To investigate the hypothesis that paracetamol is absorbed faster from a hot drink than from a standard tablet using simultaneous scintigraphic imaging and pharmacokinetic sampling .


Twenty-five healthy male volunteers received both paracetamol formulations in a randomised manner .


The formulation administered in the first treatment arm was radiolabelled to allow scintigraphic monitoring .


In both treatment arms , blood samples were taken for assessing paracetamol absorption .


Following the hot drink , paracetamol absorption was both significantly faster and greater over the first 60min post-dose compared with the tablet , as evidenced by the median time to reach t0 .25 g/mL of 4.6 and 23.1 min , respectively , and AUC0-60 of 4668.00 and 1331.17 h * ng/mL , respectively .


In addition , tmax was significantly shorter for the hot drink ( median time = 1.50 h ) compared with the tablet ( 1.99 h ) .


However , Cmax was significantly greater following the tablet ( 9,077 ng/mL ) compared with the hot drink ( 8,062 ng/mL ) .


Onset of gastric emptying after the hot drink was significantly faster than after the standard tablet ( 7.9 versus 54.2 min ) , as confirmed scintigraphically .


Compared with a standard tablet , a hot drink provides faster absorption of paracetamol potentially due to more rapid gastric emptying .


Despite its documented importance , communication between clinicians and patients ' families in the intensive care unit often fails to meet families ' needs , and interventions to improve communication are needed .


Use of a communication facilitator-an additional staff member-to improve communication between clinicians and patients ' families is the focus of an ongoing randomized trial .


The clinical team 's acceptance of the communication facilitator as an integral part of the team is important .


To explore clinicians ' perceptions of the usefulness of a communication facilitator in the intensive care unit .


Fourteen semistructured qualitative interviews to assess perspectives of physicians , nurses , and social workers who had experience with the communication facilitator intervention on the intervention and the role of the facilitator .


Methods based on grounded theory were used to analyze the data .


Clinicians perceived facilitators as ( 1 ) facilitating communication between patients ' families and clinicians , ( 2 ) providing practical and emotional support for patients ' families , and ( 3 ) providing practical and emotional support for clinicians .


Clinicians were enthusiastic about the communication facilitator but concerned about overlapping or conflicting roles .


Clinicians in the intensive care unit saw the facilitator intervention as enhancing communication and supporting both patients ' families and clinicians .


They also identified the importance of the facilitator within the interdisciplinary team .


Negative perceptions about the use of a facilitator should be addressed before the intervention is implemented , in order to ensure its effectiveness .


The impact of boosted protease inhibitor therapy on inflammatory and cardiovascular biomarker levels in treatment-naive HIV-infected patients remains unclear and may differ between agents .


Unconjugated bilirubin elevation , which favourably affects vascular biomarkers and cardiovascular disease risk in Gilbert 's syndrome , occurs with atazanavir .


CASTLE was a 96-week study comparing efficacy and safety in treatment-naive HIV-1-infected patients randomized to atazanavir/ritonavir ( ATV/r ) versus lopinavir/ritonavir ( LPV/r ) , each in combination with tenofovir disoproxil fumarate/emtricitabine .


In this substudy , fasting plasma tumour necrosis factor - ( TNF - ) , interleukin-6 ( IL-6 ) , high sensitivity C-reactive protein ( hs-CRP ) , plasminogen activator inhibitor-1 ( PAI-1 ) and fibrinogen were assessed at baseline , week 12 , 24 , 48 and 96 .


Impact of grade 3-4 hyperbilirubinaemia on biomarkers was examined .


CASTLE demonstrated similar efficacy in both treatment arms with higher rates of hyperbilirubinaemia on ATV/r and elevated lipids on LPV/r .


In this substudy ( n = 224 ) , patterns of biomarker expression were similar between the ATV/r and LPV/r groups and between-group differences in biomarker percentage change from baseline were not significant at 48 and/or 96 weeks .


Hyperbilirubinaemia did not influence fasting biomarker expression .


No significant differences were noted between ATV/r and LPV/r for biomarker percentage changes from baseline .


Furthermore , no association was found between total bilirubin levels and biomarker expression .


Bone graft substitutes are widely used for reconstruction of posttraumatic bone defects .


However , their clinical significance in comparison to autologous bone grafting , the gold-standard in reconstruction of larger bone defects , still remains under debate .


This prospective , randomized , controlled clinical study investigates the differences in pain , quality of life , and cost of care in the treatment of tibia plateau fractures-associated bone defects using either autologous bone grafting or bioresorbable hydroxyapatite/calcium sulphate cement ( CERAMENT | BONE VOID FILLER ( CBVF ) ) .


CERTiFy ( CERament Treatment of Fracture defects ) is a prospective , multicenter , controlled , randomized trial .


We plan to enroll 136 patients with fresh traumatic depression fractures of the proximal tibia ( types AO 41-B2 and AO 41-B3 ) in 13 participating centers in Germany .


Patients will be randomized to receive either autologous iliac crest bone graft or CBVF after reduction and osteosynthesis of the fracture to reconstruct the subchondral bone defect and prevent the subsidence of the articular surface .


The primary outcome is the SF-12 Physical Component Summary at week 26 .


The co-primary endpoint is the pain level 26 weeks after surgery measured by a visual analog scale .


The SF-12 Mental Component Summary after 26 weeks and costs of care will serve as key secondary endpoints .


The study is designed to show non-inferiority of the CBVF treatment to the autologous iliac crest bone graft with respect to the physical component of quality of life .


The pain level at 26 weeks after surgery is expected to be lower in the CERAMENT bone void filler treatment group .


CERTiFy is the first randomized multicenter clinical trial designed to compare quality of life , pain , and cost of care in the use of the CBVF and the autologous iliac crest bone graft in the treatment of tibia plateau fractures .


The results are expected to influence future treatment recommendations .


ClinicalTrials.gov : NCT01828905 .


This study assesses the effect of sending a Survivorship Care Plan ( SCP ) to primary care physicians ( PCP ) on the communication of the PCP with the medical specialist and the patient and to describe PCPs ' opinions regarding the SCP .


In a pragmatic cluster randomized controlled trial conducted in 12 hospitals , the PCP of endometrial and ovarian cancer patients received usual information , while in addition the SCP-care arm received a copy of the patient 's SCP .


A questionnaire was returned by 266 PCPs ( 76 % ) .


One third of the PCPs in the SCP-care arm indicated having received an SCP .


PCPs in the SCP-care arm were more likely to have had personal contact with the medical specialist ( 52 vs. 37 % , p = 0.01 ) but were equally satisfied with the information as PCPs in the usual care arm ( 7.2 vs. 6.9 on a scale from 1 to 10 , p = 0.25 ) .


Of all PCPs , 82 % indicated they would want to receive an SCP in the future .


A quarter of the PCPs who received an SCP reported that the SCP supported contact with the patient .


However , the SCP was found too long .


Supplying an SCP to PCPs potentially has a positive effect on the communication between the PCP and the medical specialist .


The SCP should be concise and focused on PCPs ' needs , such as contact information and tailored information on patient diagnosis , treatment , and possible consequences .


In the light of transition of cancer care to PCPs , survivors may benefit from improved information provision and communication .


Resistance exercise ( RE ) may lead to a post-exercise hypotension ( PEH ) response .


Previous studies showed that green tea ( GT ) and its polyphenols , especially Epigallocatechin-3-gallate ( EGCG ) may have a favorable effect on blood pressure ( BP ) .


We investigated the green tea extract ( GTE ) effects on BP , heart rate ( HR ) , and rate pressure product ( RPP ) responses to a low-intensity RE in hypertensive women .


Middle-aged women ( n = 24 , 46.4 6.3 years old ; 66.6 9.2 kg ; 166.3 4.2 cm ) were randomly assigned into three groups of eight persons .


GTE consumption group ( T ) and RE group ( R ) , respectively , ingested GTE ( ~ 75 mg EGCG ) and placebo ( PL ; maltodextrin ) capsules two times a day for three weeks and then completed 2 circuits of six RE using 50 % one repetition maximum ( 1RM ) .


Patients of control group ( C ) just ingested PL and rested in a non-exercise control trial .


BP , HR and RPP were measured prior and post-exercise at 0 , 15 , 30 , 45 , and 60 min .


The repeated measures analysis of variance ( ANOVA ) revealed that there were no significant alterations for arterial BP , HR and RPP of C group .


HR of T and R groups was increased immediately after RE .


A significant fall of systolic BP ( SBP ) and diastolic BP ( DBP ) occurred in both T and R groups for 60 min post-exercise compared to resting values .


Mean arterial BP ( MAP ) and RPP decreased significantly after RE in both exercise groups from 15 to 60 min .


During 45 and 60 time points , T group had a lower RPP values than C group .


The differences between T and R groups were only MAP at 0 and 15 time points .


Three weeks of GTE ingestion did not influenced SBP , DBP and HR but may be have a favorable effect on MAP and RPP responses to an acute RE during 1 h recovery of exercise .


This study was done to compare 2 techniques of pulse oximeter sensor application during neonatal resuscitation for faster signal detection .


Sensor to infant first ( STIF ) and then to oximeter was compared with sensor to oximeter first ( STOF ) and then to infant in 28 weeks gestations .


The primary outcome was time from completion of sensor application to reliable signal , defined as stable display of heart rate and saturation .


Time from birth to sensor application , time taken for sensor application , time from birth to reliable signal , and need to reapply sensor were secondary outcomes .


An intention-to-treat analysis was done , and subgroup analysis was done for gestation and need for resuscitation .


One hundred fifty neonates were randomized with 75 to each technique .


The median ( IQR ) time from sensor application to detection of reliable signal was longer in STIF group compared with STOF group ( 16 [ 15-17 ] vs. 10 [ 6-18 ] seconds ; P < 0.001 ) .


Time taken for application of sensor was longer with STIF technique than with STOF technique ( 12 [ 10-16 ] vs. 11 [ 9-15 ] seconds ; P = 0.04 ) .


Time from birth to reliable signal did not differ between the 2 methods ( STIF : 61 [ 52-76 ] seconds ; STOF : 58 [ 47-73 ] seconds [ P = .09 ] ) .


Time taken for signal acquisition was longer with STIF than with STOF in both subgroups .


In the delivery room setting , the STOF method recognized saturation and heart rate faster than the STIF method .


The time from birth to reliable signal was similar with the 2 methods .


Neocollagenesis can be achieved using a dermal rolling needle device , thereby reducing the appearance of acne scars .


To determine the efficacy of a needling device for treatment of acne scars .


We performed a single-center , rater-blinded , balanced ( 1:1 ) , split-face , placebo-controlled , parallel-group randomized clinical trial at an urban academic institution .


The study took place from November 30 , 2009 , through July 27 , 2010 .


Twenty healthy adults ( age range , 20-65 years ) with acne scars on both sides of the face were enrolled .


Fifteen individuals completed the study , and no enrolled participants were withdrawn for adverse effects .


For each participant , one side of the face was randomized for needling .


Three needling treatments were performed at 2-week intervals .


Two blinded dermatologists separately rated participants ' acne scars based on standard digital photographs obtained at baseline and at the 3-month and 6-month follow-up visits on the quantitative global scarring grading system .


Mean scar scores were significantly lower in the treatment group compared with baseline at 6 months ( mean difference , 3.4 ; 95 % CI , 0.2-6 .5 ; P = .03 ) and nominally but not significantly lower compared with baseline at 3 months ( mean difference , 2.4 ; 95 % CI , -0.01 to 4.8 ; P = .052 ) .


In the control group , mean scar scores did not vary significantly from baseline at 3 months ( mean difference , 1.0 ; 95 % CI , -1.4 to 3.4 ; P = .96 ) and at 6 months ( mean difference , 0.4 ; 95 % CI , -2.3 to 3.5 ; P > .99 ) .


The needling procedure was not particularly painful , with a mean pain rating of 1.08 of 10 .


Participants perceived a 41 % mean improvement in overall scar appearance on the treated side .


No adverse events were reported .


After 3 needling treatments , there was improvement in the appearance of acne scars over time compared with the control group , with minimal pain reported .


clinicaltrials.gov Identifier : NCT00974870 .


Pro-inflammatory mediators are thought to play both peripheral and central roles in migraine pathophysiology .


Prostaglandins and leukotrienes , known as the eicosanoids , are degradation products of arachidonic acid and constitute signalization components of inflammatory pathways .


This study was designed to assess concentrations of leukotriene E4 ( LT-E4 ) and prostaglandin F2a ( PG-F2a ) in children with migraine .


This study involved patients aged 18 years who presented to the Ondokuz Mayis University Children 's Hospital with migrainous headache between January and October 2011 .


Urinary LT-E4 and PG-F2a concentrations were measured in patients during a headache episode and at a headache-free time and in a control group .


The patient group consisted of 38 girls and 26 boys aged 5-18 years diagnosed with migraine and having at least 6 months of headache , whereas the control group consisted of 21 girls and 29 boys .


Mean standard deviation ( SD ) urinary LT-E4 concentrations were significantly higher in patients during a migraine episode than in controls ( 1466.81052.5 pg/ml vs 811.6460.0 pg/ml , P < 0.001 ) .


In patients with migraine , both urinary LT-E4 ( P < 0.001 ) and PG-F2a ( P = 0.021 ) levels were significantly higher during headache than during non-headache periods .


Urinary LT-E4 and PG-F2a were both significantly higher in children with migraine during headache than during non-headache periods .


The elevation in the levels of these inflammatory mediators was compatible with the hypothesis relating neuroinflammation in trigeminal vascular blood vessels with migraine pathophysiology .


Leukotriene antagonists may be effective in the prophylaxis of migraine attacks .


Repeated exposure to a neutral conditioned stimulus ( CS ) in the absence of a noxious unconditioned stimulus ( US ) elicits fear memory extinction .


The aim of the current study was to investigate the effects of mild tone exposure ( CS ) during slow wave sleep ( SWS ) on fear memory extinction in humans .


The healthy volunteers underwent an auditory fear conditioning paradigm on the experimental night , during which tones served as the CS , and a mild shock served as the US .


They were then randomly assigned to four groups .


Three groups were exposed to the CS for 3 or 10 min or an irrelevant tone ( control stimulus , CtrS ) for 10 min during SWS .


The fourth group served as controls and was not subjected to any interventions .


All of the subjects completed a memory test 4 h after SWS-rich stage to evaluate the effect on fear extinction .


Moreover , we conducted similar experiments using an independent group of subjects during the daytime to test whether the memory extinction effect was specific to the sleep condition .


Ninety-six healthy volunteers ( 44 males ) aged 18-28 y.


Participants exhibited undisturbed sleep during 2 consecutive nights , as assessed by sleep variables ( all P > 0.05 ) from polysomnographic recordings and power spectral analysis .


Participants who were re-exposed to the 10 min CS either during SWS and wakefulness exhibited attenuated fear responses ( wake-10 min CS , P < 0.05 ; SWS-10 min CS , P < 0.01 ) .


Conditioned stimulus re-exposure during SWS promoted fear memory extinction without altering sleep profiles .


The physical and mental health of college-age youths tends to continuously decline around the world .


It is therefore important to promote health during this period .


As a traditional Chinese mind-body exercise , Tai Chi Chuan ( TCC ) may be an available selection .


However for the college student population , the evidence is unclear as to whether TCC can be recommended as an effective exercise for promoting their physical and psychological wellbeing .


Therefore high quality , rigorous , prospective , and well-controlled randomized trials are needed to further understand TCC serving as a psychological and physical intervention in college age populations .


We designed a randomized , single-blind , parallel-controlled trial with a sample size of 206 participants .


All the participants who meet the inclusion criteria come from Fujian University of Traditional Chinese Medicine ( FJTCM ) .


Participants of the TCC training group will receive TCC training at a frequency of five days per week for one hour per day for 12weeks .


No specific exercise will be administered on the participants in the control group .


Both physical and mental health outcomes , including balance ability , lower limb proprioception , flexibility , physical fitness , self-efficacy , psychological symptoms , attention span , stress , self-esteem , mood and mindfulness , quality of life , and quality of sleep .


Safety outcomes will be evaluated by blinded operators at baseline , 12 and 24-weeks post-intervention .


This protocol presents an objective design of a randomized , single-blind trial that will test the effectiveness and safety of TCC on the physical and psychological wellbeing of college students .


If the outcome is positive , the results will provide higher quality evidence of TCC on the physical and mental health of college age populations .


Chinese Clinical Trial Registry : ChiCTR-TRC-13003328 .


To assess whether the volume of callosal hyperintensities in the genu and splenium of older adults with mobility impairment is differentially associated with the degree of gain in gait speed after 2 types of gait interventions .


Single-blind randomized controlled trial of 2 types of gait exercises in older adults .


Research center in an academic institution .


Ambulatory adults ( N = 44 ) aged 65 years with a slow and variable gait .


Twelve-week physical therapist-guided trial of a conventional walking , endurance , balance , and strength ( WEBS ) intervention ( n = 20 ) versus a timing and coordination of gait ( TC ) intervention ( n = 22 ) .


Gain in gait speed after the intervention and its relation to callosal hyperintensities in the genu and splenium of the corpus callosum .


Gait speed improved in both the WEBS group ( mean change , 0.16 m/s ) and the TC group ( mean change , 0.21 m/s ; both P < .05 ) .


The volume of white matter hypertintensities ( WMHs ) in the genu was differentially associated with gait speed gain ( group genual WMH interaction , P = .05 ) .


Greater genual WMH volume was related to a smaller gait speed gain in the WEBS group ( P = .01 ) but not in the TC ( P = .10 ) group .


Splenial WMH volume was not differentially associated with gait speed gain ( interaction , P = .90 ) .


Callosal hyperintensities differentially influence gait speed gain by the type of gait rehabilitation .


Mobility impaired older adults with genual hyperintensities may benefit from a rehabilitation program focused on motor skill learning rather than on strength and endurance training .


The purpose of this study was to determine whether iterative reconstruction improves the quality of cranial CT ( CCT ) images of stroke patients .


Fifty-one CCT studies of patients with infarction performed with either a low ( 260 mAs ; n = 21 ) or standard ( 340 mAs ; n = 30 ) dose were reconstructed with both filtered back projection ( FBP ) and sinogram-affirmed iterative reconstruction ( SAFIRE ) with five strength levels ( S1-S5 ) .


The resulting six image sets ( one FBP and one each for SAFIRE levels S1-S5 ) were rated separately by two blinded radiologists in terms of conspicuity of infarcted areas on a 5-point scale .


Noise and infarct-to-normal brain as well as medullary-to-cortical contrast-to-noise ratios ( CNRs ) were measured .


Ratings , noise , and CNRs were intraindividually compared within the same dose group ( Fisher exact test ) and interindividually between the different dose groups ( Wilcoxon-Mann-Whitney U test ) .


The strength level S4 showed the best conspicuity of infarcted areas .


Compared with FBP , SAFIRE S4 statistically significantly ( p < 0.01 ) reduced noise and improved CNRs without statistically significant differences in all subjective and objective criteria ( p > 0.01 ) when the dose was reduced .


Patients examined with a 260-mAs low-dose were exposed to a statistically significantly lower dose ( 1.77 vs 2.33 mSv ; p < 0.01 ) .


Iterative reconstruction ( SAFIRE at strength level S4 ) leads to increased subjective and objective image quality in CCT and allows dose reduction ( -24 % ) without losses in the demarcation of ischemic lesions .


After-hours telephone communications are common in patient management .


Patterns of communication of key information during after-hours phone calls were evaluated , and the utility of problem-specific Situation , Background , Assessment , Recommendation ( SBAR ) forms in improving this communication was assessed .


In a randomized trial using a simulated on-call setting , 20 nurses called physicians regarding six cases adapted from inpatient records and based on the six most common reasons for after-hours nurse-physician communication .


Three of the cases were handled without the SBAR forms ( control cases ) , and three cases were handled with the forms ( SBAR cases ) .


Two cue types of communication were evaluated : situation cues , which conveyed the patient 's situation ( for example , a patient is confused ) , and background cues , which conveyed problem-specific data indicated on the SBAR forms ( for example , the patient has a low sodium level ) .


Ninety-two phone calls were analyzed ( 43 SBAR/49 controls ) .


Most of the nurses reported the situation cues ( SBAR 88 % , control 84 % , p = .60 ) but not the background cues .


There was a trend toward fewer background cues communicated in the SBAR cases ( 14 % versus 31 % , p = .08 ) .


In 14 % of the cases , on average , nurses omitted information or reported wrong information regarding the background cue .


Physicians asked questions that resulted in the communication of the cues in a minority of the cases when the background cues were not originally provided by the nurses ( SBAR 6 % , control 16 % , p = .39 ) .


In after-hours phone communication between physicians and nurses , significant information was often not communicated and physicians did not elicit the necessary information .


Simply providing an SBAR-based form did not ensure complete communication of key information .


The use of opioid analgesics in the United States has significantly increased in recent years .


However , there is minimal consensus on what discharge counseling should accompany these high-risk prescriptions and large variations in what is done in practice .


The objective of this study was to evaluate the effect of a dual-modality ( written and spoken ) literacy-appropriate educational strategy on patients ' knowledge of and safe use of opioid analgesics .


This was a prospective , randomized controlled trial .


Consecutive discharged patients at an urban academic ED ( > 88,000 visits ) with new prescriptions for hydrocodone-acetaminophen were enrolled .


Patients were randomized to receive either usual care or the educational intervention .


The educational intervention was a one-page information sheet about hydrocodone-acetaminophen , which was both given to the patients and read aloud by the research assistant ( nonblinded ) .


Follow-up phone calls were conducted 4 to 7 days after the visit to assess patient knowledge about the medication and self-report of activities associated with safety of use ( e.g. , double-dipping with acetaminophen , storage , use with alcohol or while driving ) .


A total of 274 patients were enrolled ; 210 completed follow-up ( 110 usual care and 100 intervention ) .


No significant differences in baseline characteristics emerged between the study arms ; 42 % were male , and 51 % were white , with a median age of 43 years .


Half of patients had non-back pain orthopedic injuries ( 49.5 % ) .


On follow-up , overall knowledge was poor , with only 28 % able to name both active ingredients in the medication .


The intervention group had better knowledge of precautions related to taking additional acetaminophen ( usual care 18.2 % , 95 % confidence interval [ CI ] = 10.9 % to 25.5 % vs. intervention 38 % , 95 % CI = 28.3 % to 47.7 % ; difference = 27.6 , 95 % CI of difference = 21.5 to 33.7 ) and knowledge of side effects ( usual care median = 1 , interquartile range [ IQR ] 0 to 2 vs. intervention median = 2 , IQR = 1 to 2 ; p < 0.0001 ) .


Additionally , those who received the intervention were less likely to have reported driving within 6 hours after taking hydrocodone ( usual care 13.6 % , 95 % CI = 7.2 % to 20 % vs. intervention 3 % , 95 % CI = -0.3 % to 6.3 % ; difference = 10.6 , 95 % CI of difference = 3.4 to 17.9 ) .


There was no difference between groups related to knowledge about drinking alcohol while taking hydrocodone ( overall 18.1 % ) or knowledge that the opioid could be addictive ( overall 72.4 % ) .


This simple strategy improved several , but not all , aspects of patient knowledge and resulted in fewer patients in the intervention arm driving while taking hydrocodone .


Integration of a patient education document into conversations about opioids holds promise for improving patient knowledge about these high-risk medications .


Problem adaptation therapy ( PATH ) is a treatment for older adults with major depression , cognitive impairment ( from mild cognitive deficits to moderate dementia ) , and disability .


Antidepressants have limited efficacy in this population and psychosocial interventions are inadequately investigated .


To test the efficacy of 12-week PATH vs supportive therapy for cognitively impaired patients ( ST-CI ) in reducing depression and disability in 74 older adults with major depression , cognitive impairment , and disability .


A randomized clinical trial at the Weill Cornell Institute of Geriatric Psychiatry from April 1 , 2006 , to September 31 , 2011 .


Interventions were administered at the participants ' homes .


Participants included 74 older individuals ( age 65 years ) with major depression and cognitive impairment to the level of moderate dementia .


They were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry and were randomly assigned to 12 weekly sessions of PATH or ST-CI ( 14.8 % attrition rate ) .


Home-delivered PATH vs home-delivered ST-CI .


Problem adaptation therapy integrates a problem-solving approach with compensatory strategies , environmental adaptations , and caregiver participation to improve patients ' emotion regulation .


Supportive therapy for cognitively impaired patients focuses on expression of affect , understanding , and empathy .


Mixed-effects models for longitudinal data compared the efficacy of PATH with that of ST-CI in reducing depression ( Montgomery-Asberg Depression Rating Scale ) and disability ( World Health Organization Disability Assessment Schedule II ) during 12 weeks of treatment .


Participants in PATH had significantly greater reduction in depression ( Cohen d , 0.60 ; 95 % CI , 0.13-1 .06 ; treatment time , F ( 1,179 ) = 8.03 ; P = .005 ) and disability ( Cohen d , 0.67 ; 95 % CI , 0.20-1 .14 ; treatment time , F ( 1,169 ) = 14.86 ; P = .001 ) than ST-CI participants during the 12-week period ( primary outcomes ) .


Furthermore , PATH participants had significantly greater depression remission rates than ST-CI participants ( 37.84 % vs 13.51 % ; ( 2 ) = 5.74 ; P = .02 ; number needed to treat = 4.11 ) ( secondary outcome ) .


Problem adaptation therapy was more efficacious than ST-CI in reducing depression and disability .


Problem adaptation therapy may provide relief to a large group of depressed and cognitively impaired older adults who have few treatment options .


Clinicaltrials.gov Identifier : NCT00368940 .


To examine the significant `` placebo effect '' in a randomized , double-blind , placebo-controlled interstitial cystitis/bladder pain syndrome trial .


Randomized clinical trials are the reference standard for therapeutic impact assessment .


However , proving efficacy of treatments for interstitial cystitis/bladder pain syndrome with rigorous placebo-controlled trials is difficult due to a significant effect of the placebo intervention .


Interstitial cystitis/bladder pain syndrome patients were randomized to receive subcutaneous adalimumab or subcutaneous placebo every 2 weeks for 12 weeks and outcome measures were assessed .


Of the 43 patients , 21 received adalimumab and 22 received placebo .


Of the patients who received placebo , there was a statistically significant improvement demonstrated in the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indexes of -8.1 ( 95 % confidence interval [ CI ] , 3.0-13 .2 ) , Interstitial Cystitis Symptom Index of -3.7 ( 95 % CI , 0.9-6 .5 ) , Interstitial Cystitis Problem Index of -4.4 ( 95 % CI , 2.0-6 .8 ) , and Pelvic Pain , Urgency , Frequency scale of -6.9 ( 95 % CI , 2.8-11 .0 ) at week 12 compared with baseline .


Most of the significantly improved placebo patients felt their improvement was because they were more conscientious about following physician advice and feeling less stress while in the study .


Patients with moderate to severe interstitial cystitis/bladder pain syndrome had significant improvement after receiving only advice and support .


This intervention is risk free and inexpensive .


Physicians should review standard advice with all interstitial cystitis/bladder pain syndrome patients before starting medical therapy .


Restoring sinus rhythm in patients with heart failure ( HF ) and atrial fibrillation ( AF ) may improve left ventricular ( LV ) function and HF symptoms .


We sought to compare the effect of a catheter ablation strategy with that of a medical rate control strategy in patients with persistent AF and HF .


Patients with persistent AF , symptomatic HF , and LV ejection fraction < 50 % were randomized to catheter ablation or medical rate control .


The primary end-point was the difference between groups in LV ejection fraction at 6 months .


Baseline LV ejection fraction was 328 % in the ablation group and 3412 % in the medical group .


Twenty-six patients underwent catheter ablation , and 24 patients were rate controlled .


Freedom from AF was achieved in 21/26 ( 81 % ) at 6 months off antiarrhythmic drugs .


LV ejection fraction at 6 months in the ablation group was 4012 % compared with 3113 % in the rate control group ( P = 0.015 ) .


Ablation was associated with better peak oxygen consumption ( 226 versus 186 mL/kg per minute ; P = 0.014 ) and Minnesota living with HF questionnaire score ( 2422 versus 4722 ; P = 0.001 ) compared with rate control .


Catheter ablation is effective in restoring sinus rhythm in selected patients with persistent AF and HF , and can improve LV function , functional capacity , and HF symptoms compared with rate control .


Clinical Trial Registration - URL : http://www.clinicaltrials.gov .


Unique identifier : NCT01411371 .


To investigate the effect of letrozole in decreasing the early-stage ovarian hyperstimulation syndrome ( OHSS ) occurrence during the luteal phase for patients of OHSS high-risk after oocyte retrieval .


A total of 176 high-risk OHSS patients were randomly divided into two groups after oocyte retrieval .


Patients in experiment group ( n = 86 ) received 5 mg letrozole per day from the retrieval day and last for 5 days .


Others in control group ( n = 90 ) received placebo .


The serum concentration of FSH , LH , estradiol ( E2 ) , progesterone ( P ) and vascular endothelial growth factor ( VEGF ) from the day of hCG injection to days after injection ( 5 days , 8 days , 10 days ) were measured .


And the incidence of moderate and severe OHSS was observed .


The concentration of E2 on the indicated days ( 5 days , 8 days , 10 days after hCG injection ) in experiment group and control group were ( 5 7272 089 ) versus ( 11 8264 281 ) pmol/L , ( 1 613879 ) versus ( 7 9253 507 ) pmol/L , ( 193 90 ) versus ( 1 628888 ) pmol/L ; the concentration of VEGF on the indicated days in the two groups were ( 8014 ) versus ( 10819 ) ng/L , ( 6611 ) versus ( 12614 ) ng/L , ( 487 ) versus ( 14814 ) ng/L ; the concentration of E2 and VEGF were lower than those in control group ( all P < 0.01 ) .


The FSH concentration in experiment group were ( 2.11.1 ) and ( 3.51.3 ) U/L on the day of fifth and eighth day after hCG injection , which were significantly higher than ( 0.70.3 ) and ( 0.70.4 ) U/L in control group ( P < 0.05 ) ; the LH concentration in experiment group were ( 0.260.19 ) and ( 0.720.60 ) U/L on the day of fifth and eighth day after hCG injection , which were significantly higher than ( 0.110.03 ) and ( 0.140.08 ) U/L in control group ( P < 0.05 ) .


The incidence of moderate and severe OHSS was signicantly decreased after letrozole treatment compared with control group [ 2 % ( 2/86 ) versus 12 % ( 11/90 ) , P < 0.05 ] .


Administration of 5 mg/d letrozole for 5 days during the luteal phase can reduce the E2 and VEGF levels for the high-risk OHSS patients who needed cryopreserve all embryos , and also reduce the occurrence of early OHSS .


Combination therapy with acetylsalicylic acid and dipyridamole is first-line treatment in secondary prevention of strokes .


Approximately 40 % of patients report headache as a side effect of dipyridamole .


Dose escalation of dipyridamole reduces this side effect .


In practice , different dose escalation schemes are used .


In theory , slower dose escalation than a standard scheme reduces headaches even more .


This study aimed to find the best dose escalation scheme for prevention of headaches as a side effect of dipyridamole in the secondary prevention of strokes .


In this randomized , open-label , 4-week trial , 114 patients who had an ischemic stroke or transient ischemic attack were randomized to receive either a standard or slow dose escalation scheme of dipyridamole .


Participants were asked to report the four most common side effects of dipyridamole in a study diary on study days 1 , 3 , 5 , 7 , 14 , 21 and 28 .


They were asked to score headache intensity on a visual analog scale ( VAS ) .


Participants were unaware that the trial was focused on headaches .


Primary end point was to determine if a slow dose escalation scheme reduces the percentage of patients with headaches .


Secondary objective was to determine the number of patients who discontinued treatment with dipyridamole because of headaches .


Overall 37 patients ( 38 % ) of the final population reported headache , 19 ( 39 % ) in the standard dose escalation group and 18 ( 37 % ) in the slow dose escalation group ( p = 1.0 ) .


In the standard dose escalation group patients scored headaches ( VAS > 4 ) on an average of 3.3 days and patients in the slow dose escalation group on 3.6 days ( p = 0.82 ) .


Mean VAS scores on study days 1 , 3 , 5 , 7 , 14 and 21 ranged from 1.4 to 3.7 in both groups .


These scores did not differ significantly .


However , on day 28 patients scored a significantly lower mean VAS score in the standard dose escalation group than in the slow dose escalation group ( 2.5 vs. 4.8 ; p = 0.05 ) .


In the standard dose escalation group 6 patients ( 11 % ) discontinued treatment because of side effects of dipyridamole and 3 patients ( 6 % ) in the slow dose escalation group ( p = 0.49 , Fisher 's exact test ) .


We showed that slower than standard dose escalation of dipyridamole in combination therapy with acetylsalicylic acid does not reduce headaches as a side effect .


The use of such schemes should be discontinued in clinical practice .


Slow dose escalation might , however , reduce the number of patients who discontinue treatment , but further research is needed to confirm this .


Despite major advances in transplant medicine , improvements in long-term kidney allograft survival have not been commensurate with those observed shortly after transplantation .


The formation of donor-specific antibodies ( DSA ) and ongoing antibody-mediated rejection ( AMR ) processes may critically contribute to late graft loss .


However , appropriate treatment for late AMR has not yet been defined .


There is accumulating evidence that the proteasome inhibitor bortezomib may substantially affect the function and integrity of alloantibody-secreting plasma cells .


The impact of this agent on the course of late AMR has not so far been systematically investigated .


The BORTEJECT Study is a randomized controlled trial designed to clarify the impact of intravenous bortezomib on the course of late AMR .


In this single-center study ( nephrological outpatient service , Medical University Vienna ) we plan an initial cross-sectional DSA screening of 1,000 kidney transplant recipients ( functioning graft at 180days ; estimated glomerular filtration rate ( eGFR ) > 20ml/minute/1 .73 m2 ) .


DSA-positive recipients will be subjected to kidney allograft biopsy to detect morphological features consistent with AMR .


Forty-four patients with biopsy-proven AMR will then be included in a double-blind placebo-controlled intervention trial ( 1:1 randomization stratified for eGFR and the presence of T-cell-mediated rejection ) .


Patients in the active group will receive two cycles of bortezomib ( 41.3 mg/m2 over 2weeks ; 3-month interval between cycles ) .


The primary end point will be the course of eGFR over 24months ( intention-to-treat analysis ) .


The sample size was calculated according to the assumption of a 5ml/minute/1 .73 m2 difference in eGFR slope ( per year ) between the two groups ( alpha : 0.05 ; power : 0.8 ) .


Secondary endpoints will be DSA levels , protein excretion , measured glomerular filtration rate , transplant and patient survival , and the development of acute and chronic morphological lesions in 24-month protocol biopsies .


The impact of anti-humoral treatment on the course of late AMR has not yet been systematically investigated .


Based on the hypothesis that proteasome inhibition improves the outcome of DSA-positive late AMR , we suggest that our trial has the potential to provide solid evidence towards the treatment of this type of rejection .


Clinicaltrials.gov : NCT01873157 .


To evaluate the effectiveness of daily tooth brushing with high-fluoride toothpaste on white spot lesion ( WSL ) formation in adolescents during treatment with fixed orthodontic appliances ( FOA ) .


Four hundred and twenty-four healthy 11 - to 16-year-old patients , referred to five Orthodontic Specialist Clinics , were randomized to use either toothpaste containing 5000 ppm fluoride or regular toothpaste with 1450 ppm fluoride .


To be eligible for inclusion , the patients had to be scheduled for bimaxillary treatment with FOA for an expected duration of at least 1 year .


The primary and secondary outcome measures were prevalence and incidence of WSL , as registered from digital photos of the maxillary incisors , canines , and premolars taken before onset and immediately after debonding .


The photos were evaluated separately by two blinded and calibrated clinicians using a 4-step score .


A random sample of 50 cases was reassessed to check intra - and interexaminer reliability ( Kappa = 0.70 ; 0.74 ) .


The use of high-fluoride toothpaste resulted in fewer WSL ( P = 0.042 ) with a prevented fraction of 32 % .


The lateral incisor was most commonly affected in both groups .


To prevent WSL during treatment of FOA , daily use of high-fluoride toothpaste may be recommended .


Sensory properties of foods promote and guide consumption in hunger states , whereas satiation should dampen the sensory activation of ingestive behaviors .


Such activation may be disordered in obese individuals .


Using functional magnetic resonance imaging ( fMRI ) , we studied regional brain responses to food odor stimulation in the sated state in obese and normal-weight individuals targeting ventral frontal regions known to be involved in coding for stimulus reward value .


Forty-eight women ( 25 normal weight ; 23 obese ) participated in a 2-day ( fed compared with fasting ) fMRI study while smelling odors of 2 foods and an inedible , nonfood object .


Analyses were conducted to permit an examination of both general and sensory-specific satiation ( satiation effects specific to a given food ) .


Normal-weight subjects showed significant blood oxygen level-dependent responses in the ventromedial prefrontal cortex ( vmPFC ) to food aromas compared with responses induced by the odor of an inedible object .


Normal-weight subjects also showed general ( but not sensory-specific ) satiation effects in both the vmPFC and orbitofrontal cortex .


Obese subjects showed no differential response to the aromas of food and the inedible object when fasting .


Within - and between-group differences in satiation were driven largely by changes in the response to the odor of the inedible stimulus .


Responses to food aromas in the obese correlated with trait negative urgency , the tendency toward negative affect-provoked impulsivity .


Ventral frontal signaling of reward value may be disordered in obesity , with negative urgency heightening responses to food aromas .


The observed nature of responses to food and nonfood stimuli suggests that future research should independently quantify each to fully understand brain reward signaling in obesity .


The objective of the following study is to determine the effect of continuous insonation using 2-MHz transcranial Doppler-ultrasound ( TCD-US ) on the recanalization rate and the short-term outcome in subjects with acute ischemic stroke due to middle cerebral artery ( MCA ) occlusion .


A total of 42 patients with acute ischemic stroke due to MCA occlusion within 24 h were recruited and randomly allotted to two groups ( 21 patients in each group ) .


Group 1 included patients who received 1 h continuous TCD-US for MCA and Group 2 included patients who did not receive 1 h continuous TCD-US .


Patients in both groups were received MCA insonation and TCD study to measure mean flow velocity ( MFV ) in MCA one after the initial study at 20 and 60 min .


All patients received aspirin ( 150-325 mg ) .


The clinical course during hospital stay was assessed before and after 1 h of US insonation , at 24 h after symptom onset using the National Institutes of Health Stroke Scale .


Change in MFV after insonation for Group 1 in comparison to Group 2 at 3 time points was significantly high ( P < 0.001 ) .


Sonothrombolysis is a therapeutic option to improve the outcomes in patients with acute ischemic stroke due to MCA occlusion .


Unsatisfactory colposcopy , an inability to visualize the entire transformation zone , is found in about 10-20 % of the patients undergoing the procedure .


These patients usually require conization for a comprehensive evaluation of the cervix .


Our study aims to compare the efficacy and safety of vaginal misoprostol versus vaginal estradiol in overcoming unsatisfactory colposcopy .


We studied 48 women with unsatisfactory colposcopy .


They were randomized into two groups : group I ( n = 24 ) received 200 g misoprostol vaginally and colposcopy was repeated after 6 h , while the subjects in group II ( n = 24 ) were prescribed a 7-day course of 50 g estradiol for vaginal insertion followed by a repeat colposcopy .


The efficacy and safety of these two drugs were compared .


Repeat colposcopy was satisfactory in 70.8 % of the women given vaginal misoprostol compared to 82.6 % of the women who used vaginal estradiol .


The difference was not statistically significant .


The adverse effects were reported more often by the women in the misoprostol group ( 41.6 % ) as compared to those in estradiol group ( 13 % ) ( p = 0.04 ) .


Both estradiol and misoprostol were comparable in overcoming unsatisfactory colposcopy .


However , a higher incidence of adverse effects was noted with misoprostol as compared to estradiol .


Thymic stromal lymphopoietin ( TSLP ) is an epithelial-cell-derived cytokine that may be important in initiating allergic inflammation .


AMG 157 is a human anti-TSLP monoclonal immunoglobulin G2 that binds human TSLP and prevents receptor interaction .


In this double-blind , placebo-controlled study , we randomly assigned 31 patients with mild allergic asthma to receive three monthly doses of AMG 157 ( 700 mg ) or placebo intravenously .


We conducted allergen challenges on days 42 and 84 to evaluate the effect of AMG 157 in reducing the maximum percentage decrease in the forced expiratory volume in 1 second ( FEV1 ) .


We also measured the fraction of nitric oxide in exhaled air , blood and sputum eosinophils , and airway hyperresponsiveness .


The primary end point was the late asthmatic response , as measured 3 to 7 hours after the allergen challenge .


AMG 157 attenuated most measures of allergen-induced early and late asthmatic responses .


The maximum percentage decrease in the FEV1 during the late response was 34.0 % smaller in the AMG-157 group than in the placebo group on day 42 ( P = 0.09 ) and 45.9 % smaller on day 84 ( P = 0.02 ) .


In addition , patients receiving AMG 157 had significant decreases in levels of blood and sputum eosinophils before and after the allergen challenge and in the fraction of exhaled nitric oxide .


There were 15 adverse events in the AMG-157 group , as compared with 12 in the placebo group ; there were no serious adverse events .


Treatment with AMG 157 reduced allergen-induced bronchoconstriction and indexes of airway inflammation before and after allergen challenge .


These findings are consistent with a key role for TSLP in allergen-induced airway responses and persistent airway inflammation in patients with allergic asthma .


Whether anti-TSLP therapeutics will have clinical value can not be determined from these data .


( Funded by Amgen ; ClinicalTrials.gov number , NCT01405963 . )


This study evaluated the effect of probiotic intervention using lactobacilli on oral malodor .


We conducted a 14-day , double-blind , placebo-controlled , randomized crossover trial of tablets containing Lactobacillus salivarius WB21 ( 2.0 10 ( 9 ) colony-forming units per day ) or placebo taken orally by patients with oral malodor .


Organoleptic test scores significantly decreased in both the probiotic and placebo periods compared with the respective baseline scores ( P < .001 and P = .002 ) , and no difference was detected between periods .


In contrast , the concentration of volatile sulfur compounds ( VSCs ) ( P = .019 ) and the average probing pocket depth ( P = .001 ) decreased significantly in the probiotic period compared with the placebo period .


Bacterial quantitative analysis found significantly lower levels of ubiquitous bacteria ( P = .003 ) and Fusobacterium nucleatum ( P = .020 ) in the probiotic period .


These results indicated that daily oral consumption of tablets containing probiotic lactobacilli could help to control oral malodor and malodor-related factors .


To elucidate the safety profile and symptom-modifying effect of Alflutop and diacerein in the treatment of Kellgren-Lawrence Stages II-III knee osteoarthrosis ( OA ) in patients with oxalate nephropathy and Stages I-II chronic kidney disease ( CKD ) and to refine the effect of these drugs on urinary syndrome and renal function as compared to a response to nonsteroidal anti-inflammatory drugs -- cyclooxygenase inhibitors ( diclofenac ) .


This open-label comparative randomized trial enrolled 86 female patients with Kellgren-Lawrence Stages II-III primary gonarthritis concurrent with oxalate nephropathy and Stages I-II CKD .


The patients were randomized into 3 groups : 1 ) 20 patients took diclofenac sodium 100 mg/day ; 2 ) 30 received a complex pharmaceutical on the basis of glycozaminoglycans Alflutop injection 1 ml per day for 20 days , then 2 ml intraartricular twice weekly in the following month ; 3 ) 36 had diacerein ( diaflex , `` Rompharm Company '' ) in a dose of 50 mg twice daily for 3 months .


On day 30 and day 90 of treatment , the symptom - modifying effect was evaluated from changes in the joint pain and morning stiffness domains of the WOMAC index .


Renal function was measured using the estimated glomerular filtration rate ( GFR ) , uric acid clearance ( C ( ua ) ) , and urinary sediment .


On day 30 of treatment , the patients taking diclofenac were found to have nephrotoxic effects ( lower GFR , C ( ua ) , evolving secondary hyperuricemia , progressive proteinuria , emerging microhematuria , elevated urinary levels of total lipid hydroperoxides , and enhanced calcium oxalate crystalluria ) .


Alflutop and diacerein exerted no negative effects on renal function .


On day 30 day of treatment , all the patient groups showed a reduction in the WOMAC pain score .


The diclofenac group displayed a more marked decrease in the pain score than did the two other groups by day 30 .


Otherwise by day 90 of therapy with Alflutop and diacerein , the pain scores were reduced by 60 and 67 % , respectively , which was similar to those in the diclofenac group by day 30 of a follow-up .


By day 30 day of treatment , the stiffness score was also observed to fall in all the groups and achieved even lower values in the Alflutop and diacerein groups compared with diclofenac group .


Alflutop and diacerein used by patients with knee OA do not produce nephrotoxic effects and by day 90 demonstrated similar to diclofenac symptom-modifying effect by reducing pain and stiffness scores .


Diclofenac administration contributed to oxalate nephropathy progress .


Cesarean section is one of the most commonly performed operations in most countries of the world including Nepal .


Hence there is a load on the financial resources of healthcare system .


The rational of this study was to utilize the remaining No ' 1 ' polyfilament after closing rectus sheath to stitch skin .


So , the primary objective was to determine the wound complication rates for subcuticular suture with No ' 1 ' petcryl ( polyfilamentpolyglycolic acid ) Vs intermittent suture with nylon 2-0 for skin closure at cesarean delivery and secondary objective was to compare postoperative pain and patient satisfaction about the scar .


One hundred and thirty eight women undergoing cesarean section at Chitwan Medical College was randomized to either intermittent skin suture with nylon 2-0 or subcuticular with polyfilament No ' 1 ' ( remaining suture after closing rectus sheath ) .


Evidence of wound infection , pain and overall satisfaction were assessed postoperatively .


The overall wound complications rate in subcuticular stitch with No ' 1 ' polyfilament suture were similar as in intermittent mattress stitch with nylon 2-0 ( 15.9 % vs. 14.49 % ) .


Pain on postoperative third day and six weeks and overall satisfaction about wound were similar in both groups .


Only prolong rupture of membrane > 18 hours was found to be a significant risk factor of wound infection ( OR : 3.4 ; p = 0.04 ) .


The remaining no ' 1 ' polyfilament suture ( petcryl ) after suturing rectus sheath can be safely used to close skin suture in cesarean section .


Failure of aldosterone suppression by sodium loading during fludrocortisone suppression testing ( FST ) or saline suppression testing ( SST ) confirms primary aldosteronism ( PA ) .


We previously found recumbent SST ( RSST ) to lack sensitivity .


Aldosterone levels can be higher upright ( e.g. seated ) than recumbent in patients with PA and upright levels are used during FST .


We therefore hypothesized that seated SST ( SSST ) is more sensitive than RSST , especially for posture-responsive PA. .


Of 66 patients who underwent FST ( upright plasma aldosterone levels measured at 10am basally and after 4 days fludrocortisone 0.1 mg 6-hourly and oral salt loading ) , 31 underwent SST ( aldosterone levels measured basally at 8am and after infusion of 2 L normal saline over 4h ) both recumbent and seated in randomized order and at least 2 weeks apart .


FST confirmed PA in 23 of 31 patients ( day 4 upright aldosterone level > 165 pmol/L ) , excluded PA in three and was originally `` inconclusive '' in five .


However , one with `` inconclusive '' FST had PA confirmed by lateralizing AVS and was reclassified `` unilateral PA '' .


Of 24 with confirmed PA ( eight unilateral , 11 bilateral , and five undetermined subtype ) , 23 ( 96 % ) tested positive by SSST ( 4-h aldosterone level > 165 pmol/L ) compared with 8 ( 33 % ) by RSST ( 4-h plasma aldosterone level > 140 pmol/L ) ( P < .001 ) .


RSST missed one unilateral , all bilateral , and four with as-yet undetermined subtype .


RSST was positive in 7 of 10 ( 70 % ) posture-unresponsive vs one of 14 ( 7.1 % ) posture-responsive patients ( P < .005 ) .


These preliminary results suggest that seated SST may be superior to recumbent SST in terms of sensitivity for detecting PA , especially posture-responsive forms , and may represent a reliable alternative to FST .


Intensive hemodialysis ( HD ) may have significant benefits .


Recently , the role of extended hemodiafiltration ( HDF ) has gained interest .


The aim of this study was to evaluate the acute effects of extended HD and HDF on hemodynamic response and solute removal .


Randomized crossover trial .


Stable patients with end-stage renal disease undergoing conventional HD .


13 patients randomly completed a single study of 4-hour HD ( HD4 ) , 4-hour HDF ( HDF4 ) , 8-hour HD ( HD8 ) , and 8-hour HDF ( HDF8 ) , with a 2-week interval between study sessions .


Between study sessions , patients received routine conventional HD treatments .


Acute hemodynamic effects and uremic toxin clearance .


Blood pressure and heart rate , pulse wave analysis , cardiac output , and microvascular density by sublingual capillaroscopy , as well as relative blood volume and thermal variables , were measured .


Clearance and removal of uremic toxins also were studied .


Long treatments showed more stability of peripheral systolic blood pressure ( change during HD4 , -21.715.6 mm Hg ; during HDF4 , -23.320.8 mm Hg ; during HD8 , -6.715.2 mm Hg [ P = 0.04 vs. HD4 ; P = 0.08 vs. HDF4 ] ; and during HDF8 , -0.514.4 mm Hg [ P = 0.004 vs. HD4 ; P = 0.008 vs. HDF4 ] ) .


A similar observation was found for peripheral diastolic and central blood pressures .


Cardiac output remained more stable in extended sessions ( change during HD4 , -1.41.5 L/min ; during HDF4 , -1.61.0 L/min ; during HD8 , -0.40.9 L/min [ P = 0.02 vs. HDF4 ] ; and during HDF8 , -0.50.8 L/min [ P = 0.06 vs. HD4 ; P = 0.03 vs. HDF4 ) , in line with the decreased relative blood volume slope in long dialysis .


No differences in microvascular density were found .


Energy transfer rates were comparable ( HD4 , 13.34.7 W ; HDF4 , 16.25.6 W ; HD8 , 14.26.0 W ; and HDF8 , 14.54.3 W ) .


Small-molecule and phosphate removal were superior during long treatments .


2-Microglobulin and fibroblast growth factor 23 ( FGF-23 ) reduction ratios were highest in HDF8 .


Small sample size , only acute effects were studied .


Treatment time , and not modality , was the determinant for the hemodynamic response .


HDF significantly improved removal of middle molecules , with superior results in extended HDF .


Enhancing the reliability and responsiveness of motor assessments required to demonstrate therapeutic efficacy is a priority for Parkinson 's disease ( PD ) clinical trials .


The objective of this study is to determine the reliability and responsiveness of a portable kinematic system for quantifying PD motor deficits as compared to clinical ratings .


Eighteen PD patients with subthalamic nucleus deep-brain stimulation ( DBS ) performed three tasks for evaluating resting tremor , postural tremor , and finger-tapping speed , amplitude , and rhythm while wearing a wireless motion-sensor unit ( Kinesia ) on the more-affected index finger .


These tasks were repeated three times with DBS turned off and at each of 10 different stimulation amplitudes chosen to yield small changes in treatment response .


Each task performance was video-recorded for subsequent clinician rating in blinded , randomized order .


Test-retest reliability was calculated as intraclass correlation ( ICC ) and sensitivity was calculated as minimal detectable change ( MDC ) for each DBS amplitude .


ICCs for Kinesia were significantly higher than those for clinician ratings of finger-tapping speed ( p < 0.0001 ) , amplitude ( p < 0.0001 ) , and rhythm ( p < 0.05 ) , but were not significantly different for evaluations of resting or postural tremor .


Similarly , Kinesia scores yielded a lower MDC as compared with clinician scores across all finger-tapping subscores ( p < 0.0001 ) , but did not differ significantly for resting and postural tremor .


The Kinesia portable kinematic system can provide greater test-retest reliability and sensitivity to change than conventional clinical ratings for measuring bradykinesia , hypokinesia , and dysrhythmia in PD patients .


To evaluate the sedative effects , intra-operation , of music therapy in orthopedic surgery patients with locoregional anesthesia in the Hospital Clnic i Provincial of Barcelona .


Prospective comparative study on a random sample of 110 patients undergoing or not music therapy .


The degree of anxiety was assessed with the Questionnaire STAIC .


The application of the music was done with a MP3 player and headphones .


The collected data were analyzed with Excel .


For the statistical analysis we used the SPSS-18 software and Chi-square test to test the hypothesis of whether there was relationship between the level of peace and music therapy .


After the analysis , the results of Chi-square were in the group of no sedation with/without music Chi2 = 2.01 , P = 0.35 .


The statistical significance level was p < 0.05 .


No relationship was found between hearing music or not and the patient 's comfort level .


Most patients recommend listening to music in the operating room despite the sounds around do not bother them .


To investigate the effects of - blockers on cardiac protection and hemodynamic in patients with septic shock .


A prospective randomized controlled trial was conducted .


Forty-one patients with septic shock in accordance with early goal directed treatment and met the target within 6 hours , and admitted to intensive care unit ( ICU ) of Affiliated Huxi Hospital of Jining Medical College from January 2012 to January 2014 were enrolled .


The patients were divided into treatment group ( n = 21 ) and control group ( n = 20 ) by random number table .


The patients in both groups were given the standard treatment , esmolol was giving to patients in treatment group in order to control the heart rate ( HR ) below 100 bpm within 2 hours , and the patients in control group only received standard treatment .


The changes in hemodynamic parameters [ mean arterial pressure ( MAP ) , central venous pressure ( CVP ) , HR , cardiac index ( CI ) , stroke volume index ( SVI ) , systemic vascular resistance ( SVRI ) , global end diastolic volume index ( GEDVI ) ] , biochemistry metabolic of tissue [ central venous oxygen saturation ( ScvO ) , lactic acid ( Lac ) ] , and cardiac markers [ troponin I ( cTnI ) ] before and 12 , 24 , 48 , 72 hours after the treatment were recorded .


( 1 ) Before treatment , the hemodynamic parameters , tissue metabolism index and cTnI had no significant differences in both groups ( all P > 0.05 ) .


( 2 ) The hemodynamic parameters after treatment in the control group showed no significant difference compared with that before treatment .


HR and CI in the treatment group were gradually declined after treatment , SVRI and GEDVI were gradually increased .


There were significant differences in HR , CI , SVRI , and GEDVI between treatment group and control group from 12 hours on [ HR ( bpm ) : 93 4 vs. 118 13 , CI ( L min m ) : 3.3 0.8 vs. 4.5 0.6 , SVRI ( kPas L m ) : 159.2 27.4 vs. 130.5 24.2 , GEDVI ( mL/m ) : 668 148 vs. 588 103 , P < 0.05 or P < 0.01 ] .


MAP , CVP and SVI in the treatment group showed no significant changes .


( 3 ) Lac after treatment in both groups was decreased slowly , Lac ( mmol/L ) at 12 hours after treatment was significantly decreased compared with that before treatment ( control group : 8.8 3.2 vs. 9.8 3.4 , treatment group : 9.5 3.1 vs. 10.5 4.1 , both P < 0.05 ) .


The Lac of control group and treatment group were 2.5 1.2 and 2.7 1.1 at 72 hours after treatment , and there was no significant difference between two groups ( all P > 0.05 ) .


The ScvOwas not decreased in both groups .


( 4 ) Compared with before treatment , cTnI in the control group was gradually increased , peaked at 72 hours , and that in the treatment group was gradually increased , peaked at 24 hours and then gradually declined .


Compared with control group , the cTnI ( g/L ) in the treatment group was decreased significantly at 24 , 48 , 72 hours ( 1.15 0.57 vs. 1.74 0.77 , 0.93 0.52 vs. 2.15 1.23 , 0.52 0.36 vs. 2.39 1.17 , all P < 0.01 ) .


- blockers ( esmolol ) can improve cardiac function and myocardial compliance , reduce the myocardial injury in patients with sepsis shock .


Although - blockers can decrease cardiac output , it has no influence on the circulation function and tissue perfusion .


Eosinophilic esophagitis ( EoE ) is a chronic antigen-mediated disease characterized by esophageal eosinophilia , remodeling , and fibrosis .


TGF-1 is a central regulator of EoE remodeling and increases esophageal smooth muscle ( ESM ) cell contraction .


In this study we aimed to understand the molecular mechanisms by which TGF-1 could induce ESM cell contraction .


We used primary human ESM cells and esophageal myofibroblasts ( EMFs ) to assess the mechanisms of TGF-1-induced contraction .


We analyzed the expression , phosphorylation , and function of phospholamban ( PLN ) , a sarcoendoplasmic reticulum regulatory protein induced by TGF-1 .


Expression of PLN , phospho-PLN , and its regulatory pathway was analyzed in the ESM of biopsy specimens from patients with EoE and control subjects .


Gene silencing in EMFs from patients with EoE was used to understand the role of PLN in contraction .


TGF-1 induced and phosphorylated PLN in primary human ESM cells and EMFs from patients with EoE .


PLN and phospho-PLN levels were increased in smooth muscle from patients with EoE compared with that seen in smooth muscle from control subjects in vivo .


PLN inhibition significantly diminished TGF-1-induced EMF contraction in patients with EoE .


PLN expression and ESM/EMF contraction depended on TGF - receptor I signals .


We describe a previously unrecognized mechanism for ESM cell contraction that depends on TGF-1 , its receptors , and PLN .


Because PLN levels are increased in smooth muscle from patients with EoE and PLN silencing diminishes contraction , we provide a novel potential mechanistic framework and therapeutic target for ESM dysfunction in patients with EoE .


To characterize the physiologic and behavioral effects of a single induction dose and two maintenance doses of alfaxalone delivered by water immersion in the anesthesia of koi ( Cyprinus carpio ) .


Prospective , within-subject complete crossover design .


Six adult koi ( Cyprinus carpio ) with a median body weight of 344.5 g ( range 292.0-405 .0 g ) .


Koi were immersed in water containing 10 mg L ( -1 ) alfaxalone until immobile and then maintained with alfaxalone at either 1 or 2.5 mg L ( -1 ) via a recirculating water system .


Times for anesthetic induction and recovery periods were recorded .


Physiologic and blood gas parameters were evaluated before , during and after the anesthetic trial .


Response to noxious stimuli was also assessed .


Median anesthesia induction time for all fish was 5.4 minutes .


Median recovery time was 11.8 and 26.4 minutes in the 1.0 and 2.5 mg L ( -1 ) doses , respectively , which were significantly different ( p = 0.04 ) .


Cessation of opercular movement occurred in 0/6 and 4/6 fish exposed to 1.0 and 2.5 mg L ( -1 ) dose respectively .


No difference was observed in median heart rate over the duration of the anesthetic events .


Response to noxious stimulation was 4/6 and 0/6 in the 1.0 and 2.5 mg L ( -1 ) doses respectively .


Oxygenation and ventilation did not change during the experiment , but there was a significant decrease in blood pH along with an increase in blood lactate concentration .


Administration of alfaxalone , via water immersion , as an induction and maintenance anesthesia agent provided rapid and reliable anesthesia of koi with no mortality .


The maintenance dose of 2.5 mg L ( -1 ) was sufficient to prevent response to noxious stimuli but was associated with a clinically relevant depression in opercular rate .


Randomised trials provide evidence that patient decision aids improve outcomes with respect to patient knowledge , involvement and satisfaction in decision making .


It is less clear how these complex interventions are implemented within patient-clinician interactions and which components are active for improving decision processes .


To investigate the experiences of using a diabetes treatment decision aid and to explore how components within a complex intervention influenced the decision making process .


A pragmatic mixed methods study nested within the PANDAs cluster randomised trial of a patient decision aid .


Themes inductively derived from interviews and observation of consultations with further triangulation with results of decision quality and involvement measurements and case analyses .


The decision aid intervention was employed flexibly within the consultation with both the patient and clinician active in marshalling elements .


The decision aid improved processing and organization of information needed for decision making within the consultation interaction .


It also improved decision quality by preparing the patient for active involvement within the clinical consultation .


The intervention was acceptable , flexible and readily implemented in primary care consultations .


The decision aid was effective in facilitating cognitive processing .


The intervention also facilitated rehearsal in preparation for active roles in a shared decision process .


Trials Register Number : ISRCTN14842077 .


Date registered : 24.06.2010 .


Individuals with posttraumatic stress disorder ( PTSD ) often exhibit high-risk substance use behaviors .


Complementary and alternative therapies are increasingly used for mental health disorders , although evidence is sparse .


Investigate the effect of a yoga intervention on alcohol and drug abuse behaviors in women with PTSD .


Secondary outcomes include changes in PTSD symptom perception and management and initiation of evidence-based therapies .


The current investigation analyzed data from a pilot randomized controlled trial comparing a 12-session yoga intervention with an assessment control for women age 18 to 65 years with PTSD .


The Alcohol Use Disorder Identification Test ( AUDIT ) and Drug Use Disorder Identification Test ( DUDIT ) were administered at baseline , after the intervention , and a 1-month follow-up .


Linear mixed models were used to test the significance of the change in AUDIT and DUDIT scores over time .


Treatment-seeking questions were compared by using Fisher exact tests .


The mean AUDIT and DUDIT scores decreased in the yoga group ; in the control group , mean AUDIT score increased while mean DUDIT score remained stable .


In the linear mixed models , the change in AUDIT and DUDIT scores over time did not differ significantly by group .


Most yoga group participants reported a reduction in symptoms and improved symptom management .


All participants expressed interest in psychotherapy for PTSD , although only two participants , both in the yoga group , initiated therapy .


Results from this pilot study suggest that a specialized yoga therapy may play a role in attenuating the symptoms of PTSD , reducing risk of alcohol and drug use , and promoting interest in evidence-based psychotherapy .


Further research is needed to confirm and evaluate the strength of these effects .


The aim of the study is to evaluate the long-term near-transfer effects of computerized working memory ( WM ) training on standard WM tasks in children with Attention-Deficit/Hyperactivity Disorder ( ADHD ) .


Sixty-seven children aged 10-12 years in Vestfold/Telemark counties ( Norway ) diagnosed with F90 .0 Hyperkinetic disorder ( ICD-10 ) were randomly assigned to training or control group .


The training group participated in a 25-day training program at school , while the control group received treatment-as-usual .


Participants were tested one week before intervention , immediately after and eight months later .


Based on a component analysis , six measures of WM were grouped into composites representing Visual , Auditory and Manipulation WM.


The training group had significant long-term differential gains compared to the control group on all outcome measures .


Performance gains for the training group were significantly higher in the visual domain than in the auditory domain .


The differential gain in Manipulation WM persisted after controlling for an increase in simple storage capacity .


Systematic training resulted in a long-term positive gain in performance on similar tasks , indicating the viability of training interventions for children with ADHD .


The results provide evidence for both domain-general and domain-specific models .


Far-transfer effects were not investigated in this article .


Controlled-Trials .


com ISRCTN19133620 .


A number of simulators have been developed to teach surgical trainees the basic skills required to effectively perform laparoscopic surgery ; however , consideration needs to be given to how well the skills taught by these simulators are maintained over time .


This study compared the maintenance of laparoscopic skills learned using box trainer and virtual reality simulators .


Participants were randomly allocated to be trained and assessed using either the Society of American Gastrointestinal Endoscopic Surgeons Fundamentals of Laparoscopic Surgery ( FLS ) simulator or the Surgical Science virtual reality simulator .


Once participants achieved a predetermined level of proficiency , they were assessed 1 , 3 , and 6 months later .


At each assessment , participants were given 2 practice attempts and assessed on their third attempt .


The study was conducted through the Simulated Surgical Skills Program that was held at the Royal Australasian College of Surgeons , Adelaide , Australia .


Overall , 26 participants ( 13 per group ) completed the training and all follow-up assessments .


There were no significant differences between simulation-trained cohorts for age , gender , training level , and the number of surgeries previously performed , observed , or assisted .


Scores for the FLS-trained participants did not significantly change over the follow-up period .


Scores for LapSim-trained participants significantly deteriorated at the first 2 follow-up points ( 1 and 3 months ) ( p < 0.050 ) , but returned to be near initial levels by the final follow-up ( 6 months ) .


This research showed that basic laparoscopic skills learned using the FLS simulator were maintained more consistently than those learned on the LapSim simulator .


However , by the final follow-up , both simulator-trained cohorts had skill levels that were not significantly different to those at proficiency after the initial training period .


To compare the effects of 2 NSAIDs ( phenylbutazone and meloxicam ) on renal function in horses .


9 Thoroughbred or Standardbred mares ( mean SD age , 5.22 1.09 years [ range , 2 to 12 years ] ; mean body weight , 470 25 kg [ range , 442 to 510 kg ] ) .


A randomized blinded placebo-controlled crossover study was conducted to examine the effects of treatment with phenylbutazone , meloxicam , or a placebo ( control solution ) on renal responses to the administration of furosemide , dobutamine , and exercise ( 15 minutes at 60 % of maximum heart rate ) .


Renal function was assessed by use of bilateral ureteral catheterization for simultaneous determination of creatinine clearance , sodium excretion , and urine flow rate .


Both phenylbutazone and meloxicam attenuated diuresis and natriuresis and reduced glomerular filtration rate , compared with results for the control solution , when horses were treated with furosemide .


Mean arterial blood pressure , urine flow rate , and glomerular filtration rate were increased during or after ( or both ) dobutamine infusion .


Both NSAIDs reduced urine flow rate and sodium excretion associated with dobutamine infusion and exercise but had no effect on glomerular filtration rate .


Responses to meloxicam , a cyclooxygenase ( COX ) -2 preferential agent , appeared comparable to those detected after phenylbutazone treatment , which suggested that COX-2 was the mediator of prostanoid-induced changes to renal function in horses and indicated that COX-2-preferential agents would be likely to have adverse renal effects similar to those for nonselective COX inhibitors in volume-depleted horses .


Cardiac autonomic neuropathy ( CAN ) and elevated nocturnal blood pressure are independent risk factors for cardiovascular disease in patients with diabetes .


Previously , associations between CAN , non-dipping of nocturnal blood pressure and coronary artery calcification have been demonstrated .


The present protocol describes a trial to test the efficacy of bedtime dosing of the ACE inhibitor enalapril on night time blood pressure and left ventricular mass in patients with type 1 diabetes .


In a randomised , double-blind , two-way cross-over study , 24 normoalbuminuric patients with type 1 diabetes with CAN will be treated for 12weeks with either morning or bedtime dosing of 20mg enalapril , followed by 12weeks of switched treatment regimen .


During each treatment period , two 24h ambulatory blood pressure measurements will be performed and after each treatment period left ventricular mass will be determined by multisliced CT. .


Primary end points will be reduction in blood pressure and reduction in left ventricular mass .


The study has been approved by the Danish Medicines Agency , the Scientific-Ethical Committee of the Capital Region of Denmark and the Danish Data Protection Agency .


An external monitoring committee ( the Good Clinical Practice Unit at Copenhagen University Hospital ) will oversee the study .


The results of the study will be presented at national and international scientific meetings and publications will be submitted to peer-reviewed journals .


EudraCT ( 2012 - 002136-90 ) .


To analyze prospectively the hypothalamic-pituitary-adrenal ( HPA ) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease ( COPD ) .


Prospective observational study .


Patients presenting to the emergency department were randomized to receive 40mg prednisone daily for 5 or 14 days in a placebo-controlled manner .


The HPA axis was longitudinally assessed with the 1g corticotropin test and a clinical hypocortisolism score at baseline , on day 6 before blinded treatment , at hospital discharge , and for up to 180 days of follow-up .


Prednisone was stopped abruptly , irrespective of the test results .


Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment .


A total of 311 patients were included in the analysis .


Mean basal and stimulated serum total cortisol levels were highest on admission ( 496398 and 816413nmol/l respectively ) and lowest on day 6 ( 235174 and 453178nmol/l respectively ) .


Pathological stimulation tests were found in 63 , 38 , 9 , 3 , and 2 % of patients on day 6 , at discharge , and on days 30 , 90 , and 180 respectively , without significant difference between treatment groups .


Clinical indicators of hypocortisolism did not correlate with stimulation test results , but cortisol levels were inversely associated with re-exacerbation risk .


There were no hospitalizations or deaths as a result of adrenal crisis .


Dynamic changes in the HPA axis occur during and after the treatment of acute exacerbations of COPD .


In hypocortisolemic patients who were provided with instructions about stress prophylaxis , the abrupt termination of prednisone appeared safe .


To compare the clinical efficacy of Black seeds and Turmeric alone and its co-administration in lower doses among patients with metabolic syndrome ( MetS ) .


Double-blind-randomized-controlled trial .


Hijrat colony , Karachi , Pakistan .


Apparently healthy males ( n = 250 ) , who screened positive for MetS , were randomized to either Black seeds ( 1.5 g/day ) , Turmeric ( 2.4 g/day ) , its combination ( 900mg Black seeds and 1.5 g Turmeric/day ) or placebo for 8 weeks .


body-mass-index ( BMI ) , body-fat-percent ( BF % ) , waist-circumference ( WC ) , hip-circumference ( HC ) , blood pressure ( BP ) , lipid-profile ( cholesterol , HDL-cholesterol , LDL-cholesterol and TG ) , fasting blood glucose ( FBG ) and c-reactive protein ( CRP ) .


At 4 weeks , compared to baseline , Black seed and Turmeric alone showed improvement in BMI , WC and BF % .


Combination improved all parameters except HDL-cholesterol with lower FBG and LDL-cholesterol as compared to placebo .


At 8 weeks , compared to placebo , Black seeds reduced lipids and FBG , while Turmeric reduced LDL-cholesterol and CRP .


Interestingly , combination group with 60 % dose of the individual herbs showed an improvement in all parameters from baseline .


When compared to placebo , it reduced BF % , FBG , cholesterol , TG , LDL-cholesterol , CRP and raised HDL-cholesterol .


Turmeric and Black seeds showed improvement in all parameters of metabolic syndrome , when co-administered at 60 % of doses of individual herbs with enhanced efficacy and negligible adverse-effects .


The combination of Black seeds and Turmeric can therefore , be recommended with lifestyle modification as a starting point for patients with MetS to halt its future complications and progression .


The aim of this study was to assess the effect of an active and novel distraction technique WITAUL ( Writing In The Air Using Leg ) on the pain behavior observed and reported by children receiving local anesthesia injections prior to dental treatment .


The study was conducted on 160 children ( 80 in control and 80 in intervention group ) between the ages of 4 - 10 years .


During the administration of anesthesia the children in the control group were made to relax by means of deep breathing and those in the intervention group were taught to use the WITAUL distraction technique .


the behavior of the children aged 4 - 5 years was noted using the Modified Toddler - Preschooler Post operative Pain Scale ( TPPPS ) and that of children aged above 6 years was measured using the FACES Pain Scale-Revised ( FPS-R ) .


The use of WITAUL was found to be statistically significant ( p value < 0.0001 ) compared to the control method in serving as a distraction and hence in managing pain during local anesthesia administration .


The mean Modified TPPPS scores ( 4 - 5 year olds ) for the WITAL group was 2.46 + / - 1.752 and that of the control was 5.64 + / - 2.328 .


The mean FPS-R scores ( 6 - 10 year olds ) for the WITAUL group was 3 + / - 1.748 and that of the control group was 6.26 + / - 1.858 .


The WITAUL technique therefore appears to be a simple and effective method of distraction during local anesthesia administration in pediatric patients .


Both antidepressant medications and psychological therapy are common treatments for depression in postpartum women .


Antidepressant treatment may have a number of practical disadvantages , including a preference by women to avoid medication while breastfeeding .


Consequently , more information about the relative benefits of the two modalities in the perinatal period is helpful .


In the treatment of depressive disorders there is some evidence that combination therapies ( pharmacological plus psychological treatment ) may be more efficacious than either form of mono-therapy in isolation .


However , in the treatment of postnatal depression , such evidence is limited .


Forty five postpartum women with a DSM-IV diagnosis of depression were randomised to receive either : 1 ) cognitive behavioural therapy ( CBT ) ; 2 ) sertraline , or 3 ) a combination of both treatment modalities .


Psychometric measures were collected weekly for 12 weeks , with a follow-up at 24 weeks .


Symptoms of depression and anxiety were reduced to a significant degree following all three treatments .


CBT mono-therapy was found to be superior to both sertraline mono-therapy and combination therapy after 12 weeks .


The CBT mono-therapy group appeared to display the most rapid initial gains after treatment commencement .


In this sample , a specialised CBT program for postnatal depression was found to be superior as a mono-therapy compared to sertraline , a commonly prescribed SSRI antidepressant .


This is in contrast to previous studies which have found no detectable difference in the efficacies of drug and psychological treatment for postnatal depression .


Unlike some previous work , this study allowed a statistically independent evaluation of CBT mono-therapy for postnatal depression compared to both antidepressant and combination therapy .


In line with previous studies in postpartum women , there was no detectable advantage of combining pharmacological and psychological treatments in the short term .


Determine changes in cognition and post-traumatic stress disorder ( PTSD ) symptoms in subjects with traumatic brain injury ( TBI ) exposed to 2.4 atmospheres absolute ( atm abs ) breathing 100 % oxygen vs. sham ( 1.3 atm-abs air ) .


Fifty randomized subjects completed a total of 30 exposures .


A concussion history was taken , then baseline , post-series , and six-week follow-up immediate post-concussion assessment and cognitive testing , Brain-checkers and PTSD Checklist for Military ( PCL-M ) tests were administered .


No statistically significant differences between groups were noted , but both groups improved .


Subgroups analyses , based on concussion history and individual test components , showed improvement in the treatment group vs. the sham .


These subgroups included the number of concussive events , time from event to consent , loss of consciousness , visual memory , processing , go -- no go , and simple reaction time .


There was no statistically significant difference between a sham and 2.4 atm abs hyperbaric oxygen ( HBO2 ) in cognitive scores from ImPACT and Brain-checkers or composite scores in the PCL-M ; however both groups showed improvement .


Subgroups with favorable response to treatment are identified .


Future studies evaluating HBO2 should consider concussion histories or focus on validating subgroup response to determine HBO2 as a potential adjunctive treatment for persistent symptoms following TBI .


We conducted a prospective randomized controlled noninferiority trial to compare objective and subjective outcomes of retropubic tension-free vaginal tape ( TVT ) with those of transobturator tape ( TVT-O ) as primary treatment for stress urinary incontinence ( SUI ) in women .


The study was conducted at 25 gynecology units in Austria and Germany ; regional and academic hospitals participated .


A total of 569 patients were randomly assigned to undergo TVT or TVT-O .


A total of 480 patients ( 85 % ) were examined at 3 months .


A negative cough stress test with stable cystometry to 300 ml was seen in 87 % of patients after TVT and in 84 % after TVT-O ; 64 % and 59 % of patients , respectively , reported no pad use , and 88 % of patients in both groups considered themselves much or very much better on the Patient Global Impression of Improvement ( PGI-I ) scale .


Quality of life ( QoL ) as assessed with the SF-12 Health Survey , Kings ' Health Questionnaire , ( KHQ ) , and EuroQol-5D ( EQ-5D ) was significantly improved in both arms , with no differences between arms .


There were no significant differences in postoperative pain or complications .


Results of this trial demonstrate noninferiority between TVT and TVT-O with regard to postoperative continence and QoL and suggest little difference in perioperative problems ( ClinicalTrials.gov NCT 00441454 ) .


Hip fractures incur the greatest medical costs of any fracture .


Valid epidemiological data are important to monitor for time-dependent changes .


In Norway , hip fractures are registered in the Norwegian Patient Registry ( NPR ) , but no published national validation exists .


The aim of the present study was a national validation of NPR as a register for hip fractures using diagnostic codes ( ICD-10 S 72.0-2 ) and/or procedure codes ( NOMESCO version 1.14 NFBxy ( x = 0-9 , y = 0-2 ) or NFJxy ( x = 0-9 , y = 0-2 ) .


A nationwide , population-based cohort comprising a random sub-sample of 1,000 hip fracture-related entries for the years 2008-09 was drawn from the NPR .


200 entries were defined by a combination of diagnostic and procedure codes ( subsample 1 ) , 400 entries were defined by diagnostic codes only ( subsample 2 ) and 400 entries were defined by procedure codes only ( subsample 3 ) .


Accuracy was ascertained through comparison with discharge summaries , procedure notes and X-ray reports requested from 40 health institutions .


Comparisons between groups were done by chi2 for categorical and t-test for continuous variables .


792 health records from 32 institutions were reviewed .


High accuracy ( 98.2 % , 95 % C.I. 96.5-99 .9 % ) was found for subsample 1 , a combination of diagnostic and procedure codes .


Coding errors were prominent in other subsamples .


Defining fractures by a combination of diagnostic and procedure codes , annual average hip fracture incidence in Norway was 9,092 ( 95 % C.I. 8,934 -9,249 ) , excluding only 6.5 % of all hip fractures defined by wider definitions .


Based on current coding practice in Norway , a reliable national estimate of hip fracture incidences is found by a combination of relevant ICD-10 and NOMESCO codes in the NPR .


This method may be used for monitoring epidemiological changes .


This study was undertaken to identify a preferred dosing strategy for patients undergoing coronary artery bypass grafting or valve replacement procedures with cardiopulmonary bypass .


Patients undergoing coronary artery bypass grafting , valve replacement surgery , or both were randomly assigned to receive either standard 1-g dosing with vancomycin before and after cardiopulmonary bypass or a single weight-based 20-mg/kg dose before surgery .


The primary outcome was the percentage of time plasma concentrations were greater than 15 g/mL during cardiopulmonary bypass and at surgical closure .


Secondary outcomes included concentration of vancomycin in endothoracic tissue after vancomycin infusion , average time patients had vancomycin concentrations greater than 15 g/mL , and vancomycin plasma and tissue pharmacokinetic parameters .


Baseline characteristics were similar between the study dosing group ( n = 10 ) and the standard dosing group ( n = 10 ) .


From postinfusion to end of bypass , the median percentage of time vancomycin concentrations remained greater than 15 g/mL was 100 % ( interquartile range [ IQR ] , 72.6 % -100 % ) for weight-based dosing versus 43.7 % ( IQR , 28.7 % -53.4 % ) for standard dosing ( P = .0005 ) .


From postinfusion to surgical closure , the percentage of time vancomycin concentrations remained greater than 15 g/mL was significantly higher in the weight-based group ( 100 % [ IQR , 58.3 % -100 % ] vs 34.6 % [ IQR , 25.3 % -41.6 % ] ; P = .0005 ) .


Weight-based dosing increased calculated time with vancomycin concentrations greater than 15 g/mL and resulted in higher endothoracic tissue vancomycin concentrations .


Weight-based vancomycin dosing before coronary artery bypass grafting or valve replacement results in vancomycin concentrations greater than 15 g/mL consistently more than does standard 1-g dosing .


Numerous open trials have demonstrated the beneficial clinical effects of aspirin desensitization ( AD ) in patients with aspirin-induced asthma ( AIA ) .


These beneficial effects might be attributable to aspirin 's potent anti-inflammatory properties , but that supposition requires further corroboration .


We sought to compare the clinical and biochemical responses to chronic oral AD in 20 patients with AIA and 14 patients with aspirin-tolerant asthma ( ATA ) .


All of the patients had chronic rhinosinusitis and nasal polyposis , and these responses were investigated in a pilot , double-blind , placebo-controlled study .


Twelve patients with AIA and 6 patients with ATA were randomly assigned to receive 624 mg of aspirin , and 8 patients with AIA and 8 patients with ATA received placebo .


Both aspirin and placebo were administered once daily for 6 months .


Nasal symptoms , Sino-Nasal Outcome Test ( SNOT20 ) scores , peak nasal inspiratory flows , Asthma Control Questionnaire scores , spirometric parameters , peak expiratory flows , blood eosinophilia , and corticosteroid doses were assessed on a monthly basis .


Levels of urinary leukotriene E4 and the stable plasma prostaglandin ( PG ) D2 metabolite 9,11-PGF2 were evaluated at baseline and after 1 , 3 , 5 , and 6 months .


Only the patients with AIA subjected to AD reported improvements in smell and reductions in sneezing and nasal blockade .


The SNOT20 and Asthma Control Questionnaire scores of these patients decreased , and their peak nasal inspiratory flows increased .


The dosages of inhaled corticosteroids were reduced .


There were no changes in leukotriene E ( 4 ) or 9,11-PGF ( 2 ) levels after AD .


The clinically beneficial effects of AD on nasal and bronchial symptoms occurred only in the patients with AIA .


To evaluate repeated subgingival air-polishing in residual pockets with a new erythritol powder containing 0.3 % chlorhexidine .


Single-centre , examiner masked , randomized clinical trial of 12months with a two-arm , within-subject parallel design .


Fifty patients in periodontal maintenance were monitored in 3-month intervals .


At months 0 , 3 , 6 and 9 , all sites presenting with a probing depth ( PD ) > 4mm were subject to subgingival air-polishing ( test side ) or ultrasonic debridement ( control side ) .


The primary endpoint was presence/absence of PD > 4mm after 12months .


Totally 6918 sites were monitored at baseline , 457 of them had a PD > 4mm ( range 5-9mm ) .


The number of pockets > 4mm per subject , PD and bleeding on probing were significantly lower at month 12 .


Differences between test and control were not significant .


There was a significant difference in favour of air-polishing for the perception of pain/discomfort .


Differences of frequencies at > 1000 and > 100,000 cells/ml of six microorganisms between baseline and month 12 were not significant .


At month 12 , test sites were less frequently positive for Aggregatibacter actinomycetemcomitans at > 1000cells/ml than controls , and counts never exceeded 100,000 cells/ml .


Repeated subgingival air-polishing reduced the number of pockets > 4mm similar to ultrasonic debridement .


It was safe and induced less pain .


Lumbar puncture ( LP ) is one of the most common procedures performed in medicine .


The aim of this prospective study is to determine the success rate of LP in lateral decubitus with 45-degree head-up tilt position , and compare it with traditional positions like sitting and lateral decubitus .


Three hundred and thirty patients between 25 and 85 years of age who had undergone abdominal , urologic , and lower limb extremities surgeries were enrolled and 300 patients were divided into three different groups .


The LP was performed with a 25-G atraumatic needle , either in the standard sitting position ( group S , n = 100 ) , lateral decubitus , knee-chest position ( group L , n = 100 ) or lateral decubitus , knee-chest position with a 45-degree head-up tilt ( group M , n = 100 ) .


The free flow of clear cerebrospinal fluid ( CSF ) upon first attempt was considered to be evidence of a successful LP .


Total LP success rate was significantly higher in group M ( 85 % ) than in groups S and L ( 70 and 65 % , respectively ) ( p = 0.004 ) .


When the significance between the groups was evaluated according to age , the increase in the LP success rate was not significant for 65 and > 65 age groups .


There were no differences among the three groups in terms of bloody CSF ( p = 0.229 ) and the number of attempts before dural puncture ( p = 0.052 ) .


The lateral decubitus in knee-chest position with a 45-degree head-up tilt may be the preferred position for spinal anesthesia in young and elderly patients , due to the high success rate .


Classification of chronic heart failure ( HF ) is on the basis of criteria that may not adequately capture disease heterogeneity .


Improved phenotyping may help inform research and therapeutic strategies .


This study used cluster analysis to explore clinical phenotypes in chronic HF patients .


A cluster analysis was performed on 45 baseline clinical variables from 1,619 participants in the HF-ACTION ( Heart Failure : A Controlled Trial Investigating Outcomes of Exercise Training ) study , which evaluated exercise training versus usual care in chronic systolic HF .


An association between identified clusters and clinical outcomes was assessed using Cox proportional hazards modeling .


Differential associations between clinical outcomes and exercise testing were examined using interaction testing .


Four clusters were identified ( ranging from 248 to 773 patients in each ) , in which patients varied considerably among measures of age , sex , race , symptoms , comorbidities , HF etiology , socioeconomic status , quality of life , cardiopulmonary exercise testing parameters , and biomarker levels .


Differential associations were observed for hospitalization and mortality risks between and within clusters .


Compared with cluster 1 , risk of all-cause mortality and/or all-cause hospitalization ranged from 0.65 ( 95 % confidence interval [ 95 % CI ] : 0.54 to 0.78 ) for cluster 4 to 1.02 ( 95 % CI : 0.87 to1 .19 ) for cluster 3 .


However , for all-cause mortality , cluster 3 had a disproportionately lower risk of 0.61 ( 95 % CI : 0.44 to 0.86 ) .


Evidence suggested differential effects of exercise treatment on changes in peak oxygen consumption and clinical outcomes between clusters ( p for interaction < 0.04 ) .


Cluster analysis of clinical variables identified 4 distinct phenotypes of chronic HF .


Our findings underscore the high degree of disease heterogeneity that exists within chronic HF patients and the need for improved phenotyping of the syndrome .


( Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure ; NCT00047437 ) .


Despite the considerable injury burden attributable to falls at home among the general population , few effective safety interventions have been identified .


We tested the safety benefits of home modifications , including handrails for outside steps and internal stairs , grab rails for bathrooms , outside lighting , edging for outside steps , and slip-resistant surfacing for outside areas such as decks and porches .


We did a single-blind , cluster-randomised controlled trial of households from the Taranaki region of New Zealand .


To be eligible , participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies .


We randomly assigned households by electronic coin toss to either immediate home modifications ( treatment group ) or a 3-year wait before modifications ( control group ) .


Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes .


The primary outcome was the rate of falls at home per person per year that needed medical treatment , which we derived from administrative data for insurance claims .


Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested .


To account for clustering at the household level , we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations .


Analysis was by intention to treat .


This trial is registered with the Australian New Zealand Clinical Trials Registry , number ACTRN12609000779279 .


Of 842 households recruited , 436 ( n = 950 individual occupants ) were randomly assigned to the treatment group and 406 ( n = 898 occupants ) were allocated to the control group .


After a median observation period of 1148 days ( IQR 1085-1263 ) , the crude rate of fall injuries per person per year was 0.061 in the treatment group and 0.072 in the control group ( relative rate 0.86 , 95 % CI 0.66-1 .12 ) .


The crude rate of injuries specific to the intervention per person per year was 0.018 in the treatment group and 0.028 in the control group ( 0.66 , 0.43-1 .00 ) .