A three-arm , randomized , controlled , non-inferiority trial was conducted among children of either gender aged six months ( > 5kg ) to ten years ( n = 720 ) with acute uncomplicated Plasmodium falciparum infection .


Parents/guardians of children provided consent prior to randomization to receive ASAQ , DHAP or AL in the ratio of 2:2:1 , respectively .


Treatment outcome was assessed based on standard WHO 2003 classification after 42days of follow-up .


The primary outcome was PCR-corrected day-42 cure rates .


The non-inferiority , one-sided , lower limit asymptotic 97.5 % confidence interval ( CI ) on the difference in PCR-corrected cure rates of ASAQ and DHAP when compared to AL was accepted if the lower limit of the CI was greater than -10 % .


Secondary outcomes were parasite and fever clearances and day 7 haemoglobin changes .


PCR-corrected PP cure rates of 96.7 , 98.1 and 96.3 , respectively , for AL , ASAQ and DHAP was observed .


The lower bound of the one-sided 97.5 % CI calculated around the difference between day-42 cure rate point estimates in AL and ASAQ groups , AL and DHAP groups were , -6 % and -4 % respectively .


There were no statistical significant differences in parasite or fever clearance times between treatments , although fever clearance pattern was different between ASAQ and DHAP .


No statistical significant differences were observed in the occurrence of adverse events among treatment groups .


ASAQ and DHAP are considered safe and tolerable and are not inferior to AL in the treatment of uncomplicated P. falciparum malaria in Cameroonian children .


NCT01845701 .


To study the effect of therapeutic hypothermia ( TH ) on deoxyribonucleic acid ( DNA ) damage and the neurodevelopmental outcome in term babies with perinatal asphyxia .


Babies in the hypothermia group were cooled for the first 72 h , using gel packs .


Rectal temperature of 33-34C was maintained .


Blood sample was collected before , at 36 h and after completion of TH for assessment of comet assay and 8-hydroxy2-deoxyguanosine ( 8-OHdG ) .


Infants were followed up till 12 months .


Baseline parameters were similar .


After 72 h , the hypothermia group showed lower olive tail moment ( 12.88 2.14 ) than the control group ( 22.16 5.26 ) ( p < 0.001 ) .


8-HDG levels increased significantly in the control group ( 1252.87 357.07 ) as compared to the hypothermia group ( 757.03 198.49 ) ( p < 0.001 ) .


Neurodevelopmental assessment at 12 months showed significantly low motor and mental developmental quotient in the control than hypothermia group .


TH reduces oxidative stress-induced DNA damage and improves neurodevelopmental outcome .


< Trial registration No : CTRI/2011/10 / 002094 >


To compare integrated automated load distributing band CPR ( iA-CPR ) with high-quality manual CPR ( M-CPR ) to determine equivalence , superiority , or inferiority in survival to hospital discharge .


Between March 5 , 2009 and January 11 , 2011 a randomized , unblinded , controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites .


After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR .


Patient follow-up was until all patients were discharged alive or died .


The primary outcome , survival to hospital discharge , was analyzed adjusting for covariates , ( age , witnessed arrest , initial cardiac rhythm , enrollment site ) and interim analyses .


CPR quality and protocol adherence were monitored ( CPR fraction ) electronically throughout the trial .


Of 4753 randomized patients , 522 ( 11.0 % ) met post enrollment exclusion criteria .


Therefore , 2099 ( 49.6 % ) received iA-CPR and 2132 ( 50.4 % ) M-CPR .


Sustained ROSC ( emergency department admittance ) , 24h survival and hospital discharge ( unknown for 12 cases ) for iA-CPR compared to M-CPR were 600 ( 28.6 % ) vs. 689 ( 32.3 % ) , 456 ( 21.8 % ) vs. 532 ( 25.0 % ) , 196 ( 9.4 % ) vs. 233 ( 11.0 % ) patients , respectively .


The adjusted odds ratio of survival to hospital discharge for iA-CPR compared to M-CPR , was 1.06 ( 95 % CI 0.83-1 .37 ) , meeting the criteria for equivalence .


The 20 min CPR fraction was 80.4 % for iA-CPR and 80.2 % for M-CPR .


Compared to high-quality M-CPR , iA-CPR resulted in statistically equivalent survival to hospital discharge .


Certain disorders , such as depression and anxiety , to which serotonin dysfunction is historically associated , are also associated with lower assessments of other people 's trustworthiness .


Serotonergic changes are known to alter cognitive responses to threatening stimuli .


This effect may manifest socially as reduced apparent trustworthiness of others .


Trustworthiness judgments can emerge from either direct observation or references provided by third parties .


We assessed whether explicit judgments of trustworthiness and social influences on those judgments are altered by changes within serotonergic systems .


We implemented a double-blind between-subject design where 20 healthy female volunteers received a single dose of the selective serotonin reuptake inhibitor ( SSRI ) citalopram ( 220 mg ) , while 20 control subjects ( matched on age , intelligence , and years of education ) received a placebo .


Subjects performed a face-rating task assessing how trustworthy they found 153 unfamiliar others ( targets ) .


After each rating , the subjects were told how other subjects , on average , rated the same target .


The subjects then performed 30 min of distractor tasks before , unexpectedly , being asked to rate all 153 faces again , in a random order .


Compared to subjects receiving a placebo , subjects receiving citalopram rated targets as less trustworthy .


They also conformed more to opinions of others , when others rated targets to be even less trustworthy than subjects had initially indicated .


The two effects were independent of negative effects of citalopram on subjective state .


This is evidence that serotonin systems can mediate explicit assessment and social learning of the trustworthiness of others .


Sarcoplasmic reticulum ( SR ) Ca ( 2 + ) - handling proteins play an important role in myocardial dysfunction after acute ischemia/reperfusion injury .


We hypothesized that nitrite would improve postresuscitation myocardial dysfunction by increasing nitric oxide ( NO ) generation and that the mechanism of this protection is related to the modulation of SR Ca ( 2 + ) - handling proteins .


We conducted a randomized prospective animal study using male Sprague-Dawley rats .


Cardiac arrest was induced by intravenous bolus of potassium chloride ( 40 g/g ) .


Nitrite ( 1.2 nmol/g ) or placebo was administered when chest compression was started .


No cardiac arrest was induced in the sham group .


Hemodynamic parameters were monitored invasively for 90 minutes after the return of spontaneous circulation ( ROSC ) .


Echocardiogram was performed to evaluate cardiac function .


Myocardial samples were harvested 5 minutes and 1 hour after ROSC .


Myocardial function was significantly impaired in the nitrite and placebo groups after resuscitation , whereas cardiac function ( i.e. , ejection fraction and fractional shortening ) was significantly greater in the nitrite group than in the placebo group .


Nitrite administration increased the level of nitric oxide in the myocardium 5 min after resuscitation compared to the other two groups .


The levels of phosphorylated phospholamban ( PLB ) were decreased after resuscitation , and nitrite increased the phosphorylation of phospholamban compared to the placebo .


No significant differences were found in the expression of sarcoplasmic reticulum Ca ( 2 + ) ATPase ( SERCA2a ) and ryanodine receptors ( RyRs ) .


postresuscitation myocardial dysfunction is associated with the impairment of PLB phosphorylation .


Nitrite administered during resuscitation improves postresuscitation myocardial dysfunction by preserving phosphorylated PLB protein during resuscitation .


Group medical clinics may improve diabetes and hypertension control , but data about dyslipidemia are limited .


We examined the impact of group medical clinics on lipids among patients with uncontrolled diabetes and hypertension .


Prespecified secondary analysis of 239 veterans randomized to group medical clinics or usual care .


Lipids were assessed at study baseline , midpoint , and end .


We used linear mixed models to compare lipid levels between arms and generalized estimating equation models to compare low-density lipoprotein cholesterol ( LDL-C ) goal attainment .


An additional post hoc analysis examined intensification of cholesterol-lowering medications in both arms .


At baseline , mean total cholesterol was 169.7 mg/dL ( SD 47.8 ) , LDL-C 98.2 mg/dL ( SD 41.7 ) , and high-density lipoprotein cholesterol ( HDL-C ) 39.3 mg/dL ( SD 13.0 ) .


Median baseline triglycerides were 131 mg/dL ( interquartile range 122 ) .


By study end , mean total cholesterol and LDL-C in group medical clinics were 14.2 mg/dL ( P = .01 ) and 9.2 mg/dL ( P = .02 ) lower than usual care , respectively ; 76 % of group medical clinic patients met goals for LDL-C , versus 61 % of usual care patients ( P = .02 ) .


Triglycerides and HDL-C remained similar between study arms .


Treatment intensification occurred in 52 % of group medical clinic patients , versus 37 % of usual care patients between study baseline and end ( P = .04 ) .


The mean statin dose was higher in group medical clinic patients at study midpoint and end .


Group medical clinics appear to enhance lipid management among patients with diabetes and hypertension .


This may be a result of greater intensification of cholesterol-lowering medications in group medical clinics relative to usual care .


Red ginseng is prepared by steaming raw ginseng , a process believed to increase the pharmacological efficacy .


Further bioconversion of red ginseng through fermentation is known to increase its intestinal absorption and bioactivity , and bioconversion diminishes the toxicity of red ginseng 's metabolite .


This study was conducted to investigate the effects of daily supplementation with fermented red ginseng ( FRG ) on glycemic status in subjects with impaired fasting glucose or type 2 diabetes .


This study was a four-week long , randomized , double-blind , placebo-controlled trial .


Forty-two subjects with impaired fasting glucose or type 2 diabetes were randomly allocated to two groups assigned to consume either the placebo or fermented red ginseng ( FRG ) three times per day for four weeks .


Fasting and postprandial glucose profiles during meal tolerance tests were assessed before and after the intervention .


FRG supplementation led to a significant reduction in postprandial glucose levels and led to an increase in postprandial insulin levels compared to the placebo group .


There was a consistently significant improvement in the glucose area under the curve ( AUC ) in the FRG group .


However , fasting glucose , insulin , and lipid profiles were not different from the placebo group .


Daily supplementation with FRG lowered postprandial glucose levels in subjects with impaired fasting glucose or type 2 diabetes .


ClinicalTrials.gov : NCT01826409 .


The aim of the study was to determine whether docosahexaenoic acid ( DHA ) supplementation improves the behavior of children with autism .


A group of 3 - to 10-year-old children with autism were randomized in a double-blind fashion to receive a supplement containing 200 mg of DHA or a placebo for 6 months .


The parents and the investigator completed the Clinical Global Impressions-Improvement scale to rate changes in core symptoms of autism after 3 and 6 months .


The parents completed the Child Development Inventory and the Aberrant Behavior Checklist , and both parents and teachers completed the Behavior Assessment Scale for Children ( BASC ) at enrollment and after 6 months .


A total of 48 children ( 40 [ 83 % ] boys , mean age [ standard deviation ] 6.1 [ 2.0 ] years ) were enrolled ; 24 received DHA and 24 placebo .


Despite a median 431 % increase in total plasma DHA levels after 6 months , the DHA group was not rated as improved in core symptoms of autism compared to the placebo group on the CGI-I .


Based on the analysis of covariance models adjusted for the baseline rating scores , parents ( but not teachers ) provided a higher average rating of social skills on the BASC for the children in the placebo group compared to the DHA group ( P = 0.04 ) , and teachers ( but not parents ) provided a higher average rating of functional communication on the BASC for the children in the DHA group compared to the placebo group ( P = 0.02 ) .


Dietary DHA supplementation of 200 mg/day for 6 months does not improve the core symptoms of autism .


Our results may have been limited by inadequate sample size .


We evaluated the efficacy and safety of an early invasive strategy post-fibrinolysis in relation to glycoprotein ( GP ) IIb/IIIa inhibitor use .


The Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction ( TRANSFER-AMI ) randomised 1059 ST elevation myocardial infarction patients to an early invasive strategy or standard therapy post-fibrinolysis .


The primary end point was the composite of death , reinfarction , recurrent ischaemia , new or worsening heart failure , or cardiogenic shock at 30 days .


In this pre-specified analysis , we examined efficacy and safety outcomes of an early invasive strategy after stratification by GPIIb/IIIa inhibitor use , which was permitted during percutaneous coronary intervention ( PCI ) at the discretion of the treating physician .


A total of 695 patients ( 65.6 % ) received GPIIb/IIIa inhibitors .


There was significant heterogeneity ( p < 0.001 ) in the efficacy of an early invasive strategy compared to standard therapy , between the strata with GPIIb/IIIa inhibitor use ( primary end point 9.6 % vs 22.3 % respectively , p < 0.001 ) and without GPIIb/IIIa inhibitor use ( primary end point 14.8 % vs 10.4 % respectively , p = 0.21 ) .


Patients who received GPIIb/IIIa inhibitors had lower Global Registry of Acute Coronary Events ( GRACE ) risk scores compared to those without GPIIb/IIIa inhibitor use ( median 121 vs 130 , p < 0.001 ) .


After adjusting for the interaction between GRACE risk score and treatment assignment , the heterogeneity in the efficacy of an early invasive strategy with respect to GPIIb/IIIa inhibitor use was no longer significant ( p interaction = 0.08 ) .


The apparent difference in the efficacy of an early invasive strategy between GPIIb/IIIa inhibitor strata likely reflects an association between GPIIb/IIIa inhibitor use and baseline risk .


GPIIb/IIIa inhibitor use during PCI at the discretion of the treating physician does not appear to modulate the efficacy of an early invasive strategy post-fibrinolysis .


http://www.clinicaltrials.gov/ct2/show/NCT00164190 , NCT00164190 .


To determine the safety and efficacy of a 50 ns Q switched Nd YAG laser vs. a 5 ns Q switched Nd YAG laser for clearance of melasma .


To compare subject satisfaction , efficacy , and comfort level between the two lasers .


This is a prospective , randomized split face clinical study .


The study was approved by the Scripps IRB .


Ten healthy female subjects with moderate to severe melasma were enrolled .


Each subject had three laser treatments one month apart .


Patients were followed up approximately 1 month , 3 months , and 6 months after the final laser treatment .


A treatment session consisted of a microdermabrasion , 1064 nm QS laser , and topicals .


Subjects were asked to rate treatment pain based on a numerical scale range 0-10 ( 0 = no pain and 10 = worst pain ) .


A melasma area and severity index ( MASI ) grading system was applied .


Also , melanin measurements were acquired by a reflectance spectrophotometer .


Side effects were documented during the study including post treatment erythema .


Eight patients completed the study .


Subjects showed improvement on both sides of the face .


From baseline to 1 month post the final laser treatment , the average MASI scores showed a 16 % reduction for the 50 ns QS 1064 nm laser vs. a 27 % reduction for the 5 ns QS 1064 nm laser ( both significant versus baseline pigment , P < 0.05 ) .


This difference in MASI scores between the two lasers was not statistically significant ( P = 0.87930 ) .


Laser treatments displayed mild erythema that resolved after one day .


The melanin meter measurements showed a reduction in pigment readings on both sides .


Three months after the final treatment there was some relapse in the melasma , as the mean pigment reduction fell to 12 % for the 50 ns laser and 11 % for the 5 ns laser .


By 3 months pigment reduction was not statistically significant for either laser , and no significant differences in pigment reduction were noted between the two pulse durations .


There was a statistically significant difference ( P < 0.05 ) in pain scores reported by the subjects ( scale 0-10 ) , the mean pain score for 50 ns QS 1064 nm laser was 1.2 and for the 5 ns QS 2.9 the score was 2.9 .


In this study , we showed that a combination of microdermabrasion , QS1064 nm laser , and topicals decreased the MASI and meter scores without clinically significant side effects .


Moreover , the longer pulsed Q switched 1064 nm laser i.e. ( 50 ns ) was associated with less pain than its shorter pulse width counterpart .


Evidence supports that adequate treatment of hyperglycemia , hypercholesterolemia , and hypertension can reduce morbidity and mortality in people with diabetes , however achieving treatment goals remains elusive .


The majority of diabetes care occurs in the primary care setting ; however there are often missed opportunities for timely intervention during office visits .


This paper describes a systematic redesign of current diabetes treatment in primary care by implementing evidence-based protocols .


This is a cluster randomized controlled trial using certified diabetes educators ( CDEs ) to intensify therapeutic management .


Fifteen primary care practices from the University of Pittsburgh Medical Center were recruited .


Practices were randomized to intervention ( implementation of diabetes management protocols ) or usual care .


Eligibility criteria included diagnosis of type 2 diabetes at least one year prior to baseline and an A1C 7 % , LDLc 100 mg/dl or blood pressure 130/80 mmHg which were the goal levels established by the American Diabetes Association at study inception .


Treatment was intensified according to preapproved protocols .


Participants also received diabetes education during their visits .


Research assessments were done at baseline , three , six and twelve months .


Clinical visits were scheduled between research visits , as needed , to adjust medications .


Primary outcomes were achievement of glycemic , blood pressure , or lipid control goals .


Secondary outcomes included quality of life , medication and diabetes care satisfaction , medication adherence , and cost-effectiveness .


Results from this study will provide the evidence to support expanded roles for CDEs in primary care .


Using this model to deliver diabetes care may offer a more cost-effective approach for diabetes management .


Long-term oral anticoagulant treatment is obligatory in patients with atrial fibrillation ( AF , score of CHADSVASc2 ) .


When these patients undergo percutaneous coronary intervention with a drug-eluting stent ( PCI-eS ) , there is also an indication for aspirin and clopidogrel treatment , according to the ESC Guidelines .


However , triple therapy has been known to increase the risk of bleeding complications .


Unfortunately , there is little prospective data available to resolve this issue .


Therefore , it is imperative that an optimal therapy for AF patients with indications of both anticoagulation and antiplatelet intervention to prevent thrombotic complications without increasing the risk of bleeding is found .


This prospective , randomized , multicenter study is going to assess the hypothesis that in persistent or permanent AF patients ( score of CHADSVASc2 ) after PCI-eS , the combination therapy of oral anticoagulation ( warfarin ) and ticagrelor ( 90 mg/bid ) could reduce the risk of bleeding events .


A multicenter , active-controlled , open-label , randomized trial is to be performed to evaluate dual antithrombotic therapy ( ticagrelor + warfarin ) in persistent or permanent AF patients ( score of CHADSVASc2 ) after PCI-eS versus the combination of triple antithrombosis ( clopidogrel + aspirin + warfarin ) .


The primary endpoint is the overall bleeding up to 6 months , according to TIMI criteria and classifications .


The secondary endpoints are the major bleeding events up to 6 months , according to TIMI criteria .


The sample size is estimated at 296 .


This study is intended to provide information about the safety characteristics of warfarin and ticagrelor in persistent or permanent AF patients after PCI-eS .


No prospective randomized study has been conducted on the issue of antithrombotic therapy using warfarin and ticagrelor in these patients .


Therefore , the MANJUSRI trial will help to explore and determine a new potential therapeutic regimen for AF patients after PCI-eS .


Clinical Trials.gov # NCT02206815 , registered July 30 , 2014 .


Acute stress produces behavioral and physiological changes modulated by central catecholamines ( CA ) .


Stress increases CA activity , and depletion of CA stores reduces responses to stress .


Increasing CA activity by administration of the dietary amino acid CA precursor tyrosine may increase responsiveness to stress .


This study determined whether tyrosine enhances the ability of humans to respond to severe stress .


Severe psychological stress was generated during training at Survival , Evasion , Resistance , and Escape ( SERE ) School .


The acute stressor consisted of two mock interrogations conducted during several days of simulated captivity .


Seventy-eight healthy male and female military personnel participated in this double-blind , between-subjects study , in which they received either tyrosine ( 300mg/kg , N = 36 ) or placebo ( N = 36 ) .


Tyrosine ( or placebo ) was administered in food bars in two doses of 150mg/kg each approximately 60min before each mock interrogation .


Mood ( Profile of Mood States ) , saliva cortisol , and heart rate ( HR ) were assessed prior to stress exposure during a week of academic training preceding mock captivity and immediately following the mock interrogations .


The severe stress produced robust effects on mood ( i.e. , increased tension , depression , anger , fatigue , vigor , and confusion ; p < .001 ) , cortisol , and HR ( p < .001 ) .


Tyrosine increased anger ( p = .002 , ANOVA treatment condition by test session interaction ) during stress but had no other effects .


Tyrosine did not alter most subjective or physiological responses to severe acute stress , but it increased ratings of anger .


The modest increase in anger may be an adaptive emotional response in stressful environments .


Org 25935 is a glycine transporter inhibitor that increases extracellular glycine levels and attenuates alcohol-induced dopaminergic activity in the nucleus accumbens .


In animal models , Org 25935 has dose-dependent effects on ethanol intake , preference , and relapse-like behavior without tolerance .


The current study aimed to translate these animal findings to humans by examining whether Org 25935 prevents relapse in detoxified alcohol-dependent patients .


This was a multicenter , randomized , double-blind , placebo-controlled clinical trial .


Adult patients diagnosed with alcohol dependence were randomly assigned to receive Org 25935 12 mg twice a day or placebo for 84 days .


The primary end point was percentage heavy drinking days ( defined as 5 standard drinks per day for men and 4 for women ) .


Secondary end points included other measures of relapse-related drinking behavior ( e.g. , drinks per day , time to relapse ) , as well as measures of global functioning , alcohol-related thoughts and cravings , and motivation .


A total of 140 subjects were included in the intent-to-treat analysis .


The trial was stopped approximately midway after a futility analysis showing that the likelihood of detecting a signal at study term was < 40 % .


There was no significant difference between Org 25935 and placebo on percentage heavy drinking days or any other measure of relapse-related drinking behavior .


Org 25935 showed no safety issues and was fairly well tolerated , with fatigue , dizziness , and transient visual events as the most commonly occurring side effects .


Org 25935 demonstrated no benefit over placebo in preventing alcohol relapse .


Study limitations and implications are discussed .


Less than 25 % of stroke patients arrive to an emergency department within the 3-hour treatment window .


Stroke Warning Information and Faster Treatment ( SWIFT ) compared an interactive intervention ( II ) with enhanced educational ( EE ) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors .


A single-center randomized controlled trial ( 2005-2011 ) randomized participants to EE ( bilingual stroke preparedness materials ) or II ( EE plus in-hospital sessions ) .


We assessed differences by randomization in the proportion arriving to emergency department < 3 hours , prepost intervention arrival < 3 hours , incidence rate ratio for total events , and stroke knowledge and preparedness capacity .


SWIFT randomized 1193 participants ( 592 EE , 601 II ) : mean age 63 years ; 50 % female , 17 % black , 51 % Hispanic , 26 % white .


At baseline , 28 % arrived to emergency department < 3 hours .


Over 5 years , first recurrent stroke ( n = 133 ) , transient ischemic attacks ( n = 54 ) , or stroke mimics ( n = 37 ) were documented in 224 participants .


Incidence rate ratio = 1.31 ( 95 % confidence interval = 1.05-1 .63 ; II to EE ) .


Among II , 40 % arrived < 3 hours versus 46 % EE ( P = 0.33 ) .


In prepost analysis , there was a 49 % increase in the proportion arriving < 3 hours ( P = 0.001 ) , greatest among Hispanics ( 63 % , P < 0.003 ) .


II had greater stroke knowledge at 1 month ( odds ratio = 1.63 ; 1.23-2 .15 ) .


II had higher preparedness capacity at 1 month ( odds ratio = 3.36 ; 1.86 , 6.10 ) and 12 months ( odds ratio = 7.64 ; 2.49 , 23.49 ) .


There was no difference in arrival < 3 hours overall between II and EE ; the proportion arriving < 3 hours increased in both groups and in race-ethnic minorities .


URL : http://www.clinicaltrials.gov .


Unique identifier : NCT00415389 .


Nonvariceal acute upper gastrointestinal bleeding ( AUGIB ) is often accompanied by post-discharge anaemia .


To investigate whether iron treatment can effectively treat anaemia and to compare a 3-month regimen of oral iron treatment with a single administration of intravenous iron prior to discharge .


Ninety-seven patients with nonvariceal AUGIB and anaemia were enrolled in a double-blind , placebo-controlled , randomised study .


The patients were allocated to one of three groups , receiving a single intravenous administration of 1000 mg of iron ; oral iron treatment , 200 mg daily for 3 months ; or placebo , respectively .


The patients were followed up for 3 months .


From week 4 onwards , patients receiving treatment had significantly higher haemoglobin levels compared with patients who received placebo only .


At the end of treatment , the proportion of patients with anaemia was significantly higher in the placebo group ( P < 0.01 ) than in the treatment groups .


Intravenous iron appeared to be more effective than oral iron in ensuring sufficient iron stores .


Iron treatment is effective and essential for treating anaemia after nonvariceal acute upper gastrointestinal bleeding .


The route of iron supplementation is less important in terms of the increase in haemoglobin levels .


Iron stores are filled most effectively if intravenous iron supplementation is administered ( ClinicalTrials.gov identifier : NCT00978575 ) .


To explore the impacts on the cognitive level of the children with mental retardation ( MR ) treated with JIN 's three scalp needling therapy and the training for cognitive and perceptual disturbance so as to seek the more effective therapeutic method for the treatment of MR in children .


Methods Sixty-six MR children were randomized into a head-point needle-retaining therapy + training group ( group A ) and a training after acupuncture group ( group B ) .


Seven cases and 12 cases were dropped in the two groups respectively .


Twenty-six cases accomplished the treatment in the group A and 21 cases in the group B.


In the group A , the points on the head were stimulated and the needles were retained ( 30 min after the general acupuncture , the needles on the body points were removed ; and those on the head points were retained for 1 h , including Sishenzhen , Naosanzhen , Zhisanzhen and Niesanzhen ) .


Simultaneously , the training for the cognitive perceptual disturbance was combined .


In the group B , 1 h after needle retaining at the body points and head points , all the needles were removed ; the training for the cognitive perceptual disturbance was followed .


The treatment was given once a day , and the treatment for 3 months was required .


Before and after treatment , the Wechsler intelligence scale for children ( WISC ) was used for evaluation and observation of verbal intelligence quotient ( VIQ ) , performance intelligence quotient ( PIQ ) and full-scale intelligence quotient ( TFIQ ) and score changes of 11 items such as information , picture vocabu ; lary , arithmetic , picture generalization , comprehension , etc. .


After treatment , FIQ , VIQ and PIQ scores were different significantly as compared with those before treatment ( all P < 0.01 ) .


In the group A , the results of picture vocabulary , animal egg laying , maze , block design and geometric figure were all improved significantly ( all P < 0.05 ) .


In the group B , the results of information , comprehension , block design and geometric figure were all improved significantly ( all P < 0.05 ) .


After treatment , concerning the value difference in FIQ and PIQ of the two groups ; the changes in the group A were more significant ( both P < 0.01 ) .


After treatment , the results of picture vocabulary and maze were improved significantly in the group A as compared with the group B ( both P < .


01 ) .


The IQ categories changed apparently after treatment in the two groups , toward the higher level in tendency generally , but without significant difference ( both P > 0.05 ) .


The simultaneous treatment with head point retaining of JIN 's three needling therapy and the training for cognitive and perceptual disturbance obviously improves children patients ' verbal comprehension , expression ability , hand-eye coordination ability , attention , logical reasoning ability and visual perception .


The efficacy is better than that in the treatment of the training after acupuncture .


This study aimed to understand the relationship between knowledge level and behavior on breast care in Chinese students , so as to provide strategies for improving the health education of breast care and subsequently for aiding in breast cancer prevention .


A self-designed questionnaire was used to evaluate breast care knowledge level and characterize related behavior .


Correlation analysis was conducted for the knowledge level and behavior .


The study was carried out using 597 female undergraduate students in medical and non-medical colleges in Wuhu , China .


The average score of breast care knowledge was 5.321.68 ( 5.621.68 and 5.001.68 for medical and non-medical students , respectively ) , with a greater score value for sophomores ( 5.591.72 ) than freshmen ( 5.181.65 ) .


The average score of breast care behavior was 2.211.13 , again with a greater value in sophomores ( 2.371.15 ) than freshmen ( 2.211.13 ) .


A significant positive correlation ( r = 0.231 , p < 0.01 ) between knowledge scores and behavior scores was observed .


In addition , various factors , including paying attention to breast care information , receiving breast self-examination guidance , TV program and Internet , were found to influence breast care knowledge .


In general , female undergraduate students lack of self-awareness of breast care with a low rate of breast self-examination .


It is necessary to carry out health education to improve early detection of breast cancer .


To volumetrically evaluate soft tissue changes of different ridge preservation techniques compared to spontaneous healing 6months after tooth extraction .


In each of 40 patients , one single-rooted tooth was extracted and four treatment modalities were randomly assigned to the following groups ( n = 10 each ) : A ) - tricalcium-phosphate-particles with a polylactid coating ( - TCP ) , B ) demineralized bovine bone mineral with 10 % collagen covered with a collagen matrix ( DBBM-C/CM ) , C ) DBBM with 10 % collagen covered with an autogenous soft tissue punch graft ( DBBM-C/PG ) , D ) spontaneous healing ( control ) .


Impressions were obtained before extraction and 6months later , casts were digitized and volumetric changes at the buccal soft tissues were determined .


One-way anova was performed and pair-wise Wilcoxon rank sum test with Bonferroni-Holm method was applied for comparison of differences between two groups .


After 6months , horizontal contour changes accounted for -1.70.7 mm ( A ) , -1.20.5 mm ( B ) , -1.20.7 mm ( C ) and -1.80.8 mm ( D ) .


None of the group comparisons reached statistical significance .


Six months after tooth extraction all groups revealed a horizontal volume change in the buccal soft tissue contour .


Application of DBBM-C/CM or DBBM-C/PG reduced the amount of volume resorption compared to - TCP or spontaneous healing without reaching statistically significant difference .


To address the high prevalence of neck dysfunction in helicopter aircrew , a 12-wk training program was designed to examine the effects on neck muscular strength and endurance .


Subjects were recruited from Canadian Forces ( CF ) helicopter aircrew and randomized into either a neck coordination training program ( CTP ; N = 10 ) , an endurance training program ( ETP ; N = 11 ) , or a nontreatment control ( CON ; N = 8 ) .


Baseline assessments determined maximal voluntary contraction ( MVC ) strength and endurance capacity using a submaximal contraction to fatigue at 70 % of their MVC for extension , flexion , and left ( Ltflx ) and right ( Rtflx ) lateral flexion .


The ETP subjects performed dynamic contractions at 30 % of their MVC in the four testing directions using a head harness and Thera-band tubing .


The CTP consisted of exercises that focused on strengthening the deep cervical musculature using the mass of the head as resistance and progressing to exercises that incorporated the superficial cervical muscles .


Post-intervention , the ETP achieved the only statistically significant increase in maximal force when compared to the CON ( 14.4 % ) .


Improved times to fatigue were achieved by the CTP for flexion ( 26.34 + / - 20.72 s ) , Ltflx ( 23.54 + / - 13.94 s ) , and Rtflx ( 28.72 + / - 4.88 s ) .


The provision of an ETP and CTP resulted in a positive trend toward improved maximal force and muscular endurance .


The greatest improvements in endurance and strength were found for those subjects assigned to the CTP treatment .


Our research demonstrates the importance of including a designed and supervised training program into the daily routine of helicopter aviators .


Long-term sick leave has considerably negative impact on the individual and society .


Hence , the need to identify effective occupational rehabilitation programs is pressing .


In Norway , group based occupational rehabilitation programs merging patients with different diagnoses have existed for many years , but no rigorous evaluation has been performed .


The described randomized controlled trial aims primarily to compare two structured multicomponent inpatient rehabilitation programs , differing in length and content , with a comparative cognitive intervention .


Secondarily the two inpatient programs will be compared with each other , and with a usual care reference group .


The study is designed as a randomized controlled trial with parallel groups .


The Social Security Office performs monthly extractions of sick listed individuals aged 18-60 years , on sick leave 2-12 months , with sick leave status 50 % - 100 % due to musculoskeletal , mental or unspecific disorders .


Sick-listed persons are randomized twice : 1 ) to receive one of two invitations to participate in the study or not receive an invitation , where the latter `` untouched '' control group will be monitored for future sick leave in the National Social Security Register , and 2 ) after inclusion , to a Long or Short inpatient multicomponent rehabilitation program ( depending on which invitation was sent ) or an outpatient cognitive behavioral therapy group comparative program .


The Long program consists of 3 weeks with full rehabilitation days .


The Short program consists of 4 +4 full days , separated by two weeks , in which a workplace visit will be performed if desirable .


Three areas of rehabilitation are targeted : mental training , physical training and work-related problem solving .


The primary outcome is number of sick leave days .


Secondary outcomes include time until full sustainable return to work , health related quality of life , health related behavior , functional status , somatic and mental health , and perceptions of work .


In addition , health economic evaluation will be performed , and the implementation of the interventions , expectations and experiences of users and service providers will be investigated with different qualitative methods .


ClinicalTrials.gov : NCT01926574 .


Enzalutamide is an oral androgen-receptor inhibitor that prolongs survival in men with metastatic castration-resistant prostate cancer in whom the disease has progressed after chemotherapy .


New treatment options are needed for patients with metastatic prostate cancer who have not received chemotherapy , in whom the disease has progressed despite androgen-deprivation therapy .


In this double-blind , phase 3 study , we randomly assigned 1717 patients to receive either enzalutamide ( at a dose of 160 mg ) or placebo once daily .


The coprimary end points were radiographic progression-free survival and overall survival .


The study was stopped after a planned interim analysis , conducted when 540 deaths had been reported , showed a benefit of the active treatment .


The rate of radiographic progression-free survival at 12 months was 65 % among patients treated with enzalutamide , as compared with 14 % among patients receiving placebo ( 81 % risk reduction ; hazard ratio in the enzalutamide group , 0.19 ; 95 % confidence interval [ CI ] , 0.15 to 0.23 ; P < 0.001 ) .


A total of 626 patients ( 72 % ) in the enzalutamide group , as compared with 532 patients ( 63 % ) in the placebo group , were alive at the data-cutoff date ( 29 % reduction in the risk of death ; hazard ratio , 0.71 ; 95 % CI , 0.60 to 0.84 ; P < 0.001 ) .


The benefit of enzalutamide was shown with respect to all secondary end points , including the time until the initiation of cytotoxic chemotherapy ( hazard ratio , 0.35 ) , the time until the first skeletal-related event ( hazard ratio , 0.72 ) , a complete or partial soft-tissue response ( 59 % vs. 5 % ) , the time until prostate-specific antigen ( PSA ) progression ( hazard ratio , 0.17 ) , and a rate of decline of at least 50 % in PSA ( 78 % vs. 3 % ) ( P < 0.001 for all comparisons ) .


Fatigue and hypertension were the most common clinically relevant adverse events associated with enzalutamide treatment .


Enzalutamide significantly decreased the risk of radiographic progression and death and delayed the initiation of chemotherapy in men with metastatic prostate cancer .


( Funded by Medivation and Astellas Pharma ; PREVAIL ClinicalTrials.gov number , NCT01212991 . )


Emphasizing societal benefits of vaccines has been linked to increased vaccination intentions in adults .


It is unclear if this pattern holds for parents deciding whether to vaccinate their children .


The objective was to determine whether emphasizing the benefits of measles-mumps-rubella ( MMR ) vaccination directly to the vaccine recipient or to society differentially impacts parents ' vaccine intentions for their infants .


In a national online survey , parents ( N = 802 ) of infants < 12 months old were randomly assigned to receive 1 of 4 MMR vaccine messages : ( 1 ) the Centers for Disease Control and Prevention Vaccine Information Statement ( VIS ) , ( 2 ) VIS and information emphasizing the MMR vaccine 's benefits to the child , ( 3 ) VIS and information emphasizing societal benefits , or ( 4 ) VIS and information emphasizing benefits both to the child and society .


Parents reported their likelihood of vaccinating their infants for MMR on a response scale of 0 ( extremely unlikely ) to 100 ( extremely likely ) .


Compared with the VIS-only group ( mean intention = 86.3 ) , parents reported increased vaccine intentions for their infants when receiving additional information emphasizing the MMR vaccine 's benefits either directly to the child ( mean intention = 91.6 , P = .01 ) or to both the child and society ( mean intention = 90.8 , P = .03 ) .


Emphasizing the MMR vaccine 's benefits only to society did not increase intentions ( mean intention = 86.4 , P = .97 ) .


We did not see increases in parents ' MMR vaccine intentions for their infants when societal benefits were emphasized without mention of benefits directly to the child .


This finding suggests that providers should emphasize benefits directly to the child .


Mentioning societal benefits seems to neither add value to , nor interfere with , information highlighting benefits directly to the child .


To study the efficacy and safety of tirofiban in patients with acute non-ST - segment elevation myocardial infarction ( NSTEMI ) without early reperfusion intervention .


A total of 151 NSTEMI patients without early reperfusion intervention were enrolled in the study and randomized to the tirofiban group ( n = 76 ) and the control group ( n = 75 ) .


Coronary angiography was performed at day 3 and day 7 , while percutaneous coronary intervention ( PCI ) was performed when necessary .


Parameters including thrombolysis in myocardial infarction ( TIMI ) flow , bleeding complications and clinic events within 30 days were compared between the two groups .


Before PCI , no increase in the percentage of patient with TIMI flow better than TIMI-2 was observed by the treatment of tirofiban ( 69.3 % vs 78.9 % , P = 0.10 ) .


While after PCI , significant increase in the percentage of patient with TIMI flow better than TIMI-2 was manifested in the tirofiban group ( 96.0 % vs 100.0 % , P = 0.04 ) .


Tirofiban treatment also significantly decreased the rate of poor myocardial perfusion after PCI ( 19.7 % vs 34.7 % , P = 0.04 ) .


There were 0 and 4 major adverse cardiovascular events ( MACE ) within 30 days observed in the tirofiban group and the control group ( 0.0 % vs 5.3 % , P = 0.05 ) .


No difference between the two groups was found in the bleeding complications within 30 days including the mild hemorrhage ( 5 vs 4 cases , P = 0.75 ) , severe hemorrhage ( 2 vs 1 cases , P = 0.56 ) or severe thrombocytopenia ( 2 vs 0 cases , P = 0.49 ) .


Tirofiban treatment does not increase the bleeding complications in NSTEMI patients without early PCI .


Tirofiban can improve the TIMI flow and the myocardial perfusion after PCI with less MACE within 30 days .


The International Lipid-Based Nutrient Supplements Project developed a small-quantity ( 20 g/d ) lipid-based nutrient supplement ( LNS ) for pregnant and lactating women .


We evaluated the effects of prenatal LNS supplementation on fetal growth .


In a community-based , partially double-blind , individually randomized controlled trial , 1320 women 20 wk pregnant received 60 mg Fe/400 g folic acid ( IFA ) , or 1-2 Recommended Dietary Allowances of 18 micronutrients , including 20 mg Fe ( MMN ) , or LNS with the same micronutrients as the MMN group , plus 4 minerals and macronutrients contributing 118 kcal ( LNS ) daily until delivery .


Fetal growth was compared across groups by using intention-to-treat analysis .


The primary outcome was birth length .


This analysis included 1057 women ( IFA = 349 , MMN = 354 , LNS = 354 ) .


Groups did not differ significantly in mean birth length , length-for-age z score ( LAZ ) , head circumference , or percentage low birth length but differed in mean birth weight ( P = 0.044 ) , weight-for-age z score ( WAZ ; P = 0.046 ) , and BMI-for-age z score ( BMIZ ; P = 0.040 ) , with a trend toward differences in low birth weight ( P = 0.069 ) .


In pairwise comparisons , the LNS group had greater mean birth weight ( +85 g ; P = 0.040 ) , WAZ ( +0.19 ; P = 0.045 ) , and BMIZ ( +0.21 ; P = 0.035 ) and a lower risk of low birth weight ( RR : 0.61 , 95 % CI : 0.39 , 0.96 ; P = 0.032 ) than did the IFA group .


The other group differences were not significant .


The effect of intervention was modified by mother 's parity , age , height , baseline hemoglobin , household food insecurity , and child sex , with parity being the most consistent modifier .


Among primiparous women ( IFA = 131 ; MMN = 110 ; LNS = 128 ) , the LNS group had greater mean birth length ( +0.91 cm ; P = 0.001 ) , LAZ ( +0.47 ; P = 0.001 ) , weight ( +237 g ; P < 0.001 ) , WAZ ( +0.56 ; P < 0.001 ) , BMIZ ( +0.52 ; P < 0.001 ) , head circumference ( 0.50 cm ; P = 0.017 ) , and head circumference-for-age z score ( +0.40 ; P = 0.022 ) than did the IFA group ; similar differences were found when comparing the LNS and MMN groups among primiparous women , and no group differences were found among multiparous women .


Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana , particularly primiparous women .


This trial was registered at clinicaltrials.gov as NCT00970866 .


Nitrate , which is an inorganic anion abundant in vegetables , increases the efficiency of isolated human mitochondria .


Such an effect might be reflected in changes in the resting metabolic rate ( RMR ) and formation of reactive oxygen species .


The bioactivation of nitrate involves its active accumulation in saliva followed by a sequential reduction to nitrite , nitric oxide , and other reactive nitrogen species .


We studied effects of inorganic nitrate , in amounts that represented a diet rich in vegetables , on the RMR in healthy volunteers .


In a randomized , double-blind , crossover study , we measured the RMR by using indirect calorimetry in 13 healthy volunteers after a 3-d dietary intervention with sodium nitrate ( NaNO ) or a placebo ( NaCl ) .


The nitrate dose ( 0.1 mmol kg d ) corresponded to the amount in 200-300 g spinach , beetroot , lettuce , or other vegetable that was rich in nitrate .


Effects of direct nitrite exposure on cell respiration were studied in cultured human primary myotubes .


The RMR was 4.2 % lower after nitrate compared with placebo administration , and the change correlated strongly to the degree of nitrate accumulation in saliva ( r = 0.71 ) .


The thyroid hormone status , insulin sensitivity , glucose uptake , plasma concentration of isoprostanes , and total antioxidant capacity were unaffected by nitrate .


The administration of nitrite to human primary myotubes acutely inhibited respiration .


Dietary inorganic nitrate reduces the RMR .


This effect may have implications for the regulation of metabolic function in health and disease .


To compare health-related quality-of-life ( HRQoL ) outcomes for robot-assisted laparoscopic radical cystectomy ( RARC ) with those of traditional open radical cystectomy ( ORC ) in a prospective randomised fashion .


This was a prospective randomised clinical trial evaluating the HRQoL for ORC vs RARC in consecutive patients from July 2009 to June 2011 .


We administered the Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index questionnaire , validated to assess HRQoL , preoperatively and then at 3 , 6 , 9 and 12 months postoperatively .


Scores for each domain and total scores were compared in terms of deviation from preoperative values for both the RARC and the ORC cohorts .


Multivariate linear regression was used to assess the association between the type of radical cystectomy and HRQoL .


At the time of the study , 47 patients had met the inclusion criteria , with 40 patients being randomised for analysis .


The cohorts consisted of 20 patients undergoing ORC and 20 undergoing RARC , who were balanced with respect to baseline demographic and clinical features .


Univariate analysis showed a return to baseline scores at 3 months postoperatively in all measured domains with no statistically significant difference among the various domains between the RARC and the ORC cohorts .


Multivariate analysis showed no difference in HRQoL between the two approaches in any of the various domains , with the exception of a slightly higher physical well-being score in the RARC group at 6 months .


There were no significant differences in the HRQoL outcomes between ORC and RARC , with a return of quality of life scores to baseline scores 3 months after radical cystectomy in both cohorts .


To assess the efficacy of corneal cross-linking ( CXL ) as an adjuvant to appropriate antifungal therapy in nonresolving deep stromal fungal keratitis .


Randomized clinical trial .


Eyes with culture-positive deep stromal fungal keratitis not responding to appropriate medical therapy for a period of 2 weeks were randomized to receive either adjuvant CXL or no additional treatment .


Antifungal medical therapy was continued in both groups .


The prespecified primary outcome was treatment failure at 6 weeks after enrollment , defined as perforation and/or increase in ulcer size by 2 mm .


The trial was stopped before full enrollment because of a marked difference in the rate of perforation between the 2 groups .


Of the 13 cases enrolled in the study , 6 were randomized to the CXL group and 7 to the non-CXL group .


Five eyes in the CXL group and 3 eyes in the non-CXL group experienced treatment failure by 6 weeks ( P = .56 ) .


In a secondary analysis , the CXL group experienced more perforations than the non-CXL group ( 4 vs 0 , respectively ; P = .02 ) .


CXL used as adjuvant therapy for recalcitrant deep stromal fungal keratitis did not improve outcomes .


Effects of palm olein ( POL ) on calcium and fat metabolic balance and gastrointestinal ( GI ) tolerance have been clinically evaluated but its use in combination with palm kernel oil ( PKO ) , and canola oil has not been similarly assessed in infants .


Calcium and fat balance and GI tolerance were evaluated in 33 healthy term infants ( age = 68-159 d ) in a randomized , double-blinded , 14 d crossover trial at a day care center in Salvador , Brazil ; followed by a 4d hospital ward metabolic balance study in 17 of the male subjects .


The study compared two commercially available milk-based powdered formulas in Brazil ; one containing POL ( 44 % of total fat ) , PKO ( 21.7 % ) and canola oil ( 18.5 % ) as predominant fats ( PALM ) , and the other containing none ( NoPALM ) .


Occasional human milk ( HM ) supplementation was allowed at home .


Formula and HM intakes , and growth were not different ( p > 0.05 ) .


Calcium absorption ( % ) for infants fed NoPALM ( 58.8 16.7 % ; means SD ) was higher ( p = 0.023 ) than those fed PALM ( 42.1 19.2 % ) , but was not significant ( p = 0.104 ) when calcium intake was used as a covariate .


Calcium intake was higher ( p < 0.001 ) in NoPALM versus PALM fed infants .


However , calcium retention ( % ) was higher in infants fed NoPALM compared to PALM with ( p = 0.024 ) or without ( p = 0.015 ) calcium intake as a covariate .


Fat absorption ( % ) for NoPALM was greater than PALM fed infants ( NoPALM = 96.9 1.2 > PALM = 95.1 1.5 ; p = 0.020 in Study Period I ) .


Mean rank stool consistency was softer in infants fed NoPALM versus PALM ( p < 0.001 ; metabolic period ) .


Adverse events , spit-up/vomit , fussiness and gassiness were not different ( p > 0.05 ) .


Formula acceptability was high and comparable for both formula feedings , regardless of HM supplementation .


Term infants fed PALM based formula ( containing palm olein , palm kernel and canola oils ) demonstrated lower calcium retention and fat absorption , and less softer stool consistency versus infants fed NoPALM based formula .


Study suggested formula fat differences may affect GI function in infants .


Exacerbations of COPD requiring hospital admission have important clinical and societal implications .


We sought to investigate the incidence , recurrence , risk factors , and mortality of patients with COPD exacerbations requiring hospital admission compared with those without hospital admission during 3-year follow-up .


Patients with COPD ( N = 2,138 ) were identified from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints ( ECLIPSE ) observational cohort .


An analysis of time to first event of hospital admission was performed using Kaplan-Meier curves and Cox proportional hazard regression adjusting for possible confounders .


Of the 2,138 patients , 670 ( 31 % ) reported a total of 1,452 COPD exacerbations requiring hospital admission during the study period ; 313 patients ( 15 % ) reported multiple events .


A prior history of exacerbation of COPD requiring hospital admission was the factor associated with the highest risk of a new hospitalization for exacerbation ( hazard ratio , 2.71 ; 95 % CI , 2.24-3 .29 ; P < .001 ) .


Other risk factors included more severe airflow limitation , poorer health status , older age , radiologic evidence of emphysema , and higher WBC count .


Having been hospitalized for exacerbation significantly increased the risk of mortality ( P < .001 ) .


Exacerbations of COPD requiring hospital admission occur across all stages of airflow limitation and are a significant prognostic factor of reduced survival across all COPD stages .


Patients with COPD at a high risk for hospitalization can be identified by their past history for similar events , and other factors , including the severity of airflow limitation , poor health status , age , presence of emphysema , and leukocytosis .


ClinicalTrials.gov ; No. : NCT00292552 ; URL : www.clinicaltrials.gov .


Friction blister research has focused on prevention and treatment approaches rather than exploring the pathophysiology of the friction blister .


Increased skin hydration has been purported to be a key risk factor in friction blister development .


This study aimed to test the effect of increased skin surface hydration on the risk of friction blister creation .


The skin on one foot was hydrated by soaking the foot in water .


Intermittent loading was carried out until an observable change of 3C was evident using infrared thermography .


The contra lateral foot acted as a control .


Skin hydration and elasticity was measured using electrical capacitance and negative pressure respectively .


The rate of temperature change of the hydrated group was significantly greater than that of the non-hydrated foot group ( P = 0.001 ) and showed a strong positive correlation ( r = 0.520 ) with skin surface hydration .


Weak negative correlations were seen between skin elasticity and rate of temperature change in response to load application ( r = -0.166 ) and skin surface hydration and elasticity at baseline ( r = -0.195 ) .


In controlled experimental conditions increased skin surface hydration increases the rate of temperature change of the skin in response to load application and consequently increases the risk of blister creation .


Foods that enhance satiety can help consumers to resist environmental cues to eat , and improve the nutritional quality of their diets .


Viscosity generated by oat - glucan , influences gastrointestinal mechanisms that mediate satiety .


Differences in the source , processing treatments , and interactions with other constituents in the food matrix affect the amount , solubility , molecular weight , and structure of the - glucan in products , which in turn influences the viscosity .


This study examined the effect of two types of oatmeal and an oat-based ready-to-eat breakfast cereal ( RTEC ) on appetite , and assessed differences in meal viscosity and - glucan characteristics among the cereals .


Forty-eight individuals were enrolled in a randomized crossover trial .


Subjects consumed isocaloric breakfast meals containing instant oatmeal ( IO ) , old-fashioned oatmeal ( SO ) or RTEC in random order at least a week apart .


Each breakfast meal contained 218kcal ( 150kcal cereal , and 68kcal milk ) Visual analogue scales measuring appetite were completed before breakfast , and over four hours , following the meal .


Starch digestion kinetics , meal viscosities , and - glucan characteristics for each meal were determined .


Appetite responses were analyzed by area under the curve .


Mixed models were used to analyze response changes over time .


IO increased fullness ( p = 0.04 ) , suppressed desire to eat ( p = 0.01 ) and reduced prospective intake ( p < 0.01 ) more than the RTEC over four hours , and consistently at the 60minute time-point .


SO reduced prospective intake ( p = 0.04 ) more than the RTEC .


Hunger scores were not significantly different except that IO reduced hunger more than the RTEC at the 60minute time-point .


IO and SO had higher - glucan content , molecular weight , gastric viscosity , and larger hydration spheres than the RTEC , and IO had greater viscosity after oral and initial gastric digestion ( initial viscosity ) than the RTEC .


IO and SO improved appetite control over four hours compared to RTEC .


Initial viscosity of oatmeal may be especially important for reducing appetite .


In-water resuscitation ( IWR ) is recommended in the 2010 guidelines of the European Resuscitation Council .


As IWR represents a physical challenge to the rescuer , a novel Rescue Tube device with an integrated `` Oxylator '' resuscitator might facilitate IWR .


The aim of the present study was the assessment of IWR using the novel Rescue Tube device .


Tidal and minute volumes were recorded using a modified Laerdal Resusci Anne mannequin .


Furthermore , rescue time , water aspiration , submersions , and physical exertion were assessed .


In this randomized cross-over trial , 17 lifeguards performed four rescue maneuvers over a 100-m distance in open water in random order : no ventilation ( NV ) , mouth-to-mouth ventilation ( MMV ) , Oxylator-aided mask ventilation ( OMV ) , and Oxylator-aided laryngeal tube ventilation ( OLTV ) .


OLTV resulted in effective ventilation over the entire rescue distance with the highest mean minute volumes ( NV 0 , MMV 2.9 , OMV 4.1 , OLTV 7.6 L min ( -1 ) ) .


NV was the fastest rescue maneuver while IWR prolonged the rescue maneuver independently of the method of ventilation ( mean total rescue time : NV 217 , MMV 280 , OMV 292 , OLTV 290 s ) .


Aspiration of substantial amounts of water occurred only during MMV ( mean NV 20 , MMV 215 , OMV 15 , OLTV 6 ml ) .


NV and OLTV were rated as moderately challenging by the lifeguards , whereas MMV and OMV were rated as substantially demanding on a 0-10 visual analog scale ( NV 5.3 , MMV 7.8 , OMV 7.6 , OLTV 5.9 ) .


The device might facilitate IWR by providing effective ventilation with minimal aspiration and by reducing physical effort .


Another advantage is the possibility of delivering 100 % oxygen .


Cervical cancer is a frequently diagnosed cancer in women worldwide .


Despite having easy preventive and therapeutic approaches , it is an important cause of mortality among women .


The CRICERVA study is a cluster clinical trial which assigned one of three interventions to the target population registered in Cerdanyola , Barcelona .


Among the 5,707 resident women aged 60 to 70 years in the study area , women with no record of cervical cytology over the last three years were selected .


The study included four arms : three interventions all including a pre-assigned date for screening visit and i ) personalized invitation letter ; ii ) adding to i ) an informative leaflet ; and , iii ) in addition to ii ) a personalized appointment reminder phone call , and iv ) no specific action taken ( control group ) .


Participants were offered a personal interview about social-demographic characteristics and about screening attitudes .


Cervical cytology and HPV DNA test ( HC2 ) were offered as screening tests .


In the case of screening positive in any of these tests , the women were followed up until a full diagnosis could be obtained .


The effect size of each study arm was estimated as the absolute gain in coverage between the original coverage and the final coverage .


From the intervention groups ( 4,775 women ) , we identified 3,616 who were not appropriately screened , of which 2,560 women answered the trial call and 1,376 were amenable to screening .


HPV was tested in 920 women and cervical cytology in all 1,376 .


Overall , there was an absolute gain in coverage of 28.8 % in the intervention groups compared to 6 % in the control group .


Coverage increased from 51.2 % to 76.0 % in strategy i ) ; from 47.4 % to 79.0 % in strategy ii ) and from 44.5 % to 74.6 % in strategy iii ) .


Lack of information about the relevance of screening was the most important factor for not attending the screening program .


The study confirms that actively contacting women and including a date for a screening visit , notably increased participation in the screening program .


Efforts to improve health education in preventative activities are warranted .


Clinical Trials.gov Identifier NCT01373723 .


Registered 14 June 2011 .


This multi-center , phase III trial assesses the efficacy of daikenchuto ( TU-100 ) on gastrointestinal disorders after hepatic resection ( UMIN Registration No. 000003103 ) .


A total of 231 patients , who underwent hepatic resection at 26 Japanese centers , were enrolled .


Patients were randomly assigned to receive either oral doses ( 15 g/day , three times a day ) of TU-100 or placebo control from preoperative day 3 to postoperative day 10 , except on the day of surgery .


Primary end points were the time from extubation until the first postoperative bowel movement ( FBM-T ) , serum C-reactive protein ( CRP ) and ammonia levels .


Finally , 209 patients ( TU-100 : n = 108 , placebo : n = 101 ) were included in the statistical analysis .


The median FBM-T was 88.2 h ( 95 % CI 74.0-94 .1 ) in the TU-100 group and 93.1 h ( 95 % CI 83.3-99 .4 ) in the placebo group , demonstrating that TU-100 accelerated the time to first bowel movement significantly more than placebo control .


Serum CRP levels did not differ significantly during the study period , although serum CRP levels in the TU-100 group tended to be lower than those in the placebo group in patients with grade B liver damage .


Meanwhile , the two groups had similar serum ammonia levels .


TU-100-related serious adverse events did not occur during the study .


TU-100 appears to improve gastrointestinal dysmotility and reduce serum CRP levels in patients with grade B liver damage after hepatectomy .


TU-100 is an effective treatment option after hepatic resection in patients with liver cancer .


This study was aimed at evaluating the clinical efficacy and safety of transcutaneous electrical acupoint stimulation ( TEAS ) to treat muscle spasticity after brain injury ( Chinese Clinical Trial Registry : ChiCTR-TRC-11001310 ) .


A total of 60 patients with muscle spasticity after brain injury were randomized to the following 3 groups : 100 , 2 , and 0 Hz ( sham ) TEAS .


The acupoints Hegu ( LI4 ) -- Yuji ( LU10 ) and Zusanli ( ST36 ) -- Chengshan ( BL57 ) on the injured side were stimulated at 0 , 2 , or 100 Hz , 5 times per week for 4 weeks .


The patients were followed up for 1 and 2 months after the treatments .


The effects of the treatments on muscle spasticity at the wrist , thumb , the other 4 fingers , elbow , shoulder , knee , and ankle were evaluated by the Modified Ashworth Scale , and the effects on disability were assessed by the Disability Assessment Scale .


The walking capability was evaluated by the Holden functional ambulation classification score .


The overall performance was assessed by the Global Assessment Scale score and the improved Barthel Index .


The safety of the treatments administered was also monitored .


The wrist spasticity was significantly reduced from baseline at weeks 2 , 3 , and 4 of treatment and at the 1 - and 2-month follow-up visits in the 100 Hz group ( P < 0.01 ) .


Compared with 2 Hz or sham TEAS , 100 Hz TEAS decreased wrist spasticity at weeks 2 , 3 , and 4 of treatment and 1 month after treatment ( P < 0.001 ) .


The other endpoints were not affected by the treatments .


No treatment-emergent adverse events were reported during treatments and follow-up visits .


TEAS appears to be a safe and effective therapy to relieve muscle spasticity after brain injury , although large-scale studies are required to further verify the findings .


Chinese Clinical Trial Registry ChiCTR-TRC-11001310 http://www.chictr.org .


In the emergency department ( ED ) , intravenous ( IV ) catheter placement is one of the most frequent interventions and may be a real challenge in some conditions .


Improvement of the success rate with new technology represents a great opportunity .


This randomized controlled trial aimed to show the superiority of AccuVein to cannulate veins in adults compared to routine care .


After giving written consent , patients were randomized into two groups : routine IV catheter insertion or insertion guided by the AccuVein , which is a hand-held instrument displaying laser light to optimize visualization of veins .


The primary outcome was the time to successful placement of catheters .


Secondary outcomes included the number of attempts , the rate of failure , technique-related pain , occurrence of movements , and efficiency of IV cannulation as perceived by the operator when using the AccuVein device .


Results are given as mean and bootstrapped 95 % confidence interval ( CI ) and percentages .


p-values of < 0.05 were considered significant .


A total of 266 six patients were included , with 157 randomized to routine cannulation and 115 to AccuVein .


Patient characteristics were similar .


Time to successful placement of IV catheter ( routine , 98 seconds , 95 % CI = 85 to 113 seconds ; and AccuVein , 119 seconds , 95 % CI = 93 to 154 seconds ) was not different between groups ( p = 0.24 ) .


Secondary outcomes ( failure and pain ) did not significantly differ , except for movements , which were more frequent when using the AccuVein device ( 19.1 % vs. 10.2 % , p = 0.05 ) .


Evaluation of the AccuVein by operators was more often negative than positive .


Use of the AccuVein did not improve IV cannulation in nonselected ED patients .


Past literature documents many individual predictors of treatment engagement among mental health clients in community settings , but few studies have examined clinic characteristics that may be associated with treatment engagement .


With data from a patient activation and self-management trial , this study examined the variation in demographic and clinic characteristics across community mental health clinics and whether this variation predicted differences in treatment engagement in mental health services .


Chart reviews were conducted for 638 clients of 12 community mental health clinics .


Client attendance records were collected for a one-year period to examine engagement ( defined as the ratio of kept versus scheduled appointments ) .


Adjusting for client variability , the investigators examined which clinic-level characteristics were associated with treatment engagement .


Clinics varied significantly in their clients ' demographic characteristics and engagement in mental health care .


Providing case management and offering transportation vouchers or free parking at the clinic were associated with lower engagement .


However , offering outreach was associated with greater engagement .


The results of this study suggest that certain clinic characteristics are associated with engagement in mental health services .


These results demonstrate the difficulties faced by community mental health clinics in reducing no-show rates even in the face of strong efforts to improve engagement .


Little is known about whether probiotics can affect outcomes of patients with cirrhosis and hepatic encephalopathy ( HE ) .


We assessed the efficacy of a probiotic preparation in preventing the recurrence of HE ( primary outcome ) and reducing the number of hospitalizations and severity of liver disease in patients with cirrhosis .


We performed a double-blind trial at a tertiary care hospital in India .


Patients with cirrhosis who had recovered from an episode of HE during the previous month were assigned randomly ( using computer-generated allocation ) to groups given a probiotic preparation ( VSL # 3 , 9 10 ( 11 ) bacteria ; CD Pharma India Private Limited , New Delhi , India ) ( n = 66 ) or placebo ( n = 64 ) daily for 6 months .


There was a trend toward a reduction in the development of breakthrough HE among patients receiving the probiotic ( 34.8 % in the probiotic group vs 51.6 % in the placebo group ; hazard ratio [ HR ] , 0.65 ; 95 % confidence interval [ CI ] , 0.38-1 .11 ; P = .12 ) .


Fewer patients in the probiotic group were hospitalized for HE ( 19.7 % vs 42.2 % , respectively ; HR , 0.45 ; 95 % CI , 0.23-0 .87 ; P = .02 ) or for complications of cirrhosis ( 24.2 % ) than in the placebo group ( 45.3 % ) ( HR , 0.52 ; 95 % CI , 0.28-0 .95 ; P = .034 ) .


Child-Turcotte-Pugh and model for end-stage liver disease scores improved significantly from baseline to 6 months in the probiotic group , but not in the placebo group .


There were no adverse events related to VSL # 3 .


Over a 6-month period , daily intake of VSL # 3 significantly reduced the risk of hospitalization for HE , as well as Child-Turcotte-Pugh and model for end-stage liver disease scores , in patients with cirrhosis .


ClinicalTrials.gov number : NCT01110447 .


There are limited data to inform the choice between parental presence at clinical bedside rounds ( PPCBR ) and non-PPCBR in neonatal intensive care units ( NICUs ) .


We performed a single-centre , survey-based , crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay > 11 days .


Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period .


At the conclusion of each arm , parents completed the ` NICU Parental Stressor Scale ' ( a validated tool ) and a satisfaction survey .


After completion of the trial , we surveyed all healthcare providers who participated at least in one PPCBR rounding episode .


We also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR .


A total of 72 parents were enrolled in this study , with 63 parents ( 87 % ) partially or fully completing the trial .


Of the parents who completed the trial , 95 % agreed that parents should be allowed to attend clinical bedside rounds .


A total of 39 healthcare providers ' surveys were returned and 35 ( 90 % ) agreed that parents should be allowed to attend rounds .


Nine healthcare providers and 8 parents participated in an interview or focus group , augmenting our understanding of the ways in which PPCBR was beneficial .


Parents and healthcare providers strongly support PPCBR .


NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns .


Australia and New Zealand Clinical Trials Register number , ACTRN12612000506897 .


Depression is not a normal side effect of aging , however it is one of the most prevalent mental health issues in later life , imposing a tremendous burden on patients , their families , and the healthcare system .


We describe the experimental implementation of a collaborative , stepped-care model for the treatment of late-life depression ( GermanIMPACT trial ) in the German primary care context .


GermanIMPACT was developed as an adaptation of a successful and widely used American model .


The aim of the study is to evaluate the model 's applicability to the German primary care setting and its cost-effectiveness .


The study will be conducted as a cluster-randomized controlled trial comparing the development of depressive symptoms in primary care patients who either receive treatment as usual ( control arm ) or treatment according to the GermanIMPACT model ( intervention arm ) .


In two German cities ( Freiburg and Hamburg ) , a total of 60 general practice offices will be selected and randomized .


Each general practice office will be asked to enroll five patients into the trial who are 60 years of age or older and who show moderate depressive symptoms in the scope of a diagnosed depressive episode , recurrent depressive disorder , or dysthymia .


General practices in the control arm will provide treatment as usual ; general practices in the intervention arm will work closely with a specially trained care manager and a supervising mental health specialist .


Evidence-based elements of the treatment plan manual include patient education , identification and integration of positive activities into the daily routine , relapse prevention , and training of problem-solving techniques as needed .


The intervention period per patient will be one year .


Data will be collected at baseline , 6 , and 12 months .


Primary outcome is the patient-reported change of depressive symptoms ( Patient Health Questionnaire , PHQ-9 ) .


Secondary outcomes include measures of quality of life , anxiety , depression-related behavior , problem-solving skills , resilience , and an overall economic evaluation of the program .


The GermanIMPACT trial will provide evidence about the effectiveness , feasibility , and cost-effectiveness of collaborative stepped care in treating late-life depression in German primary care .


Positive results will be a first step toward integrating specialized depression care managers into the primary care setting .


German Clinical Trials Register : DRKS00003589 ( September 2012 ) .


Probiotic supplementation significantly reduces the risk of necrotising enterocolitis ( NEC ) and all cause mortality in preterm neonates .


Independent quality assessment is important before introducing routine probiotic supplementation in this cohort .


To assess product quality , and confirm that Bifidobacterium breve ( B. breve ) M-16V supplementation will increase fecal B. breve counts without adverse effects .


Strain identity ( 16S rRNA gene sequencing ) , viability over 2 year shelf-life were confirmed , and microbial contamination of the product was ruled out .


In a controlled trial preterm neonates ( Gestation < 33 weeks ) ready to commence or on feeds for < 12 hours were randomly allocated to either B. breve M-16V ( 3109 cfu/day ) or placebo ( dextrin ) supplementation until the corrected age 37 weeks .


Stool samples were collected before ( S1 ) and after 3 weeks of supplementation ( S2 ) for studying fecal B. breve levels using quantitative PCR ( Primary outcome ) .


Secondary outcomes included total fecal bifidobacteria and NECStage II .


Categorical and continuous outcomes were analysed using Chi-square and Mann-Whitney tests , and McNemar and Wilcoxon signed-rank tests for paired comparisons .


A total of 159 neonates ( Probiotic : 79 , Placebo : 80 ) were enrolled .


Maternal and neonatal demographic characteristics were comparable between the groups .


The proportion of neonates with detectable B. breve increased significantly post intervention : Placebo : [ S1 :2 / 66 ( 3 % ) , S2 : 25/66 ( 38 % ) , p < 0.001 ] Probiotic : [ S1 : 29/74 ( 40 % ) , S2 : 67/74 ( 91 % ) , p < 0.001 ] .


Median S1 B. breve counts in both groups were below detection ( < 4.7 log cells x g ( -1 ) ) , increasing significantly in S2 for the probiotic group ( log 8.6 ) while remaining < 4.7 log in the control group ( p < 0.001 ) .


There were no adverse effects including probiotic sepsis and no deaths .


NECStage II occurred in only 1 neonate ( placebo group ) .


B. breve M-16V is a suitable probiotic strain for routine use in preterm neonates .


Australia New Zealand Clinical Trial Registry ACTRN 12609000374268 .


To investigate the effect of manual physiotherapy and exercises compared with exercises alone in patients with shoulder impingement syndrome one year after inclusion .


Randomized controlled trial .


Patients with shoulder impingement of more than 4 weeks .


The intervention group received individualized manual physiotherapy plus individualized exercises ; the control group received individualized exercises only .


Both groups had 10 treatments over 5 weeks ; afterwards all patients continued their exercises for another 7 weeks at home .


Primary outcomes were the Shoulder Pain and Disability Index and Patients ' Global Impression of Change .


The Generic Patient-Specific Scale was used as secondary outcome .


Costs were recorded in a log-book .


Ninety patients were included in the study and 87 could be analyzed at 1-year follow-up .


Both groups showed significant improvements in all outcome measures , but no difference was detected between the groups .


Only costs differed significantly in favour of the control group ( p = 0.03 ) after 5 weeks .


Individualized exercises resulted in lower costs than manual physiotherapy and showed a significant effect on pain and functioning within the whole group after one year .


Exercises should therefore be considered as a basic treatment .


Due to the progressive improvement that occurred during the follow-up period with individualized exercises further treatments should be delayed for 3 to 4 months .


Dengue infection is the most common mosquito-borne viral disease worldwide , but no suitable antiviral drugs are available .


We tested the - glucosidase inhibitor celgosivir as a treatment for acute dengue fever .


To establish eligibility for inclusion in a phase 1b , randomised , double-blind , placebo-controlled , proof-of-concept trial , individuals aged 21-65 years who had had a fever ( 38C ) for less than 48 h , met at least two criteria indicating probable dengue infection , and had a positive result on a dengue point-of-care test kit or PCR assay were referred for screening at a centre in Singapore between July 30 , 2012 , and March 4 , 2013 .


Using a web-based system , we randomly assigned patients who met full inclusion criteria after screening ( 1:1 ; random permuted block length four ) to celgosivir ( initial 400 mg loading dose within 6 h of randomisation , followed by 200 mg every 12 h for a total of nine doses ) or matched placebo .


Patients and the entire study team were masked to group assignment .


The primary endpoints were mean virological log reduction ( VLR ) from baseline for days 2 , 3 , and 4 , and area under the fever curve ( AUC ) for a temperature above 37C from 0 h to 96 h. Efficacy analyses were by intention to treat .


This study is registered with ClinicalTrials.gov , number NCT01619969 .


We screened 69 patients and randomly assigned 50 ( 24 to celgosivir , 26 to placebo ) .


Mean VLR was greater in the celgosivir group ( -186 , SD 107 ) than in the placebo group ( -164 , 075 ) , but the difference was non-significant ( -022 , 90 % CI -065 to 022 ; one-sided p = 0203 ) .


The mean AUC was also higher in the celgosivir group ( 5492 , SD 3104 ) than in the placebo group ( 4072 , 1869 ) , but again the difference was non-significant ( 1420 , 90 % CI 216-2625 ; one-sided p = 0973 ) .


We noted similar incidences of adverse events between groups .


Although generally safe and well tolerated , celgosivir does not seem to reduce viral load or fever burden in patients with dengue .


STOP Dengue Translational Clinical Research .


Patients with cirrhosis have reduced exercise tolerance , measured objectively as decreased peak exercise oxygen uptake ( peak VO2 ) .


Reduced peak VO2 is associated with decreased survival time .


The effect of aerobic exercise training on peak VO2 has not been well studied in patients with cirrhosis .


We evaluated the safety and efficacy of 8 weeks of supervised exercise on peak VO2 , quadriceps muscle thickness , and quality of life .


In a prospective pilot study , stable patients ( 79 % male , 57.6 6.7 years old ) with Child-Pugh class A or B cirrhosis ( mean Model for End-Stage Liver Disease score , 10 2.2 ) were randomly assigned to groups that received exercise training ( n = 9 ) or usual care ( controls , n = 10 ) at the University of Alberta Hospital in Canada from February through June 2013 .


Supervised exercise was performed on a cycle ergometer 3 days/week for 8 weeks at 60 % -80 % of baseline peak VO2 .


Peak VO2 , quadriceps muscle thickness ( measured by ultrasound ) , thigh circumference , answers from Chronic Liver Disease Questionnaires , EQ-visual analogue scales , 6-minute walk distance , and Model for End-Stage Liver Disease scores were evaluated at baseline and at week 8 .


Analysis of covariance was used to compare variables .


At week 8 , peak VO2 was 5.3 mL/kg/min higher in the exercise group compared with controls ( 95 % confidence interval , 2.9-7 .8 ; P = .001 ) .


Thigh circumference ( P = .001 ) , thigh muscle thickness ( P = .01 ) , and EQ-visual analogue scale determined self-perceived health status ( P = .01 ) was also significantly higher in the exercise group compared with controls at week 8 ; fatigue subscores of the Chronic Liver Disease Questionnaires were lower in the exercise group compared with controls ( P = .01 ) .


No adverse events occurred during cardiopulmonary exercise testing or training .


In a controlled prospective pilot trial , 8 weeks of supervised aerobic exercise training increased peak VO2 and muscle mass and reduced fatigue in patients with cirrhosis .


No relevant adverse effects were observed .


Larger trials are needed to evaluate the effects of exercise in patients with cirrhosis .


ClinicalTrials.gov number : NCT01799785 .


Guidelines consider certain probiotics useful in the management of acute gastroenteritis .


This study evaluated the use of Lactobacillus ( L ) reuteri DSM 17938 .


A multicentre , randomised , single-blind clinical trial was performed in hospitalised children with acute gastroenteritis lasting 12-72 h. Children received conventional therapy with , or without , 1 10 ( 8 ) CFU of L. reuteri DSM 17938 for 5 days .


The primary endpoint was the duration of diarrhoea and secondary outcomes were days of hospitalisation and the percentage of children with diarrhoea after each day of treatment .


We compared 64 children receiving L. reuteri with 63 controls .


Lactobacillus reuteri reduced the duration of diarrhoea after 24 h ( p < 0.001 ) and more diarrhoea-free children were seen in the L. reuteri than control group after 24 and 48 h ( 50 % versus 5 % , p < 0.001 ) and 72 h ( 69 % versus 11 % , p < 0.001 ) .


Lactobacillus reuteri reduced mean hospital stays ( 4.31 1.3 days versus 5.46 1.77 days , p < 0.001 ) .


Prolonged diarrhoea occurred in 17 % of the controls , but none of the L. reuteri group .


No adverse effects were reported .


Lactobacillus reuteri effectively reduced the duration of acute diarrhoea and hospital stays in children hospitalised with acute gastroenteritis .


Outpatient data are now required .


To compare postoperative voice recovery time of vocal polyps treated with different power levels of CO2 laser and conventional laryngeal microsurgery on vocal polyps .


Two hundred patients with vocal polyps were randomly divided into four groups , which were respectively treated with conventional laryngeal microsurgery and different power levels of CO2 laser ( 2 W , 4 W and 6 W ) under laryngoscope .


The postoperative voice recovery time were analyzed .


All vocal polyps were resected at one time without any serious complications like dyspnea or bleeding .


The postoperative voice recovery time were 7.2 days for the group of patients received conventional laryngeal microsurgery and 7.6 days for the group of patients treated with 2 W CO2 laser , which were hoch significantly different from that in the group of patients treated with 6 W CO2 laser ( P < 0.05 ) .


The postoperative recovery time of patients treated with conventional laryngeal microsurgery and small power of CO2 laser is shorter than those operated with the other larger power of CO2 laser .


Low-intensity pulsed ultrasound ( LIPUS ) has been used successfully to accelerate healing of fresh fractures and non-unions .


It also improved callus maturation with distraction osteogenesis in animal trials .


However , only few clinical studies are available to support its widespread use for the latter indication in humans .


Twenty-one patients undergoing callus distraction for posttraumatic tibial defects were randomized into two groups : the trial group ( 12 men ; mean age 32 years ) which received 20 minutes LIPUS daily during treatment and the control group ( six men and three women ; mean age 29 years ) without LIPUS treatment .


The Ilizarov ring fixator was used in all cases .


Results were examined clinically and radiologically , analysing callus maturation with a computer-assisted measurement .


Patients in the LIPUS group needed a mean of 33 days to consolidate every 1 cm of new bone in comparison to 45 days in the control group .


The healing index was therefore shortened by 12 days/cm in the LIPUS group .


This means that callus maturation was 27 % faster in the LIPUS group .


The fixator time was shortened by 95 days in the LIPUS group .


The overall daily increase in radiographic callus density was 33 % more in the LIPUS group than in the control group .


LIPUS treatment is an effective non-invasive adjuvant method to enhance callus maturation in distraction osteogenesis .


With the help of this treatment , the healing time and the duration of external fixation can be reliably shortened .


Anatomical suitability for arteriovenous fistula ( AVF ) formation was formerly determined by clinical examination alone .


There are potential benefits from imaging to assess anatomical suitability .


Existing studies examined the role of routine preoperative ultrasonography versus clinical examination alone .


The role of a selective duplex ultrasound imaging policy is unknown .


This study aimed to compare a policy of selective versus routine ultrasound assessment before AVF formation .


All patients referred for fistula formation were assessed for inclusion .


Suitable patients were randomized to either routine or selective preoperative ultrasound imaging ; selective imaging was performed only when clinical criteria were not met .


The primary outcome measures were site of AVF formation and 30-day primary failure rate , and secondary outcome measures included the rate of complications .


A total of 106 patients were assessed , and 94 were randomized : 47 to selective and 47 to routine duplex ultrasonography .


The groups were well matched for age , co-morbidities and medications .


The primary failure rate ( 29 per cent overall ) was not significantly different between the selective and routine imaging groups : 36 per cent ( 14 of 39 ) and 21 per cent ( 8 of 38 ) respectively ( P = 0144 ) .


There were no significant differences in the sites of AVF formation or complication rates .


Routine preoperative ultrasound vessel imaging did not significantly reduce early failure rates , influence the site of AVF formation or reduce complications .


If clinical evaluation detects anatomy suitable for AVF formation , duplex imaging may not be needed .


NCT01004627 ( http://www.clinicaltrials.gov ) .


Medication adherence is critical for patient treatment .


This study involved evaluating how implementing Short Message Service ( SMS ) reminders affected patient medication adherence and related factors .


We used a structured questionnaire to survey outpatients at three medical centers .


Patients aged 20 years and older who were prescribed more than 7 days of a prescription medication were randomized into SMS intervention or control groups .


The intervention group received daily messages reminding them of aspects regarding taking their medication ; the control group received no messages .


A phone follow-up was performed to assess outcomes after 8 days .


Data were collected from 763 participants in the intervention group and 435 participants in the control group .


After participants in the intervention group received SMS reminders to take medication or those in the control group received no messages , incidences of delayed doses were decreased by 46.4 and 78.8 % for those in the control and intervention groups , respectively .


The rate of missed doses was decreased by 90.1 % for participants in the intervention group and 61.1 % for those in the control group .


We applied logistic regression analysis and determined that participants in the intervention group had a 3.2-fold higher probability of having a decrease in delayed doses compared with participants in the control group .


Participants in the intervention group also showed a 2.2-fold higher probability of having a decrease in missed doses compared with participants in the control group .


Use of SMS significantly affected the rates of taking medicine on schedule .


Therefore , daily SMS could be useful for reminding patients to take their medicine on schedule .


Olfactory loss impairs the patient 's quality of life .


In individualized therapies , olfactory drug effects gain clinical importance .


Molecular evidence suggests that among drugs with potential olfactory effects is ( 9 ) - tetrahydrocannabinol ( THC ) , which is approved for several indications , including neuropathic pain or analgesia in cancer patients .


The present study aimed at assessing the olfactory effects of THC to be expected during analgesic treatment .


The effects of 20mg oral THC on olfaction were assessed in a placebo-controlled , randomized cross-over study in healthy volunteers .


Using an established olfactory test ( Sniffin ' Sticks ) , olfactory thresholds , odour discrimination and odour identification were assessed in 15 subjects at baseline and 2h after THC administration .


( 9 ) - Tetrahydrocannabinol impaired the performance of subjects ( n = 15 ) in the olfactory test .


Specifically , olfactory thresholds were increased and odour discrimination performance was reduced .


This resulted in a significant drop in composite threshold , discrimination , identification ( TDI ) olfactory score by 5.5 points ( from 37.7 4.2 to 32.2 5.6 , 95 % confidence interval for differences THCvs .


placebo , -7.8 to -2.0 , P = 0.003 ) , which is known to be a subjectively perceptible impairment of olfactory function .


Considering the resurgence of THC in medical use for several pathological conditions , the present results indicate that THC-based analgesics may be accompanied by subjectively noticeable reductions in olfactory acuity .


In particular , for patients relying on their sense of smell , this might be relevant information for personalized therapy strategies .


The purpose of this study was to examine the feasibility of core stabilization exercise with real-time feedback on balance and gait function in patients with chronic hemiparetic stroke .


Nineteen stroke subjects were enrolled in this study .


The patients were randomly divided into the experimental ( n = 10 ) and control groups ( n = 9 ) .


Subjects in the experimental group performed core stabilization exercise with real-time feedback training for 30 minutes per day during a period of six weeks .


Subjects in the control group performed core stabilization exercise during the same period .


This study assessed the kinematic parameters using a portable walkway system , and timed up-and-go test .


Gait velocity showed significantly greater improvement in the experimental group ( 7.3 5.0 sec ) than in the control group ( -0.7 10.6 ) .


Stride length showed significantly greater increase in the experimental group ( 13.2 7.9 on the affected side and 12.6 8.0 on the less affected side ) than the control group ( 3.5 8.7 on the affected side and 3.4 8.5 on the less affected side ) .


After training , change in results on the timed up and go test was significantly greater in the experimental group than in the control group .


Core stabilization exercise using real-time feedback produces greater improvement in gait performance in chronic hemiparetic stroke patients than core stabilization exercise only .


Interparental violence is both common and harmful and impacts children 's lives directly and indirectly .


Direct effects refer to affective , behavioral , and cognitive responses to interparental violence and psychosocial adjustment .


Indirect effects refer to deteriorated parental availability and parent-child interaction .


Standard Trauma Focused Cognitive Behavioral Therapy may be insufficient for children traumatized by exposure to interparental violence , given the pervasive impact of interparental violence on the family system .


HORIZON is a trauma focused cognitive behavioral therapy based group program with the added component of a preparatory parenting program aimed at improving parental availability ; and the added component of parent-child sessions to improve parent-child interaction .


This is a multicenter , multi-informant and multi-method randomized clinical trial study with a 2 by 2 factorial experimental design .


Participants ( N = 100 ) are children ( 4-12 years ) , and their parents , who have been exposed to interparental violence .


The main aim of the study is to test the effects of two parental components as an addition to a trauma focused cognitive behavioral based group therapy for reducing children 's symptoms .


Primary outcome measures are posttraumatic stress symptoms , and internalizing and externalizing problems in children .


The secondary aim of the study is to test the effect of the two added components on adjustment problems in children and to test whether enhanced effects can be explained by changes in children 's responses towards experienced violence , in parental availability , and in quality of parent-child interaction .


To address this secondary aim , the main parameters are observational and questionnaire measures of parental availability , parent-child relationship variables , children 's adjustment problems and children 's responses to interparental violence .


Data are collected three times : before and after the program and six months later .


Both intention-to-treat and completer analyses will be done .


The current study will enhance our understanding of the efficacy interparental violence-related parental components added to trauma focused cognitive behavioral group program for children who have been exposed to IPV .


It will illuminate mechanisms underlying change by considering multiple dimensions of child responses , parenting variables and identify selection criteria for participation in treatment .


Netherlands Trial Register NTR4015 .


Registered 4th of June , 2013 .


The epilepsy treatment gap is largest in resource-poor countries .


We evaluated the efficacy of a 1-day health education program in a rural area of Kenya .


The primary outcome was adherence to antiepileptic drugs ( AEDs ) as measured by drug levels in the blood , and the secondary outcomes were seizure frequency and Kilifi Epilepsy Beliefs and Attitudes Scores ( KEBAS ) .


Seven hundred thirty-eight people with epilepsy ( PWE ) and their designated supporter were randomized to either the intervention ( education ) or nonintervention group .


Data were collected at baseline and 1year after the education intervention was administered to the intervention group .


There were 581 PWE assessed at both time points .


At the end of the study , 105 PWE from the intervention group and 86 from the nonintervention group gave blood samples , which were assayed for the most commonly used AEDs ( phenobarbital , phenytoin , and carbamazepine ) .


The proportions of PWE with detectable AED levels were determined using a standard blood assay method .


The laboratory technicians conducting the assays were blinded to the randomization .


Secondary outcomes were evaluated using questionnaires administered by trained field staff .


Modified Poisson regression was used to investigate the factors associated with improved adherence ( transition from nonoptimal AED level in blood at baseline to optimal levels at follow-up ) , reduced seizures , and improved KEBAS , which was done as a post hoc analysis .


This trial is registered in ISRCTN register under ISRCTN35680481 .


There was no significant difference in adherence to AEDs based on detectable drug levels ( odds ratio [ OR ] 1.46 , 95 % confidence interval [ 95 % CI ] 0.74-2 .90 , p = 0.28 ) or by self-reports ( OR 1.00 , 95 % CI 0.71-1 .40 , p = 1.00 ) between the intervention and nonintervention group .


The intervention group had significantly fewer beliefs about traditional causes of epilepsy , cultural treatment , and negative stereotypes than the nonintervention group .


There was no difference in seizure frequency .


A comparison of the baseline and follow-up data showed a significant increase in adherence-intervention group ( 36-81 % [ p < 0.001 ] ) and nonintervention group ( 38-74 % [ p < 0.001 ] ) - using detectable blood levels .


The number of patients with less frequent seizures ( 3 seizures in the last 3months ) increased in the intervention group ( 62-80 % [ p = 0.002 ] ) and in the nonintervention group ( 67-75 % [ p = 0.04 ] ) .