vergueiro, 235/249, CEP 01504-001 São Paulo, Brazil
| | - Priscila Larcher Longo
- Biophotonics Applied to Health Sciences Postgraduation Program, Universidade Nove de Julho – UNINOVE, R. Vergueiro, 235/249, CEP 01504-001 São Paulo, Brazil
| | | | - Christiane Pavani
- Biophotonics Applied to Health Sciences Postgraduation Program, Universidade Nove de Julho – UNINOVE, R. Vergueiro, 235/249, CEP 01504-001 São Paulo, Brazil
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