Postmenopausal women with hormone receptor-positive ( HR ( + ) ) breast cancer in whom disease progresses or there is recurrence while taking a nonsteroidal aromatase inhibitor ( NSAI ) are usually treated with exemestane ( EXE ) , but no single standard of care exists in this setting .


The BOLERO-2 trial demonstrated that adding everolimus ( EVE ) to EXE improved progression-free survival ( PFS ) while maintaining quality of life when compared with EXE alone .


Because many women with HR ( + ) advanced breast cancer are elderly , the tolerability profile of EVE plus EXE in this population is of interest .


BOLERO-2 , a phase III randomized trial , compared EVE ( 10mg/d ) and placebo ( PBO ) , both plus EXE ( 25 mg/d ) , in 724 postmenopausal women with HR ( + ) advanced breast cancer recurring/progressing after treatment with NSAIs .


Safety and efficacy data in elderly patients are reported at 18-month median follow-up .


Baseline disease characteristics and treatment histories among the elderly subsets ( 65 years , n = 275 ; 70 years , n = 164 ) were generally comparable with younger patients .


The addition of EVE to EXE improved PFS regardless of age ( hazard ratio , 0.59 [ 65 years ] and 0.45 [ 70 years ] ) .


Adverse events ( AEs ) of special interest ( all grades ) that occurred more frequently with EVE than with PBO included stomatitis , infections , rash , pneumonitis , and hyperglycemia .


Elderly EVE-treated patients had similar incidences of these AEs as did younger patients but had more on-treatment deaths .


Adding EVE to EXE offers substantially improved PFS over EXE and was generally well tolerated in elderly patients with HR ( + ) advanced breast cancer .


Careful monitoring and appropriate dose reductions or interruptions for AE management are recommended during treatment with EVE in this patient population .


The current study tested whether self-affirmation in the context of a threatening health message helps promote a health behavior ( fruit and vegetable consumption ) over a 3-month period , and whether adding a manipulation to support the translation of intentions into behavior ( an implementation intentions induction ) enhances the impact of self-affirmation .


Participants ( N = 332 , 71 % women ) reported their baseline consumption and were randomly assigned to condition in a 2 ( self-affirmation : yes , no ) 2 ( implementation intentions : formed , not formed ) between-subjects factorial design .


They completed a self-affirmation/control task and then read a health communication advising eating at least 5 portions of fruit and vegetables daily .


Next participants reported intentions for behavior change , after which they formed/did not form relevant implementation intentions .


Consumption was measured again 7 days and 3 months postintervention .


Self-affirmed ( vs. nonaffirmed ) participants reported eating more fruit and vegetables at both follow-ups .


Forming ( vs. not forming ) implementation intentions was also beneficial for consumption .


At 7 days , there was also a significant self-affirmation implementation intentions interaction : consumption was highest when self-affirmed participants also formed implementation intentions .


The present study offers new evidence concerning the impact and durability of self-affirmation on health behaviors and the role of implementation intentions in enhancing the impact of self-affirmation .


Classical conditioning of the eyeblink reflex is a simple form of motor learning which depends on the integrity of the cerebellum .


Acquisition of conditioned eyeblink responses is markedly reduced in patients with cerebellar disorders .


Noninvasive transcranial direct current stimulation ( tDCS ) has been reported to modify the excitability of the cerebellar cortex .


The aim of the study was to assess whether acquisition of conditioned eyeblink responses ( CR ) is altered by cerebellar tDCS .


A standard delay conditioning paradigm with a 540 ms tone as conditioned stimulus ( CS ) coterminating with a 100 ms air puff as unconditioned stimulus ( US ) was used in a total of 30 healthy subjects ( 18 female , 12 male , mean age 23.4 1.9 years ) .


One hundred paired CS-US trials and 30 extinction CS alone trials were given .


tDCS ( 2 mA intensity , ramp like onset ) was applied over the right cerebellar hemisphere ipsilaterally to the US during the acquisition phase .


Subjects were randomly assigned to three groups ( n = 10 ) using anodal , cathodal or sham stimulation .


The investigator as well as the participants was blinded to the stimulation modality .


CR acquisition was significantly enhanced by anodal tDCS ( mean total CR incidence 73.4 25.2 % ) and significantly reduced by cathodal stimulation ( 12.6 17.2 % ) compared to sham stimulation ( 43.8 24.1 % ) .


During anodal tDCS CR onset occurred significantly earlier , that is mean onset of responses was shifted closer to CS onset .


Acquisition and timing of conditioned eyeblink responses is modified by cerebellar tDCS in a polarity dependent manner .


This study aimed to test the effects of boiled Anethum Graveolens seeds on pain intensity and duration of labor stages .


A randomized clinical trial was conducted on 153 eligible participants who had regular uterine contractions .


Participants were allocated to either intervention or control group receiving boiled Anethum Graveolens seeds or routine care , respectively .


Preparation of Anethum Graveolens boiled solution was as follows : 10g ( two tablespoons ) of seed in 100cc water boiled for 10min .


After filtration , this solution used by intervention group only once after starting active phase ( 3-4cm of cervix dilatation ) .


Participants were followed up to the delivery time .


Data were analyzed using T , and Chi square tests .


Findings showed that the length of the all stages of labor were significantly lower in intervention compared to control group in except for second stage in primiparous .


The second stage of labor in primiparous participants in intervention group was shorter than control group , although the difference is not significant .


Moreover , intervention group had a significantly better dilatation and effacement scores after 1 , 2 , 3 and 4h following the intervention compared to control group .


Results supported the boiled Anethum Graveolens seeds as an effective way to progress of the labor .


Results from an observational study involving neonates suggested that high-frequency oscillatory ventilation ( HFOV ) , as compared with conventional ventilation , was associated with superior small-airway function at follow-up .


Data from randomized trials are needed to confirm this finding .


We studied 319 adolescents who had been born before 29 weeks of gestation and had been enrolled in a multicenter , randomized trial that compared HFOV with conventional ventilation immediately after birth .


The trial involved 797 neonates , of whom 592 survived to hospital discharge .


We compared follow-up data from adolescents who had been randomly assigned to HFOV with follow-up data from those who had been randomly assigned to conventional ventilation , with respect to lung function and respiratory health , health-related quality of life , and functional status , as assessed with the use of questionnaires completed when the participants were 11 to 14 years of age .


The primary outcome was forced expiratory flow at 75 % of the expired vital capacity ( FEF75 ) .


The HFOV group had superior results on a test of small-airway function ( z score for FEF75 , -0.97 with HFOV vs. -1.19 with conventional therapy ; adjusted difference , 0.23 [ 95 % confidence interval , 0.02 to 0.45 ] ) .


There were significant differences in favor of HFOV in several other measures of respiratory function , including forced expiratory volume in 1 second , forced vital capacity , peak expiratory flow , diffusing capacity , and impulse-oscillometric findings .


As compared with the conventional-therapy group , the HFOV group had significantly higher ratings from teachers in three of eight school subjects assessed , but there were no other significant differences in functional outcomes .


In a randomized trial involving children who had been born extremely prematurely , those who had undergone HFOV , as compared with those who had received conventional ventilation , had superior lung function at 11 to 14 years of age , with no evidence of poorer functional outcomes .


( Funded by the National Institute for Health Research Health Technology Assessment Programme and others . )


There is a metabolic pathway by which mammals can convert the omega-3 ( n-3 ) essential fatty acid - linolenic acid ( ALA ) into longer-chain n-3 polyunsaturated fatty acids ( LC n-3 PUFA ) including eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) .


As far as we know there are currently no studies that have specifically examined sex differences in the LC n-3 PUFA response to increased dietary ALA intake in humans , although acute studies with isotope-labelled ALA identified that women have a significantly greater capacity to synthesise EPA and DHA from ALA compared to men .


Available data from a placebo-controlled , randomised study were re-examined to identify whether there are sex differences in the LC n-3 PUFA response to increased dietary ALA intake in humans .


There was a significant difference between sexes in the response to increased dietary ALA , with women having a significantly greater increase in the EPA content of plasma phospholipids ( mean +2.0 % of total fatty acids ) after six months of an ALA-rich diet compared to men ( mean +0.7 % , P = 0.039 ) .


Age and BMI were identified as predictors of response to dietary ALA among women .


Women show a greater increase in circulating EPA than men during increased dietary ALA consumption .


Further understanding of individual variation in the response to dietary ALA could inform nutrition advice , with recommendations being specifically tailored according to habitual diet , sex , age and BMI .


Persistent use of guideline-recommended drugs after acute myocardial infarction ( AMI ) is frequently reported to be inadequate in the elderly and scarce knowledge exists about factors that influence persistence in outpatient care .


Our aim was to evaluate drug use and its predictors in survivors of AMI above 64 years from hospital discharge to 1-year post-AMI .


In a single-centre randomised controlled trial , discharge medication of 259 patients with AMI was obtained from medical records at hospital stay .


Follow-up drug use and use of the healthcare system were self-reported to study nurses over 1 year in 3-month intervals .


Predictors for persistence were modelled with multivariate logistic regression analysis considering demographics , co-morbidities and treatment characteristics .


At discharge , 99.2 % of the patients used anti-platelets , 86.5 % beta blockers , 95.0 % statins and 90.4 % angiotensin-converting enzyme inhibitors or angiotensin receptor blockers .


Use of the combination of all four drug classes decreased from discharge to 1 year post-AMI from 74.1 to 37.8 % and was significantly reduced by age 75 years ( odds ratio [ OR ] 0.49 ; 95 % confidence interval [ CI ] 0.29-0 .85 ) and ten or more visits with general practitioners ( GPs ) over 1 year ( OR 0.29 ; 95 % CI 0.17-0 .51 ) .


Persistence from month 3 to 12 was significantly associated with drug use at discharge for the single drug classes , but not for the drug combination .


Older age and frequent GP visits are associated with decreased use of the guideline-recommended drug combination after AMI .


Further research is needed to specify underlying reasons and develop measures to improve persistence .


Abiraterone acetate ( an androgen biosynthesis inhibitor ) plus prednisone is approved for treating patients with metastatic castration-resistant prostate cancer ( mCRPC ) .


Study COU-AA-302 evaluated abiraterone acetate plus prednisone versus prednisone alone in mildly symptomatic or asymptomatic patients with progressive mCRPC without prior chemotherapy .


Report the prespecified third interim analysis ( IA ) of efficacy and safety outcomes in study COU-AA-302 .


Study COU-AA-302 , a double-blind placebo-controlled study , enrolled patients with mCRPC from April 2009 to June 2010 .


A total of 1088 patients were stratified by Eastern Cooperative Oncology Group performance status ( 0 vs 1 ) .


Patients were randomised 1:1 to abiraterone 1000mg plus prednisone 5mg twice daily by mouth versus prednisone .


Co-primary end points were radiographic progression-free survival ( rPFS ) and overall survival ( OS ) .


Median times to event outcomes were estimated using the Kaplan-Meier method .


Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) were derived using the Cox model , and treatment comparison used the log-rank test .


The O'Brien-Fleming Lan-DeMets - spending function was used for OS .


Adverse events were summarised descriptively .


With a median follow-up duration of 27.1 mo , improvement in rPFS was statistically significant with abiraterone treatment versus prednisone ( median : 16.5 vs 8.2 mo ; HR : 0.52 [ 95 % CI , 0.45-0 .61 ] ; p < 0.0001 ) .


Abiraterone improved OS ( median : 35.3 vs 30.1 mo ; HR : 0.79 [ 95 % CI , 0.66-0 .95 ] ; p = 0.0151 ) but did not reach the prespecified statistical efficacy boundary ( - level : 0.0035 ) .


A post hoc multivariate analysis for OS using known prognostic factors supported the primary results ( HR : 0.74 [ 95 % CI , 0.61-0 .89 ] ; p = 0.0017 ) , and all clinically relevant secondary end points and patient-reported outcomes improved .


While the post hoc nature of the long-term safety analysis is a limitation , the safety profile with longer treatment exposure was consistent with prior reports .


The updated IA of study COU-AA-302 in patients with mCRPC without prior chemotherapy confirms that abiraterone delays disease progression , pain , and functional deterioration and has clinical benefit with a favourable safety profile , including in patients treated for 24 mo. .


Study COU-AA-302 , ClinicalTrials.gov number , NCT00887198 .


The updated results of this ongoing study showed that disease progression was delayed in patients with advanced prostate cancer who were treated with abiraterone acetate and prednisone , and there was a continued trend in prolongation of life compared with patients treated with prednisone alone .


Treatment with abiraterone acetate and prednisone was well tolerated by patients who were treated for > 2 yr .


Both Miller and Macintosh blades are widely used for laryngoscopy in small children , though the Miller blade is more commonly recommended in pediatric anesthetic literature .


The aim of this study was to compare laryngoscopic views and ease and success of intubation with Macintosh and Miller blades in small children under general anesthesia .


One hundred and twenty children aged 1-24 months were randomized for laryngoscopy to be performed in a crossover manner with either the Miller or the Macintosh blade first , following induction of anesthesia and neuromuscular blockade .


The tips of both the blades were placed at the vallecula .


Intubation was performed following the second laryngoscopy .


The glottic views with and without external laryngeal maneuver ( ELM ) and ease of intubation were observed .


Similar glottic views with both blades were observed in 52/120 ( 43 % ) children , a better view observed with the Miller blade in 35/120 ( 29 % ) children , and with the Macintosh blade in 33/120 ( 28 % ) .


Laryngoscopy was easy in 65/120 ( 54 % ) children with both the blades .


Restricted laryngoscopy was noted in 55 children : in 27 children with both the blades , 15 with Miller , and 13 with Macintosh blade .


Laryngoscopic view improved following ELM with both the blades .


In children aged 1-24 months , the Miller and the Macintosh blades provide similar laryngoscopic views and intubating conditions .


When a restricted view is obtained , a change of blade may provide a better view .


Placing the tip of the Miller blade in the vallecula provides satisfactory intubating conditions in this age group .


Topical Cyperus rotundus oil is an effective and safe method to decrease hair growth .


The oil 's flavonoids have antiandrogenic activity on androgenic hair .


To date , there have been no randomized controlled trials comparing topical C rotundus oil to the available allopathic modalities , such as laser-assisted hair removal .


In an open-label pilot study , the author prospectively evaluated the efficacy of C rotundus essential oil , compared with the Alexandrite laser ( GentleLase ; Candela Laser Corp , Wayland , Massachusetts ) and saline , for reducing unwanted axillary hair .


Eligible participants ( n = 65 ) with unwanted axillary hair were assigned randomly to 1 of 3 study groups : topical C rotundus oil ( group 1 ) , saline ( group 2 ) , and Alexandrite laser ( group 3 ) .


Sixty patients completed the entire study .


Three methods were used to evaluate the results : hair counts , observations of independent professionals , and patient self-assessments .


Overall results did not differ significantly between C rotundus oil and the Alexandrite laser ( P > .05 ) .


However , statistically significant differences were noted with respect to decreased growth of white hair ( P < .05 ) , favoring the oil .


This finding was evident by all 3 methods of assessment .


No side effects were detected .


Cyperus rotundus essential oil is as effective as the Alexandrite laser for decreasing the growth of axillary hair ( both dark and white ) .


3 .


To determine the optimal iodine mass ( IM ) to achieve a 50-HU increase in hepatic attenuation for the detection of liver metastasis based on total body weight ( TBW ) or body surface area ( BSA ) at 80-kVp computed tomography ( CT ) imaging of the liver .


One-hundred and fifty patients who underwent contrast-enhanced CT at 80-kVp were randomised into three groups : 0.5 gI/kg , 0.4 gI/kg and 0.3 gI/kg .


Portal venous phase images were evaluated for hepatic parenchymal enhancement ( HU ) and visualisation of liver metastasis .


Iodine mass per BSA ( gI/m ( 2 ) ) calculated in individual patients were evaluated .


Mean HU for the 0.5 gI/kg group ( 84.2 HU ) was higher than in the 0.4 gI/kg ( 66.1 HU ) and 0.3 gI/kg ( 53.7 HU ) groups ( P < 0.001 ) .


Linear correlation equations between HU and IM per TBW or BSA are HU = 7.0 +153.0 IM/TBW ( r = 0.73 , P < 0.001 ) and HU = 11.4 +4.0 IM/BSA ( r = 0.75 , P < 0.001 ) , respectively .


The three groups were comparable for the visualisation of hepatic metastases .


The iodine mass to achieve a 50-HU increase in hepatic attenuation at 80-kVp CT was estimated to be 0.28 gI/kg of body weight or 9.6 gI/m ( 2 ) of body surface area .


Hepatic enhancement is expressed as HU = 7.0 +153.0 IM [ g ] / TBW [ kg ] .


Hepatic enhancement is expressed as HU = 11.4 +4.0 IM [ g ] / BSA [ m ( 2 ) ] .


Essential iodine dose at 80-kVp CT was 0.28 gI/kg or 9.6 gI/m ( 2 ) .


The objective of this study was to investigate if a verbal task can improve alertness and if performance changes are associated with changes in alertness as measured by EEG .


Previous research has shown that a secondary task can improve performance on a short , monotonous drive .


The current work extends this by examining longer , fatiguing drives .


The study also uses EEG to confirm that improved driving performance is concurrent with improved driver alertness .


A 90-min , monotonous simulator drive was used to place drivers in a fatigued state .


Four secondary tasks were used : no verbal task , continuous verbal task , late verbal task , and a passive radio task .


When engaged in a secondary verbal task at the end of the drive , drivers showed improved lane-keeping performance and had improvements in neurophysiological measures of alertness .


A strategically timed concurrent task can improve performance even for fatiguing drives .


Secondary-task countermeasures may prove useful for enhancing driving performance across a range of driving conditions .


The evidence base for the efficacy of cognitive behaviour therapy ( CBT ) for treating body dysmorphic disorder ( BDD ) is weak .


To determine whether CBT is more effective than anxiety management ( AM ) in an outpatient setting .


This was a single-blind stratified parallel-group randomised controlled trial .


The primary endpoint was at 12 weeks , and the Yale-Brown Obsessive Compulsive Scale for BDD ( BDD-YBOCS ) was the primary outcome measure .


Secondary measures for BDD included the Brown Assessment of Beliefs Scale ( BABS ) , the Appearance Anxiety Inventory ( AAI ) and the Body Image Quality of Life Inventory ( BIQLI ) .


The outcome measures were collected at baseline and week 12 .


The CBT group , unlike the AM group , had 4 further weekly sessions that were analysed for their added value .


Both groups then completed measures at their 1-month follow-up .


Forty-six participants with a DSM-IV diagnosis of BDD , including those with delusional BDD , were randomly allocated to either CBT or AM .


At 12 weeks , CBT was found to be significantly superior to AM on the BDD-YBOCS [ = -7.19 ; SE ( ) = 2.61 ; p < 0.01 ; 95 % CI = -12.31 to -2.07 ; d = 0.99 ] as well as the secondary outcome measures of the BABS , AAI and BIQLI .


Further benefits occurred by week 16 within the CBT group .


There were no differences in outcome for those with delusional BDD or depression .


CBT is an effective intervention for people with BDD even with delusional beliefs or depression and is more effective than AM over 12 weeks .


The medical food Souvenaid , containing the specific nutrient combination Fortasyn Connect , is designed to improve synapse formation and function in patients with Alzheimer 's disease ( AD ) .


Two double-blind randomized controlled trials ( RCT ) with Souvenaid of 12 and 24 week duration ( Souvenir I and Souvenir II ) showed that memory performance was improved in drug-nave mild AD patients , whereas no effects on cognition were observed in a 24-week RCT ( S-Connect ) in mild to moderate AD patients using AD medication .


Souvenaid was well-tolerated in all RCTs .


In this 24-week open-label extension ( OLE ) study to the 24-week Souvenir II RCT , long-term safety and intake adherence of the medical food Souvenaid was evaluated .


Patients with mild AD ( n = 201 ) received Souvenaid once-daily during the OLE .


Main outcome parameters were safety and product intake adherence .


The memory domain z-score from a revised neuropsychological test battery was continued as exploratory parameter .


Compared to the RCT , a similar ( low ) incidence and type of adverse events was observed , being mainly ( 68.3 % ) of mild intensity .


Pooled data ( RCT and OLE ) showed that 48-week use of Souvenaid was well tolerated with high intake adherence ( 96.1 % ) .


Furthermore , a significant increase in the exploratory memory outcome was observed in both the active-active and control-active groups during Souvenaid intervention .


Souvenaid use for up to 48-weeks was well tolerated with a favorable safety profile and high intake adherence .


The findings in this OLE study warrant further investigation toward the long-term safety and efficacy of Souvenaid in a well-controlled , double-blind RCT .


Numerous studies have demonstrated that sleep promotes memory consolidation , but there is little research on the effect of hypnotics on sleep-dependent memory consolidation .


We compared bedtime administration of zolpidem-ER 12.5 mg ( 6 - to 8-h duration of action ) , middle-of-the-night administration of zaleplon 10 mg ( 3 - to 4-h duration of action ) , and placebo to examine the effect of different durations of hypnotic drug exposure on memory consolidation during sleep .


Twenty-two participants with no sleep complaints underwent 3 conditions in a counterbalanced crossover study : ( 1 ) zolpidem-ER 12.5 mg ( bedtime dosing ) , ( 2 ) zaleplon 10 mg ( middle-of-the-night dosing ) , and ( 3 ) placebo .


Memory testing was conducted before and after an 8-h sleep period , using a word pair association task ( WPT ; declarative memory ) and a finger-tapping task ( FTT ; procedural memory ) .


ANOVA revealed a significant condition effect for the WPT ( p = 0.025 ) and a trend for the FTT ( p = 0.067 ) , which was significant when sex was added to the model ( p = 0.014 ) .


Improvement in memory performance following sleep was lower with bedtime dosing of zolpidem-ER compared to placebo and middle-of-the-night dosing of zaleplon .


There were no differences between placebo and zaleplon .


The results suggest that in some circumstances hypnotics may have the potential to reduce the degree of sleep-dependent memory consolidation and that drug-free sleep early in the night may ameliorate this effect .


The aim of this study was to ascertain whether individual atrioventricular delay ( AVD ) optimization using impedance cardiography ( ICG ) offers beneficial hemodynamic effects as well as improved exercise tolerance and quality of life in patients with requiring constant right ventricular pacing .


There were 37 patients with advanced AV block included in the study .


Several examinations were performed at the beginning .


Next , the optimization of AVD by ICG was done .


The next step of the study patients have been randomized into optimal AVD group ( AVDopt ) or factory setting group ( AVDfab ) .


After 3 months , the follow-up all data were collected again and crossover was performed .


After another 3 months , during the final follow-up all these measures were repeated .


In 87.5 % patients , AVDopt were different than factory value .


Cardiac output ( CO ) , cardiac index ( CI ) , and stroke volume ( SV ) were significantly ( P < 0.001 ) higher in AVDopt group than in AVDfab group ( CO : 6.0 1.4 L/minute vs. 5.3 1.2 L/minute ; SV : 85.8 25.7 mL vs. 76.9 22.5 mL ; CI : 3.2 0.7 L/minute/m ( 2 ) vs. 2.7 0.6 L/minute/m ( 2 ) ) .


There was a statistical significant ( P < 0.05 ) reduction of proBNP and NYHA class in patients with AVDopt compared to AVDfab ( proBNP : 196.4 144.7 pg/mL vs. 269.4 235.8 pg/mL ; NYHA class : 1.7 0.5 vs. 2.3 0.6 ) .


Six-minute walking test was significantly ( P < 0.05 ) higher in AVDopt group ( 409 90 m ) than in AVDfab group ( 362 93 m ) .


There were no statistically significant differences in echocardiographic parameters between AVDopt and AVDfab settings .


Our study results suggest that AVD optimization in patients with DDD pacemaker with ICG improves hemodynamic when compared to the default factory settings .


Furthermore , optimally programmed AVD reduces BNP and improves exercise tolerance and functional class .


The prevalence of smoke-free policies in multiunit housing ( MUH ) in South Dakota was examined .


Owner beliefs about smoke-free policies were identified .


Stratified random sampling included 27 South Dakota counties classified as frontier , large rural , or urban .


Data collection with MUH owners in selected counties employed a telephone survey with mailed backup .


The owner response rate was 41.5 % ( 324/780 ) .


A written smoke-free policy was reported by 175 ( 54.0 % ) owners , and 31 ( 10 % ) reported a verbal smoke-free policy .


Owners in large rural counties ( 57.4 % ) had more written smoke-free policies than owners in urban ( 52.2 % ) and frontier ( 53.5 % ) counties .


Only 8.5 % of properties had policies covering both buildings and grounds .


Owners without policies were more than twice as likely to manage U.S. Department of Housing and Urban Development subsidized units and were three times as likely to be current smokers .


Owners without a smoke-free policy anticipated that a policy would decrease maintenance costs but increase turnover and vacancy rates .


Nearly one-half ( 47.9 % ) of owners with no smoke-free policy had previously considered implementing a policy .


Owners self-reported beliefs about smoke-free policies identified perceived benefits such as decreased maintenance and costs , improved tenant safety and health , and conscientious tenants .


Perceived drawbacks included increased outdoor maintenance , enforcement problems , concerns about long-term tenants who smoke , and freedom/rights of smokers .


This study provides a baseline assessment of smoke-free polices in MUH settings .


Perceptions of owners without smoke-free policies focused on economic concerns that were inconsistent with reports from those owners with smoke-free policies .


As evidence-based practice ( EBP ) becomes a necessity in athletic training , Web-based modules have been developed and made available to the National Athletic Trainers ' Association membership as a mechanism to educate athletic trainers ( ATs ) on concepts of EBP .


To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs .


Randomized controlled trial .


Web-based modules and knowledge assessment .


A total of 164 of 473 ATs ( 34.7 % response rate ) , including professional athletic training students , graduate students , clinical preceptors , educators , and clinicians , were randomized into a control group ( 40 men , 42 women ) or experimental group ( 33 men , 49 women ) .


Ten Web-based modules were developed that covered concepts involved in the EBP process .


Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase .


During the intervention phase , the experimental group had access to the Web-based modules for 4 weeks , whereas the control group had no direct responsibilities for the investigation .


The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules .


Test-retest reliability was determined to be good ( intraclass correlation coefficient [ 2,1 ] = 0.726 , 95 % confidence interval = 0.605 , 0.814 ) .


Independent variables consisted of group ( control , experimental ) and time ( preassessment , postassessment ) .


Knowledge scores were tabulated by awarding 1 point for each correct answer ( maximum = 60 ) .


Between-group and within-group differences were calculated using a 2 2 repeated-measures analysis of variance ( P .05 ) , post hoc t tests , and Hedges g effect size with 95 % confidence intervals .


We found a group time interaction ( F , = 26.29 , P < .001 ) .


No differences were identified between the control ( 30.12 5.73 ) and experimental ( 30.65 5.93 ) groups during the preassessment ( t = 0.58 , P = .84 ) .


The experimental group ( 36.35 8.58 ) obtained higher scores on the postassessment than the control group ( 30.99 6.33 ; t162 = 4.55 , P = .01 ) .


No differences were identified among time instances within the control group ( t = 1.77 , P = .08 ) ; however , the experimental group obtained higher scores on the postassessment than the preassessment ( t = 7.07 , P < .001 ) .


An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs .


However , it is not known whether ATs are integrating EBP into daily clinical practice .


Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs .


The aim of this studywas to observe the effects of stellate ganglion block ( SGB ) on hemodynamic changes and intrapulmonary shunt during one-lung ventilation ( OLV ) .


Thirty ASA class I-II patients undergoing elective esophageal surgery were randomly divided into two groups : general anesthesia group ( group N , n = 15 ) and general anesthesia combined SGB group ( group S , n = 15 ) , patients in group S were received left SGB before induction .


Radial artery was cannulated for arterial blood pressure ( ABP ) monitoring and blood sampling and Swan-Ganz catheter was position in the pulmonary artery via right internal jugular vein under local anesthesia .


ECG , MAP , HR , CVP , continuous cardiac output ( CCO ) index and BIS were continuously monitored during anesthesia .


General anesthesia was induced with propofol 1.5-2 .0 mg/kg , sufentanil 0.4 g/kg , and Rocuronium 0.6-0 .9 mg/kg .


Endobronchial occluder was placed blindly after tracheal indubation and the correct position was verified by auscultation and fiberoptic bronchoscopy .


The patients were mechanically ventilated .


The ventilation conditions were Fio2 = 100 % , VT = 8-10 ml/kg , I : E = 1:2 and respiratory rate was adjusted to maintained PETCO2 at 35-45 mmHg during both two-lung ventilation ( TLV ) and OLV .


Anesthesia was maintained with continuous infusion of propofol 4-10 mg/kgh , sufentanil 0.2 g/kgh , vecuronium o. 1 mg/kgh , BIS was maintained at 45-55 .


Blood samples were taken from radial artery and S-G catheter for blood gas analysis at following intervals : during spontaneous breathing when the patient was awake ( T0 ) , 1 min after tracheal indubation ( T1 ) , 1 min after patient was placed in lateral position ( T2 ) and 15 min after it ( T3 ) , 1 min after ribs was braced ( T4 ) , 30 , 60 , 120 min during the course of OLV ( T5 , T6 , T7 ) , the two lungs were ventilated again for 30 min ( T8 ) and Qs/Qt was calculated .


SVRI , MAP , HR in group N increased significantly at T1 , T2 , T4 compared with group S ( p < 0.05 ) .


Qs/Qt was significantly increased after patient was placed in lateral position and increased further during OLV ; the calculated Qs/Qt values were highest at T5 PaO2 was significantly lower after OLV was started and reached the lowest level at T6 then was gradually increasing .


There was no significant difference in Qs/Qt and PaO2 at all time points between two groups .


SGB before induction effectively suppress the stress response work as stable blood dynamics and does not affect Qs/Qt and arterial oxygenation during OLV , SGB is a safe technique of anesthesia for general thoracic surgery .


Acute coronary syndromes ( ACSs ) are a major cause of morbidity and mortality , yet effective ACS treatments are frequently underused in clinical practice .


Randomized trials including the CPACS-2 study suggest that quality improvement initiatives can increase the use of effective treatments , but whether such programs can impact hard clinical outcomes has never been demonstrated in a well-powered randomized controlled trial .


The CPACS-3 study is a stepped-wedge cluster-randomized trial conducted in 104 remote level 2 hospitals without PCI facilities in China .


All hospitalized ACS patients will be recruited consecutively over a 30-month period to an anticipated total study population of more than 25,000 patients .


After a 6-month baseline period , hospitals will be randomized to 1 of 4 groups , and a 6-component quality improvement intervention will be implemented sequentially in each group every 6months .


These components include the following : establishment of a quality improvement team , implementation of a clinical pathway , training of physicians and nurses , hospital performance audit and feedback , online technical support , and patient education .


All patients will be followed up for 6months postdischarge .


The primary outcome will be the incidence of in-hospital major adverse cardiovascular events comprising all-cause mortality , myocardial infarction or reinfarction , and nonfatal stroke .


The CPACS-3 study will be the first large randomized trial with sufficient power to assess the effects of a multifaceted quality of care improvement initiative on hard clinical outcomes , in patients with ACS .


Strabismus surgery in children is often associated with undesirable intraoperative and postoperative side effects including pain , postoperative nausea and vomiting ( PONV ) , and occulocardiac reflex ( OCR ) .


Systemic analgesics have side effects and are contraindicated in some cases .


We hypothesized that the preoperative subtenon injection of bupivacaine would reduce postoperative pain and the incidence of side effects adverse effects .


Sixty children ( 2 to 6 years of age , ASA status I to II ) were randomized to receive either subtenon bupivacaine 0.5 % or a saline injection before the beginning of surgery in a double-blind manner .


Pain scores using the Face , Legs , Cry , Activity , and Consolability ( FLACC ) scale , incidence of OCR and PONV , requirement of additional systemic analgesia , and time to discharge from the recovery room were compared .


The pain scores were significantly lower in the subtenon bupivacaine group at 0 min ( p = 0.0056 ) and at 30 min ( p = 0.013 ) .


There was no significant difference between the two groups at the other time intervals .


There was a significant reduction in the incidence of occulocardiac reflex and the incidence of vomiting in the subtenon bupivacaine group .


Eight of the 27 patients in the subtenon bupivacaine group required additional systemic analgesia compared to 19 of 29 controls .


The time to discharge from recovery room was lower in the subtenon bupivacaine group .


These data provide some evidence that a preoperative subtenon block with bupivacaine combined with general anesthesia allows efficient control of postoperative pain as well as a reduction in the incidence of OCR and PONV in young children undergoing strabismus surgery .


The aim of this study was to compare the diagnostic performances of multi-detector computed tomography ( MDCT ) reconstruction at two different slice thicknesses ( 1mm , ` high resolution ' vs. 5mm , ` routine ' ) with respect to the detection of blebs and bullae ( BBs ) in patients with primary spontaneous pneumothorax ( PSP ) .


Thirty-one patients underwent wedge resection of BBs ( 29 unilateral and 2 bilateral ) for PSP from January 2010 to January 2013 .


Two observers assessed the presence and locations of BBs independently using high-resolution CT ( HRCT ) and routine CT reconstruction , and compared the sensitivities of each reconstruction method for BB detection using operative findings as a standard reference .


In addition , the number of BBs in each CT image set was recorded and inter-observer agreements were evaluated .


Sensitivity for the detection of BBs was significantly better for HRCT than routine CT ( 97.0 % vs. 63.6 % for observer 1 and 94.0 % vs. 57.6 % for observer 2 , respectively , both P-values < 0.001 ) .


On a per-bleb and a per-bulla basis , inter-observer agreements regarding BBs by HRCT were good and very good ( k = 0.66 and 0.94 , respectively ) and superior to those determined by routine CT ( k = 0.59 and 0.60 , respectively ) .


Different slice thickness reconstructions influence the diagnostic efficacy of MDCT for the detection of BBs in patients with PSP .


High-resolution thin slice CT reconstruction was found to have a significantly greater sensitivity than routine thicker slice thickness reconstruction for the detection of BBs .


The aim of this study is to conduct a preliminary examination of long-term outcomes on a broad range of affective disorder symptoms treated with a newly developed intervention : The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ( UP ) .


Maintenance of treatment gains at long-term follow-up ( LTFU ) were explored in patients ( N = 15 , mean age = 32.27 ; 60 % female ) who completed a clinical trial of the UP .


Treatment gains observed at 6-month follow-up ( 6MFU ) on measures of clinical severity , general symptoms of depression and anxiety , and a measure of symptom interference in daily functioning were largely maintained 12months later ( at an average of 18months posttreatment ) , and any significant changes from 6MFU to LTFU reflected small increases in symptoms that remained , on average , in the subclinical range .


These findings provide the first initial support for the durability of broad treatment gains following transdiagnostic treatment .


High-density lipoprotein ( HDL ) particles perform numerous vascular-protective functions .


Animal studies demonstrate that exposure to fine or ultrafine particulate matter ( PM ) can promote HDL dysfunction .


However , the impact of PM on humans remains unknown .


We aimed to determine the effect of exposure to coarse concentrated ambient particles ( CAP ) on several metrics of HDL function in healthy humans .


Thirty-two adults ( 25.96.6 years ) were exposed to coarse CAP [ 76.251.5 gm ( -3 ) ] in a rural location and filtered air ( FA ) for 2h in a randomized double-blind crossover study .


Venous blood collected 2 - and 20-h post-exposures was measured for HDL-mediated efflux of [ ( 3 ) H ] - cholesterol from cells and 20-h exposures for HDL anti-oxidant capacity by a fluorescent assay and paraoxonase activity .


The changes [ median ( first , third quartiles ) ] between exposures among 29 subjects with available results were compared by matched Wilcoxon tests .


HDL-mediated cholesterol efflux capacity did not differ between exposures at either time point [ 16.60 % ( 15.17 , 19.19 ) 2-h post-CAP versus 17.56 % ( 13.43 , 20.98 ) post-FA , p = 0.768 and 14.90 % ( 12.47 , 19.15 ) 20-h post-CAP versus 17.75 % ( 13.22 , 23.95 ) post-FA , p = 0.216 ] .


HOI [ 0.26 ( 0.24 , 0.35 ) versus 0.28 ( 0.25 , 0.40 ) , p = 0.198 ] and paraoxonase activity [ 0.54 ( 0.39 , 0.82 ) versus 0.60 molmin ( -1 ) mlplasma ( -1 ) ( 0.40 , 0.85 ) , p = 0.137 ] did not differ 20-h post-CAP versus FA , respectively .


Brief inhalation of coarse PM from a rural location did not acutely impair several facets of HDL functionality .


Whether coarse PM derived from urban sites , fine particles or longer term PM exposures can promote HDL dysfunction warrant future investigations .


To compare the symptoms and lower airway inflammatory factors of patients with allergic rhinitis ( AR ) , and to observe the effect of nasal irrigation in the treatment of allergic rhinitis .


Sixty-one cases diagnosed as AR after skin prick test ( SPT ) were selected and randomly divided into three groups : 17 patients in group A used nasal steroid spray ; 21 cases in group B used nasal irrigation ; 23 patients in group C combined ir rigation with nasal steroid .


Before and after 3 months treatment , nasal visual analogue scale ( VAS ) score , rhino conjunctivtis quality of life questionnaire ( RQLQ ) score , fractional exhaled nitric oxide ( FENO ) values were observed and compared in each group .


Before treatment , there is no statistically difference between three groups ( P > 0.05 ) .


After 3 months of treatment , VAS , RQLQ , FENO of all patients was significantly decreased ( P < 0.05 ) ; VAS , RQLQ score was not significantly different among the three groups ( P > 0.05 ) , FENO value has no statistically significant difference between group A and group B ( P > 0.05 ) , but were less than that in group C ( P < 0.05 ) .


Nasal irrigation can ameliorate nasal symptoms , improve quality of life , decrease lower airway inflammation of allergic rhinitis patients .


Nasal irrigation is an effective treatment of allergic rhinitis .


Nasal irrigation combined with nasal steroid can achieve more significant efficacy .


The US public is increasingly using online rating sites to make decisions about a variety of consumer goods and services , including physicians .


We sought to understand , within the context of other types of rating sites , parents ' awareness , perceptions , and use of physician-rating sites for choosing primary care physicians for their children .


This cross-sectional , nationally representative survey of 3563 adults was conducted in September 2012 .


Participants were asked about rating Web sites in the context of finding a primary care physician for their children and about their previous experiences with such sites .


Overall , 2137 ( 60 % ) of participants completed the survey .


Among these respondents , 1619 were parents who were included in the present analysis .


About three-quarters ( 74 % ) of parents were aware of physician-rating sites , and about one-quarter ( 28 % ) had used them to select a primary care physician for their children .


Based on 3 vignettes for which respondents were asked if they would follow a neighbor 's recommendation about a primary care physician and using multivariate analyses , respondents exposed to a neighbor 's recommendation and positive online physician ratings were significantly more likely to choose the recommended physician ( adjusted odds ratio : 3.0 [ 95 % confidence interval : 2.1-4 .4 ] ) than respondents exposed to the neighbor 's recommendation alone .


Conversely , respondents exposed to the neighbor 's recommendation and negative online ratings were significantly less likely to choose the neighbor children 's physician ( adjusted odds ratio : 0.09 [ 95 % confidence interval : 0.03-0 .3 ] ) .


Parents are beginning to use online physician ratings , and these ratings have the potential to influence choices of their children 's primary care physician .


To evaluate the efficacy and safety of duloxetine hydrochloride in the treatment of patients affected by chronic prostatitis/chronic pelvic pain syndrome ( CP/CPPS ) .


Thirty-eight CP/CPPS patients completed the National Institutes of Health Chronic Prostatitis Symptom Index ( NIH-CPSI ) and International Index of Erectile Function-Erectile Function-5 ( IIEF-5 ) questionnaires , uroflowmetry , and evaluation of psychologic status using Hamilton Anxiety Scale ( HAM-A ) and Hamilton Depression Scale ( HAM-D ) .


Patients were randomly assigned to 2 treatments groups .


Treatment in group 1 consisted of a simultaneous oral administration of tamsulosin ( 0.4 mg/d , 60 mg/d ) , saw palmetto ( 320 mg/d ) , and duloxetine ( 60 mg/d ) .


Treatment in group 2 consisted of tamsulosin ( 0.4 mg/d ) and saw palmetto ( 320 mg/d ) .


NIH-CPSI and IIEF-5 questionnaires , uroflowmetry , and evaluation of the psychological status were repeated at 16 weeks of follow-up .


At 16 weeks , a significant improvement in NIH-CPSI pain subscore , NIH-CPSI quality of life subscore , and NIH-CPSI total score were observed in group 1 patients compared with those in group 2 ( P < .01 , respectively ) , together with a significant improvement in HAM-A and HAM-D scores ( P < .01 , respectively ) .


Patients in group 2 showed a significant improvement in NIH-CPSI total score , in the urinary symptoms subscore , and in the HAM-A total score .


No significant differences were observed in IIEF-5 scores in the 2 groups .


Maximum flow rate significantly increased in both groups .


In group 1 , 20 % of patients stopped the study due to adverse effects .


The use of duloxetine in a multimodal treatment with an - blocker medication and a saw palmetto extract allowed better results in controlling clinical symptoms , psychologic status and quality of life patients affected by CP/CPPS .


Artificial language learning studies have demonstrated that learners exposed to many different nonword combinations representing a grammatical form demonstrate rapid learning of that form without explicit instruction .


However , learners presented with few exemplars , even when they are repeated frequently , fail to learn the underlying grammar .


This study translated this experimental finding in a therapeutic context .


Eighteen preschool children with language impairment received conversational recast treatment for morpheme errors .


Over a 6-week period , half heard 12 unique verbs twice each during recasts ( low-variability condition ) , and half heard 24 unique verbs ( high-variability condition ) .


Children 's use of trained and untrained morphemes on generalization probes as well as spontaneous use of trained morphemes was tracked throughout treatment .


The high-variability condition only produced significant change in children 's use of trained morphemes , but not untrained morphemes .


Data from individual children confirmed that more children in the high - than the low-variability condition showed a strong treatment effect .


Children in the high-variability condition also produced significantly more unique utterances containing their trained morpheme than children in the low-variability condition .


The results support the use of highly variable input in a therapeutic context to facilitate grammatical morpheme learning .


To determine factors mediating the effects of a depression intervention for older African Americans on functional disability and , secondarily , whether functional improvements mediate intervention effects on depressive symptoms .


Structural equation modeling to examine mediators in a secondary analysis of a randomized trial with 4-month follow-up .


Philadelphia region .


Community-dwelling African Americans ( 55 ) with depressive symptoms living in an urban area ( N = 208 ) .


Up to 10 one-hour sessions over 4 months conducted by licensed social workers who provided care management , referrals and linkages , stress reduction techniques , depression knowledge and symptom recognition , and behavioral activation techniques .


Main outcome was self-reported functional difficulty level for 18 basic activities .


Mediators included depression severity ( Patient Health Questionnaire ) , depression knowledge and symptom recognition , behavioral activation , and anxiety .


At 4 months , the intervention had positive effects on functional difficulty and all mediators ( P < .001 ) .


Separate structural equation models indicated that two factors ( reduced depressive symptoms ( 23.5 % mediated ) and improved depression knowledge and symptom recognition ( 52.9 % mediated ) ) significantly mediated the intervention 's effect on functional disability .


Enhancing behavioral activation and decreasing anxiety were not found to mediate improvements in functional disability .


The two significant mediators jointly explained 62.5 % of the intervention 's total effect on functional disability .


Functional improvement was not found to mediate the intervention 's effect on depressive symptoms .


This multicomponent depression intervention for African Americans has an effect on functional disability that is driven primarily by enhancing symptom recognition and decreasing depressive symptoms .


Reduction of functional difficulties did not account for improvements in depressive symptoms .


Nonpharmacological treatments for depressive symptoms that enhance symptom recognition in older African Americans can also reduce their functional difficulties with daily living activities .


Studies suggest that MRI is an accurate means for assessing tumor size after neoadjuvant chemotherapy ( NAC ) .


However , accuracy might be dependent on the receptor status of tumors .


MRI accuracy for response assessment after homogenous NAC in a relative large group of patients with stage II/III HER2-negative breast cancer has not been reported before .


250 patients from 26 hospitals received NAC ( docetaxel , adriamycin and cyclophosphamide ) in the context of the NEOZOTAC trial .


MRI was done after 3 cycles and post-NAC .


Imaging ( RECIST 1.1 ) and pathological ( Miller and Payne ) responses were recorded .


Accuracy measures were calculated and MRI and pathologically assessed tumor sizes were correlated .


Tumor size over - and underestimation were quantified .


Accuracy of MRI for determining pathological complete response ( pCR ) was 76 % .


The ROC-curve of MRI response and pCR had an area under the curve value of 0.63 ( 95 % C.I. 0.52-0 .74 ) .


The correlation coefficient of MRI and histopathological tumor measurements was 0.46 ( p < 0.001 ) .


Correlations were different for ER-positive ( r = 0.40 , p < 0.001 ) and ER-negative ( r = 0.76 , p < 0.001 ) breast tumors .


MRI under - and overestimated the tumor size in 47 % and 40 % of all patients .


In cases of substantial tumor size underestimation ( > 2 cm ) , surgical margins were more often tumor positive compared to the rest of the patients ( 33 % vs. 12 % , p = 0.005 ) .


MRI measurements correlated moderately with tumor size on the surgical specimen .


Only in ER-negative breast tumors , MRI tumor sizes correlated sufficiently with residual tumor size on the pathological specimen .


Therefore , post-NAC MRI should be interpreted with caution .


To evaluate the efficacy of alveolar corticotomy on orthodontic tooth movement when retracting upper canines compared with the conventional technique and to evaluate patients ' pain and discomfort levels after corticotomy .


A split-mouth design randomized controlled trial at the Department of Orthodontics ( University Al-Baath Dental School ) was performed .


A total of 30 patients whose orthodontic treatment required canine retraction were included .


The predictor variable was the use of corticotomy to facilitate tooth movement .


The velocity of space closure was evaluated as the primary outcome variable by measuring the distance between the canine and first molar on each side of the mouth immediately after corticotomy and at 1 , 2 , 4 , 8 , and 12 weeks after corticotomy .


The levels of pain and discomfort were evaluated as the secondary outcome variables using a questionnaire administered 4 times during the first week after corticotomy .


Paired t tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences .


A total of 30 patients ( 15 males and 15 females ) were recruited with a mean age of 20.04 3.63 years ( range 15 to 24 ) .


The space closure velocity after corticotomy was significantly faster on the experimental side than on the control side ( mean = 0.74 mm/week vs 0.20 mm/week between 1 week after and immediately after corticotomy , respectively ; P < .001 ) .


The pain encountered during eating was high , with 50 % and 30 % of patients reporting severe pain at 1 and 3 days postoperatively , respectively .


No significant differences were detected between the male and female patients regarding the tooth movement velocity on the experimental side .


Alveolar corticotomy increased orthodontic tooth movement and was accompanied by moderate degrees of pain and discomfort .


The purpose of this study was to determine the effect of amoxicillin/clavulanic acid to prevent infection following completely bone-impacted lower third molar removal .


A random , double-blind placebo-controlled clinical trial including 118 adults randomly allocated to placebo ( 60 patients ) or antibiotic treatment ( 58 patients ) : 2g amoxicillin/125mg clavulanic acid 2hours before the surgery and post-operatively twice a day for 4days .


Infection was clinically assessed until 8weeks after surgery .


Adverse events , as well as clinical and surgical variables , were recorded .


Analysis was by intention to treat .


Infections developed in five patients in the placebo group , all in the first postoperative week , and in two in the antibiotic group , both after the first week , the difference not being statistically significant ( P = .278 , number needed to treat 19 [ 8 - ] ) .


There were no relationships between any variables studied and infection .


No serious adverse events were reported .


There is insufficient evidence to recommend routine use of this antibiotic treatment .


Treatment regimens for omalizumab are guided by a dosing table that is based on total serum IgE and body weight .


Limited data exist about onset and offset of omalizumab efficacy in children and adolescents or subgroups that most benefit from treatment .


Post hoc analyses were conducted to ( 1 ) examine patient characteristics of those eligible and ineligible for omalizumab , ( 2 ) describe onset of effect after initiation of omalizumab and offset of treatment effect after stopping therapy , and ( 3 ) determine whether the efficacy differs by age , asthma severity , dosing regimen , and prespecified biomarkers .


Inner-city children and adolescents with persistent allergic asthma were enrolled in the Inner-City Anti-IgE Therapy for Asthma trial that compared omalizumab with placebo added to guidelines-based therapy for 60 weeks .


Two hundred ninety-three of 889 participants ( 33 % ) clinically suitable for omalizumab were ineligible for dosing according to a modified dosing table specifying IgE level and body weight criteria .


Baseline symptoms were comparable among those eligible and ineligible to receive omalizumab , but other characteristics ( rate of health care utilization and skin test results ) differed .


The time of onset of omalizumab effect was < 30 days and time of offset was between 30 and 120 days .


No difference in efficacy was noted by age or asthma severity , but high exhaled nitric oxide , blood eosinophils , and body mass index predicted efficacy .


A significant portion of children and adolescents particularly suited for omalizumab because of asthma severity status may be ineligible due to IgE > 1300 IU/mL .


Omalizumab reduced asthma symptoms and exacerbations rapidly ; features associated with efficacy can be identified to guide patient selection .


Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing .


There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease .


We sought to study the short - and long-term effects of prednisolone treatment of the first acute , moderate-to-severe , rhinovirus-induced wheezing episode in young children .


After confirming rhinovirus from nasopharyngeal aspirate by using PCR , 79 children with a first wheezing episode at age 3 to 23 months were randomized to receive oral prednisolone ( first dose of 2 mg/kg , followed by 2 mg/kg/d in 2 divided doses for 3 days ) or placebo .


The trial was double blind throughout the 12-month follow-up .


The primary outcomes were long term : new physician-confirmed wheezing episode within 2 months , number of physician-confirmed wheezing episodes within 12 months , and initiation of regular controller medication for asthma symptoms within 12 months .


The primary interaction analysis examined rhinovirus load .


Seventy-four patients completed the study ( mean age , 13 months ; 28 % atopic ) .


Long-term outcomes did not differ between groups ( all P .30 ) .


For short-term outcomes , the prednisolone group had less cough , rhinitis , noisy breathing , severe breathing difficulties , and nocturnal respiratory symptoms at home within 2 weeks ( all P < .05 ) .


The 25 children with greater than 7000 rhinovirus copies/mL ( most sensitive cutoff ) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo ( both P < .05 ) .


Prednisolone can not be routinely recommended for all young children experiencing their first acute , moderate-to-severe , rhinovirus-induced wheezing episode .


Prednisolone might be beneficial in a subgroup of children with high viral loads .


This study aims to investigate two different distraction methods , distraction cards and kaleidoscope , on pain and anxiety relief of children during phlebotomy .


This study is a prospective , randomized and controlled trial .


The sample consisted of 7-11 year-old children who required blood tests .


Children were randomized into three groups : the distraction cards group , the kaleidoscope group , and the control group .


Data were obtained by interviewing the children with their parents and the observer before and after the procedure .


The pain levels of the children were assessed by the parent and observer reports as well as self report using the Wong Baker FACES Pain Rating Scale .


The anxiety levels of children were assessed by parent and observer reports using Children Fear Scale .


One hundred and eighty-eight children ( mean age , 8.81.5 years ) were included .


The pain levels of children showed significant differences among the groups ( p = .005 ) .


Both the distraction card group ( 2.412.49 ) and the kaleidoscope group ( 3.102.16 ) had lower pain levels than the control group did ( 4.443.64 ) .


The distraction card group had the lowest pain levels ( 2.412.49 ) among all groups .


The procedural anxiety levels of children were significantly different among the groups ( p = < .001 ) .


Both the distraction card group ( 1.101.20 ) and the kaleidoscope group ( 1.611.12 ) had lower anxiety levels than the control group did ( 2.411.30 ) .


The distraction card group had the lowest anxiety levels ( p = < .001 ) .


The distraction cards were the most effective method for pain and anxiety relief of children during phlebotomy .


Also the distraction method with kaleidoscope was an effective method for pain and anxiety relief during phlebotomy in children .


Chronic obstructive pulmonary disease ( COPD ) affects millions worldwide .


Although many therapies exist and are being developed to relieve symptoms and reduce mortality , few data are available to understand which of the therapeutic alternatives is the most cost-effective for COPD patients in everyday clinical practice , especially for traditional Chinese medicine ( TCM ) .


Comparative effectiveness research can help patients , clinicians , and decision-makers make best informed treatment decisions where such evidence was previously lacking .


This study aims to compare the effectiveness and economic evaluation of three treatments : ( 1 ) conventional Western medicine ; ( 2 ) TCM treatments , which have been evaluated and have certain effect ; and ( 3 ) a combination of both conventional Western medicine and TCM treatments , and then determine which treatment is the most suitable for COPD patients .


A multicenter , pragmatic , randomized , controlled trial is adopted .


A total of 360 patients will be recruited and randomly assigned to one of the three treatments group , with 120 in each group .


Patients in the conventional Western medicine group will be given Salbutamol , Formoterol , Salmeterol/fluticasone , respectively , according to the guidelines .


For the TCM group , patients will be given Bufei granule , Bu-Fei Jian-Pi granule , Bu-Fei Yi-Shen granule , and Yi-Qi Zi-Shen granule based on their corresponding TCM syndrome patterns , respectively .


For the combination of conventional medicine and TCM treatments group , patients will be given a combination of conventional Western medicine and TCM granules .


Treatments in each group are recognized as a whole comprehensive intervention .


After the 26-week treatment , another 26weeks will be followed up .


The outcome measures including the frequency and duration of acute exacerbations , lung function , dyspnea , exercise capacity , quality of life , and economic evaluation will be assessed .


It is hypothesized that each of the three treatments will have beneficial effects in reducing the frequency and duration of acute exacerbations , improving exercise capacity and psychosocial function of COPD patients .


In addition , the combination of conventional medicine and TCM treatments may be most suitable for COPD patients with better effectiveness and economic evaluation .


ClinicalTrials.gov NCT01836016 .


The objective was to evaluate the effects of aortic annulus size on valve hemodynamics and clinical outcomes in those patients included in the Placement of Aortic Transcatheter Valves ( PARTNER ) randomized controlled trial cohort A and the nonrandomized continued access cohort .


Patients included the randomized controlled trial ( n = 574 ) and nonrandomized continued access ( n = 1358 ) cohorts were divided in tertiles according to aortic annulus diameter ( small aortic annulus tertile , medium aortic annulus tertile , and large aortic annulus tertile [ LAA ] , respectively ) as measured by transthoracic echocardiography .


Severe prosthesis-patient mismatch was defined as an effective aortic orifice area of < 0.65 cm ( 2 ) / m ( 2 ) .


In the randomized controlled trial cohort , patients in the small aortic annulus tertile who underwent transcatheter aortic valve replacement had a lower incidence of severe prosthesis-patient mismatch ( 19.7 % versus 37.5 % ; P = 0.03 ) and only a trend toward a higher incidence of moderate-to-severe paravalvular leaks compared with surgical aortic valve replacement ( 5.7 % versus 0 % ; P = 0.06 ) .


In the LAA tertile , there were no differences in the rate of prosthesis-patient mismatch between groups , and a significant increase in moderate-to-severe paravalvular leaks was associated with transcatheter aortic valve replacement ( 9 % versus 0 % ; P = 0.01 ) .


There were no differences in mortality between transcatheter aortic valve replacement and surgical aortic valve replacement .


In the nonrandomized continued access cohort , there were no differences in prosthesis-patient mismatch between the small aortic annulus and LAA tertiles , but a higher rate of moderate-to-severe paravalvular leaks was observed in the LAA tertile ( 5.9 % versus 11.5 % ; P = 0.009 ) .


Patients in the LAA tertile had a higher mortality rate at 1-year follow-up ( P = 0.02 ) , and differences persisted in multivariable analysis ( P = 0.048 for LAA versus medium aortic annulus tertile , P = 0.035 for LAA versus small aortic annulus tertile ) .


Aortic annulus size had a major impact on valve hemodynamics and clinical outcomes after transcatheter aortic valve replacement and surgical aortic valve replacement .


This study highlights the importance of considering aortic annulus size in the evaluation of high-risk patients who are candidates for aortic valve replacement .


http://www.clinicaltrials.gov .


Unique identifier : NCT00530894 .


The survival benefits of colon cancer surveillance programs are well delineated , but less is known about the magnitude of false positive testing .


The objective of this study was to estimate the false positive rate and positive predictive value of testing as part of a surveillance program based on national guidelines , and to estimate the degree of testing and resource use needed to identify a curable recurrence .


Analysis of clinically significant events leading to suspicion of cancer recurrence , false positive events , true cancer recurrences , time to confirmation of diagnosis , and resource use ( radiology , blood samples , colonoscopies , consultations ) among patients included in a randomised colon cancer surveillance trial .


110 patients surgically treated for colon cancer were followed according to national guidelines for 1884 surveillance months .


1105 tests ( 503 blood samples , 278 chest x-rays , 209 liver ultrasounds , 115 colonoscopies ) and 1186 health care consultations were performed .


Of the 48 events leading to suspicion of cancer recurrence , 34 ( 71 % ) represented false positives .


Thirty-one ( 65 % ) were initiated by new symptoms , and 17 ( 35 % ) were initiated by test results .


Fourteen patients had true cancer recurrence ; 7 resections of recurrent disease were performed , 4 of which were successful R0 metastasis Resections .


276 tests and 296 healthcare consultations were needed per R0 resection ; the cost per R0 surgery was 103207 .


There was a 29 % probability ( positive predictive value ) of recurrent cancer when a diagnostic work-up was initiated based on surveillance testing or patient complaints .


We observed a high false positive rate and low positive predictive value for significant clinical events suggestive of possible colorectal cancer relapse in the setting of a post-treatment surveillance program based on national guidelines .


Providers and their patients should have an appreciation for the modest positive predictive value inherent in colorectal cancer surveillance programs in order to make informed choices , which maximize quality of life during survivorship .


Better means of tailoring surveillance programs based on patient risk would likely lead to more effective and cost-effective post-treatment follow-up .


ClinicalTrials.gov identifier NCT00572143 .


Date of trial registration : 11th of December 2007 .


There are many instruments with different energy modalities or with different properties that are available for use in total laparoscopic hysterectomy .


The aim of the study was to compare the use of LigaSure ( Valleylab , Boulder , CO ) , HALO PKS cutting forceps ( Gyrus-ACMI , Maple Grove , MA ) , and ENSEAL tissue sealer ( SurgRx , Inc. .


Redwood City , CA ) in total laparoscopic hysterectomy with respect to operation time and blood loss as main outcomes .


Perioperative complications , return of gastrointestinal activity , and hospitalization time were assessed as secondary outcomes .


Randomized prospective study ( Canadian Task Force classification I ) .


Adana Numune Training and Research Hospital .


Forty-five patients with the indication of hysterectomy were randomized into 3 groups for total laparoscopic hysterectomy .


Patients with malignancies , having 3 or more previous abdominal surgeries , a uterus larger than 12weeks of gestation , and who had to undergo additional surgical procedures during the same operation were excluded .


Total laparoscopic hysterectomy .


Operations were completed in all 15 patients in the LigaSure and HALO PKS Cutting Forceps groups with the planned instruments .


In 2 patients in the ENSEAL group , bleeding could not be controlled with ENSEAL , and additional instruments were used .


One patient in the ENSEAL group had bladder injury .


The mean operation time and blood loss were 52.412.8 , 51.8614.11 , and 55.715.7 minutes ( p > .05 ) and 13854.3 , 11863.3 , and 218115.9 mL ( p < .05 ) in the LigaSure , HALO PKS , and ENSEAL groups , respectively .


Changes in hemoglobin/hematocrit levels , return of gastrointestinal activity , and hospitalization time did not differ between groups .


These 3 novel bipolar platforms had similar results in total laparoscopic hysterectomy .


These instruments were not determined to be independent predictors of operating time and amount of blood loss .


Parents often want to provide support to their children during medical procedures , but not all parents are effective in providing distraction after brief training .


The aim of this study was to investigate the effects of three doses of distraction intervention for children at high and medium risk for procedure-related distress .


Children undergoing scheduled intravenous insertions for diagnostic or treatment purposes and their parents participated .


A computerized application , Children , Parents and Distraction , was used to predict distress risk .


Doses of intervention were basic ( parents trained on providing distraction ) , enhanced ( basic training plus tailored instructions , environmental modifications , and support and guidance from the research assistant ) , and professional ( a trained research assistant provided distraction ) .


Outcome measures were Observational Scale of Behavioral Distress-Revised for behavioral distress , Oucher for self-reported pain , parent report of child distress , and salivary cortisol for physiological distress .


A total of 574 children , ages 4-10 , and their parents participated .


The Children , Parents and Distraction predicted that the risk for distress was high for 156 children , medium for 372 , and low for 46 .


Children predicted to have higher risk for distress displayed more behavioral distress ( p < .01 ) .


Children in the medium-risk group who had the professional intervention displayed significantly less behavioral distress ( p < .001 ) .


Children in the high-risk group tended to have less behavioral distress when receiving the professional intervention ( p = .07 ) .


There were no significant group differences for self-report of pain , parent report of distress , or cortisol levels .


Some parents may need additional training in providing distraction to their children during procedures , and some children at medium and high risk for distress may need professional support .


Parents should be asked about their preferences in acting as the distraction coach and , if willing , be provided as much training and support as possible in the clinical situation .


The purposes of this study were to evaluate the reproducibility for measuring the cold pressor test ( CPT ) - induced myocardial blood flow ( MBF ) alteration using phase-contrast ( PC ) cine MRI , and to determine if this approach could detect altered MBF response to CPT in smokers .


After obtaining informed consent , ten healthy male non-smokers ( mean age : 285 years ) and ten age-matched male smokers ( smoking duration 5 years , mean age : 283 years ) were examined in this institutional review board approved study .


Breath-hold PC cine MR images of the coronary sinus were obtained with a 3T MR imager with 32 channel coils at rest and during a CPT performed after immersing one foot in ice water .


MBF was calculated as coronary sinus flow divided by the left ventricular ( LV ) mass which was given as a total LV myocardial volume measured on cine MRI multiplied by the specific gravity ( 1.05 g/mL ) .


In non-smokers , MBF was 0.860.25 mL/min/g at rest , with a significant increase to 1.200.36 mL/min/g seen during CPT ( percentage change of MBF ( MBF ( % ) ) ; 39.2 % 14.4 % , p < 0.001 ) .


Inter-study reproducibility for MBF ( % ) measurements by different MR technologist was good , as indicated by the intraclass correlation coefficient of 0.93 and reproducibility coefficient of 10.5 % .


There was no significant difference between smokers and non-smokers for resting MBF ( 0.850.32 mL/min/g , p = 0.91 ) .


However , MBF ( % ) in smokers was significantly reduced ( -4.032.2 % vs. 39.214.4 % , p = 0.011 ) .


PC cine MRI can be used to reproducibly quantify MBF response to CPT and to detect impaired flow response in smokers .


This MR approach may be useful for monitoring the sequential change of coronary blood flow in various potentially pathologic conditions and for investigating its relationship with cardiovascular risk .


We compared the efficacy of melatonin and placebo as adjuvants in the withdrawal of patients from long term temazepam , zopiclone or zolpidem ( here ` BZD ' ) use .


A double-blind , placebo-controlled , randomized trial was conducted in a primary health care outpatient clinic .


Ninety-two men or women ( 55 years ) with primary insomnia and chronic BZD use received controlled release melatonin 2 mg ( CRM ) ( n = 46 ) or placebo ( n = 46 ) during the 1 month withdrawal from BZDs .


Psychosocial support was provided .


Follow-up continued for up to 6 months .


Successful BZD withdrawal by the end of 1 month was confirmed by BZD plasma determinations , while reduction in BZD use and abstinence continuing for 6 months were noted .


There were two drop-outs on CRM and one on placebo .


After a 1 month withdrawal , 31 participants ( 67 % ; 95 % CI 54 , 81 ) on CRM and 39 ( 85 % ; 74 , 95 ) on placebo had withdrawn completely ( intention-to-treat analysis between groups , P = 0.051 ; per protocol P = 0.043 ) .


Reduction in BZD use was similar or even more rare in the CRM than in the placebo group ( P = 0.052 per protocol ) .


After 6 months , 14 participants in the CRM group and 20 in the placebo group remained non-users of BZD ( NS between groups ) .


BZD doses were higher in the CRM than in the placebo group at the end of the 6 month follow-up ( P = 0.025 ) .


Withdrawal symptoms did not differ between the groups .


Gradual dose reduction of BZDs combined with CRM or placebo , and psychosocial support produced high short term and moderate long term BZD abstinence .


CRM showed no withdrawal benefit compared with placebo .


Pain due to bone metastases is a common cause of cancer-related morbidity , with few options available for patients refractory to medical therapies and who do not respond to radiation therapy .


This study assessed the safety and efficacy of magnetic resonance-guided focused ultrasound surgery ( MRgFUS ) , a noninvasive method of thermal tissue ablation for palliation of pain due to bone metastases .


Patients with painful bone metastases were randomly assigned 3:1 to receive MRgFUS sonication or placebo .


The primary endpoint was improvement in self-reported pain score without increase of pain medication 3 months after treatment and was analyzed by Fisher 's exact test .


Components of the response composite , Numerical Rating Scale for pain ( NRS ) and morphine equivalent daily dose intake , were analyzed by t test and Wilcoxon rank-sum test , respectively .


Brief Pain Inventory ( BPI-QoL ) , a measure of functional interference of pain on quality of life , was compared between MRgFUS and placebo by t test .


Statistical tests were two-sided .


One hundred forty-seven subjects were enrolled , with 112 and 35 randomly assigned to MRgFUS and placebo treatments , respectively .


Response rate for the primary endpoint was 64.3 % in the MRgFUS arm and 20.0 % in the placebo arm ( P < .001 ) .


MRgFUS was also superior to placebo at 3 months on the secondary endpoints assessing worst score NRS ( P < .001 ) and the BPI-QoL ( P < .001 ) .


The most common treatment-related adverse event ( AE ) was sonication pain , which occurred in 32.1 % of MRgFUS patients .


Two patients had pathological fractures , one patient had third-degree skin burn , and one patient suffered from neuropathy .


Overall 60.3 % of all AEs resolved on the treatment day .


This multicenter phase III trial demonstrated that MRgFUS is a safe and effective , noninvasive treatment for alleviating pain resulting from bone metastases in patients that have failed standard treatments .


Intestinal immunity induced by oral poliovirus vaccine ( OPV ) is imperfect and wanes with time , permitting transmission of infection by immunised children .


Inactivated poliovirus vaccine ( IPV ) does not induce an intestinal mucosal immune response , but could boost protection in children who are mucosally primed through previous exposure to OPV .


We aimed to assess the effect of IPV on intestinal immunity in children previously vaccinated with OPV .


We did an open-label , randomised controlled trial in children aged 1-4 years from Chinnallapuram , Vellore , India , who were healthy , had not received IPV before , and had had their last dose of OPV at least 6 months before enrolment .


Children were randomly assigned ( 1:1 ) to receive 05 mL IPV intramuscularly ( containing 40 , 8 , and 32 D antigen units for serotypes 1 , 2 , and 3 ) or no vaccine .


The randomisation sequence was computer generated with a blocked randomisation procedure with block sizes of ten by an independent statistician .


The laboratory staff did blinded assessments .


The primary outcome was the proportion of children shedding poliovirus 7 days after a challenge dose of serotype 1 and 3 bivalent OPV ( bOPV ) .


A second dose of bOPV was given to children in the no vaccine group to assess intestinal immunity resulting from the first dose .


A per-protocol analysis was planned for all children who provided a stool sample at 7 days after bOPV challenge .


This trial is registered with Clinical Trials Registry of India , number CTRI/2012/09 / 003005 .


Between Aug 19 , 2013 , and Sept 13 , 2013 , 450 children were enrolled and randomly assigned into study groups .


225 children received IPV and 225 no vaccine .


222 children in the no vaccine group and 224 children in the IPV group had stool samples available for primary analysis 7 days after bOPV challenge .


In the IPV group , 27 ( 12 % ) children shed serotype 1 poliovirus and 17 ( 8 % ) shed serotype 3 poliovirus compared with 43 ( 19 % ) and 57 ( 26 % ) in the no vaccine group ( risk ratio 062 , 95 % CI 040-097 , p = 00375 ; 030 , 018-049 , p < 00001 ) .


No adverse events were related to the study interventions .


The substantial boost in intestinal immunity conferred by a supplementary dose of IPV given to children younger than 5 years who had previously received OPV shows a potential role for this vaccine in immunisation activities to accelerate eradication and prevent outbreaks of poliomyelitis .


Bill & Melinda Gates Foundation .


It is unclear how much the length of a cardiopulmonary resuscitation ( CPR ) training program can be reduced without ruining its effectiveness .


The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression-only CPR training and conventional CPR training .


Participants were randomly assigned to either the compression-only CPR group , which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator ( AED ) use with personal training manikins , or the conventional CPR group , which underwent a 180-minute training program with chest compressions , rescue breathing , and AED use .


Participants ' resuscitation skills were evaluated 6 months and 1 year after the training .


The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training .


A total of 146 persons were enrolled , and 63 ( 87.5 % ) in the compression-only CPR group and 56 ( 75.7 % ) in the conventional CPR group completed the 1-year evaluation .


The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression ( mean SD = 59.8 % 40.0 % vs. 46.3 % 28.6 % ; p = 0.036 ) and the number of appropriate chest compressions ( mean SD = 119.5 80.0 vs. 77.2 47.8 ; p = 0.001 ) .


Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group ( mean SD = 11.8 21.1 seconds vs. 52.9 14.9 seconds ; p < 0.001 ) .


The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program .


UMIN-CTR UMIN000001675 .


Hangeshashinto ( TJ-14 , a Kampo medicine ) , which reduces the level of prostaglandin E2 and affects the cyclooxygenase activity , alleviates chemotherapy-induced oral mucositis ( COM ) .


We conducted a double-blind , placebo-controlled , randomized comparative trial to investigate whether TJ-14 prevents and controls COM in patients with colorectal cancer .


Ninety-three patients with colorectal cancer who developed moderate-to-severe COM ( WHO grade 1 ) during any cycle of chemotherapy using FOLFOX , FOLFIRI , and/or XELOX treatment were randomly assigned to receive either TJ-14 ( n = 46 ) or placebo ( n = 47 ) .


Patients received the administration of placebo or TJ-14 for 2weeks at the start of the next course of chemotherapy .


Patients were assessed three times per week for safety and for COM incidence and its severity using the WHO grading .


Ninety eligible patients ( TJ-14 ; 43 , placebo ; 47 ) per protocol set analysis were included in the analysis after the key-opening .


Although the incidence of grade 2 oral mucositis was lower for patients treated with TJ-14 compared to those treated with placebo , there was no significant difference ( 48.8 vs. 57.4 % ; p = 0.41 ) .


The median duration of grade 2 mucositis was 5.5 versus 10.5 days ( p = 0.018 ) .


No difference in other treatment toxicity was observed between the two groups , and patients exhibited high compliance in dosing administration .


The present study results did not meet the primary endpoint .


However , TJ-14 demonstrated a significant effect in the treatment of grade 2 mucositis in patients with colorectal cancer compared to the placebo .


This preliminary study aimed to investigate the effects of the probiotic Saccharomyces boulardii on proinflammatory and anti-inflammatory cytokines in patients with diarrhea-dominant irritable bowel syndrome ( IBS-D ) .


The other objectives were to document any clinical improvement as judged by symptoms , quality of life , and histology .


This was a randomized , double blind , placebo-controlled trial in which S. boulardii , 750 mg/day , or placebo was administered for 6 weeks in IBS-D patients , in addition to ispaghula husk standard treatment .


Thirty-seven patients received S. boulardii and 35 patients received the placebo .


As compared with placebo , the S. boulardii group showed a significant decrease in blood and tissue levels of proinflammatory cytokines interleukin-8 ( IL-8 ) and tumor necrosis factor - ( P < 0.001 ) and an increase in anti-inflammatory IL-10 levels , as well as an increase in the tissue IL-10 / IL-12 ratio ( P < 0.001 ) .


No significant change in the blood and tissue levels of cytokines was found in the placebo group .


Bowel-related IBS-D symptoms reported in the patients ' daily diary improved in both groups .


However , overall improvement in the quality of life was more marked in the S. boulardii group .


Although baseline histological findings were mild , an improvement was observed in the probiotic group in the lymphocyte and neutrophil infiltrates ( P = 0.017 and 0.018 ) , epithelial mitosis ( P = 0.003 ) , and intraepithelial lymphocytes ( P = 0.024 ) .


No serious adverse events were found in either group .


S. boulardii with ispaghula husk was superior to placebo with ispaghula husk in improving the cytokine profile , histology , and quality of life of patients with IBS-D .


These preliminary results need to be confirmed in a well-powered trial .


Intermittent preventive treatment with sulphadoxine-pyrimethamine ( IPTp-SP ) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight ( LBW ) and the prevalence of maternal anaemia .


Nevertheless , where the risk of infection close to delivery is high because of intense transmission , a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome .


Pregnant women in the 2nd or 3rd trimester were randomized to receive either 2 ( SP2 ) or 3 doses ( SP3 ) of SP .


Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule .


Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed .


The prevalence of LBW ( < 2500 g ) , severe anaemia ( Hb < 8 g/dL ) and premature birth was analysed using intention-to-treat ( ITT ) and per-protocol ( PP ) analysis .


Data from 1274 singleton pregnancies were analysed ( 641 in the SP3 and 633 in the SP2 group ) .


The uptake of the intervention appeared to be low .


Though the prevalence of LBW in both intervention groups was similar ( adjusted Incident Rate Ratio , AIRR = 0.92 , 95 % CI : 0.69-1 .24 ) in the ITT analysis , the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group ( AIRR = 0.38 , 95 % CI : 0.16 - 0.90 ) .


The PP analysis showed a trend of reduced risk of LBW , severe anaemia and premature delivery in the SP3 group , albeit the difference between two and three IPTp-SP did not reach statistical significance .


The risk of LBW and severe anaemia tended to be lower in the SP3 group , though this was not statistically significant , probably due to the low uptake of the intervention which reduced the power of the study .


Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasonal .


Safety and efficacy of long-term olanzapine treatment in Japanese patients with bipolar depression were assessed .


An integrated analysis of data from two studies was performed in olanzapine-treated patients ( n = 165 ) with bipolar depression .


Study 1 was a 6-week , double-blind , global study .


Patients were randomly assigned to olanzapine or placebo followed by 18 weeks of open-label treatment .


Study 2 was an open-label extension of Study 1 involving only Japanese patients .


Patients assigned to Pre-olanzapine and Pre-placebo in Study 1 were treated for 24 weeks ( total olanzapine exposure 42 or 48 weeks ) and newly recruited patients ( New-olanzapine ) were treated for 48 weeks .


Safety outcomes included treatment-emergent adverse events and changes in metabolic parameters .


Efficacy outcome was assessed with Montgomery-sberg Depression Rating Scale score .


Forty-three percent of patients completed the 42 - or 48-week olanzapine treatment period .


The most common treatment-emergent adverse event was weight increased ( 47.9 % ) .


Significant increases were seen in weight ( 3.5 kg ) , and in fasting glucose ( 3.5 mg/dL ) , fasting total cholesterol ( 8.1 mg/dL ) , and fasting triglycerides ( 35.1 mg/dL ) .


Remission rates ( Montgomery-sberg Depression Rating Scale total score 12 at any time ) were 79.8 % for the Pre-olanzapine group , 90.2 % for the Pre-placebo group , and 85.0 % for the New-olanzapine group .


No patents developed mania during treatment .


Long-term use of olanzapine in a Japanese population with bipolar depression is associated with increases in weight and fasting metabolic measures , and also with improved depressive symptoms with avoidance of mania .


Clinicians must carefully consider the benefits and risks of long-term therapy with olanzapine .


To evaluate the prevalence of significant aortic valve stenosis ( AS ) in a randomly selected study population of elderly individuals representing the general population of Iceland .


Furthermore , to predict the number of individuals likely to have severe AS in the future .


Echocardiography and computed tomography ( CT ) data from individuals who participated in the AGES-Reykjavik study were used .


Echocardiography data from 685 individuals ( 58 % females ) aged 67-95 years were available .


In both sexes combined , the prevalence for severe AS , defined as an aortic valve area index of < 0.6 cm2/m2 , in the age groups < 70 , 70-79 and 80 years was 0.92 % , 2.4 % and 7.3 % , respectively .


A ROC analysis on the relation between the echocardiography data and the aortic valve calcium score on CT defined a score500 to be indicative of severe AS .


Subsequently , in a CT study cohort of 5256 individuals the prevalence of severe AS in the same age groups was 0.80 % , 4.0 % and 9.5 % , respectively .


Overall , the prevalence of severe AS by echocardiography and CT in individuals70 years was 4.3 % and 5.9 % , respectively .


A prediction on the number of elderly70 years for the coming decades demonstrated that patients with severe AS will have increased 2.4 fold by the year 2040 and will more than triple by the year 2060 .


This study , in a cohort of elderly individuals representative of the general population in a Nordic country , predicts that AS will be a large health problem in the coming decades .


Endometrial hyperplasia is clinically important , because it can lead to abnormal uterine bleeding ( AUB ) which itself can precede endometrial cancer .


Endometrial carcinoma is the most common malignancy of the female genital tract , occurring in about 75 % -85 % younger , perimenopausal women as endometrial hyperplasia .


The treatment is hysterectomy or hormone therapy with progesterone .


The aim of this study was , therefore , to compare the effect of levonorgestrel intrauterine device ( LNG-IUD ) with medroxyprogesterone acetate ( MPA ) on simple endometrial hyperplasia for fertility preservation .


Forty women in reproductive age ( 22-47 years ) with AUB with endometrial biopsies confirming simple hyperplasia , were enrolled in this study and then randomly divided into two groups .


All patients presented with designed special checklist which was filled with satisfaction .


Complete history and physical examination especially blood pressure ( BP ) , body mass index ( BMI ) , breast examination , bimanual vaginal examination , and transvaginal sonography ( to measure the thickness of endometrial and exclude the other pathologic lesions ) were performed .


In the first group , treatment was performed with MPA ( 20 mg/daily ) for ten days and in other group with LNG-IUD was prescribed .


After three months , transvaginal sonography and biopsy of endometrium were done .


The status of AUB and side-effects of two methods , along with the rate of satisfactory were evaluated .


The findings showed the significant differences in the treatment of simple hyperplasia between two groups ( LNG-IUD group vs. MPA group ) ( p < 0.047 ) .


Recovery of AUB in the group LNG was enhanced ( p < 0.047 ) .


Endometrial thickness was reduced in both groups ( p < 0.001 ) , but further reduction in LNG group was seen .


Also , LNG was tolerated more than MPA .


Side-effects of MPA were more and reached significance ( p < 0.003 ) .


The rate of satisfaction with LNG was higher than MPA and reached significance ( p < 0.048 ) .


The results of this study show that LNG-IUD is more effective than MPA in treatment of simple endometrial hyperplasia and can be helpful in young women who want to preserve their fertilities .


Evidence of the effectiveness of printed educational messages in narrowing the gap between guideline recommendations and practice is contradictory .


Failure to screen for retinopathy exposes primary care patients with diabetes to risk of eye complications .


Screening is initiated by referral from family practitioners but adherence to guidelines is suboptimal .


We aimed to evaluate the ability of printed educational messages aimed at family doctors to increase retinal screening of primary care patients with diabetes .


Design : Pragmatic 23 factorial cluster trial randomized by physician practice , involving 5,048 general practitioners ( with 179,833 patients with diabetes ) .


Setting : Ontario family practitioners .


Interventions : Reminders ( that retinal screening helps prevent diabetes-related vision loss and is covered by provincial health insurance for patients with diabetes ) with prompts to encourage screening were mailed to each physician in conjunction with a widely-read professional newsletter .


Alternative printed materials formats were an ` outsert ' ( short , directive message stapled to the outside of the newsletter ) , and/or a two-page , evidence-based article ( ` insert ' ) and a pre-printed sticky note reminder for patients .


Main Outcome Measure : A successful outcome was an eye examination ( which includes retinal screening ) provided to a patient with diabetes , not screened in the previous 12 months , within 90 days after visiting a family practitioner .


Analysis accounted for clustering of doctors within practice groups .


No intervention effect was detected ( eye exam rates were 31.6 % for patients of control physicians , 31.3 % for the insert , 32.8 % for the outsert , 32.3 % for those who received both , and 31.2 % for those who received both plus the patient reminder with the largest 95 % confidence interval around any effect extending from -1.3 % to 1.1 % ) .


This large trial conclusively failed to demonstrate any impact of printed educational messages on screening uptake .


Despite their low cost , printed educational messages should not be routinely used in attempting to close evidence-practice gaps relating to diabetic retinopathy screening .


ISRCTN72772651 .


Individually , levosimendan and nesiritide have been associated with substantial clinical benefits for the treatment of acute decompensated heart failure ( ADHF ) .


The aim of this study was to evaluate the efficacy of the combination of levosimendan and nesiritide for the treatment of ADHF .


One hundred and twenty patients were randomly assigned to control , levosimendan , nesiritide or combination groups .


The patients received 2 drugs : 1 was levosimendan or placebo A and the other was nesiritide or placebo B.


The primary end points were rates of clinical effectiveness at 1 , 3 , 5 and 9 days after the start of therapy .


Nine days after the initiation of drug infusion , the clinical effectiveness rate in the combination group was better than that in the control group ( odds ratio : 1.43 , 95 % confidence interval : 0.46-2 .41 , P = 0.004 ) .


The combination treatment also resulted in higher rates of clinical effectiveness than individually provided levosimendan or nesiritide at 1 day ( both P = 0.04 ) or placebo at 1 , 3 or 5 days ( P = 0.002 , 0.006 and 0.009 , respectively ) .


The combination method was associated with fewer deaths and readmissions , as compared with the rate observed in the placebo group during the 3-month follow-up ( hazard ratio : 0.43 , 95 % confidence interval : 0.19-0 .96 , P = 0.038 ) .


Among patients with ADHF , intravenous infusion of levosimendan and nesiritide was superior to placebo and single-drug therapies in terms of improvements in clinical conditions during the early stages of therapy .


The aim of the study was to compare ligation anopexy ( LA ) and conventional hemorrhoidectomy ( CH ) in treatment of second - and third-degree hemorrhoids .


A prospective controlled randomized clinical trial included 100 patients who underwent CH ( CH group ) and 100 patients who underwent LA ( LA group ) .


A detailed history was taken from all the patients .


The effectiveness , safety , postoperative complications , operative time , length of hospital stay , time until first bowel movement , time until return to work , and postoperative pain score were assessed .


There was no significant difference between groups regarding age , sex , and preoperative symptoms .


The LA group had significantly shorter operative times , earlier first bowel movement , and an earlier return to work/activities .


The postoperative pain score in the LA group was significantly lower than that in the CH group on days 1 , 3 , 7 , and 14 after surgery .


There was no significant difference between groups as regards postoperative complications .


LA is safe , and as effective as CH in the treatment of grade II and grade III hemorrhoids , with shorter operative times , earlier mobilization , and lower postoperative pain scores .


Repetitive transcranial magnetic stimulation of the left temporo-parietal junction area has been studied as a treatment option for auditory verbal hallucinations .


Although the right temporo-parietal junction area has also shown involvement in the genesis of auditory verbal hallucinations , no studies have used bilateral stimulation .


Moreover , little is known about durability effects .


We studied the short and long term effects of 1 Hz treatment of the left temporo-parietal junction area in schizophrenia patients with persistent auditory verbal hallucinations , compared to sham stimulation , and added an extra treatment arm of bilateral TPJ area stimulation .


In this randomized controlled trial , 51 patients diagnosed with schizophrenia and persistent auditory verbal hallucinations were randomly allocated to treatment of the left or bilateral temporo-parietal junction area or sham treatment .


Patients were treated for six days , twice daily for 20 minutes .


Short term efficacy was measured with the Positive and Negative Syndrome Scale ( PANSS ) , the Auditory Hallucinations Rating Scale ( AHRS ) , and the Positive and Negative Affect Scale ( PANAS ) .