Galleria mellonella Model of Coccidioidomycosis for Drug Susceptibility Tests and Virulence Factor Identification.

Coccidioidomycosis (CM) can manifest as respiratory and disseminated diseases that are caused by dimorphic fungal pathogens, such as Coccidioides species. The inhaled arthroconidia generated during the saprobic growth phase convert into multinucleated spherules in the lungs to complete the parasitic lifecycle. Research on coccidioidal virulence and pathogenesis primarily employs murine models typically associated with low lethal doses (LD100 < 100 spores). However, the Galleria model has recently garnered attention due to its immune system bearing both structural and functional similarities to the innate system of mammals. Our findings indicate that Coccidioides posadasii can convert and complete the parasitic cycle within the hemocoel of the Galleria larva. In Galleria, the LD100 is between 0.5 and 1.0 × 106 viable spores for the clinical isolate Coccidioides posadasii C735. Furthermore, we demonstrated the suitability of this model for in vivo antifungal susceptibility tests to validate the bioreactivity of newly discovered antifungals against Coccidioides. Additionally, we utilized this larva model to screen a Coccidioides posadasii mutant library showing attenuated virulence. Similarly, the identified attenuated coccidioidal mutants displayed a loss of virulence in a commonly used murine model of coccidioidomycosis. In this study, we demonstrated that Galleria larvae can be applied as a model for studying Coccidioides infection.

Retrospective Study of Long-term Surgical Outcomes in Patients Who had a Vaginal Hysterectomy in Conjunction with Pelvic Organ Prolapse Surgery.

INTRODUCTION: Data on long-term outcomes and subjective patient symptom improvement following primary native tissue pelvic organ prolapse repair is limited. Our primary aim was to evaluate the long-term prolapse recurrence and retreatment rates of women who have undergone native tissue prolapse repair. Our secondary aim was to evaluate subjective patient improvement in pelvic floor symptoms and quality of life 7 to 10 years after surgery. METHODS: This retrospective cohort study included patients who had undergone primary prolapse repair surgery including a hysterectomy and native tissue repair by a single surgeon at a tertiary pelvic floor center from 2009 to 2013. The Pelvic Floor Distress Inventory was distributed to subjects before and 7 to 10 years after surgery and preand post-operative survey results were compared. Subjects were asked if they had symptom recurrence and if they required retreatment. RESULTS: One hundred twelve of the 204 distributed surveys were returned, yielding a 54.9% response rate. 8.6% of subjects reported prolapse symptom recurrence. 1.9% of subjects were retreated with a pessary. No subjects required additional prolapse repair surgery. 77.1% of subjects had improved PFDI-20 scores following surgery with an average improvement of 46.21 points. Statistically significant score improvements were also observed on PFDI-20 subsections. CONCLUSIONS: Primary pelvic organ prolapse repair utilizing native tissue results in low recurrence and retreatment rates. Patients can expect long-term clinical improvement in pelvic floor disorders and quality of life following prolapse surgery. Definitions of surgical success should be based on subjective patient symptoms and quality of life measures.

Neuromodulation and the toolkit for behavioural evolution: can ecdysis shed light on an old problem?

The geneticist Thomas Dobzhansky famously declared: 'Nothing in biology makes sense except in the light of evolution'. A key evolutionary adaptation of Metazoa is directed movement, which has been elaborated into a spectacularly varied number of behaviours in animal clades. The mechanisms by which animal behaviours have evolved, however, remain unresolved. This is due, in part, to the indirect control of behaviour by the genome, which provides the components for both building and operating the brain circuits that generate behaviour. These brain circuits are adapted to respond flexibly to environmental contingencies and physiological needs and can change as a function of experience. The resulting plasticity of behavioural expression makes it difficult to characterize homologous elements of behaviour and to track their evolution. Here, we evaluate progress in identifying the genetic substrates of behavioural evolution and suggest that examining adaptive changes in neuromodulatory signalling may be a particularly productive focus for future studies. We propose that the behavioural sequences used by ecdysozoans to moult are an attractive model for studying the role of neuromodulation in behavioural evolution.

Why South Dakota is Ready for a Perineal Clinic: A Research-Based Proposal and Review.

Perineal trauma is a significant complication of childbirth that can drastically influence an individual's quality of life. Pain, infection, fecal incontinence, and many other adverse outcomes can impact and endanger a woman's life following perineal injury. Early identification, referral and multi-disciplinary care are vital in the correct management of these injuries. The purpose of this manuscript is to discuss the prevalence and etiology of perineal trauma, explain the management of perineal injury and to highlight the important role a perineal clinic would play in South Dakota, especially rural areas, which could improve pelvic floor function and quality of life for these women.

Electric scooters: a quick way to get to the emergency department?

Introduction Electric scooters (e-scooters) are rife but are yet to be legalised in the UK. The aim of this paper was to investigate whether there had been an increase in the number of e-scooter injuries referred to the oral and maxillofacial surgery (OMFS) service at our unit. We present here what is, to our knowledge, the largest dataset regarding e-scooter-related injuries in the UK.Method A double cohort study in which details of patients sustaining e-scooter-related injuries that were referred to the OMFS department were collected, prospectively, for a 16-week period in 2020 (investigation period). This was compared with data collected, retrospectively, from the emergency department (ED) referral database for the same date range in 2019 (control period).Results In the investigation period, 12/649 referrals to OMFS from the ED were for e-scooter-related injuries. There were eight male patients and four female patients with a mean age of 35 years (interquartile range 24-48). Of these, only one patient was wearing a helmet and 8/12 had consumed alcohol. Head and neck injuries sustained included avulsed teeth, mandibular and midface fractures, skull fractures, facial lacerations and cervical spine injuries. One patient died as a result of their injuries. During the control period, 2/997 ED referrals to OMFS were for e-scooter-related injuries (12/649 versus 2/997; Fisher's exact test p <0.001).Conclusion There was a significant rise in e-scooter-related injuries seen at our major trauma unit compared with 2019. We recommend that e-scooters are subject to at least the same requirements in safety equipment and sobriety as bicycles and that their top speed is limited to 12.5 mph. We hope that these measures will allow the benefits of this technology to be enjoyed while reducing associated morbidity and mortality.

Training of Physical Therapists in Pelvic Floor Techniques: Is Care Available in the Rural Midwest?

INTRODUCTION: The number of patients affected by pelvic floor disfunction is predicted to continue to grow in the future. Pelvic floor physical therapy (PFPT) is a benign, first-line treatment for a variety of pelvic disorders. There is currently a failure rate estimated at 19.8 percent for this conservative therapy. The present study aims to investigate if the high failure rate of conservative treatment is due to a lack of training and availability of therapists in the rural health care setting. METHODS: An anonymous survey was distributed to 53 physical therapists who practice within a targeted rural healthcare setting. Questions were designed to determine training received in graduate and post-graduate courses in PFPT while gauging level of involvement of PFPT within their practice. Proportions were calculated and then analyzed independently for standard deviation, standard error, and 80 percent confidence intervals. RESULTS: This project had a 45 percent response rate. 58 percent of these therapists received less than 2 hours of didactics in PFPT, and only 29 percent of the participants had a lab included in their graduate school curriculum. 95 percent of the participants attended additional post-graduate training in PFPT. The average number of courses attended was 3.33. Participants who stated that their training included hands-on training in female and/or male external and internal physical exam was 91.6 percent. CONCLUSION: This study identified only 53 providers in this rural healthcare region who are not receiving adequate training in PFPT during graduate school. Therapists have to seek post-graduate courses in order to be prepared to provide these services to patients.

Effects of an oral hygiene regimen on progression of gingivitis/early periodontitis: A randomized controlled trial.

Background: Periodontal disease continues to be prevalent globally, but little clinical research has been undertaken to evaluate the long-term benefits of a daily oral hygiene regimen on progression of gingivitis/early periodontitis. The objective of this study was to evaluate the effects of an oral hygiene regimen (OHR) on the periodontal health of adults in good general health with established gingivitis and early periodontitis over 24 months. Methods: A randomized controlled trial was conducted in adults with established gingivitis, with isolated sites of probing pocket depth >4 mm. Study participants were randomized to the OHR (bioavailable stannous fluoride dentifrice, oscillating-rotating electric toothbrush, cetylpyridinium chloride rinse, and floss; P&G) or usual care products (sodium fluoride dentifrice and manual toothbrush; P&G) groups. At baseline and every 6 months, gingivitis and periodontal measures were assessed and a prophylaxis was conducted. The primary outcome was Gingival Bleeding Index-Bleeding Sites (GBI-BS). Analyses used ANCOVA at 5% significance levels. Results: A total of 107 individuals were enrolled; 87 completed the study. Mean GBI-BS, Modified Gingival Index, and Probing Pocket Depth (PPD) scores were significantly lower at each visit for the OHR versus usual care group by 28% to 39%, 12% to 18%, and 6% to 13%, respectively (p≤ 0.0009). The magnitude of reduction in median number of ≥2 mm PPD loss events for OHR versus the usual care group at 24 months was 74%. Conclusion: Long-term use of the OHR produced significant periodontal health improvements versus the usual care products.

Contexte: La maladie parodontale continue d'être prévalente sur le plan mondial, mais peu de recherches cliniques ont été effectuées pour évaluer les avantages à long terme d'un régime d'hygiène buccodentaire sur la progression de la gingivite ou de la parodontite précoce. L'objectif de cette étude était d'évaluer les effets d'un régime d'hygiène buccodentaire (RHB) sur la santé parodontale des adultes en bonne santé générale qui présentent une gingivite établie et une parodontite précoce au cours de 24 mois. Méthodologie: Un essai contrôlé randomisé a été effectué chez des adultes présentant une gingivite établie et des sites isolés de profondeurs de poches au sondage >4 mm. Les participants de l'étude ont été confiés à un groupe de RHB aléatoire (pâte dentifrice au fluorure stanneux biodisponible, une brosse à dents électrique rotative et oscillante, un rince-bouche au chlorure de cétylpyridinium et la soie dentaire; P & G) ou à un groupe de produits de soins habituels (dentifrice au fluorure de sodium et une brosse à dents manuelle; P & G). La gingivite et les mesures parodontales ont été évaluées au début de l'intervention et tous les 6 mois et une prophylaxie avait été effectuée. Le résultat primaire était l'Indice de saignement gingival­les sites de saignements (ISG­SS). L'analyse de covariance a été utilisée à des seuils de signification de 5 %. Résultats: Un total de 107 personnes ont été inscrites : 87 ont terminé l'étude. Les cotes moyennes de l'ISG­SS, de l'indice gingival modifié et des cotes de profondeurs des poches au sondage (PPS) étaient significativement plus faibles à chaque visite du groupe de RHB par rapport au groupe de soins habituels, de 28 % à 39 %, 12 % à 18 % et 6 % à 13 %, respectivement (p≤ 0,0009). L'ampleur de la réduction en nombre médian d'événements de perte de PPS ≥2 mm du groupe de RHB par rapport au groupe de soins habituels était de 74 % à 24 mois. Conclusion: L'utilisation à long terme du RHB a produit des améliorations significatives de la santé parodontale par rapport aux produits de soins habituels.

Dually targeted bioinspired nanovesicle delays advanced prostate cancer tumour growth in vivo.

Prostate cancer (PC) is second-leading cancer in men, with limited treatment options available for men with advanced and metastatic PC. Prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) have been exploited as therapeutic targets in PC due to their upregulation in the advanced stages of the disease. To date, several PSA- and PSMA-activatable prodrugs have been developed to reduce the systemic toxicity of existing chemotherapeutics. Bioinspired nanovesicles have been exploited in drug delivery, offering prolonged drug blood circulation and higher tumour accumulation. For the first time, this study describes the engineering of dually targeted PSA/PSMA nanovesicles for advanced PC. PSMA-targeted bioinspired hybrids were prepared by hydrating a lipid film with anti-PSMA-U937 cell membranes and DOX-PSA prodrug, followed by extrusion. The bioinspired hybrids were characterised using dynamic light scattering, transmission electron microscopy, Dot blot, flow cytometry and Western blot. Cellular binding and toxicity studies in PC cancer cell lines were carried out using flow cytometry, confocal microscopy, and resazurin assay. Finally, tumour targeting and therapeutic efficacy studies were performed in solid and metastatic C4-2B-tumor-bearing mice. Interestingly, our PSMA-targeted hybrids demonstrated high cell uptake in PSMA-expressing cells with significant accumulation in solid and metastatic C4-2B tumour tissues following intravenous administration. More promisingly, our dually targeted PSA/PSMA hybrid significantly slowed down the C4-2B tumour growth in vivo, compared to free DOX-PSA and non-targeted PSA-hybrid. Our PSA/PSMA bioinspired hybrid could offer a highly selective treatment for advanced PC with lower side effects. STATEMENT OF SIGNIFICANCE: This study investigates a new approach to treat prostate cancer using dually targeted bioinspired nanovesicle . Our bioinspired vesicles are made mainly of a human blood cell membrane with a ligand recognising a specific marker (PSMA) on the surface of the prostate cancer cells. The present work describes the successful loading of a doxorubicin prodrug linked to a PSA- activatable peptide into these targeted bioinspired nanovesicle , where the active PSA enzyme presents in these cells converts the drug to its active form. Our dually targeted PSA/PSMA hybrid vesicles has successfully improved site-specific prodrug delivery to tackle advanced prostate cancer, offering a novel and effective prostate cancer treatment.

PD1 blockade potentiates the therapeutic efficacy of photothermally-activated and MRI-guided low temperature-sensitive magnetoliposomes.

This study investigates the effect of PD1 blockade on the therapeutic efficacy of novel doxorubicin-loaded temperature-sensitive liposomes. Herein, we report photothermally-activated, low temperature-sensitive magnetoliposomes (mLTSL) for efficient drug delivery and magnetic resonance imaging (MRI). The mLTSL were prepared by embedding small nitrodopamine palmitate (NDPM)-coated iron oxide nanoparticles (IO NPs) in the lipid bilayer of low temperature-sensitive liposomes (LTSL), using lipid film hydration and extrusion. Doxorubicin (DOX)-loaded mLTSL were characterized using dynamic light scattering, differential scanning calorimetry, electron microscopy, spectrofluorimetry, and atomic absorption spectroscopy. Photothermal experiments using 808 nm laser irradiation were conducted. In vitro photothermal DOX release studies and cytotoxicity was assessed using flow cytometry and resazurin viability assay, respectively. In vivo DOX release and tumor accumulation of mLTSL(DOX) were assessed using fluorescence and MR imaging, respectively. Finally, the therapeutic efficacy of PD1 blockade in combination with photothermally-activated mLTSL(DOX) in CT26-tumor model was evaluated by monitoring tumor growth, cytokine release and immune cell infiltration in the tumor tissue. Interestingly, efficient photothermal heating was obtained by varying the IO NPs content and the laser power, where on-demand burst DOX release was achievable in vitro and in vivo. Moreover, our mLTSL exhibited promising MR imaging properties with high transverse r2 relaxivity (333 mM-1 s-1), resulting in superior MR imaging in vivo. Furthermore, mLTSL(DOX) therapeutic efficacy was potentiated in combination with anti-PD1 mAb, resulting in a significant reduction in CT26 tumor growth via immune cell activation. Our study highlights the potential of combining PD1 blockade with mLTSL(DOX), where the latter could facilitate chemo/photothermal therapy and MRI-guided drug delivery.

Clinical Parameters and Oral Fluid Biomarkers in Gingivitis Subjects using an Electric Toothbrush with Irrigator vs a Manual Toothbrush Alone over 8 Weeks: A Randomised Controlled Clinical Trial.

PURPOSE: To compare clinical outcomes and oral fluid biomarkers in gingivitis subjects using an electric toothbrush/irrigator combination (test) or a manual toothbrush alone (control) over 8 weeks. MATERIALS AND METHODS: Subjects were randomly assigned to two groups of n = 30. In both groups, toothbrushing was performed twice daily at home and no additional interdental cleaning aids were allowed. Plaque Index (PLI), Gingival Index (GI), whole saliva (WS), and gingival crevicular fluid (GCF) samples were collected at weeks 2, 4, and 8. RESULTS: Subjects' mean age was 23 years and 52% were female. Overall baseline means were 1.31 for PLI, 1.07 for GI, and 34.9 for number of bleeding sites. At every follow-up visit, both groups differed statistically significantly (p < 0.001) from baseline for all clinical parameters. The test group demonstrated statistically significantly (p < 0.001) greater reductions in GI vs the control group by 18% at week 2, 17% at week 4 and 24% at week 8. The test group also demonstrated statistically significantly (p < 0.002) greater reductions in the number of bleeding sites vs the control group by 33% at week 2, 34% at week 4 and 43% at week 8. Between-group comparisons for both WS and GCF revealed numerical trends for decreased levels of interleukin (IL)-1ß in GCF after 4 and 8 weeks, but these were not statistically significant. CONCLUSION: In subjects using the electric toothbrush/irrigator combination, increased clinical improvements may be found accompanied by similarly improved trends for oral fluid biomarkers such as IL-1ß.

Developing an Advanced Alternative Payment Model for Stress Urinary Incontinence.

ABSTRACT: Historically, our health care system has been based on a fee-for-service model, which has resulted in high-cost and fragmented care. The Center for Medicare & Medicaid Services is moving toward a paradigm in which health care providers are incentivized to provide cost-effective, coordinated, value-based care in an effort to control costs and ensure high-quality care for all patients. In 2015, the Medicare Access and Children's Health Insurance Program Reauthorization Act repealed the Sustainable Growth Rate and the fee-for-service model, replacing them with a 2-track system: Merit-based Incentive Payment System and the advanced Alternative Payment Model (aAPM) system. In 2016, the American Urogynecologic Society Payment Reform Committee was created and tasked with developing aAPMs for pelvic floor disorders. The purpose of this article is to describe the stress urinary incontinence aAPM framework, the data selected and associated data plan, and some of the challenges considered and encountered during the aAPM development.

Fixation Method and Subsequent Revision Rates for Elective Primary Hip Arthroplasty in People Aged 70 Years and Older: Analysis of National Administrative Data Sets by the UK Getting It Right First Time Program.

BACKGROUND: We aimed to understand the role of fixation method in predicting subsequent revision rates in people aged 70 years and older undergoing elective primary total hip arthroplasty (THA) within the UK National Health Service (NHS). METHODS: Data on elective primary THAs conducted in people aged 70 years and older between April 1, 2012, and March 31, 2018, and subsequent revisions conducted up to March 31, 2019, were extracted from the Hospital Episodes Statistics database for all NHS procedures in England. A flexible parametric competing risks model was used to identify the role of fixation method in predicting revision and adjust for age, sex, frailty, year of surgery, and all-cause mortality. RESULTS: Data were available for 190,656 procedures. Crude revision rates at 1-7 years follow-up in those who had cemented, hybrid/reverse hybrid, and uncemented fixation were 1.8%, 1.8%, and 2.3%, respectively. There was a high level of variation between NHS trusts in the proportionate use of fixation method. The differences in the hazard of revision between uncemented and cemented fixation (hazard ratio, 1.238 [95% confidence interval, 1.148-1.336]) and hybrid/reverse hybrid fixation (hazard ratio, 1.184 [95% confidence interval, 1.082-1.297]) were both significant. In secondary analysis, there was evidence that revision rates in trusts where uncemented fixation predominated were not significantly lower for uncemented fixation compared to all other fixation methods. CONCLUSIONS: Revision rates were significantly higher for elective primary THA in people aged 70 years and older who have uncemented fixation, compared to those who had cemented and hybrid/reverse hybrid fixation.

Treating Deficits in Auditory Processing Abilities.

Background The relationship between auditory processing (AP) test results and reading has shown significant correlations in the literature; however, whether the relationship is more coincidental or more causal is uncertain. Improving AP deficits is also not well understood, especially regarding its impacts on real-world benefits such as with reading and language. Purpose This study investigates the efficacy of two deficit-specific AP therapy programs and compares them to a control therapy program on behavioral AP measures. It also investigates relationships between the improved AP skills and related real-world skills, particularly reading ability. Method From three school regions, 335 children were tested using the Feather Squadron Diagnostic Assessment AP test and, if qualified, given a deficit-specific AP therapy (either Insane Earplane or Zoo Caper Skyscraper) or placed in a control therapy group. After therapy, AP abilities were measured again and compared across groups. For one region, pre- and posttherapy reading abilities were also compared across groups. Results Both experimental therapies were significantly efficacious for the AP areas in which they claimed to target, whereas the control therapy group was not. One experimental therapy revealed significant improvement (p < .01) and the other approached significant improvement (p < .02) of the reading ability of the participants, whereas the control group did not. Conclusions The current study found significant improvements for both AP skills and real-world skills compared to the control group. This information provides evidence that bottom-up, deficit-specific therapy approaches are beneficial for the targeted areas and can have associated benefits as well. One of the schools in the study was a special school for children with known speech and language disorders. Of the children tested at this special speech and language school, 83% of them qualified for an AP deficit-specific therapy, indicating a very strong relationship between AP and speech/language difficulties.

Testing Clinical Skills: A Look at the OSCE and USMLE Clinical Skills Exams.

The Objective Structured Clinical Examination (OSCE) was introduced in the mid-1970s as a method of testing students' clinical skills with more objectivity. The University of South Dakota Sanford School of Medicine (USD SSOM) administered its first OSCE to third year students in 1996. At a national level, the U.S. Medical Licensing Examination (USMLE) incorporated clinical skills testing for all medical students in the form of Step 2 Clinical Skills (CS) in 2004. The USMLE Step 2 CS exam has both proponents and opponents, but at this time will continue to be used. The USD SSOM OSCE has evolved over the years to include standardized patients, simulations, and note writing in an effort to better assess students and prepare them for Step 2 CS. Currently, the USD SSOM OSCE administered at the end of Pillar 2 is a requirement for graduation. The formal OSCE committee works diligently throughout the year to provide students with ample opportunity to prepare them for success. A significant ongoing part of student preparation is the clinical training that they receive in the offices of dedicated community preceptors.

Naked Liquid Marbles: A Robust Three-Dimensional Low-Volume Cell-Culturing System.

Three-dimensional (3D) multicellular structures allow cells to behave and interact with each other in a manner that mimics the in vivo environment. In recent years, many 3D cell culture methods have been developed with the goal of producing the most in vivo-like structures possible. Whilst strongly preferable to  conventional cell culture, these approaches are often poorly reproducible, time-consuming, expensive, and labor-intensive and require specialized equipment. Here, we describe a novel 3D culture platform, which we have termed the naked liquid marble (NLM). Cells are cultured in a liquid drop (the NLM) in superhydrophobic-coated plates, which causes the cells to naturally form 3D structures. Inside the NLMs, cells are free to interact with each other, forming multiple 3D spheroids that are uniform in size and shape in less than 24 h. We showed that this system is highly reproducible, suitable for cell coculture, compound screening, and also compatible with laboratory automation systems. The low cost of production, small volume of each NLM, and production via automated liquid handling make this 3D cell-culturing system particularly suitable for high-throughput screening assays such as drug testing as well as numerous other cell-based research applications.

Effect of Electronic Video Education on Patient's Self-Assessed Knowledge About Obesity and Pelvic Floor Disorders: A Randomized Controlled Trial.

OBJECTIVE: The objective of this study was to study the effect of electronic video education on patient's self-assessed perception of knowledge about pelvic floor disorders in relation to obesity in a prospective randomized controlled trial. METHODS: From June to July 2015, women with a body mass index of 25 kg/m or higher seeking care at a single urogynecology center were recruited and randomized into either a standard visit with an 8-minute video (group A) or a standard visit control (group B). Randomization was performed with computer-generated number blocks of 4. Allocation sequence was concealed from the caregiver, in sequentially numbered, opaque, and sealed envelopes. Immediately after their visit, patients answered a series of 3 questionnaires, which were statistically analyzed using unpaired t tests, Wilcoxon rank sum and analysis of variance tests, presented as mean and standard deviation. Primary outcome was a difference in self-assessed perception of knowledge questionnaire scores. Secondary outcome was a difference in motivation to lose weight. RESULTS: Forty-eight women enrolled, and 40 completed all questionnaires, 20 in each group. Representation in both groups was demographically similar. The mean (SD) answers for the postvisit survey measuring participant's self-assessed perception of knowledge was 3.9 (0.8) for group A and 3.5 (1.1) for group B (P = 0.002). Ninety percent of women in group A reported motivation to lose weight, compared with 75% in group B (P = 0.4). CONCLUSIONS: Participants who received electronic video education scored significantly higher on self-assessed perception of knowledge questionnaire about pelvic floor disorders in relation to obesity. The video did not increase motivation to lose weight.

A randomized controlled trial of a power brush/irrigator/mouthrinse routine on plaque and gingivitis reduction in orthodontic patients.

OBJECTIVES: To assess plaque and gingivitis reduction in orthodontic patients after 4 weeks' use of an oscillating-rotating power brush, irrigator, and mouthrinse. MATERIALS AND METHODS: This was a randomized, examiner-blind, clinical trial comparing plaque and gingivitis outcomes for an experimental power brush/irrigator/mouthrinse oral hygiene routine vs a dental prophylaxis followed by regular manual brushing (positive control). Fifty-one participants with fixed orthodontic appliances in the upper and lower jaw and a minimum of 15 gingival bleeding sites were randomly assigned to experimental or positive control treatment. Both groups were instructed to use their products at least twice daily. At baseline, week 1, and week 4, plaque was evaluated using digital plaque imaging analysis and a conventional subjective index. Gingival inflammation and bleeding were also measured. Analysis of covariance was used to compare groups. RESULTS: Fifty-one participants (mean age = 13.9 years) were randomized; 50 (25 per group) completed the study. At baseline, group means were not statistically different (P > .1) for gingival inflammation or bleeding. At week 4, the experimental and control groups had a 10.0% to 32.7% and 5.9% to 6.7% reduction vs baseline, respectively, in plaque (across both methods); 12.6% and 8.3% reduction, respectively, in gingival inflammation; and 50.6% and 37.8% reduction, respectively, in bleeding. At week 4, group differences favoring the experimental group were statistically significant (P < .05) for gingival inflammation, gingival bleeding, and plaque (by conventional and digital imaging indexes). CONCLUSIONS: Use of a power brush/irrigator/mouthrinse resulted in statistically significantly greater plaque and gingivitis reductions than prophylaxis followed by manual brushing in patients with fixed appliances over 4 weeks.

A Randomized Controlled Clinical Trial to Evaluate the Efficacy of an Oscillating-Rotating Electric Toothbrush, a Stannous Fluoride Dentifrice, and Floss on Gingivitis.

OBJECTIVES: To evaluate the gingival health efficacy of an oscillating-rotating electric toothbrush, a stannous fluoride dentifrice, and dental floss in adults with mild-to-moderate gingivitis. METHODS: This was a single-center, randomized, controlled, examiner-blind, two-treatment, eight-week parallel group study in adults with at least 20 gingival bleeding sites. Eligible subjects were randomized equally to one of two groups: experimental oral hygiene group that included an Oral-B® oscillating-rotating electric toothbrush with round brush head (D20/EB20), Crest® stabilized stannous fluoride dentifrice (SnF2 1100 ppm F, NaF 350 ppm F), and Oral-B® Glide® floss; or regular oral hygiene control group that included a regular manual toothbrush (Oral-B® Indicator 35) and Crest® anti-cavity sodium fluoride dentifrice (NaF 1450 ppm F). Subjects followed manufacturer's instructions and used their assigned products over an eight-week period. Gingival health was measured at baseline, Week 4, and Week 8 using three assessments: Gingival Bleeding Index (GBI), number of bleeding sites, and Modified Gingival Index (MGI). Analysis of Covariance was used to compare gingival health between treatment groups. RESULTS: One hundred and twenty subjects, mean age 44 years (range: 21 to 74 years), were assessed at baseline (60 per group); 113 subjects (57 in control group, 56 in experimental group) completed the study with fully evaluable data. At baseline, the groups were balanced; overall means were 0.41 for GBI, 51.7 for bleeding sites, and 1.44 for MGI. Only the experimental group showed statistically significant reductions from baseline (p < 0.0001) for all three gingivitis assessments at both Weeks 4 and 8. At these time points, better gingival health for the experimental group was seen as significantly lower adjusted mean scores versus the control group (p < 0.0001) for all three assessments. Reductions in favor of the experimental group at Weeks 4 and 8, respectively, were 51% and 45% for GBI, 46% and 40% for number of bleeding sites, and 37% and 20% for MGI. The study treatments were well tolerated. CONCLUSIONS: Over an eight-week period, an oral hygiene routine with an oscillating-rotating electric toothbrush, stannous fluoride dentifrice, and floss significantly improved gingivitis compared to regular hygiene with a manual toothbrush and an anti-cavity sodium fluoride dentifrice.

Cortical Auditory-Evoked Potential and Behavioral Evidence for Differences in Auditory Processing between Good and Poor Readers.

BACKGROUND: The relationship between auditory processing (AP) and reading is thought to be significant; however our understanding of this relationship is somewhat limited. Previous studies have investigated the relation between certain electrophysiological and behavioral measures of AP and reading abilities in children. This study attempts to further understand that relation. PURPOSE: Differences in AP between good and poor readers were investigated using electrophysiological and behavioral measures. STUDY SAMPLE: Thirty-two children (15 female) aged 9-11 yr were placed in either a good reader group or poor reader group, based on the scores of a nationally normed reading test in New Zealand. RESEARCH DESIGN: Children were initially tested using an automated behavioral measuring system that runs through a tablet computer known as "Feather Squadron." Following the administration of Feather Squadron, cortical auditory-evoked potentials (CAEPs) were recorded using a speech stimulus (/m/) with the HEARLab® Cortical Auditory Evoked Potential Analyzer. DATA COLLECTION AND ANALYSIS: The children were evaluated on eight subsections of the Feather Squadron, and CAEP waveform peaks were visually identified and averaged. Separate Kruskal-Wallis analyses were performed for the behavioral and electrophysiological variables, with group (good versus poor readers) serving as the between-group independent variable and scores from the Feather Squadron AP tasks as well as CAEP latencies and amplitudes as dependent variables. After the children's AP status was determined, the entire group was further divided into three groups: typically developing, auditory processing disorder + reading difficulty (APD + RD), and RDs only. Statistical analyses were repeated for these subgroups. RESULTS: Poorer readers showed significantly worse scores than the good readers for the Tonal Pattern 1, Tonal Pattern 2, and Word Double Dichotic Right tasks. CAEP differences observed across groups indicated comorbid effects of RD and AP difficulties. N2 amplitude was significantly smaller for the poor readers. CONCLUSIONS: The current study found altered AP in poor readers using behavioral Feather Squadron measures and speech-evoked cortical potentials. These results provide further evidence that intact central auditory function is fundamental for reading development.