There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic .


In zinc villages ( 1,440 children analyzed ) , 61.2 % of diarrheal episodes were treated with zinc , compared to 5.4 % in comparison villages ( 1,584 children analyzed , p < 0.0001 ) .


There were no differences in ORS use between zinc ( 59.6 % ) and comparison villages ( 58.8 % ) .


Among children with fever or cough without diarrhea , zinc use was low ( < 0.5 % ) .


There was a lower incidence of reported ALRI in zinc villages ( adjusted RR 0.68 , 95 % CI 0.46-0 .99 ) , but not presenting at clinic .


In this study , home zinc use to treat diarrhea did not decrease disease rates in the community .


However , with proper training , availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low .


ClinicalTrials.gov NCT00530829 .


A study was undertaken to test in a subgroup reanalysis of the URICO-ICTUS trial whether uric acid is superior to placebo in improving the functional outcome in patients with acute stroke and hyperglycemia .


Patients were part of the URICO-ICTUS trial , a double-blind study that compared the administration of uric acid versus placebo in stroke patients treated with alteplase within 4.5 hours of onset .


The effect of therapy on the rate of excellent outcome at 90 days ( modified Rankin Scale2 ) in each tertile of admission glucose was assessed with multivariate adjusted models in 409 of the 421 randomized patients who had available pretreatment glucose levels .


The effect of therapy on infarct growth was assessed in 72 patients who had longitudinal multimodal brain imaging .


Uric acid was associated with an increased rate of excellent outcome in patients with glucose levels in the upper tertile range ( odds ratio [ OR ] = 2.9 , 95 % confidence interval [ CI ] = 1.0-8 .3 ) .


However , the effect was not apparent for patients in the middle tertile ( OR = 1.6 , 95 % CI = 0.8-3 .6 ) or lower tertile of glucose ( OR = 1.1 , 95 % CI = 0.5-2 .6 ) .


Uric acid therapy was more effective than placebo in limiting infarct growth in the upper tertile range ( Mann-Whitney U test , p = 0.04 ) but not in the middle tertile ( p = 0.95 ) or lower tertile of glucose ( p = 0.30 ) .


Uric acid also proved superior to placebo in reducing infarct growth in patients with early recanalization .


Uric acid therapy was associated with reduced infarct growth and improved outcome in patients with hyperglycemia during acute stroke .


Cocaine pharmacotherapy trials are often confounded by considerable variability in baseline cocaine-use levels , obscuring possible medication efficacy .


Testing the feasibility of using a prerandomization , abstinence-induction protocol , we screened three candidate medications to explore treatment response in patients who did , or did not , achieve abstinence during an extended baseline phase .


Eligible treatment-seeking , cocaine-dependent subjects entered a 4-week baseline period ( Phase I ) with high-value abstinence contingent vouchers and two motivational interviewing sessions , followed by a 12-week medication trial ( Phase II ) with random assignment stratified on Phase I abstinence status to ( 1 ) modafinil ( 400mg/d ) , ( 2 ) levodopa/carbidopa ( 800/200mg/d ) , ( 3 ) naltrexone ( 50mg/d ) , or ( 4 ) placebo .


Treatment consisted of thrice-weekly clinic visits for urine benzoylecgonine testing and weekly cognitive behavioral therapy with contingency management targeting medication compliance .


Of the 118 subjects enrolled , 81 ( 80 % ) completed Phase I , with 33 ( 41 % ) achieving abstinence , defined a priori as 6 consecutive cocaine-negative urines .


Tests of the interaction of each medication ( active versus placebo ) by baseline status ( abstinent versus nonabstinent ) permitted moderator effect analysis .


Overall , baseline abstinence predicted better outcome .


Cocaine-use outcomes for levodopa and naltrexone treatment differed as a function of Phase I abstinence status , with both medications producing benefit in nonabstinent but not baseline-abstinent subjects .


There was no evidence of a moderator effect for modafinil .


The two-phase screening trial demonstrated that subgrouping of patients with respect to baseline abstinence status is feasible and clinically useful for exploring cocaine cessation and relapse-prevention effects of candidate medications .


Prevention of new IgE sensitizations has been described during allergen-specific immunotherapy .


However , prospective data using a preventive approach in very young children who would benefit most are missing .


We initiated a prospective pilot study investigating the safety , immunomodulatory , and sensitization-preventive effect of sublingual immunotherapy ( SLIT ) in mono/oligoclonally sensitized , clinically asymptomatic children 2-5 yr of age .


In this double-blinded , randomized , placebo-controlled pilot study , 31 mono - / oligosensitized children to house-dust mite or grass pollen were included .


SLIT with the respective source ( n = 15 ) or placebo ( n = 16 ) was applied .


After dose-up-phase therapy was continued for 2 yr .


Parents recorded clinical events , vaccinations , and drug intake in a diary .


Skin prick testing and specific IgE and IgG measurements were recorded at baseline , 12 and 24 months .


At the same time , allergen-specific proliferation and IL10 - and TGF-dependent Treg function were measured .


Preventive application of SLIT in young children was safe ( no relevant side effects in 21,170 single applications ) .


After 12 and 24 months of treatment , the rate of allergen-specific sensitization ( specific IgE and SPT reactivity ) was comparable in the treatment and the placebo group .


However , verum-treated patients displayed a significant up-regulation of allergen-specific IgG ( p < 0.05 ) .


Furthermore , IL10-dependent inhibition ( p < 0.05 ) was observed in vitro in the treatment group but not in the placebo group .


Preventive SLIT is safe in children 2-5 yr of age and induces regulatory mechanisms involving allergen-specific IgG and IL10 .


Based on this pilot study , large-scale trials will need to investigate the modulation of sensitization and clinically relevant allergy .


Radiofrequency ablation ( RFA ) is associated with an excellent outcome in the treatment of great saphenous vein ( GSV ) incompetence .


The use of thermal energy as a treatment source requires the instillation of tumescence anesthesia .


Mechanochemical endovenous ablation ( MOCA ) combines mechanical endothelial damage , using a rotating wire , with the infusion of a liquid sclerosant .


Tumescence anesthesia is not required .


Preliminary experiences with MOCA showed good results and low post-procedural pain .


The MARADONA ( Mechanochemical endovenous Ablation versus RADiOfrequeNcy Ablation ) trial is a multicenter randomized controlled trial in which 460 patients will be randomly allocated to MOCA or RFA .


All patients with primary GSV incompetence who meet the eligibility criteria will be invited to participate in this trial .


The primary endpoints are anatomic and clinical success at a one-year follow-up , and post-procedural pain .


The secondary endpoints are technical success , complications , operation time , procedural pain , disease-specific quality of life , time taken to return to daily activities and/or work , and cost-efficiency analyses after RFA or MOCA .


Both groups will be evaluated on an intention to treat base .


The MARADONA trial is designed to show equal results in anatomic and clinical success after one year , comparing MOCA with RFA .


In our hypothesis MOCA has an equal anatomic and clinical success compared with RFA , with less post-procedural pain .


Clinicaltrials NCT01936168 .


Postoperative pain is an unavoidable consequence of open abdominal surgery .


Although cryotherapy , the application of ice to a surgical wound site , has been shown to be effective in reducing postoperative pain in orthopaedic , gynecologic , and hernia operations , it has not been assessed in patients who undergo major open abdominal operations .


We hypothesized that patients who receive cryotherapy would report lower pain scores as a primary outcomes measure .


Patients undergoing abdominal operations with midline incisions were randomized to receive cryotherapy for a minimum of 24 hours in time intervals dictated by patient preference vs no cryotherapy .


The primary outcome of pain relief was assessed with visual analog pain scores ( VAS ) .


The study was powered to detect a clinically significant difference in VAS between the control and cryotherapy group .


Comparisons between groups were measured by Student 's t-test or Mann-Whitney U test for parametric and nonparametric data , respectively .


There were 55 patients randomized : 28 to the control group and 27 to the cryotherapy group .


For the primary measure , mean postoperative pain score on postoperative days ( PODs ) 1 and 3 after surgery was significantly lower between the control and cryotherapy groups on the visual analog pain scale ( p < 0.005 ) .


Narcotic use was decreased in the cryotherapy group on POD 1 by 3.9 morphine equivalents ( p = 0.008 ) .


No statistically significant difference was found between the 2 treatment groups with respect to length of hospital stay , pulmonary complications , and wound infection rate in terms of secondary measures .


Ice packs are a simple , cost-effective adjuvant for decreasing postoperative pain and narcotic use in patients undergoing major abdominal operations .


Cognitive behavior therapy for psychosis has been a prominent intervention in the psychological treatment of psychosis .


It is , however , a challenging therapy to deliver and , in the context of increasingly rigorous trials , recent reviews have tempered initial enthusiasm about its effectiveness in improving clinical outcomes .


Acceptance and commitment therapy shows promise as a briefer , more easily implemented therapy but has not yet been rigorously evaluated in the context of psychosis .


The purpose of this trial is to evaluate whether Acceptance and Commitment Therapy could reduce the distress and disability associated with psychotic symptoms in a sample of community-residing patients with chronic medication-resistant symptoms .


This is a single ( rater ) - blind multi-centre randomised controlled trial comparing Acceptance and Commitment Therapy with an active comparison condition , Befriending .


Eligible participants have current residual hallucinations or delusions with associated distress or disability which have been present continuously over the past six months despite therapeutic doses of antipsychotic medication .


Following baseline assessment , participants are randomly allocated to treatment condition with blinded , post-treatment assessments conducted at the end of treatment and at 6 months follow-up .


The primary outcome is overall mental state as measured using the Positive and Negative Syndrome Scale .


Secondary outcomes include preoccupation , conviction , distress and disruption to life associated with symptoms as measured by the Psychotic Symptom Rating Scales , as well as social functioning and service utilisation .


The main analyses will be by intention-to-treat using mixed-model repeated measures with non-parametric methods employed if required .


The model of change underpinning ACT will be tested using mediation analyses .


This protocol describes the first randomised controlled trial of Acceptance and commitment therapy in chronic medication-resistant psychosis with an active comparison condition .


The rigor of the design will provide an important test of its action and efficacy in this population .


Australian New Zealand Clinical Trials Registry : ACTRN12608000210370 .


Date registered : 18 April 2008 .


To evaluate the effectiveness of low-frequency TENS ( LFT ) and high-frequency TENS ( HFT ) in post-episiotomy pain relief .


A randomized , controlled , double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain .


TENS was applied for 30 minutes to groups : HFT ( 100 Hz ; 100 s ) , LFT ( 5 Hz ; 100 s ) , and placebo ( PT ) .


Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale .


The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating .


The third and fourth evaluation took place 30 and 60 minutes after TENS removal , only in the resting position .


Intragroup differences were verified using the Friedman and Wilcoxon tests , and the intergroup analysis employed the Kruskal-Wallis test .


In the intragroup analysis , there was no significant difference in the PT during rest , sitting , and ambulation ( P > 0.05 ) .


In the HFT and LFT , a significant difference was observed in all activities ( P < 0.001 ) .


In the intergroup analysis , there was a significant difference in the resting position in the HFT and LFT ( P < 0.001 ) .


In the sitting activity , a significant difference was verified in the second evaluation in the HFT and LFT ( P < 0.008 ) .


No significant difference was verified among the groups in ambulation ( P < 0.20 ) .


LFT and HFT are an effective resource that may be included in the routine of maternity wards .


To assess the clinical relevance ( functional outcome ) of a 3-month allopurinol regimen in patients with high serum uric acid ( SUA ) levels and acute ischemic stroke without considering the changes in SUA levels .


In a randomized , double-blind , controlled study , 70 patients ( 45 females , 25 males ) with acute ischemic stroke who had elevated levels of SUA were included .


They were divided in two 35-patient groups to investigate the effect of 3 months of an allopurinol ( 200 mg/day ) regimen versus placebo on their functional outcome , which was evaluated using a modified Rankin scale .


The overall mean age was 68.9 11.33 years ( range 27-89 ) .


The final favorable functional status ( mRS = 0-2 ) was 23 ( 65.7 % ) and 14 ( 40.0 % ) in the treated and placebo groups , respectively , which was strongly associated with allopurinol consumption ( OR = 4.646 , p = 0.014 ) and age 70 years ( OR = 0.139 , p = 0.005 ) in patients with ischemic stroke after adjusting for confounders .


There was no significant difference in death between allopurinol-treated cases ( 3 ; 8.6 % ) and placebo-treated ones ( 6 ; 17.2 % ; p = 0.278 ) .


Allopurinol treatment was well tolerated and improved the 3-month functional status of patients with acute ischemic stroke who had high levels of SUA without considering the decreasing effect of allopurinol on SUA .


To compare new onset dyslipidaemia in live-related renal transplant recipients taking cyclosporine versus tacrolimus after 3 months of therapy .


The randomised controlled trial was conducted at the Sindh Institute of Urology and Transplantation ( SIUT ) Karachi , from September 2010 to April 2011 , and included 182 End Stage Renal Disease patients on maintenance haemodialysis with pre-transplant normal lipid profile .


The patients , who had live-related renal transplant , were randomly allocated to two equal groups using lottery .


Group A received cyclosporine ( 3 mg/kg ) and group B was treated with tacrolimus ( 0.1 mg/kg ) .


All patients had pre-transplant fasting lipid profile checked when they were on maintenance haemodialysis and 3 months after renal transplantation .


Serum fasting lipid profile was collected by taking 5 ml blood by venipuncture after an overnight fast of 9-12 hours .


SPSS 10 was used for statistical analyses .


Of the 182 patients , 144 ( 79.1 % ) were males and 38 ( 20.9 % ) were females .


The overall mean age was 30.18 + / - 9.57 years , and the mean weight was 54.41 + / - 11.144 kg .


Significant difference was not observed between the two groups regarding age and weight of the patients .


Dyslipidaemia was found in 115 ( 63.2 % ) subjects ; 61 ( 67 % ) in group A and 54 ( 59.3 % ) in group B.


There was no statistical difference ( p = 0.28 ) when comparison was done after 3 months of therapy .


The occurrence of new onset hyperlipidaemia is similar in renal transplant recipients receiving either cyclosporine or tacrolimus in first 3 months post-transplant , but there is room for more research in this field as dyslipidaemia following successful renal transplantation is a frequent and persistent complication .


Postoperative ileus has been considered an inevitable consequence of abdominal surgery .


The aim of the study was to investigate the efficacy of same treatments in resolving postoperative ileus in various surgical approaches .


A total of 360 patients underwent abdominal surgery , and was divided into four groups : videolaparoscopic cholecystectomy , laparotomic colo-rectal surgery , laparotomic Hartmann procedure , laparotomic gastric surgery .


In each group , patients received different postoperative treatments : chewing gum , olive oil , both , and water .


Each group was compared with a control group .


In patients who underwent videolaparoscopic cholecystectomy , median postoperative first passage of flatus and stool in the water group was 10 and 34 hours , respectively ( P = 0.006 , P = 0.021 ) and significantly earlier than in the control group ( median postoperative 24 and 72 hours ) .


Postoperative stay for the water group was lower ( median day 1 , 3rd interquartile 2.5 ) compared with control ( median day 3 ; 3rd interquartile 7.0 , P = 0.01 ) .


In patients who underwent gastric surgery , median postoperative first passage of stool in the olive oil and chewing gum group was 48 hours , significantly earlier than in the control ( median postoperative hour 120 , P = 0.04 ) .


Median time to first passage of flatus and stool was also earlier in the other groups compared with the control group , though this difference was not significant .


Chewing gum , olive oil or both do not induce a relevant reduction of ileus after surgery .


Water may be a safe and inexpensive option in reducing ileus .


( United States National Institutes of Health , www.clinicaltrial.gov , number NCT01869231 ) .


Calcium needs are physiologically upregulated during pregnancy and lactation to meet demands of the developing fetus and breastfeeding infant .


Maternal calcium homeostasis is maintained by hormonal adaptive mechanisms , thus , the role of dietary calcium supplementation in altering maternal responses to fetal-infant demand for calcium is thought to be limited .


However , increased calcium absorption is directly related to maternal calcium intake and dietary supplementation has been suggested to prevent transient bone loss associated with childbearing .


In a double-blind , randomized placebo-controlled trial , we randomly assigned 670 women in their first trimester of pregnancy to 1,200 mg/day calcium ( N = 334 ) or placebo ( N = 336 ) .


Subjects were followed through 1-month postpartum and the effect on urinary cross-linked N-telopeptides ( NTx ) of type I collagen , a specific marker of bone resorption , was evaluated using an intent-to-treat analysis .


Women with a baseline and at least one follow-up measurement ( N = 563 ; 84 % ) were included .


Subsequent analyses were conducted stratifying subjects by compliance assessed using pill counts .


In random subsets of participants , bone-specific alkaline phosphatase ( BAP ) ( N = 100 ) and quantitative ultrasound ( QUS ) ( N = 290 ) were also measured .


Calcium was associated with an overall reduction of 15.8 % in urinary NTx relative to placebo ( p < 0.001 ) .


Among those who consumed 50 % , 67 % , and 75 % of pills , respectively , the effect was associated with 17.3 % , 21.3 % , and 22.1 % reductions in bone resorption ( all p < 0.001 ) .


There was no significant effect of calcium on bone formation measured by BAP .


However , by 1-month postpartum , those in the calcium group had significantly lower NTx/BAP ratios than those in the placebo group ( p = 0.04 ) indicating a net reduction in bone loss in the supplement group by the end of follow-up .


Among subjects who consumed 50 % and 75 % of pills , respectively , calcium was also associated with an increase of 26.3 m/s ( p = 0.03 ) and 59.0 m/s ( p = 0.009 ) in radial SOS relative to placebo by 1-month postpartum .


Calcium administered during pregnancy and the early postpartum period , to women with intakes around adequacy , was associated with reduced bone resorption and , thus , may constitute a practical intervention to prevent transient skeletal loss associated with childbearing .


ClinicalTrials.gov Identifier NCT00558623 .


The aim of this study was to investigate clinical application of remifentanil in local anesthesia for resection of tumors in functional brain area .


Twenty-four patients were randomly divided into two groups : control group and remifentanil group .


In remifentanil group remifentanil was infused intravenously with micro pump in 0.05-0 .1 gkg-1min-1 .


The hemodynamic changes and complications during operation were monitored .


The satisfactory degree for surgical procedure was evaluated .


The surgery of two groups could be completed in a conscious state .


Mean artery pressure ( MAP ) , heart rate ( HR ) in remifentanil group during opening or closing skull or intra - cranial period were significantly lower than control group ( p < 0.05 ) .


There were no conspicuous complications in two groups such as respiratory depression , nausea , vomitting and dysphoria .


Satisfaction rate of remifentanyl group was significantly higher than control group ( p < 0.05 ) .


Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia , and hemodynamics were stable and the patients were well tolerated .


Brivaracetam ( BRV ) is a novel high-affinity synaptic vesicle protein 2A ligand in clinical development for the treatment of epilepsy .


This phase III study ( N01252 ; NCT00490035 ) evaluated the efficacy and safety/tolerability of BRV ( 20 , 50 , and 100 mg/day ) compared with placebo ( PBO ) in patients aged 16-70 years with uncontrolled focal seizures with/without secondary generalization , despite treatment with one to two concomitant antiepileptic drugs at a stable and optimal dosage .


This was a double-blind , randomized , placebo-controlled trial conducted across Europe and India .


Eligible patients had two or more focal seizures/month for 3 months prior to screening and eight or more focal seizures during the 8-week prospective baseline .


Concomitant use of levetiracetam was limited to 20 % of randomized patients .


Patients were randomized ( 1:1:1:1 ) to BRV 20 , 50 , 100 mg/day or PBO with no up-titration for 12 weeks , followed by down-titration or entry into a long-term follow-up study .


The primary efficacy end point was percent reduction over PBO in baseline-adjusted focal seizure frequency/week over the 12-week treatment period .


Comparison of BRV with PBO was sequential to control for multiplicity ( 50 , 100 , 20 mg/day ) , and thus required BRV to demonstrate superiority over PBO at 50 mg/day to meet the primary efficacy end point .


Secondary efficacy variables were median percent reduction from baseline in focal seizure frequency/week , 50 % responder rate , and seizure freedom ( all seizure types ) .


Safety assessments included treatment-emergent adverse events ( TEAEs ) .


Of 399 randomized patients , 398 were included in the intent-to-treat ( ITT ) and safety populations .


Overall , 367 ( 92.2 % ) of 398 patients completed the study ( BRV : 93.9 % , 88.9 % , and 94.0 % for 20 , 50 , and 100 mg/day , respectively ; PBO : 92.0 % ) and 345 ( 86.7 % ) of 398 patients continued into long-term follow-up studies ( BRV : 87.9 % , 82.8 % , and 88.0 % for 20 , 50 , and 100 mg/day , respectively ; PBO : 88.0 % ) .


The study did not meet its primary efficacy end point based on the predefined sequential testing strategy .


Indeed , percent reduction over PBO in baseline-adjusted focal seizure frequency/week ( primary efficacy analysis ) was 6.8 % ( p = 0.239 ) , 6.5 % ( p = 0.261 ) , and 11.7 % ( p = 0.037 ) for BRV 20 , 50 , and 100 mg/day , respectively .


Median percent reduction from baseline in focal seizure frequency/week was 30.0 % ( p = 0.019 ) , 26.8 % ( p = 0.092 ) , and 32.5 % ( p = 0.004 ) for BRV 20 , 50 , and 100 mg/day , respectively , compared with 17.0 % for PBO .


Responder rates ( 50 % ) were 27.3 % ( p = 0.339 ) , 27.3 % ( p = 0.372 ) , and 36.0 % ( p = 0.023 ) for BRV 20 , 50 , and 100 mg/day , respectively , compared with 20.0 % for PBO .


Complete seizure freedom was reported by 2/99 , 0/99 , and 4/100 patients on BRV 20 , 50 , and 100 mg/day , respectively , compared with 0/100 on PBO .


The incidence of TEAEs was higher for BRV 20 ( 56/99 , 56.6 % ) , 50 ( 62/99 , 62.6 % ) , and 100 mg/day ( 63/100 , 63.0 % ) than PBO ( 53/100 , 53.0 % ) ; most TEAEs were mild or moderate in severity .


The most frequently reported TEAEs in the BRV groups were headache , somnolence , dizziness , and fatigue .


In this study of adjunctive BRV ( 20-100 mg/day ) in adults with uncontrolled focal seizures , the primary efficacy analysis based on the 50 mg/day dose was not statistically significant .


However , BRV 100 mg/day reduced baseline-adjusted focal seizure frequency/week by 11.7 % over PBO , achieving statistical significance ( p = 0.037 ) .


Secondary efficacy analyses ( percent reduction from baseline in focal seizure frequency/week , 50 % responder rate ) provided supportive evidence for the efficacy of BRV 100 mg/day .


BRV 20-100 mg/day was well tolerated without up-titration , with a high completion rate .


Medication errors related to hospital discharge result in rehospitalization and emergency department ( ED ) visits , yet no systematic approach has been implemented nationally to decrease these medication errors .


Pharmacist involvement during postdischarge transitions of care may be an important strategy to prevent and correct medication discrepancies and reduce costly rehospitalization and ED visits .


This prospective , randomized , open-label , pilot study evaluated the effect of a pharmacy clinic visit focused on medication reconciliation and patient education after hospital discharge on the incidence of rehospitalization and ED visits and the resolution of medication discrepancies .


Of the 61 subjects included in the study , 33 ( 54 % ) had medication discrepancies identified at discharge .


Fifty percent of medication discrepancies were resolved in subjects randomized to the pharmacist intervention arm compared with 9.5 % in the usual care arm ( P = .015 ) .


Patients randomized to the intervention arm had significantly lower rates of the primary composite outcome of 30-day rehospitalization and ED visits compared with the usual care arm ( 0 % vs 40.5 % , P < .001 ) .


A pharmacist-driven intervention focused on patient education and medication reconciliation after discharge improved medication use and reduced health care resource utilization in this pilot study .


Prostate-specific antigen ( PSA ) screening is controversial .


A community jury allows presentation of complex information and may clarify how participants view screening after being well-informed .


We examined whether participating in a community jury had an effect on men 's knowledge about and their intention to participate in PSA screening .


Random allocation to either a 2-day community jury or a control group , with preassessment , postassessment and 3-month follow-up assessment .


Participants from the Gold Coast ( Australia ) recruited via radio , newspaper and community meetings .


Twenty-six men aged 50-70 years with no previous diagnosis of prostate cancer .


The control group ( n = 14 ) received factsheets on PSA screening .


Community jury participants ( n = 12 ) received the same factsheets and further information about screening for prostate cancer .


In addition , three experts presented information on PSA screening : a neutral scientific advisor provided background information , one expert emphasised the potential benefits of screening and another expert emphasised the potential harms .


Participants discussed information , asked questions to the experts and deliberated on personal and policy decisions .


Our primary outcome was change in individual intention to have a PSA screening test .


We also assessed knowledge about screening for prostate cancer .


Analyses were conducted using intention-to-treat .


Immediately after the jury , the community jury group had less intention-to-screen for prostate cancer than men in the control group ( effect size = -0.6 SD , p = 0.05 ) .


This was sustained at 3-month follow-up .


Community jury men also correctly identified PSA test accuracy and considered themselves more informed ( effect size = 1.2 SD , p < 0.001 ) .


Evidence-informed deliberation of the harms and benefits of PSA screening effects men 's individual choice to be screened for prostate cancer .


Community juries may be a valid method for eliciting target group input to policy decisions .


Australian and New Zealand Clinical Trials Registry ( ACTRN12612001079831 ) .


Mobile-phone-based text ( SMS ) messaging is an effective method for delivering smoking cessation assistance ; however , little is known about optimal program use .


This paper reports on the use of 2 forms of interaction ( reporting changes in quit status and emergency help ) among users of QuitTxt , an interactive , automated text messaging advice program .


We examined preferences for messaging intensity , duration of use , and their associations with short-term cessation outcome or perceived helpfulness .


QuitTxt was offered during participation in a previously reported randomized controlled trial and was activated by 924 smokers or recent quitters , of whom 862 used it to a criterion level .


Outcome data ( quit attempts , 7-day point prevalence abstinence , and perceived helpfulness ) were collected 1 month after first use .


Most ( 68.9 % ) accepted the default of 4-8 messages per day , and median use duration was 27 days .


Half ( 49.1 % ) appeared to miss reporting at least 1 status change , with relapses less likely to be reported than quit progression .


Emergency help was used by 27.0 % of those eligible for it ; emergency help was used more frequently among those with recent quit experience and lower nicotine dependence .


Use of emergency help was unrelated to short-term cessation outcome .


The most notable finding is the variability in use .


Some users complied fully with the requirement to report status changes , while even among those who did not , many found QuitTxt to be very helpful , suggesting that perfect congruence between message content and quit status is not essential .


The use of emergency help functionality was relatively rare but was appreciated .


To test whether a weight loss program promotes greater weight loss , glycemic control , and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake .


This randomized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling , with prepackaged foods in a planned menu during the initial phase , or to usual care ( UC ; two weight loss counseling sessions and monthly contacts ) .


Relative weight loss was 7.4 % ( 95 % CI 5.7-9 .2 % ) , 9.0 % ( 7.1-10 .9 % ) , and 2.5 % ( 1.3-3 .8 % ) for the lower fat , lower carbohydrate , and UC groups ( P < 0.001 intervention effect ) .


Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year ( fasting glucose 141 [ 95 % CI 133-149 ] vs. 159 [ 144-174 ] mg/dL , P = 0.023 ; hemoglobin A1c 6.9 % [ 6.6-7 .1 % ] vs. 7.5 % [ 7.1-7 .9 % ] or 52 [ 49-54 ] vs. 58 [ 54-63 ] mmol/mol , P = 0.001 ; triglycerides 148 [ 134-163 ] vs. 204 [ 173-234 ] mg/dL , P < 0.001 ) .


The lower versus higher carbohydrate groups maintained lower hemoglobin A1c ( 6.6 % [ 95 % CI 6.3-6 .8 % ] vs. 7.2 % [ 6.8-7 .5 % ] or 49 [ 45-51 ] vs. 55 [ 51-58 ] mmol/mol ) at 1 year ( P = 0.008 ) .


The weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes .


Recurrent miscarriage is a major women 's health problem .


Aspirin and heparin have been shown to have potentially beneficial effects on trophoblast implantation .


However , few published data on this issue are available from developing countries .


An open clinical trial was conducted at the Department of Obstetrics and Gynecology at Misurata Teaching Hospital in Libya from January 2009 to December 2010 to investigate the effects of treatment with low dose aspirin ( LDA ) versus treatment with low-molecular-weight-heparin ( LMWH ) in combination with LDA on patients with a history of recurrent miscarriages .


A total of 150 women were enrolled in the study .


Women were eligible for the study if they had a history of three or more consecutive miscarriages .


Participants were randomly assigned to receive either LDA ( 75 mg daily ) alone or a combination of LDA and LMWH ( 75 women per treatment group ) .


The primary outcomes were the rate of miscarriages and live births for each group .


Compared with the group who received LDA alone , the combination group had a significantly lower number of miscarriages ( 22/75 [ 29 % ] vs. 43/75 [ 47 % ] , P < 0.001 ) and had a significantly higher number of live births ( 53/75 [ 71 % ] vs. 32/75 [ 42 % ] , P < 0.001 ) .


Two preterm infants in the LDA group and three in the combination group were admitted to the neonatal intensive care unit .


There were no significant differences in the mean ( SD ) birth weights of neonates born in either group ( 2955.4 560 vs. 3050 540 g for the LDA and combination groups , respectively , P = 0.444 ) .


There were no congenital abnormalities detected in either group .


The combination of LDA and LMWH is better than LDA alone for the maintenance of pregnancy in patients with recurrent first trimester miscarriage .


NCT01917799 .


Because heart rate affects ventricular filling , the aim of the present study was to assess the effects of increasing heart rate and tidal volume on stroke volume variability to determine whether this dynamic index is heart-rate dependent .


Prospective , randomized study .


Single university hospital .


Eighteen vascular surgery patients having general anesthesia and endotracheal intubation with an arterial catheter connected to the Vigileo FloTrac system ( Edwards Lifesciences , Irvine , CA ) and a transesophageal atrial pacemaker ( CardioComman Inc , Tampa , FL ) .


A 2 2 factorial study of changes in heart rate ( 80 bpm and 110 bpm ) and tidal volume ( 6 mL/kg and 10 mL/kg ) .


With tidal volume at 6 mL/kg , increasing heart rate from 80 mL/kg to 110 bpm caused stroke volume variability to increase from 12.2 % 5.7 % to 13.2 % 5.3 % ( p < 0.05 ) , and with tidal volume at 10 mL/kg , increasing heart rate from 80 mL/kg to 110 bpm caused stroke volume variability to increase from 19.7 % 7.9 % to 22.0 % 8.6 % ( p < 0.05 ) .


In comparison , increasing tidal volume from 6 mL/kg to 10 mL/kg produced a significantly greater effect on stroke volume variability than increasing heart rate .


Stroke volume variability is sensitive to increases in heart rate in addition to tidal volume .


Increasing heart rate caused stroke volume variability to increase significantly , although not to the same magnitude as increasing tidal volume .


When using dynamic volume indices , clinicians should be aware of increases in heart rate , although its clinical impact may be relatively minor compared with changes in tidal volume .


To determine the effect of oral acetazolamide on lowering the peak and duration of intraocular pressure ( IOP ) rise in glaucoma and glaucoma suspect patients , following intravitreal injection of ranibizumab for neovascular age-related macular degeneration .


The study was an open-label , parallel , randomised , controlled trial ( EudraCT Number : 2010-023037-35 ) .


Twenty-four glaucoma or glaucoma suspect patients received either 500mg acetazolamide or no treatment 60-90min before 0.5 mg ranibizumab .


The primary outcome measure was the difference in IOP immediately after injection ( T0 ) and 5 , 10 , and 30min following injection .


ANCOVA was used to compare groups , adjusting for baseline IOP .


The study was powered to detect a 9-mmHg difference at T0 .


The IOP at T0 was 2.3 mmHg higher in the non-treated group ( mean 44.5 mmHg , range ( 19-86mmHg ) ) compared with the treated group ( mean 42.2 mmHg , range ( 25-58mmHg ) ) , but was not statistically significant after adjusting for baseline IOP ( P = 0.440 ) .


At 30min , IOP was 4.9 mmHg higher in the non-treated group ( mean 20.6 mmHg , range ( 11-46mmHg ) ) compared with the treated group ( mean 15.7 mmHg , range ( 8-21mmHg ) ) .


This was statistically significant after adjusting for baseline IOP ( P = 0.013 ) .


Although the primary end points were not reached , 500mg oral acetazolamide , 60-90min before intravitreal injection , results in a statistically significant reduction in IOP at 3O min post injection .


Prophylactic treatment may be considered as an option to minimise neuro-retinal rim damage in high-risk glaucoma patients who are most vulnerable to IOP spikes and undergoing repeated intravitreal injections of ranibizumab .


The effects of an anticholinergic or antidiuretic agent as add-on therapy to an alpha-blocker for lower urinary tract symptoms ( LUTS ) according to a voiding diary in 3 days are unknown .


We prospectively investigated the efficacy of an anticholinergic or antidiuretic agent as add-on therapy for nocturia in men previously treated with an alpha-blocker for LUTS .


Patients were randomly subdivided into two groups .


All patients had a 4-week washout .


Group A had alpha-blocker for 4 weeks , then an alpha-blocker plus an anticholinergic agent for 4 weeks , and , finally , 4 weeks of an alpha-blocker plus an antidiuretic agent .


Group B had an alpha-blocker for 4 weeks , then an alpha-blocker plus an antidiuretic agent for 4 weeks , and , finally , 4 weeks of an alpha-blocker plus an anticholinergic agent .


In both groups , patients were subdivided into nocturnal polyuria , decreased nocturnal bladder capacity ( NBC ) , or nocturia by both causes subgroups .


A 3-day voiding diary , total International Prostate Symptom Score ( IPSS ) , IPSS sub-scores , Overactive Bladder Symptom Score , uroflowmetry , and post-void residual urine volume , were assessed at baseline , and at 4 , 8 , and 12 weeks .


A total of 405 patients completed the study .


During treatment , the changes from baseline in total IPSS and IPSS sub-scores were significantly decreased at 4 weeks and were maintained for 12 weeks .


In the nocturnal polyuria subgroup of Groups A and B , the number of episodes of nocturia in 3 days , nocturnal urine volume , and nocturnal index were significantly decreased using an alpha-blocker plus an antidiuretic agent .


In the decreased NBC subgroup of Groups A and B , IPSS storage sub-score , Overactive Bladder Symptom Score , number of episodes of nocturia in 3 days , number of episodes of urgency in 3 days , and NBC index were all significantly decreased using an alpha-blocker plus an anticholinergic agent .


An anticholinergic agent or antidiuretic agent as an add-on therapy in men previously treated with an alpha-blocker improves nocturia including LUTS .


The negative effect of hypoxia on cognitive function has been well described .


However , less has been published regarding cognitive dysfunction resulting from hypoxia produced by exposure to different altitudes .


We measured short-term and working memory capacity ( Digit Span tasks ) , cognitive flexibility and selective attention ( Word-Color Stroop Task ) , and executive functioning ( Trailmaking A and B tests ) at baseline and simulated altitudes equal to 17,500 ft ( 5334 m ) and 25,000 ft ( 7620 m ) in order to obtain more information about the role of altitude exposure on cognitive tasks important for optimal functioning in the aviation environment .


Behavioral observations indicated that hypoxia was induced at different simulated altitudes .


Marked declines in cognitive performance were also observed for all tests at 25,000 ft , with scores indicating greater impairment in this condition relative to others .


Subjects also showed greater impairment when scores obtained in the 17,500-ft condition were compared to baseline , although the effects were not as clearly defined relative to the 25,000 vs. baseline contrasts .


The results of this study suggest that electronic versions of these tests may be useful in screening for acute symptoms of hypoxia and could provide insight into how discrete cognitive processes become impaired with oxygen deprivation at various altitudes .


Given that these tests also assess neuropsychological functioning , our results allow for inferences to be made about the effects of hypoxia on human brain functioning .


Recent years have seen remarkable progress in cancer therapy , although treatment-induced adverse reactions and complications are not uncommon .


Approximately 40 % of patients undergoing chemotherapy for cancer experience adverse reactions in the oral cavity , with nearly half of them developing severe oral mucositis that necessitates postponing therapy and/or changing the drug dosage .


The objective of this study was to assess the usefulness of prophylactic professional oral health care ( POHC ) for preventing mucositis in patients undergoing chemotherapy .


Twenty-six female patients scheduled for chemotherapy for breast cancer were included in this study and randomized to the self-care or POHC groups .


Assessment parameters included oral cavity photographs , plaque control records , Saxon test scores , Oral Assessment Guide scores , and grading using the Common Terminology Criteria for Adverse Events .


Beginning before surgery and continuing through the completion of chemotherapy , the POHC patient group received weekly professional oral health care , including scaling , professional cleaning of the tooth surfaces , brushing instructions , and nutritional and lifestyle guidance .


More patients in the self-care group developed oral mucositis than in the POHC group .


The Oral Assessment Guide score , which was used as an index of oral mucositis , was also significantly lower in the POHC group .


Based on the Oral Assessment Guide and plaque control records , there was almost no deterioration of the oral environment in the POHC group , whereas deterioration was observed in the self-care group .


These findings demonstrate the efficacy of regular POHC in reducing the risk of oral mucositis in breast cancer patients undergoing chemotherapy .


To compare the superficial incisional surgical site infection ( SSI ) rate after cesarean section ( CS ) in obese women using subcuticular versus interrupted skin suturing .


The current randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital .


Obese non-diabetic women who underwent elective CS were randomized into two groups : group I included women who had their skin closed with interrupted mattress suture using non-absorbable polypropylene , and group II included women who had their skin closed with subcuticular suture using the same suture material .


Primary outcome measure was superficial incisional SSI and secondary outcome measures were skin closure time , postoperative pain assessed by ten-point visual analog scale ( VAS ) and short-term cosmetic wound outcome according to the Stony Brook Scar Evaluation Scale ( SBSES ) .


A total of 130 obese women were finally analyzed .


Group II ( n = 67 ) was associated with higher incidence of superficial incisional SSI .


There were nine cases ( 13.4 % ) compared to three cases ( 4.8 % ) in group I ( n = 63 ) ; however , this difference was statistically not significant ( P = 0.088 ) .


Skin closure time was significantly prolonged in group I ( 8.6 2.3 min versus 5.7 2.2 min , respectively , P < 0.001 ) .


Postoperative pain was significantly lower in group I and the mean VAS in group I was 4.7 2 versus 5.5 1.8 in group II ( P = 0.017 ) .


Using SBSES , group II had mean score 4.5 0.7 , while group I had mean score 2.7 1.1 .


This was statistically significant ( P < 0.001 ) , which means a better cosmetic outcome in group II .


Subcuticular skin closure during CS for non-diabetic obese women was significantly associated with better short-term cosmetic outcome , less skin closure time , yet , with slightly higher risk of superficial incisional SSI and significantly more postoperative pain .


Adherence to pre-exposure prophylaxis ( PrEP ) is critical for efficacy .


Antiretroviral concentrations are an objective measure of PrEP use and correlate with efficacy .


Understanding patterns and correlates of drug detection can identify populations at risk for nonadherence and inform design of PrEP adherence interventions .


Blood antiretroviral concentrations were assessed among active arm participants in iPrEx , a randomized placebo-controlled trial of emtricitabine/tenofovir in men who have sex with men and transgender women in 6 countries .


We evaluated rates and correlates of drug detection among a random sample of 470 participants at week 8 and a longitudinal cohort of 303 participants through 72 weeks of follow-up .


Overall , 55 % of participants ( 95 % confidence interval : 49 to 60 ) tested at week 8 had drug detected .


Drug detection was associated with older age and varied by study site .


In longitudinal analysis , 31 % never had drug detected , 30 % always had drug detected , and 39 % had an inconsistent pattern .


Overall detection rates declined over time .


Drug detection at some or all visits was associated with older age , indices of sexual risk , including condomless receptive anal sex , and responding `` do n't know '' to a question about belief of PrEP efficacy ( 0-10 scale ) .


Distinct patterns of study product use were identified , with a significant proportion demonstrating no drug detection at any visit .


Research literacy may explain greater drug detection among populations having greater research experience , such as older men who have sex with men in the United States .


Greater drug detection among those reporting highest risk sexual practices is expected to increase the impact and cost-effectiveness of PrEP .


In patients with chronic kidney disease ( CKD ) hyperuricemia is common .


Evidence that hyperuricemia might also play a causal role in vascular disease , hypertension and progression of CKD is accumulating .


Therefore , we studied the association between baseline uric acid ( UA ) levels and the rate of decline in renal function and time until start of dialysis in pre-dialysis patients .


Data from the PREPARE-2 study were used .


The PREPARE-2 study is an observational prospective cohort study including incident pre-dialysis patients with CKD stages IV-V in the years between 2004 and 2011 .


Patients were followed for a median of 14.9 months until start of dialysis , kidney transplantation , death , or censoring .


Main outcomes were the change in the rate of decline in renal function ( measured as estimated glomerular filtration rate ( eGFR ) ) estimated using linear mixed models , and time until start of dialysis estimated using Cox proportional hazards models .


In this analysis 131 patients were included with a baseline UA level ( mean ( standard deviation ( SD ) ) of 8.0 ( 1.79 ) mg/dl ) and a mean decline in renal function of -1.61 ( 95 % confidence interval ( CI ) , -2.01 ; -1.22 ) ml/min/1 .73 m2/year .


The change in decline in GFR associated with a unit increase in UA at baseline was -0.14 ( 95 % CI -0.61 ; 0.33 , p = 0.55 ) ml/min/1 .73 m2/year .


Adjusted for demography , comorbidities , diet , body mass index ( BMI ) , blood pressure , lipids , proteinuria , diuretic and/or allopurinol usage the change in decline in eGFR did not change .


The hazard ratio ( HR ) for starting dialysis for each mg/dl increase in UA at baseline was 1.08 ( 95 % CI , 0.94 ; 1.24 , p = 0.27 ) .


After adjustment for the same confounders the HR became significant at 1.26 ( 95 % CI , 1.06 ; 1.49 , p = 0.01 ) , indicating an earlier start of dialysis with higher levels of UA .


Although high UA levels are not associated with an accelerated decline in renal function , a high serum UA level in incident pre-dialysis patient is a risk factor for an earlier start of dialysis .


A higher protein to carbohydrate ratio in the diet may potentiate weight loss , improve body composition and cardiometabolic risk , including glucose homeostasis in adults .


The aim of this randomised control trial was to determine the efficacy of two structured lifestyle interventions , differing in dietary macronutrient content , on insulin sensitivity and body composition in adolescents .


We hypothesised that a moderate-carbohydrate ( 40-45 % of energy ) , increased-protein ( 25-30 % ) diet would be more effective than a high-carbohydrate diet ( 55-60 % ) , moderate-protein ( 15 % ) diet in improving outcomes in obese , insulin resistant adolescents .


Obese 10-17 year olds with either pre-diabetes and/or clinical features of insulin resistance were recruited at two hospitals in Sydney , Australia .


At baseline adolescents were prescribed metformin and randomised to one of two energy restricted diets .


The intervention included regular contact with the dietician and a supervised physical activity program .


Outcomes included insulin sensitivity index measured by an oral glucose tolerance test and body composition measured by dual-energy x-ray absorptiometry at 12months .


Of the 111 adolescents recruited , 85 ( 77 % ) completed the intervention .


BMI expressed as a percentage of the 95th percentile decreased by 6.8 % [ 95 % CI : -8.8 to -4.9 ] , ISI increased by 0.2 [ 95 % CI : 0.06 to 0.39 ] and percent body fat decreased by 2.4 % [ 95 % CI : -3.4 to -1.3 ] .


There were no significant differences in outcomes between diet groups at any time .


When treated with metformin and an exercise program , a structured , reduced energy diet , which is either high-carbohydrate or moderate-carbohydrate with increased-protein , can achieve clinically significant improvements in obese adolescents at risk of type 2 diabetes .


Australian New Zealand Clinical Trail Registry ACTRN12608000416392 .


Registered 25 August 2008 .


Oxidative stress and inflammation can be altered by dietary factors in various species .


However , little data are available in true carnivorous species such as domestic cats .


As numerous anti-inflammatory and anti-oxidative additives become available and might be of use in cats with chronic low-grade inflammatory diseases , the current study aimed to develop a model of diet-induced inflammation by use of two opposite diets .


It was hypothesized that a high fat diet enhanced in n-6 PUFA and with lower concentrations of antioxidants would evoke inflammation and oxidative stress in domestic cats .


Sixteen healthy adult cats were allocated to two groups .


One group received a moderate fat diet , containing pork lard and salmon oil ( AA : ( EPA+DHA ) ratio 0.19 ) ( MFn-3 ) , while the other group was fed a high fat diet , containing pork lard and chicken fat ( AA : ( EPA+DHA ) ratio 2.06 ) ( HFn-6 ) for 12weeks .


Prior to and 2 , 4 , 6 , 8 , 10 and 12weeks after starting the testing period , blood samples were collected .


Erythrocytic fatty acid profile showed clear alterations in accordance to the dietary fatty acid profile .


Serum thiobarbituric acid reactive substances was higher when fed MFn-3 compared to the HFn-6 , suggesting augmented oxidative stress .


This was associated with a reduced serum vitamin E status , as serum - tocopherol concentrations were lower with MFn-3 , even with higher dietary levels of vitamin E. Serum cytokine and serum amyloid A concentrations were not influenced by diet .


These results point towards a resistance of cats to develop dietary fat-induced inflammation , but also suggest a high susceptibility to oxidative stress when fed a fish oil-supplemented diet even with moderate fat level and additional vitamin E.


It is still unknown how best to maintain effects of exercise programmes in COPD in the long-term .


We present the long-term effects of a community-based exercise programme incorporated in a self-management programme , compared to a self-management programme only in patients with COPD .


All included patients participated in four self-management sessions .


Additionally , patients in the intervention group participated in an 11-month community-based exercise programme led by physiotherapists .


Patients trained three times/week for six months and two times/week during the subsequent five months .


To encourage a behavioural change towards exercise , one of these weekly training sessions was home-based ( unsupervised ) .


No formal exercise training was offered to intervention patients in the second year .


The intervention was assigned to 80 patients , and the control condition to 79 patients .


82.5 % and 78.5 % of the intervention and control group , respectively , completed 24 months follow-up .


Modified intention-to-treat analyses were performed .


Although statistically significant after 12 months ( 35.1 m ( 95 % CI : 8.4-61 .8 ) ) , the between-group difference on maximal exercise capacity was not statistically significant after 24 months ( 12.2 m ( 95 % CI : -16.6 to 41.0 ) .


Nevertheless , the between-group difference in daily physical activity was maintained after 24 months ( 1193 steps/day ( 95 % CI : 203-2182 ) ) .


A beneficial effect was also found on CRQ dyspnoea score but not on other CRQ domains , CCQ and HADS .


Our intervention was effective in achieving a behavioural change reflected by a sustained increase in daily physical activity , not accompanied by a sustained increase in maximal exercise capacity after two years of follow-up ( ISRCTN81447311 ) .


Tension-type headache ( TTH ) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments .


To assess the effectiveness of manual therapy techniques , applied to the suboccipital region , on aspects of disability in a sample of patients with tension-type headache .


Randomized Controlled Trial .


Specialized centre for headache treatment .


Seventy-six ( 62 women ) patients ( age : 39.9 10.9 years ) with episodic chronic TTH .


Patients were randomly divided into four treatment groups : 1 ) suboccipital soft tissue inhibition ; 2 ) occiput-atlas-axis manipulation ; 3 ) combined treatment of both techniques ; 4 ) control .


Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory ( HDI ) .


Headache frequency , severity and the functional and emotional subscales of the questionnaire were assessed .


Photophobia , phonophobia and pericranial tenderness were also monitored .


Headache frequency was significantly reduced with the manipulative and combined treatment ( P < 0.05 ) , and the severity and functional subscale of the HDI changed in all three treatment groups ( P < 0.05 ) .


Manipulation treatment also reduced the score on the emotional subscale of the HDI ( P < 0.05 ) .


The combined intervention showed a greater effect at reducing the overall HDI score compared to the group that received suboccipital soft tissue inhibition and to the control group ( both P < 0.05 ) .


In addition , photophobia , phonophobia and pericranial tenderness only improved in the group receiving combined therapy ( P < 0.05 ) .


When given individually , suboccipital soft tissue inhibition and occiput-atlas-axis manipulation resulted in changes in different parameters related to the disability caused by TTH .


However , when the two treatments were combined , effectiveness was noted for all aspects of disability and other symptoms including photophobia , phonophobia and pericranial tenderness .


Although individual manual therapy treatments showed a positive change in headache features , measures of photophobia , photophobia and pericranial tenderness only improved in the group that received the combined treatment suggesting that combined treatment is the most appropriate for symptomatic relief of TTH .


The evaluation of the safety and preliminary efficacy of 125 g ocriplasmin intravitreal injection in patients with focal vitreomacular adhesion ( VMA ) and exudative age-related macular degeneration ( AMD ) .


Randomized , sham-injection controlled , double-masked , multicenter , phase II trial .


A total of 100 patients with VMA and wet AMD were randomized 3:1 to receive 125 g ocriplasmin intravitreal injection or sham injection .


Study treatment was administered in the mid-vitreous cavity by injection .


Post-treatment safety and efficacy assessments were made at baseline and on days 7 , 14 , and 28 and months 3 , 6 , and 12 after injection .


Secondary efficacy end points were exploratory in nature .


The safety and tolerability of ocriplasmin were evaluated .


The primary efficacy end point was the proportion of patients with VMA release at day 28 after injection .


Secondary end points reported included VMA release over time , total posterior vitreous detachment ( PVD ) , change in visual acuity from baseline , and number of anti-vascular endothelial growth factor ( VEGF ) injections .


The safety of ocriplasmin in patients with VMA and wet AMD was shown to be comparable to the known safety profile , with the majority of adverse events in the study eye occurring in the first 7 days after study treatment .


A greater proportion of patients achieved VMA resolution and total PVD at month 12 with ocriplasmin compared with sham treatment .


There was a decrease in the number of anti-VEGF injections with ocriplasmin at month 12 compared with the sham group , although no differences in visual acuity were observed .


Ocriplasmin treatment in this population seems to be generally safe and well tolerated and resulted in more patients achieving VMA resolution and PVD with less anti-VEGF use compared with sham treatment .


At present , it is unknown whether the use of nutrient-rich dairy proteins improves the markers of sarcopenia syndrome .


Therefore , our proposal was to investigate whether adding 210 g of ricotta cheese daily would improve skeletal muscle mass , handgrip strength , and physical performance in non-sarcopenic older subjects .


This was a single-blind randomized clinical trial that included two homogeneous , randomized groups of men and women over 60 years of age .


Participants in the intervention group were asked to consume their habitual diet but add 210 g of ricotta cheese ( IG/HD + RCH ) , while the control group was instructed to consume only their habitual diet ( CG/HD ) .


Basal and 12-week follow-up measurements included appendicular skeletal muscle mass ( ASMM ) by dual-energy X-ray absorptiometry , handgrip strength by a handheld dynamometer , and physical performance using the short physical performance battery ( SPPB ) and the stair-climb power test ( SCPT ) .


The main outcomes were relative changes in ASMM , strength , SPPB , and SCPT .


ASMM increased in the IG/HD + RCH ( 0.63.5 kg ) , but decreased in the CG/HD ( -1.02.6 ) .


The relative change between groups was statistically significant ( P = 0.009 ) .


The relative change in strength in both groups was negative , but the loss of muscle strength was more pronounced in CG/HD , though in this regard statistical analysis found only a tendency ( P = 0.07 ) .


The relative change in the balance-test scores was positive for the IG/HD + RCH , while in the CG/HD it was negative , as those individuals had poorer balance .


In this case , the relative change between groups did reach statistical significance .


The addition of 210 g of ricotta cheese improves ASMM and balance-test scores , while attenuating the loss of muscle strength .


These results suggest that adding ricotta cheese to the habitual diet is a promising dietetic strategy that may improve the markers of sarcopenia in subjects without a pronounced loss of ASMM or sarcopenia .


The heel-lance ( HL ) method for blood collection from the newborn is controversial for the pain it causes .


This is the first randomized controlled trial on the management and reduction of pain using the music of Wolfgang Amadeus Mozart ( `` Sonata K. 448 '' ) in premature infants hospitalized in a neonatal intensive care unit ( NICU ) .


This study has compared nonpharmacological techniques with standard procedure for reducing pain during HL procedure .


Thirty-five premature infants were enrolled , each for 3 HL procedures , of which each was randomized to 1 of the 3 study arms .


Arms were then compared in terms of the Premature Infant Pain Profile ( PIPP ) changes by analysis of variance ( ANOVA ) .


One hundred five HL procedures were available for analysis ( 35 standard procedure , 35 music , 35 glucose ) .


Median baseline PIPP was 3 , and median PIPP after the HL procedure was 5 .


PIPP scale change was +3 in the control arm , +1 in the glucose arm , +2 in the music arm ( p = .008 ) .


Both glucose and music were safe and effective in limiting pain increase when compared to standard procedure in HL procedures in preterm infants .


Glutamate excitotoxicity might contribute to the pathophysiology of amyotrophic lateral sclerosis .


In animal models , decreased excitatory aminoacid transporter 2 ( EAAT2 ) overexpression delays disease onset and prolongs survival , and ceftriaxone increases EAAT2 activity .


We aimed to assess the safety and efficacy of ceftriaxone for amyotrophic lateral sclerosis in a combined phase 1 , 2 , and 3 clinical trial .


This three-stage randomised , double-blind , placebo-controlled study was done at 59 clinical sites in the USA and Canada between Sept 4 , 2006 , and July 30 , 2012 .


Eligible adult patients had amyotrophic lateral sclerosis , a vital capacity of more than 60 % of that predicted for age and height , and symptom duration of less than 3 years .


In stages 1 ( pharmacokinetics ) and 2 ( safety ) , participants were randomly allocated ( 2:1 ) to ceftriaxone ( 2 g or 4 g per day ) or placebo .


In stage 3 ( efficacy ) , participants assigned to ceftriaxone in stage 2 received 4 g ceftriaxone , participants assigned to placebo in stage 2 received placebo , and new participants were randomly assigned ( 2:1 ) to 4 g ceftriaxone or placebo .


Participants , family members , and site staff were masked to treatment assignment .


Randomisation was done by a computerised randomisation sequence with permuted blocks of 3 .


Participants received 2 g ceftriaxone or placebo twice daily through a central venous catheter administered at home by a trained caregiver .


To minimise biliary side-effects , participants assigned to ceftriaxone also received 300 mg ursodeoxycholic acid twice daily and those assigned to placebo received matched placebo capsules .


The coprimary efficacy outcomes were survival and functional decline , measured as the slope of Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised ( ALSFRS-R ) scores .


Analyses were by intention to treat .


This study is registered with ClinicalTrials.gov , number NCT00349622 .


Stage 3 included 66 participants from stages 1 and 2 and 448 new participants .


In total , 340 participants were randomly allocated to ceftriaxone and 173 to placebo .


During stages 1 and 2 , mean ALSFRS-R declined more slowly in participants who received 4 g ceftriaxone than in those on placebo ( difference 051 units per month , 95 % CI 002 to 100 ; p = 00416 ) , but in stage 3 functional decline between the treatment groups did not differ ( 009 , -006 to 024 ; p = 02370 ) .


No significant differences in survival between the groups were recorded in stage 3 ( HR 090 , 95 % CI 071 to 115 ; p = 04146 ) .


Gastrointestinal adverse events and hepatobiliary adverse events were more common in the ceftriaxone group than in the placebo group ( gastrointestinal , 245 of 340 [ 72 % ] ceftriaxone vs 97 of 173 [ 56 % ] placebo , p = 00004 ; hepatobiliary , 211 [ 62 % ] vs 19 [ 11 % ] , p < 00001 ) .


Significantly more participants who received ceftriaxone had serious hepatobiliary serious adverse events ( 41 participants [ 12 % ] ) than did those who received placebo ( 0 participants ) .


Despite promising stage 2 data , stage 3 of this trial of ceftriaxone in amyotrophic lateral sclerosis did not show clinical efficacy .


The adaptive design allowed for seamless transition from one phase to another , and central venous catheter use in the home setting was shown to be feasible .


National Institute of Neurological Disorders and Stroke .


This study describes a single-site investigation on the effects of a randomized double-blind placebo trial targeting duloxetine added to opioid use ( duloxetine + opioid ) against a comparator ( placebo + opioid ) in spine surgery patients , independent of major depression .


The double-blind comparator study assessed two groups on opioids : one using duloxetine and the other a placebo .


Subjects were administered the respective medication 2 weeks prior to surgery and continued on this for more than 3 months .


Subjects were assessed at three times : prior to surgery , 4 weeks postsurgery , and 12 weeks postsurgery .


They completed a battery of tests assessing for pain , adjustment , and psychiatric problems .


Neurosurgical outpatient and inpatient setting .


Sixty-eight patients completed the study .


They received one of three types of elective spine surgery .


Subjects were given duloxetine or placebo 2 weeks prior to surgery and continued with the regimen for more than 3 months .


The primary focus was pain and second on adjustment factors and psychiatric symptoms : depression and anxiety .


The amount of opioid use presurgery and postsurgery was also evaluated .


There were differences among the groups on Brief Pain Inventory ( BPI ) - Average , the core pain marker , and BPI-Sleep .


Within-subject analyses showed that duloxetine subjects improved significantly from baseline .


For function , post-CIBIC and post-Functional Adjustment Questionnaire were significant , favoring duloxetine .


Reduction of opioid use was not a factor ; both groups ' utilization declined .


For affect , both groups were significantly improved over time .


Duloxetine seems to improve pain , assist with maintaining function , and reduce intensity of affect .


Examine the effect of ABT-335 ( fenofibric acid ) on postprandial lipemia and susceptibility of plasma lipoproteins to Cu ( + + ) - mediated oxidation in patients with metabolic syndrome .


This is a randomized double-blind , placebo-controlled study with cross-over and includes a 4-week wash-out period between the two treatment periods .


At the end of each 8-week treatment period , subjects were challenged with a standardized mixed meal followed by blood collection over the ensuing 6 h. Plasma lipoproteins were isolated by a combination of ultracentrifugation and FPLC for the continuous monitoring of conjugated dienes formation as an assessment of oxidative susceptibility .


Fasting plasma TG was reduced by 20 % ( p < 0.0002 ) and there was a modest reduction in hsCRP ( 6.1 % , p < 0.06 ) .


There was no change in either HDLc or LDLc in these subjects .


Postprandial lipemia was reduced with ABT-335 as demonstrated by a 28.5 % reduction ( p < 0.0005 ) in incremental area under the curve for TG during the 6-h period after the meal challenge .


Lag times for both fasting LDL ( +16 % ) and postprandial LDL ( +28 % ) were increased with the ABT-335 therapy , suggestive of reduced oxidative susceptibility .


Co-incubation with autologous HDL did not reduced LDL oxidative susceptibility in these patients .


ABT-335 therapy reduced fasting and postprandial triglycerides in patients with metabolic syndrome .


Autologous HDL may be dysfunctional in these patients as co-incubation with HDL failed to reduce oxidative susceptibility of LDL .


During ABT-335 therapy , LDL was less susceptible to Cu ( + + ) - mediated oxidative modification , in spite of the lack of changes in LDLc levels .


To determine whether culture at a more physiologically cooler temperature , as suggested by limited human and animal data , would improve blastulation and pregnancy rates in human clinical IVF .


Paired randomized controlled trial .


Academic .


Infertile couples ( n = 52 ) with a female partner less than 42 years old with eight or more mature oocytes retrieved .


Mature oocytes obtained from a single cohort of oocytes were randomly divided into two groups ; one was cultured at 37C and the other at 36C from the time of ICSI to the time of embryo transfer or vitrification .


Paired embryo transfers were accomplished by transferring one euploid embryo from each group .


DNA fingerprinting was used as needed to determine the outcome for each embryo .


Rate of development of expanded blastocysts suitable for transfer or vitrification ( primary outcome ) , fertilization , aneuploidy , and sustained implantation .


A total of 805 mature oocytes were cultured ; 399 at 36C and 406 at 37C .


Paired analysis demonstrated a higher rate of usable blastocyst formation per zygote at 37C ( 48.4 % ) vs. at 36C ( 41.2 % ) .


Rates of fertilization , aneuploidy , and sustained implantation were equivalent .


IVF culture at 36C does not improve clinically relevant parameters of embryo development or sustained implantation rates .


NCT01506089 .


To explore the protective effect and possible mechanism of intensive lipid modulation on the perioperative period of patients with stable coronary artery disease undergoing noncardiac surgery .


In the study , 60 patients with stable coronary artery disease undergoing elective noncardiac surgery were randomly divided into intensive lipid modulation group ( n = 30 ) and conventional group ( n = 30 ) .


In intensive lipid modulation group , the patients were given atorvastatin 40 mg every night before surgery , 80 mg 12 h before surgery , and 40 mg 2 h before surgery , and 40 mg every night after noncardiac surgery .


In conventional group , the patients were given atorvastatin 20 mg every night before surgery and also after the surgery .


The occurrence of perioperative major adverse cardiac events ( including sudden cardiac death , acute myocardial infarction , unplanned revascularization ) were compared in the two groups .


Preoperative and 48 h postoperative changes of lipid levels and inflammatory markers were also compared in the two groups .


In conventional group , one patient suffered myocardial infarction with acute anterior ST-segment elevation and was given emergency left anterior descending artery interventional reperfusion therapy , and 7 patients suffered asymptomatic myocardial infarction .


In intensive lipid modulation group , one patient suffered asymptomatic myocardial infarction , and the incidence rate of perioperative acute myocardial infarction reduced significantly compared with conventional group ( P < 0.05 ) .


There was no significant difference in preoperative and postoperative changes of lipid levels in the two groups ( P > 0.05 ) , and compared with conventional group , there was significantly lower levels of inflammatory markers in intensive lipid modulation group ( P < 0.05 ) .


The intensive lipid modulation group significantly reduced the incidence of perioperative major adverse cardiac events especially asymptomatic myocardial infarction , and the inhibition of the inflammatory response may be one of the protective mechanisms , which still needs to be further confirmed by large multicenter randomized controlled clinical trials .


Calcium inhibits and ascorbic acid ( AA ) enhances iron absorption from iron-fortified foods .


Absorption efficiency depends on iron status , although the interaction is unclear .


We investigated the ability of AA to overcome calcium-induced inhibition of iron absorption in children differing in iron status .


The effect of calcium ( 0 , 100 , and 200 mg/test meal ) on iron absorption in the absence and presence of AA ( 0 , 42.5 , and 85 mg/test meal ) from a casein/whey-based drink fortified with ferrous sulfate was assessed in a series of randomized crossover studies both in iron-replete ( IR ) Indian schoolchildren and in children with iron deficiency anemia ( IDA ) ( 6-11 y ; n = 14-16 / group ) by using stable isotopes .


In the absence of calcium and AA , iron absorption from the casein/whey-based drink was 20 % lower in IR children than in children with IDA .


The addition of calcium reduced mean iron absorption by 18-27 % , with the effect being stronger for high added calcium ( P < 0.01 ) .


AA at a 2:1 or 4:1 molar ratio enhanced iron absorption by a factor of 2-4 and greatly overcompensated for the inhibitory effect of calcium on iron absorption in a dose-dependent manner ( P < 0.001 ) .


The dose-response effect tended to be stronger ( P < 0.1 ) in the IDA group , and iron status was of far less influence on iron absorption than the enhancing effect of AA .


When adding AA to iron-fortified milk products , care should be taken not to provide absorbable iron in excess of needs .


Migraine remains poorly treated , with few effective preventive drugs available .


We assessed the safety and efficacy of LY2951742 , a fully humanised monoclonal antibody to calcitonin gene-related peptide , for migraine prevention .


We did a randomised , double-blind , placebo-controlled , phase 2 proof-of-concept study at 35 centres in the USA .


Patients aged 18-65 years with four to 14 migraine headache days per month were randomly assigned ( 1:1 ) to LY2951742 or placebo by a computerised randomisation scheme .


LY2951742 ( 150 mg ) or placebo were given as a subcutaneous injection once every 2 weeks for 12 weeks .


The primary endpoint was the mean change in number of migraine headache days per 28-day period assessed at 9-12 weeks .


Safety was assessed over 24 weeks , including the 12-week treatment period and the subsequent 12 weeks after study drug administration .


Patients and treating investigators were masked to treatment allocation .


Analyses were by intention to treat .


A mixed-effects model of repeated measures was used , including patient baseline value , treatment , visit , and treatment-by-visit interaction as fixed effects , and patients as random effects .


Safety measures were analysed according to the treatment received .


This study has been completed and is registered with ClinicalTrials.gov , NCT01625988 .


Between July 31 , 2012 , and Sept 18 , 2013 , 218 patients were randomly assigned to LY2951742 ( n = 108 , but one patient withdrew before treatment ) or placebo ( n = 110 ) .


The mean change from baseline to week 12 in the number of migraine headache days was -42 ( SD 31 ; 625 % decrease ) in the LY2951742 group compared with -30 ( SD 30 ; 423 % decrease ) in the placebo group ( least-squares mean difference -12 , 90 % CI -19 to -06 ; p = 00030 ) .


Adverse events that occurred more frequently with LY2951742 than with placebo included injection site pain , erythema , or both ( 21 [ 20 % ] of 107 vs seven [ 6 % ] of 110 ) , upper respiratory tract infections ( 18 [ 17 % ] vs ten [ 9 % ] ) , and abdominal pain ( six [ 6 % ] vs three [ 3 % ] ) .


There were two serious adverse events reported in the treatment arm and four in the placebo arm , none of which were deemed to be related to the study drug .


These results provide preliminary evidence that LY2951742 might be beneficial in migraine prevention and provide support for the role of calcitonin gene-related peptide in the pathogenesis of migraine .


Further controlled studies are needed to assess the safety and efficacy of monoclonal calcitonin gene-related peptide antibodies for the preventive treatment of migraine .


Arteaus Therapeutics .


Although the WHO recommends that complementary feeding in infants should begin at 6 mo of age , it often begins before this in developed countries .


Our objective was to determine whether lactation consultant ( LC ) support , with educational resources given at 4-mo postpartum , can delay the introduction of complementary foods until around 6 mo of age .


A total of 802 mother-infant pairs were recruited from the single maternity hospital serving Dunedin , New Zealand ( 59 % response rate ) and randomly assigned to the following : 1 ) usual care ( control group ) ; 2 ) infant sleep education intervention ( Sleep ) ; 3 ) food , activity , and breastfeeding intervention ( FAB ) ; or 4 ) combination ( both ) intervention ( Combo ) .


Certified LCs delivered 3 intervention sessions ( late pregnancy and 1-wk and 4-mo postpartum ) .


The 4-mo contact used educational resources focused on developmental readiness for complementary foods .


Age when complementary foods were introduced was obtained from repeated interviews ( monthly from 3 - to 27-wk postpartum ) .


A total of 49.5 % and 87.2 % of infants received complementary foods before 5 and 6 mo of age , respectively .


There was evidence of group differences in the number of infants introduced to complementary foods before 5 mo ( P = 0.006 ) , with those receiving support and resources ( FAB and Combo groups combined ; 55.6 % ) more likely to wait until at least 5 mo compared with controls ( control and Sleep groups combined ; 43.3 % ) ( OR : 1.52 ; 95 % CI : 1.08 , 2.16 ) .


However , there was no evidence they were more likely to wait until 6 mo of age ( P = 0.52 ) .


Higher maternal age , higher parity , and a less positive attitude toward breastfeeding were positively associated , and drinking alcohol during pregnancy was negatively associated , with later age of introduction of complementary foods .


Providing an LC and educational resources at 4-mo postpartum to predominantly well-educated , mainly European , women can delay the introduction of complementary foods until 5 mo of age , but not until the WHO recommendation of 6 mo. .


This trial was registered at clinicaltrials.gov as NCT00892983 .


Intradialytic hypertension affects 15 % of hemodialysis patients and is associated with increased morbidity and mortality .


While intradialytic hypertension is associated with increases in endothelin 1 relative to nitric oxide ( NO ) , the cause of these imbalances is unknown .


Invitro evidence suggests that altering plasma sodium levels could affect endothelial-derived vasoregulators and blood pressure ( BP ) .


Thus , we hypothesized that compared to high dialysate sodium , low dialysate sodium concentration would lower endothelin 1 levels , increase NO release , and reduce BP .


3-week , 2-arm , randomized , crossover study .


16 patients with intradialytic hypertension .


Low ( 5 mEq/L below serum sodium ) versus high ( 5 mEq/L above serum sodium ) dialysate sodium concentration .


Endothelin 1 , nitrite ( NO2 ( - ) ) , and BP .


Mixed linear regression was used to compare the effect of dialysate sodium ( low vs high ) and randomization arm ( low-then-high vs high-then-low ) on intradialytic changes in endothelin 1 , NO2 ( - ) , and BP values .


The average systolic BP throughout all hemodialysis treatments in a given week was lower with low dialysate sodium concentrations compared with treatments with high dialysate sodium concentrations ( parameter estimate,-9 .9 [ 95 % CI,-13 .3 to-6 .4 ] mm Hg ; P < 0.001 ) .


The average change in systolic BP during hemodialysis also was significantly lower with low vs high dialysate sodium concentrations ( parameter estimate,-6 .1 [ 95 % CI,-9 .0 to-3 .2 ] mm Hg ; P < 0.001 ) .


There were no significant differences in intradialytic levels of endothelin 1 or NO2 ( - ) with low vs high dialysate sodium concentrations .


Carryover effects limited the power to detect significant changes in endothelial-derived vasoregulators , and future studies will require parallel trial designs .


Low dialysate sodium concentrations significantly decreased systolic BP and ameliorated intradialytic hypertension .


Longer studies are needed to determine the long-term effects of low dialysate sodium concentrations on BP and clinical outcomes .


To observe the efficacy of He-wei Jie-gu ( Chinese characters ) decoction on femoral intertrochanteric fractures after internal fixation in elderly .


From January 2010 to January 2012 , 90 elderly patients with osteoporotic intertrochanteric fracture were randomly divided into two groups .


The patients in experimental group were treated with open reduction and internal fixation , He-wei Jie-gu decoction and Caltrate D in oral , including 18 males and 27 females with an average age of ( 77.811.3 ) years old ranging from 65 to 89 years old ; the time from injured to operation was 2 to 9 days with an average of ( 6.62.1 ) days ; according to Evans-Jensen classification , 17 cases were in type I , 8 in type II , 15 in type III , 3 in type IV , 2 in type V. Meanwhile , the patients in control group were treated with open reduction and internal fixation , Caltrate D in oral , including 16 males and 29 females with an average age of ( 81.29.6 ) years old ranging from 67 to 91 years old ; the time from injury to operation was 2 to 10 days with an average of ( 6.82.6 ) days ; according to Evans-Jensen classification , 15 cases were in type I , 10 in type II , 14 in type III , 4 in type W , 2 in type V.


The VAS score , hip BMD value before and after treatment , fracture healing and the Harris function score after operation were recorded and compared .


All patients were followed up from 3 to 9 months with an average of ( 5.62.8 ) months .


Compared with the control group , the VAS score of the experimental group had an obviously reduction ( F = 98.138 , P < 0.01 ) after treatment ; the hip BMD value at 3 months after treatment in the experimental group was higher than that of the control group ( P < 0.05 ) ; the fracture healing rate of the experimental group was higher than that of the control group ( P < 0.05 ) ; Harris score in 3 months of follow-up in the experimental group was higher than that of the control group ( t = 2.542 , P < 0.05 ) ; all the differences between two groups were statistically significant ( P < 0.05 ) .


He-wei Jie-gu decoction can reduce postoperative pain and increase bone mineral density after internal fixation of femoral intertrochanteric fracture in elderly , promote the fracture healing and functional recovery in the hip joint .


A novel musical memory aid has been proposed for aiding laypersons in complying with the American Heart Association ( AHA ) cardiopulmonary resuscitation ( CPR ) guidelines of 100 compressions per minute ( cpm ) .


This study tested usefulness of such a memory aid to improve layperson long-term compliance with CPR compression rate guidelines .


A prospective randomized controlled trial was conducted using CPR-untrained laypersons .


Subjects received either a standard CPR educational experience ( AHA Heartsaver CPR class ) or an experimental CPR educational experience ( AHA Heartsaver CPR class augmented with a musical metronome ) .


Experimental group subjects were taught to perform compressions to the cadence of a pop music song ( The Bee Gees `` Stayin ' Alive '' ; Saturday Night Fever , The Original Movie Soundtrack ; Polygram International Music , 1977 ) with a tempo of 100 beats/min .


Compression rates , depth of compressions , and correct compressions were measured initially and upon retesting 6 weeks post-training .


Control subjects had a higher mean compression rate both immediately ( 121 [ standard deviation { SD } = 21 ] vs. 109 [ SD = 15 ] cpm ; 95 % confidence interval [ CI ] of mean difference 4-19 ; p = 0.002 ) and at follow-up ( 120 [ SD = 20 ] vs. 111 [ SD = 13 ] cpm ; 95 % CI of mean difference 2-16 ; p = 0.014 ) .


Compression rates stratified to 100-120 cpm demonstrated no difference between groups initially ( 39 % vs. 48 % ; p = 0.382 ) , but more experimental subjects maintained these rates at follow-up ( 43 % vs. 74 % ; p = 0.003 ) .


Subjects trained to use a musical metronome more often maintained a compression rate of 100-120 cpm at 6-week follow-up , suggesting the memory aid may improve long-term guideline adherence .


Pain is frequent and distressing in people with dementia , but no randomized controlled trials have evaluated the effect of analgesic treatment on pain intensity as a key outcome .


Three hundred fifty-two people with dementia and significant agitation from 60 nursing home units were included in this study .


These units , representing 18 nursing homes in western Norway , were randomized to a stepwise protocol of treating pain ( SPTP ) or usual care .


The SPTP group received acetaminophen , morphine , buprenorphine transdermal patch and pregabalin for 8 weeks , with a 4-week washout period .


Medications were governed by the SPTP and each participant 's existing prescriptions .


We obtained pain intensity scores from 327 patients ( intervention n = 164 , control n = 163 ) at five time points assessed by the primary outcome measure , Mobilization-Observation-Behaviour-Intensity-Dementia-2 ( MOBID-2 ) Pain Scale .


The secondary outcome was activities of daily living ( ADL ) .


We used a linear intercept mixed model in a two-way repeated measures configuration to assess change over time and between groups .


The SPTP conferred significant benefit in MOBID-2 scores compared with the control group [ average treatment effect ( ATE ) -1.388 ; p < 0.001 ] at week 8 , and MOBID-2 scores worsened during the washout period ( ATE = -0.701 ; p = 0.022 ) .


Examining different analgesic treatments , benefit was conferred to patients receiving acetaminophen compared with the controls at week 2 ( ATE = -0.663 ; p = 0.010 ) , continuing to increase until week 8 ( ATE = -1.297 ; p < 0.001 ) .


Although there were no overall improvements in ADL , an increase was seen in the group receiving acetaminophen ( ATE = +1.0 ; p = 0.022 ) .


Pain medication significantly improved pain in the intervention group , with indications that acetaminophen also improved ADL function .


To explore the clinical efficacy and safety of compound digestive enzyme tablet in the treatment of dyspepsia .


A randomized , double-blind , double-dummy , positive drug parallel controlled , multicenter clinical trial was conducted for 203 dyspeptic patients from October 2011 to August 2012 .


And they were randomized into group A ( experimental , n = 106 ) and group B ( control , n = 97 ) .


Group A received 1 tablet of compound digestive enzyme tablet ( Bearse ) plus 2 analog capsules of compound digestive enzyme thrice daily .


And group B had 2 capsules of compound digestive enzyme capsule ( Dages ) plus 1 analog tablet of compound digestive enzyme thrice daily .


The total duration of drug treatment was 2 weeks .


There were 3 follow-up visits ( W0 , W1 , W2 ) .


The primary endpoint was the total effective rate of all dyspeptic symptoms .


The total efficacy rate of groups A and B were 80.2 % ( 85/106 ) and 79.4 % ( 77/97 ) ( P > 0.05 ) .


The adverse effects were 1.9 % ( 2/106 ) and 4.1 % ( 4/97 ) in groups A and B ( P > 0.05 ) .


The adverse effects were mild in both groups .


Compound digestive enzyme tablet and capsule are effective and safe for patients with dyspepsia .


And compound digestive enzymes tablet is comparable to compound digestive enzyme capsule .


Onychomycosis is difficult to cure .


Systemic and topical treatments , including the 1,064-nm Nd : YAG laser , are not very effective when used individually .


To compare the efficacy and safety of combined treatment with a long-pulsed 1,064-nm Nd : YAG laser and oral terbinafine with those of either treatment alone .


We randomly divided 53 patients with a total of 90 infected nails into 3 treatment groups : the T group received oral terbinafine , the L group received long-pulsed Nd : YAG laser treatment , and the T + L group received both treatments .


We evaluated the mycological clearance rate ( MCR ) and the clinical clearance rate ( CCR ) of the 3 groups at Weeks 4 , 8 , 12 , 16 , and 24 .


The MCR and CCR increased in all 3 groups in a time-dependent manner .


The MCR and CCR of the T + L group were significantly higher than those of the T group and the L group at Weeks 8 , 12 , 16 , and 24 ( p < .05 ) .


These data indicate that 12 weeks of combined treatment with a long-pulsed Nd : YAG laser and oral terbinafine produce more rapid and effective mycological and clinical clearance in patients with onychomycosis than either treatment alone , without any obvious side effects .


This study investigated the effects of ethanol consumption on recovery from traditional resistance exercise in recreationally trained individuals .


Nine recreationally trained volunteers ( eight males and one female , 26 4 yr , 81 4 kg ) conducted four resistance exercise sessions and consumed a low ( 0.6 ( females ) and 0.7 ( males ) g kg ( -1 ) body mass ) or a high dose ( 1.2 or 1.4 g kg ( -1 ) body mass ) of ethanol 1-2 .5 h after exercise on two occasions .


The first session was for familiarization with the tests and exercises and was performed without ethanol consumption .


As a control trial , alcohol-free drinks were consumed after the exercise session .


The sequence of trials , with low and high ethanol doses and alcohol-free drinks ( control ) , was randomized .


Maximal voluntary contractions ( MVC ) ( knee extension ) , electrically stimulated contractions ( knee extension ) , squat jumps , and hand grip strength were assessed 10-15 min and 12 and 24 h after the ethanol/placebo drinks .


In addition to a baseline sample , blood was collected 1 , 12 , and 24 h after the ethanol/placebo drinks .


The exercise session comprised 4 8 repetition maximum of squats , leg presses , and knee extensions .


MVC were reduced by 13 % -15 % immediately after the exercise sessions ( P < 0.01 ) .


MVC , electrically stimulated force , and squat jump performance were recovered 24 h after ethanol drinks .


MVC was not fully recovered at 24 h in the control trial .


Compared with those in the control , cortisol increased and the free testosterone/cortisol ratio were reduced after the high ethanol dose ( P < 0.01 ) .


Neither a low nor a high dose of ethanol adversely affected recovery of muscle function after resistance exercise in recreationally strength-trained individuals .


However , the increased cortisol levels and reduced testosterone/cortisol ratio after the high ethanol dose could translate into long-term negative effects .


Early detection of melanoma improves survival .


Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma , an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations ( SSEs ) .


Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent , detect , or cope with their health issues .


The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined .


The electronic interactive educational intervention was created to develop a scalable , effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma .


The intervention in the office was conducted using one of the following three methods : ( 1 ) in-person through a facilitator , ( 2 ) with a paper workbook , or ( 3 ) with a tablet device used in the clinical office .


Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention .


The three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE , encourage performing SSE , and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance .


In creating the electronic interactive SSE educational intervention , the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study .


Enrollment totaled 500 pairs ( melanoma patient and their SSE partner ) with randomization of 165 pairs to the in-person , 165 pairs to the workbook , and 70 pairs to electronic interactive SSE educational intervention .


The demographic survey data showed no significant mean differences between groups in age , education , or income .


The tablet usability survey given to the first 30 tablet pairs found that , overall , participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist 's examination was particularly helpful in understanding what they were asked to do for the study .


The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles , and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles .


While the in-person intervention performed significantly better on a skill-based quiz , the electronic interactive group performed significantly better than the workbook group .


The electronic interactive and in-person interventions were more efficient ( 30 minutes ) , while the workbook took longer ( 45 minutes ) .


This study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods , and the experience can be accommodated during the customary outpatient office visit with the physician .


Further testing of the electronic interactive intervention 's role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations .


ClinicalTrials.gov NCT01013844 ; http://clinicaltrials.gov/show/NCT01013844 ( Archived by WebCite at http://www.webcitation.org/6LvGGSTKK ) .


Experts advise against parenteral nutrition ( PN ) for patients with advanced cancer at the end of life .


But because many patients and families fear starvation , many physicians administer PN to patients with terminal cancer in Korea .


We designed this study to investigate the effect of PN on survival in patients with terminal cancer at the end of life .


We planned a randomized phase II study enrolling 116 patients randomized to receive either fluid or PN .


Eligible patients are who could not tolerate enteral feeding and had short life expectancies ( < 3 months ) due to progressive cancer .


Patients with functioning bowels were excluded .


The primary end point was overall survival and the secondary end point was total administered calories .


We prospectively enrolled 31 consecutive patients and 16 patients were assigned to the PN group .


The study ended early because many patients and families were extremely concerned about starvation .


The baseline characteristics , including nutritional parameters , were not significantly different between the two groups .


The mean administered calories was 374.7 ( 71.7 ) kcal/d for the fluid group and 1286.8 ( 108.3 ) kcal/d for the PN group ( p < 0.001 ) .


Median survival was 8 days ( 95 % confidence interval [ CI ] , 5.7-10 .3 days ) in the fluid group and 13 days ( 95 % CI : 3.1-22 .9 days ) in the PN group , and this difference was not statistically significant ( p = 0.982 by Log-rank test ) .


This study did not conclusively determine the role of PN for patients with advanced cancer , however , PN support failed to significantly prolong survival in these patients compared to similar patients receiving only fluid .


Breast ptosis may be caused by several factors , including significant weight loss , pregnancy , long breastfeeding periods , and involution of the postmenopausal breast tissue .


The authors performed a prospective study to evaluate patient satisfaction and the rate of complications after modified round block mastopexy versus traditional round block mastopexy .


Forty-four patients fulfilled the inclusion criteria for undergoing round block mastopexy in a prospective randomized controlled study performed from 2007 to 2008 .


All the patients received polyurethane silicone implants .


Group A included patients who underwent the traditional round block technique described by Benelli .


Group B included patients who underwent the traditional round block and 4 cardinal glando-glandular permanent sutures .


The overall satisfaction with body appearance after breast mastopexy was rated on a scale of 1 ( poor ) , 2 ( fair ) , 3 ( good ) , 4 ( very good ) , and 5 ( excellent ) .


Group A patient ages ranged from 28 to 52 years and in Group B ranged from 29 to 49 years .


The mean implant volume was 215 cc in both Groups .


The complication and satisfaction rates for both Groups are reported .


The combination of the cardinal glandulo-glandular sutures along with the traditional round block appears to be key to preventing the areolar enlargement and persistent breast ptosis .


The satisfaction rates in patients who underwent the modified round mastopexy appear superior when compared to the traditional round block mastopexy .


Furhter long-term follow-up need to be performed in order to confirm the favorable results seen in this series of cases .


Urinary tract infections ( UTI ) are the most frequent bacterial infection affecting women and account for about 15 % of antibiotics prescribed in primary care .


However , some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics , while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics .


Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance , and wastes resources .