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Extrinsic stain resides in the dental pellicle and can be caused by introduction of chromogenic materials or therapeutic agents into the oral cavity. In contrast, intrinsic tooth stain is found within the tooth structure and can be caused by a variety of agents, including hematological and developmental abnormalities and drugs such as tetracycline. The mechanisms of extrinsic stain formation differ with respect to the causative agent. For example, stain induced by chlorhexidine (CH) can be explained by an increased rate in the non-enzymatic browning reactions occurring at the pellicle surface, while food stains are retained on the surface via ion exchange mechanisms. Although most extrinsic dental stain can be removed by abrasive and/or surface-active materials, removal of certain types of surface stain, e.g., staining due to cationic antimicrobial agents, requires specific agents such as aminoguanidine to reduce the stain. A broad-spectrum approach to reduce both intrinsic and extrinsic dental stains clinically requires oxygenating agents. To evaluate this approach and understand the mechanisms of stain removal, we developed a spectroscopic method for measuring stain in vivo. A series of clinical studies was performed to evaluate stain removal by the agents. The results showed that carbamide peroxide in combination with surfactants and anti-redeposition agents, e.g., sodium pyrophosphate, was more effective in bleaching dental stain compared with carbamide peroxide alone. A detailed examination of the tooth structure by microhardness measurements, x-ray photoelectron spectroscopy, and scanning electron microscopy showed that stain decolorization with this system did not have any adverse effects. [ABSTRACT FROM AUTHOR]

Traditionally, Electronic Medical Records (EMR) have been designed to mimic paper records. Organizing and presenting medical information along the lines that evolved for non-digital records over the decades, reduced change management for medical users, but failed to make use of the potential of organizing digital data. We proposed a method to create clinical dashboards to increase the usability of information in the medical records. Official clinical guidelines were studied by a working group, including dashboard target users. Necessary clinical concepts contained in the medical records were identified according to the clinical context and finally, dedicated technical tools with standard terminologies were used to represent categories of information. We used this method to generate and implement a dashboard for sepsis. The dashboard was found to be appropriate and easy to use by the target users.

Background: Copper is a mineral that is absorbed in the stomach, duodenum, and jejunum. Gastric bypass surgery, gastrectomy, and short-bowel syndrome commonly lead to copper malabsorption. Copper deficiency primarily presents with hematological and neurological sequelae, including macrocytic anemia and myelopathy. Although hematological disturbances often correct with copper supplementation, neurological manifestations of copper deficiency may be irreversible. We present the case of copper deficiency secondary to malabsorption and management strategies to prevent irreversible neurological sequelae., Presentation: A 48-year-old female with a history of hypothyroidism, ischemic stroke, and Crohn's disease, complicated by subtotal colectomy and small-bowel resections, was admitted for fatigue and progressive neurological deficiencies. Her vital signs were stable, and physical examination was remarkable for weakness of both upper and lower extremities, ataxia, and upper extremities paresthesia. Computed tomography scan of the head without contrast was unremarkable. Magnetic resonance imaging enterography revealed a focal area of narrowing of the remaining small bowel. Copper level was low at 39 µg/dL. After 5 days of intravenous replacement using trace element within parenteral nutrition, her copper level corrected to 81 µg/dL. Her ataxia improved after intravenous copper supplementation and did not recur., Conclusions: Our patient presented with copper deficiency secondary to malabsoprtion. This case highlights the importance of copper testing in the bariatric surgery population and in patients with short-bowel syndrome. Given the irreversible nature of neurological symptoms when compared with the expense of nutrition supplements, routine copper testing should be considered in patients with malabsorptive states or altered anatomy, regardless of initial presentation., (© 2020 American Society for Parenteral and Enteral Nutrition.)

Background: Care provision underpinned by compassion builds trust and ensures a deeper understanding of the health needs of older people. Yet nursing curricula in the United Kingdom focus on knowledge and skill acquisition rather than caring with compassion. This negatively impacts on the quality of care. Despite this, there is limited research on compassion in the care of older people., Aim: To explore the views of nurse educators (NE), pre-registration nursing students (PNS) and clinical mentors (CM) of the determinants of compassion in the care of older people., Methods: A generic qualitative research design was used. Data were collected using semi-structured interviews with 39 participants (NE = 8; CM = 8; PNS = 23). These were digitally-recorded, fully transcribed and analysed thematically using NVivo software., Findings: Three main themes emerged from the data analysis: the meaning of compassion, extrinsic determinants of compassion in care, and intrinsic determinants of compassion in care., Discussion: The outcome of this study suggests that nurses and students think that compassion speeds up older people's recovery and enhances the quality of care. NEs consider its application in clinical practice a demonstration of competence., Conclusion: The inclusion of compassion in practical sessions of pre-registration nursing curricula and in the care of the older person may result in improved understanding of the latter and provision of holistic, safe and effective care., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Endocrine therapy reduces the risk of breast cancer recurrences and mortality in hormone receptor-positive (HR+) breast cancer survivors. However, non-adherence to treatment remains a significant problem. The aim of this study was to review current literature and ongoing trials to identify interventions employed to improve adherence to adjuvant endocrine therapy (AET) in breast cancer survivors., Methods: We searched PubMed and the National Library of Medicine registry of clinical trials using the terms "breast cancer" and "adherence" or "compliance" and "intervention" and "medication" or "endocrine therapy" or "hormone therapy" to identify published studies as well as ongoing clinical trials., Results: Three hundred and sixty-three studies were identified; five studies met the inclusion criteria. Most studies enrolled postmenopausal women diagnosed with early stage HR+ breast cancer. Providing educational materials was the most common intervention implemented to improve adherence to one or more aromatase inhibitors. None of the studies found a significant improvement in adherence with the intervention evaluated. Twelve clinical trials investigating various interventions, mostly based on technology, to improve AET adherence were also identified., Conclusions: Improving adherence to AET in HR+ breast cancer survivors is an urgent medical need. While newer clinical trials are overcoming some of the limitations seen with published studies, tailored interventions led by clinicians need further investigation., Implications for Cancer Survivors: Our study highlights the unmet clinical need to develop and test feasible interventions to improve AET adherence in HR+ breast cancer survivors to extend their long-term survival.

Background: Esophageal Crohn's disease is reported as a rare manifestation, although its prevalence may be underestimated because upper endoscopies are not routinely performed in asymptomatic adults. Tofacitinib, an oral janus kinase inhibitor, is a new biologic that has shown promise in the treatment of ulcerative colitis and may be effective in the treatment of Crohn's disease according to phase 2 trials. We report the first case of esophageal Crohn's disease successfully treated with tofacitinib in a patient with worsening symptoms despite maintenance therapy with a tumor necrosis factor-α inhibitor., Case Presentation: A 67-year-old Caucasian woman presented with new dysphagia and had findings of esophageal Crohn's disease on endoscopy. The dosage of her current biologic therapy-adalimumab-was increased in frequency, without improvement. Our patient was started on tofacitinib and demonstrated an improvement in symptoms, with a repeat endoscopy showing resolution of the previous lesions., Conclusion: Esophageal Crohn's disease is likely underdiagnosed but is an important consideration in a patient with new symptoms of dysphagia and known Crohn's disease. Tofacitinib, while a novel agent, could have a role in the treatment of esophageal Crohn's disease that does not improve with intensification of the current biologic therapy. It provides a different mechanism in patients who become refractory to maintenance therapy.

Objectives: This randomized, prospective clinical trial was conducted to determine the safety and effectiveness of a new whitening dentifrice formulation in comparison to that of both a negative and a positive control dentifrice., Methods: Seventy-nine qualifying subjects were randomly assigned to either the new whitening dentifrice (Arm & Hammer® Truly Radiant™ Clean & Fresh Toothpaste), a positive control whitening dentifrice (Crest® 3-D White® Radiant Mint Toothpaste), or a negative control regular dentifrice (Colgate® Cavity Protection Toothpaste). The subjects brushed with their assigned dentifrice for two minutes, twice daily, for five days. Extrinsic tooth stain was assessed using a Modified Lobene Stain Index (MLSI) at baseline and after five days of product use., Results: All entering subjects completed the study. There were no significant differences (p > 0.05) in stain among the three groups at baseline. The Arm & Hammer Truly Radiant and positive control groups had statistically significant (p < 0.001) mean composite MLSI reduction scores of 13.2% and 7.8%, respectively, from baseline to day five. The negative control dentifrice group was virtually unchanged during this period. Intergroup comparisons showed the Truly Radiant group to have significantly greater stain removal (p < 0.0001) scores than the negative control. The Truly Radiant group also had greater stain removal than the positive control, though the differences were not statistically significant., Conclusions: This study demonstrates that five-days' use of Arm & Hammer Truly Radiant Clean & Fresh dentifrice was significantly more effective in stain removal than a regular (non-whitening) dentifrice and comparable in effectiveness to a whitening dentifrice positive control., Competing Interests: A. Buelo, A. Ghassemi, L. Vorwerk, and W. Hooper were employees of Church & Dwight at the time the study was conducted. S. Nathoo declares no conflict of interest.

Objective: Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms., Method: Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery-Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays., Results: Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery-Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%)., Conclusion: Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

The lysophosphatidylcholine analogue edelfosine is a potent antitumor and antiparasitic drug that targets cell membranes. Previous studies have shown that edelfosine alters membrane domain organization inducing internalization of sterols and endocytosis of plasma membrane transporters. These early events affect signaling pathways that result in cell death. It has been shown that edelfosine preferentially partitions into more rigid lipid domains in mammalian as well as in yeast cells. In this work we aimed at investigating the effect of edelfosine on membrane domain organization using monolayers prepared from whole cell lipid extracts of cells treated with edelfosine compared to control conditions. In Langmuir monolayers we were able to detect important differences to the lipid packing of the membrane monofilm. Domain formation visualized by means of Brewster angle microscopy also showed major morphological changes between edelfosine treated versus control samples. Importantly, edelfosine resistant cells defective in drug uptake did not display the same differences. In addition, co-spread samples of control lipid extracts with edelfosine added post extraction did not fully mimic the results obtained with lipid extracts from treated cells. Altogether these results indicate that edelfosine induces changes in membrane domain organization and that these changes depend on drug uptake. Our work also validates the use of monolayers derived from complex cell lipid extracts combined with Brewster angle microscopy, as a sensitive approach to distinguish between conditions associated with susceptibility or resistance to lysophosphatidylcholine analogues., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Objective: This study was conducted to evaluate the effectiveness of Arm & Hammer (A&H) Truly Radiant Rejuvenating toothpaste in removing extrinsic tooth stain compared to that of a conventional fluoride/silica-containing dentifrice., Methods: This was a randomized, examiner-blind, parallel-design study with two groups of subjects who brushed unsupervised with their assigned dentifrice for two minutes, twice daily, for five days. Extrinsic stain was measured on the labial surfaces of the eight incisor teeth by the Modified Lobene Stain Index (MLSI) at baseline and following five days of product use. After balancing for baseline MLSI, beverage and tobacco use, fifty-four healthy adults with existing stain were randomly distributed into two comparable groups: Arm and Hammer Truly Radiant Rejuvenating toothpaste or Colgate Cavity Protection toothpaste (negative control). Within-treatment comparisons between baseline and day five were made using matched-pair t-tests, and between-treatment comparisons of MSLI scores were performed using ANCOVA, with baseline scores as covariates., Results: Twenty-eight subjects in the Truly Radiant Rejuvenating toothpaste group and twenty-six subjects in the negative control group completed the study. The groups had comparable mean scores at baseline (p > 0.05). The Truly Radiant Rejuvenating toothpaste produced a statistically significant 23.1% total (composite) stain reduction from baseline after five days of product use (p < 0.0001) while the negative control was essentially unchanged (p > 0.05). Between-treatment analysis showed statistically significantly (p < 0.0001) greater stain removal for Truly Radiant Rejuvenating toothpaste compared to the Colgate control following five days of product use. There were no adverse events reported during the study., Conclusion: The A&H Truly Radiant Rejuvenating toothpaste is safe and effective in reducing extrinsic stain compared to a regular toothpaste control.

Objective: This randomized controlled clinical trial was conducted to determine the effectiveness and safety of a new whitening dentifrice., Methods: One hundred eighty-two qualifying subjects were randomly assigned to either a whitening dentifrice group (Arm & Hammer Truly Radiant Toothpaste), a negative control dentifrice group (Colgate Cavity Protection Toothpaste), or a positive control dentifrice group (Crest 3-D White Radiant Mint Toothpaste) and were instructed to brush twice daily with their assigned dentifrice for six weeks. Extrinsic tooth stain was assessed using a Modified Lobene Stain Index (MLSI) and tooth shade was assessed using the VITA Classic Shade Guide at baseline and after five days and two, four, and six weeks of dentifrice use. Safety was monitored by clinical examinations and panelist assessment at each evaluation period., Results: The Arm & Hammer Truly Radiant group showed a statistically significant improvement from baseline in mean composite MLSI and VITA shade at each examination period (p < 0.0001). Significant improvements on day 5 progressively increased with increasing duration of product use. By week 6, there was a 45.4% reduction in stain and a 2.08 improvement in tooth shade. The between-group comparison revealed that Truly Radiant toothpaste was significantly more effective than both the negative and positive control dentifrices for these parameters (p < 0.0001) at each exam time., Conclusion: This study showed that the new dentifrice formulation is safe and effective on stain removal and tooth whitening.

Efficient clearance of apoptotic cells (efferocytosis) prevents inflammation and permits repair following tissue injury. Kidney injury molecule-1 (KIM-1) is a receptor for phosphatidylserine, an "eat-me" signal exposed on the surface of apoptotic cells that marks them for phagocytic clearance. KIM-1 is upregulated on proximal tubule epithelial cells (PTECs) during ischemic acute kidney injury (AKI), enabling efferocytosis by surviving PTECs. KIM-1 is spontaneously cleaved at its ectodomain region to generate a soluble fragment that serves a sensitive and specific biomarker for AKI, but the biological relevance of KIM-1 shedding is unknown. Here, we sought to determine how KIM-1 shedding might regulate efferocytosis. Using cells that endogenously and exogenously express KIM-1, we found that hydrogen peroxide-mediated oxidative injury or PMA treatment accelerated KIM-1 shedding in a dose-dependent manner. KIM-1 shedding was also accelerated when apoptotic cells were added. Accelerated shedding or the presence of excess soluble KIM-1 in the extracellular milieu significantly inhibited efferocytosis. We also identified that TNF-α-converting enzyme (TACE or ADAM17) mediates both the spontaneous and PMA-accelerated shedding of KIM-1. While accelerated shedding inhibited efferocytosis, we found that spontaneous KIM-1 cleavage does not affect the phagocytic efficiency of PTECs. Our results suggest that KIM-1 shedding is accelerated by worsening cellular injury, and excess soluble KIM-1 competitively inhibits efferocytosis. These findings may be important in AKI when there is severe cellular injury., (Copyright © 2014 the American Physiological Society.)

Objective: To evaluate the efficacy of a power toothbrush with distinct multi-directional cleaning action using two different heads (Colgate ProClinical C200 toothbrush with either a triple clean head or a sensitive head) as compared to a manual flat-trim toothbrush (Oral B Indicator toothbrush) on supragingival plaque and established gingivitis., Methods: This examiner-blind, randomized, controlled, three-treatment, parallel-group clinical research study assessed plaque removal via the comparison of pre- to post-brushing after a single use and again after four weeks of use, using the Rustogi Modified Navy Plaque Index. This study also assessed gingivitis at four weeks using the Löe-Silness Gingival Index. Qualifying adult male and female subjects from the central New Jersey, USA area reported to the study site after refraining from any oral hygiene procedures for 24 hours, and from eating, drinking, and smoking for four hours. Following an examination for plaque and gingivitis, they were randomized into three balanced groups. Subjects were instructed to brush their teeth for two minutes under supervision with their assigned toothbrush and a commercially available toothpaste (Colgate Cavity Protection toothpaste), after which they were again evaluated for plaque. Subjects were dismissed from the study site with the toothpaste and their assigned toothbrush to use at home twice daily for the next four weeks. They reported to the study site after four weeks of product use, at which time they were evaluated for plaque and gingivitis., Results: One hundred twenty (120) enrolled subjects complied with the protocol and completed the clinical study. The results of the study indicated that all three test products provided statistically significant reductions in pre-brushing to post-brushing plaque scores for whole mouth and interproximal sites after a single use. For gingival margin plaque sites, only the Colgate ProClinical C200 toothbrush, with either the triple clean head or the sensitive head, provided statistically significant reductions in pre- to post-brushing plaque scores. After four weeks of product use, all three test products provided statistically significant reductions in baseline to four-week whole mouth and interproximal site plaque scores, but only the Colgate ProClinical C200 toothbrush, with either the triple clean head or the sensitive head, provided a statistically significant reduction in plaque scores at gingival margin sites. All three test products provided statistically significant reductions in gingival and gingivitis severity index scores after four weeks of product use. Relative to the manual toothbrush group, after a single tooth brushing the Colgate ProClinical C200 toothbrush, with either the triple clean head or sensitive head, provided statistically significantly greater reductions in whole mouth plaque index scores (51.9% and 59.3%, respectively), in gingival margin plaque index scores (700% and 650%, respectively), and interproximal plaque index scores (64.2% and 60.4%, respectively). Relative to the manual toothbrush group, after four weeks of use the Colgate ProClinical C200 toothbrush, with either the triple clean head or sensitive head, provided statistically significantly greater reductions in whole mouth plaque index scores (78.6%, and 82.1%, respectively), in gingival margin plaque index scores (3700% and 3400%, respectively), and interproximal plaque index scores (50.8% and 52.5%, respectively). Relative to the manual toothbrush group, after four weeks of use the Colgate ProClinical C200 toothbrush, with either the triple clean head or sensitive head, provided statistically significantly greater reductions in gingival index scores of 900% and 833%, respectively, and in gingivitis severity index scores of 466.7% and 600%, respectively. All statistically significant reductions were at the p ≤ 0.05 level. There were no statistically significant differences between the scores of the Colgate ProClinical C200 toothbrush with triple clean head and the scores of the Colgate ProClinical C200 toothbrush with sensitive head at any comparison time point., Conclusion: The Colgate ProClinicaI C200 toothbrush, with either a triple clean head or a sensitive head, provides statistically significant and clinically relevant levels of efficacy in the removal of supragingival dental plaque in the whole mouth, at the gingival margin, and interproximally after a single tooth brushing and after four weeks of use, as well as a statistically significantly greater level of efficacy in the reduction of gingivitis and gingival bleeding when compared to a manual flat-trim toothbrush.

Understanding lipid-protein interactions to enhance our knowledge of membrane architecture is a critical step in the development of novel therapeutic measures to respond to the drastic rise of drug resistant microorganisms. Escherichia coli contains a small archetypal inner membrane multidrug resistance protein, EmrE, that must multimerize to be functional but this multimerization is difficult to demonstrate in vivo. We studied three major E. coli lipids (phosphatidylethanolamine, phosphatidylglycerol and cardiolipin) that varied in head group structure, acyl chain length and saturation. These were investigated both in the presence and absence of EmrE to determine which lipid(s) EmrE influenced most strongly. Langmuir monolayers and Brewster angle microscopy demonstrated that varying each head group, acyl chain length and saturation contributed to differences in membrane packing and affected lipid-protein associations. Long unsaturated anionic lipids were influenced most strongly by EmrE. Shorter acyl chains initiated string-like formations of EmrE clusters, whereas longer chains contributed to enhance protein clustering. Longer partially unsaturated acyl chains in phosphatidylglycerol showed a significant surface pressure decrease in the presence of the protein, indicating that the monolayer was destabilized. Interestingly, longer unsaturated chains of cardiolipin formed the most stable monolayer in the presence of EmrE. These studies indicate cardiolipin acyl chains that hydrophobically match protein helical lengths stabilize EmrE structural forms., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

In 1961, David C. Poskanzer and Robert S. Schwab presented a paper, "Studies in the epidemiology of Parkinson's disease predicting its disappearance as a major clinical entity by 1980." This paper introduced the hypothesis that Parkinson's disease was derived from a single aetiology, the influenza virus. We review the original Poskanzer and Schwab hypothesis that Parkinson's disease was based on the association between the 1918-19 influenza epidemic and the later observation of Parkinsonism in some influenza sufferers. We also further explore the prediction that Parkinson's disease would totally disappear as an entity once original influenza victims were all deceased. Current research has revealed that there are many potential causes and factors important in the occurrence of Parkinson's disease, postencephalitic Parkinsonism, and encephalitis lethargica. Poskanzer and Schwab presented a novel hypothesis; however, it was proven false by a combination of research and time.

A detailed understanding of biomembrane architecture is still a challenging task. Many in vitro studies have shown lipid domains but much less information is known about the lateral organization of membrane proteins because their hydrophobic nature limits the use of many experimental methods. We examined lipid domain formation in biomimetic Escherichia coli membranes composed of phosphatidylethanolamine and phosphatidylglycerol in the absence and presence of 1% and 5% (mol/mol) membrane multidrug resistance protein, EmrE. Monolayer isotherms demonstrated protein insertion into the lipid monolayer. Subsequently, Brewster angle microscopy was applied to image domains in lipid matrices and lipid-protein mixtures. The images showed a concentration dependent impact of the protein on lipid domain size and shape and more interestingly distinct coexisting protein clusters. Whereas lipid domains varied in size (14-47μm), protein clusters exhibited a narrow size distribution (2.6-4.8μm) suggesting a non-random process of cluster formation. A 3-D display clearly indicates that these proteins clusters protrude from the membrane plane. These data demonstrate distinct co-existing lipid domains and membrane protein clusters as the monofilm is being compressed and illustrate the significant mutual impact of lipid-protein interactions on lateral membrane architecture., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Souring in the Medicine Hat Glauconitic C field, which has a low bottom-hole temperature (30 °C), results from the presence of 0.8 mM sulfate in the injection water. Inclusion of 2 mM nitrate to decrease souring results in zones of nitrate-reduction, sulfate-reduction, and methanogenesis along the injection water flow path. Microbial community analysis by pyrosequencing indicated dominant community members in each of these zones. Nitrate breakthrough was observed in 2-PW, a major water- and sulfide-producing well, after 4 years of injection. Sulfide concentrations at four other production wells (PWs) also reached zero, causing the average sulfide concentration in 14 PWs to decrease significantly. Interestingly, oil produced by 2-PW was depleted of toluene, the preferred electron donor for nitrate reduction. 2-PW and other PWs with zero sulfide produced 95% water and 5% oil. At 2 mM nitrate and 5 mM toluene, respectively, this represents an excess of electron acceptor over electron donor. Hence, continuous nitrate injection can change the composition of produced oil and nitrate breakthrough is expected first in PWs with a low oil to water ratio, because oil from these wells is treated on average with more nitrate than is oil from PWs with a high oil to water ratio.

Objective: This study was designed to evaluate the efficacy of a new specially engineered sonic powered toothbrush with unique sensing and control technologies, as compared to a manual flat-trim toothbrush on supragingival plaque and established gingivitis., Methods: This examiner-blind, two-treatment, parallel clinical research study assessed plaque removal via the comparison of pre- to post-brushing after a single use, and again after four- and 12-weeks' use using the Rustogi Modification of the Modified Navy Plaque Index. This study also assessed gingivitis at four and 12 weeks using the Löe and Silness Gingival Index. Qualifying adult male and female subjects from the southern Florida area reported to the study site after refraining from any oral hygiene procedures for 24 hours, and from eating, drinking, and smoking for four hours. Following an examination for plaque (pre-brushing) and gingivitis, they were randomized (for both plaque and gingivitis) into two balanced groups, each group using one of the two study toothbrushes. Subjects were instructed to brush their teeth for two minutes under supervision with their assigned toothbrush according to the manufacturer's instructions, and commercially available toothpaste (Colgate Cavity Protection Toothpaste), after which they were again evaluated for plaque (post-brushing). Subjects were then dismissed from the study site with the toothpaste and their assigned toothbrush to use at home twice daily for the next 12 weeks. They again reported to the study site after four and 12 weeks of product use, at which time they were evaluated for plaque and gingivitis., Results: Seventy-six out of 82 enrolled subjects complied with the protocol and completed the clinical study. The new specially engineered sonic powered toothbrush with unique sensing and control technologies provided statistically significant reductions in gingival and gingivitis severity index scores after four and 12 weeks of product use. The manual toothbrush provided a statistically significant reduction in gingival index score only at the 12-week time point. Relative to the manual toothbrush group, after a single tooth brushing and after four and 12 weeks, the new sonic powered toothbrush provided statistically significantly greater reductions in whole mouth plaque index scores (1.6, 2.05, and 1.9 times, respectively), gingival margin plaque index scores (12.0, 90.0, and 8.2 times, respectively), and interproximal plaque index scores (2.0, 3.2, and 2.1 times, respectively). Relative to the manual toothbrush group after four and 12 weeks, the new sonic powered toothbrush provided statistically significant reductions in gingival index scores of 11.0 and 7.0 times, respectively, and in gingivitis severity index scores of 3.0 and 3.5 times, respectively. All statistically significant reductions were at the p < or = 0.05 level., Conclusion: The new specially engineered sonic powered toothbrush unique sensing and control technologies provides statistically significant and clinically relevant levels of efficacy in the removal of supragingival dental plaque after a single tooth brushing, and after four and 12 weeks' use. The new sonic powered toothbrush also provides statistically significantly greater levels of efficacy in the reduction of supragingival plaque, gingivitis, and gingival bleeding when compared to a manual flat-trim toothbrush.

Objective: The primary purpose of this randomized, controlled, six-week clinical trial was to determine the effectiveness and safety of a new whitening dentifrice in removing extrinsic tooth stain and whitening teeth. An additional two-week exploratory study was conducted to determine whether the whitening or stain-prevention activity of the dentifrice would persist following cessation of use., Methods: In the first study (Phase I), one-hundred and forty-six qualifying subjects were randomly assigned to either a sodium bicarbonate whitening dentifrice group (Arm & Hammer Advance White Extreme Whitening Baking Soda and Peroxide Toothpaste) or a silica-based negative control dentifrice group, and brushed twice daily with their assigned dentifrice for six weeks. Tooth shade on the labial surfaces of the eight incisors was assessed using a Vita Classic shade guide, and extrinsic tooth stain was scored using a Modified Lobene Stain Index (MLSI) at baseline, week 4, and week 6. In Phase II (after the week 6 examination), volunteers from the Arm & Hammer whitening dentifrice group were randomly assigned to continue using the whitening dentifrice or to use the negative control dentifrice twice daily for two weeks. The six-week shade and stain index scores served as the baseline for this exploratory phase and were rescored after two weeks., Results: The whitening dentifrice group had statistically significant (p < 0.0001) mean shade score reductions of 1.82 and 2.57 from baseline to weeks 4 and 6, respectively. For the same periods, the negative control dentifrice group was virtually unchanged from baseline. For tooth stain, the MLSI total mean scores for the whitening dentifrice group showed statistically significant (p < 0.0001) decreases from baseline of 1.42 (41.6%) and 2.11 (61.6%) at weeks 4 and 6, respectively. In contrast, the negative control dentifrice group had a MLSI reduction of 0.07 at week 4 and a 0.06 increase at week 6. Between-group analyses using baseline-adjusted ANCOVA showed the whitening dentifrice to be statistically significantly more effective (p < 0.0001) than the negative control for shade and tooth stain reductions for all index comparisons. Compared to the six-week (baseline) scores, subjects who continued to use the whitening dentifrice for the additional two weeks experienced statistically significant (p < 0.0001) further mean reductions of 0.88 in shade score and 0.46 in MLSI score, while subjects who switched to the negative control dentifrice experienced smaller, statistically significant (p < 0.05) reductions of 0.34 in shade score and 0.13 in total MLSI score., Conclusion: The Arm & Hammer whitening dentifrice tested in this study is effective for removing extrinsic tooth stain and whitening teeth. While the results also suggest that this dentifrice may have stain-prevention activity that persists following cessation of product use, such activity would need to be confirmed with further studies.

Background: It is not clear whether treatment modality (clipping or coiling) affects the risk of seizures after treatment for cerebral aneurysms., Objective: To determine whether there is an increased risk of seizures after clipping vs coiling., Methods: Hospitalizations for clipping or coiling of ruptured and unruptured aneurysms were identified in the Nationwide Inpatient Sample Database for 2002 to 2007 by International Classification of Diseases 9th Revision codes for subarachnoid hemorrhage or unruptured cerebral aneurysm and codes for clipping or coiling. Clipping and coiling were compared for the combined primary endpoint of seizures or epilepsy. The analysis was adjusted for patient-specific and hospital-specific factors using generalized linear models with generalized estimated equations., Results: There were 10 899 hospitalizations for ruptured aneurysms (6593 clipping, 4306 coiling), and 9686 hospitalizations for unruptured aneurysms (4483 clipping, 5203 coiling). For ruptured aneurysm patients, clipping had a similar incidence of seizures or epilepsy compared with coiling (10.7% vs 11.1%, respectively, adjusted odds ratio: 0.596; 95% confidence interval: 0.158-2.248; P = .445 after adjustment for patient-specific and hospital-specific factors). For unruptured aneurysm patients, clipping was associated with a significantly higher risk of seizures or epilepsy (9.2%) compared with coiling (6.2%) (adjusted odds ratio: 1.362; 95% confidence interval: 0.155-1.606; P < .001 after adjustment for patient-specific and hospital-specific factors). Seizures or epilepsy were significantly associated with longer hospitalizations (P < .01) and higher hospital charges (P < .0001), except in coiled unruptured aneurysm patients, in which seizures or epilepsy were not significantly associated with hospital charges (P = .31)., Conclusion: In unruptured cerebral aneurysm patients, clipping is associated with a higher risk of seizures or epilepsy.

Purpose: This single-center, double-blind, randomized, parallel-group clinical study was designed to investigate the extrinsic stain removal efficacy of a new antisensitivity dentifrice containing 0.3% triclosan, 2% polyvinylmethyl ether/maleic acid copolymer (PVM/MA copolymer), 0.243% NaF and a new silica specially-designed to occlude dentin tubules, relative to a Positive Control dentifrice and a Negative Control dentifrice., Methods: 117 qualifying adults were stratified by baseline Lobene Stain Index scores and randomly assigned to brush twice daily using a soft-bristled toothbrush and one of three dentifrices: (1) the Test Dentifrice; (2) a previously clinically proven dentifrice variant containing 0.3% triclosan, 2% PVM/MA copolymer, 0.243% NaF in a high cleaning silica base (Positive Control); and (3) a dentifrice containing 0.243% NaF in a silica base (Negative Control). Extrinsic stain area and stain intensity examinations were repeated after 3 and 6 weeks of product use., Results: Relative to the Negative Control group, the Test group and the Positive Control group exhibited statistically significant improvements in mean Lobene composite stain scores after 3 weeks of product use (39.8% and 40.7% respectively) and after 6 weeks of product use (58.8% and 61.8% respectively). There were no statistically significant differences observed between the stain removal performance of the Test Dentifrice and the Positive Control Dentifrice after 3 and 6 weeks of product use.

Given the current interest in the pulmonary route for targeted drug delivery, assessing the impact of drug delivery vehicles on the surfactant layer lining the surface of the lung alveoli is critical. As gelatin-based nanoparticles are one such vehicle, this study addresses their interaction with the major saturated phospholipid component of native lung surfactant, dipalmitoylphosphatidylcholine (DPPC). Nanoparticles are colloidal particles in the size range of 1 to 1000 nm that are presently investigated for site-specific drug delivery in the emerging field of nanomedicine. Monolayer studies of DPPC films were performed both in the presence and absence of nanoparticles in order to assess the interaction in terms of average molecular areas occupied at given surface pressures. In Brewster angle microscopy experiments, nanoparticles significantly changed the shape and reduced the size of DPPC domains suggesting a considerable interaction of the two systems. For safe pulmonary drug delivery, understanding this interaction is a prerequisite so nanoparticles can be a feasible alternative to more conventional therapies in the future.

Antimicrobial peptides are naturally produced by numerous organisms including insects, plants and mammals. Their non-specific mode of action is thought to involve the transient perturbation of bacterial membranes but the molecular mechanism underlying the rearrangement of the lipid molecules to explain the formation of pores and micelles is still poorly understood. Biological membranes mostly adopt planar lipid bilayers; however, antimicrobial peptides have been shown to induce non-lamellar lipid phases which may be intimately linked to their proposed mechanisms of action. This paper reviews antimicrobial peptides that alter lipid phase behavior in three ways: peptides that induce positive membrane curvature, peptides that induce negative membrane curvature and peptides that induce cubic lipid phases. Such structures can coexist with the bilayer structure, thus giving rise to lipid polymorphism induced upon addition of antimicrobial peptides. The discussion addresses the implications of induced lipid phases for the mode of action of various antimicrobial peptides.

Objective: The objective of this double-blind, randomized, parallel-design clinical study was to compare the efficacy in reducing dentin hypersensitivity of a novel toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste containing 1450 ppm fluoride, instantly after a single direct topical self-application using a fingertip, and after subsequent brushing twice daily for three days., Methods: Qualifying subjects from the Piscataway, New Jersey, USA area who presented two hypersensitive teeth with a tactile hypersensitivity score (Yeaple Probe) between 10 and 50 grams of force, and an air blast hypersensitivity score of 2 or 3 (Schiff Sensitivity Scale), participated in this study. The first phase of the study consisted of a single topical application of the assigned product directly onto the hypersensitive surface of each of the two baseline-designated hypersensitive teeth. Study subjects applied a pea-size amount of their assigned toothpaste onto the hypersensitive surface of each tooth and massaged each surface for one minute. The second phase of the study consisted of twice-daily at-home brushing with the assigned toothpaste for three days. Dentin hypersensitivity assessments, as well as examinations of oral hard and soft tissues, were conducted at baseline, immediately after direct topical application, and after three days of product use., Results: One-hundred and twenty-five subjects complied with the study protocol and completed the study. Relative to the benchmark desensitizing toothpaste and the control toothpaste groups, the 8.0% arginine toothpaste group exhibited statistically significant (p < 0.05) reductions in dentin hypersensitivity on both tactile and air blast hypersensitivity scores immediately after direct application. Reductions in sensitivity for the 8.0% arginine toothpaste compared to the benchmark desensitizing toothpaste and control toothpaste were 161.2% and 180.2% (tactile), and 59.8% and 58.0% (air blast), respectively. Relative to the benchmark desensitizing toothpaste and control toothpaste groups, the 8.0% arginine group exhibited statistically significant (p < 0.05) reductions in sensitivity after the subsequent three days of twice-daily regular tooth brushing of 147.1% and 181.2% (tactile), and 70.1% and 70.9% (air blast), respectively., Conclusion: A single fingertip topical self-application of a new 8.0% arginine-calcium carbonate toothpaste directly onto the hypersensitive surface of teeth provides significant immediate improvement in dentin hypersensitivity relative to an identical application of a control toothpaste and to a benchmark potassium-based desensitizing toothpaste. Significant improvements in dentin hypersensitivity were also demonstrated after three days of brushing with the 8.0% arginine-calcium carbonate toothpaste, subsequent to the single topical self-application of the product, relative to an identical application of the control toothpaste and to the potassium-based desensitizing toothpaste. The improvement demonstrated by the 8.0% arginine toothpaste after direct application was maintained after three days of twice-daily brushing.

Objective: The objective of these two six-week, double-blind clinical studies was to compare the extrinsic stain prevention (Study #1) and stain removal (Study #2) efficacy of a new dentifrice (Colgate Total Advanced Toothpaste) containing 0.3% triclosan/ 2.0% polyvinylmethyl ether/maleic acid (PVM/MA) copolymer/0.243% sodium fluoride in a 17% dual silica base, to a commercially available fluoride dentifrice without tooth whitening ingredients (Crest Cavity Protection Toothpaste) containing 0.243% sodium fluoride in a silica base., Methods: Following baseline examinations for extrinsic tooth stain and an oral tissue examination, qualifying adult male and female subjects from the northern and central New Jersey, USA areas were randomized for each study into two treatment groups which were balanced for gender and level of extrinsic tooth stain. Subjects received a full oral prophylaxis at the start of Study #1 only. All subjects were provided with their assigned product and a soft-bristled adult toothbrush for home use. Subjects were instructed to brush their teeth for one minute twice daily (morning and evening) using only the dentifrice and toothbrush provided, and to refrain from using any other oral hygiene products for the entire six weeks of the study. There were no restrictions regarding diet or smoking habits during the course of the study. Examinations for extrinsic tooth stain and oral tissue assessments were repeated after three weeks and six weeks of product use., Results: One-hundred fourteen (114) subjects participating in Study #1 and 119 subjects participating in Study #2 complied with the protocol and completed the entire study. In both studies, at the three-week and the six-week examinations, subjects who used the new dentifrice exhibited statistically significantly lower levels of extrinsic tooth stain area and extrinsic tooth stain intensity than did those subjects who used the commercially available fluoride control dentifrice., Conclusion: A new dentifrice containing 0.3% triclosan/2.0% PVM/MA copolymer/0.243% sodium fluoride in a 17% dual silica base is more efficacious in the prevention and removal of extrinsic tooth stain than a commercially marketed fluoride dentifrice.

Purpose: To evaluate the safety and efficacy of a new manual toothbrush by comparing plaque removal and gingivitis reduction after 4 weeks of use., Methods: This monadic clinical study included 46 subjects from the Northern New Jersey area who reported to the clinical facility for a baseline plaque and gingivitis examination after having refrained from all oral hygiene procedures and chewing gum for 8 hours, and from eating, drinking, or smoking for 4 hours. The population was comprised of healthy adult male and female subjects aged 27-68 years. Subjects were instructed to brush their teeth for 1 minute, twice a day with their assigned toothbrush and a commercially-available fluoride toothpaste (Colgate Cavity Protection Great Regular Flavor). After 4 weeks of use, subjects returned to the clinical facility for a final gingivitis and plaque examination., Results: All 46 subjects complied with the protocol and completed the 4-week clinical study. The results of the study indicated that the new manual toothbrush was significantly effective in reducing gingivitis and removing plaque after 4 weeks of use. Specifically, the results indicated a 17-39% reduction in gingival sites. In addition, the results indicated plaque removal of up to 96.5% in some parts of the mouth.

The objective of this controlled, examiner-blind, 4-week clinical study was to evaluate and compare the safety and efficacy of a newly designed manual toothbrush (Colgate 360 degrees toothbrush) to the Oral-B CrossAction toothbrush for the control of supragingival plaque and gingivitis. A total of 80 subjects from the central New Jersey area reported to the clinical facility for a baseline plaque and gingivitis examination after having refrained from all oral hygiene procedures for 12 hours and from eating, drinking, or smoking for 4 hours. The population was comprised of healthy adult men and women 18 to 67 years of age. After the baseline examinations, qualifying subjects were randomized into two groups and assigned to one of the two test toothbrushes. All subjects were instructed to brush their teeth for 1 minute under supervision, after which they were again examined for supragingival plaque. They were then instructed to brush their teeth twice a day for 1 minute with their assigned toothbrush and a commercially available toothpaste (Colgate Cavity Protection Great Regular Flavor Fluoride Toothpaste) for the next 4 weeks. After 4 weeks of use, subjects returned to the clinical facility for a final gingivitis and plaque examination. Seventy-eight subjects complied with the protocol and completed the 4-week clinical study. The results of the study indicated that the new manual toothbrush was statistically significantly effective in reducing gingivitis after 4 weeks and in removing plaque after a single toothbrushing and after 4 weeks of use. Also, the group using the new manual toothbrush exhibited a statistically significant greater reduction in plaque of up to 40% and no statistically significant difference in gingivitis reduction after 4 weeks of use, as compared to the Oral-B CrossAction toothbrush.

In response to the HIV/AIDS pandemic, antiretroviral treatment is currently being implemented in sub-Saharan Africa, where malaria and HIV-1 co-infections are highly prevalent. The effectiveness and tolerability of antiretrovirals in patients with malaria and HIV-1 co-infection have not been investigated. Antiretrovirals decrease CD36 surface concentrations in vivo, which might impair receptor function and affect parasite-host interactions. Thus, we investigated the effects of these drugs on CD36-mediated cytoadherence and non-opsonic phagocytosis of Plasmodium falciparum parasitised erythrocytes in vitro. The protease-inhibitor class of antiretrovirals particularly impairs CD36-mediated cytoadherence and non-opsonic phagocytosis of parasitised erythrocytes by human macrophages. Such treatment might therefore contribute to altered malaria disease outcomes in co-infected patients.

Objective: The objective of this single-use, examiner-blind clinical study, was to evaluate the efficacy of a newly designed Colgate Actibrush (battery-powered toothbrush) relative to the Crest SpinBrush (battery-powered toothbrush) for the removal of supragingival plaque., Methodology: This study included the assessment of plaque removal via the comparison of pre- and post-brushing plaque levels. A total of 80 adult male and female subjects from the central New Jersey area reported to the clinical facility for a baseline (pre-brushing) plaque examination after having refrained from all oral hygiene procedures and chewing gum for 24 hours, and from eating, drinking, or smoking for four hours. Subjects were entered into the study and stratified into two balanced groups based on their baseline plaque scores. Subjects were instructed to brush their teeth for one minute under supervision with their assigned toothbrush and a commercially available toothpaste (Colgate Cavity Protection Great Regular Flavor Fluoride Toothpaste), after which they were once again evaluated for supragingival plaque (post-brushing)., Results: All 80 subjects complied with the protocol, and completed the single-use clinical study. The subjects assigned to the Colgate Actibrush group exhibited a statistically significant 44.5% greater whole-mouth plaque reduction after a single brushing than did those subjects assigned to the Crest SpinBrush group. Relative to the pre-brushing baseline scores, the Colgate Actibrush group exhibited a statistically significant 63.7% reduction in whole-mouth plaque removal., Conclusion: The results of this single-use, examiner-blind, clinical study support the conclusion that the newly designed Colgate Actibrush provides significantly greater efficacy for the removal of supragingival plaque than does the Crest SpinBrush.

Objective: This single-use, examiner-blind clinical study evaluated the efficacy of a newly introduced battery-powered toothbrush (Colgate Motion Toothbrush) relative to a manual toothbrush (Oral-B CrossAction toothbrush) for the removal of supragingival plaque., Methodology: This study assessed plaque removal via the comparison of pre- and post-brushing plaque levels. A total of 126 adult male and female subjects from the northern New Jersey area reported to the clinical facility for a baseline (pre-brushing) plaque examination after having refrained from all oral hygiene procedures and chewing gum for 24 hours, and from eating, drinking or smoking for four hours. Subjects were entered into the study and stratified into two balanced groups based on their baseline plaque scores. Subjects were instructed to brush their teeth for one minute under supervision with their assigned toothbrush and a commercially available dentifrice, after which they were once again evaluated for supragingival plaque (post-brushing)., Results: All 126 subjects completed all aspects of the single-use clinical study. The subjects who used the Colgate Motion toothbrush exhibited a statistically significant 42.1% greater plaque reduction after a single tooth brushing than did those subjects who used the Oral-B CrossAction toothbrush. Relative to the pre-brushing baseline scores, the Colgate Motion toothbrush group exhibited a statistically significant 59.0% reduction in plaque removal., Conclusion: The results of this single-use, examiner-blind, clinical study support the conclusion that the battery-powered Colgate Motion toothbrush provides significantly greater efficacy for the removal of supragingival plaque than does the manual Oral-B Cross-Action toothbrush.

Objective: The objective of this randomized, double-blind, parallel-group clinical study was to compare the tooth whitening efficacy of two tooth whitening gel products--Colgate Simply White Night Clear Whitening Gel containing either 25% carbamide peroxide, or 8.7% hydrogen peroxide--when used once daily at night., Methodology: Following a baseline tooth shade evaluation using the Vita Shade Guide, qualifying adult male and female subjects from the Central New Jersey area were randomized into two treatment groups, which were balanced for baseline Vita Shade Guide scores, gender and age. The treatment groups were: 1) a tooth whitening gel containing 25% carbamide peroxide; or 2) a tooth whitening gel containing 8.7% hydrogen peroxide. All subjects were given a commercially available, non-whitening dentifrice and a soft-bristled toothbrush at the beginning of the study. In addition, they were also given one of the two tooth whitening gel products. All subjects were instructed to brush their teeth for one minute twice daily (morning and evening) with the non-whitening toothpaste. The subjects were further instructed to apply their assigned tooth whitening gel product once daily at night, per the instructions provided. Evaluations of tooth shade for each subject were repeated after two weeks, and again after three weeks of product use., Results: Fifty-nine (59) subjects complied with the protocol and completed the three-week study. At both the two-week and three-week examinations, all subjects exhibited statistically significant (p < 0.05) tooth shade lightening relative to baseline tooth shade. Further, there was no statistically significant difference in tooth shade lightening between the two tooth whitening gel products., Conclusion: The results of this clinical study indicate that after once daily use at night for two or three weeks, a tooth whitening gel containing 25% carbamide peroxide and a tooth whitening gel containing 8.7% hydrogen peroxide both provided statistically significant tooth shade lightening relative to baseline tooth shade. The results also showed that there was no statistical difference in tooth whitening efficacy between the two tooth whitening gel products.