Lactate and COHb levels were statistically significantly higher in patients with GCS < 15 than the ones with GCS = 15 ( p < 0.01 ) .


The patients whose both Troponin-I and CK-MB levels increased have higher lactate levels ( p = 0.038 ) , but COHb levels of these patients did not change ( p = 0.495 ) .


According to our study , blood lactate and COHb levels were both correlated with the changes of consciousness in CO poisoning .


Blood lactate levels together with COHb in defining indications for HBO treatment might be suggested .


To evaluate ixekizumab , an anti-interleukin-17A ( anti-IL-17A ) monoclonal antibody , in 2 populations of rheumatoid arthritis ( RA ) patients : biologics-naive patients and patients with an inadequate response to tumor necrosis factor ( TNF ) inhibitors .


In this phase II , randomized , double-blind study , placebo or ixekizumab was administered subcutaneously to 260 biologics-naive patients and 188 patients with an inadequate response to TNF inhibitors at weeks 0 , 1 , 2 , 4 , 6 , 8 , and 10 with concomitant disease-modifying antirheumatic drugs .


The primary objective was to determine the dose-response relationship of ixekizumab as measured by the proportion of biologics-naive patients meeting the American College of Rheumatology 20 % improvement criteria ( ACR20 ) at week 12 .


Using a logistic regression model defined a priori , a statistically significant dose-response relationship as measured by ACR20 response rates at week 12 was detected in biologics-naive patients ( P = 0.031 ) .


For patients with an inadequate response to TNF inhibitors , ACR20 responses at week 12 were significantly better with ixekizumab than placebo ( P < 0.05 ) .


Decreases in the Disease Activity Score in 28 joints using the C-reactive protein level ( DAS28-CRP ) , Clinical Disease Activity Index ( CDAI ) , and CRP level from baseline were observed at week 12 in the ixekizumab groups in both populations ( P < 0.05 versus placebo ) .


Onset of action was rapid in some dose groups in both populations , with improvements in the ACR20 , DAS28-CRP , CRP levels , and CDAI observed by day 3 ( P < 0.05 ) .


Adverse events occurred with similar frequencies overall in the ixekizumab and placebo groups .


Infections were more frequent with ixekizumab than placebo ( biologics-naive 25 % versus 19 % ; inadequate responders to TNF inhibitors 27 % versus 25 % ) .


No mycobacterial or invasive fungal infections were reported .


Ixekizumab improved RA signs and symptoms in RA patients who were either naive to biologics treatment or had an inadequate response to TNF inhibitors .


The safety profile was similar to that of other biologic agents , with no unexpected safety concerns .


Io compare the difference on the clinical efficacy in treatment of chronic nephritis albuminuria between acupuncture and moxibustion at `` Xiasanhuang '' , DONG 's extra points and benazepril hydrochloride so as to provide the effective therapeutic method for the treatment of chronic nephritis albuminuria .


Methods One hundred and six cases of nephritis albuminuria were randomized into an acupuncture and moxibustion group and a western medication group , 53 cases in each one .


In the acupuncture and moxibustion group , acupuncture and moxibustion were applied to `` Xiasanhuang '' ( Tianhuang fuxue namely `` shenguan '' , `` Dihuang '' , `` Renhuang '' ) , once a day , the interval of 2 days once every 10 treatments .


In the western medication group , benazepril hydrochloride was prescribed for oral administration , 5 to 10 mg each time , once a day .


The treatment of 2 months made , one session in the two groups .


After 1 session treatment , the clinical efficacy , red blood cell count ( RBC ) of urinary sediment , 24 h urine protein quantitation and creatinine clearance rate ( Ccr ) before and after treatment were observed in the two groups .


The total effective rate was 84.9 % ( 45/53 ) in the acupuncture and moxibustion group , superior to 52.8 % ( 28/53 ) in the western medication group ( P < 0.01 ) .


After treatment , RBC of urinary sediment and 24 h urine protein quantitation were reduced as compared with those before treatment ( P < 0.01 , P < 0.05 ) , and the results in the acupuncture and moxibustion group were lower than those in the western medication group ( P < 0.05 , P < 0.01 ) .


After treatment , Ccr in the acupuncture and moxibustion group was higher than that before treatment ( P < 0.05 ) and higher than that in the western medication group ( P < 0.05 ) .


Ccr was not different significantly before and after treatment in the western medication group ( P > 0.05 ) .


Acupuncture and moxibustion at DONG 's extra points ( Xiasanhuang ) reduce proteinuria and improve kidney , function in patients of chronic nephritis and the efficacy is better than that with benazepril hydrochloride .


Depression is a common comorbidity of diabetes , undesirably affecting patients ' physical and mental functioning .


Psychological interventions are effective treatments for depression in the general population as well as in patients with a chronic disease .


The aim of this study was to assess the efficacy of individual mindfulness-based cognitive therapy ( MBCT ) and individual cognitive behavior therapy ( CBT ) in comparison with a waiting-list control condition for treating depressive symptoms in adults with type 1 or type 2 diabetes .


In this randomized controlled trial , 94 outpatients with diabetes and comorbid depressive symptoms ( i.e. , Beck Depression Inventory-II [ BDI-II ] 14 ) were randomized to MBCT ( n = 31 ) , CBT ( n = 32 ) , or waiting list ( n = 31 ) .


All participants completed written questionnaires and interviews at pre - and postmeasurement ( 3 months later ) .


Primary outcome measure was severity of depressive symptoms ( BDI-II and Toronto Hamilton Depression Rating Scale ) .


Anxiety ( Generalized Anxiety Disorder 7 ) , well-being ( Well-Being Index ) , diabetes-related distress ( Problem Areas In Diabetes ) , and HbA1c levels were assessed as secondary outcomes .


Results showed that participants receiving MBCT and CBT reported significantly greater reductions in depressive symptoms compared with patients in the waiting-list control condition ( respectively , P = 0.004 and P < 0.001 ; d = 0.80 and 1.00 ; clinically relevant improvement 26 % and 29 % vs. 4 % ) .


Both interventions also had significant positive effects on anxiety , well-being , and diabetes-related distress .


No significant effect was found on HbA1c values .


Both individual MBCT and CBT are effective in improving a range of psychological symptoms in individuals with type 1 and type 2 diabetes .


To explore the better therapy in the treatment of ganglion .


Ninety cases of ganglion were randomized into a two-way quintuple puncture group , a common quintuple puncture group and a fire needling group , 30 cases in each one .


In the two-way quintuple puncture group , the `` 9-in-1 '' multiple penetrating needling technique was used .


In the common quintuple puncture group , the traditional `` 5-in-1 '' multiple penetrating needling technique was applied .


In the fire needling group , the traditional multiple fire needling technique was adopted .


The treatment was given once a day , 3 treatments made one session and the efficacy was analyzed statistically after 1 session treatment in the three groups .


All of the three therapeutic methods achieved the efficacy on ganglion .


The curative rate was 96.7 % ( 29/30 ) in the two-way quintuple puncture group , which was better obviously than 66.7 % ( 20/30 ) in the common quintuple puncture group and 60.0 % ( 18/30 ) in the fire needling group ( both P < 0.01 ) .


The two-way quintuple puncture technique achieves the remarkably superior efficacy on ganglion as compared with the common quintuple puncture technique and fire needling technique .


Existing evidence suggests that administration of intravenous fluids has been shown to improve outcomes including pain in gynecological laparoscopic surgery but the optimum fluid dose has not been determined .


To determine the effect of administration of intravenous fluids on post-operative pain and pulmonary function after gynecological laparoscopy .


In a prospective randomized double-blinded study 100 ASA 1 and 2 elective patients undergoing gynecological laparoscopy were randomized to receive intravenous compound sodium lactate 10 ml kg ( -1 ) ( CSL10-restrictive ) or 30 ml kg ( -1 ) ( CSL30-liberal ) administered intra-operatively .


The primary outcome measure was the post-operative pain score at 24 , 48 and 72 h , assessed by 0-10 verbal rating scale ( VRS ) .


Pulmonary function ( FEV1 , FVC , PEFR ) and oxygen saturation were also measured .


Patients who received CSL 30 had lower post-operative pain scores than CSL 10 ( ANCOVA-mean difference = 0.47 , 95 % CI 0.11-0 .83 , P = 0.01 ) .


Post-operative pain VRS was lower in CSL30 than CSL10 at 48 h ( mean difference 0.56 , 95 % CI 0.04-1 .09 , P = 0.036 ) .


Patients in CSL30 reported shoulder tip pain less frequently than those in CSL10 ( 30.4 vs. 43.9 % of assessments , P = 0.03 , OR 0.58 ) but reported wound pain more frequently 39.0 vs. 24.2 % , P = 0.01 , OR 2.0 ) .


Indices of pulmonary function did not differ between groups at any time .


Liberal compared to restrictive administration of i.v. crystalloid is associated with a clinical modest reduction in pain .


Pulmonary dysfunction was not increased with liberal fluid administration .


Borderline personality disorder ( BPD ) is associated with a high socioeconomic burden .


Although a number of evidence-based treatments for BPD are currently available , they are not widely disseminated ; furthermore , there is a need for more research concerning their efficacy and cost-effectiveness .


Such knowledge promises to lead to more efficient use of resources , which will facilitate the effective dissemination of these costly treatments .


This study focuses on the efficacy and cost-effectiveness of Mentalization-Based Treatment ( MBT ) , a manualized treatment for patients with BPD .


Studies to date have either investigated MBT in a day hospitalization setting ( MBT-DH ) or MBT offered in an intensive outpatient setting ( MBT-IOP ) .


No trial has compared the efficacy and cost-effectiveness of these MBT programmes .


As both interventions differ considerably in terms of intensity of treatment , and thus potentially in terms of efficacy and cost-effectiveness , there is a need for comparative trials .


This study therefore sets out to investigate the efficacy and cost-effectiveness of MBT-DH versus MBT-IOP in patients with BPD .


A secondary aim is to investigate the association between baseline measures and outcome , which might improve treatment selection and thus optimize efficacy and cost-effectiveness .


A multicentre randomized controlled trial comparing MBT-DH versus MBT-IOP in severe BPD patients .


Patients are screened for BPD using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders , and are assessed before randomization , at the start of treatment and 6 , 12 , 18 , 24 , 30 and 36 months after the start of treatment .


Patients who refuse to participate will be offered care as usual in the same treatment centre .


The primary outcome measure is symptom severity as measured by the Brief Symptom Inventory .


Secondary outcome measures include parasuicidal behaviour , depression , substance use , social , interpersonal , and personality functioning , attachment , mentalizing capacities , and quality of life .


All analyses will be conducted based on the intention-to-treat principle .


Cost-effectiveness will be calculated based on costs per quality-adjusted life-year .


This multisite randomized trial will provide data to refine criteria for treatment selection for severe BPD patients and promises to optimize ( cost - ) effectiveness of the treatment of BPD patients .


NTR2292 .


Registered 16 April 2010 .


Neuroplasticity drives recovery of walking after a lesion of the descending tract .


Intramuscular coherence analysis provides a way to quantify corticomotor drive during a functional task , like walking and changes in coherence serve as a marker for neuroplasticity .


Although intramuscular coherence analysis is already applied and rapidly growing in interest , the reproducibility of variables derived from coherence is largely unknown .


The purpose of this study was to determine the test-retest reliability and agreement of intramuscular coherence variables obtained during walking in healthy subjects .


Ten healthy participants walked on a treadmill at a slow and normal speed in three sessions .


Area of coherence and peak coherence were derived from the intramuscular coherence spectra calculated using rectified and non-rectified M. tibialis anterior Electromyography ( EMG ) .


Reliability , defined as the ability of a measurement to differentiate between subjects and established by the intra-class correlation coefficient , was on the limit of good for area of coherence and peak coherence when derived from rectified EMG during slow walking .


Yet , the agreement , defined as the degree to which repeated measures are identical , was low as the measurement error was relatively large .


The smallest change to exceed the measurement error between two repeated measures was 66 % of the average value .


For normal walking and/or other EMG-processing settings , not rectifying the EMG and/or high-pass filtering with a high cutoff frequency ( 100 Hz ) the reliability was only moderate to poor and the agreement was considerably lower .


Only for specific conditions and EMG-processing settings , the derived coherence variables can be considered to be reliable measures .


However , large changes ( > 66 % ) are needed to indicate a real difference .


So , although intramuscular coherence is an easy to use and a sufficiently reliable tool to quantify intervention-induced neuroplasticity , the large effects needed to reveal a real change limit its practical use .


To analyze the efficacy and safety of mexidol and their effect on the dynamics of neurological signs of the disease , emotional status and quality of life in patients with chronic cerebral ischemia ( CCI ) .


We studied 45 patients with CCI who received mexidol in dose 500 mg a day during 14 days by introvenal introduction with the following peroral administration in doses 500 mg twice a day during 60 days .


A comparison group included 30 patients with CCI matched for age , risk factors and severity of neurological symptoms , who did not receive mexidol .


Patients of both groups received standard treatment that included medications needed for the complete correction of the risk factors .


Cognitive function ( MMSE ) , movement activity and quality of life ( SF-36 ) were assessed .


To the end of the study ( 74th day ) , a decrease in the severity of movement disorders , normalization of SF-36 scores and improvement of mean values of screening-assessment of cognitive function were identified in patients of the main group compared to those of the comparison group .


The high efficacy and safety of treatment of CCI patients with mexidol using .


To compare the efficacy of non-nutritive sweetened beverages ( NNS ) or water for weight loss during a 12-week behavioral weight loss treatment program .


An equivalence trial design with water or NNS beverages as the main factor in a prospective randomized trial among 303 men and women was employed .


All participants participated in a behavioral weight loss treatment program .


The results of the weight loss phase ( 12 weeks ) of an ongoing trial ( 1 year ) that is also evaluating the effects of these two treatments on weight loss maintenance were reported .


The two treatments were not equivalent with the NNS beverage treatment group losing significantly more weight compared to the water group ( 5.95 kg versus 4.09 kg ; P < 0.0001 ) after 12 weeks .


Participants in the NNS beverage group reported significantly greater reductions in subjective feelings of hunger than those in the water group during 12 weeks .


These results show that water is not superior to NNS beverages for weight loss during a comprehensive behavioral weight loss program .


Adequate monitoring tools are required to optimise the immunosuppressive therapy of an individual patient .


Particularly , in calcineurin inhibitors , as critical dose drugs with a narrow therapeutic range , the optimal monitoring strategies are discussed in terms of safety and efficacy .


Nevertheless , no pharmacokinetic monitoring markers reflect the biological activity of the drug .


A new quantitative analysis of gene expression was employed to directly measure the functional effects of calcineurin inhibition : the transcriptional activities of the nuclear factor of activated T-cell ( NFAT ) - regulated genes in the peripheral blood .


The CIS study is a randomised prospective controlled trial , comparing a ciclosporin A ( CsA ) - based immunosuppressive regimen monitored by CsA trough levels to a CsA-based immunosuppressive regimen monitored by residual NFAT-regulated gene expression .


Pulse wave velocity as an accepted surrogate marker of the cardiovascular risk is assessed in both study groups .


Our hypothesis is that an individualised CsA therapy monitored by residual NFAT-regulated gene expression results in a significantly lower cardiovascular risk compared to CsA therapy monitored by CsA trough levels .


There is a lack of evidence in individualising standard immunosuppression in renal allograft recipients .


The CIS study will consider the feasibility of individualised ciclosporin A immunosuppression by pharmacodynamic monitoring and evaluate the opportunity to reduce cardiovascular risk while maintaining sufficient immunosuppression .


EudraCT identifier 2011-003547-21 , registration date 18 July 2011https : / / www.clinicaltrialsregister.eu .


To systematically study the effects of shared medical appointments ( SMAs ) compared with individual appointments for patients with a chronic neuromuscular disorder and their partners .


In this randomized controlled trial with a follow-up of 6 months , we included patients with a chronic neuromuscular disorder and their partners .


Participants were randomly allocated to an SMA or an individual outpatient appointment .


The primary outcome measure was patients ' health-related quality of life ( QOL ) ( 36-Item Short Form Health Survey ) .


Secondary outcome measures included self-efficacy , social support , patient and partner satisfaction with the appointment , and time available per patient .


Two hundred seventy-two patients and 149 partners were included .


Health-related QOL showed greater improvement in patients who had attended an SMA ( mean difference 2.8 points , 95 % confidence interval 0.0-5 .7 , p = 0.05 ) .


Secondary outcomes showed small improvements in the control group for satisfaction with the appointment ( p = 0.01 ) .


Neurologists spent less time per patient during the SMAs : mean 16 minutes ( range 11-30 ) vs. 25 minutes ( range 20-30 ) for individual appointments .


This study provides evidence that SMAs can improve aspects of QOL of patients with a chronic neuromuscular disorder .


This could result in an alternative to individual appointments and improvements in both effectiveness and efficiency .


Further research to optimize SMAs and to identify critical success factors seems warranted .


These data extend evidence on SMAs for neurologic patients .


This study provides Class III evidence that for patients with chronic neuromuscular disorders , SMAs improve QOL as compared with individual medical appointments .


To study features of lipid peroxidation in patients with different types of gastroesophageal reflux disease ( GERD ) .


We examined 120 patients with different clinical variants of GERD and 25 healthy individuals .


It was determined the concentration of diene conjugates ( DC ) ketodienes ( KD ) , conjugated trienes ( CT ) by biochemical methods in serum and mucosal biopsies of the lower third of the esophagus .


In biopsies of esophagus mucosa the content of DK , CD , CT was increased in patients with complications of GERD ( ulcerative esophagitis and Barrett 's esophagus ) in 2,2-5 ,3 times compared with healthy individuals .


In blood serum registered similar but less pronounced regularities .


It was revealed a significant intensification of free radical oxidation in the tissues of the esophagus and the blood of patients with GERD , which was exacerbated in proportion to the severity of the disease .


Our previous studies have demonstrated the treatment benefits of dense cranial electroacupuncture stimulation ( DCEAS ) , a novel brain stimulation therapy in patients with major depression , postpartum depression and obsessive-compulsive disorder .


The purpose of the present study was to further evaluate the effectiveness of DCEAS combined with body acupuncture and selective serotonin reuptake inhibitors ( SSRIs ) in patients with post-stroke depression ( PSD ) .


In a single-blind , randomized controlled trial , 43 patients with PSD were randomly assigned to 12 sessions of DCEAS plus SSRI plus body electroacupuncture ( n = 23 ) , or sham ( non-invasive cranial electroacupuncture , n-CEA ) plus SSRI plus body electroacupuncture ( n = 20 ) for 3 sessions per week over 4 weeks .


Treatment outcomes were measured using the 17-item Hamilton Depression Rating Scale ( HAMD-17 ) , the Clinical Global Impression - Severity scale ( CGI-S ) and Barthel Index ( BI ) , a measure used to evaluate movement ability associated with daily self-caring activity .


DCEAS produced a significantly greater reduction of both HAMD-17 and CGI-S as early as week 1 and CGI-S at endpoint compared to n-CEA , but subjects of n-CEA group exhibited a significantly greater improvement on BI at week 4 than DCEAS .


Incidence of adverse events was not different in the two groups .


These results indicate that DCEAS could be effective in reducing stroke patients ' depressive symptoms .


Superficial electrical stimulation in n-CEA group may be beneficial in improving movement disability of stroke patients .


A combination of DCEAS and body acupuncture can be considered a treatment option for neuropsychiatric sequelae of stroke .


http://www.clinicaltrials.gov , NCT01174394 .


To evaluate safety , tolerability , seizure frequency , and regional variations in treatment responses with the AMPA antagonist , perampanel , in a large extension study during up to 3 years of treatment .


Patients 12 years old with partial-onset seizures despite treatment with 1-3 antiepileptic drugs at baseline completed a perampanel phase III trial and entered extension study 307 ( NCT00735397 ) .


Patients were titrated to 12 mg/day ( or their individual maximum tolerated dose ) during the blinded conversion period , followed by open-label maintenance .


Exposure , safety ( adverse events [ AEs ] , vital signs , weight , electrocardiography [ ECG ] , laboratory values ) and seizure outcomes were analyzed ; key measures were assessed by geographic regions .


Among 1,216 patients , median exposure was 1.5 years ( range 1 week to 3.3 years ) , with > 300 patients treated for > 2 years .


Treatment retention was 58.5 % at cutoff .


AEs reported in 10 % of patients were dizziness , somnolence , headache , fatigue , irritability , and weight increase .


Only dizziness and irritability caused discontinuation in > 1 % of patients ( 3.9 % and 1.3 % , respectively ) .


The only serious AEs reported in > 1 % of patients were epilepsy-related ( convulsion , 3.0 % ; status epilepticus , 1.1 % ) .


No clinically relevant changes in vital signs , ECG or laboratory parameters were seen .


After titration/conversion , responder rate and median percentage change from baseline in seizure frequency were stable : 46 % for both measures at 9 months ( in 980 patients with 9 months ' exposure ) and 58 % and 60 % , respectively , at 2 years ( in the 337 patients with 2 years ' exposure ) .


Median percentage reduction in frequency of secondarily generalized ( SG ) seizures ranged from 77 % at 9 months ( N = 422 ) to 90 % at 2 years ( N = 141 ) .


Among the 694 patients with maintenance data 1 year , 5.3 % were seizure-free for the entire year .


No new safety signals emerged during up to 3 years of perampanel exposure in 39 countries .


Seizure responses remained stable , with marked reductions , particularly in SG seizures .


Sensitivity of the myofascial trigger point ( MTrP ) can be inhibited by electrical stimulation of remote site .


However , it remains unclear whether remote pain control of the MTrP occurs in the same spinal segment or in the supraspinal system .


The aims of this study were to identify whether the remote pain control occurs in the spinal segment corresponding to the MTrP or in the supraspinal system .


Test subjects ( n = 10 ) received transcutaneous electrical nerve stimulation for 5 minutes , whereas control subjects ( n = 10 ) received no intervention .


The threshold for tactile sensory modulation at the lateral elbow was assessed using Von Frey filaments .


The pressure sensitivities of MTrPs in both the infraspinatus and upper trapezius muscles were quantified by algometry .


Measurements were performed at baseline and 1 and 15 minutes after the intervention .


Increases of the tactile threshold at the remote site decreased the sensitivity of the MTrP innervated by same spinal segment .


However , no changes were observed at MTrP sites innervated by contralateral fibers or those from different spinal segment .


MTrP sensitivity is more strongly affected by interventions at remote ipsilateral sites in the same spinal segment than by stimulation of extra-segmental sites .


Thrombocytopenia occurs in 20 % to 45 % of critically ill medical-surgical patients .


The 4Ts heparin-induced thrombocytopenia ( HIT ) score ( with 4 domains : Thrombocytopenia , Timing of thrombocytopenia , Thrombosis and oTher reason [ s ] for thrombocytopenia ) might reliably identify patients at low risk for HIT .


Interobserver agreement on 4Ts scoring is uncertain in this setting .


To evaluate whether a published clinical prediction rule ( the `` 4Ts score '' ) reliably rules out HIT in `` low-risk '' intensive care unit ( ICU ) patients as assessed by research coordinators ( who prospectively scored ) and 2 adjudicators ( who scored retrospectively ) during an international heparin thromboprophylaxis trial ( PROTECT , NCT00182143 ) .


Of 3746 medical-surgical ICU patients in PROTECT , 794 met the enrollment criteria for this HIT substudy .


Enrollment was predicated on one of the following occurring in ICU : platelets less than 5010 ( 9 ) / L , platelets decreased to 50 % of ICU admission value ( if admission value < 10010 ( 9 ) / L ) , any venous thrombosis , or if HIT was otherwise clinically suspected .


Independently , 4Ts scores were completed in real time by research coordinators blinded to study drug and laboratory HIT results , and retrospectively by 2 adjudicators blinded to study drug , laboratory HIT results , and research coordinators ' scores ; the adjudicators arrived at consensus in all cases .


Of the 763 patients , 474 had a central or local laboratory HIT test performed and had 4Ts scoring by adjudicators ; 432 were scored by trained research coordinators .


Heparin-induced thrombocytopenia was defined by a centrally performed positive serotonin release assay ( SRA ) .


Of the 474 patients with central adjudication , 407 ( 85.9 % ) had a 4Ts score of 3 or lower , conferring a low pretest probability ( PTP ) of HIT ; of these , 6 ( 1.5 % [ 95 % confidence interval , 0.7 % -3.2 % ) had a positive SRA .


Fifty-nine ( 12.4 % ) had a moderate PTP ( 4Ts score of 4-5 ) ; of these , 4 ( 6.8 % ) had a positive SRA .


Eight patients had a high PTP ( 4Ts score of 6 ) ; of these , 1 ( 12.5 % ) had a positive SRA .


Raw agreement between research coordinators and central adjudication on each domain of the 4Ts score and low , intermediate , and high PTP was good .


However , chance-corrected agreement was variable between adjudicators ( weighted values of 0.31-0 .93 ) and between the adjudicator consensus and research coordinators ( weighted values of 0.13 and 0.78 ) .


Post hoc review of the 6 SRA-positive cases with an adjudicated low PTP demonstrated that their scores would have been increased if the adjudicators had had additional information on heparin exposure prior to ICU admission .


In general , the fourth domain of 4Ts ( oTher causes of thrombocytopenia ) generated the most disagreement .


Real-time 4Ts scoring by research coordinators at the time of testing for HIT was not consistent with 4Ts scores obtained by central adjudicators .


The results of this comprehensive HIT testing highlight the need for further research to improve the assessment of PTP scoring of HIT for critically ill patients .


Subendocardial strain analysis is currently feasible in two-dimensional and three-dimensional ( 3D ) echocardiography ; however , there is a lack of clarity regarding the most useful strain component for subclinical disease detection .


The aim of this study was to test the hypothesis that strain analysis along the direction of strongest and weakest systolic compression ( referred to as principal and secondary strain , respectively ) circumvents the need for multidirectional strains and provides a more simplified assessment of left ventricular subendocardial function .


Strain analyses were performed by using two-dimensional and 3D echocardiography in 41 consecutive subjects with normal results on electron-beam computed tomography , including 15 controls and 26 patients with systemic hypertension .


The direction of principal strain referenced the myofiber geometry obtained from diffusion tensor magnetic resonance imaging of a normal autopsied human heart .


The incremental value of principal strain over multidirectional two-dimensional and 3D strain was analyzed .


In healthy subjects , 50 3 % of the subendocardial shortening occurred in the cross-fiber direction ( left-handed helical ) ; this balance was significantly altered in patients with hypertension ( P = .01 ) .


The magnitude of longitudinal and circumferential strain was similar in patients with hypertension and controls .


However , the alteration of the directional contraction pattern resulted in reduced secondary strain magnitude in patients with hypertension ( P = .01 ) , and the differences were further exaggerated when the secondary strain was normalized by the principal strain magnitude ( P = .004 ) .


Two-component principal and secondary strain analysis can be related to left ventricular myofiber geometry and may simplify the assessment of 3D left ventricular deformation by circumventing the need to assess multiple shortening and shear strain components .


Children with type 1 diabetes ( T1D ) and elevated LDL-C have an increased risk for cardiovascular disease , a process that can begin in childhood .


To assess the safety and efficacy of atorvastatin improving lipid profiles in children with T1D and elevated LDL-C .


Sixty children ( 31M/29F ) with T1D , mean age : 15 0.3 yr , mean diabetes duration : 6.8 0.5 yr , HbA ( 1c ) : 8.8 0.2 % , with mean LDL-C 124 4.0 mg/dl were recruited .


After a 3-month run-in period , subjects were randomized double-blindly to atorvastatin or placebo for 6 months .


Lipoprotein subfractions were measured by ion mobility and glucose control by HbA1C ; continuous glucose monitors were worn quarterly .


After a run-in period , 42 subjects were randomized .


There were decreases in total cholesterol ( -21 % ) , LDL-C ( -32 % ) , non-HDL-C ( -31 % ) and apoB ( -26 % ) in the atorvastatin group versus placebo ( p < 0.001 ) .


Lipoprotein subparticles ( LDL-large 1 and 2A , IDL-large and small , VLDL - medium and small ) decreased with statins ( p < 0.03 all ) .


Insulin sensitivity scores remained constant in both groups and correlated inversely with apoB ( r = -0.312 p = 0.039 ) and small LDL 3A ( r = -0.404 p = 0.007 ) .


One subject had asymptomatic elevation of creatinine kinase which normalized after atorvastatin discontinuation .


Atorvastatin lowered LDL-C , apoB , and atherogenic lipoprotein subparticles in children with T1D and elevated LDL-C without worsening insulin resistance .


The drug was well tolerated and safe .


Long-term studies would provide better insight on the impact of these interventions in the development of cardiovascular disease in children with diabetes .


Protected sleep periods for internal medicine interns have previously resulted in increased amount slept and improved cognitive alertness but required supplemental personnel .


The authors evaluated intern and patient outcomes associated with protected nocturnal nap periods of three hours that are personnel neutral .


Randomized trial at Philadelphia Veterans Affairs Medical Center ( PVAMC ) Medical Service and Hospital of the University of Pennsylvania ( HUP ) Oncology Unit .


During 2010-2011 , four-week blocks were randomly assigned to a standard intern schedule ( extended duty overnight shifts of up to 30 hours ) , or sequential protected sleep periods ( phone sign-out midnight to 3:00 AM [ early shift ] intern 1 ; 3:00 to 6:00 AM [ late shift ] intern 2 ) .


Participants wore wrist Actiwatches , completed sleep diaries , and performed daily assessments of behavioral alertness .


Between-group comparisons of means and proportions controlled for within-person correlations .


HUP interns had significantly longer sleep durations during both early ( 2.40 hours ) and late ( 2.44 hours ) protected periods compared with controls ( 1.55 hours , P < .0001 ) .


At PVAMC sleep duration was longer only for the late shift group ( 2.40 versus 1.90 hours , P < .036 ) .


Interns assigned to either protected period were significantly less likely to have call nights with no sleep and had fewer attentional lapses on the Psychomotor Vigilance Test .


Differences in patient outcomes between standard schedule months versus intervention months were not observed .


Protected sleep periods of three hours resulted in more sleep during call and reductions in periods of prolonged wakefulness , providing a plausible alternative to 16-hour shifts .


Determine whether SNPs of OPRM1 118A > G ( asn ( 40 ) asp ) , COMT 472G > A ( val ( 158 ) met ) and ARRB2 8622C > T are associated with morphine rescue in newborns on mechanical ventilation .


This is a pharmacogenetic analysis of a randomized controlled trial in ( pre ) term newborns ( n = 64 ) at a level III Neonatal Intensive Care Unit ( NICU ) who received placebo infusion and for whom need and dose for rescue morphine was documented .


For OPRM1 and COMT separately , the expected risk for rescue morphine or morphine dose was not significantly increased .


However , the combined OPRM1/COMT ` high-risk ' genotype lead to a significant association with the need for rescue ( OR : 5.12 ; 95 % CI : 1.12-23 .3 ; p = 0.035 ) .


No association was found between OPRM1/COMT ` high-risk ' genotype and total morphine dose administered .


Combined OPRM1 118A > G and COMT 472G > A genotype might serve as a predictor for the need of rescue morphine in premature and term newborns on mechanical ventilation .


To determine if application of silver sodium zirconium phosphate polyurethane semi-occlusive foam ( SPF ) dressing would improve measures of wound healing and decrease bacterial contamination compared with a non-adherent , absorbent dressing applied to wounds created on the distal aspect of the equine limb .


Controlled randomized experimental study .


Adult Quarter Horse and Thoroughbred horses ( n = 5 ) .


One 6.25 cm ( 2 ) wound was created on the dorsomedial aspect of the proximal metacarpus on each forelimb .


A SPF dressing was applied to 1 randomly assigned limb as a treatment and a non-adherent , absorbent dressing was applied to the opposite limb as control .


Bandages were changed every 3 days for 60 days .


Granulation tissue was scored every 3 days , wound area measured every 6 days , and wound bed was cultured every 12 days .


SPF-treatment wounds had significantly decreased wound area and decreased granulation tissue scores when evaluated < 30 days and over the 60 day study , although complete wound healing times were not significantly different .


Bacteria were cultured from all wounds at varying times throughout the study .


The SPF wound dressing improved some measures of wound healing compared with the control dressing , most significantly during the first 30 days .


This suggests that the SPF wound dressing may be useful in the early management of wounds on the equine lower limb .


Further studies using the SPF dressing are needed to characterize the temporal and cellular effects on wound healing and evaluate this dressing in a clinical environment .


The aim of this study was to investigate the effects of ingesting caffeine and green coffee bean extract on blood glucose and insulin concentrations during a post-exercise oral glucose tolerance test .


Ten male cyclists ( age : 26 5 y ; height : 179.9 5.4 cm ; weight : 77.6 13.3 kg ; body mass index : 24 4.3 kg/m ( 2 ) ; VO2 peak : 55.9 8.4 mLkgmin ( -1 ) ) participated in this study .


In a randomized order , each participant completed three 30-min bouts of cycling at 60 % of peak power output .


Immediately after exercise , each participant consumed 75 g of dextrose with either 5 mg/kg body weight of caffeine , 10 mg/kg of green coffee bean extract ( 5 mg/kg chlorogenic acid ) , or placebo .


Venous blood samples were collected immediately before and after exercise during completion of the oral glucose tolerance test .


No significant time treatment effects for blood glucose and insulin were found .


Two-h glucose and insulin area under the curve values , respectively , for the caffeine ( 658 74 mmol/L and 30,005 13,304 pmol/L ) , green coffee bean extract ( 637 100 mmol/L and 31,965 23,586 pmol/L ) , and placebo ( 661 77 mmol/L and 27,020 12,339 pmol/L ) trials were not significantly different ( P > 0.05 ) .


Caffeine and green coffee bean extract did not significantly alter postexercise blood glucose and insulin concentrations when compared with a placebo .


More human research is needed to determine the impact of these combined nutritional treatments and exercise on changes in blood glucose and insulin .


Exercise has beneficial effects on pain in knee osteoarthritis ( OA ) , yet the underlying mechanisms are unclear .


The purpose of this study was to investigate the effects of exercise on pressure-pain sensitivity in patients with knee OA .


In a randomized controlled trial , participants were assigned to 12 weeks of supervised exercise therapy ( ET ; 36 sessions ) or a no attention control group ( CG ) .


Pressure-pain sensitivity was assessed by cuff pressure algometry on the calf of the most symptomatic leg .


The coprimary outcomes were pressure-pain thresholds ( PPTs ) and cumulated visual analog scale pain scores during constant pressure for 6 minutes at 125 % of the PPT as a measure of temporal summation ( TS ) of pressure-pain .


Secondary outcomes included self-reported pain using the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) questionnaire .


Analyses were based on the `` per-protocol '' population ( participants following the protocol ) .


Sixty participants were randomized ( 31 in ET group , 29 in CG ) , and the per-protocol population included 48 participants ( 25 in ET group , 23 in CG ) .


At followup , mean group differences in the change from baseline were 3.1 kPa ( 95 % confidence interval [ 95 % CI ] 0.2 , 6.0 ; P = 0.038 ) for the PPT , 2,608 mm seconds ( 95 % CI 458 , 4,758 ; P = 0.019 ) for TS , and 6.8 points ( 95 % CI 1.2 , 12.4 ; P = 0.018 ) for KOOS pain , all in favor of ET .


Pressure-pain sensitivity , TS , and self-reported pain are reduced among patients completing a 12-week supervised exercise program compared to a no attention CG .


These results demonstrate beneficial effects of exercise on basic pain mechanisms and further exploration may provide a basis for optimized treatment .


To explore the therapeutic effect evaluation of proton magnetic resonance spectroscopy ( ( 1 ) H-MRS ) in patients with vascular cognitive impairment no dementia ( VCIND ) with dioscorea modified pill .


A total of 100 patients with VCIND were randomly assigned into the dioscorea modified pill group ( n = 50 ) and the aricept group ( n = 50 ) .


And 50 healthy volunteers were recruited as normal group .


Each patient was examined with ( 1 ) H-MRS and scored with mini-mental state examination ( MMSE ) and clinical dementia rating ( CDR ) scale pre - and post-treatment .


After therapy , the NAA/Cr ratios and the itemized scores of cognitive scale compared with that of pre-therapy had significantly difference ( P < 0.05 ) in the dioscorea modified pill group ( MMSE ( 26.5 2.0 ) , CDR ( 0.14 0.23 ) ) vs ( MMSE ( 25.1 2.3 ) , CDR ( 0.5 ) ) .


But no difference existed in the aricept group ( P > 0.05 ) .


( 1 ) H-MRS may objectively reflect cognitive dysfunction in VCIND patients .


And it has important values in the therapeutic effect evaluation of VCIND with dioscorea modified pill .


Soluble CD14 ( sCD14 ) is a monocyte activation marker associated with increased mortality in HIV infection .


We assessed 48-week changes in sCD14 and other inflammatory biomarkers in virologically suppressed , HIV-infected women switching to raltegravir ( RAL ) from a protease inhibitor ( PI ) or nonnucleoside reverse transcriptase inhibitor ( NNRTI ) .


HIV-infected women with central adiposity and HIV-1 RNA < 50 HIV-1 RNA copies/mL continued their thymidine-sparing nucleoside reverse transcriptase inhibitor ( NRTI ) backbone and were randomized to switch to open-label RAL at week 0 ( immediate ) or 24 ( delayed ) .


In an exploratory analysis , inflammatory biomarkers were measured on stored fasting plasma .


Of the 37 evaluable subjects , 78 % were non-White ; the median age was 43 years , the median body mass index ( BMI ) was 32kg/m ( 2 ) and the median CD4 count was 558cells/L .


At baseline , biomarker values were similar between groups .


After 24 weeks , median sCD14 significantly declined in subjects switching to RAL [ -21 % ( P < 0.001 ) vs.PI / NNRTI -5 % ( P = 0.49 ) ; between-group P < 0.01 ] .


After 48 weeks , immediate-switch subjects maintained this decline and delayed-switch subjects experienced a similar decline following the switch to RAL ( -10 % ; within-group P < 0.01 ) .


Immediate-switch subjects also experienced an initial increase in tumour necrosis factor ( TNF ) - that was neither maintained after 48 weeks nor seen in delayed-switch subjects .


After adjustment for multiple testing , only declines in sCD14 remained significant .


In this randomized trial of women with central adiposity , a switch to RAL from a PI or NNRTI was associated with a statistically significant decline in sCD14 .


Further studies are needed to determine whether integrase inhibitors have improved monocyte activation profiles compared with PIs and/or NNRTIs , and whether measured differences between antiretroviral agents translate to demonstrable clinical benefit .


To evaluate the efficacy of abdominal acupuncture for adhesion-stage shoulder periarthritis .


One hundred and fifty-seven cases of shoulder periarthritis were randomly divided into an abdominal acupuncture group ( 79 cases ) and a body acupuncture group ( 78 cases ) .


The abdominal acupuncture was applied at Zhongwan ( CV 12 ) , Shangqu ( KI 17 ) and Huaroumen ( ST 24 ) in the abdominal acupuncture group while conventional acupuncture was applied at Jianyu ( LI 15 ) , Jianliao ( TE 14 ) and Jianzhen ( SI 9 ) in the body acupuncture group .


The treatment was given three times a week for both groups and ten times made an observation course .


Before and after treatment , visual analogue scale ( VAS ) was adopted for pain assessment and functional activity score ( Mallet score ) was used for shoulder joint function assessment for all the patients .


Also the efficacy of both groups was compared .


The total effective rate in the abdominal acupuncture group was 92.4 % ( 73/79 ) , which was superior to 71.8 % ( 56/78 ) in the body acupuncture group .


The score of VAS after the treatment was 2.58 + / - 1.64 in the abdominal acupuncture group while 3.12 + / - 1.93 in the body acupuncture group , which had no statistical significance between each other ( P > 0.05 ) .


The functional activity score after the treatment was 8.34 + / - 3.02 in the abdominal acupuncture group while 7.49 + / - 3.36 in the body acupuncture group , which had no statistical significance between each other ( P > 0.05 ) .


The abdominal acupuncture is an ideal treatment for adhesion-stage shoulder periarthritis , which has better total efficacy than conventional acupuncture .


It achieves the same effect in relieving pain and improving functional activity as conventional acupuncture , but also has an advantage at fast selection of acupoint and less discomfort of needling sensation .


We evaluated the feasibility of a trial of Wii interactive video gaming , and its potential efficacy at improving cognitive functioning compared with health education , in a community sample of older adults with neuropsychologically defined mild cognitive impairment .


Twenty older adults were equally randomized to either group-based interactive video gaming or health education for 90min each week for 24weeks .


Although the primary outcomes were related to study feasibility , we also explored the effect of the intervention on neuropsychological performance and other secondary outcomes .


All 20 participants completed the intervention , and 18 attended at least 80 % of the sessions .


The majority ( 80 % ) of participants were `` very much '' satisfied with the intervention .


Bowling was enjoyed by the most participants and was also rated the highest among the games for mental , social , and physical stimulation .


We observed medium effect sizes for cognitive and physical functioning in favor of the interactive video gaming condition , but these effects were not statistically significant in this small sample .


Interactive video gaming is feasible for older adults with mild cognitive impairment , and medium effect sizes in favor of the Wii group warrant a larger efficacy trial .


To assess the effect of preoperative topical nonsteroidal antiinflammatory drugs ( NSAIDs ) on postoperative pain after laser-assisted subepithelial keratectomy ( LASEK ) and to investigate their mechanism .


Severance Eye Hospital and Saeyan Eye Clinic , Seoul , South Korea .


Prospective randomized clinical trial .


Participants in 2 related studies were assessed .


Study 1 comprised patients scheduled for bilateral LASEK ( Group 1 ) who were randomized to receive an NSAID in 1 eye and a placebo in the fellow eye 30 , 20 , and 10 minutes before LASEK .


Postoperative pain , glare , tearing , and irritation were assessed using a visual analog scale .


Study 2 comprised healthy subjects ( Group 2 ) who were randomly divided into subgroups .


The participants in these subgroups were randomized to receive ketorolac tromethamine 0.5 % in 1 eye and placebo ( ofloxacin 0.3 % ) in the fellow eye ( Group 2A ) , proparacaine hydrochloride 0.5 % in 1 eye and placebo in the fellow eye ( Group 2B ) , or ketorolac tromethamine 0.5 % in 1 eye and placebo in the fellow eye , followed 10 minutes later by 1 drop of proparacaine hydrochloride 0.5 % in both eyes ( Group 2C ) .


In all 3 groups , corneal sensitivity was measured after 1 , 2 , and 6 hours .


The mean postoperative pain score in the NSAID-pretreated eye was statistically significantly lower than in the placebo-pretreated eye 6 , 12 , and 24 hours postoperatively ( P < .05 ) .


The mean corneal sensitivity was statistically significantly lower in the NSAID-treated eye than in the placebo-treated eye at 1 and 2 hours in Groups 2A and 2C ( P < .05 ) .


Preoperative administration of topical NSAIDs before LASEK effectively reduces postoperative pain .


No author has a financial or proprietary interest in any material or method mentioned .


Sufentanil sublingual microtablets ( SSMs ) at a dose of 15 g per tablet have been studied for postoperative patient-controlled analgesia with a 20-minute lockout via a bedside handheld system over 2 days to 3 days of use .


For more short-term ( < 24 hours ) management of acute moderate-to-severe pain , such as in the ambulatory surgical setting , a single , higher-strength SSM dose administered via a health care provider would be of benefit as it would require less frequent administration and avoid the setup of a drug delivery system .


This study was a two-center , randomized , double-blind , placebo-controlled trial for 12 hours in patients 18 years to 80 years of age who were undergoing bunionectomy alone or with hammertoe repair .


Patients were randomly assigned at a 2:2:1 ratio to treatment with SSM 20 g , SSM 30 g , or placebo .


The primary endpoint was time-weighted summed pain intensity difference to baseline over 12 hours ( SPID12 ) .


Patients had to have a pain intensity score of 4 or higher just before initial microtablet dosing .


Additional doses were administered when requested by the patient , with a minimum redosing interval of 1 hour .


One hundred patients were randomized and received study drug .


The SSM 30 g was superior in the treatment of postbunionectomy surgical pain compared with placebo as demonstrated by the SPID12 score ( 6.53 vs. -7.12 , respectively ; p = 0.003 ) as well as all other secondary efficacy end points .


The SSM 20-g dosage strength was not superior to placebo for primary or secondary efficacy measures .


Adverse events were similar among the three groups with the exception of nausea , vomiting , and somnolence , which demonstrated a dose-dependent increase in occurrence .


The SSM 30 g may be an effective , noninvasive alternative to health care provider-administered intravenous , intramuscular , or oral opioids for the management of moderate-to-severe acute pain .


Therapeutic study , level I.


Fibromyalgia ( FM ) is a chronic disorder that can have a devastating effect on patients ' lives .


This study assessed the efficacy of a 6-week interdisciplinary treatment that combines coordinated PSYchological , Medical , Educational , and PHYsiotherapeutic interventions ( PSYMEPHY ) compared with standard pharmacologic care .


The study was a randomized controlled trial ( 54 participants in the PSYMEPHY group and 56 in the control group [ CG ] ) with follow-up at 6 months .


PSYMEPHY patients were also assessed at 12 months .


The main outcomes were changes in total Fibromyalgia Impact Questionnaire ( FIQ ) score , pain , fatigue , morning tiredness , anxiety , and use of pain coping strategies as measured by the FIQ , the visual analog scale , and the Coping with Chronic Pain Questionnaire .


After the 6-month assessment , patients in the CG were offered the PSYMEPHY treatment , and completed all of the instruments immediately after treatment , and at 6 - and 12-month follow-up visits ( N = 93 ) .


Subjects received therapy at two different outpatient clinical locations .


Fibromyalgia patients .


Six months after the intervention , significant improvements in total FIQ score ( P = 0.04 ) , and pain ( P = 0.03 ) were seen in the PSYMEPHY group compared with controls .


Twelve months after the intervention , all patients in the PSYMEPHY group maintained statistically significant improvements in total FIQ score , and pain , and showed an improvement in fatigue , rested , anxiety , and current pain compared with baseline .


Data from the control patients who underwent the PSYMEPHY intervention corroborated the initial results .


This study highlights the beneficial effects of an interdisciplinary treatment for FM patients in a hospital pain management unit .


A 6-week interdisciplinary intervention showed significant improvement in key domains of fibromyalgia , as quality of life , pain , fatigue , rested , and anxiety at 12 months .


Radical prostatectomy reduces mortality among men with localized prostate cancer ; however , important questions regarding long-term benefit remain .


Between 1989 and 1999 , we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012 .


The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 ( SPCG-4 ) were death from any cause , death from prostate cancer , and the risk of metastases .


Secondary end points included the initiation of androgen-deprivation therapy .


During 23.2 years of follow-up , 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died .


Of the deaths , 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer ; the relative risk was 0.56 ( 95 % confidence interval [ CI ] , 0.41 to 0.77 ; P = 0.001 ) , and the absolute difference was 11.0 percentage points ( 95 % CI , 4.5 to 17.5 ) .


The number needed to treat to prevent one death was 8 .


One man died after surgery in the radical-prostatectomy group .


Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy ( a difference of 25.0 percentage points ; 95 % CI , 17.7 to 32.3 ) .


The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age ( relative risk , 0.45 ) and in those with intermediate-risk prostate cancer ( relative risk , 0.38 ) .


However , radical prostatectomy was associated with a reduced risk of metastases among older men ( relative risk , 0.68 ; P = 0.04 ) .


Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy ; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk .


A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment .


( Funded by the Swedish Cancer Society and others . )


To evaluate the effectiveness of a 3-month treadmill desk intervention in eliciting changes in physical activity and sedentary behavior among overweight/obese office workers .


A randomized controlled trial was conducted among overweight/obese office workers ( n = 41 ; mean age = 40.1 10.1 years ) at a private workplace .


Participants were randomly assigned to a shared-treadmill desk intervention ( n = 21 ) or a usual working condition control group ( n = 20 ) .


Accelerometer-determined physical activity and sedentary behavior were measured before and after the intervention .


Compared with the control group , the intervention group increased daily steps ( 1622 steps/day ; P = 0.013 ) and light physical activity ( 1.6 minutes/hour ; P = 0.008 ) , and decreased sedentary time ( -3.6 minutes/hour ; P = 0.047 ) during working hours .


Shared-treadmill desks in the workplace can be effective at promoting favorable changes in light physical activity ( specifically 40 to 99 steps/minute ) and sedentary behavior among overweight/obese office workers .


Lower impacted third molar surgical extraction usually causes post-surgical sequelae like pain , trismus and swelling as a result of postoperative inflammatory response .


The aim of this study was to evaluate and compare the efficacy of single dose 40-mg ( 1 cc ) of methylprednisolone acetate , injected into the masseter muscle , preoperatively one hour before the surgery or post-operatively , immediately following the surgical removal of impacted lower third molars , in controlling most common postoperative sequelae , i.e. trismus , pain and swelling of facial soft tissue .


A randomized control study was done of 60 patients .


Each patient was categorized in two groups , group I and group II , according to the time of receiving methylprednisolone acetate .


Group I was injected 40 mg of methylprednisolone acetate into the masseter muscle via the intrabuccal approach , one hour before the surgery .


Group II was injected 40 mg of methylprednisolone acetate into the masseter muscle via the intrabuccal approach , immediately after suturing of the surgical wound .


The washout period was one month after the first operation .


Evaluation were made of postoperative pain , trismus and swelling .


The numeric pain scale ( NPS ) was used for pain assessment .


When the patients were administered methylprednisolone acetate preoperatively , showed superior results in terms of oral aperture , pain and all the facial swelling parameters , with statistically significant differences versus the postoperatively administered methylprednisolone acetate ( p < 0.05 ) .


A single dose of 40 mg ( 1 cc ) methylprednisolone acetate injected into the masseter muscle preoperatively is more effective in reducing pain , trismus and swelling , when compared to that administered postoperatively .


Gaining too much weight in pregnancy poses health risks for mother and child .


Eating style has been shown to be related to weight gain in general but the relation to maternal weight gain in pregnancy is unclear .


To assess the influence of eating style and psycho social factors on maternal weight gain .


Healthy pregnant women ( n = 161 ) , filled in a questionnaire at 15 and 35 weeks of pregnancy .


Eating style , social norm , self-efficacy and attitude with regard to weight gain and health during pregnancy were measured .


Self-reported pre-pregnancy body mass index ( BMI ) was used to determine weight category and weight was objectively measured at 15 and 35 weeks of gestation .


Linear regression was used to study the relationship between eating style , psychosocial factors and gestational weight gain , controlling for BMI and age .


Hierarchical regression analyses were carried out where the effects of the other eating styles were partialled out .


During pregnancy , 66 % of the women remained stable as far as individual eating style concerned .


At 15 weeks of gestation , 11 ( 7 % ) women were classified as emotional eaters , 89 ( 55 % ) as external eaters and 61 ( 38 % ) as restrained eaters .


At first sight being an emotional eater was associated with higher weight gain in pregnancy .


In hierarchical regression analyses however none of the eating styles was associated with higher gestational weight gain .


Of the psychosocial factors , a better healthy pregnancy attitude at 35 weeks of gestation was associated with less weight gain .


In the long list of potential drivers of gestational weight gain , eating style does not seem to be of any significance .


Healthy pregnancy attitude in late pregnancy was found to be related with less weight gain .


The prevalence of chronic venous disease is high and occurs more frequently in females .


According to the clinical , etiological , anatomical , and pathological classification ( CEAP ) definition , the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints .


Several invasive techniques are used for treatment , including mini phlebectomy , laser ablation , and radiofrequency ablation .


However , a wide range of sclerosing agents may serve as minimally invasive alternatives , promoting chemical sclerosis of the vein wall .


Although this technique is routinely performed around the world , there is no consensus on the most efficacious and safe chemical agent to be used .


Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs , on the outer side of the leg/thigh .


Patients with CEAP 2 to 6 , or with allergies , pregnancy , performing breastfeeding , or with any dermatologic or clinical problems will be excluded .


Patients with venous ultrasound mapping showing involvement of saphenous trunks and/or a deep venous system will also be excluded .


Patients will be randomized into two groups , one receiving 75 % pure glucose and the other group receiving 0.2 % polidocanol diluted in 70 % glucose .


Just one limb and one session per patient will be performed .


The sclerosing agent volume will not exceed 5 mL .


Clinical follow-up will include visits on days 7 and 60 , always with photographic documentation .


This project aims to enroll 96 patients and subject them to a double-blind treatment after the randomization process .


The design is intended to evaluate efficacy through a primary end point and safety through a secondary end point .


Forty-eight patients have currently been enrolled .


Preliminary results for these patients showed that 25 received treatment , 2 were excluded , and 22 returned after 7 days and showed no greater adverse events .


To date , establishing efficacy criteria has not been possible , and no patients have reached the 60-day return point .


These data may help doctors choose the best chemical agent for the treatment of reticular veins .


ClinicalTrials.gov Identifier : NCT02054325 , 3/02/2014 .


This study aims to qualitatively evaluate the feasibility of using a pragmatic network of community-based Tai Chi schools to deliver 9-month exercise interventions to women with osteopenia and to explore the impact of this design feature on facilitators and barriers to trial recruitment and participant adherence during and after the trial .


In a randomized trial comparing 9 months of Tai Chi plus usual care with usual care alone for postmenopausal women with moderately low bone mass , exit interviews were conducted with 43 participants randomized to the pragmatically delivered Tai Chi intervention .


Transcripts were digitially recorded , transcribed , and imported into NVivo , a computer-assisted qualitative data analysis software .


Qualitative content analysis was used to code the data .


Patterns emerging from among the codes were further examined and clustered into themes .


Analyses revealed features of pragmatically delivered Tai Chi programs that both facilitated and impeded study participation and/or posttrial adherence .


Direct facilitators included convenience of class locations and times , alternative learning modalities , quality of teaching , community and social support , and perceived health benefits .


Barriers consisted primarily of time-related issues .


A possible causal mechanism ( self-efficacy ) was also identified .


Factors related to the use of pragmatically delivered interventions are beneficial for fostering both study participation and posttrial adherence to the Tai Chi programs .


This qualitative substudy is valuable for identifying these factors and a possible causal mechanism .


These findings will assist in the design and conduct of future studies exploring the use of Tai Chi in fracture prevention and health-related quality of life in postmenopausal women .


To study the characteristics of asthenic syndrome in elderly people after acute respiratory viral infection .


We examined 87 patients with chronic cerebral ischemia and other comorbid disorders , aged from 63 to 78 years .


Patients were randomized to two groups .


Patients of the main group received mexidol ( 1 tablet ( 125 mg ) 3 times a day during 3 weeks ) along with standard treatment .


Patients of the control group received standard treatment only .


All patients underwent neuropsychological testing for the assessment of symptoms of asthenic syndrome .


A comparative analysis of the patient 's condition in both groups has demonstrated a reduction in symptoms of asthenia , autonomic lability and cognitive deficit in patients treated with mexidol .


Exercise at altitude places additional physiological stress on the individual in comparison with sea-level performance .


This study examines the effect of a moderate hypoxic environment ( FiO2 = ~ 17 % ) on intermittent sprint exercise performance .


Nine male games players completed two consecutive sets of a 40 minute cycling intermittent sprint protocol ( CISP2 ) in a hypoxic ( HYP ; FiO2 = ~ 17 % ) and normoxic ( NORM ; FiO2 = ~ 21 % ) environment .


During each sprint peak power output ( PPO ; the highest power during each 5 s sprint ) , mean power output ( MPO ; the average power during the 3 s sprint ) were measured and total work done ( WD ; force applied from the highest 3 s period of power output ) was calculated .


Physiological responses were recorded throughout the testing procedure .


Reductions were found in PPO ( 944155 vs. 983167 W ) , MPO ( 900176 vs. 853177 W ) and WD ( 10220 vs. 10820 kJ ) during the CISP2 ( P < 0.05 ) at HYP compared to NORM .


Reductions in PPO , MPO and WD were also found between the 1st half and 2nd half CISP ( P < 0.05 ) and there was a greater decline from the 1st half CISP to the 2nd half CISP in PPO , MPO and WD at HYP .


Heart rate was higher and peripheral arterial oxygen saturation lower during HYP compared to NORM ( P < 0.05 ) .


Moderate hypoxia significantly reduced PPO ( ~ 4 % ) , MPO ( ~ 5 % ) and WD ( ~ 5 % ) compared to normoxia .


The results suggest athletes will be at a disadvantage when performing intermittent sprinting at moderate altitude .


Several case series have reported the effects of fecal microbiota transplantation ( FMT ) for ulcerative colitis ( UC ) .


We assessed the efficacy and safety of FMT for patients with UC in a double-blind randomized trial .


Patients with mild to moderately active UC ( n = 50 ) were assigned to groups that underwent FMT with feces from healthy donors or were given autologous fecal microbiota ( control ) ; each transplant was administered via nasoduodenal tube at the start of the study and 3 weeks later .


The study was performed at the Academic Medical Center in Amsterdam from June 2011 through May 2014 .


The composite primary end point was clinical remission ( simple clinical colitis activity index scores 2 ) combined with 1-point decrease in the Mayo endoscopic score at week 12 .


Secondary end points were safety and microbiota composition by phylogenetic microarray in fecal samples .


Thirty-seven patients completed the primary end point assessment .


In the intention-to-treat analysis , 7 of 23 patients who received fecal transplants from healthy donors ( 30.4 % ) and 5 of 25 controls ( 20.0 % ) achieved the primary end point ( P = .51 ) .


In the per-protocol analysis , 7 of 17 patients who received fecal transplants from healthy donors ( 41.2 % ) and 5 of 20 controls ( 25.0 % ) achieved the primary end point ( P = .29 ) .


Serious adverse events occurred in 4 patients ( 2 in the FMT group ) , but these were not considered to be related to the FMT .


At 12 weeks , the microbiota of responders in the FMT group was similar to that of their healthy donors ; remission was associated with proportions of Clostridium clusters IV and XIVa .


In this phase 2 trial , there was no statistically significant difference in clinical and endoscopic remission between patients with UC who received fecal transplants from healthy donors and those who received their own fecal microbiota , which may be due to limited numbers .


However , the microbiota of responders had distinct features from that of nonresponders , warranting further study .


ClinicalTrials.gov Number : NCT01650038 .


Even facial pigmentation is considered a universal sign of youth and beauty in all cultures and at all ages in both men and women .


The recent FDA concern about the safety of topical hydroquinone has provided the impetus for research into new pigment lightening alternatives in the cosmetic OTC market .


This research examined a novel hydroxyphenoxy propionic acid , ellagic acid , yeast extract , and salicylic acid formulation applied twice daily compared to the standard prescription combination of 4 % hydroquinone cream and 0.025 % tretinoin cream applied nightly .


This single-center investigator-blinded 12week study enrolled 82 subjects ( 7 male , 75 female ) ages 25-60years divided into 2 balanced groups of 41 subjects each with one group using a novel hydroxyphenoxy propionic acid , ellagic acid , yeast extract , and salicylic acid formulation applied twice daily compared to the standard prescription combination of 4 % hydroquinone cream and 0.025 % tretinoin cream applied nightly .


Significant tolerability issues arose with the prescription combinations that were not seen with the cosmetic formulation .


In terms of ability to even skin tone , decrease spot intensity , decrease spot size , and improve overall pigmentation , both products demonstrated parity .


This research demonstrated the value of cosmetic formulations as part of a treatment regimen for pigmentation issues .


Studies all over the world reported that smoking relapses occur during the first two weeks after a quit date .


The current study aimed to assess the impact of the additional phone calls counselling during the first month on the abstinence rate at 3 and 6months after quit date among smokers in Penang , Malaysia .


The study was conducted at Quit Smoking Clinic of two major hospitals in Penang , Malaysia .


All the eligible smokers who attended the clinics between February 1st and October 31st 2012 were invited .


Participants were randomly assigned by using urn design method either to receive the usual care that followed in the clinics ( control ) or the usual care procedure plus extra counselling sessions through phone calls during the first month of quit attempt ( intervention ) .


Participants in our cohort smoked about 14 cigarettes per day on average ( mean = 13.787.0 ) .


At 3months , control group was less likely to quit smoking compared to intervention group ( 36.9 % vs. 46.7 % , verified smoking status ) but this did not reach statistical significance ( OR = 0.669 ; 95 % CI = 0.395-1 .133 , P = 0.86 ) .


However , at 6months , 71.7 % of the intervention group were successfully quit smoking ( bio-chemically verified ) compared to 48.6 % of the control group ( P < 0.001 ) .


The control group were significantly less likely to quit smoking ( OR = 0.375 ; 95 % CI = 0.217-0 .645 , P < 0.001 ) .


Smoking cessation intervention consisting of phone calls counselling delivered during the first month of quit attempt revealed significantly higher abstinence rates compared with a standard care approach .


Therefore , the additional counselling in the first few weeks after stop smoking is a promising treatment strategy that should be evaluated further .


TCTR20140504001 .


Many methods reportedly prevent contrast-induced nephropathy ( CIN ) , but the effect of brain natriuretic peptide ( BNP ) on CIN is unknown .


In this study we investigated recombinant BNP use before coronary angiography ( CA ) or nonemergent percutaneous coronary intervention ( PCI ) in patients with unstable angina .


One thousand patients with unstable angina were prospectively evaluated .


The patients were randomly assigned to : group A , isotonic normal saline ( NaCl 0.9 % , 1 mL/kg/h ) for 24 hours before CA or PCI ; and group B , human recombinant BNP ( rhBNP ; 0.005 g/kg/min ) .


Serum creatinine ( Scr ) levels and estimated glomerular filtration rate were measured before and 24 , 48 , and 72 hours , and 7 days after the procedure .


The primary outcome was CIN incidence defined according to a relative ( 25 % ) or absolute ( 0.5 mg/dL and 44 mol/L , respectively ) increase in Scr from baseline within 48 hours .


The secondary end points were the changes in the Scr and estimated glomerular filtration rate , before and after the procedure .


Contrast volume , a history of diabetes mellitus , and BNP administration independently predicted CIN .


The incidence of CIN was significantly greater in group A than in group B ( 14.8 % vs 5.6 % ; P < 0.01 ) .


Renal function was less compromised in patients who received rhBNP .


The Scr of all patients with CIN remained increased for 24 hours , but it was lower and recovered faster in patients who received rhBNP .


rhBNP administration before CA or PCI protects renal function and can significantly decrease CIN incidence .


To investigate the effect of aerobic exercise on immune factor IL-4 , TNF-alpha in patients with allergic rhinitis , which provide a theoretical basis for the treatment of allergic rhinitis .


Thirty-two allergic rhinitis patients were selected and divided into a control group ( 14 people ) and the experimental group ( 18 people ) .


During the treatment , both groups receive conventional symptomatic treatment .


Meanwhile , aerobic exercise therapy is applied to the experimental group for 40 - 60 minutes a day , 3 - 4 days a week .


Serum IL-4 , TNF-alpha and allergic rhinitis symptoms graded scoring were tested before and after 6 month therapy .


After six months of exercise intervention , the 11-4 , and TNF-alpha levels of experimental group were significantly lower than the level of control group .


The symptoms score is also significantly decreased in experimental group .


Aerobic exercise had good therapeutic effect in patients with allergic rhinitis .


The mechanism may be that aerobic exercise can reduce the level of IL-4 and TNF-alpha , which can relieve infiltration and activation of inflammatory cells .


To examine the impact of a pre-bariatric surgery physical activity intervention ( PAI ) , designed to increase bout-related ( 10 min ) moderate to vigorous PA ( MVPA ) , on health-related quality of life ( HRQoL ) .


Analyses included 75 adult participants ( 86.7 % female ; BMI = 45.0 6.5 kg m ( -2 ) ) who were randomly assigned to 6 weeks of PAI ( n = 40 ) or standard pre-surgical care ( SC ; n = 35 ) .


PAI received 6 individual weekly counseling sessions to increase walking exercise .


Participants wore an objective PA monitor for 7 days and completed the SF-36 Health Survey at baseline and post-intervention to evaluate bout-related MVPA and HRQoL changes , respectively .


PAI increased bout-related MVPA from baseline to post-intervention ( 4.4 5.5 to 21.0 21.4 min day ( -1 ) ) versus no change ( 7.9 16.6 to 7.6 11.5 min day ( -1 ) ) for SC ( P = 0.001 ) .


PAI reported greater improvements than SC on all SF-36 physical and mental scales ( P < 0.05 ) , except role-emotional .


In PAI , better baseline scores on the physical function and general health scales predicted greater bout-related MVPA increases ( P < 0.05 ) , and greater bout-related MVPA increases were associated with greater post-intervention improvements on the physical function , bodily pain , and general health scales ( P < 0.05 ) .


Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery candidates .


Future studies should examine whether this effect improves surgical safety , weight loss outcomes , and postoperative HRQoL .


Insomnia is a significant risk factor for depression onset , can result in more disabling depressive illness , and is a common residual symptom following treatment cessation that can increase the risk of relapse .


Internet-based cognitive behavioural therapy for insomnia has demonstrated efficacy and acceptability to men who are less likely than women to seek help in standard care .


We aim to evaluate whether internet delivered cognitive behavioural therapy for insomnia as an adjunct to a standard depression therapeutic plan can lead to improved mood outcomes .


Male participants aged 50 years or more , meeting Diagnostic and Statistical Manual of Mental Disorders criteria for current Major Depressive Episode and/or Dysthymia and self-reported insomnia symptoms , will be screened to participate in a single-centre double-blind randomised controlled trial with two parallel groups involving adjunctive internet-delivered cognitive behavioural therapy for insomnia and an internet-based control program .


The trial will consist of a nine-week insomnia intervention period with a six-month follow-up period .


During the insomnia intervention period participants will have their depression management coordinated by a psychiatrist using standard guideline-based depression treatments .


The study will be conducted in urban New South Wales , Australia , where 80 participants from primary and secondary care and direct from the local community will be recruited .


The primary outcome is change in the severity of depressive symptoms from baseline to week 12 .


This study will provide evidence on whether a widely accessible , evidence-based , internet-delivered cognitive behavioural therapy for insomnia intervention can lead to greater improvements than standard treatment for depression alone , in a group who traditionally do not readily access psychotherapy .


The study is designed to establish effect size , feasibility and processes associated with implementing e-health solutions alongside standard clinical care , to warrant undertaking a larger more definitive clinical trial .


Australian and New Zealand Clinical Trials Registry ACTRN12612000985886 .


In acute cough patients , impaired lung function as present in chronic lung conditions like asthma and chronic obstructive pulmonary disease ( COPD ) are often thought to negatively influence course of disease , but clear evidence is lacking .


To investigate the influence of lung function abnormalities on course of disease and response to antibiotic therapy in primary care patients with acute cough .


A total of 3,104 patients with acute cough ( 28 days ) were included in a prospective observational study with a within-nested trial , of which 2,427 underwent spirometry 28-35 days after inclusion .


Influence of the lung function abnormalities fixed obstruction ( forced expiratory volume in 1s ( FEV1 ) / forced vital capacity ( FVC ) ratio < 0.7 ) and bronchodilator responsiveness ( FEV1 increase of 12 % or 200ml after 400g salbutamol ) on symptom severity , duration and worsening were evaluated using uni - and multivariable regression models .


Antibiotic use was defined as the reported use of antibiotics 5 days in the first week .


Interaction terms were calculated to investigate modifying effects of lung function on antibiotic effect .


The only significant association was the effect of severe airway obstruction on symptom severity on days 2-4 ( difference = 0.31 , 95 % confidence interval ( CI ) = 0.03-0 .60 , P = 0.03 ) .


No evidence of a differential effect of lung function on the effect of antibiotics was found .


Prior use of inhaled steroids was associated with a 30 % slower resolution of symptoms rated ` moderately bad ' or worse ( hazard ratio = 0.75 , 95 % CI = 0.63-0 .90 , P = 0.00 ) .


In adult patients with acute cough , lung function abnormalities were neither significantly associated with course of disease nor did they modify the effect of antibiotics .


To determine whether an avatar-based , online , self-management program is an effective therapeutic approach for women with overactive bladder ( OAB ) .


OAB is a highly prevalent symptom complex that significantly impacts health-related quality of life ( HRQOL ) .


Behavioral interventions can produce substantial improvement in symptoms and HRQOL .


Online education programs offer patients with OAB an alternative to face-to-face self-management instruction .


Evidence suggests that avatars ( digital humans ) embedded into online programs may help persuade and motivate patients to adopt healthy behaviors .


In a 12-week , randomized , controlled trial , women ( aged > 55 years ) with symptoms of OAB for at least 3 months were randomized to 2 versions of a 3-part , online , self-management program .


After collecting the baseline metrics , the intervention group viewed a generic avatar coach with a self-avatar peer mentor designed to resemble the participant , and the control group viewed the identical online program with voice only .


Participants viewed part 1 at week 1 and parts 2 and 3 at week 6 .


Participants completed daily bladder diaries throughout the 12-week period and OAB-related outcome measures at weeks 1 , 6 , and 12 .


Forty-one women completed the study ( mean age = 61 years , standard deviation = 6 ) .


The analysis of covariance of week-12 outcome measures with the baseline as covariates demonstrated significant improvements in the intervention group in OAB questionnaire HRQOL ( P = .02 ; large effect ) , 24-hour frequency ( P < .001 ; large effect ) , night-time urination ( P < .001 ; large effect ) , urgency ( P < .001 ; large effect ) , and urge incontinence ( P < .001 ; large effect ) .


An avatar-based intervention embedded into an online self-management program improved OAB HRQOL and symptoms in women .


Pharmacokinetic interactions between rifampicin and protease inhibitors ( PIs ) complicate the management of HIV-associated tuberculosis .


Rifabutin is an alternative rifamycin , for patients requiring PIs .


Recently some international guidelines have recommended a higher dose of rifabutin ( 150mg daily ) in combination with boosted lopinavir ( LPV/r ) , than the previous dose of rifabutin ( 150mg three times weekly { tiw } ) .


But there are limited pharmacokinetic data evaluating the higher dose of rifabutin in combination with LPV/r .


Sub-optimal dosing can lead to acquired rifamycin resistance ( ARR ) .


The plasma concentration of 25-O-desacetylrifabutin ( d-RBT ) , the metabolite of rifabutin , increases in the presence of PIs and may lead to toxicity .


Sixteen patients with TB-HIV co-infection received rifabutin 300mg QD in combination with tuberculosis chemotherapy ( initially pyrazinamide , isoniazid and ethambutol then only isoniazid ) , and were then randomized to receive isoniazid and LPV/r based ART with rifabutin 150mg tiw or rifabutin 150mg daily .


The rifabutin dose with ART was switched after 1month .


Serial rifabutin and d-RBT concentrations were measured after 4weeks of each treatment .


The median AUC0-48 and Cmax of rifabutin in patients taking 150mg rifabutin tiw was significantly reduced compared to the other treatment arms .


Geometric mean ratio ( 90 % CI ) for AUC0-48 and Cmax was 0.6 ( 0.5-0 .7 ) and 0.5 ( 0.4-0 .6 ) for RBT 150mg tiw compared with RBT 300mg and 0.4 ( 0.4-0 .4 ) and 0.5 ( 0.5-0 .6 ) for RBT 150mg tiw compared with 150mg daily .


86 % of patients on the tiw rifabutin arm had an AUC0-24 < 4.5 g.h / mL , which has previously been associated with acquired rifamycin resistance ( ARR ) .


Plasma d-RBT concentrations increased 5-fold with tiw rifabutin dosing and 15-fold with daily doses of rifabutin .


Rifabutin was well tolerated at all doses and there were no grade 4 laboratory toxicities .


One case of uveitis ( grade 4 ) , occurred in a patient taking rifabutin 300mg daily prior to starting ART , and grade 3 neutropenia ( asymptomatic ) was reported in 4 patients .


These events were not associated with increases in rifabutin or metabolite concentrations .


A daily 150mg dose of rifabutin in combination with LPV/r safely maintained rifabutin plasma concentrations in line with those shown to prevent ARR .


ClinicalTrials.gov Identifier : NCT00640887 .


Oats are high in soluble fibers and effective in reducing the risk of cardiovascular diseases ( CVD ) .


We assessed the effects of beta-glucan from oat bran on serum nitric oxide ( NO ) endothelial function in patients with hypercholesterolemia .


Sixty hypercholesterolemic patients were randomly divided to receive an experimental bread rich in beta-glucan from oat bran ( intervention ) or bread rich in wheat fiber ( control ) for four weeks .


All subjects had the same diet for two-week baseline period and hypocaloric diet for four weeks of intervention .


Serum NO concentration and flow-mediated dilation ( FMD ) were determined before and after the experiment .


Mean age of the participants was 51.1 9.3 years and 65 % ( n = 39 ) were female .


After intervention , serum NO concentration increased by 50.2 19.8 mol/lit in the intervention group ( P = 0.017 ) , but no change was observed in the control group ( 17.5 27.5 mol/lit ; P = 0.530 ) .


No change of FMD was observed in the intervention ( 0.48 0.78 % ; P = 0.546 ) or in the control group ( 0.59 0.92 % ; P = 0.533 ) .


Consumption of oat bread for four weeks increases serum NO concentration but has no effect on FMD .


Further studies are warranted in this regard .


To compare two regimens of reduced bowel preparation and faecal tagging for CT colonography .


Single centre , prospective , randomized , noninferiority study , in which 52 consecutive adults underwent routine CT colonography .


Patients , following a three-day low-fibre diet , received one of the two reduced preparations : 1-L polyethylene glycol and four tablets of bisacodyl in association with 90 mL of Iopamidol for faecal tagging administered on the same day as CTC examination ( group 1 ) ; or a standard `` iodine-only '' preparation , consisting in 180 ml of Iopamidol the day before the examination ( group 2 ) .


Primary outcome was the overall quality of bowel preparation .


Twenty-six patients per group were included .


Per segment analysis showed preparation of diagnostic quality in 97.4 % of segments in group 1 and in 95.5 % in group 2 ( p = ns ) .


Per-patient analysis showed optimal quality of preparation in 76.9 % of patients in group 1 and in 84.6 % in group 2 ( p = ns ) .


Patient tolerability to both preparations was not different .


A limited bowel preparation consisting of 1-L PEG and four tablets of bisacodyl in association with 90 mL of Iodine for faecal tagging administered on the same day as CTC examination is feasible and offers bowel cleansing comparable to `` iodine-only '' preparation .


Low-dose PEG bisacodyl and Iopamidol preparation is feasible , providing adequate bowel cleansing .


Faecal tagging is not different from the two limited preparations .


Patient tolerability to the two colon cleansing regimens is similar .


This study aims to determine the impact of increasing polyunsaturated fatty acid intake on blood glucose , lipid metabolism , and pregnancy outcomes of pregnant women with gestational diabetes mellitus .


Under constant total energy and protein intake , 84 pregnant women with gestational diabetes mellitus were randomly divided into the experimental and control groups , which were given oil-rich and conventional low-oil meals , respectively .


After the dietary intervention , the intake and energy supply of fat and the three fatty acids were significantly higher in the experimental group than the control group ( p < 0.001 ) .


The intake and energy supply of polyunsaturated fatty acids increased significantly post-intervention in the experimental group but did not change in the control group .


In both the intervention and the control group , fasting blood glucose , 2 h postprandial plasma glucose , and the insulin resistance index decreased significantly post-intervention ( p < 0.05 ) ; the lipid changes were consistent between groups .


Pregnancy outcomes did not differ significantly between the two groups ( p > 0.05 ) .


An appropriate increase in polyunsaturated fatty acid intake benefits pregnant women with gestational diabetes mellitus as well as fetuses , as long as the diet therapy follows basic recommendations and total energy intake is strictly controlled .


Hypothermia improves outcome in resuscitated patients and newborns with hypoxic brain injury .


We studied the safety and feasibility of mild hypothermia in awake patients with stroke after intravenous thrombolysis .


Patients were randomized 1:1 to mild hypothermia ( 35C ) or to standard stroke unit care within 6 hours of symptom onset .


Hypothermia was induced with a surface-cooling device and cold saline infusions .


Active cooling was restrained gradually after 12 hours at < 35.5 C.


The primary outcome measure was the number of patients with < 36C body temperature for > 80 % of the 12-hour cooling period .


We included 36 patients with a median of National Institutes of Health Stroke Scale score of 9 one hour after thrombolysis .


Fifteen of 18 ( 83 % ) patients achieved the primary end point .


Sixteen ( 89 % ) patients reached < 35.5 C in a median time of 10 hours ( range , 7-16 hours ) from symptom onset , spent 10.5 hours ( 1-17 hours ) in hypothermia , and were back to normothermia in 23 hours ( 15-29 hours ) .


Few serious adverse events were more common in the hypothermia group .


At 3 months , 7 patients ( 39 % ) in both groups had good outcome ( modified Ranking Scale , 0-2 ) , whereas poor outcome ( modified Ranking Scale , 4-6 ) was twice as common in the normothermia group ( 44 % versus 22 % ) .


Mild hypothermia with a surface-cooling device in an acute stroke unit is safe and feasible in thrombolyzed , spontaneously breathing patients with stroke , despite the adverse events .


http://www.clinicaltrials.gov .


Unique identifier : NCT00987922 .


In patients with ulcerative colitis ( UC ) , colonoscopy is an essential procedure for evaluating mucosal damage , and treatment outcomes .


A new flexible ultrathin colonoscope ( PCF-PQ260 ) has been developed to readily pass through tortuous and narrow lesions of the colon and cause minimum patient discomfort .


The objective of the present study was to evaluate the comfort and performance of this new type of scope in UC patients who underwent colonoscopy for estimation of mucosal inflammation , basically without sedation .


In a prospective , single-center setting , among 107 UC patients who were to undergo colonoscopy , 84 eligible cases were randomly assigned to the new ultrathin flexible colonoscope , PCF-PQ260 ( n = 42 ) or to a conventional colonoscope , PCF-Q260A ( n = 42 ) .


Main outcome measure was patient pain level determined by visual analogue scale ( VAS ) with 0 = none , and 100 = extremely painful .


Other outcomes were cecal intubation time , rate of complete intubation ( to reach the cecum ) and rate of procedural complications .


VAS score was significantly lower in the new-scope group as compared with the conventional-scope group : meanSD , median ( range ) : 19.316.9 , 14 ( 0-62 ) vs 32.021.6 , 31.8 ( 0-100 , P = 0.005 ) .


However , cecal intubation rate ( 97.6 % ) and time ( 4min ) were similar in the two groups .


There was no procedure-related serious complication in either group .


The findings indicated that the flexible ultrathin colonoscope PCF-PQ260 has significantly better tolerability in UC patients compared to a conventional colonoscope .


In a pan-European randomised controlled trial ( GRACE INTRO ) of two interventions , ( i ) a point-of-care C-reactive protein test and/or ( ii ) training in communication skills and use of an interactive patient booklet , both interventions resulted in large reductions in antibiotic prescribing for acute cough .


This process evaluation explored patients ' views of primary care consultations using the two interventions in six European countries .


Sixty-two interviews were conducted with patients who had participated in the GRACE INTRO trial .


Interviews were transcribed verbatim and translated into English where necessary .


Analysis used techniques from thematic and framework analysis .


Most patients were satisfied with their consultation despite many not receiving an antibiotic .


Patients appeared to accept the use of both intervention approaches .


A minority , but particularly in the trial arm with both interventions , reported that they would wait longer before consulting for cough in future .


Patients perceived that both interventions supported the general practitioner 's ( GP 's ) prescribing decisions by helping them understand when an antibiotic was , and was not , needed .


Patients consulting with acute cough had largely positive views about the GP 's enhanced communication skills , which included understanding their concerns , and the use of a near-patient test as an additional investigation .


Prior analysis in the Open vs Endovascular Repair Veterans Affairs ( VA ) Cooperative Study ( CSP # 498 ) demonstrated that survival , quality of life , and total health care costs are not significantly different between the open and endovascular methods of repair of abdominal aortic aneurysm .


The device is a major cost of this method of repair , and the objective of this study was to evaluate the costs of the device , abdominal aortic aneurysm repair , and total health care costs when different endograft systems are selected for the endovascular repair ( EVR ) .


Within each selected system , EVR costs are compared with open repair costs .


The study randomized 881 patients to open ( n = 437 ) or EVR ( n = 444 ) .


Device selection was recorded before randomization ; therefore , open repair controls were matched to each device cohort .


Data were excluded for two low-volume devices , implanted in only 13 individuals , leaving 423 control and 431 endovascular patients : 166 Zenith ( Cook Medical , Bloomington , Ind ) , 177 Excluder ( W. L. Gore & Associates , Flagstaff , Ariz ) , and 88 AneuRx ( Medtronic , Minneapolis , Minn ) .


Mean device , hospitalization , and total health care costs from randomization to 2 years were compared .


Health care utilization data were obtained from patients and national VA and Medicare data sources .


VA costs were determined using methods previously developed by the VA Health Economics Resource Center .


Non-VA costs were obtained from Medicare claims data and billing data from the patient 's health care providers .


Implant costs were 38 % of initial hospitalization costs .


Mean device ( range , $ 13,600 - $ 14,400 ) , initial hospitalization ( range , $ 34,800 - $ 38,900 ) , and total health care costs at 2 years in the endovascular ( range , $ 72,400 - $ 78,200 ) and open repair groups ( range , $ 75,600 - $ 82,100 ) were not significantly different among device systems .


Differences between endovascular and corresponding open repair cohorts showed lower mean costs for EVR ( range , $ 3200 - $ 8300 ) , but these were not statistically different .


The implant costs of endovascular aneurysm repair are substantial .


When evaluating total health care system expenditures , there is large individual variability in costs , and there is no significant difference at 2 years among systems or when an individual system is compared with open repair .


Itolizumab , a humanized monoclonal antibody to CD6 , is a novel therapeutic agent evaluated in chronic plaque psoriasis .


We sought to assess the safety and efficacy of itolizumab in moderate to severe chronic plaque psoriasis .


A total of 225 patients were randomized ( 2:2:1 ) to 2 different itolizumab arms ( A or B ; A = 4-week loading dose of 0.4 mg/kg/wk followed by 1.6 mg/kg every 2 weeks ; B = 1.6 / mg every 2 weeks ) or placebo .


At week 12 , the placebo arm was switched to 1.6 mg/kg itolizumab every 2 weeks .


The primary end point was the proportion of patients with at least 75 % improvement in Psoriasis Area and Severity Index score at week 12 .


At week 12 , 27.0 % in arm A ( P = .0172 vs placebo ) , 36.4 % in B ( P = .0043 vs placebo ) , and 2.3 % in the placebo arm had at least 75 % improvement in Psoriasis Area and Severity Index score .


At week 28 , the proportion with at least 75 % improvement in Psoriasis Area and Severity Index score was comparable : 46.1 % , 45.5 % , and 41.9 % for A , B , and placebo , respectively .


In weeks 1 to 12 , the incidence of all adverse events was comparable across arms ( A , 43 % ; B , 38 % ; placebo , 47 % ) and the incidence of infections was not greater than placebo ( 11.1 % , 8.9 % , and 18.6 % for A , B , and placebo ) .


No active comparator is a limitation .


Itolizumab is an effective and well-tolerated novel biological therapy in moderate to severe psoriasis .


Unlike most chronic diseases , osteoporosis treatments are generally limited to a single drug at a fixed dose and frequency .


Nonetheless , no approved therapy is able to restore skeletal integrity in most osteoporotic patients and the long-term use of osteoporosis drugs is controversial .


Thus , many patients are treated with the sequential use of two or more therapies .


The DATA study showed that combined teriparatide and denosumab increased bone mineral density more than either drug alone .


Discontinuing teriparatide and denosumab , however , results in rapidly declining bone mineral density .


In this DATA-Switch study , we aimed to assess the changes in bone mineral density in postmenopausal osteoporotic women who transitioned between treatments .


This randomised controlled trial ( DATA-Switch ) is a preplanned extension of the denosumab and teriparatide administration study ( DATA ) , in which 94 postmenopausal osteoporotic women were randomly assigned to receive 24 months of teriparatide ( 20 mg daily ) , denosumab ( 60 mg every 6 months ) , or both drugs .


In DATA-Switch , women originally assigned to teriparatide received denosumab ( teriparatide to denosumab group ) , those originally assigned to denosumab received teriparatide ( denosumab to teriparatide group ) , and those originally assigned to both received an additional 24 months of denosumab alone ( combination to denosumab group ) .


Bone mineral density at the spine , hip , and wrist were measured 6 months , 12 months , 18 months , and 24 months after the drug transitions as were biochemical markers of bone turnover .


The primary endpoint was the percent change in posterior-anterior spine bone mineral density over 4 years .


Between-group changes were assessed by one-way analysis of variance in our modified intention-to-treat population .


This study is registered with ClinicalTrials.gov , number NCT00926380 .


Between Sept 27 , 2011 , and Jan 28 , 2013 , eligible women from the DATA study were enrolled into DATA-Switch .


Of 83 potential enrollees from the DATA study , 77 completed at least one post-baseline visit .


After 48 months , the primary outcome of mean spine bone mineral density increased by 183 % ( 95 % CI 149-218 ) in 27 women in the teriparatide to denosumab group , 140 % ( 109-172 ) in 27 women the denosumab to teriparatide group , and 160 % ( 140-180 ) in 23 women in the combination to denosumab group , although this increase did not differ significantly between groups ( for between-group comparisons , p = 013 for the teriparatide to denosumab group vs the denosumab to teriparatide group , p = 030 for the teriparatide to denosumab group vs the combination to denosumab group , and p = 041 for the denosumab to teriparatide group vs the combination to denosumab group ) .