Eighty patients of knee replacement under epidural and general anesthesia were randomly divided into warming blood transfusion and infusion ( WBI ) group ( n = 40 ) and control group ( n = 40 ) .


The changes of nasopharyngeal temperature , middle cerebral artery blood flow , CERO , and SjVO of the two groups were recorded at each time point for the assessment of the postoperative overall quality of recovery and cognitive recovery situation .


The nasopharyngeal temperatures of the two groups at different time points after transfusion were significantly lower than that at T1 , and there was a significant difference between the two groups ( P < 0.05 ) .


The CERO values of the two groups at T3 were significantly higher than at T1 , while the SjVO values were significantly decreased ( P < 0.01 ) .


The WBI can significantly reduce the occurrence of the perioperative hypothermia , while it has no significant effect toward cerebral oxygen metabolism , postoperative overall recovery , and recovery of cognitive function .


To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment ( STOPP/START ) medication intervention on clinical and economic outcomes .


Parallel-group randomized trial .


Chronic care geriatric facility .


Residents aged 65 and older prescribed with at least one medication ( N = 359 ) were randomized to receive usual pharmaceutical care or undergo medication intervention .


Screening medications with STOPP/START criteria followed up with recommendations to the chief physician .


The outcome measures assessed at the initiation of the intervention and 1year later were number of hospitalizations and falls , Functional Independence Measure ( FIM ) , quality of life ( measured using the Medical Outcomes Study 12-item Short-Form Health Survey ) , and costs of medications .


The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1year ( P < .001 ) .


The average drug costs in the intervention group decreased by 103 shekels ( US$ 29 ) per participant per month ( P < .001 ) .


The average number of falls in the intervention group dropped significantly ( P = .006 ) .


Rates of hospitalization , FIM scores , and quality of life measurements were similar for both groups .


Implementation of STOPP/START criteria reduced the number of medications , falls , and costs in a geriatric facility .


Their incorporation in those and similar settings is recommended .


The combination melphalan-prednisone-thalidomide ( MPT ) is considered a standard therapy for patients with myeloma who are ineligible for stem-cell transplantation .


However , emerging data on the use of lenalidomide and low-dose dexamethasone warrant a prospective comparison of the two approaches .


We randomly assigned 1623 patients to lenalidomide and dexamethasone in 28-day cycles until disease progression ( 535 patients ) , to the same combination for 72 weeks ( 18 cycles ; 541 patients ) , or to MPT for 72 weeks ( 547 patients ) .


The primary end point was progression-free survival with continuous lenalidomide-dexamethasone versus MPT .


The median progression-free survival was 25.5 months with continuous lenalidomide-dexamethasone , 20.7 months with 18 cycles of lenalidomide-dexamethasone , and 21.2 months with MPT ( hazard ratio for the risk of progression or death , 0.72 for continuous lenalidomide-dexamethasone vs. MPT and 0.70 for continuous lenalidomide-dexamethasone vs. 18 cycles of lenalidomide-dexamethasone ; P < 0.001 for both comparisons ) .


Continuous lenalidomide-dexamethasone was superior to MPT for all secondary efficacy end points , including overall survival ( at the interim analysis ) .


Overall survival at 4 years was 59 % with continuous lenalidomide-dexamethasone , 56 % with 18 cycles of lenalidomide-dexamethasone , and 51 % with MPT .


Grade 3 or 4 adverse events were somewhat less frequent with continuous lenalidomide-dexamethasone than with MPT ( 70 % vs. 78 % ) .


As compared with MPT , continuous lenalidomide-dexamethasone was associated with fewer hematologic and neurologic toxic events , a moderate increase in infections , and fewer second primary hematologic cancers .


As compared with MPT , continuous lenalidomide-dexamethasone given until disease progression was associated with a significant improvement in progression-free survival , with an overall survival benefit at the interim analysis , among patients with newly diagnosed multiple myeloma who were ineligible for stem-cell transplantation .


( Funded by Intergroupe , Francophone du Mylome and Celgene ; FIRST ClinicalTrials.gov number , NCT00689936 ; European Union Drug Regulating Authorities Clinical Trials number , 2007-004823-39 . )


To determine the effect of implementation of the Integrated Management of Neonatal and Childhood Illness strategy on treatment seeking practices and on neonatal and infant morbidity .


Cluster randomised trial .


Haryana , India .


29,667 births in nine intervention clusters and 30,813 births in nine control clusters .


The pre-specified outcome was the effect on treatment seeking practices .


Post hoc exploratory analyses assessed morbidity , hospital admission , post-neonatal infant care , and nutritional status outcomes .


The Integrated Management of Neonatal and Childhood Illness intervention included home visits by community health workers , improved case management of sick children , and strengthening of health systems .


Outcomes were ascertained through interviews with randomly selected caregivers : 6204 , 3073 , and 2045 in intervention clusters and 6163 , 3048 , and 2017 in control clusters at ages 29 days , 6 months , and 12 months , respectively .


In the intervention cluster , treatment was sought more often from an appropriate provider for severe neonatal illness ( risk ratio 1.76 , 95 % confidence interval 1.38 to 2.24 ) , for local neonatal infection ( 4.86 , 3.80 to 6.21 ) , and for diarrhoea at 6 months ( 1.96 , 1.38 to 2.79 ) and 12 months ( 1.22 , 1.06 to 1.42 ) and pneumonia at 6 months ( 2.09 , 1.31 to 3.33 ) and 12 months ( 1.44 , 1.00 to 2.08 ) .


Intervention mothers reported fewer episodes of severe neonatal illness ( risk ratio 0.82 , 0.67 to 0.99 ) and lower prevalence of diarrhoea ( 0.71 , 0.60 to 0.83 ) and pneumonia ( 0.73 , 0.52 to 1.04 ) in the two weeks preceding the 6 month interview and of diarrhoea ( 0.63 , 0.49 to 0.80 ) and pneumonia ( 0.60 , 0.46 to 0.78 ) in the two weeks preceding the 12 month interview .


Infants in the intervention clusters were more likely to still be exclusively breast fed in the sixth month of life ( risk ratio 3.19 , 2.67 to 3.81 ) .


Implementation of the Integrated Management of Neonatal and Childhood Illness programme was associated with timely treatment seeking from appropriate providers and reduced morbidity , a likely explanation for the reduction in mortality observed following implementation of the programme in this study.Trial registration Clinical trials NCT00474981 ; ICMR Clinical Trial Registry CTRI/2009/091 / 000715 .


We have already reported that , for patients undergoing elective colon cancer operations , perioperative infection can be prevented by a single intravenous dose of an antibiotic given immediately beforehand if mechanical bowel preparation and the administration of oral antibiotics are implemented .


Synbiotics has been reported to reduce the rate of infection in patients after pancreatic cancer operations .


The effectiveness of oral antibiotics and probiotics in preventing postoperative infection in elective colon cancer procedures was examined in a randomized controlled trial .


Three hundred ten patients with colon cancer randomly were assigned to one of three groups .


All patients underwent mechanical bowel preparation and received a single intravenous dose of flomoxef immediately before operation .


Probiotics were administered in Group A ; oral antibiotics were administered in Group B ; and neither probiotics nor oral antibiotics were administered in Group C. Stool samples were collected 9 and 2 days before and 7 and 14 days after the procedure .


Clostridium difficile toxin and the number of bacteria in the intestine were determined .


The rates of incisional surgical-site infection were 18.0 % , 6.1 % , and 17.9 % in Groups A , B , and C , and the rates of leakage were 12.0 % , 1.0 % , and 7.4 % in Groups A , B , and C , respectively , indicating that both rates were lesser in Group B than in Groups A and C ( P = .014 and P = .004 , respectively ) .


The detection rates of C. difficile toxin were not changed among the three groups .


We recommend oral antibiotics , rather than probiotics , as bowel preparation for elective colon cancer procedures to prevent surgical-site infections .


Orthodontic appliances can promote accumulation of dental plaque , with associated enamel decalcification or gingival inflammation .


The aim of this study was to examine longer-term microbiological changes during orthodontic treatment with fixed appliances .


Twenty-four orthodontic patients aged 11-14 years undergoing fixed appliance therapy were recruited into the study .


Each was randomized for cross-mouth assignment of molar bands and bonded molar tubes to contralateral quadrants of the mouth .


All patients received self-ligating brackets , but again using randomization , one upper lateral incisor bracket ( left or right ) also received an elastomeric ligature .


Plaque samples from the molars and upper lateral incisors were obtained at intervals during treatment and up to 1 year after appliance removal .


Denaturing gradient gel electrophoresis and 16S rDNA microarray were used to compare plaque microbial fingerprints .


Plaque populations changed within 3 months of commencing treatment at all sites .


The greatest differences in plaque composition were seen with self-ligating brackets with an elastomeric ligature .


Post-treatment plaque associated with both types of molar attachment contained increased levels of periodontal pathogens Porphyromonas gingivalis , Tannerella forsythia , and Eubacterium nodatum , while Campylobacter rectus , Parvimonas micra , and Actinomyces odontolyticus were also elevated with bonds .


The results suggest that orthodontic treatment may cause sustained changes in plaque microbiotas and that molar bond-associated plaque may have raised disease potential .


Oral corticosteroids were used to control stable chronic obstructive pulmonary disease ( COPD ) decades ago .


However , recent guidelines do not recommend long-term oral corticosteroids ( LTOC ) use for stable COPD patients , partly because it causes side-effects such as respiratory muscle deterioration and immunosuppression .


Nonetheless , the impact of LTOC on life prognosis for stable COPD patients has not been clarified .


We used the data of patients randomized to non-surgery treatment in the National Emphysema Treatment Trial .


Severe and very severe stable COPD patients who were eligible for volume reduction surgery were recruited at 17 clinical centers in the United States and randomized during 1998-2002 .


Patients were followed-up for at least five years .


Hazard ratios for death by LTOC were estimated by three models using Cox proportional hazard analysis and propensity score matching .


The pre-matching cohort comprised 444 patients ( prescription of LTOC : 23.0 % .


Age : 66.65.4 year old .


Female : 35.6 % .


Percent predicted forced expiratory volume in one second : 27.07.1 % .


Mortality during follow-up : 67.1 % ) .


Hazard ratio using a multiple-variable Cox model in the pre-matching cohort was 1.54 ( P = 0.001 ) .


Propensity score matching was conducted with 26 parameters ( C-statics : 0.73 ) .


The propensity-matched cohort comprised of 65 LTOC ( + ) cases and 195 LTOC ( - ) cases ( prescription of LTOC : 25.0 % .


Age : 66.55.3 year old .


Female : 35.4 % .


Percent predicted forced expiratory volume in one second : 26.16.8 % .


Mortality during follow-up : 71.3 % ) .


No parameters differed between cohorts .


The hazard ratio using a single-variable Cox model in the propensity-score-matched cohort was 1.50 ( P = 0.013 ) .


The hazard ratio using a multiple-variable Cox model in the propensity-score-matched cohort was 1.73 ( P = 0.001 ) .


LTOC may increase the mortality of stable severe and very severe COPD patients .


Induction methods for therapeutic cooling are under investigated .


We compared the effectiveness and safety of cold infusions ( CI ) and nasopharyngeal cooling ( NPC ) for cooling induction in stroke patients .


A prospective , open-label , randomised ( 1:1 ) , single-centre pilot trial with partially blinded safety endpoint assessment was conducted at the neurointensive care unit of Heidelberg University .


Intubated stroke patients with an indication for therapeutic cooling and an intracranial pressure ( ICP ) / temperature brain probe were randomly assigned to CI ( 4C , 2L at 4L/h ) or NPC ( 60L/min for 1 h ) .


Previous data suggested a maximum decrease of tympanic temperature for CI ( 2.1 L within 35 min ) after 52 min .


Therefore the study period was 1 hour ( 15 min subperiods I-IV ) .


The brain temperature course was the primary endpoint .


Secondary measures included continuous monitoring of neurovital parameters and extracerebral temperatures .


Statistical analysis based on repeated-measures analysis of variance .


Of 221 patients screened , 20 were randomized within 5 months .


Infusion time of 2L CI was 334 min in 10 patients and 10 patients received NPC for 60 min .


During active treatment ( first 30 min ) , brain temperature decreased faster with CI than during NPC ( I : -0.31 0.2 versus -0.12 0.1 C , P = 0.008 ; II : -1.0 0.3 versus -0.49 0.3 C , P = 0.001 ) .


In the CI-group , after the infusion was finished , the intervention no longer decreased brain temperature , which increased after 3.53.3 min .


Oesophageal temperature correlated best with brain temperature during CI and NPC .


Tympanic temperature reacted similarly to relative changes of brain temperature during CI , but absolute values slightly differed .


CI provoked three severe adverse events during subperiods II-IV ( two systolic arterial pressure ( SAP ) , one shivering ) compared with four in the NPC-group , all during subperiod I ( three SAP , one ICP ) .


Classified as possibly intervention-related , two cases of ventilator failure occurred during NPC .


In intubated stroke patients , brain cooling is faster during CI than during NPC .


Importantly , contrary to previous expectations , brain cooling stopped soon after CI cessation .


Oesophageal but neither bladder nor rectal temperature is suited as surrogate for brain temperature during CI and NPC .


Several severe adverse events in CI and in NPC demand further studying of safety .


ClinicalTrials.gov NCT01573117 .


Registered 31 March 2012 .


Despite widespread popularity , text messaging has rarely been used for data collection in clinical research .


This paper reports on the development , feasibility , acceptability , validity , and discriminant utility of a single item depression rating scale , delivered weekly via an automated SMS system , as part of a large randomised controlled trial .


755 depressed patients ( BDI-II score 20 ) were recruited from primary care into a randomised trial of acupuncture versus counselling or usual care , and invited to opt into a repeated-measures text messaging sub-study .


Two weeks following random allocation , trial participants were sent a weekly text message for 15 weeks .


Texts were a single question asking , on a scale from 1 to 9 , the extent to which they felt depressed .


Feasibility and acceptability of the automated SMS system were evaluated according to cost , ease of implementation , proportion consenting , response rates , and qualitative feedback .


Concurrent validity was estimated by correlating SMS responses with the Patient Health Questionnaire ( PHQ-9 ) .


SMS responses were compared between groups over time to explore treatment effects .


527 ( 69.8 % ) trial participants consented to the texting sub-study , of whom 498 ( 94.5 % ) responded to at least one message .


Participants provided a valid response to an average of 12.5 messages .


Invalid responses accounted for 1.1 % of texts .


The automated SMS system was quick to set-up , inexpensive , and well received .


Comparison of PHQ-9 and SMS responses at 3 months demonstrated a moderate to high degree of agreement ( Kendall 's tau-b = 0.57 , p < 0.0001 , n = 220 ) .


SMS depression scores over the 15 weeks differed significantly between trial arms ( p = 0.007 ) , with participants allocated to the acupuncture and counselling arms reporting improved depression outcomes compared to usual GP care alone , which reached statistical significance ten weeks after randomisation .


Overall , the single item SMS scale also appeared more responsive to changes in depression , resulting from treatment , than the PHQ-9 .


Automated SMS systems offer a feasible and acceptable means of monitoring depression within clinical research .


This study provides clear evidence to support the regular use of a simple SMS scale as a sensitive and valid outcome measure of depression within future randomised controlled trials .


Current Controlled Trials - ISRCTN63787732 http://www.controlled-trials.com/ISRCTN63787732/ACUDEP Date of registration : 15/12/2009 .


To explore the effectiveness and safety of transcutaneous electrical acupoint stimulation ( TEAS ) combined with infusion of propofol in anodynia bronchoscopy .


Ninety patients who received selective bronchoscopy were randomized into a group of compound TEAS with infusion of propofol ( group A ) , a group of compound fentanyl with propofol ( group B ) and a group of simple propofol ( group C ) .


In group A , the plaster electrode stimulation was applied at bilateral Hegu ( LI 4 ) , Laogong ( PC 8 ) , Neiguan ( PC 6 ) and Waiguan ( TE 5 ) .


The anesthesia was induced after 20 min of stimulation till the end of examination .


In group B and group C , the electric stimulation was not adopted .


In group B , before anesthesia , fentanyl 1 microg/kg was injected intravenously .


Afterwards , the intravenous infusion of propofol was used in the the three groups for anesthesia .


The mean arterial pressure ( MAP ) , heart rate ( HR ) , saturation of pulse oximetry ( SpO2 ) and respiratory rate ( RR ) were recorded at different time points .


The induced dosage and total dosage of propofol , examination time , the awakening time and adverse reactions were observed in the patients of each group .


The difference in examination time was not significant among the three groups ( P > 0.05 ) .


The postoperative awakening time in group A was earlier than that in group B and group C [ ( 220.3 + / - 110.5 ) s vs ( 285.6 + / - 109.4 ) s , ( 290.1 + / - 105.1 ) s , both P < 0.05 ] .


The total dosage of propofol in group C was larger than those in group A and group B [ ( 288.5 + / - 26.7 ) mg vs ( 225.1 + / - 30.2 ) mg , ( 230.4 + / - 29.3 ) mg , both P < 0.05 ] .


The induced dosage in group C was larger than those in group A and group B [ ( 193.7 + / - 42.3 ) mg vs ( 152.3 + / - 36.1 ) mg , ( 155.4 + / - 40.5 ) mg , both P < 0.05 ] .


Every life physical sign in group A during examination was more stable as compared with that in group B and group C.


The incidence of hypotension and bradycardia in group A were lower than those in group C [ 3.3 % ( 1/30 ) vs 26.7 % ( 8/30 ) , 0 % ( 0/30 ) vs 20.0 % ( 6/30 ) , both P < 0.05 ] .


The adverse incidence of oxygen supply in group A was lower than that in group B [ 6.7 % ( 2/30 ) vs 33.3 % ( 10/30 ) , P < 0.05 ] .


Intraoperative awareness and improper memory did not happen in postoperative investigation .


In the transcutaneous electrical acupoint stimulation combined with infusion of propofol in anodynia bronchoscopy , the physical sign of patient is stable with less adverse reactions .


This method reduces anesthetic dosage and shortens the postoperative awakening time , which can be effectively applied in bronchoscopy .


The purpose of this study was to assess the association between positive post-radiation therapy ( RT ) biopsy results and subsequent clinical outcomes in males with localized prostate cancer .


Radiation Therapy Oncology Group study 94-08 analyzed 1979 males with prostate cancer , stage T1b-T2b and prostate-specific antigen concentrations of 20 ng/dL , to investigate whether 4 months of total androgen suppression ( TAS ) added to RT improved survival compared to RT alone .


Patients randomized to receive TAS received flutamide with luteinizing hormone releasing hormone ( LHRH ) agonist .


According to protocol , patients without evidence of clinical recurrence or initiation of additional endocrine therapy underwent repeat prostate biopsy 2 years after RT completion .


Statistical analysis was performed to evaluate the impact of positive post-RT biopsy results on clinical outcomes .


A total of 831 patients underwent post-RT biopsy , 398 were treated with RT alone and 433 with RT plus TAS .


Patients with positive post-RT biopsy results had higher rates of biochemical failure ( hazard ratio [ HR ] = 1.7 ; 95 % confidence interval [ CI ] = 1.3-2 .1 ) and distant metastasis ( HR = 2.4 ; 95 % CI = 1.3-4 .4 ) and inferior disease-specific survival ( HR = 3.8 ; 95 % CI = 1.9-7 .5 ) .


Positive biopsy results remained predictive of such outcomes after correction for potential confounders such as Gleason score , tumor stage , and TAS administration .


Prior TAS therapy did not prevent elevated risk of adverse outcome in the setting of post-RT positive biopsy results .


Patients with Gleason score 7 with a positive biopsy result additionally had inferior overall survival compared to those with a negative biopsy result ( HR = 1.56 ; 95 % CI = 1.04-2 .35 ) .


Positive post-RT biopsy is associated with increased rates of distant metastases and inferior disease-specific survival in patients treated with definitive RT and was associated with inferior overall survival in patients with high-grade tumors .


To compare the extent of bleeding and patient discomfort during packing removal of three different polyvinyl alcohol ( PVA ) packs : 1 ) a standard PVA sponge ( s-PVA ) ( Mondocel Standard 10 cm ; Mondomed NV , Hamont-Achel , Belgium ) ; 2 ) a PVA sponge with oxidized cellulose ( oc-PVA ) ( Merocel Hemox 10 cm ; Medtronic Xomed Surgical Products , Jacksonville , FL ) ; and 3 ) a PVA sponge with polyethylene film ( pf-PVA ) ( Merocel 2000 8 cm ; Medtronic Xomed Surgical Products , Jacksonville , FL ) , after functional endoscopic sinus surgery and inferior turbinoplasty .


A prospective , randomized , blinded , controlled trial .


Ninety consecutive patients were enrolled and randomized to receive in each side one pack in the middle meatus and another pack of the same material in the nasal fossa .


The patients were equally divided in three groups of 30 patients each .


Group A received the pf-PVA ; group B received oc-PVA ; and group C received s-PVA .


Postoperatively , bleeding after removal of the entire nasal packing was evaluated by an observer , whereas the severity of pain was rated by patients with visual analog scales .


Our study evaluated three nasal packing materials , demonstrating that the pf-PVA is less painful than the others but with intermediate bleeding ratio .


However , the oc-PVA has an intermediate pain score but minimum bleeding .


The s-PVA showed the worst pain and bleeding results .


Considering that removal of the second pack ( middle meatus ) is more painful than the first ( nasal fossa ) , our results suggest that a pf-PVA can be placed in the middle meatus and a oc-PVA in the nasal fossa in order to reduce patient 's discomfort in terms of pain and bleeding .


1b .


To compare patency and overall survival achieved with covered versus uncovered metallic stents among patients with inoperable malignant extrahepatic biliary obstruction .


There were 40 patients enrolled in this prospective randomized study between January 2012 and July 2013 .


Mean age of patients was 62.6 years ( range , 43-86 y ) .


The malignancies causing extrahepatic biliary obstruction were pancreatic cancer ( n = 18 ) , stomach cancer ( n = 13 ) , gallbladder cancer ( n = 3 ) , common bile duct cancer ( n = 2 ) , and other cancer types ( n = 4 ) .


Uncovered ( n = 20 ) and covered ( n = 20 ) stents were used .


Stent patency , overall survival , and complications were evaluated and statistically compared .


Mean patency of uncovered stents ( 413.3 d 63.0 ) was significantly longer than mean patency of covered ones ( 207.5 d 46.0 ; P = .041 ) .


Mean overall survival was 359.9 days 61.5 for uncovered stents , which was statistically similar to survival of 350.5 days 43.8 for covered stents ( P = .271 ) .


Causes of recurrent obstruction included tumor ingrowth ( n = 2 ) , tumor overgrowth ( n = 5 ) , debris or food material ( n = 5 ) , and stent migration ( n = 2 ) .


One case of acute cholecystitis occurred in covered stent group .


Uncovered metallic stents had superior patency duration than covered stents for patients with malignant extrahepatic biliary obstruction .


However , the overall complication and survival rates achieved with covered and uncovered stents were similar .


To evaluate the clinical and microbiological effects of neodymium : yttrium-aluminum-garnet laser therapy as an adjunct to scaling and root planing during the hygienic phase .


In eight patients , sites with a mean probing pocket depth ( PPD ) of 5 mm were treated by either scaling and root planing ( n = 28 ) ( control ) or by scaling and root planing and adjunctive laser therapy ( n = 28 ) ( power : 5W ) .


Re-evaluation was at 4-6 weeks .


Thereafter , remaining pockets ( mean PPD 5 mm ) were eliminated by either laser surgery ( power : 7 W ) or gingivectomy ( control ) .


At baseline , the mean PPD of sites originally presenting with a mean PPD 4 mm were 4.69 and 4.73 mm in the test and control sites , respectively .


Six months following surgery , there was a similar average mean PPD reduction in the test ( 1.18 mm , P < 0.01 ) and control sites ( 1.35 mm , P < 0.01 ) .


Also , the reduction in bleeding on probing in both groups was statistically significant ( P < 0.01 , paired t-tests ) .


No statistically-significant differences between the test and control sites were found for any clinical or microbiological parameters at baseline , after initial , and 3 or 6 months ' post-surgical therapy .


During the hygienic phase , neodymium : yttrium-aluminum-garnet ( 1064 nm ) laser treatment yielded no superiority in clinical efficacy compared to conventional debridement .


Laser gingivectomy resulted in similar treatment outcomes ( mean PPD and bleeding on probing reduction ) , as did conventional gingivectomy .


A pilot study to compare the effectiveness of an individual therapy program with the effects of a general physical therapy program .


A randomized , single-blind cross-over design .


Ten ambulant children with bilateral spastic cerebral palsy , age four to nine years .


Participants were randomly assigned into a ten-week individually defined , targeted or a general program , followed by a cross-over .


Evaluation was performed using the Gross Motor Function Measure-88 and three-dimensional gait analysis .


General outcome parameters were Gross Motor Function Measure-88 scores , time and distance parameters , gait profile score and movement analysis profiles .


Individual goal achievement was evaluated using z-scores for gait parameters and Goal Attainment Scale for gross motor function .


No significant changes were observed regarding gross motor function .


Only after individualized therapy , step - and stride-length increased significantly ( p = 0.022 ; p = 0.017 ) .


Change in step-length was higher after the individualized program ( p = 0.045 ) .


Within-group effects were found for the pelvis in transversal plane after the individualized program ( p = 0.047 ) and in coronal plane after the general program ( p = 0.047 ) .


Between-program differences were found for changes in the knee in sagittal plane , in the advantage of the individual program ( p = 0.047 ) .


A median difference in z-score of 0.279 and 0.419 was measured after the general and individualized program , respectively .


Functional goal attainment was higher after the individual therapy program compared with the general program ( 48 to 43.5 ) .


The results indicate slightly favorable effects towards the individualized program .


To detect clinically significant changes , future studies require a minimal sample size of 72 to 90 participants .


Mental illness stigma is a serious societal problem and a critical impediment to treatment seeking for mentally ill people .


To improve the understanding of mental illness stigma , this study focuses on the simultaneous analysis of people 's aetiological beliefs , attitudes ( i.e. perceived dangerousness and social distance ) , and recommended treatments related to several mental disorders by devising an over-arching latent structure that could explain the relations among these variables .


Three hundred and sixty university students randomly received an unlabelled vignette depicting one of six mental disorders to be evaluated on the four variables on a Likert-type scale .


A one-factor Latent Class Analysis ( LCA ) model was hypothesized , which comprised the four manifest variables as indicators and the mental disorder as external variable .


The main findings were the following : ( a ) a one-factor LCA model was retrieved ; ( b ) alcohol and drug addictions are the most strongly stigmatized ; ( c ) a realistic opinion about the causes and treatment of schizophrenia , anxiety , bulimia , and depression was associated to lower prejudicial attitudes and social rejection .


Beyond the general appraisal of mental illness an individual might have , the results generally point to the acknowledgement of the specific features of different diagnostic categories .


The implications of the present results are discussed in the framework of a better understanding of mental illness stigma .


We examined data from a Phase 2 trial { NCT00457821 } of ivacaftor , a CFTR potentiator , in cystic fibrosis ( CF ) patients with aG551D mutation to evaluate standardized approaches to sweat chloride measurement and to explore the use of sweat chloride and nasal potential difference ( NPD ) to estimate CFTR activity .


Sweat chloride and NPD were secondary endpoints in this placebo-controlled , multicenter trial .


Standardization of sweat collection , processing , and analysis was employed for the first time .


Sweat chloride and chloride ion transport ( NPD ) were integrated into a model of CFTR activity .


Within-patient sweat chloride determinations showed sufficient precision to detect differences between dose-groups and assess ivacaftor treatment effects .


Analysis of changes in sweat chloride and NPD demonstrated that patients treated with ivacaftor achieved CFTR activity equivalent to approximately 35 % 40 % of normal .


Sweat chloride is useful in multicenter trials as a biomarker of CFTR activity and to test the effect of CFTR potentiators .


This study aims to determine whether vitamin D levels are associated with menopause-related symptoms in older women .


A randomly selected subset of 1,407 women , among 26,104 potentially eligible participants of the Women 's Health Initiative Calcium and Vitamin D trial of postmenopausal women aged 51 to 80 years , had 25-hydroxyvitamin D [ 25 ( OH ) D ] levels measured at the Women 's Health Initiative Calcium and Vitamin D trial baseline visit .


Information about menopause-related symptoms at baseline was obtained by questionnaire and included overall number of symptoms and composite measures of sleep disturbance , emotional well-being , and energy/fatigue , as well as individual symptoms .


After exclusions for missing data , 530 women ( mean [ SD ] age , 66.2 [ 6.8 ] y ) were included in these analyses .


Borderline significant associations between 25 ( OH ) D levels and total number of menopausal symptoms were observed ( with P values ranging from 0.05 to 0.06 for fully adjusted models ) ; however , the effect was clinically insignificant and disappeared with correction for multiple testing .


No associations between 25 ( OH ) D levels and composite measures of sleep disturbance , emotional well-being , or energy/fatigue were observed ( P 's > 0.10 for fully adjusted models ) .


There is no evidence for a clinically important association between serum 25 ( OH ) D levels and menopause-related symptoms in postmenopausal women .


Hypothermia in patients undergoing major clean surgery results in higher incidence of perioperative complications .


The aim of this study was to evaluate whether the additional use of a thermal reflective blanket can prevent hypothermia in patients undergoing primary unilateral total hip or knee replacement surgery .


A randomized , single-blinded study design was used .


A total of 58 patients were randomized , 29 received a thermal reflective blanket , and 29 did not .


Outcome measures included core temperature , thermal comfort , and shivering .


The mean of the lowest core temperature was below 36C in both the groups ( 35.90.4 C vs 35.80.4 C ) ; thermal comfort and shivering were not significantly different between the groups .


A thermal reflective blanket did not prevent hypothermia in this group of patients .


Labelling of food from fast food restaurants at point-of-purchase has been suggested as one strategy to reduce population energy consumption and contribute to reductions in obesity prevalence .


The aim of this study was to examine the effects of energy and single traffic light labelling systems on the energy content of child and adult intended food purchases .


The study employed a randomised controlled trial design .


English speaking parents of children aged between three and 12 years were recruited from an existing research cohort .


Participants were mailed one of three hypothetical fast food menus .


Menus differed in their labelling technique either energy labels , single traffic light labels , or a no-label control .


Participants then completed a telephone survey which assessed intended food purchases for both adult and child .


The primary trial outcome was total energy of intended food purchase .


A total of 329 participants completed the follow-up telephone interview .


Eighty-two percent of the energy labelling group and 96 % of the single traffic light labelling group reported noticing labelling information on their menu .


There were no significant differences in total energy of intended purchases of parents , or intended purchases made by parents for children , between the menu labelling groups , or between menu labelling groups by socio-demographic subgroups .


This study provided no evidence to suggest that energy labelling or single traffic light labelling alone were effective in reducing the energy of fast food items selected from hypothetical fast food menus for purchase .


Additional complementary public health initiatives promoting the consumption of healthier foods identified by labelling , and which target other key drivers of menu item selection in this setting may be required .


The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times .


We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia .


MeTHODS : Fifty patients undergoing perianal surgery were randomized into two groups .


The bupivacaine-fentanyl group ( Group B ) received 7.5 mg , 0.5 % hyperbaric bupivacaine + 20 g fentanyl in total 1.9 mL .


The prilocaine-fentanyl group ( Group P ) received 30 mg , 0.5 % hyperbaric prilocaine + 20 g fentanyl in the same volume .


Time to L1 block and maximum block was shorter in Group P than in Group B ( Group P 4.6 1.3 min versus Group B 5.9 01.9 min , P = 0.017 , and Group P 13.2 7.5 min versus Group B 15.3 6.6 min , P = 0.04 ) .


The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B ( 45.7 21.9 min versus 59.7 20.9 min , P = 0.024 , and 133.8 41.4 min versus 200.4 64.8 min , P < 0.001 ) .


The mean time to home readiness was shorter for Group P than for Group B ( 155 100.2 min versus 207.2 62.7 min ( P < 0.001 ) ) .


Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery .


The present randomized study was designed to compare the efficacy between two active vitamin D analogs , alfacalcidol ( ACD ) and maxacalcitol ( OCT ) , for the management of mild secondary hyperparathyroidism ( SHPT ) in dialysis patients .


SHPT in all 32 patients analyzed in the study was initially treated with OCT. .


Once patients ' intact PTH levels decreased to the target range of 150 - 180 pg/mL , they were randomized either to switch to ACD at 0.5 g/day ( n = 14 ) , or to remain on an effectively unchanged dose of OCT ( n = 13 ) .


Phosphate , calcium , and intact PTH levels were measured every 2 weeks for 12 weeks and vitamin D doses were changed according to target ranges of phosphate ( 3.5 - 6.0 mg/dL ) , calcium ( albuminadjusted calcium : 8.4 - 10.0 mg/dL ) , and intact parathyroid hormone ( 60 - 180 pg/mL ) .


Achievement rates of the target ranges of the parameters were estimated .


Baseline calcium levels in the OCT group were significantly higher than in the ACD group .


Changes in achievement rates of target ranges of intact PTH and calcium during the study did not differ significantly between the vitamin D drugs .


Changes in calcium levels in the OCT and ACD groups were similar during the study .


Achievement rates of the target range of phosphate in both groups were also similar until 8 weeks , although the rate in the OCT group declined at 10 weeks .


The efficacy and safety of OCT for the treatment of mild SHPT are similar to those of ACD in hemodialysis patients .


Trimetazidine has been shown to improve angina pectoris and left ventricular ( LV ) function in diabetic patients with ischaemic cardiomyopathy .


The objective of this study was to evaluate the effects of trimetazidine on recurrent angina pectoris and LV structure after drug-eluting stent ( DES ) implantation in elderly multivessel coronary heart disease ( CHD ) patients with diabetes mellitus ( DM ) and a left ventricular ejection fraction ( LVEF ) of 50 % .


This was a single-centre , prospective , randomized , double-blind evaluation study .


Between January 2010 and September 2010 , 700 CHD patients with DM who were aged 65 years and undergoing coronary angiography at An Zhen Hospital ( Beijing , China ) were recruited and prospectively randomized to receive trimetazidine ( 20 mg three times daily ) or placebo after DES implantation as an addition to conventional CHD treatment .


The primary end points were the incidence of recurrent angina pectoris and measures of various echocardiographic parameters , which included LVEF .


At 2-year follow-up , patients in the trimetazidine group ( n = 255 ) showed significant improvements in the incidence ( P = 0.024 ) and severity of angina pectoris , compared with the control group , as well as silent myocardial ischaemia ( P = 0.009 ) and angina pectoris-free survival ( P = 0.011 ) .


LV function and structure in trimetazidine-treated patients were relatively stable at 2-year follow-up , while they deteriorated in the control group ( n = 255 ) with a significant difference between groups ( all P < 0.01 ) .


The E peak to A peak ( E/A ) ratio in trimetazidine-treated patients and in the control group decreased after 2 years ; the E/A ratio in trimetazidine-treated patients was slightly better than that in the control group , without a significant difference ( P = 0.170 ) .


There was no significant difference in event-free survival for the composite end point including death , myocardial infarction , cerebrovascular accident ( P = 0.422 ) and subsequent revascularization ( P = 0.073 ) .


Adjunctive therapy with trimetazidine after DES implantation can have a beneficial effect on recurrent angina pectoris as well as LV function and structure in elderly multivessel CHD patients with DM .


To study the factors affecting long-term treatment results of displaced intraarticular calcaneal fractures ( DIACFs ) .


A post hoc analysis .


Tertiary care teaching hospitals .


Eight to twelve years of results from a randomized controlled multicenter trial of operative versus nonoperative treatment ( n = 56 ) were divided into 2 groups : the superior 50 % results ( n = 28 ) and the inferior 50 % results ( n = 28 ) , regardless of the treatment given .


The determinant of this division was a visual analog score for pain and function .


The operative treatment consists of open reduction and internal fixation , whereas the nonoperative treatment consists of nonweight bearing and early range of motion exercise .


A visual analog score for pain and function , the short-form 36 ( SF-36 ) general health outcome questionnaire , the American Orthopaedic Foot & Ankle Society ( AOFAS ) hindfoot scale , and Olerud-Molander score .


We compared age , sex , fracture type ( Sanders classification ) , treatment given , Bhler angle , residual articular surface step-off at healing , type of occupation , and injury insurance between the 2 groups .


Patients of the superior group had higher physical SF-36 , AOFAS , and Olerud-Molander score than in the inferior group .


Operative treatment , better Bhler angle and articular surface restoration , light labor/retirement , and absence of injury insurance were more common in the superior group .


Age , sex , pretreatment Bhler angle , and fracture type were comparable in the superior and inferior groups .


The decision making for definitive treatment of intraarticular calcaneal fractures is multifactorial with a spectrum of results and trends such as patient demographic features that should be considered in choosing the best treatment option .


Prognostic Level II .


See Instructions for Authors for a complete description of levels of evidence .


This phase II study examined the efficacy of mapatumumab in combination with paclitaxel and carboplatin in patients with non-small-cell lung cancer ( NSCLC ) .


Patients with stage IIIB or stage IV advanced primary NSCLC were randomly assigned ( 1:1:1 ) to receive up to 6 courses of standard-dose paclitaxel and carboplatin or a combination of paclitaxel , carboplatin , and mapatumumab ( 10 mg/kg or 30 mg/kg ) .


Primary efficacy end points were overall response rate and median progression-free survival ( PFS ) .


Secondary efficacy end points included disease control rate , overall survival ( OS ) , time to response , and duration of response .


Exploratory studies included evaluation of historical biopsy materials for TRAIL-R1 expression by immunohistochemical analysis and serum levels of M30 , a marker of apoptosis , before and after the first 2 doses of mapatumumab .


Safety parameters , including adverse events ( AEs ) , laboratory tests , and immunogenicity , were assessed .


The majority of patients had stage IV disease ( 79 % ) and an Eastern Cooperative Oncology Group ( ECOG ) performance status of 0 ( 58 % ) ; baseline characteristics were similar across treatment arms .


No improvements in response or disease control rates , PFS , or OS were gained from the addition of mapatumumab .


Adverse events in the mapatumumab arms were generally consistent with toxicities seen in the carboplatin and paclitaxel control arm .


Levels of M30 were highly variable , and consistent patterns were not seen across treatment arms .


This study showed no clinical benefit from adding mapatumumab to carboplatin and paclitaxel in unselected patients with NSCLC .


The combination was generally well tolerated .


The possibility of subgroups sensitive to mapatumumab is discussed .


In the context of a group randomized field trial , we evaluated whether parents who participated in a workplace intervention , designed to increase supervisor support for personal and family life and schedule control , reported significantly more daily time with their children at the 12-month follow-up compared with parents assigned to the Usual Practice group .


We also tested whether the intervention effect was moderated by parent gender , child gender , or child age .


The Support-Transform-Achieve-Results Intervention was delivered in an information technology division of a US Fortune 500 company .


Participants included 93 parents ( 45 % mothers ) of a randomly selected focal child aged 9 to 17 years ( 49 % daughters ) who completed daily telephone diaries at baseline and 12 months after intervention .


During evening telephone calls on 8 consecutive days , parents reported how much time they spent with their child that day .


Parents in the intervention group exhibited a significant increase in parent-child shared time , 39 minutes per day on average , between baseline and the 12-month follow-up .


By contrast , parents in the Usual Practice group averaged 24 fewer minutes with their child per day at the 12-month follow-up .


Intervention effects were evident for mothers but not for fathers and for daughters but not sons .


The hypothesis that the intervention would improve parents ' daily time with their children was supported .


Future studies should examine how redesigning work can change the quality of parent-child interactions and activities known to be important for youth health and development .


Otolaryngology residents need concise , easily accessible modules to expand educational opportunities between surgical cases .


These modules should be inexpensive to create and improve learning outcomes .


The purpose of this pilot study was to assess whether otolaryngology residents at multiple institutions used online video modules to supplement their studying for the Otolaryngology Training Exam , whether the modules had any effect on their Otolaryngology Training Examination Scores , and to obtain survey feedback about the modules .


This randomized trial was conducted in 3 academic departments of otolaryngology in the United States among 37 residents enrolled in 3 otolaryngology residency programs .


Residents were randomized into 2 groups , one with access to the educational modules and the other with no access .


Otolaryngology training examination scores were obtained from the year prior to the intervention ( 2012 ) and the year following module access ( 2013 ) .


Residents with access to the modules were also surveyed to assess use and obtain feedback about the modules .


Otolaryngology training examination scores improved significantly from 2012 to 2013 among both residents who had access to the modules and those who did not in the sections of head and neck , laryngology , and sleep medicine .


However , scores in the sections of pediatric otolaryngology ( 8 % increase , P = .03 ) , otology ( 7 % increase , P = .02 ) , and facial plastic surgery ( 10 % increase , P = .02 ) improved from 2012 to 2013 only among residents with access to the modules .


All respondents rated the videos as very helpful , with a rating of 4 of 5 on a Likert scale .


Online otolaryngology educational modules are an inexpensive way to expand resident learning opportunities .


Despite the lack of quantifiable improvement in otolaryngology training examination scores in this study , use of online modules sends a message to otolaryngology residents that their education is a priority ; self-study outside the hospital and clinics is necessary and expected ; and that instructors are willing to try more nontraditional or progressive forms of education to increase resident knowledge .


The aim of the present prospective , randomized , controlled , clinical study was to compare the outcomes of periradicular surgery of the maxillary first molar tooth using the vestibular approach between 2 preoperative radiologic evaluation methods : cone beam computed tomography ( CBCT ) and conventional radiography .


Periradicular surgery was applied to the maxillary first molar tooth in 40 patients .


The patients were divided into 2 groups .


The patients in group 1 underwent examination and preoperative planning with CBCT , and the patients in group 2 underwent examination and preoperative planning with conventional radiography .


The outcomes of the treatment were evaluated radiographically and clinically , and the data were analyzed statistically .


The mean operative time was significantly shorter in group 1 than in group 2 .


According to the radiographic and clinical healing criteria used in the present study , the healing of patients in group 1 was rated as a success in 35 % , an improvement in 40 % , and a failure in 25 % .


In the group 2 patients , healing was rated as a success in 42.1 % , an improvement in 31.6 % , and a failure in 26.3 % .


Sinus membrane elevation was performed in 92.3 % of all patients .


Sinus membrane perforation occurred in 20 % of the patients in group 1 and 36.8 % of the patients in group 2 .


Periradicular surgery of maxillary first molars using a vestibular approach is a viable treatment method with a low complication rate .


Preoperative CBCT examination demonstrated positive contributions to the treatment outcomes .


To evaluate safety and visual outcomes after proton beam irradiation ( PBI ) therapy for subfoveal choroidal neovascularisation ( CNV ) secondary to causes other than age-related macular degeneration ( AMD ) .


This study is a prospective , unmasked and randomised clinical trial using two dosage regimens , conducted in the Massachusetts Eye and Ear Infirmary .


The study included 46 patients with CNV secondary to non-AMD and best-corrected visual acuity of 20/320 or better .


Patients were randomly assigned to receive 16 or 24 cobalt gray equivalents ( CGE ) of PBI in two equal fractions .


Complete ophthalmological examinations , fundus photography and fluorescein angiography were performed at baseline and 6 , 12 , 18 and 24months after treatment .


At 1year after treatment , 82 % and 72 % lost fewer than 1.5 lines of vision in the 16 CGE and in 24 CGE groups , respectively .


At 2years after therapy , 77 % in the lower dose group and 64 % in the higher dose group lost fewer than 1.5 lines of vision .


Mild radiation complications such as radiation vasculopathy developed in 17.6 % of patients .


PBI is a safe and efficacious treatment for subfoveal CNV not due to AMD .


The data with respect to visual outcomes and radiation complications trend in favour of the 16 CGE group , although differences do not reach statistical significance .


PBI may be considered as an alternative to current therapies .


Recently , rimabotulinumtoxinB has been increasingly used as an off-label treatment of primary axillary hyperhidrosis ( PAH ) .


However , the optimal conversion ratios for onabotulinumtoxinA and rimabotulinumtoxinB remain to be determined .


To compare effectiveness , satisfaction level , and safety of rimabotulinumtoxinB with onabotulinumtoxinA at a conversion ratio of 1:30 for the treatment of PAH .


Adults with PAH were enrolled in this bilaterally paired single-subject study .


Each patient was randomly treated with 1,500 U rimabotulinumtoxinB on 1 axilla and 50 U onabotulinumtoxinA contralaterally .


Hyperhidrosis Disease Severity Scale was assessed before and after treatment up to 20 weeks .


A 10-cm visual analog scale representing improvement of hidrotic symptom and starch-iodine test were also used to assess therapeutic efficacy .


Twenty-four patients completed the study .


Both groups showed comparable and efficacious anhidrotic effects through 20 weeks for any variable .


There were no significant differences in terms of the onset of action or mean duration of action between the 2 groups .


Overall satisfaction with the treatment was equally high in both groups .


Both toxins showed comparable anhidrotic effect for the treatment of axillary hyperhidrosis at a conversion ratio of 1:30 .


Video capsule endoscopy ( VCE ) is recommended as the first exploration in obscure digestive bleeding .


The efficiency of the PillCam SB2 ( Given Imaging ) has been widely reported .


The CapsoCam capsule ( Capsovision ) has four cameras allowing the exploration of the small bowel through 360 lateral viewing .


This system does not include a recording system so the capsule has to be retrieved by the patient after expulsion in order for the film to be downloaded .


The aim of this study was to evaluate diagnostic concordance ( kappa value ) of the PillCam SB2 and CapsoCam capsules in the same patients .


This was a prospective comparative study in four French referral endoscopy units .


Consecutive patients ingested the two capsules 1 hour apart and in a randomized order .


In the 73 included patients there were 13 technical issues ( 11 CapsoCam , 2 PillCam SB2 ) .


Of the 60 patients with analyzable data , and following expert review of all discordant cases , a concordant positive diagnosis was obtained in 23 ( 38.3 % ) and a negative diagnosis was obtained and 26 patients ( 43.3 % ) .


Concordance was good , with a kappa value of 0.63 in analyzable patients , and 46.7 % diagnosis with CapsoCam vs. 48.3 % with PillCam SB2.CapsoCam and PillCam SB2 procedures identified 81.8 % ( 27/33 ) and 84.8 % ( 28/33 ) of positive patients , respectively ( P = 0.791 ) .


In a per lesion analysis , the CapsoCam capsule detected significantly more lesions ( 108 vs. 85 lesions ; P = 0.001 ) .


Reading time was longer for CapsoCam procedures ( 32.0 vs. 26.2 minutes ; P = 0.002 ) .


This study shows comparable efficiency of the CapsoCam and PillCam SB2 capsule systems in terms of diagnostic yield and image quality .


The impact of omega-3 polyunsaturated fatty acids ( PUFAs ) for prevention of atrial fibrillation ( AF ) is still part of a lively debate .


The present study evaluates the impact of orally administered omega-3 ethyl ester concentrate ( omega-3 PUFA ) on postoperative onset of AF in patients with recent myocardial infarction ( 3 months ) undergoing isolated coronary artery bypass grafting ( CABG ) .


Patients and


The study included a total of 198 patients with recent ( 3 months ) myocardial infarction .


The treatment group consisted of 99 prospectively and randomly assigned patients .


A matched control group was generated out of the entirety of patients undergoing isolated CABG during the same time period , being not treated with omega-3 PUFA .


Primary endpoint was onset of postoperative AF .


Patients of the treatment group received a daily dose of 2g omega-3 PUFA , initiated 5 days before surgery .


Effective serum levels were confirmed by laboratory testing .


Patients of the treatment group had less frequently postoperative AF ( treatment : 31.3 % vs. control : 48.0 % ; p = 0.017 ) .


The reduction in relative risk was 34.8 % in the treatment group , which conforms a number needed to treat ( NNT ) of 6.0 patients .


A more pronounced effect with a NNT of 4.1 was observed in patients70 years ( p = 0.007 ) .


Besides , patients of the treatment group had a shorter intensive care unit stay ( p = 0.001 ) and suffered less frequently from impaired wound healing by trend ( p = 0.063 ) .


One patient out of treatment group and two out of control group died during hospital stay ( p = 1.000 ) .


Preoperative administration of 2g omega-3 PUFA reduces incidence of postoperative AF in patients with recent ( 3 months ) myocardial infarction undergoing isolated CABG .


Magnesium enhances the effect of rocuronium .


Sugammadex reverses rocuronium-induced neuromuscular block .


The authors investigated whether magnesium decreased the efficacy of sugammadex for the reversal of rocuronium-induced neuromuscular block .


Thirty-two male patients were randomized in a double-blinded manner to receive magnesium sulfate ( MgSO4 ) 60 mg/kg or placebo intravenously before induction of anesthesia with propofol , sufentanil , and rocuronium 0.6 mg/kg .


Neuromuscular transmission was monitored using TOF-Watch SX acceleromyography ( Organon Ltd. , Dublin , Ireland ) .


In 16 patients , sugammadex 2 mg/kg was administered intravenously at reappearance of the second twitch of the train-of-four ( moderate block ) .


In 16 further patients , sugammadex 4 mg/kg was administered intravenously at posttetanic count 1 to 2 ( deep block ) .


Primary endpoint was recovery time from injection of sugammadex to normalized train-of-four ratio 0.9 .


Secondary endpoint was recovery time to final T1 .


Average time for reversal of moderate block was 1.69 min ( SD , 0.81 ) in patients pretreated with MgSO4 and 1.76 min ( 1.13 ) in those pretreated with placebo ( P = 0.897 ) .


Average time for reversal of deep block was 1.77 min ( 0.83 ) in patients pretreated with MgSO4 and 1.98 min ( 0.58 ) in those pretreated with placebo ( P = 0.572 ) .


Times to final T1 were longer compared with times to normalized train-of-four ratio 0.9 , without any difference between patients pretreated with MgSO4 or placebo .


Pretreatment with a single intravenous dose of MgSO4 60 mg/kg does not decrease the efficacy of recommended doses of sugammadex for the reversal of a moderate and deep neuromuscular block induced by an intubation dose of rocuronium .


Systemic glucocorticoids reduce the incidence of bronchopulmonary dysplasia among extremely preterm infants , but they may compromise brain development .


The effects of inhaled glucocorticoids on outcomes in these infants are unclear .


We randomly assigned 863 infants ( gestational age , 23 weeks 0 days to 27 weeks 6 days ) to early ( within 24 hours after birth ) inhaled budesonide or placebo until they no longer required oxygen and positive-pressure support or until they reached a postmenstrual age of 32 weeks 0 days .


The primary outcome was death or bronchopulmonary dysplasia , confirmed by means of standardized oxygen-saturation monitoring , at a postmenstrual age of 36 weeks .


A total of 175 of 437 infants assigned to budesonide for whom adequate data were available ( 40.0 % ) , as compared with 194 of 419 infants assigned to placebo for whom adequate data were available ( 46.3 % ) , died or had bronchopulmonary dysplasia ( relative risk , stratified according to gestational age , 0.86 ; 95 % confidence interval [ CI ] , 0.75 to 1.00 ; P = 0.05 ) .


The incidence of bronchopulmonary dysplasia was 27.8 % in the budesonide group versus 38.0 % in the placebo group ( relative risk , stratified according to gestational age , 0.74 ; 95 % CI , 0.60 to 0.91 ; P = 0.004 ) ; death occurred in 16.9 % and 13.6 % of the patients , respectively ( relative risk , stratified according to gestational age , 1.24 ; 95 % CI , 0.91 to 1.69 ; P = 0.17 ) .


The proportion of infants who required surgical closure of a patent ductus arteriosus was lower in the budesonide group than in the placebo group ( relative risk , stratified according to gestational age , 0.55 ; 95 % CI , 0.36 to 0.83 ; P = 0.004 ) , as was the proportion of infants who required reintubation ( relative risk , stratified according to gestational age , 0.58 ; 95 % CI , 0.35 to 0.96 ; P = 0.03 ) .


Rates of other neonatal illnesses and adverse events were similar in the two groups .


Among extremely preterm infants , the incidence of bronchopulmonary dysplasia was lower among those who received early inhaled budesonide than among those who received placebo , but the advantage may have been gained at the expense of increased mortality .


( Funded by the European Union and Chiesi Farmaceutici ; ClinicalTrials.gov number , NCT01035190 . )


To observe the impact of Xinkeshu on top of standard medication on psychological stress-related emotional and biophysiological parameters in patients with mental stress-induced myocardial ischemia ( MSIMI ) .


A randomized controlled clinical trial was conducted on 40 patients with MSIMI and patients were randomized into treatment group ( n = 21 ) and control group ( n = 19 ) by random number table method .


Patients in the treatment group received Xinkeshu ( 12 capsules/d ) on top of standard therapy , and the control group received placebo on top of standard therapy .


Serum homocysteine ( Hcy ) , Patient Health Questionnaire-9 ( PHQ-9 ) , Generalized Anxiety Disorder-7 ( GAD-7 ) , left ventricular ejection fraction ( LVEF ) and left ventricular fractional shortening ( LVFS ) were compared between the groups at baseline and after 8 weeks therapy .


( 1 ) Baseline data were similar between the 2 groups ( all P > 0.05 ) .


( 2 ) After 8 weeks , LVFS was significantly increased ( from ( 34.62 5.76 ) % to ( 35.90 4.99 ) % , P = 0.027 ) and serum Hcy ( from ( 18.08 1.81 ) mol/L to ( 16.06 10.10 ) mol/L ) , PHQ-9 ( from 8.14 3.98 to 6.28 2.87 ) and GAD-7 ( from 9.52 4.98 to 6.48 3.84 ) were significantly reduced in treatment group ( all P < 0.05 ) compared to baseline .


In the control group , only GAD-7 was significantly reduced ( from 8.89 5.06 to 6.74 4.80 , P = 0.003 ) after 8 weeks therapy compared to baseline ( P < 0.05 ) while other parameters remained unchanged ( all P > 0.05 ) .


Xinkeshu on the top of standard therapy can improve the emotional state and left ventricular systolic function in patients with MSIMI .


To study the effect of protocolized measurement ( three times daily ) of the Modified Early Warning Score ( MEWS ) versus measurement on indication on the degree of implementation of the Rapid Response System ( RRS ) .


A quasi-experimental study was conducted in a University Hospital in Amsterdam between September and November 2011 .


Patients who were admitted for at least one overnight stay were included .


Wards were randomized to measure the MEWS three times daily ( `` protocolized '' ) versus measuring the MEWS `` when clinically indicated '' in the control group .


At the end of each month , for an entire seven-day week , all vital signs recorded for patients were registered .


The outcomes were categorized into process measures including the degree of implementation and compliance to set monitoring standards and secondly , outcomes such as the degree of delay in physician notification and Rapid Response Team ( RRT ) activation in patients with raised MEWS ( MEWS3 ) .


MEWS calculations from vital signs occurred in 70 % ( 2513/3585 ) on the protocolized wards versus 2 % ( 65/3013 ) in the control group .


Compliance with the protocolized regime was presents in 68 % ( 819/1205 ) , compliance in the control group was present in 4 % ( 47/1232 ) of the measurements .


There were 90 calls to primary physicians on the protocolized and 9 calls on the control wards .


Additionally on protocolized wards , there were twice as much RRT calls per admission .


Vital signs and MEWS determination three times daily , results in better detection of physiological abnormalities and more reliable activations of the RRT .


Influenza virus infection-induced inflammatory responses are associated with fever and other symptoms .


Although macrolide antibiotics ( macrolides ) provide anti-inflammatory effects , these effects have not been well studied in influenza patients .


We examined the effects of clarithromycin on influenza symptoms .


A randomized , prospective , and open-label study was performed between December 2010 and March 2011 and between December 2012 and March 2013 in patients with pandemic A/H1 2009 influenza or seasonal influenza virus infections .


Patients aged > 15 years received either neuraminidase inhibitors ( control group ) or clarithromycin plus neuraminidase inhibitors ( clarithromycin group ) .


Body temperature and other symptoms were recorded for 5 days after initiating treatment .


Serum interleukin ( IL ) -6 and IL-8 levels were also measured .


Herein , 79 patients were enrolled over the two influenza seasons , and data from 63 patients were analyzed .


All patients showed fever and other symptoms , including rhinorrhea ( n = 38 ) , cough ( n = 50 ) , sore throat ( n = 39 ) , arthralgia or myalgia ( n = 46 ) , and general malaise ( n = 50 ) .


Fever duration was approximately 42 % shorter in patients with temperatures 38.5 C ( p = 0.02 ) , decreasing from 42 h to 24 h. Among patients with pandemic influenza infections ( n = 20 ) , the rhinorrhea improvement rate was higher in the clarithromycin group ( p = 0.03 ; 88 % vs. 20 % ) .


Serum IL-6 levels decreased 5 days after treatment , but no differences between the two groups were detected .


Clarithromycin may have the additional clinical benefit of improving fever , the main symptom of influenza , in patients treated with neuraminidase inhibitors .


Community-based participatory research ( CBPR ) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research .


Five cancer screening and prevention trials in three National Cancer Institute ( Bethesda , MD ) - funded Community Networks Program Centers ( CNPC ) , in Florida , Kansas , and South Carolina , were conducted across diverse populations .


Data were collected on total time period of recruitment , ratios of participants enrolled over potential participants approached , selected CBPR strategies , capacity-building development , and systematic procedures for community stakeholder involvement .


Community-engaged approaches used included establishing colearning opportunities , participatory procedures for community-academic involvement , and community and clinical capacity building .


A relatively large proportion of individuals identified for recruitment was actually approached ( between 50 % and 100 % ) .


The proportion of subjects who were eligible among all those approached ranged from 25 % to more than 70 % ( in the community setting ) .


Recruitment rates were very high ( 78 % -100 % of eligible individuals approached ) and the proportion who refused or who were not interested among those approached was very low ( 5 % -11 % ) .


Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects .


Adherence to CBPR principles in the spectrum of research activities , from strategic planning to project implementation , has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations .


CBPR strategies should be more widely implemented to enhance study recruitment .


Affecting mother and child , malaria during pregnancy ( MiP ) provokes a double morbidity and mortality burden .


Within a package of interventions to prevent MiP in endemic areas , the WHO currently recommends intermittent preventive treatment ( IPTp ) .


Concerns about anti-malarial resistance have however prompted interest in intermittent screening and treating ( IST ) as an alternative approach to IPTp .


IST involves screening for malaria infection at scheduled antenatal care ( ANC ) clinic visits and treating malaria cases .


In light of the need to comprehensively evaluate new interventions prior to roll out , this article explores the acceptability of IST with artemether-lumefantrine ( AL ) compared to IPTp with sulphadoxine-pyrimethamine ( SP ) and in Upper East Region , northern Ghana .


Data were collected alongside an open-label , randomized , controlled trial of IST-AL and IPTp-SP in Kassena-Nankana District .


Thirty pregnant women enrolled in the clinical trial participated in six focus group discussions .


Ten in-depth interviews were carried out with clinical trial staff .


Observations were also made at the health facilities where the clinical trial took place .


Trial participants were generally willing to endure the discomfort of the finger prick necessary for a rapid diagnostic test for malaria and this reflected a wider demand for diagnostic techniques .


Reports of side effects were however linked to both trial anti-malarials .


Direct complaints about SP were particularly severe with regard to women 's experience of vomiting .


Although the follow-up treatment doses of AL for IST were not supervised , based on blister inspection and questioning trial , staff were confident about participants ' adherence to the treatment course .


One case of partial adherence to the AL treatment course was reported .


Despite the discomfort of the finger prick required to perform the intermittent malaria screening , trial participants generally expressed more positive sentiments towards IST-AL than IPTp-SP .


Nonetheless , questions remain about adherence to a multiple dose anti-malarial regimen during pregnancy , particularly in endemic areas where MiP is often non-symptomatic .


Any implementation of IST must be accompanied by appropriate health messages on adherence and the necessary training for health staff regarding case management .


The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service .


This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy ( UGFS ) and endovenous laser ablation ( EVLA ) compared with conventional surgery as treatment for primary varicose veins .


Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial , which compared EVLA , surgery and UGFS .


Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years ( QALYs ) at 6 months .


A Markov model , incorporating available evidence on clinical recurrence rates , was developed to extrapolate the trial data over a 5-year time horizon .


Compared with surgery at 6 months , UGFS and EVLA reduced mean costs to the health service by 655 and 160 respectively .


When additional overhead costs associated with theatre use were included , these cost savings increased to 902 and 392 respectively .


UGFS produced 0005 fewer QALYs , whereas EVLA produced 0011 additional QALYs .


Extrapolating to 5 years , EVLA was associated with increased costs and QALYs compared with UGFS ( costing 3640 per QALY gained ) , and generated a cost saving ( 206-439 ) and QALY gain ( 0078 ) compared with surgery .


Applying a ceiling willingness-to-pay ratio of 20 000 per QALY gained , EVLA had the highest probability ( 787 per cent ) of being cost-effective .


The results suggest , for patients considered eligible for all three treatment options , that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY .


This study investigated whether self-reports of alcohol-related postings on Facebook by oneself or one 's Facebook friends were related to common motives for drinking and were uniquely predictive of self-reported alcohol outcomes ( alcohol consumption , problems , and cravings ) .


Pacific Northwest undergraduates completed a survey of alcohol outcomes , drinking motives , and alcohol-related Facebook postings .


Participants completed the survey online as part of a larger study on alcohol use and cognitive associations .


Participants were randomly selected through the university registrar 's office and consisted of 1,106 undergraduates ( 449 men , 654 women , 2 transgender , 1 declined to answer ) between the ages of 18 and 25 years ( M = 20.40 , SD = 1.60 ) at a large university in the Pacific Northwest .


Seven participants were excluded from analyses because of missing or suspect data .


Alcohol-related postings on Facebook were significantly correlated with social , enhancement , conformity , and coping motives for drinking ( all ps < .001 ) .


After drinking motives were controlled for , self-alcohol-related postings independently and positively predicted the number of drinks per week , alcohol-related problems , risk of alcohol use disorders , and alcohol cravings ( all ps < .001 ) .


In contrast , friends ' alcohol-related postings only predicted the risk of alcohol use disorders ( p < .05 ) and marginally predicted alcohol-related problems ( p = .07 ) .


Posting alcohol-related content on social media platforms such as Facebook is associated with common motivations for drinking and is , in itself , a strong predictive indicator of drinking outcomes independent of drinking motives .


Moreover , self-related posting activity appears to be more predictive than Facebook friends ' activity .


These findings suggest that social media platforms may be a useful target for future preventative and intervention efforts .


We aimed to compare the effectiveness of intravenous piracetam with that of intravenous dimenhydrinate in the treatment of acute peripheral vertigo in the emergency department .


This double-blind study comprised a total of 200 patients , aged between 18 and 70 years , who had presented to the emergency department of Ankara Training and Research Hospital and were diagnosed with peripheral vertigo .


Evaluation of the severity of the patients ' vertigo was performed using a visual analogue scale , before and after drug administration .


Both drugs were found to be effective ( p < 0.001 ) and had comparable effects ( p < 0.474 ) .


Dimenhydrinate was also found to have about two times the side effects of piracetam .


Drowsiness was found to be the most common side effect of these two drugs .


Dimenhydrinate and piracetam have similar levels of effectiveness with regard to acute vertigo .


We conclude that piracetam , which has fewer side effects than dimenhydrinate , better vestibular compensation , and is effective for both acute and chronic vertigo , could be more frequently used in the emergency treatment of acute vertigo .


Chronic constipation is frequent in children .


The objective of this study is to compare the efficacy and safety of PEG 4000 and lactulose for the treatment of chronic constipation in young children .


This randomised , double-blind study enrolled 88 young children aged 12 to 36 months , who were randomly assigned to receive lactulose ( 3.3 g per day ) or PEG 4000 ( 8 g per day ) for four weeks .


The primary efficacy variable was stool frequency during the fourth week of treatment .


Secondary outcomes were the number and frequency of subjective symptoms associated with defecation at each visit .


Stool frequency was comparable in the two groups at baseline ( lactulose : 0.7 0.5 ; PEG 4000 : 0.5 0.55 ) .


Mean stool frequency increased from 0.70 0.50 stools/day at baseline to 0.80 0.41 at Week 4 in the lactulose group and from 0.50 0.55 to 1.10 0.55 stools/day in the PEG 4000 group .


A significant difference was observed in the adjusted mean change from baseline , which was 0.15 stools/day in the lactulose group and 0.51 stools/day in the PEG 4000 group , with a least-squares mean difference of 0.36 stools/day [ 95 % CI : 0.16 to 0.56 ] .


With respect to secondary outcome variables , stool consistency and ease of stool passage improved more in the PEG 4000 group ( p = 0.001 ) .


The incidence of adverse events was similar in both groups , the majority of which were mild .


PEG 4000 has superior efficacy to lactulose for the treatment of chronic constipation in young children and is well tolerated .


US National Institute of Health Clinical Trials database ; study NCT00255372 first registered 17th November 2005 .


Stem cell-based therapy has emerged as a potential therapy in acute myocardial infarction ( AMI ) .


Although various approaches have been studied , intracoronary injection of bone marrow autologous mononuclear cells ( BMMC ) and the ability of granulocyte colony-stimulating factor ( G-CSF ) to mobilize endogenous cells have attracted the most attention .


This study compares , for the first time , the efficacy of BMMC injection , G-CSF mobilization , and the combination of both with standard treatment .


On Day 1 after primary percutaneous coronary intervention , 120 patients were randomized to a 1 ) intracoronary BMMC injection ; 2 ) mobilization with G-CSF ; 3 ) both ( BMMC injection plus G-CSF ) ; or 4 ) conventional treatment ( control group ) .


G-CSF , 10 g/kg/day subcutaneously , was started Day 1 and maintained for 5 days .


BMMC injection was performed on Days 3 to 5 .


Our primary endpoint was absolute change in 12-month left ventricular ejection fraction ( LVEF ) and left ventricular end-systolic volume ( LVESV ) relative to baseline measured by cardiac magnetic resonance .


The mean change in LVEF between baseline and follow-up for all patients was 4 6 % ( p = 0.006 ) .


Change in LVEF and LVESV over time did not differ significantly among the 4 groups .


Patients actively treated with any stem cell approach showed similar changes in LVEF and LVESV versus control subjects , with a small but significant reduction in infarct area ( p = 0.038 ) .


In our study , 3 different bone marrow-derived stem cell approaches in AMI did not result in improvement of LVEF or volumes compared with standard AMI care ( Trial of Hematopoietic Stem Cells in Acute Myocardial Infarction [ TECAM ] ; NCT00984178 ) .


The impact of anaesthetic agents on cognitive recovery during the first post-operative week in a middle-aged population undergoing general anaesthesia is insufficiently studied .


We hypothesised that patients receiving anaesthesia based on desflurane would have a quicker recovery and regain cognitive capacity faster than patients receiving anaesthesia based on propofol .


We performed a prospective , randomised , single-blinded study comparing the effects of desflurane and propofol as primary anaesthetic agents on cognitive recovery in 59 American Society of Anesthesiologists Physical Status Classification System I-II women undergoing breast surgery .


Cognitive recovery was evaluated using the Cognitive Failure Questionnaire and a modified version of the Post-operative Quality of Recovery Scale .


Post-operative cognitive recovery according to Cognitive Failure Questionnaire was 65 % and 66 % at 72h , and 71 % and 72 % at 1 week for the desflurane and the propofol groups , respectively .


Recovery according to Post-operative Quality of Recovery Scale was 52 % and 50 % at 2h , increasing to 71 % and 87 % at 48h for the desflurane and the propofol groups , respectively .


At the final point of measurement ( Cognitive Failure Questionnaire 1 week , Post-operative Quality of Recovery Scale 48h ) , many of the patients had still not reached their baseline cognitive performance .


There was no difference in overall cognitive recovery between the desflurane and propofol groups .


Cognitive recovery was not complete 1 week after surgery in any of the groups .


There was no difference in the rate of cognitive recovery in middle-aged patients receiving desflurane or propofol anaesthesia during ambulatory breast surgery .


The purpose of this study was to compare the discomfort and surgical outcomes of a piezosurgery device with those of rotatory instruments in lower third molar extraction .


A split-mouth , randomized , unblinded clinical study was designed ; the 2 molars had to have the same extraction difficulty score .


The test side was extracted using a piezosurgery technique and the control side was extracted using a conventional handpiece .


The primary endpoint was patient discomfort evaluated with the Postoperative Symptom Severity ( PoSSe ) scale , which was administered to each patient ; secondary endpoints were pain , trismus , swelling , and surgical time evaluation .


Paired-samples t test and repeated-measures analysis of variance were used to compare outcomes within patients .


Ten consecutive patients ( 6 female , 4 male ; mean age , 22.4 2.3 yr ) were recruited .


The total score on the PoSSe scale was significantly lower for piezosurgery compared with the conventional rotating handpiece ( 24.7 10.3 vs 36.0 7.6 ; t = -4.27 ; P = .002 ) .


Moreover , postoperative swelling 1 week after surgery was significantly lower for piezosurgery than for the conventional rotating handpiece ( 2.75 0.23 vs 3.1 0.39 cm ; t = -2.63 ; P = .027 ) .


Piezosurgery was associated with less postoperative discomfort and yielded better results for swelling .


Piezosurgery seems to be a good technique in daily surgical practice , especially if applied in the critical steps in which safety and respect for soft tissue , bone , and nerves are necessary .


Many strategies have been evaluated to improve the prevention and control of cardiovascular ( CVD ) risk factors .


Nursing telephonic and tele-counseling individualized lifestyle educational programs have been found to improve blood pressure control and adherence to lifestyle recommendation .


This study tested the efficacy of a nurse-led reminder program through email ( NRP-e ) to improve CVD risk factors among hypertensive adults .


All participants received usual CVD prevention and a guideline-based educational program .


Subjects in the NRP-e group also received weekly email alerts and phone calls from a nurse care manager for 6 months .


Emails contained a reminder program on the need for adherence with a healthy lifestyle based upon current guidelines .


Follow-up visits were scheduled at 1 , 3 and 6 months after enrollment ; randomization was made centrally and blood samples were evaluated into a single laboratory .


The final sample consisted of 98 ( control ) and 100 ( NRP-e ) subjects ( mean age 59.0 14.5 years ; 51.0 % males ) .


After 6 months , the following CVD risk factors significantly improved in both groups : body mass index , alcohol and fruit consumption , cigarette smoking , adherence to therapy hours , systolic and diastolic blood pressure , fasting blood glucose , low-density lipoproteins ( LDL ) and total cholesterol , triglycerides , and physical activity .


In the NRP-e group , however , the prevalence of several behaviors or conditions at risk decreased significantly more than in the control group : obesity ( -16 % ) , low fruit consumption ( -24 % ) , uncontrolled hypertension ( -61 % ) , LDL ( -56 % ) , and total cholesterol ( -40 % ) .


The NRP-e improved a range of CVD risk factors .


The program had low costs , required only an average of < 20 min per day in addition to normal practice , and may deserve further evaluation for the inclusion among existing care management approaches .


Epilepsy is the most common neurological problem that affects people with learning disabilities .


The high seizure frequency , resistance to treatments , associated skills deficit and co-morbidities make the management of epilepsy particularly challenging for people with learning disabilities .


The Books Beyond Words booklet for epilepsy uses images to help people with learning disabilities manage their condition and improve quality of life .


Our aim is to conduct a randomized controlled feasibility trial exploring key methodological , design and acceptability issues , in order to subsequently undertake a large-scale randomized controlled trial of the Books Beyond Words booklet for epilepsy .


We will use a two-arm , single-centre randomized controlled feasibility design , over a 20-month period , across five epilepsy clinics in Hertfordshire , United Kingdom .


We will recruit 40 eligible adults with learning disabilities and a confirmed diagnosis of epilepsy and will randomize them to use either the Books Beyond Words booklet plus usual care ( intervention group ) or to receive routine information and services ( control group ) .


We will collect quantitative data about the number of eligible participants , number of recruited participants , demographic data , discontinuation rates , variability of the primary outcome measure ( quality of life : Epilepsy and Learning Disabilities Quality of Life scale ) , seizure severity , seizure control , intervention 's patterns of use , use of other epilepsy-related information , resource use and the EQ-5D-5L health questionnaire .


We will also gather qualitative data about the feasibility and acceptability of the study procedures and the Books Beyond Words booklet .


Ethical approval for this study was granted on 28 April 2014 , by the Wales Research Ethics Committee 5 .


Recruitment began on 1 July 2014 .


The outcomes of this feasibility study will be used to inform the design and methodology of a definitive study , adequately powered to determine the impact of the Books Beyond Words intervention to improve the management of epilepsy in people with learning disabilities .


http://ISRCTN80067039 ( Date of ISRCTN assignation : 23 April 2014 ) .


To study the efficacy and safety of low-dose oral tetrahydrocannabinol ( THC ) in the treatment of dementia-related neuropsychiatric symptoms ( NPS ) .


This is a randomized , double-blind , placebo-controlled study .


Patients with dementia and clinically relevant NPS were randomly assigned to receive THC 1.5 mg or matched placebo ( 1:1 ) 3 times daily for 3 weeks .


Primary outcome was change in Neuropsychiatric Inventory ( NPI ) , assessed at baseline and after 14 and 21 days .


Analyses were based on intention-to-treat .


Twenty-four patients received THC and 26 received placebo .


NPS were reduced during both treatment conditions .


The difference in reduction from baseline between THC and placebo was not significant ( mean difference NPItotal : 3.2 , 95 % confidence interval [ CI ] -3.6 to 10.0 ) , nor were changes in scores for agitation ( Cohen-Mansfield Agitation Inventory 4.6 , 95 % CI -3.0 to 12.2 ) , quality of life ( Quality of Life-Alzheimer 's Disease -0.5 , 95 % CI -2.6 to 1.6 ) , or activities of daily living ( Barthel Index 0.6 , 95 % CI -0.8 to 1.9 ) .


The number of patients experiencing mild or moderate adverse events was similar ( THC , n = 16 ; placebo , n = 14 , p = 0.36 ) .


No effects on vital signs , weight , or episodic memory were observed .


Oral THC of 4.5 mg daily showed no benefit in NPS , but was well-tolerated , which adds valuable knowledge to the scarce evidence on THC in dementia .


The benign adverse event profile of this dosage allows study of whether higher doses are efficacious and equally well-tolerated .


This study provides Class I evidence that for patients with dementia-related NPS , low-dose THC does not significantly reduce NPS at 21 days , though it is well-tolerated .


This study aimed to investigate the effects of an interpersonal-psychotherapy-oriented postnatal psychoeducation programme on postpartum depressive symptoms , social support and maternal role competence in Chinese first-time mothers .


A randomized , controlled trial was conducted in the postnatal unit of a regional hospital in China .


The intervention consisted of a 1-h education session before discharge and one telephone follow-up within the 2 weeks after discharge from the hospital .


One hundred and eighty first-time Chinese mothers were randomly assigned to the study group ( n = 90 ) or the control group ( n = 90 ) .


Outcomes of the study included symptoms of postpartum depression , social support and maternal role competence which were measured by the Edinburgh Postnatal Depression Scale , the Perceived Social Support Scale and the Parenting Sense of Competence Scale-Efficacy subscale , respectively .


Women receiving the postnatal psychoeducation programme had significantly fewer depressive symptoms ( Mean [ SD ] = 7.61 [ 3.43 ] versus 8.96 [ 4.55 ] ; t = -2.24 ; p = 0.026 ) , higher level of social support ( Mean [ SD ] = 65.44 [ 8.43 ] versus 61.82 [ 9.99 ] ; t = 2.63 ; p = 0.009 ) and better maternal role competence ( Mean [ SD ] = 35.87 [ 4.41 ] versus 32.79 [ 6.86 ] ; t = 3.59 ; p < 0.001 ) at 6 weeks postpartum as compared with those who received routine postnatal care .


An interpersonal-psychotherapy-oriented postnatal psychoeducation programme may have the potential to facilitate the Chinese first-time mothers ' transition to motherhood .


A larger trial is needed to test for therapist effects , a full economic evaluation , and whether the intervention is acceptable to staff and feasible to use in current practice .


Reduced epidermal ceramide content may lead to an impaired skin barrier in atopic dermatitis .


Plasma concentration of the ceramide precursor sphingomyelin increases after milk-fat consumption due to affected lipoprotein metabolism , although sphingomyelin , a main component of milk phospholipids , might also directly influence plasma sphingomyelin levels .


The aim was to determine whether supplementation of a dairy drink with milk phospholipids improves skin parameters and influences plasma lipid profile .


In a double-blind cross-over study , 39 patients were randomized into 2 groups and daily received phospholipid milk ( 3g phospholipids 0.75 g sphingomyelin ) or normal whole milk as placebo control for 6 weeks .


SCORAD indices , serum immune and plasma lipid parameters were determined .


SCORAD indices did not differ between groups following control and phospholipid milk supplementation ( control milk : 10.95.9 vs. phospholipid milk : 11.76.9 , P = 0.416 ) , but were significantly decreased compared to baseline ( baseline : 15.68.8 , P < 0.05 ) .


Plasma sphingomyelin proportions were also similar after the treatments ( control milk : 27.52.3 vs. phospholipid milk : 27.42.6 % of total phospholipids , P = 0.894 ) , but were significantly increased compared to baseline ( 20.72.4 % of total phospholipids , P < 0.05 ) .


Supplementation of a dairy drink with milk phospholipids has no beneficial effect on skin parameters compared to consumption of whole milk in patients with atopic dermatitis .


To elucidate an impact of the plasma sphingomyelin proportion on skin conditions , further studies are necessary .


Clinical trial ID : Registered under ClinicalTrials.gov .


Identifier no .


NCT01326520 .


Our study examined the effect of a ChinaYuan ( CNY ) 10 cash incentive on the participation rate in a face-to-face health survey among the general Chinese population .


Subjects older than 15 years of age and had been living in the two selected districts for more than 6 months were selected using multistage random sampling .


Participants from only one district received a cash incentive ( CNY 10 ) for completing the survey .


The participation rates in the nonincentive and incentive groups were 39.9 % and 61.2 % , respectively , P < 0.01 .


In the nonincentive group , the 65-74 years age group had the highest participation rate ( 54.4 % ) ; no significant difference was found between men ( 39.4 % ) and women ( 40.5 % ) , P = 0.59 .


In the incentive group , the highest participation rate was observed in the 75 years ( 78.1 % ) age group .


The cost for a completed interview was CNY 34.5 in the incentive group and CNY 35.8 in the nonincentive group .


Cash incentives might increase participation rates in face-to-face surveys in China .


The absolute cost was higher for the incentive group , whereas cost for a completed interview was actually the lowest .


Furthermore , participation rate did not differ between men and women , but elders were more likely to participate in health surveys .


Vitamin D , its biologically most active metabolite 1,25-dihydroxyvitamin D ( 1,25 ( OH ) D ) , and the vitamin D receptor ( VDR ) are important for adipose tissue biology .


We extrapolated genomic VDR association loci in adipocytes from 55 conserved genome-wide VDR-binding sites in nonfat tissues .


Taking the genes DUSP10 , TRAK1 , NRIP1 , and THBD as examples , we confirmed the predicted VDR binding sites upstream of their transcription start sites and showed rapid mRNA up-regulation of all four genes in SGBS human pre-adipocytes .


Using adipose tissue biopsy samples from 47 participants of a 5-month vitamin D intervention study , we demonstrated that all four primary VDR target genes can serve as biomarkers for the vitamin D responsiveness of human individuals .


Changes in DUSP10 gene expression appear to be the most comprehensive marker , while THBD mRNA changes characterized a rather different group of study participants .


We present a new approach to predict vitamin D target genes based on conserved genomic VDR-binding sites .


Using human adipocytes as examples , we show that such ubiquitous VDR target genes can be used as markers for the individual 's response to a supplementation with vitamin D.


To examine the relationship between premature ejaculation and plasma melatonin levels , and assess the efficacy of selective serotonin reuptake inhibitors in treating premature ejaculation .


A total of 60 men with lifelong premature ejaculation and 40 healthy male controls were included in the present study .


For each participant , a medical history was obtained , a physical examination was carried out , and intravaginal ejaculation latency time and melatonin levels were measured .


Premature ejaculation patients were randomly categorized into three treatment groups : group1 received fluoxetine ( 20mg/day ) , group2 received paroxetine ( 20mg/day ) and group3 received sertraline ( 50mg/day ) .


The mean baseline plasma melatonin levels in men with premature ejaculation were significantly lower than in the healthy controls ( 5.34 vs 14.84 pg/mL ) .


After 4weeks of treatment , the mean intravaginal ejaculation latency time scores for all of the premature ejaculation treatment groups showed a significant improvement from the baseline values .


The plasma melatonin levels were also significantly increased ( P < 0.05 ) from baseline ( 5.34 pg/mL ) to 9.50 pg/mL , 10.24 pg/mL or 13.30 pg/mL for groups1 , 2 and 3 , respectively .


Our findings show that premature ejaculation is associated with decreased plasma melatonin levels .


After treatment with selective serotonin reuptake inhibitors , an increased plasma melatonin level can retard ejaculation , presumably by both central and peripheral mechanisms .


This is the first study to evaluate the possible role of serotoninergic interactions on the melatoninergic system in premature ejaculation .


To develop a whole joint scoring system , the Anterior Cruciate Ligament OsteoArthritis Score ( ACLOAS ) , for magnetic resonance imaging ( MRI ) - based assessment of acute anterior cruciate ligament ( ACL ) injury and follow-up of structural sequelae , and to assess its reliability .


Baseline and follow-up 1.5 T MRI examinations from 20 patients of the KANON study , a randomized controlled study comparing a surgical and non-surgical treatment strategy , were assessed for up to six longitudinal visits using a novel MRI scoring system incorporating acute structural tissue damage and longitudinal changes including osteoarthritis ( OA ) features .


Joint features assessed were acute osteochondral injury , traumatic and degenerative bone marrow lesions ( BMLs ) , meniscus morphology and extrusion , osteophytes , collateral and cruciate ligaments including ACL graft , Hoffa-synovitis and effusion-synovitis .


Cross-sectional ( baseline ) and longitudinal ( all time points and change ) intra - and inter-observer reliability was calculated using weighted ( w ) kappa statistics and overall percent agreement on a compartmental basis ( medial tibio-femoral , lateral tibio-femoral , patello-femoral ) .


Altogether 87 time points were evaluated .


Intra-observer reliability ranged between 0.52 ( baseline , Hoffa-synovitis ) and 1.00 ( several features ) , percent agreement between 52 % ( all time points , Hoffa-synovitis ) and 100 % ( several features ) .


Inter-observer reliability ranged between 0.00 and 1.00 , which is explained by low frequency of some of the features .


Altogether , 73 % of all assessed 142 parameters showed w-kappa values between 0.80 and 1.00 and 92 % showed agreement above 80 % .


ACLOAS allows reliable scoring of acute ACL injury and longitudinal changes .


This novel scoring system incorporates features that may be relevant for structural outcome not covered by established OA scoring instruments .


Gliomas are among the biggest challenges in neurological and oncology rehabilitation and optimising treatment is of major clinical importance in this population .


Although inpatient rehabilitation among glioma patients ' results in improved functional measures , rehabilitation efforts are still not emphasised in this patient group and the literature lacks studies investigating the impact of outpatient rehabilitation .


This protocol describes a randomised 6-week parallel group rehabilitation study investigating an outpatient interdisciplinary rehabilitation programme .


The intervention consists of 6weeks intensive physiotherapy as groups exercise in conjunction with 0-6weeks of individual occupational therapy if a need is present .


The aim of this study is to describe the design of the upcoming randomised control trial ( RCT ) .


The results of the RCT will add to the growing body of literature investigating the potential role of exercise as a supportive therapeutic intervention for a patient with cancer .


The project is approved by the Regional Scientific Ethical Committees for Southern Denmark under Project-ID : ( S-20140108 ) and by the Danish Data Protection Agency ( J. no.2008-58-0035 ) .


Dissemination will occur through presentation and findings will be published in peer-reviewed journals .


The key strength of this study is its randomised design and it is the first study to investigate a standardised outpatient interdisciplinary rehabilitation programme among patients with glioma .


A potential limitation is the uncertainty and risk of side effects to the concomitant treatment , which enhances the risk of dropout .


ClinicalTrials.gov Identifier NCT02221986 .


The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained .


Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations .


Using a community-based participatory approach ( CBPR ) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans , who bear a disproportionate burden of the obesity epidemic .


Led by a collaborative community-academic partnership , The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural , African American adults of faith .