Testing the efficacy of 2 prototype brush heads for a powered toothbrush: refining the model

OBJECTIVES: To compare 2 prototype powered toothbrush (PTB) heads (A, B) to a marketed head (Sensiflex 2000) for plaque removing efficacy on the Philips/Jordan HX2550 PTB. MATERIALS AND METHODS: A 2-week, 3-group, single-blind trial recruited 78 volunteers (18-25). Plaque indices (PIs) were recorded at screening and 14 days later at baseline. Subjects were stratified (gender and PI) and then asked to abstain from oral hygiene measures for 48 h. A supervised episode of brushing with the allocated PTB head followed. Subjects then used the PTBs at home for the next 12 days before being asked to abstain from all oral hygiene measures for another 48 h prior to a second supervised brushing episode. Plaque was scored using a new modification of the Quigley & Hein Index (PI) at full mouth (FM), interproximal (IP) and smooth surfaces (SS). PIs were recorded before and after the supervised brushing episodes to enable the means of the within subject differences (pre- to post-brushing) to be compared between groups (ANOVA/t-tests). RESULTS: There were no significant differences in PI between groups at baseline or prior to the supervised brushings (p>0.05). Highly significant, mean reductions in PIs (approximately 1/2 of one PI unit) were observed for design B compared with the Sensiflex 2000 at FM and IP sites (p<0.0001) for both supervised brushing episodes. A significant reduction in PI at SS was seen only after the first brushing episode (p=0.0004). For design A, PI reductions were consistently greater than those for the Sensiflex 2000 but differences were only significant at the p<0.05 level. CONCLUSION: It is concluded that this model of clinical trial has sufficient power to demonstrate clinical superiority with respect to plaque removal for PTBs and can be used for testing one or more prototype designs of brush heads.     

High and low brushing force in relation to efficacy and gingival abrasion

Objectives: Does a high brushing force induce more gingival abrasion than a low (regular) brushing force? Furthermore, what is the effect of a low or high force on the efficacy? Methods: Thirty-five non-dental students were selected. All received an appointment prior to which they abstained from oral hygiene for at least 48 h. At baseline the teeth and surrounding tissues were disclosed using Mira-2-Tone® disclosing solution. Next, the examiner (PAV) evaluated the number of sites with gingival abrasion and the amount of dental plaque (Quigley & Hein) at 6 surfaces of each tooth. In the absence of this examiner, the subject's teeth were brushed by a hygienist (MP) using the Braun/Oral-B®-D17 oscillating rotating toothbrush. Brushing was performed in two randomly selected contra-lateral quadrants for 60 s with either a low force (±1.5 N) or high force (±3.5 N) and in the opposing quadrants for 60 s with the alternative force. Visual feedback was given to control force. The brush was moved from the distal tooth to the central incisor perpendicular to the tooth surface with an angle of approximately 10–15° towards the gingival margin. Next, the number of sites with abrasion and the remaining plaque were assessed again. Results: The overall baseline gingival abrasion scores were 3.1 and 3.2 sites for high and low force, respectively, and increased to 5.0 and 5.9 sites respectively after brushing. There was no significant difference with respect to incidence of abrasion. At baseline, 48 h. plaque levels were 2.2. The reduction in plaque scores with the low force was 60% and with the high force 56%. This difference was significant. Conclusion: With the oscillating rotating power toothbrush (Braun/Oral-B D17) the use of high force (±3.5 N) is less efficacious as compared to a regular low force (±1.5 N) while the incidence of gingival abrasion sites was comparable. (This study was sponsored by Gillette.)     

Efficacy of powered intracapsular tonsillectomy and adenoidectomy

Objectives/Hypothesis: We sought to determine the effectiveness of powered intracapsular tonsillectomy and adenoidectomy (PITA) in the treatment of children with moderately severe obstructive sleep apnea and to measure changes in quality of life that occur with such treatment. Study Design: Prospective, nonrandomized clinical trial in an academic pediatric otolaryngology practice. Methods: Convenience sample of children ages 3 to 12 years diagnosed with obstructive sleep apnea of moderate severity, defined as an apnea‐hypopnea index (AHI) between 5 and 20 on polysomnography. Children with recurrent streptococcal pharyngitis, chromosomal abnormalities, craniofacial abnormalities, neuromotor disease, sickle cell disease, obesity, or coagulopathy were excluded. PITA was performed by using the microdebrider. Polysomnography was performed before surgery and repeated 4 to 8 weeks after surgery. The Obstructive Sleep Apnea (OSA)‐18 questionnaire was completed at surgery and at the time of postoperative polysomnography to assess quality of life changes. The main outcome measure was cure of obstructive sleep apnea, as defined by a postoperative AHI of 1 or less for complete cure and less than 5 for partial cure. Improvements in quality of life were assessed by changes in the OSA‐18 questionnaire. Results: Nineteen children underwent PITA for moderate obstructive sleep apnea syndrome (OSAS), and 14 completed postoperative polysomnography. All 14 subjects who completed the study achieved at least partial cure. Thirteen of 14 (93%) subjects had a complete cure of OSAS after PITA. The median preoperative AHI was 7.9, and the median AHI after surgery was 0.1. The mean number of arousals per hour before surgery was 9.5, and this was reduced to a mean of 5.6 after surgery. Quality of life measures on OSA‐18 also improved, with large improvements in total quality of life scores and in all five domains seen after surgery. Conclusions: PITA cures otherwise healthy children with obstructive sleep apnea of moderate severity, at least in the short‐term, as documented by postoperative polysomnography. Improvements in quality of life measures, as documented by changes in OSA‐18, were seen in all children as well.     

强制循环蒸发器的设备设计及制造

蒸发器产品在医药、化工等生产中应用广泛,是各种溶液的蒸发、浓缩、提纯的关键设备.介绍了一种强制循环蒸发器的设备参数和整体结构,针对设计和制造过程中的实际问题进行了阐述.     

Robotic gait trainer in water: development of an underwater gait-training orthosis

Purpose. To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions.

Method. The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water.

Results. The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water.

Conclusion. Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.     

Evaluation of an ambient noise insensitive hum-based powered wheelchair controller

Purpose: A recently-developed assistive technology nicknamed “the Hummer” was investigated as a potential powered wheelchair controller for individuals with severe and multiple disabilities. System performance in a noisy environment was compared to that obtained with a commercial automatic speech recognition (ASR) system. Method: A bi-hum driving protocol was developed to allow the Hummer to serve as a powered wheelchair controller. Participants performed several virtual wheelchair driving tasks of increasing difficulty using the two systems. Custom-written software recorded task execution time, number of commands issued and wall collisions, speed, and trajectory. Results: The bi-hum protocol was shown to be non-intuitive and required user training. Overall, the Hummer achieved lower performance relative to ASR. Once users became accustomed to the protocol, the difference in performance between the two systems became insignificant, particularly for the higher-difficulty task. Conclusions: The Hummer provides a promising new alternative for powered wheelchair control in everyday environments for individuals with severe and multiple disabilities who are able to hum, particularly for those with severe dysarthria which precludes ASR usage. A more intuitive driving protocol is still needed to reduce user frustration and mitigate user-generated errors; recommendations on how this can be achieved are given herein.

Implications for Rehabilitation

• The “Hummer” allows for noise-insensitive powered wheelchair control in everyday environments

• The “Hummer” accommodates individuals without functional speech or those with severe dysarthria to gain mobility independence, thus improving their quality of life.

     

The effect of an outdoor powered wheelchair on activity and participation in users with stroke

Purpose.Persons with disabilities after stroke are often restricted in activity and participation in society because of mobility limitations. An outdoor powered wheelchair may be one among other interventions in a rehabilitation programme. The aim of this study was to describe and compare activity limitations and participation restrictions in persons with stroke from their own perspective, before and after using an outdoor powered wheelchair.

Method. At baseline and follow-up two instruments were used: Individually Prioritized Problem Assessment (IPPA) and World Health Organization Disability Assessment Schedule II (WHODAS II).

Results. The results indicated that the powered wheelchair has a great positive effect on activity and participation assessed with IPPA. The results also showed that most of the participants' problems could be categorised as belonging to the domain of ‘Community, social and civic life’ according to the International Classification of Functioning, Disability and Health (ICF), and the effect size in this domain was large (2.4) after the participants had used the wheelchair.

Conclusion. An outdoor powered wheelchair is an essential device for persons with disability after stroke with regard to overcoming activity limitations and participation restrictions in everyday life.     

喉内窥镜下吸引旋切加射频治疗复发性喉乳头状瘤

目的：探讨喉内窥镜下吸引旋切加射频消融治疗复发性喉乳头状瘤的疗效。方法：对21例复发性喉部乳头状瘤患者行在喉内窥镜下吸引旋切后再用射频消融。结果：术后随访6个月～3年。2例扩展至声门下气管内的4、6岁儿童分别在术后5、7个月复发再次手术。1例局部涂鸦胆子油，另1例术后使用干扰素，已观察6个月，未见复发。1例38岁患者术后1年复发并癌变，行大部喉切除术。结论：在支撑喉镜加喉内窥镜成像系统监视下，用吸引旋切刀切除肿瘤后再用射频消融为一种有效治疗喉乳头状瘤的方法。     

透光旋切术与传统手术治疗大隐静脉曲张临床效果对比研究

目的:回顾性分析传统方法与透光旋切术治疗大隐静脉曲张的近期及远期临床效果。方法:将329例患者按采取的手术方式的不同分为传统组与透光旋切术(transilluminated powered phlebectomy,TIPP)组,传统组采用大隐静脉高位结扎+抽剥的方法手术,TIPP组采用大隐静脉高位结扎+曲张静脉透光旋切的方法手术。比较两组平均术中出血量、平均手术时间、平均术后住院时间,术后早期并发症(皮肤麻木、皮下血肿、静脉炎、深静脉血栓形成)的发生率,术后皮肤溃疡愈合情况以及术后复发率(长期随访)等指标。结果:平均术中出血量、平均手术时间及术后早期并发症(皮肤麻木、皮下血肿、静脉炎、深静脉血栓形成)发生率两组无显著差异,TIPP组术后住院时间短、术后皮肤溃疡愈合快、术后复发率低。结论:透光旋切治疗大隐静脉曲张明显优于传统手术方法,具有微创、术后恢复快、术后复发率低等优点,远期临床效果显著,特别适合于静脉曲张严重及合并下肢皮肤溃疡的大隐静脉曲张患者。