We included 20 patients with AF ( 65 % male , 60.110.5 years old , 80 % persistent AF [ PeAF ] ) who had undergone empirically-based catheter ablation : circumferential pulmonary vein isolation ( CPVI ) for paroxysmal AF ( PAF ) and additional posterior box lesion ( L1 ) and anterior line ( L2 ) for PeAF .


Using patient-specific three-dimensional left atrial ( LA ) geometry , we generated a finite element model and tested the AF termination rate after 5 different virtual ablations : CPVI alone , CPVI+L 1 , CPVI+L 1,2 , CPVI with complex fractionated atrial electrogram ( CFAE ) ablation , and CFAE ablation alone .


1 .


Virtual CPVI+L 1,2 ablation showed the highest AF termination rate in overall patients ( 55 % ) and PeAF patients ( n = 16 , 62.5 % ) .


2 .


The virtual AF maintenance duration was shortest in the case of virtual CPVI+L 1,2 ablation in overall patients ( 2.191.28 vs. 2.911.04 s , p = 0.009 ) and in patients with PeAF ( 2.051.23 vs. 2.9310.2 s , p = 0.004 ) compared with other protocols .


Virtual AF ablation using personalized in-silico model of LA is feasible .


Virtual ablation with CPVI+L 1,2 shows the highest antifibrillatory effect , concordant with the empirical ablation protocol in patients with PeAF .


To investigate the effectiveness of Lactobacillus reuteri DSM 17938 for the treatment of infantile colic in breastfed Canadian infants , compared with placebo .


A randomized , double-blind , placebo-controlled trial was conducted involving 52 infants with colic , according to modified Wessel criteria , who were assigned at random to receive L reuteri DSM 17938 ( 10 ( 8 ) colony-forming units ) ( n = 24 ) or placebo ( n = 28 ) for 21 days .


Daily crying and fussing times were recorded in a structured diary , and maternal questionnaires were completed to monitor changes in infant colic symptoms and adverse events .


Total average crying and fussing times throughout the study ( from baseline to day 21 ) were significantly shorter among infants with colic in the probiotic group compared with infants in the placebo group ( 1719 750 minutes [ 29 13 hours ] vs 2195 764 minutes [ 37 13 hours ] ; P = .028 ) ( relative risk , 0.78 ; 95 % CI , 0.58-0 .98 ) .


Infants given L reuteri DSM 17938 showed a significant reduction in daily crying and fussing times at the end of treatment period compared with those receiving placebo ( median , 60 minutes/day [ IQR , 64 minutes/day ] vs 102 minutes/day [ IQR , 87 minutes/day ] ; P = .045 ) .


On day 21 , a significantly higher proportion of infants in the L reuteri DSM 17938 group responded to treatment with a 50 % crying time reduction compared with infants given placebo ( 17 vs 6 , P = .035 ; relative risk , 3.3 ; 95 % CI , 1.55-7 .03 ) .


Administration of L reuteri DSM 17938 significantly improved colic symptoms by reducing crying and fussing times in breastfed Canadian infants with colic .


Tendinopathy is a difficult problem to manage and can result in significant patient morbidity .


Currently , the clinical use of platelet-rich plasma ( PRP ) in painful tendons is widespread but its efficacy remains controversial .


This study is a single-center , randomized double-blind controlled trial .


Eighty patients will be allocated to have ultrasound ( US ) - guided needling combined with a leukocyte-depleted ( that is , pure ) PRP or lidocaine each alternate week for a total of two interventions .


Outcome data will be collected before intervention , and at 6 weeks , 3 , 6 , and 12 months after intervention .


Changes in pain and activity levels , as assessed by Disabilities of the Arm , Shoulder and Hand ( DASH-E , Spanish version ) score , at 6 months .


We will compare the percentage of patients in each group that achieve a successful treatment defined as a reduction of at least 25 % in the DASH-E score .


Secondary outcome measures include changes in DASH-E at 3 and 12 months , changes in pain as assessed by the visual analogue scale ( VAS ) at the 6-week , 3 - , 6 - , and 12-month follow-up , changes in sonographic features and neovascularity , and percentage of patients in each group with adverse reactions at 3 , 6 , and 12 months .


The results of this study will provide insights into the effect of pure PRP in tendon and may contribute to identifying the best protocol for PRP application in tendinopathies .


ClinicalTrials.gov : NCT01945528 .


In Japan nursing care lags behind the growing population of patients with malignant pleural mesothelioma .


This study evaluated an educational program for nurses about caring for patients with malignant pleural mesothelioma in Japan .


In this randomized controlled study relative to care for malignant pleural mesothelioma , Knowledge , Difficulties and Attitude were measured at baseline , at post-test and at follow-up one month later .


The two-day program with a half-day follow-up program included lectures , group work , role-playing and group discussion .


188 participants were randomly assigned to the intervention group ( program , n = 96 ) and control group ( n = 92 ; self-study by a similar content handbook ) .


At baseline the groups showed no statistical differences in Knowledge ( p = 0.921 ) , Difficulty ( p = 0.458 ) and Attitude ( p = 0.922 ) .


Completing the study were 177 participants yielding 88 in the intervention group and 89 in the control group .


Human rights and privacy of participants were protected .


The Knowledge score was significantly higher in the intervention post-test ( t = 14.03 , p = 0.000 ) and follow-up test ( t = 8.98 , p = 0.000 ) .


Difficulty score was significantly lower in the intervention at post-test ( t = -3.41 , p = 0.001 ) and follow-up test ( t = -3.70 , p = 0.000 ) .


The Attitude score was significantly higher in the intervention post-test ( t = 7.11 , p = 0.000 ) and follow-up test ( t = 4.54 , p = 0.000 ) .


The two-way analysis of variance with repeated measures on time showed an interaction between time and group ; the subsequent simple main effect test found significant differences ( p = 0.000-0 .001 ) between groups for after-program and at follow-up and a significant difference ( p = 0.000 ) in time only within the intervention group .


The educational program was effective in improving the nurses ' knowledge and attitude toward malignant pleural mesothelioma care and decreasing the difficulty in MPM care , therefore this program has potential for nurses ' in-service education throughout Japan .


Discontinuation of anti-hyperglycemic oral agents and initiation of insulin is recommended in certain clinical situations for inpatients with type 2 diabetes ( T2D ) .


The effects on glucose turnover when these agents are acutely withdrawn are poorly understood and may be of importance when insulin therapy is initiated .


Our objective was to investigate alterations in glucose turnover after acute withdrawal of noninsulin therapy .


This was a randomized crossover study at a clinical research facility .


Participants included 12 insulin-naive subjects with T2D .


Subjects attended two 24-hour visits .


Standard therapy was discontinued and replaced by closed-loop insulin delivery during the intervention visit .


Usual anti-hyperglycemic therapy was continued during the control visit .


Systemic glucose appearance ( Ra ) and glucose disposal ( Rd ) were measured using a tracer dilution technique with iv [ 6,6 - ( 2 ) H2 ] glucose .


Plasma glucose profiles during both visits were comparable ( P = .48 ) .


Glucose Ra increased during the day ( 21.4 [ 19.5 , 23.5 ] vs 18.6 [ 17.0 , 21.6 ) mol/kg/min , P = .019 ) and decreased overnight ( 9.7 [ 8.5 , 11.4 ] vs 11.6 [ 10.3 , 12.9 ] mol/kg/min , P = .004 ) when the usual therapy was discontinued and replaced with insulin .


Increased daytime glucose Rd ( 21.2 [ 19.4 , 23.9 ] vs 18.8 [ 18.3 , 21.7 ] mol/kg/min , P = .002 ) and decreased overnight Rd ( 10.4 [ 9.1 , 12.0 ] vs 11.8 [ 10.7 , 13.7 ] mol/kg/min , P = .005 ) were observed when the usual therapy was discontinued , whereas daytime peripheral insulin sensitivity was reduced ( 47.8 [ 24.8 , 66.1 ] vs 62.5 [ 34.8 , 75.8 ] nmol/kg/min per pmol/L , P = .034 ) .


In T2D , acute discontinuation of anti-hyperglycemic therapy and replacement with insulin increases postprandial Ra and reduces peripheral insulin sensitivity .


Insulin dose initiation may need to compensate for these alterations .


To evaluate the effect of perioperative gabapentin treatment for the prevention of persistent post-thoracotomy pain and to establish whether gabapentin has a significant therapeutic impact on acute postoperative pain .


Consecutive patients with pulmonary malignancies scheduled for anterior thoracotomy were enrolled in this randomized , double-blinded , placebo-controlled trial .


Patients were given 1200 mg gabapentin or placebo 2 h before surgery followed by increasing doses during 5 postoperative days : 600 mg for day 1 ; 900 mg for day 2 ; and 1200 mg for days 3-5 .


Effective pain relief was provided with perioperative multimodal analgesia with epidural infusion of bupivacaine and morphine for 72 h , and oral acetaminophen , ibuprofen and morphine .


The main outcome was persistent post-thoracotomy pain at 6 months .


Secondary outcomes included measures of early postoperative post-thoracotomy pain , morphine requirements , recovery and analgesia-related adverse effects over the first 3 weeks as well as persistent post-thoracotomy pain at 3 months .


A total of 104 patients were randomly assigned to the intervention or control group ; 86 ( 83 % ) patients were available for the 14-day analysis , 76 ( 73 % ) for the 3-month analysis and 67 ( 64 % ) for the 6-month follow-up .


At 6 months postoperatively , 47 % of patients treated with gabapentin reported persistent post-thoracotomy pain compared with 49 % in the placebo group ( P = 0.9 ) .


No overall clinically or statistically significant differences were observed between groups receiving placebo and gabapentin , respectively , for the secondary outcome measures and treatment-related adverse events .


We found no evidence for the superiority of gabapentin over placebo for the treatment of acute pain following thoracotomy or for the prevention of persistent post-thoracotomy pain .


We previously reported an inverse association between flavonoid intake and breast cancer incidence , which has been confirmed by others , but no studies have considered simultaneously potential interactions of flavonoids with multiple genetic polymorphisms involved in biologically relevant pathways ( oxidative stress , carcinogen metabolism , DNA repair , and one-carbon metabolism ) .


To estimate interaction effects between flavonoids and 13 polymorphisms in these four pathways on breast cancer risk , we used population-based data ( n = 875 cases and 903 controls ) and several statistical approaches , including conventional logistic regression and semi-Bayesian hierarchical modeling ( incorporating prior information on the possible biologic functions of genes ) , which also provides biologic pathway-specific effect estimates .


Compared to the standard multivariate model , the results from the hierarchical model indicate that gene-by-flavonoid interaction estimates are attenuated , but more precise .


In the hierarchical model , the average effect of the deleterious versus beneficial gene , controlling for average flavonoid intake in the DNA repair pathway , and adjusted for the three other biologically relevant pathways ( oxidative stress , carcinogen metabolism , and one-carbon metabolism ) , resulted in a 27 % increase risk for breast cancer [ odds ratio = 1.27 ; 95 % confidence interval ( CI ) = 0.70 , 2.29 ] .


However , the CI was wide .


Based on results from the semi-Bayesian model , breast cancer risk may be influenced jointly by flavonoid intake and genes involved in DNA repair , but our findings require confirmation .


Improvement in quality of life ( QOL ) is a long term goal of drug treatment .


Although some brief interventions have been found to reduce illicit drug use , no trial among adult risky ( moderate non-dependent ) drug users has tested effects on health-related quality of life .


A single-blind randomized controlled trial of patients enrolled from February 2011 to November 2012 was conducted in waiting rooms of five federally qualified health centers .


413 adult primary care patients were identified as risky drug users using the WHO-ASSIST and 334 ( 81 % response ; 171 intervention , 163 control ) consented to participate in the trial .


Three-month follow-ups were completed by 261 patients ( 78 % ) .


Intervention patients received the QUIT intervention of brief clinician advice and up to two drug-use health telephone sessions .


The control group received usual care and information on cancer screening .


Outcomes were three-month changes in the Short Form Health Survey ( SF-12 ) mental health component summary score ( MCS ) and physical health component summary score ( PCS ) .


The average treatment effect ( ATE ) was non-significant for MCS ( 0.2 points , p-value = 0.87 ) and marginally significant for PCS ( 1.7 points , p-value = 0.08 ) .


The average treatment effect on the treated ( ATT ) was 0.1 ( p-value = 0.93 ) for MCS and 1.9 ( p-value = 0.056 ) for PCS .


The effect on PCS was stronger at higher ( above median ) baseline number of drug use days : ATE = 2.7 , p-value = 0.04 ; ATT = 3.21 , p-value = 0.02 .


The trial found a marginally significant effect on improvement in PCS , and significant and stronger effect on the SF-12 physical component among patients with greater frequency of initial drug use .


In subjects with hypercholesterolaemia , cholesterol values remain above guideline levels .


One of the limiting factors to the achievement of goals in such patients is therapeutic non-adherence .


The aim of this study is to assess the effectiveness of an intervention designed to improve control of hypercholesterolaemic patients , consisting of a combined strategy that would include the delivery of printed information , treatment-compliance check cards and the dispatch of text messages as complementary measures in support of the intervention at the general practitioner 's practice .


A randomised , parallel-group clinical trial will be conducted at the family medicine outpatient facilities of eight health centres in three of Spain 's Autonomous Regions ( Comunidades Autnomas ) , covering a total of 358 subjects aged 18years or over with diagnosis of hypercholesterolaemia .


Patients in the intervention group will be supplied with printed material with information on the disease and its management , mobile-telephone text messages with guideline summaries , reminders of forthcoming appointments and/or arrangements for making new appointments in the event of non-attendance , and self-report cards to check compliance with recommendations .


Both groups - intervention and control - will receive routine recommendations from their physicians in accordance with current European clinical practice guidelines for hypercholesterolaemia and cardiovascular risk management .


As regards the measurements to be made , the main variable is the proportion of subjects who attain the low density lipoprotein cholesterol levels set as a target across a follow-up period of 24months .


The secondary variables are as follows : adherence to recommendations on lifestyle and adherence to drug treatment ; variation in lipid profiles and cardiovascular risk levels ; appearance of cardiovascular events ; physical activity ; food consumption ; smoking habit ; anthropometric measures ; blood pressure ; health problems ; use of hypolipidaemic agents ; socio-demographic data ; beliefs and expectations about preventive recommendations ; and degree of satisfaction with the combined strategy .


Should this intervention prove effective , a recommendation could be issued on the application of this combined strategy to subjects with hypercholesterolaemia .


It is a simple , relatively inexpensive intervention .


ClinicalTrials.gov : NCT02314663 .


In vitro : To assess the effect of common crushing techniques on particle size reduction ( PSR ) and in vitro drug-release kinetics of oxycodone DETERx ( herein DETERx ) and of a commercially available oxycodone extended-release ( ER ) tablet .


In vivo : To evaluate the impact of the most effective manipulation method identified in the in vitro study and the effect of chewing on the pharmacokinetics ( PK ) of DETERx relative to oxycodone solution .


In vitro : Mechanical manipulation of dosage forms using common household utensils .


In vivo : Open-label , randomized , active-controlled , crossover PK study .


In vivo : Forty-four healthy male and female volunteers .


In vitro : DETERx capsule contents and marketed comparator tablets were subjected to manipulation ( crushing ) using 10 different household utensils .


Particle size and dissolution analysis were conducted .


In vivo : Subjects were randomly assigned to receive DETERx 40-mg capsules intact , crushed , or chewed or oxycodone solution .


Serial blood samples were drawn for PK assessment .


In vitro : The utensils used to manipulate DETERx capsule contents were either ineffective in reducing the particle size or produced only a small change in the median particle size and dissolution rate relative to the marketed comparator .


In vivo : DETERx intact capsules provided significantly lower Cmax and longer Tmax values than oxycodone solution .


Manipulation of DETERx by crushing ( using the most effective method established in vitro ) or chewing resulted in bioequivalent plasma concentration-time profiles to the intact dosage form .


These mechanical manipulation and PK studies demonstrated that DETERx beads retained their ER properties after mechanical tampering and chewing by study subjects .


To observe the impacts of acupoint catgut embedding therapy and acupuncture-moxibustion therapy on the long-term efficacy and patient 's life quality in the treatment of allergic rhinitis .


Sixty-nine patients were randomized into the combined acupuncture-moxibustion and acupoint catgut embedding therapy group ( combined therapy group , 36 cases ) and an acupuncture-moxibustion group ( 33 cases ) .


In the acupuncture-moxibustion group , acupuncture was applied at Yingxiang ( LI 20 ) , Shangyingxiang ( EX-HN 8 ) , Yintang ( GV 29 ) , Shangxing ( GV 23 ) , Tongtian ( BL 7 ) and Zusanli ( ST 36 ) .


Moxibustion was applied at Zusanli ( ST 36 ) , Feishu ( BL 13 ) , Dazhui ( GV 14 ) and Fengmen ( BL 12 ) .


In the combined therapy group , on the basis of the treatment as acupuncture-moxibustion group , the catgut embedding therapy was applied at Feishu ( BL 13 ) , Fengmen ( BL 12 ) , Pishu ( BL 20 ) , Shenshu ( BL 23 ) , Zhongwan ( CV 12 ) and Qihai ( CV 6 ) .


The treatment duration was 4 weeks in the two groups .


The clinical efficacy of allergic rhinitis and rhinoconjunctivitis quality of life questionnaire ( RQLQ ) score were observed before and after treatment as well as in the 4-weeks follow-up after the end of treatment respectively .


The markedly effective rate was 72.7 % ( 24/33 ) in the combined therapy group and 48.4 % ( 15/31 ) in the acupuncture-moxibustion group after treatment .


The efficacy was similar between the two groups ( P > 0.05 ) .


It was 57.6 % ( 19/33 ) in the combined therapy group and was 22.6 % ( 7/31 ) in the 4-week follow-up after treatment , indicating the long-term efficacy in the combined therapy group was superior to that in the acupuncture-moxibustion group ( P < 0.05 ) .


Scores of RQLO after treatment and in 4-week follow-up after treatment in both groups were improved as compared with those before treatment ( all P < 0.05 ) .


In 4-week follow-up , the improvements in sleep and affection in the combined therapy group were superior to the acupuncture-moxibustion group ( 3.27 + / - 3.23 vs 4.61 + / - 3.56 , 3.48 + / - 3.67 vs 5.81 + / - 4.15 , both P < 0.05 ) .


The acupoint catgut embedding therapy combined with acupuncture-moxibustion therapy are safe and effective in the treatment of allergic rhinitis and display the more roles in the long-term efficacy .


Osteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment , cartilage , and other structures necessary to joint stability .


There is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources ( low-level laser therapy and light-emitting diode therapy ) in the same apparatus for the treatment of osteoarthritis .


The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for individuals with osteoarthritis of the knee .


A double-blind , controlled , randomized clinical trial will be conducted involving patients with osteoarthritis of the knee .


Evaluations will be performed using functional questionnaires before and after the treatment protocols , in a reserved room with only the evaluator and participant present , and no time constraints placed on the answers or evaluations .


The following functional tests will also be performed : stabilometry ( balance assessment ) , dynamometry ( muscle strength of gluteus medius and quadriceps ) , algometry ( pain threshold ) , fleximeter ( range of motion ) , timed up-and-go test ( functional mobility ) , and the functional reach test .


The participants will then be allocated to three groups through a randomization process using opaque envelopes : exercise program , exercise program + phototherapy , or exercise program + placebo phototherapy , all of which will last for eight weeks .


The purpose of this randomized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee .


The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee .


Data will be published after the study is completed .


The protocol for this study has been submitted to Clinical Trials , registration number NCT02102347 , on 29 March 2014 .


Prescription opioids have substantial abuse potential .


This study compared the positive subjective drug effects of a newly developed extended-release ( ER ) oxycodone ( OC ) / acetaminophen ( acetyl-para-aminophenol [ APAP ] ) formulation with those of immediate-release ( IR ) OC/APAP .


This randomized , double-blind , active - and placebo-controlled , 7-way crossover study enrolled healthy volunteers who were recreational prescription opioid users .


The protocol was approved by an institutional review board and all participants provided written informed consent .


Participants received single doses of intact ER and IR OC/APAP 15/650 mg , intact ER and IR OC/APAP 30/1300 mg , crushed ER and IR OC/APAP 30/1300 mg , and placebo .


Peak subjective effects ( Emax ) , time to Emax , and area under the drug-effect curves for drug liking , drug high , and good drug effects were measured using visual analogue scales .


Least squares means with 95 % confidence interval were compared using analysis of variance .


Among completers ( N = 55 ) , intact ER OC/APAP produced delayed and lower peak effects versus IR OC/APAP .


Comparing intact tablets , the drug liking Emax ( least squares means [ 95 % confidence interval ] ) was significantly lower for OC/APAP 30/1300 mg ( 76.4 [ 72.8 to 80.0 ] ) than for IR OC/APAP 30/1300 mg ( 85.6 [ 81.9 to 89.2 ] ; difference , -9.2 [ -13.1 to -5.2 ] ; P < 0.001 ) .


Similar results were observed for intact ER and IR OC/APAP ( 15 mg/650 mg ) .


Crushing ER OC/APAP 30/1300 mg further delayed these effects compared with the same dose of crushed IR OC/APAP and intact ER OC/APAP .


Extended-release OC/APAP produced lower subjective drug effects than IR OC/APAP .


Crushing ER OC/APAP further delayed onset of subjective effects compared with intact ER OC/APAP .


The ER OC/APAP may be less attractive for abuse than IR OC/APAP .


This phase 1 study conducted in the United States was not registered .


Teleophthalmology has the potential to reduce costs and inconveniences associated with frequent patient visits .


Evaluating teleophthalmology in the management of age-related macular degeneration ( AMD ) will allow for future implementation of this technology .


To evaluate teleophthalmology as a tool for the screening and monitoring of neovascular AMD .


Prospective , randomized clinical trial that included 106 referral eyes for suspected neovascular AMD and 63 eyes with stable neovascular AMD .


New referrals for patients with suspected neovascular AMD and patients with stable neovascular AMD were randomized into either routine or teleophthalmologic groups .


In the routine group , patients received clinical assessment and diagnostic imaging at a tertiary hospital-based retina clinic .


In the teleophthalmologic group , patients received basic examination and diagnostic imaging at a stand-alone teleophthalmologic site , where patient information and imaging studies were acquired and electronically sent over to tertiary hospital-based retina specialists .


Patients in the teleophthalmologic group were called back to the tertiary treatment center if the teleophthalmologic data set suggested pathology or was inconclusive for diagnosis .


Patient wait times for diagnosis and/or treatment , referral accuracy , and visual outcome .


For neovascular AMD screening , the average referral-to-diagnostic imaging time was 22.5 days for the teleophthalmologic group and 18.0 days for the routine group , for a difference of 4.5 days ( 95 % CI , 11.8 to -2.8 days ; P = .23 ) .


The average diagnostic imaging to treatment time was 16.4 days for the teleophthalmologic group and 11.6 days for the routine group , for a difference of 4.8 days ( 95 % CI , 10.7 to -1.1 days ; P = .11 ) .


For neovascular AMD monitoring , the average recurrence to treatment time was shorter for the routine group ( 0.04 days ) compared with 13.6 days for the teleophthalmologic group , for a difference of -13.5 days ( 95 % CI , -18.2 to -9.0 days ; P < .01 ) .


There was no difference identified between end-of-study visual acuities in the 2 groups ( P = .99 ) .


A delay of referral to treatment time could not be identified when comparing teleophthalmologic screening for suspected neovascular AMD with retinal specialist-based screening .


Teleophthalmologic monitoring for neovascular AMD recurrence resulted in longer wait times for treatment reinitiation , but no adverse visual outcomes were identified .


clinicaltrials.gov Identifier : NCT01581606 .


To evaluate safety and efficacy of weekly ( qw ) and every other week ( q2w ) dosing of sarilumab , a fully human anti-interleukin 6 receptor ( anti-IL-6R ) monoclonal antibody , for moderate-to-severe rheumatoid arthritis ( RA ) .


In this dose-ranging study , patients ( n = 306 ) with active RA , despite methotrexate , were randomly assigned to placebo or one of five subcutaneous doses/regimens of sarilumab : 100mg q2w , 150mg q2w , 100mg qw , 200mg q2w , 150mg qw for 12weeks , plus methotrexate .


The primary end point was ACR20 at Week 12 .


Secondary endpoints included ACR50 , ACR70 , Disease Activity Score in 28 joints ( C reactive protein ) .


Safety , pharmacokinetics , pharmacodynamics and efficacy in population subgroups were assessed .


The proportion of patients achieving an ACR20 response compared with placebo was significantly higher for sarilumab 150mg qw ( 72.0 % vs 46.2 % , multiplicity adjusted p = 0.0203 ) .


Higher ACR20 responses were also attained with 150mg q2w ( 67 % ; unadjusted ( nominal ) p = 0.0363 ) and 200mg q2w ( 65 % ; unadjusted p = 0.0426 ) versus placebo .


Sarilumab 150mg q2w reduced C reactive protein , which did not return to baseline between dosing intervals .


Infections were the most common adverse event ; none were serious .


Changes in laboratory values ( neutropenia , transaminases and lipids ) were consistent with reports with other IL-6R inhibitors .


Sarilumab improved signs and symptoms of RA over 12weeks in patients with moderate-to-severe RA with a safety profile similar to reports with other IL-6 inhibitors .


Sarilumab 150mg and sarilumab 200mg q2w had the most favourable efficacy , safety and dosing convenience and are being further evaluated in Phase III .


We examined risk of newly detected human papillomavirus ( HPV ) infection and cervical abnormalities in relation to HPV type 16/18 antibody levels at enrollment in PATRICIA ( Papilloma Trial Against Cancer in Young Adults ; NCT00122681 ) .


Using Poisson regression , we compared risk of newly detected infection and cervical abnormalities associated with HPV-16 / 18 between seronegative vs seropositive women ( 15-25 years ) in the control arm ( DNA negative at baseline for the corresponding HPV type [ HPV-16 : n = 8193 ; HPV-18 : n = 8463 ] ) .


High titers of naturally acquired HPV-16 antibodies and/or linear trend for increasing antibody levels were significantly associated with lower risk of incident and persistent infection , atypical squamous cells of undetermined significance or greater ( ASCUS + ) , and cervical intraepithelial neoplasia grades 1/2 or greater ( CIN1 + , CIN2 + ) .


For HPV-18 , although seropositivity was associated with lower risk of ASCUS + and CIN1 + , no association between naturally acquired antibodies and infection was demonstrated .


Naturally acquired HPV-16 antibody levels of 371 ( 95 % confidence interval [ CI ] , 242-794 ) , 204 ( 95 % CI , 129-480 ) , and 480 ( 95 % CI , 250-5756 ) EU/mL were associated with 90 % reduction of incident infection , 6-month persistent infection , and ASCUS + , respectively .


Naturally acquired antibodies to HPV-16 , and to a lesser extent HPV-18 , are associated with some reduced risk of subsequent infection and cervical abnormalities associated with the same HPV type .


Children with severe cutaneous burn injury show persistent metabolic abnormalities , including inflammation and insulin resistance .


Such abnormalities could potentially increase their future risk for developing type 2 diabetes mellitus ( T2DM ) and cardiovascular disease ( CVD ) .


This could be related to changes in body composition and fat distribution .


We studied body composition , fat distribution , and inflammatory cytokines changes in children with severe burn injury up to 6 months from discharge .


Sixty-two boys and 35 girls ( burn 30 % of total body surface area ) were included .


We found a decrease in total body fat and subcutaneous peripheral fat at 6 months ( 6 % and 2 % , respectively ; P < 0.05 each ) .


An inverse correlation between the decrease in peripheral fat content at 6 months and the extent of burn injury ( r = -041 , P = 0.02 ) was also observed .


In addition , there was a 12 % increase in serum tumor necrosis factor - ( TNF - ) ( P = 0.01 vs. discharge ) and 9 % decrease in serum interleukin-10 ( IL-10 ) ( P < 0.0001 vs. discharge ) over 6 months after burn .


Severe burn injury in children is associated with changes in body fat content and distribution up to 6 months from hospital discharge .


These changes , accompanied by persisting systemic inflammation , could possibly mediate the observed persistence of insulin resistance , predisposing burn patients to the development of T2DM and CVD .


To integrate group-based lifestyle sessions ( GBLS ) within prenatal care for gestational weight gain ( GWG ) management .


In Study 1 , participants attended GBLS during prenatal care visits .


Participants in Study 2 attended off-site GBLS whereby care providers were asked to discuss the program with patients .


Process and outcome evaluation were conducted through a mixed-methods approach .


In both pre-experimental feasibility studies , data provide preliminary support for GBLS ( eg , positive care provider and patient feedback , weight gain patterns ) as well as highlight areas for future research ( eg , lack of GWG management discussions , preference for GBLS location ) .


GBLS represents a promising approach to GWG management .


Future research should assess the generalizability , sustainably , and compatibility of GBLS within prenatal care .


Secondary hyperparathyroidism ( SHPT ) is a frequent complication of chronic kidney disease .


We evaluated AMG 416 , a long-acting peptide agonist of the calcium-sensing receptor , to assess its safety , tolerability , and efficacy and to determine a safe and effective starting dose for subsequent phase 2 studies .


The study was not designed to titrate AMG 416 dosing to achieve a specific PTH treatment goal .


This is a multicenter , double-blind , randomized , placebo-controlled , dose-escalation study designed to evaluate the safety and efficacy of AMG 416 administered thrice weekly by IV bolus at the end of hemodialysis for up to 4 weeks .


Eligible subjects were enrolled in one of three cohorts and treated with 5mg of AMG 416 or placebo for 2 weeks ( Cohort 1 ) or 5 or 10mg of AMG 416 or placebo for 4 weeks ( Cohorts 2 and 3 ) .


The primary endpoint was mean percentage change from baseline in PTH during the efficacy assessment phase ( EAP ) in Cohorts 2 and 3 .


Analysis of the primary endpoint showed that treatment with AMG 416 at 10mg ( Cohort 2 ) and 5mg ( Cohort 3 ) for up to 4 weeks resulted in mean 49.4 % and 33.0 % reductions from baseline in PTH during the efficacy assessment phase , respectively ( p < 0.05 for both cohorts compared to placebo group within the cohort ) .


A substantial proportion of subjects treated with AMG 416 achieved PTH 300pg/mL and 30 % reduction in PTH from baseline in both cohorts .


The observed decreases in serum-corrected calcium were well tolerated and serum phosphate levels also tended to decrease .


The present clinical findings support the continued development of AMG 416 as a treatment for SHPT in hemodialysis patients .


Although there is general agreement that parents should be involved in pediatric obesity treatment , few studies have investigated the effectiveness of interventions that target parents exclusively .


Moreover , the effectiveness of this approach has not been adequately assessed with racially diverse families , particularly African Americans ( AA ) , a group at high risk for elevated Body Mass Index ( BMI ) .


NOURISH ( Nourishing Our Understanding of Role modeling to Improve Support and Health ) is a culturally-sensitive parenting intervention targeting overweight ( AA ) children ( ages 6-11 ; MBMI = 98.0 % ile ) .


Families ( N = 84 ; 61 % AA , 37 % White ) were randomly assigned to NOURISH or a control group .


NOURISH families significantly improved on child BMI from pre - to post-testing after adjustment for random effects , baseline BMI , and child race .


NOURISH parents were very satisfied with the intervention and would recommend it to other parents ; 91 % strongly or moderately agreed that NOURISH helped them eat in a healthier manner .


These pilot data suggest that NOURISH is acceptable and , with refinement , offers promise for reducing pediatric BMI .


Outcomes , lessons learned , and parent feedback will inform a larger randomized controlled trial .


The eradication rate of 10-day sequential therapy for Helicobacter pylori ( H. pylori ) infection was not satisfactory in Korea , probably due to antibiotic resistance .


To compare the treatment efficacy of 15-day and 10-day sequential therapy of conventional 7-day proton pump inhibitor ( PPI ) triple therapy for the treatment of H. pylori infection .


A total of 332 patients with H. pylori infection were randomly assigned to receive either 7-day PPI triple therapy , 10-day sequential therapy or 15-day sequential therapy .


Eradication rate , drug compliance , and adverse events were compared among the three regimens .


The eradication rates by intention-to-treat analysis were 64.3 % ( 95 % CI : 55.5-73 .2 ; 74 of 115 patients ) , 72.1 % ( 95 % CI : 63.6-80 .5 ; 80 of 111 patients ) , and 80.2 % ( 95 % CI : 72.5-87 .9 ; 85 of 106 patients ) in the 7-day PPI triple , 10-day and 15-day sequential therapy groups , respectively ( p = 0.032 ) .


The eradication rates by per-protocol analysis were 68.5 % ( 95 % CI : 59.6-77 .4 ; 74 of 108 patients ) , 78.4 % ( 95 % CI : 70.3-86 .5 ; 80 of 102 patients ) , and 89.5 % ( 95 % CI : 83.2-95 .8 ; 85 of 95 patients ) in the 7-day PPI triple , 10-day and 15-day sequential therapy groups , respectively ( p = 0.001 ) .


There were no statistically significant differences between the three eradication therapy groups in regard to drug compliance and adverse events .


The 15-day sequential therapy demonstrated improved eradication efficacy compared with 7-day PPI triple and 10-day sequential therapy in Korea .


We aimed to assess the impact of eplerenone on cardiovascular ( CV ) outcomes in STEMI without known heart failure , when initiated within 24 h of symptom onset .


In this randomized , placebo-controlled , double-blind trial , we assigned 1012 patients with acute STEMI and without a history of heart failure to receive either eplerenone ( 25-50 mg once daily ) or placebo in addition to standard therapy .


The primary endpoint was the composite of CV mortality , re-hospitalization , or , extended initial hospital stay , due to diagnosis of HF , sustained ventricular tachycardia or fibrillation , ejection fraction 40 % , or elevated BNP/NT-proBNP at 1 month or more after randomization .


BNP elevation was defined as BNP levels or values above 200 pg/mL or NT-proBNP values above 450 pg/mL ( in patients aged below 50 ) ; above 900 pg/mL ( age 50-75 years ) or above 1800 pg/mL ( patients older than 75 ) .


After a mean follow-up of 10.5 months , the primary endpoint occurred in 92 patients ( 18.2 % ) in the eplerenone group and in 149 patients ( 29.4 % ) in the placebo group [ adjusted hazard ratio ( HR ) , 0.58 ; 95 % confidence interval ( CI ) , 0.45-0 .76 ; P < 0.0001 ] .


The primary endpoint was driven by a high BNP/NT-proBNP level ( adjusted HR , 0.60 ; 95 % CI , 0.45-0 .79 ; P < 0.0003 ) .


Adverse event rates were similar in both groups .


Serum potassium levels exceeded 5.5 mmol/L in 5.6 vs. 3.2 % ( P = 0.09 ) and were below 3.5 mmol/L in 1.4 vs. 5.6 % of patients ( P = 0.0002 ) , in the eplerenone and placebo groups , respectively .


The addition of eplerenone during the acute phase of STEMI was safe and well tolerated .


It reduced the primary endpoint over a mean 13 months follow-up mostly because of significantly lower BNP/NT-proBNP levels .


Additional studies are needed to clarify the role of early use of MRAs in STEMI patients without heart failure .


NCT01176968 .


Weight-loss trials tend to recruit highly selective , non-representative samples .


Effective weight-loss approaches are needed for real-world challenging populations .


To test whether a small-changes intervention , delivered in groups or via telephone , promotes greater weight loss than standard obesity treatment in a predominantly male , high-risk Veteran population .


Data were collected in 2010-2012 and analyzed in 2013 .


A three-arm , 12-month randomized pragmatic effectiveness trial .


Four-hundred eighty-one overweight/obese participants from two Midwestern Veterans Affairs ( VA ) Medical Centers were randomly assigned to one of three programs : the 12-month Aspiring to Lifelong Health ( ASPIRE ) weight-loss program delivered ( 1 ) individually over the phone ( ASPIRE-Phone ) or ( 2 ) in-person group sessions ( ASPIRE-Group ) ; compared to ( 3 ) VA 's standard weight-loss program ( MOVE ! )


Twenty-eight sessions with a non-clinician coach via telephone or in-person groups using a small-changes obesity treatment approach compared to a 15-30-session standard VA program .


Twelve-month change in weight ( kilograms ) .


Participants in all three arms lost significant ( p < 0.01 ) weight at 12 months .


Participants in the ASPIRE-Group arm lost significantly more weight at 12 months than those in the other two treatment arms ( -2.8 kg , 95 % CI = -3.8 , -1.9 , in ASPIRE-Group vs -1.4 kg , 95 % CI = -2.4 , -0.5 , in ASPIRE-Phone and -1.4 kg , 95 % CI = -2.3 , -0.4 ) in MOVE !


ASPIRE-Group resulted in greater improvements in all other anthropometric measures compared to MOVE !


at 12 months ( p < 0.05 ) and for all ( p < 0.05 ) but waist circumference ( p = 0.23 ) compared to ASPIRE-Phone .


Group-based delivery of the ASPIRE weight management program is more effective than MOVE !


and the phone-based version of ASPIRE at promoting sustained weight loss in a predominantly male population with multiple comorbidities .


The incremental benefits of group-based ASPIRE over the current MOVE !


program could yield significant population-level benefits if implemented on a large scale .


Disorders of homocysteine and B-vitamin metabolism represent a significant problem in clinical practice .


Establishing the diagnosis requires specialized tests with demanding preanalytical requirements .


To advance the detection of patients with these disorders , we developed a method for the simultaneous determination of cystathionine ( Cysta ) , methionine ( Met ) and total homocysteine ( tHcy ) in dried blood spots ( DBSs ) .


A punch from a DBS sample was mixed with a solution of isotopically labeled internal standards , and analytes were extracted using methanol/0 .1 % formic acid/0 .5 mol/L dithiothreitol .


The extract was injected into an LC-MS/MS system operating in MRM mode .


The analytical performance of the method employing DBS is adequate for its purpose and the type of sample .


Compared with Cysta , tHcy and Met plasma levels , our method exhibited a negative bias between -3.8 % and -42.2 % due to the lower concentrations of these analytes in erythrocytes .


The tHcy level and the Met/Cysta ratio in DBS enabled the clear detection of 12 patients with disorders of transsulfuration and with genetic and nutritional remethylation defects .


The ease of collecting and transporting DBS samples may advance diagnostic procedures in patients with neuropsychiatric disorders and thromboembolism .


Consequently , this approach may facilitate detection and simplify the monitoring of patients with homocystinuria .


The effects of short course of corticosteroids on the metabolic processes and bone formation has not been well studied .


Our aim was to compare the efficacy , the side effects and the bone and lipid metabolisms in IBD patients using bolus or conventional tapering of methylprednisolone for 12 weeks .


Nineteen IBD patients received intravenous methylprednisolone of 1mg/kg for 5 days tapered by 4 mg per week .


Patients were prospectively randomized in two groups .


In `` conventional '' group ( I ) steroids were given daily .


In `` pulse '' group ( II ) weekly doses of steroids were given on special days of the week .


The body mass index ( BMI ) was measured before and after the corticosteroid therapy .


Blood samples were collected to assess glucose level , electrolytes , cholesterol and triglyceride levels , inflammatory parameters , cortisol , osteocalcin and crosslaps values .


Total body composition analysis was performed at the beginning and at the end of the steroid therapy .


In Group I , BMI increased , total body bone density decreased significantly at the end of the steroid therapy .


Body fat percent showed a tendency to be higher at the end of steroid therapy in Group I. Cholesterol level increased significantly in Group I patients .


The decrease in serum cortisol level was more remarkable in Group I vs. Group II after steroid therapy .


Less side-effect occurred in Group II vs. Group I.


Our results suggest that bolus tapering of corticosteroids may have more favorable short term outcome than conventional tapering that may revolutionize steroid therapy in IBD .


Compared with other countries , patients with chronic hepatitis C infection in Japan tend to be older , have more advanced liver disease , and are more likely to have been previously treated for hepatitis C.


We aimed to assess the efficacy and safety of an all-oral , fixed-dose combination of the hepatitis C virus NS5A inhibitor ledipasvir and the NS5B nucleotide polymerase inhibitor sofosbuvir with and without ribavirin for 12 weeks in treatment-naive and previously treated Japanese patients with chronic genotype 1 hepatitis C virus infection .


In this randomised , open-label study , we enrolled patients from 19 clinical Japanese centres .


Patients were randomly assigned ( 1:1 ) to receive either ledipasvir ( 90 mg ) and sofosbuvir ( 400 mg ) or ledipasvir , sofosbuvir , and ribavirin ( dosed according to the Japanese Copegus product label-ie , patients 60 kg received 600 mg daily , patients > 60 kg to 80 kg received 800 mg daily , and patients > 80 kg received 1000 mg daily ) orally once daily for 12 weeks .


After completion or early discontinuation of treatment , patients were followed up off-treatment for 24 weeks .


Eligible patients were at least 20 years of age with chronic genotype 1 hepatitis C virus infection with serum hepatitis C virus RNA concentrations of at least 5 log10 IU/mL , creatinine clearance of at least 10 mL/s , and a platelet count of at least 5010 ( 9 ) per L.


An interactive web response system was used to manage patient randomisation and treatment assignment .


Randomisation was stratified by the presence or absence of cirrhosis for treatment-naive patients and stratified by presence or absence of cirrhosis and by previous treatment category ( relapser or breakthrough , non-responder , or interferon-intolerant ) for previously treated patients .


Within each strata , patients were sequentially assigned to either treatment with ledipasvir-sofosbuvir or ledipasvir-sofosbuvir plus ribavirin in a 1:1 ratio with block size of 4 .


The primary endpoint was sustained virological response 12 weeks after completion of treatment ( SVR12 ) assessed in all patients who were randomly assigned and received at least one dose of study drug ; safety outcomes were assessed in all patients who received at least one dose of study drug .


This trial is registered with ClinicalTrials.gov , number NCT01975675 .


Between Oct 15 , 2013 and Dec 13 , 2013 , 341 patients were randomly assigned to treatment groups and received at least one dose of study treatment .


SVR12 was achieved in all 171 ( 100 % ) patients ( 83 of 83 treatment naive and 88 of 88 treatment experienced ) receiving ledipasvir-sofosbuvir ( 95 % CI 98-100 ) and 167 ( 98 % ) of 170 patients ( 80 of 83 treatment naive and 87 of 87 treatment experienced ) receiving ledipasvir-sofosbuvir plus ribavirin ( 95 % CI 95-100 ) .


Of the 76 patients with baseline NS5A resistant variants , 75 ( 99 % ) achieved SVR12 .


Two ( 12 % ) of 170 patients in the ledipasvir-sofosbuvir plus ribavirin group discontinued treatment because of adverse events .


The most common adverse events were nasopharyngitis ( 50 [ 292 % ] of 171 ) , headache ( 12 [ 70 % ] of 171 ) , and malaise ( nine [ 53 % ] of 171 ) in patients receiving ledipasvir-sofosbuvir ; and nasopharyngitis ( 40 [ 235 % ] of 170 ) , anaemia ( 23 [ 135 % ] of 170 ) , and headache in those receiving ledipasvir-sofosbuvir and ribavirin ( 15 [ 88 % ] of 170 ) .


Although existing regimens for the treatment of hepatitis C virus are effective for many patients , medical needs remain unmet , particularly in Japan where the population with hepatitis C virus genotype 1 is generally older and treatment-experienced , with advanced liver disease .


The efficacy , tolerability , and absence of drug-drug interactions of ledipasvir-sofosbuvir suggest that it could be an important option for treatment of genotype 1 hepatitis C virus in Japanese patients .


Gilead Sciences .


The effect of fluticasone furoate nasal spray ( FFNS ) on growth in prepubescent children has not been evaluated .


To characterize the difference in mean prepubescent growth velocities , as determined by stadiometry , between patients treated continuously for 1 year with FFNS 110mcg once daily and placebo nasal spray .


This was a multicenter , randomized , double-blind , placebo-controlled , parallel-group 76-week safety study .


Nasal symptom assessments were used as a measure of adherence .


Eligible patients were ages 5 to < 8.5 years at screening and had at least a 1-year clinical history and diagnosis of perennial allergic rhinitis , including a positive skin test or specific IgE to an appropriate perennial allergen within the past year .


One hundred eighty-six patients in the FFNS group and 187 patients in the placebo group completed the entire 52-week treatment period .


During treatment , the least squares mean growth velocity was 5.19 cm/y for the FFNS group and 5.46 cm/y for the placebo group ; mean difference,-0 .270 cm/y ( 95 % CI,-0 .48 to-0 .06 cm/y ) .


Other safety assessments , including 24-hour urinary cortisol excretion , were comparable between the treatment groups .


Daily reflective total nasal symptom scores declined similarly in both the FFNS and placebo groups .


Once-daily treatment with FFNS over 52 weeks in prepubescent children resulted in a small reduction in growth velocity compared with placebo .


Clinicians will need to balance the reduction in growth observed with FFNS to its potential for clinical benefit .


To evaluate the effect of a multidisciplinary rehabilitation programme on disability , kinesiophobia , catastrophizing , pain , quality of life and gait disturbances in patients with chronic low back pain ( CLBP ) .


This was a parallel-group , randomised , superiority-controlled pilot study in which 20 patients were randomly assigned to a programme consisting of motor training ( spinal stabilising exercises plus usual-care ) and cognitive-behavioural therapy ( experimental group , 10 subjects ) or usual-care alone ( control group , 10 subjects ) .


Before treatment , 8 weeks later ( post-treatment ) , and 3 months after the end of treatment , the Oswestry Disability Index , the Tampa Scale for Kinesiophobia , the Pain Catastrophizing Scale , a pain numerical rating scale , and the Short-Form Health Survey were assessed .


Spatio-temporal gait parameters were also measured by means of an electronic walking mat .


A linear mixed model for repeated measures was used for each outcome measure .


The programme had significant group ( p = 0.027 ) , time ( p < 0.001 ) , and time-by-group interaction ( p < 0.001 ) effects on disability , with the experimental group showing an improvement after training of about 61 % ( 25 % in the control group ) .


The analyses of kinesiophobia , catastrophizing , and the quality of life also revealed significant time , group , and time-by-group interaction effects in favour of the experimental group , and there was a significant effect of time on pain .


Both groups showed a general improvement in gait parameters , with the experimental group increasing cadence significantly more .


The multidisciplinary rehabilitation programme including cognitive-behavioural therapy was superior to the exercise programme in reducing disability , kinesiophobia , catastrophizing , and enhancing the quality of life and gait cadence of patients with CLBP .


Vascular endothelial growth factor ( VEGF ) promotes angiogenesis , a mediator of disease progression in cervical cancer .


Bevacizumab , a humanized anti-VEGF monoclonal antibody , has single-agent activity in previously treated , recurrent disease .


Most patients in whom recurrent cervical cancer develops have previously received cisplatin with radiation therapy , which reduces the effectiveness of cisplatin at the time of recurrence .


We evaluated the effectiveness of bevacizumab and nonplatinum combination chemotherapy in patients with recurrent , persistent , or metastatic cervical cancer .


Using a 2-by-2 factorial design , we randomly assigned 452 patients to chemotherapy with or without bevacizumab at a dose of 15 mg per kilogram of body weight .


Chemotherapy consisted of cisplatin at a dose of 50 mg per square meter of body-surface area , plus paclitaxel at a dose of 135 or 175 mg per square meter or topotecan at a dose of 0.75 mg per square meter on days 1 to 3 , plus paclitaxel at a dose of 175 mg per square meter on day 1 .


Cycles were repeated every 21 days until disease progression , the development of unacceptable toxic effects , or a complete response was documented .


The primary end point was overall survival ; a reduction of 30 % in the hazard ratio for death was considered clinically important .


Groups were well balanced with respect to age , histologic findings , performance status , previous use or nonuse of a radiosensitizing platinum agent , and disease status .


Topotecan-paclitaxel was not superior to cisplatin-paclitaxel ( hazard ratio for death , 1.20 ) .


With the data for the two chemotherapy regimens combined , the addition of bevacizumab to chemotherapy was associated with increased overall survival ( 17.0 months vs. 13.3 months ; hazard ratio for death , 0.71 ; 98 % confidence interval , 0.54 to 0.95 ; P = 0.004 in a one-sided test ) and higher response rates ( 48 % vs. 36 % , P = 0.008 ) .


Bevacizumab , as compared with chemotherapy alone , was associated with an increased incidence of hypertension of grade 2 or higher ( 25 % vs. 2 % ) , thromboembolic events of grade 3 or higher ( 8 % vs. 1 % ) , and gastrointestinal fistulas of grade 3 or higher ( 3 % vs. 0 % ) .


The addition of bevacizumab to combination chemotherapy in patients with recurrent , persistent , or metastatic cervical cancer was associated with an improvement of 3.7 months in median overall survival .


( Funded by the National Cancer Institute ; GOG 240 ClinicalTrials.gov number , NCT00803062 . )


The anterolateral approach is a commonly used technique for total hip replacement .


It requires the detachment of a large part of the gluteus medius muscle .


However , it is known that this muscle has a great impact on hip stability .


Using the percutaneous assisted approach the damage to the gluteus medius can be limited .


The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome .


This study uses a prospective , randomized , parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery .


The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach .


Prior to surgery patients will undergo baseline measurements .


These will consist of gluteus medius measurements ( surface-electromyography , strength measurements of abductors and quadriceps and the Trendelenburg test ) , questionnaires ( Oxford Hip Score and 36-item Short Form Health Survey ) and functional measures ( the Timed Get-Up-and-Go test , Five times Sit-to-Stand test and Six-Minute Walk test ) .


These measurements will be repeated four and 12 weeks after surgery .


After surgery both groups will receive usual care .


The gluteus medius is the main stabilizer of the hip joint .


Therefore , we assume that functional outcome and gluteus medius function of patients after the percutaneous assisted approach will be better than after the anterolateral approach .


This trial was registered with ClinicalTrials.gov on 8 January 2014 , registration number : NCT02032017 .


To determine and compare the adverse events and long-term effectiveness for patients with small hepatocellular carcinoma ( HCC ) ( 3cm ) treated by percutaneous radiofrequency ablation ( RFA ) or hepatectomy .


Small HCC from 120 patients were randomized into either percutaneous RFA therapy or hepatectomy group , and the effectiveness and complications of two treatment modalities were analyzed .


The complications of post-RFA or hepatectomy , the complete treatment rate , treatment-related mortality , and disease-free and overall survival rate were followed up and conducted .


In patients with small HCC , complete remission rates were achieved in 95 % and 96.7 % in the percutaneus RFA and hepatectomy groups , respectively ( P > 0.05 ) .


Hepatic function at day-7 status post-treatment , including albumin and bilirubin levels , were significantly worse in the hepatectomy group ( P < 0.01 ) .


Compared with the RFA group , the incidence of postoperative complications ( 27.5 % vs 5.0 % ) and hospital stay ( 11.83.1 vs 4.31.5 ) were significantly higher in the hepatectomy group ( P < 0.01 ) .


After a mean follow-up of 40 months , 22 patients ( 36.6 % ) in the RFA group and 21 patients ( 35.0 % ) in the hepatectomy group developed a recurrence ( P > 0.05 ) .


There was no significant difference of the disease-free and overall survival rates at 1 , 2 , and 3 years between the RFA group and the surgical hepatectomy group ( P = 0.443 and P = 0.207 , respectively ) .


In patients with small HCC , percutaneous RFA showed similar local control and long-term survival compared with hepatectomy .


Importantly , percutaneous RFA are accompanied with a lower complication rate and shorter hospital stay day .


Burned patients have increased level of mortality , possibly due to late introduction of enteral feeding .


The aim of this study was to compare the benefits and safety of very early enteral nutrition introduction compared to the normal diet among burns patients in an intensive care unit .


Participants consisted of 101 patients , aged 20-76 years ( mean age 48 years ) , 49 men and 52 women , with burns that covered more than 20 % of the body .


The intervention group consisted of 52 subjects fed via introduced nasojejunal probe that started within four hours after admission to the hospital .


The control group consisted of fifty patients fed in standard manner per os ( three standard hospital meals ) immediately after the first wound dressing .


The average decline BMI in control group was 2.270.56 kg/m2 , while the average reduction in BMI in the intervention group was 1.770.38 kg/m2 ( p < 0.001 ) .


The largest drop of albumin concentration in the control group was 28.5 % , whereas in the intervention group was 23.8 % .


( p < 0.001 ) .


The greatest decrease of transferrin concentration in the control group was 31.1 % , while the average reduction in the intervention group was 18.3 % .


C-reactive protein values were statistically higher in control group ( p < 0.001 ) .


Intervention group had lower rate of complications and infection rates .


Enteral nutrition in burned patients should begin within few hours of burn onset .


Such approach leads to better outcomes , reduces complications , and improves nutritional profile .


The purpose of this study was to identify optimal target propofol and remifentanil concentrations to avoid a gag reflex in response to insertion of an upper gastrointestinal endoscope .


Patients presenting for endoscopy received target-controlled infusions ( TCI ) of both propofol and remifentanil for sedation-analgesia .


Patients were randomized to 4 groups of fixed target effect-site concentrations : remifentanil 1 ngmL ( REMI 1 ) or 2 ngmL ( REMI 2 ) and propofol 2 gmL ( PROP 2 ) or 3 gmL ( PROP 3 ) .


For each group , the other drug ( propofol for the REMI groups and vice versa ) was increased or decreased using the `` up-down '' method based on the presence or absence of a gag response in the previous patient .


A modified isotonic regression method was used to estimate the median effective Ce ,50 from the up-down method in each group .


A concentration-effect ( sigmoid Emax ) model was built to estimate the corresponding Ce ,90 for each group .


These data were used to estimate propofol bolus doses and remifentanil infusion rates that would achieve effect-site concentrations between Ce ,50 and Ce ,90 when a TCI system is not available for use .


One hundred twenty-four patients were analyzed .


To achieve between a 50 % and 90 % probability of no gag response , propofol TCIs were between 2.40 and 4.23 gmL ( that could be achieved with a bolus of 1 mgkg ) when remifentanil TCI was fixed at 1 ngmL , and target propofol TCIs were between 2.15 and 2.88 gmL ( that could be achieved with a bolus of 0.75 mgkg ) when remifentanil TCI was fixed at 2 ngmL .


Remifentanil ranges were 1.00 to 4.79 ngmL and 0.72 to 3.19 ngmL when propofol was fixed at 2 and 3 gmL , respectively .


We identified a set of propofol and remifentanil TCIs that blocked the gag response to endoscope insertion in patients undergoing endoscopy .


Propofol bolus doses and remifentanil infusion rates designed to achieve similar effect-site concentrations can be used to prevent gag response when TCI is not available .


Total atrial conduction time ( TACT ) is the most important parameter in predicting the development of new-onset atrial fibrillation .


We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease .


Thirty patients with peripheral artery disease were treated with cilostazol ( 200 mg/day ) for 6 months .


The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up .


The TACT duration was decreased in all patients compared with the baseline after therapy ( 121.8 19.3 vs. 109.1 15.9 milliseconds , p < 0.001 ) .


However , left atrial ( LA ) diameter was not changed with the therapy .


The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio ( r = -0.48 , p < 0.003 ) .


Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease , which may also prevent the development and/or recurrence of atrial fibrillation ( AF ) .


Protease-activated receptor 1 antagonism with vorapaxar represents a novel strategy for platelet inhibition .


In TRACER , vorapaxar was compared with placebo plus standard of care among 12,944 patients with non-ST-segment elevation acute coronary syndromes .


We anticipated that most patients would have received clopidogrel as part of standard care .


We investigated the modification of vorapaxar 's effect associated with clopidogrel use over time .


The marginal structural model method was used to estimate causal modification of vorapaxar effect by use of clopidogrel over time .


The primary outcomes were the composite of cardiovascular death , myocardial infarction , or stroke and Global Use of Strategies to Open Occluded Coronary Arteries moderate or severe bleeding .


The event accrual period excluded the time during which clopidogrel was clinically warranted .


Among 12,887 patients who received study medication , 11,117 ( 86.3 % ) received clopidogrel before randomization , of whom 38.5 % stopped later in the trial ( median time to stoppage 200 days with placebo ; interquartile range [ IQR ] 14-367 ) ( 186 days with vorapaxar ; IQR 17-366 ) .


In total , 1,770 ( 13.7 % ) patients were not on clopidogrel at randomization , of whom 47.8 % started afterward ( median time to start 2 days ; IQR 2-4 ) .


During the period of event accrual , vorapaxar was associated with a 26 % reduction in the composite of cardiovascular death , myocardial infarction , or stroke when used with clopidogrel ( hazard ratio [ HR ] 0.74 ; 95 % CI 0.60-0 .91 ) and a 24 % reduction when used without clopidogrel ( HR 0.76 ; 95 % CI 0.56-1 .02 ) ( interaction ; P = .89 ) .


The hazard of Global Use of Strategies to Open Occluded Coronary Arteries bleeding with vorapaxar was not significantly different without clopidogrel ( HR 1.33 ; 95 % CI 0.81-2 .20 ) or with clopidogrel ( HR 1.09 ; 95 % CI 0.76-1 .56 ) ( interaction ; P = .53 ) .


We observed no interaction between vorapaxar and clopidogrel after non-ST-segment elevation acute coronary syndromes on efficacy or safety outcomes , supporting a complementary role of protease-activated receptor 1 and P2Y12 antagonism .


To test whether combining bevacizumab , an anti-vascular endothelial growth factor treatment , with endocrine therapy ( ET ) could potentially delay the emergence of resistance to ET .


A multicenter , randomized , open-label , phase III , binational ( Spain and Germany ) study added bevacizumab ( 15 mg/kg every 3 weeks ) to ET ( ET-B ; letrozole or fulvestrant ) as first-line therapy in postmenopausal patients with human epidermal growth factor receptor 2 ( HER2 ) - negative and hormone receptor-positive advanced breast cancer .


We compared progression-free survival ( PFS ) , overall survival ( OS ) , overall response rate ( ORR ) , response duration ( RD ) , time to treatment failure ( TTF ) , clinical benefit rate ( CBR ) , and safety .


From 380 patients recruited ( 2007 to 2011 ) , 374 were analyzed by intent to-treat ( 184 patients on ET and 190 patients on ET-B ) .


Median age was 65 years , 270 patients ( 72 % ) had Eastern Cooperative Oncology Group performance status of 0 , 178 patients ( 48 % ) had visceral metastases , and 171 patients ( 46 % ) and 195 patients ( 52 % ) had received prior chemotherapy or ET , respectively .


Median PFS was 14.4 months in the ET arm and 19.3 months in the ET-B arm ( hazard ratio , 0.83 ; 95 % CI , 0.65 to 1.06 ; P = .126 ) .


ORR , CBR , and RD with ET versus ET-B were 22 % versus 41 % ( P < .001 ) , 67 % versus 77 % ( P = .041 ) , and 13.3 months versus 17.6 months ( P = .434 ) , respectively .


TTF and OS were comparable in both arms .


Grade 3 to 4 hypertension , aminotransferase elevation , and proteinuria were significantly higher in the ET-B arm .


Eight patients ( 4.2 % ) receiving ET-B died during study or within 30 days of end of treatment .


The addition of bevacizumab to ET in first-line treatment failed to produce a statistically significant increase in PFS or OS in women with HER2-negative/hormone receptor-positive advanced breast cancer .


Secretory phospholipase A2 ( sPLA2 ) generates bioactive phospholipid products implicated in atherosclerosis .


The sPLA2 inhibitor varespladib has favorable effects on lipid and inflammatory markers ; however , its effect on cardiovascular outcomes is unknown .


To determine the effects of sPLA2 inhibition with varespladib on cardiovascular outcomes .


A double-blind , randomized , multicenter trial at 362 academic and community hospitals in Europe , Australia , New Zealand , India , and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome ( ACS ) to either varespladib ( n = 2572 ) or placebo ( n = 2573 ) with enrollment between June 1 , 2010 , and March 7 , 2012 ( study termination on March 9 , 2012 ) .


Participants were randomized to receive varespladib ( 500 mg ) or placebo daily for 16 weeks , in addition to atorvastatin and other established therapies .


The primary efficacy measure was a composite of cardiovascular mortality , nonfatal myocardial infarction ( MI ) , nonfatal stroke , or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks .


Six-month survival status was also evaluated .


At a prespecified interim analysis , including 212 primary end point events , the independent data and safety monitoring board recommended termination of the trial for futility and possible harm .


The primary end point occurred in 136 patients ( 6.1 % ) treated with varespladib compared with 109 patients ( 5.1 % ) treated with placebo ( hazard ratio [ HR ] , 1.25 ; 95 % CI , 0.97-1 .61 ; log-rank P = .08 ) .


Varespladib was associated with a greater risk of MI ( 78 [ 3.4 % ] vs 47 [ 2.2 % ] ; HR , 1.66 ; 95 % CI , 1.16-2 .39 ; log-rank P = .005 ) .


The composite secondary end point of cardiovascular mortality , MI , and stroke was observed in 107 patients ( 4.6 % ) in the varespladib group and 79 patients ( 3.8 % ) in the placebo group ( HR , 1.36 ; 95 % CI , 1.02-1 .82 ; P = .04 ) .


In patients with recent ACS , varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI .


The sPLA2 inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS .


clinicaltrials.gov Identifier : NCT01130246 .


Postoperative nausea and vomiting ( PONV ) occur frequently after laparoscopic bariatric surgery .


The combination of haloperidol , dexamethasone , and ondansetron may reduce these undesirable events .


The aim of this study was to evaluate the intensity of nausea and pain , the number of vomiting episodes , and morphine consumption in postoperative ( PO ) obese patients undergoing laparoscopic sleeve gastrectomy ( LSG ) .


A clinical , randomized , controlled , double-blind study conducted with 90 patients with body mass index 35 kg.cm ( -2 ) .


Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg ( Group O ) ; ondansetron 8 mg and dexamethasone 8 mg ( Group OD ) ; and ondansetron 8 mg , dexamethasone 8 mg , and haloperidol 2mg ( Group HDO ) .


We evaluated the intensity of nausea and pain using the verbal numeric scale , cumulative number of vomiting episodes , and morphine consumption in the period of 0-2 , 2-12 , 12-24 , and 24-36 hours postoperatively .


Nausea intensity was lower in Group HDO compared to Group O ( p = 0.001 ) , pain intensity was lower in Group HDO compared to Group O ( p = 0.046 ) , and morphine consumption was lower in Group HDO compared to Group O ( p = 0.037 ) .


There was no difference between groups regarding the number of vomiting episodes ( p = 0.052 ) .


The combination of haloperidol , ondansetron , and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG .


We determined the effect of an intensive lifestyle intervention on the prevalence , incidence and resolution of bothersome nocturia , increased daytime urinary voiding and urinary incontinence in overweight/obese men with type 2 diabetes after 1 year in the Look AHEAD trial .


A subset of male Look AHEAD participants was selected for this secondary data analysis .


Overall 1,910 men with an average ( mean SD ) age of 59.9 6.7 years and body mass index of 35.2 5.5 kg/m ( 2 ) were randomized to an intensive lifestyle intervention or diabetes support and education group .


All participants self-reported information regarding incontinence , nocturia and daytime urinary voiding at entry and 1 year .


After 1 year the intensive lifestyle intervention group lost significantly more weight than the diabetes support and education group ( 9.4 % 7.0 % vs 0.7 % 4.5 % , respectively ; p < 0.001 ) .


The odds of prevalent urinary incontinence at 1 year were reduced by 38 % in the intensive lifestyle intervention group compared to the diabetes support and education group .


The prevalence of urinary incontinence decreased from 11.3 % to 9.0 % in the intensive lifestyle intervention group and increased from 9.7 % to 11.6 % in the diabetes support and education group .


The intensive lifestyle intervention group also had increased odds of urinary incontinence resolving ( OR 1.93 , 95 % CI 1.04-3 .59 , p = 0.04 and 56.0 % vs 40.7 % , p = 0.03 ) and trend toward reduced odds of new onset , incident urinary incontinence ( OR 0.66 , 95 % CI 0.42-1 .02 , p = 0.06 ) compared with the diabetes support and education arm .


In contrast , no differences between intensive lifestyle intervention and diabetes support and education were seen at 1 year for frequency of nocturia or frequency of daytime voiding .


Intensive lifestyle intervention should be considered for the treatment of urinary incontinence in overweight/obese men with type 2 diabetes .


This study is conducted to investigate an optimal timing of sequential noninvasive positive pressure ventilation ( NPPV ) applied for patients with acute exacerbations of chronic obstructive pulmonary disease ( AECOPD ) .


Application of NPPV for 102 patients was randomly observed in the conditions of a 2-hour spontaneous breathing trial ( SBT-2 ) and pulmonary infection control ( PIC ) window .


Efficiency of NPPV in treatment of the patients , an incidence rate of tracheal reintubation , length of time for patients received invasive mechanical ventilation , and a morbidity rate of ventilator-associated pneumonia were examined in each group of 51 patients .


The incidence rates for the patients treated successfully with NPPV and for tracheal reintubation were shown as 88.2 and 60.8 , and 11.8 and 39.2 in SBT-2 and PIC , respectively ( both p < 0.05 ) .


Length of time ( hour ) for use of the invasive ventilation was 116 and 82.5 in SBT-2 and PIC , respectively ( p < 0.05 ) .


There was a similar morbidity rate of ventilator-associated pneumonia seen in both groups .


SBT-2 would be the optimal timing considered to use NPPV for AECOPD patients based on a high success rate and a low risk of tracheal reintubation .


To explore the effect of nursing intervention on the prevention of burns in warm needling moxibustion .


Two hundred patients received warm needling treatment were collected from January to December 2011 and were randomized into an observation group and a control group , 100 cases veceived ten hundreds of treatment in each group .


In the control group , the routine nursing was applied in warm needling moxibustion .


In the observation group , on the basic method as the control group , the nursing intervention was used .


The burns incidence and the satisfaction of patients in warm needling moxibustion were recorded in the patients of the two groups .


The burns incidence was 0.6 % ( 6/1000 ) in the observation group , which was lower apparently than 1.5 % ( 15/1000 ) in the control group ( P < 0.05 ) .


The satisfaction of patients in warm needling moxibustion was 99.0 % ( 99/100 ) in the observation group , which was higher obviously than 88.0 % ( 88/100 ) in the control group ( P < 0.01 ) .


The nursing intervention prevents effectively from burns in warm needling moxibustion , reduces medical injuries , avoids the pains of patients and plays the active role in the patient satisfaction .


The macro - and microcirculation disease , in patients with type 2 diabetes mellitus ( T2DM ) , induces ischemic wounds of the lower limbs .


We have tried to reduce the aggregation of red blood cells and to improve the O2 supply to the tissues and speed the healing of ulcers in T2DM patients .


We enrolled 25 obese subjects without glucose intolerance ( group A ; BMI greater than 30 kg/m2 ) , 20 obese adults intolerant to glucose ( group B ) and two subgroups , groups C and D , with T2DM and with leg ulcers .


The groups A , B and C were treated with PESF .


Body weight , O2 extraction , the capillary pulse , blood pressure and the surface of the ulcers were monitored .


The technique PESF shows to have positive effects on the metabolism , on the reduction of body weight in the groups A and B , increasing extraction of O2 in group C and increase the speed of healing of wounds in group C compared to group D.


In group A , there was a significant reduction in systolic and diastolic blood pressure .


The technique PESF has affected the metabolic processes and the speed of wound healing ulcer in patients with T2DM .


Labor induction in post-term pregnancy is considered as a conventional process of mothers ' care .


Shiatsu technique is one of the complementary methods which use for post-term pregnancy induction .


Therefore , the researchers decided to examine the effect of Shiatsu technique on the induction of post-term pregnancy .


This is a randomized control trials which conducted on 288 women with post-term pregnancy who referred to consulting clinic at Ali - Ibn - Abi - Talib Hospital , in Zahedan-Iran in 2010-2011 .


Participants were selected based on random table .


The participants divided into two groups : the first was shiatsu technique and the second group was control group ( routine procedure ) .


Shiatsu technique was conducted on the participants of intervention group for 30s on three points by an experienced midwife .


The gathered data analyzed by SPSS version 15.00 and comparing tests were t-students tests , chi-square .


Mothers ages range were between 16 to 42 years ( mean 26.5-5 .7 ) in shiatsu and 17 to 43 years ( mean 24.5-5 .1 ) in control group .


Regarding spontaneous initiation of labor , 82 women ( 56.9 % ) in Shiatsu group had spontaneous initiation of labor , whereas the number of women was only 12 ( 8.3 % ) in control group .


Women who have used Shiatsu technique were significantly more likely to have spontaneous labour than those women who did not .


Results of the study showed that shiatsu technique can be used as one of safe complementary methods for post-term pregnancy induction .


The progression of carotid intima-media thickness ( CIMT ) is closely associated with ischemic stroke recurrence .


However , the efficacy of cilostazol on preventing CIMT progression in stroke patients has never been investigated properly by a prospective trial .


This study is a part of `` Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis-2 . ''


Six centers that are available to measure CIMT according to the protocol participated in this substudy .


After 7 months of randomization , the changes of CIMT were compared between cilostazol group and clopidogrel group .


CIMT was measured by a semiautomated software ( Intimascope ) and was presented as the mean of maximum ( CIMT-max ) and average ( CIMT-ave ) of both common carotid arteries .


Linear logistic regression analysis and analysis of covariance were performed to verify the independent factors associated with CIMT progression .


Among the 85 patients , 39 subjects were assigned to cilostazol group and 46 subjects to clopidogrel group .


Follow-up CIMT significantly decreased in cilostazol group ( CIMT-max : -.03.11 and CIMT-ave : -.02.08 ) compared with the increase in clopidogrel group ( CIMT-max : .04.20 and CIMT-ave : .04.11 ; P = .05 and P = .04 , respectively ) .


Female , diabetes , and smoking were independently associated with the progression of CIMT , whereas the use of cilostazol was against CIMT progression from the results of linear regression analysis ( P = .03 for both CIMT-max and CIMT-ave ) .


The use of cilostazol also well predicted less progression of CIMT at follow-up after adjusting for baseline CIMT values and conventional risk factors ( CIMT-max : P = .04 and CIMT-ave : P = .03 ) .


Cilostazol has a beneficial effect in preventing the progression of CIMT in ischemic stroke patients .


Low-dose GH ( LGH ) therapy has been reported to improve insulin sensitivity in GH-deficient adults ; however , the mechanism is unclear .


Effects of LGH therapy on insulin sensitivity are mediated through changes in cortisol metabolism and ectopic fat accumulation .


This was a double-blind , placebo-controlled , parallel , 3-month study .


Seventeen GH-deficient adults were randomized to receive either daily LGH or placebo injections .


Fasting blood samples were collected at baseline , and months 1 and 3 , whereas hyperinsulinemic-euglycemic clamps , magnetic resonance spectroscopy scans , 24-hour cortisol production rates ( CPRs ) , and sc abdominal fat biopsies were performed at baseline and month 3 .


Clamp glucose infusion rate , intramyocellular , extramyocellular , and intrahepatic lipid content , 24-hour CPRs , adipocyte size , and adipocyte 11-hydroxysteroid dehydrogenase activity in adults with GH deficiency were evaluated .


At month 1 , LGH did not alter fasting levels of glucose , insulin , C-peptide , free fatty acid , adiponectin , total IGF-1 , IGF-1 bioactivity , IGF-2 , IGF binding protein ( IGFBP ) -2 , or IGF-1 to IGFBP-3 molar ratio .


At month 3 , LGH increased clamp glucose infusion rates ( P < .01 ) and IGF-1 to IGFBP-3 molar ratio ( P < .05 ) , but fasting glucose , insulin , C-peptide , free fatty acid , adiponectin , IGF-1 bioactivity , IGF-2 , IGFBP-2 , 24-hour CPRs , adipocyte size , adipocyte 11-hydroxysteroid dehydrogenase activity , intrahepatic lipid , extramyocellular , or intramyocellular were unchanged .


In the placebo group , all within-group parameters from months 1 and 3 compared with baseline were unchanged .


Short-term LGH therapy improves insulin sensitivity without inducing basal lipolysis and had no effect on cortisol metabolism and ectopic fat accumulation in GH-deficient adults .


This may reflect an LGH-induced increase in IGF-1 to IGFBP-3 molar ratio exerting insulin-like effects through the abundant muscle IGF-1 receptors , but this hypothesis requires confirmation with further studies .


It has been shown that serum concentrations of 1,25 ( OH ) 2D3 are decreased in patients with gout .


A short-term administration of allopurinol increases plasma concentrations of 1,25 ( OH ) 2D3 in mild to moderate renal failure , with or without hyperuricemia .


It has been reported that subjects who perform regular vigorous and / or moderate physical activities have higher plasma and serum 25 ( OH ) D3 levels .


However , little is known about the influence of allopurinol and/or physical exercise on serum 25 ( OH ) D3 concentrations in humans .


We investigated the effect of allopurinol administration and/or physical activity on vitamin D metabolism by measuring serum uric acid , 25 ( OH ) D3 , and calcium levels in twelve professional soccer players .


The athletes supplemented with allopurinol , but not those who received placebo , exhibited a significant decrease in uric acid serum concentrations after the match .


We also found a significant increase in serum calcium and 25 ( OH ) D3 concentrations in the supplemented group .


We conclude that allopurinol administration might be an effective drug to lower hyperuricemia and treat hypovitaminosis D.


To observe the improvements in constipation differentiated as intestine system syndrome and lung system syndrome treated with electroacupuncture ( EA ) and explore their correlation .


Seventy cases of severe functional constipation were randomized into an EA group and a pseudo-EA group , 35 cases in each one .


In the EA group , the needles were inserted deeply at Tianshu ( ST 25 ) and Fujie ( SP 14 ) on bilateral sides , and directly went to parietal peritoneum .


EA was attached to the needles , dense-disperse wave , 2 Hz/15 Hz , and 0.1 to 1.0 mA .


The perpendicular insertion was done at Shangjuxu ( ST 37 ) , 25 mm in depth .


After qi arrival , the needle was lifted , thrusted and rotated once every 10 min , for 3 times totally .


The needles were retained for 30 min .


In the pseudo-EA group , the pseudo-points lateral to Tianshu ( ST 25 ) , Fujie ( SP 14 ) and Shangjuxu ( ST 37 ) on bilateral sides were punctured shallowly .


The electric stimulation was pretended to connect but with the electric wire cutting off .


The treatment was given 5 times weekly in the first two weeks and 3 times weekly in the later 6 weeks .


Totally , 28 treatments were required .


TCM intestine and lung syndrome scale was used for evaluation .


The changes in TCM syndromes were observed before and after treatment in the patients of the two groups .


The total score of intestine and lung syndrome and the score of individual syndrome were all reduced after treatment as compared with those before treatment in the two groups ( both P < 0.01 ) .


The improvements of the EA group in the total score of intestine system syndrome , the scores of large .


intestine syndrome and stomach syndrome , the total score of lung system syndrome and the score of lung dysfunction in dispersing and descending syndrome were superior to those of the pseudo-EA group ( P < 0.01 , P < 0.05 ) .


The differences in the scores of lung qi deficiency syndrome and throat syndrome were not significant between the two groups ( all P > 0.05 ) .


Simultaneously , the very strong positive correlation ( P < 0.01 ) and positive linear correlation ( P < 0.01 ) were presented in the total score of intestine and lung syndrome of the two groups .


EA obviously improves in intestine system syndrome ( including large intestine syndrome and stomach syndrome ) , as well as lung system syndrome ( lung dysfunction in dispersing and descending ) in the treatment of constipation .


But the improvements are not apparent in the treatment of lung qi deficiency and throat disorder .


Additionally , the obvious correlation is displayed in the improvements in intestine and lung syndrome .


The purpose of this study was to analyze the removal of implant-supported crowns retained by three different cements using an air-accelerated crown remover and to evaluate the patients ' response to the procedure .


This controlled clinical trial was conducted with 21 patients ( 10 women , 11 men ; mean age : 51 10.2 years ) who had received a total of 74 implants ( all placed in the posterior zone of the mandible ) .


Four months after implant surgery , the crowns were cemented on standard titanium abutments of different heights .


Three different cements ( two temporary : Harvard TEMP and Improv ; and one definitive : Durelon ) were used and randomly assigned to the patients .


Eight months later , one blinded investigator removed all crowns .


The number of activations of the instrument ( CORONAflex , KaVo ) required for crown removal was recorded .


The patients completed a questionnaire retrospectively to determine the impact of the procedure and to gauge their subjective perception .


A linear regression model and descriptive statistics were used for data analysis .


All crowns could be retrieved without any technical complications or damage .


Both abutment height ( P = .019 ) and cement type ( P = .004 ) had a significant effect on the number of activations , but the type of cement was more important .


An increased total number of activations had no or only a weak correlation to the patients ' perception of concussion , noise , pain , and unwillingness to use the device .


Cemented implant crowns can be removed , and the application of an air-accelerated device is a practicable method .


A type of cement with appropriate retention force has to be selected .


The impact on the patients ' subjective perception should be taken into account .


Women with severe aortic valve stenosis ( AS ) have better LV systolic function and more concentric LV geometry than their male counterparts .


However , sex differences in cardiovascular ( CV ) outcome during progression of AS have not been reported from a longitudinal prospective study .


Doppler echocardiography and CV events were recorded during a median of 4.0 years in 979 men and 632 women aged 28-86 ( mean 6710 ) years in the Simvastatin Ezetimibe in Aortic Stenosis ( SEAS ) study .


LV systolic function was assessed by EF and midwall shortening ( MWS ) .


Study outcomes were AS-related events , ischaemic CV events and total mortality .


The annular cumulative incidence of AS events , ischaemic CV events and death was 8.1 % , 3.4 % and 2.8 % in women , and 8.9 % , 4.4 % and 2.4 % in men , respectively .


Women and men had similar AS progression rate whether measured by peak jet velocity , mean gradient or valve area .


In multivariate analyses , female sex independently predicted less reduction in LV MWS and EF during follow-up ( both p < 0.05 ) .


In time-varying Cox analyses , women had a 40 % lower rate of ischaemic CV events ( 95 % CI 21 % to 54 % ) , in particular , more than 50 % lower rate of stroke and coronary artery bypass grafting , and a 31 % lower all-cause mortality ( 95 % CI 1 % to 51 % ) , independent of active study treatment , age and hypertension , as well as time-varying valve area , low systolic function and abnormal LV geometry .


AS event rate did not differ by sex .


In the SEAS study , women and men had similar rates of AS progression and AS-related events .


However , women had lower total mortality and ischaemic CV event rate than men independent of confounders .


ClinicalTrials.gov identifier : NCT00092677 .


The purpose of the present study was to compare the effect of oral bromelain ( 4 250 mg ) versus oral diclofenac sodium ( 4 25 mg ) on pain , swelling , trismus , and quality of life ( QOL ) after surgical removal of impacted lower third molars .


A randomized , double-blind , placebo-controlled study was planned .


The sample included patients requiring extraction under local anesthesia of a single partial bony impacted mandibular third molar .


The patients were randomly distributed into 1 of 3 groups : bromelain , diclofenac , and placebo .


Treatment started 1 day before surgery and continued for 4 days .


The predictor variable was the type of the drug given to the patients .


The outcome variables were pain , swelling , and trismus , which were measured at 1 , 3 , and 7 days postoperatively .


The other study variables included QOL measures to assess the patients ' perception regarding the effect of surgery on their well-being and daily activities .


A validated questionnaire was used to measure QOL .


The data were analyzed using analysis of variance , multiple measures analysis of variance , or Pearson 's ( 2 ) test , as appropriate .


P < .05 was considered significant .


A total of 45 subjects requiring surgical removal of a single impacted mandibular third molar under local anesthesia were included in the present study .


The bromelain and diclofenac groups both showed a significant reduction in pain compared with the placebo group at all intervals ( P < .05 ) .


Diclofenac also resulted in a significant reduction of swelling at 3 and 7 days , and bromelain resulted in an insignificant reduction .


A nonsignificant reduction in trismus occurred in both treatment groups compared with the placebo group .


Both treatment groups also showed a significant difference in the effect on QOL in most subscales and total scores ( P < .05 ) .


The effect was comparable between the 2 treatment groups for all parameters and at all intervals .


The results of our study have shown that oral bromelain is an effective therapy to improve the QOL after surgical removal of impacted lower third molars , with an effect on the postoperative sequelae comparable to that of preemptive diclofenac sodium .


Little is known about the effect of various dietary fatty acids on pro- and anti-inflammatory processes .


We investigated the effect of 5 oils containing various amounts of alpha-linolenic acid ( ALA ) , linoleic acid ( LA ) , oleic acid ( OA ) and docosahexaenoic acid ( DHA ) on plasma inflammatory biomarkers and expression levels of key inflammatory genes and transcription factors in whole blood cells .


In a randomized , crossover controlled nutrition intervention , 114 adult men and women with abdominal obesity and at least one other criterion for the metabolic syndrome consumed 5 experimental isoenergetic diets for 4 weeks each , separated by 4-week washout periods .


Each diet provided 60 g/3000 kcal of different oils : 1 ) control corn/safflower oil blend ( CornSaff ; LA-rich ) , 2 ) flax/safflower oil blend ( FlaxSaff ; ALA-rich ) , 3 ) conventional canola oil ( Canola ; OA-rich ) , 4 ) high oleic canola oil ( CanolaOleic ; highest OA content ) , 5 ) DHA-enriched high oleic canola oil ( CanolaDHA ; OA - and DHA-rich ) .


Gene expression in whole blood cells was assessed in a subset of 62 subjects .


CanolaDHA increased plasma adiponectin concentrations compared with the control CornSaff oil treatment ( +4.5 % , P = 0.04 ) and FlaxSaff ( +6.9 % , P = 0.0008 ) .


CanolaDHA also reduced relative expression levels of interleukin ( IL ) 1B compared with CornSaff and Canola ( -11 % and -13 % , respectively , both P = 0.03 ) .


High-sensitivity C-reactive protein concentrations were lower after Canola than after FlaxSaff ( -17.8 % , P = 0.047 ) .


DHA-enriched canola oil exerts anti-inflammatory effects compared with polyunsaturated fatty acids from plant sources .


The present study aimed to compare the treatment outcomes of a fixed-functional appliance ( Twin-Force Bite Corrector - TFBC ) and a conventional removable functional appliance ( Activator ) in the treatment of skeletal Class II malocclusions .


The TFBC and Activator Groups each included 10 young adults possessing a skeletal Class II malocclusion , and the treatment outcomes of both groups were quantified and compared , using lateral cephalometric radiographs , with an untreated skeletal Class II Control Group .


A skeletal Class I relationship and a marked reduction in overjet were achieved in both treatment groups ; however , the duration of treatment was significantly shorter in the TFBC Group ( 0.45 years ) when compared with the Activator Group ( 1.37 years ) ( p < 0.001 ) .


Effective length and sagittal positioning of the mandible underwent significant changes in the TFBC and Activator Groups .


Vertical facial dimensions increased in each group ; however , these increases were significantly greater in the Activator Group when compared to the TFBC and Control Groups ( p < 0.05 ) .


Dentoalveolar changes also contributed to the reduction in overjet .


Although both appliances succeeded in eliminating the Class II relationship and improving the overjet and overbite , the short treatment time in the TFBC Group raises questions regarding the long-term stability of the results .


NHS Health Checks is a new program for primary prevention of heart disease , stroke , diabetes , chronic kidney disease , and vascular dementia in adults aged 40 to 74years in England .


Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5years .


Uptake among those invited is lower than anticipated .


The project is a three-arm randomized controlled trial to test the hypothesis that enhanced invitation methods , using the Question-Behaviour Effect ( QBE ) , will increase uptake of NHS Health Checks compared with a standard invitation .


Participants comprise individuals eligible for an NHS Health Check registered in two London boroughs .


Participants are randomized into one of three arms .


Group A receives the standard NHS Health Check invitation letter , information sheet , and reminder letter at 12weeks for nonattenders .


Group B receives a QBE questionnaire 1week before receiving the standard invitation , information sheet , and reminder letter where appropriate .


Group C is the same as Group B , but participants are offered a 5 retail voucher if they return the questionnaire .


Participants are randomized in equal proportions , stratified by general practice .


The primary outcome is uptake of NHS Health Checks 6months after invitation from electronic health records .


We will estimate the incremental health service cost per additional completed Health Check for trial groups B and C versus trial arm A , as well as evaluating the impact of the QBE questionnaire , and questionnaire plus voucher , on the socioeconomic inequality in uptake of Health Checks.The trial includes a nested comparison of two methods for implementing allocation , one implemented manually at general practices and the other implemented automatically through the information systems used to generate invitations for the Health Check .


The research will provide evidence on whether asking individuals to complete a preliminary questionnaire , by using the QBE , is effective in increasing uptake of Health Checks and whether an incentive alters questionnaire return rates as well as uptake of Health Checks .


The trial interventions can be readily translated into routine service delivery if they are shown to be cost-effective .


Current Controlled Trials ISRCTN42856343 .


Date registered : 21.03.2013 .


To compare the difference in the clinical efficacy on posterior circulation ischemia between acupuncture at stellate ganglion and conventional acupuncture as well as the impacts on blood pressure .


Eighty cases of posterior circulation ischemia were randomized into an observation group ( 40 cases ) and a control group ( 40 cases ) .


In the observation group , acupuncture was applied to the bilateral stellate ganglions on the neck , stimulated with reinforcing technique by rotating the needles .


In the control group , the acupuncture of reducing technique was applied to Fengchi ( GB 20 ) , Baihui ( GV 20 ) , Neiguan ( PC 6 ) and Taichong ( LR 3 ) in the excess syndrome .


The even needling or reinforcing technique was applied to Fengchi ( GB 20 ) , Baihui ( GV 20 ) , Ganshu ( BL 18 ) , Shenshu ( BL 23 ) and Zusanli ( ST 36 ) for the deficiency syndrome .


The treatment was given once every 3 days and 4 treatments were required totally in the two groups .


The changes in total syndrome score , peak Systolic blood flow velocity ( Vp ) of vertebral artery and basilar artery , systolic and diastolic blood pressures were compared before and after treatment in the two groups .


The clinical efficacy was compared between the two groups .


The total syndrome score was reduced apparently after treatment compared with that before treatment in the two groups ( P < 0.01 ) , and the reducing was more obvious in the observation group as compared with that in the control group ( P < 0.01 ) .


The total effective rate was 87.5 % ( 35/40 ) in the observation group , higher than 67.5 % ( 27/40 , P < 0.05 ) in the control group .


After treatment , the reduced Vp of vertebral artery was not improved apparently as compared with that before treatment in the control group , Vp in blood velocity abnormality ( including vascular spasm , stenosis or reduced velocity ) of vertebral artery and basilar artery was all improved as compared with that before treatment in the two groups ( P < 0.01 ) , and the improvements in the observation group were more obvious than those in the control group ( P < 0.01 ) .


After treatment , the systolic and diastolic pressures were reduced as compared with those before treatment in the two groups , and the reduced systolic and diastolic pressures in the observation group were more apparent than those in the control group ( P < 0.01 ) .


Acupuncture at stellate ganglion achieves the satisfactory efficacy in the treatment of posterior circulation ischemia and the significant efficacy of reducing blood pressure , more advanced than the conventional acupuncture .


To compare self-reported physical activity recorded in physical activity diaries or the Active Australia Survey with objectively measured physical activity using accelerometry in sedentary middle-aged adults completing two physical activity interventions .


Cross-sectional study .


Sedentary 50-65 year olds were recruited to a non-randomized 6-month community group exercise program ( G ) or a physiotherapist-led home-based physical activity program ( HB ) .


Over 7-days , 76 participants ( HB 39 , G 37 ) wore an ActiGraph GT1M accelerometer ( 5s epochs ) , completed the Active Australia Survey ( AAS ) and a daily physical activity diary .