Both type I and type II muscle fiber size increased after exercise training ( P < 0.001 ) , with a greater increase in type II muscle fiber size in the PRO group ( +2319 368 m ( 2 ) ) than in the PLA group ( +1017 353 m ( 2 ) ; P < 0.05 ) .


Protein ingestion before sleep represents an effective dietary strategy to augment muscle mass and strength gains during resistance exercise training in young men .


This trial was registered at clinicaltrials.gov as NCT02222415 .


The transient receptor potential vanilloid 1 ( TRPV1 ) - expressing sensory C-fibers may play a role in the development of nasal hyper-responsiveness and symptoms of non-allergic rhinitis ( NAR ) .


To evaluate the effects of a TRPV1-antagonist , SB-705498 , on cold dry air ( CDA ) - induced symptoms in patients with NAR .


This randomized , double-blind , placebo-controlled , crossover study evaluated 14 days of once daily , topical intranasal SB-705498 12 mg in 40 patients with NAR using a CDA challenge experimental model in an environmental exposure chamber ( EEC , Cetero Research , Mississauga , Ontario ) .


The primary endpoint was total symptom score ( TSS ) , expressed as weighted mean over 60 minutes ( WM0-60 ) or maximum TSS at 1 hour and 24 hours postdosing .


Treatment with SB-705498 , relative to placebo , did not improve WM0-60 or maximum TSS at 1 hour and 24 hours post-dosing on days 1 or 14 .


Mean ( 95 % CI ) treatment differences ( SB-705498 - placebo ) on day 14 were , for WM0-60 at 1 hour : -0.12 ( -0.60 , 0.36 ) ; for maximum TSS at 1 hour : -0.03 ( -0.58 , 0.51 ) .


SB-705498 had no impact on any other efficacy parameters .


SB-705498 was well tolerated and pharmacokinetics analysis supported the dosing regimen .


SB-705498 12 mg for 14 days did not alleviate the CDA-induced symptoms of NAR .


Despite engagement of the TRPV1 receptor , there was no translation to clinical efficacy , suggesting redundancy in symptom pathways .


A prospective randomized clinical trial was conducted to evaluate the efficacy of tamoxifen plus doxorubicin and cyclophosphamide compared to tamoxifen plus tegafur-uracil as an adjuvant therapy to treat node-positive premenopausal breast cancer ( PreMBC ) .


Eligibility criteria included pathologically node-positive ( n = 1-9 ) preMBC with curative resection , in stages I-IIIA .


Patients were randomized to receive either tamoxifen 20 mg/day plus tegafur-uracil 400 mg/day ( TU ) for 2 years or six courses of a 28-day cycle of doxorubicin 40 mg/m ( 2 ) plus cyclophosphamide 500 mg/m ( 2 ) on day 1 along with tamoxifen ( ACT ) given for 2 years as adjuvant therapy .


Primary endpoint was overall survival ( OS ) , and secondary endpoint was recurrence-free survival ( RFS ) .


In total , 169 patients were recruited ( TU arm 87 , ACT arm 82 ) between October 1994 and September 1999 .


The HR for OS was 0.76 ( 95 % CI 0.35 , 1.66 , log-rank p = 0.49 ) and that for RFS was 0.77 ( 95 % CI 0.44 , 1.36 , log-rank p = 0.37 ) , with ACT resulting in a better HR .


The 5-year OS was 79.7 % for patients in the TU arm and 83 % for those in the ACT arm .


The 5-year RFS was 66.1 % for patients in the TU arm and 70.6 % for those in the ACT arm .


A higher proportion of patients in the ACT arm experienced grade 3 leucopenia ( 0 % in the TU arm , 4 % in the ACT arm ) .


There were no significant differences in the efficacy of TU and ACT as adjuvant therapy .


Obesity runs in families , and family-based behavioral treatment ( FBT ) is associated with weight loss in overweight/obese children and their overweight/obese parents .


This study was designed to estimate the costs and cost-effectiveness of FBT compared to separate group treatments of the overweight/obese parent and child ( PC ) .


Fifty overweight/obese 8 - to 12-year-old children with overweight/obese parents were randomly assigned to 12 months of either FBT or PC treatment program .


Assessment of societal costs ( payer plus opportunity costs ) were completed based on two assumptions : ( 1 ) programs for parent and child were available on separate days ( PC-1 ) or ( 2 ) interventions for parent and child were available in the same location at sequential times on the same day ( PC-2 ) .


Cost-effectiveness was calculated based on societal cost per unit of change using percent overBMI for children and weight for parents .


The average societal cost per family was $ 1,448 for FBT and $ 2,260 for PC-1 ( p < 0.001 ) and $ 2,124 for PC-2 ( p < 0.001 ) .


Child cost-effectiveness for FBT was $ 209.17 / percent overBMI , compared to $ 1,036.50 / percent overBMI for PC-1 and $ 973.98 / percent overBMI for PC-2 .


Parent cost-effectiveness was $ 132.97 / pound ( lb ) for FBT and $ 373.53 / lb ( PC-1 ) or $ 351.00 / lb ( PC-2 ) .


For families with overweight/obese children and parents , FBT presents a lower cost per unit of weight loss for parents and children than treating the parent and child separately .


Given the high rates of pediatric and adult obesity , FBT may provide a unique cost-effective platform for obesity intervention that alters weight in overweight/obese parents and their overweight/obese children .


Pseudogynecomastia refers to benign male breast enlargement due to excess subareolar fat .


Standard treatment is surgical excision under general anesthesia , liposuction , or a combination of both .


The safety and efficacy of cryolipolysis was investigated for nonsurgical treatment of pseudogynecomastia .


Enrollment consisted of 21 males with pseudogynecomastia .


Subjects received a first treatment consisting of a 60-minute cryolipolysis cycle , followed by a two-minute massage , and a second 60-minute cycle with 50 % treatment area overlap .


At 60 days of follow-up , subjects received a second 60-minute treatment .


Safety was evaluated by monitoring side effects and adverse events .


Efficacy was assessed by ultrasound , clinical photographs , and subject surveys .


Surveys revealed that 95 % of subjects reported improved visual appearance and 89 % reported reduced embarrassment associated with pseudogynecomastia .


Ultrasound showed mean fat layer reduction of 1.6 1.2 mm .


Blinded reviewers correctly identified 82 % of baseline photographs .


Side effects included mild discomfort during treatment and transient paresthesia and tenderness .


One case of paradoxical hyperplasia ( PH ) occurred but likelihood of PH in the male breast is not believed to be greater than in any other treatment area .


This study demonstrated feasibility of cryolipolysis for safe , effective , and well-tolerated nonsurgical treatment of pseudogynecomastia .


Although fatigue , sleep disturbance , depression , and anxiety are associated with pain in breast cancer patients , it is unknown whether acupuncture can decrease these comorbid symptoms in cancer patients with pain .


The objective of this study was to evaluate the effect of electroacupuncture ( EA ) on fatigue , sleep , and psychological distress in breast cancer survivors who experience joint pain related to aromatase inhibitors ( AIs ) .


The authors performed a randomized controlled trial of an 8-week course of EA compared with a waitlist control ( WLC ) group and a sham acupuncture ( SA ) group in postmenopausal women with breast cancer who self-reported joint pain attributable to AIs .


Fatigue , sleep disturbance , anxiety , and depression were measured using the Brief Fatigue Inventory ( BFI ) , the Pittsburgh Sleep Quality Index ( PSQI ) , and the Hospital Anxiety and Depression Scale ( HADS ) .


The effects of EA and SA versus WLC on these outcomes were evaluated using mixed-effects models .


Of the 67 randomly assigned patients , baseline pain interference was associated with fatigue ( Pearson correlation coefficient [ r ] = 0.75 ; P < .001 ) , sleep disturbance ( r = 0.38 ; P = .0026 ) , and depression ( r = 0.58 ; P < .001 ) .


Compared with the WLC condition , EA produced significant improvements in fatigue ( P = .0095 ) , anxiety ( P = .044 ) , and depression ( P = .015 ) and a nonsignificant improvement in sleep disturbance ( P = .058 ) during the 12-week intervention and follow-up period .


In contrast , SA did not produce significant reductions in fatigue or anxiety symptoms but did produce a significant improvement in depression compared with the WLC condition ( P = .0088 ) .


Compared with usual care , EA produced significant improvements in fatigue , anxiety , and depression ; whereas SA improved only depression in women experiencing AI-related arthralgia .


The present study examined self-affirmation theory , cigarette smoking , and health-related images depicting adverse effects of smoking .


Previous research examining self-affirmation and negative health-related images has shown that individuals who engage in a self-affirmation activity are more receptive to messages when compared to those who do not affirm .


We were interested in examining the extent to which self-affirmation would reduce defensive responding to negative health images related to cigarette smoking .


Participants included 203 daily smokers who were undergraduate students at a large southern university .


Participants completed a battery of questionnaires and were then randomly assigned to one of four conditions ( non-smoking image control , smoking image control , low affirmation , and high affirmation ) .


Analyses evaluated the effectiveness of affirmation condition as it related to defensive responding .


Results indicated that both affirmation conditions were effective in reducing defensive responding for those at greatest risk ( heavier smokers ) and those more resistant to health benefits associated with quitting .


Findings are discussed in terms of potential public health implications as well as the role defensive responding plays in the evaluation and processing of negative health messages .


Ketamine is one of the most commonly used sedatives for facilitating painful procedures for paediatric patients in the emergency department ( ED ) .


However , the use of ketamine is associated with a common , though not serious , adverse event usually called ketamine-associated vomiting ( KAV ) .


The purpose of this study is to evaluate the anti-emetic effect of adjunctive ondansetron in paediatric patients receiving ketamine sedation in the ED .


We conducted a prospective , randomised , open , controlled study in children from 1 to 18 years of age who had undergone intramuscular ketamine sedation in the ED .


The patients were randomised into two groups : a ketamine-only group and a ketamine/ondansetron group .


The patients in the first group received ketamine alone , while those in the second group received ketamine with oral ondansetron .


The incidence of KAV was estimated in the ED and after discharge , and the time to resumption of a normal diet was measured after sedation .


A total of 237 patients were analysed .


The incidence of KAV was 29.7 % in the ketamine-only group and 25.2 % in the ketamine/ondansetron group ( P = 0.47 ) .


After administration of ketamine , the mean time to resumption of a normal diet was 8 h 54 min in the ketamine-only group and 8 h 39 min in the ketamine/ondansetron group ( P = 0.67 ) .


A relatively high rate of KAV ( 29.7 % ) was observed , and the time to resumption of a normal diet after ketamine sedation was rather long .


It turned out that , however , the adjunctive administration of ondansetron did not effectively reduce the incidence of KAV .


Neurologic diseases such as stroke are risk factors for new-onset epilepsy in older adults .


Recent evidence suggests that psychiatric disorders independently predict epilepsy in older male veterans .


Our aim was to examine the relationship between these disorders in a population-based study of older adults that also included women and minorities .


We used a national 5 % random sample of 2005 Medicare beneficiaries including all 50 US states and Washington , DC .


Beneficiaries were 65 years of age or older , with continuous Medicare Part A and Part B coverage and not in managed care plans .


Epilepsy cases were identified from claims for physician visits , hospitalizations , and outpatient procedures .


We used logistic regressions for the overall sample and stratified by gender to determine whether risk of new-onset epilepsy was associated with prior history of psychiatric ( i.e. , depression , psychosis , bipolar disorder , schizophrenia , posttraumatic stress disorder ( PTSD ) , adjustment disorder , and substance abuse/dependence ) and neurologic conditions ( i.e. , cerebrovascular disease , dementia , traumatic brain injury , brain tumor , metastatic cancer ) .


Preexisting psychiatric disorders were significantly associated with new-onset epilepsy in the study population as were the neurologic conditions evaluated .


Five of the seven psychiatric disorders examined were independently associated with new-onset epilepsy ; substance abuse , psychosis , bipolar disorder , schizophrenia , and depression .


Gender interaction effects were found for substance abuse/dependence and brain tumors .


Both neurologic and psychiatric factors significantly predicted new-onset epilepsy in a population-based sample of male and female older adults .


These results support earlier findings and extend the understanding of risk models for new-onset epilepsy in broader older adult populations .


Whereas it is established that endothelin-1 elicits sustained deleterious effects on the cardiovascular system during cardiopulmonary bypass ( CPB ) , presently it remains unknown whether the inhaled administration of the dual ETA and ETB antagonist tezosentan prevents the development of pulmonary endothelial dysfunction .


A prospective , randomized laboratory investigation .


University research laboratory .


Landrace swine .


Three groups of animals underwent a 90-minute period of full bypass followed by a 60-minute period of reperfusion .


Among treated groups , one received tezosentan through inhalation prior to CPB , whereas the other one received it intravenously at weaning from CPB ; the third group remained untreated .


Pulmonary vascular reactivity studies , realized on a total of 285 rings , were performed in all groups , including 1 sham .


The contractility of pulmonary arteries to prostaglandin F2 and to the thromboxane A2 mimetic U46619 was preserved in animals submitted to CPB .


By contrast , there were significant increases both in the maximal contraction to endothelin-1 and in the plasma levels of the peptide 60minutes after reperfusion .


Tezosentan administered by inhalation or intravenously did not prevent the development of pulmonary CPB-associated endothelial dysfunction .


However , while hemodynamic disturbances were improved with both routes , the inhaled administration had a beneficial effect on oxygen parameters over intravenous administration .


Despite the blockade of the endothelin-1 pathway with tezosentan , the development of the pulmonary endothelial dysfunction associated with CPB still occurred .


However , only the inhalation route had a significant impact on gas exchange during CPB .


Recently , the UK CCLG and COG reported that an intrachromosomal amplification of chromosome 21 ( iAMP21 ) in acute lymphoblastic leukemia ( ALL ) loses its adverse prognostic impact with intensified therapy .


We evaluated the prognosis of iAMP21 among patients from the ALL-BFM ( Berlin-Frankfurt-Mnster ) 2000 trial with 46 of 2637 ( 2 % ) patients iAMP21 + .


8-year event-free-survival ( EFS , 64 8 % vs. 81 1 % , p = 0.0026 ) and cumulative incidence of relapse ( CIR , 29 8 % vs. 14 1 % , p = 0.008 ) of the iAMP21 cases were significantly worse compared with non-iAMP21 patients .


Within the MRD low-risk group , iAMP21 cases ( n = 14 ) had an inferior 8-year EFS ( 76 12 % vs. 92 1 % , p = 0.0081 ) , but no increased CIR ( 10 10 % vs. 6 1 % , p = 0.624 ) .


Within the MRD intermediate-risk group , iAMP21 cases ( n = 27 ) had a worse 8-year EFS ( 56 11 % vs. 78 2 % , p = 0.0077 ) and CIR ( 44 11 % vs. 20 2 % , p = 0.003 ) with 6/10 relapses occurring after 2 years .


Conclusively , we believe that there is no necessity for enrolling all iAMP21 patients into the high-risk arm of ongoing ALL-BFM trials because MRD low-risk patients have a moderate relapse risk under current therapy .


Whether the increased relapse risk in MRD intermediate-risk patients can be avoided by late treatment intensification remains to be answered by the AIEOP-BFM ALL 2009 trial randomly using protracted pegylated L-asparaginase during delayed intensification and early maintenance .


We investigated which factors can best predict relapse in older patients with major depressive disorder ( MDD ) who have achieved remission with escitalopram .


A total of 405 patients who were 65 years or older with a primary diagnosis of MDD received 12 week , open-label escitalopram 10 or 20mg/day .


Patients in remission ( MADRS 12 ) at Week 12 were randomized to 24 weeks of double-blind treatment with either placebo or escitalopram ( fixed dose from Week 6 ) .


After randomization of 312 patients in remission , patients whose dose had been increased to 20mg escitalopram after 2 weeks of open-label treatment had a high escitalopram relapse rate ( 16.7 % ) and a placebo relapse rate of 32.5 % with a hazard ratio ( HR ) of 2.2 , whereas patients titrated to 20mg escitalopram at Weeks 4 or 6 had a high placebo relapse rate ( 41.2 % ) and an escitalopram relapse rate of 5.7 % with a HR = 8.9 .


A high placebo relapse rate was also observed for patients with a baseline MADRS below median , while low escitalopram relapse rates were characteristic of patients who had achieved remission by Week 6 or 8 ( HR = 8.9 ) , had a current depressive episode length below median , baseline MADRS below median ( HR = 11.8 ) , or received 10mg for 12 weeks ( HR = 6.3 ) .


A key limitation of the study was that some analyses were post-hoc and that none of the comparisons between complementary subgroups had nominal p-values < 0.05 .


In this post-hoc analysis of elderly patients with MDD , several factors , including female gender , early remission , low baseline MADRS score , major depressive episode ( MDE ) duration , and escitalopram dosage , significantly affected the relapse rate after randomization to escitalopram or placebo .


The study aims to compare the stress shielding effects of implantable anatomical and traditional prostheses after in vitro total hip joint replacement simulation .


The study serves as a biomechanical basis for novel artificial prostheses and for clinical hip joint replacements .


Sixteen femoral specimens from adult male corpses were randomly divided into two groups : the traditional prosthesis group implanted into femur specimens using simulated total hip joint replacement ( n = 8 ) and the femoral neck-preserved anatomical prosthesis implantation group that used a collum femoris preserving stem/trabeculae oriented pattern ( CFP/TOP ) acetabular cup ( n = 8 ) .


The strain values in the two groups before and after prosthesis implantation were measured at different test points using electric resistance strain gauges .


The stress shielding rate was calculated according to the related formula .


The results showed that the rates of proximal femoral stress shielding were significantly higher at test points 1-10 in the traditional femoral prosthesis transplantation group than in the anatomical prosthesis group ( p < 0.05 ) .


There were different effects of stress shielding between the anatomical and traditional prostheses .


Retained femoral anatomical implants should reduce stress shielding and increase the stability of anatomical prosthesis implants .


The self-control strength model suggests that exertion of self-control leads to poorer subsequent self-control performance .


Failure of self-control has been suggested as an important underlying mechanism of excessive drinking .


This study tested the effects of self-control failure on ad libitum drinking , and the potential moderating role of glucose and self-awareness on this relationship .


The current research examined in two experiments whether the effects of self-control failure were different for males and females , and whether glucose ( experiment 1 ) and self-awareness ( experiment 2 ) would counteract the effects of self-control failure .


A between-participants design with four conditions was employed in each experiment .


A semi-naturalistic drinking setting in the form of a laboratory bar .


Undergraduate students recruited at Radboud University Nijmegen , the Netherlands ( experiment 1 : n = 106 ; experiment 2 : n = 108 ) .


The total amount of alcohol consumed during an experimental break ( observational data ) and questionnaire data on drinking patterns .


Self-control failure led to increased levels of drinking in males ( P < 0.05 ) , whereas females drank less after being depleted ( P < 0.01 ) .


Self-awareness , but not glucose , was found to counteract the effects of self-control failure among males ( P < 0.05 ) .


Self-control failure leads to increased drinking of alcohol in males and decreased levels of drinking alcohol in females .


However , increasing self-awareness appears to be a promising strategy in facing the temptation to drink when cognitive resources to inhibit intake are low .


Access to fruit and vegetables ( FV ) is associated with adolescents ' FV consumption .


However , little is known about implementation of strategies to increase access to FV at schools .


We examined the implementation of two environmental components designed to increase access to FV at Danish schools .


We used data from 20 intervention schools involved in the school-based multicomponent Boost trial targeting 13-year-olds ' FV consumption .


The environmental components at school included daily provision of free FV and promotion of a pleasant eating environment .


Questionnaire data was collected by the end of the nine-month intervention period among 1,121 pupils ( 95 % ) , from all school principals ( n = 20 ) and half way through the intervention period and by the end of the intervention among 114 teachers ( 44 % ) .


The implementation of the components was examined descriptively using the following process evaluation measures ; fidelity , dose delivered , dose received and reach .


Schools with stable high implementation levels over time were characterised by context , intervention appreciation and implementation of other components .


For all process evaluation measures , the level of implementation varied by schools , classes and over time .


Dose received : 45 % of pupils ( school range : 13-72 % , class range : 7-77 % ) ate the provided FV daily ; 68 % of pupils ( school range : 40-93 % , class range : 24-100 % ) reported that time was allocated to eating FV in class .


Reach : The intake of FV provided did not differ by SEP nor gender , but more girls and low SEP pupils enjoyed eating FV together .


Dose delivered : The proportion of teachers offering FV at a daily basis decreased over time , while the proportion of teachers cutting up FV increased over time .


Schools in which high proportions of teachers offered FV daily throughout the intervention period were characterized by being : small ; having a low proportion of low SEP pupils ; having a school food policy ; high teacher - and pupil intervention appreciation ; having fewer teachers who cut up FV ; and having high implementation of educational components .


The appliance of different approaches and levels of analyses to describe data provided comprehension and knowledge of the implementation process .


This knowledge is crucial for the interpretation of intervention effect .


Current Controlled Trials ISRCTN11666034 .


Garlic is effective against Candida species invitro , and along with other alternative therapies , is used by women with vulvovaginal candidiasis .


The objective of this study was to ascertain whether oral garlic reduced vaginal candida counts during the second half of the menstrual cycle in asymptomatic women colonised with Candida species .


A simple randomised double-blinded controlled trial .


Melbourne , Australia .


Sixty-three asymptomatic women who were culture-positive for Candida species at screening .


Participants were randomised to three garlic tablets or placebo orally , twice daily , for 14days .


The primary outcome was the proportion of women with colony counts of candida > 100 colony-forming units per ml in any given day during the last 7days before menstruation , defined as a ` case ' .


Secondary outcomes included the mean quantitative colony counts of candida over 14days prior to menses .


There was no evidence of a difference between the proportion of cases in the garlic and placebo groups ( 76 versus 90 % ; relative risk , RR0 .85 ; 95 % confidence interval , 95 % CI 0.67-1 .08 ) , in the mean colony counts in both groups ( ratio of geometric means of candidal colony counts 0.63 ; 95 % CI 0.39-10 .03 ; P = 0.74 ) , or difference in the number of women reporting abnormal vaginal symptoms during the 2weeks before menstruation ( RR1 .03 ; 95 % CI 0.67-1 .58 ; P = 0.91 ) .


The garlic group reported more adverse effects ( 83 % compared 43 % in the placebo group ; difference in proportions 39 % ; 95 % CI 17 - % ; P < 0.01 ) .


This study provided data for sample size calculations in future studies on the antifungal effect of garlic , but provided no evidence to inform clinical practice regarding the use of garlic in vaginal candidiasis .


Further studies might investigate longer courses or topical formulations .


Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique .


One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A ( robot-assisted procedure ) or group B ( conventional procedure ) .


Size , distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups .


Procedure duration , dose length product ( DLP ) , precision of needle positioning , diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique .


All biopsies were successfully performed .


The size ( p = 0.41 ) , distance from entry point ( p = 0.86 ) and position in lung ( p = 0.32 ) of target lesions were similar in both groups ( p = 0.05 ) .


Procedure duration and radiation dose were significantly reduced in group A as compared to group B ( p = 0.001 ) .


Precision of needle positioning , diagnostic performance of the biopsy and rate of complications were similar in both groups ( p = 0.05 ) .


Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy , reducing procedure duration and radiation dose in comparison to the conventional manual technique .


CT-guided biopsy is the main procedure to obtain diagnosis in lung tumours .


The robotic device facilitates percutaneous needle placement under CT guidance .


Robot-assisted CT-guided lung biopsy reduces procedure duration and radiation dose .


To pilot-test the feasibility and preliminary effect of a community health worker ( CHW ) intervention to reduce hospital readmissions .


Patient-level randomized quality improvement intervention .


An academic medical center serving a predominantly low-income population in the Boston , Massachusetts area and 10 affiliated primary care practices .


Medical service patients with an in-network primary care physician who were discharged to home ( n = 423 ) and had one of five risk factors for readmission within 30 days .


Inpatient introductory visit and weekly post-discharge telephonic support for 4 weeks to assist patient in coordinating medical visits , obtaining and using medications , and in self-management .


Number of completed CHW contacts ; CHW-reported barriers and facilitators to assisting patients ; primary care , emergency department and inpatient care use .


Roughly 70 % of patients received at least one post-discharge CHW call ; only 38 % of patients received at least four calls as intended .


Hospital readmission rates were lower among CHW patients ( 15.4 % ) compared with usual care ( 17.9 % ) ; the difference was not statistically significant .


Under performance-based payment systems , identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals , especially safety-net systems .


This pilot study suggests that with appropriate supportive infrastructure , hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations .


An ongoing , randomized , controlled trial of a CHW intervention , developed according to the lessons of this pilot , will provide further insight into the utility of this approach to reducing readmissions .


Fluid management in the perioperative period has been extensively studied but , despite that , `` the right amount '' still remains uncertain .


The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today .


In the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is .


The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence .


An intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy .


Finally , we propose a rational approach currently used at our institution .


High primary stability is important for long-term survival of uncemented femoral stems .


Different stem designs are currently in use .


The ABG-I is a well-documented anatomical stem with a press-fit design .


The Unique stem is designed for a tight customized fit to the cortical bone of the upper femur .


This implant was initially developed for patients with abnormal anatomy , but the concept can also be used in patients with normal femoral anatomy .


We present 5-year radiostereometric analysis ( RSA ) results from a randomized study comparing the ABG-I anatomical stem with the Unique femoral stem .


100 hips with regular upper femur anatomy were randomized to either the ABG-I stem or the Unique femoral stem .


RSA measurements were performed postoperatively and after 3 , 6 , 12 , 24 , and 60 months .


RSA measurements from 80 hips were available for analysis at the 5-year follow-up .


Small amounts of movement were observed for both stems , with no statistically significant differences between the 2 types .


No improvement in long-term stability was found from using a customized stem design .


However , no patients with abnormal geometry of the upper femur were included in this study .


Paracetamol / codeine has shown a strong analgesic activity in several studies conducted among different kind of subjects , including those with trauma .


Nevertheless , its efficacy in patients accessing the Emergency Department ( ED ) for different kind of pain has never been tested .


This is a cross-sectional , observational , prospective , cohort study .


Inclusion criteria were patients > 18 year old presenting to the ED for localized traumatic or inflammatory pain involving only extremities .


Numeric scale ( NRS ) was recorded thirty minutes and two hours after the administration of the analgesic therapy , consisting of 15 mg of ketorolac or 1000 mg/60 mg of paracetamol / codeine , both orally .


Two-hundred patients were consecutively enrolled ; 87 were treated with paracetamol/codeine and 113 with ketorolac .


The combination paracetamol/codeine resulted to be not inferior to ketorolac in non-traumatic pain group and trauma group ( p = 0.635 and p = 0.482 , respectively ) .


Compared to ketorolac , the combination paracetamol/codeine exerted a significantly higher analgesic activity in patients with fractures and muscular pain ( p = 0.044 ) and was more effective in acute pain ( p = 0.002 ) , with a significant effect two hours after the administration ( p = 0.029 ) .


Paracetamol/codeine is equivalent to ketorolac in non-traumatic pain and post-traumatic pain , but is superior in acute pain and in patients with fractures and muscular pain .


Those results play in favor of the use of the combination paracetamol/codeine in patients accessing the ED for non-traumatic or traumatic pain of the extremities .


The purpose of this study was to objectively determine and compare the efficacy and effectiveness of xylitol solution ( Xlear Nasal Sprey ) compared with xylometazoline and physiological saline with respect to quality of life ( QoL ) in patients with nasal congestion .


A prospective , randomized study was performed in 42 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment .


The study population was randomized into 3 groups according to the application of xylometazoline , physiological saline , and xylitol hyperosmolar solution .


The efficacy of treatment was evaluated objectively ( 4-phase rhinomanometry ) and subjectively ( visual analogue scale VAS . )


before and after the application of the nasal solutions .


QoL was evaluated by means of Rhinoconjunctivitis Quality of Life Questionnaire ( RQLQ ) .


VAS scores and 4-phase rhinomanometry scores were better in the group treated with xylometazoline compared to those treated with xylitol or saline .


The xylitol procedure yielded better results than the saline procedure , but differences were not statistically significant in both objective and subjective evaluation methods .


For overall QoL , there was a significant improvement from baseline for the xylometazoline and xylitol groups .


However , the improvement in the xylometazoline group was significantly greater than that obtained in the xylitol group .


Xlear Nasal Spray is an effective modality in the treatment of nasal congestion and has positive effect on the QoL of patients .


Further studies are needed in order to plan an ongoing treatment of Xlear Nasal Sprey at certain intervals for continuous relief of symptoms and a better and longstanding QoL .


Frequent use and serious adverse effects related to non-steroidal anti-inflammatory drugs ( NSAIDs ) underscore the need to raise patient awareness about potential risks .


Partial success of patient - or provider-based interventions has recently led to interest in combined approaches focusing on both patient and physician .


This research tested a shared decision-making intervention for increasing patient-reported awareness of NSAID risk .


A group randomized trial was performed in Alabama from 2005 to 2007 .


Intervention group doctor practices received continuing medical education ( CME ) about NSAIDs and patient activation tools promoting risk assessment and communication during visits .


Comparison group doctor practices received only CME .


Cross-sectional data were collected before and after the intervention .


Generalized linear latent and mixed models with logistic link tested relationships among the intervention , study phase , intervention by study phase interaction and patient-reported awareness of risks with either prescription or over-the-counter ( OTC ) NSAIDs .


Three hundred and forty-seven patients at baseline and 355 patients at follow-up participated in this study .


The intervention [ adjusted odds ratio ( AOR ) = 0.74 , P = 0.248 ] , follow-up study phase ( AOR = 1.31 , P = 0.300 ) and intervention by study phase interaction ( AOR = 0.98 , P = 0.942 ) were not significantly associated with patient-reported awareness of any prescription NSAID risk .


Follow-up study phase was associated with increased odds of reporting any OTC NSAID risk awareness ( AOR = 2.99 , P < 0.001 ) , but the patient activation intervention and intervention by study phase interaction were not significantly associated with patient-reported awareness of any OTC NSAID risk ( AOR = 0.98 , P = 0.929 ; AOR = 0.87 , P = 0.693 , respectively ) .


Our point-of-care intervention encouraging shared decision making did not increase NSAID risk awareness .


Delirium is common after cardiac surgery and may be partly related to the systemic inflammatory response triggered by the surgery and the use of cardiopulmonary bypass .


We hypothesized that intraoperative administration of high-dose dexamethasone , a drug with potent anti-inflammatory effects , would reduce the incidence of delirium at any time point during the first 4 postoperative days after cardiac surgery .


This was a single-center substudy within a larger , multicenter placebo-controlled randomized clinical trial , the Dexamethasone for Cardiac Surgery ( DECS ) trial that randomized patients 18 years , undergoing cardiac surgery with cardiopulmonary bypass , to receive , in a double-blind fashion , either dexamethasone 1 mg/kg or placebo at the induction of anesthesia .


Over the first 4 postoperative days , we compared between groups the incidence of delirium ( based on the Confusion Assessment Method adapted for the intensive care unit , or after intensive care unit discharge , by the Confusion Assessment Method , accompanied by chart review ) , restraint use , and administered haloperidol , benzodiazepines , and opioids .


Data were analyzed according to the intention-to-treat principle .


The proportion of patients with delirium in the dexamethasone versus the placebo group was compared using the odds ratio ( OR ) with a 95 % confidence interval ( CI ) .


The proportion also was compared using logistic regression to adjust for common baseline variables that might confound the presence of delirium between the 2 groups .


Of 768 eligible patients , 737 subjects ( 96.0 % ) had complete data .


The incidence of delirium was similar between the dexamethasone ( 14.2 % ) and placebo ( 14.9 % ) groups ( crude OR = 0.95 , 95 % CI , 0.63-1 .43 ; adjusted OR = 0.85 , 95 % CI , 0.55-1 .31 ) .


Among patients who developed delirium , the median ( interquartile range ) duration of delirium was similar between the dexamethasone and placebo groups ( 2 [ 1-3 ] vs 2 [ 1-2 ] days , respectively , P = 0.45 ; WMWodds 0.98 , 95 % CI , 0.83-1 .17 ) .


Restraint use and the administration of haloperidol , benzodiazepines , and opioids were also similar between the 2 groups .


The intraoperative administration of dexamethasone did not reduce the incidence or duration of delirium in the first 4 days after cardiac surgery .


Intraoperative awareness ( IA ) is diagnosed when patients can recall their surroundings or an event related to the surgery that occurred while they were under general anaesthesia .


The female gender and Caesarean section are considered to be contributing factors .


The aim of the present study was to analyse the frequency of IA in patients undergoing general anaesthesia either for Caesarean section or gynaecological procedures .


ASA I and II women were included into the study .


Patients were randomly allocated to 4 groups : A , B and C included patients qualified for elective gynaecological surgery , and group D comprised Caesarean section patients .


Premedication was not given .


Group A received total intravenous anaesthesia with TCI , and groups B , C and D received balanced anaesthesia .


The depth of anaesthesia was monitored with an AEP monitor .


Blinded structured interviews were conducted 2 hours after anaesthesia and on postoperative days 7 and 30 .


337 patients were enrolled into the study .


45 patients reported diverse sensations connected to the anaesthesia ( Group A - 7 patients , B - 9 patients , C - 2 patients , D - 28 patients ) .


There were mainly dream sensations , but IA was present in 3 cases .


In all of the cases , IA was recognised during the first interview .


One episode of awareness appeared in group B , and the other two appeared in group D.


One Caesarean section was complicated by intraoperative haemorrhage .


The patient from group B had similar sensations during previous anaesthesia .


Two women enrolled in the study reported awareness in the past , which did not occur this time .


Awareness during general anaesthesia occurs occasionally .


The frequency of occurrence in a group of patients undergoing general anaesthesia for uncomplicated Caesarean section is not higher than for other procedures .


The anaesthesia for Caesarean section , as well as for other procedures , may be accompanied by pleasant dreams .


This study tests whether the genetic predictor ( CHRNA5 nicotine receptor gene variants ) and an environmental risk factor ( partner smoking ) interact in the prediction of smoking reduction .


Subjects were from a community-based , longitudinal study of women ( n = 1856 ) who smoked before pregnancy , and a randomized comparative effectiveness smoking cessation trial ( n = 1065 ) .


Smoking reduction was defined as the trajectory of self-reported smoking quantities over time in the observational study , and as the trajectory of alveolar CO levels in the cessation trial .


In the pregnancy study , rs16969968 genotype and partner smoking status interacted such that the smoking reduction was lowest for expectant mothers with high genetic risk and partner smoking , and highest for those with high genetic risk but not partner smoking ( interaction of genotypepartner smoking on smoking quantity trajectory slope = 0.071 , 95 % CI = 0.013 , 0.13 , p = 0.017 ) .


In the clinical trial , a similar interaction was found ( interaction = 0.20 , 95 % CI = 0.049 , 0.36 , p = 0.010 ) .


Furthermore , these associations were moderated by pharmacotherapy such that the interactive relation of genetic and environmental factors occurred in the placebo group , but not in the active pharmacotherapy group ( interaction of genotypepartner smokingpharmacotherapy on CO trajectory slope = -0.25 , 95 % CI = -0.42 , -0.091 , p = 0.0023 ) .


The CHRNA5 genetic risk synergized the effect of partner smoking , producing an especially low likelihood of successful smoking reduction in two complementary studies .


This suggests that the genetic vulnerability may be mitigated by altering environmental factors .


In addition , cessation pharmacotherapy neutralizes the increase in cessation failure associated with combined genetic and environmental risks , which has possible relevance to treatment algorithms .


Considering the extensive neural network of the oculomotor subsystems , traumatic brain injury ( TBI ) could affect oculomotor control and related reading dysfunction .


To evaluate comprehensively the effect of oculomotor-based vision rehabilitation ( OBVR ) in individuals with mTBI .


Twelve subjects with mTBI participated in a cross-over , interventional study involving oculomotor training ( OMT ) and sham training ( ST ) .


Each training was performed for 6 weeks , 2 sessions a week .


During each training session , all three oculomotor subsystems ( vergence/accommodation/version ) were trained in a randomized order across sessions .


All laboratory and clinical parameters were determined before and after OMT and ST. In addition , nearvision-related symptoms using the Convergence Insufficiency Symptom Survey ( CISS ) scale and subjective visual attention using the Visual Search and Attention Test ( VSAT ) were assessed .


Following the OMT , over 80 % of the abnormal parameters significantly improved .


Reading rate , along with the amplitudes of vergence and accommodation , improved markedly .


Saccadic eye movements demonstrated enhanced rhythmicity and accuracy .


The improved reading-related oculomotor behavior was reflected in reduced symptoms and increased visual attention .


None of the parameters changed with ST.


OBVR had a strong positive effect on oculomotor control , reading rate , and overall reading ability .


This oculomotor learning effect suggests considerable residual neuroplasticity following mTBI .


Epidemiological studies of the association between bisphenol A ( BPA ) exposure and diabetes have been inconsistent .


The present study determined serum BPA concentrations in the Thai population and their association with hyperglycemia and diabetes .


In all , 2581 serum samples from the Thai National Health Examination Survey ( 2009 ) were used to determine BPA levels .


Impaired fasting glucose ( IFG ) was defined as fasting plasma glucose 100 and < 126mg/dL .


Diabetes was defined as a history of a physician 's diagnosis or fasting plasma glucose 126mg/dL .


Multinomial logistic regression was used to examine the association of serum BPA with IFG and diabetes .


Of 2581 samples tested , BPA was detected in 2135 samples ( weighted percentage 78.1 % ) , with a geometric mean concentration of 0.34 ng/mL BPA .


Serum BPA levels were significantly higher among those with diabetes or IFG compared with normoglycemic individuals ( 0.52 and 0.38 vs 0.33 ng/mL , respectively ; P < 0.001 ) .


After adjusting for potential confounders , compared with the first quartile ( 0.071 ng/mL ) , the overall adjusted odds ratios ( OR ) of serum BPA concentration in the third and fourth quartiles ( 0.319-0 .745 and 0.746 ng/mL , respectively ) for IFG were 1.72 ( 95 % confidence interval [ CI ] 1.19 , 2.49 ) and 1.23 ( 95 % CI 0.80 , 1.89 ) , respectively ; for diabetes , the adjusted OR were 1.88 ( 95 % CI 1.18 , 2.99 ) and 1.83 ( 95 % CI 1.12 , 2.95 ) , respectively , with a slightly stronger association among men than in women .


Serum BPA concentrations were not associated with IFG , but were positively associated with diabetes in the Thai population .


Further prospective studies are needed to confirm the relationship .


Reduced arterial elasticity contributes to an obesity-related increase in cardiovascular risk in adults .


To evaluate the effect of fat loss on arterial elasticity in obese adolescents at risk of type 2 diabetes .


A secondary data analysis of the RESIST study was performed in two hospitals in Sydney , Australia .


The study included 56 subjects ( ages , 10 to 17 y ; 25 males ) with prediabetes and/or clinical features of insulin resistance .


A 12-month lifestyle plus metformin intervention .


Arterial elasticity and systemic vascular resistance were measured using radial tonometry pulse contour analysis , percentage body fat ( % BF ) was measured by dual-energy x-ray absorptiometry , and insulin sensitivity index was derived from an oral glucose tolerance test and lipids .


Adolescents ( n = 31 ) with decreased % BF ( mean change [ range ] , -4.4 % [ -18.3 to -0.01 % ] ) after the intervention had significant increases in the mean large arterial elasticity index ( mean change [ 95 % CI ] , 5.1 [ 1.9 to 8.2 ] mL/mm Hg * 10 ; P = .003 ) and insulin sensitivity index ( 0.5 [ 0.1 to 0.9 ] ; P = .010 ) and a decrease in systemic vascular resistance ( -82 [ -129 to -35 ] dyne * s * cm ( -5 ) ; P = .001 ) .


There were no significant changes in these parameters in adolescents who increased their % BF .


Nor was there any significant change in the mean small arterial elasticity index in either group .


Long-term follow-up of these adolescents is warranted to assess whether the observed changes in vascular elasticity will lead to a clinical benefit including reduced cardiovascular morbidity and mortality .


The Lifestyle in Pregnancy intervention in obese pregnant women resulted in significantly lower gestational weight gain compared with the control group , but without improvement in rates of clinical pregnancy complications .


The impact of the lifestyle intervention on metabolic measurements in the study participants is now reported .


The Lifestyle in Pregnancy study was a randomized controlled trial among 360 obese women ( BMI 30-45 kg/m ) who were allocated in early pregnancy to lifestyle interventions with diet counselling and physical activities or to the control group .


Fasting blood samples , including plasma glucose , insulin , lipid profile and capillary blood glucose during a 2-h oral glucose tolerance test were carried out three times throughout pregnancy .


Insulin resistance was estimated with the homeostasis model assessment of insulin resistance .


Three hundred and four women ( 84 % ) were followed until delivery .


Women in the intervention group had a significantly lower change in insulin resistance ( HOMA-IR ) from randomization to 28-30 weeks ' gestation compared with control subjects ( mean SD : 0.7 1.3 vs. 1.0 1.3 , P = 0.02 ) .


Despite a significantly lower gestational weight gain in the intervention group , there was no difference between the groups with respect to total cholesterol , HDL , LDL or triglycerides .


Lifestyle intervention in obese pregnant women resulted in attenuation of the physiologic pregnancy-induced insulin resistance .


Despite restricted gestational weight gain , there were no changes in glucose or lipid metabolism between the groups .


Phototherapy , ie , bright light therapy , is an effective and safe treatment of major depressive disorder ( MDD ) .


It exerts rapid mood-elevating activity , similar to antidepressant medications , most likely mediated through both monoaminergic and circadian system melatonergic mechanisms .


We assessed the efficiency of bright light therapy as an adjuvant treatment to antidepressant pharmacotherapy in patients with severe MDD randomized by Hamilton Depression Rating Scale ( HDRS ) score to either ( 1 ) 150 mg venlafaxine hydrochloride daily at 7:00 AM or ( 2 ) 150 mg venlafaxine plus 60-minute light of 7000 lux the initial week of clinical management ( venlafaxine + bright light therapy ) daily at 7:00 AM .


50 inpatients with severe MDD at the Psychiatry Clinic of Yznc Yl University Training and Education Hospital participated .


The study , which was conducted from January 2013 through June 2014 , entailed patients diagnosed with severe MDD based on DSM-IV-TR for the first time .


Mood states were assessed by the HDRS , Profile of Mood States ( POMS ) , and Beck Depression Inventory ( BDI ) before treatment and at 1 , 2 , 4 , and 8 weeks of treatment .


On the basis of the HDRS score as the primary outcome variable , both strategies significantly improved depression and negative mood states already at the first treatment week ( P < .001 ) .


Differences in therapeutic effects by treatment strategy were remarkable at the second and fourth weeks of clinical management ( P = .018 and P = .011 , respectively ) , with beneficial effects continuing until trial conclusion .


Those treated with venlafaxine + bright light therapy evidenced significantly lower HDRS depression scores ( P < .05 ) as well as BDI scores ( P < .05 ) and POMS negative mood states scores ( depression-dejection , tension-anxiety , anger-hostility , fatigue-inertia , and confusion-bewilderment subscales ; all P < .05 ) after the second week .


At week 4 of the trial , 19 ( 76 % ) of the 25 venlafaxine + bright light therapy patients versus just 11 ( 44 % ) of the 25 venlafaxine patients ( P < .05 ) attained the target goal of treatment , a HDRS score 13 , indicative of mild depression , and , although not statistically significant in our small sample study ( P = .36 ) , at week 8 , 76 % of venlafaxine + bright light therapy patients ( n = 19 ) versus just 64 % of the venlafaxine patients ( n = 16 ) experienced complete remission of depression ( HDRS score 7 ) .


Both venlafaxine and venlafaxine + bright light therapy treatment strategies significantly reversed the depressive mood of patients with severe MDD ; however , the latter induced significantly stronger and more rapid beneficial effects .


Future longer-term studies with large sample sizes , nonetheless , are required to confirm and generalize these results to patients of diverse ethnicities and cultures with both severe and mild MDD .


ANZCTR.org.au registration number : ACTRN12614001061628 .


Diabetic nephropathy ( DN ) is one of the major late complications of diabetes .


Treatment aimed at slowing down the progression of DN is available but methods for early and definitive detection of DN progression are currently lacking .


The ` Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria trial ' ( PRIORITY ) aims to evaluate the early detection of DN in patients with type 2 diabetes ( T2D ) using a urinary proteome-based classifier ( CKD273 ) .


In this ancillary study of the recently initiated PRIORITY trial we aimed to validate for the first time the CKD273 classifier in a multicentre ( 9 different institutions providing samples from 165 T2D patients ) prospective setting .


In addition we also investigated the influence of sample containers , age and gender on the CKD273 classifier .


We observed a high consistency of the CKD273 classification scores across the different centres with areas under the curves ranging from 0.95 to 1.00 .


The classifier was independent of age ( range tested 16-89 years ) and gender .


Furthermore , the use of different urine storage containers did not affect the classification scores .


Analysis of the distribution of the individual peptides of the classifier over the nine different centres showed that fragments of blood-derived and extracellular matrix proteins were the most consistently found .


We provide for the first time validation of this urinary proteome-based classifier in a multicentre prospective setting and show the suitability of the CKD273 classifier to be used in the PRIORITY trial .


To compare the analgesic efficacy and rate of wound healing of combination of 0.2 % Glyceryl Trinitrate and 2 % lignocaine ointments with 0.2 % Glyceryl Trinitrate and 2 % lignocaine ointment separately after Milligan Morgan hemorrhoidectomy .


Randomized control trial .


Combined Military Hospital , Kharian , Malir and Bannu .


November 2007 to August 2011 .


Patients undergoing Milligan Morgan hemorrhoidectomy were randomized into 3 groups by using computer generated table .


Group A received combination of 0.2 % Glyceryl Trinitrate and 2 % lignocaine ointment , Group B 2 % lignocaine and Group C received 0.2 % Glyceryl Trinitrate ointment .


These ointments were given on twice daily basis .


Pain scores were measured on a 100mm Visual Analog Scale .


Pain scores and quantity of oral analgesics used were compared daily until the 7th post-operative day .


The time required for complete healing ( in weeks ) was also compared .


Out of 210 patients , 192 ( 67 Group A , 64 Group B and 61 Group C ) completed the study .


Demographic data were comparable in all three groups .


There were statistically significant reductions in pain scores and quantity of analgesics used from the first to the fourth post-operative days in Group A.


The time required for complete healing was also significantly reduced in the combination group .


There were no significant side effects in any group .


The combination of 0.2 % GTN and 2 % lignocaine showed better pain relief resulting in less use of oral analgesics and faster healing of the wound after Milligan Morgan hemorrhoidectomy .


Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide .


This situation can be prevented through food fortification .


To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency .


This study was a blinded clinical trial with randomized groups .


We analyzed 56 preschoolers with iron deficiency ( ferritin < 24 ng/ml ) that received 13 g of milk with 12.5 mg of iron , either amino acid chelate or in the ferrous sulfate form .


After two months , hemoglobin , hematocrit and serum ferritin concentrations were measured .


In the ferrous sulfate group , ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml , while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group , with statistically differences in both cases .


Serum ferritin was different between groups , being higher in iron amino acid chelate group ( p = 0.022 ) .


Hemoglobin and hematocrit levels did not change after the intervention .


Adverse reactions in the ferrous sulfate group were 35.7 % , compared with 42.9 % in the iron amino acid chelate group ; 5 children had respiratory tract infection , without statistical differences .


Both compounds increased serum ferritin concentration , with a higher increase in those who were given milk with iron amino acid chelate .


There were no differences in the adverse reactions and infections incidences between the groups .


The purpose of this pilot study was to begin to examine the effect of dietary protein source ( soy protein versus non-soy protein ) during weight loss on body composition , and cardiometabolic and functional decline risk factors in older , abdominally obese adults .


Two-arm , single-blind , randomized , controlled trial .


Wake Forest School of Medicine , Winston-Salem NC 27157 , USA .


25 older ( 68.45.5 years , 88 % female ) , abdominally obese ( BMI : 35.14.3 kg/m2 ; WC : 101.413.1 cm ) men and women were randomized to participate in the study .


A 12-week weight loss intervention , with participants randomized to consume soy protein-based meal replacements ( S ; n = 12 ) or non-soy protein-based meal replacements ( NS ; n = 12 ) , in addition to prepared meals , and all participants targeted to receive an individualized caloric deficit of 500 kcal/day .


Body weight and composition ( assessed via DXA and CT ) , conventional biomarkers of cardiometabolic risk , and physical performance measures were assessed pre - and post-intervention .


Additional endpoints of feasibility ( accrual , participation , retention , compliance , and safety ) are reported .


A total of 24 participants ( 87 % female ) completed the study ( 96 % retention ) and lost an average of 7.83.0 kg over the 12-week period , with no difference seen between groups ( p = 0.83 ) .


Although nearly all measures of global and regional body composition were significantly reduced following the 12-week intervention , differences were not observed between groups .


Among cardiometabolic risk factors and physical performance measures , only diastolic blood pressure was significantly lower in the NS group compared to the S group ( 66.72.7 mmHg vs 73.52.7 mmHg , respectively ; p = 0.04 ) .


Interestingly , in groups combined , despite significant reductions in body weight and lean mass , no significant changes in 400-meter walk time ( +5.343.4 s ) , short physical performance battery score ( +0.11.0 ) , grip strength ( -0.33.2 kg ) , or relative knee extensor strength ( -0.00.0 N/m/cm3 thigh muscle volume ) were observed .


Data presented here suggest that a 12-week weight loss intervention , which incorporates S and NS meal replacement products , is associated with clinically significant weight loss and improvements in several parameters of cardiometabolic risk and unchanged physical function and strength .


RESULTS do not differ by protein source and suggest that soy protein is at least as good as other protein sources for weight loss during low-calorie dietary interventions in older adults .


Long-lasting insecticidal nets ( LLINs ) have limited effect on malaria transmitted outside of sleeping hours .


Topical repellents have demonstrated reduction in the incidence of malaria transmitted in the early evening .


This study assessed whether 15 % DEET topical repellent used in combination with LLINs can prevent greater malaria transmission than placebo and LLINs , in rural Tanzania .


A cluster-randomized , placebo-controlled trial was conducted between July 2009 and August 2010 in a rural Tanzanian village .


Sample size calculation determined that 10 clusters of 47 households with five people/household were needed to observe a 24 % treatment effect at the two-tailed 5 % significance level , with 90 % power , assuming a baseline malaria incidence of one case/person/year .


Ten clusters each were randomly assigned to repellent and control groups by lottery .


A total of 4,426 individuals older than six months were enrolled .


All households in the village were provided with an LLIN per sleeping space .


Repellent and placebo lotion was replaced monthly .


The main outcome was rapid diagnostic test ( RDT ) - confirmed malaria measured by passive case detection ( PCD ) .


Incidence rate ratios were estimated from a Poisson model , with adjustment for potential confounders , determined a priori .


According-to-protocol approach was used for all primary analyses .


The placebo group comprised 1972.3 person-years with 68.29 ( 95 % C.I 37.05-99 .53 ) malaria cases/1 ,000 person-years .


The repellent group comprised 1,952.8 person-years with 60.45 ( 95 % C.I 48.30-72 .60 ) cases/1 ,000 person-years , demonstrating a non-significant 11.44 % reduction in malaria incidence rate in this group , ( Wilcoxon rank sum z = 0.529 , p = 0.596 ) .


Principal components analysis ( PCA ) of the socio-economic status ( SES ) of the two groups demonstrated that the control group had a higher SES ( Pearson 's chi square = 13.38 , p = 0.004 ) .


Lack of an intervention effect was likely a result of lack of statistical power , poor capture of malaria events or bias caused by imbalance in the SES of the two groups .


Low malaria transmission during the study period could have masked the intervention effect and a larger study size was needed to increase discriminatory power .


Alternatively , topical repellents may have no impact on malaria transmission in this scenario .


Design and implementation of repellent intervention studies is discussed .


The trial was registered ISRCTN92202008 -- http://www.controlled-trials.com/ISRCTN92202008 .


Considerable evidence suggests that performance across a variety of cognitive tasks is effectively supported by the use of verbal and nonverbal strategies .


Studies exploring the usefulness of such strategies in children with specific language impairment ( SLI ) are scarce and report inconsistent findings .


To examine the effects of induced labelling and auditory cues on the performance of children with and without SLI during a categorization task .


Sixty-six school-age children ( 22 with SLI , 22 age-matched controls , 22 language-matched controls ) completed three versions of a computer-based categorization task : one baseline , one requiring overt labelling and one with auditory cues ( tones ) on randomized trial blocks .


Labelling had no effect on performance for typically developing children but resulted in lower accuracy and longer reaction time in children with SLI .


The presence of tones had no effect on accuracy but resulted in faster reaction time and post-error slowing across groups .


Verbal strategy use was ineffective for typically developing children and negatively affected children with SLI .


All children showed faster performance and increased performance monitoring as a result of tones .


Overall , effects of strategy use in children appear to vary based on task demands , strategy domain , age and language ability .


Results suggest that children with SLI may benefit from auditory cues in their clinical intervention but that further research is needed to determine when and how verbal strategies might similarly support performance in this population .


The unenhanced MR angiography ( MRA ) technique time-spatial labeling inversion pulse ( time-SLIP ) may provide a safe alternative for evaluating the renal arteries for stenosis .


This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography ( CTA ) .


Four centers ( United States , Europe , Asia ) enrolled 75 patients ( average age SD , 58 13 years ; 41 [ 55 % ] men and 34 [ 45 % ] women ) .


Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession .


All images were visually assessed for quality ( arterial signal intensity ) and for the absence or presence of renal artery stenosis ( 50 % or > 50 % stenosis , respectively ) .


In addition , for arteries with any visible disease , the severity of the stenosis was quantified .


Two blinded readers evaluated each study .


No arteries were excluded from analysis .


Unenhanced MRA image quality was excellent for 56 of 75 patients ( 75 % ) and good for 16 of 75 patients ( 21 % ) .


CTA was used as the reference standard and showed that 23 of 161 renal arteries ( 14.3 % ) had stenosis > 50 % .


Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50 % stenosis and correctly classified 128 of the 138 renal arteries as not having disease ( 50 % stenosis ) to yield a sensitivity of 74 % , specificity of 93 % , and accuracy of 90 % ( ( 2 ) = 0.56 ; p = 0.45 , no statistically significant difference ) .


Of the 16 misclassified arteries , only three had a clinically relevant misclassification ( CTA 70 % stenosis and unenhanced MRA 50 % stenosis or unenhanced MRA 70 % stenosis and CTA 50 % stenosis ) .


On average , measured stenotic severity ( n = 28 arteries ) was similar for unenhanced MRA ( 64 % 17 % ) and CTA ( 62 % 16 % ) ( p = 0.51 ) .


Compared with contrast-enhanced CTA , the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis .


The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis .


Although previous studies assessed the effects of Serenoa repens , quercetin and - sitosterol on inflammatory parameters , no randomized studies have tested the combination of these agents neither on BPH symptoms nor on the inflammatory pattern .


The aim of this trial was to evaluate the effects of Difaprost on voiding dysfunction , histological inflammatory alterations and apoptotic molecular mechanisms in BPH patients .


We included 36 patients affected by BPH with obstructive symptoms eligible for surgery .


Patients were randomly assigned to two groups : 18 patients received Difaprost for three months before surgery , and 18 patients did not receive any additional therapy and were scheduled for surgery .


All patients receiving Difaprost were evaluated with uroflowmetry with post-void residual volume ( PVR ) evaluation , serum PSA , and IPSS questionnaire before and after treatment .


Moreover , we evaluated inflammatory patterns in prostatic specimens at final pathology .


Even without statistically significant differences on inflammatory pattern between patients receiving Difaprost and controls , patients receiving Difaprost had lower presence of edema and angiectasia at histological evaluation of prostate specimens .


Moreover , patients included in the treatment group had a clinically significant reduction of PVR ( 46.1 vs. 25.2 mL ; P = 0.1 ) and a slight increase in Qmed ( 5.6 vs. 6.5 mL/s ; P = 0.9 ) after three months of chronic treatment with Difaprost .


No statistically significant differences were recorded in other clinical parameters between patients receiving Difaprost and controls .


Although not statistically significant , patients treated with Difaprost showed an improvement in voiding function compared to controls ( namely , an increase in Qmed and a reduction of PVR ) .


Future trials with a larger number of patients and a longer treatment period could be necessary to evaluate the clinical efficacy of Difaprost .


To compare the long-term outcomes of a tension-free vaginal tape ( TVT ; Gynecare , Somerville , NJ , USA ) , autologous fascial sling ( AFS ) and xenograft sling ( porcine dermis , Pelvicol ; Bard , Murray Hill , NJ , USA ) in the management of female stress urinary incontinence ( SUI ) .


A multicentre randomised controlled trial carried out in four UK centres from 2001 to 2006 involving 201 women requiring primary surgery for SUI .


The women were randomly assigned to receive TVT , AFS or Pelvicol .


The primary outcome was surgical success defined as ` women reporting being completely ` dry ' or ` improved ' at the time of follow-up ' .


The secondary outcomes included ` completely dry ' rates , changes in the Bristol Female Lower Urinary Tract Symptoms ( BFLUTS ) and EuroQoL EQ-5D questionnaire scores .


In all , 162 ( 80.6 % ) women were available for follow-up with a median ( range ) duration of 10 ( 6.6-12 .6 ) years .


` Success ' rates for TVT , AFS and Pelvicol were 73 % , 75.4 % and 58 % , respectively .


Comparing the 1 - and 10-year ` success ' rates , there was deterioration from 93 % to 73 % ( P < 0.05 ) in the TVT arm and 90 % to 75.4 % ( P < 0.05 ) in the AFS arm ; ` dry ' rates were 31.7 % , 50.8 % and 15.7 % , respectively .


Overall , the ` dry ' rates favoured AFS when compared with Pelvicol ( P < 0.001 ) and TVT ( P = 0.036 ) .


The re-operation rate for persistent SUI was 3.2 % ( two patients ) in the TVT arm , 13.1 % ( five ) in the Pelvicol arm , while none of the patients in the AFS arm required further intervention .


Our study indicates there is not enough evidence to suggest a difference in long-term success rates between AFS and TVT .


However , there is some evidence that ` dry ' rates for AFS may be more durable than TVT .


To evaluate and compare the long-term outcome of unstable thoracolumbar burst fractures treated using anterior , posterior or combined anterior and posterior approaches .


The prospective randomised controlled study was conducted at the Tianjin 4th Centre Hospital , Tianjin , China , and comprised patients of unstable thoracolumbar burst fracture operated between July 2004 and July 2006 and followed up for five years .


The patients were divided randomly into three groups of anterior , posterior and combined anterior and posterior approaches .


Clinical data was analysed using SPSS 17 .


Of the 66 cases in the study , 45 ( 68.18 % ) were male and 21 ( 31.8 % ) were female , with overall age ranging from 19 to 69 years .


There were 22 ( 33.3 % ) patients in the anterior group , 23 ( 35 % ) in the posterior group , and 21 ( 32 % ) in the combined anterior and posterior group .


Comparison was made between two respective groups .


The combined group was found to have the longest operation time ( p < 0.02 ; p < 0.01 , respectively ) , larger blood loss ( p < 0.006 ; p < 0.005 , respectively ) , longer hospital stay ( p < 0.01 ; p < 0.003 , respectively ) and higher hospitalisation costs ( p < 0.004 ; p < 0.001 , respectively ) .


The postoperative kyphotic angle was significantly smaller than preoperative one in all groups ( p < 0.01 ; p < 0.02 ; p < 0.01 ) .


The anterior approach or combined anterior and posterior approach were better options in managing unstable thoracolumbar burst fracture , while the latter should be used only for the burst fracture with a significant posterior column injury .


Cervical cancer is the leading cause of cancer mortality among women in India .


Because Pap smear screening is not feasible in India , we need to develop effective alternatives .


A cluster-randomized controlled study was initiated in 1998 in Mumbai , India , to investigate the efficacy of visual inspection with acetic acid ( VIA ) performed by primary health workers in reducing cervical cancer mortality .


Four rounds of cancer education and VIA screening were conducted at 24-month intervals in the screening group , whereas cancer education was offered once at entry to the control group .


The study was planned for 16 years to include four screening rounds followed by four monitoring rounds .


We present results after 12 years of follow-up .


Poisson regression method was used to calculate the rate ratios ( RRs ) ; two-sided ( 2 ) was used to calculate the probability .


We recruited 75360 women from 10 clusters in the screening group and 76178 women from 10 comparable clusters in the control group .


In the screening group , we achieved 89 % participation for screening and 79.4 % compliance for diagnosis confirmation .


The incidence of invasive cervical cancer was 26.74 per 100000 ( 95 % confidence interval [ CI ] = 23.41 to 30.74 ) in the screening group and 27.49 per 100000 ( 95 % CI = 23.66 to 32.09 ) in the control group .


Compliance to treatment for invasive cancer was 86.3 % in the screening group and 72.3 % in the control group .


The screening group showed a statistically significant 31 % reduction in cervical cancer mortality ( RR = 0.69 ; 95 % CI = 0.54 to 0.88 ; P = .003 ) .


VIA screening by primary health workers statistically significantly reduced cervical cancer mortality .


Our study demonstrates the efficacy of an easily implementable strategy that could prevent 22000 cervical cancer deaths in India and 72600 deaths in resource-poor countries annually .


In a randomized controlled trial ( RCT ) in a blood bank in So Paulo , we tested the hypotheses that offering client-centered human immunodeficiency virus ( HIV ) counseling and testing to blood donors would : 1 ) reduce the risk of HIV contamination in the blood supply by diverting higher-risk , test-seeking donors away from donation and 2 ) increase return for results and referrals to care .


We randomly selected weeks between August 2012 and May 2013 when donors were offered HIV counseling and testing ( n = 6298 ) , leaving usual procedure weeks as control ( n = 5569 ) .


Few candidate donors chose HIV testing ( n = 81 , 1.3 % ) .


There was no significant difference in herpes simplex virus Type 2 ( HSV-2 ) prevalence ( a marker of sexual risk ) among donors during intervention weeks compared to control ( 10.4 % vs. 11.1 % , p = 0.245 ) .


No donor choosing testing was HIV infected , and there was no difference in HSV-2 prevalence between testers and donors ( 9.9 % vs. 10.4 % , p = 0.887 ) .


Returning for positive results did not differ between testers and donors ( three of three vs. 58 of 80 , p = 0.386 ) .


A higher proportion of donors acknowledged that HIV testing was a strong motivation to donate during intervention weeks compared to control ( 2.6 % vs. 2.0 % , p = 0.032 ) .


The evidence of our RCT is that offering HIV counseling and testing at the time of donation would not change the risk of contamination in the blood supply , nor improve results disclosure and referral to care .


To evaluate the feasibility of day and night closed-loop insulin delivery in adults with type 1 diabetes under free-living conditions .


Seventeen adults with type 1 diabetes on insulin pump therapy ( means SD age 34 9 years , HbA1c 7.6 0.8 % , and duration of diabetes 19 9 years ) participated in an open-label multinational three-center crossover study .


In a random order , participants underwent two 8-day periods ( first day at the clinical research facility followed by 7 days at home ) of sensor-augmented insulin pump therapy ( SAP ) or automated closed-loop insulin delivery .


The primary end point was the time when sensor glucose was in target range between 3.9 and 10.0 mmol/L during the 7-day home phase .


During the home phase , the percentage of time when glucose was in target range was significantly higher during closed-loop compared with SAP ( median 75 % [ interquartile range 61-79 ] vs. 62 % [ 53-70 ] , P = 0.005 ) .


Mean glucose ( 8.1 vs. 8.8 mmol/L , P = 0.027 ) and time spent above target ( P = 0.013 ) were lower during closed loop , while time spent below target was comparable ( P = 0.339 ) .


Increased time in target was observed during both daytime ( P = 0.017 ) and nighttime ( P = 0.013 ) .


Compared with SAP , 1 week of closed-loop insulin delivery at home reduces mean glucose and increases time in target without increasing the risk of hypoglycemia in adults with relatively well-controlled type 1 diabetes .


Elevated homocysteine ( Hcy ) levels might play a role in the development of essential hypertension ( EH ) .


Telomere dynamics provide valuable insight into the pathogenesis of age-related diseases .


The contribution of Hcy to leukocyte telomere length ( LTL ) shortening in EH and the underlying mechanism was examined .


LTL ( ratio of the copy number of telomere [ T ] repeats to that of a single [ S ] gene , T/S ratio ) was inversely associated with age in patients with EH ( n = 258 ) and healthy controls ( n = 137 ) , but significantly decreased with the Hcy level only in patients with hypertension after adjustment for age and sex .


Age , hypertension and levels of Hcy and low-density lipoprotein combined contributed to LTL shortening ; an increased serum folate level could reverse the Hcy effect seen on multivariate regression analysis .


In addition , qPCR and methylation-specic PCR assay revealed that LTL shortening and mRNA expression and the methylation ratio of human telomerase reverse transcriptase ( hTERT ) were lower in patients with EH than in controls , and gradually decreased with increasing Hcy level , but not with blood pressure , in EH patients ( Ptrend < 0.0001 , 0.004 and 0.012 , respectively ) .


Furthermore , Hyperhomocysteinemia , but not hypertension , promoted telomerase reverse transcriptase DNA hypomethylation and reduced mRNA levels , which contributed to shortened LTL in the hypertension rat model .


Elevated Hcy but not hypertension was related to hTERT DNA hypomethylation and reduced mRNA level , thus contributing to the shortening of LTL hypertension .


This study aimed to evaluate differences in transcranial electrical motor evoked potential ( tcMEP ) amplitudes between desflurane/remifentanil and propofol/remifentanil anesthesia treatment plans in patients without preexisting motor deficits ( PMDs ) undergoing carotid endarterectomy ( CEA ) .


This prospective trial included 21 patients who were randomly assigned to an effect group ( Group ( DESFLURANE ) ; n = 14 ) or a control group ( Group ( STANDARD-PROPOFOL ) ; n = 7 ) .


tcMEP amplitudes were measured 35 min post-induction ( T1 ) either with desflurane or propofol .


Treatment was then changed to propofol in Group ( DESFLURANE ) .


After an additional 35 min , the tcMEP amplitudes were reevaluated ( T2 ) .


Differences in amplitudes ( DW ) between T1 and T2 were calculated for each patient , and the means of these differences were compared between groups .


tcMEPs were recorded in all 21 patients .


At T1 , the mean amplitude was 840.1 ( SD 50.3 ) V and 358.9 ( SD 74 ) V for Group ( STANDARD-PROPOFOL ) and Group ( DESFLURANE ) , respectively .


The absolute mean difference ( T1-T2 ) between groups was -496.75 V ( p = 0.0006 ) .


Desflurane reduces the tcMEP amplitude significantly more than propofol in patients without PMDs undergoing CEA .


TcMEPs were recorded in all patients regardless of the anesthesia regimen .


In patients with initially small amplitudes , desflurane may limit tcMEP recording because it produces a remarkable amplitude reduction , even in patients without PMDs .


The relative efficacy and safety of intravitreous aflibercept , bevacizumab , and ranibizumab in the treatment of diabetic macular edema are unknown .


At 89 clinical sites , we randomly assigned 660 adults ( mean age , 6110 years ) with diabetic macular edema involving the macular center to receive intravitreous aflibercept at a dose of 2.0 mg ( 224 participants ) , bevacizumab at a dose of 1.25 mg ( 218 participants ) , or ranibizumab at a dose of 0.3 mg ( 218 participants ) .


The study drugs were administered as often as every 4 weeks , according to a protocol-specified algorithm .


The primary outcome was the mean change in visual acuity at 1 year .


From baseline to 1 year , the mean visual-acuity letter score ( range , 0 to 100 , with higher scores indicating better visual acuity ; a score of 85 is approximately 20/20 ) improved by 13.3 with aflibercept , by 9.7 with bevacizumab , and by 11.2 with ranibizumab .


Although the improvement was greater with aflibercept than with the other two drugs ( P < 0.001 for aflibercept vs. bevacizumab and P = 0.03 for aflibercept vs. ranibizumab ) , it was not clinically meaningful , because the difference was driven by the eyes with worse visual acuity at baseline ( P < 0.001 for interaction ) .


When the initial visual-acuity letter score was 78 to 69 ( equivalent to approximately 20/32 to 20/40 ) ( 51 % of participants ) , the mean improvement was 8.0 with aflibercept , 7.5 with bevacizumab , and 8.3 with ranibizumab ( P > 0.50 for each pairwise comparison ) .


When the initial letter score was less than 69 ( approximately 20/50 or worse ) , the mean improvement was 18.9 with aflibercept , 11.8 with bevacizumab , and 14.2 with ranibizumab ( P < 0.001 for aflibercept vs. bevacizumab , P = 0.003 for aflibercept vs. ranibizumab , and P = 0.21 for ranibizumab vs. bevacizumab ) .


There were no significant differences among the study groups in the rates of serious adverse events ( P = 0.40 ) , hospitalization ( P = 0.51 ) , death ( P = 0.72 ) , or major cardiovascular events ( P = 0.56 ) .


Intravitreous aflibercept , bevacizumab , or ranibizumab improved vision in eyes with center-involved diabetic macular edema , but the relative effect depended on baseline visual acuity .


When the initial visual-acuity loss was mild , there were no apparent differences , on average , among study groups .


At worse levels of initial visual acuity , aflibercept was more effective at improving vision .


( Funded by the National Institutes of Health ; ClinicalTrials.gov number , NCT01627249 . )


Pre-exposure prophylaxis ( PrEP ) with daily oral emtricitabine ( FTC ) / tenofovir disoproxil fumarate may select for drug resistance if there is low adherence .


Plasma viral HIV-1 RNA level , CD4 + T-cell counts , and drug resistance were evaluated among seroconverting women in the FEM-PrEP trial ( clinicaltrials.gov NCT00625404 ) using standard clinical tests , allele-specific PCR ( ASPCR ) , and by deep sequencing .


Tenofovir , FTC , and their intracellular metabolites were measured in plasma and cells .


There was no difference in plasma HIV-1 RNA level or CD4 + cell count among seroconverters in the active arm versus those receiving placebo .


Tenofovir resistance was not observed .


FTC resistance was detected using clinical assays in five seroconverters ( four in the active arm and one in the placebo arm ) ; two in the active arm occurred among women having moderate concentrations of PrEP drugs in the blood .


The first evidence of infection occurred at the first postenrollment visit in three of the four with FTC resistance , although none had detectable viral nucleic acids at enrollment .


FTC-resistant minor variants were detected in an additional four seroconverters ( one in the active arm and three in the placebo arm ) .


Drug resistance detected during ineffective PrEP use had characteristics suggesting transmitted infection or incubating infection prior to starting PrEP .


The authors sought to determine the level of inspiratory pressure minimizing the risk of gastric insufflation while providing adequate pulmonary ventilation .


The primary endpoint was the increase in incidence of gastric insufflation detected by ultrasonography of the antrum while inspiratory pressure for facemask pressure-controlled ventilation increased from 10 to 25 cm H2O .


In this prospective , randomized , double-blind study , patients were allocated to one of the four groups ( P10 , P15 , P20 , and P25 ) defined by the inspiratory pressure applied during controlled-pressure ventilation : 10 , 15 , 20 , and 25 cm H2O .


Anesthesia was induced using propofol and remifentanil ; no neuromuscular-blocking agent was administered .


Once loss of eyelash reflex occurred , facemask ventilation was started for a 2-min period while gastric insufflation was detected by auscultation and by real-time ultrasonography of the antrum .


The cross-sectional antral area was measured using ultrasonography before and after facemask ventilation .


Respiratory parameters were recorded .


Sixty-seven patients were analyzed .


The authors registered statistically significant increases in incidences of gastric insufflation with inspiratory pressure , from 0 % ( group P10 ) to 41 % ( group P25 ) according to auscultation , and from 19 to 59 % according to ultrasonography .


In groups P20 and P25 , detection of gastric insufflation by ultrasonography was associated with a statistically significant increase in the antral area .


Lung ventilation was insufficient for group P10 .


Inspiratory pressure of 15 cm H2O allowed for reduced occurrence of gastric insufflation with proper lung ventilation during induction of anesthesia with remifentanil and propofol in nonparalyzed and nonobese patients .


( Anesthesiology 2014 ; 120:326 -34 ) .


Chronic lymphedema occurs frequently in breast cancer patients and is associated with significant morbidity and reduced quality-of-life .


In this pilot study , the authors ( 1 ) addressed whether conducting a larger randomized controlled trial of aqua lymphatic therapy ( ALT ) would be feasible and ( 2 ) estimated the extent to which ALT combined with home-based exercise compared with home-based exercise alone would reduce arm disability in patients with breast cancer-related lymphedema .


Twenty-five women with breast cancer-related lymphedema were randomized to either ALT in addition to a home land-based exercise program ( ALT group ; n = 13 ) or to a home land-based exercise program alone ( control group ; n = 12 ) .


The participants were evaluated before and after a 12-wk intervention period composed of weekly pool exercise sessions .


Main outcome measures were arm volume , arm disability , pain , and quality-of-life .


At follow-up , there was no statistical difference between the control and ALT groups in any of the outcomes , except for present pain intensity .


At the end of the study period , there was no change in the lymphedematous limb volume in either group .


Grip strength was improved in both groups .


Only the ALT group showed a statistically significant difference with a reduction in pain intensity score and arm disability .


Furthermore , quality-of-life significantly improved only in the ALT group .


Conducting a larger randomized controlled trial would be feasible .


In comparison with the beginning of the intervention , the participants in the ALT group showed significant beneficial changes after 12 wks of treatment , whereas the control group did not improve .


ALT did not make the lymphedema volume worse and therefore may serve as a safe alternative to land-based treatments of breast cancer-related lymphedema .


The aim of the study was to elicit the safety and efficacy of breast stimulation as an intervention to prevent postdatism and as an aid in spontaneous onset of labour .


Primigravidas with cephalic presentation , without any high-risk factor , were recruited between 36 to 38 weeks of gestation .


200 patients were recruited and randomized into two groups ( n = 100 ) .


Breast stimulation was advised to one group but not to the other group .


Bishop 's scoring was done at 38 weeks and repeated at 39 weeks of gestation .


Maternal and fetal outcomes were compared in two groups .


Bishop 's score changed from 3.12 ( 1.01 ) to 3.9 ( 1.08 ) in control group and from 3.02 ( 0.82 ) to 6.08 ( 1.29 ) in breast stimulation group after one week ( P value < 0.0001 ) .


The period of gestation at delivery was 39.5 ( 2.3 ) weeks in control group and 39.2 ( 2.8 ) weeks in intervention group ( P value : 0.044 ) .


There were increased chances of vaginal delivery in intervention group ( P value : 0.046 ) .


Duration of labor , hyperstimulation , presence of meconium stained liquor , postpartum hemorrhage , and neonatal outcomes were similar in both groups .


Breast stimulation in low-risk primigravidas helps in cervical ripening and increases chances of vaginal delivery .


We examined whether an empirically based , randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation .


Divorced mothers and children ( age 9-12 ) were randomly assigned to a literature control condition or the 11-week New Beginnings Program , a family-focused group preventive intervention for mothers and children in newly divorced families .


Fifteen years after the trial , offspring salivary cortisol ( n = 161 ) was measured before and after a social stress task .


Multilevel mixed models were used to predict cortisol from internalizing symptoms , externalizing symptoms , group assignment and potential moderators of intervention effects .


Across the sample , higher externalizing symptoms were associated with lower cortisol reactivity .


There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group , and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group .


Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress .


Results highlight the importance of examining moderators of program effects .


The aim of this study was to compare the effect of administration of probiotics on feeding tolerance and growth outcomes of HIV-exposed ( but uninfected ) versus HIV non-exposed preterm infants .


The null hypothesis of this study states that there will be no difference in the feeding tolerance and growth outcomes for both probiotic-exposed and unexposed premature very low birth weight infants .


A randomized , double-blind , placebo-controlled trial was conducted during the period from July 2011 to August 2012 .


HIV-exposed and non-exposed premature ( < 34 wk gestation ) infants with a birth weight of 500 g and 1250 g were randomized to receive either a probiotic mixture or placebo .


The multispecies probiotic mixture consisted of 1 10 ( 9 ) CFU , Lactobacillus rhamnosus GG and Bifidobacterium infantis per day and was administered for 28 d. Anthropometrical parameters , daily intakes , and feeding tolerance were monitored .


Seventy-four HIV-exposed and 110 unexposed infants were enrolled and randomized ( mean birth weight 987 g 160 g , range , 560-1244 g ; mean gestational age 28.7 wk ) .


In all 4227 probiotic doses were administered ( mean 22.9 / infant ) .


There was no difference in the average daily weight gain for treatment groups or HIV exposure .


The HIV-exposed group achieved significantly higher z scores for length and head circumference at day 28 than the unexposed group ( P < 0.01 and P = 0.03 , respectively ) .


There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups .


Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV exposure .


The use of evidence-based guidelines can improve the care for asthma patients .


We implemented a computerized asthma management system in a pediatric emergency department ( ED ) to integrate national guidelines .


Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system ( Bayesian network ) combined with an asthma management system embedded in the workflow decreases time to disposition decision .


We performed a prospective , randomized controlled trial in an urban , tertiary care pediatric ED .


All patients 2-18 years of age presenting to the ED between October 2010 and February 2011 were screened for inclusion by the disease detection system .


Patients identified to have an asthma exacerbation were randomized to intervention or control .


For intervention patients , asthma management was computer-driven and workflow-integrated including computer-based asthma scoring in triage , and time-driven display of asthma-related reminders for re-scoring on the electronic patient status board combined with guideline-compliant order sets .


Control patients received standard asthma management .


The primary outcome measure was the time from triage to disposition decision .


The Bayesian network identified 1339 patients with asthma exacerbations , of which 788 had an asthma diagnosis determined by an ED physician-established reference standard ( positive predictive value 69.9 % ) .


The median time to disposition decision did not differ among the intervention ( 228 min ; IQR = ( 141 , 326 ) ) and control group ( 223 min ; IQR = ( 129 , 316 ) ) ; ( p = 0.362 ) .


The hospital admission rate was unchanged between intervention ( 25 % ) and control groups ( 26 % ) ; ( p = 0.867 ) .


ED length of stay did not differ among intervention ( 262 min ; IQR = ( 165 , 410 ) ) and control group ( 247 min ; IQR = ( 163 , 379 ) ) ; ( p = 0.818 ) .


The control and intervention groups were similar in regards to time to disposition ; the computerized management system did not add additional wait time .


The time to disposition decision did not change ; however the management system integrated several different information systems to support clinicians ' communication .


Understanding the characteristics of young adults who have difficulty achieving a healthy weight may help develop more effective interventions .


Signal detection was conducted to identify subgroups of overweight/obese young adults more or less likely to lose weight ( 5 % weight loss ) over 6 months .


Data were collected from a diverse sample involved in a randomized controlled behavioral weight loss intervention ( N = 404 ) .


Overall , 15 % ( N = 57 ) of participants achieved < 5 % weight loss .


Change in self-monitoring weight , baseline score of gym attendance/participating in exercise classes , and change in eating less fat were the best predictors of weight loss .


These strategies may be particularly helpful to promote short-term weight loss in overweight/obese young adults .


The Central Retinal Enrichment Supplementation Trials ( CREST ) aim to investigate the potential impact of macular pigment ( MP ) enrichment , following supplementation with a formulation containing 10mg lutein ( L ) , 2mg zeaxanthin ( Z ) and 10mg meso-zeaxanthin ( MZ ) , on visual function in normal subjects ( Trial 1 ) and in subjects with early age-related macular degeneration ( AMD ; Trial 2 ) .


CREST is a single center , double-blind , randomized clinical trial .


Trial 1 ( 12-month follow-up ) subjects are randomly assigned to a formulation containing 10mgL , 10mg MZ and 2mg Z ( n = 60 ) or placebo ( n = 60 ) .


Trial 2 ( 24-month follow-up ) subjects are randomly assigned to a formulation containing 10mgL , 10mg MZ , 2mg Z plus 500mg vitamin C , 400IU vitamin E , 25mg zinc and 2mg copper ( Intervention A ; n = 75 ) or 10mgL and 2mg Z plus 500mg vitamin C , 400IU vitamin E , 25mg zinc and 2mg copper ( Intervention B ; n = 75 ) .


Contrast sensitivity ( CS ) at 6 cycles per degree represents the primary outcome measure in each trial .


Secondary outcomes include : CS at other spatial frequencies , MP , best-corrected visual acuity , glare disability , photostress recovery , light scatter , cognitive function , foveal architecture , serum carotenoid concentrations , and subjective visual function .


For Trial 2 , AMD morphology , reading speed and reading acuity are also being recorded .


CREST is the first study to investigate the impact of supplementation with all three macular carotenoids in the context of a large , double-blind , randomized clinical trial .


This randomized double blind controlled study is aimed at determining the effect of repeated vibratory stimuli focally applied to the contracted quadriceps muscles ( repeated muscle vibration = rMV ) on bone mineral density , leg power and balance of postmenopausal osteoporotic women .


The study has been conducted on 40 voluntary postmenopausal osteoporotic women , randomised at 2 groups for rMV treatment and for control .


The treatment group underwent rMV ( 100Hz , 300-500 m ; three applications per day , each lasting 10-minutes , for 3 consecutive days ) applied to voluntary contracted quadriceps ( VC = vibrated and contracted group ) .


The control group , received a sham stimulation on contracted quadriceps ( NV = non vibrated group ) .


Bone mineral density T-score of proximal femur of the participants , was evaluated in two weeks before and 360 days after intervention ; body balance and explosive leg power were measured 1 day before , 30 days and 360 days after treatment .


VC group T-score at one year did n't change significantly relative to baseline values ( pretreatment : -2.610.11 , post-treatment -2.620.13 ) ; conversely in NV subjects T-score decreased significantly from -2.64 0.15 SD down to -2.99 0.28 SD .


A significant improvement of balance and explosive leg power was observed only in VC group at 30 and 360 days after the intervention .


We conclude that rMV is a safe , short-lasting and non-invasive treatment that can significantly and persistently improve muscle performance and can effectively counteract progressive demineralisation in postmenopausal and osteoporotic women .


To evaluate the efficacy of calf pulmonary surfactant ( PS ) in the treatment of respiratory distress syndrome ( RDS ) in late preterm and full-term infants .


A randomized controlled trial was designed to evaluate the efficacy of calf PS intratracheally given at different times and doses in infants with RDS who had a gestational age of 35 weeks and an oxygenation index ( OI ) of 10-20 .


The subjects were randomly assigned to treatment group 1 ( n = 58 ) , treatment group 2 ( n = 58 ) , and control group ( n = 59 ) .


Treatment group 1 was given PS ( 50 mg/kg ) within 6 hours after admission .


Treatment group 2 was given PS ( 70 mg/kg ) within 6 hours after admission .


The control group was not given PS within 6 hours after admission and was given PS ( 50 mg/kg ) over 6 hours after admission if having no remission by conventional therapy including mechanical ventilation .


For each group , a second dose of PS ( 50 mg/kg ) was given if no remission was observed within 12 hours after the first administration .


There were no significant differences in mortality between the three groups .


Treatment group 2 had lower hospitalization expense and shorter duration of mechanical ventilation compared with treatment group 1 , and treatment group 1 had lower hospitalization expense and shorter duration of mechanical ventilation compared with the control group .


The incidence of ventilator-associated pneumonia and length of hospital stay in treatment group 2 was lower than those in treatment group 1 and control group .