The relative changes in total and LDL cholesterol were significantly greater for subjects with severe hypercholesterolemia ( > 6.6 mmol/L ) than those with moderate hypercholesterolemia ( 5.2-6 .6 mmol/L ) .


The present study showed for the first time that incorporation of 25 g/d of lupin protein into a variety of complex food products lowers total and LDL cholesterol , triacylglycerols , homocysteine , and uric acid in hypercholesterolemic subjects .


The hypocholesterolemic effect is stronger in subjects with severe hypercholesterolemia .


Arginine might be responsible for some , but not all of the beneficial effects of lupin protein .


This trial was registered at http://clinicaltrials.gov ( study ID number NCT01598649 ) .


Liquid preserved packed red blood cell ( LPRBC ) transfusions are used to treat anemia and increase end-organ perfusion .


Throughout their storage duration , LPRBCs undergo biochemical and structural changes collectively known as the storage lesion .


These changes adversely affect perfusion and oxygen off-loading .


Cryopreserved RBCs ( CPRBC ) can be stored for up to 10 years and potentially minimize the associated storage lesion .


We hypothesized that CPRBCs maintain a superior biochemical profile compared with LPRBCs .


This was a prospective , randomized , double-blinded study .


Adult trauma patients with an Injury Severity Score ( ISS ) greater than 4 and an anticipated 1-U to 2-U transfusion of PRBCs were eligible .


Enrolled patients were randomized to receive either CPRBCs or LPRBCs .


Serum proteins ( haptoglobin , serum amyloid P , and C-reactive protein ) , proinflammatory and anti-inflammatory cytokines , d-dimer , nitric oxide , and 2,3-DPG concentrations were analyzed .


Mann-Whitney U-test and Wilcoxon rank sum test were used to assess significance ( p < 0.05 ) .


Fifty-seven patients were enrolled ( CPRBC , n = 22 ; LPRBC , n = 35 ) .


The LPRBC group 's final interleukin 8 , tumor necrosis factor , and d-dimer concentrations were elevated compared with their pretransfusion values ( p < 0.05 ) .


After the second transfused units , 2,3-DPG was higher in the patients receiving CPRBCs ( p < 0.05 ) ; this difference persisted throughout the study .


Finally , serum protein concentrations were decreased in the transfused CPRBC units compared with LPRBC ( p < 0.01 ) .


CPRBC transfusions have a superior biochemical profile : an absent inflammatory response , attenuated fibrinolytic state , and increased 2,3-DPG .


A blood banking system using both storage techniques will offer the highest-quality products to critically injured patients virtually independent of periodic changes in donor availability and transfusion needs .


Therapeutic study , level II .


To compare the efficacy and cognitive side effects of high-dose unilateral brief pulse electroconvulsive therapy ( ECT ) with those of high-dose unilateral ultrabrief pulse ECT in the treatment of major depression .


From April 2007 until March 2011 , we conducted a prospective , double-blind , randomized multicenter trial in 3 tertiary psychiatric hospitals .


All patients with a depressive disorder according to DSM-IV criteria were eligible .


Depression severity was assessed with the Montgomery-Asberg Depression Rating Scale ; primary efficacy outcomes were response , defined as a score decrease 60 % from baseline , and remission , defined as a score < 10 at 2 consecutive weekly assessments .


Total scores on the Autobiographical Memory Interview and Amsterdam Media Questionnaire were the primary outcome measures for retrograde amnesia .


Other cognitive domains included category fluency ( semantic memory ) and letter fluency ( lexical memory ) .


Patients received twice-weekly unilateral brief pulse ( 1.0 millisecond ) or ultrabrief pulse ( 0.3-0 .4 millisecond ) ECT 8 times seizure threshold until remission , for a maximum of 6 weeks .


Of the 116 patients , 75 % ( n = 87 ) completed the study .


Among completers , 68.4 % ( 26/58 ) of those in the brief pulse group achieved remission versus 49.0 % ( 24/49 ) of those in the ultrabrief pulse group ( P = .019 ) , and the brief pulse group needed fewer treatment sessions to achieve remission : mean ( SD ) of 7.1 ( 2.6 ) versus 9.2 ( 2.3 ) sessions ( P = .008 ) .


No significant group differences were found in the evaluation of the cognitive assessments .


The efficacy and speed of remission seen with high-dose brief pulse right unilateral ECT twice weekly were superior to those seen with high-dose ultrabrief pulse right unilateral ECT , with equal cognitive side effects as defined by retrograde amnesia , semantic memory , and lexical memory .


Netherlands National Trial Register number : NTR1304 .


The effects of ovarian function suppression ( OFS ) on survival and patient-reported outcomes were evaluated in a phase III trial in which premenopausal women were randomly assigned to tamoxifen with or without OFS .


Premenopausal women with axillary node-negative , hormone receptor-positive breast cancer tumors measuring 3 cm were randomly assigned to tamoxifen alone versus tamoxifen plus OFS ; adjuvant chemotherapy was not permitted .


Primary end points were disease-free survival ( DFS ) and overall survival ( OS ) .


Secondary end points included toxicity and patient-reported outcomes .


Patient-reported outcome data included health-related quality of life , menopausal symptoms , and sexual function .


These were evaluated at baseline , 6 months , 12 months , and then annually for up to 5 years after registration .


In all , 345 premenopausal women were enrolled : 171 on tamoxifen alone and 174 on tamoxifen plus OFS .


With a median follow-up of 9.9 years , there was no significant difference between arms for DFS ( 5-year rate : 87.9 % v 89.7 % ; log-rank P = .62 ) or OS ( 5-year rate : 95.2 % v 97.6 % ; log-rank P = .67 ) .


Grade 3 or higher toxicity was more common in the tamoxifen plus OFS arm ( 22.4 % v 12.3 % ; P = .004 ) .


Patients treated with tamoxifen plus OFS had more menopausal symptoms , lower sexual activity , and inferior health-related quality of life at 3-year follow-up ( P < .01 for all ) .


Differences diminished with further follow-up .


When added to tamoxifen , OFS results in more menopausal symptoms and sexual dysfunction , which contributes to inferior self-reported health-related quality of life .


Because of early closure , this study is underpowered for drawing conclusions about the impact on survival when adding OFS to tamoxifen .


The present study examined how gain - and loss-framed informational videos about oral health influence self-reported flossing behavior over a 6-month period , as well as the roles of perceived susceptibility to oral health problems and approach/avoidance motivational orientation in moderating these effects .


An age and ethnically diverse sample of 855 American adults were randomized to receive no health message , or either a gain-framed or loss-framed video presented on the Internet .


Self-reported flossing was assessed longitudinally at 2 and 6 months .


Among the entire sample , susceptibility interacted with frame to predict flossing .


Participants who watched a video where the frame ( gain/loss ) matched perceived susceptibility ( low/high ) had significantly greater likelihood of flossing at recommended levels at the 6-month follow-up , compared with those who viewed a mismatched video or no video at all .


However , young adults ( 18-24 ) showed stronger moderation by motivational orientation than by perceived susceptibility , in line with previous work largely conducted with young adult samples .


Brief informational interventions can influence long-term health behavior , particularly when the gain - or loss-frame of the information matches the recipient 's beliefs about their health outcome risks .


The aim of this study is to compare the efficacy and safety of expectant management with surgical management of first-trimester miscarriage .


This randomised prospective study was conducted in the Gynaecology Department at University of Saarland Hospital , Germany between February 2011 and April 2012 .


A total of 234 women were recruited following diagnosis of the first-trimester incomplete or missed miscarriage and randomised into two groups : 109 women were randomised to expectant management ( group I ) , and 125 women to surgical management ( groupII ) .


All women were examined clinically and sonographically during the follow-up appointments at weekly intervals for up to 4 weeks as appropriate .


The outcome measures were : efficacy , short-term complications and duration of vaginal bleeding and pain .


Of 234 eligible women , 17 were lost to follow-up , and the remaining 217 women were analysed .


The baseline characteristics were similar in both groups .


The total success rate at 4 weeks was lower for expectant than for surgical management ( 81.4 vs 95.7 % ; P = 0.0029 ) .


The type of miscarriage was a significant factor affecting the success rate .


For missed miscarriage , the success rates for expectant versus surgical management were 75 and 93.8 % , respectively .


For women with incomplete miscarriage , the rates were 90.5 and 98 % .


No differences were found in the number of emergency curettages between the two study groups .


The duration of bleeding was significantly more in the expectant than the surgical management ( mean 11 vs 7 days ; P < 0.0001 ) .


The duration of pain was also more in the expectant than the surgical group ( mean 8.1 vs 5.5 days ; P < 0.0001 ) .


The total complication rates were similar in both groups ( expectant 5.9 % vs surgical group 6.1 % ; P = 0.2479 ) .


However , the pelvic infection was significantly lower in the expectant than the surgical group ( 1.9 vs 3.5 % , respectively ; P = 0.0146 ) .


Expectant management of clinically stable women with first-trimester miscarriage is safe and effective and avoids the need for surgery and the subsequent risk of anaesthesia in about 81.4 % of cases , and has lower pelvic infection rate than surgical curettage .


However , surgical management is more successful , and with a shorter duration of bleeding and pain .


Therefore , the patient 's preference should be considered in the counselling process .


To examine the effectiveness of dance on motor functions , cognitive functions , and mental symptoms of Parkinson 's disease ( PD ) .


This study employed a quasi-randomised , between-group design .


Dance , PD exercise , and all assessments were performed in community halls in different regions of Japan .


Forty-six mild-moderate PD patients participated .


Six PD patient associations that agreed to participate in the study were randomly assigned to a dance group , PD exercise group , or non-intervention group .


The dance and PD exercise groups performed one 60-min session per week for 12 weeks .


Control group patients continued with their normal lives .


All groups were assessed before and after the intervention .


We used the Timed Up-and-Go Test ( TUG ) and Berg Balance Scale ( BBS ) to assess motor function , the Frontal Assessment Battery at bedside ( FAB ) and Mental Rotation Task ( MRT ) to assess cognitive function , and the Apathy Scale ( AS ) and Self-rating Depression Scale ( SDS ) to assess mental symptoms of PD .


The Unified Parkinson 's Disease Rating Scale ( UPDRS ) was used for general assessment of PD .


When comparing results before and after intervention , the dance group showed a large effect in TUG time ( ES = 0.65 , p = 0.006 ) , TUG step number ( ES = 0.66 , p = 0.005 ) , BBS ( ES = 0.75 , p = 0.001 ) , FAB ( ES = 0.77 , p = 0.001 ) , MRT response time ( ES = 0.79 , p < 0.001 ) , AS ( ES = 0.78 , p < 0.001 ) , SDS ( ES = 0.66 , p = 0.006 ) and UPDRS ( ES = 0.88 , p < 0.001 ) .


Dance was effective in improving motor function , cognitive function , and mental symptoms in PD patients .


General symptoms in PD also improved .


Dance is an effective method for rehabilitation in PD patients .


Ischemic mitral regurgitation is associated with a substantial risk of death .


Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited .


We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety .


The primary end point was the left ventricular end-systolic volume index ( LVESVI ) at 12 months , as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank .


At 12 months , the mean LVESVI among surviving patients was 54.625.0 ml per square meter of body-surface area in the repair group and 60.731.5 ml per square meter in the replacement group ( mean change from baseline , -6.6 and -6.8 ml per square meter , respectively ) .


The rate of death was 14.3 % in the repair group and 17.6 % in the replacement group ( hazard ratio with repair , 0.79 ; 95 % confidence interval , 0.42 to 1.47 ; P = 0.45 by the log-rank test ) .


There was no significant between-group difference in LVESVI after adjustment for death ( z score , 1.33 ; P = 0.18 ) .


The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group ( 32.6 % vs. 2.3 % , P < 0.001 ) .


There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events , in functional status , or in quality of life at 12 months .


We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement .


Replacement provided a more durable correction of mitral regurgitation , but there was no significant between-group difference in clinical outcomes .


( Funded by the National Institutes of Health and the Canadian Institutes of Health ; ClinicalTrials.gov number , NCT00807040 . )


Efficacy of available therapies for patients with HCV who have previously failed treatment is limited .


Two Phase III , open-label trials in Japan investigated efficacy and safety of simeprevir and peginterferon -- 2a/ribavirin ( PR ) combination therapy in treatment-experienced patients with genotype 1 HCV infection .


In CONCERTO-2 , prior non-responders to IFN-based therapy ( N = 106 ) received simeprevir ( TMC435 ) 100 mg QD with PR for 12 ( SMV12 , n = 53 ) or 24 weeks ( SMV24 , n = 53 ) followed by response-guided therapy ( RGT ) with PR for 12/36 ( SMV12 ) or 0/24 ( SMV24 ) weeks .


In CONCERTO-3 , relapsers after IFN-based therapy ( N = 49 ) received simeprevir 100 mg QD with PR for 12 weeks followed by RGT with PR for 12/36 weeks .


Primary endpoints were the rates of sustained virologic response 12 weeks after treatment end ( SVR12 ) .


SVR12 rates were 52.8 % ( SMV12 ) and 35.8 % ( SMV24 ) for prior non-responders , and 95.9 % for prior relapsers ( SMV12 ; p 0.0001 vs null hypothesis , respectively ) .


Most prior non-responders ( SMV12 : 81.1 % ; SMV24 : 73.6 % ) and prior relapsers ( 95.9 % ) met RGT criteria and completed PR to Week 24 .


Of these , 60.5 % , 48.7 % , and 95.7 % , respectively , achieved SVR12 .


Viral breakthrough occurred in 13.2 % ( SMV12 ) and 11.3 % ( SMV24 ) of prior non-responders ; no viral breakthrough occurred in prior relapsers .


Viral relapse occurred in 38.6 % ( SMV12 ) and 51.1 % ( SMV24 ) of prior non-responders and 8.2 % of prior relapsers .


Simeprevir with PR was generally well tolerated in both studies .


Re-treatment with 12 weeks of simeprevir QD with PR provided high SVR in treatment-experienced patients with chronic HCV genotype 1 infection , and allowed most patients to complete treatment in 24 weeks .


To compare intraobserver repeatability and interobserver and intersession reproducibility of lower tear meniscus height measurements ( LTMH ) obtained with the new Keratograph 5M and a Fourier-domain optical-coherence tomography ( OCT ; Spectralis OCT ) and to assess the agreement between the two devices .


This is a observational cross-sectional study .


Thirty eyes of 30 normal subjects were randomly imaged twice with both devices in our setting .


Two examiners randomly made LTMH measurements using the devices .


To assess intraobserver repeatability and interobserver and intersession reproducibility within-subject SD ( Sw ) , test-retest repeatability , coefficient of variation ( CoV ) and intraclass correlation coefficients ( ICCs ) were calculated .


Agreement between both devices was also determined .


Average LMTH for Keratograph was 235.4657.61 m , whereas the mean LTMH measured by OCT was 245.8467.18 m. Intraobserver repeatability and interobserver and intersession reproducibility were moderate with Keratograph ( CoV 0.16 % , 0.19 % , 0.17 % and ICC 0.83 , 0.76 , 0.83 , respectively ) and high for the Spectralis OCT ( CoV 0.13 % , 0.12 % , 0.11 % and ICC 0.9 , 0.92 , 0.92 , respectively ) .


No statistically significant difference was detected in mean LMTH measurements made with both devices , although correlation was low ( CoV 0.25 % , ICC 0.55 ) .


Spectralis OCT LTMH measurements were more reliable than the new Keratograph data .


Agreement between the devices was poor .


The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea .


One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial .


The mefenamic group received 250 mg capsules every 8 h , and the ginger group received 250 mg capsules ( zintoma ) every 6 h from the onset of menstruation until pain relief lasted 2 cycles .


The intensity of pain was assessed by the visual analog scale .


Data were analyzed by descriptive statistics , t test , Chi-square , Fisher exact test and repeated measurement .


The pain intensity in the mefenamic and ginger group was 39.01 17.77 and 43.49 19.99 , respectively , in the first month , and 33.75 17.71 and 38.19 20.47 , respectively , in the second month ( p > 0.05 ) .


The severity of dysmenorrhea , pain duration , cycle duration and bleeding volume was not significantly different between groups during the study .


The menstrual days were more in the ginger group in the first ( p = 0.01 ) and second cycle ( p = 0.04 ) .


Repeated measurement showed a significant difference in pain intensity within the groups by time , but not between groups .


Ginger is as effective as mefenamic acid on pain relief in primary dysmenorrhea .


Ginger does not have adverse effects and is an alternative treatment for primary dysmenorrhea .


This prospective , randomized trial compared ultrasound-guided targeted intracluster injection ( TII ) supraclavicular brachial plexus block ( SCB ) and infraclavicular brachial plexus block ( ICB ) .


Sixty-four patients were randomly allocated to receive an ultrasound-guided TII SCB ( n = 32 ) or ICB ( n = 32 ) .


The local anesthetic agent ( lidocaine 1.5 % with epinephrine 5 g/mL ) was identical in all subjects .


In the TII SCB group , half the volume ( 16 mL ) was injected inside the largest neural cluster ( confluence of trunks and divisions of the brachial plexus ) .


Subsequently , the remaining half ( 16 mL ) was divided into equal aliquots and injected inside every single satellite cluster .


In the ICB group , the entire volume ( 35 mL ) was injected dorsal to the axillary artery .


During the performance of the block , the performance time , number of needle passes , procedural pain , and complications ( vascular puncture , paresthesia ) were recorded .


Subsequently , a blinded observer assessed the onset time , incidence of Horner syndrome , and success rate ( surgical anesthesia ) .


The main outcome variable was the total anesthesia-related time ( sum of performance and onset times ) .


Due to a quicker onset [ 8.9 ( 5.6 ) vs 17.6 ( 5.3 ) minutes ; P < 0.001 ] , the total anesthesia-related time was shorter with TII SCB [ 18.2 ( 6.1 ) vs 22.8 ( 5.3 ) minutes ; P < 0.001 ] .


However no differences were observed between the 2 groups in terms of success rate ( 93.7 % -96.9 % ) , block-related pain scores , and adverse events such as vascular puncture and paresthesia .


Expectedly , the ICB group required fewer needle passes ( 2 vs 6 ; P < 0.001 ) as well as shorter needling [ 4.8 ( 2.3 ) vs 9.0 ( 2.9 ) minutes ; P < 0.001 ] and performance [ 5.6 ( 2.3 ) vs 9.5 ( 2.9 ) minutes ; P < 0.001 ] times .


Moreover , the ICB approach was associated with a decreased incidence of Horner syndrome ( 3.1 % vs 53.1 % ; P < 0.001 ) .


Ultrasound-guided TII SCB and ICB provide comparable success rates .


Due to its quick onset , TII SCB results in a shorter total anesthesia-related time .


To evaluate the therapeutic effects of tamsulosin on recurrent urinary tract infections in women with dysfunctional voiding .


A total of 155 women with recurrent urinary tract infections and dysfunctional voiding were included and randomly assigned to the following groups : uroflowmetry biofeedback ( group 1 ) , 1-adrenoceptor antagonists ( group 2 ) , uroflowmetry biofeedback combined with 1-adrenoceptor antagonists ( group 3 ) and no treatment ( group 4 ) .


Patients were evaluated by the American Urological Association Symptom Index at 3 , 6 and 12 months .


Urodynamics was carried out in patients of groups 1 , 2 , and 3 at 3 , 6 and 12 months , whereas urodynamics was only carried out at 12 months in group 4 .


All patients were followed up for 1 year with monthly urine cultures .


The incidence of storage and emptying symptoms decreased significantly at 3 , 6 and 12 months .


Mean flow rate , flow time and voiding volume increased significantly ( with a better outcome in patients of group 3 ) , whereas post-void residual urine decreased .


Mean opening detrusor pressure and detrusor pressure at maximum flow decreased significantly ( with a better outcome in patients of group 3 ) .


Mean urethral closure pressure and maximum urethral closure pressure decreased significantly with a more significant decrease for patients in group 3 .


The prevalence of urinary tract infection decreased significantly in all groups after treatment , and this decrease remained stable during the follow up .


In women with dysfunctional voiding and recurrent urinary tract infection , tamsulosin associated with uroflowmetry biofeedback might be an effective and safe treatment option for improving urinary symptoms and quality of life .


We conducted a prospective single-blind randomized study to assess whether a single 80,000 IU dose of human recombinant erythropoietin ( HRE ) , given just 2 days before cardiac surgery , could be effective in reducing perioperative allogeneic red blood cell transfusion ( aRBCt ) .


Six-hundred patients presenting with preoperative hemoglobin ( Hb ) level of not more than 14.5 g/dL were randomly assigned to either HRE or control .


The primary endpoint was the incidence of perioperative aRBCt .


The secondary endpoints were mortality and the incidence of adverse events in the first 45 days after surgery , Hb level on Postoperative Day 4 , and number of units of RBC transfusions in the first 4 days after surgery .


A total of 17 % ( HRE ) versus 39 % ( control ) required transfusion ( relative risk , 0.436 ; p < 0.0005 ) .


After baseline Hb was controlled for , there was no difference in the incidence of aRBCt between HRE ( 0 % ) and control ( 3.5 % ) among the patients with baseline Hb of 13.0 g/dL or more , which included the nonanemic fraction of the study population .


The mean ( range ) Hb level on Postoperative Day 4 was 10.2 ( 9.9-10 .6 ) g/dL ( HRE ) versus 8.7 ( 8.5-9 .2 ) g/dL ( control ; p < 0.0005 ) .


The distribution of number of units transfused was shifted toward fewer units in HRE ( p < 0.0005 ) .


The all-cause mortality at 45 days was 3.00 % ( HRE ) versus 3.33 % ( control ) .


The 45-day adverse event rate was 4.33 % ( HRE ) versus 5.67 % ( control ; both p = NS ) .


In anemic patients ( Hb < 13 g/dL ) , a single high dose of HRE administered 2 days before cardiac surgery is effective in reducing the incidence of aRBCt without increasing adverse events .


Controversy surrounds the effectiveness of dietary guidelines for cardiovascular disease ( CVD ) prevention in healthy middle-aged and older men and women .


The objective was to compare effects on vascular and lipid CVD risk factors of following the United Kingdom dietary guidelines with a traditional British diet ( control ) .


With the use of a parallel-designed randomized controlled trial in 165 healthy nonsmoking men and women ( aged 40-70 y ) , we measured ambulatory blood pressure ( BP ) on 5 occasions , vascular function , and CVD risk factors at baseline and during 12 wk after random assignment to treatment .


The primary outcomes were differences between treatments in daytime ambulatory systolic BP , flow-mediated dilation , and total cholesterol/HDL cholesterol .


Secondary outcomes were differences between treatment in carotid-to-femoral pulse wave velocity , high-sensitivity C-reactive protein , and a measure of insulin sensitivity ( Revised Quantitative Insulin Sensitivity Check Index ) .


Data were available on 162 participants , and adherence to the dietary advice was confirmed from dietary records and biomarkers of compliance .


In the dietary guidelines group ( n = 80 ) compared with control ( n = 82 ) , daytime systolic BP was 4.2 mm Hg ( 95 % CI : 1.7 , 6.6 mm Hg ; P < 0.001 ) lower , the treatment effect on flow-mediated dilation [ -0.62 % ( 95 % CI : -1.48 % , 0.24 % ) ] was not significant , the total cholesterol : HDL cholesterol ratio was 0.13 ( 95 % CI : 0 , 0.26 ; P = 0.044 ) lower , pulse wave velocity was 0.29 m/s ( 95 % CI : 0.07 , 0.52 m/s ; P = 0.011 ) lower , high-sensitivity C-reactive protein was 36 % ( 95 % CI : 7 % , 48 % ; P = 0.017 ) lower , the treatment effect on the Revised Quantitative Insulin Sensitivity Check Index [ 2 % ( 95 % CI : -2 % , 5 % ) ] was not significant , and body weight was 1.9 kg ( 95 % CI : 1.3 , 2.5 kg ; P < 0.001 ) lower .


Causal mediated effects analysis based on urinary sodium excretion indicated that sodium reduction explained 2.4 mm Hg ( 95 % CI : 1.0 , 3.9 mm Hg ) of the fall in blood pressure .


Selecting a diet consistent with current dietary guidelines lowers BP and lipids , which would be expected to reduce the risk of CVD by one-third in healthy middle-aged and older men and women .


This study is registered at www.isrctn.com as 92382106 .


Preventing recurrence of depression forms an important challenge for current treatments .


Cognitive control impairments often remain present during remission of depression , putting remitted depressed patients at heightened risk for new depressive episodes by disrupting emotion regulation processes .


Importantly , research indicates that cognitive control training targeting working memory functioning shows potential in reducing maladaptive emotion regulation and depressive symptomatology in clinically depressed patients and at-risk student samples .


The current study aims to test the effectiveness of cognitive control training as a preventive intervention in a remitted depressed sample , exploring effects of cognitive control training on rumination and depressive symptomatology , along with indicators of adaptive emotion regulation and functioning .


We present a double blind randomized controlled design .


Remitted depressed adults will complete 10 online sessions of a cognitive control training targeting working memory functioning or a low cognitive load training ( active control condition ) over a period of 14days .


Effects of training on primary outcome measures of rumination and depressive symptomatology will be assessed pre-post training and at three months follow-up , along with secondary outcome measure adaptive emotion regulation .


Long-term effects of cognitive control training on broader indicators of functioning will be assessed at three months follow-up ( secondary outcome measures ) .


This study will provide information about the effectiveness of cognitive control training for remitted depressed adults in reducing vulnerability for depression .


Furthermore , this study will address key questions concerning the mechanisms underlying the effects of cognitive control training , will take into account the subjective experience of the patients ( including a self-report measure for cognitive functioning ) , and explore whether these effects extend to broad measures of functioning such as Quality of Life and disability .


This study is registered with ClinicalTrials.Gov , number NCT02407652 .


Vitamin D levels are alarmingly low ( < 75 nmol/L ) in 65-70 % of North American children older than 1 year .


An increased risk of viral upper respiratory tract infections ( URTI ) , asthma-related hospitalizations and use of anti-inflammatory medication have all been linked with low vitamin D. No study has determined whether wintertime vitamin D supplementation can reduce the risk of URTI and asthma exacerbations , two of the most common and costly illnesses of early childhood .


The objectives of this study are : 1 ) to compare the effect of ` high dose ' ( 2000 IU/day ) vs. ` standard dose ' ( 400 IU/day ) vitamin D supplementation in achieving reductions in laboratory confirmed URTI and asthma exacerbations during the winter in preschool-aged Canadian children ; and 2 ) to assess the effect of ` high dose ' vitamin D supplementation on vitamin D serum levels and specific viruses that cause URTI .


This study is a pragmatic randomized controlled trial .


Over 4 successive winters we will recruit 750 healthy children 1-5 years of age .


Participating physicians are part of a primary healthcare research network called TARGet Kids !


Children will be randomized to the ` standard dose ' or ` high dose ' oral supplemental vitamin D for a minimum of 4 months ( 200 children per group ) .


Parents will obtain a nasal swab from their child with each URTI , report the number of asthma exacerbations and complete symptom checklists .


Unscheduled physician visits for URTIs and asthma exacerbations will be recorded .


By May , a blood sample will be drawn to determine vitamin D serum levels .


The primary analysis will be a comparison of URTI rate between study groups using a Poisson regression model .


Secondary analyses will compare vitamin D serum levels , asthma exacerbations and the frequency of specific viral agents between groups .


Identifying whether vitamin D supplementation of preschoolers can reduce wintertime viral URTIs and asthma exacerbations and what dose is optimal may reduce population wide morbidity and associated health care and societal costs .


This information will assist in determining practice and health policy recommendations related to vitamin D supplementation in healthy Canadian preschoolers .


Macrophage recruitment through C-C motif chemokine receptor-2 ( CCR2 ) into adipose tissue is believed to play a role in the development of insulin resistance and type 2 diabetes mellitus ( T2DM ) .


The objective of this Phase 2 proof-of-concept study was to evaluate the safety , tolerability , pharmacokinetics and pharmacodynamics of JNJ-41443532 , an orally bioavailable CCR2 antagonist , in patients with T2DM .


This was a 4-week , double-blind , placebo-controlled , randomized , multicenter study .


A total of 89 patients were randomized to receive either 250 - or 1000-mg of JNJ-41443532 twice daily , 30-mg of pioglitazone once daily ( reference arm ) , or placebo .


The primary endpoint was change from baseline in 23-h weighted mean glucose ( WMG ) ; secondary endpoints included change from baseline in fasting plasma glucose ( FPG ) , insulin resistance ( Homeostatic Model Assessment [ HOMA-IR ] ) , insulin secretion ( HOMA - % B ) and body weight .


Absorption of JNJ-41443532 into the systemic circulation occurred at a median tmax of 2 h , and the mean t was approximately 8 h for both doses ; plasma systemic exposures increased slightly more than dose-proportionally .


After 4 weeks , reductions in 23-h WMG and FPG were observed in all treatment groups compared with placebo and were significantly lower for 250-mg JNJ-41443532 and pioglitazone .


HOMA-IR was lower for all treatment groups , but significantly lower only for pioglitazone .


Conversely , HOMA - % B was increased for all groups , but significantly increased only for 250-mg JNJ-41443532 .


All groups , including placebo , had decreased body weight over time .


There were no clinically significant findings during routine safety assessments and the incidence of treatment-emergent adverse events was similar across all groups .


Administration of JNJ-41443532 resulted in modest improvement in glycaemic parameters compared with placebo , and was generally well tolerated in patients with T2DM .


Extracurricular programmes could provide a mechanism to increase the physical activity ( PA ) of primary-school-aged children .


The aim of this feasibility study was to examine whether the Action 3:30 intervention , which is delivered by teaching assistants , holds promise as a means of increasing the PA of Year 5 and 6 children .


A cluster randomised feasibility trial was conducted in 20 primary schools .


Ten schools received the Action 3:30 intervention and 10 schools were allocated to the control arm .


The intervention was 40 one-hour sessions , delivered twice a week by teaching assistants .


The proportion of participants recruited per school was calculated .


Session delivery and session attendance was calculated for intervention schools .


Weekday and after-school ( 3.30 to 8.30 pm ) moderate to vigorous intensity physical ( MVPA ) was assessed by accelerometer at baseline ( T0 ) , during the last few weeks of the intervention ( T1 ) and four months after the intervention had ended ( T2 ) .


The costs of delivering the intervention were estimated .


Five intervention schools ran all 40 of the intended sessions .


Of the remaining five , three ran 39 , one ran 38 and one ran 29 sessions .


Mean attendance was 53 % .


The adjusted difference in weekday MVPA at T1 was 4.3 minutes ( 95 % CI -2.6 to 11.3 ) .


Sex-stratified analyses indicated that boys obtained 8.6 more minutes of weekday MVPA than the control group ( 95 % CI 2.8 to 14.5 ) at T1 with no effect for girls ( 0.15 minutes , 95 % CI -9.7 to 10.0 ) .


There was no evidence that participation in the programme increased MVPA once the club sessions ceased ( T2 ) .


The indicative average cost of this intervention was 2,425 per school or 81 per participating child during its first year and 1,461 per school or 49 per participating child thereafter .


The effect of the Action 3:30 intervention was comparable to previous physical activity interventions but further analysis indicated that there was a marked sex difference with a positive impact on boys and no evidence of an effect on girls .


The Action 3:30 intervention holds considerable promise but more work is needed to enhance the effectiveness of the intervention , particularly for girls .


ISRCTN58502739 .


The aim of this study was to evaluate the impact of intravascular ultrasound ( IVUS ) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention ( PCI ) .


To date , few approaches have been described to reduce the final dose of contrast agent in PCIs .


We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI , thereby reducing the use of iodine contrast .


A total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI ; both groups were treated according to a pre-defined meticulous procedural strategy .


The primary endpoint was the total volume contrast agent used during PCI .


Patients were followed clinically for an average of 4 months .


The median total volume of contrast was 64.5 ml ( interquartile range [ IQR ] : 42.8 to 97.0 ml ; minimum , 19 ml ; maximum , 170 ml ) in the angiography-guided group versus 20.0 ml ( IQR : 12.5 to 30.0 ml ; minimum , 3 ml ; maximum , 54ml ) in the IVUS-guided group ( p < 0.001 ) .


Similarly , the median volume of contrast/creatinine clearance ratio was significantly lower among patients treated with IVUS-guided PCI ( 1.0 [ IQR : 0.6 to 1.9 ] vs. 0.4 [ IQR : 0.2 to 0.6 , respectively ; p < 0.001 ) .


In-hospital and 4-month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI .


Thoughtful and extensive use of IVUS as the primary imaging tool to guide PCI is safe and markedly reduces the volume of iodine contrast compared with angiography-alone guidance .


The use of IVUS should be considered for patients at high risk of contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty .


( Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy [ MOZART ] ; NCT01947335 ) .


General anesthesia ( GA ) is the most commonly used anesthetic technique for spinal surgery .


This study aimed to compare spinal anesthesia ( SA ) and GA in patients undergoing spinal surgery , in terms of perioperative outcome and cost effectiveness .


The study included 80 patients with ASA ( American Society of Anesthesiologists ) physical status I-II .


The patients were randomized to receive SA ( n = 40 ) or GA ( n = 40 ) .


Heart rate ( HR ) , mean arterial blood pressure ( MABP ) , blood loss , duration of surgery , duration of anesthesia , surgeon satisfaction , and duration in the post-anesthesia care unit ( PACU ) were recorded .


Postoperative analgesic requirement , nausea and vomiting ( PONV ) , perioperative hemodynamic variables , and anesthetic costs were determined .


HR and MABP were significantly higher in the GA group than in the SA group at the end of surgery and at PACU admission .


Duration of anesthesia , surgeon satisfaction , postoperative analgesic requirement , and anesthetic costs were significantly higher in the GA group .


Mean blood loss was lower in the SA group than in the GA group , but the difference was not significant .


Duration of surgery , duration in the PACU , perioperative hemodynamic variables , and complications were similar in both groups .


SA could be considered a reliable alternative to GA in patients undergoing lumber spine surgery , as it is clinically as effective as GA , but more cost effective .


Obese men are more likely to have poor dietary patterns compared to women , increasing diet-related chronic disease risk .


The impact of a male-only weight loss intervention on dietary intakes is under-evaluated .


The aim was to determine whether overweight/obese men randomised to self-help paper-based resources with or without online support , achieved greater improvements in diet compared with Wait-list controls at 3 and 6 months following a gender tailored weight-loss intervention .


Dietary intake was assessed using a 120-item semi-quantitative food frequency questionnaire ( FFQ ) , in a secondary analysis of a three-arm weight loss RCT grounded in Social Cognitive Theory ; ( 1 ) RESOURCES : gender-tailored weight loss resources ( DVD , handbooks , pedometer , tape measure ) ; ( 2 ) Online : resources plus website and efeedback , ( 3 ) Wait-list control .


Energy , total fat , saturated fat , and carbohydrate intakes decreased in the online group , which differed significantly from controls at 3 - and 6-month follow-up ( P < 0.05 ) .


There was a significant reduction in energy , fat and carbohydrate intakes in the Resource group at 3 and 6 months , but no difference from controls ( P > 0.05 ) .


In the online group there was an increase in % energy from core foods and decrease in % energy from energy-dense nutrient-poor foods ( P < 0.05 ) that was significantly different compared to controls at 3 and 6 months ( P < 0.05 ) .


Results suggest that men randomised to the SHED-IT intervention arms were able to implement key dietary messages up to 6 months compared to controls .


Future interventions should include targeted and gender-tailored messages as a strategy to improve men 's dietary intake within weight loss interventions .


To compare the efficacy and safety of sublingual misoprostol with intracervical dinoprostone gel for cervical ripening in prelabour rupture of membrane after 34 weeks of gestation .


One eighty-eight women having > 34 weeks of gestation with PROM , singleton viable fetus and no prior caesarean section were randomized to sublingual misoprostol ( 50 g every 4 h and maximum of 3 doses ) and intracervical dinoprostone ( 0.5 mg every 2 h and maximum of 2 doses ) .


Oxytocin augmentation was commenced in those with a satisfactory Bishop score , inadequate contractions and who did not go into spontaneous active labour .


Primary outcome measures were induction-delivery interval and the number of women that went into spontaneous labour without oxytocin augmentation .


There was a significant reduction in induction to delivery interval in sublingual misoprostol group compared to intracervical dinoprostone ( 8.3 3.6 h vs 12.2 6.6 h ; p = 0.000 ) .


There was a significant reduction in duration of rupture of membrane to delivery interval ( p = 0.015 ) , 1st stage of labour ( p = 0.000 ) in sublingual misoprostol group as compared to the intravaginal dinoprostone group .


There was no difference observed in spontaneous vaginal delivery between the groups ( 0.919 ) .


Oxytocin requirement was significantly higher in the dinoprostone group p = 0.006 ) .


There were more maternal adverse effects of sublingual misoprostol ( p = 0.026 ) .


However , maternal and neonatal safety profiles were comparable .


Sublingual misoprostol and intracervical dinoprostone at the dose studied are equally efficacious in achieving spontaneous vaginal delivery , reduction in induction-delivery interval and in reducing the need for oxytocin , in women after 34 weeks gestation with rupture of membranes .


Oral nutritional supplements ( ONS ) are often considered for hospitalized patients with acute severe malnutrition , however the compliance to the supplements is known to be variable .


The aim of our study was to investigate whether providing a lower volume of ONS at a higher frequency during medication rounds would improve the intake of the supplements .


In this randomized controlled trial , 234 malnourished inpatients ( mean age 71.2 years , 55 % male , median LOS 10 days ) were randomized to receive ONS ( 300 kcal and 12 g Protein per 125 ml serving ) in one of three different schemes .


The usual care group ( n = 88 ) was offered ONS 125 ml twice per day in between meals .


This was compared to two intervention groups that were offered ONS during medication rounds : intervention group 1 ( n = 66 ) received 125 ml of ONS twice per day , at 12 and 17 o'clock , and intervention group 2 ( n = 80 ) received 62 ml of ONS four times a day , at 8 , 12 , 17 and 20 o'clock .


Follow-up was performed until discharge or until ONS was no longer needed , with a maximum follow-up period of 30 days .


The primary outcome measure was the percentage of patients who consumed at least 75 % of the prescribed volume of ONS .


No significant differences were observed between the control groups and intervention group 1 ( risk difference of -16.0 % ( 95 % CI -33.2 -1.2 ) .


However , the percentage of patients consuming at least 75 % of the prescribed ONS was higher in intervention group 2 , with a risk difference 23.4 % ( 95 % CI 7.8-39 .0 % ) and a mean increased intake of 35 ml ( 84 kcal ) per day , p < 0.001 ) .


Median time ONS were taken was 5 days ( range 1-17 ) .


A higher frequency of a lower volume of ONS during medication rounds increased the compliance of patients needing ONS .


Clinical trial registration number NTR2535 ; www.trialregister.nl .


To investigate whether low-dose dynamic CT of the liver with iterative reconstruction can reduce both the radiation dose and the amount of contrast medium .


This study was approved by our institutional review board .


113 patients were randomly assigned to one of two groups .


Group A/group B ( fifty-eight/fifty-five patients ) underwent liver dynamic CT at 120/100 kV , with 0/40 % adaptive statistical iterative reconstruction ( ASIR ) , with a contrast dose of 600/480 mg I/kg , respectively .


Radiation exposure was estimated based on the manufacturer 's phantom data .


The enhancement value of the hepatic parenchyma , vessels and the tumor-to-liver contrast of hepatocellular carcinomas ( HCCs ) were compared between two groups .


Two readers independently assessed the CT images of the hepatic parenchyma and HCCs .


The mean CT dose indices : 6.38 / 4.04 mGy , the dose-length products : 194.54 / 124.57 mGy cm , for group A/group B.


The mean enhancement value of the hepatic parenchyma and the tumor-to-liver contrast of HCCs with diameters greater than 1cm in the post-contrast all phases did not differ significantly between two groups ( P > 0.05 ) .


The enhancement values of vessels in group B were significantly higher than that in group A in the delayed phases ( P < 0.05 ) .


Two reader 's confidence levels for the hepatic parenchyma in the delayed phases and HCCs did not differ significantly between the groups ( P > 0.05 ) .


Low-dose dynamic CT with ASIR can reduce both the radiation dose and the amount of contrast medium without image quality degradation , compared to conventional dynamic CT without ASIR .


Thoracoscopic wedge resection is generally accepted as a standard surgical procedure for primary spontaneous pneumothorax .


Because of the relatively high recurrence rate after surgery , additional procedures such as mechanical pleurodesis or visceral pleural coverage are usually applied to minimize recurrence , although mechanical pleurodesis has some potential disadvantages .


The aim of this study was to clarify whether an additional coverage procedure on thestaple line after thoracoscopic bullectomy prevents postoperative recurrence compared with additional pleurodesis .


A total of 1,414 patients in 11 hospitals with primary spontaneous pneumothorax undergoing thoracoscopic bullectomy were enrolled .


After bullectomy with staplers , patients were randomly assigned to either the coverage group ( n = 757 ) or the pleurodesis group ( n = 657 ) .


In the coverage group , the staple line was covered with absorbable cellulose mesh and fibrin glue .


The pleurodesis group underwent additional mechanical abrasion on the parietal pleura .


The coverage group and the pleurodesis group showed comparable surgical outcomes .


After a median follow-up of 19.5 months , the postoperative 1-year recurrence rate was 9.5 % in the coverage group and 10.7 % in the pleurodesis group .


The 1-year recurrence rate requiring intervention was 5.8 % in the coverage group and 7.8 % in the pleurodesis group .


The coverage group showed better recovery from pain .


In terms of postoperative recurrence rate , visceral pleural coverage after thoracoscopic bullectomy was not inferior to mechanical pleurodesis .


Visceral pleural coverage may potentially replace mechanical pleurodesis , which has potential disadvantages such as disturbed normal pleural physiology .


Lung cancer ( LC ) is the most common cause of cancer death in Denmark , and triaging patients through fast-track diagnostic pathways is recommended to improve patient outcome .


Data on the most efficient triage organisation of such pathways are limited .


The aim of this study was to test a strategy of a straight-to-test model for patients referred to the fast-track pathway .


Outcomes were number of computed tomographies ( CT ) performed , use of specialist time and staff acceptability .


We performed a randomised controlled study enrolling 493 patients who were referred from general practice to fast-track LC evaluation ( 1 January-1 December 2012 ) .


Half of the patients were randomly assigned to the intervention and went straight to a chest CT before chest-physician evaluation .


Time was measured for patients at random days .


Acceptability was examined in a focus group interview .


In the intervention group , 95.5 % of patients had a CT performed compared with 97.2 % in the control group .


There was no difference in the number of CTs between the groups ( risk difference ( RD ) = 1.3 % ( 95 % confidence interval ( CI ) : 4.4-2 .0 ; p = 0.454 ) ) .


In the intervention group , chest-physician time was 13.3 min .


( min.-max. : 7.7-19 .5 min . )


lower per referred patient than in the control group .


Giving general practitioners direct access to a CT did not change the number of CTs performed and significantly reduced chest-physician time per patient .


In addition , the strategy was associated with high levels of staff acceptability .


The project was supported by the Danish Cancer Research Foundation , the Danish Cancer Society and the Novo Nordisk Foundation .


ClinicalTrials.gov : NCT01779726 .


To assess the efficacy and safety of sono-electro-magnetic therapy compared to placebo in men with refractory CPPS .


In a randomized , placebo-controlled , double-blind single center trial , we assessed the effect of sono-electro-magnetic therapy in men with treatment refractory CPPS .


Sixty male patients were randomly assigned to treatment with either sono-electro-magnetic ( n = 30 ) or placebo therapy ( n = 30 ) for 12 weeks .


The primary outcome was a change in the National Institutes of Health Chronic Prostatitis Symptom Index ( NIH-CPSI ) from baseline to 12 weeks .


The 12-week difference between sono-electro-magnetic and placebo therapy in changes of the NIH-CPSI total score was -3.1 points ( 95 % CI -6.8 to 0.6 , p = 0.11 ) .


In secondary comparisons of NIH-CPSI sub-scores , we found differences between groups most pronounced for the quality-of-life sub-score ( difference at 12 weeks -1.6 , 95 % CI -2.8 to -0.4 , p = 0.015 ) .


In stratified analyses , the benefit of sono-electro-magnetic therapy appeared more pronounced among patients who had a symptom duration of 12 months or less ( difference in NIH-CPSI total score -8.3 , 95 % CI -14.5 to 2.6 ) than in patients with a longer symptom duration ( -0.8 , 95 % CI -4.6 to 3.1 ; p for interaction = 0.023 ) .


Sono-electro-magnetic therapy did not result in a significant improvement of symptoms in the overall cohort of treatment refractory CPPS patients compared to placebo treatment .


Subgroup analysis indicates , however , that patients with a symptom-duration of 12 months or less may benefit from sono-electro-magnetic therapy , warranting larger randomized controlled trials in this subpopulation .


ClinicalTrials.gov NCT00688506 .


The prevalence of diabetes has been growing rapidly in developing countries .


This causes devastating economic burdens and increases demands on the health care system .


Therefore , there is an urgent need to find a cost-effective and multi-faceted approach for diabetes care .


Peer support models provide a potentially low-cost , flexible means which complements the current existing health care services .


In this way , trained peer leaders can become qualified extensions to a formal healthcare system , capable of assisting education delivery and bolstering the efforts of professional staff .


As such , creating a cultural specific peer support program and determining whether it is acceptable and cost-effective in rural communities of China is crucial .


This study aims to implement and evaluate biophysical and psychosocial outcomes of peer support program for people with type 2 diabetes in rural communities , and to explore the program 's feasibility and sustainability in China .


This study is a cluster randomised controlled trial .


All consenting patients will be randomised by community staff members to receive either peer support or the control care .


The data collection and analysis including social demographics , health status , psychosocial status , economic status and biomedical measures will be collected at baseline , 6 months , and 12 months .


The primary indicator measured is the change in HbA1c , whereas secondary indicators include biophysical , psychosocial functioning and other lifestyle factors .


Finally , economic evaluations will determine whether the program is cost effective .


This protocol is a cluster randomized , controlled trial of group-based peer support for people with type 2 diabetes in the community settings of rural China .


Results from this trial may provide evidence to the effectiveness of peer support ; furthermore , they will provide valuable information concerning the acceptability and feasibility of a new approach to improve diabetes self-management among resource-constrained settings .


ClinicalTrials.gov Identifier : NCT02119572 , April 18 , 2014 .


Evidence-based treatments for posttraumatic stress disorder ( PTSD ) have not been established for adolescents despite high prevalence of PTSD in this population .


To examine the effects of counselor-delivered prolonged exposure therapy compared with supportive counseling for adolescents with PTSD .


A single-blind , randomized clinical trial of 61 adolescent girls with PTSD using a permuted block design .


Counselors previously naive to prolonged exposure therapy provided the treatments in a community mental health clinic .


Data collection lasted from February 2006 through March 2012 .


Participants received fourteen 60 - to 90-minute sessions of prolonged exposure therapy ( n = 31 ) or supportive counseling ( n = 30 ) .


All outcomes were assessed before treatment , at mid-treatment , and after treatment and at 3 - , 6 - , and 12-month follow-up .


The primary outcome , PTSD symptom severity , was assessed by the Child PTSD Symptom Scale-Interview ( range , 0-51 ; higher scores indicate greater severity ) .


Secondary outcomes were presence or absence of PTSD diagnosis assessed by the DSM-IV Schedule for Affective Disorders and Schizophrenia for School-Age Children and functioning assessed by the Children 's Global Assessment Scale ( range , 1-100 ; higher scores indicate better functioning ) .


Additional secondary measures , PTSD severity assessed by the Child PTSD Symptom Scale-Self-Report ( range , 0-51 ; higher scores indicate greater severity ) and depression severity assessed by the Children 's Depression Inventory ( range , 0-54 ; higher scores indicate greater severity ) , were also assessed weekly during treatment .


Data were analyzed as intent to treat .


During treatment , participants receiving prolonged exposure demonstrated greater improvement on the PTSD symptom severity scale ( difference between treatments in improvement , 7.5 ; 95 % CI , 2.5-12 .5 ; P < .001 ) and on all secondary outcomes ( loss of PTSD diagnosis : difference , 29.3 % , 95 % CI , 20.2 % -41.2 % ; P = .01 ; self-reported PTSD severity : difference , 6.2 ; 95 % CI , 1.2-11 .2 ; P = .02 ; depression : difference , 4.9 ; 95 % CI , 1.6-8 .2 ; P = .008 ; global functioning : difference , 10.1 ; 95 % CI , 3.4-16 .8 ; P = .008 ) .


These treatment differences were maintained through the 12-month follow-up : for interviewer-assessed PTSD ( difference , 6.0 ; 95 % CI , 1.6-10 .4 ; P = .02 ) , loss of PTSD diagnosis ( difference , 31.1 ; 95 % CI , 14.7-34 .8 ; P = .01 ) , self-reported PTSD ( difference , 9.3 ; 95 % CI , 1.2-16 .5 ; P = .02 ) , depression ( difference , 7.2 ; 95 % CI , 1.4-13 .0 ; P = .02 ) , and global functioning ( difference , 11.2 ; 95 % CI , 4.5-17 .9 ; P = .01 ) .


Adolescents girls with sexual abuse-related PTSD experienced greater benefit from prolonged exposure therapy than from supportive counseling even when delivered by counselors who typically provide supportive counseling .


clinicaltrials.gov Identifier : NCT00417300 .


Having shown in a recent randomized controlled trial that evidence-based patient information ( EBPI ) significantly increased knowledge on primary prevention of diabetes compared to standard patient information , we now investigated interaction between socioeconomic status ( SES ) and the effect of an EBPI .


1,120 visitors ( aged 40-70 years , without known diabetes ) to the `` Techniker Krankenkasse '' and the `` German Diabetes Center '' websites were randomized .


The intervention group received a newly developed on-line EBPI , the control group standard on-line information .


The primary outcome measure was knowledge , classified as `` good/average/poor '' .


We analyzed associations of knowledge with socioeconomic variables ( education , vocational training , employment , subjective social status ) combined with intervention effect including interactions , adjusted for possible confounding by knowledge before intervention , self-reported blood glucose measurements , blood pressure , blood lipid levels , age and gender .


Logistic regression models were fitted to the subpopulation ( n = 647 ) with complete values in these variables.Education ( high vs. low ) was significantly associated with knowledge ( good vs. average/poor ) ; however , there was no significant interaction between education and intervention .


After adjustment , the other socioeconomic variables were not significantly associated with knowledge .


Socioeconomic variables did not significantly change the effect of the intervention .


There was a tendency towards a lower effect where lower educated individuals were concerned .


Possibly the power was too low to detect interaction effects .


Larger studies using SES-specific designs are needed to clarify the effect of SES .


We suggest considering the socioeconomic status when evaluating a decision aid , e.g. an EBPI , to ensure its effectiveness not only in higher socioeconomic groups .


Current Controlled Trials ISRCTN22060616 ( Date assigned : 12 September 2008 ) .


Childhood asthma is a serious and common chronic disease that requires the attention of nurses and other school personnel .


Schools are often the first setting that children take the lead in managing their asthma .


Often , children are ill prepared for this role .


Our study evaluated a school-based , multifaceted asthma program that targeted students with asthma and the broader school community .


A randomized trial involving 130 schools with grades 1-5 and 1316 children with asthma and their families was conducted .


Outcomes of interest for the child , at 1year , were urgent care use and school absenteeism for asthma , inhaler technique , and quality of life , and for the school , at 14months , were indicators of a supportive school environment .


Improvements were observed at the child and school level for the intervention group .


Fewer children in the intervention group had a school absence ( 50 % vs 60 % ; p < .01 ) , required urgent care for asthma ( 41 % vs 51 % ; p < .0001 ) , or reported a day of interrupted activity ( 51 % vs 63 % ; p < .01 ) , and had improved quality of life ( 5.81.2 vs 5.41.4 ; p < .0001 ) .


Schools in the intervention group were more likely to have practices supporting an asthma-friendly environment .


Implementation of a multifaceted school-based asthma program can lead to asthma-friendly schools that support children with asthma to be successful managers of their asthma and experience improved quality of life and decreased disease associated burden .


The potential role of renal denervation ( RD ) in patients with AF and less severe hypertension is unknown .


The purpose of this study was to assess the potential role of RD as an adjunct to pulmonary vein isolation ( PVI ) in patients with atrial fibrillation ( AF ) and moderate resistant or severe resistant hypertension .


The data for this study were obtained from 2 different prospective randomized studies , analyzed by meta-analysis .


Patients with paroxysmal AF or persistent AF and moderate resistant hypertension ( office blood pressure BP 140/90 mm Hg and < 160/100 mm Hg ; first study ; n = 48 ) or severe resistant hypertension ( 160/100 mm Hg ; second study ; n = 38 ) were randomized to PVI or PVI with RD. .


At 12 months , 26 of the 41 PVI with RD patients ( 63 % ) were AF-free vs 16 of the 39 patients ( 41 % ) in the PVI-only group ( P = .014 ) .


In patients with severe hypertension , 11 of the 18 PVI with RD patients ( 61 % ) vs 5 of the 18 PVI-only patients ( 28 % ) were AF-free ( P = .03 ) .


For moderate hypertension , the differences were less dramatic : 11 of 21 ( 52 % ) vs 15 of 23 ( 65 % ) when RD added ( P = .19 ) .


The superior efficacy of adding RD was most apparent in persistent AF and severe hypertension ( hazard ratio 0.25 , confidence interval 0.09-0 .72 , P = .01 ) .


Duration of the procedure and fluoroscopy were nonsignificantly longer in the RD group .


RD may improve the results of PVI in patients with persistent AF and/or severe resistant hypertension .


The slow digestion and amino acid absorption kinetics of isolated micellar casein have been held responsible for its relatively lower postprandial muscle protein synthetic response compared with rapidly digested proteins such as isolated whey .


However , casein is normally consumed within a milk matrix .


We hypothesized that protein digestion and absorption kinetics and the subsequent muscle protein synthetic response after micellar casein ingestion are modulated by the milk matrix .


The aim of this study was to determine the impact of a milk matrix on casein protein digestion and absorption kinetics and postprandial muscle protein synthesis in older men .


In a parallel-group design , 32 healthy older men ( aged 71 1 y ) received a primed continuous infusion of L - [ ring - ( 2 ) H5 ] - phenylalanine , L - [ ring-3 ,5 - ( 2 ) H2 ] - tyrosine , and L - [ 1 - ( 13 ) C ] - leucine , and ingested 25 g intrinsically L - [ 1 - ( 13 ) C ] - phenylalanine and L - [ 1 - ( 13 ) C ] - leucine labeled casein dissolved in bovine milk serum ( Cas + Serum ) or water ( Cas ) .


Plasma samples and muscle biopsies were collected in the postabsorptive state and for 300 min in the postprandial period to examine whole-body and skeletal muscle protein metabolism .


Casein ingestion increased plasma leucine and phenylalanine concentrations and L - [ 1 - ( 13 ) C ] - phenylalanine enrichments , with a more rapid rise after Cas vs. Cas + Serum .


Nonetheless , dietary protein-derived phenylalanine availability did not differ between Cas + Serum ( 47 2 % , mean SEM ) and Cas ( 46 3 % ) when assessed over the 300-min postprandial period ( P = 0.80 ) .


The milk matrix did not modulate postprandial myofibrillar protein synthesis rates from 0 to 120 min ( 0.038 0.005 vs. 0.031 0.007 % / h ) or from 120 to 300 min ( 0.052 0.004 vs. 0.067 0.005 % / h ) after Cas + Serum vs. Cas .


Similarly , no treatment differences in muscle protein-bound L - [ 1 - ( 13 ) C ] - phenylalanine enrichments were observed at 120 min ( 0.003 0.001 vs. 0.002 0.001 ) or 300 min ( 0.015 0.002 vs. 0.016 0.002 mole percent excess ) after Cas + Serum vs. Cas .


Casein ingestion in a milk matrix delays protein digestion and absorption but does not modulate postprandial muscle protein synthesis when compared to the ingestion of micellar casein only in healthy older men .


This trial was registered at Nederlands Trial Register as NTR4429 .


On the basis of evidence that resistance to vascular endothelial growth factor ( VEGF ) receptor inhibition is caused by hypoxia-driven residual VEGF and other proangiogenic factors , combinations of agents from these classes were hypothesized to improve treatment outcomes relative to single-agent VEGF pathway blockade .


A total of 361 patients with metastatic clear cell renal cell carcinoma were randomly assigned equally to arm A ( bevacizumab monotherapy 10 mg/kg intravenously [ IV ] every 2 weeks ) , B ( bevacizumab 10 mg/kg IV every 2 weeks and temsirolimus 25 mg IV every week ) , C ( bevacizumab 5 mg/kg IV every 2 weeks and sorafenib 200 mg orally twice daily on days 1 to 5 , 8 to 12 , 15 to 19 , and 22 to 26 ) , or D ( sorafenib 200 mg twice daily and temsirolimus 25 mg IV weekly ) .


Progression-free survival was the primary end point .


Among 331 eligible treated patients , median PFS was 7.5 months for bevacizumab alone ( 90 % CI , 5.8 to 10.8 months ) , 7.6 months for bevacizumab plus temsirolimus ( 90 % CI , 6.7 to 9.2 months ) , 9.2 months for bevacizumab plus sorafenib ( 90 % CI , 7.5 to 11.4 months ) , and 7.4 months for sorafenib plus temsirolimus ( 90 % CI , 5.6 to 7.9 months ) .


Hazard ratios from stratified Cox proportional hazards models were 1.01 , 0.89 , and 1.07 ( with respective P values of .95 , .49 , and .68 ) for the three combinations , respectively , compared with bevacizumab alone .


Adverse events did not differ significantly among treatment arms .


The activity of sorafenib , temsirolimus , and bevacizumab administered in doublet combinations did not significantly improve median progression-free survival in comparison with bevacizumab monotherapy .


Full-time clinician educators are becoming more predominant in China , yet their effect is unknown .


The purpose of this study was to compare the teaching quality of full-time ( FT ) faculty with that of part-time ( PT ) faculty in one Chinese medical school .


In 3 consecutive years , 881 3rd year medical students were enrolled and randomly distributed into two groups , being taught by either a FT faculty member or a PT faculty member .


Their teaching quality was evaluated with student performance on a written exam , the standardized patient exam , and student satisfaction .


The students in the FT group always scored better on the written exam ( 1st year = 79.82 9.2 vs. 81.26 8.2 , p < .188 ; 2nd year = 73.10 9.8 vs. 76.51 7.9 , p = .001 ; 3rd year = 75.15 9.0 vs. 79.51 8.7 , p < .0001 ) .


In the standardized patient exam , the students from FT groups always showed better performance in history taking and physical examination .


Students continually gave higher evaluations to FT faculty in questionnaires ( 1st year = 76.8 6.5 vs. 84.3 2.2 ; 2nd year = 78.6 3.9 vs. 89.7 4.2 ; 3rd year = 75.8 3.9 vs. 88.5 3.5 , all ps < .001 ) .


The teaching quality of FT faculty in clinical-skills training is better than PT faculty in this study .


Muscle loss and metabolic changes occur with disuse [ i.e. bed rest ( BR ) ] .


We hypothesized that BR would lead to a metabolically unhealthy profile defined by : increased circulating tumor necrosis factor ( TNF ) - , decreased circulating insulin-like-growth-factor ( IGF ) -1 , decreased HDL-cholesterol , and decreased muscle density ( MD ; measured by mid-thigh computerized tomography ) .


We investigated the metabolic profile after 28 days of BR with 8 6 % energy deficit in male individuals ( 30-55 years ) randomized to resistance exercise with amino acid supplementation ( RT , n = 24 ) or amino acid supplementation alone ( EAA , n = 7 ) .


Upper and lower body exercises were performed in the horizontal position .


Blood samples were taken at baseline , after 28 days of BR and 14 days of recovery .


We found a shift toward a metabolically unfavourable profile after BR [ compared to baseline ( BLN ) ] in both groups as shown by decreased HDL-cholesterol levels ( EAA : BLN : 39 4 vs. BR : 32 2 mg/dL , RT : BLN : 39 1 vs. BR : 32 1 mg/dL ; p < 0.001 ) and Low MD ( EAA : BLN : 27 4 vs. BR : 22 3 cm ( 2 ) , RT : BLN : 28 2 vs. BR : 23 2 cm ( 2 ) ; p < 0.001 ) .


A healthier metabolic profile was maintained with exercise , including NormalMD ( EAA : BLN : 124 6 vs. BR : 110 5 cm ( 2 ) , RT : BLN : 132 3 vs. BR : 131 4 cm ( 2 ) ; p < 0.001 , time-by-group ) ; although , exercise did not completely alleviate the unfavourable metabolic changes seen with BR .


Interestingly , both groups had increased plasma IGF-1 levels ( EAA : BLN :168 22 vs. BR 213 20 ng/mL , RT : BLN :180 10 vs. BR : 219 13 ng/mL ; p < 0.001 ) and neither group showed TNF changes ( p > 0.05 ) .


We conclude that RT can be incorporated to potentially offset the metabolic complications of BR .


The use of corticosteroids as adjunctive therapy might be effective in patients with community-acquired pneumonia ( CAP ) .


Oral administration of dexamethasone is a practical and safer alternative to the intravenous route .


Since patients hospitalized with pneumonia might have delayed gastric emptying , this study explored systemic exposure in terms of area under the concentration-time curve ( AUC ) of oral dexamethasone in patients hospitalized with CAP .


In this randomized , open label study , 30 patients admitted with CAP were randomized to receive either 4mg intravenous or 6mg oral dexamethasone for 4consecutive days .


Serial blood samples were obtained before and after drug administration .


Median AUC to infinity was 626gl ( -1 ) h ( IQR 401-1161 ) for the intravenous group and 774gl ( -1 ) h ( IQR 618-1146 ) for the oral group .


The AUC ratio of 6mg oral and 4mg intravenous dexamethasone was 1.22 ( 95 % confidence interval ( CI ) 0.81 , 1.82 ) , which represents a bioavailability of 81 % ( 95 % CI 54 , 121 ) after correction for differences in dexamethasone dose .


Bioavailability of oral dexamethasone in patients hospitalized with pneumonia is sufficient .


This makes oral dexamethasone an appropriate alternative for intravenous administration in these patients .


Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society .


Medication and psychological therapies are effective for treating depression and maintenance anti-depressants ( m-ADM ) can prevent relapse .


However , individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term .


A recently developed treatment , mindfulness-based cognitive therapy ( MBCT ) , shows potential as a brief group program for people with recurring depression.This trial asks the policy research question ; is MBCT with support to taper/discontinue antidepressant medication ( MBCT-TS ) superior to m-ADM in terms of : a primary outcome of preventing depressive relapse/recurrence over 24 months ; and secondary outcomes of ( a ) depression free days , ( b ) residual depressive symptoms , ( c ) antidepressant medication ( ADM ) usage , ( d ) psychiatric and medical co-morbidity , ( e ) quality of life , and ( f ) cost effectiveness ?


An explanatory research question also asks whether an increase in mindfulness skills is the key mechanism of change.The design is a single-blind , parallel randomized controlled trial examining MBCT-TS versus m-ADM with an embedded process study .


To answer the main policy research question the proposed trial compares MBCT-TS with m-ADM for patients with recurrent depression .


Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care .


Depressive relapse/recurrence over two years is the primary outcome variable .


Analyses will be conducted following CONSORT standards and overseen by the trial 's Data Monitoring and Safety Committee .


Initial analyses will be conducted on an intention-to-treat basis , with subsequent analyses being per protocol .


The explanatory question will be addressed in two mutually informative ways : quantitative measurement of potential mediating variables pre - and post-treatment and a qualitative study of service users ' views and experiences .


If the results of our exploratory trial are extended to this definitive trial , MBCT-TS will be established as an alternative approach to maintenance antidepressants for people with a history of recurrent depression .


The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches .


Trial registered 7 May 2009 ; ISRCTN26666654 .


The primary study objective was to compare the cosmetic result of radioguided seed localization ( RSL ) with wire localization ( WL ) .


A subgroup of patients enrolled in a multicentered , randomized trial comparing WL with RSL participated .


Frontal photographs were taken 1 and 3years postsurgery .


The European Organization for Research and Treatment of Cancer Cosmetic Rating System was used to evaluate cosmesis outcomes by the patient and a panel of 5 raters .


The study enrolled 73 patients ( WL , n = 38 ; RSL , n = 35 ) .


Most patients rated their overall cosmesis as `` excellent '' or `` good '' ( 76 % WL , 80 % RSL ) .


Patient and panel ratings on all cosmetic outcomes were similar between groups .


Multivariable regression for overall cosmesis found larger specimen volume and reoperation to be predictors of worse ratings .


All cosmetic outcomes assessed were similar after WL and RSL .


The comparable outcomes may reflect similar reoperation rates and volumes of excision between groups .


To determine the effectiveness of presenting individualized colorectal cancer ( CRC ) risk information for increasing CRC screening rates in primary care patients at above-average risk of CRC .


Randomized controlled trial .


Georgia Regents University in Augusta-an academic family medicine clinic in the southeastern United States .


Outpatients ( 50 to 70 years of age ) scheduled for routine visits in the family medicine clinic who were determined to be at above-average risk of CRC .


Individualized CRC risk information calculated from the Your Disease Risk tool compared with a standard CRC screening handout .


Intention to complete CRC screening .


Secondary measures included the proportions of subjects completing fecal occult blood tests , flexible sigmoidoscopy , and colonoscopy .


A total of 1147 consecutive records were reviewed to determine eligibility .


Overall , 210 ( 37.7 % ) of 557 eligible participants were randomized to receive either individualized CRC risk information ( prepared by a research assistant ) or a standard CRC screening handout .


The intervention group had a mean ( SD ) age of 55.7 ( 4.8 ) years and the control group had a mean ( SD ) age of 55.6 ( 4.6 ) years .


Two-thirds of the participants in each group were female .


The intervention group and the control group were matched by race ( P = .40 ) .


There was no significant difference between groups for intention to complete CRC screening ( P = .58 ) .


Overall , 26.7 % of the intervention participants and 27.7 % of the control participants completed 1 or more CRC screening tests ( P = .66 ) .


Presentation of individualized CRC risk information by a nonphysician assistant as a decision aid did not result in higher CRC screening rates in primary care patients compared with presentation of general CRC screening information .


Future research is needed to determine if physician presentation of CRC risk information would result in increased screening rates compared with research assistant presentation .


Mechanisms such as neural sensitization and maladaptive cortical organization provide novel targets for therapy in chronic recurrent low back pain ( CLBP ) .


We investigated the effect of a transcranial direct current stimulation ( tDCS ) and peripheral electrical stimulation ( PES ) treatment on pain , cortical organization , sensitization and sensory function in CLBP .


Using a placebo-controlled crossover design , 16 individuals received four treatments in separate sessions : ( i ) anodal tDCS/PES ; ( ii ) anodal tDCS/sham PES ; ( iii ) sham tDCS/PES ; or ( iv ) sham tDCS/sham PES .


Pain was assessed at baseline , immediately following , and at 1 and 3 days after treatment .


Motor cortical organization , sensitization and sensory function were measured before and immediately after treatment .


Combined tDCS/PES reduced pain and sensitization , normalized motor cortical organization and improved sensory function .


The reduction in pain was greater in individuals with more pronounced sensitization .


Applied alone , tDCS or PES also reduced pain .


However , with the exception of improved sensory function and reduced map volume following PES , clinical and neurophysiological outcomes were unaltered by tDCS or PES applied separately .


No changes were observed following sham treatment .


Our data suggest a combined tDCS/PES intervention more effectively improves CLBP symptoms and mechanisms of cortical organization and sensitization , than either intervention applied alone or a sham control .


Subcutaneous or intrafascial wound infiltration of local anaesthetic with systemic opioids has been shown to enhance patient comfort with improved analgesia and reduced opioid requirements .


To demonstrate improved pulmonary function when postoperative analgesia was provided by combined bupivacaine wound infiltration and systemic opioid .


In a prospective , randomized , placebo-controlled study , 46 patients ( 23 per group ) scheduled for elective gynaecological surgery under general anaesthesia had subcutaneous and intrafascial wound infiltration of 40 ml , 0.25 % bupivacaine ( study patients ) or 40 ml 0.9 % saline ( control ) just before the end of surgery .


Forced vital capacity ( FVC ) , forced expiratory volume in 1 second ( FEV1 ) and peak expiratory flow rate ( PEFR ) were done before surgery and at 6 , 12 and 24 hours postoperatively .


Student 's T and chi-square tests were used for tests of significance set at P < 0.05 .


Postoperative analgesia was provided with intramuscular morphine 0.15 mg/kg 4 hourly and 10mg/kg of intravenous paracetamol as rescue analgesia .


PEFR , FVC and FEV1 were reduced in both the control and study groups but the reduction was greater in the control group .


Bupivacaine wound infiltration produced statistically significant elevations in pulmonary function tests results at all assessment periods .


Lipid deposition on silicone hydrogel ( SiHy ) lenses , which are believed to be caused by their hydrophobic surface , can lead to discomfort , reduced vision , and inflammatory reactions .


This study used a highly specific and sensitive fluorometric enzymatic assay for ex vivo cholesterol analysis of seven types of SiHy lenses : balafilcon A , comfilcon A , enfilcon A , enhanced-lotrafilcon A , enhanced-lotrafilcon B , galyfilcon A , and senofilcon A.


Cholesterol sorption was assessed in 140 previously worn SiHy lenses from 8 clinical trials conducted in the United States and Australia between 2006 and 2008 .


Patients wore the lenses for 2 to 4 weeks .


Unworn negative control lenses for each lens material were obtained directly from the manufacturer .


Lipids were isolated from the lenses using a two-step chloroform : methanol extraction method , and total cholesterol was quantified using a fluorometric enzymatic assay .


Nonparametric Mann Whitney statistical analysis was performed to determine the differences in total cholesterol sorption between lens-specific data sets .


Enhanced-lotrafilcon A and enhanced-lotrafilcon B contact lenses showed significantly lower median total cholesterol sorption ( medianquartile , 0.300.2 g/lens and 0.090.1 g/lens , respectively ) than all other types of lenses that were tested ( P < 0.0001 ) .


By contrast , enfilcon A ( 3.960.8 g/lens ) and galyfilcon A ( 3.751.1 g/lens ) showed the highest median total cholesterol sorption of all tested lenses .


Cholesterol deposition in SiHy contact lenses seems to be lens polymer dependent .


Enhanced-lotrafilcon A and enhanced-lotrafilcon B both sorbed the lowest amount of cholesterol compared with the other five types of SiHy lenses that were tested in this study .


University students usually overestimate peer alcohol use , resulting in them ` drinking up ' to perceived norms .


Social norms theory suggests correcting these inflated perceptions can reduce alcohol consumption .


Recent findings by the current authors show portraying oneself as ' a drinker ' is considered by many students to be a socially desirable component of their Facebook identity , perpetuating an online culture that normalises binge drinking .


However , social networking sites have yet to be utilised in social norms interventions .


Actual and perceived descriptive and injunctive drinking norms were collected from 244 university students .


Ninety-five students screened positive for hazardous drinking and were randomly allocated to a control group or intervention group that received social norms feedback via personalised Facebook private messages over three sessions .


At 1 month post-intervention , the quantity and frequency of alcohol consumed by intervention group during the previous month had significantly reduced compared with baseline and controls .


Reductions were maintained 3 months post-intervention .


Intervention group perceived drinking norms were significantly more accurate post-intervention .


This is the first study to test the feasibility of using Facebook to deliver social norms interventions .


Correcting misperceptions of peer drinking norms resulted in clinically significant reductions in alcohol use .


Facebook has many advantages over traditional social norms delivery , providing an innovative method for tackling problem drinking at university .


These results have implications for the use of Facebook to deliver positive messages about safe alcohol use to students , which may counter the negative messages regarding alcohol normally seen on Facebook .


Randomized trials evaluating efficacy of local infiltration analgesia ( LIA ) have been published but many of these lack standardized analgesics .


There is a paucity of reports on the effects of LIA on functional capability and quality of life .


56 patients undergoing unilateral total knee arthroplasty ( TKA ) were randomized into 2 groups in this placebo-controlled study with 12-month follow-up .


In the LIA group , a mixture of levobupivacaine ( 150 mg ) , ketorolac ( 30 mg ) , and adrenaline ( 0.5 mg ) was infiltrated periarticularly .


In the placebo group , infiltration contained saline .


4 different patient-reported outcome measures ( PROMs ) were used for evaluation of functional outcome and quality of life .


During the first 48 hours postoperatively , patients in the LIA group used less oxycodone than patients in the placebo group in both cumulative and time-interval follow-up .


The effect was most significant during the first 6 postoperative hours .


The PROMs were similar between the groups during the 1-year follow-up .


Single periarticular infiltration reduced the amount of oxycodone used and enabled adequate pain management in conjunction with standardized peroral medication without adverse effects .


No clinically marked effects on the functional outcome after TKA were detected .


The glomerular filtration rate ( GFR ) estimating equation incorporating both cystatin C and creatinine perform better than those using creatinine or cystatin C alone in patients with reduced GFR .


Whether this equation performs well in kidney transplant recipients cross-sectionally , and more importantly , over time has not been addressed .


We analyzed four GFR estimating equations in participants of the Angiotensin II Blockade for Chronic Allograft Nephropathy Trial ( NCT 00067990 ) : Chronic Kidney Disease Epidemiology Collaboration equations based on serum cystatin C and creatinine ( eGFR ( CKD-EPI-Creat + CysC ) ) , cystatin C alone ( eGFR ( CKD-EPI-CysC ) ) , creatinine alone ( eGFR ( CKD-EPI-Creat ) ) and the Modification of Diet in Renal Disease study equation ( eGFR ( MDRD ) ) .


Iothalamate GFR served as a standard ( mGFR ) .


mGFR , serum creatinine , and cystatin C shortly after transplant were 56.1 17.0 ml/min/1 .73 m ( 2 ) , 1.2 0.4 mg/dl , and 1.2 0.3 mg/l respectively .


eGFR ( CKD-EPI-Creat + CysC ) was most precise ( R ( 2 ) = 0.50 ) but slightly more biased than eGFR ( MDRD ) ; 9.0 12.7 versus 6.4 15.8 ml/min/1 .73 m ( 2 ) , respectively .


This improved precision was most evident in recipients with mGFR > 60 ml/min/1 .73 m ( 2 ) .


For relative accuracy , eGFR ( MDRD ) and eGFR ( CKD-EPI-Creat + CysC ) had the highest percentage of estimates falling within 30 % of mGFR ; 75.8 and 68.9 % , respectively .


Longitudinally , equations incorporating cystatin C most closely paralleled the change in mGFR .


eGFR ( CKD-EPI-Creat + CysC ) is more precise and reflects GFR change over time reasonably well .


eGFR ( MDRD ) had superior performance in recipients with mGFR between 30 and 60 ml/min/1 .73 m ( 2 ) .


We conducted a prospective , randomized , comparative study to compare the clinical outcome between the Trendelenburg position ureteroscopic lithotripsy ( tURSL ) and the conventional position ureteroscopic lithotripsy ( cURSL ) for the management of single proximal ureteral stone .


From January 2012 to September 2013 , consecutive patients with single proximal ureteral calculi less than 2 cm and planned for ureteroscopic lithotripsy at our institution were enrolled in this study .


The eligible patients were randomized into cURSL group and tURSL group according to sequence of random numbers generated by computer .


In tURSL group , patients were turned into a Trendelenburg lithotomy position with head down 30 while the conventional lithotomy position was applied in cURSL group .


URSL was performed using a 6/7 .5 F semi-rigid ureteroscope with holmium laser .


When retropulsion occurred , the stones fragments were followed by semi-rigid ureteroscope up to the renal collecting system .


The Olympus P5 flexible ureteroscope was used if there was any suspicion of stone migration into lower calices or incomplete stone fragmentation by semi-rigid ureteroscope .


Patients ' demographics between the two groups , perioperative course , clinical outcome and complication rates were compared .


Data were analyzed using Chi-square test , Fisher 's exact test or Student 's t test .


Binary logistic regression analysis was applied to estimate the effects of surgical position and stone size on stone migration .


A total of 355 cases were finally analyzed in this study ( 176 in cURSL group and 179 in tURSL group ) .


The mean operative time was significantly prolonged in cURSL group than in tURSL group , while the stone-free rate ( SFR ) at 4 weeks was significantly higher in tURSL group .


A statistically significant difference was found in stone migration rate between the two groups ( 26.7 vs. 43.6 % , P = 0.001 ) .


In the stone migration subsetting , less stones fragments were found to migrate into lower calices in tURSL stone migration subgroup ( P = 0.000 ) .


Also , the flexible ureteroscope utilization as well as the operative time was significantly decreased in tURSL stone migration subgroup ( 25.5 vs. 72.3 % , P = 0.000 ) , ( 44.96 11.0 min vs. 59.17 9.2 min , P = 0.000 ) with higher SFR after retrograde intrarenal surgery ( RIRS ) ( 96.2 vs. 74.5 % , P = 0.000 ) .


The tURSL was safe and highly efficacious for the management of proximal ureteral calculus , especially in nonobese patient .


Even with important stone migration risk , it rendered higher SFR and less operative time compared with cURSL .


Moreover , less utilization of flexible ureteroscope and decreased deflection time in tURSL could potentially reduce the medical cost .


To investigate short-term and long-term effects of repetitive peripheral magnetic stimulation ( rpMS ) on spasticity and motor function .


Monocentric , randomized , double-blind , sham-controlled trial .


Neurologic rehabilitation hospital .


Patients ( N = 66 ) with severe hemiparesis and mild to moderate spasticity resulting from a stroke or a traumatic brain injury .


The average time SD since injury for the intervention groups was 26 71 weeks or 37 82 weeks .


rpMS for 20 minutes or sham stimulation with subsequent occupational therapy for 20 minutes , 2 times a day , over a 2-week period .


Modified Tardieu Scale and Fugl-Meyer Assessment ( arm score ) , assessed before therapy , at the end of the 2-week treatment period , and 2 weeks after study treatment .


Additionally , the Tardieu Scale was assessed after the first and before the third therapy session to determine any short-term effects .


Spasticity ( Tardieu > 0 ) was present in 83 % of wrist flexors , 62 % of elbow flexors , 44 % of elbow extensors , and 10 % of wrist extensors .


Compared with the sham stimulation group , the rpMS group showed short-term effects on spasticity for wrist flexors ( P = .048 ) , and long-term effects for elbow extensors ( P < .045 ) .


Arm motor function ( rpMS group : median 5 [ 4-27 ] ; sham group : median 4 [ 4-9 ] ) did not significantly change over the study period in either group , whereas rpMS had a positive effect on sensory function .


Therapy with rpMS increases sensory function in patients with severe limb paresis .


The magnetic stimulation , however , has limited effect on spasticity and no effect on motor function .


Abdominal pain is commonly reported by youth with IBD .


In a significant subset of youth , pain severity and pain catastrophizing ( i.e. , unhelpful thoughts related to the pain ) may contribute to more negative outcomes and greater impairment in functioning .


This study aimed to examine relationships of pain severity and pain catastrophizing with functional disability among a sample of youth with inflammatory bowel disease ( IBD ) .


Seventy-five youth aged 11 to 18 years completed ratings of abdominal pain severity , pain catastrophizing , and functional disability using validated measures .


Disease activity was rated by treating physicians .


Over half of participants reported abdominal pain in the past two weeks , and pain was present among those with and without clinical disease activity .


Nearly one-third of youth reported mild to moderate functional disability .


After controlling for gender , pain severity accounted for 15 % of the variance in patient functional disability .


Moreover , pain catastrophizing contributed significant variance to the prediction of functional disability ( approximately 7 % ) beyond the role of pain severity .


Greater attention to the role of pain catastrophizing in contributing to functional disability in youth with IBD may be important given that pain-related cognitions are modifiable via intervention .


This study attempted to clarify the mechanisms of action of fluoridated acidic liquid dentifrices against dental caries .


In the in vitro leg , enamel specimens were submitted to a pH-cycling model , treated with distinct dentifrices ( 0 , 550 gF/g pH 4.5 and pH 7.0 , 1100 or 5000 gF/g pH 7.0 ) and analyzed using hardness .


Alkali-soluble fluoride ( F ) deposition was quantified on pre-demineralized specimens treated with the dentifrices .


In the clinical leg , 2-to-4-year-old children who had been using liquid dentifrices for 6 months ( 550 gF/g pH 4.5 or pH 7.0 or 1100 gF/g pH 7.0 ) had their plaque samples collected 5 and 60 min after the last brushing .


Fluoride uptake in whole plaque was evaluated .


The reduction of the pH had a partial preventive effect on subsurface hardness loss only .


[ F ] had a significant influence on the deposition of fluoride , surface and subsurface hardness loss .


In vivo , the reduction of the pH was able to significantly increase plaque F uptake , leading to similar levels as those found for the neutral dentifrice containing twice [ F ] .


The results obtained from in vitro studies whose design does not include the presence of dental plaque should be interpreted with caution .


The beneficial effects of fish and n-3 polyunsaturated fatty acids ( PUFAs ) consumption on atherosclerosis have been reported in numerous epidemiological studies .


However , to the best of our knowledge , the effects of a fish-based diet intervention on endothelial function have not been investigated .


Therefore , we studied these effects in postmenopausal women with type 2 diabetes mellitus ( T2DM ) .


Twenty-three postmenopausal women with T2DM were assigned to two four-week periods of either a fish-based diet ( n-3 PUFAs 3.0 g/day ) or a control diet in a randomized crossover design .


Endothelial function was measured with reactive hyperemia using strain-gauge plethysmography and compared with the serum levels of fatty acids and their metabolites .


Endothelial function was determined with peak forearm blood flow ( Peak ) , duration of reactive hyperemia ( Duration ) and flow debt repayment ( FDR ) .


A fish-based dietary intervention improved Peak by 63.7 % , Duration by 27.9 % and FDR by 70.7 % , compared to the control diet .


Serum n-3 PUFA levels increased after the fish-based diet period and decreased after the control diet , compared with the baseline ( 1.49 vs. 0.97 vs. 1.19 mmol/l , p < 0.0001 ) .


There was no correlation between serum n-3 PUFA levels and endothelial function .


An increased ratio of epoxyeicosatrienoic acid/dihydroxyeicosatrienoic acid was observed after a fish-based diet intervention , possibly due to the inhibition of the activity of soluble epoxide hydrolase .


A fish-based dietary intervention improves endothelial function in postmenopausal women with T2DM .


Dissociation between the serum n-3 PUFA concentration and endothelial function suggests that the other factors may contribute to this phenomenon .


To compare the rates of recurrence of chronic subdural hematoma following surgical evacuation by one of two methods , namely , using frontal and parietal burr holes without a drain or a single parietal burr hole with the addition of a subdural drain .


This was a randomized controlled trial with two groups of 70 patients each .


Patients in group I had two burr holes and those in group II had a single burr-hole .


A subdural drain was placed for the second group , and this was removed 48-72 hours later .


Patients were followed up for 3 months and symptomatic recurrences underwent re-exploration .


11 out of 70 patients in group I had recurrent hematomas requiring surgery while only two out of 70 patients in group II had symptomatic recurrences .


The difference was statistically significant ( p = 0.0168 ) .


The use of a single burr hole with drain appears to be a safe and effective procedure for the treatment of chronic subdural hematoma .


Effective motor imagery performance , seen as strong suppression of the sensorimotor rhythm , is the key element in motor imagery therapy .


Therefore , optimization of methods to classify whether the subject is performing the imagery task is a prerequisite .


An optimal classification method should have high performance accuracy and use a small number of channels .


We investigated the additional benefit of the common spatial pattern filtering ( CSP ) to a linear discriminant analysis ( LDA ) classifier , for different channel configurations .


Ten hemispheric acute stroke patients and 11 healthy subjects were included .


EEGs were recorded using 60 channels .


The classifier was trained with a motor execution task .


For both healthy controls and patients , analysis of recordings was initially limited to 3 and 11 electrodes recording from the motor cortex area , and later repeated using 45 electrodes .


No significant improvement on the addition of CSP to LDA was found ( in both cases , the area under the receiving operating characteristic ( AU-ROC ) 0.70 ( acceptable ) ) .


We then repeated the LDA+CSP method on recordings of 45 electrodes , since the use of imagery neuronal circuits may well extend beyond the motor area .


AU-ROC rose to 0.90 , but no virtual ` most responsible ' electrode was observed .


Finally , in mild-to-moderate stroke patients we could successfully use the EEG data recorded from the healthy hemisphere to train the classifier ( AU-ROC 0.70 ) .


Including only the channels on the unaffected motor cortex is sufficient to train a classifier .


Idiopathic inflammatory bowel disease ( IBD ) is a common chronic enteropathy in dogs .


There are no published studies regarding the use of probiotics in the treatment of canine IBD .


The objectives were to compare responses to treatment with either combination therapy ( prednisone and metronidazole ) or probiotic strains ( VSL # 3 ) in dogs with IBD .


Twenty pet dogs with a diagnosis of IBD , ten healthy pet dogs , and archived control intestinal tissues from three euthanized dogs were used in this open label study .


Dogs with IBD were randomized to receive either probiotic ( D-VSL # 3 , n = 10 ) or combination drug therapy ( D-CT , n = 10 ) .


Dogs were monitored for 60 days ( during treatment ) and re-evaluated 30 days after completing treatment .


The CIBDAI ( P < 0.001 ) , duodenal histology scores ( P < 0.001 ) , and CD3 + cells decreased post-treatment in both treatment groups .


FoxP3 + cells ( p < 0.002 ) increased in the D-VSL # 3 group after treatment but not in the D-CT group .


TGF - + cells increased in both groups after treatment ( P = 0.0043 ) with the magnitude of this increase being significantly greater for dogs in the D-VSL # 3 group compared to the D-CT group .


Changes in apical junction complex molecules occludin and claudin-2 differed depending on treatment .


Faecalibacterium and Turicibacter were significantly decreased in dogs with IBD at T0 , with a significant increase in Faecalibacterium abundance observed in the animals treated with VSL # 3 strains .


A protective effect of VSL # 3 strains was observed in dogs with IBD , with a significant decrease in clinical and histological scores and a decrease in CD3 + T-cell infiltration .


Protection was associated with an enhancement of regulatory T-cell markers ( FoxP3 + and TGF - + ) , specifically observed in the probiotic-treated group and not in animals receiving combination therapy .


A normalization of dysbiosis after long-term therapy was observed in the probiotic group .


Larger scale studies are warranted to evaluate the clinical efficacy of VSL # 3 in canine IBD .


Anaesthesia is required for catheter ablation of atrial fibrillation ( A-fib ) to achieve patient comfort and immobilization to avoid map shifts .


This study compared the analgesic and sedative efficacies of dexmedetomidine-remifentanil with those of midazolam-remifentanil for catheter ablation of A-fib .


Ninety patients were randomized to receive either intermittent midazolam boluses ( 1-2 mg ) with 3.6-7 .2 g/kg/h of remifentanil ( MR group ) or dexmedetomidine 0.2-0 .7 g/kg/h after a loading dose of 1 g/kg with 1.2-2 .4 g/kg/h of remifentanil ( DR group ) .


The sedation level assessed by the Ramsay sedation and bispectral index scores , haemodynamic variables , pain score ( 10-point numerical scale ) , and satisfaction levels of the patients and cardiologists ( 5-point numerical scale ) were recorded .