Recurrent Transient Osteoporosis during Pregnancy and Treatment with Oral Bisphosphonates: A Case Report

Transient osteoporosis of the hip (TOH), also known as “Bone marrow edema Syndrome”, is a rare disorder mainly affecting pregnant women in their third trimester, as well as middle-aged, overweight men. A 30-year-old Caucasian female G2P2, with history of transient osteoporosis of both ankles and C-Section during the last pregnancy in 2011, presented progressively severe bilateral hip pain with onset already in the 12th gestational week. Imaging of the pelvis and bilateral hips with MRI obtained 6 days after the C-Section demonstrated bilateral bone-marrow edema of the hips. The patient was treated with a monthly single dose of 150 mg ibandronate acid per os, for 3 months and physiotherapy. Repeated MRI performed 5 months postpartum revealed a complete remission of the disease. In contrast to the first onset of transient osteoporosis during the first pregnancy, which was only treated conservatively without bisphosphonates, the remission of the disease and patient’s recovery with oral ibandronate therapy showed to be 4 months shorter. This case is unique in literature for both describing the onset of this rare disease twice in the same patient as well as its oral therapeutic approach.

Use of Oral Agents and/or Insulin in the Treatment of Diabetes during Pregnancy: An Examination of Outcomes in Pregestational versus Gestational Diabetics

The management of diabetes in pregnancy varies depending on whether the condition was first diagnosed during pregnancy (gestational diabetes) or was diagnosed before pregnancy (pregestational diabetes). Little has been published comparing the relative efficacy of various oral agents for the treatment of gestational diabetes and the reported experience with the insulin pump in pregnancy for pregestational diabetes remains meager. We conducted a retrospective chart review of women managed in a specialized diabetic clinic to compare the results of treatment of gestational diabetes with oral agents, glyburide and acarbose, to those treated with split-mixed insulin and treatment of pregestational diabetes with either the insulin pump or conventional splitmixed insulin. Gestational diabetics treated with split-mixed insulin were hospitalized significantly more often (p < 0.001) than those treated with oral agents only. The incidence of several important pregnancy complications (growth restriction, preterm labor, preeclampsia, oligohydramnios) did not differ between groups. Pregestational diabetics managed with an insulin pump had comparable glycemic control, as measured by hemoglobin A1c, to those managed with split-mixed insulin. Infant birth weights and Apgar scores were similar in each group. There were no perinatal deaths in either group. Acarbose and glyburide showed comparable efficacy in treating gestational diabetics. In addition, our experience adds to the small number of pregnant women with pregestational diabetes who were managed with an insulin pump that have been reported in the literature.

Has Coca-Cola treatment become the first-line therapy for gastric bezoars,both in general and specifically for western countries?

Phytobezoars is a rare disease and less common in Western countries.The stomach is the primary site for these formations,and endoscopic treatment involving fragmentation and extraction has traditionally been the most effective approach.However,medical treatments using enzymatic and chemical agents,such as cellulase and Coca-Cola,aimed at dissolving the bezoars,have also been utilized,showing varying degrees of resolution success.Notably,the oral dissolution treatment with Coca-Cola has emerged as a promising,simpler,and more costeffective method.The study by Liu et al represents an important step in clinical research on this topic,despite some limitations that need addressing for a more comprehensive understanding of its findings.Key considerations for future research include sample size calculation,endoscopic procedure details,outpatient vs.inpatient treatment,and detailed cost calculations.The study's exclusions,such as patients with upper gastric surgery,phytobezoars older than 14 d,and cases of gastroparesis,limit its applicability to broader populations,especially in Western countries.Given the promising outcomes of the Coca-Cola treatment,it's advocated as a first-line therapy for phytobezoars.Nonetheless,further research is essential to overcome these limitations.However special situations such as perforation or small bowel obstruction will require surgical treatment.

Oral Propranolol: A Useful Treatment for Infantile Hemangioma

Background: Infantile haemangioma is the commonest childhood tumor. Several lines of treatment are available. Recent reports have focused on the value of propranolol in treating rapidly proliferating haemangioma. The aim of this study was to assess oral propranolol in treatment for facial haemangioma. Patients and Methods: Fifteen patients with rapidly proliferating infantile facial haemangioma with cosmetic disfigurement were treated with oral propranolol. All patients had cardiovascular pre-treatment work-up and commenced on oral propranolol at 3 mg/kg/day. Results: A rapid decrease in hemangioma proliferation was seen in 100% of patients and significant regressions occuring in all patients. This treatment was well tolerated and had little side effects. Conclusions: Oral propranolol is a reliable and easily reproducible method for treatment of facial hemangioma.

Obstructive Sleep Apnea, Prevalence, Etiology &Role of Dentist &Oral Appliances in Treatment: Review Article

Objective: The aim of this article is to provide a detailed description for obstructive sleep apnea regarding its signs and symptoms, the way it is diagnosed, the risk factors, management, the role of dentists and oral appliances in treatment and consequences of untreated condition. Material and Method: Electronic searching was done in PubMed, Medline, EMBASE and CENTRAL databases. Inclusion criteria were: dental, oral and maxillofacial oriented articles. Exclusion criteria: cardiac, obesity and non dental oriented articles were excluded. Result: 59 articles meet the criteria. Conclusion: Obstructive sleep apnea (OSA) is a potentially life threatening disorder characterized by repeated collapse of the upper airway during sleep, with periodic cessation of breathing for more than ten seconds. The frequency of obstructive sleep apnea has been found to increase with age;ranging from two percent among children to two and half percent - six percent among adolescents. Overnight polysomnographic test at specialized sleep clinics remains the gold standard for diagnosing obstructive sleep apnea disorder. Management of this condition can be performed via surgical and non surgical methods. Continuous positive airway pressure represents the first line of treatment for most patients with obstructive sleep apnea.

Treatment of Irritable Bowel Syndrome by Oral Administration of Chinese Medicines and Retention-Enema——A Report of 50 Cases

Irritable bowel syndrome (IBS), a common disease of intestinal dysfunction, is also called emotional enteritis, mucous enteritis, irritable colon and so on1. It is often lingering with a long disease course and is easy to recur. The author has in recent years treated 50 cases of the disease by oral administration of Chinese medicines and retention-enema, with satisfactory results reported as follows.

Treatment of Peripheral Neuropathy: Combination Therapy Using LED Light, Extracorporeal Shockwave Therapy, Platelet Rich Plasma, and an Oral Dietary Supplement

Objectives: Peripheral neuropathy (PN) is a significant contributor to disability in the elderly. It is also one of the most prevalent complications of type 2 diabetes, prediabetes and metabolic syndrome. PN is commonly associated with pain, numbness, tingling, burning, and cramping in the feet and legs. Current treatment options are limited to controlling pain, seizures and use of antidepressant medications. These treatments have undesirable side effects and don’t stop PN progression. Here we utilized a combination of individual-specific modalities to improve local circulation and relieve PN symptoms. Methods: We conducted an open-label, multicenter pilot trial with 34 subjects (19 males and 15 females ranging from 40 - 85 years of age). All of the participants were diagnosed with peripheral neuropathy and had bilateral symptoms in their feet, and many reported the same symptoms (pain, numbness, tingling, burning, and cramping) in their lower legs. The duration of symptoms ranged from four months to over six years. On Day 0, subjects were given a 90-day supply of the oral supplement with dosing instructions and a LED light therapy device. They also received three platelet-rich plasma (PRP) injections in their lower extremities. Subjects also received an extracorporeal shockwave therapy (ESWT) treatment for each foot and subsequently twice per week for the first six weeks, then once weekly for the duration of the study. Subjects filled out the Brief Pain Index (BPI) at weekly intervals. On Day 90, subjects completed the Patient Global Impression of Change (PGIC) survey. Results: There were significant responses to pain, as evidenced by BPI scores at weeks 8, 9, 10 and 11 (p = 0.02, 0.01, 0.02, and 0.003, respectively). Analysis of the final day PGIC survey showed a favorable outcome for 73% of participants (p = 0.003), with the majority reporting Very Much Improved. Conclusions: By utilizing a multi-modality treatment protocol that includes PRP, LED light therapy, ESWT and an oral dietary supplement, we observed significant reductions in BPI scores. Quality of life and their overall impression of change (PGIC) were significantly improved, and there were no significant side effects.

Oral Hygiene in the Presence of Orthodontic Therapy

Orthodontic treatment offers great advantages in improving facial and smile aesthetics, self-confidence and the function of the stomatognathic apparatus. The pursuit of these advantages makes use of orthodontic appliances that could be fixed or removable. However, it’s worth stating that these appliances interfere with tooth brushing, making it more difficult to brush teeth effectively. Orthodontics appliances therefore promote the accumulation of dental plaque, which results in both quantitative and qualitative changes in the oral microbiota, hence, exposing patients to several adverse effects such as White spot lesions, dental caries, periodontal pathologies and halitosis. For this reason, oral assessment of patients before, during and after treatment is necessary as well as oral hygiene instructions and motivation. Orthodontists therefore, should educate patients on oral and periodontal hygiene in order to control dental and periodontal complications. Prescriptions of plaque control materials adapted to each patient are done in order to optimize the final result and minimize unwanted complications.

自锁托槽矫治改善患者口腔健康及氧化应激反应的研究

目的探究正畸治疗患者使用自锁托槽矫治对口腔健康状况、龈沟液氧化应激及炎性因子的影响。方法纳入本院正畸治疗共60例患者进行随机分组(2022年4月至2024年4月),依据随机数字表法划分两组各30例。对照组均采取结扎托槽矫治,观察组均采取自锁托槽矫治。基于口腔健康评分、龈沟液氧化应激指标、龈沟液炎性因子水平,分别在治疗前及治疗4周时对其综合评价。结果两组治疗后中文版口腔健康影响程度量表(OHIP-49)得分较治疗前减少(P<0.05);同时观察组OHIP-49得分比对照组更低(P<0.05)。治疗后两组龈沟液丙二醛(MDA)水平和治疗前对比更低,超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GXH-Px)水平和治疗前对比更高(P<0.05);同时观察组MDA比对照组更低,SOD、GXH-Px比对照组更高(P<0.05)。两组治疗后龈沟液前列腺素E_(2)(PGE_(2))、白细胞介素1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平较治疗前均上升(P<0.05);但观察组上述指标仍比对照组更低(P<0.05)。结论正畸治疗患者使用自锁托槽矫治能调节牙周组织氧化应激反应,减轻炎症反应状态,提升口腔健康水平。

以手口综合征为唯一临床表现的脑梗死4例临床分析并文献复习

目的分析4例以手口综合征为唯一临床表现的脑梗死的疾病特点,提高大家对该综合征的认识,避免漏诊、误诊。方法回顾性总结于2021年2月至2022年11月阜阳市人民医院收治的4例以手口综合征为唯一临床表现的脑梗死病人的人口学信息、既往史、临床表现、入院时美国国立卫生研究院卒中量表(NIHSS)评分、缺血性脑卒中病因学分类标准(TOAST)分型、头颅磁共振成像(MRI)所示病变部位、头颈部血管成像、治疗方式及长期预后等资料。结果4例病人均存在至少1种脑梗死高危因素,均表现为同侧口周手部麻木症状,均为腔隙性脑梗死且均为轻型卒中,头颈部血管壁存在斑块或狭窄,给予抗栓、调脂固斑等治疗,2例长期预后留有感觉障碍后遗症,2例无任何后遗症。结论手口综合征最常见于脑梗死病人,该类型脑梗死与其他类型的脑梗死危险因素、TOAST分型、治疗及预后方面存在共性,然而局限性的手口麻木为其特有临床表现。

In Vivo Animal Model Evaluation of a Powerful Oral Nanomedicine for Treating Breast Cancer in BALB/c Mice Using 4T1 Cell Lines without Chemotherapy

Nanopharmaceuticals containing quantum dot nanoparticles (Q-Dot NPs) for treating serious cancers such as breast cancer have made fantastic proposals. In this study, ZnO quantum dot NPs are formulated via ZnO@PVP nanopolymer as co-assistants coordinating with efficacious suitable wetting agents, PEG-binding compound, and W/O emulsifier for producing eco-friendly water-based nanodrug. Several characterization techniques containing SEM, TEM, FTIR, photoluminescence, zeta potential, and UV-Vis absorption were employed for ZnO Q-Dot NPs in nanodrug. This work aims to investigate the anti-tumor effects of such nanomedicine on the 4T1 breast cancer cell line in BALB/c mice, being elaborated through intraperitoneal, injection (IVP) and oral therapy. The impressive findings showed that ZnO nanodrug caused changes in blood factors, having the most effectiveness at 40 μg/ml concentration after two weeks of oral treatments. The significant increase in white blood cells (WBC) neutrophils and meaningful decreases in lymphocytes and especially cholesterol were powerful simultaneous impacts, successfully treating malignant breast cancer masses. In this significant animal model research for breast cancer, the sick mice recovered entirely and even had a safe space to mate. Histopathological results showed no evidence of breast tumor formation or metastasis in the group treated with nanodrug and their children. This nanomedicine has a therapeutic effect, and is ready to be applied for treating volunteer breast cancer patients. However, its prevention (inhibitory) effect can also be analyzed and added to current data in future studies.

西帕依固龈液含漱联合沙利度胺片口服治疗糜烂型口腔扁平苔藓的临床效果及菌群分析

目的观察西帕依固龈液含漱联合沙利度胺片口服治疗糜烂型口腔扁平苔藓(E-OLP)的临床效果及菌群变化分析。方法选取2020年9月—2021年7月于佳木斯大学附属口腔医院就诊的E-OLP患者60例。依照随机分组对照试验原则分为观察组和对照组,各30例。在常规予沙利度胺片治疗基础上,对照组予蒸馏水含漱,观察组予西帕依固龈液含漱。观察组中再随机选取10例患者,以治疗4周前后时间点分为A组与B组,采集双颊黏膜及唾液的混合拭子进行高通量测序技术。比较观察组和对照组治疗4周后的临床疗效,治疗前、治疗1、4周时口腔健康状况(VAS评分、REU评分、OHIP-14评分)变化,不良反应以及A、B组的口腔菌群的变化情况。结果观察组患者治疗总有效率为80.00%,高于对照组的53.33%(χ^(2)=4.800,P=0.028);治疗后,观察组与对照组REU、VAS及OHIP-14评分均较治疗前及前一时点降低,且观察组低于同期对照组;治疗1周、治疗4周时同期组间差异均有统计学意义(P<0.05或P<0.01);对照组出现轻微皮疹1例(3.33%),余患者均未出现不良反应。高通量测序A组与B组样本共获取949302个清晰读数,9245个特征序列(ASVs),碱基平均长度为426 bp。组间差异分析A、B组间Beta多样性显示组间菌群差异有统计学意义(P<0.05)。物种组成分析显示丰度变化中属水平,梭杆菌、罗斯氏菌和纤毛菌;门水平,柔壁菌、TM7等有统计学意义(P<0.05)。结论西帕依固龈液可以调节E-OLP患者口腔菌群,与传统免疫调节类药物联合应用治疗E-OLP可提高临床疗效,具有积极的意义。

口腔根管治疗在牙周病患者中的应用效果及对预后的影响研究

目的观察口腔根管治疗在牙周病患者中的应用效果及对预后的影响。方法选取2023年2月至2024年1月本院收治的80例牙周病患者,根据就诊顺序进行分组,序号为单数的40例为观察组,双数的40例为对照组。对照组行牙周基础治疗,观察组在对照组的基础上实施口腔根管治疗。比较两组治疗效果、牙周健康状况、咀嚼功能、牙齿美观度、生活质量及治疗期间并发症发生率。结果观察组治疗总有效率高于对照组(P<0.05);两组治疗前牙周健康状况指标、咀嚼功能、牙齿美观度及生活质量指标得分比较无统计学意义(P>0.05);观察组治疗后牙周健康状况各指标得分均低于对照组,咀嚼功能、牙齿美观度及生活质量各指标得分高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论口腔根管治疗可有效改善牙周病患者的牙周健康状况,并提升治疗效果,纠正牙齿美观度,降低并发症,促进咀嚼功能和生活质量的恢复。

严重口腔颌面部创伤急救与麻醉处理的效果

目的观察严重口腔颌面部创伤患者采取急救措施和麻醉处理的效果。方法回顾性分析2021年6月至2024年6月泉州市医学高等专科学校附属人民医院收治的80例严重口腔颌面部创伤患者,对患者落实急救措施和麻醉处理,统计分析治疗效果。结果手术期间,有1例行气管切开,4例患者发生颈部出血,2例患者出现呼吸困难,2例病患做气管切开术。患者均在苏醒之后拔管,未发生任何不良反应。经统计疗效,得出显效58例(72.50%),有效20例(25.00%),无效2例(2.50%),总治疗有效率为97.50%。急救后,收缩压、舒张压均较急救前上升(P<0.05)。结论对于严重口腔颌面部创伤患者,采取急救措施和麻醉处理,可助于维持急救治疗安全有效性。

Novel oral-targeted therapies for mucosal healing in ulcerative colitis

Ulcerative colitis(UC), a chronic, relapsing, remitting disease of the colon and rectum, is characterized by inflammatory ulceration of the mucosa. Current UC therapy relies on controlling acute episodes and preventing relapse. To predict modifications in the natural course of UC, mucosal healing(MH) has emerged as a major treatment goal. Endoscopic evaluation is considered the gold standard for assessing MH, which can be achieved by conventional drugs and biologics in many, but not all, patients. Consequently, interest is focusing on the development of new substances for UC therapy, and new oral agents are in the pipeline. This review will focus on the ability of newly developed oral drugs to induce and maintain MH in UC patients.

细胞外囊泡在口腔鳞状细胞癌诊疗中的作用

背景:细胞外囊泡在不同的生理和病理生理条件下由多种细胞类型(包括肿瘤细胞)分泌到细胞外环境中,存在着广泛的生物学信号及细胞之间的信号传导。肿瘤衍生的细胞外囊泡可能会加剧癌症的进展、存活、侵袭和促进血管生成。目的:综述细胞外囊泡在口腔鳞状细胞癌诊疗中的研究进展。方法:由第一作者在Pub Med、万方和中国知网数据库中进行文献检索,关键词为“EVs,Oral squamous cell carcinoma,Diagnosis and treatment,Biopsy,Tissue engineering”及“细胞外囊泡,口腔鳞状细胞癌,诊疗,活检,组织工程”,最终纳入63篇文献进行分析。结果与结论:(1)在口腔鳞状细胞癌唾液活检中,细胞外囊泡作为肿瘤细胞与周围微环境间的信息传递工具,携带包括可溶性蛋白、脂质、DNA和RNA在内的多种生物分子,对口腔鳞状细胞癌的进展起着至关重要的作用,这些微小囊泡不仅在肿瘤的生长和扩散中扮演着关键角色,还提供了有关肿瘤生物学特性的重要信息。(2)唾液活检作为一种非侵入性诊断方法,通过分析其中的细胞外囊泡,可以为口腔鳞状细胞癌的早期诊断和靶向治疗开辟新的可能性。(3)研究发现,细胞外囊泡内含的生物活性分子,如micro RNAs(mi RNAs)和特定蛋白质,能作为口腔鳞状细胞癌的生物标志物,提高早期诊断的准确性。细胞外囊泡中的特定蛋白质如EHD2,CAVIN1,PF4V1和CXCL7等显示了作为新型预测性生物标志物的潜力。(4)此外,文章还强调了细胞外囊泡在口腔鳞状细胞癌治疗中的应用潜力,通过工程化改造,细胞外囊泡可以作为新一代纳米级药物输送系统,增强肿瘤靶向治疗的效率和特异性。(5)未来的研究将进一步深入探索细胞外囊泡在口腔鳞状细胞癌治疗中的作用及其机制,有望改善患者的生存率和生活质量。

Update on the treatment of type 2 diabetes mellitus

To achieve good metabolic control in diabetes and keep long term, a combination of changes in lifestyle and pharmacological treatment is necessary. Achieving near-normal glycated hemoglobin significantly, decreases risk of macrovascular and microvascular complications. At present there are different treatments, both oral and injectable, available for the treatment of type 2 diabetes mellitus(T2DM). Treatment algorithms designed to reduce the development or progression of the complications of diabetes emphasizes the need for good glycaemic control. The aim of this review is to perform an update on the benefits and limitations of different drugs, both current and future, for the treatment of T2 DM. Initial intervention should focus on lifestyle changes. Moreover, changes in lifestyle have proven to be beneficial, but for many patients is a complication keep long term. Physicians should be familiar with the different types of existing drugs for the treatment of diabetes and select the most effective, safe and better tolerated by patients. Metformin remains the first choice of treatment for most patients. Other alternative or second-line treatment options should be individualized depending on the characteristics of each patient. This article reviews the treatments available for patients with T2 DM, with an emphasis on agents introduced within the last decade.

Oral refeeding in mild acute pancreatitis:An old challenge

Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP)therapy,the right time and type of diet to be offered to patients recovering from an acute attack are a great challenge to clinicians who treat this condition.Fortunately,the last decade was noted for several trials looking for the best answer to the question:"when and how to start oral refeeding in AP?"It is well known that 80%of patients present with mild disease characterized by usually uncomplicated clinical course are managed with pancreatic rest through nil per oral;while the use of specific nutritional intervention is an exception.Therefore,mild AP has been the most investigated form of AP and researchers have tried different kind of meals to offer calories and reduce costs by shortening hospitalization time.Usually in mild AP,the oral refeeding is introduced between the first 3 d and 7 d after hospitalization but,the type of diet and patients’tolerance have been scrutinized in detail with mixed results.Although 20%to 25%have pain recurrence requiring nutritional support and greater time of hospitalization,most patients seem to tolerate oral refeeding well.We propose analyzing the most recent investigations of this matter and their conclusions to develop a better understanding of the management of AP.

Soft and Hard Tissue Changes Following Treatment of Class Ⅱ Division 1 Malocclusion with Twin-Block and Myofunctional Appliance: A Pilot Study

Background Many cases of ClassⅡdeformities have been reported to be treated with prefabricated appliances.The aim of this study was to distinguish the clinical effect of traditional custom-made appliances and prefabricated appliances in the treatment of ClassⅡdivision 1 malocclusion.Therefore,soft and hard tissue changes following treatment of ClassⅡdivision 1 malocclusion using the twin-block(TB)appliance was compared to that using the Myofunctional Research Company(MRC)appliance(K1+K2)combined with oral myofunctional treatment(OMT)(MRC+OMT).Methods The study included 22 children(6 boys and 16 girls aged 9–11 years)with ClassⅡdivision 1 malocclusion along with mandibular retrognathism with a 5–12 mm overjet,basic normal maxillary status,and stage 2 or 3 cervical vertebral maturation(CVM).Participants were randomly assigned into two groups,the TB group and the MRC+OMT group for 12 months.Standardized lateral cephalograms were used to assess skeletal,dental,and soft tissue changes from pre-to post-treatment.Independent t-tests were used to compare the initial and final cephalometric status and tissue changes between the groups.Results The TB and MRC+OMT groups resulted in different degrees of lateral changes;however,improvements of skeletal and soft tissue indices were significantly greater in the TB group than in the MRC+OMT group.Conclusion TB was more effective than MRC+OMT in treating children aged 9–11 years with ClassⅡdivision 1 malocclusion.However,further research using custom-made appliances with OMT is recommended,and further investigations are needed to confirm these findings.

Preference of Dogs between Two Commercially Available Oral Formulations of Ectoparasiticide Containing Isoxazolines,Afoxolaner or Fluralaner

Because of their convenience, oral dosage forms are an emerging trend in companion animal formulations. Ectoparasiticides represent a significant proportion of the treatments administered to pets, and recently oral formulations have been commercialized. They have to demonstrate high palatability to ensure that they are voluntarily accepted by the animal especially because they are repeatedly offered medications. The present study aimed to compare the dog’s preference between two commercially available oral ectoparasiticide formulations containing either afoxolaner (NexGard&reg;, Merial) or fluralaner (Bravecto&reg;, MSD Animal Health). In two separate experiments, 225 individual dogs (115 and 110 respectively) were offered a choice of afoxolaner or fluralaner chewable tablets. The 225 dogs were given an opportunity to smell both products, and then the products were simultaneously offered to each dog by hand for 4 consecutive days with products offered from alternate hands on each day. Individual consumption and related behaviors were recorded. The same individual offered the products to the dogs throughout each study. The total number of chewable tablets for each formulation was recorded and preference was evaluated as the consumption of a given formulation during more days. A total amount of 797 tablets were consumed by the 225 dogs during the 4 days of the studies. A total of 573 (71.9%) afoxolaner chews and 224 (28.1%) fluralaner chews were consumed voluntarily. The overall consumption ratio was 2.56 to 1 for NexGard&reg;?to Bravecto&reg;, with significantly (p &reg;?than Bravecto&reg;?on each day. As for dogs demonstrating a preference over the entire test period;83% of the dogs tested preferred NexGard&reg;?to Bravecto&reg;, resulting in a preference ratio of 5 to 1 for afoxolaner formulation versus fluralaner formulation. This study demonstrated that when dogs were offered a choice between the two ectoparasiticide products, a significant preference for NexGard&reg;?was observed.