A mood cluster consisting of depression , anxiety , sleep disorders , apathy and appetite items from the Neuropsychiatric Inventory-Nursing Home ( NPI-NH ) was the primary outcome .


Analysed by Mann-Whitney U-tests , Stepwise Protocol of Treating Pain conferred significant benefit in treatment of the NPI-NH mood cluster ( F = 13.4 , df = 1 ; 299 , p < 0.001 ) and depression ( F = 2.0 , df = 1 ; 301 , p = 0.025 ) .


Further analyses highlighted improvements in apathy ( F = 5.3 , df = 1 ; 300 , p = 0.017 ) , night-time behaviours ( F = 3.1 , df = 1 ; 301 , p = 0.050 ) , and appetite items ( F = 11.6 , df = 1 ; 301 , p = 0.005 ) , but not irritability ( p = 0.092 ) and anxiety ( p = 0.125 ) .


Mood symptoms including depression significantly improved with pain treatment , emphasizing the importance of more rigorous treatment of pain in agitated people with dementia .


Findings have potentially immediate clinical relevance .


Specific computer-based auditory training may be a useful completion in the rehabilitation process for cochlear implant ( CI ) listeners to achieve sufficient speech intelligibility .


This study evaluated the effectiveness of a computerized , phoneme-discrimination training programme .


The study employed a pretest-post-test design ; participants were randomly assigned to the training or control group .


Over a period of three weeks , the training group was instructed to train in phoneme discrimination via computer , twice a week .


Sentence recognition in different noise conditions ( moderate to difficult ) was tested pre - and post-training , and six months after the training was completed .


The control group was tested and retested within one month .


Twenty-seven adult CI listeners who had been using cochlear implants for more than two years participated in the programme ; 15 adults in the training group , 12 adults in the control group .


Besides significant improvements for the trained phoneme-identification task , a generalized training effect was noted via significantly improved sentence recognition in moderate noise .


No significant changes were noted in the difficult noise conditions .


Improved performance was maintained over an extended period .


Phoneme-discrimination training improves experienced CI listeners ' speech perception in noise .


Additional research is needed to optimize auditory training for individual benefit .


In clinical trials where participants are likely to be able to distinguish between true and sham interventions , informing participants that they may receive a sham intervention increases the likelihood of participants ` breaking the blind ' and invalidating trial findings .


The present study explored participants ' perceptions of the consent process in a sham controlled acupressure trial which did not explicitly indicate participants may receive a sham intervention .


Nested qualitative study within a randomised sham controlled trial of acupressure wristbands for chemotherapy-related nausea .


Convenience sample of 26 patients participated in semi-structured interviews .


Interviews were audio-recorded and transcribed verbatim .


Transcripts analysed thematically using framework analysis .


Study conducted within three geographical sites in the UK : Manchester , Liverpool , and Plymouth .


All participants indicated that they believed they were fully informed when providing written consent to participate in the trial .


Participants ' perceived it was acceptable to employ a sham intervention within the trial of acupressure wristbands without informing potential participants that they may receive a sham treatment .


Despite the fact that participants were not informed that one of the treatment arms was a sham intervention the majority indicated they assumed one of the treatment arms would be placebo .


Many trials of acupuncture and acupressure do not inform participants they may receive a sham intervention .


The current study indicates patients ' perceive this approach to the consent process as acceptable .


However , the fact participants assume one treatment may be placebo threatens the methodological basis for utilising this approach to the consent process .


Bipolar disorder ( BD ) and borderline personality disorder ( BPD ) both are severe and chronic psychiatric disorders .


Both disorders have overlapping symptoms , and current research shows that the presence of a BPD has an adverse effect on the course of BD .


The limited research available shows an unfavorable illness course , a worse prognosis and response to medication , longer treatment duration , more frequent psychiatric admissions , higher drop-out , increased risk of substance abuse , increased risk of suicide , and more impairment of social and occupational functioning .


However , there is no research available on the effect of specific psychotherapeutic treatment for this patients .


This paper presents the protocol of a RCT to investigate the presence of borderline personality features in patients treated for BD ( study part 1 ) and the effectiveness of STEPPS ( Systems Training for Emotional Predictability and Problem Solving ) added to treatment as usual ( TAU ) for BD compared to TAU in patients with BD and comorbid borderline personality features ( study part 2 ) .


STEPPS is a validated and effective intervention for BPD .


The study population consists of patients treated for BD at specialized outpatient clinics for BD in the Netherlands .


At first the prevalence of comorbid borderline personality features in outpatients with BD is investigated .


Inclusion criteria for study part 2 is defined as having three or more of the DSM-IV-TR diagnostic criteria of BPD , including impulsivity and anger bursts .


Primary outcomes will be the frequency and severity of manic and depressive recurrences as well as severity , course and burden of borderline personality features .


Secondary outcomes will be quality of life , utilizing mental healthcare and psychopathologic symptoms not primarily related to BD or BPD .


Assessment will be at baseline , at the end of the intervention , and at 12 and 18 months follow-up .


This will be the first randomized controlled trial of a specific intervention in patients with BD and comorbid BPD or borderline personality features .


There are no recommendations in the guideline of treatment of bipolar disorders for patients with this complex comorbidity .


We expect that a combined treatment aimed at mood disorder and emotion regulation will improve treatment outcomes for these patients .


Although serum under-O-glycosylated IgA1 in IgA nephropathy ( IgAN ) patients may deposit more preferentially in glomeruli than heavily-O-glycosylated IgA1 , the relationship between the glomerular IgA deposition level and the O-glycan profiles of serum IgA1 remains obscure .


Serum total under-O-glycosylated IgA1 levels were quantified in 32 IgAN patients by an enzyme-linked immunosorbent assay ( ELISA ) with Helix aspersa ( HAA ) lectin .


Serum under-O-glycosylated polymeric IgA1 ( pIgA1 ) was selectively measured by an original method using mouse Fc / receptor ( mFc/R ) transfectant and flow cytometry ( pIgA1 trap ) .


The percentage area of IgA deposition in the whole glomeruli ( Area-IgA ) was quantified by image analysis on the immunofluorescence of biopsy specimens .


Correlations were assessed between the Area-IgA and data from HAA-ELISA or pIgA1 trap .


The relationships between clinical parameters and data from HAA-ELISA or pIgA1 trap were analyzed by data mining approach .


While the under-O-glycosylated IgA1 levels in IgAN patients were significantly higher than those in healthy controls when measured ( p < 0.05 ) , there was no significant difference in under-O-glycosylated pIgA1 .


There was neither a correlation observed between the data from HAA-ELISA and pIgA1 trap ( r2 = 0.09 ) in the IgAN patients ( r2 = 0.005 ) nor was there a linear correlation between Area-IgA and data from HAA-ELISA or the pIgA1 trap ( r2 = 0.005 , 0.03 , respectively ) .


Contour plots of clinical parameters versus data from HAA-ELISA and the pIgA1 trap revealed that patients with a high score in each clinical parameter concentrated in specific areas , showing that patients with specific O-glycan profiles of IgA1 have similar clinical parameters .


A decision tree analysis suggested that dominant immune complexes in glomeruli were consisted of : 1 ) IgA1-IgG and complements , 2 ) pIgA1 and complements , and 3 ) monomeric IgA1-IgA or aggregated monomeric IgA1 .


Serum under-O-glycosylated IgA1 levels are not correlated with glomerular IgA deposition based upon heterogeneity in the composition of glomerular immune complexes in IgAN patients .


Proton-pump inhibitors are known to be effective in the treatment and prevention of ulcers related to low-dose aspirin ( LDA ) , but few reports address H2 - receptor antagonists ( H2RAs ) and gastroprotective agents ( GPs ) .


This study was intended to compare the therapeutic effects of an H2RA and a GP against gastroduodenal mucosal injuries in patients taking LDA .


The subjects consisted of patients requiring continuous LDA treatment , in whom no peptic ulcer was found on endoscopy at enrollment .


The patients were randomized to either famotidine 20mg/day ( group F ) or teprenone 150mg/day ( group T ) .


The study medication was administered for 12 weeks .


The patients underwent endoscopy after administration of the study medication in order to obtain a Lanza score .


A total of 66 patients ( 38 in group F , 28 in group T ) were included in the efficacy analysis population .


The Lanza score changed as follows : in group F , it improved significantly , from 0.891.03 ( meanstandard deviation ) before medication to 0.390.75 after medication ( P = 0.006 ) ; in group T , no significant difference was observed : 0.750.93 before medication and 0.680.82 after medication .


Famotidine is better than teprenone in terms of reducing the number of the erosions under use of LDA .


To evaluate the effect of exogenous creatine phosphate ( CP ) on myocardial injury after percutaneous coronary intervention ( PCI ) .


Four hundred patients were divided to receive conventional therapy ( control group ) or 3-day intravenous infusion of CP after PCI ( CP group ) .


Levels of creatine kinase MB ( CK-MB ) and troponin I ( TnI ) were measured before and on postprocedural day 3 .


Postprocedural CK-MB and TnI in the CP group were significantly increased compared to the control group .


In the CP group , 8.0 % and 5.0 % of patients had an increase in CK-MB 1 to 3 times and > 3 times , respectively , which were significantly lower than that of the control group ( 19.0 % and 9.0 % , respectively ) ; 12.0 % and 10.0 % of patients had an increase in TnI 1 to 3 times and > 3 times , respectively , which were significantly lower than that of the control group ( 21.0 % and 18.0 % , respectively ) .


Exogenous CP was helpful to reduce myocardial injury after PCI .


A relationship between echolucency of carotid plaques and the consequent risk of ipsilateral ischemic stroke has been observed .


An aggressive lipid-lowering therapy may increase the echogenicity of carotid plaque in patients with elevated low-density lipoprotein cholesterol levels .


The aim of this study is to prospectively evaluate the long-term effect of high-dose atorvastatin on carotid plaque morphology in patients with first-ever transient ischemic attack or stroke .


All patients with symptomatic first ischemic atherosclerotic cerebrovascular event occurred within the previous 10 days were enrolled .


Carotid Doppler ultrasound of the neck vessels with 7-11 MHz probe for the definition of the atherosclerotic carotid framework was performed .


The analysis of the gray-scale median ( GSM ) of each plate was carried out with image processing software .


A total of 240 symptomatic plaques were included and divided into 3 groups : 80 in group A ( atorvastatin 80 mg ) , 80 in group B ( atorvastatin 40 mg ) , and 80 to group C ( no atorvastatin ) .


GSM score increases significantly more extensive in group A than in group B ( +48.65 vs. +39.46 , P < .02 ) and group C ( +48.65 vs. 19.3 , P = .0002 ) .


An inverse association between reduction of low-density lipoprotein and the increase in the GSM score ( r = -.456 , P = .007 ) has been observed .


Moreover , the reduction of high-sensitive C-reactive protein correlates inversely with the increase of the GSM ( r = -.398 , P = .021 ) .


Dose-dependent effect of atorvastatin on symptomatic carotid plaque morphology may suggest a specific role of this drug in the atherosclerotic stroke prevention .


Although social support is an integral element in smoking cessation , the literature presents mixed findings regarding the type ( s ) of social support that are most helpful .


The Partner Interaction Questionnaire ( PIQ ) is commonly used to measure social support in this context .


We explored the possibility that more nuanced distinctions between items on the PIQ than what is customarily used could improve the prediction of cessation .


Baseline PIQ responses of smokers enrolled in a cessation program was submitted to an exploratory factor analysis .


Emergent factors were used to predict cessation at several time points .


Four factors emerged , which differed from the two subscales that are typically used .


The four-factor version predicted cessation ; the two-factor version did not .


Identifying the types of social support that predict smoking cessation depend on our ability to measure social support .


More nuanced measures will likely clarify the role of social support in cessation .


The present intervention study investigated the efficacy of the ACT & Check Strategy intervention to improve inference generation when reading , metacognitive ability , general reading comprehension , and social inference ability in adults with high-functioning autism spectrum disorder ( HF-ASD ) .


Twenty-five adults with HF-ASD were randomly assigned to either a treatment or a control group .


Treatment sessions were conducted in 1-hr sessions , twice a week , for a total of 6 weeks .


Treatment focused on explicit instruction of components of inference generation , categories of inferences , and increasingly independent strategy use .


The treatment group demonstrated significantly superior performance on 1 of 2 measures of inference generation in reading and 1 measure of metacognitive ability compared with the control group .


Significant differences between groups were not found on measures of reading comprehension or social inference ability .


These findings suggest that the ACT & Check Strategy was effective in improving participants ' ability to generate inferences in reading and certain metacognitive abilities , but the skills do not appear to generalize to other social communication contexts , such as social inference generation .


This research provides a measure of support for explicitly teaching inference generation to address a reading inference deficit in adults with HF-ASD .


Previous studies have revealed lower prostate specific antigen concentrations in men with type 2 diabetes , paralleling the reported lower prevalence of prostate cancer in diabetic men .


Data are lacking on prostate specific antigen in men with type 1 diabetes whose insulin and obesity profiles differ from those with type 2 diabetes mellitus .


In this study we examined the relationship between long-term glycemic control and prostate specific antigen in men with type 1 diabetes mellitus .


Total prostate specific antigen was measured at one time in 639 men in the EDIC , the observational followup of participants in the DCCT .


The relationship between DCCT/EDIC weighted mean hemoglobin A1c and log prostate specific antigen was assessed using linear regression modeling after adjusting for age , body mass index , total testosterone , statin and thiazide medication use , diabetes duration , and DCCT randomization arm and cohort .


Median subject age was 52 years , body mass index was 28.4 kg/m ( 2 ) and DCCT/EDIC time-weighted hemoglobin A1c was 7.9 % .


Median prostate specific antigen was 0.64 ng/ml ( IQR 0.43 , 1.05 ) .


Prostate specific antigen increased significantly with age ( p < 0.0001 ) and with lower time-weighted hemoglobin A1c ( p < 0.0001 ) .


Each 10 % increase in hemoglobin A1c was accompanied by an 11 % reduction in prostate specific antigen ( p = 0.0001 ) .


Prostate specific antigen decreases as hemoglobin A1c increases in men with type 1 diabetes mellitus .


This relationship is independent of age , body mass index , androgen levels , medication use and measures of diabetes severity , which suggests that factors related to glycemia may directly affect prostate specific antigen levels .


To validate the association between accommodation and visual asthenopia by measuring objective accommodative amplitude with the Optical Quality Analysis System ( OQAS , Visiometrics , Terrassa , Spain ) , and to investigate associations among accommodation , ocular surface instability , and visual asthenopia while viewing 3D displays .


Fifteen normal adults without any ocular disease or surgical history watched the same 3D and 2D displays for 30 minutes .


Accommodative ability , ocular protection index ( OPI ) , and total ocular symptom scores were evaluated before and after viewing the 3D and 2D displays .


Accommodative ability was evaluated by the near point of accommodation ( NPA ) and OQAS to ensure reliability .


The OPI was calculated by dividing the tear breakup time ( TBUT ) by the interblink interval ( IBI ) .


The changes in accommodative ability , OPI , and total ocular symptom scores after viewing 3D and 2D displays were evaluated .


Accommodative ability evaluated by NPA and OQAS , OPI , and total ocular symptom scores changed significantly after 3D viewing ( p = 0.005 , 0.003 , 0.006 , and 0.003 , respectively ) , but yielded no difference after 2D viewing .


The objective measurement by OQAS verified the decrease of accommodative ability while viewing 3D displays .


The change of NPA , OPI , and total ocular symptom scores after 3D viewing had a significant correlation ( p < 0.05 ) , implying direct associations among these factors .


The decrease of accommodative ability after 3D viewing was validated by both subjective and objective methods in our study .


Further , the deterioration of accommodative ability and ocular surface stability may be causative factors of visual asthenopia in individuals viewing 3D displays .


Vitamin D insufficiency is common in subjects with type 2 diabetes .


Observational studies suggest that vitamin D plays a role in the pathogenesis of type 2 diabetes .


However , results of intervention studies have been inconsistent .


We investigated the effects of improving vitamin D status on insulin sensitivity , insulin secretion , and inflammatory markers in patients with type 2 diabetes .


A double blind , randomized , placebo controlled trial was conducted .


Sixteen patients with type 2 diabetes and hypovitaminosis D were recruited .


Eight patients received colecalciferol and ( 280 g daily for 2 weeks , 140 g daily for 10 weeks ) and 8 patients received identical placebo tablets for 12 weeks .


Before and after intervention , patients underwent IVGTT , hyperinsulinemic euglycemic clamp , assessment of baseline high-frequency insulin pulsatility , glucose-entrained insulin pulsatility , DXA scans , 24-hour-ambulatory blood pressure monitorings , and fasting blood samples .


Serum-25 ( OH ) vitamin D and serum-1 ,25 ( OH ) vitamin D increased significantly after 12 weeks in the intervention group ( p = 0.01 , p = 0.004 ) .


Serum-25 ( OH ) vitamin D was also significantly higher in the vitamin D group compared to the placebo group ( p = 0.02 ) after intervention .


Although no significant changes in insulin sensitivity , inflammation , blood pressure , lipid profile , or HbA1c were found , we observed borderline ( p between 0.05 and 0.10 ) improvements of insulin secretion , in terms of c-peptide levels , first phase incremental AUC insulin and insulin secretory burst mass .


Improvement in vitamin D status does not improve insulin resistance , blood pressure , inflammation or HbA1c , but might increase insulin secretion in patients with established type 2 diabetes .


We investigated acute bone turnover marker ( BTM ) responses to high-intensity resistance exercise with and without whole-body vibration ( WBV ) in young men ( n = 10 ) .


In this randomized crossover study , subjects performed 2 protocols separated by 2-week wash out periods : 1 ) resistance exercise only ( RE ) ( 3 sets 10 repetitions 80 % 1RM for 9 exercises ) ; and 2 ) WBV + RE ( side-alternating vibration platform 5 intermittent , 1-minute bouts 20 Hz , 3.38 mm peak-to-peak displacement followed by RE ) .


Fasting morning blood draws were taken before RE or WBV ( PRE ) , immediately post RE ( IP ) , and 30 minutes post RE ( 30P ) .


WBV + RE also had a blood draw after the WBV exposure ( POST WBV ) .


Blood samples were analyzed for lactate , hematocrit , bone-specific alkaline phosphatase ( Bone ALP , U/L ) , C-terminal telopeptide of type I collagen ( CTX-I , ng/mL ) and tartrate-resistant acid phosphatase 5b ( TRAP5b , U/L ) .


Lactate , hematocrit , and Bone ALP significantly increased ( p < 0.05 ) IP for both protocols .


Bone resorption markers did not change during RE only .


CTX-I significantly decreased POST WBV .


TRAP5b increased POST WBV , then significantly decreased at 30P .


Generally , BTM changes to RE only were not significant when adjusted for hemoconcentration .


The WBV stimulus altered bone resorption marker but not bone formation marker responses .


Cervical radiculopathy caused by spondylotic foraminal stenosis may require surgical treatment .


Surgical options include anterior cervical foraminotomy and fusion or posterior cervical foraminotomy .


Controversy remains regarding the preferable surgical approach .


Pertinent clinical evidence is limited to low-quality observational reports .


Therefore , treatment decisions are predominantly based on the individual surgeon 's preference and skill .


The study objective is to evaluate the efficacy and safety of posterior foraminotomy in comparison to anterior foraminotomy with fusion for the treatment of spondylotic foraminal stenosis .


This is a multicenter randomized , controlled , parallel group superiority trial .


A total of 88 adult patients are allocated in a ratio of 1:1 .


Sample size and power calculations were performed to detect the minimal clinically important difference of 14 points , with an expected standard deviation of 20 in the primary outcome parameter , Neck Disability Index , with a power of 80 % , based on an assumed maximal dropout rate of 20 % .


Secondary outcome parameters include the Core Outcome Measures Index , which investigates pain , back-specific function , work disability , social disability and patient satisfaction .


Changes in physical and mental health are evaluated using the Short Form-12 ( SF-12 ) questionnaire .


Moreover , radiological and health economic outcomes are evaluated .


Follow-up is performed 3 , 6 , 12 , 24 , 36 , 48 and 60 months after surgery .


Major inclusion criteria are cervical spondylotic foraminal stenosis causing radiculopathy of C5 , C6 or C7 and requiring decompression of one or two neuroforaminae .


Study data generation ( study sites ) and data storage , processing and statistical analysis ( Department of Medical Statistics , Informatics and Health Economics ) are clearly separated .


Data will be analyzed according to the intention-to-treat principle .


The results of the ForaC study will provide surgical treatment recommendations for spondylotic foraminal stenosis and will contribute to the understanding of its short - and long-term clinical and radiological postoperative course .


This will hopefully translate into improvements in surgical treatment and thus , clinical practice for spondylotic foraminal stenosis .


Current Controlled Trials : ISRCTN82578069 .


To explore the effects of five-element music therapy on elderly patients with seasonal affective disorder in a Chinese nursing home .


The patients ( n = 50 ) were recruited from a Shijingshan district nursing home in Beijing , China .


They were randomly assigned to two groups , a treatment group and a control group , with 25 participants in each group .


The patients received music therapy for 1-2 h each week over an 8-week period .


The music therapy involved four phases : introduction , activities , listening to the Chinese five-element music , and a concluding phase .


The participants in the control group did not listen to the five-element music .


This study consisted of two parts : ( a ) a qualitative study that used focus groups to understand the feelings of the patients with seasonal affective disorder ; ( b ) a quantitative study that involved administration of the self-rating depression scale ( SDS ) and Hamilton depression scale ( HAMD ) before and after treatment .


( a ) Qualitative analysis results : strength derived from the five-element group music therapy and emotional adjustment .


The five-element group music therapy can reduce patients ' psychological distress and let them feel inner peace and enhance their life satisfaction .


( b ) No significant difference in SDS and HAMD scores was found between the two groups ( P > 0.05 ) prior to treatment .


After treatment , the mean SDS score of the control group was 49.9 + / - 18.8 , while the treatment group 's score was 40.2 + / - 18.1 .


The HAMD score of the control group was 11.2 + / -3.1 , and the treatment group 's score was 8.8 + / - 4.9 .


Following 8 weeks of music therapy , the SDS and HAMD scores of the treatment group were significantly lower than those for the control group ( P < 0.05 ) .


Five-element music therapy alleviated the symptoms of seasonal affective disorder in the elderly patients .


Intubation in patients with suspected cervical spine injury must be cautiously performed to avoid any further neurologic trauma .


Several intubation techniques have been introduced to minimize cervical spine motion such as the use of the videolaryngoscope .


The present study aims to compare the movement of the cervical spine during intubation by using McGrath series 5 videolaryngoscope ( MGL ) and that of the conventional Macintosh laryngoscope from cinefluoroscopic imaging .


Twenty-two patients undergoing elective orthopedic surgery that did not involve cervical spine procedure and required general anesthesia were recruited into the study .


All patients were randomized either to have intubation with MGL ( n = 11 ) or Macintosh laryngoscope ( n = 11 ) in a neutral position with manual in-line stabilization ( MILS ) .


The primary outcome was the cervical vertebral angle changes pre - and post-intubation , measured by cinefluoroscopy .


The number of intubation attempts , the laryngoscopic view , the time to intubation , and the incidence ofany complications were recorded as well .


Eleven patients were included in each group without any exclusion from the study .


The cervical vertebral angle changes pre - and post-intubation with the MGL was less than with the Macintosh laryngoscope at C3/4 ( 2.00 vs. 4.27 degrees , respectively ; p-value = 0.034 ) and the cumulative changes of all cervical spine levels ( 9.18 vs. 17.18 degrees , respectively ; p-value = 0.017 ) .


However , the time to intubation with the MGL was longer ( 35.07 vs. 23.21 seconds , p-value = 0.004 ) , the laryngoscope view was better .


There were no statistically significant differences in the intubation success rate , the number of attempts , and the incidence of complications .


Orotracheal intubation with MGL provided less cervical spine motion and improved visualization of the vocal cords , without causing adverse consequences as compared with Macintosh laryngoscope and MILS .


Protease inhibitor monotherapy is associated with more frequent episodes of viral rebounds above 50 copies/mL than triple therapy .


To evaluate if , compared to triple-drug therapy , protease inhibitor monotherapy is associated with increased levels of inflammatory/procoagulant markers and more frequent plasma residual viremia detection .


In this cross-sectional study , we included patients treated for 1 year with darunavir/ritonavir or lopinavir/ritonavir as monotherapy ( n = 72 ) or with two nucleos ( t ) ides ( n = 74 ) .


All samples were tested for CRP , IL-6 , fibrinogen and D-dimer .


Residual viremia was determined using an ultrasensitive qualitative nested-PCR of the HIV pol gene with a limit of detection of 1 copy of HIV-RNA .


We found no differences in levels of inflammatory/procoagulant markers or in the proportion of patients with plasma residual viremia detection by treatment group .


The long-term treatment with protease inhibitor monotherapy in the setting of routine clinical practice is not associated with a higher prevalence of plasma residual viremia or more elevated inflammatory/procoagulant markers levels than triple drug therapy .


There is limited evidence with regard to the effect of different sources of protein on appetite during weight loss .


Vegetarian and meat-based high-protein diets may have contrasting effects on appetite and biomarkers of protein-induced satiety .


The aim was to assess appetite response to meat or vegetarian high-protein weight-loss ( HPWL ) diets in obese men to monitor plasma amino acid profile and gut peptide response as potential satiety biomarkers .


Twenty obese [ body mass index ( in kg/m ) : 34.8 ] men participated in a dietary intervention study .


After 3 d of a maintenance diet , they were provided in a crossover design with either a vegetarian HPWL ( Soy-HPWL ) or a meat-based HPWL ( Meat-HPWL ) diet for 2 wk .


Both diets comprised 30 % protein , 30 % fat , and 40 % carbohydrate , provided to measured resting metabolic rate .


Body weight and the motivation to eat were measured daily .


Plasma satiety biomarkers were collected during a test-meal challenge ( 5 h ) at the end of each diet period .


Over the 2 wk , subjects lost , on average , 2.41 and 2.27 kg with consumption of the Soy - and Meat-HPWL diets , respectively [ P = 0.352 ; SE of the difference ( SED ) : 0.1 ] .


ANOVA confirmed that subjectively rated hunger ( P = 0.569 ; SED : 3.8 ) , fullness ( P = 0.404 ; SED : 4.1 ) , desire to eat ( P = 0.356 ; SED : 3.7 ) , preservation of lean body mass ( P = 0.334 ; SED : 0.2 ) , and loss of percentage fat mass ( P = 0.179 ; SED : 0.2 ) did not differ between the 2 HPWL diets .


There were differences in absolute concentrations of ghrelin and peptide YY between the 2 HPWL diets , although the response as net area under the curve was not different .


Appetite control and weight loss were similar for both HPWL diets .


Gut hormone profile was similar between the diets , which suggests that vegetarian diets can be as effective as meat-based diets for appetite control during weight loss .


Alveolar osteitis ( AO ) is a commonly seen post-operative complication during the wound-healing period after permanent tooth extraction or surgical removal of impacted third molar teeth .


The aim of this clinical study was to evaluate the effects of administration of the topical hemostatic agent Ankaferd Blood Stopper ( ABS ) into the socket on AO formation after impacted mandibular third molar extraction .


Bilaterally , 100 half-impacted mandibular third molars were extracted in 50 patients .


Then , 1.0 mL ABS was administered to achieve hemostasis in one half of the sockets and as a control , the other half was irrigated with 1.0 mL physiological serum after surgery .


There was no statistically significant difference in terms of AO formation ( P > 0.05 ) between the extraction sites .


However , the postoperative pain in ABS administration sites was higher than in the other sites for the first 2 days after surgery ( P < 0.05 ) .


The results showed that ABS administration did not increase the incidence of AO formation .


Thus , ABS can be used safely for hemostasis after impacted mandibular third molar surgery .


To determine the effects of co-ingesting caffeine ( CAF ) and carbohydrate ( CHO ) on high-intensity intermittent sprints ( HIS ) performance and physiological responses .


Twelve active males underwent 4 interventions at least 7days apart in a randomized , double-blind , placebo-controlled , balanced trial .


A meal contained 65 % CHO was provided 2h before the HIS test .


Participants ingested the placebo ( PLA ) or CAF ( 6mgkg ( -1 ) BW ) 1h before taking an HIS test , and ingested a PLA or CHO solution ( 0.8 gkg ( -1 ) BW ) before undergoing the testing protocol .


The HIS protocol comprised ten sets of 54-s sprints on a cycle ergometer with a 2-min recovery between each set .


There was no significant difference between peak power output and mean power output between trials ( p > 0.05 ) .


Compared with PLA , CAF+CHO resulted in a 5.2 % reduction in total work , corresponding to a 24.7-25 .7 % increase in fatigue at the end stage of the HIS .


The administration of CAF+CHO supplementation also resulted in an 11.1 % increase in blood lactate , and elevated blood glucose concentrations throughout HIS testing compared with PLA ( p < 0.05 ) .


Cortisol concentrations also increased with CAF+CHO intake compared with PLA ; however , there was no significant effect of CAF+CHO supplementation on testosterone concentrations .


Co-ingestion of CAF and CHO did not improve high-intensity sprint cycling performance or reduce fatigue in active males .


Moreover , combined CAF and CHO supplementation might facilitate catabolism during prolonged high-intensity intermittent exercise .


Transversus abdominis plane block ( TAPB ) has emerged as a safe and effective regional anesthesia technique for providing postoperative lower abdominal analgesia .


Complications associated with TAPB are rare and pose a lower overall risk to the patient receiving a TAPB versus a caudal block , which is considered the gold standard for pediatric lower abdominal regional anesthesia .


Our study hypothesis was that TAPB would initially be equivalent to caudal block in providing postoperative pain control but would also show improved pain relief beyond the anticipated caudal duration .


This study was a double-blinded randomized controlled trial .


Forty-five children between the ages of 1 and 9 undergoing bilateral ureteral reimplantation surgery through a low transverse incision were enrolled .


Narcotic requirement , pain scores ( FLACC/Wong-Baker FACES ) , episodes of emesis , and antispasmodic requirement were recorded in the postanesthesia care unit ( PACU ) and at 6-hour intervals for 24 hours from the time of block placement .


Our protocol used a multimodal approach toward pain management in all children , including randomized regional technique , scheduled ketorolac , morphine as needed , and the antispasmodic , oxybutynin , as needed .


Morphine requirement showed no statistical difference during the initial 12 hours ( all P 0.68 at PACU , 6 and 12 hours ) .


However , at 24 hours those patients randomized to receive the TAPB required less cumulative morphine than the caudal group ( 0.05 mg/kg 0.06 vs 0.09 mg/kg 0.07 , P = 0.03 ) .


There was a trend toward fewer episodes of emesis in the TAPB group which reached statistical significance at 18 and 24 hours ( 6 vs 1 episodes , P = 0.03 ; and 9 vs 2 episodes , P = 0.02 ) .


Pain scores ( 0-10 ) were higher in the TAPB group in the PACU ( 3.46 2.69 vs 1.71 2.1 , P = 0.02 ) , but there were no significant differences at all subsequent time points ( all P 0.10 ) .


The TAPB group also had a higher requirement for the bladder antispasmodic oxybutynin at 24 hours ( 0.49 0.58 vs 0.28 0.17 , P = 0.003 ) .


TAPB provided superior analgesia compared with the caudal block at 6 to 24 hours after block placement , as demonstrated by a statistically significant decrease in cumulative opioid requirement , which was the primary end point .


The lower incidence of emesis in the TAPB group likely reflected the decreased opioid consumption .


Although TAPB appears to be less effective than the caudal block in preventing viscerally mediated bladder spasms , as evidenced by the higher PACU pain scores and increased oxybutynin requirement at 24 hours , this effect may be counteracted in future clinical practice by scheduled administration of the antispasmodic medications .


Considering the overall safety advantages of the TAPB over the caudal block , this should be considered a preferred regional technique for lower abdominal surgeries .


We investigated the effects of anakinra , an interleukin-1 receptor antagonist , on coronary and left ventricular function in coronary artery disease ( CAD ) patients with rheumatoid arthritis .


In a double-blind crossover trial , 80 patients with rheumatoid arthritis ( 60 with CAD and 20 without ) were randomized to a single injection of anakinra or placebo and after 48 hours to the alternative treatment .


At baseline and 3 hours after treatment , we assessed ( 1 ) flow-mediated dilation of brachial artery ; ( 2 ) coronary flow reserve , ejection fraction , systemic arterial compliance , and resistance by echocardiography ; ( 3 ) left ventricular global longitudinal and circumferential strain , peak twisting , untwisting velocity by speckle tracking ; and ( 4 ) interleukin-1 , nitrotyrosine , malondialdehyde , protein carbonyl , and Fas/Fas ligand levels .


At baseline , patients with CAD had 3-fold higher interleukin-1 , protein carbonyl , higher nitrotyrosine , malondialdehyde , and Fas/Fas ligand than non-CAD ( P < 0.05 ) .


After anakinra , there was a greater improvement of flow-mediated dilation ( 574 % versus 475 % ) , coronary flow reserve ( 374 % versus 292 % ) , arterial compliance ( 2018 % versus 217 % ) , resistance ( -1119 % versus 921 % ) , longitudinal strain ( 335 % versus 182 % ) , circumferential strain ( 225 % versus 135 % ) , peak twisting ( 305 % versus 125 % ) , untwisting velocity ( 235 % versus 135 % ) , ejection fraction ( 125 % versus 0.55 % ) , apoptotic and oxidative markers , and , in particular , of protein carbonyl ( 3520 % versus 149 % ) in CAD than in non-CAD patients ( P < 0.01 ) .


No changes in the examined markers were observed after placebo .


Interleukin-1 inhibition causes a greater improvement in endothelial , coronary aortic function in addition to left ventricular myocardial deformation and twisting in rheumatoid arthritis patients with CAD than in those without .


http://www.clinicaltrials.gov .


Unique identifier : NCT01566201 .


Preoperative short-term radiotherapy ( PRT ) in combination with total mesorectal excision ( TME ) has shown to improve local control in rectal cancer treatment , however without a survival benefit and at the cost of increased morbidity .


The current study investigates the long-term health-related quality of life ( HRQL ) of patients 14 years after treatment in the Dutch TME trial .


In the TME trial ( 1996-1999 ) 1530 Dutch patients with rectal cancer were treated with TME and randomly assigned to PRT ( 5 5 Gy ) .


In 2012 HRQL was evaluated in surviving patients ( n = 606 ) using a questionnaire combining EORTC QLQ-C30 , EORTC QLQ-CR29 and additional questions .


Results were obtained from 478 patients ( 82 % ) , with a median follow up of 14 years .


PRT+TME patients without stoma reported more faecal leakage and higher stool frequency , resulting in increased need of pads .


Furthermore , irradiated males reported more erection problems .


However , radiotherapy did not have negative effects on overall functioning .


Compared with Dutch population , patients in both treatment arms reported a small decrease in overall functioning and males reported less sexual activity , interest and enjoyment and more erection difficulties .


Irradiated females reported more vaginal dryness and more pain at intercourse compared with Dutch population .


Long-term HRQL evaluation shows that treatment-related symptoms are still present 14 years after treatment for rectal cancer .


Radiotherapy increased bowel dysfunction in patients without stoma .


Compared with the Dutch population , both groups reported increased sexual dysfunction .


Despite these treatment-related symptoms , there was no difference in overall functioning and global health between TME and PRT+TME .


We investigated the temporal changes in circulating levels of markers of extracellular cardiac matrix ( ECCM ) turnover and their relationship with infarct size ( IS ) , ejection fraction ( EF ) , and left ventricular ( LV ) volumes , determined by serial cardiac magnetic resonance ( CMR ) imaging in patients with first-time ST-elevation myocardial infarction ( STEMI ) .


Forty-two patients with a first-time STEMI , successfully revascularized by primary percutaneous coronary intervention ( pPCI ) had serum samples taken prior to pPCI , 2 , 7 days , 2 months , and 1 year following STEMI for the analysis of the markers of collagen synthesis , and collagen degradation .


Late enhancement and cine CMR was performed on Days 2 , 7 , 2 months , and 1-year post-STEMI .


There was a significant increase in type I collagen degradation following STEMI that was not accompanied by an increase in collagen type I synthesis until 2 months and 1 year .


In contrast to the delay in type I collagen synthesis , there was an immediate increase in type III collagen synthesis that was sustained for 1 year .


N-terminal procollagen type I levels assessed prior to pPCI were predictive of adverse LV remodelling at all CMR time-points .


Our findings indicate a net type I collagen breakdown in the first week following STEMI compensated by an early increase in collagen type III synthesis .


There is an increase in both type I and III collagen synthesis markers at 2 months and 1 year , indicating a persistent increase in collagen turnover even in these apparently successfully treated patients .


Virtually all early cases of knee osteoarthritis have degenerative medial meniscus lesions accompanying the chondral defects on MRI .


It is difficult to determine if the symptoms are caused by the unstable meniscus or by osteoarthritis , hence unclear guidance towards treatment .


We , therefore , aimed to determine the clinical improvement following arthroscopic meniscectomy compared to intraarticular administration of corticosteroids for degenerative ruptures of the medial meniscus in the presence of early stage medial compartment knee osteoarthritis .


We included 120 consecutive cases of nontraumatic symptomatic knees which had degenerative lesions of the medial compartment ( cartilage and meniscus ) on MRI 's .


They were randomized to receive either intraarticular steroid injection or arthroscopic debridement .


We also analyzed the correlation between BMI , age , gender , MRI , intraoperative aspect of the meniscus and cartilage and clinical improvement using the Oxford Knee Score up to one year .


At one month there was significant improvement of the scores for all the examined cases .


Also at one month , the arthroscopic group performed better in terms of symptom improvement .


This was maintained for 79 % of the knees in the arthroscopic group and 61 % in the intraarticular steroid injection respectively , out of those available for follow up at one year .


At one month , symptoms reappeared for 12 patients in the steroid group and 7 in the arthroscopy respectively .


Gender and age did not correlate with treatment , whereas extrusion of the meniscus , bone marrow edema , duration of the clinical symptoms , obesity and a low preoperative score were negative prognostic factors .


Degenerative medial meniscal tears , in the presence of osteoarthritis , can only marginally benefit from arthroscopic debridement over intraarticular steroid injections in short term follow up .


When considering individual cases , factors become more predictive when analyzed in group .


To assess the efficacy of an exercise program on a whole-body vibration platform ( WBV ) in improving body balance and muscle performance and preventing falls in institutionalized elderly people .


A multicentre randomized parallel assessor-blinded clinical trial was conducted in elderly persons living in nursing homes .


Participants were randomized to an exercise program performed either on a whole body vibratory platform ( WBV plus exercise group ) or on a stationary surface ( exercise group ) .


The exercise program for both groups consisted of static and dynamic exercises ( balance and strength training over a 6-week training period of 3 sessions per week ) .


The frequency applied on the vibratory platform was 30 to 35 Hz and amplitude was 2 to 4 mm .


The primary outcome measurement was static/dynamic body balance .


Secondary outcomes were muscle strength and number of falls .


Efficacy was analyzed on an intention-to-treat basis and per protocol .


The effects of the intervention were evaluated using the t test , Mann-Whitney test , or chi-square test , depending on the type of outcome .


Follow-up measurements were collected 6 weeks and 6 months after randomization .


A total of 159 participants from 10 centers were included : 81 in the WBV plus exercise group and 78 in the control group .


Mean age was 82 years , and 67.29 % were women .


The Tinetti test score showed a significant overall improvement in both groups ( P < .001 ) .


No significant differences were found between groups at week 6 ( P = .890 ) or month 6 ( P = .718 ) .


The Timed Up and Go test did not improve ( P = .599 ) in either group over time , and no significant differences were found between groups at week 6 ( P = .757 ) or month 6 ( P = .959 ) .


Muscle performance results from the 5 Sit-To-Stand tests improved significantly across time ( P = .001 ) , but no statistically significant differences were found between groups at week 6 ( P = .709 ) or month 6 ( P = .841 ) .


A total of 57 falls ( 35.8 % ) were recorded during the follow-up period , with no differences between groups ( P = .406 ) .


Exercise program on a vibratory platform provides benefits similar to those with exercise program on a stationary surface in relation to body balance , gait , functional mobility , and muscle strength in institutionalized elderly people .


Longer studies in larger samples are needed to assess falls .


Depressive disorders are highly prevalent in the working population and are associated with excessive costs .


The evidence for effective worker-directed interventions for employees with depressive symptoms is limited .


Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving .


In this study , we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms .


We report on the posttreatment effectiveness of the intervention .


This study is a two-arm randomized controlled trial comparing a Web-based guided self-help course to care as usual ( CAU ) .


We recruited employees from 6 different companies via the companies ' intranet and posters .


The main inclusion criterion was elevated depressive symptoms as measured by a score of 16 on the Center for Epidemiological Studies Depression scale ( CES-D ) .


The intervention ( Happy@Work ) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons .


Participants were asked to submit their weekly assignment via the website after completion .


They subsequently received feedback from a coach via the website .


Self-report questionnaires on depressive symptoms ( CES-D ; primary outcome ) , anxiety measured by the Hospital Anxiety and Depression Scale ( HADS ) , burnout measured by the Maslach Burnout Inventory ( MBI ) , and work performance measured by the Health and Work Performance Questionnaire ( HPQ ; secondary outcomes ) were completed at baseline and at posttreatment .


A total of 231 employees were randomized to either the intervention group ( n = 116 ) or CAU ( n = 115 ) .


The posttreatment assessment was completed by 171 ( 74.0 % ) participants .


Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms , but no differences between the conditions was found ( d = 0.16 , 95 % CI -0.10 to 0.41 , P = .29 ) .


Significant but small effects in favor of the intervention group were found for anxiety symptoms ( d = 0.16 , 95 % CI -0.09 to 0.42 , P = .04 ) and exhaustion ( d = 0.17 , 95 % CI -0.09 to 0.43 , P = .02 ) .


This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU .


Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed .


Chronic hepatitis C virus ( HCV ) infection is characterised by a failure of virus-specific CD8 + T cells that is mainly caused by viral escape and T cell exhaustion .


Constant antigen stimulation has been suggested to contribute to HCV-specific CD8 + T cell exhaustion .


However , IFN-based therapies failed to recover HCV-specific CD8 + T cell function suggesting that the damage to CD8 + T cells may be permanent even after antigen removal .


It was therefore the objective of this study to analyse the impact of inhibition of ongoing viral replication by IFN-free therapy with direct acting antivirals ( DAA ) on the phenotype and function of HCV-specific CD8 + T cells .


Virus-specific CD8 + T cells obtained from a patient cohort of 51 previously untreated chronically infected patients undergoing IFN-free therapy with a combination of faldaprevir ( a protease inhibitor ) and deleobuvir ( a non-nucleoside polymerase inhibitor ) with or without ribavirin were analysed ex vivo and after in vitro expansion at baseline , wk4 , wk 12 , and after treatment .


Our results show the rapid restoration of proliferative HCV-specific CD8 + T cells in the majority of patients with SVR12 within 4 weeks of therapy suggesting that IFN-free therapy mediated antigen removal may restore CD8 + T cell function .


This study indicates a specific restoration of proliferative HCV-specific CD8 + T cells under IFN-free therapy .


This is in contrast to PegIFN-based therapies that have been shown not to restore T cell function during and after chronic infection .


Obesity is associated with metabolic dysfunctions , which may be mediated by changes in adipose tissue signaling factors .


These molecules are denoted as Adipose Tissue Generated Mediators of CardioVascular Risk ( ATGMCVR ) here , and include leptin , adiponectin , C-reactive protein ( CRP ) , interleukin 6 ( IL-6 ) , tumor necrosis factor alpha ( TNF ) , and plasminogen activator inhibitor 1 ( PAI-1 ) .


This study examined the effect of a weight loss program on ATGMCVR in obese adults with prediabetes .


Subjects were randomized to usual care ( UC ; n = 15 ) or lifestyle weight loss groups ( LWL ; n = 15 ) .


LWL was a community-based weight loss intervention to promote physical activity and healthy eating .


ATGMCVR at 1-year were compared between groups by analysis of covariance ; baseline value of the mediator was the covariate .


Baseline means for ATGMCVR were compared between those with ( n = 21 ) and without ( n = 9 ) metabolic syndrome ( MetS ) .


At baseline , subjects were 589 ( SD ) years , 70 % female , with a BMI of 344kg/m ( 2 ) .


One-year weight loss ( % ) was 7.86.0 % for LWL and 1.74.5 % for UC .


Group differences at 1-year were noted ( adjusted means [ 95 % CI ] for UC and LWL , respectively ) for adiponectin ( 8526.3 [ 7397.7 , 9827 ] ; 10,870.9 [ 9432.0 , 12,529.3 ] ng/ml ; p = 0.02 ) , leptin ( 30.4 [ 26.1 , 35.4 ] ; 23.7 [ 20.3 , 27.5 ] ng/ml ; p = 0.02 ) , IL-6 ( 0.4 [ 0.3 , 0.5 ] ; 0.2 [ 0.1 , 0.2 ] pg/ml ; p = 0.001 ) , and PAI-1 ( 50 [ 42.7 , 58.7 ] ; 36.2 [ 30.8 , 42.4 ] pg/ml ; p = 0.01 ) .


No differences in baseline ATGMCVR were seen between subjects with and without MetS .


These findings suggest ATGMCVR can be improved with weight loss ; larger studies are needed to determine if improvements in metabolic dysfunction are related to changes in ATGMCVR .


The blood glucose-lowering effects of - glucan from oats and barley depend on the amounts consumed and their rheological properties .


This has been recently challenged with growing evidence that the food matrix may also be an important factor in predicting its physiological response .


The objective of this study was to examine the effects of varying doses of - glucan from oats and barley and added to a snack bar on postprandial glycemia .


In a randomized crossover study , 12 healthy males and females consumed one of 8 snack bars containing 0 ( control ) , 1.5 , 3 , and 6 g of - glucan derived from oats or barley or 3 white bread controls .


All treatments contained 50 g of available carbohydrate .


Blood glucose concentrations were measured after ingestion of the treatments over 2 hours .


Incorporation of 1.5 to 6 g of - glucan into snack bars had no additional glucose-lowering benefits irrespective of dose and source compared to the control bars ( 0 g - glucan ) , suggesting that both the solid food matrix and composition of the bars may play a role in their effects on glycemic response .


All bars reduced blood glucose area under the curve ( AUC ) by an average of 25 % ( p < 0.05 ) compared to the mean of the 3 white bread controls .


Adding - glucan from oats and barley to the snack bar formulation used in this study did not yield any additional benefits beyond the glucose-lowering effects of the snack bars themselves .


A randomized clinical trial assessing the difference in quality of life and clinical outcomes between delayed and simultaneous phlebectomies in the context of endovenous truncal vein ablation .


Endovenous ablation has replaced open surgery as the treatment of choice for truncal varicose veins .


Timing of varicosity treatment is controversial with delayed and simultaneous pathways having studies advocating their benefits .


A previous small randomized study has shown improved outcomes for simultaneous treatment .


Patients undergoing local anesthetic endovenous thermal ablation were randomized to either simultaneous phlebectomy or delayed varicosity treatment .


Patients were reviewed at 6 weeks , 6 months , and 1 year with clinical and quality of life scores completed , and were assessed at 6 weeks for need for further varicosity intervention , which was completed with either ultrasound-guided foam sclerotherapy or local anesthetic phlebectomy .


Duplex ultrasound assessment of the treated trunk was completed at 6 months .


101 patients were successfully recruited and treated out of 221 suitable patients from a screened population of 393 .


Patients in the simultaneous group ( n = 51 ) showed a significantly improved Venous Clinical Severity Score at all time points , 36 % of the delayed group required further treatment compared with 2 % of the simultaneous group ( P < 0.001 ) .


There were no deep vein thromboses , with 1 superfificial venous thrombosis in each group .


Combined endovenous ablation and phlebectomy delivers improved clinical outcomes and a reduced need for further procedures , as well as early quality of life improvements .


Although guidelines recommend in-person counseling before BRCA1/BRCA2 gene testing , genetic counseling is increasingly offered by telephone .


As genomic testing becomes more common , evaluating alternative delivery approaches becomes increasingly salient .


We tested whether telephone delivery of BRCA1/2 genetic counseling was noninferior to in-person delivery .


Participants ( women age 21 to 85 years who did not have newly diagnosed or metastatic cancer and lived within a study site catchment area ) were randomly assigned to usual care ( UC ; n = 334 ) or telephone counseling ( TC ; n = 335 ) .


UC participants received in-person pre - and post-test counseling ; TC participants completed all counseling by telephone .


Primary outcomes were knowledge , satisfaction , decision conflict , distress , and quality of life ; secondary outcomes were equivalence of BRCA1/2 test uptake and costs of delivering TC versus UC .


TC was noninferior to UC on all primary outcomes .


At 2 weeks after pretest counseling , knowledge ( d = 0.03 ; lower bound of 97.5 % CI , -0.61 ) , perceived stress ( d = -0.12 ; upper bound of 97.5 % CI , 0.21 ) , and satisfaction ( d = -0.16 ; lower bound of 97.5 % CI , -0.70 ) had group differences and confidence intervals that did not cross their 1-point noninferiority limits .


Decision conflict ( d = 1.1 ; upper bound of 97.5 % CI , 3.3 ) and cancer distress ( d = -1.6 ; upper bound of 97.5 % CI , 0.27 ) did not cross their 4-point noninferiority limit .


Results were comparable at 3 months .


TC was not equivalent to UC on BRCA1/2 test uptake ( UC , 90.1 % ; TC , 84.2 % ) .


TC yielded cost savings of $ 114 per patient .


Genetic counseling can be effectively and efficiently delivered via telephone to increase access and decrease costs .


To evaluate the effectiveness of a 12-month multicomponent obesity prevention intervention .


Setting .


9 elementary schools in Santiago , Chile .


Subjects .


6-8y old low-income children ( N = 1474 ) .


Randomized controlled study ; 5 intervention/4 control schools .


We trained teachers to deliver nutrition contents and improve the quality of PE classes .


We determined % healthy snacks brought from home , children 's nutrition knowledge , nutritional status , duration of PE classes , and % time in moderate/vigorous activity ( MVA ) .


Effectiveness was determined by comparing BMI Z between intervention and control children using PROCMIXED .


% obesity increased in boys from both types of schools and in girls from control schools , while decreasing in girls from intervention schools ( all nonsignificant ) .


% class time in MVA declined ( 24.5-16 .2 ) while remaining unchanged ( 24.8-23 .7 % ) in classes conducted by untrained and trained teachers , respectively .


In boys , BMI Z declined ( 1.33-1 .24 ) and increased ( 1.22-1 .35 ) in intervention and control schools , respectively .


In girls , BMI Z remained unchanged in intervention schools , while increasing significantly in control schools ( 0.91-1 .06 , P = 0.024 ) .


Interaction group time was significant for boys ( P < 0.0001 ) and girls ( P = 0.004 ) .


This intervention was effective in controlling obesity , but not preventing it .


Even though impact was small , results showed that when no intervention is implemented , obesity increases .


Although the potential benefits of 3-dimensional ( 3-D ) vs 2-dimensional ( 2-D ) and high-definition ( HD ) vs standard-definition ( SD ) endoscopic visualization have long been recognized in other surgical fields , such endoscopes are generally considered too large and bulky for use within the brain .


The recent development of 3-D and HD neuroendoscopes may therefore herald improved depth perception , better appreciation of anatomic details , and improved overall surgical performance .


To compare simultaneously the effectiveness of 3-D vs 2-D and HD vs SD neuroendoscopy .


Ten novice neuroendoscopic surgeons were recruited from a university hospital .


A preclinical randomized crossover study design was adopted to compare 3-D vs 2-D and HD vs SD neuroendoscopy .


The primary outcomes were time to task completion and accuracy .


The secondary outcomes were perceived task workload using the NASA ( National Aeronautics and Space Administration ) Task Load Index and subjective impressions of the endoscopes using a 5-point Likert scale .


Time to task completion was significantly shorter when using the 3-D vs the 2-D neuroendoscopy ( P = .001 ) , and accuracy of probe placement was significantly greater when using the HD vs the SD neuroendoscopy ( P = .009 ) .


We found that 3-D endoscopy significantly improved perceived depth perception ( P < .001 ) , HD endoscopy significantly improved perceived image quality ( P < .001 ) , and both improved participants ' overall impression ( P < .001 ) .


Three-dimensional neuroendoscopy and HD neuroendoscopy have differing but complementary effects on surgical performance , suggesting that neither alone can completely compensate for the lack of the other .


There is therefore strong preclinical evidence to justify 3-D HD neuroendoscopy .


To present the safety and efficacy of intravitreal implants releasing 0.2 g/day fluocinolone acetonide ( FAc ) in patients with chronic versus nonchronic diabetic macular edema ( DME ) .


To assess ocular characteristics , anatomic changes , and re-treatment and ancillary therapies that may explain the differential treatment effect seen with intravitreal implants releasing FAc 0.2 g/day in patients with chronic and nonchronic DME .


An overall benefit-to-risk assessment for the FAc 0.2-g / day and FAc 0.5-g / day doses has been reported previously .


Preplanned subgroup analysis of chronic ( duration of diagnosis , 3 years ) and nonchronic ( duration of diagnosis , < 3 years ) DME in patients from 2 randomized , sham injection-controlled , double-masked , multicenter clinical trials .


Patients with persistent DME despite 1 or more macular laser treatment were randomized 1:2:2 to sham injection ( n = 185 ) , FAc 0.2 g/day ( n = 375 ) , or FAc 0.5 g/day ( n = 393 ) .


Patients received study drug or sham injection and after 6 weeks were eligible for rescue laser .


Based on re-treatment criteria , additional masked study drug could be given after 1 year .


Percentage of patients with improvement of 15 letters or more from baseline .


Secondary outcomes included other parameters of visual function and foveal thickness .


At month 36 , the difference between FAc 0.2 g/day and sham control in the percentage of patients who gained 15 letters or more was significantly greater in chronic DME patients ( FAc 0.2 g/day , 34.0 % vs. sham , 13.4 % ; P < 0.001 ) , compared with patients with nonchronic DME ( FAc 0.2 g/day , 22.3 % vs. sham , 27.8 % ; P = 0.275 ) .


The greater response in patients with chronic DME was not associated with baseline ocular characteristics , changes in anatomic features , or differences in re-treatment or ancillary therapies .


The ocular adverse event profile for FAc 0.2 g/day was similar regardless of DME duration .


This is the first published analysis correlating duration of diagnosis of DME with treatment effect .


In patients with chronic DME , FAc 0.2 g/day provides substantial visual benefit for up to 3 years and would provide an option for patients who do not respond to other therapy .


Ischemic postconditioning ( PCON ) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction ( STEMI ) .


We evaluated the effect of PCON on microvascular obstruction ( MVO ) in STEMI patients and in an experimental swine model .


A prospective randomized study in patients and an experimental study in swine were carried out in two university hospitals in Spain .


101 consecutive STEMI patients were randomized to undergo primary angioplasty followed by PCON or primary angioplasty alone ( non-PCON ) .


Using late gadolinium enhancement cardiovascular magnetic resonance , infarct size and MVO were quantified ( % of left ventricular mass ) .


In swine , using an angioplasty balloon-induced anterior STEMI model , MVO was defined as the % of area at risk without thioflavin-S staining .


In patients , PCON ( n = 49 ) in comparison with non-PCON ( n = 52 ) did not significantly reduce MVO ( 0 [ 0-1 .02 ] % vs. 0 [ 0-2 .1 ] % p = 0.2 ) or IS ( 18 13 % vs. 21 14 % , p = 0.2 ) .


MVO ( > 1 segment in the 17-segment model ) occurred in 12/49 ( 25 % ) PCON and in 18/52 ( 35 % ) non-PCON patients , p = 0.3 .


No significant differences were observed between PCON and non-PCON patients in left ventricular volumes , ejection fraction or the extent of hemorrhage .


In the swine model , MVO occurred in 4/6 ( 67 % ) PCON and in 4/6 ( 67 % ) non-PCON pigs , p = 0.9 .


The extent of MVO ( 10 7 % vs. 10 8 % , p = 0.9 ) and infarct size ( 23 14 % vs. 24 10 % , p = 0.8 ) was not reduced in PCON compared with non-PCON pigs .


Ischemic postconditioning does not significantly reduce microvascular obstruction in ST-segment elevation myocardial infarction .


Clinical Trial Registration http://www.clinicaltrials.gov .


Unique identifier : NCT01898546 .


Sub-anesthetic ketamine infusions may benefit a variety of psychiatric disorders , including addiction .


Though ketamine engenders transient alterations in consciousness , it is not known whether these alterations influence efficacy .


This analysis evaluates the mystical-type effects of ketamine , which may have therapeutic potential according to prior research , and assesses whether these effects mediate improvements in dependence-related deficits , 24h postinfusion .


Eight cocaine dependent individuals completed this double-blind , randomized , inpatient study .


Three counter-balanced infusions separated by 48h were received : lorazepam ( 2mg ) and two doses of ketamine ( 0.41 mg/kg and 0.71 mg/kg , with the former dose always preceding the latter ) .


Infusions were followed within 15min by measures of dissociation ( Clinician Administered Dissociative Symptoms Scale : CADSS ) and mystical-type effects ( adapted from Hood 's Mysticism Scale : HMS ) .


At baseline and 24h postinfusion , participants underwent assessments of motivation to stop cocaine ( University of Rhode Island Change Assessment ) and cue-induced craving ( by visual analogue scale for cocaine craving during cue exposure ) .


Ketamine led to significantly greater acute mystical-type effects ( by HMS ) relative to the active control lorazepam ; ketamine 0.71 mg/kg was associated with significantly higher HMS scores than was the 0.41 mg/kg dose .


HMS score , but not CADSS score , was found to mediate the effect of ketamine on motivation to quit cocaine 24h postinfusion .


These findings suggest that psychological mechanisms may be involved in some of the anti-addiction benefits resulting from ketamine .


Future research can evaluate whether the psychoactive effects of ketamine influence improvements in larger samples .


Although facial hyperhidrosis has been frequently associated with a diminished quality of life , various conservative modalities for its management are still far from satisfactory .


To evaluate the antiperspirant efficacy and safety of the topical glycopyrrolate on facial hyperhidrosis at specified posttreatment intervals .


Thirty-nine patients with facial hyperhidrosis were enrolled and treated with 2 % topical glycopyrrolate on one-half of the forehead , whereas the other half of the forehead was treated with a placebo .


All patients applied topical glycopyrrolate or placebo once a day for nine successive days .


Each evaluation included weighing sweat and assessing the Hyperhidrosis Disease Severity Scale ( HDSS ) score and any adverse effects .


Compared with the placebo-treated sides , topical glycopyrrolate-treated sides showed a reduction in the rate of sweat production at the forehead of 25.16 10.30 % ( mean SD ) at 90 min after the first application ( day 1 ) , 29.63 7.74 % at 24 h after the first application ( day 2 ) and 36.68 11.41 % at 24 h after eight additional successive daily applications ( day 10 ) ( all P < 0.025 ) .


There was a little more decrease in HDSS score with the topical glycopyrrolate-treated half of the forehead , but the difference was not statistically significant ( P > 0.025 ) .


No serious adverse events were reported during the course of this study .


Only one patient developed a transient headache after treatment .


Topical glycopyrrolate application appears to be significantly effective and safe in reducing excessive facial perspiration .


To examine the association between Mini-Mental State Examination ( MMSE ) score and motor vehicle crash ( MVC ) risk in a large cohort of community-dwelling participants with cardiovascular disease ( CVD ) or diabetes mellitus .


Prospective observational study .


Participants enrolled in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease clinical trial , which included individuals aged 55 and older with CVD or diabetes mellitus .


Totally 17,538 frequent drivers ( defined as driving at least once per week ) who had completed a baseline MMSE .


Involvement in a MVC as the driver .


Baseline MMSE score was divided into four categories : 30 , 27-29 , 24-26 , and < 24 .


The median MMSE score was 29 ( interquartile range 27-30 ) , and 726 ( 4.1 % ) has a MMSE score of less than 24 at baseline .


After a mean follow-up of 4.5 years , 1,068 ( 6.1 % ) participants were drivers in a MVC .


Lower scores were not associated with future MVCs ( MMSE score 29-27 , hazard ratio ( HR ) = 1.06 , 95 % confidence interval ( CI ) = 0.93-1 .22 ) ; MMSE score 26-24 , HR = 0.96 , 95 % CI = 0.78-1 .19 ; MMSE score < 24 , HR = 0.72 , 95 % CI = 0.50-1 .05 ) on multivariable analysis .


A MVC within the previous 2 years ( HR = 2.68 , 95 % CI = 2.29-3 .13 ) was the strongest predictor of future MVCs .


Other clinical factors associated with greater MVC risk were depression , falls within the previous year , sleep apnea , and lower baseline systolic blood pressure .


In a population of frequent drivers , the MMSE does not predict MVCs .


Other clinical factors have a stronger association with MVC risk .


Primary dysmenorrhea refers to painful menstrual cramps without pelvic pathology .


The condition is highly prevalent among women and exerts negative effects on their quality of life .


Considering the evidence for anti-inflammatory properties of Boron , the present study aimed to determine the effects of Boron supplementation on the severity and duration of menstrual pain in female university students .


This triple-blind randomized clinical trial study recruited 113 university students .


The participants were matched for the severity and duration of dysmenorrhea and randomly allocated into the case and control groups ( n = 58 and 55 , respectively ) .


The case group consumed 10 mg/day Boron from two days before the menstrual flow until its third day .


The control group received placebo capsules ( similar to those distributed among the cases ) .


All subjects were asked to take the capsules for two consecutive menstrual cycles .


Pain severity ( measured on a visual analog scale ) and duration ( in hours ) were measured at baseline and during the two cycles .


The two groups had no significant differences in the severity and duration of pain at baseline .


After the intervention , however , the severity and duration of pain were significantly lower in the case group than in the control group ( P < 0.05 ) .


Based on our findings , Boron supplementation can reduce the severity and duration of menstrual pain through exerting anti-inflammatory effects .


In order to clarify the effects of Boron on dysmenorrhea , future studies are required to measure the levels of hormones and inflammatory biomarkers .


The present study examined the impact of BP from childhood to mid-adulthood on retinal microvascular architecture .


The Cardiovascular Risk in Young Finns Study included children aged 3-18 years , from five Finnish University cities , with participants chosen randomly from the national population registrar from those areas .


The age of participants included in the current analyses in childhood ( 1980 ) ranged from three to nine years and in mid-adulthood ( 2011 ) ranged from 34 to 40 years ( complete data n = 657 ) .


Measures of retinal microvasculature architecture measured in adulthood included diameters , tortuosity , lengths , and LDR .


Regression analysis showed a strong negative association between childhood systolic BP and adult arteriolar diameter ( standardized regression coefficient [ ] -0.300 ; p < 0.001 ) and with change in systolic BP from childhood to adulthood ( = -0.249 ; p < 0.001 ) .


For arteriolar tortuosity , there was a strong positive association between childhood systolic BP and adult arteriolar tortuosity ( = 0.154 ; p < 0.001 ) and no association with change in systolic BP from childhood to adulthood ( = 0.072 ; p = 0.110 ) .


High BP in childhood and increased BP from childhood to adulthood impacts on retinal microvascular architecture in mid-adulthood .


To evaluate quantitative relationships between baseline Q-wave width and 90-day outcomes in ST-segment elevation myocardial infarction ( STEMI ) .


Baseline Q-waves are useful in predicting clinical outcomes after MI .


3589 STEMI patients were assessed from a multi-centre study .


1156 patients of the overall cohort had pathologic Q-waves .


The 90-day mortality and the composite of mortality , congestive heart failure ( CHF ) , or cardiogenic shock ( p < 0.001 for both outcomes ) rose as Q-wave width increased .


After adapting a threshold 40ms for inferior and 20ms for lateral/apical MI in all patients ( n = 3065 ) with any measureable Q-wave we found hazard ratios ( HR ) for mortality ( HR : 2.44 , 95 % confidence interval ( CI ) ( 1.54-3 .85 ) , p < 0.001 ) and the composite ( HR : 2.32 , 95 % CI ( 1.70-3 .16 ) , p < 0.001 ) .


This improved reclassification of patients experiencing the composite endpoint versus the conventional definition ( net reclassification index ( NRI ) : 0.23 , 95 % CI ( 0.09-0 .36 ) , p < 0.001 ) and universal MI definition ( NRI : 0.15 , 95 % CI ( 0.02-0 .29 ) , p = 0.027 ) .


The width of the baseline Q-wave in STEMI adds prognostic value in predicting 90-day clinical outcomes .


A threshold of 40ms in inferior and 20ms for lateral/apical MI enhances prognostic insight beyond current criteria .


The relationship between current asthma symptoms and rescue bronchodilator ( reliever ) use is uncertain , leading to different recommendations about the preferred reliever metric to use when assessing asthma control .


In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever , we measured inhaler use by electronic monitoring .


To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment .


Data on albuterol use were extracted for the 7-day period before visit 2 ( at week 3 ) from 150 adult patients with asthma .


Current asthma symptoms were measured by Asthma Control Questionnaire-5 ( ACQ-5 ) score at the clinic visit .


The number of days of albuterol use , the average number of albuterol actuations/day , and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score ( r = 0.41-0 .45 , P < .001 ) and had moderate discrimination for well-controlled and not well-controlled asthma ( ACQ-5 scores 0.75 and 1.5 , respectively ) , with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77 , respectively .


Cut points of 3 days of albuterol use , average albuterol use of 1 actuation/day , and highest albuterol use of 4 actuations/day in the 1-week period had 73 % sensitivity and 62 % specificity , 78 % sensitivity and 67 % specificity , and 78 % sensitivity and 66 % specificity , respectively , for predicting an ACQ-5 1.5 .


Our findings support the use of the number of days of albuterol use , the average number of albuterol actuations per day , and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control .


Tenofovir has been associated with a decrease in bone mineral density ( BMD ) .


However , data on changes in BMD after discontinuing tenofovir are lacking .


We performed a two-centre randomized pilot study in virologically suppressed HIV-infected patients receiving tenofovir with osteopenia/osteoporosis ( OsteoTDF study , ClinicalTrials.gov number NCT 01153217 ) .


Fifty-four patients were randomly assigned to switch from tenofovir to abacavir ( n = 26 ) or to continue with tenofovir ( n = 28 ) .


Changes in lumbar and total hip BMD were evaluated at Week 48 from baseline .


Five patients discontinued the study ( three from the tenofovir group and two from the abacavir group ) .


No significant differences were detected between the groups at Week 48 ( P = 0.229 for total hip and P = 0.312 for lumbar spine ) .


However , hip BMD improved by 2.1 % ( 95 % CI -0.6 to 4.7 ) ( P = 0.043 ) in the abacavir group and 0.7 % ( 95 % CI -0.9 to 2.4 ) ( P = 0.372 ) in the tenofovir group .


Lumbar spine BMD varied by -0.7 % ( 95 % CI -3.8 to 3.3 ) ( P 0.001 ) in the abacavir group and -1.2 % ( 95 % CI -3.8 to 0.4 ) ( P < 0.001 ) in the tenofovir group .


Switching from tenofovir to abacavir led to a slight improvement in femoral BMD although no differences were detected between groups .


Larger studies are necessary before firm recommendations can be made on the discontinuation of tenofovir in patients with a low BMD .


Binaural interaction can be investigated using auditory evoked potentials .


A binaural interaction component can be derived from the auditory brainstem response ( ABR-BIC ) and is considered evidence for binaural interaction at the level of the brainstem .


Although click ABR-BIC has been investigated thoroughly , data on 500 Hz tone-burst ( TB ) ABR-BICs are scarce .


In this study , characteristics of click and 500 Hz TB ABR-BICs are described .


Furthermore , reliability of both click and 500 Hz TB ABR-BIC are investigated .


Eighteen normal hearing young adults ( eight women , ten men ) were included .


ABRs were recorded in response to clicks and 500 Hz TBs .


ABR-BICs were derived by subtracting the binaural response from the sum of the monaural responses measured in opposite ears .


Good inter-rater reliability is obtained for both click and 500 Hz TB ABR-BICs .


The most reliable peak in click ABR-BIC occurs at a mean latency of 6.06 ms ( SD 0.354 ms ) .


Reliable 500 Hz TB ABR-BIC are obtained with a mean latency of 9.47 ms ( SD 0.678 ms ) .


Amplitudes are larger for 500 Hz TB ABR-BIC than for clicks .


The most reliable peak in click ABR-BIC occurs at the downslope of wave V. Five hundred Hertz TB ABR-BIC is characterized by a broad positivity occurring at the level of wave V.


The ABR-BIC is a useful technique to investigate binaural interaction in certain populations .


Examples are bilateral hearing aid users , bilateral cochlear implant users and bimodal listeners .


The latter refers to the combination of unilateral cochlear implantation and contralateral residual hearing .


The majority of these patients have residual hearing in the low frequencies .


The current study suggests that 500 Hz TB ABR-BIC may be a suitable technique to assess binaural interaction in this specific population of cochlear implant users .


To evaluate the possible association between pressure pain sensitivity of the chest bone ( PPS ) and cardiovascular physiological factors related to persistent stress in connection with a three-month PPS-guided stress-reducing experimental intervention programme .


Forty-two office workers with an elevated PPS ( 60 arbitrary units ) as a sign of increased level of persistent stress , completed a single-blinded cluster randomized controlled trial .


The active treatment was a PPS ( self-measurement ) - guided stress management programme .


Primary endpoints : Blood pressure ( BP ) , heart rate ( HR ) and work of the heart measured as Pressure-Rate-Product ( PRP ) ; Secondary endpoints : Other features of the metabolic syndrome .


PPS decreased and changes in PPS after the intervention period were significantly associated with HR , PRP , body mass index ( BMI ) and visceral fat index ( all correlation coefficients > 0.2 , p < 0.05 ) .


Compared to the control cluster group , the active cluster group obtained a significant reduction in PPS , Low-density lipoprotein ( LDL ) cholesterol and total number of elevated risk factors ( p < 0.05 ) .


On an individual level , significant and clinically relevant between-group reductions were observed in respect to BP , HR , PRP , total and LDL cholesterol , and total number of elevated risk factors ( p < 0.05 ) .


The stress intervention method applied in this study induced a decrease in PPS which was associated with a clinically relevant decrease in resting blood pressure , heart rate , work of the heart and serum cholesterols .


The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality .


To improve access to high-quality healthcare and equity , national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting .


There is a need to evaluate the implementation of these unique approaches .


We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms , the fidelity between the activities initially planned and those conducted , the implementation and adaptation processes , the sustainability of the interventions , the possibilities for scaling them up , and their ethical implications .


The study adopts a longitudinal multiple case study design with several embedded levels of analyses .


To represent the diversity of contexts where the intervention arms are carried out , we will select three districts .


Within districts , we will select both primary healthcare centers ( n = 18 ) representing different intervention arms and the district or regional hospital ( n = 3 ) .


We will select contrasted cases in relation to their initial performance ( good , fair , poor ) .


Over a period of 18 months , we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews , participatory observation , research diaries , and questionnaires .


We will give more weight to qualitative methods compared to quantitative methods .


Performance-based financing is expanding rapidly across low - and middle-income countries .


The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity .


Obesity is a major public health problem for which early preventive interventions are needed .


Large numbers of young children are enrolled in some form of child care program , making these facilities influential environments in children 's development .


Family child care homes ( FCCH ) are a specific type of child care in which children are cared for within the provider 's own residence .


FCCHs serve approximately 1.5 million children in the U.S. ; however , research to date has overlooked FCCH providers and their potential to positively influence children 's health-related behaviors .


Keys to Healthy Family Child Care Homes ( Keys ) is a cluster-randomized controlled trial testing the efficacy of an intervention designed to help providers become healthy role models , provide quality food - and physical activity-supportive FCCH environments , and implement effective business practices .


The intervention is delivered through workshops , home visits , tailored coaching calls , and educational toolkits .


Primary outcomes are child physical activity measured via accelerometry data and dietary intake data collected using direct observation at the FCCH .


Secondary outcomes include child body mass index , provider weight-related behaviors , and observed obesogenic environmental characteristics .


Keys is an innovative approach to promoting healthy eating and physical activity in young children .


The intervention operates in a novel setting , targets children during a key developmental period , and addresses both provider and child behaviors to synergistically promote health .


Benign essential blepharospasm ( BEB ) is characterized by progressive involuntary contractions of the protractor muscles , sometimes leading to a debilitating closure of the lids .


It is currently treated with the injection of botulinum neurotoxin A ( BoNT/A ) .


The purpose of this study was to compare 2 BoNT/A preparations ( i.e. , Xeomin and Botox ) in the treatment of BEB .


This was a prospective , randomized , double-blinded split-face technique in 48 patients already treated by Botox for BEB .


Patients received the same medication to either side of the face for 4 injections , and were then evaluated using subjective and objective measures .


Blepharospasm Disability Index ( BSDI ) and Jankovic Rating Scale ( JRS ) were assessed using a repeated-measures analysis of variance ( ANOVA ) and paired t test .


Patient preference and objective comparison of residual orbicularis strength and spasm were compared using a multinomial logistic regression model , a repeated-measures ANOVA , and a paired t test .


A paired t test showed no preference between Xeomin and Botox ( P = 0.7205 ) and demonstrated a tendency toward not having a preference for either medication ( P = 0.0301 vs Botox and P = 0.0039 vs Xeomin ) .


The regression model showed no effect of time on patient preference ( P = 0.4217 ) .


The ANOVA for BSDI scores did not reveal any difference between the 2 medications as compared with baseline ( P = 0.8161 ) , nor did it demonstrate an effect of time on BSDI scores ( P = 0.6108 ) .


A paired t test found no difference between the 2 scores ( P = 0.1909 ) at baseline .


There was no difference in JRS scores for either medication when compared with baseline ( P = 0.2314 ) , nor was there an effect of time on such scores ( P = 0.4951 ) .


There was also no difference between the 2 medications according to paired t test ( P = 0.3224 ) at baseline .


Baseline residual orbicularis strength was similar between the 2 medications ( paired t test ; P = 0.3228 ) .


ANOVA shows an effect of time on orbicularis strength ( P = 0.0055 ) , but no difference was seen at any of the 5 visits ( P > 0.05 ) .


Baseline spasm scores were similar between Botox and Xeomin ( paired Student t test ; P = 0.3228 ) .


The ANOVA shows no difference between both medications at any point in time ( P = 0.4408 ) , and that time had no effect on the efficacy of either treatment ( P = 0.3268 ) .


No difference between Xeomin and Botox was detected in either subjective or objective measures for the treatment of BEB .


Co-morbid depression in HIV-positive patients on anti-retroviral ( ART ) treatment poses a public health threat .


It compromises treatment adherence and accelerates disease progression .


This study aimed to assess the feasibility of a group-based counselling intervention for depressed HIV-positive patients in primary health care ( PHC ) in South Africa using a task shifting approach .


Using a randomized control design , 76 HIV-positive patients with co-morbid depression were initially recruited .


This reduced to 34 in the final cohort .


Participants were assessed using the Patient Health Questionnaire ( PHQ9 ) , Hopkins Symptom Checklist ( HSCL-25 ) and Multidimensional Scale of Perceived Social Support ( MSPSS ) at baseline and 3-month follow-up .


The intervention was adapted from a local group-based Interpersonal Therapy ( IPT ) intervention .


Process evaluation interviews were held with the HIV counsellors who delivered the intervention and a sub-sample of participants .


Repeated measures ANOVA analysis showed significantly greater improvement on depression scores on the PHQ9 in the intervention group compared to the control group .


A significant decline in the mean scores on the HSCL-25 was found for both groups although this was more pronounced for the intervention group .


There was no significant improvement in the MSPSS scores .


The small sample size of the final cohort affected the power of the study to detect significant differences between the intervention and control groups on the MSPSS .


Longer term impact of the intervention is unknown .


These preliminary findings suggest that group-based counselling for depression in HIV-positive patients can potentially be effectively delivered by appropriately trained and supported lay HIV counsellors .


The need for a larger trial is indicated .


To evaluate antinociceptive effects and pharmacokinetics of butorphanol tartrate after IM administration to American kestrels ( Falco sparverius ) .


Fifteen 2 - to 3-year-old American kestrels ( 6 males and 9 females ) .


Butorphanol ( 1 , 3 , and 6 mg/kg ) and saline ( 0.9 % NaCl ) solution were administered IM to birds in a crossover experimental design .


Agitation-sedation scores and foot withdrawal response to a thermal stimulus were determined 30 to 60 minutes before ( baseline ) and 0.5 , 1.5 , 3 , and 6 hours after treatment .


For the pharmacokinetic analysis , butorphanol ( 6 mg/kg , IM ) was administered in the pectoral muscles of each of 12 birds .


In male kestrels , butorphanol did not significantly increase thermal thresholds for foot withdrawal , compared with results for saline solution administration .


However , at 1.5 hours after administration of 6 mg of butorphanol/kg , the thermal threshold was significantly decreased , compared with the baseline value .


Foot withdrawal threshold for female kestrels after butorphanol administration did not differ significantly from that after saline solution administration .


However , compared with the baseline value , withdrawal threshold was significantly increased for 1 mg/kg at 0.5 and 6 hours , 3 mg/kg at 6 hours , and 6 mg/kg at 3 hours .


There were no significant differences in mean sedation-agitation scores , except for males at 1.5 hours after administration of 6 mg/kg .


Butorphanol did not cause thermal antinociception suggestive of analgesia in American kestrels .


Sex-dependent responses were identified .


Further studies are needed to evaluate the analgesic effects of butorphanol in raptors .


To evaluate the efficacy and safety of dapagliflozin in patients with type 2 diabetes inadequately controlled with metformin and sulfonylurea .


Patients with HbA1c of 7.0 % ( 53 mmol/mol ) to 10.5 % ( 91 mmol/mol ) receiving sulfonylurea and metformin were randomized to receive dapagliflozin 10 mg/day ( n = 109 ) or placebo ( n = 109 ) for 24 weeks .


HbA1c ( baseline : dapagliflozin 8.08 % [ 65 mmol/mol ] ; placebo 8.24 % [ 67 mmol/mol ] ) and fasting plasma glucose ( baseline : dapagliflozin 167.4 mg/dL [ 9.29 mmol/L ] ; placebo 180.5 mg/dL [ 10.02 mmol/L ] ) significantly improved from baseline with dapagliflozin ( placebo-subtracted change -0.69 % [ -7.5 mmol/mol ] , P < 0.0001 ; -33.5 mg/dL [ -1.86 mmol/L ] , P < 0.0001 , respectively ) .


More patients achieved a therapeutic glycemic response ( HbA1c < 7.0 % [ 53 mmol/mol ] ) with dapagliflozin ( 31.8 % ) versus placebo ( 11.1 % ) ( P < 0.0001 ) .


Body weight and systolic blood pressure were significantly reduced from baseline over 24 and 8 weeks , respectively , with dapagliflozin ( placebo-subtracted change -2.1 kg , P < 0.0001 ; -3.8 mmHg , P = 0.0250 ) .


Patients receiving dapagliflozin showed placebo-subtracted increases in total , LDL , and HDL cholesterol ( 11.4 mg/dL , P = 0.0091 ; 11.4 mg/dL , P = 0.0030 ; 2.2 mg/dL , P = 0.0172 , respectively ) with no change in LDL/HDL cholesterol ratio ( 0.1 ; P = 0.2008 ) or triglycerides ( -16.5 mg/dL ; P = 0.1755 ) .


Adverse events occurred in 48.6 % of patients receiving dapagliflozin and 51.4 % receiving placebo .


Significantly more patients with dapagliflozin compared with placebo experienced hypoglycemia ( 12.8 vs. 3.7 % ; P = 0.024 ) and genital infections ( 5.5 vs. 0 % ; P = 0.029 ) .


Events of urinary tract infection were reported by 6.4 % of patients in both groups .


Dapagliflozin was well tolerated and effective over 24 weeks as add-on to metformin plus sulfonylurea .


Adverse effects included hypoglycemia and genital infections .


Patients treated with radiation therapy for laryngeal cancer often experience voice problems .


The aim of this randomized controlled trial was to assess the efficacy of voice rehabilitation for laryngeal cancer patients after having undergone radiation therapy and to investigate whether differences between different tumor localizations with regard to rehabilitation outcomes exist .


Sixty-nine male patients irradiated for laryngeal cancer participated .


Voice recordings and self-assessments of communicative dysfunction were performed 1 and 6 months after radiation therapy .


Thirty-three patients were randomized to structured voice rehabilitation with a speech-language pathologist and 36 to a control group .


Furthermore , comparisons with 23 healthy control individuals were made .


Acoustic analyses were performed for all patients , including the healthy control individuals .


The Swedish version of the Self Evaluation of Communication Experiences after Laryngeal Cancer and self-ratings of voice function were used to assess vocal and communicative function .


The patients who received vocal rehabilitation experienced improved self-rated vocal function after rehabilitation .


Patients with supraglottic tumors who received voice rehabilitation had statistically significant improvements in voice quality and self-rated vocal function , whereas the control group did not .


Voice rehabilitation for male patients with laryngeal cancer is efficacious regarding patient-reported outcome measurements .


The patients experienced better voice function after rehabilitation .


Patients with supraglottic tumors also showed an improvement in terms of acoustic voice outcomes .


Rehabilitation with a speech-language pathologist is recommended for laryngeal cancer patients after radiation therapy , particularly for patients with supraglottic tumors .


Antireflux therapy may lead to recovery of impaired mucosal integrity in gastro-esophageal reflux disease ( GERD ) patients as reflected by an increase in baseline impedance .


The study objective was to evaluate the effect of endoscopic fundoplication and proton pump inhibitor ( PPI ) PPI therapy on baseline impedance and heartburn severity in GERD patients .


Forty-seven GERD patients randomized to endoscopic fundoplication ( n = 32 ) or PPI therapy ( n = 15 ) , and 29 healthy controls were included .


Before randomization and 6months after treatment , baseline impedance was obtained during 24-h pH-impedance monitoring .


Heartburn severity was evaluated using the GERD-HRQL questionnaire .


Before treatment , baseline impedance in GERD patients was lower than in healthy controls ( p < 0.001 ) .


Antireflux therapy increased baseline impedance ( from 1498 [ IQR 951-2472 ] to 2393 [ IQR 1353-3027 ] , p = 0.001 ) , however it only led to a partial recovery when compared to healthy controls ( 2393 [ IQR 1353-3027 ] vs 2983 [ 2335-3810 ] , p < 0.01 ) .


The effect of both treatment options was not significantly different ( p = 0.13 ) despite the increased number of non-acid reflux events in the PPI group .


No correlation was found between baseline impedance and GERD symptoms before or after treatment .


Reduction in acid reflux by endoscopic fundoplication or PPI therapy leads to an increase in baseline impedance in GERD patients , likely to reflect recovery of mucosal integrity .


The impact of non-acid reflux events on esophageal mucosal integrity may be limited as no difference in the increase in baseline impedance was observed after both treatment options .


The lack of association between impedance baseline and heartburn severity indicates that other factors may contribute to heartburn perception in GERD .


Nitrate supplementation improves endurance exercise and single bouts of high-intensity activity , but its effect on repeated sprints is unclear .


This study is the first to investigate the effects of acute dietary nitrate supplementation during a high-intensity intermittent-sprint test to exhaustion .


Team-sport athletes ( 9 male , age 22.3 2.1 y , VO2max 57.4 8.5 mL kg-1 min-1 ; 7 female , age 20.7 1.3 y , VO2max 47.2 8.5 mL kg-1 min-1 ) were assigned to a double-blind , randomized , crossover design .


Participants consumed 70 mL of concentrated beetroot juice containing a minimum of 0.3 g of nitrate ( NT ) or 70 mL of placebo ( PL ) 2 h before a repeated-sprint protocol involving repeated 8-s sprints with 30-s recovery on a cycle ergometer to exhaustion .


Fewer sprints ( NT = 13 5 vs PL = 15 6 , P = .005 , d = 0.41 ) and less total work ( NT = 49.2 24.2 kJ vs PL = 57.8 34.0 kJ , P = .027 , d = 0.3 ) were completed in NT relative to PL .


However there was no difference in overall mean power output or the mean power output for each individual 8-s sprint .


These findings suggest that dietary nitrate is not beneficial for improving repeated-sprint performance , at least when such sprints are near-maximal and frequent in nature .


The lack of an effect of nitrate at near-maximal oxygen uptake supports the suggestion that at greater exercise intensities nitrate does not have an ergogenic effect .


Abelmoschus manihot , a single medicament of traditional Chinese medicine , has been widely used to treat kidney disease .


This is the first randomized controlled clinical trial to assess its efficacy and safety in patients with primary glomerular disease .


Prospective , open-label , multicenter , randomized , controlled , clinical trial .


From May 2010 to October 2011 , a total of 417 patients with biopsy-proven primary glomerular disease from 26 hospitals participated in the study .


A manihot in the form of a huangkui capsule , 2.5 g , 3 times per day ; losartan potassium , 50mg/d ; or combined treatment , a huangkui capsule at 2.5 g 3 times per day , was combined with losartan potassium , 50mg/d .


The duration of intervention was 24 weeks .


The primary outcome was change in 24-hour proteinuria from baseline after treatment .


Change in estimated glomerular filtration rate ( eGFR ) from baseline after treatment was a secondary outcome .


The 24-hour proteinuria was measured every 4 weeks and eGFR was measured at 0 , 4 , 12 , and 24 weeks .


Mean baseline urine protein excretion was 1,045 , 1,084 , and 1,073 mg/d in the A manihot , losartan , and combined groups , respectively , and mean eGFR was 108 , 106 , and 106 mL/min/1 .73 m2 , respectively .