Plasma S100A12 and sRAGE , biomarkers of inflammation and nutritional status , and comorbidities were investigated in 200 CKD Stage 5 patients [ median age of 56 years , 62 % men and median glomerular filtration rate ( GFR ) of 6.2 mL/min/1 .73 m ( 2 ) ] in conjunction with initiation of dialysis therapy .


Associations between mortality risk and S100A12 or sRAGE were assessed after a median follow-up period of 23 months .


In addition , for comparative analyses , S100A12 and sRAGE levels were assessed also in 58 haemodialysis and 78 peritoneal dialysis patients after 1 year of dialysis , 56 CKD Stages 3-4 patients and 50 community-based control subjects .


The median level of S100A12 was 4-fold higher , median sRAGE 2.4 higher and median ratio S100A12/sRAGE 2.27 times higher in CKD 5 patients than in controls .


Similar alterations were observed in CKD 3-4 patients ; however , CKD 5 patients had a higher median level of sRAGE than the CKD 3-4 patients .


In the CKD 5 patients , S100A12 levels were higher in those with diabetes or CVD than in those without these comorbidities .


Furthermore , S100A12 correlated with high-sensitivity C-reactive protein ( hsCRP ) levels ( = 0.53 ; P < 0.001 ) and a 1-SD higher level of S100A12 associated with increased all-cause mortality risk ( hazard ratio 1.32 , 95 % confidence interval 1.01-1 .73 ) after adjustment for age , sex , comorbidity , nutritional status and inflammation ( hsCRP ) .


In the CKD 5 patients , sRAGE correlated negatively with GFR ( = -0.26 ; P < 0.01 ) but sRAGE did not associate with hsCRP , comorbidities or mortality .


Plasma concentrations of sRAGE , S100A12 and the ratio S100A12/sRAGE , are markedly elevated in CKD 5 patients starting on dialysis as well as in CKD 3-4 patients and prevalent dialysis patients suggesting that these alterations are typical for patients with moderate or severe CKD .


In CKD 5 patients , an increased concentration of S100A12 are associated with inflammation , comorbidities and increased mortality risk whereas no such associations were observed for sRAGE .


These results suggest that while high plasma S100A12 is an independent predictor of increased mortality risk , sRAGE does not seem to be a valid risk marker in this patient population .


In this study we sought to determine whether a Titin peptide fragment can serve as a clinical biomarker for changes in muscle mass .


Mass spectrometry was used to identify Titin fragment in urine .


An antibody against this Titin sequence was raised and used to develop a competitive ELISA assay for measurement in serum .


Rat tissue extractions in the presence or absence of a series of proteases of interest were used to identify its enzymatic origin .


A rat model of dexamethasone ( DEX ) induced muscle atrophy and a human 56-day bed rest study with and without vibration therapy were used to assess biological and clinical relevance .


A technically robust ELISA measuring the Titin fragment was developed against a Titin peptide fragment identified in human urine .


The fragment was shown to be produced primarily by MMP-2 cleavage of Titin .


In the rat muscle DEX induced atrophy model , Titin-MMP2 fragment was decreased in the beginning of DEX treatment , and then significantly increased later on during DEX administration .


In the human bed rest study , the Titin-MMP2 fragment was initially decreased 11.9 ( 3.7 ) % after 1day of bed rest , and then gradually increased ending up at a 16.4 ( 4.6 ) % increase at day 47 .


We developed a robust ELISA measuring a muscle derived MMP-2 generated Titin degradation fragment in rat and human serum .


Importantly , the fragment can be measured in serum and that these levels are related to induction of skeletal muscle atrophy .


This study compared the effects of short-term titrated colestilan ( a novel non-absorbable , non-calcium , phosphate binder ) with placebo , and evaluated the safety and efficacy of colestilan over 1 year compared with sevelamer , in patients with chronic kidney disease ( CKD ) 5D .


This prospective multicentre study comprised a 4-week phosphate binder washout period , a 16-week short-term , flexible-dose , treatment period ( including a 4-week placebo-controlled withdrawal period ) and a 40-week extension treatment phase .


At Week 16 ( the end of the 4-week placebo-controlled withdrawal period ) , serum phosphorus level was 0.43 mmol/L ( 1.32 mg/dL ) lower with colestilan than placebo ( P < 0.001 ; primary end point ) .


Serum LDL-C level was also lower with colestilan than with placebo ( P < 0.001 ) .


Both colestilan and sevelamer produced significant reductions from baseline in serum phosphorus levels ( P < 0.001 ) , maintained for 1 year , and the proportion of patients achieving target levels of 1.78 mmol/L ( 5.5 mg/dL ) or 1.95 mmol/L ( 6.0 mg/dL ) at study end were similar ( 65.3 and 73.3 % , respectively , for colestilan , and 66.9 and 77.4 % , respectively , for sevelamer ) .


Serum calcium level remained stable in the colestilan group but tended to increase slightly in the sevelamer group ( end-of-study increase of 0.035 mmol/L over baseline ) .


Both binders produced similar reductions from baseline in LDL-C level ( P < 0.001 ) , and responder rates after 1 year , using a target of < 1.83 mmol/L ( 70 mg/dL ) or < 2.59 mmol/L ( 100 mg/dL ) were similar in both groups ( 50.7 and 85.3 % for colestilan and 54.0 and 80.6 % for sevelamer ) .


Colestilan was generally well tolerated .


Colestilan is effective and safe for the treatment of hyperphosphataemia in patients with CKD 5D , and affords similar long-term phosphorus and cholesterol reductions/responder rates to sevelamer .


We investigated the association of HIV infection and highly active antiretroviral therapy ( HAART ) with sleep disordered breathing ( SDB ) , fatigue , and sleepiness .


HIV-uninfected men ( HIV - ; n = 60 ) , HIV-infected men using HAART ( HIV + / HAART + ; n = 58 ) , and HIV-infected men not using HAART ( HIV + / HAART - ; n = 41 ) recruited from two sites of the Multicenter AIDS cohort study ( MACS ) underwent a nocturnal sleep study , anthropometric assessment , and questionnaires for fatigue and the Epworth Sleepiness Scale .


The prevalence of SDB in HIV - men was compared to that in men matched from the Sleep Heart Health Study ( SHHS ) .


The prevalence of SDB was unexpectedly high in all groups : 86.7 % for HIV - , 70.7 % for HIV + / HAART + , and 73.2 % for HIV + / HAART - , despite lower body-mass indices ( BMI ) in HIV + groups .


The higher prevalence in the HIV - men was significant in univariate analyses but not after adjustment for BMI and other variables .


SDB was significantly more common in HIV - men in this study than those in SHHS , and was common in participants with BMIs < 25 kg/m2 .


HIV + men reported fatigue more frequently than HIV - men ( 25.5 % vs. 6.7 % ; p = 0.003 ) , but self-reported sleepiness did not differ among the three groups .


Sleepiness , but not fatigue , was significantly associated with SDB .


SDB was highly prevalent in HIV - and HIV + men , despite a normal or slightly elevated BMI .


The high rate of SDB in men who have sex with men deserves further investigation .


Sleepiness , but not fatigue , was related to the presence of SDB .


Clinicians caring for HIV-infected patients should distinguish between fatigue and sleepiness when considering those at risk for SDB , especially in non-obese men .


To compare the efficacy of percutaneous sodium tetradecyl sulfate ( STS ) injection with ethanol injection in the treatment of benign nonfunctioning thyroid nodules .


This prospective study included 47 patients with 50 benign thyroid nodules .


The lesions were randomly assigned into two groups : 20 in the ethanol arm and 30 in the STS arm .


The mean lesion volume was 25.6 mL 28.5 ( range , 4-122 .1 mL ) in the ethanol arm and 25.4 mL 27 ( range , 0.72-129 mL ) in the STS arm .


One sitting of sclerosant injection was done in 20 lesions , and two injections , three injections , four injections , five injections , six injections , seven injections , and eight sittings of injections were done in 9 lesions , 4 lesions , 8 lesions , 4 lesions , 2 lesions , 2 lesions , and 1 lesion .


The mean volumes of the instilled ethanol and STS were 5.3 mL and 7.8 mL , respectively , per sitting .


Follow-up sonography was performed at 1 , 3 , 6 , and 12 months after the procedure .


The final 12-month follow-up lesion volumes were 4.1 mL 3.7 ( range , 0.3-15 .2 mL ) in the ethanol group and 4.4 mL 5.8 ( range , 0.01-29 .6 mL ) in the STS group ( P = .85 ) .


The mean volume reduction was 84 % and 82.8 % in the two groups .


No significant adverse effects were seen in either of the two groups .


Sonographically guided percutaneous ethanol and STS injections are not significantly different from each other in terms of the volume reduction achieved in benign nonfunctioning thyroid nodules .


Parathyroid hormone ( PTH ) promotes calcium reabsorption in the cortical distal nephron ( CDN ) .


The phosphate concentration ( [ P ] f ) rises in that segment in chronic kidney disease ( CKD ) ; in theory , high [ P ] f could reduce availability of calcium for reabsorption and necessitate a compensatory rise in [ PTH ] .


With assumptions , [ P ] f is proportional to phosphate excreted/volume of filtrate ( EP/GFR ) .


We therefore hypothesized that [ PTH ] would correlate with EP/GFR in CKD , and PTH ] would correlate with EP/GFR after sevelamer therapy .


We conducted a 4-week , placebo-controlled trial of sevelamer carbonate in patients with CKD .


[ PTH ] 1-84 and parameters of phosphate homeostasis were measured before and after treatment .


GFR was assumed to equal creatinine clearance ( Ccr ) .


Pertinent linear regressions were performed .


Phosphate excretion fell in the sevelamer group only .


Decrements in [ PTH ] with sevelamer differed from increments with placebo .


With either treatment , [ PTH ] correlated with EP/Ccr and PTH ] correlated with EP/Ccr .


Changes in [ PTH ] were minimal in some sevelamer recipients despite reductions in EP/Ccr ; calcium excreted/volume of filtrate was low in these subjects .


Phosphate influx affected [ PTH ] in CKD by determining [ P ] f in the CDN .


In some patients , low calcium influx may have blunted the effect of sevelamer on [ PTH ] .


In a previous uncontrolled experiment , oral vancomycin improved the symptoms ( S ) of chronic constipation ( CC ) .


The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet .


On days 0-to-10 , patients were randomized to 500 mg oral lincomycin + high fiber ( L + F ) or to placebo + high fiber ( P + F ) .


Participants and patients were blinded .


From days 10-to-21 , patients were continued solely on the high fiber diet .


The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale ( VAS ) calibrated from 0 = severe S to 10 = asymptomatic .


The means of all S were significantly improved by L + F but not by P + F.


A significant higher proportion of L + F patients increased the VAS > or = 3 points .


The initial course of L facilitated the effect of F probably by its effect on the colon flora .


This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs .


We explored the differential effect of cessation interventions ( behavioral support sessions with [ BSS + ] and without [ BSS ] bupropion ) between hookah and cigarette smokers .


We reanalyzed the data from a major cluster-randomized controlled trial , ASSIST ( Action to Stop Smoking In Suspected Tuberculosis ) , which consisted of 3 conditions : ( a ) behavioral support sessions ( BSS ) , ( b ) behavioral support sessions plus 7 weeks of bupropion therapy ( BSS + ) , and ( c ) controls receiving usual care .


The trial originally recruited 1,955 adult smokers with suspected tuberculosis from 33 health centers in the Jhang and Sargodha districts of Pakistan between 2010 and 2011 .


The primary endpoint was continuous 6-month smoking abstinence , which was determined by carbon monoxide levels .


Subgroup-specific relative risks ( RRs ) of smoking abstinence were computed and tested for differential intervention effect using log binomial regression ( generalized linear model ) between 3 subgroups ( cigarette-only : 1,255 ; mixed : 485 ; and hookah-only : 215 ) .


The test result for homogeneity of intervention effects between the smoking forms was statistically significant ( p-value for BSS + : .04 and for BSS : .02 ) .


Compared to the control , both interventions appeared to be effective among hookah smokers ( RR = 2.5 ; 95 % CI = 1.3-4 .7 and RR = 2.2 ; 95 % CI = 1.3-3 .8 , respectively ) but less effective among cigarette smokers ( RR = 6.6 ; 95 % CI = 4.6-9 .6 and RR = 5.8 ; 95 % CI = 4.0-8 .5 ) , respectively .


The differential intervention effects on hookah and cigarette smokers were seen ( a ) because the behavioral support intervention was designed primarily for cigarette smokers ; ( b ) because of differences in demographic characteristics , behavioral , and sociocultural determinants ; or ( c ) because of differences in nicotine dependency levels between the 2 groups .


To observe the effect of the Traditional Chinese Medicine , modified Taohongsiwu decoction , versus pyridoxine on patients with hand-foot syndrome ( HFS ) from capecitabine , sorafenib , and gefitinib chemotherapy for gastric , lung , breast , colon , or rectal cancer .


Also , to compare quality of life of patients in each group .


Patients were assigned randomly to group A or B. Group A was given modified Taohongsiwu decoction to soak hands and feet for 30 min , once daily .


Group B was given 100 mg pyridoxine orally , twice daily .


After a 2-week treatment , the therapeutic effect was assessed by observing three major symptoms , including pain , ulceration , and muscular atrophy .


This was assessed with the HFS-14 questionnaire .


Significant differences were observed between the two groups in pain relief , and improvement of daily life , walking , and interpersonal communication ( P < 0.01 ) .


No significant differences in driving ability or interpersonal relationships were found .


After 2 weeks , the effective rate was 88.3 % in group A , which was significantly higher than the 50 % in group B ( P = 0.00 ) .


Modified Taohongsiwu decoction is effective in the treatment of patients with HFS .


It improves patients ' quality of life according to the HFS-14 .


To evaluate the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery .


In the randomized , double blind , controlled study , 120 patients undergoing septoplasty were divided into 3 groups ( n = 40 ) : group A received parecoxib 40 mg by muscle injection 30 min before the operation ; group B received pentazocine 30 mg ; group C received an equal volume of saline .


The preemptive analgesia effect was evaluated with VAS scores which recorded at different time points .


The proportion of participants using rescue analgesia after the operation were recorded as additional measures of preemptive analgesia .


Intra-operative as well as the postoperative pain scores were less in the group A and group B than in the control group .


Fewer participants required rescue medication after operation with parecoxib as well as pentazocine than placebo .


However there were no difference in the preemptive effects between the group A and group B.


Administration of both the parecoxib and pentazocine before the nasal endoscopic surgery can provide preemptive analgesia without serious adverse side effects that deserves popularization in the clinic .


A recent phase III randomized controlled trial ( NCT00434148 ) showed efficacy of pasireotide in the treatment of patients with Cushing 's disease ( CD ) .


Patients were invited to participate in an extension phase of the protocol and a subgroup had a sustained response .


We report the experience with 4 patients in our center of which 2 full responders have completed 5.5 and 4.25 years of treatment with disease control .


The trial protocol was described previously .


The extension phase consisted of 3-monthly visits with clinical , biochemical , and imaging evaluation and investigator-driven pasireotide titration .


Research charts were retrospectively analyzed .


Four patients with persistent CD following pituitary surgery completed the first 6 months of the trial and 3 continued in the next 6 month open-label phase .


Two patients with baseline urinary free cortisol ( UFC ) 5.3-6 .7 times the upper limit of normal had a rapid sustained response to pasireotide and entered the extension phase after 12 months .


They remain in clinical and biochemical disease remission and 1 patient now only requires 300 g daily of pasireotide .


All 4 patients developed glucose intolerance ; however , the two patients in the extension phase were eventually able to discontinue all diabetes pharmacotherapy .


Adverse events included second degree atrioventicular block type 1 without QT prolongation in a patient with pre-existing sinus bradycardia , and symptomatic cholelithiasis requiring cholecystectomy in a second patient .


Pasireotide therapy can provide normalization of UFC and of clinical symptoms and signs of CD during up to 5 years of follow-up .


This study demonstrates the possible recuperation of normoglycemia after continued use of pasireotide and control of underlying hypercortisolemia .


Longer-term monitoring for potential adverse events related to continued use of pasireotide is indicated .


Low molecular weight heparins ( LMWHs ) constitute the mainstay of anticoagulant therapy for pediatric venous thromboembolism ( VTE ) .


The safety and effectiveness of dalteparin , an LMWH , has not been established in children , and pediatric data on dalteparin for VTE are limited to one single-center experience .


To establish dose-finding ( primary endpoint ) and efficacy/safety outcomes ( secondary endpoints ) in children treated with dalteparin in a substudy of the Kids-DOTT trial .


A prospective multicenter trial using dalteparin subcutaneously twice daily for acute VTE in children aged 21 years was conducted under an investigator-held Investigational New Drug application registered with the US Food and Drug Administration .


Initial weight-based dosing per protocol was as follows : infants ( < 12 months ) , 150 IU kg ( -1 ) ; children ( 1-12 years ) , 125 IU kg ( -1 ) ; and adolescents ( 13-18 years ) , 100 IU kg ( -1 ) .


Bleeding events were categorized according to ISTH criteria .


Descriptive non-parametric statistics were employed for all analyses .


Eighteen patients ( 67 % male ) were enrolled from January 2010 to October 2013 across four centers .


No supratherapeutic levels were observed .


Median ( range ) therapeutic doses by age group were as follows : infants ( n = 3 ) , 180 IU kg ( -1 ) ( 146-181 IU kg ( -1 ) ) ; children ( n = 7 ) , 125 IU kg ( -1 ) ( 101-175 IU kg ( -1 ) ) ; and adolescents ( n = 8 ) , 100 IU kg ( -1 ) ( 91-163 IU kg ( -1 ) ) .


The median duration of dalteparin use was 48 days ( range : 2-169 days ) , and the median follow-up was 10.5 months ( range : 2-35 months ) .


There were no related serious adverse events , no clinically relevant bleeding events , and no symptomatic recurrent VTEs .


Dalteparin successfully achieved targeted anti-factor Xa levels in 18 children and young adults with acute VTE with a standardized age-based dosing regimen , with a favorable safety and efficacy profile .


Pulmonary rehabilitation has been demonstrated to improve exercise capacity , dyspnoea , quality of life and to reduce the adverse effects of acute exacerbations .


Current guidelines recommend exercise training in patients with mild to very severe disease .


However , there is insufficient data comparing the efficacy of different training approaches and intensities .


Between January 2009 and December 2012 , 105 COPD patients were screened to participate in the study .


61 patients were randomly assigned into an individualized training group or into a non-individualized training group .


Both groups exercised once a week for 60minutes over a time period of three months .


At the beginning and after three months , the following measurements were performed : 6-minute walking test ( 6-MWT ) , health-related quality of life ( St. Georges Respiratory Questionnaire ; SGRQ and COPD-Assessment-Test ; CAT ) , M. rectus femoris cross-sectional area , and inflammatory markers in peripheral blood .


Only in the individualized training group we observed a significant change of the 6-MWT ( increase of 32.47 m ; p = 0.012 ) and the cross-sectional area of the M. rectus fermoris ( increase of 0.57 cm2 ; p = 0.049 ) , while no significant changes occurred in the non-individualized training group .


Peroxisome-proliferator-activated receptor - coactivator 1 increased in the individualized training only after the three months training period ( increase of 0.43 relative copies ; p = 0.017 ) , all other myokines and inflammatory markers were not influenced by either of the programs .


The total drop-out-rate was 44.3 % .


A low frequency outpatient training program may induce modest improvements in exercise capacity and muscle mass only if it is performed on an individualized basis .


To determine the DA and cost-effectiveness of the dermoscope in primary care for skin lesions suspected of malignancy .


In a cluster randomized clinical trial , 48 Dutch general practices were randomized to either intervention group using a dermoscope or control group using only naked-eye examination .


A total of 194 lesions from 170 patients in the intervention group and 222 lesions from 211 patients in the control group were analysed for DA and cost-effectiveness .


The percentage of correctly diagnosed lesions in intervention group and control group was 50.5 % and 40.5 % respectively .


This was 61.5 % and 22.2 % for melanomas .


In the intervention group , three malignancies were treated with the expectative treatment option compared to none in the control group .


The odds ratio ( OR ) of a correct diagnosis in the intervention group , compared to control group , was 1.51 ( 95 % CI : 0.962.37 ) P = 0.07 .


Consequently , the relative risk was 1.25 .


The incremental cost-effectiveness ratio was 89 ( 95 % CI 60 to 598 ) , indicating that using a dermoscope costs an additional 89 for one additional correctly diagnosed patient .


Additional analyses showed better effects of dermoscopy compared to the control group for 98 % of the bootstrap resamples .


The probability of a correct diagnosis was 1.25 times higher using a dermoscope than without a dermoscope .


Although this difference is marginally not statistically significant , dermoscopy in general practice appears to be cost effective .


We therefore think that GPs should be trained to use a dermoscope , although they should realize that even with the use of a dermoscope not all lesions will be diagnosed correctly .


Elevated polyclonal serum immunoglobulin free light chains ( FLCs ; combined FLC+FLC [ cFLC ] ) are associated with adverse clinical outcomes and increased mortality ; we investigated cFLC and cardiovascular disease ( CVD ) events in type 2 diabetes .


In a cohort study of 352 south Asian patients with type 2 diabetes , serum cFLC , high-sensitivity C-reactive protein ( hsCRP ) , and standard biochemistry were measured .


CVD events over 2 years were recorded and assessed using multiple logistic regression .


cFLC levels were elevated significantly in 29 of 352 ( 8 % ) patients with CVD events during 2 years of follow-up ( 50.7 vs. 42.8 mg/L ; P = 0.004 ) .


In multivariate analysis , elevated cFLC ( > 57.2 mg/L ) was associated with CVD outcomes ( odds ratio 3.3 [ 95 % CI 1.3-8 .2 ] ; P = 0.012 ) and remained significant after adjusting for age , albumin-to-creatinine ratio , diabetes duration , or treatment .


cFLC elevation is a novel marker for CVD outcomes in type 2 diabetes that warrants further investigation .


The aim of this study was to evaluate the survival and success of screw-retained versus cement-retained implant restorations in immediately loaded implants at 8-year follow-up .


Patients who were scheduled for full-arch ceramic prosthetic restorations were divided into two groups by randomization : in one group , prosthetic frameworks were screwed onto implants ( screw-retained group , SRG ) , and in the second group , the frameworks were cemented on abutments ( cement-retained group , CRG ) .


Dental implants were placed both in postextraction and in healed sites .


A temporary full-arch prosthesis was placed immediately after implant placement .


Intraoral digital radiographic examinations ( evaluating marginal bone levels ) were made at baseline , 6 months , and each year after implant placement .


In 28 patients , 24 full arches and 192 implants were placed in the maxilla and 10 full arches and 80 implants in the mandible ( 17 rehabilitations in each group ) .


After an 8-year follow-up period , a survival rate of 99.27 % was reported for all implants .


Within the first year after implant placement , bone loss was recorded as follows : the CRG showed mean bone levels of -1.23 0.45 mm , while the SRG showed mean bone levels of -1.01 0.33 mm .


After a 3-year follow-up , a slight increase was found ( 0.30 0.25 mm in CRG and 0.45 0.29 mm in SRG ) .


After that point , marginal bone levels remained stable over time , up to the 8-year follow-up .


No statistically significant differences were found between groups ( P > .05 ) .


Definitive cement - and screw-retained ceramic restorations are highly predictable , biocompatible , and esthetically pleasing , and the two groups presented no statistically significant differences in bone loss .


Social anxiety disorder ( SAD ) is one of the most common mental disorders and causes subjective suffering and economic burden worldwide .


Although effective treatments are available , a lot of cases go untreated .


Internet-based self-help is a low-threshold and flexible treatment alternative for SAD .


Various studies have already shown that internet-based self-help can be effective to reduce social phobic symptoms significantly .


Most of the interventions tested include therapist support , whereas the role of peer support within internet-based self-help has not yet been fully understood .


There is evidence suggesting that patients ' mutual exchange via integrated discussion forums can increase the efficacy of internet-based treatments .


This study aims at investigating the added value of therapist-guided group support on the treatment outcome of internet-based self-help for SAD .


The study is conducted as a randomized controlled trial .


A total of 150 adults with a diagnosis of SAD are randomly assigned to either a waiting-list control group or one of the active conditions .


The participants in the two active conditions use the same internet-based self-help program , either with individual support by a psychologist or therapist-guided group support .


In the group guided condition , participants can communicate with each other via an integrated , protected discussion forum .


Subjects are recruited via topic related websites and links ; diagnostic status will be assessed with a telephone interview .


The primary outcome variables are symptoms of SAD and diagnostic status after the intervention .


Secondary endpoints are general symptomology , depression , quality of life , as well as the primary outcome variables 6 months later .


Furthermore , process variables such as group processes , the change in symptoms and working alliance will be studied .


The results of this study should indicate whether group-guided support could enhance the efficacy of an internet-based self-help treatment for SAD .


This novel treatment format , if shown effective , could represent a cost-effective option and could further be modified to treat other conditions , as well .


ISRCTN75894275 .


This study aimed to test the feasibility of implementing a psychoeducational intervention program for gynecological cancer patients .


A single-blinded randomized controlled trial and mixed-method design were used .


Study subjects were newly diagnosed gynecological cancer patients with surgery as the first-line treatment .


They were randomly assigned to the intervention group , in which a psychoeducational intervention program based on a thematic counseling model was offered , or to the attention control group .


Quantitative data on sexual functioning , quality of life , uncertainty , anxiety , depression and social support were collected at recruitment , post-operative and during the in-hospital period , and eight weeks after the operation .


Participants in the intervention group and three nurses working in the clinical setting were invited to have semi-structured interviews .


Of the 30 eligible subjects , 26 were successfully recruited into the study .


Following the psychoeducational intervention program , there was significant improvement in the level of inconsistent information about the illness within the category of uncertainty among participants in the intervention group .


In addition , trends towards improvement were demonstrated in quality of life , uncertainty , depression and perceived social support with the provision of the interventions .


Qualitative data indicated the interventions were desired and appreciated by the participants , as well as being feasible and practical to implement in Hong Kong clinical settings .


The findings suggest that it is feasible to deliver the psychoeducational intervention program and it may have beneficial effects in gynecological cancer patients .


A full-scale study is warranted to confirm the results .


The objectives of this study were ( 1 ) to investigate the effect of nurse training on the use of potentially harmful medications ; and ( 2 ) to explore the effect of nurse training on residents ' health-related quality of life ( HRQoL ) , health service utilization , and mortality .


A randomized controlled trial .


In total , 227 residents in 20 wards of assisted living facilities in Helsinki were recruited .


The 20 wards were randomized into those in which ( 1 ) staff received two 4-hour training sessions on appropriate medication treatment ( intervention group ) , and ( 2 ) staff received no additional training and continued to provide routine care ( control group ) .


Two 4-hour interactive training sessions for nursing staff based on constructive learning theory to recognize potentially harmful medications and corresponding adverse drug events .


Use of potentially harmful medications , HRQoL assessed using the 15 dimensional instrument of health-related quality of life , health service utilization , and mortality assessed at baseline , and 6 and 12 months .


During the 12-month follow-up , the mean number of potentially harmful medications decreased in the intervention wards [ -0.43 , 95 % confidence interval ( CI ) -0.71 to -0.15 ] but remained constant in the control wards ( +0.11 , 95 % CI -0.09 to +0.31 ) ( P = .004 , adjusted for age , sex , and comorbidities ) .


HRQoL declined more slowly in the intervention wards ( -0.038 ( 95 % CI -0.054 to -0.022 ) than in the control wards ( -0.072 ( 95 % CI -0.089 to -0.055 ) ( P = .005 , adjusted for age , sex , and comorbidities ) .


Residents of the intervention wards had significantly less hospital days ( 1.4 days/person/year , 95 % CI 1.2-1 .6 ) than in the control wards ( 2.3 days/person/year ; 95 % CI 2.1-2 .7 ) ( relative risk 0.60 , 95 % CI 0.49-0 .75 , P < .001 , adjusted for age , sex , and comorbidities ) .


Activating learning methods directed at nurses in charge of comprehensive care can reduce the use of harmful medications , maintain HRQoL , and reduce hospitalization in residents of assisted living facilities .


Nontargeted metabolite profiling allows for concomitant examination of a wide range of metabolite species , elucidating the metabolic alterations caused by dietary interventions .


The aim of the current study was to investigate the effects of dietary modifications on the basis of increasing consumption of whole grains , fatty fish , and bilberries on plasma metabolite profiles to identify applicable biomarkers for dietary intake and endogenous metabolism .


Metabolite profiling analysis was performed on fasting plasma samples collected in a 12-wk parallel-group intervention with 106 participants with features of metabolic syndrome who were randomly assigned to 3 dietary interventions : 1 ) whole-grain products , fatty fish , and bilberries [ healthy diet ( HD ) ] ; 2 ) a whole-grain-enriched diet with the same grain products as in the HD intervention but with no change in fish or berry consumption ; and 3 ) refined-wheat breads and restrictions on fish and berries ( control diet ) .


In addition , correlation analyses were conducted with the food intake data to define the food items correlating with the biomarker candidates .


Nontargeted metabolite profiling showed marked differences in fasting plasma after the intervention diets compared with the control diet .


In both intervention groups , a significant increase was observed in 2 signals identified as glucuronidated alk ( en ) - ylresorcinols [ corrected P value ( Pcorr ) < 0.05 ] , which correlated strongly with the intake of whole-grain products ( r = 0.63 , P < 0.001 ) .


In addition , the HD intervention increased the signals for furan fatty acids [ 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid ( CMPF ) ] , hippuric acid , and various lipid species incorporating polyunsaturated fatty acids ( Pcorr < 0.05 ) .


In particular , plasma CMPF correlated strongly with the intake of fish ( r = 0.47 , P < 0.001 ) but not with intakes of any other foods .


Novel biomarkers of the intake of health-beneficial food items included in the Nordic diet were identified by the metabolite profiling of fasting plasma and confirmed by the correlation analyses with dietary records .


The one with the most potential was CMPF , which was shown to be a highly specific biomarker for fatty fish intake .


This trial was registered at clinicaltrials.gov as NCT00573781 .


Previous studies have found that family-based psychosocial treatments are effective adjuncts to pharmacotherapy among adults and adolescents with bipolar disorder ( BD ) .


The objective of this study was to compare the efficacy of adjunctive child - and family-focused cognitive-behavioral therapy ( CFF-CBT ) to psychotherapy as usual ( control ) for mood symptom severity and global functioning in children with BD .


Sixty-nine youth , aged 7 to 13 years ( mean = 9.19 , SD = 1.61 ) with DSM-IV-TR bipolar I , II , or not otherwise specified ( NOS ) disorder were randomly assigned to CFF-CBT or control groups .


Both treatments consisted of 12 weekly sessions followed by 6 monthly booster sessions delivered over a total of 9months .


Independent evaluators assessed participants at baseline , week 4 , week 8 , week 12 ( posttreatment ) , and week 39 ( 6-month follow-up ) .


Participants in CFF-CBT attended more sessions , were less likely to drop out , and reported greater satisfaction with treatment than controls .


CFF-CBT demonstrated efficacy compared to the control treatment in reducing parent-reported mania at posttreatment and depression symptoms at posttreatment and follow-up .


Global functioning did not differ at posttreatment but was higher among CFF-CBT participants at follow-up .


CFF-CBT may be efficacious in reducing acute mood symptoms and improving long-term psychosocial functioning among children with BD .


Antioxidants effectiveness in prostate cancer ( PCa ) chemoprevention has been severely questioned , especially after the recent results of the Selenium and Vitamin E Cancer Prevention Trial .


We present the results of a double-blind randomized controlled trial ( dbRCT ) on the pharmacokinetic , clinical , and molecular activity of dietary supplements containing lycopene , selenium , and green tea catechins ( GTCs ) in men with multifocal high grade prostatic intraepithelial neoplasia ( mHGPIN ) and/or atypical small acinar proliferation ( ASAP ) .


From 2009 to 2014 , we conducted a dbRCT including 60 patients with primary mHGPIN and/or ASAP receiving daily lycopene 35mg , selenium 55g , and GTCs 600mg , or placebo for 6 months .


Pharmacokinetic analysis were performed with UV-Visible spectrophotometric assay under standard ( SC ) and accelerated ( AC ) conditions .


Upon plasma lycopene concentrations falling within the expected range ( 1.2-90mcg / l ) and no side-effects of grade > 1 , study proceeded to phase II ( n = 50 ) .


After unblinding of results , eight men ( 4 per arm , 2 without and 2 with PCa , respectively ) were randomly selected and totRNA extracted from `` non-pathological '' tissues .


MicroRNA profiling was performed with the Agilent platform .


Raw data processing used R-statistical language and linear models for microarray analysis .


Samples were stable except for lycopene , showing significant degradation ( SC = 56 % , AC = 59 % ) and consequently stabilized under vacuum in a dark packaging .


Mean plasmatic lycopene concentration was 1,450,4 M.


At 6 months , 53 men underwent re-biopsy and 13 ( 24.5 % ) were diagnosed with PCa ( supplementation n = 10 , placebo n = 3 [ P = 0.053 ] ) .


At a mean 37 months follow-up , 3 additional PCa were found in the placebo group .


No significant variations in PSA , IPSS , and PR25 questionnaires were observed .


Stronger modulation of miRNAs was present on re-biopsy in the supplementation group compared to the placebo , including : ( i ) overexpression of miRNAs present in PCa versus non-cancer tissue ; ( ii ) underexpression of miRNAs suppressing PCa proliferation ; ( iii ) detection of 35 miRNAs in PCa patients versus disease-free men , including androgen-regulated miR-125b-5p and PTEN-targeting miR-92a-3p ( both upregulated ) .


Administration of high doses of lycopene , GTCs , and selenium in men harboring HGPIN and/or ASAP was associated with a higher incidence of PCa at re-biopsy and expression of microRNAs implicated in PCa progression at molecular analysis .


The use of these supplements should be avoided .


Diabetes self-management education ( DSME ) is recommended for all patients with diabetes .


Current estimates indicate that < 50 % of patients receive DSME , increasing risk for hospitalization which occurs more frequently with diabetes .


Hospitalization presents opportunities to provide DSME , potentially decreasing readmissions .


To address this , we investigated the feasibility of providing DSME to inpatients with diabetes .


Patients hospitalized on four medicine units were randomized to receive DSME ( Education Group ) ( n = 9 ) prescribed by a certified diabetes educator and delivered by a registered nurse , or Usual Care ( n = 12 ) .


Participants completed Diabetes Knowledge Tests ( DKT ) , Medical Outcomes Short Form ( SF-36 ) , Diabetes Treatment Satisfaction Questionnaire ( DTSQ ) , and the DTSQ-inpatient ( DTSQ-IP ) .


Bedside capillary blood glucoses ( CBG ) on day of admission , randomization and discharge were compared .


There were no group differences in demographics , diabetes treatment , admission CBG ( 18693 mg/dL vs. 21984 mg/dL , p = 0.40 ) , DKT scores ( Education vs. Usual Care 4825 vs. 6819 , p = 0.09 ) , SF-36 , and DTSQ scores ( 286 vs. 257 , p = 0.41 ) .


Patients receiving education reported more satisfaction with inpatient treatment ( 8313 vs. 6519 , p = 0.03 ) , less hyperglycemia prior to ( 2.74.5 vs. 4.51.4 , p = 0.03 ) and during hospitalization ( 3.91.9 vs. 5.51.2 , p = 0.04 ) ; and had lower mean discharge CBG ( 15938 mg/dL vs. 21167 mg/dL , p = 0.02 ) .


Inpatient diabetes education has potential to improve treatment satisfaction , and reduce CBG .


A direct renin inhibitor ( DRI ) , aliskiren , may be effective for blood pressure ( BP ) control in hemodialysis patients .


However , it is unclear whether aliskiren has a greater beneficial effect on BP and humoral factors than angiotensin II receptor antagonists ( ARBs ) in hypertensive patients on hemodialysis .


Eighteen hemodialysis patients ( 58 14 years ) on the recommended dose of an ARB were prospectively randomized into two groups : ARB and DRI groups .


Patients in the ARB group continued taking their previous ARB , whereas those in the DRI group switched to aliskiren ( 150 mg/day ) for 12 weeks .


Baseline measurements of BP and humoral factors such as plasma renin activity ( PRA ) , plasma aldosterone concentration ( PAC ) and brain natriuretic peptide ( BNP ) were performed .


Measurements were repeated every 4 weeks .


At baseline , no differences were observed in age , gender or BP between the two groups .


Systolic BP was unaffected by treatment in either groups ( group effect , p = 0.26 ; time effect , p = 0.38 ; group time effect , p = 0.24 ) .


PRA decreased in DRI ( p 0.02 , group effect , p = 0.65 ; time effect , p = 0.13 ; group time effect , p = 0.048 ) , but not in ARB ( p 0.94 ) .


PAC increased only in DRI ( p 0.03 ) , whereas BNP was unaffected in either group .


Aliskiren at a dose of 150 mg/day had a similar effect on BP compared with ARBs , but significantly lowered PRA .


Irritable bowel syndrome ( IBS ) is a chronic gastrointestinal ( GI ) disorder that affects 15-20 % of the Western population .


There are currently few therapeutic options available for the treatment of IBS .


The aim of this study is to evaluate the efficacy and the safety of a medical device containing a combination of Simethicone and Bacillus coagulans in the treatment of IBS .


This is a monocentric double-blind , placebo-controlled parallel group clinical trial .


Adult subjects suffering from IBS as defined by Rome III criteria were enrolled .


Bloating , discomfort , abdominal pain were assessed as primary end point .


Subjects received the active treatment or placebo 3 time a day after each meal for 4 weeks of study period .


Subjects were submitted to visit at Day 0 ( T1 ) , at Days 14 ( T2 ) and 29 ( T3 ) .


Fifty-two patients were included into the study .


Intragroup analysis showed a significant reduction of the bloating , discomfort and pain in Colinox group ( CG ) compared to placebo group ( PG ) .


Between group analysis confirmed , at T1-T3 , significant differences between CG and PG in bloating and discomfort .


Simethicone is an inert antifoaming able to reduce bloating , abdominal discomfort .


Literature offers increasing evidence linking alterations in the gastrointestinal microbiota and IBS and it is well known that probiotics are important to restore the native gut microbiota .


The Colinox medical device is specifically targeted against most intrusive symptom of IBS ( bloating ) and it is also able to counteract the most accredited ethiopathogenetic factor in IBS ( alterations of intestinal microbiota ) .


This is the first randomized double-blind placebo-controlled clinical trial demonstrating the efficacy and safety of a combination of simethicone and Bacillus coagulans in treatment of IBS .


It is widely agreed that chronic depression is difficult to treat , knowledge about optimal treatment approaches is emerging .


A multisite randomized controlled trial was conducted comparing the cognitive behavioral analysis system of psychotherapy ( CBASP ) , a psychotherapy model developed specifically to treat chronic depression ( n = 67 ) with care as usual ( CAU ; evidence-based treatments , n = 72 ) over a period of 52 weeks , with 23 sessions on average , in 3 outpatient clinics in the Netherlands .


In both arms algorithm-based pharmacotherapy was provided .


Patients ( aged 18-65 ) met criteria for a DSM-IV diagnosis of major depressive disorder with diagnostic specifiers ( chronic , without interepisode recovery ) or with co-occurring dysthymic disorder indicating a chronic course .


The Inventory for Depressive Symptomatology ( IDS ) Self-Report was used as the primary outcome measure .


Mixed-effects linear regression analysis was used to compare the changes on the IDS scores between CBASP and CAU .


The IDS was administered before treatment , and after 8 , 16 , 32 and 52 weeks .


At week 52 , patients assigned to CBASP had a greater reduction of depressive symptoms compared to patients assigned to CAU ( t = -2.00 , p = 0.05 ) .


However , CBASP and CAU did not differ from each other on the IDS after 8 weeks ( t = 0.49 , p = 0.63 ) , 16 weeks ( t = -0.03 , p = 0.98 ) and 32 weeks ( t = -0.17 , p = 0.86 ) of treatment .


This trial shows that CBASP is at least as effective as standard evidence-based treatments for chronic depression .


In the long run , CBASP appears to have an added effect .


To evaluate feasibility and superiority of large liver hemangioma treated with laparoscopic microwave ablation .


Between March 2006 and May 2013 , 47 patients with liver hemangioma ( 5-10 cm ) were surgically treated in our department , and were randomly divided into three groups , laparoscopic microwave ablation group ( treatment group ) , traditional opening group , and laparoscopic resection group .


Three groups were compared in respect of postoperative ambulation time , gastrointestinal function recovery time , postoperative liver function recovery time , intraoperative blood loss , postoperative hospital stay , using SPSS13 .0 software and analysis of variance , P < 0.05 indicates significant , then adopting Student-Newman-Keuls method to compare mean value of every two groups .


And the treatment group of patients were tracked and reviewed .


With regard to above aspects , treatment group and two control groups were compared , P < 0.05 was considered statistically significant , then the result of S-N-K method showed that the treatment group was far better than the control group in the above four areas , however compared with traditional opening group laparoscopic resection group did not demonstrate any superiority .


Tracking the patients of treatment group proved no recurrence , and one case 's CT films before and after surgery were compared , further confirming the feasibility of microwave ablation .


To large hepatic hemangioma , laparoscopic microwave ablation in respect of intraoperative injury , postoperative recovery and costs is superior to other methods , and the treatment effect is certain , it 's feasible and worthy of promotion .


By use of a parallel and partly crossover randomised , controlled trial design we sought to elucidate the underlying mechanisms behind the advantageous effects of interval walking training ( IWT ) compared with continuous walking training ( CWT ) on glycaemic control in individuals with type 2 diabetes .


We hypothesised that IWT , more than CWT , would improve insulin sensitivity including skeletal muscle insulin signalling , insulin secretion and disposition index ( DI ) .


By simple randomisation ( sequentially numbered , opaque sealed envelopes ) , eligible individuals ( diagnosed with type 2 diabetes , no exogenous insulin treatment ) were allocated to three groups : a control group ( CON , n = 8 ) , an IWT group ( n = 12 ) and an energy expenditure-matched CWT group ( n = 12 ) .


Training groups were prescribed free-living training , five sessions per week ( 60 min/session ) .


A three-stage hyperglycaemic clamp , including glucose isotope tracers and skeletal muscle biopsies , was performed before and after a 4 month intervention in a hospitalised setting .


No blinding was performed .


The improved glycaemic control , which was only seen in the IWT group , was consistent with IWT-induced increases in insulin sensitivity index ( 49.8 14.6 % ; p < 0.001 ) , peripheral glucose disposal ( 14.5 4.9 % ; p < 0.05 ) and DI ( 66.2 21.8 % ; p < 0.001 ) , with no changes in the CWT or CON group .


Moreover , only IWT improved insulin signalling in skeletal muscle via increased insulin-stimulated phosphorylation of AS160 ( 29.0 10.8 % ; p < 0.05 ) .


No changes were seen in insulin secretion during hyperglycaemia alone , hyperglycaemia + glucagon-like peptide 1 infusion or arginine injection .


IWT maintains insulin secretion and improves insulin sensitivity and DI , in contrast to energy expenditure-matched CWT .


These results suggest that training with alternating intensity , and not just training volume and mean intensity , is a key determinant of changes in whole body glucose disposal in individuals with type 2 diabetes .


ClinicalTrials ( NCT01234155 ) .


Although bereavement and depression are both common in older primary care patients , the effect of bereavement on depression intervention outcomes is unknown .


We examined whether standard interventions for depression in primary care were as effective for bereaved as for non-bereaved depressed patients .


Randomized controlled trial .


Twenty community-based primary care practices in New York City , greater Philadelphia , and Pittsburgh .


Randomization to either intervention or usual care occurred by practice .


Patients aged 60 years or older who met criteria for major depression or clinically significant minor depression ( N = 599 ) .


Patients who did not complete the bereavement measure or who were missing 4-month data were excluded ( final N = 417 ) .


Study-trained depression care managers offered guideline-concordant recommendations to primary care physicians at intervention sites and assisted patients with treatment adherence .


Patients who did not wish to take antidepressants could receive interpersonal psychotherapy .


Bereavement was captured using the Louisville Older Persons Events Schedule .


Depression severity was assessed using the 24-item Hamilton Depression Rating Scale ( HDRS ) .


Outcomes at 4 months were remission ( HDRS7 ) and response ( HDRS reduction50 % from baseline ) .


Logistic regressions indicated that , for non-bereaved participants , response and remission were higher in intervention than usual care .


However , recently bereaved older adults were less likely to achieve response or remission at 4 months if treated in the intervention condition .


Standard depression care management appears to be ineffective among recently bereaved older primary care patients .


Greater attention should be paid in primary care to emotional distress in the context of bereavement .


Maternal overweight , obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide .


The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before , during and after pregnancy in a primary health care setting for preventing gestational diabetes , later type 2 diabetes and other metabolic consequences .


RADIEL is a randomized controlled multi-center intervention trial in women at high risk for diabetes ( a previous history of gestational diabetes or prepregnancy BMI 30 kg/m2 ) .


Participants planning pregnancy or in the first half of pregnancy were parallel-group randomized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics .


All participants visited a study nurse every three months before and during pregnancy , and at 6 weeks , 6 and 12 months postpartum .


Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers.Of the 728 women [ mean age 32.5 years ( SD 4.7 ) ; median parity 1 ( range 0-9 ) ] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [ mean gestational age 13 ( range 6 to 18 ) weeks ] at the time of enrollment .


The proportion of nulliparous women was 29.8 % ( n = 217 ) .


Out of all participants , 79.6 % of the non-pregnant and 40.4 % of the pregnant women had previous gestational diabetes and 20.4 % of the non-pregnant and 59.6 % of the pregnant women were recruited because of a prepregnancy BMI 30 kg/m2 .


Mean BMI at first visit was 30.1 kg/m2 ( SD 6.2 ) in the non-pregnant and 32.7 kg/m2 ( SD 5.6 ) in the pregnant group .


To our knowledge , this is the first randomized lifestyle intervention trial , which includes , besides the pregnancy period , both the prepregnancy and the postpartum period .


This study design also provides an opportunity to focus upon the health of the next generation .


The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating resources to prevent obesity and diabetes in women of reproductive age .


Human immunodeficiency virus ( HIV ) - infected individuals are at increased risk of cardiovascular disease ( CVD ) due in part to inflammation .


Statins decrease inflammation in the general population , but their effect during HIV infection is largely unknown .


This is an ongoing randomized , double-blinded , placebo-controlled trial to evaluate the effect of statin therapy on inflammatory markers during HIV infection .


Subjects received rosuvastatin 10 mg daily or placebo for 24 weeks .


Subjects were receiving stable ( > 12 weeks ) antiretroviral therapy and had a low-density lipoprotein ( LDL ) cholesterol level of 130 mg/dL and evidence of heightened immune activation or inflammation .


This was a prespecified interim analysis .


A total of 147 subjects were enrolled ( 78 % were male , 70 % were black , and the median age was 47 years ) .


By 24 weeks , LDL cholesterol levels had decreased in the statin group , compared with an increase in the placebo group ( -28 % vs +3.8 % ; P < .01 ) .


A 10 % reduction in the lipoprotein-associated phospholipase A2 ( Lp-PLA2 ) level was seen in the statin group , compared with a 2 % reduction in the placebo group ( P < .01 ) .


In multivariable regression , receipt of statin treatment and having a nadir CD4 ( + ) T-cell count of 100 cell/L were the only statistically significant predictors of a decrease in Lp-PLA2 level .


Markers of systemic inflammation did not change significantly between groups .


Twenty-four weeks of rosuvastatin therapy significantly decreased the level of Lp-PLA2 , a vascular-specific , inflammatory enzyme that predicts cardiovascular events in the general population .


Statins may hold promise as a means of attenuating CVD risk in HIV-infected individuals by decreasing Lp-PLA2 levels .


A non-blinded , cluster randomised controlled trial to test whether footwear reduces prevalence and intensity of hookworm infection in school-aged children on Pemba Island , Zanzibar .


Six schools were randomised to receive shoes and standard care ( deworming with albendazole and health education ) and six control schools to receive standard care only .


Children provided a stool sample to assess prevalence and intensity of infection with soil transmitted helminthiases ( Ascaris lumbricoides , Trichuris trichiura and hookworm ) .


Shoes were then distributed to pupils in the intervention schools ; deworming took place as part of the government 's mass drug administration programme and a further round of stool samples were collected six months later .


Nine hundred and fifteen children were traced at follow-up ( 1056 at baseline ) .


As many children wore shoes in the control arm as the intervention arm .


There was no difference in hookworm prevalence ( 23.4 % for intervention schools , 21.3 % for control schools , p = 0.48 ) , and no difference in mean hookworm infection in eggs/gram of stool ( 18 , 1-36 in intervention schools , 18 , 7-29 in control schools , p = 0.23 ) .


Shoe-wearing increased across all schools , from 47.4 to 82.4 % .


If a child wore shoes at the end of the study , the relative risk of hookworm infection was 0.7 ( CI 0.53-0 .91 ) .


Due to contamination , the trial could not conclude that shoes were protective against hookworm infection but the intervention led to behavioural change , and observational data suggest that shoes are protective against hookworm .


This trial is registered at ClinicalTrials.gov , NCT01869127 .


The optimal anti-reflux procedure after Heller cardiomyotomy for oesophageal achalasia remains unclear .


The most commonly used procedure is the anterior partial fundoplication according to Dor , although during recent years the posterior counterpart ( Toupet ) has become popular .


Patients with newly diagnosed achalasia and referred for cardiomyotomy were randomised to receive either an anterior or partial posterior fundoplication following a classical cardiomyotomy .


The effect of surgery was assessed during the first postoperative year by Eckardt scores , EORTC QLQ-OES18 scores and HRQL questionnaires .


Timed barium oesophagogram ( TBO ) and ambulatory 24-h pH monitoring were performed to determine oesophageal emptying and the degree of reflux control , respectively .


Forty-two patients were randomised into Dor ( n = 20 ) and Toupet ( n = 22 ) groups .


Eckardt scores improved dramatically with both procedures , but the EORTC QLQ-OES18 ( functional scales ) scores revealed significantly better relative improvements in the Toupet group compared to the Dor repair ( P = 0.044 ) .


Corresponding advantages in favour of Toupet were observed postoperatively in the percentage of oesophageal emptying at TBO ( P = 0.011 in height and P = 0.018 in area ) , an effect not observed in the Dor group .


There were no other significant differences recorded between the study groups concerning HRQL evaluations and objective assessment of gastro-oesophageal acid reflux .


A partial posterior fundoplication after cardiomyotomy seems to achieve more improvement in oesophageal emptying and EORTC QLQ-OES18 functional scale scores than the anterior fundoplication .


Otherwise no differences between the two anti-reflux repairs were noted .


ClinicalTrials.gov Identifier : NCT01933373 .


To evaluate a new perfusate solution to be used for ex vivo lung perfusion .


Randomized experimental study using lungs from rejected brain-dead donors harvested and submitted to 1 hour of ex vivo lung perfusion ( EVLP ) using mainstream solution or the alternative .


From 16 lungs blocs tested , we found no difference on weight after EVLP : Steen group ( SG ) = 1,097526 g ; Alternative Perfusion Solution ( APS ) = 743248g , p = 0.163 .


Edema formation , assessed by Wet/dry weigh ratio , was statistically higher on the Alternative Perfusion Solution group ( APS = 3.63 1.26 ; SG = 2.06 0.28 ; p = 0.009 ) .


No difference on PaO2 after EVLP ( SG = 49837.53 mmHg ; APS = 52155.43 mmHg , p = 0.348 , nor on histological analyses : pulmonary injury score : SG = 4.381.51 ; APS = 4.501.77 , p = 0.881 ; apoptotic cells count after perfusion : SG = 2.4 2.0 cells/mm2 ; APS = 4.8 6.9 cells/mm2 ; p = 0.361 ) .


The ex vivo lung perfusion using the alternative perfusion solution showed no functional or histological differences , except for a higher edema formation , from the EVLP using Steen Solution ( r ) on lungs from rejected brain-dead donors .


To evaluate whether anti-inflammatory doses of cyclosporine activate Toxoplasma gondii in chronically infected cats or potentiate infection in cats exposed for the first time .


30 T gondii-negative cats .


Cats were assigned to 1 of 3 groups ( 10 cats/group ) .


Group 1 ( control ) cats were administered a placebo for 126 days ; group 2 cats were administered a placebo for 84 days , followed by cyclosporine at 7.5 mg/kg/d , PO , for 42 days ; and group 3 cats were administered cyclosporine at 7.5 mg/kg/d , PO , for 126 days .


Cats were orally inoculated with T gondii on day 42 .


Results for fecal flotations , PCR assays , and histologic examinations and IgM and IgG titers were analyzed .


Cyclosporine concentrations were measured on selected days .


All cats were infected by T gondii and developed signs of self-limiting gastrointestinal tract infection .


Group 3 had the highest incidence and severity of CNS and pulmonary histopathologic findings typical of toxoplasmosis .


One cat in group 3 died of systemic toxoplasmosis ; that cat had a cyclosporine concentration of 1,690 ng/mL .


Group 2 cats infected with T gondii before cyclosporine administration did not have repeated oocyst shedding .


Group 3 cats shed fewer oocysts for a shorter time than did control cats of group 1 .


Oral administration of cyclosporine in accordance with the protocol for this study did not potentiate the enteroepithelial phase of T gondii infection .


Cats with high cyclosporine blood concentrations at the time of primary T gondii infection may be at risk of developing systemic toxoplasmosis .


Ibrutinib is an oral Bruton 's tyrosine kinase inhibitor , recently approved for the treatment of mantle cell lymphoma ( MCL ) and chronic lymphocytic leukemia ( CLL ) patients with at least one prior therapy .


We developed a population pharmacokinetic ( PK ) model for ibrutinib in patients .


Ibrutinib PK data ( 3,477 observations/245 patients ) were available from the following clinical studies : ( 1 ) A phase I dose-escalation study in recurrent B cell malignancies ( dose levels of 1.25-12 .5 mg/kg/day and fixed dose of 560 mg/day ) ; ( 2 ) a phase II study in MCL ( fixed dose level of 560 mg/day ) ; ( 3 ) a phase Ib/II dose-finding study in CLL ( fixed dose levels of 420 and 840 mg/day ) .


Different compartmental PK models were explored using nonlinear mixed effects modeling .


A two-compartment PK model with sequential zero-first-order absorption and first-order elimination was able to characterize the PK of ibrutinib .


The compound was rapidly absorbed , had a high oral plasma clearance ( approximately 1,000 L/h ) and a high apparent volume of distribution at steady state ( approximately 10,000 L ) .


PK parameters were not dependent on dose , study , or clinical indication .


The fasting state was characterized by a 67 % relative bioavailability compared with the meal conditions used in the trials and administration after a high-fat meal .


Body weight and coadministration of antacids marginally increased volume of distribution and duration of absorption , respectively .


The proposed population PK model was able to describe the plasma concentration-time profiles of ibrutinib across various trials .


The linear model indicated that the compound 's PK was dose independent and time independent .


To observe the efficacy differences between acupoint catgut embedding at cervical Jiaji ( EX-B 2 ) points combined with electroacupuncture ( EA ) at acupoints near ear and simple EA for the treatment of nervous tinnitus .


Sixty-three patients were randomly divided into an observation group ( 31 cases ) and a control group ( 32 cases ) .


The observation group was treated with acupoint catgut embedding at C4-C7 Jiaji ( EXB 2 ) points on the affected side combined with EA at acupoints near ears , including Ermen ( TE 21 ) .


Tinggong ( SI 19 ) , Tinghui ( GB 2 ) , etc. ; the control group was treated with EA at regular acupoints near ears alone .


The EA treatment was given five times per week , and the acupoint catgut embedding was given once every two weeks .


All the treatment was given for 6 weeks .


The Tinnitus severity score ( TSS ) was applied to assess the severity of tinnitus before the treatment , 2 weeks , 4 weeks and 6 weeks into treatment and one month after treat ment .


Also the efficacy of two groups was compared .


After the treatment , the severity of tinnitus was both improved in two groups at each time point ( all P < 0.05 ) .


which was more significant in the observation group ( P < 0.05 , P < 0.01 ) .


The cured and markedly effective rate was 77.4 % ( 24/31 ) in the observation group , which was superior to 50.0 % ( 16/32 ) in the control group ( P < 0.05 ) .


The short-term and long-term efficacy of acupoint catgut embedding at cervical Jiaji ( EX-B 2 ) points combined with electroacupuncture are both superior to those of simple electroacupuncture for treatment of nervous tinnitus .


To observe the clinical efficacy difference on vegetative state in children between acupoint injection combined with plum-blossom needle and western medication based on basic treatment .


Forty-eight children of vegetative state were randomized into an observation group and a control group , 24 cases in each one .


On the basis of the treatment of transcranial magnetic stimulation apparatus , balancing treatment apparatus and massage , the acupoint injection and tapping method with plum-blossom needle were adopted in the observation group , in which Xingnaojing injection , mouse nerve growth factor ( mNGF ) injection , monosialotetrahexosylganglioside sodium injection ( MSI ) , compound Danshen injection were divided in 6 pairs and were injected respectively in Baihui ( GV 20 ) , Yongquan ( KI 1 ) , Fengfu ( GV 16 ) , Yamen ( GV 15 ) and the others , 0.5 mL in each acupoint , once a day for continuous 10 days .


Additionally , the tapping method with plum-blossom needle was used on the Governor Vessel and Jiaji ( EX-B 2 ) on the back .


In the control group , the intravenous infusion was adopted with citicoline sodium injection , mannitol injection and dexamethasone injection .


The treatment was given once a day , 20 days of treatment made one session and totally 3 sessions were required in the two groups .


The clinical efficacy , the vegetative state score and the mean curing time were observed after 20 days , 40 days and 60 days of treatment between the two groups .


The effective rates were 58.3 % ( 14/24 ) , 70.8 % ( 17/24 ) and 79.2 % ( 19/24 ) in 20 days , 40 days and 60 days of treatment in the observation group and 20.8 % ( 5/24 ) , 45.8 % ( 11/24 ) and 58.3 % ( 14/24 ) in the control group respectively .


The efficacy in the observation group was superior to those in the control group ( P < 0.01 , P < 0.05 ) .


The vegetative state score was improved apparently after 20 days , 40 days and 60 days of treatment as compared with those before treatment separately ( all P < 0.05 ) .


It was improved obviously at the each time point after treatment in the observation group as compared with that in the control group ( 3.34 + / - 2.41 vs 2.64 + / - 11.56 , 6.20 + / - 1.46 vs 4.34 + / - 1.64 , 11.26 + / - 2.63 vs 8.75 + / - 2.18 , all P < 0.05 ) .


The mean curing time was ( 45.67 + / - 16.24 ) days in the observation group , which was shorter apparently than that of ( 55.34 + / - 4.57 ) days in the control group ( P < 0.05 ) .


Based on basic treatment acupoint injection combined with tapping method of plum-blossom needle achieve the reliable efficacy on vegetative state in children .


Three-percent hypertonic saline ( HTS ) is a hyperosmotic therapy used in pediatric traumatic brain injury to treat increased intracranial pressure and cerebral edema .


It also promotes plasma volume expansion and cerebral perfusion pressure , immunomodulation , and anti-inflammatory response .


We hypothesized that HTS will improve concussive symptoms of mild traumatic brain injury .


The study was a prospective , double-blind , randomized controlled trial .


Children , 4 to 7 years of age with a Glasgow Coma Scale score greater than 13 , were enrolled from a pediatric emergency department following closed-head injury upon meeting Acute Concussion Evaluation criteria with head pain .


Patients were randomized to receive 10 mL/kg of HTS or normal saline ( NS ) over 1 hour .


Self-reported pain values were obtained using the Wong-Baker FACES Pain Rating Scale initially , immediately following fluids , and at 2 to 3 days of discharge .


The primary outcome measure was change in self-reported pain following fluid administration .


Secondary outcome measures were a change in pain and postconcussive symptoms within 2 to 3 days of fluid administration .


We used an intention-to-treat analysis .


Forty-four patients , ranging from 7 to 16 years of age with comparable characteristics , were enrolled in the study ; 23 patients ( 52 % ) received HTS , and 21 ( 48 % ) received NS .


There was a significant difference ( P < 0.001 ) identified in the self-reported improvement of pain following fluid administration between the HTS group ( mean improvement = 3.5 ) and the NS group ( mean improvement = 1.1 ) .


There was a significant difference ( P = 0.01 ) identified in the self-reported improvement of pain at 2 to 3 days after treatment between the HTS group ( mean improvement = 4.6 ) and the NS group ( mean improvement = 3.0 ) .


We were unable to determine a difference in other postconcussive symptoms following discharge .


Three-percent HTS is more effective than NS in acutely reducing concussion pain in children .


There is good evidence of the positive effects of person-centered care ( PCC ) on agitation in dementia .


We hypothesized that a person-centered environment ( PCE ) would achieve similar outcomes by focusing on positive environmental stimuli , and that there would be enhanced outcomes by combining PCC and PCE .


38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified , then randomized to one of four intervention groups : ( 1 ) PCC ; ( 2 ) PCE ; ( 3 ) PCC + PCE ; ( 4 ) no intervention .


People with dementia , over 60 years of age and consented were eligible .


Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation , emotional responses in care , quality of life and depression , and care interaction quality .


From 38 homes randomized , 601 people with dementia were recruited .


At follow-up the mean change for quality of life and agitation was significantly different for PCE ( p = 0.02 , p = 0.05 , respectively ) and PCC ( p = 0.0003 , p = 0.002 respectively ) , compared with the non-intervention group ( p = 0.48 , p = 0.93 respectively ) .


Quality of life improved non-significantly for PCC+PCE ( p = 0.08 ) , but not for agitation ( p = 0.37 ) .


Improvements in care interaction quality ( p = 0.006 ) and in emotional responses to care ( p = 0.01 ) in PCC+PCE were not observed in the other groups .


Depression scores did not change in any of the groups .


Intervention compliance for PCC was 59 % , for PCE 54 % and for PCC+PCE 66 % .


The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported , even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group .


The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369 .


Neuropathic pain is a condition resulting from injury to the peripheral and/or central nervous system .


Despite extensive research over the last several decades , neuropathic pain remains difficult to manage .


The authors conducted a randomized , placebo-controlled , double-blinded , and crossover clinical trial to examine the effect of 1.5 % topical diclofenac ( TD ) on neuropathic pain .


The authors hypothesized that 1.5 % TD would reduce the visual pain score and improve both quantitative sensory testing and functional status in subjects with neuropathic pain .


The authors recruited subjects with postherpetic neuralgia and complex regional pain syndrome .


The primary outcome was subject 's visual pain score .


Twenty-eight subjects completed the study ( 12 male and 16 female ) with the mean age of 48.8 yr .


After 2 weeks of topical application , subjects in 1.5 % TD group showed lower overall visual pain score compared with placebo group ( 4.9 [ 1.9 ] vs. 5.6 [ 2.1 ] , difference : 0.8 ; 95 % CI , 0.1 to 1.3 ; P = 0.04 ) as well as decreased burning pain ( 2.9 [ 2.6 ] vs. 4.3 [ 2.8 ] , difference , 1.4 ; 95 % CI , 0.2 to 2.6 ; P = 0.01 ) .


There were no statistical differences in constant pain , shooting pain , or hypersensitivity over the painful area between the groups .


This self-reported improvement of pain was corroborated by the decreased pain summation detected by quantitative sensory testing .


There were no statistically significant changes in functional status in these subjects .


There were no complications in both groups .


The findings indicate that 1.5 % TD may serve as an effective treatment option for patients with neuropathic pain from postherpetic neuralgia and complex regional pain syndrome .


Powered or manual toothbrushes are daily-used instrument in the Western area for the control and removal of bacterial biofilm .


Among powered-toothbrushes , sonic technology has shown to produce fluid turbulent activity that might assist in plaque removal ; however , limited knowledge is available in-vivo .


The objectives of this study were to compare the plaque removal efficacy of two different toothbrushes in a population not familiar with sonic technology , and to collect and analyse data regarding oral hygiene habits .


The null-hypothesis was that a sonic toothbrush is able to remove a superior amount of plaque compared to the manual type .


Forty young adult patients were enrolled in the study .


A single-cohort crossover clinical trial was designed .


For each patient , three appointments were scheduled : the first ( T0 ) was used for oral care education and explanations of toothbrushes techniques , for a preliminary professional hygiene session , and for delivery of a questionnaire ; at one week ( T1 ) , plaque evaluation was performed ( Turesky modification of the Quigley and Hein index ) at baseline and after asking patients to brush with the randomly selected manual or sonic device .


At the last appointment ( week 3 , T2 ) , the same plaque evaluations of T1 were repeated asking patients to brush with the other toothbrush .


Entire mouth indexes were calculated and mean reductions in whole mouth plaque scores were obtained ( pre-brushing minus post-brushing values ) for the two tested toothbrushes .


Multiple ANOVA tests ( p = 0.05 ) were used 1 ) to compare plaque levels between male and female subjects at baseline and post-brushing , regardless the type of toothbrush , and 2 ) to differentiate between mean reductions in whole mouth plaque scores according to the type of toothbrush ( manual versus sonic ) .


The study population was subjected to descriptive statistical analysis ; potential relationships between socio-demographic variables and obtained plaque scores were evaluated ( Mann-Whitney and Kruskal-Wallis tests ) .


Full-mouth plaque levels were reduced at post-brushing sessions , regardless the device , by approximately 62 % ( p < 0.0001 ) .


Mean plaque index reductions for manual and sonic toothbrush were of 1.05 0.22 and 1.19 0.37 , respectively .


A statistically significant difference was found between the two devices ( p = 0.0342 ) .


The powered sonic toothbrush removed about 10 % more plaque than the manual type .


From the collected questionnaire financial data , willingness to pay ( WTP ) values expressing economic efforts of patients for the purchase of toothbrushes were of Euros 4.83 3.86 and of Euros 54.75 36 , for the manual and sonic devices , respectively .


Within the limitations of the study , in subjects without any previous experience of a similar technology , the single use of the sonic toothbrush showed a significantly greater plaque reduction compared to the manual traditional toothbrush ( null-hypothesis accepted ) .


The effect of vitamin D replacement on hemoglobin ( Hb ) concentration in subjects with concurrent deficiencies of vitamin D and iron is not known .


We report on an investigator-initiated , randomized , single-blinded , placebo-controlled , 12-week interventional trial .


Thirty subjects with iron-deficiency anemia ( serum ferritin < 15 g/l ) were randomized to an intervention arm ( cholecalciferol , i.e. vitamin D3 , 0.6 million units i.m. once ) or placebo .


In all subjects , iron deficiency was corrected with parental iron .


Other causes of anemia were excluded with appropriate investigation .


The primary end point was a rise in Hb concentration .


Baseline parameters of age , BMI , hemogram values and levels of serum ferritin , 25-hydroxyvitamin D [ 25 ( OH ) D ] and parathyroid hormone ( PTH ) were similar in the 2 arms .


Twelve weeks after vitamin D replacement , there was a significant increase in 25 ( OH ) D levels ( 57.7 20.5 vs. 14.1 6.2 ng/ml , p < 0.0001 ) and a decrease in PTH levels ( 32.4 16.4 vs. 52.9 18.4 pg/ml , p = 0.003 ) in subjects in the intervention arm when compared to the placebo arm .


However , the increments in serum ferritin and Hb concentration in the intervention and placebo arm did not differ .


Vitamin D replacement in subjects with iron-deficiency anemia after iron correction does not improve Hb concentration further .


Premedication with intranasal dexmedetomidine ( DEX ) has shown to be an effective sedative in pediatric patients .


This prospective , randomized , and controlled investigation was designed to evaluate whether the difference in intranasal DEX dosing would produce different beneficial effects on the attenuation of cardiovascular and arousal responses during anesthesia induction and intubation .


Forty children , aged from 3 to 6years , of American Society of Anesthesiologists physical status I or II and scheduled for elective adenotonsillectomy randomly received intranasal DEX 1gkg ( -1 ) ( group D1 ) or 2gkg ( -1 ) ( group D2 ) 30min before anesthesia induction .


Anesthesia was induced with sevoflurane in oxygen flow .


Mean arterial pressure ( MAP ) and heart rate ( HR ) as measurements of cardiovascular response and bispectral index ( BIS ) as an index of arousal response were recorded every 5min after intranasal DEX administration and measured every 1min for 5min after intubation .


Sedation status , behavior scores , and mask induction scores were also assessed .


Mean arterial pressure did not show statistical differences during the anesthesia induction , but did demonstrate significantly milder responses to laryngoscopy and intubation in group D2 compared with group D1 .


Change in HR was consistent with MAP during laryngoscopy and intubation .


Patients who received 2gkg ( -1 ) DEX presented with deeper sedation and less anxiety by the assessments of the alertness scale , behavior score , and BIS scores .


Group D2 dosing achieved more favorable scores in children undergoing mask induction .


Intranasal DEX 2gkg ( -1 ) administered 30min before anesthesia induction provides considerable effect to attenuate the increase in MAP caused by intubation response .


Changes in HR and BIS also demonstrate that this kind of premedication provides effective attenuation of intubation response .


And preoperative intranasal DEX 2gkg ( -1 ) produces optimal-sedation , more favorable anesthesia induction course in pediatric patients .


Premedication of intranasal DEX is a considerable way to blunt cardiovascular and arousal responses to endotracheal intubation .


To assess the effect of ginger consumption on glycemic status , lipid profile and some inflammatory markers in patients with type 2 diabetes mellitus .


In a double-blinded , placebo-controlled clinical trial , 70 type 2 diabetic patients were enrolled .


They allocated randomly into ginger group and control group .


They consumed 1600mg ginger versus 1600mg wheat flour placebo daily for 12 weeks .


Serum sugar , lipids , CRP , PGE2 and TNF were measured before and after intervention .


Ginger reduced fasting plasma glucose , HbA1C , insulin , HOMA , triglyceride , total cholesterol , CRP and PGE significantly compared with placebo group ( p < 0.05 ) .


There were no significant differences in HDL , LDL and TNF between two groups ( p > 0.05 ) .


Ginger improved insulin sensitivity and some fractions of lipid profile , and reduced CRP and PGE in type 2 diabetic patients .


Therefore ginger can be considered as an effective treatment for prevention of diabetes complications .


Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous ( IV ) opioids in the control of acute pain in the emergency department ( ED ) .


The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients .


A double-blind , randomized , placebo-controlled trial with three study groups was conducted at a large , urban academic ED over a 10-month period .


Eligible patients were 18 to 65 years old with acute moderate to severe pain ( score of at least 5 out of 10 on the numerical pain rating scale [ NRS ] and pain duration < 7 days ) who were deemed by their treating physician to require IV opioids .


The three study groups were : 1 ) morphine and normal saline placebo ( standard care group ) , 2 ) morphine and 0.15 mg/kg ketamine ( group 1 ) , or 3 ) morphine and 0.3 mg/kg ketamine ( group 2 ) .


Participants were assessed at 30 , 60 , and 120 minutes after study medication administration and received rescue analgesia as needed to target a 50 % reduction in pain .


The primary outcome measure of pain relief , or pain intensity reduction , was derived using the NRS and calculated as the summed pain-intensity ( SPID ) difference over 2 hours .


The amount and timing of rescue opioid analgesia was evaluated as a secondary outcome .


The occurrence of adverse events was also measured .


Sixty patients were enrolled ( n = 20 in each group ) .


There were no differences between study groups with respect to age , sex , race/ethnicity , preenrollment analgesia , or baseline NRS .


Over the 2-hour poststudy medication administration period , the SPIDs were higher ( greater pain relief ) for the ketamine study groups than the control group ( standard care 4.0 , interquartile range [ IQR ] = 1.8 to 6.5 ; group 1 7.0 , IQR = 4.3 to 10.8 ; and group 2 7.8 , IQR = 4.8 to 12.8 ; p < 0.02 ) .


The SPIDs for the ketamine groups were similar ( p < 0.46 ) .


When compared to standard care , group 2 sustained the reduction in pain intensity up to 2 hours , whereas group 1 was similar to standard care by 2 hours .


Similar numbers of patients received rescue analgesia : standard care group , seven of 20 , 35 % ; group 1 , four of 20 , 20 % ; and group 2 , four of 20 , 20 % ( p = 0.48 ) .


Among those receiving rescue analgesia , those in the standard care group received analgesia sooner than either low-dose ketamine group , on average .


More participants in the low-dose ketamine groups reported dysphoria and dizziness .


Low-dose ketamine is a viable analgesic adjunct to morphine for the treatment of moderate to severe acute pain .


Dosing of 0.3 mg/kg is possibly more effective than 0.15 mg/kg , but may be associated with minor adverse events .


Future studies should evaluate additional outcomes , optimum dosing , and use in specific populations .


Melasma is distressing for patients and challenging for physicians to treat .


Clinical data from controlled comparative studies is lacking to support the efficacy , longevity , and safety of laser treatments for melasma .


Compare the efficacy and safety of low fluence Q-switched neodymium-doped yttrium aluminum garnet ( 1,064 nm ) laser ( Nd : YAG ) versus low-fluence Q-switched alexandrite laser ( 755nm ) ( QSAL ) for the treatment of facial melasma .


Twenty male and female subjects with moderate to severe mixed-type melasma on both sides of the face were randomized to six , weekly treatments with the low-fluence Q-switched Nd : YAG laser on one side and the low-fluence QSAL to the other side .


Two independent investigators conducted Modified Melasma Area and Severity Index ( MMASI ) evaluations and subjects completed self-assessment questionnaires at baseline , after three treatments and each follow-up visit 2 , 12 , and 24 weeks after the last treatment .


Standardized digital photographs were taken at baseline and at each subsequent follow-up visit .


One male and fifteen females , mean age of 43.4 ( range 32-64 ) years , completed the 29-week study .


Both laser treated sides showed a significant improvement in MMASI evaluations after two treatments ( 22 % improvement on the QS-Nd : YAG , 17 % QSAL ) and each follow-up visit 2 ( 36 % QS-Nd : YAG ; 44 % QSAL ) , 12 ( 27 % QS-Nd : YAG ; and 24 % QSAL ) , and 24 weeks ( 27 % QS-Nd : YAG ; and 19 % QSAL ) after the last treatment , but no significant difference was seen between study groups at any visit .


There was also no significant difference in subject evaluation of improvement between both treatment sides at any visit .


Both laser treated sides were tolerated well , and no serious adverse events were noted .


Only one subject was taken out of the study due to development of post-inflammatory hyperpigmentation bilaterally .


Both low-fluence Q-switched Nd : YAG and low-fluence QSAL were equally effective at improving moderate to severe mixed-type facial melasma .


This was a single-center trial and patients were not able to use complimentary lightening agents during the study .


This is a prospective , randomized , multicenter , investigator-initiated trial to evaluate the 12-month effectiveness of isovolemic hemodilution ( IH ) with prompt versus deferred intravitreal injections ( IVI ) of ranibizumab 0.5 mg for the treatment of macular edema secondary to early central retinal vein occlusion ( CRVO ) .


Eyes with macular edema due to CRVO having occurred not more than 8 weeks previously received either monthly ranibizumab IVI in combination with IH ( group I , n = 28 ) or IH alone ( group II , n = 30 ) .


From month 2 to 12 , the patients in both groups could be treated with monthly intravitreal ranibizumab .


The main outcome variables were gain of visual acuity and the course of central retinal thickness as measured with optical coherence tomography .


At 12 months , eyes in group I on average gained +28.1 ( 19.3 ) letters compared to +25.2 ( 20.9 ) letters in group II ( p = 0.326 ) .


This result was achieved with significantly fewer injections in group II .


Additionally , 30 % of the eyes in group II did not need ranibizumab IVI during the 12 months of the trial .


Ranibizumab IVI in addition to IH proved to be highly effective in increasing visual acuity and reducing macular edema secondary to CRVO .


Initial IH in early CRVO may be a first treatment option in patients anxious about IVI .


Friction foot blisters are a common injury occurring in up to 39 % of marathoners , the most common injury in adventure racing , and represent more than 70 % of medical visits in multi-stage ultramarathons .


The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners .


This prospective randomized trial was undertaken during RacingThePlanet 155-mile ( 250-km ) , 7-day self-supported ultramarathons in China , Australia , Egypt , Chile , and Nepal in 2010 and 2011 .


Paper tape was applied prerace to one randomly selected foot , with the untreated foot acting as the own control .


The study end point was development of a hot spot or blister on any location of either foot .


One hundred thirty-six participants were enrolled with 90 ( 66 % ) having completed data for analysis .


There were 36 % women , with a mean age of 40 9.4 years ( range , 25-40 years ) and pack weight of 11 1.8 kg ( range , 8-16 kg ) .


All participants developed blisters , with 89 % occurring by day 2 and 59 % located on the toes .


No protective effect was observed by the intervention ( 47 versus 35 ; 52 % versus 39 % ; P = .22 ) , with fewer blisters occurring around the tape on the experimental foot than under the tape ( 23 vs 31 ; 25.6 % versus 34.4 % ) , yet 84 % of study participants when queried would choose paper tape for blister prevention in the future .


Although paper tape was not found to be significantly protective against blisters , the intervention was well tolerated with high user satisfaction .


The aim of the current study was to compare the effects of intraoperative infusion of 20 % human albumin versus 0.9 % normal saline on early and late graft function in renal transplantation .


This prospective , randomized study was conducted on 44 patients with end-stage renal disease undergoing kidney transplantation .


Patients were 32 males ( 72.7 % ) and 12 females ( 27.3 % ) with a mean age of 54.35 11.15 years ( range 20-58 years ) .


Patients with cardiac disease and liver dysfunction were excluded from the study .


Twenty-two of the 44 patients were given intraoperative intravenous infusion of 20 % human albumin with 0.9 % normal saline ( albumin group ) , and the remaining 22 patients received intraoperative intravenous infusion of 0.9 % normal saline alone ( saline group ) , as part of the intraoperative fluid hydration to keep central venous pressure between 10 and 15 mm of Hg .


There was no statistically significant difference in mean intravenous fluid volume infused until the end of surgery between the saline group and the albumin group ( P = 0.8326 ) .


Time of onset of diuresis and total intraoperative urine output were statistically insignificant between the two groups ( P = 0.6255 , P = 0.9231 , respectively ) .


Post-transplant serum creatinine on day 1 , 3 and 5 between the albumin and saline groups were comparable ( P = 0.8998 , P = 0.7257 , P = 0.8092 , respectively ) .


Post-transplant urine output on day 1 , 3 and 5 between the albumin and saline groups were also comparable ( P = 0.653 , P = 0.9075 , P = 0.946 , respectively ) .


Mean postoperative weight gain was higher in the saline group compared with the albumin group , but was not statistically significant ( P = 0.6348 ) .


This study revealed that the use of 20 % human albumin as an intraoperative volume expander provides no more benefit than the use of 0.9 % normal saline in terms of immediate graft function in living donor renal transplantation .


To observe the clinical efficacy differences between regular acupuncture combined with acupuncture at trigone of urinary bladder and simple regular acupuncture for treatment of urination dysfunction induced by spinal cord injury .


Sixty patients were randomized into an observation group and a control group , 30 cases in each one .


The control group was treated with regular acupuncture at Sanyinjiao ( SP 6 ) , Zusanli ( ST 36 ) , Zhongwan ( CV 12 ) and Tianshu ( ST 25 ) , etc. .


Based on the treatment of control group , the observation group was additionally treated with intensive needling at trigone of urinary bladder , once a day , 30 min per treatment .


Ten treatments were considered as one course , and there was an interval of two days between courses , 4 courses of treatment were given in two groups .


The improvement of urination function in two groups was evaluated , and the efficacy of urination function in two groups was compared .


After treatment , the times of urine leakage , maximum urine output , bladder capacity and residual urine were all improved in two groups ( all P < 0.05 ) .


The improvement of times of urine leakage , bladder capacity and residual urine in the observation group was superior to that in the control group ( all P < 0.05 ) .


The total effective rate was 96.7 % ( 29/30 ) in the observation group , which was superior to 83.3 % ( 25/30 ) in the control group ( P < 0.05 ) .


The efficacy of regular acupuncture combined with intensive needling at trigone of urinary bladder on urination dysfunction induced by spinal cord injury is significantly superior to that of simple regular acupuncture .


To investigate the curative effects of Xuebijing ( XBJ ) injection , a Chinese patent medicine , on severe pulmonary contusion ( PC ) .


Sixty-three patients with PC were randomized to conventional therapy plus XBJ injection ( n = 33 ) or conventional therapy alone ( n = 30 ) .


Between groups differences in corticosteroid treatment , immune regulation therapy , hemofiltration , infusion volume , transfusion volume and antibiotic period were measured , as were intensive care unit ( ICU ) - free time , ventilation time , 28-day mortality rate and incidence of ventilation-associated pneumonia ( VAP ) .


Serum concentrations of procalcitonin ( PCT ) , tumor necrosis factor-alpha ( TNF-alpha ) , interleukin ( IL ) -6 , and IL-10 , white blood cell ( WBC ) counts and percentages of human leukocyte antigen DR / CD14 + ( HLA-DR/CD14 + ) peripheral blood mononuclear cells were compared .


Markers of ventilation were determined by blood gas analysis and ventilator parameters .


WBC counts and serum concentrations of PCT , TNF-alpha , IL-6 and IL-10 were reduced significantly more quickly , and CD14 + percentage was increased significantly earlier , in the XBJ group than in the control group ( P < 0.05 each ) .


The level of ventilation and oxygenation index were ameliorated earlier in the XBJ than in the control group ( P < 0.05 ) .


XBJ treatment significantly reduced ICU-free time , ventilation time and incidence of VAP ( P < 0.05 each ) , but had no effect on 28-day mortality rate


XBJ treatment can shorten ICU-free and ventilation times and reduce the incidence of VAP , improving outcomes in patients with severe PC .


XBJ may act by regulating inflammation and immunity , alleviating systemic inflammatory response syndrome induced by trauma .


This study aimed to investigate the effects of a simulation-based curriculum for ward-based care on ward round ( WR ) performance .


Variability in surgical outcomes does not relate to surgical skill alone .


Prevention , diagnosis , and treatment of peri - and postoperative morbidity are dependent on provision of high-quality ward-based care .


The focal point of this is the surgical WR .


Although WR conduct is learned primarily through experience , a simulated environment and validated assessment tools may enable measurement and enhancement of WR quality .


Junior surgical residents were randomized either to a half-day educational intervention with lectures , structured feedback , and debriefing , or to standard practice ( control ) .


All conducted a standardized , validated , simulated WR of 3 patients .


Surgical Ward Care Assessment Tool and W-NOTECHS rating scales were used for technical and nontechnical skills assessment , respectively , and compared between groups .


Subjects completed pre - and posttest confidence questionnaires and feedback forms .


Twenty-nine trainees were randomized to intervention ( n = 14 ) or control ( n = 15 ) .


Baseline confidence and demographics were equal between groups .


Intervention group demonstrated better patient assessment : 63.5 8.1 % ( control ) versus 79.8 11.9 % ( P = 0.002 ) , management 56.0 % 19.7 % versus 72.2 10.3 % ( P = 0.014 ) , and nontechnical skills : W-NOTECHS 17.75 2.06 versus 23.33 1.21 ( P < 0.001 ) .


Hundred percent of subjects felt that the curriculum improved their practice .


Conducting WRs is a crucial skill but not currently subject to formal training .


Implementation of a comprehensive curriculum for surgical WRs led to significant improvement in quality of patient assessment , management , and nontechnical skills .


Improved WR performance may lead to earlier identification and amelioration of complications and improve patient outcomes .


To explore the enhancing effect of alcohol consumption on attractiveness ratings , in that few studies on the Beer Goggles effect control the stimuli attractiveness level and researchers have seldom considered extending the effect to stimuli other than faces .


Male and female participants ( n = 103 ) were randomly assigned to alcohol consumption or placebo groups .


Both groups were asked to assess the attractiveness of two types of pictures ( faces and landscapes ) with three levels of attractiveness for each stimulus category ( high , moderate and low ) .


We found significant interactions between beverage type and attractiveness level .


Attractiveness ratings for moderate - and low-attractiveness faces were significantly higher in the alcohol compared with placebo condition , while there was no significant difference for high-attractiveness stimuli between these two conditions .


As for landscapes , only low-attractiveness stimuli were rated significantly higher in the alcohol condition .


Whether or not alcohol consumption leads to an increase in attractiveness ratings depends on the initial attractiveness of the stimulus materials .


Alcohol consumption tends to affect ratings for stimuli with relatively low attractiveness .


Furthermore , this effect is not limited to faces ; it extends to other types of stimuli like landscapes .


To describe the minimum inhibitory concentration ( MIC ) of fungal isolates to natamycin and voriconazole , and to compare these MICs to previous ocular susceptibility studies .


Experimental laboratory study using isolates from a randomized clinical trial .


The Mycotic Ulcer Treatment Trial I was a randomized , double-masked , multicenter trial comparing topical natamycin and voriconazole for fungal keratitis treatment .


Susceptibility testing to natamycin and voriconazole were performed according to Clinical and Laboratory Standards Institute methods .


The relationship between organism and MIC was assessed .


A literature review was performed to compare results to previous ocular susceptibility studies .


Of the 323 patients enrolled in the trial , MICs were available for 221 ( 68 % ) .


Fusarium ( n = 126 ) and Aspergillus species ( n = 52 ) were the most commonly isolated organisms .


MICs to natamycin and voriconazole were significantly different across all genera ( P < .001 ) .


The MIC median ( MIC50 ) and 90th percentile ( MIC90 ) for natamycin were equal to or higher than voriconazole for all organisms except Curvularia species .


Compared to other organisms , Fusarium species isolates had the highest MICs to voriconazole and Aspergillus flavus isolates had the highest MICs to natamycin .


Our results were similar to previous reports except that the voriconazole MIC90 against Aspergillus species was 2-fold higher and the natamycin MIC90 against Aspergillus fumigatus was 4-fold higher in our study .


In this large susceptibility study , Fusarium isolates were least susceptible to voriconazole and A flavus isolates were least susceptible to natamycin when compared to other filamentous fungi .


In the future , susceptibility testing may help guide therapy if performed in a timely manner .


To determine the optimal duration of energy corrective treatment of ischemic stroke ( II ) with cytoflavin or ascorbic acid .


A multicenter randomized clinical trial included 185 patients , aged 40-75 years .


Patients were randomized into 3 groups : the control group ( n = 64 ) received ascorbic acid ; cytoflavin group 1 ( n = 72 ) was treated for 10 days and cytoflavin group 2 ( n = 49 ) for 20 days .