PG massage reduced the radioiodine uptake in the PG , and the effect of PG massage for 1 min was comparable with that of PG massage for 2 min .


PG massage can be applied to thyroid cancer patients who receive radioiodine therapy to reduce PG dysfunction .


Executive dysfunction after traumatic brain injury ( TBI ) in children is common and leads to significant short - and long-term problems in functioning across multiple settings .


We hypothesized that improvements in short-term executive function would be maintained to 24 months after injury and that improvements would increase over time in a counselor-assisted problem-solving ( CAPS ) intervention .


To evaluate the efficacy of a CAPS intervention administered within 7 months of complicated mild to severe TBI compared with an Internet resource condition in improving long-term executive dysfunction .


Multisite , assessor-blinded , randomized clinical trial at 3 tertiary pediatric hospitals and 2 tertiary general medical centers .


Participants included 132 adolescents aged 12 to 17 years who sustained a moderate to severe TBI 1 to 7 months before study enrollment .


Web-based CAPS intervention .


The primary outcome was the parent-reported Global Executive Composite ( GEC ) of the Behavior Rating Inventory of Executive Function .


Secondary outcomes included the Behavioral Regulation Index ( BRI ) and Metacognition Index ( MI ) of the GEC .


In older ( > 14 to 17 years ) adolescents , the CAPS intervention was associated with lower GEC ratings at 12 ( = -0.46 ; P = .03 ) and 18 ( = -0.52 ; P = .02 ) months after enrollment .


Trends were also observed for older adolescents toward lower GEC ratings at 6 months ( = -0.40 ; P = .05 ) , lower BRI ratings at 12 ( = -0.40 ; P = .06 ) and 18 ( = -0.47 ; P = .04 ) months , and lower MI ratings at 6 ( = -0.41 ; P = .05 ) , 12 ( = -0.46 ; P = .03 ) , and 18 ( = -0.50 ; P = .03 ) months .


In younger ( 12-14 years ) adolescents , no group differences were found on the GEC , BRI , or MI ratings .


Delivery of the CAPS intervention early after TBI in older adolescents improves long-term executive function .


This trial is , to our knowledge , one of the few large , randomized clinical treatment trials performed in pediatric TBI to demonstrate the efficacy of an intervention for management of executive dysfunction and long-term benefits of an intervention delivered soon after injury .


Use of the CAPS intervention clinically should be considered ; however , further research should explore ways to optimize delivery .


clinicaltrials.gov Identifier : NCT00409448 .


Pain control has been emphasized as a priority for both practitioners and inpatients with rib fractures , since analgesia could only offer limited relief from severe pain .


A prospective and randomized controlled trial was conducted to analyze the efficacy and efficiency of acupuncture in acute pain relief for inpatients with rib fractures .


A total of 58 inpatients were recruited and allocated to two groups , receiving identical doses of conventional oral analgesics as well as filiform needles as treatment and thumbtack intradermal ( TI ) needles placed upon the skin surface as a control , respectively , via novel acupuncture modality once daily for three consecutive days .


The effect of pain relief was evaluated during activities that induce pain , and sustained maximal inspiration ( SMI ) lung volumes and sleep quality were assessed .


The patients treated with filiform needles had more effective pain relief than those in the TI needle group during deep breathing , coughing , and turning over the body ( p < 0.05 ) , and the effect persisted for at least 6 h in most patients .


Sustained maximal inspiration lung volumes and sleep quality did not show improvement through every acupuncture intervention , and they could not respond accurately to pain relief via acupuncture .


The active evaluation could provide a more adaptive model for assessing pain intensity due to rib fractures .


This novel acupuncture modality in which the needle insertion sites are corresponding to the pain spots can be a safe and viable therapy for relieving pain in inpatients with rib fractures .


Impaired glucose tolerance ( IGT ) is a pre-diabetic state of hyperglycemia that is associated with insulin resistance , increased risk of type II diabetes , and cardiovascular pathology .


Recently , investigators hypothesized that decreased vagus nerve activity may be the underlying mechanism of metabolic syndrome including obesity , elevated glucose levels , and high blood pressure .


In this pilot randomized clinical trial , we compared the efficacy of transcutaneous auricular vagus nerve stimulation ( taVNS ) and sham taVNS on patients with IGT .


72 participants with IGT were single-blinded and were randomly allocated by computer-generated envelope to either taVNS or sham taVNS treatment groups .


In addition , 30 IGT adults were recruited as a control population and not assigned treatment so as to monitor the natural fluctuation of glucose tolerance in IGT patients .


All treatments were self-administered by the patients at home after training at the hospital .


Patients were instructed to fill in a patient diary booklet each day to describe any side effects after each treatment .


The treatment period was 12weeks in duration .


Baseline comparison between treatment and control group showed no difference in weight , BMI , or measures of systolic blood pressure , diastolic blood pressure , fasting plasma glucose ( FPG ) , 2-hour plasma glucose ( 2hPG ) , or glycosylated hemoglobin ( HbAlc ) .


100 participants completed the study and were included in data analysis .


Two female patients ( one in the taVNS group , one in the sham taVNS group ) dropped out of the study due to stimulation-evoked dizziness .


The symptoms were relieved after stopping treatment .


Compared with sham taVNS , taVNS significantly reduced the two-hour glucose tolerance ( F ( 2 ) = 5.79 , p = 0.004 ) .


In addition , we found that taVNS significantly decreased ( F ( 1 ) = 4.21 , p = 0.044 ) systolic blood pressure over time compared with sham taVNS .


Compared with the no-treatment control group , patients receiving taVNS significantly differed in measures of FPG ( F ( 2 ) = 10.62 , p < 0.001 ) , 2hPG F ( 2 ) = 25.18 , p < 0.001 ) and HbAlc ( F ( 1 ) = 12.79 , p = 0.001 ) over the course of the 12week treatment period .


Our study suggests that taVNS is a promising , simple , and cost-effective treatment for IGT / pre-diabetes with only slight risk of mild side-effects .


South Africa has 6.4 million adults over the age of 15 living with HIV .


Gender inequality issues continue to drive the HIV epidemic in South Africa , where Black African women bear the greatest HIV burden .


Limited access to services ; little capacity to negotiate sex and condom use ; and other legal , social , and economic inequities make women highly vulnerable to HIV infection .


Behavioral interventions have been shown to decrease risk behaviors , but they have been less successful in reducing HIV incidence .


Conversely , biomedical prevention strategies have proven to be successful in reducing HIV incidence , but require behavioral interventions to increase uptake and adherence .


Consequently , there is a need for integrated approaches that combine biomedical and behavioral interventions .


Effective combination prevention efforts should comprise biomedical , behavioral , and structural programming proven in randomized trials that focuses on the driving forces and key populations at higher risk of HIV infection and transmission .


This prospective , geographically clustered randomized field experiment is enrolling participants into two arms : a control arm that receives standard HIV testing and referral for treatment ; and an intervention arm that receives an evidence-based , woman-focused behavioral intervention that emphasizes risk reduction and retention , the Women 's Health CoOp .


We divided the city of Pretoria into 14 mutually exclusive geographic zones and randomized these zones into either the control arm or the intervention arm .


Outreach workers are recruiting drug-using women from each zone .


At baseline , eligible participants complete a questionnaire and biological testing for HIV , recent drug use , and pregnancy .


Follow-up interviews are completed at 6 and 12months .


The biobehavioral intervention in this study merges an efficacious behavioral HIV prevention intervention for women with biomedical prevention through HIV treatment as prevention using a Seek , Test , Treat and Retain strategy .


This combination biobehavioral intervention is designed to ( 1 ) improve the quality of life and reduce HIV infectiousness among women who are HIV positive , and ( 2 ) reduce HIV risk behaviors among women regardless of their HIV status .


If efficacious , this intervention could help control the HIV epidemic in South Africa .


Trial registration no : NCT01497405 .


Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes .


Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care .


The objective of the study was to determine whether e-learning can be an effective means of improving implementation of a quality improvement project in delirium care .


This project aims primarily at improving the early recognition of older patients who are at risk of delirium .


In a stepped wedge cluster randomised trial an e-learning course on delirium was introduced , aimed at nursing staff .


The trial was conducted on general medical and surgical wards from 18 Dutch hospitals .


The primary outcome measure was the delirium risk screening conducted by nursing staff , measured through monthly patient record reviews .


Patient records from patients aged 70 and over admitted onto wards participating in the study were used for data collection .


Data was also collected on the level of delirium knowledge of these wards ' nursing staff .


Records from 1,862 older patients were included during the control phase and from 1,411 patients during the intervention phase .


The e-learning course on delirium had a significant positive effect on the risk screening of older patients by nursing staff ( OR 1.8 , p-value < 0.01 ) , as well as on other aspects of delirium care .


The number of patients diagnosed with delirium was reduced from 11.2 % in the control phase to 8.7 % in the intervention phase ( p = 0.04 ) .


The e-learning course also showed a significant positive effect on nurses ' knowledge of delirium .


Nurses who undertook a delirium e-learning course showed a greater adherence to the quality improvement project in delirium care .


This improved the recognition of patients at risk and demonstrated that e-learning can be a valuable instrument for hospitals when implementing improvements in delirium care .


The Netherlands National Trial Register ( NTR ) .


NTR2885 .


Smoking now represents one of the biggest modifiable risk factors for disease and mortality in people living with HIV ( PLHIV ) .


To produce significant changes in smoking rates among this population , treatments will need to be both acceptable to the larger segment of PLHIV smokers and feasible to implement in busy HIV clinics .


The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic .


PLHIV smokers ( N = 100 ) were proactively identified through their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual .


Participants were tracked in-person for 12 weeks .


Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session .


The findings revealed that many smokers reported using prescribed medications when provided with a supply of cessation medication as determined by an algorithm .


Compared with smokers receiving treatment as usual , PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking .


Proxy measures of cessation readiness ( eg , motivation , self-efficacy ) also favored participants receiving algorithm treatment .


This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation .


Given these promising findings coupled with the brief nature of this treatment , the overall pattern of results suggests strong potential for dissemination into clinical settings and significant promise for further advancing clinical health outcomes in this population .


To assess efficacy and safety of post-operative intra-peritoneal wash with lactated Ringer 's for 48h after myomectomy in reduction of adhesions compared to routine intra-operative irrigation .


Study design A prospective , randomized trial that included 52 eligible participants who had undergone abdominal myomectomy .


Participants were randomly allocated to a treatment group ( n = 26 ) which was subjected to continuous peritoneal wash for 48h via two intraperitoneal drains , and a control group ( n = 26 ) .


The incidence of de novo adhesions and their severity and extent were scored at a second-look laparoscopy 8-10 weeks postoperatively .


Adhesions were graded using the local adhesion barrier scoring system score .


Adverse effects were also assessed and reported .


There was no statistically significant difference in duration of hospital stay or in the incidence of adverse events .


A significantly higher proportion of adhesion-free patients was found in the treatment group [ 11/23 , 47.8 % ] compared to the control group [ 4/21 , 19 % ] ( P < 0.01 ) .


The mean number of pelvic sites covered by adhesions was significantly lower in the treatment group than in the control group ( 2.20.3 versus 4.60.8 , P < 0.05 ) .


The total adhesion score was significantly lower in the treatment group than in the control group ( 2.10.5 versus 4.81.4 , P < 0.05 ) and the adhesion score was significantly lower at most of the individual anatomical sites .


Application of postoperative intraperitoneal wash with lactated Ringer 's solution for 48h may have reasonable safety and efficacy in minimizing postoperative pelvic de novo adhesions following abdominal myomectomy .


In the AXIS trial , axitinib prolonged progression-free survival ( PFS ) vs sorafenib in patients with advanced renal cell carcinoma ( RCC ) previously treated with sunitinib or cytokines .


In post hoc analyses , patients were grouped by objective response to prior therapy ( yes vs no ) , prior therapy duration ( < vs median ) , and tumour burden ( baseline sum of the longest diameter < vs median ) .


PFS and overall survival ( OS ) , and safety by type and duration of prior therapy were evaluated .


Response to prior therapy did not influence outcome with second-line axitinib or sorafenib .


PFS was significantly longer in axitinib-treated patients who received longer prior cytokine treatment and sorafenib-treated patients with smaller tumour burden following sunitinib .


Overall survival with the second-line therapy was longer in patients who received longer duration of prior therapy , although not significant in the sunitinib-to-axitinib sequence subgroup ; OS was also longer in patients with smaller tumour burden , but not significant in the cytokine-to-axitinib sequence subgroup .


Safety profiles differed modestly by type and duration of prior therapy .


AXIS data suggest that longer duration of the first-line therapy generally yields better outcome with the second-line therapy and that lack of response to first-line therapy does not preclude positive clinical outcomes with a second-line vascular endothelial growth factor-targeted agent in patients with advanced RCC .


To examine baseline predictors of moderate-to-vigorous intensity physical activity ( MVPA ) at the 12-week follow-up in a sample of adults with arthritis participating in a self-directed , multicomponent exercise program .


Pretest-posttest .


Analyses were limited to those randomized to the exercise intervention .


Participants ( n = 152 ) completed a survey assessing demographic , health-related , and arthritis-related factors , and completed anthropometric and functional measurements at baseline .


Self-reported MVPA was assessed at baseline and 12 weeks .


Participants were classified as engaging in 2.5 or < 2.5 h/week of MVPA at the 12-week follow-up .


Baseline demographic , health-related , arthritis-related , and functional factors were examined as predictors of engaging in 2.5 h of MVPA .


At the 12-week follow-up , 66.5 % ( n = 101 ) of participants engaged in 2.5 h/week of MVPA .


Those with a higher body mass index , more days with poor physical health , a greater number of health conditions , self-reported hypertension , self-reported high cholesterol , and greater pain and stiffness were less likely to engage in 2.5 h of MVPA at the 12-week follow-up ; those with greater arthritis self-efficacy and better performance on the 6 minute walk test were more likely .


None of the other factors examined were associated with MVPA .


This study uncovered health-related , arthritis-related , and functional factors associated with MVPA that may help guide intervention strategies .


Participants with less severe symptoms , better functional performance and fewer comorbidities at baseline were more likely to achieve the recommended MVPA level at 12 weeks ; therefore self-directed PA interventions may be best suited for those with relatively good health status despite arthritis , while those with worse symptoms and health status may benefit more from other intervention delivery modalities such as structured , individualized programs where additional support for managing arthritis symptoms and comorbidity can be addressed .


The relative effects of radiation dose escalation ( RDE ) and androgen suppression ( AS ) duration on local prostatic progression ( LP ) remain unclear .


We addressed this in the TROG 03.04 RADAR trial by incorporating a RDE programme by stratification at randomisation .


Men were allocated 6 or 18 months AS18 months zoledronate ( Z ) .


The main endpoint was a composite of clinically diagnosed LP or PSA progression with a PSA doubling time 6 months .


Fine and Gray competing risk modelling with adjustment for site clustering produced cumulative incidence estimates at 6.5 years for each RDE group .


Composite LP declined coherently in the 66 , 70 and 74 Gy external beam dosing groups and was lowest in the high dose rate brachytherapy boost ( HDRB ) group .


At 6.5 years , adjusted cumulative incidences were 22 % , 15 % , 13 % and 7 % respectively .


Compared to 6 months AS , 18 months AS also significantly reduced LP ( p < 0.001 ) .


Post-radiation urethral strictures were documented in 45 subjects and increased incrementally in the dosing groups .


Crude incidences were 0.8 % , 0.9 % , 3.8 % and 12.7 % respectively .


RDE and increasing AS independently reduce LP and increase urethral strictures .


The risks and benefits to the individual must be balanced when selecting radiation dose and AS duration .


A randomised , parallel group , pragmatic trial .


A large UK maternity hospital .


Term infants < 2 weeks old with a mild or moderate degree of tongue-tie , and their mothers who were having difficulties breastfeeding .


To determine if immediate frenotomy was better than standard breastfeeding support .


Participants were randomised to an early frenotomy intervention group or a ` standard care ' comparison group .


Primary outcome was breastfeeding at 5 days , with secondary outcomes of breastfeeding self-efficacy and pain on feeding .


Final assessment was at 8 weeks ; 20 also had qualitative interviews .


Researchers assessing outcomes , but not participants , were blinded to group assignment .


107 infants were randomised , 55 to the intervention group and 52 to the comparison group .


Five-day outcome measures were available for 53 ( 96 % ) of the intervention group and 52 ( 100 % ) of the comparison group , and intention-to-treat analysis showed no difference in the primary outcome-Latch , Audible swallowing , nipple Type , Comfort , Hold score .


Frenotomy did improve the tongue-tie and increased maternal breastfeeding self-efficacy .


At 5 days , there was a 15.5 % increase in bottle feeding in the comparison group compared with a 7.5 % increase in the intervention group .


After the 5-day clinic , 44 of the comparison group had requested a frenotomy ; by 8 weeks only 6 ( 12 % ) were breastfeeding without a frenotomy .


At 8 weeks , there were no differences between groups in the breastfeeding measures or in the infant weight .


No adverse events were observed .


Early frenotomy did not result in an objective improvement in breastfeeding but was associated with improved self-efficacy .


The majority in the comparison arm opted for the intervention after 5 days .


To investigate the effect of anti-inflammatory therapy on selective laser trabeculoplasty ( SLT ) outcomes .


Randomized , double-masked , placebo-controlled trial .


Patients with primary open-angle or pseudo-exfoliation glaucoma .


Patients undergoing SLT were randomized to receive placebo ( artificial tears ) , prednisolone acetate 1 % , or ketorolac tromethamine 0.5 % eye drops 4 times per day for 5 days commencing immediately after SLT .


Change in intraocular pressure ( IOP ) from baseline to the 1-month post-SLT visit .


Mean change in IOP at the 1-month primary outcome time point , as well as all other time points , was not significantly different among groups ( P = 0.99 ) .


Likewise , a repeated-measures , mixed-effects model did not find significant differences in IOP outcome at the 1-month time point ( P = 0.95 ) .


The IOP was reduced in all groups at the 1-month post-SLT time point and all other time points , and no significant differences were found between groups using separate unadjusted cross-sectional analyses of variance ( P > 0.15 for analyses at all time points ) .


Treatment failure rates were not different among groups ( P = 0.75 ) , and at 1 year after SLT , the percentage of patients maintaining a 20 % IOP reduction ranged from 18 % to 22 % in the 3 study groups .


Anti-inflammatory therapy after SLT does not seem to substantially influence the IOP-lowering effect of SLT .


In this study of patients with low baseline IOP , SLT showed limited efficacy in achieving a sustained reduction in IOP .


The aim of the present randomized study was to evaluate the efficacy of intermaxillary fixation screw ( IMFS ) versus eyelet interdental wiring for intermaxillary fixation ( IMF ) in minimally displaced mandibular fractures .


A total of 50 patients with a minimally displaced mandibular fracture were enrolled , with 25 patients randomly selected for each group .


In group I ( study group , n = 25 ) , the patients were treated using IMFS , and in group II ( control group , n = 25 ) , they received eyelet interdental wiring .


Both techniques were assessed for the following parameters : time required for placement and removal of each type of IMF technique , time required for placement of IMF wires , postoperative occlusion , stability of the IMF wire , local anesthesia requirement during removal of each fixation type , oral hygiene status , glove perforation rate , and complications associated with both techniques .


The collected data were analyzed using Student 's unpaired t test or 2 test .


P < .05 was considered significant and the Statistical Package for Social Sciences software , version 10 , was used for analysis .


The average time required for placement in groups I and II was 17.56 and 35.08 minutes , respectively ( P = .000 ) .


The time required for placement of the IMF wire in group I was 2.1 minutes and in group II was 6 minutes .


The oral hygiene status was assessed , and the mean plaque index score for groups I and II was 1.44 and 2.12 , respectively ( P = .00 ) .


The glove perforation rate was much less in group I than in group II .


Finally , the most common complication in both groups was mucosal growth .


The results established the supremacy of IMFS compared with eyelet interdental wiring .


Thus , we have concluded that IMFS , in the present scenario , is a safe and time-saving technique .


IMFS is a cost-effective , straightforward , and viable alternative to cumbersome eyelet interdental and other wiring techniques for providing IMF , with satisfactory occlusion during closed reduction or intraoperative open reduction internal fixation of fractures .


In addition , oral hygiene can be maintained , and the glove perforation rate was very low using IMFS .


The relatively small sample size and limited follow-up period were the study limitations .


This study compares the effects of neutral temperature , cold and ice-slush beverages , with and without 0.5 % menthol on cycling performance , core temperature ( Tco ) and stress responses in a tropical climate ( hot and humid conditions ) .


Twelve trained male cyclists/triathletes completed six 20-km exercise trials against the clock in 30.7 C0 .8 C and 78 % 0.03 % relative humidity .


Before and after warm-up , and before exercise and every 5 km during exercise , athletes drank 190 mL of either aromatized ( i.e. , with 0.5 mL of menthol ( 5 gr/L ) ) or a non-aromatized beverage ( neutral temperature : 23C0 .1 C , cold : 3C0 .1 C , or ice-slush : -1 C0 .7 C ) .


During the trials , heart rate ( HR ) was continuously monitored , whereas core temperature ( Tco ) , thermal comfort ( TC ) , thermal sensation ( TS ) and rate of perceived exertion ( RPE ) were measured before and after warm-up , every 5 km of exercise , and at the end of exercise and after recovery .


Both the beverage aroma ( P < 0.02 ) and beverage temperature ( P < 0.02 ) had significant and positive effects on performance , which was considerably better with ice-slush than with a neutral temperature beverage , whatever the aroma ( P < 0.002 ) , and with menthol vs non-menthol ( P < 0.02 ) .


The best performances were obtained with ice-slush/menthol and cold/menthol , as opposed to neutral/menthol .


No differences were noted in HR and Tco between trials .


Cold water or ice-slush with menthol aroma seems to be the most effective beverage for endurance exercise in a tropical climate .


Further studies are needed to explore its effects in field competition .


Artemisinin resistance in Plasmodium falciparum has emerged in Southeast Asia and now poses a threat to the control and elimination of malaria .


Mapping the geographic extent of resistance is essential for planning containment and elimination strategies .


Between May 2011 and April 2013 , we enrolled 1241 adults and children with acute , uncomplicated falciparum malaria in an open-label trial at 15 sites in 10 countries ( 7 in Asia and 3 in Africa ) .


Patients received artesunate , administered orally at a daily dose of either 2 mg per kilogram of body weight per day or 4 mg per kilogram , for 3 days , followed by a standard 3-day course of artemisinin-based combination therapy .


Parasite counts in peripheral-blood samples were measured every 6 hours , and the parasite clearance half-lives were determined .


The median parasite clearance half-lives ranged from 1.9 hours in the Democratic Republic of Congo to 7.0 hours at the Thailand-Cambodia border .


Slowly clearing infections ( parasite clearance half-life > 5 hours ) , strongly associated with single point mutations in the `` propeller '' region of the P. falciparum kelch protein gene on chromosome 13 ( kelch13 ) , were detected throughout mainland Southeast Asia from southern Vietnam to central Myanmar .


The incidence of pretreatment and post-treatment gametocytemia was higher among patients with slow parasite clearance , suggesting greater potential for transmission .


In western Cambodia , where artemisinin-based combination therapies are failing , the 6-day course of antimalarial therapy was associated with a cure rate of 97.7 % ( 95 % confidence interval , 90.9 to 99.4 ) at 42 days .


Artemisinin resistance to P. falciparum , which is now prevalent across mainland Southeast Asia , is associated with mutations in kelch13 .


Prolonged courses of artemisinin-based combination therapies are currently efficacious in areas where standard 3-day treatments are failing .


( Funded by the U.K. Department of International Development and others ; ClinicalTrials.gov number , NCT01350856 . )


Benzodiazepines ( BDZs ) are the gold standard in the treatment of alcohol withdrawal syndrome ( AWS ) .


Sodium oxybate ( SMO ) has been tested as a treatment for AWS with encouraging results .


The aim of this phase IV , multicenter , randomized , double-blind , double-dummy study was to evaluate the efficacy of SMO in comparison with oxazepam in the treatment of uncomplicated AWS .


Alcohol-dependent outpatients ( n = 126 ) affected by uncomplicated AWS according to the Clinical Institute Withdrawal Assessment for Alcohol-revised ( CIWA-Ar ) scale were enrolled in the study and randomized in two groups : 61 patients received SMO and 65 patients received oxazepam for 10 days .


The primary endpoint was the reduction of symptoms of AWS measured by the change in the total CIWA-Ar score from baseline ( day 1 ) to the end of the study ( day 10 ) .


This study is registered with ClinicalTrials.gov , number : NCT02090504 RESULTS : A significant decrease of the mean total CIWA-Ar score from baseline to the end of the study was found in both the SMO ( p < 0.0001 ) and the oxazepam group ( p < 0.0001 ) , with no significant differences between the two treatments ( p = 0.21 ) .


Treatment with SMO and oxazepam resulted in a marked decrease in the severity of the mean CIWA subscales , i.e. sweating , tremor , and anxiety , with no significant differences between the two treatments .


Both drugs were well tolerated and no severe side effects were reported .


SMO is as effective as oxazepam , one of the gold standard BDZs , in the treatment of uncomplicated AWS .


Due to its tolerability and absence of significant side effects , SMO may be considered a valid alternative choice in the treatment of AWS .


Cervical cancer is the second most common cancer among Malaysian women with an ASR of 17.9 and a mortality rate of 5.6 per 100,000 population in 2008 ( GLOBOCAN , 2008 ) .


The 5 year prevalence was estimated to be 14.5 per 100,000 population .


As the second most common cancer affecting productive females , cervical cancer imposes an impact to the socioeconomic aspect of the country .


However , the poor uptake of cervical cancer screening is a major problem in detecting early pre-cancerous lesions and thus , delay in initiating treatment for cervical cancer .


Realizing the urgency to increase the uptake of PAP smear , besides enhancing the promotion of PAP smear screening for women above 35 years old , the call-recall system for pap smear screening had been piloted in one of the suburban districts which aimed to improve regular participation of women for cervical and breast cancer screening .


This is of public health importance as identifying the best feasible option to increase patient 's respond to participate in the screening program effectively in our setting will be helpful in implementing an organized regular population based screening program tailored to our setting .


The pilot program of cervical cancer screening in Klang was an opportunity to assess different options in recalling patients for a repeat pap smear to increase their participation and adherence to the program .


This was a population based randomized control trial .


Women aged 20-65 years in the population that matched the inclusion and exclusion criteria were re-called for a repeat smear .


There are four different intervention groups ; letter , registered letters , short messages services ( SMS ) and phone calls where 250 subjects were recruited into each group .


Samples were generated randomly from the same population in Klang into four different groups .


The first group received a recall letter for a repeat smear similar to the one that has been given during the first invitation .


The intervention groups were either be given a registered letter , an SMS or a phone call to re-call them .


The socio-demographic data of the patients who came for uptake were collected for further analysis .


All the groups were followed up after 8 weeks to assess their compliance to the recall .


The study will provide recommendations about the most effective methods for recall in a population based pap smear screening program on two outcomes : i ) patients response ; ii ) uptake for repeat pap smear .


To determine the pharmacokinetics ( PK ) and placental transfer of intravenous ( i.v. ) N-acetylcysteine ( NAC ) in mothers with a clinical diagnosis of chorioamnionitis ( CA ) and determine the PK of i.v. NAC in their infants .


In this prospective , double-blind study i.v. NAC 100 mg/kg/dose or saline was administered within 4 hours of CA diagnosis to pregnant women 24 weeks ' gestation and then every 6 hours until delivery .


Maternal PK and placental transfer were determined with maternal blood and matched maternal and cord venous blood .


Neonatal PK estimates were determined from i.v. NAC ( 12.5-25 mg/kg/dose ) administered every 12 hours for 5 doses .


Noncompartmental analyses were performed for maternal and neonatal PK estimates .


Eleven mothers ( 5 preterm , 6 near-term ) and 12 infants ( 1 set of twins ) received NAC .


Maternal clearance ( CL ) of NAC was faster than in nonpregnant adults , with a terminal elimination half-life of 1.2 0.2 hours .


The NAC cord to maternal ratio was 1.4 0.8 , suggesting rapid placental transfer and slower rate of fetal CL .


Neonatal PK estimates for near-term compared with preterm infants showed a significantly shorter terminal elimination half-life ( 5.1 vs 7.5 hours , respectively ) and greater CL ( 53.7 vs 45.0 mL/h/kg , respectively ) .


Maternal CL and placental transfer of NAC was rapid , with umbilical cord concentrations frequently exceeding maternal concentrations .


The administration of NAC to mothers with CA achieves predictable NAC plasma concentrations in the fetus , indicating that antenatal neuroprotection may be possible for these newborns at high risk for neuroinflammation .


The primary study hypothesis was that ranibizumab 0.5 mg monotherapy or combined with laser is superior to laser monotherapy based on mean average change in best-corrected visual acuity ( BCVA ) over 12 months in Asian patients with visual impairment resulting from diabetic macular edema ( DME ) .


A 12-month , randomized , double-masked , multicenter , laser-controlled , phase III study .


Three hundred ninety-six patients aged 18 years , with type 1 or 2 diabetes mellitus , BCVA of 78-39 Early Treatment Diabetic Retinopathy Study ( ETDRS ) letters , and visual impairment resulting from DME .


Patients were randomized to ranibizumab + sham laser ( n = 133 ) , ranibizumab + active laser ( n = 132 ) , or sham injection + active laser ( n = 131 ) .


Ranibizumab/sham injections were administered on day 1 and continued monthly .


As of month 3 , monthly injections were continued if stable vision was not reached .


Treatment was reinitiated if BCVA decreased because of DME progression .


Active/sham laser was administered on day 1 and thereafter according to ETDRS guidelines .


Average change in BCVA from baseline to months 1 through 12 , central retinal subfield thickness ( CRST ) , and safety over 12 months .


Ranibizumab monotherapy or combined with laser was superior to laser in improving mean average change in BCVA from baseline to months 1 through 12 ( +5.9 and +5.7 vs +1.4 letters ) .


At month 12 , greater proportion of patients gained 15 letters with ranibizumab and ranibizumab + laser compared with laser ( 18.8 % and 17.8 % vs 7.8 % ) .


Mean CRST reduced significantly from baseline to month 12 with ranibizumab ( -134.6 m ) and ranibizumab + laser ( -171.8 m ) versus laser ( -57.2 m ) .


Patients received a mean of 7.8 and 7.0 ranibizumab injections in the ranibizumab and ranibizumab + laser arms , respectively , and 1.5-1 .9 active laser across treatment arms over 12 months .


Conjunctival hemorrhage was the most common ocular , whereas nasopharyngitis and hypertension were the most common nonocular adverse events .


Ranibizumab was not associated with any cases of cerebrovascular hemorrhage and cerebrovascular ischemia .


No death related to study treatment was reported .


Ranibizumab monotherapy or combined with laser showed superior BCVA improvements over laser treatment alone in Asian patients with visual impairment resulting from DME .


No new ocular or nonocular safety findings were observed and treatment was well tolerated over 12 months .


Despite promising results of Er : YAG laser in periodontal debridement , to date there is no consensus about the ideal settings for clinical use .


This experimental clinical trial aimed to determine the effects of debridement using Er : YAG laser and to compare with ultrasonic treatment .


Sixty-four teeth were divided into two in vivo and in vitro subgroups .


Each tooth received ultrasonic treatment on one side and Er : YAG laser debridement at either 60 , 100 , 160 or 250 mJ pulse ( -1 ) and at 10 Hz on the other side on a random basis .


All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure .


Treatment duration ( d ) was also recorded .


Laser debridement produced an irregular , rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface .


The number of exposed dentinal tubules ( n ) followed an energy-dependent trend .


The number of exposed tubules among the in vivo laser groups was n 60 mJ = n 100 mJ < n 160 mJ < n 250 mJ ( P < 0.001 ) .


Also 160 and 250 mJ lasers led to significantly more dentinal exposure than ultrasound under in vivo condition .


Within the in vitro laser groups , dentinal tubules exposure was n 60 mJ < n 100 mJ < n 160 mJ < n 250 mJ ( P 0.0015 ) .


Furthermore , in vitro laser treatments at 100 , 160 and 250 mJ led to significantly more dentinal denudation than ultrasound .


Treatment duration ( d ) for the in vivo groups was d 60 mJ > d 100 mJ > d Ultrasound = d 160 mJ > d 250 mJ ( P 0.046 ) , while for the in vitro groups it was d 60 mJ > d 100 mJ = d Ultrasound = d 160 mJ > d 250 mJ ( P 0.046 ) .


Due to excessive treatment duration and surface damage , Er : YAG laser debridement at 60 and 250 mJ pulse ( -1 ) , respectively , is not appropriate for clinical use .


Although laser debridement at 100 and 160 mJ pulse ( -1 ) seems more suitable for clinical application , compared to ultrasound the former is more time-consuming and the latter is more aggressive .


Using a feedback device or lower pulse energies are recommended when using laser in closed field .


To determine whether dexmedetomidine sedation in the postanesthesia care unit ( PACU ) could decrease agitation and delirium after free flap surgery .


Eighty patients were randomly divided into 2 groups .


In the experimental group , dexmedetomidine was given at an hourly infusion rate of 0.5 g/kg for 1hour before the operation was completed and continued in the PACU at 0.2 to 0.7 g/kg continuously until the next morning .


In the control group , normal saline was given during the same periods .


Patients in the 2 groups received sufentanil and midazolam for sedation and pain relief when necessary .


Agitation was monitored with the Riker Sedation-Agitation Scale in the PACU and delirium was monitored with the Confusion Assessment Method for the Intensive Care Unit for 5days postoperatively .


The overall incidence of agitation was similar between the 2 groups .


However , when the influence of patient shifting was excluded , the incidence of agitation in the dexmedetomidine group was apparently lower than that in the control group ( 10.3 vs 30 % ; P = .029 ) .


No difference was found in the occurrence of delirium between the experimental and control groups ( 5.1 vs 12.5 % ; P = .432 ) .


Dexmedetomidine does not change the overall incidence of agitation after free flap surgery ; however , it does decrease agitation after PACU admission .


It does not prevent delirium within 5days postoperatively .


Through many years , the standard care has been to use continuous sedation of critically ill patients during mechanical ventilation .


However , preliminary randomised clinical trials indicate that it is beneficial to reduce the sedation level .


No randomised trial has been conducted comparing sedation with no sedation , a priori powered to have all-cause mortality as primary outcome.The objective is to assess the benefits and harms of non-sedation versus sedation with a daily wake-up trial in critically ill patients .


The non-sedation ( NONSEDA ) trial is an investigator-initiated , randomised , clinical , parallel-group , multinational trial designed to include 700 patients from at least six ICUs in Denmark , Norway and Sweden.Inclusion criteria are mechanically ventilated patients with expected duration of mechanical ventilation > 24 hours.Exclusion criteria are non-intubated patients , patients with severe head trauma , coma at admission or status epilepticus , patients treated with therapeutic hypothermia , patients with PaO2/FiO2 < 9 where sedation might be necessary to ensure sufficient oxygenation or place the patient in prone position.Experimental intervention is non-sedation supplemented with pain management during mechanical ventilation.Control intervention is sedation with a daily wake-up trial.The primary outcome will be all cause mortality at 90 days after randomization .


Secondary outcomes will be : days until death throughout the total observation period ; coma - and delirium-free days ; highest RIFLE score ; days until discharge from the intensive care unit ( within 28 days ) ; days until the participant is without mechanical ventilation ( within 28 days ) ; and proportion of patients with a major cardiovascular outcome .


Explorative outcomes will be : all cause mortality at 28 days after randomisation ; days until discharge from the intensive care unit ; days until the participant is without mechanical ventilation ; days until discharge from the hospital ; organ failure.Trial size : we will include 700 participants ( 2350 ) in order to detect or reject 25 % relative risk reduction in mortality with a type I error risk of 5 % and a type II error risk of 20 % ( power at 80 % ) .


The trial investigates potential benefits of non-sedation .


This might have large impact on the future treatment of mechanically ventilated critically ill patients .


ClinicalTrials.gov NCT0196768 , 09.01.2014 .


Few school programs are effective in preventing adolescents ' tobacco smoking initiation .


The `` Lega contro i Tumori - Luoghi di Prevenzione '' is a cluster randomized controlled trial designed to evaluate a school-based peer-led smoking prevention intervention with extracurricular activities for students aged 14-15 years .


This paper presents the study design and the baseline characteristics of the study population .


Twenty secondary schools located in the Reggio Emilia province took part in the study .


Five schools were excluded because they already participated in smoking prevention interventions .


The schools were randomized to control or intervention arms .


The study population consisted of students attending the first grade .


Components of the intervention included 1 ) the out-of-school `` Smoking Prevention Tour '' ( SPT ) at the `` Luoghi di Prevenzione '' Center , a 4-hour ( 4 sessions ) extracurricular activity ; 2 ) the `` Smoke-free Schools '' intervention , combining a life-skills-based peer-led intervention at school , an in-depth lesson on one of the SPT sessions , and enforcement surveillance of the school antismoking policy .


Tobacco use was studied through a questionnaire administered before and 6 months after the intervention .


Eleven high schools and 9 vocational secondary schools took part in the study for a total of 2,476 out of 3,050 eligible students ( 81.2 % ) .


The proportions of respondents in high schools and vocational secondary schools were 90.9 % and 64.5 % , respectively ( P < 0.001 ) .


Intervention and control arms showed a different distribution of gender and school type , whereas no difference was observed in any tobacco-use characteristic .


This study is one of the few Italian trials to evaluate the effectiveness of a school-based program for preventing smoking initiation .


To study the change in spherical equivalent and other ocular parameters 1 year after stopping the administration of atropine .


Prospective randomized double-masked clinical trial .


We assigned 400 myopic children , 6 to 12 years of age , to receive atropine 0.5 % , 0.1 % or 0.01 % for 24 months , after which medication was stopped .


Parents and children gave informed consent to participate in the research .


Children were reviewed at 26 , 32 and 36 months , and changes in cycloplegic spherical equivalent ( SE ) , axial length ( AL ) , visual acuity , pupil size , and accommodation were assessed .


Of the children , 356 ( 89 % ) entered into the washout phase .


At entry , there was no significant difference in age , gender , SE , or AL among the children in the various atropine groups .


Over the following 12 months , myopic progression was greater in the 0.5 % eyes ( -0.87 0.52 D ) , compared to the 0.1 % ( -0.68 0.45 D ) and 0.01 % eyes ( -0.28 0.33 D , P < 0.001 ) .


AL growth was also greater in the 0.5 % ( 0.35 0.20 mm ) and 0.1 % ( 0.33 0.18 mm ) eyes , compared to the 0.01 % eyes ( 0.19 0.13 mm , P < 0.001 ) .


Pupil size and near visual acuity returned to pre-atropine levels in all groups , but accommodation at 36 months was less in the 0.5 % eyes ( 13.24 2.72 D ) compared to the 0.1 % ( 14.45 2.61 D ) and 0.01 % eyes ( 14.04 2.90 D , P < 0.001 ) .


The overall increase in SE over the entire 36 months in the 0.5 % , 0.1 % and 0.01 % groups was -1.15 0.81 D , -1.04 0.83 D and -0.72 0.72 D , respectively ( P < 0.001 ) .


There was a myopic rebound after atropine was stopped , and it was greater in eyes that had received 0.5 % and 0.1 % atropine .


The 0.01 % atropine effect , however , was more modulated and sustained .


The purpose of this prospective , randomized , double-blind , placebo-controlled study was to determine the effect of the administration of the combination acetaminophen/hydrocodone on the anesthetic success of mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis .


One hundred emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received , in a double-blind manner , identical capsules of either a combination dose of 1000 mg acetaminophen/10 mg hydrocodone or placebo 60 minutes before the administration of a conventional inferior alveolar nerve ( IAN ) block .


Endodontic access was begun 15 minutes after completion of the block , and all patients used for data analysis had profound lip numbness .


Success was defined as no or mild pain ( visual analog scale recordings ) on pulpal access or instrumentation .


The success rate for the IAN block was 32 % for the combination dose of 1000 mg acetaminophen/10 hydrocodone and 28 % for the placebo dose , with no statistically significant difference between the 2 groups ( P = .662 ) .


A combination dose of 1000 mg acetaminophen/10 mg hydrocodone given 60 minutes before the administration of the IAN block did not result in a statistically significant increase in anesthetic success for mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis .


The aim of this study is to evaluate the benefits and disadvantages of closing the mesenteric defects during gastric bypass to avoid internal herniation ( IH ) .


The study is performed as a single-centre , randomised , controlled , blinded trial .


Patients are randomly assigned to either conventional laparoscopic Roux-en-Y gastric bypass ( LRYGB ) without closing the mesenteric defects ( n = 250 ) or RYGB with closing of the defects with hernia clips ( n = 250 ) .


Follow-up is conducted at six months , one year , two years and five years after RYGB .


The primary endpoint is the incidence of IH .


This study will be the first Danish , randomised , controlled study comparing conventional LRYGB with and without closure of the mesenteric defects .


The results will contribute to evidence-based recommendations for the prevention of IH .


not relevant .


The study was registered with the Danish Data Protection Agency ( SN-10-2012 ) and The Central Denmark Regional Committees on Biomedical Research Ethics ( 1-01-83-0209-12 , SJ-284 ) .


The study is registered with clinicaltrials.gov : NCT01595230 .


We performed a multicenter , randomized , double-blind trial to assess the efficacy and safety of a single , fixed , intravenous dose of palonosetron ( 0.075 mg ) in the treatment of established postoperative nausea and vomiting ( PONV ) .


Three hundred and eighty-four patients who had at least one risk factors of PONV and underwent surgery under general anesthesia were screened .


Those who developed PONV were randomized to receive either 0.075 mg intravenous palonosetron or a placebo .


The incidence of nausea and vomiting , severity of nausea , requirements for rescue anti-emetics , and adverse effects at 2 , 24 , and 72 h after drug administration were evaluated .


Complete response ( CR ) and complete control ( CC ) rate were compared for 24 and 72 h.


Among the 384 patients , 152 ( 39.6 % ) developed PONV and were randomized to either the palonosetron ( n = 75 ) or placebo ( n = 77 ) group .


The number of patients with CR at 24 and 72 h was higher in the palonosetron group than the placebo group [ 0-24 h : n = 49 ( 68.1 % ) vs. n = 30 ( 40.5 % ) , p < 0.001 ; 0-72 h : n = 47 ( 65.3 % ) vs. n = 28 ( 37.8 % ) , p < 0.001 ] .


The incidence of PONV at 2 , 24 , and 72 h periods was lower in the palonosetron group than the placebo group ( 29.2 , 45.8 , and 50.0 % in the palonosetron group vs. 50.0 , 62.2 , and 66.2 % in the placebo group , p = 0.010 , 0.048 , 0.047 , respectively ) .


The incidence of adverse events was not different between the groups .


A single 0.075 mg IV dose of palonosetron effectively increased the CR rates at 24 and 72 h in these moderate-risk patients with established PONV .


Assessing the immunogenicity of a single dose of hepatitis A virus ( HAV ) vaccines is important because some people receive only a single dose .


However , previous studies have shown variable results and have not examined the effects of demographic characteristics other than gender .


This study was performed to examine the immunogenicity of a single dose of HAV vaccine according to the vaccine type and demographic characteristics in young adults .


Seronegative medical school students were randomly allocated to receive either Havrix or Epaxal .


After approximately 11 months , the seroconversion rate in 451 participants was 80.7 % .


In men , the Havrix group showed a significantly higher seroconversion rate ( 81.9 % ) than the Epaxal group ( 69.2 % ) , whereas both vaccine groups showed similarly high immunogenicity in women ( Havrix : 90.1 % , Epaxal : 92.9 % ; P for interaction = 0.062 ) .


According to the results of a multivariate analysis , Epaxal showed significantly lower immunogenicity than Havrix only in men .


Age , obesity , drinking , smoking , and follow-up time did not significantly affect seroconversion in either gender .


The seroconversion rate of single-dose HAV vaccines was low in men , particularly in those who received Epaxal .


Our results suggest that gender effects should be considered when comparing the immunogenicity of different HAV vaccines .


To compare the corticosteroid injection ( CSI ) with or without thumb spica cast ( TSC ) for de Quervain tendinitis .


In this prospective trial , 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI + TSC ( 33 cases ) and CSI ( 34 cases ) groups .


All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2 % in the first dorsal compartment at the area of maximal point tenderness .


The primary outcome was the treatment success rate , and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm , Shoulder and Hand and visual analog scale scores .


The groups had no differences in mean age , sex , and occupation .


The visual analog scale and Quick Disabilities of the Arm , Shoulder and Hand scores were similar in both groups before the treatment .


The treatment success rate was 93 % in the CSI + TSC group and 69 % in the CSI group .


Although both methods improved the patients ' conditions significantly in terms of relieving pain and functional ability , CSI + TSC had a significantly higher treatment success rate .


The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes .


Therapeutic II .


Preoperative oral rehydration solution ( ORS ) prevents hypovolemia .


The aim of this study was to compare the effect of intubating dose of rocuronium in patients taking and those not taking preoperative ORS .


Twenty patients , ASA I aged 20-50 years scheduled for elective surgery , were investigated and randomly assigned to two groups : drinking 1,500 ml ORS 6 to 2 hours before anesthesia ( ORS group ) and nothing by mouth from 6 hours before anesthesia ( control group ) .


Anesthesia was maintained with propofol and remifentanil , and rocuronium 0.6 mg x kg ( -1 ) was administrated .


To evaluate the effect of rocuronium , acceleromyography at the adductor pollicis was performed using 0.1 Hz stimulation .


Cardiac index ( CI ) and stroke volume variation ( SVV ) from FloTra/Vigileo , times to 95 % twitch depression as onset time ( OT ) , and times to first twitch re-detection ( TR ) were recorded .


SVV was significantly lower in ORS group ( P = 0.03 ) , and CI showed no difference .


In ORS group , TR was significantly shorter than that of control group ( P = 0.002 ) , and OT tended to be prolonged ( 99.0 36.3 s vs. 84.0 37.5 s ) , but not significantly .


Preoperative oral rehydration possibly increases circulating blood volume , and shortens the duration of rocuronium effect .


Measles vaccine ( MV ) has a greater effect on child survival when administered in early infancy , when maternal antibody may still be present .


To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody , we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4-6 months and at 9 months of age .


In both trials antibody levels had been measured before early measles vaccination .


In trial I ( 1993-1995 ) , the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody ( mortality rate ratio [ MRR ] , 0.0 ; 95 % confidence interval [ CI ] , 0 -.52 ) .


In trial II ( 2003-2007 ) , the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody ( MRR , 0.29 ; 95 % CI , .09 -.91 ) .


Possible confounding factors did not explain the difference .


In a combined analysis , children who had measles antibody detected when they received their first dose of MV at 4-6 months of age had lower mortality than children with no maternal antibody , the MRR being 0.22 ( 95 % CI , .07 -.64 ) between 4-6 months and 5 years .


Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody , using a 2-dose schedule with the first dose at 4-6 months ( earlier than currently recommended ) and a booster dose at 9-12 months of age .


NCT00168558 .


Acute hydrocephalus is a well-known sequela of aneurysmal subarachnoid hemorrhage ( SAH ) .


Controversy exists about whether open microsurgical methods serve to reduce shunt dependency compared with endovascular techniques .


To determine predictors of shunt-dependent hydrocephalus and functional outcomes after aneurysmal SAH .


A total of 471 patients who were part of a prospective , randomized , controlled trial from 2003 to 2007 were retrospectively reviewed .


All variables including demographic data , medical history , treatment , imaging , and functional outcomes were included as part of the trial .


No additional variables were retrospectively collected .


Ultimately , 147 patients ( 31.2 % ) required a ventriculoperitoneal shunt ( VPS ) in our series .


Age , dissecting aneurysm type , ruptured vertebrobasilar aneurysm , Fisher grade , Hunt and Hess grade , admission intraventricular hemorrhage , admission intraparenchymal hemorrhage , blood in the fourth ventricle on admission , perioperative ventriculostomy , and hemicraniectomy were significant risk factors ( P < .05 ) associated with shunt-dependent hydrocephalus on univariate analysis .


On multivariate analysis , intraventricular hemorrhage and intraparenchymal hemorrhage were independent risk factors for shunt dependency ( P < .05 ) .


Clipping vs coiling treatment was not statistically associated with VPS after SAH on both univariate and multivariate analyses .


Patients who did not receive a VPS at discharge had higher Glasgow Outcome Scale and Barthel Index scores and were more likely to be functionally independent and to return to work 72 months after surgery ( P < .05 ) .


There is no difference in shunt dependency after SAH among patients treated by endovascular or microsurgical means .


Patients in whom shunt-dependent hydrocephalus does not develop after SAH tend to have improved long-term functional outcomes .


Acute neural effects of antidepressant medication on emotion processing biases may provide the foundation on which clinical outcomes are based .


Along with effects on positive and negative stimuli , acute effects on neutral stimuli may also relate to antidepressant efficacy , yet these effects are still to be investigated .


The present study therefore examined the impact of a single dose of the selective serotonin reuptake inhibitor escitalopram ( 20 mg ) on positive , negative and neutral stimuli using pharmaco-fMRI .


Within a double-blind , randomized , placebo-controlled crossover design , healthy women completed 2 sessions of treatment administration and fMRI scanning separated by a 1-week washout period .


We enrolled 36 women in our study .


When participants were administered escitalopram relative to placebo , left amygdala activity was increased and right inferior frontal gyrus ( IFG ) activity was decreased during presentation of positive pictures ( potentiation of positive emotion processing ) .


In contrast , escitalopram was associated with decreased left amygdala and increased right IFG activity during presentation of negative pictures ( attenuation of negative emotion processing ) .


In addition , escitalopram decreased right IFG activity during the processing of neutral stimuli , akin to the effects on positive stimuli ( decrease in negative appraisal ) .


Although we used a women-only sample to reduce heterogeneity , our results may not generalize to men .


Potential unblinding , which was related to the subjective occurrence of side effects , occurred in the study ; however , manipulation check analyses demonstrated that results were not impacted .


These novel findings demonstrate that a single dose of the commonly prescribed escitalopram facilitates a positive information processing bias .


These findings provide an important lead for better understanding effects of antidepressant medication .


We explored whether preoperative rosuvastatin could protect the cardiac health of patients with coronary artery disease undergoing emergency , noncardiac surgery .


We randomized 550 noncardiac emergency surgery patients with stable coronary artery disease on long-term statin therapy to treatment with and without preoperative rosuvastatin .


All patients received rosuvastatin after surgery .


We evaluated the incidence of myocardial necrosis and major adverse cardiovascular and cerebrovascular events ( MACCE ) 30 days and 6 months after surgery .


Creatinine kinase-myocardial band ( CK-MB ) isoform elevations occurred less frequently 12 and 24 h after noncardiac emergency surgery in the experimental group than in the control group ( p = 0.029 ) .


After surgery , the incidence of MACCE was also lower in the experimental group than in the control group ( p = 0.019 ) .


The difference was mainly due to the incidence of perioperative myocardial infarction ( p = 0.029 ) .


Multivariable analysis found that rosuvastatin reload reduced the incidence of MACCE 52 % 6 months after surgery ( p = 0.03 ) .


Preoperative rosuvastatin reload therapy decreases the incidence of myocardial necrosis and MACCE after noncardiac emergency surgery in patients with stable coronary artery disease on long-term statin therapy .


To compare the effect , safety , and advantage of flexible fixation with paperboard and pad versus short leg plaster in treating the fifth metatarsal base fracture , and establish the standard of diagnosis and treatment of the fifth metatarsal base fractures in flexible fixation with paperboard and pad .


From June 2010 to March 2013,59 patients with the fifth metatarsal base fracture were treated with paperboard and pad fixation or short leg plaster .


Patients were enrolled and divided into paperboard and pad treatment group ( paperboard group ) and short leg plaster treatment group ( plaster group ) randomly according to the random number table .


In paperboard group , there were 29 cases including 9 males and 20 females with an average age of ( 51.7911.40 ) years old ; the average course of injury was ( 11.596.58 ) hours .


In plaster group , there were 30 cases including 9 males and 21 females with an average age of ( 52.13 +17.34 ) years old ; the average course of injury was ( 11.037.06 ) hours .


According to whether the fracture line across the articular surface , in paperboard group there were 14 cases of type A ,15 of type B ; in plaster group ,16 of type A , 14 of type B.


According to the degree of dislocation , in paperboard group there were 16 cases of degree I ,13 of degree II ; in plaster group ,20 were degree I ,10 were degree II .


Fracture was restored according to the type in manual .


Patients in paperboard group were treated with paperboard and pad , and patients in plaster group were treated with short leg plaster .


Fracture was fixed for 4 to 6 weeks according to fracture healing .


On the 2nd , 4th ,6 th , 8th week and 3rd , 6th month after fixation , patients were followed up , and the foot function score was used to evaluate the function of injured foot .


X-ray of injured foot was taken on the 2nd , 4th , 6th and 8th week were used to assess fracture healing .


All patients got complete follow-up .


The X-ray result showed that all fracture reached at clinical healing on the 8th week after fixation without skin ulcer , nonunion and displacement of fracture .


From the 4th to 8th week after fixation , paperboard group had a higher X-ray score than plaster group , but the difference between two groups had no statistically significance .


Repeated analysis result showed that there was interact at different time point and between groups , the difference had statistically significance ( P < 0.01 ) .


The foot function score showed that at all time point , paperboard group had a higher score than plaster group , and on the 2nd , 4th , and 6th week , it had statistically significant difference ( P < 0.01 ) between two groups .


On the 6th months after fixation , the excellent and good rate of paperboard group was 93.10 % , higher than that of plaster group , which was 86.67 % .


But it had no statistically difference ( P = 0.483 ) between two groups .


Using paperboard and pad fixation to treat the fifth metatarsal base fracture has the advantage of simplicity operating , reliable fixation , satisfactory effects , easily obtainable material .


In the present study , we investigated how the electrical activity in the sensorimotor cortex contributes to improved cognitive processing capabilities and how SMR ( sensorimotor rhythm , 12-15Hz ) neurofeedback training modulates it .


Previous evidence indicates that higher levels of SMR activity reduce sensorimotor interference and thereby promote cognitive processing .


Participants were randomly assigned to two groups , one experimental ( N = 10 ) group receiving SMR neurofeedback training , in which they learned to voluntarily increase SMR , and one control group ( N = 10 ) receiving sham feedback .


Multiple cognitive functions and electrophysiological correlates of cognitive processing were assessed before and after 10 neurofeedback training sessions .


The experimental group but not the control group showed linear increases in SMR power over training runs , which was associated with behavioural improvements in memory and attentional performance .


Additionally , increasing SMR led to a more salient stimulus processing as indicated by increased N1 and P3 event-related potential amplitudes after the training as compared to the pre-test .


Finally , functional brain connectivity between motor areas and visual processing areas was reduced after SMR training indicating reduced sensorimotor interference .


These results indicate that SMR neurofeedback improves stimulus processing capabilities and consequently leads to improvements in cognitive performance .


The present findings contribute to a better understanding of the mechanisms underlying SMR neurofeedback training and cognitive processing and implicate that SMR neurofeedback might be an effective cognitive training tool .


We ( i ) described variability in colorectal cancer ( CRC ) test use across multiple levels , including physician , clinic , and neighborhood ; and ( ii ) compared the performance of novel cross-classified models versus traditional hierarchical models .


We examined multilevel variation in CRC test use among patients not up-to-date with screening in a large , urban safety net health system ( 2011-2012 ) .


Outcomes included : ( i ) fecal occult blood test ( FOBT ) or ( ii ) colonoscopy and were ascertained using claims data during a 1-year follow-up .


We compared Bayesian ( i ) cross-classified four-level logistic models nesting patients within separate , nonoverlapping `` levels '' ( physicians , clinics , and census tracts ) versus ( ii ) three hierarchical two-level models using deviance information criterion .


Models were adjusted for covariates ( patient sociodemographic factors , driving time to clinic , and census tract poverty rate ) .


Of 3,195 patients , 157 ( 4.9 % ) completed FOBT and 292 ( 9.1 % ) completed colonoscopy during the study year .


Patients attended 19 clinics , saw 177 physicians , and resided in 332 census tracts .


Significant variability was observed across all levels in both hierarchical and cross-classified models that was unexplained by measured covariates .


For colonoscopy , variance was similar across all levels .


For FOBT , physicians , followed by clinics , demonstrated the largest variability .


Model fit using cross-classified models was superior or similar to 2-level hierarchical models .


Significant and substantial variability was observed across neighborhood , physician , and clinic levels in CRC test use , suggesting the importance of factors at each of these levels on CRC testing .


Future multilevel research and intervention should consider the simultaneous influences of multiple levels , including clinic , physician , and neighborhood .


Prevalence of tobacco use is higher in the rural than urban areas of India .


Unlike tobacco cessation clinics located in urban areas , community-based smoking cessation intervention has the potential to reach a wider section of the community to assist in smoking cessation in the rural setting .


The present study aimed to assess the effectiveness of a cessation intervention in rural Kerala state , India .


Current daily smoking resident males in the age group 18-60 years from four community development blocks in rural Kerala were randomly allocated to intervention and control groups .


The intervention group received multiple approaches in which priority was given to face-to-face interviews and telephone counselling .


Initially educational materials on tobacco hazards were distributed .


Further , four rounds of counselling sessions were conducted which included a group counselling with a medical camp as well as individual counselling by trained medical social workers .


The control group received general awareness training on tobacco hazards along with an anti-tobacco leaflet .


Self-reported smoking status was assessed after 6 and 12 months .


Factors associated with tobacco cessation were estimated using binomial regression method .


Overall prevalence of smoking abstinence was 14.7 % in the intervention and 6.8 % in the control group ( Relative risk : 1.85 , 95 % CI : 1.05 , 3.25 ) .


A total of 41.3 % subjects in the intervention area and 13.6 % in the control area had reduced smoking by 50 % or more at the end of 12 months .


Lower number of cigarettes / bidi used , low nicotine dependence and consultation with a doctor for a medical ailment were the statistically significant predictors for smoking cessation .


Rigorous approaches for smoking cessation programmes can enhance quit rates in smoking in rural areas of India .


The benefits of pharmacotherapy with tiotropium HandiHaler 18g for patients with chronic obstructive pulmonary disease ( COPD ) have been previously demonstrated .


However , few data exist regarding the treatment of moderate disease ( Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage II ) .


To determine whether tiotropium improves lung function/patient-reported outcomes in patients with GOLD stage II COPD naive to maintenance therapy .


A randomised 24-week double-blind placebo-controlled trial of tiotropium 18g once daily ( via HandiHaler ) was performed in maintenance therapy-naive patients with forced expiratory volume in 1 s ( FEV1 ) / forced vital capacity ( FVC ) ratio < 0.7 and post-bronchodilator FEV1 50 and < 80 % .


A total of 457 patients were randomised ( 238 tiotropium , 219 placebo ; mean age 62 years ; FEV1 1.93 l ( 66 % predicted ) ) .


Tiotropium was superior to placebo in mean change from baseline in post-dose FEV1 area under the curve from 0 to 3h ( AUC0-3h ) at week 24 ( primary endpoint ) : 0.19 vs. -0.03 l ( least-squares mean difference 0.23 l , P < 0.001 ) .


FVC AUC0-3h , trough and peak FEV1 and FVC were significantly improved with tiotropium versus placebo ( P < 0.001 ) .


Compared with placebo , tiotropium provided numerical improvements in physical activity ( P = NS ) .


Physician 's Global Assessment ( health status ) improved ( P = 0.045 ) with less impairment on the Work Productivity and Activity Impairment questionnaire ( P = 0.043 ) at week 24 .


The incidence of exacerbations , cough , bronchitis and dyspnoea was lower with tiotropium than placebo .


Tiotropium improved lung function and patient-reported outcomes in maintenance therapy-naive patients with GOLD stage II COPD , suggesting benefits in initiating maintenance therapy early .


To determine the effect of removing presumptive apoptotic sperm cells from samples from unselected males by means of magnetic activated cell sorting ( MACS ) on live-birth delivery rates after intracytoplasmic sperm injection ( ICSI ) in couples undergoing ovum donation ( OD ) .


Prospective , randomized , triple-blinded , and controlled study .


Private university-affiliated IVF center .


A total of 237 infertile couples undergoing ICSI as part of an OD program .


Semen specimens from the control group were prepared by swim-up .


Samples from the study group were prepared by swim-up followed by MACS and incubation with annexin V-conjugated microbeads to remove annexin V-positive ( AV + ) sperm cells .


Fertilization rates , morphological features of early embryo development , implantation rates , ongoing pregnancy rates , and live-birth rates .


Similar results were obtained between groups for all the parameters compared : fertilization rates of 75.3 % ( 95 % confidence interval [ CI ] , 71.6-78 .9 ) versus 72.1 % ( 95 % CI , 68.6-75 .7 ) ; percentage of good-quality embryos on day 2 of 53.7 % ( 95 % CI , 50.3-57 .1 ) versus 51.8 % ( 95 % CI , 48.3-55 .3 ) and on day 3 of 54.2 % ( 95 % CI , 50.7-57 .6 ) versus 48.9 % ( 95 % CI , 45.3-52 .4 ) ; implantation rates of 42.2 % ( 95 % CI , 33.8-48 .1 ) versus 40.1 % ( 95 % CI , 34.8-49 .6 ) ; positive beta-hCG tests of 63.2 % ( 95 % CI , 54.7-71 .6 ) versus 68.6 % ( 95 % CI , 60.2-76 .9 ) , and live-birth rates of 48.4 % ( 95 % CI , 39.6-57 .1 ) versus 56.4 % ( 95 % CI , 47.3-65 .5 ) in the MACS versus control group .


None of the differences reached statistical significance .


Applying MACS technology to remove AV + sperm cells from unselected males does not improve the reproductive outcome of ICSI in OD .


In-situ audiometry is a hearing aid feature that enables the measurement of hearing threshold levels through the hearing instrument using the built-in sound generator and the hearing aid receiver .


This feature can be used in hearing aid fittings instead of conventional pure-tone audiometry ( PTA ) , particularly in places where no standard audiometric equipment is available .


Differences between conventional and in-situ thresholds are described and discussed for some particular hearing aids .


No previous investigation has measured and compared these differences for a number of current hearing aid models by various manufacturers across a wide range of hearing losses .


The purpose of this study was to perform a model-based comparison of conventionally and in-situ measured hearing thresholds .


Data were collected for a range of hearing aid devices to study and generalize the effects that may occur under clinical conditions .


Research design was an experimental and regression study .


A total of 30 adults with sensorineural hearing loss served as test persons .


They were assigned to three subgroups of 10 subjects with mild ( M ) , moderate to severe ( MS ) , and severe ( S ) sensorineural hearing loss .


All 30 test persons underwent both conventional PTA and in-situ audiometry with four hearing aid models by various manufacturers .


The differences between conventionally and in-situ measured hearing threshold levels were calculated and evaluated by an exploratory data analysis followed by a sophisticated statistical modeling process .


At 500 and 1500 Hz , almost all threshold differences ( conventional PTA minus in-situ data ) were negative , i.e. , in the low to mid frequencies , hearing loss was overestimated by most devices relative to PTA .


At 4000 Hz , the majority of differences ( 7 of 12 ) were positive , i.e. , in the frequency range above 1500 Hz , hearing loss was frequently underestimated .


As hearing loss increased ( MMSS ) , the effect of the underestimation decreased .


At 500 and 1500 Hz , Resound devices showed the smallest threshold deviations , followed by Phonak , Starkey , and Oticon instruments .


At 4000 Hz , this observed pattern partly disappeared and Starkey and Oticon devices showed a reversed effect with increasing hearing loss ( MMSS ) .


Because of high standard errors for the estimates , only a few explicit rankings of the devices could be established based on significant threshold differences ( 5 % level ) .


Differences between conventional PTA and in-situ threshold levels may be attributed to ( 1 ) frequency , ( 2 ) device/hearing loss , and ( 3 ) calibration/manufacturer effects .


Frequency effects primarily resulting in an overestimation of hearing loss by in-situ audiometry in the low and mid frequencies are mainly due to sound drain-off through vents and leaks .


Device/hearing loss effects may be due to leakage as well as boundary effects because in-situ audiometry is confined to a limited measurement range .


Finally , different calibration approaches may result in different offset levels between PTA and in-situ audiometry calibration .


In some cases , the observed threshold differences of up to 10-15 dB may translate to varied hearing aid fittings for the same user depending on how hearing threshold levels were measured .


Vitamin D is related to resistance to chronic diseases , physiological parameters and functional measures .


All of these relationships underscore the potential benefits of cholecalciferol or D3 ( nutritional vitamin D ) in cancer .


This is the first study designed to obtain conclusive evidence on the effect of cholecalciferol in advanced patients with cancer .


The main goal is to assess its effects on the patient 's perceived quality of life .


Cholecalciferol 's impact on fatigue and physical performance , as well as its cost utility , will also be assessed .


A randomised triple-blind phase II/III placebo-controlled multicentre trial has been designed .


Patients satisfying the inclusion and exclusion criteria will be randomly assigned to receive cholecalciferol or placebo .


Eligible patients will be adults with a locally advanced or metastatic or inoperable solid cancer in palliative care , who have given signed informed consent and have matched inclusion and exclusion criteria .


The randomisation will be based on a computer-generated procedure and centralised by the pharmacy service of the coordinating centre .


The assigned treatment will be administered by the hospital 's pharmacy to conceal group allocation for patients and healthcare providers .


Cholecalciferol ( 4000 IU/day ) or placebo , starting at day 15 and continuing up to day 42 , will be added to palliative care treatment .


Outpatient visits will be scheduled every 14 days .


Ethical approval was received from the Medical Ethical Commitee of the HUAV ( CEIC-1169 ) .


Participants and their families will receive the research findings which will also be disseminated on local and national media , presented at national and international meetings of the specialty , and published in peer-reviewed scientific journals .


EudraCT : 2013-003478-29 .


Adherence to medication is an issue of great importance for patients with ulcerative colitis .


Once daily mesalazine seems to be no worse than divided doses in preventing relapse in remitting patients .


Although this has been attributed to improved adherence , detailed measures of adherence have been lacking from previous studies .


A 1-year substudy was conducted alongside a trial that compared 2 different dosing regimens ( once daily versus three times daily ) of mesalazine for patients in remission with ulcerative colitis .


Participants in the substudy had their adherence monitored electronically using the medication event monitoring system , self-report , and tablet counts .


We compared measures , determined factors associated with adherence and associations between adherence and relapse , modeled adherence over time , and explored behavioral aspects .


We included 58 participants .


Adherence was high across all measures ( 89.3 % self-report , 96.7 % tablet counts , and 89.2 % medication event monitoring system ) .


Agreement between the measures was poor at times .


Adherence according to the medication event monitoring system best distinguished between the participants who relapsed ( 71.4 % ) and those who remained in remission ( 93.4 % ) , although this difference was not statistically discernible at the 5 % level .


Adherence deteriorated over the study period , with three times daily participants generally less adherent than once-daily participants ( odds ratio , 0.03 ; 95 % confidence interval , 0.01-0 .08 ) .


Adherence was higher on weekdays ( odds ratio , 1.47 ; 95 % confidence interval , 1.31-1 .65 ) and around clinic visit dates ( odds ratio , 1.43 ; 95 % confidence interval , 1.18-1 .72 ) .


Simple dosing regimens are preferable to multiple daily dosing regimens .


Electronic monitoring of adherence should be used more often in clinical studies .


Self-reported adherence and tablet counts may underestimate adherence .


Adherence declined over time , and adherence was generally lower and more varied for those allocated to the three times daily regimen .


The role of adjuvant chemotherapy for patients with rectal cancer is controversial , especially when used after preoperative chemoradiotherapy .


Fluoropyrimidine-based adjuvant chemotherapy , including fluorouracil and leucovorin , has been widely used ; however , the addition of oxaliplatin to fluorouracil and leucovorin ( FOLFOX ) , a standard adjuvant regimen for colon cancer , has not been tested in rectal cancer .


We aimed to compare the efficacy and safety of adjuvant fluorouracil and leucovorin with that of FOLFOX in patients with locally advanced rectal cancer after preoperative chemoradiotherapy .


In this open-label , multicentre , phase 2 , randomised trial , patients with postoperative pathological stage II ( ypT3-4N0 ) or III ( ypTanyN1-2 ) rectal cancer after preoperative fluoropyrimidine-based chemoradiotherapy and total mesorectal excision were recruited and randomly assigned ( 1:1 ) via a web-based software platform to receive adjuvant chemotherapy with either four cycles of fluorouracil and leucovorin ( fluorouracil 380 mg/m ( 2 ) and leucovorin 20 mg/m ( 2 ) on days 1-5 , every 4 weeks ) or eight cycles of FOLFOX ( oxaliplatin 85 mg/m ( 2 ) , leucovorin 200 mg/m ( 2 ) , and fluorouracil bolus 400 mg/m ( 2 ) on day 1 , and fluorouracil infusion 2400 mg/m ( 2 ) for 46 h , every 2 weeks ) .


Stratification factors were pathological stage ( II vs III ) and centre .


Neither patients nor investigators were masked to group assignment .


The primary endpoint was 3-year disease-free survival , analysed by intention to treat .


This study is fully enrolled , is in long-term follow-up , and is registered with ClinicalTrials.gov , number NCT00807911 .


Between Nov 19 , 2008 , and June 12 , 2012 , 321 patients were randomly assigned to fluorouracil and leucovorin ( n = 161 ) and FOLFOX ( n = 160 ) .


141 ( 95 % ) of 149 patients in the fluorouracil plus leucovorin group and 141 ( 97 % ) of 146 in the FOLFOX group completed all planned cycles of adjuvant treatment .


Median follow-up was 382 months ( IQR 264-506 ) .


3-year disease-free survival was 716 % ( 95 % CI 646-786 ) in the FOLFOX group and 629 % ( 554-704 ) in the fluorouracil plus leucovorin group ( hazard ratio 0657 , 95 % CI 0434-0994 ; p = 0047 ) .


Any grade neutropenia , thrombocytopenia , fatigue , nausea , and sensory neuropathy were significantly more common in the FOLFOX group than in the fluorouracil plus leucovorin group ; however , we noted no significant difference in the frequency of these events at grade 3 or 4 .


The most common grade 3 or worse adverse events were neutropenia ( 38 [ 26 % ] of 149 patients in the fluorouracil plus leucovorin group vs 52 [ 36 % ] of 146 patients in the FOLFOX group ) , leucopenia ( eight [ 5 % ] vs 12 [ 8 % ] ) , febrile neutropenia ( four [ 3 % ] vs one [ < 1 % ] ) , diarrhoea ( four [ 3 % ] vs two [ 1 % ] ) , and nausea ( one [ < 1 % ] vs two [ 1 % ] ) .


Adjuvant FOLFOX improves disease-free survival compared with fluorouracil plus leucovorin in patients with locally advanced rectal cancer after preoperative chemoradiotherapy and total mesorectal excision , and warrants further investigation .


Korea Healthcare Technology R&D Project ( South Korean Ministry of Health and Welfare ) .


To investigate the efficacy and safety of corneal collagen cross-linking ( CXL ) with photoactivated riboflavin ( photoactivated chromophore for infectious keratitis [ PACK ] - CXL ) in the management of infectious keratitis with corneal melting .


Prospective clinical trial .


Forty eyes from 40 patients with advanced infectious keratitis and coexisting corneal melting .


Twenty-one patients ( 21 eyes ) underwent PACK-CXL treatment in addition to antimicrobial therapy .


The control group consisted of 19 patients ( 19 eyes ) who received only antimicrobial therapy .


The slit-lamp characteristics of the corneal ulceration , corrected distance visual acuity , duration until healing , and complications were documented in each group .


The Mann-Whitney U test was used for statistical analysis .


P values less than 0.05 were considered statistically significant .


The average time until healing was 39.76 18.22 days in the PACK-CXL group and 46.05 27.44 days in the control group ( P = 0.68 ) .


After treatment and healing , corrected distance visual acuity was 1.64 0.62 in the PACK-CXL group and 1.67 0.48 in the control group ( P = 0.68 ) .


The corneal ulceration 's width and length was significantly bigger in the PACK-CXL group ( P = 0.004 and P = 0.007 ) .


Three patients in the control group demonstrated corneal perforation ; infection recurred in 1 of them .


No serious complications occurred in the PACK-CXL group .


Corneal CXL with photoactivated riboflavin did not shorten the time to corneal healing ; however , the complication rate was 21 % in the control group , whereas there was no incidence of corneal perforation or recurrence of the infection in the PACK-CXL group .


These results indicate that PACK-CXL may be an effective adjuvant therapy in the management of severe infectious keratitis associated with corneal melting .


Sweet esophagectomy is performed widely in China , while the Ivor-Lewis procedure , with potential benefit of an extended lymphadenectomy , is limitedly conducted owing to concern for a higher risk for morbidity .


Thus , the role of the Ivor-Lewis procedure for thoracic esophageal cancer needs further investigation .


To determine whether Ivor-Lewis esophagectomy is associated with increased postoperative complications compared with the Sweet procedure .


A randomized clinical trial was conducted from May 2010 to July 2012 at Fudan University Shanghai Cancer Center , Shanghai , China , of 300 patients with resectable squamous cell carcinoma in the middle and lower third of the thoracic esophagus .


Intent-to-treat analysis was performed .


Patients were randomly assigned to receive either the Ivor-Lewis ( n = 150 ) or Sweet ( n = 150 ) esophagectomy .


The primary outcome of this clinical trial was operative morbidity ( any surgical or nonsurgical complications ) .


Secondary outcomes included oncologic efficacy ( number of lymph nodes resected and positive lymph nodes ) , postoperative mortality ( 30-day and in-hospital mortality ) , and patient discharge .


Resection without macroscopical residual ( R0/R1 ) was achieved in 149 of 150 patients in each group .


Although there was no significant difference between the 2 groups regarding the incidence of each single complication , a significantly higher morbidity rate was found in the Sweet group ( 62 of 150 [ 41.3 % ] ) than in the Ivor-Lewis group ( 45 of 150 [ 30 % ] ) ( P = .04 ) .


More patients in the Sweet group ( 8 of 150 [ 5.3 % ] ) received reoperations than in the Ivor-Lewis group ( 1 of 150 [ 0.7 % ] ) ( P = .04 ) .


The median hospital stay was 18 days in the Sweet group vs 16 days in the Ivor-Lewis group ( P = .002 ) .


Postoperative mortality rates in the Ivor-Lewis ( 1 of 150 ) and Sweet ( 3 of 150 ) groups were 0.7 % and 2.0 % , respectively ( P = .25 ) .


More lymph nodes were removed during Ivor-Lewis esophagectomy than during the Sweet procedure ( 22 vs 18 , P < .001 ) .


Early results of this study demonstrate that the Ivor-Lewis procedure can be performed with lower rates of postoperative complications and more lymph node retrieval .


Ivor-Lewis and Sweet esophagectomies are both safe procedures with low operative mortalities .


clinicaltrials.gov Identifier : NCT01047111 .


Hypotensive anesthesia is routinely used during craniosynostosis corrections to reduce blood loss .


Noting that cerebral oxygenation levels often fell below recommended levels , the authors sought to measure the effects of hypotensive versus standard anesthesia on blood transfusion rates .


One hundred children undergoing craniosynostosis corrections were randomized prospectively into two groups : a target mean arterial pressure of either 50 mm Hg or 60 mm Hg .


Aside from anesthesiologists , caregivers were blinded and strict transfusion criteria were followed .


Multiple variables were analyzed , and appropriate statistical testing was performed .


The hypotensive and standard groups appeared similar , with no statistically significant differences in mean age ( 46.5 months versus 46.5 months ) , weight ( 19.25 kg versus 19.49 kg ) , procedure [ anterior remodeling ( 34 versus 31 ) versus posterior ( 19 versus 16 ) ] , or preoperative hemoglobin level ( 13 g/dl versus 12.9 g/dl ) .


Intraoperative mean arterial pressures differed significantly ( 56 mm Hg versus 66 mm Hg ; p < 0.001 ) .


The captured cell saver amount was lower in the hypotensive group ( 163 cc versus 204 cc ; p = 0.02 ) , yet no significant differences were noted in postoperative hemoglobin levels ( 8.8 g/dl versus 9.3 g/dl ) .


Fifteen of 100 patients ( 15 percent ) received allogenic transfusions , but no statistically significant differences were noted in transfusion rates between the hypotensive [ nine of 53 ( 17.0 percent ) ] and standard anesthesia [ six of 47 ( 13 percent ) ] group ( p = 0.056 ) .


No significant difference in transfusion requirements was found between hypotensive and standard anesthesia during craniosynostosis corrections .


Considering potential benefits of improved cerebral blood flow and total body perfusion , surgeons might consider performing craniosynostosis corrections without hypotension .


Therapeutic , II .


Sensorimotor rhythm patterns in patients with lower limb amputations might be altered because of reorganization of the sensorimotor cortices .


The authors evaluated the sensorimotor rhythm of motor imagery ( MI ) in healthy subjects and patients with lower limb amputations .


In addition , the authors investigated whether transcranial direct current stimulation ( tDCS ) could modulate sensorimotor rhythm control .


Six healthy subjects and six patients with lower limb amputations were assigned to receive anodal , cathodal , or sham tDCS over the foot motor area in a randomized order .


The authors evaluated event-related desynchronization and event-related synchronization ( ERS ) of unilateral hand and bilateral foot MI before and after tDCS .


Beta ERS of foot MI in patients with lower limb amputations was significantly lesser than that in healthy subjects .


Compared with sham stimulation , cathodal tDCS enhanced beta ERS of foot MI in patients with lower limb amputations .


In contrast , anodal tDCS decreased beta ERS of foot MI in healthy subjects .


This is the first study to demonstrate that cathodal tDCS can enhance a weak beta ERS of foot MI in patients with lower limb amputations .


These findings might contribute in improving the effectiveness of sensorimotor rhythm-based brain computer interface for gait restoration after lower limb amputation .


To determine whether topical aqueous suppressants affect the duration of pure expansile intraocular gas in nonvitrectomized eyes .


A prospective randomized controlled trial was performed on nonvitrectomized patients undergoing retinal detachment repair with scleral buckle or pneumatic retinopexy using 0.3 mL of 100 % perfluoropropane ( C3F8 ) gas tamponade .


Eyes were randomly assigned to receive topical dorzolamide 2 % and timolol 0.5 % twice daily postoperatively until gas dissolution or to observation .


Twenty-one patients met all inclusion and exclusion criteria .


Twelve were randomized to the control group and nine to the dorzolamide-timolol group .


In the dorzolamide-timolol group , mean intraocular pressure was 17.4 on postoperative Day 1 and 12.5 on postoperative Week 1 ( P = 0.03 ) .


In the control group , mean intraocular pressure was 14.5 on postoperative Day 1 and 15.1 on postoperative Week 1 ( P = 0.73 ) .


The mean duration of C3F8 was 37.8 days in the dorzolamide-timolol group and 40.4 days in the control group ( P = 0.70 ) .


Topical aqueous suppression does not seem to have a significant effect on the duration of pure expansile intraocular C3F8 in nonvitrectomized eyes after pneumatic retinopexy or scleral buckling .


Inhibitors of the phosphatidylinositol-3-kinase / protein kinase B/mammalian target of rapamycin ( PI3K/AKT/mTOR ) pathway can overcome endocrine resistance in estrogen receptor ( ER ) - positive breast cancer , but companion diagnostics indicating PI3K/AKT/mTOR activation and consequently endocrine resistance are lacking .


PIK3CA mutations frequently occur in ER-positive breast cancer and result in PI3K/AKT/mTOR activation in vitro .


Nevertheless , the prognostic and treatment-predictive value of these mutations in ER-positive breast cancer is contradictive .


We tested the clinical validity of PIK3CA mutations and other canonic pathway drivers to predict intrinsic resistance to adjuvant tamoxifen .


In addition , we tested the association between these drivers and downstream activated proteins .


Primary tumors from 563 ER-positive postmenopausal patients , randomized between adjuvant tamoxifen ( 1 to 3 years ) versus observation were recollected .


PIK3CA hotspot mutations in exon 9 and exon 20 were assessed with Sequenom Mass Spectometry .


Immunohistochemistry was performed for human epidermal growth factor receptor 2 ( HER2 ) , phosphatase and tensin homolog ( PTEN ) , and insulin-like growth factor 1 receptor ( IGF-1R ) .


We tested the association between these molecular alterations and downstream activated proteins ( like phospho-protein kinase B ( p-AKT ) , phospho-mammalian target of rapamycin ( p-mTOR ) , p-ERK1 / 2 , and p-p70S6K ) .


Recurrence-free interval improvement with tamoxifen versus control was assessed according to the presence or absence of canonic pathway drivers , by using Cox proportional hazard models , including a test for interaction .


PIK3CA mutations ( both exon 9 and exon 20 ) were associated with low tumor grade .


An enrichment of PIK3CA exon 20 mutations was observed in progesterone receptor - positive tumors .


PIK3CA exon 20 mutations were not associated with downstream-activated proteins .


No significant interaction between PIK3CA mutations or any of the other canonic pathway drivers and tamoxifen-treatment benefit was found .


PIK3CA mutations do not have clinical validity to predict intrinsic resistance to adjuvant tamoxifen and may therefore be unsuitable as companion diagnostic for PI3K/AKT/mTOR inhibitors in ER - positive , postmenopausal , early breast cancer patients .


Osteoarthritis of the first metatarsophalangeal joint ( hallux rigidus ) leads to pain and poor function and mobility .


Arthrodesis is the gold standard treatment for end-stage disease .


Total joint arthroplasties have been attempted , but early loosening has been attributed to dorsally directed shear forces on the metatarsal component .


Metallic proximal phalangeal hemiarthroplasty theoretically avoids this .


Whilst early results are promising , no comparative trials exist comparing this to arthrodesis .


The primary objectives are to determine the range of outcome scores between the two treatment arms ( to inform a power calculation ) .


Outcome measures will include the MOXFQ , AOFAS-Hallux and EuroQol EQ-5D-5 L. Secondary objectives are to determine the accrual rate , dropout rate and trial acceptability to both patients and surgeons .


These data will allow the development of a larger trial with longer follow-up .


This is a prospective randomised controlled single-centre study comparing proximal phalanx hemiarthroplasty ( AnaToemic , Arthrex Ltd. , Sheffield , UK ) with arthrodesis ( 15 patients in each arm ) .


Randomisation will be performed using a 1:1 allocation ratio in blocks of six.Patients meeting the eligibility criteria will be recruited from three foot and ankle consultant surgeon 's clinics ( East Lancashire Hospitals NHS Trust ) .


If agreeable , informed consent will be obtained before patients are randomised.The outcome measure scores will be completed pre-operatively and repeated at 6 weeks , 3 months and 12 months .


A radiological review will be performed at 6 weeks and 12 months to determine rates of loosening ( hemiarthroplasty ) and union ( arthrodesis ) .


Data on length of stay , return to work , complications and re-operation rates will also be collected.The analysis will compare the change in outcome scores between treatment groups at all follow-up time points .


Scores will be compared using a Student t-test , adjusting for scores at baseline.This study will be conducted in accordance with the current revision of the Declaration of Helsinki ( 1996 ) and the ICH-GCP Guideline ( International Conference on Harmonisation , Good Clinical Practice , E6 ( R1 ) , 1996 ) .


This study has been approved by the sponsor , the Trust Research & Development office .


Ethical approval has been received from the National Research Ethics Service ( North East : 12/NE/0385 for protocol version 5.3 dated 3 June 2013 ) .


Current Controlled Trials ISRCTN88273654 .


Selumetinib ( AZD6244 , ARRY-142886 ) + docetaxel increases median overall survival ( OS ) and significantly improves progression-free survival ( PFS ) and objective response rate ( ORR ) compared with docetaxel alone in patients with KRAS mutant , stage IIIB/IV non-small-cell lung cancer ( NSCLC ; NCT00890825 ) .


Retrospective analysis of OS , PFS , ORR and change in tumour size at week 6 for different sub-populations of KRAS codon mutations .


In patients receiving selumetinib + docetaxel and harbouring KRAS G12C or G12V mutations there were trends towards greater improvement in OS , PFS and ORR compared with other KRAS mutations .


Different KRAS mutations in NSCLC may influence selumetinib/docetaxel sensitivity .


Minimal sedation obviates patient recovery burdens , but intolerable pain limits success of cecal intubation .