The non-Internet access ( NIA ) group consisted of patients who had access to the Internet-based glaucoma care support system during the 4-year period only when they were examined by ophthalmologists .


The Internet access ( IA ) group consisted of patients who had the same Internet-based glaucoma care support system access as the NIA group for the first 2 years following enrollment but who were also given free access to the glaucoma care support system for the remaining 2 years .


Changes in glaucoma medication use were investigated .


In total , 81 patients in the IA group and 90 patients in the NIA group satisfied the study protocol .


The number of antiglaucoma ophthalmic solutions used during the study period significantly increased in the NIA group ( P < .03 ) but not in the IA group .


The percentages of patients with unchanged , increased , and decreased antiglaucoma ophthalmic solution use during the study period were 61.1 % ( 55/90 ) , 17.8 % ( 16/90 ) , and 3.3 % ( 3/90 ) , respectively , in the NIA group , and 56.8 % ( 46/81 ) , 8.6 % ( 7/81 ) , and 13.6 % ( 11/81 ) , respectively , in the IA group ( P < .001 ) .


Internet access significantly shifted from an increasing intraocular pressure trend to a decreasing trend in the IA group ( P = .002 ) among the patients who did not have any medication changes .


Allowing patients to browse their medical data may reduce the use and improve the effectiveness of glaucoma medication .


UMIN-CTR Clinical Trial Number : UMIN000006982 ; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000008238&language=E ( Archived by WebCite at http://www.webcitation.org/6MRPQeEAv ) .


To confirm the superiority of transdermal rotigotine up to 16mg/24h over placebo , and non-inferiority to ropinirole , in Japanese Parkinson 's disease ( PD ) patients on concomitant levodopa therapy .


This trial was a randomized , double-blind , double-dummy , three-arm parallel group placebo - and ropinirole-controlled trial .


Four-hundred and twenty PD patients whose motor symptoms were not well controlled by levodopa treatment were randomized 2:2:1 to receive rotigotine , ropinirole ( up to 15mg/day ) or placebo during a 16-week treatment period followed by a 4-week taper period .


The primary variable was change in the Unified Parkinson 's Disease Rating Scale ( UPDRS ) Part III ( ON state ) sum score from baseline to the end of the treatment period .


The difference in the change in the UPDRS Part III ( ON state ) sum score from baseline to the end of treatment between rotigotine and placebo groups was-6 .41.2 ( 95 % CI : -8.7 to-4 .1 ; p < 0.001 ) , indicating superiority of rotigotine over placebo .


The difference between rotigotine and ropinirole groups was-1 .41.0 ( 95 % CI : -3.2 to 0.5 ) , below the non-inferiority margin , indicating the non-inferiority of rotigotine to ropinirole .


Application site reaction was seen in 57.7 % of the patients in the rotigotine group and in 18.6 % in the ropinirole group ( P < 0.001 ) .


No other safety issue was noted .


Rotigotine was well tolerated at doses up to 16mg/24h and showed similar efficacy to ropinirole except that the application site reaction was much higher in the rotigotine group .


Ultrasound-guided foam sclerotherapy and endovenous laser ablation are widely used alternatives to surgery for the treatment of varicose veins , but their comparative effectiveness and safety remain uncertain .


In a randomized trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom , we compared the outcomes of foam , laser , and surgical treatments .


Primary outcomes at 6 months were disease-specific quality of life and generic quality of life , as measured on several scales .


Secondary outcomes included complications and measures of clinical success .


After adjustment for baseline scores and other covariates , the mean disease-specific quality of life was slightly worse after treatment with foam than after surgery ( P = 0.006 ) but was similar in the laser and surgery groups .


There were no significant differences between the surgery group and the foam or the laser group in measures of generic quality of life .


The frequency of procedural complications was similar in the foam group ( 6 % ) and the surgery group ( 7 % ) but was lower in the laser group ( 1 % ) than in the surgery group ( P < 0.001 ) ; the frequency of serious adverse events ( approximately 3 % ) was similar among the groups .


Measures of clinical success were similar among the groups , but successful ablation of the main trunks of the saphenous vein was less common in the foam group than in the surgery group ( P < 0.001 ) .


Quality-of-life measures were generally similar among the study groups , with the exception of a slightly worse disease-specific quality of life in the foam group than in the surgery group .


All treatments had similar clinical efficacy , but complications were less frequent after laser treatment and ablation rates were lower after foam treatment .


( Funded by the Health Technology Assessment Programme of the National Institute for Health Research ; Current Controlled Trials number , ISRCTN51995477 . )


The purpose of the present study was to determine whether lamivudine in combination with transarterial chemoembolization ( TACE ) could reduce hepatitis B virus ( HBV ) activation and improve the survival of patients with hepatocellular carcinoma ( HCC ) .


From July 2008 to October 2011 , a total of 181 consecutive HBV-related HCC patients undergoing TACE were randomized to two groups ( 92 : lamivudine , 89 : control ) .


Follow up was every 3 months .


Primary and secondary end-points were time to progression ( TTP ) and overall survival ( OS ) , respectively , both of which were evaluated by the Kaplan Meier technique and summarized by the hazard ratio .


The level of HBV-DNA became undetectable in 42 ( 45.6 % ) patients in the lamivudine group , compared with 10 ( 11.2 % ) in the control group ( P < 0.001 ) .


The median TTP was 8.2 months in lamivudine group and 4.3 months in control group ( P = 0.005 ) , and lamivudine therapy was an independent protective factor related to TTP ( P = 0.006 ) .


Moreover , 1 - , 2 - , and 3-year survival rates were 83 % , 69 % , and 58 % in lamivudine group and 60 % , 48 % , and 48 % in control group , respectively ( P = 0.002 ) .


With multivariate Cox regression model , lamivudine therapy ( P = 0.002 ) and - fetoprotein ( AFP ) level ( P = 0.003 ) were two independent predictors for OS .


Lamivudine therapy could reduce HBV activation and improve survival of HCC patients treated with TACE .


Lamivudine therapy and AFP level are two independent factors affecting OS .


Pharyngocutaneous fistula is a common complication of total laryngectomy .


We hypothesized that perioperative proton pump inhibitor ( PPI ) treatment could reduce the incidence of pharyngocutaneous fistulae .


This prospective placebo-controlled double-blind randomized controlled trial compared PPI treatment ( 14 days enteral omeprazole ) with a placebo in patients undergoing primary total laryngectomy .


Forty patients were randomized into PPI ( n = 21 ) and placebo arms ( n = 19 ) .


One of 21 patients receiving omeprazole developed a fistula in comparison to 6 of 19 patients in the placebo group ( p = .04 ) .


No other statistically significant risk factors for pharyngocutaneous fistula were identified .


The mean hospital stay of patients with and without a fistula was 32 and 7.5 days , respectively .


Pharyngocutaneous fistulae result in prolonged hospitalization and morbidity .


We observed a statistically significant reduction in fistulae with PPI prophylaxis .


Further research to better define the role of reflux and antacid management is suggested .


The aim of this study was to determine the possible existence of a correlation between the gastric transit time ( GTT ) measured by video capsule endoscopy ( VCE ) and the parameters of gastric emptying determined using 13C breath test ( BreathID system ) .


Eight healthy male volunteers participated in this randomized , two-way crossover study .


The subjects were randomly assigned to undergo VCE using the PillCam SB capsule endoscopy system or the 13C breath test for 4 hours after a test meal ( 400 kcal per 400 mL ) containing 100 mg of 13C acetic acid administered after overnight fasting .


The VCE images were analyzed and the GTT was determined using the proprietary RAPID software .


The parameters , namely T lag , T 1/2 and GEC were calculated using the Oridion Research Software ( version ) .


The GTT measured by VCE and the parameters of gastric emptying were compared statistically .


No significant correlation was observed between the GTT and T lag ( p = 0.5263 ) , T 1/2 ( p = 0.4100 ) or GEC ( p = 0.2410 ) , as determined by calculation of the Spearmans rank correlation coefficient .


GTT measured by VCE can not serve as asubstitute for the gastric emptying time measured bythe 13C breath test .


The efficacy of brace application for the treatment of osteoporotic compression fractures remains unclear .


The purpose of this study was to compare the treatment outcomes in patients with osteoporotic compression fractures with regard to whether the patients had no braces , rigid braces , or soft braces .


We randomly assigned sixty patients with acute one-level osteoporotic compression fractures within three days of injury to the no-brace , soft-brace , and rigid-brace groups through 1:1:1 allocation .


The primary outcome was the baseline adjusted Oswestry Disability Index score at twelve weeks after compression fracture .


The non-inferior margin of the Oswestry Disability Index was set at an average of 10 points .


The baseline adjusted Oswestry Disability Index score at twelve weeks after compression fracture in the no-brace group was not inferior to that in the soft-brace or rigid-brace groups .


The mean adjusted Oswestry Disability Index score was 35.95 points ( 95 % confidence interval , 25.42 to 46.47 points ) in the no-brace group and 37.83 points ( 95 % confidence interval , 26.77 to 48.90 points ) in the soft-brace group , with a difference of -1.88 points ( 95 % confidence interval , -7.02 to 9.38 points ) between the groups .


Similarly , the mean adjusted Oswestry Disability Index score was 35.95 points ( 95 % confidence interval , 25.42 to 46.47 points ) in the no-brace group and 33.54 points ( 95 % confidence interval , 23.79 to 43.29 points ) in the rigid-brace group , with a difference of 2.41 points ( 95 % confidence interval , -7.86 to 9.27 points ) between the groups .


During the follow-up assessment period , there was no significant difference among the groups for the overall Oswestry Disability Index scores ( p = 0.260 ) , visual analog scale for pain scores for back pain ( p = 0.292 ) , and anterior body compression ratios ( p = 0.237 ) .


However , the Oswestry Disability Index scores and the visual analog scale scores for back pain significantly improved with time after the fractures ( p < 0.001 ) , and the body compression ratios significantly decreased with time in all three groups ( p < 0.001 ) .


The Oswestry Disability Index scores for the treatment of compression fractures without a brace were not inferior to those with soft or rigid braces .


Moreover , the improvement in back pain and progression of anterior body compression were similar among the three groups .


Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence .


Present guidelines emphasise the importance of low concentrations of LDL cholesterol ( LDL-C ) in patients with familial hypercholesterolaemia .


In most patients with the disease , however , these concentrations are not achieved with present treatments , so additional treatment is therefore warranted .


Inhibition of cholesteryl ester transfer protein has been shown to reduce LDL-C concentrations in addition to regular statin treatment in patients with hypercholesterolaemia or at high risk of cardiovascular disease .


We aimed to investigate the safety and efficacy of anacetrapib , a cholesteryl ester transfer protein inhibitor , in patients with heterozygous familial hypercholesterolaemia .


In this multicentre , randomised , double-blind , placebo-controlled , phase 3 study , patients aged 18-80 years with a genotype-confirmed or clinical diagnosis of heterozygous familial hypercholesterolaemia , on optimum lipid-lowering treatment for at least 6 weeks , and with an LDL-C concentration of 259 mmol/L or higher without cardiovascular disease or 181 mmol/L or higher with cardiovascular disease from 26 lipid clinics across nine countries were eligible .


We randomly allocated participants with a computer-generated allocation schedule ( 2:1 ; block size of six ; no stratification ) to oral anacetrapib 100 mg or placebo for 52 weeks , with a 12 week post-treatment follow-up afterwards .


We masked patients , care providers , and those assessing outcomes to treatment groups throughout the study .


The primary outcome was percentage change from baseline in LDL-C concentration .


We did analysis using a constrained longitudinal repeated measures model .


This trial is registered with ClinicalTrials.gov , number NCT01524289 .


Between Feb 10 , 2012 , and Feb 12 , 2014 , we randomly allocated 204 patients to anacetrapib and 102 to placebo .


One patient in the anacetrapib group did not receive the drug .


At week 52 , anacetrapib reduced mean LDL-C concentration from 33 mmol/L ( SD 08 ) to 21 mmol/L ( 08 ; percentage change 360 % [ 95 % CI -395 to -325 ] compared with an increase with placebo from 34 mmol/L ( 12 ) to 35 mmol/L ( 16 ; percentage change 37 % [ -12 to 86 ] , with a difference in percentage change between anacetrapib and placebo of -397 % ( 95 % CI -457 to -337 ; p < 00001 ) .


The number of cardiovascular events was increased in patients given anacetrapib compared with those given placebo ( 4 [ 2 % ] of 203 vs none [ 0 % ] of 102 ; p = 01544 ) , but the proportion with adverse events leading to discontinuation was similar ( 12 [ 6 % ] of 203 vs five [ 5 % ] of 102 ) .


In patients with heterozygous familial hypercholesterolaemia , treatment with anacetrapib for 1 year was well tolerated and resulted in substantial reductions in LDL-C concentration .


Whether this change leads to a reduction of cardiovascular events will be answered in an outcome study .


Merck & Co , Inc. .


To observe the clinical efficacy on pain in postmenopausal osteoporosis treated with the warm acupuncture therapy and discuss its effect mechanism .


Ninety cases of postmenopausal osteoporosis were randomized into a warm acupuncture group , an electroacupuncture group and a medication group , 30 cases in each group .


In the warm acupuncture group and the electroacupuncture group , Dazhu ( BL 11 ) , Shenshu ( BL 23 ) and Xuanzhong ( GB 39 ) were selected bilaterally and stimulated with the warm acupuncture and electroacupuncture therapies respectively , once a day for 30 days totally .


In the medication group , caltrate-D tablets were prescribed , 600 mg , once a day for 30 days totally .


The changes in the bone density T value , visual analogue scale ( VAS ) score , serum insulin like growth factor 1 ( IGF-1 ) , interleukin 6 ( IL-6 ) and tumor necrosis factor ( TNF-alpha ) were observed before and after treatment in the three groups .


( 1 ) The bone density T value in the patients of postmenopausal osteoporosis did not change obviously after 30 days treatment with the three therapies ; ( 2 ) VAS score was all reduced after treatment , in which , the result in the warm acupuncture group was the most obvious ( 6.73 + / - 0.24 before treatment vs 4.43 + / - 0.26 after treatment ) .


The value after treatment in the warm acupuncture group was different significantly as compared with the electroacupuncture group ( 5.13 + / - 0.31 ) and the medication group ( 5.17 + / - 0.33 , both P < 0.05 ) .


( 3 ) The level of serum IGF-1 was improved after treatment in the warm acupuncture therapy [ ( 119.5 + / - 20.1 ) ng/mL before treatment vs ( 156.5 + / - 23.9 ) ng/mL after treatment ] , which was more apparent as compared with the electroacupuncture group [ ( 136.3 + / - 24.5 ) ng/mL ] and the medication group [ ( 127.7 + / - 22.1 ) ng/mL , all P < 0.05 ] .


Concerning to reducing the levels of IL-6 and TNF-alpha in serum , the results in the warm acupuncture group were superior to the other two groups ( all P < 0.05 ) .


The warm acupuncture therapy achieves the significant efficacy on pain in postmenopausal osteoporosis , which could be related to increasing the level of IGF-1 , decreasing the levels of IL-6 and TNF-alpha , promoting bone formation and inhibting bone absorption .


Endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA ) is superior to conventional transbronchial needle aspiration ( cTBNA ) in the staging of lung cancer .


However , its efficiency in diagnosis of sarcoidosis when combined with endobronchial biopsy ( EBB ) and transbronchial lung biopsy ( TBLB ) has not been studied .


This randomized controlled trial compares diagnostic yield of EBUS-TBNA vs cTBNA in combination with EBB and TBLB .


Patients with clinical diagnosis of sarcoidosis were randomized 1:1 to EBUS-TBNA or cTBNA .


All patients underwent TBLB and EBB .


The primary outcome was detection of granulomas .


The secondary end points were the individual and cumulative yields of various procedures , serious adverse events , and procedure time .


Of the 130 patients , sarcoidosis was diagnosed in 117 ( 62 cTBNA , 55 EBUS-TBNA ) .


The two groups were similar at baseline .


Granulomas were demonstrated in 104 ( 53 cTBNA , 51 EBUS-TBNA ) patients and were similar in two groups ( 85.5 % vs 92.7 % , P = .34 ) .


Individually , EBUS-TBNA had the highest yield ( 41 of 55 , 74.5 % ) , which was better than cTBNA ( 30 of 62 , 48.4 % , P = .004 ) or EBB ( 40 of 111 , 36.3 % , P < .0001 ) but not TBLB ( 78 of 112 , 69.6 % , P = .54 ) .


Adding EBB/TBLB to cTBNA led to an increase in granuloma detection , whereas the addition of TBLB ( but not EBB ) significantly enhanced the yield of EBUS-TBNA .


The procedure time was significantly longer with EBUS-TBNA .


No major adverse events occurred .


Individually , EBUS-TBNA has the highest diagnostic yield in sarcoidosis , but it should be combined with TBLB for the optimal yield .


The diagnostic yield of cTBNA ( plus EBB and TBLB ) is similar to EBUS-TBNA plus TBLB .


ClinicalTrials.gov ; No. : NCT01908868 ; URL : www.clinicaltrials.gov .


Pharmacological inhibition of the renin-angiotensin-aldosteron system ( RAAS ) may have a beneficial impact on proteinuria and chronic kidney diseases ( CKD ) progression .


Despite recent progress by means of angiotensin-converting enzyme inhibitors ( ACEI ) and angiotensin II receptor blockers ( ARB ) , there is still no optimal therapy which can stop progression of the nephropathy .


Recently introduced aliskiren is the first orally bioavailable direct renin inhibitor approved for the treatment of hypertension .


The purpose was to evaluate the extent of oxidative stress and tubular injury after the direct renin inhibitor , aliskiren compared with placebo and perindopril in patients with non-diabetic chronic kidney disease ( NDCKD ) .


A randomized , double-blind , cross-over trial was performed in 14 patients receiving 300mg aliskiren , 10mg perindopril and placebo in random order .


The end point was a change in the urinary excretion of N-acetyl -- D-glucosaminidase ( NAG ) and 1-microglobulin ( 1m ) and 15-F ( 2 ) - isoprostane .


Aliskiren reduced excretion of 15-F ( 2 ) - isoprostane ( p = 0.03 ) and 1m ( p = 0.01 ) as compared to placebo .


There were no differences between aliskiren and perindopril in this regard .


NAG urine excretion did not change after aliskiren and perindopril .


Aliskiren attenuates oxidative stress and may improve functional status of tubules in patients with NDCKD .


This phase 3 study evaluated the endometrial safety of bazedoxifene ( BZA ) / conjugated estrogens ( CE ) and bone mineral density ( BMD ) effects vs BZA alone , hormone therapy , and placebo ( PBO ) .


The Selective estrogens , Menopause , And Response to Therapy ( SMART ) -5 trial was a multicenter , randomized , double-blind , PBO - and active-controlled study in postmenopausal women with an intact uterus ( N = 1843 ; aged 40-65 years ) seeking treatment for menopausal symptoms .


Subjects received daily oral BZA 20 mg/CE 0.45 or 0.625 mg , BZA 20 mg , CE 0.45 mg/medroxyprogesterone acetate ( MPA ) 1.5 mg , or PBO .


Primary endpoints were incidence of endometrial hyperplasia and percent change in lumbar spine BMD at 12 months .


Secondary endpoints included additional osteoporosis parameters and assessments of tolerability and safety .


At 12 months , endometrial hyperplasia incidence was low ( < 1 % ) and similar among groups .


The BZA/CE group showed significantly greater increases in lumbar spine and total hip BMD vs decreases with PBO ( P < .001 ) ; the CE/MPA group had increased lumbar spine BMD compared with that in the BZA/CE group .


The BZA 20 mg/CE 0.45 and 0.625 mg groups had cumulative amenorrhea rates similar to those with PBO and BZA and significantly higher than those with CE 0.45 mg/MPA 1.5 mg ( P < .001 ) .


The incidence of breast tenderness with BZA/CE was similar to that with PBO and BZA and significantly lower than with that with CE/MPA ( P < .01 ) .


Although adverse event ( AE ) rates were similar among the groups , the incidence of serious AEs overall and AE-related discontinuation rates were higher with CE/MPA than with BZA/CE , BZA , or PBO .


BZA/CE showed low rates of endometrial hyperplasia and improved lumbar spine and total hip BMD and was generally safe and well tolerated .


A pre-planned substudy of a larger multicenter randomized trial was undertaken to compare the efficacy of everolimus with reduced-dose cyclosporine in the prevention of cardiac allograft vasculopathy ( CAV ) after heart transplantation to that of mycophenolate mofetil ( MMF ) with standard-dose cyclosporine .


CAV is a major cause of long-term mortality following heart transplantation .


Everolimus has been shown to reduce the severity and incidence of CAV as measured by first year intravascular ultrasound ( IVUS ) .


MMF , in combination with cyclosporine , has also been shown to have a beneficial effect in slowing the progression of CAV .


Study patients were a pre-specified subgroup of the 553-patient Everolimus versus mycophenolate mofetil in heart transplantation : a randomized , multicenter trial who underwent heart transplantation and were randomized to everolimus 1.5 mg or MMF 3 g/day .


IVUS was performed at baseline and at 12 months .


Evaluable IVUS data were available in 189 patients ( 34.6 % ) .


Increase in average maximal intimal thickness ( MIT ) from baseline to month 12 was significantly smaller in the everolimus 1.5 mg group compared with the MMF group ( 0.03 mm vs. 0.07 mm , p < 0.001 ) .


The incidence of CAV , defined as an increase in MIT from baseline to month 12 of greater than 0.5 mm , was 12.5 % with everolimus versus 26.7 % with MMF ( p = 0.018 ) .


These findings remained irrespective of sex , age , diabetic status , donor disease , and across lipid categories .


Everolimus was significantly more efficacious than MMF in preventing CAV as measured by IVUS among heart-transplant recipients after 1 year , a finding , which was maintained in a range of patient subpopulations .


CV surgery : transplantation , ventricular assistance , cardiomyopathy .


The prevalence of severe and complex obesity is increasing worldwide and surgery may offer an effective and lasting treatment .


Laparoscopic adjustable gastric band and Roux-en-Y gastric bypass surgery are the two main surgical procedures performed .


This open parallel-group randomised controlled trial will compare the effectiveness , cost-effectiveness and acceptability of gastric band ( Band ) versus gastric bypass ( Bypass ) in adults with severe and complex obesity .


It has an internal pilot phase ( in two centres ) with integrated qualitative research to establish effective and optimal methods for recruitment .


Adults with a body mass index ( BMI ) of 40 kg/m2 or more , or a BMI of 35 kg/m2 or more and other co-morbidities will be recruited .


At the end of the internal pilot the study will expand into more centres if the pre-set progression criteria of numbers and rates of eligible patients screened and randomised are met and if the expected rates of retention and adherence to treatment allocation are achieved .


The trial will test the joint hypotheses that Bypass is non-inferior to Band with respect to more than 50 % excess weight loss and that Bypass is superior to Band with respect to health related quality of life ( HRQOL , EQ-5D ) at three years .


Secondary outcomes include other weight loss measures , waist circumference and remission/resolution of co-morbidities ; generic and symptom-specific HRQOL ; nutritional blood test results ; resource use ; eating behaviours and adverse events .


A core outcome set for reporting the results of obesity surgery will be developed and a systematic review of the evidence for sleeve gastrectomy undertaken to inform the main study design .


By-Band is the first pragmatic study to compare the two most commonly performed bariatric surgical procedures for severe and complex obesity .


The design will enable and empower surgeons to learn to recruit and participate in a randomised study .


Early evidence shows that timely recruitment is possible .


Current Controlled Trials ISRCTN00786323 .


To document the effects of two doses of dexmedetomidine on the induction characteristics and dose requirements of alfaxalone .


Randomized controlled clinical trial .


Sixty one client owned dogs , status ASA I-II .


Dogs were allocated randomly into three groups , receiving as pre-anaesthetic medication , no dexmedetomidine ( D0 ) , 1 g kg ( -1 ) dexmedetomidine ( D1 ) intramuscularly ( IM ) or 3 g kg ( -1 ) dexmedetomidine IM ( D3 ) .


All dogs also received 0.2 mg kg ( -1 ) methadone IM .


Level of sedation was assessed prior to induction of anaesthesia .


Induction of general anaesthesia was performed with alfaxalone administered intravenously to effect at a rate of 1 mg kg ( -1 ) minute ( -1 ) ; the required dose to achieve tracheal intubation was recorded .


Anaesthesia was maintained with isoflurane in oxygen .


Cardiopulmonary parameters were recorded throughout the anaesthetic period .


Quality of intubation , induction and recovery of anaesthesia were recorded .


Quantitative data were compared with one-way anova or Kruskal-Wallis test .


Repeated measures were log-transformed and analysed with repeated measures anova ( p < 0.05 ) .


Treatment groups were similar for categorical data , with exception of sedation level ( p < 0.001 ) .


The doses ( mean SD ) of alfaxalone required for intubation were D0 1.68 0.24 , D1 1.60 0.36 and D3 1.41 0.43 , the difference between D0 and D3 being statistically significant ( p = 0.036 ) .


Heart and respiratory rates during the anaesthetic period were significantly different over time and between groups ( p < 0.001 ) ; systolic arterial blood pressure was significantly different over time ( p < 0.001 ) but not between groups ( p = 0.833 ) .


Induction quality and recovery scores were similar between groups ( p = 1.000 and p = 0.414 , respectively ) .


The administration of alfaxalone resulted in a good quality anaesthetic induction which was not affected by the dose of dexmedetomidine .


Dexmedetomidine at 3 g kg ( -1 ) IM combined with methadone provides good sedation and enables a reduction of alfaxalone requirements .


To observe the clinical efficacy of multiple sclerosis ( MS ) treated with electroacupuncture and acupoint injection .


The block randomization method was used to divide 40 cases into an electroacupuncture ( EA ) group and an EA + acupoint injection ( AI ) group , 20 cases in each one .


In the EA group , EA was used at corresponding Jiaji ( EX-B 2 ) , Weizhong ( BL 40 ) , Chengshan ( BL 57 ) , etc. .


In the EA + AI group , on the basis of EA , the acupoint injection of mouse nerve growth factor was supplemented .


The activity of daily life ( ADL ) and expanded disability status score ( EDSS ) were observed in the two groups before and after treatment for the evaluation of the efficacy .


The efficacy was achieved on MS after treatment in both groups ( P < 0.01 ) .


After treatment , the scores of EDSS and Barthel index were ( 3.01 + / - 1.31 ) and ( 83.11 + / - 8.45 ) in the EA + AI group , which were better than those of ( 4.23 + / - 1.21 ) and ( 75.25 + / - 6.25 ) in the EA group ( both P < 0.01 ) .


EA and AI co-act on reducing disability and improving the life quality in the treatment of MS and have achieved coordinately the significant effects .


Athletic taping skills are highly valued clinical competencies in the athletic therapy and training profession .


The Technical Skill Assessment Instrument ( TSAI ) has been content validated and tested for intrarater reliability .


To test the reliability of the TSAI using a more robust measure of reliability , generalizability theory , and to hypothetically and mathematically project the optimal number of raters and scenarios to reliably measure athletic taping skills in the future .


Mount Royal University .


Observational study .


A total of 29 university students ( 8 men , 21 women ; age = 20.79 1.59 years ) from the Athletic Therapy Program at Mount Royal University .


Participants were allowed 10 minutes per scenario to complete prophylactic taping for a standardized patient presenting with ( 1 ) a 4-week-old second-degree ankle sprain and ( 2 ) a thumb that had been hyperextended .


Two raters judged student performance using the TSAI .


Generalizability coefficients were calculated using variance scores for raters , participants , and scenarios .


A decision study was calculated to project the optimal number of raters and scenarios to achieve acceptable levels of reliability .


Generalizability coefficients were interpreted the same as other reliability coefficients , with 0 indicating no reliability and 1.0 indicating perfect reliability .


The result of our study design ( 2 raters , 1 standardized patient , 2 scenarios ) was a generalizability coefficient of 0.67 .


Decision study projects indicated that 4 scenarios were necessary to reliably measure athletic taping skills .


We found moderate reliability coefficients .


Researchers should include more scenarios to reliably measure athletic taping skills .


They should also focus on the development of evidence-based practice guidelines and standards of athletic taping and should test those standards using a psychometrically sound instrument , such as the TSAI .


Nearly all clinical trials investigating patients with pulmonary arterial hypertension ( PAH ) have used the 6-min walk test ( 6MWT ) to evaluate exercise tolerance .


The incremental shuttle walk test ( SWT ) , however , has been proposed as a more valid and reproducible alternative to the 6MWT in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease .


The efficacy of SWT in clinical practice to evaluate the exercise capacity of patients with PAH was investigated .


The peak oxygen consumption ( pVO2 ) and oxygen consumption at anaerobic threshold ( VO2 at AT ) , the gold standard for measurement of exercise tolerance , 6MWT and SWT were measured in 19 clinically stable PAH patients ( WHO functional class II-III ) and the data compared .


There was a higher correlation between SWT walk distance and pVO2 than between 6MWT walk distance and pVO2 ( r = 0.866 and 0.765 , respectively ; P < 0.05 ) , and a higher correlation between SWT walk distance and VO2 at AT than between 6MWT walk distance and VO2 at AT ( r = 0.775 and 0.587 , respectively ; P < 0.05 ) .


No adverse events occurred during the exercise tests .


SWT is a better reflection than 6MWT of exercise tolerance in PAH patients , and thus is a preferable alternative for assessment of exercise tolerance in PAH patients .


The development of troponin assays with increased diagnostic sensitivity and greater analytic precision has improved the diagnosis of myocardial infarction in high risk patients .


However for those patients at intermediate or low risk in whom a small troponin rise is detected , a cascade of clinical decisions and investigations could result ; potentially having uncertain impact on recurrent ischemic events and increasing bleeding risk and resource utilization .


Clinical equipoise remains as to the clinical utility of high sensitivity troponin .


We designed a pragmatic randomized clinical trial to evaluate the short and long term clinical impact and resource implications of high sensitivity 5th generation troponin T reporting compared with 4th generation troponin T reporting .


Two thousand patients presenting with a suspected acute coronary syndrome were randomized and risk stratified in 5 metropolitan emergency departments in South Australia , Australia .


Clinical events occurring after the first 24 h and within 30 days were assessed as the primary endpoint with subsequent events evaluated at 6 and 12 months .


The true translational benefits of innovations in diagnostic testing need to be evaluated in robust clinical trials as they can be costly to introduce and the adoption process often focuses on sensitivity and specificity at the expense of measuring improvements in clinical outcome .


The results of this study will provide valuable information on contemporary patterns of troponin utilization on the heterogeneous population of chest pain patients presenting to emergency departments , while providing important information from the clinical practice setting for health administrators , government and policy makers .


Tenofovir disoproxil fumarate ( TDF ) is active against lamivudine-resistant hepatitis B virus ( HBV ) infection , but data to support its clinical efficacy in this setting are limited .


In a prospective , double-blind , 96-week trial , patients were randomly assigned ( 1:1 ) to groups given TDF ( 300 mg , n = 141 ) or a combination of emtricitabine ( FTC , 200 mg ; n = 139 ) and TDF ( 300 mg , FTC/TDF ) .


Patients were hepatitis B e antigen ( HBeAg ) - positive or HBeAg-negative , with levels of HBV DNA 3 log10 IU/mL and lamivudine resistance mutations ( HBV polymerase or reverse transcriptase amino acid substitutions rtM204I/V rtL180M by INNO-LiPA Multi-DR v3 ; Innogenetics , Inc , Alpharetta , GA ) .


The primary end point was proportion with HBV DNA < 69 IU/mL ( Roche COBAS Taqman assay ; Roche Molecular Systems , Inc , Pleasanton , CA ) .


Patient groups were well matched for demographic and disease characteristics , including region ( 60 % from Europe ) , HBV genotype ( 45 % genotype D ) , HBeAg status ( 47 % HBeAg-positive ) , and duration of lamivudine treatment ( mean , 3.8 years ) .


At week 96 of treatment , 89.4 % of patients in the TDF group and 86.3 % in the FTC/TDF group had levels of HBV DNA < 69 IU/mL ( P = .43 ) .


HBeAg loss and seroconversion did not differ between groups ; only 1 patient ( 0.7 % ) in the FTC/TDF group lost hepatitis B surface antigen .


Treatment was well tolerated ; confirmed renal events ( creatinine increase of 0.5 mg/dL [ > 44 umol/L ] , creatinine clearance < 50 mL/min , or level of PO4 < 2 mg/dL [ < 0.65 mmol/L ] ) were generally mild and infrequent ( < 1 % ) .


Small reductions ( < 2 % ) in mean bone mineral density of hip and spine were detected by dual-energy x-ray absorptiometry in both groups .


No TDF resistance developed through 96 weeks of treatment .


TDF alone is safe and effective for treatment of patients with lamivudine-resistant , chronic HBV infection .


Clinical Trials.gov No , NCT00737568 .


The purpose of this study was to determine whether administration of postoperative antibiotics affects the incidence of complications after primary cleft palate repair in a developing area .


This study was a prospective , double-blind , randomized , placebo-controlled trial composed of 518 consecutive patients who underwent primary cleft palate repair at a single institution .


Patients were aged 1 to 43 years at the time of surgery ( median , 9 years ) .


The patients were divided randomly into two groups .


One group received a 5-day regimen of oral amoxicillin ( 50 mg/kg/day ) postoperatively and the other group received placebo medication .


Both groups received a single dose of cefuroxime ( 30 mg/kg ) before incision .


Patients and providers were blinded to the randomization .


Patients were followed postoperatively for early complications ( infection and wound breakdown ) and for late complications ( palatal fistulas ) .


The incidence of early complications was 13.8 percent among the patients in the placebo group and 8.7 percent among the patients in the antibiotic group ( p = 0.175 ) .


Fistulas were noted in 17.1 percent in the placebo group and in 10.7 percent in the antibiotic group ( p = 0.085 ) .


Logistic regression analysis identified visiting surgeons as the only covariate related to early complications ( OR , 3.71 ; p < 0.001 ) .


However , the use of placebo ( OR , 2.09 ; p = 0.037 ) , female sex ( OR , 2.04 ; p = 0.047 ) , and Veau III and IV ( OR , 3.31 ; p = 0.004 ) were observed as factors associated with the incidence of fistulas .


The authors ' results indicate that postoperative antibiotic prophylaxis can reduce the incidence of fistulas after primary cleft palate repair in a developing area .


To compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy .


A total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition ( FJI ) group ( 52 cases ) and Roux-en-Y ( R-Y ) group ( 57 cases ) .


The post-operative complications , nutritional status , and the quality of life were compared between two groups .


One , 3 and 6 months after operation , the incidence of R-S syndrome in FJI group was lower as compared to R-Y group [ 13 % ( 6/45 ) vs. 37 % ( 18/49 ) , 3 % ( 1/30 ) vs. 42 % ( 14/33 ) , 5 % ( 1/21 ) vs. 48 % ( 11/23 ) , all P < 0.01 ] , while 3 months after operation , the incidence of reflux and heartburn in FJI group was higher [ 53 % ( 16/30 ) vs. 21 % ( 7/33 ) , P < 0.01 ; 37 % ( 11/30 ) vs. 12 % ( 4/33 ) , P < 0.05 ] .


There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups .


QLQ-STO22 stomach module revealed in FJI group , the eating score was better , but reflux score was worse as compared to R-Y group 3 months after operation ( all P < 0.01 ) .


Functional jejunal interposition keeps intestinal continuity preserving and food duodenal passing , which is a reasonable digestive reconstruction procedure .


To compare central corneal swelling after eight hours of sleep in eyes wearing four different silicone hydrogel lenses with three different powers .


Twenty-nine neophyte subjects wore lotrafilcon A ( Dk , 140 ) , balafilcon A ( Dk , 91 ) , galyfilcon A ( Dk , 60 ) and senofilcon A ( Dk , 103 ) lenses in powers -3.00 , -10.00 and +6.00 D on separate nights , in random order , and on one eye only .


The contra-lateral eye ( no lens ) served as the control .


Central corneal thickness was measured using a digital optical pachometer before lens insertion and immediately after lens removal on waking .


For the +6.00 D and -10.00 D , lotrafilcon A induced the least swelling and galyfilcon A the most .


The +6.00 D power , averaged across lens materials , induced significantly greater central swelling than the -10.00 and -3.00 D ( Re-ANOVA , p < 0.001 ) , ( 7.72.9 % vs. 6.82.8 % and 6.52.5 % respectively ) but there was no difference between -10.00 and -3.00 D. Averaged for power , lotrafilcon A induced the least ( 6.22.8 % ) and galyfilcon A the most ( 7.63.0 % ) swelling at the center ( Re-ANOVA , p < 0.001 ) .


Central corneal swelling with +6.00 D was significantly greater than -10.00 D lens power despite similar levels of average lens transmissibility of these two lens powers .


The differences in corneal swelling of the lens wearing eyes are consistent with the differences in oxygen transmission of the silicone hydrogel lenses .


In silicone hydrogel lenses central corneal swelling is mainly driven by central lens oxygen transmissibility .


Zinc deficiency is common in children among populations in developing areas .


Zinc deficiency alters the immune system and the resistance to infections .


To evaluate the effect of two zinc compounds in the prevention of acute respiratory infection and acute diarrhea .


Randomized triple-blind community trial with 301 children between 2-5 years of age from six child daycare centers in Medellin , Colombia .


Children were distributed in three groups receiving zinc amino acid chelate , zinc sulfate and placebo five days a week for 16 weeks .


Daily symptoms of respiratory infection , acute diarrhea and side effects were evaluated .


The incidence of respiratory infection was lower with zinc amino acid chelate ( 1.42 per 1,000 child-days ) compared with placebo ( 3.3 per 1,000 child-days ) ( RR = 0.43 , 95 % CI : 0.196 to 0.950 , p = 0.049 ) and with zinc sulfate ( 1.57 per 1,000 child-days ) ( RR = 0.90 , 95 % CI 0.382 to 2.153 , p = 0.999 ) .


The incidence of acute diarrhea with zinc amino acid chelate ( 0.15 per 1,000 child-days ) was lower than with placebo ( 0.49 per 1,000 child-days ) ( RR = 0.32 , 95 % CI 0.006 to 3.990 , p = 0.346 ) and with zinc sulfate ( 0.78 per 1,000 child-days ) ( RR = 0.20 , 95 % CI : 0.0043 to 1.662 , p = 0.361 ) .


Zinc amino acid chelate had a better effect in reducing the incidence of acute respiratory infection and acute diarrhea in preschool children when compared with the other groups .


For maximum effect pre-exposure prophylaxis should be targeted to the subpopulations that account for the largest proportion of infections ( population-attributable fraction [ PAF ] ) and for whom the number needed to treat ( NNT ) to prevent infection is lowest .


We aimed to estimate the PAF and NNT of participants in the iPrEx ( Pre-Exposure Prophylaxis Initiative ) trial .


The iPrEx study was a randomised controlled efficacy trial of pre-exposure prophylaxis with coformulated tenofovir disoproxil fumarate and emtricitabine in 2499 men who have sex with men ( MSM ) and transgender women .


Participants aged 18 years or older who were male at birth were enrolled from 11 trial sites in Brazil , Ecuador , Peru , South Africa , Thailand , and the USA .


Participants were randomly assigned ( 1:1 ) to receive either a pill with active pre-exposure prophylaxis or placebo , taken daily .


We calculated the association between demographic and risk behaviour during screening and subsequent seroconversion among placebo recipients using a Poisson model , and we calculated the PAF and NNT for risk behaviour subgroups .


The iPrEx trial is registered with ClinicalTrials.gov , NCT00458393 .


Patients were enrolled between July 10 , 2007 , and Dec 17 , 2009 , and were followed up until Nov 21 , 2010 .


Of the 2499 MSM and transgender women in the iPrEx trial , 1251 were assigned to pre-exposure prophylaxis and 1248 to placebo .


83 of 1248 patients in the placebo group became infected with HIV during follow-up .


Participants reporting receptive anal intercourse without a condom seroconverted significantly more often than those reporting no anal sex without a condom ( adjusted hazard ratio [ AHR ] 511 , 95 % CI 155-1679 ) .


The overall PAF for MSM and transgender women reporting receptive anal intercourse without a condom was 64 % ( prevalence 60 % ) .


Most of this risk came from receptive anal intercourse without a condom with partners with unknown serostatus ( PAF 53 % , prevalence 54 % , AHR 476 , 95 % CI 144-1571 ) ; by contrast , the PAF for receptive anal intercourse without a condom with an HIV-positive partner was 1 % ( prevalence 1 % , AHR 711 , 95 % CI 070-7275 ) .


The overall NNT per year for the cohort was 62 ( 95 % CI 44-147 ) .


NNTs were lowest for MSM and transgender women self-reporting receptive anal intercourse without a condom ( NNT 36 ) , cocaine use ( 12 ) , or a sexually transmitted infection ( 41 ) .


Having one partner and insertive anal sex without a condom had the highest NNTs ( 100 and 77 , respectively ) .


Pre-exposure prophylaxis may be most effective at a population level if targeted toward MSM and transgender women who report receptive anal intercourse without a condom , even if they perceive their partners to be HIV negative .


Substance use history and testing for STIs should also inform individual decisions to start pre-exposure prophylaxis .


Consideration of the PAF and NNT can aid in discussion of the benefits and risks of pre-exposure prophylaxis with MSM and transgender women .


National Institute of Allergy and Infectious Diseases and the Bill & Melinda Gates Foundation .


Epidermal growth factor receptor ( EGFR ) mutation testing is standard practice after lung adenocarcinoma diagnosis , and provision of high-quality tumor tissue is ideal .


However , there are knowledge gaps regarding the utility of cytology or low tumor content histology samples to establish EGFR mutation status , particularly with regard to the proportion of testing performed using these sample types , and the lack of an established link with efficacy of treatment .


The randomized phase III Iressa Pan-ASia Study ( IPASS ; ClinicalTrials.gov identifier NCT00322452 ) of first-line gefitinib versus chemotherapy analyzed samples meeting preplanned specifications ( n = 437 evaluable for EGFR mutation ; n = 261 mutation-positive ) .


This supplementary analysis assessed tumor content and mutation status of histology ( n = 99 ) and cytology samples ( n = 116 ) which were previously unanalyzed due to sample quality , type , and tumor content ( < 100 cells ) .


Objective response rate ( ORR ) and change in tumor size with gefitinib treatment were assessed .


EGFR mutation testing was successful in 80 % and 19 % of previously unanalyzed histology and cytology samples , respectively .


Mutations were detected in 54 tumors previously described as mutation-unknown ( histology , n = 45 ; cytology , n = 9 ) .


ORRs in mutation-positive cytology ( 83 % ) and histology ( 74 % ) subgroups were consistent with previous analyses ( 71 % ) .


Tumor size decrease was consistent across previously analyzed and unanalyzed samples ( all mutation subgroups ) , with less consistency across ORRs in mutation-negative cytology ( 16 % ) and histology ( 25 % ) subgroups versus the previous analysis ( 1 % ) .


Histology samples with low tumor content and cytology samples can be used for EGFR mutation testing ; patients whose mutation status was confirmed using these sample types achieved a response to treatment consistent with those confirmed using high-quality histology samples .


Better sample quantity/quality can potentially reduce false-negative results .


The main objective was to evaluate two models of care for children and adolescents requiring hospitalization due to severe mental illness .


Model 1 : early discharge followed by a newly established home treatment service enhanced by clinical elements according to need ( BeZuHG ) ; Model 2 : admission to an inpatient unit ( TAU ) .


100 children and adolescents admitted to inpatient care were randomized to either a control group ( regular inpatient stay ) or an intervention group ( BeZuHG group ) .


Sociodemographic data , ICD-10 and DSM-IV diagnoses , health and social functioning , psychopathology , clinical impairment , and service use were assessed pre - and posttreatment regarding effectiveness , outcome , contact time , and acceptance within the families .


Clinical outcome in BeZuHG treatment was as effective as inpatient care .


There was a good acceptance within the families , family resources enhanced treatment outcome , and a significant reduction in length of inpatient stay could be shown .


The BeZuHG model should be a regular option in child and adolescent psychiatric care .


Further rigorous evaluation of the model is required : A 1-year follow-up investigating the stability of the shown effects is planned .


Examine how different dosing schedules and recent stimulant therapy effect incidence , time to onset , and duration of common treatment-emergent adverse events ( TEAEs ) during atomoxetine treatment .


Post hoc analyses including safety data ( open-ended questions ) from 22 pediatric and 3 adult atomoxetine trials ( 1998-2009 ) in patients with attention-deficit/hyperactivity disorder .


Most common TEAEs were determined by incidence rates and frequency of consumer and clinician inquiries .


Onset and duration of TEAEs with slow versus fast titration , once-daily versus twice-daily dosing , and previous stimulant exposure were compared among treatment groups using Kaplan-Meier methods .


In pediatric patients , the most commonly reported TEAEs were abdominal pain , decreased appetite , fatigue , nausea , somnolence , and vomiting ; time to onset of TEAEs was significantly shorter for once-daily versus twice-daily dosing for all TEAEs ( P .007 ) and for fast versus slow titration for abdominal pain , decreased appetite , and somnolence ( all P values .009 ) ; duration of TEAEs with once-daily dosing was significantly longer for decreased appetite ( P = .001 ) and nausea ( P = .041 ) ; and more common in stimulant-naive patients versus patients with prior stimulant use were abdominal pain , decreased appetite , and fatigue ( P .047 ) .


In adult patients , the most commonly reported TEAEs ( erectile dysfunction data were excluded ) were nausea , insomnia , decreased appetite , urinary hesitation/urinary retention , and fatigue ; insomnia had a significantly shorter time to onset and longer duration with twice-daily versus once-daily dosing ( P .032 ) and fast versus slow titration ( P .007 ) .


Time to onset and resolution of TEAEs appear dependent on dosing schedule and titration speed .


These findings can help to better manage tolerability issues and set appropriate expectations for clinicians and patients during atomoxetine titration , potentially improving treatment adherence and success .


To investigate the renoprotective effect of nicardipine in patients with pre-existing renal insufficiency undergoing robot-assisted laparoscopic radical prostatectomy ( RALRP ) .


Men with preoperative renal insufficiency ( estimated glomerular filtration rate [ eGFR ] < 60 ml/min per 1.73 m ( 2 ) ) were enrolled and randomized to receive either 0.5 g/kg per min nicardipine continuous infusion ( nicardipine group ) or normal saline ( control group ) during RALRP .


Renal function was determined by eGFR and serum creatinine concentration .


Serum creatinine levels on postoperative days ( POD ) 1 and 3 were significantly lower than baseline values in the nicardipine group ( n = 50 ) .


In the control group ( n = 50 ) , eGFR was significantly higher on POD 3 than baseline , and was significantly higher than baseline on POD 1 and 3 in the nicardipine group .


The change in eGFR from baseline to POD 1 was significantly higher in the nicardipine group than the control group .


Continuous infusion of nicardipine during RALRP improved postoperative renal function on POD 1 in patients with pre-existing renal insufficiency .


There are few comparative studies about the optimal method of pneumatic compression to prevent deep vein thrombosis ( DVT ) .


The aim of this prospective randomized study was to compare venous hemodynamic changes and their clinical influences between two graded sequential compression groups ( an alternate sequential compression device [ ASCD ] vs. a simultaneous sequential compression device [ SSCD ] ) .


In total , 34 patients ( 68 limbs ) undergoing knee and spine operations were prospectively randomized into two device groups ( ASCD vs. SSCD groups ) .


Duplex ultrasonography examinations were performed on the 4th and 7th postoperative days for the detection of DVT and the evaluation of venous hemodynamics .


Continuous data for the two groups were analyzed using a two-tailed , unpaired t-test .


Relative frequencies of unpaired samples were compared using Fisher exact test .


Mixed effects models that might be viewed as ANCOVA models were also considered .


DVT developed in 7 patients ( 20.6 % ) , all of whom were asymptomatic for isolated calf DVTs .


Two of these patients were from the ASCD group ( 11.8 % ) and the other five were from the SSCD group ( 29.4 % ) , but there was no significant difference ( p = 0.331 ) .


Baseline peak velocity , mean velocity , peak volume flow , and total volume flow were enhanced significantly in both device groups ( p < 0.001 ) .


However , the degrees of flow and velocity enhancement did not differ significantly between the groups .


The accumulated expelled volumes for an hour were in favor of the ASCD group .


Both graded sequential compression devices showed similar results both in clinical and physiological efficacies .


Further studies are required to investigate the optimal intermittent pneumatic compression method for enhanced hemodynamic efficacy and better thromboprophylaxis .


Although the local response induced by acupuncture manipulation has been considered to be among the important factors that induce the effects of acupuncture , this connection has not yet been properly studied with standardized tools .


The aims of this study are to examine the local changes in microcirculation that occur at different manipulation intensities and explore any associations of these changes with the analgesic effects of acupuncture .


Twelve healthy volunteers received three acupuncture interventions ( insertion only , a single manipulation , and repeated manipulations ) at the right LI4 ( Hegu or Hapgok ) in random order .


Skin blood perfusion was measured in a 100-mm ( 2 ) area ellipse centered on LI4 by using laser Doppler perfusion imaging ( LDPI ) before , during , and after acupuncture stimulation .


Pressure pain thresholds ( PPTs ) were measured at ipsilateral areas , including acupoints ST25 ( abdomen ) , LI5 ( hand ) , LI10 ( arm ) , and SP9 ( leg ) .


Repeated acupuncture manipulations enhanced microcirculatory perfusion compared with the insertion-only ( p < 0.01 ) and the single-manipulation ( p < 0.05 ) conditions .


The repeated acupuncture manipulations significantly decreased the pressure pain at ST25 compared with the other groups ( each p < 0.05 ) .


Of note , Spearman correlation analysis revealed significant correlation between changes of local perfusion and PPTs ( r = 0.393 ; p = 0.018 ) .


These results suggested that repeated manipulation induced higher local microcirculatory changes that were correlated with the analgesic effects at the relevant sites .


The findings suggest that a proper dose of acupuncture stimulation might be essential to elicit the acupuncture effects .


The dose-response relationship between doxorubicin and superabsorbent drug-eluting microspheres has not been established .


In this study , we investigated the relationships between dose and delivery parameters as they pertain to toxicity and response in surgically resectable hepatocellular carcinoma ( HCC ) .


Twenty-five patients with resectable HCC were randomly assigned and divided into four groups , each receiving either bland , 25 mg , 50 mg or 75 mg of doxorubicin loaded Super Absorbent Polymer microspheres , with 24 patients undergoing surgical resection .


Response Evaluation and Criteria in Solid Tumors ( RECIST ) 1.0 and European Association for the Study of the Liver ( EASL ) - based volumetric response was performed at one month and surgical resection of the reference tumor was performed at two months .


Adverse events were collected at regular intervals .


Fifty-six percent of patients demonstrated complete response according to EASL criteria as opposed to 0 % according to RECIST ( v1 .0 ) criteria .


Residual tumor was identified in all groups ( 0 mg : 35 % 28.5 % ; 25 mg : 42 % 30.4 % ; 50 mg : 3.6 % 3.3 % ; and 75 mg : 49.29 % 32.6 % .


A total of 112 adverse events of grades 1-3 occurred ( average 5.1 per patient ) , with no grade 4 or 5 .


No difference was noted between bland embolic and drug-loaded groups .


Subset analysis did demonstrate a significantly increased degree of necrosis in the 50 mg-loaded group ( p = 0.018 ) .


Strong correlation existed between arterial phase Computer Tomography EASL-based response and histopathology ( r = 0.81 ; p < 0.0001 ) .


All groups had residual tumor .


Histology correlates strongly with one-month post-procedural imaging and response optimized at 50 mg of loading per vial .


Adverse events were a reflection of embolization , with no relationship between loading dose or administered dose of doxorubicin .


Increased systolic blood pressure variability between outpatient visits is associated with increased incidence of cardiovascular end points .


However , few studies have examined the association of visit-to-visit variability in systolic blood pressure with clinically relevant kidney disease outcomes .


We analyzed the association of systolic blood pressure visit-to-visit variability with renal and cardiovascular morbidity and mortality among individuals with diabetes and nephropathy .


Observational analysis of IDNT ( Irbesartan Diabetic Nephropathy Trial ) and the RENAAL ( Reduction of End Points in Non-Insulin-Dependent Diabetes With the Angiotensin II Antagonist Losartan ) Study .


2,739 participants with type 2 diabetes and nephropathy with at least 1 year of blood pressure measurements available .


Systolic blood pressure visit-to-visit variability was calculated from the SD of the systolic blood pressure from 4 visits occurring 3-12 months postrandomization .


The kidney disease outcome was defined as time to confirmed doubling of serum creatinine level , end-stage renal disease , or death ; the cardiovascular outcome was defined as time to cardiovascular death , myocardial infarction , stroke , hospitalization for heart failure , or revascularization .


Mean visit-to-visit variability in systolic blood pressure from 3 to 12 months postrandomization was 12.06.8 ( SD ) mmHg .


Following this ascertainment period , there were 954 kidney disease and 542 cardiovascular events .


Greater systolic blood pressure visit-to-visit variability was associated independently with increased risk of the composite kidney disease end point ( HR per 1-SD increment , 1.08 [ 95 % CI , 1.01-1 .16 ] ; P = 0.02 ) and end-stage renal disease , but not with the cardiovascular outcome .


Observational study with the potential for confounding .


In diabetic individuals with nephropathy , systolic blood pressure visit-to-visit variability is associated independently with hard kidney disease outcomes .


To evaluate the effects of surface electrical stimulation ( SES ) and to compare them with the effects of the intravaginal electrical stimulation ( IVES ) in women with stress urinary incontinence ( SUI ) .


This randomized controlled study included 48 women aged over 50 years , who complained of SUI evaluated according to two structured questions of King 's Health Questionnaire ( KHQ ) and who had not previously undergone physical therapy for SUI .


The calculation of the sample size estimated a sample of 45 volunteers with a significance level of 5 % and statistical power of 90 % .


The women were randomized to : Surface Electrical Stimulation Group ( SESG ) ( n = 15 ) , Intravaginal Electrical Stimulation Group ( IVESG ) ( n = 15 ) and Control Group ( CG ) ( n = 15 ) .


Subjects in the intervention groups were treated with the same parameters of electrical stimulation for 12 sessions .


The SESG had four silicone electrodes fixed in the suprapubic and ischial tuberosity regions .


The IVES group used an intravaginal electrode .


The CG did not receive any treatment during the corresponding time .


They were evaluated before and after treatment by a physical therapist who was blind to group allocation .


The primary outcomes were urinary leakage , pressure and strength of pelvic floor muscle ( PFM ) contraction .


The secondary outcome was quality of life ( QOL ) evaluated by KHQ .


Forty-five women completed the study and were included in the analysis .


Statistical analysis was performed using the Wilcoxon test for intragroup analysis and Kruskal-Wallis and Mann-Whitney tests for intergroup analysis ( p < 0.05 ) .


There was significant improvement in urinary loss and pressure of contraction in the SESG and IVESG .


PFM strength increased only in the IVESG .


Intergroup analysis found differences after the treatment in : urinary leakage between the SESG and CG ( p < 0.001 ) and the IVESG and CG ( p < 0.001 ) .


Regarding QOL , there was significant reduction in the incontinence impact , limitations of daily activities , physical limitation , emotion , sleep and disposition and severity domains in the SESG ( all p < 0.02 ) and IVESG ( all p < 0.04 ) after the treatments .


SES and IVES are important treatments to improve the SUI .


Both improved the QOL , urinary leakage , and strength and pressure of PFM contraction .


Scarce data are available concerning effects of certain bioactive substances such as Maillard reaction products ( MRP ) on the gut microbiota composition , and the question of how a diet rich in MRP affects gut microbiota in humans is still open .


Two experiments were conducted .


In expt .


1 , adolescents consumed diets either high or low in MRP in a two-period crossover trial ; in expt .


2 , rats were fed diets supplemented or not with MRP model-systems .


Intestinal microbiota composition in fecal ( adolescents ) or cecal ( rat ) samples was assessed by qPCR analysis .


Negative correlations were found in the human assay between lactobacilli numbers and dietary advanced MRP ( r = -0.418 and -0.387 , for hydroxymethylfurfural and carboxymethyl-lysine respectively , p < 0.05 ) , whereas bifidobacteria counts were negatively correlated with Amadori compounds intake .


In the rat assay , total bacteria and lactobacilli were negatively correlated with MRP intake ( r = -0.674 , -0.675 and -0.676 , for Amadori compounds , hydroxymethylfurfural and carboxymethyl-lysine respectively , p < 0.05 ) , but no correlations were found with bifidobacteria .


Dietary MRP are able to modulate in vivo the intestinal microbiota composition both in humans and in rats , and the specific effects are likely to be linked to the chemical structure and dietary amounts of the different browning compounds .


The Americans with Disabilities Act set in motion a series of policies and actions to promote community integration and participation , including for those individuals with psychiatric disabilities .


Measuring participation in this population is in its infancy .


This study examines the test-retest reliability of two modes of administration of a measure that assesses participation in four social life domains and the extent to which participation is viewed as sufficient and important .


One hundred and 19 individuals with a diagnosis of schizophrenia , bipolar disorder , or major depression were randomly assigned to either an interviewer - or self-administered method of completing the measure , and filled out the measure again in the same format within 48-72 hr .


Correlations at the individual participation item and scale levels between the two time points were nearly all in the r = .6 -.9 range .


Agreement on the importance and sufficiency of their participation was also consistently high .


The importance of participation in each area ranged from 36 % to 95 % , and among these individuals , between 18 % and 71 % indicated they were not participating as much as desired .


Community participation of individuals with psychiatric disabilities can be reliably measured using 2 methods of administration as an outcome in rehabilitation research and evaluation studies with this population .


These individuals are engaged to varying degrees in a wide-range of participation areas in the community that are important , but most not to the degree that they desire .


More intervention efforts are needed to increase the sufficiency of community participation .


Reports of long-term tenofovir disoproxil fumarate ( TDF ) treatment in HIV-infected adolescents are limited .


We present final results from the open-label ( OL ) TDF extension following the randomized , placebo ( PBO ) - controlled , double-blind phase of GS-US-104-0321 ( Study 321 ) .


HIV-infected 12 - to 17-year-olds treated with TDF 300mg or PBO with an optimized background regimen ( OBR ) for 24-48 weeks subsequently received OL TDF plus OBR in a single arm study extension .


HIV-1 RNA and safety , including bone mineral density ( BMD ) , was assessed in all TDF recipients .


Eighty-one subjects received TDF ( median duration 96 weeks ) .


No subject died or discontinued OL TDF for safety/tolerability .


At week 144 , proportions with HIV-1 RNA < 50 copies/mL were 30.4 % ( 7 of 23 subjects with baseline HIV-1 RNA > 1000 c/mL initially randomized to TDF ) , 41.7 % ( 5 of 12 subjects with HIV-1 RNA < 1000 c/mL who switched PBO to TDF ) and 0 % ( 0 of 2 subjects failed randomized PBO plus OBR with HIV-1 RNA > 1000 c/mL and switched PBO to TDF ) .


Viral resistance to TDF occurred in 1 subject .


At week 144 , median decrease in estimated glomerular filtration rate was 38.1 mL/min/1 .73 m ( n = 25 ) .


Increases in median spine ( +12.70 % , n = 26 ) and total body less head BMD ( +4.32 % , n = 26 ) and height-age adjusted Z-scores ( n = 21 ; +0.457 for spine , +0.152 for total body less head ) were observed at week 144 .


Five of 81 subjects ( 6 % ) had persistent > 4 % BMD decreases from baseline .


Some subjects had virologic responses to TDF plus OBR , and TDF resistance was rare .


TDF was well tolerated and can be considered for treatment of HIV-infected adolescents .


To evaluate efficacy , safety , and tolerability of a fixed combination clindamycin phosphate 1.2 % and benzoyl peroxide 3.75 % ( clindamycin-BP 3.75 % ) aqueous gel in moderate to severe acne vulgaris .


A total of 498 patients , 12-40 years of age , were randomized to receive clindamycin-BP 3.75 % or vehicle in a double-blind , controlled 12-week , 2-arm study evaluating safety and efficacy using inflammatory and noninflammatory lesion counts , Evaluator Global Severity Scores ( EGSS ) and subject self-assessment ( SSA ) .


In addition , patients completed a patient satisfaction survey ( PSS ) , acne-specific QoL questionnaire , and assessed their facial skin for shininess/oiliness .


Clindamycin-BP 3.75 % demonstrated statistical superiority to vehicle in reducing both inflammatory and noninflammatory lesions and acne severity .


Clindamycin-BP 3.75 % showed greater efficacy relative to vehicle in assessments of skin oiliness , SSA and PSS .


No substantive differences were seen in cutaneous tolerability among treatment groups and no patients discontinued treatment with Clindamycin-BP 3.75 % because of adverse events .


Data from controlled studies may differ from clinical practice .


It is not possible to determine the contributions from the individual active ingredients .


Clindamycin-BP 3.75 % provides statistically significant greater efficacy than vehicle with a favorable safety and tolerability profile .


To determine if the belief that thirdhand smoke is harmful to children is associated with smoking parents ' attitudes , home or car smoking policies , and quitting behaviors .


Data from a national randomized controlled trial , Clinical Effort Against Secondhand Smoke Exposure , assessed thirdhand smoke beliefs of 1947 smoking parents in an exit survey after a pediatric office visit in 10 intervention and 10 control practices .


Twelve-month follow-up data were collected from 1355 parents .


Multivariable logistic regression determined whether belief that thirdhand smoke harms the health of children is independently associated with parental behaviors and attitudes 12 months later .


A ( 2 ) test assessed whether parents who disagreed that thirdhand smoke is harmful were more likely to make a quit attempt if they later believed that thirdhand smoke is harmful .


Belief at the exit survey that thirdhand smoke is harmful was independently associated with having a strictly enforced smoke-free home policy ( adjusted odds ratio : 2.05 ; 95 % CI : 1.37-3 .05 ) and car policy ( adjusted odds ratio : 1.69 ; 95 % CI : 1.04-2 .74 ) at the 12-month follow-up .


A significantly higher percentage ( 71 % vs 50 % ) of parents who did not hold the thirdhand smoke harm belief at baseline made at least 1 quit attempt if they agreed that thirdhand smoke is harmful at the 12-month follow-up ( P = .02 ) .


Thirdhand smoke harm belief was associated with a strictly enforced smoke-free home and car and attempts to quit smoking .


Sensitizing parents to thirdhand smoke risk could facilitate beneficial tobacco control outcomes .


Active video games may offer an effective strategy to increase physical activity in overweight and obese children .


However , the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown .


To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence-based weight management program delivered in the community .


Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts , Rhode Island , and Texas .


Seventy-five overweight or obese children ( 41 girls [ 55 % ] , 34 whites [ 45 % ] , 20 Hispanics [ 27 % ] , and 17 blacks [ 23 % ] ) enrolled in a community-based pediatric weight management program .


Mean ( SD ) age of the participants was 10.0 ( 1.7 ) years ; body mass index ( BMI ) z score , 2.15 ( 0.40 ) ; and percentage overweight from the median BMI for age and sex , 64.3 % ( 19.9 % ) .


All participants received a comprehensive family-based pediatric weight management program ( JOIN for ME ) .


Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program .


Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program .


Objectively measured daily moderate-to-vigorous and vigorous physical activity , percentage overweight , and BMI z score .


Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous ( mean [ SD ] , 7.4 [ 2.7 ] min/d ) and vigorous ( 2.8 [ 0.9 ] min/d ) physical activity at week 16 ( P < .05 ) .


In the program-only group , a decline or no change was observed in the moderate-to-vigorous ( mean [ SD ] net difference , 8.0 [ 3.8 ] min/d ; P = .04 ) and vigorous ( 3.1 [ 1.3 ] min/d ; P = .02 ) physical activity .


Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16 .


However , the program and active gaming group exhibited significantly greater reductions in percentage overweight ( mean [ SD ] , -10.9 % [ 1.6 % ] vs -5.5 % [ 1.5 % ] ; P = .02 ) and BMI z score ( -0.25 [ 0.03 ] vs -0.11 [ 0.03 ] ; P < .001 ) .


CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight .


TRIAL REGISTRATION clinicaltrials.gov Identifier : NCT01757925 .


To investigate the impact of self-efficacy theory health education in patients of diabetic osteoporosis .


We used SPSS 19.0 software to generate random numbers and 260 diabetic osteoporosis patients were randomly divided into an observation group and a control group .


There was 130 patients in observation group , 130 in control group .


The self-efficacy theory health education was carried out in observation group , and routine health education in control group .


SF-36 questionnaire was used to assess the quality of life .


Osteoporosis self-efficacy scale ( OSES ) was used to assess self-efficacy .


Bone mineral density ( BMD ) was measured by dual energy X-ray absorptiometry .


Blood glucose was detected by glucose oxidase method .


Glycosylated hemoglobin was detected by high efficiency liquid chromatography to estimate the index change before intervention and after one year 's follow up .


The number of patients that had completed follow-up was 104 in control group and 107 in observation group .


The self-efficacy scores , movement efficiency scores and calcium intake efficiency scores were all higher in intervention group ( ( 82.25 13.54 ) , ( 79.26 15.37 ) , ( 84.39 17.09 ) points ) than which in the control group ( ( 71.14 14.19 ) , ( 63.89 19.87 ) , ( 75.24 10.70 ) points ) after one year 's follow up , there were significant differences in two groups ( t values were 6.04 , 7.95 , 5.77 , all P values < 0.05 ) .


The scores of quality of life in the dimension of general health , vitality , social function , role emotional and mental health were all higher in intervention group ( ( 75.29 14.90 ) , ( 68.61 17.38 ) , ( 75.74 18.50 ) , ( 71.22 17.93 ) , ( 73.69 14.40 ) points ) than in the control group ( ( 44.25 11.01 ) , ( 47.39 18.90 ) , ( 63.54 15.95 ) , ( 49.04 19.36 ) , ( 55.15 19.74 ) points ) , there were significant differences in two groups ( t values were 8.45 , 8.83 , 6.92 , 8.79 , 8.05 , all P values < 0.05 ) .


Fasting blood-glucose 2 hour postprandial blood glucose and glycosylated hemoglobin were all lower in intervention group ( ( 7.29 1.81 ) mmol/L , ( 8.21 2.37 ) mmol/L , ( 6.59 0.92 ) % ) than in the control group ( ( 8.53 1.66 ) mmol/L , ( 9.41 3.30 ) mmol/L , ( 7.66 1.50 ) % ) , there were significant differences in two groups ( t values were 5.33 , 4.67 , 5.49 , all P values < 0.05 ) .


There were 1 ( 0.93 % ) fracture case in observation group and 7 ( 6.73 % ) cases in control group during one year 's follow up , there are significant difference in two groups ( ( 2 ) = 4.86 , P = 0.028 ) .


The self-efficacy theory health education may improve the quality of life and decreased fracture risk of diabetic osteoporosis patients .


Cranial nerve palsy ( CNP ) and neck haematoma are complications of carotid endarterectomy ( CEA ) .


The effects of patient factors and surgical technique were analysed on the risk , and impact on disability , of CNP or haematoma in the surgical arm of the International Carotid Stenting Study ( ICSS ) , a randomized controlled clinical trial of stenting versus CEA in patients with symptomatic carotid stenosis .


A per-protocol analysis of early outcome in patients receiving CEA in ICSS is reported .


Haematoma was defined by the surgeon .


CNP was confirmed by an independent neurologist .


Factors associated with the risk of CNP and haematoma were investigated in a binomial regression analysis .


Of the patients undergoing CEA , 45/821 ( 5.5 % ) developed CNP , one of which was disabling ( modified Rankin score = 3 at 1 month ) .


Twenty-eight ( 3.4 % ) developed severe haematoma .


Twelve patients with haematoma also had CNP , a significant association ( p < .01 ) .


Independent risk factors modifying the risk of CNP were cardiac failure ( risk ratio [ RR ] 2.66 , 95 % CI 1.11 to 6.40 ) , female sex ( RR 1.80 , 95 % CI 1.02 to 3.20 ) , the degree of contralateral carotid stenosis , and time from randomization to treatment > 14 days ( RR 3.33 , 95 % CI 1.05 to 10.57 ) .


The risk of haematoma was increased in women , by the prescription of anticoagulant drugs pre-procedure and in patients with atrial fibrillation , and was decreased in patients in whom a shunt was used and in those with a higher baseline cholesterol level .


CNP remains relatively common after CEA , but is rarely disabling .


Women should be warned about an increased risk .


Attention to haemostasis might reduce the incidence of CNP .


ICSS is a registered clinical trial : ISRCTN 25337470 .


Vesnarinone Trial ( VesT ) was a three-armed , placebo-controlled , randomized clinical trial designed to study the effects of 30 mg or 60 mg/day vesnarinone .


Certain contradictory results involving patient health-related quality-of-life ( HRQOL ) and overall survival ( OS ) have made a definitive and unified conclusion difficult .


To reconcile these findings , we have focused on the HRQOL-adjusted OS , commonly known as quality-adjusted life years ( QALYs ) .


Currently , analyses of QALYs incorporate a single HRQOL subscale .


However , the VesT HRQOL instrument had two subscales : physical ( PHYS ) and emotional ( EMOT ) .


We have developed new ways to visualize and compare EMOT - and PHYS-adjusted OS .


In each VesT arm , there was an increased probability of superior EMOT-adjusted OS , compared to PHYS-adjusted OS .


The magnitude of these findings was comparable across trial arms .


Despite inferior survival and superior EMOT and PHYS scores , the 60-mg/day arm presents similar EMOT - and PHYS-adjusted OS compared to the placebo arm .


We have provided a fresh perspective on the complex interactions between multiple HRQOL dimensions and OS .


These novel methods address the burgeoning need for robust information on the interplay between OS and HRQOL from a patient , clinical care and public policy perspective .


Hypertension is common in autosomal dominant polycystic kidney disease ( ADPKD ) and is associated with increased total kidney volume , activation of the renin-angiotensin-aldosterone system , and progression of kidney disease .


In this double-blind , placebo-controlled trial , we randomly assigned 558 hypertensive participants with ADPKD ( 15 to 49 years of age , with an estimated glomerular filtration rate [ GFR ] > 60 ml per minute per 1.73 m ( 2 ) of body-surface area ) to either a standard blood-pressure target ( 120/70 to 130/80 mm Hg ) or a low blood-pressure target ( 95/60 to 110/75 mm Hg ) and to either an angiotensin-converting-enzyme inhibitor ( lisinopril ) plus an angiotensin-receptor blocker ( telmisartan ) or lisinopril plus placebo .


The primary outcome was the annual percentage change in the total kidney volume .


The annual percentage increase in total kidney volume was significantly lower in the low-blood-pressure group than in the standard-blood-pressure group ( 5.6 % vs. 6.6 % , P = 0.006 ) , without significant differences between the lisinopril-telmisartan group and the lisinopril-placebo group .


The rate of change in estimated GFR was similar in the two medication groups , with a negative slope difference in the short term in the low-blood-pressure group as compared with the standard-blood-pressure group ( P < 0.001 ) and a marginally positive slope difference in the long term ( P = 0.05 ) .


The left-ventricular-mass index decreased more in the low-blood-pressure group than in the standard-blood-pressure group ( -1.17 vs. -0.57 g per square meter per year , P < 0.001 ) ; urinary albumin excretion was reduced by 3.77 % with the low-pressure target and increased by 2.43 % with the standard target ( P < 0.001 ) .


Dizziness and light-headedness were more common in the low-blood-pressure group than in the standard-blood-pressure group ( 80.7 % vs. 69.4 % , P = 0.002 ) .


In early ADPKD , the combination of lisinopril and telmisartan did not significantly alter the rate of increase in total kidney volume .


As compared with standard blood-pressure control , rigorous blood-pressure control was associated with a slower increase in total kidney volume , no overall change in the estimated GFR , a greater decline in the left-ventricular-mass index , and greater reduction in urinary albumin excretion .


( Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others ; HALT-PKD [ Study A ] ClinicalTrials.gov number , NCT00283686 . )


Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response .


Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties .


The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy .


Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study .


After midazolam premedication , a 1 g/kg/min remifentanil infusion was started , and patients were randomly allocated to receive either propofol ( Group P ) or ketamine ( Group K ) as well as mivacurium for muscle relaxation .


Anesthesia was maintained with a 1 g/kg/min remifentanil infusion and bolus doses of propofol or ketamine .


After the rigid bronchoscopy , 0.05 g/kg/min of remifentanil was maintained until extubation .


Hemodynamic parameters , emergence characteristics , and adverse events were evaluated .


The demographic variables were comparable between the two groups .


The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P ( p = 0.049 ) , while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups .


The need for assisted or controlled mask ventilation after extubation was higher in Group K.


Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy .


Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy , while propofol seems more suitable during the recovery period .


Proton-pump inhibitors ( PPIs ) reduce acid gastroesophageal reflux ( GER ) and esophageal acid exposure in infants ; however , they do not reduce total GER or symptoms attributed to GER .


Reflux is reduced in the left lateral position ( LLP ) .


We hypothesize that the effect of LLP in combination with acid suppression is most effective in reducing GER symptoms in infants .


In this prospective sham-controlled trial , infants ( 0-6 months ) with symptoms suggestive of gastroesophageal reflux disease were studied using 8-hour pH-impedance , cardiorespiratory and video monitoring , direct nurse observation , and a validated questionnaire .


Infants demonstrating a positive GER symptom association were randomized to 1 of 4 groups ; PPI + LLP , PPI + head of cot elevation ( HE ) , antacid ( AA ) + LLP , or AA + HE .


HE and AA were considered `` sham '' therapies .


After 2 weeks the 8-hour studies were repeated on-therapy .


Fifty-one patients were included ( aged 13.6 [ 2-26 ] weeks ) .


PPI + LLP was most effective in reducing GER episodes ( 69 [ 13 ] to 46 [ 10 ] , P < 0.001 ) and esophageal acid exposure ( median [ interquartile range ] 8.9 % [ 3.1 % -18.1 % ] to 1.1 % [ 0 % -4.4 % ] , P = 0.02 ) .


No treatment group showed improvement in crying/irritability , although vomiting was reduced in AA + LLP ( from 7 [ 2 ] to 2 [ 0 ] episodes P = 0.042 ) .


LLP compared with HE produced greater reduction in total GER ( -21 [ 4 ] vs -10 [ 4 ] , P = 0.056 ) , regardless of acid-suppressive therapy .


Acid exposure was reduced on PPI compared with AA ( -6.8 [ 2.1 ] vs -0.9 [ 1.4 ] % , pH < 4 , P = 0.043 ) regardless of positional intervention .


A post-hoc analysis using automated analysis software revealed a significant reduction in crying symptoms in the PPI + LLP group ( 99 [ 65-103 ] to 62 [ 32-96 ] episodes , P = 0.018 ) .


`` Symptomatic gastroesophageal reflux disease '' implies disease causation for distressing infant symptoms .


In infants with symptoms attributed to GER , LLP produced a significant reduction in total GER , but did not result in a significant improvement in symptoms other than vomiting ; however , automated analysis appeared to identify infants with GER-associated crying symptoms who responded to positioning therapy .


This is an important new insight for future research .


A bivalent killed whole cell oral cholera vaccine has been found to be safe and efficacious for five years in the cholera endemic setting of Kolkata , India , when given in a two dose schedule , two weeks apart .


A randomized controlled trial revealed that the immune response was not significantly increased following the second dose compared to that after the first dose .


We aimed to evaluate the impact of an extended four week dosing schedule on vibriocidal response .


In this double blind randomized controlled non-inferiority trial , 356 Indian , non-pregnant residents aged 1 year or older were randomized to receive two doses of oral cholera vaccine at 14 and 28 day intervals .


We compared vibriocidal immune responses between these schedules .


Among adults , no significant differences were noted when comparing the rates of seroconversion for V. cholerae O1 Inaba following two dose regimens administered at a 14 day interval ( 55 % ) vs the 28 day interval ( 58 % ) .


Similarly , no differences in seroconversion were demonstrated in children comparing the 14 ( 80 % ) and 28 day intervals ( 77 % ) .


Following 14 and 28 day dosing intervals , vibriocidal response rates against V. cholerae O1 Ogawa were 45 % and 49 % in adults and 73 % and 72 % in children respectively .


Responses were lower for V. cholerae O139 , but similar between dosing schedules for adults ( 20 % , 20 % ) and children ( 28 % , 20 % ) .


Comparable immune responses and safety profiles between the two dosing schedules support the option for increased flexibility of current OCV dosing .


Further operational research using a longer dosing regimen will provide answers to improve implementation and delivery of cholera vaccination in endemic and epidemic outbreak scenarios .


The association between testosterone deficiency and insulin resistance in men with type 2 diabetes is well established and current endocrine society guidelines recommend the measurement of testosterone levels in all men with type 2 diabetes or erectile dysfunction .


We report the first double-blind , placebo-controlled study conducted exclusively in a male type 2 diabetes population to assess metabolic changes with long-acting testosterone undecanoate ( TU ) .


The type 2 diabetes registers of seven general practices identified 211 patients for a 30-week double-blind , placebo-controlled study of long-acting TU 1,000 mg followed by 52 weeks of open-label use .


Because of the established impact of age , obesity , and depression on sexual function , these variables were also assessed for influence on metabolic parameters .


Changes in glycated hemoglobin ( HbA1c ) and the level of testosterone at which response are achieved .


Treatment with TU produced a statistically significant reduction in HbA1c at 6 and 18 weeks and after a further 52 weeks of open-label medication most marked in poorly controlled patients with baseline HbA1c greater than 7.5 where the reduction was 0.41 % within 6 weeks , and a further 0.46 % after 52 weeks of open-label use .


There was significant reduction in waist circumference , weight , and body mass index in men without depression , and improvements were related to achieving adequate serum levels of testosterone .


There were no significant safety issues .


Testosterone replacement therapy significantly improved HbA1c , total cholesterol , and waist circumference in men with type 2 diabetes .


Improvements were less marked in men with depression at baseline , and therapeutic responses were related to achieving adequate serum testosterone levels .


Current advice on 3 - to 6-month trials of therapy may be insufficient to achieve maximal response .


Patients reported significant improvements in general health .


This randomized trial evaluated the feasibility and safety of thulium 2010-nm laser to perform anatomic lung resections in patients with incomplete fissures , as compared to mechanical staplers with or without sealants .


Seventy-two patients scheduled for segmentectomy or lobectomy were enrolled .


After intraoperative confirmation of the extent of resection and incomplete fissures ( Craig type 2 , 3 or 4 ) , they were randomized and allocated to one of the following arms : laser resection by thulium ( group A ) or standard resection with mechanical staplers with or without sealants ( group B ) .


The primary endpoints of the study included analysis of intraoperative and postoperative course , and costs .


Thirty-eight patients were assigned to group A ( 32 lobectomies , 6 segmentectomies ) and 34 to group B ( 31 lobectomies , 3 segmentectomies ) .


No 30-day mortality was observed .


Median operative times were 145.0 minutes ( group A ) and 142.5 minutes ( group B , P = 0.83 ) .


The median time to drainage removal was 5 days ( group A ) and 4 days ( group B ) , while the median length of hospital stay was the same ( 7 days ) .


Prolonged air leaks > 7 days were observed in 12 patients of group A ( 32 % ) and 10 patients of group B ( 29 % , P = 0.46 ) .


Unpredictable late pneumothorax occurred in 3 patients of group A ( 2 readmissions , need for 1 repeat thoracotomy ) .


Cost analysis demonstrated an intraoperative advantage for group A ( mean 807 212 euro ) versus group B ( mean 1,047 + / -276 euro , P < 0.0001 ) , but the differences in total costs could be due to chance ( P = 0.83 ) .


The use of laser to complete fissures can lead to late pneumothorax , even in the absence of postoperative air leaks .


Moreover , the use of laser to complete fissures did not prove to reduce overall costs .


Trial Registration Identification Number : 41/10 ( IRB00001457 - FWA00001798 - IORG0001063 ) .


Childhood obesity is a major public health concern worldwide while the current epidemic may be secondary to over consumption of high-fat , energy-rich foods .


Purslane ( Portulaca oleracea L. ) has been traditionally used in medicine for several antioxidant and anti-atherogenic activities .


In this study the anti-dyslipidemic effects of Poleracea was evaluated in obese adolescents .


In this triple-blinded randomized placebo-controlled clinical trial which was done from July 2011 to June 2012 , obese adolescent patients whom were referred to the Isfahan Cardiovascular Research Institute ( Iran ) were randomly allocated to the two arms of cases and controls .


The cases group was asked to take one capsule containing powdered P. oleracea seeds ( 500 milligrams ) two times a day for one month , and the controls group were asked to take identical but placebo ( lactose ) capsules in the same way .


Biochemical parameters including 12-hours fasting serum levels of total cholesterol , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , and triglycerides ( TG ) were measured before the initiation and after the completion of the study protocol .


Total cholesterol , LDL-C , and TG showed statistically significant changes over time ( one month ) in the P. oleracea group ( p < 0.05 ) .


However , between-group analysis using general linear model ( multivariate ) test revealed that the differences in the mentioned parameters between two study groups were statistically significant just for LDL-C and TG , while others did not differ significantly .


P. oleracea L. may have positive effects on serum lipids profile which may be attributed to its polyphenolic and antioxidant compounds .


This herbal drug seems to be well-tolerated in adolescent population as well .


Further studies are recommended .


To examine whether optimism/pessimism reliably predicts depression and whether such function is stable also in older age .


In a prospective study , we observed a representative sample of n = 4,046 primary care patients over 5 years .


The Life Orientation Test ( LOT-R , measuring optimism/pessimism ) and the Depression-Screening Questionnaire were applied .


Medical diagnoses were recorded by the treating physician in a structured medical interview .


Depression could only be predicted by LOT-R scores in younger-age cohorts .


In older adults , test stability and predictive accuracy of optimism/pessimism were markedly reduced , while somatic comorbidity gained importance as a predictor .


Predictive value of screening measures for mental disorders may be specific in older age due to lower trait stability and age-specific psychometric limitations as well as age-related changes in relevant predictors .


To compare the effects of vildagliptin with those of glimepiride on glycaemic control , fat tolerance and inflammatory markers in people with Type 2 diabetes mellitus receiving metformin treatment .


A total of 167 participants were randomized to vildagliptin 50mg twice a day or glimepiride 2mg three times a day , for 6months .


We evaluated the following variables : BMI ; glycaemic control ; fasting plasma insulin ; homeostatic model assessment of insulin resistance index ; fasting plasma proinsulin ; glucagon ; lipid profile ; adiponectin ; high-sensitivity C-reactive protein ; interleukin-6 ; and tumour necrosis factor - .


A euglycaemic-hyperinsulinaemic clamp procedure and an oral fat load test were also performed .


Despite a similar decrease in HbA1c levels ( P = 0.009 , and P = 0.008 , respectively ) , body weight increased with glimepiride ( P = 0.048 vs baseline ) and decreased with vildagliptin ( P = 0.041 vs baseline and vs glimepiride ) .


Fasting plasma insulin and homeostatic model assessment of insulin resistance index were significantly lower with vildagliptin compared with glimepiride ( P = 0.035 and 0.047 ) .


M value , an index of insulin sensitivity , increased with vildagliptin , both compared with baseline and with glimepiride ( P = 0.028 and 0.039 , respectively ) .


Vildagliptin improved all post-oral fat load peaks of lipid profile compared with glimepiride .


Adiponectin levels were higher ( P = 0.035 ) and high-sensitivity C-reactive protein levels were lower ( P = 0.038 ) with vildagliptin vs glimepiride .


During the oral fat load test , interleukin-6 , high-sensitivity C-reactive protein and tumour necrosis factor - peaks were lower and adiponectin peak was higher in the vildagliptin group than in the glimepiride group .


There was a higher dropout rate as a result of hypoglycaemia in the glimepiride group than in the vildagliptin group .


Vildagliptin was more effective than glimepiride in reducing post-oral fat load peaks of lipid-trafficking adipocytokines and inflammatory markers .


Congenital cytomegalovirus ( CMV ) is the most common congenital infection in the U.S. and can result in permanent disabilities , such as hearing and vision loss , intellectual disability , and psychomotor and language impairments .


Women can adopt prevention behaviors in an attempt to reduce their exposure to CMV .


Currently , few women are familiar with CMV .


To increase awareness of CMV , the Centers for Disease Control and Prevention ( CDC ) developed draft health education materials .


The purpose of this study was to pilot test two health education materials to gauge their appeal and to determine if they increase knowledge about CMV and motivate audiences to seek additional information on CMV and adopt CMV prevention behaviors .


African-American ( n = 404 ) and Caucasian women ( n = 405 ) , who had a young child and were either pregnant or planning a pregnancy , were recruited to participate in a 15-minute web survey .


Participants were randomly assigned to view one of two CMV health education materials , either a factsheet or video .


Pre and post survey measures were used to assess changes in knowledge of CMV and motivation to adopt prevention behaviors .


We also examined audience preferences regarding materials and motivation .


CMV knowledge score increased significantly after presentation of either the video or factsheet ( from 3.7 out of 10 to 9.1 out of 10 , p < 0.001 ) .


The average materials appeal score was high , with a mean of 3.6 on a four-point scale , indicating women responded very positively to both materials .


Regression analyses indicated that appeal , message involvement ( e.g. , information seeking , discussing with others ) , post materials knowledge score , and viewing the video ( vs. factsheet ) were significantly positively associated with increased support for CMV prevention behaviors .


Overall , we found that the health education materials improved women 's knowledge of CMV and encouraged them to adopt prevention behaviors .


Given the low awareness levels among women currently , these findings suggest that appropriate education materials have the potential to greatly increase knowledge of CMV .


As women become more knowledgeable about CMV and transmission routes , we expect they will be more likely to adopt prevention behaviors , thereby reducing their risk of CMV infection .


Prospective studies have shown an inverse relationship between whole grain consumption and the risk of type 2 diabetes , where short chain fatty acids ( SCFA ) may be involved .


Our objective was to determine the effect of isolated arabinoxylan alone or in combination with whole grain rye kernels on postprandial glucose , insulin , free fatty acids ( FFA ) , gut hormones , SCFA and appetite in subjects with the metabolic syndrome ( MetS ) .


Fifteen subjects with MetS participated in this acute , randomised , cross-over study .


The test meals each providing 50g of digestible carbohydrate were as follows : semolina porridge added concentrated arabinoxylan ( AX ) , rye kernels ( RK ) or concentrated arabinoxylan combined with rye kernels ( AXRK ) and semolina porridge as control ( SE ) .


A standard lunch was served 4h after the test meals .


Blood samples were drawn during a 6-h period , and appetite scores and breath hydrogen were assessed every 30min .


The AXRK meal reduced the acute glucose ( P = 0.005 ) and insulin responses ( P < 0.001 ) and the feeling of hunger ( P = 0.005 ; 0-360min ) compared with the control meal .


The AX and AXRK meals increased butyrate and acetate concentrations after 6h .


No significant differences were found for the second meal responses of glucose , insulin , FFA , glucagon-like peptide-1 or ghrelin .


Our results indicate a stimulatory effect of arabinoxylan on butyrate and acetate production , however , with no detectable effect on the second meal glucose response .