In order to assess demographic , socio-economic , reproductive , and cancer-related determinants of participation in BSE , CBE , and referral , uni - and multi-variate logistic regression was employed .


Of the interviewed women , 23.2 % reported practicing BSE , 96.8 % had attended CBE , and 49.1 % of 2,880 screen-positives attended referral .


Results showed an influence of various determinants on participation ; women who were currently not married or who had no family history of cancer were significantly less likely to attend the screening process at any level .


Increasing awareness about breast cancer , early detection methods , and the advantages of early diagnoses among women , and their families , as well as health care workers offering social support , could help to increase participation over the entire screening process in India .


Reducing consumption of food away from home is often targeted during pediatric obesity treatment , given the associations with weight status and gain .


However , the effects of this dietary change on weight loss are unknown .


Our aim was to evaluate associations between changes in dietary factors and child anthropometric outcomes after treatment .


It is hypothesized that reduced consumption of food away from home will be associated with improved dietary intake and greater reductions in anthropometric outcomes ( standardized body mass index [ BMI ] and percent body fat ) , and the relationship between food away from home and anthropometric outcomes will be mediated by improved child dietary intake .


We conducted a longitudinal evaluation of associations between dietary changes and child anthropometric outcomes .


Child diet ( three 24-hour recalls ) and anthropometric data were collected at baseline and 16 weeks .


Participants were 170 overweight and obese children ages 7 to 11 years who completed a 16-week family-based behavioral weight-loss treatment as part of a larger multi-site randomized controlled trial conducted in two cohorts between 2010 and 2011 ( clinical research trial ) .


Dietary treatment targets during family-based behavioral weight-loss treatment included improving diet quality and reducing food away from home .


The main outcome measures in this study were child relative weight ( standardized BMI ) and body composition ( percent body fat ) .


We performed t tests and bootstrapped single-mediation analyses adjusting for relevant covariates .


As hypothesized , decreased food away from home was associated with improved diet quality and greater reductions in standardized BMI ( P < 0.05 ) and percent body fat ( P < 0.01 ) .


Associations between food away from home and anthropometric outcomes were mediated by changes in diet quality .


Specifically , change in total energy intake and added sugars mediated the association between change in food away from home and standardized BMI , and change in overall diet quality , fiber , added sugars , and added fats mediated the association between change in food away from home and percent body fat .


Including physical activity as a covariate did not significantly impact these findings .


These results suggest that reducing food away from home can be an important behavioral target for affecting positive changes in both diet quality and anthropometric outcomes during treatment .


Music has been employed in various clinical settings to reduce anxiety .


However , meta-analysis has shown music to have little influence on haemodynamic parameters .


This study aimed at investigating the effect of relaxing music on heart rate recovery after exercise .


Twenty-three student volunteers underwent treadmill exercise and were assessed for heart rate recovery and saliva analysis ; comparing exposure to sedative music with exposure to silence during the recovery period immediately following exercise .


No differences were found between music and non-music exposure regarding : heart rate recovery , resting pulse rate , and salivary cortisol .


Music was no different to silence in affecting these physiological measures , which are all associated with anxiety .


Relaxing music unaccompanied by meditation techniques or other such interventions may not have a major role in reducing anxiety in certain experimental settings .


Fatigue is one problem that is seen in high numbers in hemodialysis patients .


Fatigue decreases quality of life by negatively affecting an individual 's daily performance , activities , professional life , relations with family and friends , and treatment process .


This study was carried out to determine the effect of acupressure on the level of fatigue in hemodialysis patients .


The study was conducted as experimental research with an acupressure ( intervention ) group and a control group .


The research , for which an ethics committee 's approval and institutional permission was obtained , was conducted in two central provinces of Turkey , Nevehir and Aksaray , at two hemodialysis centers with similar characteristics .


The research was completed with a total of 118 participants ( 52 in the intervention group and 66 in the control group ) who met the inclusion criteria .


A total of 12 acupressure sessions , 3 / wk for 1 mo , were performed for all participants in the intervention group , as required by the acupressure application protocol , applying acupressure at the Stomach 36 ( ST-36 ) , Gallbladder 34 ( GB-34 ) , Spleen 6 ( SP-6 ) , and Kidney 1 ( K-1 ) acupuncture points with a transcutaneous electrical nerve stimulation ( TENS ) acupuncture pen ( XFT-320 acupuncture pen , Shenzhen Xunfegtong Electronics Co , Ltd , Shenzhen , China ) .


A visual analog scale ( VAS ) for fatigue and the Piper Fatigue Scale ( PFS ) were used to evaluate the fatigue level of the participants before and after the acupressure application .


After the acupressure applications for 1 mo , the subscale and total fatigue scores for the VAS ( P < .001 ) and PFS were lower ( P < .05 ) for participants in the intervention group compared to the controls , except for the cognitive subscale on the PFS ( P < .05 ) .


The study found that acupressure , applied using an acupuncture pen , was effective in decreasing fatigue in hemodialysis patients .


Based on this result , the current research team suggests that hemodialysis patients and nurses should be informed about acupressure application so as to extend the use of acupressure in reducing fatigue symptoms .


The aim of our study was to measure the volume of gestational sac and amniotic sac in physiological pregnancies and missed abortion .


We wanted to create nomograms for individual weeks of gestation .


Retrospective cohort study .


Institute for the Care of Mother and Child , Prague .


The study randomized 413 women after spontaneous conception .


The patients were divided into two groups : women with physiological pregnancy and childbirth in the period ( 374 ) , and women with pregnancy terminated by missed abortion .


Both groups were performed measurement volume of gestational and amniotic sac in the first trimester of pregnancy .


Analysis was performed using 4D View software applications , and volume calculations were performed using VOCAL ( Virtual Organ Computer Aided anaLysis ) .


We have created the first in the Czech Republic nomograms volumes of gestational and amniotic sac in physiological pregnancies and missed abortion .


We performed a correlation between the size of gestational sac and prosperity pregnancy .


In our study we found no correlation between the volume of gestational sac and the development of the pregnancy .


To evaluate the effect of structured physical activity on sleep-wake behaviors in sedentary community-dwelling elderly adults with mobility limitations .


Multicenter , randomized trial of moderate-intensity physical activity versus health education , with sleep-wake behaviors prespecified as a tertiary outcome over a planned intervention period ranging from 24 to 30 months .


Lifestyle Interventions and Independence for Elders Study .


Community-dwelling persons aged 70 to 89 who were initially sedentary and had a Short Physical Performance Battery score less than 10 ( N = 1,635 ) .


Sleep-wake behaviors were evaluated using the Insomnia Severity Index ( ISI ) ( 8 defined insomnia ) , Epworth Sleepiness Scale ( ESS ) ( 10 defined daytime drowsiness ) , and Pittsburgh Sleep Quality Index ( PSQI ) ( > 5 defined poor sleep quality ) administered at baseline and 6 , 18 , and 30 months .


The randomized groups were similar in terms of baseline demographic variables , including mean age ( 79 ) and sex ( 67 % female ) .


Structured physical activity resulted in a significantly lower likelihood of having poor sleep quality ( adjusted odds ratios ( aOR ) for PSQI > 5 = 0.80 , 95 % confidence interval ( CI ) = 0.68-0 .94 ) , including fewer new cases ( aOR for PSQI > 5 = 0.70 , 95 % CI = 0.54-0 .89 ) , than health education but not in resolution of prevalent cases ( aOR for PSQI 5 = 1.13 , 95 % CI = 0.90-1 .43 ) .


No significant intervention effects were observed for the ISI or ESS .


Structured physical activity resulted in a lower likelihood of developing poor sleep quality ( PSQI > 5 ) over the intervention period than health education but had no effect on prevalent cases of poor sleep quality or on sleep-wake behaviors evaluated using the ISI or ESS .


These results suggest that the benefit of physical activity in this sample was preventive and limited to sleep-wake behaviors evaluated using the PSQI .


The results of preclinical studies suggest that baclofen may be useful in the treatment of stroke patients with persistent hiccups .


This study was aimed to assess the possible efficacy of baclofen for the treatment of persistent hiccups after stroke .


In total , 30 stroke patients with persistent hiccups were randomly assigned to receive baclofen ( n = 15 ) or a placebo ( n = 15 ) in a double-blind , parallel-group trial .


Participants in the baclofen group received 10mg baclofen 3 times daily for 5days .


Participants assigned to the placebo group received 10mg placebo 3 times daily for 5days .


The primary outcome measure was cessation of hiccups .


Secondary outcome measures included efficacy in the two groups and adverse events .


All 30 patients completed the study .


The number of patients in whom the hiccups completely stopped was higher in the baclofen group than in the placebo group ( relative risk , 7.00 ; 95 % confidence interval , 1.91-25 .62 ; P = 0.003 ) .


Furthermore , efficacy was higher in the baclofen group than in the placebo group ( P < 0.01 ) .


No serious adverse events were documented in either group .


One case each of mild transient drowsiness and dizziness was present in the baclofen group .


Baclofen was more effective than a placebo for the treatment of persistent hiccups in stroke patients .


Chinese Clinical Trials Register : ChiCTR-TRC-13004554 .


A cardiac arrest can lead to hypoxic-ischaemic brain injury which can result in cognitive and emotional impairments and may negatively affect daily functioning , participation in society and quality of life .


Furthermore , the impact on the family of the patient can be high .


We designed an intervention called ` Stand still , and move on ' , which is a concise , individualised , semi-structured intervention for survivors of cardiac arrest and their caregivers , consisting of between one and six face-to-face consultations provided by a trained nurse .


The intervention is directed at early detection of cognitive and emotional problems , provision of information , promotion of self-management and referral to specialised care if necessary .


The effectiveness of the intervention is being examined in a randomised controlled trial [ ISRCTN74835019 ] .


Alongside this trial we performed a process evaluation which aims to investigate the feasibility of the intervention by assessing : 1 ) the attendance and dose delivered ; 2 ) performance according to protocol ; and 3 ) the opinion of patients , caregivers and nurses on the intervention .


Participants of this process evaluation were 97 patients allocated to the intervention group of the RCT , their 91 caregivers , and six nurses who conducted the intervention .


Measurement instruments used were evaluation forms for patients and caregivers , registration and evaluation forms for nurses , and semi-structured interviews with nurses .


Seventy-nine of the patients ( 81 % ) allocated to the intervention group and 65 caregivers ( 71 % ) participated in the intervention .


The mean ( SD ) number of consultations per patient was 1.8 ( 1.0 ) , and most consultations were conducted at the patients ' home .


The intervention was performed largely according to protocol , except that the intervention usually started later than intended , consultations were longer than expected , and the topic of self-management was not regularly addressed .


Patients marked the quality of the intervention with a mean score of 7.5 and the performance of the nurse with an 8.0 out of ten .


Overall , the intervention was positively evaluated by patients , caregivers and nurses .


The intervention ` Stand still , and move on ' is a promising intervention which was performed largely according to protocol and seems feasible for implementation after some adaptations , if it is found to be effective .


To investigate the efficacy of bupivacaine-soaked spongostan in cesarean section wound for postoperative anxiety level , satisfaction and early postpartum depression rate .


A total of 121 women , American Society of Anesthesiologists physical status I-II , scheduled to undergo general anesthesia and elective cesarean section were recruited and randomized into a study group ( n = 61 ) or a control group ( n = 60 ) .


In the spongostan group , bupivacaine-soaked spongostan was placed in the cesarean section wound .


The control group did not receive spongostan , but only general postoperative care .


Maternal health was assessed using a visual analog scale for satisfaction , a visual analog scale for anxiety and the Edinburgh Postpartum Depression Scale for postpartum depression .


Also , first breast-feeding time , first mobilization time and opioid consumption were recorded and compared .


The anxiety level of the spongostan group was lower than that of the control group and the difference was statistically significant at all time intervals ( 1 , 6 , 12 , 18 , 24 , 30 , 36 and 48 h , p < 0.001 , respectively ) .


Postpartum depression rate again was significantly lower in the spongostan group both on postoperative day 2 and day 9 ( p 0.01 ) .


All satisfaction scores were significantly higher in the spongostan group than in the control group ( p < 0.001 ) .


Additionally , first breast-feeding and first mobilization times were significantly shorter and opioid consumption was lower in the spongostan group ( p < 0.001 ) .


Placement of bupivacaine-soaked spongostan into the cesarean section wound resulted in decreased postoperative anxiety level and postpartum depression rate and increased satisfaction .


Chronic hepatitis C treatment for prior non-responders to peginterferon ( PegIFN ) / ribavirin remains suboptimal .


The MATTERHORN study evaluated regimens containing ritonavir-boosted danoprevir ( danoprevir/r ) in prior PegIFN alfa/ribavirin non-responders .


Prior partial responders ( N = 152 ) were randomized to 24 weeks of twice-daily danoprevir/r 100/100mg , mericitabine 1000 mg and ribavirin 1000/1200 mg ( IFN-free ) ; danoprevir/r plus PegIFN alfa-2a / ribavirin ( triple ) ; or danoprevir/r , mericitabine and PegIFN alfa-2a / ribavirin ( Quad ) .


Prior null responders ( N = 229 ) were randomized to 24 weeks of IFN-free therapy , or quad alone ( Quad 24 ) or quad plus 24-weeks of PegIFN alfa-2a / ribavirin ( Quad 48 ) .


The primary endpoint was sustained virological response ( HCV RNA < 25 IU/ml ) 24 weeks after end-of-treatment ( SVR24 ) .


Due to high relapse rates , genotype ( G ) 1a patients in IFN-free arms were offered additional PegIFN alfa-2a / ribavirin .


Among prior partial responders , SVR24 rates were 46.2 % , 51.0 % , and 86.0 % , in the IFN-free , Triple and Quad arms , respectively ; among prior null responders , SVR24 rates were 45.5 % , 80.5 % , and 83.8 % respectively .


Relapse rates were lower and SVR24 rates higher in G1b-infected than G1a-infected patients .


SVR24 rates in G1a and G1b patients randomized to Quad were 75.0 % and 96.2 % , respectively , in the partial Quad arm , and 68.1 % and 100 % , respectively , in the null Quad 24 arm .


Treatment failure was associated with resistance to danoprevir , but not to mericitabine , and was more common in G1a infected patients .


Treatment was well-tolerated .


Danoprevir/r , mericitabine plus PegIFN alfa-2a / ribavirin was well-tolerated and produced high overall SVR24 rates in prior partial and null responders to PegIFN alfa/ribavirin .


In contrast , IFN-free regimens were associated with unacceptably high relapse rates .


Long chain omega-3 polyunsaturated fatty acids ( LC n-3 PUFA ) such as EPA and DHA have been shown to possess beneficial health effects , and it is believed that many of their effects are mediated by their oxygenated products ( oxylipins ) .


Recently , we have shown that serum levels of several hydroxy , epoxy , and dihydroxy FAs are dependent on the individual status of the parent FAs in a cohort of normo - and hyperlipidemic subjects .


So far , the effect of an increased dietary LC n-3 PUFA intake on hydroxy , epoxy , and dihydroxy FA levels has not been investigated in subjects with mild combined hyperlipidemia .


In the present study , we compared oxylipin patterns of 10 hyperlipidemic ( cholesterol > 200mg/dl ; triglyceride > 150mg/ml ) and 10 normolipidemic men in response to twelve weeks of LC n-3 PUFA intake ( 1.14 g DHA and 1.56 g EPA ) .


Levels of 44 free hydroxy , epoxy and dihydroxy FAs were analyzed in serum by LC-MS .


Additionally , oxylipin levels were compared with their parent PUFA levels in erythrocyte membranes ; a biomarker for the individual PUFA status .


Differences in the oxylipin pattern between normo - and hyperlipidemic subjects were minor before and after treatment .


In all subjects , levels of EPA-derived oxylipins ( 170-4800pM ) were considerably elevated after LC n-3 PUFA intake ( 150-1400 % ) , the increase of DHA-derived oxylipins ( 360-3900pM ) was less pronounced ( 30-130 % ) .


The relative change of EPA in erythrocyte membranes is strongly correlated ( r0 .5 ; p < 0.05 ) with the relative change of corresponding epoxy and dihydroxy FA serum levels .


The effect on arachidonic acid ( AA ) - derived oxylipin levels ( 140-27 ,100 pM ) was inconsistent .


The dietary LC PUFA composition has a direct influence on the endogenous oxylipin profile , including several highly biological active EPA - and DHA-derived lipid mediators .


The shift in oxylipin pattern appears to be dependent on the initial LC PUFA status particularly for EPA .


The finding that also levels of other oxylipins derived from ALA , LA or AA are modified by LC n-3 PUFA intake might suggest that at least some of the effects of EPA and DHA could be mediated by a shift in the entire oxylipin profile .


A small subset of HIV-positive adults have low HIV RNA in the absence of therapy , sometimes for years .


Clinical factors associated with low HIV RNA in early infection have not been well defined .


We assessed factors associated with low plasma HIV RNA level at study entry in the Strategic Timing of AntiRetroviral Treatment ( START ) trial .


All START participants had a baseline HIV RNA assessment within 60 days prior to randomization .


The key covariables considered for this analysis were race , and hepatitis B virus ( HBV ) and hepatitis C virus ( HCV ) status .


We assessed factors associated with HIV RNA 50 and 400 HIV-1 RNA copies/mL using logistic regression .


Because of the strong association between region of randomization and baseline low HIV RNA , analyses were stratified by region .


We found that , of 4676 eligible participants randomized in START with a baseline HIV RNA assessment , 113 ( 2.4 % ) had HIV RNA 50copies/mL at baseline , and a further 257 ( 5.5 % ) between 51 and 400copies/mL .


We found that HIV exposure routes other than male homosexual contact , higher high-density lipoprotein ( HDL ) cholesterol levels , higher CD4 cell counts , and higher CD4 : CD8 ratio were associated with increased odds of low HIV RNA .


HCV antibody positivity was borderline statistically significantly associated with low HIV RNA .


Race and HBV surface antigen positivity were not significantly associated with low HIV RNA .


In a modern cohort of individuals with early untreated HIV infection , we found that HIV exposure routes other than male homosexual contact and higher HDL cholesterol were associated with increased odds of low HIV RNA .


To compare the efficacy and toxicity of chemotherapy under the guidance of molecular markers and with vinorelbine in elderly patients with epidermal growth factor receptor ( EGFR ) wild-type advanced non-small cell lung cancer ( NSCLC ) .


A total of 86 elderly patients with pathologically-confirmed advanced NSCLC with EGFR wild-type were recruited between June 2010 to October 2012 .


There were 69 males and 17 females , aging from 70 to 83 years .


They were divided randomly into 2 groups according to the proportion of 1 : 1 by SPSS 16.0 software .


The study group received chemotherapy ( cisplatin , gemcitabine , paclitaxel , and pemetrexed ) under the guidance of molecular markers ( excision repair cross-complementing 1 ERCC1 , ribonucleotide reductase M1 RRM1 , Class III beta-tubulin , thymidylate synthetase TS ) .


The control group received vinorelbine 25 mg/m ( 2 ) days 1 and 8 with 21 days as a cycle .


The progression-free survival ( PFS ) of the study group and the control group was 4.0 months ( 95 % CI : 3.1-4 .9 ) and 3.0 months ( 95 % CI : 2.4-3 .6 ) respectively , the difference being statistically significant ( ( 2 ) = 4.750 , P = 0.029 ) .


The objective response rate ( ORR ) was 23 % ( 10/43 ) and 19 % ( 8/43 ) ( ( 2 ) = 0.281 , P = 0.596 ) , the disease control rate ( DCR ) was 79 % ( 34/43 ) and 77 % ( 33/43 ) ( ( 2 ) = 0.068 , P = 0.795 ) , and the median overall survival ( OS ) was 8.3 months and 7.5 months ( ( 2 ) = 0.756 , P = 0.385 ) , respectively ; the differences being not significant .


Adverse effects were similar between the study group and the control group .


The most commonly seen adverse events were hematological toxicity , nausea , vomiting , fatigue , alopecia , joint and muscle pain .


Most of the toxicity was of grade I and grade II .


There was no treatment-related death .


The PFS was prolonged in elderly patients with EGFR wild-type advanced NSCLC under the guidance of molecular markers , but there was no improvement in ORR , DCR and OS .


Further studies are needed to evaluate the clinical significance of this treatment modality .


To investigate the modulatory effects that dynamic hyperinflation ( DH ) , defined as a reduction in inspiratory capacity ( IC ) , has on exercise tolerance after bronchodilator in patients with COPD .


An experimental , randomized study involving 30 COPD patients without severe hypoxemia .


At baseline , the patients underwent clinical assessment , spirometry , and incremental cardiopulmonary exercise testing ( CPET ) .


On two subsequent visits , the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo .


All patients then underwent spirometry and submaximal CPET at constant speed up to the limit of tolerance ( Tlim ) .


The patients who showed IC ( peak-rest ) < 0 were considered to present with DH ( DH + ) .


In this sample , 21 patients ( 70 % ) had DH .


The DH + patients had higher airflow obstruction and lower Tlim than did the patients without DH ( DH - ) .


Despite equivalent improvement in FEV1 after bronchodilator , the DH - group showed higher IC ( bronchodilator-placebo ) at rest in relation to the DH + group ( p < 0.05 ) .


However , this was not found in relation to IC at peak exercise between DH + and DH - groups ( 0.19 0.17 L vs. 0.17 0.15 L , p > 0.05 ) .


In addition , both groups showed similar improvements in Tlim after bronchodilator ( median [ interquartile range ] : 22 % [ 3-60 % ] vs. 10 % [ 3-53 % ] ; p > 0.05 ) .


Improvement in TLim was associated with an increase in IC at rest after bronchodilator in HD - patients with COPD .


However , even without that improvement , COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise .


Acute otitis media ( AOM ) is a common childhood illness and the leading indication for antibiotic prescriptions for US children .


Xylitol , a naturally occurring sugar alcohol , can reduce AOM when given 5 times per day as a gum or syrup , but a more convenient dosing regimen is needed for widespread adoption .


We designed a pragmatic practice-based randomized controlled trial to determine if viscous xylitol solution at a dose of 5 g 3 times per day could reduce the occurrence of clinically diagnosed AOM among otitis-prone children 6 months through 5 years of age .


A total of 326 subjects were enrolled , with 160 allocated to xylitol and 166 to placebo .


In the primary analysis of time to first clinically diagnosed AOM episode , the hazard ratio for xylitol versus placebo recipients was 0.88 ( 95 % confidence interval [ CI ] 0.61 to 1.3 ) .


In secondary analyses , the incidence of AOM was 0.53 episodes per 90 days in the xylitol group versus 0.59 in the placebo group ( difference 0.06 ; 95 % CI -0.25 to 0.13 ) ; total antibiotic use was 6.8 days per 90 days in the xylitol group versus 6.4 in the placebo group ( difference 0.4 ; 95 % CI -1.8 to 2.7 ) .


The lack of effectiveness was not explained by nonadherence to treatment , as the hazard ratio for those taking nearly all assigned xylitol compared with those taking none was 0.93 ( 95 % CI 0.56 to 1.57 ) .


Viscous xylitol solution in a dose of 5 g 3 times per day was ineffective in reducing clinically diagnosed AOM among otitis-prone children .


To compare efficacy and safety of thromboprophylaxis with semuloparin started postoperatively versus enoxaparin started preoperatively in major abdominal surgery .


Venous thromboembolism is an important complication following major abdominal surgery .


Semuloparin is a novel ultra-low-molecular-weight heparin with high antifactor Xa and minimal antifactor IIa activity .


In this double-blind noninferiority trial , adult patients undergoing major abdominal or pelvic operation under general anesthesia lasting more than 45 minutes were assigned to either daily enoxaparin 40 mg commenced preoperatively or daily semuloparin 20 mg commenced postoperatively , for 7 to 10 days .


Patients underwent bilateral leg venography between 7 and 11 days postsurgery .


The primary efficacy end point was the composite of any deep vein thrombosis , nonfatal pulmonary embolism , or all-cause death .


The primary safety outcome was bleeding .


Both were independently adjudicated .


In total , 4413 patients were randomized ; 3030 ( 1499 in the enoxaparin and 1531 in the semuloparin groups ) were evaluable for the primary efficacy end point , which occurred in 97 patients ( 6.3 % ) in the semuloparin group and 82 patients ( 5.5 % ) in the enoxaparin group [ odds ratio ( OR ) = 1.16 , 95 % confidence interval ( CI ) : 0.84-1 .59 ] .


On the basis of a noninferiority margin of 1.25 , postoperative semuloparin did not demonstrate noninferiority to preoperative enoxaparin .


Major bleeding occurred in 63 of 2175 patients ( 2.9 % ) in the semuloparin group and 98 of 2177 patients ( 4.5 % ) in the enoxaparin group ( OR = 0.63 , 95 % CI : 0.46-0 .87 ) .


Semuloparin commenced postoperatively did not demonstrate noninferiority to enoxaparin initiated preoperatively for thromboprophylaxis after major abdominal surgery .


Study registered with clinicaltrials.gov : NCT00679588 .


To compare visual outcome , higher-order aberrations , and corneal asphericity ( Q value ) between wavefront-guided and aspheric LASIK for myopia and myopic astigmatism .


Forty patients were randomly selected to receive wavefront-guided LASIK ( wavefront-guided group ) or aspheric LASIK ( aspheric group ) ( 40 eyes of 20 patients in each group ) using the Technolas 217z excimer laser platform ( Bausch & Lomb , Rochester , NY ) .


Flaps were created using the Zyoptix XP microkeratome ( Bausch & Lomb ) .


Preoperative and postoperative evaluation included uncorrected distance visual acuity ( UDVA ) , corneal topography , wavefront aberrometry , and contrast sensitivity .


Minimum follow-up period was 6 months .


At 6 months postoperatively , the aspheric group had significantly better UDVA ( logMAR 0.04 0.04 [ Snellen 20/16 ] [ range : -0.079 to 0.000 ] ) and lower mean residual spherical error ( +0.10 0.52 diopters [ D ] [ range : -1.12 to 1.25 D ] ) than the wavefront-guided group ( logMAR UDVA 0.00 0.07 [ range : -0.079 to 0.176 ] ; MRSE -0.35 0.47 D [ range : -1.5 to 0.62 D ] ) ( P = .003 and < .001 , respectively ) .


Mean change in higher-order aberration root mean square at 6 months postoperatively ( 6-mm pupil ) was 0.16 0.17 m after aspheric LASIK and 0.27 0.28 m after wavefront-guided LASIK ( P = .02 ) .


Aspheric LASIK induced minimal change in spherical aberrations postoperatively ( 0.03 0.12 m , P = .09 ) , unlike wavefront-guided LASIK ( 0.23 0.17 m , P < .01 ) .


Change in Q value was significantly less in the aspheric group ( 0.53 0.31 ) than the wavefront-guided group ( 0.91 0.30 ) ( P < .01 ) .


The aspheric group had significant improvement in contrast sensitivity at all spatial frequencies ( P < .01 ) , whereas the wavefront-guided group showed a slight decrease at higher spatial frequency ( 18 cycles per degree ) .


Aspheric LASIK induced significantly less change in higher-order aberrations and maintained corneal asphericity better than wavefront-guided LASIK .


The visual outcome and contrast sensitivity was better in the aspheric group at 6 months postoperatively .


Hyperparathyroidism occurs frequently in X-linked hypophosphatemia ( XLH ) and may exacerbate phosphaturia , potentially affecting skeletal abnormalities .


The objective of the study was to suppress elevated PTH levels in XLH patients .


This was a prospective , randomized , placebo-controlled , double-blind , 1-year trial of paricalcitol , with outcomes measured at entry and 1 year later .


PATIENTS were recruited from the investigators ' clinics or referred from throughout the United States .


Data were collected in an in-patient hospital research unit .


Subjects with a clinical diagnosis of XLH and hyperparathyroidism were offered participation and were eligible if they were 9 years old or older and not pregnant , and their serum calcium level was less than 10.7 mg/dL , their 25-hydroxyvitamin D level was 20 ng/mL or greater , and their creatinine level was 1.5 mg/dL or less .


The intervention for this study was the use of paricalcitol or placebo for 1 year .


Determined prior to trial onset was the change in PTH area under the curve .


Secondary outcomes included renal phosphate threshold per glomerular filtration rate , serum phosphorus , serum alkaline phosphatase activity , and ( 99m ) Tc-methylenediphosphonate bone scans .


PTH area under the curve decreased 17 % with paricalcitol , differing ( P = .007 ) from the 20 % increase with placebo .


The renal phosphate threshold per glomerular filtration rate increased 17 % with paricalcitol and decreased 21 % with placebo ( P = .05 ) .


Serum phosphorus increased 12 % with paricalcitol but did not differ from placebo .


Paricalcitol decreased alkaline phosphatase activity in adults by 21 % ( no change with placebo , P = .04 ) .


Bone scans improved in 6 of 17 paricalcitol subjects , whereas no placebo-treated subject improved .


Hypercalciuria developed in six paricalcitol subjects and persisted from baseline in one placebo subject .


Suppression of PTH may be a useful strategy for skeletal improvement in XLH patients with hyperparathyroidism , and paricalcitol appears to be an effective adjunct to standard therapy in this setting .


Although paricalcitol was well tolerated , urinary calcium and serum calcium and creatinine should be monitored closely with its use .


Whether the type of dietary fat could alter cardiometabolic responses to a hypercaloric diet is unknown .


In addition , subclinical cardiometabolic consequences of moderate weight gain require further study .


In a 7-week , double-blind , parallel-group , randomized controlled trial , 39 healthy , lean individuals ( mean age of 274 ) consumed muffins ( 51 % of energy [ % E ] from fat and 44 % E refined carbohydrates ) providing 750 kcal/day added to their habitual diets .


All muffins had identical contents , except for type of fat ; sunflower oil rich in polyunsaturated fatty acids ( PUFA diet ) or palm oil rich in saturated fatty acids ( SFA diet ) .


Despite comparable weight gain in the 2 groups , total : high-density lipoprotein ( HDL ) cholesterol , low-density lipoprotein : HDL cholesterol , and apolipoprotein B : AI ratios decreased during the PUFA versus the SFA diet ( -0.370.59 versus +0.070.29 , -0.310.49 versus +0.050.28 , and -0.070.11 versus +0.010.07 , P = 0.003 , P = 0.007 , and P = 0.01 for between-group differences ) , whereas no significant differences were observed for other cardiometabolic risk markers .


In the whole group ( ie , independently of fat type ) , body weight increased ( +2.2 % , P < 0.001 ) together with increased plasma proinsulin ( +21 % , P = 0.007 ) , insulin ( +17 % , P = 0.003 ) , proprotein convertase subtilisin/kexin type 9 , ( +9 % , P = 0.008 ) fibroblast growth factor-21 ( +31 % , P = 0.04 ) , endothelial markers vascular cell adhesion molecule-1 , intercellular adhesion molecule-1 , and E-selectin ( +9 , +5 , and +10 % , respectively , P < 0.01 for all ) , whereas nonesterified fatty acids decreased ( -28 % , P = 0.001 ) .


Excess energy from PUFA versus SFA reduces atherogenic lipoproteins .


Modest weight gain in young individuals induces hyperproinsulinemia and increases biomarkers of endothelial dysfunction , effects that may be partly outweighed by the lipid-lowering effects of PUFA .


http://ClinicalTrials.gov .


Unique identifier : NCT01427140 .


To characterize the variability in exposure and metabolic effect of insulin glargine 300U/ml ( Gla-300 ) at steady state in people with type 1 diabetes ( T1DM ) .


A total of 50 participants with T1DM underwent two 24-h euglycaemic clamps in steady-state conditions after six once-daily administrations of 0.4 U/kg Gla-300 in a double-blind , randomized , two-treatment , two-period , crossover clamp study .


Participants were randomized to receive Gla-300 as a standard cartridge formulation in the first treatment period , and as a formulation with enhanced stability through polysorbate-20 addition in the second treatment period , or vice versa .


This design allowed the assessment of bioequivalence between formulations and , subsequently , within - and between-day variability .


The cumulative exposure and effect of Gla-300 developed linearly over 24h , and were evenly distributed across 6 - and 12-h intervals .


Diurnal fluctuation in exposure ( within-day variability ) was low ; the peak-to-trough ratio of insulin concentration profiles was < 2 , and both the swing and peak-to-trough fluctuation were < 1 .


Day-to-day reproducibility of exposure was high : the between-day within-subject coefficients of variation for total systemic exposure ( area under the serum insulin glargine concentration time curve from time 0 to 24h after dosing ) and maximum insulin concentration were 17.4 % [ 95 % confidence interval ( CI ) 15-21 ] and 33.4 % ( 95 % CI 28-41 ) , respectively .


Reproducibility of the metabolic effect was lower than that of exposure .


Gla-300 provides predictable , evenly distributed 24-h coverage as a result of low fluctuation and high reproducibility in insulin exposure , and appears suitable for effective basal insulin use .


Echocardiography-guided ( EG ) lead placement at the site of latest left ventricular ( LV ) mechanical activation improves outcome in patients receiving a cardiac resynchronization therapy ( CRT ) defibrillator ( D ) .


The purpose of this study is to examine whether a strategy of EG LV lead placement equally improves outcome in CRT recipients with wide ( 150 ms ) versus intermediate ( 120-149 ms ) QRS duration .


Patients treated with a CRT-D in the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region ( STARTER ) prospective , randomized trial ( 108 EG strategy and 75 routine strategy ) were followed to the endpoint of death or first appropriate CRT-D therapy .


Of the patients enrolled in STARTER , 115 had QRS150 ms and 68 had 120 < QRS149 ms.


Over a mean follow-up period of 3.72.1 years , 62 ( 33 % ) patients died and 40 ( 22 % ) received appropriate CRT-D therapy .


Compared to patients with QRS150 ms , patients with intermediate QRS had meaningfully worse survival free from ICD therapy ( HR = 1.48 , p = 0.056 ) .


CRT-D therapy-free survival was significantly worse in patients with intermediate QRS duration randomized to the routine LV lead placement strategy , compared to patients with intermediate QRS duration randomized to the EG LV lead placement strategy or patients with wide QRS duration regardless of LV implantation strategy ( HR = 2.08 , 95 % confidence interval = 1.21-3 .56 , P = 0.008 ) .


This finding was independent in type of cardiomyopathy .


A strategy of EG LV lead placement improves survival free from defibrillator therapy in patients with QRS between 120-149 ms to levels comparable to those of patients with QRS150 ms.


After traumatic brain injury ( TBI ) , catecholamines ( CAs ) may be needed to maintain adequate cerebral perfusion pressure ( CPP ) , but there are no recommended alternative vasopressor therapies .


This is an interim report of the first study to test the hypothesis that arginine vasopressin ( AVP ) is a safe and effective alternative to CAs for the management of CPP in patients with severe TBI .


Since 2008 , all TBI patients requiring intracranial pressure monitoring at this Level 1 trauma center have been eligible for a randomized trial to receive either CA or AVP if vasopressors were required to maintain CPP greater than 60 mm Hg .


To date , 96 patients have been consented and randomized .


Demographics , vital signs , and laboratory values were similar .


As treated , 60 required no vasopressors and were the least severely injured group with the best outcomes .


Twenty-three patients received CA ( 70 % levophed , 22 % dopamine , 9 % phenylephrine ) and 12 patients received AVP .


The two vasopressor groups had similar demographics , but Injury Severity Score ( ISS ) and fluid requirements on intensive care unit Day 1 were worse in the AVP versus the CA groups ( all p < 0.05 ) before treatment .


These differences indicate more severe injury with accompanying hemodynamic instability .


Nevertheless , adverse events were not increased with AVP versus CA .


Trends favored AVP versus CA , but no apparent differences were statistically significant at this interim point .


There was no difference in mortality rates between CA and AVP .


These preliminary results suggest that AVP is a safe and effective alternative to CA for the management of CPP after TBI and support the continued investigation and use of AVP when vasopressors are required for CPP management in TBI patients .


Therapeutic study , level II .


Artemisinin-based combination therapy ( ACT ) is widely recommended as first-line therapy for uncomplicated Plasmodium falciparum malaria worldwide .


Artemisinin resistance has now been reported in Southeast Asia with a clinical phenotype manifested by slow parasite clearance .


Although there are no reliable reports of artemisinin resistance in Africa , there is a need to better understand the dynamics of parasite clearance in African children treated with ACT in order to better detect the emergence of artemisinin resistance .


Data from a cohort of Ugandan children four to five years old , enrolled in a longitudinal , randomized , clinical trial comparing two leading ACT , artemether-lumefantrine ( AL ) and dihydroartemisinin-piperaquine ( DP ) , were analysed .


For all episodes of uncomplicated P. falciparum malaria over a 14-month period , daily blood smears were performed for three days following the initiation of therapy .


Associations between pre-treatment variables of interest and persistent parasitaemia were estimated using multivariate , generalized , estimating equations with adjustment for repeated measures in the same patient .


A total of 202 children were included , resulting in 416 episodes of malaria treated with AL and 354 episodes treated with DP .


The prevalence of parasitaemia on days 1 , 2 , and 3 following initiation of therapy was 67.6 , 5.6 and 0 % in those treated with AL , and 52.2 , 5.7 and 0.3 % in those treated with DP .


Independent risk factors for persistent parasitaemia on day 1 included treatment with AL vs DP ( RR = 1.34 , 95 % CI 1.20-1 .50 , p < 0.001 ) , having a temperature 38.0 C vs < 37.0 C ( RR = 1.19 , 95 % CI 1.05-1 .35 , p = 0.007 ) and having a parasite density > 20,000 / L vs < 4,000 / L ( RR = 3.37 , 95 % CI 2.44-4 .49 , p < 0.001 ) .


Independent risk factors for having persistent parasitaemia on day 2 included elevated temperature , higher parasite density , and being HIV infected .


Among Ugandan children , parasite clearance following treatment with AL or DP was excellent with only one of 752 patients tested having a positive blood slide three days after initiation of therapy .


The type of ACT given , pre-treatment temperature , pre-treatment parasite density and HIV status were associated with differences in persistent parasitaemia , one or two days following therapy .


Current Controlled Trials Identifier NCT00527800 .


Understanding the nature and time course of the pharmacodynamic effects of attention-deficit/hyperactivity disorder ( ADHD ) medications is useful .


The Cognitive Drug Research Computerized Battery of Tests ( CDR-CBT ) is a 20-min battery of ten standardized , validated neuropsychometric tasks .


This pilot study examined the sensitivity and responsiveness of the CDR-CBT for assessing cognitive function in adults with ADHD prior to and up to 16 h postdose during treatment with lisdexamfetamine dimesylate ( LDX ) or mixed amphetamine salts immediate release ( MAS-IR ; various generics available ) .


This was a double-blind three-period crossover study .


Participants received LDX 50 mg/day , MAS-IR 20 mg/day , and placebo ( ~ 7 a.m. ) for 7 days each in randomized order .


CDR-CBT was administered on day 1 of period 1 and day 7 of each period at scheduled times between -0.5 ( predose ) and 16 h postdose .


Composite power of attention ( PoA ) score ( sum of simple reaction time , choice reaction time , and digit vigilance speed ) was the primary outcome measure .


The Conners ' Adult ADHD Rating Scales-Self-Report : Short Version ( CAARS-S : S ) was administered at baseline and on day 1 of period 1 , and days 6 and 7 of each treatment period .


Tertiary outcomes included CDR-CBT composite continuity of attention scores , its component task scores , cognitive reaction time , and response variability scores .


No inferential statistical comparisons were conducted .


Safety assessments included adverse events ( AEs ) and vital signs .


This analysis included 18 participants ( mean age 30.8 years ) ; one withdrew because of AEs .


Mean pretreatment PoA scores were 1175.9-1361 .2 ms , scores commensurate with a normative age of > 40 years .


Maximum reductions in PoA scores with LDX and MAS-IR occurred at 5 h postdose at day 7 ( least squares mean difference [ 95 % CI ] of -150.0 [ -235.41 to -64.50 ] and -79.8 [ -165.72 to 6.21 ] ms vs. placebo , respectively ) .


CAARS-S : S scores were unchanged with LDX and MAS-IR ( vs. placebo ) at all postdose timepoints .


Tertiary attention-related CDR-CBT outcomes were sensitive to LDX and MAS-IR ( vs. placebo ) .


Treatment-emergent AEs and vital signs were consistent with previous studies in adult ADHD .


In adults with ADHD , PoA scores indicated impaired attention at baseline and response to treatment with LDX and MAS-IR ( vs. placebo ) , demonstrating value for measuring the time course of pharmacologic treatment effects .


To evaluate approximal caries increment among 12 - to 16-year-olds in a low caries prevalence area in Sweden after a 3.5-year school-based fluoride ( F ) varnish programme with Bifluorid 12 and Duraphat .


The design was a RCT study with 1365 adolescents , divided into following four groups : Group 1 Bifluorid 12 two applications/year ; Group 2 Duraphat two applications/year ; Group 3 Bifluorid 12 four applications/year and Group 4 no F varnish at school .


1143 children ( 84 % ) completed the study .


Approximal caries was registered on bitewing radiographs .


There were no statistically significant differences in caries prevalence among the groups either at baseline or after 3.5 years .


The caries increment for Group 1 was 1.342.99 ( meanSD ) , 1.242.84 for Group 2 , 1.072.66 for Group 3 and 1.252.75 for Group 4 , with no statically significant differences either between Bifluorid 12 and Duraphat with the same frequency of F varnish applications or between the F groups and the control group .


In an area with low caries prevalence in Sweden , the supplementary caries-preventive effect of school-based F varnish applications , to regular use of F toothpaste at home and to regular caries prevention given at the Public Dental Clinics , appears to be nonsignificant regarding approximal caries increment .


Dexmedetomidine and midazolam both modulate spinal analgesia by different mechanisms , and yet , no human studies are available to compare them for postoperative analgesia after neuraxial administration .


We investigated the addition of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of effective analgesia and clinical safety profile .


Prospective , randomized , double blind , placebo controlled study .


University teaching hospital .


The study cohort included a consecutive and prospective series of patients , referred for endourological procedures .


The patients were randomly allocated into 3 groups ( 20 patients each ) to receive intrathecally 3 mL of 0.5 % hyperbaric bupivacaine in combination with 5 mcg of dexmedetomidine ( dexmedetomidine group ) , 1 mg of midazolam ( midazolam group ) or 0.5 mL of 0.9 % saline ( control group ) .


The groups were compared to the regression time of sensory block , duration of effective analgesia ( defined as the time interval between administration of intrathecal drug to the time of first analgesic request or a numeric rating scale = 4.0 ) , sedation score , and side effects in the first 24 hours .


One way-ANOVA , Kruskal Wallis test , and Chi-square test ( ) , significance level : P < 0.05 .


The duration of effective analgesia ( time to first analgesic request ) was significantly prolonged in the dexmedetomidine group ( 286 64 minutes , P < 0.01 ) when compared with midazolam group ( 236.9 64.9 minutes ) and the control group ( 212.7 70.2 minutes ) .


Pairwise comparisons among the 3 groups with Bonferroni adjustment revealed that patients from the dexmedetomidine group were more sedated in comparison to the midazolam and control groups at the end of the first 15 minutes after intrathecal injection [ ( 2 ) = 7.157 , P = 0.028 ] , with a mean rank sedation score of 35.58 for dexmedetomidine , 25.00 for midazolam , and 30.93 for control .


No significant differences in the side effects were observed during the study period .


Midazolam did not lengthen the time of the two segment sensory regression or the time to first request analgesia .


The study can not be extrapolated to muscle cutting surgeries under spinal anaesthesia .


The addition of dexmedetomidine ( 5 mcg ) to 3 mL of intrathecal hyperbaric bupivacaine ( 0.5 % ) significantly prolongs the duration of effective analgesia in comparison to 1 mg midazolam or placebo ( 0.9 % normal saline ) with a comparable incidences of side effects .


Several studies have presented evidence suggesting that dairy consumption has beneficial effects on blood pressure ( BP ) in healthy subjects ; however , only a few studies have examined this possibility in patients with established essential hypertension using ambulatory blood pressure monitoring .


The objective of this study was to investigate how consuming dairy products impacts mean daytime systolic and diastolic BP in men and women with mild to moderate essential hypertension .


Eighty-nine men and women with systolic BP135mm Hg and160mm Hg and diastolic BP110mm Hg were enrolled in this single-blind , randomized , cross-over , controlled study .


Participants had to incorporate three daily servings of dairy products or control products equivalent in macronutrients and sodium during four-week treatment phases .


Twenty-four hour ambulatory BP and endothelial function were assessed at screening and at the end of each dietary phase .


The consumption of three daily servings of dairy products led to a significant reduction in mean daytime ambulatory systolic BP ( -2 mm Hg ; P = 0.05 ) in men compared with readings after the control phase .


In women , dairy consumption had no effect on ambulatory systolic BP .


Moreover , endothelial function was significantly improved by dairy consumption in the whole cohort .


These data indicate that the consumption of three daily servings of dairy products have beneficial effects on daytime systolic ambulatory BP compared to a heart-healthy , dairy-free , diet in men with mild to moderate essential hypertension .


This trial is registered at clinicaltrials.gov as NCT01776216 .


The Age-Related Eye Disease Study 1 ( AREDS 1 ) has shown that nutritional supplementation with antioxidants and zinc modifies the natural course of AMD .


It is presumed that the supplements exert their beneficial effects by ameliorating oxidative stress due to the scavenging of reactive oxygen species ( ROS ) .


We have shown in a human model that under oxidative stress induced by administration of lipopolysaccharide ( LPS ) the vasoconstrictor response of retinal vessels to oxygen breathing is diminished .


This reduced vascular response to hyperoxia was previously shown to be normalized by the AREDS 1 supplements .


In the present study , we tested the hypothesis that the response can also be restored by a different antioxidant formulation .


This randomized , double-masked , placebo-controlled parallel group study included 40 healthy volunteers .


On each study day , retinal red blood cell ( RBC ) flow and the reactivity of retinal RBC flow to hyperoxia were investigated in the absence and presence of 2 ng/kg LPS .


Between the two study days , subjects received either the supplement or placebo for 14 days .


Before supplementation LPS reduced retinal arterial vasoconstriction ( P < 0.001 ) and reactivity of retinal RBC flow ( P = 0.03 ) in response to 100 % oxygen breathing .


Two weeks of supplementation did not affect baseline retinal RBC flow , but normalized the LPS-induced change in the response to hyperoxia .


The arterial vasoconstrictor response during LPS and 100 % oxygen breathing was 4.1 1.0 % after administration of placebo and 10.6 0.9 % after supplementation ( P = 0.005 ) .


The response of RBC flow to 100 % oxygen breathing during LPS was 52.2 2.1 % after administration of placebo and 59.5 2.0 % after supplementation ( P = 0.033 ) .


Our data show that the supplement used in the present study can normalize the response of retinal RBC flow to hyperoxia under LPS administration .


This indicates that supplementation can prevent endothelial dysfunction induced by oxidative stress , which is assumed to play a role in the pathophysiology of AMD .


( ClinicalTrials.gov number , NCT00914576 . )


The aim of this clinical study was to identify changes in pulpal blood flow ( PBF ) in human central incisors resulting from short - and long-term intrusive orthodontic forces from mini-implants .


A total of 40 sound upper central and lateral incisors in 20 patients scheduled for intrusion for orthodontic reasons were divided into two groups .


From each group , 20 teeth were subjected to intrusive force from mini-implants ( Group 1 = Light Force : 40 g ; Group 2 = Heavy Force : 120 g ) , whereas the remaining 20 contralateral teeth were not subjected to forces from mini-implants and served as controls .


Laser-Doppler flowmetry ( LDF ) measurements were recorded at baseline and at 3 days and 3 weeks following intrusion .


PBF decreased significantly at 3 days ( Light Force Group : 7.72 0.50 ; Heavy Force Group : 7.72 0.52 ) and then increased towards baseline at 3 weeks ( Light Force Group : 10.37 0.58 ; Heavy Force Group : 10.31 0.45 ) following intrusion .


In other words , despite slight regressive changes in pulpal tissue in the short-term , PBF improved after 3 weeks following intrusion by mini-implants , indicating that the changes observed in PBF is reversible , even following radical incisor intrusion .


Depression during pregnancy has been demonstrated to be predictive of low birthweight , prematurity , and postpartum depression .


These adverse outcomes potentially have lasting effects on maternal and child well-being .


Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression ( MDD ) , but have proven difficult to engage and retain in treatment .


Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse , pregnant women on Medicaid receiving care in a public health system .


This paper describes the design , methodology , culturally relevant enhancements , and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services ( MSS ) .


Pregnant , public health patients , > 18 years with a likely diagnosis of MDD or dysthymia , measured respectively by the Patient Health Questionnaire-9 ( PHQ-9 ) or the Mini-International Neuropsychiatric Interview ( MINI ) , were randomized to the intervention or to public health MSS .


The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline ( one-year postpartum ) .


168 women with likely MDD ( 96.4 % ) and/or dysthymia ( 24.4 % ) were randomized .


Average age was 27.6 years and gestational age was 22.4 weeks ; 58.3 % racial/ethnic minority ; 71.4 % unmarried ; 22 % no high school degree/GED ; 65.3 % unemployed ; 42.1 % making < $ 10,000 annually ; 80.4 % having recurrent depression ; 64.6 % PTSD , and 72 % unplanned pregnancy .


A collaborative care team , including a psychiatrist , psychologist , project manager , and 3 social workers , met weekly , collaborated with the patients ' obstetrics providers , and monitored depression severity using an electronic tracking system .


Potential sustainability of the intervention within a public health system requires further study .


This pilot trial evaluated the feasibility and safety of an early discharge strategy ( EDS : 72 h , followed by outpatient lifestyle interventions ) , in comparison with a conventional discharge strategy ( CDS ) for low-risk ( Zwolle risk score 3 ) ST-elevation myocardial infarction ( STEMI ) patients treated with primary angioplasty .


One hundred patients were randomized to an EDS ( n = 54 ) or a CDS ( n = 46 ) .


The primary end point was the feasibility of the EDS : ( 1 ) 70 % of EDS patients discharged 72 h , ( 2 ) 70 % visited by a nurse 7 days after discharge , ( 3 ) 70 % with 3 visits by the nurse and ( 4 ) 70 % visited by a cardiologist 3 months .


The mean age was 59.2 12.2 years and ejection fraction 54.0 7.1 % .


Eighty-six percent were male ( 12 % diabetics ) .


Vascular access was radial in 91 % .


Ischemic time was 4 h in 75 % .


Length of stay was shorter in EDS as compared with CDS ( 70.1 8.1 vs. 111.8 28.3 h , p < 0.001 ) .


EDS feasibility was : ( 1 ) 72.2 % ; ( 2 ) 81.5 % ; ( 3 ) 76.9 % ; ( 4 ) 72.2 % .


There were no adverse events or differences in intervention goals and quality of life between groups .


An EDS in low-risk STEMI patients is feasible and seems to be safe .


A shorter hospital stay could benefit patients and health care systems .


ICU-acquired weakness ( ICU-AW ) has immediate and long-term consequences for critically ill patients .


Strategies for the prevention of weakness include modification of known risk factors , such as hyperglycemia and immobility .


Intensive insulin therapy ( IIT ) has been proposed to prevent critical illness polyneuropathy .


However , the effect of insulin and early mobilization on clinically apparent weakness is not well known .


This is a secondary analysis of all patients with mechanical ventilation ( N = 104 ) previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy , which evaluated the end point of functional independence .


Every patient had IIT and blinded muscle strength testing on hospital discharge to determine the incidence of clinically apparent weakness .


The effects of insulin dose and early mobilization on the incidence of ICU-AW were assessed .


On logistic regression analyses , early mobilization and increasing insulin dose prevented the incidence of ICU-AW ( OR , 0.18 , P = .001 ; OR , 0.001 , P = .011 ; respectively ) independent of known risk factors for weakness .


Early mobilization also significantly reduced insulin requirements to achieve similar glycemic goals as compared with control patients ( 0.07 units/kg/d vs 0.2 units/kg/d , P < .001 ) .


The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT .


The prevalence of chronic diseases such as type 2 diabetes and chronic low back pain is rising .


Patient empowerment is a key strategy in the management of chronic diseases .


Patient empowerment can be fostered by Web-based interactive health communication applications ( IHCAs ) that combine health information with decision support , social support , and/or behavioral change support .


Tailoring the content and tone of IHCAs to the needs of individual patients might improve their effectiveness .


The main objective was to test the effectiveness of a Web-based , tailored , fully automated IHCA for patients with type 2 diabetes or chronic low back pain against a standard website with identical content without tailoring ( control condition ) on patients ' knowledge and empowerment .


We performed a blinded randomized trial with a parallel design .


In the intervention group , the content was delivered in dialogue form , tailored to relevant patient characteristics .


In the control group , the sections of the text were presented in a content tree without any tailoring .


Participants were recruited online and offline and were blinded to their group assignments .


Measurements were taken at baseline ( t0 ) , directly after the first visit ( t1 ) , and at 3-month follow-up ( t2 ) .


The primary hypothesis was that the tailored IHCA would have larger effects on knowledge and patient empowerment ( primary outcomes ) than the control website .


The secondary outcomes were decisional conflict and preparation for decision making .


All measurements were conducted by online self-report questionnaires .


Intention-to-treat ( ITT ) and available cases ( AC ) analyses were performed for all outcomes .


A total of 561 users agreed to participate in the study .


Of these , 179 ( 31.9 % ) had type 2 diabetes and 382 ( 68.1 % ) had chronic low back pain .


Usage was significantly higher in the tailored system ( mean 51.2 minutes ) than in the control system ( mean 37.6 minutes ; P < .001 ) .


Three months after system use , 52.4 % of the sample was retained .


There was no significant intervention effect in the ITT analysis .


In the AC analysis , participants using the tailored system displayed significantly more knowledge at t1 ( P = .02 ) and more emotional well-being ( subscale of empowerment ) at t2 ( P = .009 ) .


The estimated mean difference between the groups was 3.9 ( 95 % CI 0.5-7 .3 ) points for knowledge and 25.4 ( 95 % CI 6.3-44 .5 ) points for emotional well-being on a 0-100 points scale .


The primary analysis did not support the study hypothesis .


However , content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs .


There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes .


This might be due to our tailored IHCA being , at its core , an educational intervention offering health information in a personalized , empathic fashion that merely additionally provides decision support .


Tailoring and interactivity may not make a difference with regard to these outcomes .


International Clinical Trials Registry : DRKS00003322 ; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 ( Archived by WebCite at http://www.webcitation.org/6WPO0lJwE ) .


In this study , we tested the hypothesis that pulmonary artery venting would decrease the incidence of atrial fibrillation after coronary artery bypass surgery .


This prospective study included 301 patients who underwent complete myocardial revascularization with cardiopulmonary bypass in our department during a 2-year period .


The patients were randomly divided into 2 groups : group I included 151 patients who underwent aortic root venting and group II included 150 patients who underwent pulmonary arterial venting for decompression of the left heart .


Pre - , peri - , and postoperative risk factors for atrial fibrillation were assessed in both groups .


The mean age was similar in the 2 groups .


The mean number of anastomoses was significantly higher in group I ( 2.8 0.8 ) than in group II ( 2.4 0.8 ) ( P = 0.001 ) .


The mean cross-clamp time was 42.7 17.4 minutes in group I and 54.1 23.8 minutes in group II ( P = 0.001 ) .


The mean cardiopulmonary bypass time was 66.4 46.1 minutes in group I and 77.4 28.6 minutes in group II ( P = 0.08 ) .


The incidence of atrial fibrillation was 14.5 % ( n = 21 ) in group I and 6.5 % ( n = 10 ) in group II ( P = 0.02 ) .


Multivariate regression analysis showed that pulmonary artery venting decreased the postoperative incidence of atrial fibrillation by 17.6 % .


Pulmonary arterial venting may be used as an alternative to aortic root venting during on-pump coronary bypass surgery , especially in patients at high risk of postoperative atrial fibrillation .


Biapenem is a newly developed carbapenem to treat moderate and severe bacterial infections .


This multicenter , randomized , parallel-controlled clinical trial was conducted to compare the clinical efficacy , bacterial eradication rates and safety of biapenem and meropenem in the treatment of bacterial lower respiratory tract infections and urinary tract infections ( UTIs ) at nine centres in China .


Patients diagnosed with bacterial lower respiratory tract infections or UTIs were randomly assigned to receive either biapenem ( 300 mg every 12 h ) or meropenem ( 500 mg every 8 h ) by intravenous infusion for 7 to 14 days according to their disease severity .


The overall clinical efficacy , bacterial eradication rates and drug-related adverse reactions of biapenem and meropenem were analyzed .


A total of 272 enrolled cases were included in the intent-to-treat ( ITT ) analysis and safety analysis .


There were no differences in demographics and baseline medical characteristics between biapenem group and meropenem group .


The overall clinical efficacies of biapenem and meropenem were not significantly different , 94.70 per cent ( 125/132 ) vs. 93.94 per cent ( 124/132 ) .


The overall bacterial eradication rates of biapenem and meropenem showed no significant difference , 96.39 per cent ( 80/83 ) vs. 93.75 per cent ( 75/80 ) .


Drug-related adverse reactions were comparable in biapenem and meropenem groups with the incidence of 11.76 per cent ( 16/136 ) and 15.44 per cent ( 21/136 ) , respectively .


The most common symptoms of biapenem-related adverse reactions were rash ( 2.2 % ) and gastrointestinal distress ( 1.5 % ) .


Biapenem was non-inferior to meropenem and was well-tolerated in the treatment of moderate and severe lower respiratory tract infections and UTIs .


Early negative postoperative behavior ( e-PONB ) is common in children and manifests itself as emergence agitation ( EA ) , emergence delirium ( ED ) , and pain .


The objective of this prospective double blind , randomized , placebo-controlled trial was to determine whether IV clonidine or IV fentanyl prior to surgery modifies e-PONB in children .


Ninety children scheduled for subumbilical surgery under sevoflurane anesthesia supplemented with regional anesthesia were randomized to either receive IV clonidine 2mcgkg ( -1 ) , IV fentanyl 2mcgkg ( -1 ) or placebo ( IV saline ) before surgery .


Primary outcome measures were the incidence of EA , ED and pain during the first hour after awakening .


Secondary outcome measures were side effects such as nausea and vomiting and delayed discharge from PACU .


Eighty-seven children ( n = 29 per group ) completed the study .


EA was present in 10 children ( six clonidine , none fentanyl , and four placebo , P = 0.04 ) whereas ED was observed in 20 children ( nine clonidine , three fentanyl , and eight placebo P = 0.13 ) .


Sixteen children who received placebo had a CHIPPS score of 4 compared with nine children in fentanyl group and 18 children receiving clonidine ( P = 0.04 ) .


Ten children receiving fentanyl vomited during the first postoperative day , compared with six children in placebo group and none in clonidine group ( P = 0.003 ) .


Discharge from PACU was not affected .


IV fentanyl before surgery but not IV clonidine modifies e-PONB in children undergoing lower abdominal surgery under general anesthesia supplemented with regional anesthesia .


The use of fentanyl in this population was also associated with reduced pain scores after awakening but with significantly greater incidence of PONV .


Although pain is a common complication of endoscopic submucosal dissection ( ESD ) , management strategies are inadequate .


The aim of this study was to evaluate the efficacy of topical bupivacaine and triamcinolone acetonide for abdominal pain relief and as a potential method of pain control after ESD for gastric neoplasia .


In this randomized , double-blind , placebo-controlled trial , 111 eligible patients with early gastric neoplasm were randomized into one of three groups : bupivacaine ( BV ) only , bupivacaine with triamcinolone ( BV-TA ) , or placebo .


The present pain intensity ( PPI ) score and the Short-Form McGill Pain Questionnaire ( SF-MPQ ) were used to evaluate pain at 0 , 6 , 12 , and 24 h after ESD .


The mean values for the 6-hour PPI in the BV-TA and BV groups were lower than those of the placebo group ( 1.57 1.09 and 1.97 1.09 vs. 2.63 0.98 , p < 0.001 ) .


The 12-hour PPI of the BV-TA group ( 1.20 0.83 ) was the lowest among the three groups ( p = 0.001 ) .


The total 6-hour SF-MPQ score , especially in the sensory domain , was higher in the placebo group than in BV and BV-TA groups .


The 12-hour SF-MPQ score was the lowest in the BV-TA group .


Multivariate analysis demonstrated that BV-TA injection protocol , fibrosis , and size of residual ulcer were independently associated with the PPI score at 6 h.


Bupivacaine after ESD was effective for pain relief at 6 h postoperatively .


Particularly , topical infiltration of bupivacaine mixed with triamcinolone acetonide was helpful for producing a more long-lasting benefit of pain relief after gastric ESD .


Physical activity is a cornerstone in therapy for patients with metabolic syndrome .


Walking and hiking in a mountain scenery represents an ideal approach to make them move .


The Austrian Moderate Altitude Study ( AMAS ) 2000 main study is a randomized controlled trial to investigate the cardiovascular effects of hiking at moderate altitude on patients with metabolic syndrome compared with a control group at low altitude , to assess a potential altitude-specific effect .


Seventy-one male patients with metabolic syndrome were randomly assigned to a moderate altitude group ( at 1700 m ) , with 36 participants , or to a low altitude group ( at 200 m ) , with 35 participants .


The 3-week vacation program included 12 hiking tours ( 4 per week , average duration 2.5 hours , intensity 55 % to 65 % of heart rate maximum ) .


Physical parameters , performance capacity , 24-hour blood pressure , and heart rate profiles were obtained before , during , and after the stay .


In both groups , we found a significant mean weight loss of -3.13 kg ; changes in performance capacity were minor .


Systolic , diastolic , and mean arterial pressures and circadian heart rate profiles were significantly reduced in both groups , with no differences between them .


Consequently , the pressure-rate product was reduced as well .


All study participants tolerated the vacation well without any adverse events .


A 3-week hiking vacation at moderate or low altitude is safe for patients with metabolic syndrome and provides several improvements in their cardiovascular parameters .


The cardiovascular benefits achieved are more likely to be the result of regular physical activity than the altitude-specific effect of a mountain environment .


Isolated limb perfusion ( ILP ) is a treatment option most commonly used in the treatment of melanoma in-transit metastases of the extremities .


The principle idea is to surgically isolate a region of the body and then deliver a high concentration of a chemotherapeutic agent together with hyperthermia .


There have been three randomised trials exploring whether adjuvant ILP to patients with recurrent or high-risk primary melanomas increases survival ; one of these trials has now been updated with a 25-year follow-up .


The original study randomised 69 patients ( between 1981 and 1989 ) with their first satellite or in-transit recurrence to either wide excision ( WE group , n = 36 patients ) or to WE and adjuvant ILP ( WE+ILP group , n = 33 patients ) .


Follow-up data 25 years later concerning survival and cause of death was retrieved from the Swedish National Cause of Death Register .


In the WE+ILP group there were 20 deaths ( 61 % ) due to melanoma compared with 26 deaths ( 72 % ) in the WE group ( p = 0.31 ) .


Median melanoma-specific survival was 95 months for WE+ILP compared to 38 months for the WE group , an almost 5 year benefit without statistical significance ( p = 0.24 ) .


There is no evidence that adjuvant ILP prolongs survival in patients with high-risk or recurrent melanoma ; however , the existing randomised trials are largely underpowered to detect such a difference .


New studies are exploring systemic immunological effects of ILP , and a combination of regional therapy and immunotherapy may serve as a rationale for new trials using ILP in the future .


Automated health behavior change interventions show promise , but suffer from high attrition and disuse .


The Internet abounds with thousands of personal narrative accounts of health behavior change that could not only provide useful information and motivation for others who are also trying to change , but an endless source of novel , entertaining stories that may keep participants more engaged than messages authored by interventionists .


Given a collection of relevant personal health behavior change stories gathered from the Internet , the aim of this study was to develop and evaluate an automated indexing algorithm that could select the best possible story to provide to a user to have the greatest possible impact on their attitudes toward changing a targeted health behavior , in this case weight loss .


An indexing algorithm was developed using features informed by theories from behavioral medicine together with text classification and machine learning techniques .


The algorithm was trained using a crowdsourced dataset , then evaluated in a 22 between-subjects randomized pilot study .


One factor compared the effects of participants reading 2 indexed stories vs 2 randomly selected stories , whereas the second factor compared the medium used to tell the stories : text or animated conversational agent .


Outcome measures included changes in self-efficacy and decisional balance for weight loss before and after the stories were read .


Participants were recruited from a crowdsourcing website ( N = 103 ; 53.4 % , 55/103 female ; mean age 35 , SD 10.8 years ; 65.0 % , 67/103 precontemplation ; 19.4 % , 20/103 contemplation for weight loss ) .


Participants who read indexed stories exhibited a significantly greater increase in self-efficacy for weight loss compared to the control group ( F1 ,107 = 5.5 , P = .02 ) .


There were no significant effects of indexing on change in decisional balance ( F1 ,97 = 0.05 , P = .83 ) and no significant effects of medium on change in self-efficacy ( F1 ,107 = 0.04 , P = .84 ) or decisional balance ( F1 ,97 = 0.78 , P = .38 ) .


Personal stories of health behavior change can be harvested from the Internet and used directly and automatically in interventions to affect participant attitudes , such as self-efficacy for changing behavior .


Such approaches have the potential to provide highly tailored interventions that maximize engagement and retention with minimal intervention development effort .


Many patients with asthma or chronic obstructive pulmonary disease ( COPD ) routinely receive a combination of an inhaled bronchodilator and anti-inflammatory glucocorticosteroid , but those with severe disease often respond poorly to these classes of drug .


We assessed the efficacy and safety of a novel inhaled dual phosphodiesterase 3 ( PDE3 ) and PDE4 inhibitor , RPL554 for its ability to act as a bronchodilator and anti-inflammatory drug .


Between February , 2009 , and January , 2013 , we undertook four proof-of-concept clinical trials in the Netherlands , Italy , and the UK .


Nebulised RPL554 was examined in study 1 for safety in 18 healthy men who were randomly assigned ( 1:1:1 ) to receive an inhaled dose of RPL554 ( 0003 mg/kg or 0009 mg/kg ) or placebo by a computer-generated randomisation table .


Subsequently , six non-smoking men with mild allergic asthma received single doses of RPL554 ( three received 0009 mg/kg and three received 0018 mg/kg ) in an open-label , adaptive study , and then ten men with mild allergic asthma were randomly assigned to receive placebo or RPL554 ( 0018 mg/kg ) by a computer-generated randomisation table for an assessment of safety , bronchodilation , and bronchoprotection .


Study 2 examined the reproducibility of the bronchodilator response to a daily dose of nebulised RPL554 ( 0018 mg/kg ) for 6 consecutive days in a single-blind ( patients masked ) , placebo-controlled study in 12 men with clinically stable asthma .


The safety and bronchodilator effect of RPL554 ( 0018 mg/kg ) was assessed in study 3 , an open-label , placebo-controlled crossover trial , in 12 men with mild-to-moderate COPD .


In study 4 , a placebo-controlled crossover trial , the effect of RPL554 ( 0018 mg/kg ) on lipopolysaccharide-induced inflammatory cell infiltration in induced sputum was investigated in 21 healthy men .


In studies 3 and 4 , randomisation was done by computer-generated permutation with a block size of two for study 3 and four for study 4 .


Unless otherwise stated , participants and clinicians were masked to treatment assignment .


Analyses were by intention to treat .


All trials were registered with EudraCT , numbers 2008-005048-17 , 2011-001698-22 , 2010-023573-18 , and 2012-000742-34 .


Safety was a primary endpoint of studies 1 and 3 and a secondary endpoint of studies 2 and 4 .


Overall , RPL554 was well tolerated , and adverse events were generally mild and of equal frequency between placebo and active treatment groups .


Efficacy was a primary endpoint of study 2 and a secondary endpoint of studies 1 and 3 .


Study 1 measured change in forced expiratory volume in 1 s ( FEV1 ) and provocative concentration of methacholine causing a 20 % fall in FEV1 ( PC20MCh ) in participants with asthma .


RPL554 produced rapid bronchodilation in patients with asthma with an FEV1 increase at 1 h of 520 mL ( 95 % CI 320-720 ; p < 00001 ) , which was a 14 % increase from placebo , and increased the PC20MCh by 15 doubling doses ( 95 % CI 063-228 ; p = 0004 ) compared with placebo .


The primary endpoint of study 2 was maximum FEV1 reached during 6 h after dosing with RPL554 in patients with asthma .


RPL554 produced a similar maximum mean increase in FEV1 from placebo on day 1 ( 555 mL , 95 % CI 442-668 ) , day 3 ( 505 mL , 392-618 ) , and day 6 ( 485 mL , 371-598 ; overall p < 00001 ) .


A secondary endpoint of study 3 ( patients with COPD ) was the increase from baseline in FEV1 .


RPL554 produced bronchodilation with a mean maximum FEV1 increase of 172 % ( SE 52 ) .


In healthy individuals ( study 4 ) , the primary endpoint was percentage change in neutrophil counts in induced sputum 6 h after lipopolysaccharide challenge .


RPL554 ( 0018 mg/kg ) did not significantly reduce the percentage of neutrophils in sputum ( 803 % in the RPL554 group vs 842 % in the placebo group ; difference -39 % , 95 % CI -94 to 16 , p = 015 ) , since RPL554 significantly reduced neutrophils ( p = 0002 ) and total cells ( p = 0002 ) to a similar degree .


In four exploratory studies , inhaled RPL554 is an effective and well tolerated bronchodilator , bronchoprotector , and anti-inflammatory drug and further studies will establish the full potential of this new drug for the treatment of patients with COPD or asthma .


Verona Pharma .


Intensified repetitive transcranial magnetic stimulation ( rTMS ) applied to the left dorsolateral prefrontal cortex ( DLPFC ) may result in fast clinical responses in treatment resistant depression ( TRD ) .


In these kinds of patients , subgenual anterior cingulate cortex ( sgACC ) functional connectivity ( FC ) seems to be consistently disturbed .


So far , no de novo data on the relationship between sgACC FC changes and clinical efficacy of accelerated rTMS were available .


Twenty unipolar TRD patients , all at least stage III treatment resistant , were recruited in a randomized sham-controlled crossover high-frequency ( HF ) - rTMS treatment study .


Resting-state ( rs ) functional MRI scans were collected at baseline and at the end of treatment .


HF-rTMS responders showed significantly stronger resting-state functional connectivity ( rsFC ) anti-correlation between the sgACC and parts of the left superior medial prefrontal cortex .


After successful treatment an inverted relative strength of the anti-correlations was observed in the perigenual prefrontal cortex ( pgPFC ) .


No effects on sgACC rsFC were observed in non-responders .


Strong rsFC anti-correlation between the sgACC and parts of the left prefrontal cortex could be indicative of a beneficial outcome .


Accelerated HF-rTMS treatment designs have the potential to acutely adjust deregulated sgACC neuronal networks in TRD patients .


Screening Tool of Older Person 's Prescriptions ( STOPP ) and the Screening Tool to Alert doctors to Right Treatment ( START ) have been increasingly used to evaluate potentially inappropriate prescriptions ( PIPs ) and potentially prescription omissions ( PPOs ) .


The impact of hospitalization on PIPs/PPOs has not been investigated in depth .


To compare the prevalence of PIPs/PPOs in elderly patients on hospital admission and discharge and to identify associated risk factors .


An acute medical geriatric division of the Tel Aviv Medical Center ( Israel ) .


This retrospective cross-sectional study included patients admitted from 12/2011 to 12/2012 aged 65 years .


Data from patients ' records included demographic details , diagnoses and medications at admission and discharge .


STOPP/START criteria were applied to each patient 's record .


Prevalence of PIPs/PPOs on hospital admission and discharge .


Three hundred patients were included ( mean SD age 81.9 7.2 years ) .


Admission PIPs prevalence was 39.3 % ( 118 patients , 172 PIPs ) and it increased to 46.0 % ( 138 patients , 209 PIPs ) at discharge ( P = 0.009 ) .


Admission PPOs prevalence was 41.0 % ( 123 patients , 153 PPOs ) and it decreased to 28.3 % ( 85 patients , 99 PPOs ) at discharge ( P < 0.001 ) .


Having at least one PIP/PPO at discharge but not at admission was associated with length of hospital stay ( OR 1.02 , 95 % CI 1.001-1 .03 ) .


History of falls increased the risk of being a `` new PIP patient '' ( OR 2.25 , 95 % CI 1.03-4 .9 ) , whereas diabetes increased the risk of being a `` new PPO patient '' ( OR 3.86 , 95 % CI 1.2-12 .5 ) .


Hospitalization in a geriatric division resulted in an increase in PIPs and a decrease in PPOs .


Strategies to reduce PIPs need to be implemented , especially for patients with longer hospital stay and a history of falls .


Tadalafil is a potent and selective phosphodiesterase type 5 inhibitor that provides effective treatment for erectile dysfunction ( ED ) .


The purpose of this study was to explore the effect of a single on-demand dose of tadalafil compared to low-dose continuous administration on regional cerebral blood flow ( rCBF ) , in patients after stroke .


Thirty consecutive male patients ( mean age 58.3 7.9 years ) with ED and a history of stroke were included in the study .


The baseline single-photon emission computed tomography ( SPECT ) study was performed 15 min after iv injection of 740 MBq Tc-99m-HMPAO ( Ceretec ; GE Healthcare Ltd. .


Chalfont St. Giles , UK ) .


Fifteen randomized patients received a single dose of 20 mg tadalafil in the morning , and a second SPECT study was performed 6 h later .


Fifteen other patients received 5 mg of tadalafil each morning for seven consecutive days , and the second SPECT study was performed 6 h after the last dose .


The imaging data were evaluated using SPM software ( Wellcome Department of Cognitive Neurology , University College , London ) .


Associations between any of the risk factors/comorbidities and the perfusion changes were not detected .


All patients showed areas of reduced relative rCBF in the affected hemisphere after tadalafil administration compared to baseline ( P < 0.001 ) .


No significant difference was found between patients on 5 mg tadalafil and 20 mg dose .


Tadalafil administration after cerebral stroke may be associated with diminished blood flow to areas adjacent to the stroke .


The alterations in perfusion suggest a need for caution in prescribing tadalafil to patients with a history of stroke , especially with continuous administration that may impose constant stress on the cerebral circulation .


To investigate the short-term effect of a mixed Kinesio taping ( KT ) model on range of ankle motion ( ROAM ) , gait , pain , perimeter of lower limbs , and quality of life in postmenopausal women with chronic venous insufficiency ( CVI ) .


Double-blinded , randomized controlled trial .


Clinical setting .


Consecutive postmenopausal women ( N = 130 ; mean age SD , 65.4414.7 y ) with mild CVI .


No participant withdrew because of adverse effects .


Participants were randomly assigned to either ( 1 ) an experimental group to receive a mixed KT-compression treatment following KT recommendations for gastrocnemius muscle enhancement and functional correction of the ankle , and adding 2 tapes to simulate traditional compression bandages ( no KT guidelines ) ; or ( 2 ) a placebo control group for sham KT .


Both interventions were performed 3 times a week during a 4-week period .


ROAM , gait , pain , perimeter of right and left lower limb , and quality of life were assessed at baseline and 48 hours posttreatment .


Quality of life was better in the intervention group by a mean of 8.76 points ( 95 % confidence interval [ CI ] , 4.96-12 .55 ) .


The experimental group also showed significant pre - / posttreatment improvements in both lower limbs in gait dorsiflexion ROAM ( 95 % CI , 1.02-2 .49 ) , cadence ( 95 % CI , 3.45-1 .47 ) , stride length ( 95 % CI , 21.48-10 .83 ) , step length ( 95 % CI , 1.68-6 .61 ) , stance phase ( 95 % CI , 61-107 ) , and foot ( 95 % CI , .56 -.92 ) and malleolus ( 95 % CI , 1.15-1 .63 ) circumference .


None of these variables were significantly modified in the placebo group .


Both groups reported a significant reduction in pain .


Ankle dorsiflexion during gait , walking parameters , peripheral edema , venous pain , and quality of life remain improved in patients with CVI at 1 month after mixed KT-compression therapy .


KT may have a placebo effect on pain perception .


The authors compared psychoanalytic psychotherapy and cognitive-behavioral therapy ( CBT ) in the treatment of bulimia nervosa .


A randomized controlled trial was conducted in which 70 patients with bulimia nervosa received either 2 years of weekly psychoanalytic psychotherapy or 20 sessions of CBT over 5 months .


The main outcome measure was the Eating Disorder Examination interview , which was administered blind to treatment condition at baseline , after 5 months , and after 2 years .


The primary outcome analyses were conducted using logistic regression analysis .


Both treatments resulted in improvement , but a marked difference was observed between CBT and psychoanalytic psychotherapy .


After 5 months , 42 % of patients in CBT ( N = 36 ) and 6 % of patients in psychoanalytic psychotherapy ( N = 34 ) had stopped binge eating and purging ( odds ratio = 13.40 , 95 % confidence interval [ CI ] = 2.45-73 .42 ; p < 0.01 ) .


At 2 years , 44 % in the CBT group and 15 % in the psychoanalytic psychotherapy group had stopped binge eating and purging ( odds ratio = 4.34 , 95 % CI = 1.33-14 .21 ; p = 0.02 ) .


By the end of both treatments , substantial improvements in eating disorder features and general psychopathology were observed , but in general these changes took place more rapidly in CBT .


Despite the marked disparity in the number of treatment sessions and the duration of treatment , CBT was more effective in relieving binging and purging than psychoanalytic psychotherapy and was generally faster in alleviating eating disorder features and general psychopathology .


The findings indicate the need to develop and test a more structured and symptom-focused version of psychoanalytic psychotherapy for bulimia nervosa .


Tobacco smoking prevalence continues to be high , particularly among adolescents and young adults with lower educational levels , and is therefore a serious public health problem .


Tobacco smoking and problem drinking often co-occur and relapses after successful smoking cessation are often associated with alcohol use .


This study aims at testing the efficacy of an integrated smoking cessation and alcohol intervention by comparing it to a smoking cessation only intervention for young people , delivered via the Internet and mobile phone .


A two-arm cluster-randomised controlled trial with one follow-up assessment after 6months will be conducted .


Participants in the integrated intervention group will : ( 1 ) receive individually tailored web-based feedback on their drinking behaviour based on age and gender norms , ( 2 ) receive individually tailored mobile phone text messages to promote drinking within low-risk limits over a 3-month period , ( 3 ) receive individually tailored mobile phone text messages to support smoking cessation for 3months , and ( 4 ) be offered the option of registering for a more intensive program that provides strategies for smoking cessation centred around a self-defined quit date .


Participants in the smoking cessation only intervention group will only receive components ( 3 ) and ( 4 ) .


Study participants will be 1350 students who smoke tobacco daily/occasionally , from vocational schools in Switzerland .


Main outcome criteria are 7-day point prevalence smoking abstinence and cigarette consumption assessed at the 6-month follow up .


This is the first study testing a fully automated intervention for smoking cessation that simultaneously addresses alcohol use and interrelations between tobacco and alcohol use .


The integrated intervention can be easily implemented in various settings and could be used with large groups of young people in a cost-effective way .


Current Controlled Trials ISRCTN02427446 ( date of registration : 08th September , 2014 ) .


To investigate the effect of intranasal ketamine versus alfentanil in addition to oral midazolam for the prevention of emergence agitation in children .


Children undergoing urological surgery with sevoflurane anaesthesia received oral midazolam 40 min before induction and were then randomly assigned to receive 2 mg/kg ketamine , 10 g/kg alfentanil or 1 ml isotonic saline intranasally .


Parental separation status and mask acceptance were assessed preoperatively .


Emergence agitation was evaluated using a paediatric anaesthesia emergence delirium ( PAED ) score .


Data from 78 children were evaluated in the study .


There were no significant differences between the groups in demographic characteristics , recovery times or parental separation scores .


Mask acceptance was significantly better in the ketamine group than in the saline group .


The mean PAED score in the ketamine group was significantly better than in the other two groups , but was similar in the saline and alfentanil groups .


The incidence of emergence agitation was 3.8 % , 36.0 % and 40.7 % in the ketamine , alfentanil and saline groups , respectively .


The addition of intranasal ketamine to oral midazolam significantly improved the quality of induction and reduced sevoflurane-induced emergence agitation , in children undergoing urological surgery .


The aim of this study was to examine the effect of chitosan membrane on wound healing .


The effect of chitosan membranes was evaluated in an experimental rat model .


On day 0 , circular full-thickness skin sections were excised from the scalps of rats .


The wounds were then measured and the surrounding area tattooed .


Rats were sacrificed either immediately after excision , or randomised into control and chitosan groups and followed up on day 3 , 7 , 14 or 21 .


Control group wounds were covered with Aquacel ( wound dressing ) .


Chitosan group wounds were covered with chitosan membranes and the wound dressing .


Wounds and the distances between the tattooed marks were measured on follow-up , the wound sites were harvested and histologically examined , and serum interleukin ( IL-4 ) levels were analysed .


A total of 54 rats were examined and all time points included 6 control and 6 chitosan treated animals , except for day 0 which consisted of control animals only .


On day 3 , wounds in the chitosan group were significantly ( p < 0.05 ) smaller ( 606 % versus 7819 % of the original wound area ) than in the control group .


Chitosan membranes were found to degrade at the wound sites between days 7 and 14 .


Leukocyte counts were lower in the chitosan group than in the control group on day seven ( p < 0.05 ) .


IL-4 levels were significantly higher on day 7 ( p < 0.001 ) and 14 ( p < 0.001 ) in the chitosan group .


According to our results chitosan membrane may promote early wound healing , reduce inflammation and affect the IL-4 pathway , however , the membrane degrades at the wound site after day 7 .


The treatment of symptomatic congenital cytomegalovirus ( CMV ) disease with intravenous ganciclovir for 6 weeks has been shown to improve audiologic outcomes at 6 months , but the benefits wane over time .


We conducted a randomized , placebo-controlled trial of valganciclovir therapy in neonates with symptomatic congenital CMV disease , comparing 6 months of therapy with 6 weeks of therapy .


The primary end point was the change in hearing in the better ear ( `` best-ear '' hearing ) from baseline to 6 months .


Secondary end points included the change in hearing from baseline to follow-up at 12 and 24 months and neurodevelopmental outcomes , with each end point adjusted for central nervous system involvement at baseline .


A total of 96 neonates underwent randomization , of whom 86 had follow-up data at 6 months that could be evaluated .


Best-ear hearing at 6 months was similar in the 6-month group and the 6-week group ( 2 and 3 participants , respectively , had improvement ; 36 and 37 had no change ; and 5 and 3 had worsening ; P = 0.41 ) .


Total-ear hearing ( hearing in one or both ears that could be evaluated ) was more likely to be improved or to remain normal at 12 months in the 6-month group than in the 6-week group ( 73 % vs. 57 % , P = 0.01 ) .


The benefit in total-ear hearing was maintained at 24 months ( 77 % vs. 64 % , P = 0.04 ) .


At 24 months , the 6-month group , as compared with the 6-week group , had better neurodevelopmental scores on the Bayley Scales of Infant and Toddler Development , third edition , on the language-composite component ( P = 0.004 ) and on the receptive-communication scale ( P = 0.003 ) .


Grade 3 or 4 neutropenia occurred in 19 % of the participants during the first 6 weeks .


During the next 4.5 months of the study , grade 3 or 4 neutropenia occurred in 21 % of the participants in the 6-month group and in 27 % of those in the 6-week group ( P = 0.64 ) .


Treating symptomatic congenital CMV disease with valganciclovir for 6 months , as compared with 6 weeks , did not improve hearing in the short term but appeared to improve hearing and developmental outcomes modestly in the longer term .


( Funded by the National Institute of Allergy and Infectious Diseases ; ClinicalTrials.gov number , NCT00466817 . )


To compare the incidence and severity of emergence agitation , recovery profile , and adverse events between desflurane and sevoflurane anesthesia in unpremedicated pediatric ambulatory urologic surgery patients .


The study was conducted among 136 healthy children , aged six months to nine years , and randomized to two groups , sevoflurane and desflurane , during maintenance anesthesia with laryngeal mask airway .


Recovery profile and perioperative adverse events were recorded .


The emergence agitation ( EA ) was assessed using a 4-point scale by an anesthetist nurse in the recovery room who was blinded to the treatment .


The incidences of EA between sevoflurane/desflurane were not significantly different at 36.8 % / 41.2 % , p = 0.73 , and neither was the median ( IQR ) of severity ( 2 ( 1 , 3 ) / 2 ( 1 , 3 ) , p = 0.4 ) .


The awakening time in the desflurane group was 6.4 + / - 4.0 minutes , faster than in the sevoflurane group of 10.6 + / - 7.6 minutes ( p < 0.001 ) .


The number of children having intraoperative respiratory events was significantly higher in the desflurane group ( 17 ) , compared to the sevoflurane group ( 7 ) ( p = 0.043 ) .


The occurrence of EA and adverse events between sevoflurane and desflurane were not different , except that the overall of intraoperative respiratory events was higher in desflurane group .


Previous research suggests that African American smokers may have improved outcomes if interventions are culturally specific .


However , few interventions sufficiently address the unique needs of this population in a format with large reach potential .


The purpose of this study was to test the efficacy of a newly developed digital video disc ( DVD ) - based cessation intervention targeting African Americans .


In a 2-arm randomized trial , smokers ( N = 140 ) were randomly assigned to view either the new Pathways to Freedom ( PTF ) DVD or a standard control DVD .


Participants were assessed at baseline , immediately postviewing the DVD , and at a 1-month follow-up .


The primary outcomes were feasibility and process variables , including intervention evaluations , readiness to quit , and risk perceptions , and smoking-related behavior changes were examined as secondary outcomes .


Findings demonstrated the hypothesized positive effects of the PTF DVD compared with the control DVD on content evaluations , risk perceptions , and readiness to quit at follow-up .


We found initial evidence for the efficacy of the PTF DVD as a stand-alone intervention .


Future research will test the efficacy of the DVD for smoking cessation in a larger randomized trial .


The ultimate goal of this research is to validate a new intervention for an underserved community of smokers that can be used in multiple settings , such as community health clinics , primary care , quitlines , cessation clinics , and seminars/workshops .


The aim of this multicenter study was to determine the normal ranges and the clinical relevance of multidirectional systolic parameters to evaluate global left ventricular ( LV ) systolic function .


Three hundred twenty-three healthy adult subjects prospectively included at 10 centers and a cohort of 310 patients with hypertension were analyzed .


Multidirectional global LV systolic function was analyzed using two-dimensional speckle-tracking echocardiography by means of two indices : longitudinal-circumferential systolic index ( the average of longitudinal and circumferential global systolic strain ) and global systolic index ( the average of longitudinal , circumferential , and radial global systolic strain ) .


The ranges of values of the multidirectional systolic parameters in healthy subjects were -21.22 2.22 % for longitudinal-circumferential systolic index and 29.71 5.28 % for global systolic index .


In addition , the lowest expected values of these multidirectional indices were determined in this population ( calculated as -1.96 SDs from the mean ) : -16.86 % for longitudinal-circumferential systolic index and 19.36 % for global systolic index .


Concerning the clinical relevance of these measurements , these indices indicated the presence of subtle LV global systolic dysfunction in patients with hypertension , even though LV global longitudinal systolic strain and LV ejection fraction were normal .


Moreover , in these patients , functional class ( dyspnea [ New York Heart Association classification ] ) was inversely related to both the longitudinal-circumferential index and the global systolic index .