Additional studies with clinical outcomes are required for the clinical relevance of these techniques and to show which one is superior .


Level I , prospective randomised comparative cohort study .


Three-dimensional ( 3D ) laparoscopes have been developed to maintain the perception of depth in the operating field .


Two-dimensional ( 2D ) imaging relies on tactile feedback , visual cues , and previous experience .


The aim of this study was to test if 3D laparoscopic vision is superior to 2D laparoscopic vision in training novice operators in completing set laparoscopic tasks .


The study population consisted of 20 interns and medical students .


The participants were randomized to completing tasks using a 2D or 3D system .


These included pegboard transfer ( PT ) , continuous suturing ( CS ) , and intracorporeal knot-tying ( IK ) .


The time to complete the task and number of errors made were recorded .


Following adjustment for potential confounders , time to complete CS and IK was significantly longer among participants who used the 2D laparoscope compared with those who used the 3D laparoscope ( CS , P < .0001 ; IK , P < .0001 ) .


This same effect was not demonstrated in time to perform PT ( PT , P = .04 ) .


The 2D laparoscope was associated with a significant increase in the number of errors on the IK task ( P < .0001 ) but not on the PT or CS tasks ( PT , P = .35 ; CS , P = .26 ) .


The 3D system assists novice operators perform more complex laparoscopic tasks in a decreased amount of time and with fewer errors .


Office computer workers are at increased risk for neck/upper extremity ( UE ) musculoskeletal pain .


A seven-month office ergonomic intervention study evaluated the effect of two engineering controls plus training on neck/UE pain and mechanical exposures in 113 computer workers , including a 3-month follow-up period .


Participants were randomised into an intervention group , who received a keyboard/mouse tray ( KBT ) , touch pad ( TP ) for the non-dominant hand and keyboard shortcuts , and a control group who received keyboard shortcuts .


Participants continued to have available a mouse at the dominant hand .


Outcomes were pain severity , computer rapid upper limb assessment ( RULA ) , and hand activity level .


Prevalence ratios ( PRs ) evaluated intervention effects using dichotomised pain and exposure scores .


In the intervention group , the dominnt proximal UE pain PR = 0.9 , 95 % CI 0.7 to 1.2 and the dominant distal UE PR = 0.8 , 95 % CI 0.5 to 1.3 , postintervention .


The non-dominant proximal UE pain PR = 1.0 , 95 % CI 0.8 to 1.4 , while the non-dominant distal UE PR = 1.2 , 95 % CI 0.6 to 2.2 , postintervention .


Decreases in non-neutral postures were found in two RULA elements ( non-dominant UE PR = 0.9 , 95 % CI 0.8 to 0.9 and full non-dominant RULA PR = 0.8 , 95 % CI 0.8 to 0.9 ) of the intervention group .


Hand activity increased on the non-dominant side ( PR = 1.4 , 95 % CI 1.2 to 1.6 ) in this group .


While the intervention reduced non-neutral postures in the non-dominant UE , it increased hand activity in the distal region of this extremity .


To achieve lower hand activity , a KBT and TP used in the non-dominant hand may not be the best devices to use .


Brassica vegetable consumption may confer a protective effect against cancer , possibly attributable to their glucosinolates .


Glucobrassicin is a predominant glucosinolate and is the precursor of indole-3-carbinol ( I3C ) , a compound with anticancer effects .


However , objective assessments of I3C uptake from Brassica vegetables have not been successful .


We conducted a randomized , crossover trial to test whether 3,3 ' - diindolylmethane ( DIM , a metabolite of I3C ) excreted in the urine after consumption of raw Brassica vegetables with divergent glucobrassicin concentrations is a marker of I3C uptake from such foods .


Twenty-five subjects were fed 50 g of either raw `` Jade Cross '' Brussels sprouts ( high glucobrassicin concentration ) or `` Blue Dynasty '' cabbage ( low glucobrassicin concentration ) once daily for 3 days .


All urine was collected for 24 hours after vegetable consumption each day .


After a washout period , subjects crossed over to the alternate vegetable .


Urinary DIM was measured using a novel liquid chromatography-electrospray ionization-tandem mass spectrometry-selected reaction monitoring ( LC-ESI-MS/MS-SRM ) method with [ ( 2 ) H2 ] DIM as internal standard .


Urinary DIM was consistently and significantly higher after Brussels sprouts feeding than after cabbage feeding , as evidenced by an average difference of 8.73 pmol/mg creatinine ( 95 % confidence interval , 5.36-12 .10 ; P = 0.00002 ) .


We have successfully quantified urinary DIM after uptake of I3C from food , and demonstrated that differences in glucobrassicin exposure are reflected in urinary DIM levels .


Our LC-ESI-MS/MS-SRM method and the results of our study indicate urinary DIM is a measure of I3C uptake from Brassica vegetables , a finding that can be utilized in prospective epidemiologic and chemoprevention studies .


This study seeks to investigate the effect of electrical stimulation ( ES ) at dorsal root ganglion ( DRG ) on disuse bone loss in a rat model .


Hindlimb unloading for 14 days resulted in significant bone loss in rat tibia while rats with ES at DRG showed a significant reduced bone loss


Mechanical unloading induces osteoporosis in both human and animals .


Previous studies demonstrated that electrical stimulation ( ES ) to dorsal root ganglion ( DRG ) could trigger secretion of calcitonin gene-related peptide ( CGRP ) which plays an important role in bone modeling and remodeling .


This study seeks to investigate the effect of ES to DRG on disuse bone loss in a rat model .


Twenty-four rats were randomly assigned in three experimental groups : cage control ( CC ) , hindlimb unloading ( HU ) , and hindlimb unloading with ES ( HUES ) .


ES was applied via implantable micro-electrical stimulators ( IMES ) to right DRGs at vertebral levels L4-L6 in HUES group .


Hindlimb unloading for 14 days resulted in 25.9 % decrease in total bone mineral content ( BMC ) , 29.2 % decrease in trabecular BMD and trabecular microarchitecture and connectivity were significantly deteriorated in the proximal tibia metaphysis in HU group , while rats with ES at DRG showed significant reduced bone loss that there was 3.8 % increase in total BMC , 2.3 % decrease in trabecular BMD , and significant improvement in trabecular microarchitecture .


There was a concurrent enhancement of expression of CGRP in stimulated DRGs .


The results confirm the effect of ES at DRG on enhancing CGRP expression and suggest potential applications of IMES for the prevention and treatment of disuse bone loss .


To assess the anti-plaque and anti-gingivitis effects of a dentifrice containing 0.3 % triclosan , 2 % copolymer and 0.243 % ( 1,100 ppm ) sodium fluoride in subjects with moderate plaque-induced gingivitis .


This was a single center , monadic study .


Subjects had at least 20 teeth remaining in the functional dentition , excluding third molars .


Following a baseline examination for plaque , gingival inflammation and bleeding , 75 qualified healthy adult males and females , ages 18-70 were selected to participate in the study .


Dental prophylaxis was performed and subjects were provided with two tubes of toothpaste ( Colgate Total ) and a soft-bristle toothbrush ( Colgate Wave Toothbrush ) .


The subjects were instructed to brush twice daily using a modified Bass brushing technique .


At the end of the 6 - to 8-week period subjects returned for collection of clinical and subjective data .


75 subjects completed the study .


Both clinical and subjective reductions were significant .


The results showed statistically significant reductions in plaque index , gingival inflammation and bleeding on probing .


The overall conclusion was that Colgate Total was a comprehensive dentifrice that produced a significant reduction in gingivitis , plaque , and bleeding .


Antimicrobial-induced thrombocytopenia is frequently described in the literature among critically ill patients .


Several antimicrobials have been implicated , although experimental evidence to demonstrate causality is limited .


We report , using a randomized trial , the potential of antimicrobials to induce thrombocytopenia .


Randomized trial allocated patients to antimicrobial treatment according to standard - of-care ( SOC group ) or drug-escalation in case of procalcitonin increases ( high-exposure group ) .


Patients were followed until death or day 28 .


Thrombocytopenia defined as absolute ( platelet count 100 x 109/L ) or relative ( 20 % decrease in platelet count ) .


Analyses were performed in the two randomized groups and as a merged cohort .


Of the 1147 patients with platelet data available , 18 % had absolute thrombocytopenia within the first 24 hours after admission to intensive care unit and additional 17 % developed this complication during follow-up ; 57 % developed relative thrombocytopenia during follow-up .


Absolute and relative thrombocytopenia day 1-4 was associated with increased mortality ( HR : 1.67 [ 95 % CI : 1.30 to 2.14 ] ; 1.71 [ 95 % CI : 1.30 to 2.30 ] , P < 0.0001 , respectively ) .


Patients in the high-exposure group received more antimicrobials including piperacillin/tazobactam , meropenem and ciprofloxacin compared with the SOC group , whereas cefuroxime was used more frequently in the SOC group ( p < 0.05 ) .


Risk of absolute and relative thrombocytopenia ( RR : 0.9 [ 0.7-1 .3 ] , p = 0.7439 ; 1.2 [ 1.0-1 .4 ] , p = 0.06 ; respectively ) , as well as absolute platelet count ( daily difference , high-exposure vs. SOC -1.7 [ -3.8 -0.5 ] , p = 0.14 ) was comparable between groups .


In observational analyses , use of ciprofloxacin and piperacillin/tazobactam predicted risk of relative thrombocytopenia ( vs. cefuroxime , RR : 2.08 [ 1.48-2 .92 ] ; 1.44 [ 1.10-1 .89 ] , respectively ) , however only ciprofloxacin were associated with a reduction in absolute platelet count ( p = 0.0005 ) .


High exposure to broad-spectrum antimicrobials does not result in a reduction in thrombocytopenia in critically ill patients .


However , single use of ciprofloxacin , and less so piperacillin/tazobactam , may contribute to a lower platelet count .


ClinicalTrials.gov NCT00271752 http://clinicaltrials.gov/ct2/show/NCT00271752 .


Severe anemia ( SA , hemoglobin < 6 g/dl ) is a leading cause of pediatric hospital admission in Africa , with significant in-hospital mortality .


The underlying etiology is often infectious , but specific pathogens are rarely identified .


Guidelines developed to encourage rational blood use recommend a standard volume of whole blood ( 20 ml/kg ) for transfusion , but this is commonly associated with a frequent need for repeat transfusion and poor outcome .


Evidence is lacking on what hemoglobin threshold criteria for intervention and volume are associated with the optimal survival outcomes .


We evaluated the safety and efficacy of a higher volume of whole blood ( 30 ml/kg ; Tx30 : n = 78 ) against the standard volume ( 20 ml/kg ; Tx20 : n = 82 ) in Ugandan children ( median age 36 months ( interquartile range ( IQR ) 13 to 53 ) ) for 24-hour anemia correction ( hemoglobin > 6 g/dl : primary outcome ) and 28-day survival .


Median admission hemoglobin was 4.2 g/dl ( IQR 3.1 to 4.9 ) .


Initial volume received followed the randomization strategy in 155 ( 97 % ) patients .


By 24-hours , 70 ( 90 % ) children in the Tx30 arm had corrected SA compared to 61 ( 74 % ) in the Tx20 arm ; cause-specific hazard ratio = 1.54 ( 95 % confidence interval 1.09 to 2.18 , P = 0.01 ) .


From admission to day 28 there was a greater hemoglobin increase from enrollment in Tx30 ( global P < 0.0001 ) .


Serious adverse events included one non-fatal allergic reaction and one death in the Tx30 arm .


There were six deaths in the Tx20 arm ( P = 0.12 ) ; three deaths were adjudicated as possibly related to transfusion , but none secondary to volume overload .


A higher initial transfusion volume prescribed at hospital admission was safe and resulted in an accelerated hematological recovery in Ugandan children with SA .


Future testing in a large , pragmatic clinical trial to establish the effect on short and longer-term survival is warranted .


ClinicalTrials.Gov identifier : NCT01461590 registered 26 October 2011 .


The objective of this study was to test the hypothesis that topical tetracaine would be safe to use for 24 hours and would not affect corneal healing , that patients would experience more pain relief , and that patients would perceive tetracaine to be more effective than saline eye drops for the treatment of pain caused by corneal abrasions .


The study was a 12-month , prospective , double-blind , randomized trial of tetracaine versus saline set in the emergency department ( ED ) of a regional tertiary care teaching hospital .


A total of 116 patients presenting with uncomplicated corneal abrasions were included in this study .


The intervention was either undiluted , preservative-free , topical tetracaine hydrochloride 1 % or saline , applied up to every 30 minutes while awake for 24 hours .


Main safety outcome measures were repeat ED examinations at 48 hours with fluorescein staining and slit-lamp examination , 1-week and 1-month telephone interviews with additional examinations as needed , and monitoring of charts for complications .


Secondary outcome measures were 100-mm visual analogue scale ( VAS ) pain scores recorded every 2 hours while awake for 48 hours and patient-perceived overall effectiveness using a numeric rating scale ( NRS ) of 0 to 10 obtained during telephone interviews .


At least one follow-up encounter was completed on each of the 116 patients .


No complications specifically attributed to topical anesthetic use occurred in the 59 patients in the tetracaine group , and the binomial probability confidence interval ( CI ) of this occurring is 0 to 6.1 .


There was no significant difference in corneal healing as measured by the percentage of patients with persistent fluorescein uptake at 48 hours between the two groups ( 23.9 % vs. 21.3 % , difference = 2.6 % , 95 % CI = -14 % to 20 % , p = 0.761 ) or persistent symptoms at 48 hours ( 21.7 % vs. 21.3 % , difference = 0.4 % , 95 % CI = -16 % to 17 % , p = 0.957 ) .


There was no clinical difference in VAS pain scores between the groups .


Patients in the tetracaine group rated the study drugs ' overall effectiveness significantly higher on the NRS ( 7.7 vs. 3.9 ) compared to patients in the saline group ( difference = 3.9 , 95 % CI = 2.4 to 5.3 , p < 0.0005 ) .


Topical tetracaine used for 24 hours is safe , and while there was no significant difference in patient VAS pain ratings over time , patient surveys on overall effectiveness showed that patients perceived tetracaine to be significantly more effective than saline .


Food insecurity is associated with deficits in child development and health , but little is known about how children 's specific food-insecurity experiences play out through nutritional and non-nutritional pathways that may compromise well-being .


This study used child self-reports of food insecurity to examine the types of food-insecurity experiences that were most prevalent and the relations between child food insecurity ( CFI ) , child diet , and child physical activity ( PA ) .


A total of 3605 fourth - and fifth-grade children whose schools participated in the Network for a Healthy California-Children 's PowerPlay !


campaign completed 24-h diary-assisted recalls and surveys including items from the Child Food Security Assessment and questions about PA. .


Data were analyzed by using regression and logistic regression models .


CFI was present in 60 % of the children and included experiences of cognitive , emotional , and physical awareness of food insecurity .


Greater levels of CFI were associated with higher consumption of energy , fat , sugar , and fiber and a diet lower in vegetables .


For instance , a child at the highest level of CFI , on average , consumed 494 kJ/d ( 118 kcal ) , 8 g/d of sugar , and 4 g/d of fat more than a food-secure child .


Higher CFI was associated with a marginally significant difference ( P = 0.06 ) in minutes of PA ( 17 min/d less for children at the highest level of CFI vs. those who were food secure ) and with significantly greater perceived barriers to PA. .


CFI is a troublingly frequent , multidomain experience that influences children 's well-being through both nutritional ( dietary ) and non-nutritional ( e.g. , PA ) pathways .


CFI may lead to poor-quality diet and less PA and their developmental consequences .


Practitioners should consider CFI when assessing child health and well-being and can do so by asking children directly about their CFI experiences .


Prenatal supplementation with docosahexaenoic acid ( DHA ) has been shown to increase birth size , but it is unclear whether these differences translate into improved postnatal growth .


We assessed the effect of prenatal supplementation with DHA on offspring weight , length , and body mass index ( BMI ) through 60 mo of age .


We examined growth patterns ( height , weight , and BMI ) in a cohort of 802 Mexican children whose mothers participated in a randomized , controlled trial of daily supplementation with 400 mg/d of DHA or a placebo from week 18-22 of gestation through delivery , with the use of a longitudinal multilevel model of growth .


Overall , means SDs of height - , weight - , and BMI-for-age z scores relative to WHO growth standards at 60 mo were -0.49 0.91 , -1.15 1.07 and 0.13 1.11 , respectively .


There were no significant differences by treatment group ( all P > 0.05 ) for height , weight , or BMI at any age through 60 mo. .


Similarly , DHA did not affect the average growth or the trajectories for these measures through 60 mo. .


Prenatal DHA supplementation did not affect height , weight , or BMI through 60 mo of age .


This trial was registered at clinicaltrials.gov as NCT00646360 .


This study investigates the clinical effects of autologous conditioned plasma ( ACP ) injections and low-level laser application as therapy options for chronic lateral epicondylitis .


A total of 52 patients with chronic lateral epicondylitis were evaluated in this study ; 26 of these patients received three ACP injections and the control group , with 26 patients , received 12 laser applications , with standardized physical therapy for all patients afterward .


Control examinations took place before treatment , after 2 and 6 mos , and in the 1 yr final follow-up .


The control examination included the visual analog scale for pain and Disabilities of the Arm , Shoulder and Hand outcome measure scores .


The analysis at final follow-up after 1 yr showed that both treatment options resulted in successful therapy outcome for the patients .


In total , 63.5 % were successfully treated .


Successful treatment was defined as more than 30 % improvement in the visual analog score and more than 10.2 points in the Disabilities of the Arm , Shoulder and Hand score .


Both groups showed a significant improvement in time response .


This study demonstrates the beneficial effects of autologous proliferative therapies in the treatment of lateral epicondylitis .


The data show that laser application and ACP therapy lead to a clinical improvement in epicondylopathia .


Especially the new treatment with ACP can be highlighted as an alternative and as an easy-to-apply therapy option for clinical practice .


The purpose of the present study was to evaluate the effects of superimposed electromyostimulation ( E ) during cycling on myokines and markers of muscle damage , as E might be a useful tool to induce a high local stimulus to skeletal muscle during endurance training without performing high external workloads .


13 subjects participated in three experimental trials each lasting 60 min in a randomized order .


1 ) Cycling ( C ) , 2 ) Cycling with superimposed E ( C+E ) and 3 ) E. Interleukin-6 ( IL-6 ) , brain-derived neurotrophic factor ( BDNF ) , creatine kinase ( CK ) and myoglobin were determined before ( pre ) and 0 ' , 30 ' , 60 ' , 240 ' and 24h after each intervention .


Only C+E caused significant increases in levels of CK and myoglobin .


BDNF and IL-6 significantly increased after C and C+E , however increases for IL-6 were significantly higher after C+E compared to C.


The present study showed that superimposed E during cycling might be a useful tool to induce a high local stimulus to skeletal muscle even when performing low to moderate external workloads .


This effect might be due the activation of additional muscle fibers and mild eccentric work due to the concomitant activation of agonist and antagonist .


However the higher load to skeletal muscle has to be taken into account .


Energy drinks are beverages containing vasoactive metabolites , usually a combination of caffeine , taurine , glucuronolactone and sugars .


There are concerns about the safety of energy drinks with some countries banning their sales .


We determined the acute effects of a popular energy drink , Red Bull , on cardiovascular and hemodynamic variables , cerebrovascular parameters and microvascular endothelial function .


Twenty-five young non-obese and healthy subjects attended two experimental sessions on separate days according to a randomized crossover study design .


During each session , primary measurements included beat-to-beat blood pressure measurements , impedance cardiography and transcranial Doppler measurements for at least 20min baseline and for 2h following the ingestion of either 355mL of the energy drink or 355mL of tap water ; the endothelial function test was performed before and two hours after either drink .


Unlike the water control load , Red Bull consumption led to increases in both systolic and diastolic blood pressure ( p < 0.005 ) , associated with increased heart rate and cardiac output ( p < 0.05 ) , with no significant changes in total peripheral resistance and without diminished endothelial response to acetylcholine ; consequently , double product ( reflecting myocardial load ) was increased ( p < 0.005 ) .


Red Bull consumption also led to increases in cerebrovascular resistance and breathing frequency ( p < 0.005 ) , as well as to decreases in cerebral blood flow velocity ( p < 0.005 ) and end-tidal carbon dioxide ( p < 0.005 ) .


Our results show an overall negative hemodynamic profile in response to ingestion of the energy drink Red Bull , in particular an elevated blood pressure and double product and a lower cerebral blood flow velocity .


While darbepoetin alfa ( DA ) can be administered once monthly ( QM ) to maintain haemoglobin ( Hb ) concentrations in anaemic patients with chronic kidney disease not on dialysis ( CKD-ND ) , the QM use of DA for anaemia correction has not been previously investigated .


In this randomized , double-blind , non-inferiority , active-controlled study , adult subjects with CKD-ND , Hb levels < 10g/dL , and not treated with an erythropoiesis-stimulating agent were randomized 1:1 to receive DA every 2 weeks ( Q2W ) or QM for 33 weeks with initial doses of 0.75 g/kg Q2W or 1.5 g/kg QM .


Subjects were treated to target Hb levels of 10-12g / dL and 1g/dL increase from baseline .


The primary end-point was Hb change between baseline and the evaluation period ( weeks 29-33 ) , with a non-inferiority margin of -0.5 g/dL .


Three hundred and fifty-five subjects received 1 dose of DA .


Mean ( 95 % confidence interval [ CI ] ) change in Hb between baseline and the evaluation period was 2.16 ( 1.98-2 .33 ) g/dL for the Q2W group and 1.97 ( 1.80-2 .14 ) g/dL for the QM group , the mean ( 95 % CI ) difference in Hb change being -0.19 ( -0.43 to 0.05 ) g/dL .


Most subjects ( 97.9 % Q2W ; 98.1 % QM ) achieved a Hb level 10.0 g/dL and 1.0 g/dL increase in Hb from baseline .


Mean DA ( SD ) weekly equivalent doses over the evaluation period were 0.20 ( 0.23 ) and 0.27 ( 0.31 ) g/kg per week for the Q2W and QM groups , respectively .


Safety profiles were similar between groups .


In subjects with CKD-ND , QM dosing was non-inferior to Q2W dosing for anaemia correction and had a similar safety profile .


To compare the effect of semi-recumbent and sitting positions on gas exchange , respiratory mechanics and hemodynamics in patients weaning from mechanical ventilation .


Upright positions are encouraged during rehabilitation of the critically ill but there effects have not been well described .


A prospective , randomized , cross-over trial was conducted .


Subjects were passively mobilized from supine into a seated position ( out of bed ) and from supine to a semi-recumbent position ( > 45 backrest elevation in bed ) .


Arterial blood gas ( PaO2/FiO2 , PaO2 , SaO2 , PaCO2 and A-a gradient ) , respiratory mechanics ( VE , VT , RR , Cdyn , RR/VT ) and hemodynamic measurements ( HR , MABP ) were collected in supine and at 5min and 30min after re-positioning .


Thirty-four intubated and ventilated subjects were enrolled .


The angle of backrest inclination in sitting ( 675 ) was greater than gained with semi-recumbent positioning ( 505 , p < 0.001 ) .


There were no clinically important changes in arterial blood gas , respiratory mechanic or hemodynamic values due to either position .


Neither position resulted in significant changes in respiratory and hemodynamic parameters .


Both positions can be applied safely in patients being weaned from ventilation .


To explore the optimal timing of tirofiban early treatment in ST-segment elevated acute myocardial infarction ( STEMI ) undergoing elective percutaneous coronary intervention ( PCI ) .


A total of 118 consecutive STEMI patients were enrolled in the study .


They were randomly assigned to the tirofiban early treatment group with tirofiban administrated routinely at 4 hours prior to angiography or the control group with tirofiban provisional administrated during or after angiography .


Thrombolysis in myocardial infarction ( TIMI ) flow , creatine kinase MB isoenzyme ( CK-MB ) levels , acute thrombus events , efficacy and safety endpoints at Day 7 , Day 30 , 6 months and 1 year ( efficacy endpoints : death , myocardial infarction , target vessel revascularization and ischemic stroke ; safety endpoints : bleeding and thrombocytopenia ) were observed and compared between the two groups .


A total of 104 STEMI patients underwent elective PCI with 52 patients in each group and the baseline characteristics were balanced between the two groups .


Tirofiban was administered ( 5.9 2.9 ) hours earlier in the tirofiban early treatment group than the control group .


No statistical difference was observed between the two groups in TIMI flow before [ grade 0 : 18 ( 34.6 % ) vs 19 ( 36.5 % ) , grade 3 : 28 ( 53.8 % ) vs 27 ( 51.9 % ) ] and after PCI [ grade 3 : 52 ( 100.0 % ) vs 51 ( 98.1 % ) ] .


No difference was shown between the two groups in CK-MB levels before PCI [ ( 12.9 5.1 ) U/L vs ( 12.0 5.2 ) U/L , P > 0.05 ] ; and the increase of CK-MB 12-24 hours after PCI [ ( 1.0 6.2 ) U/L vs ( 2.3 8.3 ) U/L , P > 0.05 ] .


The incidence of acute thrombus events was similar ( 7.7 % vs 15.4 % , P > 0.05 ) .


No statistical difference was observed between the two groups in the efficacy endpoints at Day 7 ( 0.0 % vs 7.7 % , P > 0.05 ) , Day 30 ( 0.0 % vs 7.8 % , P > 0.05 ) , 6 months ( 2.0 % vs 9.8 % , P > 0.05 ) and 1 year ( 2.2 % vs 9.8 % , P > 0.05 ) .


Similar incidence was shown in the slight bleeding ( 15.4 % vs 5.8 % , P > 0.05 ) and the slight thrombocytopenia ( 0.0 % vs 1.9 % , P > 0.05 ) , while no severe to moderate bleeding or severe thrombocytopenia happened in both groups .


Tirofiban early treatment is not better than the tirofiban bailout treatment during or after PCI in STEMI patients undergoing elective PCI .


Trail registration ChiCTR-TRC-10000809 .


To investigate whether Sudarshan Kriya and related practices ( SK&P ) can lead to increased global assessment of functioning ( GAF ) and increased feeling of wellness in male prisoners with a non psychotic psychiatric disorder .


This is a six month parallel randomized controlled study with sample size of 230 male prisoners .


Participants meeting inclusion and exclusion criteria were assigned to a study or control group by simple random allocation in which random allocation sequence was generated using a random number table .


Each individual study participant was involved in a daily program of SK&P for six weeks .


Each individual control participant was instructed to sit in an armchair with his eyes closed and gentle attention to their breath for duration of six weeks .


To be included in this study , a participant must be a male prisoner diagnosed to be suffering from a psychiatric disorder ( except psychosis and bipolar affective disorder [ BPAD ] ) by ICD-10 ( DCR ) criteria with age between 18 and 65 years .


Majority of subjects were unemployed married individuals , educated until undermatric level and not having occupational skills of more than an unskilled labor level .


Practicing SK&P for six weeks led to improvement in meanSD score of study participants in GAF , anxiety ( ANX ) , depressed mood ( DEP ) , positive well being ( PWB ) , general health ( GH ) , self control ( SC ) , vitality ( VT ) and total positive general well being ( PGWB ) .


Change in meanSD score of study participants when compared with control participants was statistically significant in terms of GAF , ANX , DEP , PWB , GH and PGWB .


Increase in SC and VT scores was statistically insignificant when compared with control participants .


Practicing SK&P helps in improving GAF , PWB , GH and total PGWB of an individual .


SK&P also causes significant reduction in anxiety and depression levels .


Effect of SK&P on SC and VT is insignificant .


The immune checkpoint inhibitor ipilimumab is the standard-of-care treatment for patients with advanced melanoma .


Pembrolizumab inhibits the programmed cell death 1 ( PD-1 ) immune checkpoint and has antitumor activity in patients with advanced melanoma .


In this randomized , controlled , phase 3 study , we assigned 834 patients with advanced melanoma in a 1:1:1 ratio to receive pembrolizumab ( at a dose of 10 mg per kilogram of body weight ) every 2 weeks or every 3 weeks or four doses of ipilimumab ( at 3 mg per kilogram ) every 3 weeks .


Primary end points were progression-free and overall survival .


The estimated 6-month progression-free-survival rates were 47.3 % for pembrolizumab every 2 weeks , 46.4 % for pembrolizumab every 3 weeks , and 26.5 % for ipilimumab ( hazard ratio for disease progression , 0.58 ; P < 0.001 for both pembrolizumab regimens versus ipilimumab ; 95 % confidence intervals [ CIs ] , 0.46 to 0.72 and 0.47 to 0.72 , respectively ) .


Estimated 12-month survival rates were 74.1 % , 68.4 % , and 58.2 % , respectively ( hazard ratio for death for pembrolizumab every 2 weeks , 0.63 ; 95 % CI , 0.47 to 0.83 ; P = 0.0005 ; hazard ratio for pembrolizumab every 3 weeks , 0.69 ; 95 % CI , 0.52 to 0.90 ; P = 0.0036 ) .


The response rate was improved with pembrolizumab administered every 2 weeks ( 33.7 % ) and every 3 weeks ( 32.9 % ) , as compared with ipilimumab ( 11.9 % ) ( P < 0.001 for both comparisons ) .


Responses were ongoing in 89.4 % , 96.7 % , and 87.9 % of patients , respectively , after a median follow-up of 7.9 months .


Efficacy was similar in the two pembrolizumab groups .


Rates of treatment-related adverse events of grade 3 to 5 severity were lower in the pembrolizumab groups ( 13.3 % and 10.1 % ) than in the ipilimumab group ( 19.9 % ) .


The anti-PD-1 antibody pembrolizumab prolonged progression-free survival and overall survival and had less high-grade toxicity than did ipilimumab in patients with advanced melanoma .


( Funded by Merck Sharp & Dohme ; KEYNOTE-006 ClinicalTrials.gov number , NCT01866319 . )


The aim of this study was to evaluate the effectiveness of specially processed cereal ( SPC ) as a suitable adjunctive treatment for Meniere 's disease .


We performed a randomized double-blinded , placebo-controlled , crossover study in a tertiary referral center of patients who had a diagnosis of Meniere 's disease based on the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery ( AAO-HNS ) .


The main outcome measure was the AAO-HNS Functional Level Scale ( FLS ) .


Thirty-nine patients completed the study without any reported complications .


The mean pretreatment FLS score for the entire study cohort was 3.8 ( median , 4 ; range , 1 to 6 ) .


The overall FLS score improved significantly ( p < 0.001 ) , to 2.8 ( median , 3 ) , after SPC treatment .


No patients showed worsening on the FLS during SPC or placebo treatment .


Of the 39 patients , 23 showed improvement on the FLS , and no change was observed in the remaining 16 .


The median improvement on the FLS in these 23 patients was 2 points ( mean , 1.7 ; range , 1 to 4 ) .


The mean FLS score after placebo cereal treatment was not significantly different from baseline ( p = 0.452 ) , but was significantly higher than that after SPC treatment ( mean , 3.7 ; p < 0.001 ) .


The marginal difference observed between the baseline FLS score and the placebo FLS score was due to the fact that 5 patients reported 1-point improvements on the FLS after placebo treatment .


Nevertheless , significantly fewer patients improved on placebo than on SPC ( p < 0.001 ) .


Treatment with SPC appears to be well tolerated by most patients ( 91 % ) without any complications .


More than half ( 59 % ) of the study cohort reported subjective improvement in functional level .


This study sought to randomly compare cerebral protection with ANGIOGUARD ( Cordis Corporation , Bridgewater , New Jersey ) with Mo.Ma ( Invatec/Medtronic Vascular Inc , Santa Rosa , California ) during carotid artery stenting ( CAS ) , using diffusion-weighted magnetic resonance imaging ( DW-MRI ) to detect new ischemic cerebral lesions .


The number , size , and location of lesions were analyzed .


The choice of the type of cerebral protection during CAS is controversial .


From July 2008 to July 2011 , 60 patients undergoing CAS were randomized to ANGIOGUARD or Mo.Ma , distributed by chance , 30 patients for each group .


All patients underwent DW-MRI before and after CAS .


An independent neuroradiologist blinded to the cerebral protection used analyzed the images .


Univariate and multivariate logistic models were fitted to analyze new ischemic lesions .


Alternatively , a propensity score approach was used to reduce the bias due to differences between the groups .


For the number of lesions , we used Poisson regression models .


New ischemic lesions seen on DW-MRI were present in 63.3 % of the ANGIOGUARD group versus 66.7 % of the Mo.Ma cohort ( p = 0.787 ) .


The number of ischemic cerebral lesions per patient , when present , was significantly lower in the Mo.Ma group ( a median of 6 lesions per patient vs. a median of 10 in the ANGIOGUARD , p < 0.001 ) .


Most lesions were small ( < 0.5 mm ) and localized in the ipsilateral territory .


One patient in the ANGIOGUARD group had a minor stroke during CAS ( 1.66 % ) .


New ischemic lesions seen on DW-MRI were present in both groups in > 60 % , but the number of lesions per patient was greater in the ANGIOGUARD group .


No death or disabling stroke occurred during at least 1 year of follow-up in both cohorts .


This double-blind randomized controlled trial assessed the effect of subgingival ozone ( O3 , gaseous ozone , HealOzone MK II , KaVo ) and/or hydrogen peroxide ( H2O2 ) on the development of peri-implant mucositis .


Twenty subjects ( mean age , 60 7.7 years ) with 80 implants ( 4 implants each ) were recruited .


First , a 2-week pretrial phase took place to achieve healthy gingiva .


Subsequently , partial gum shields were constructed for the experimental area ( around the 4 implants ) ; subjects were asked to refrain from brushing in that area by wearing the gum shield .


The following treatments were randomly applied ( for 60 seconds ) to implant sites on days 0 , 7 , and 14 : ( 1 ) air ( O2 ) and saline ( 0.9 % NaCl ) ( control group ) , ( 2 ) O2 and H2O2 ( 3 % ) , ( 3 ) O3 and saline , and ( 4 ) O3 and H2O2 .


Plaque , gingival , and bleeding indices were recorded on days 0 , 7 , 14 , and 21 .


Significant differences were seen among the treatments ( P < .01 ) in plaque ( F = 16.68 ) , modified gingival ( F = 7.86 ) , and bleeding ( F = 18.42 ) indices .


O3 + saline and O3 + H2O2 produced optimum gingival health scores and were equally effective and the most effective in controlling bleeding ( mean score = 0.05 ) , while O2 + saline was the least effective ( mean score = 0.56 ) .


Ozone showed great potential for management of peri-implant mucositis .


Cardiogenic shock ( CS ) complicating acute myocardial infarction ( AMI ) is associated with high mortality .


Previous studies regarding gender-specific differences in CS are conflicting and there are insufficient data for the presence of gender-associated differences in the contemporary percutaneous coronary intervention era .


Aim of this study was therefore to investigate gender-specific differences in a large cohort of AMI patients with CS undergoing contemporary treatment .


In the randomized Intra-aortic Balloon Pump in Cardiogenic Shock II ( IABP-SHOCK II ) trial , 600 patients with CS complicating AMI undergoing early revascularization were assigned to therapy with or without intra-aortic balloon pump .


We compared sex-specific differences in these patients with regard to baseline and procedural characteristics as well as short - and long-term clinical outcome .


Of 600 patients 187 ( 31 % ) were female .


Women were significantly older than men and had a significantly lower systolic and diastolic blood pressure at presentation ( p < 0.05 for all ) .


Diabetes mellitus and hypertension were more frequent in women , whereas smoking was more frequent in men ( p < 0.05 for all ) .


Women showed a higher mortality within the first day after randomization ( p = 0.004 ) .


However , after multivariable adjustment this numerical difference was no longer statistically significant .


No gender-related differences in clinical outcome were observed after 1 , 6 and 12 months of follow-up .


In this large-scale multicenter study in patients with CS complicating AMI , women had a worse-risk profile in comparison to men .


No significant gender-related differences in treatment as well as short - and long-term outcome were observed .


Performing rigorously designed clinical trials in device-based treatments is challenging .


Continuous positive airway pressure ( CPAP ) is the most effective device-based treatment for obstructive sleep apnoea .


We performed a randomised crossover trial of CPAP versus placebo therapy and did not disclose the presence of placebo .


We assessed rates of staff unblinding , the likelihood of patient unblinding and obtained patient perceptions on lack of full disclosure .


All patients ( n = 30 ) underwent a semi-structured exit interview .


Prior to full disclosure patients were asked questions to ascertain whether they suspected one therapy was ineffective .


The use of placebo was then disclosed and additional questions were administered to indicate the likelihood of unblinding had full disclosure occurred during consent .


Staff unblinding was determined by means of a questionnaire that was completed after each patient encounter .


While the lack of full disclosure prevented patient unblinding during the trial , patients revealed a clear preference for active CPAP .


After disclosing the presence of placebo , 73 % ( n = 22 ) felt they would have been unblinded had they known at the start of the trial .


Only one patient described unease about the lack of full disclosure .


Staff thought they were unblinded in 6 % ( n = 16/282 ) of encounters .


They correctly identified the treatment device in 69 % of cases ( n = 11/16 , p < 0.001 ) .


Successful patient blinding was achieved , however this was probably reliant on the lack of full disclosure .


Staff unblinding occurred and highlights the difficulty with investigator blinding in device-based trials .


Ethical challenges in this type of study are likely to compromise research feasibility .


This clinical trial is registered with the Australian and New Zealand Clinical Trials Registry at http://www.anzctr.org.au ( ACTRN 12605000066684 ) .


Closer clinical supervision has been increasingly promoted to improve patient care .


However , the continuous bedside presence of supervisors may threaten the model of progressive independence traditionally associated with effective clinical training .


Studies have shown favourable effects of closer supervision on trainees ' learning , but have not paid specific attention to the learning processes involved .


We conducted a simulation-based study to explore the learning opportunities created during simulated resuscitation scenarios under different levels of supervision .


Fifty-three residents completed a supervised scenario .


Residents were randomised to one of three levels of supervision : telephone ( distant ) ; in-person after telephone consultation ( immediately available ) , and in-person from the beginning of the simulation ( direct ) .


These interactions were converted into 234 pages of transcripts for analysis .


We performed an inductive thematic analysis followed by a deductive analysis using situated learning theory as a theoretical framework .


Learning opportunities created during simulated scenarios were identified as belonging to either of two categories , incidental and engineered opportunities .


The themes resulting from this framework contributed to our understanding of trainees ' contributions to patient care , supervisors ' influences on patient care , and trainee-supervisor interactions .


All forms of supervision offered trainees incidental opportunities for practice , although the nature of these contributions could be affected by the bedside presence of supervisors .


Supervisors ' involvement in patient care by telephone and in person was associated with a shift of responsibility for patient care , but represented , respectively , engineered and incidental opportunities for observation .


In-person supervisor-trainee interactions added value to observation and created additional opportunities for incidental feedback and engineered practice .


The shift of responsibility for patient care occurred during both direct and distant supervision , and did not necessarily translate into a lack of opportunities for trainee participation and practice .


To evaluate the effect of muscovite in preventing small bowel injury induced by nonsteroidal anti-inflammatory drugs ( NSAIDs ) .


We recruited and screened thirty-two healthy volunteers who were randomly allocated equally into two groups : an NSAID control group , who received 75 mg slow-release diclofenac , twice daily for 14 d ; and an NSAID-muscovite group , who received 3 g of muscovite in addition to the 75 mg of slow-release diclofenac , twice daily for 14 d. For gastroprotection , both groups were administered 20 mg/d of the proton pump inhibitor omeprazole .


All eligible subjects underwent video capsule endoscopy ( CE ) prior to and 14 d after treatment .


Thirty subjects ( NSAID-muscovite group , n = 16 ; NSAID control group , n = 14 ) finally completed the whole trail .


At the baseline CE examination , no statistically significant differences between the two groups have been observed .


However , after 14 d of drug treatment , a significant difference was observed in the percentage of subjects with mucosal breaks when comparing the NSAID-muscovite group with the NSAID control group .


While 71.4 % ( 10/14 ) of subjects in the NSAID control group had at least one mucosal break , co-administration of muscovite in the NSAID-muscovite group reduced the rate to 31.3 % ( 5/16 ) ( P = 0.028 ) .


Moreover , higher number of mucosal breaks was found in the NSAID control group vs that in the NSAID-muscovite group ( P < 0.05 ) .


Muscovite co-therapy reduced the incidence of small intestinal injury after 14 d of diclofenac administration .


Bursectomy , a traditional operative procedure to remove the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon , has been performed for serosa-positive gastric cancer in Japan and Eastern Asia .


We conducted a multicenter , randomized , controlled trial to demonstrate the noninferiority of the omission of bursectomy .


Between July 2002 and January 2007 , 210 patients with cT2-3 gastric adenocarcinoma were randomized intraoperatively to D2 gastrectomy with or without bursectomy .


The primary endpoint was overall survival ( OS ) .


We provide the results of the final analysis of the complete 5-year follow-up data .


After the median follow-up of 80 months , 5-year OS was 77.5 % for the bursectomy group and 71.3 % for the nonbursectomy group ( 2-sided P = .16 for superiority ; 1-sided P = .99 for noninferiority ) .


The hazard ratio for death in the nonbursectomy group was 1.40 ( 95 % CI , 0.87-2 .25 ) .


The 5-year recurrence-free survivals were 73.7 % and 66.6 % in the bursectomy and nonbursectomy groups , respectively ( 2-sided P = .33 for superiority ; 1-sided P = .99 for noninferiority ) .


Cox multivariate analysis revealed that bursectomy was an independent prognostic factor of good OS ( P = .033 ) .


Subgroup analysis showed a trend toward improved survival after bursectomy for tumors in the middle or lower third of the stomach and for pathologically serosa-positive tumors .


The final analysis could not demonstrate the noninferiority of the omission of bursectomy .


Bursectomy should not be abandoned as a futile procedure .


To assess the comparative efficacy and safety of pregabalin and levetiracetam for the reduction of seizure frequency in patients with partial seizures .


This was a randomized , double-blind , flexible-dose , parallel-group noninferiority study of pregabalin and levetiracetam ( randomized 1:1 ) as adjunctive treatment in adult patients with refractory partial seizures .


The study included a 6-week baseline phase , 4-week dose-escalation phase , and 12-week maintenance phase .


The primary endpoint was the proportion of patients with a 50 % reduction in 28-day seizure rate during the 12-week maintenance phase , as compared with baseline .


Noninferiority of pregabalin was declared if the lower limit of the 95 % confidence interval ( CI ) for the difference in responder rates was greater than the prespecified noninferiority margin of -12 % .


A key secondary endpoint was the percent change from baseline in 28-day seizure rate during the dose-escalation and maintenance phases .


Five hundred nine patients were randomized to pregabalin ( n = 254 ) or levetiracetam ( n = 255 ) and 418 ( 208 pregabalin , 210 levetiracetam ) completed the maintenance phase .


With both pregabalin and levetiracetam , the proportion of patients with a 50 % reduction in 28-day seizure rate was 0.59 ( difference between groups [ 95 % CI ] , 0.00 [ -0.08 to 0.09 ] ) .


Because the lower bound of the 95 % CI was greater than the prespecified noninferiority margin of -12 % , pregabalin was not inferior to levetiracetam .


There was no significant difference between pregabalin and levetiracetam in the percent change in 28-day seizure rate ( median difference [ 95 % CI ] , 4.1 [ -2.6 to 10.9 ] , p = 0.3571 ) .


In a post hoc analysis , the proportion of patients who were seizure-free for the maintenance phase was lower with pregabalin ( 8.4 % ) than with levetiracetam ( 16.2 % ) , p = 0.0155 .


Safety profiles were similar and consistent with prior trials .


These results indicate that pregabalin is noninferior , and has a similar tolerability , to levetiracetam as adjunctive therapy in reducing seizure frequency in patients with partial seizures .


Nicorandil , an ATP sensitive potassium channel opener , may reduce the incidence of microvascular dysfunction after percutaneous coronary intervention ( PCI ) by dilating coronary resistance vessels .


The aim of the study was evaluation of the impact of the administration of intravenous nicorandil on measuring the index of microcirculatory resistance ( IMR ) in PCI to patients with stable angina pectoris ( SAP ) .


Intravascular ultrasound ( IVUS ) , fractional flow reserve ( FFR ) , IMR and blood examination ( CK-MB ) , cardiac troponin I ( cTnI ) immediately post-PCI ( and 24 hours later ) were performed in 62 consecutive patients with SAP undergoing PCI .


FFR and IMR were measured simultaneously with a single coronary pressure wire .


IMR was defined as Pd/coronary flow ( or Pd * mean transit time ) at peak hyperaemia .


Patients were randomised to the control ( n = 29 ) , or nicorandil group ( n = 33 ) .


In the nicorandil group , nicorandil was intravenously administered as a 6 mg bolus injection just before PCI and as a constant infusion at 6 mg/hour for 24 hours thereafter .


All volumetric IVUS parameters and FFR were similar between the two groups both pre - and post-PCI .


However , IMR immediately post-PCI and cTnI 24 hours post-PCI were significantly higher in the control group compared to the nicorandil group ( IMR : 25.412.1 vs. 17.99.1 units , and cTnI : 0.210.13 vs. 0.120.08 ng/mL , for control vs. nicorandil ) .


The incidence for cTnI elevation more than fivefold the normal range ( > 0.20 ng/mL ) was significantly larger in the control group than in the nicorandil group ( 41 % vs. 12 % , p < 0.01 ) .


Additionally , the control group showed a closer correlation between plaque volume reduction during stenting as assessed by volumetric IVUS , and cTnI elevation than the nicorandil group ( r = 0.55 vs. 0.42 , p < 0.001 for control vs. nicorandil ) .


In patients undergoing successful coronary stenting for stable angina , administration of nicorandil is associated with reduced microvascular dysfunction induced by PCI .


Methadone maintenance treatment ( MMT ) patients have an exceedingly high prevalence of tobacco use , and interventions that have been specifically developed for this vulnerable subpopulation have struggled to attain even modest rates of cessation .


A significant barrier has been an inability to initiate a quit attempt early in the treatment process and adherence to treatment .


This study examined the extent to which self-efficacy , medication adherence , and other demographic and smoking variables predicted an early quit day in a sample of MMT smokers ( n = 315 ) enrolled in a smoking cessation pharmacotherapy trial .


Using logistic regression , we estimated the association of having an early quit day-24hr without smoking during the first month of treatment .


Only 35.2 % of participants reported a successful early quit day .


The likelihood of an early quit day increased significantly ( odds ratio [ OR ] = 1.39 , 95 % CI = 1.04-1 .86 , p < .05 ) with education level and if a quit attempt was made in the past year ( OR = 2.27 , 95 % CI = 1.33-3 .87 , p < .01 ) .


Compared to the placebo arm , those randomized to either nicotine replacement therapy ( OR = 3.25 , 95 % CI = 1.30-8 .10 , p < .01 ) or varenicline ( OR = 3.16 , 95 % CI = 1.26-7 .92 ) were significantly more likely to have an early quit day .


The likelihood of an early quit day was also positively associated with adherence to the medication protocol ( OR = 2.05 , 95 % CI = 1.52-2 .76 ) .


Difficulty in achieving an early quit attempt may help explain the very low cessation rates found in studies of MMT smokers .


Most women with breast cancer who undergo breast-conserving surgery receive whole-breast irradiation .


We examined whether the addition of regional nodal irradiation to whole-breast irradiation improved outcomes .


We randomly assigned women with node-positive or high-risk node-negative breast cancer who were treated with breast-conserving surgery and adjuvant systemic therapy to undergo either whole-breast irradiation plus regional nodal irradiation ( including internal mammary , supraclavicular , and axillary lymph nodes ) ( nodal-irradiation group ) or whole-breast irradiation alone ( control group ) .


The primary outcome was overall survival .


Secondary outcomes were disease-free survival , isolated locoregional disease-free survival , and distant disease-free survival .


Between March 2000 and February 2007 , a total of 1832 women were assigned to the nodal-irradiation group or the control group ( 916 women in each group ) .


The median follow-up was 9.5 years .


At the 10-year follow-up , there was no significant between-group difference in survival , with a rate of 82.8 % in the nodal-irradiation group and 81.8 % in the control group ( hazard ratio , 0.91 ; 95 % confidence interval [ CI ] , 0.72 to 1.13 ; P = 0.38 ) .


The rates of disease-free survival were 82.0 % in the nodal-irradiation group and 77.0 % in the control group ( hazard ratio , 0.76 ; 95 % CI , 0.61 to 0.94 ; P = 0.01 ) .


Patients in the nodal-irradiation group had higher rates of grade 2 or greater acute pneumonitis ( 1.2 % vs. 0.2 % , P = 0.01 ) and lymphedema ( 8.4 % vs. 4.5 % , P = 0.001 ) .


Among women with node-positive or high-risk node-negative breast cancer , the addition of regional nodal irradiation to whole-breast irradiation did not improve overall survival but reduced the rate of breast-cancer recurrence .


( Funded by the Canadian Cancer Society Research Institute and others ; MA .20 ClinicalTrials.gov number , NCT00005957 . )


Screening for lung cancer with low-dose spiral computed tomography ( LDCT ) has been shown to reduce lung cancer mortality by 20 % compared with screening with chest X-ray ( CXR ) in the National Lung Screening Trial , but uncertainty remains concerning the efficacy of LDCT screening in a community setting .


To explore the effect of LDCT screening on lung cancer mortality compared with no screening .


Secondary endpoints included incidence , stage , and resectability rates .


Male smokers of 20 + pack-years , aged 60 to 74 years , underwent a baseline CXR and sputum cytology examination and received five screening rounds with LDCT or a yearly clinical review only in a randomized fashion .


A total of 1,264 subjects were enrolled in the LDCT arm and 1,186 in the control arm .


Their median age was 64.0 years ( interquartile range , 5 ) , and median smoking exposure was 45.0 pack-years .


The median follow-up was 8.35 years .


One hundred four patients ( 8.23 % ) were diagnosed with lung cancer in the screening arm ( 66 by CT ) , 47 of whom ( 3.71 % ) had stage I disease ; 72 control patients ( 6.07 % ) were diagnosed with lung cancer , with 16 ( 1.35 % ) being stage I cases .


Lung cancer mortality was 543per100 ,000 person-years ( 95 % confidence interval , 413-700 ) in the LDCT arm versus 544per100 ,000 person-years ( 95 % CI , 410-709 ) in the control arm ( hazard ratio , 0.993 ; 95 % confidence interval , 0.688-1 .433 ) .


Because of its limited statistical power , the results of the DANTE ( Detection And screening of early lung cancer with Novel imaging TEchnology ) trial do not allow us to make a definitive statement about the efficacy of LDCT screening .


However , they underline the importance of obtaining additional data from randomized trials with intervention-free reference arms before the implementation of population screening .


Migraine headaches are a significant problem for American women with many of them suffering from headaches around the time of their menstrual cycle .


Women taking oral contraceptives in the standard 21/7 cycle regimen often suffer from headaches around the time of the hormone free intervals ( HFIs ) as well .


Extended oral contraceptive regimens have been shown to decrease the frequency , but not eliminate these headaches .


This study is a double-blind , randomized , placebo-controlled pilot study of participants with menstrual-related migraines ( MRMs ) who were initiated on extended combined oral contraceptives and given frovatriptan prophylactically during HFIs .


Participants having spontaneous menstrual cycles or taking daily combined oral contraceptives in a 21/7 regimen with MRMs were placed on a contraceptive containing levonorgestrel and ethinyl estradiol .


Analyses compared headache scores during pre-study baseline cycles to those in a 168-day extended regimen with placebo versus frovatriptan treatments during HFIs .


Daily headache scores decreased ( p = 0.034 ) from 1.29 0.10 during pre-study cycles to 1.10 0.14 during extended combined oral contraceptive use .


Frovatriptan blocked the increase in headache score over the placebo during HFIs .


However , following the withdrawal of frovatriptan , headache scores increased ( p > 0.01 ) despite resuming combined oral contraceptive use .


Extended combined oral contraceptive regimen reduces MRM severity .


Frovatriptan prevents headaches during HFIs , but is associated with new headache symptoms when withdrawn .


To compare the anaesthetic , analgesic and cardiorespiratory effects of intramuscular ( IM ) medetomidine and ketamine administered alone or combined with morphine or tramadol , for orchiectomy in cats .


Randomised , blinded , prospective clinical study .


Thirty client-owned cats .


Cats ( n = 10 in each group ) received a combination of medetomidine ( 60 gkg ( -1 ) ) and ketamine ( 10 mg kg ( -1 ) ) alone ( MedK ) ; combined with morphine ( 0.2 mg kg ( -1 ) ) ( MedKM ) , or combined with tramadol ( 2 mg kg ( -1 ) ) ( MedKT ) IM .


Time of induction , surgical and recovery events were recorded , and physiological parameters measured and recorded .


Analgesia was evaluated with a visual analogue scale , a composite scoring system and the von Frey mechanical threshold device , every hour from three to eight hours post-drug administration injection .


Data were analyzed with a linear mixed model , Kruskal-Wallis or Chi-square tests ( p < 0.05 ) .


Median ( IQR ) induction and recovery times ( minutes ) were not significantly ( p = 0.125 ) different between groups : 5.6 ( 2.7-8 .0 ) , 7.4 ( 5.1-9 .6 ) and 8.0 ( 5.8-14 .9 ) for induction and 128.5 ( 95.1-142 .8 ) , 166.4 ( 123.1-210 .0 ) and 142.9 ( 123.4-180 .2 ) for recovery , with MedK , MedKT and MedKM , respectively .


Two cats ( MedKM ) required alfaxalone for endotracheal intubation .


In all groups , three or four cats required additional isoflurane for surgery .


Arterial oxygen tension overall ( mean SD : 66 2 mmHg ) was low .


Surgery resulted in increased systolic arterial blood pressure ( p < 0.001 ) , haemoglobin saturation ( p < 0.001 ) , respiratory ( p = 0.003 ) and heart rates ( p = 0.002 ) .


Pain scores did not differ significantly between groups .


Von Frey responses decreased over time ; changes over time varied by treatment ( p < 0.001 ) , MedK returning to baseline values more rapidly than MedKM and MedKT .


No cat required rescue analgesics .


All three protocols can provide adequate anaesthesia and analgesia for orchiectomy in cats .


However , rescue intervention to maintain surgical anaesthesia may be required in some cats .


Oxygen supplementation is advised .


The value of frequent Carcino-Embryonic Antigen ( CEA ) measurements and CEA-triggered imaging for detecting recurrent disease in colorectal cancer ( CRC ) patients was investigated in search for an evidence-based follow-up protocol .


This is a randomized-controlled multicenter prospective study using a stepped-wedge cluster design .


From October 2010 to October 2012 , surgically treated non-metastasized CRC patients in follow-up were followed in eleven hospitals .


Clusters of hospitals sequentially changed their usual follow-up care into an intensified follow-up schedule consisting of CEA measurements every two months , with imaging in case of two CEA rises .


The primary outcome measures were the proportion of recurrences that could be treated with curative intent , recurrences with definitive curative treatment outcome , and the time to detection of recurrent disease .


3223 patients were included ; 243 recurrences were detected ( 7.5 % ) .


A higher proportion of recurrences was detected in the intervention protocol compared to the control protocol ( OR = 1.80 ; 95 % - CI : 1.33-2 .50 ; p = 0.0004 ) .


The proportion of recurrences that could be treated with curative intent was higher in the intervention protocol ( OR = 2.84 ; 95 % - CI : 1.38-5 .86 ; p = 0.0048 ) and the proportion of recurrences with definitive curative treatment outcome was also higher ( OR = 3.12 , 95 % - CI : 1.25-6 .02 , p-value : 0.0145 ) .


The time to detection of recurrent disease was significantly shorter in the intensified follow-up protocol ( HR = 1.45 ; 95 % - CI : 1.08-1 .95 ; p = 0.013 ) .


The CEAwatch protocol detects recurrent disease after colorectal cancer earlier , in a phase that a significantly higher proportion of recurrences can be treated with curative intent .


To monitor the development of graft vascularization after pterygium excision with conjunctival autograft transplantation ( CAT ) using indocyanine green angiography ( ICGA ) and to compare the graft vascularization between 2 different fixation techniques ( fibrin glue and sutures ) .


A total of 26 eyes of 26 patients with primary pterygium were randomly assigned after pterygium excision as having either fibrin glue ( 13 eyes ) or Vicryl sutures ( 13 eyes ) for CAT .


Anterior segment ICGA findings were evaluated postoperatively at 1 , 7 , and 15 days and the percentages of graft vascularization in both groups were compared using pixel analysis software program .


The mean SD age of patients in the suture and fibrin glue groups was 52.1 12.7 years and 57.1 9.82 years , respectively .


There was no statistically significant difference between the groups regarding age , sex , or follow-up ( p < 0.05 for all ) .


Also , the mean intraoperative defect size was not significantly different between the groups , which was measured as 20.11 10.44 mm2 in the suture group and 23.44 12.34 mm2 in the fibrin glue group ( p = 0.343 ) .


The mean percentage of vascularized graft area at postoperative day 1 and 7 was 18.1 7.8 % and 25.3 8.6 % in the suture group and 34.8 10.2 % and 66.1 17.8 % in the fibrin glue group .


The difference between the groups was statistically significant ( p < 0.01 for both ) .


At postoperative day 15 , all grafts were 100 % perfused in both groups .


Fibrin glue fixation of conjunctival autografts led to more vascularization in the early postoperative period than suture fixated grafts , which in turn may have significance in terms of graft health and pterygium recurrence .


To explore the effects of parecoxib sodium multimode analgesia on postoperative analgesia in patients undergoing laparoscopic cholecystectomy ( LC ) .


A prospective , double-blind , randomized and placebo-controlled study was conducted on 80 patients undergoing elective LC at Department of Endoscopic Surgery , First Affiliated Hospital , Wenzhou Medical College from March 2011 to June 2011 .


They were randomized to receive either 40 mg parecoxib infusion 30 min preoperative and at 12 , 24 , 36 , 48 h post-operation ( treatment group ) .


And 2 ml normal saline infusion was administered similarly as a placebo ( control group ) .


All patients received ropivacaine infusion at port sites at the end of LC .


The degree of postoperative pain was assessed with visual analog scale ( VAS ) at 1 , 2 , 4 , 8 , 12 , 24 , 36 , 48 h post-operation respectively .


The consumption of pethidine in the first 24 h post-operation was also recorded .


The VAS pain scores at each timepoint were significantly lower in the treatment group than those in the control group ( 1 h : 1.0 0.6 vs 1.8 0.6 , t = -1.650 , P = 0.000 ; 2 h : 1.3 0.6 vs 1.9 0.7 , t = -4.302 , P = 0.000 ; 4 h : 1.6 0.7 vs 2.7 1.2 , t = -4.752 , P = 0.000 ; 8 h : 2.5 1.4 vs 5.0 1.8 , t = -6.835 , P = 0.000 ; 12 h : 2.2 1.1 vs 3.3 1.5 , t = -3.902 , P = 0.000 ; 24 h : 1.6 0.8 vs 2.5 1.4 , t = -3.649 , P = 0.000 ; 36 h : 1.2 0.6 vs 2.2 0.8 , t = -6.390 , P = 0.000 ; 48 h : 1.0 0.5 vs 1.5 0.6 , t = -3.710 , P = 0.000 ) .


And the amount of pethidine used in the first 24h after LC was also less in the treatment group ( 150 vs 950 mg , ( 2 ) = 16.200 , P = 0.000 ) .


The infusion multimode analgesia of parecoxib sodium 40 mg provides significant effect of postoperative pain relief after laparoscopic cholecystectomy .


In this study we aimed to assess the feasibility and safety of fast-track surgery ( FTS ) combined with laparoscopy for treating patients with rectal cancer and compare the results with those of the conventional perioperative intervention group .


A total of 120 patients with rectal cancer were prospectively randomly assigned to the FTS combined with laparoscopy group and the conventional perioperative intervention plus laparoscopy group from November 2011 to November 2012 .


All patients received radical anterior resection with total mesorectal excision .


Their baseline characteristics and the perioperative outcomes were recorded for analyses .


Compared with the conventional perioperative intervention group , the fast-track protocol combined with laparoscopy could shorten the time to the first flatus ( 53.4423.64 h vs 67.8520.12 h , P = 0.001 ) and first defecation ( 65.2322.24 h vs 86.9824.85 h , P = 0.000 ) after operation , accelerate the decrease of white blood cell count ( P < 0.05 ) , inhibit body temperature augmentation ( P < 0.05 ) and reduce postoperative complication rate ( 16.9 % vs 3.5 % , P = 0.030 ) .


In addition , the length of postoperative stay was also shortened ( 5.051.38 days vs 6.982.26 days , P = 0.000 ) .


The medical cost of hospitalization was also reduced in the FTS group .


FTS in combination with laparoscopy may accelerate the clinical recovery of patients with rectal cancer after surgery .


Plant-made biotherapeutics are gathering momentum and some plant glycoproteins are allergens .


Glycans with core 1-2xylose and 1,3 fucose motifs and antennae terminated by mannose residues ( e.g. : MMXF ) are found on several plant allergens and can cross-react with glyco-epitopes from other sources .


To date , reactivity to these cross-reactive determinants has not been associated with clinical symptoms .


We produced VLP vaccines bearing the hemagglutinin ( HA ) of H5 ( A/Indonesia/5 / 05 ) or H1 ( A/California/07 / 09 ) influenza viruses by transfection of Nicotiana benthamiana .


Subjects enrolled in Phase I/II trials were followed for evidence of allergy/hypersensitivity and development of antibodies against plant glyco-epitopes .


A total of 280/349 subjects received either one ( H1 ) or 2 doses ( H5 ) of vaccine ( 5-45 g of HA/dose ) intramuscularly including 40 with pre-existing plant allergies .


Subjects were monitored for 6 months .


IgG and IgE to plant glyco-epitopes were measured by ELISA using corn - / egg-derived avidin and bromelain as target antigens .


No subject developed allergic/hypersensitivity symptoms .


Some ( 34 % ) developed transient IgG and , in some cases IgE , to plant glyco-epitopes but no subject mounted an IgE response to the MMXF motif .


Antibodies returned to baseline by 6 months in most subjects .


VLP vaccines bearing influenza HA glycoproteins can elicit transient IgG and , in some cases , IgE responses that are not associated with either the development or worsening of allergic/hypersensitivity symptoms .


Cognitive training has been shown to improve both cognitive and everyday abilities in older adults ; however , little is known concerning the amount of training needed or the characteristics of those who benefit .


These analyses examined the longitudinal impact of dosage ( number of training sessions ) on the improvement and maintenance of cognitive and everyday function .


ACTIVE is a longitudinal , randomized , single-blind clinical trial evaluating cognitive interventions in older adults ( aged 65-94 ) from six states in the United States .


Latent growth curve models indicated that initial training effects were maintained over 5 years and amplified by booster sessions .


A single booster session counteracted 4.92 months of age-related processing speed decline .


Cognitive performance improved by 2.5 standard deviations for participants who attended all 10 initial sessions and all 8 booster sessions compared to randomized participants who attended none .


Implications for the broader application of cognitive training interventions are discussed .


Galectin-3 is a prognostic heart failure biomarker associated with aldosterone-induced myocardial fibrosis ; mineralocorticoid receptor antagonists ( MRAs ) may reduce such fibrosis .


We sought to examine outcomes of patients with heart failure with reduced ejection fraction ( HFrEF ) as a function of galectin-3 and MRA therapy .


A total of 151 patients with chronic HFrEF were categorized by baseline galectin-3 and subsequent MRA therapy trends with regard to cardiovascular ( CV ) events , left ventricular remodeling , safety , and quality of life , over a mean of 10 months .


Although galectin-3 > 20 ng/mL was associated with doubling in adjusted risk for CV events , regardless of MRA treatment , there was no difference in CV event rates with regard to MRA use patterns , independent of galectin-3 concentrations .


Specifically , in patients with elevated galectin-3 treated with intensified MRA therapy , a significant difference was not detected in CV event rates ( P = .79 ) or the cumulative number of such events ( P = .76 ) .


Adjusted analysis revealed no difference in time to first CV event if MRA was added/intensified in those with elevated galectin-3 ( hazard ratio 0.99 , 95 % CI 0.97-1 .02 , P = .74 ) ; similarly , cumulative MRA dose was not a specific predictor of benefit .


In those with elevated galectin-3 , MRA therapy did not affect left ventricular remodeling indices or quality of life at follow-up ; these patients had the highest rates of treatment-related adverse events with intensified MRA use .


Regardless of MRA use , elevated galectin-3 was associated with more significant renal dysfunction .


Among patients with chronic HFrEF and elevated galectin-3 concentrations , we found no specific benefit from addition or intensification of MRA therapy .


To observe the curative effect of acupuncture at hour-prescriptive points , a method of midnight-noon ebb-flow , to treat female adult abdominal obesity with spleen deficiency and exuberant dampness .


Seventy-two patients with adult abdominal obesity with spleen deficiency and exuberant dampness were randomly divided into a treatment group and a control group with 36 patients in each group .


Patients in the treatment group were treated with acupuncture at hour-prescriptive points from 9 to 11 AM every day on the principle of taking points along channels in time .


Patients in the control group were treated with acupuncture at any time beyond 9 to 11 AM .


Patients in both groups were treated for three courses of treatment .


The total effective rate was 87.5 % in the treatment group and 78.8 % in the control group .


The total curative effect in the treatment group was significantly better than that in the control group in reducing body weight , body mass index , waistline , obesity level , and clinical symptoms ( P < 0.05 ) .


After treatment , t-test was used on two independent samples to analyze the ratio of waistline to hipline and hipline .


A value of 0.01 < P < 0.05 expressed a weaker outcome and similar curative effect between the two groups in reducing ratio of waistline to hipline and hipline of patients .


This value indicates that the treatment group has no obvious superiority to that of the control group for curative effect .


Because it was superior in reducing waistline and body weight of female adult patients suffering from abdominal obesity with spleen deficiency and exuberant dampness , acupuncture at hour-prescriptive points , a method of midnight-noon ebb-flow , is an effective method to treat obesity .


To evaluate how an intervention , which combined hand washing promotion aimed at 5-year-olds with provision of free soap , affected illnesses among the children and their families and children 's school absenteeism .


We monitored illnesses , including diarrhoea and acute respiratory infections ( ARIs ) , school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai , India ( 35 communities per arm ) .


Outcomes from 847 intervention households ( containing 847 5-year-olds and 4863 subjects in total ) and 833 control households ( containing 833 5-year-olds and 4812 subjects ) were modelled using negative binomial regression .


Intervention group 5-year-olds had fewer episodes of diarrhoea ( -25 % , 95 % confidence intervals [ CI ] = -37 % , -2 % ) , ARIs ( -15 % , 95 % CI = -30 % , -8 % ) , school absences due to illnesses ( -27 % , 95 % CI = -41 % , -18 % ) and eye infections ( -46 % , 95 % CI = -58 % , -31 % ) .


Further , there were fewer episodes of diarrhoea and ARIs in the intervention group for ` whole families ' ( -31 % , 95 % CI = -37 % , -5 % ; and -14 % , 95 % CI = -23 % , -6 % , respectively ) , 6 - to 15-year-olds ( -30 % , 95 % CI = -39 % , -7 % ; and -15 % , 95 % CI = -24 % , -6 % ) and under 5 s ( -32 % , 95 % CI = -41 % , -4 % ; and -20 % , 95 % CI = -29 % , -8 % ) .


Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family .


These may be scalable through public-private partnerships and classroom-based campaigns .


Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference .


Canine babesiosis due to Babesia canis is an endemic disease in many European countries .


A vaccine is available in some countries , but it does not prevent the infection and just helps in reducing the gravity of clinical signs .


Therefore , the major way to help preventing the disease is by controlling tick infestations on dogs.To assess the preventive efficacy of afoxolaner ( NexGard ) , a new oral anti- flea and tick product , against Babesia canis infected adult Dermacentor reticulatus in an experimentally controlled study .


Sixteen healthy mixed breed adult dogs , negative for Babesia canis antibodies were included in a single centre , randomized , blinded and controlled study to evaluate the impact of treatment with afoxolaner on the transmission of Babesia canis to dogs exposed to Dermacentor reticulatus .


The dogs were randomly allocated into two groups of 8 dogs each .


One group remained untreated .


In the other group , dogs were treated orally with a novel formulation of afoxolaner ( NexGard ) on day 0 .


All dogs were infested each by 50 adult Dermacentor reticulatus ticks ( equal sex ratio ) at days 7 , 14 , 21 and 28 .


The Dermacentor reticulatus ticks were confirmed to harbour Babesia canis by Polymerase Chain Reaction ( PCR ) .


The treatment was well tolerated by all dogs without any adverse effects .


Babesia canis was transmitted by D. reticulatus to all untreated control dogs , confirmed following demonstration of hyperthermia , detection of B. canis parasites in blood smears and PCR assay from blood and serology .


These confirmed infected dogs were subsequently treated with imidocarb and diminazene .


The treated dogs remained negative based on all criteria until the last study , Day 56 , confirming that the oral treatment of dogs with NexGard prevented transmission of Babesia canis and development of clinical babesiosis for up to 28 days .


This is the first demonstration that an oral acaricidal treatment may prevent the transmission of a pathogen despite the need for the tick to attach and start feeding before being killed by the acaricide .


Medical trainees have identified stress as an important contributor to their medical errors in acute care environments .


The objective of this study was to determine if the addition of acute stressors to simulated resuscitation scenarios would impact on residents ' simulated clinical performance .


Fifty-four residents completed a control and a high-stress simulated scenario on separate visits .


Stress measures were collected before and after scenarios .


Two assessors independently evaluated residents ' videotaped performance .


Both control and high-stress scenarios triggered significant stress responses among participants ; however , stress responses were not significantly different between control and high-stress conditions .


No difference in performance was found between control and high-stress conditions ( F value = 2.84 , p = .098 ) .


Residents exposed to simulated resuscitation scenarios experienced significant stress responses irrespective of the presence of acute stressors during these scenarios .


This anticipatory stressful response could impact on resident learning and performance and should be further explored .


This prospective , randomized , double-blind study was designed to evaluate the use of intranasally administered dexmedetomidine vs intranasal midazolam as a premedication in children undergoing complete dental rehabilitation .


Seventy-two children of American Society of Anesthesiology classification ( ASA ) physical status ( I & II ) , aged 3-6 years , were randomly assigned to one of two equal groups .


Group M received intranasal midazolam ( 0.2 mgkg ( -1 ) ) , and group D received intranasal dexmedetomidine ( 1 gkg ( -1 ) ) .


The patients ' sedation status , mask acceptance , and hemodynamic parameters were recorded by an observer until anesthesia induction .


Recovery conditions , postoperative pain , and postoperative agitation were also recorded .


The median onset of sedation was significantly shorter in group M 15 ( 10-25 ) min than in group D 25 ( 20-40 ) min ( P = 0.001 ) .


Compared with the children in group M , those in group D were significantly more sedated when they were separated from their parents ( 77.8 % vs 44.4 % , respectively ) ( P = 0.002 ) .


Satisfactory compliance with mask application was 58.3 % in group M vs 80.6 % in group D ( P = 0.035 ) .


The incidences of postoperative agitation and shivering were significantly lower in Group D compared with group M. Thirteen children ( 36.1 % ) in group M , showed signs of nasal irritation with teary eyes , and none of these signs was seen in the children in group D ( P = 0.000 ) .


There were no incidences of bradycardia , hypotension , in either of the groups during study observation .


Intranasal dexmedetomidine ( 1 gkg ( -1 ) ) is an effective and safe alternative for premedication in children ; it resulted in superior sedation in comparison to 0.2 mgkg ( -1 ) intranasal midazolam .


However , it has relatively prolonged onset of action .


To examine the effectiveness , acceptability and sustainability of interventions to reduce vitamin B12 ( B12 ) deficiency in South Asian women before conception .


A 6-month randomised controlled trial conducted in Auckland , New Zealand .


Participants ( 62 South Asian women , 18-50 years old ) were stratified by dietary practices , then randomised to three treatment groups : B12 Supplement ( oral cyanocobalamin 6g/day ) ( n = 21 ) , Placebo ( n = 21 ) , or B12 Dietary Advice ( n = 20 ) .


Primary outcome measures were changes in B12 biomarkers ( serum B12 and holotranscobalamin ( holoTC ) ) at 6 months .


Dietary B12 intake was estimated from a B12 food-specific frequency questionnaire ( B12FFQ ) .


Intention-to-treat analysis was applied using ` last observation carried forward ' method .


Changes in B12 biomarkers by treatment were compared using analysis of variance .


Pearson 's correlations tested relationships between dietary B12 intake and B12 biomarkers .


At baseline , 48 % of women tested as insufficient or deficient in serum B12 ( < 222pmol/l ) and 51 % as insufficient or deficient in holoTC ( < 45pmol/l ) .


B12 status was moderately correlated with dietary B12 intake ( r = 0.5 , 95 % confidence interval ( CI ) ( 0.3-0 .7 ) ) and 44 % of women reported insufficient dietary intake ( < 2.4 g/day ) .


B12 Supplement was the only treatment group to record a significant increase in B12 biomarkers over 6 months : serum B12 by 30 % ( 95 % CI ( 11-48 % ) ) and holoTC by 42 % ( 12-72 % ) .


The prevalence of B12 insufficiency among Auckland South Asian women is high and moderately correlated with inadequate intake of foods that contain B12 .


Cyanocobalamin supplementation ( 6g/day ) was associated with improved B12 biomarkers , with a potential to improve preconception B12 status in South Asian women .


To compare the results of combined non-penetrating deep sclerectomy with phacoemulsification ( Phaco-NPDS ) to those of non-penetrating deep sclerectomy ( NPDS ) alone .


Fifty-two eyes with cataract and primary open angle glaucoma ( POAG ) or pseudoexfoliative glaucoma ( PXG ) were randomly assigned to either Phaco-NPDS or NPDS .


Follow-up was performed at regular intervals for up to 36 months .


Complete success was defined as intraocular pressure ( IOP ) < 21mmHg without medication and qualified success was defined as IOP < 21mmHg with medication .


Mean IOP in the Phaco-NPDS group decreased from 23.07.8 mmHg to 14.12.8 mmHg and in the NPDS group from 23.5 5.1 to 14.62.2 mmHg 24 months after surgery .


The decreases of IOP in the postoperative period were statistically significant in both groups ( p < 0.05 ) .


There was no significant IOP difference between Phaco-NPDS and NPDS patients postoperatively ( p > 0.05 ) .


The mean number of glaucoma medications decreased from 1.81.3 to 0.150.4 and from 1.71.4 to 0.220.6 in the Phaco-NPDS and NPDS groups , respectively .


The decreases in the mean number of the anti-glaucoma medications at the end of the postoperative , 24-month follow-up period were found to be statistically significant for both Phaco-NPDS and NPDS groups ( p < 0.05 ) .


Mean BCVA increased significantly in both groups .


However , the visual outcome was significantly better for the Phaco-NPDS group ( p < 0.05 ) .


The complete and qualified success rates were 65.3 % and 88.4 % for Phaco-NPDS patients and 73.1 % and 92.3 % for NPDS patients , respectively ( p > 0.05 ) .


Phaco-NPDS surgery achieved excellent IOP control , while also providing immediate visual recovery .


The success rate was similar to that of the NPDS procedure alone .


It is advisable to consider Phaco-NPDS as a primary surgery for patients with coexisting cataract and open angle glaucoma , including PXG .


Depression is a major public health problem that affects both individuals and society .


Previous studies report that university teachers are particularly susceptible to high levels of occupational stress and depressive symptoms .


The aims of this study were to explore the association between occupational stress and depressive symptoms in a group of university teachers , and assess the mediating role of psychological capital between these variables .


A cross-sectional study was performed between November 2013 and January 2014 .


Teachers from six universities were randomly sampled in Shenyang .


The Center for Epidemiologic Studies Depression Scale , effort-reward imbalance scale , and psychological capital questionnaire ( PCQ-24 ) , as well as questions about demographic and working factors , were administered in questionnaires distributed to 1,500 university teachers .


Completed questionnaires were received from 1,210 participants .


Hierarchical linear regression analysis was used to examine the mediating role of psychological capital .


In the present study , 58.9 % ( 95 % CI ( Confidence Intervals ) : 56.1 % to 61.7 % ) of university teachers had a CES-D score equal to or above the cut-off of 16 .


Both effort-reward ratio ( ERR ) and scores of over-commitment were positively associated with depressive symptoms , whereas psychological capital was negatively associated with depressive symptoms among university teachers .


Psychological capital partially mediated the relationship between occupational stress and depressive symptoms .


Among Chinese university teachers , occupational stress may be a risk factor for depressive symptoms , whereas psychological capital might be protective against depressive symptoms .


Our results suggest that college administrators could support the development of psychological capital in their staff to alleviate depressive symptoms .


To examine the associations between amyloid - brain deposition and physical activity ( PA ) in elderly adults without dementia and to investigate whether the association has a dose-response relationship .


Cross-sectional study .


French community-dwelling people .


Elderly adults with normal or mildly impaired cognition ( mean age 74.7 4.2 ; 60.4 % female ) with available information on current self-reported PA and amyloid - brain deposition measured using positron emission tomography ( PET ) using the PET-ligand florbetapir F 18 ( n = 268 ) .


A standardized uptake value ratio ( SUVR ) was obtained for each subject .


Participants were divided according to amyloid plaque cortical retention defined according to a SUVR cutoff of 1.10 ( SUVR + vs SUVR - ) .


Bivariate and multivariate analyses showed that PA was not significantly associated with SUVR .


SUVR + and SUVR - participants did not differ in terms of volume ( continuous PA variables ) and levels ( categorical PA variables ) of PA. .


PA was not correlated with SUVR in apolipoprotein E 4 carriers or noncarriers .


PA was not associated with cognitive function .


Although PA protects against dementia , there is no solid evidence that this protection involves a reduction in amyloid - brain deposition .


Further studies are needed to determine whether PA ( ideally measured at several time-points using objective measures ) is involved in the pathophysiology of Alzheimer 's disease .


Forearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable .


However there is little evidence utilising clinical populations to support this substitution .


To determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients .


The secondary objective was to explore the relationship of blood pressure differences with age , sex , ethnicity , smoking history and obesity .


Single centre comparison study .


Adult Emergency Department , Tertiary Trauma Centre .


Forty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board .


A random assignment of order of measurement for left upper arm and forearm blood pressures was utilised .


Participants were eligible if they were aged 18 years or older , had been assigned an Australasian Triage Scale code of 2 , 3 , 4 , or 5 , were able to consent , and able to have blood pressures measured on their left arm whilst lying at a 45 angle .


The Bland-Altman method of statistical analysis was used , with the level of agreement for clinical acceptability for the systolic , diastolic and mean arterial pressure defined as 10 mmHg .


The forearm measure overestimated systolic ( mean difference 2.2 mmHg , 95 % limits of agreement 19 mmHg ) , diastolic ( mean difference 3.4 mmHg , 95 % limits of agreement 14.4 mmHg ) , and mean arterial pressures ( mean difference 4.1 mmHg , 95 % limits of agreement 13.7 mmHg ) .


The systolic measure was not significantly different from zero .


Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene 's test ( p = 0.002 , F-statistic = 11.09 ) .


Blood pressure disparity was not associated with participant characteristics .


Forearm measures can not routinely replace upper arm measures for blood pressure measurement .


If the clinical picture requires use of forearm blood pressure , the potential variance from an upper arm measure is 19 mmHg for systolic pressure , although the variability may be close to 10 mmHg if the systolic blood pressure is below 140 mmHg .


This study compared the effects of a 2-week program of low-volume high-intensity interval training ( HIT ) with the effects of higher-volume moderate-intensity continuous training ( CT ) on cardiopulmonary and vascular functions in postmenopausal women .


Twenty-two postmenopausal women were randomly assigned to undertake six HIT ( n = 12 ) or CT ( n = 10 ) sessions for 2 weeks .


HIT sessions consisted of ten 1-minute intervals of cycling exercise at 100 % of peak power output separated by 1 minute of active recovery .


CT sessions involved 40 minutes of continuous cycling at 65 % of peak power output .


Variables assessed at baseline and 2 weeks included cardiopulmonary function ( ventilatory threshold , peak oxygen uptake ) , macrovascular endothelial function ( flow-mediated dilation of the brachial artery ) , and microvascular function ( reactive hyperemia and local thermal hyperemia of forearm skin ) .


Eighteen participants completed the study ( HIT , 11 ; CT , 7 ) .


Adherence to the exercise programs was excellent , with 107 of 108 sessions completed .


Despite substantially lower total time commitment ( 2.5 vs. 5 h ) and training volume ( 558 vs. 1,237 kJ ) for HIT versus CT , increases from baseline in peak oxygen uptake achieved significance ( P = 0.01 ) for the HIT group only ( = 2.2 mL kg min ; P for interaction = 0.688 ) .


Improvements in exercise test duration were observed in both groups ( HIT , 13 % ; CT , 5 % ; P for interaction = 0.194 ) .


There were no significant changes in macrovascular or microvascular function in either group .


The findings suggest that low-volume HIT is feasible and can lead to rapid improvements in cardiopulmonary function in postmenopausal women .


Breast cancer surgery with axillary lymphadenectomy may be associated with prolonged stay of the drain in the axilla due to high wound output , which may require further treatments and prolong the length of stay , impairing quality of life .


No definitive data are available concerning how to prevent this complication .


Our aim was to assess the efficacy of a new low-thrombin fibrin glue in reducing the serous output from the axillary surgical wound in patients undergoing axillary node dissection for breast cancer , and its long-term effects on lymphedema .


Sixty patients undergoing surgery between September 2012 and June 2013 were enrolled .


Thirty patients received Artiss ( Baxter , UK ) fibrin glue plus drainage , and 30 drainage alone .


A multivariate analysis was performed to identify predictors of seroma , and subgroup analyses were performed .


Lymphedema was assessed 12 months after surgery .


Patients who received fibrin glue had reduced serum output collected in the drain after surgery ( 94.3 22.4 vs 176 24.6 ml p < 0.001 ) and shorter length of postoperative hospital stay ( p = 0.001 ) .


Incidence of seroma at 4-week follow-up did not differ between groups .


At multivariate analysis , BMI 30 kg/m ( 2 ) was the only independent predictor of seroma formation ( OR = 2.7 , 95 % CI 1.4-5 .3 ; p = 0.002 ) .


Overweight patients receiving Artiss had fewer seroma at 4-week follow-up compared with control overweight patients ( 0 % vs 55.6 % , p = 0.03 ) .


No differences were observed in lymphedema between groups ( 6.7 % vs 10 % , p > 0.99 ) .


Low-thrombin fibrin glue reduced the amount of fluid produced in the axilla after breast surgery .


Overweight patients may be the ideal candidates for this treatment .


Such sealant did not increase the rates of lymphedema .


Ecological intervention programs are recommended to prevent overweight and obesity in children .


The National Institute of Public Health ( INSP ) in Mexico implemented a successful ecological intervention program to promote healthy lifestyle behaviors in school age children .


This study assessed the integration of ecological principles and Social Cognitive Theory ( SCT ) constructs in this effective school-based obesity prevention program implemented in 15 elementary schools in Mexico City .


Two coders applied the Intervention Analysis Procedure ( IAP ) to `` map '' the program 's integration of ecological principles .


A checklist gauged the use of SCT theory in program activities .


Thirty-two distinct intervention strategies were implemented in one setting ( i.e. , school ) to engage four different target-groups ( students , parents , school representatives , government ) across two domains ( Nutrition and Physical Activity ) .


Overall , 47.5 % of the strategies targeted the school infrastructure and/or personnel ; 37.5 % of strategies targeted a key political actor , the Public Education Secretariat while fewer strategies targeted parents ( 12.5 % ) and children ( 3 % ) .


More strategies were implemented in the Nutrition domain ( 69 % ) than Physical Activity ( 31 % ) .


The most frequently used SCT construct within both intervention domains was Reciprocal Determinism ( e.g. , where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment ) ; no significant differences were observed in the use of SCT constructs across domains .


Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program .


Strategies emphasized school-level infrastructure/personnel change and strong political engagement and were most commonly underpinned by Reciprocal Determinism for both Nutrition and Physical Activity .


Intradialytic hypotension ( IDH ) is the most common complication of hemodialysis ( HD ) , and it plays a significant role in the morbidity and mortality associated with maintenance HD .


This was a placebo-controlled , parallel-group study evaluating efficacy and safety of droxidopa in improving intradialytic blood pressure ( BP ) responses in 85 adults with end-stage renal disease ( ESRD ) and prone to IDH .


Following screening and baseline periods , patients received 400 mg or 600 mg droxidopa , or placebo , orally 1 hour before HD for 4 weeks .


Primary outcome endpoint was the change between baseline and last 2 treatment weeks in average mean arterial pressure ( MAP ) during HD .


Also assessed were changes from baseline in systolic BP ( SBP ) and diastolic BP ( DBP ) during and after HD ; number of hypotension-induced interventions and symptoms ; and adverse events .


Increase in droxidopa intra-HD MAP were not significantly different from placebo , although droxidopa groups showed significant improvements in mean SBP after HD of +4.8 11.6 mm Hg ( 600-mg ) and +3.4 13.1 ( 400-mg ) compared with -4.4 17.9 mm Hg in placebo , and the drop seen in mean nadir SBP pre - to intra-HD was also reduced .


Changes in mean DBP pre - and post-HD , changes in mean nadir SBP post-HD , or intra-HD SBP were not significant over the treatment period .


HD terminations decreased 5-fold in the 600-mg group and 2-fold in the 400-mg group , whereas the number of discontinuations stayed unchanged in the placebo group .


Overall , treatment with 600-mg or 400-mg droxidopa was well tolerated in this population .


These data suggest that droxidopa may have a role in reducing IDH complications in patients with ESRD on chronic HD .


The efficacy and safety of subcutaneous tocilizumab ( TCZ-SC ) versus subcutaneous placebo ( PBO-SC ) was evaluated in patients with rheumatoid arthritis who had an inadequate response to disease-modifying antirheumatic drugs in the BREVACTA study .


Patients ( n = 656 ) were randomized 2:1 to receive TCZ-SC 162 mg every other week or PBO-SC every other week for 24 weeks ; 20 % previously received anti-tumor necrosis factor treatment .


Escape therapy with TCZ-SC 162 mg weekly was offered from week 12 for inadequate response .


The primary end point was the American College of Rheumatology 20 % improvement ( ACR20 ) response at week 24 .


The key secondary outcomes were radiographic progression and safety .


TCZ-SC was superior to PBO-SC for ACR20 response at week 24 ( 60.9 % versus 31.5 % ; P < 0.0001 ) .


All secondary end points showed TCZ-SC to be superior to PBO-SC , including ACR50 and ACR70 response ( 40 % and 20 % for TCZ-SC , respectively , and 12 % and 5 % for PBO-SC , respectively ; P < 0.0001 for both ) and Disease Activity Score in 28 joints ( DAS28 ) remission ( DAS28 < 2.6 ; 32 % versus 4 % [ P < 0.0001 ] ) .


The mean change in modified Sharp/van der Heijde score was significantly lower in the TCZ-SC group than the PBO-SC group ( 0.62 versus 1.23 ; P = 0.0149 ) .


Adverse events ( AEs ) and serious AEs ( SAEs ) were comparable between the TCZ-SC and PBO-SC groups ; 4.6 % and 3.7 % of patients had at least 1 SAE , respectively , and infection was the most common SAE in 2.1 % and 1.8 % of patients , respectively .


More injection site reactions occurred with TCZ-SC than PBO-SC ( 7.1 % versus 4.1 % ) .


No anaphylaxis or serious hypersensitivity reactions occurred .


There were 3 deaths in the TCZ-SC group and 0 in the PBO-SC group .


TCZ-SC every other week had significantly greater efficacy , including ACR end points and inhibition of joint damage , compared with PBO-SC .


TCZ-SC was well tolerated and its safety profile was comparable with that of previous intravenous TCZ studies .


Impaired nitric oxide synthesis has been implicated as one of the underlying causes of diabetic painful neuropathy ( DPN ) .


Hence , effects of a cutaneous , nitric oxide releasing patch ( NitroSense Derma Protect ) were evaluated in subjects with DPN .


Fifty diabetics were randomised to active/placebo arms after a 2 wk wash-out period .


Patients received 24 mg patches ( each patch releases around 9 nmol/cm2/min of nitric oxide ) for 3 hrs , every other day during a 3 wks period , or indistinguishable placebo patches .


The extent of pain was recorded at start , at each visit and following completion of the study .


Changes in pain from baseline were measured using the 11 point lickert scale ( PLS ) , visual analogue scale ( VAS ) , short form mcgill , pain questionnaire ( SF-MPQ ) , present pain intensity ( PPI ) scale .


Subjects treated with patch experienced a statistically significant reduction in pain from baseline when compared to placebo ( PLS scale ; p = 0.05 ) .


Defining responders as subjects with a > 50 % reduction in PLS score from baseline , the number needed to treat ( NNT ) was calculated as 3.0 .