Among patients with acute ischemic stroke , blood pressure reduction with antihypertensive medications , compared with the absence of hypertensive medication , did not reduce the likelihood of death and major disability at 14 days or hospital discharge .


clinicaltrials.gov Identifier : NCT01840072 .


Reactivity to smoking cues is an important factor in the motivation to smoke and has been associated with the dopamine receptor 4 variable number tandem repeat ( DRD4 exon III VNTR ) polymorphism .


However , little is known about the associated neural mechanisms .


Non-treatment-seeking Caucasian smokers completed overnight abstinence and viewed smoking and neutral cues during 2 separate functional magnetic resonance imaging scans while wearing either a nicotine or placebo patch ( order randomized ) and were genotyped for the DRD4 VNTR .


We conducted mixed-effects repeated-measures analyses of variance ( within-subject factor : nicotine or placebo patch ; between-subject factor : DRD4 long [ L : 1 copy of 7 repeats ] or short [ S : 2 copies 6 repeats ] genotype ) of 6 a priori regions of interest .


Relative to neutral cues , smoking cues elicited greater activity in bilateral ventral striatum and left amygdala during nicotine replacement and deactivation in these regions during nicotine deprivation .


A patch DRD4 interaction was observed in the left amygdala , an area associated with appetitive reinforcement and relapse risk , such that S allele carriers demonstrated greater activation on active patch than on placebo patch .


Brain systems associated with reward salience may become primed and overreactive at nicotine replacement doses intended for the first step of smoking cessation and may become inhibited during nicotine withdrawal in DRD4 S but not in DRD4 L carriers .


These findings are consistent with the role of these regions in drug reinforcement and suggest a differential influence of nicotine replacement on amygdala activation in the association of incentive salience with smoking stimuli across DRD4 genotypes .


This double-blind , randomized , placebo-controlled study investigated the impact of repetitive transcranial magnetic stimulation ( rTMS ) on quality of life ( QoL ) of patients with fibromyalgia , and its possible brain metabolic substrate .


Thirty-eight patients were randomly assigned to receive high-frequency rTMS ( n = 19 ) or sham stimulation ( n = 19 ) , applied to left primary motor cortex in 14 sessions over 10 weeks .


Primary clinical outcomes were QoL changes at the end of week 11 , measured using the Fibromyalgia Impact Questionnaire ( FIQ ) .


Secondary clinical outcomes were mental and physical QoL component measured using the 36-Item Short Form Health Survey ( SF-36 ) , but also pain , mood , and anxiety .


Resting-state [ ( 18 ) F ] - fluorodeoxyglucose-PET metabolism was assessed at baseline , week 2 , and week 11 .


Whole-brain voxel-based analysis was performed to study between-group metabolic changes over time .


At week 11 , patients of the active rTMS group had greater QoL improvement in the FIQ ( p = 0.032 ) and in the mental component of the SF-36 ( p = 0.019 ) than the sham stimulation group .


No significant impact was found for other clinical outcomes .


Compared with the sham stimulation group , patients of the active rTMS group presented an increase in right medial temporal metabolism between baseline and week 11 ( p < 0.001 ) , which was correlated with FIQ and mental component SF-36 concomitant changes ( r = -0.38 , p = 0.043 ; r = 0.51 , p = 0.009 , respectively ) .


QoL improvement involved mainly affective , emotional , and social dimensions .


Our study shows that rTMS improves QoL of patients with fibromyalgia .


This improvement is associated with a concomitant increase in right limbic metabolism , arguing for a neural substrate to the impact of rTMS on emotional dimensions involved in QoL .


This study provides Class II evidence that rTMS compared with sham rTMS improves QoL in patients with fibromyalgia .


Long-term Mechanical Low-Back Pain ( LMLBP ) negatively impacts on patients ' physical capacity and quality of life .


This study investigated the relationship between Health-Related Quality of Life ( HRQoL ) and pain intensity , and the influence of static and dynamic back extensors ' endurance exercises on HRQoL in Nigerian patients with LMLBP treated with the McKenzie Protocol ( MP ) .


A single-blind controlled trial involving 84 patients who received treatment thrice weekly for eight weeks was conducted .


Participants were assigned to the MP Group ( MPG ) , MP plus Static Back Endurance Exercise Group ( MPSBEEG ) or MP plus Dynamic Endurance Exercise Group ( MPDBEEG ) using permuted randomization .


HRQoL and pain was assessed using the Short-Form ( SF-36 ) questionnaire and Quadruple Visual Analogue Scale respectively .


Sixty seven participants aged 51.8 7.35 years completed the study .


A total drop-out rate of 20.2 % was observed in the study .


Within-group comparison across weeks 0-4 , 4-8 and 0-8 of the study revealed significant differences in HRQoL scores ( p < 0.05 ) .


Treatment Effect Scores ( TES ) across the groups were significantly different ( p = 0.001 ) .


MPSBEEG and MPDBEEG were comparable in TES on General Health Perception ( GHP ) at week 4 ; and GHP and Physical Functioning at week 8 respectively ( p > 0.05 ) .


However , MPDEEG had significantly higher TES in the other domains of the SF-36 ( p = 0.001 ) .


HRQoL in patients with LMLBP decreases with pain severity .


Each of MP , static and dynamic back extensors endurance exercises significantly improved HRQoL in LMLBP .


However , the addition of dynamic back extensors endurance exercise to MP led to greater improvement in HRQoL .


High-grade prostatic intraepithelial neoplasia ( HGPIN ) is considered a precursor lesion of prostate cancer ( PCa ) .


The predictive value of ERG gene fusion in HGPIN for PCa was interrogated as a post hoc analysis in the context of a randomized clinical trial .


The GTx Protocol G300104 randomly assigned 1,590 men with biopsy-diagnosed HGPIN to receive toremifene or placebo for 3 years or until a diagnosis of PCa was made on prostate biopsy .


As part of this phase III clinical trial , a central pathologist evaluated biopsies of patients with isolated HGPIN at baseline and 12 , 24 , and 36 months of follow-up .


ERG immunohistochemistry was performed on biopsies from 461 patients and evaluated for protein overexpression .


ERG expression was detected in 11.1 % of patients ( 51 of 461 patients ) with isolated HGPIN .


In the first year and during the 3-year clinical trial , 14.7 % and 36.9 % of 461 patients were diagnosed with PCa , respectively .


Patients with ERG expression were more likely to develop PCa , with 27 ( 53 % ) of 51 ERG-positive and 143 ( 35 % ) of 410 ERG-negative patients experiencing progression to PCa ( P = .014 , Fisher 's exact test ) .


ERG expression was not associated with age , baseline PSA , Gleason score , or tumor volume .


This study underscores the necessity of more stringent follow-up for men with HGPIN that is also positive for ERG overexpression .


Clinicians should consider molecular characterization of HGPIN as a means to improve risk stratification .


Limited disease knowledge is frequently the cause of disease-related anxiety in myocardial infarction patients .


The ability to communicate effectively serves multiple purposes in the professional nursing practice .


By communicating effectively with myocardial infarction patients , nurses may help reduce their anxiety by keeping them well informed about their disease and teaching them self-care strategies .


This research evaluates the communication skills of nurses following scenario-based simulation education in the context of communication with myocardial infarction patients .


This study used an experimental design and an educational intervention .


The target population comprised nurses of medicine ( clinical qualified level N to N2 for nursing ) working at a municipal hospital in Taipei City , Taiwan .


A total 122 participants were enrolled .


Stratified block randomization divided participants into an experimental group and a control group .


The experimental group received clinical scenario-based simulation education for communication .


The control group received traditional class-based education for communication .


Both groups received a pre-test and a Communication Skills Checklist post-test assessment .


Results were analyzed using SPSS 17.0 for Windows software .


A t-test showed significant increases in communication skills ( p < .001 ) in the experimental group and ANCOVA results identified significant between-group differences ( p < .001 ) in communication skills following the education intervention .


The results indicate that clinical scenario-based simulation education for communication is significantly more effective than traditional class-based education in enhancing the ability of nurses to communicate effectively with myocardial infarction patients .


To observe the effects on post-stroke depression treated with acupuncture at the acu points based on ziwuliuzhu ( the midnight-noon ebb-flow theory ) .


Ninety-three patients were randomized into a comprehensive group , a ziwuliuzhu group and a prozac group , 31 cases in each group .


In the ziwuliuzhu group , acupuncture was applied to the acupoints based on ziwuliuzhu , once a day , 5 times in a week .


In the prozac group , fluoxertine hydrochloride ( prozac ) was prescribed for oral administration , once a day , 20 mg each time .


In the comprehensive group , acupuncture based on ziwuliuzhu combined with the oral administration of prozac were adopted and the treatment frequency was the same as the ziwuliuzhu group and the prozac group .


The 4-week treatment was taken as one session in the three groups and 6 sessions were required totally .


The clinical efficacy and the Hamilton depression rating scale ( HAMD ) score and the adverse reaction were compared among the 3 groups .


The total effective rate was 96.8 % ( 30/31 ) in the comprehensive group , better than 83.9 % ( 26/31 ) in the ziwuliuzhu group and 80.6 % ( 25/31 ) in the prozac group ( both P < 0.05 ) .


In 4 , 12 and 24 weeks of treatment , HAMD score was lower significantly than that before the treatment in the three groups ( all P < 0.05 ) , and the score in the comprehensive group at each time point after treatment was lower than the other two groups ( all P < 0.05 ) .


In 4 and 12 weeks of treatment , there were not different significantly between the ziwuliuzhu group and the prozac group ( both P > 0.05 ) .


In 24 weeks of treatment , HAMD score in the ziwuliuzhu group was lower than that in the prozac group ( P < 0.05 ) .


For the adverse reaction , there were 2 cases in the comprehensive group , 6 cases in the prozac group and 0 case in the ziwzuliuzhu group .


The comprehensive therapy of acupuncture at the acupoints based on ziwuliuzhu and oral administration of prozac is superior to either the simple oral administration of prozac or the ziwuliuzhu acu-puncture in terms of clinical efficacy and the improvements in depressive state .


Regarding the clinical efficacy , the impact of simple ziwuliuzhu acupuncture is not different significantly as compared with the simple oral administration of prozac , but it is better than the simple oral administration of prozac in terms of the long-term HAMD score and safety .


A hardcopy or paper cognitive aid has been shown to improve performance during the management of simulated local anesthetic systemic toxicity ( LAST ) when given to the team leader .


However , there remains room for improvement to ensure a system that can achieve perfect adherence to the published guidelines for LAST management .


Recent research has shown that implementing a checklist via a designated reader may be of benefit .


Accordingly , we sought to investigate the effect of an electronic decision support tool ( DST ) and designated `` Reader '' role on team performance during an in situ simulation of LAST .


Participants were randomized to Reader + DST ( n = 16 , rDST ) and Control ( n = 15 , memory alone ) .


The rDST group received the assistance of a dedicated Reader on the response team who was equipped with an electronic DST .


The primary outcome measure was adherence to guidelines .


For overall and critical percent correct scores , the rDST group scored higher than Control ( 99.3 % vs 72.2 % , P < 0.0001 ; 99.5 % vs 70 % , P < 0.0001 , respectively ) .


In the LAST scenario , 0 ( 0 % ) of 15 in the control group performed 100 % of critical management steps , whereas 15 ( 93.8 % ) of 16 in the rDST group did so ( P < 0.0001 ) .


In a prospective , randomized single-blinded study , a designated Reader with an electronic DST improved adherence to guidelines in the management of an in situ simulation of LAST .


Such tools are promising in the future of medicine , but further research is needed to ensure the best methods for implementing them in the clinical arena .


To evaluate multiple doses of gabapentin 250 mg on polysomnography ( PSG ) and participant-reported sleep assessments in a 5-h phase advance insomnia model .


Adults reporting occasional disturbed sleep received gabapentin 250 mg ( n = 128 ) or placebo ( n = 128 ) .


On Days 1 and 28 , participants received medication 30 min before bedtime and were in bed from 17:00 to 01:00 , 5 h before their habitual bedtime .


Sleep was assessed by PSG , a post sleep questionnaire , and the Karolinska Sleep Diary .


Next-day residual effects and tolerability were evaluated .


On Days 2-27 , participants took medication at home 30 min before their habitual bedtime .


Treatment-group demographics were comparable .


Gabapentin resulted in significantly less PSG wake after sleep onset ( WASO ) compared with placebo on Day 1 ( primary endpoint , mean : 107.0 versus 149.1 min , p 0.001 ) and Day 28 ( 113.6 versus 152.3 min , p = 0.002 ) , and significantly greater total sleep time ( TST ; Day 1 : 347.6 versus 283.9 min ; Day 28 : 335.3 versus 289.1 min ) ( p 0.001 ) .


Participant-reported WASO and TST also showed significant treatment effects on both days .


Gabapentin was associated with less % stage1 on Day 1 , and greater % REM on Day 28 , versus placebo .


During home use , gabapentin resulted in significantly less participant-reported WASO and higher ratings of sleep quality .


Gabapentin was well tolerated ( most common adverse events : headache , somnolence ) with no evidence of next-day impairment .


Gabapentin 250 mg resulted in greater PSG and participant-reported sleep duration following a 5-h phase advance on Day 1 and Day 28 of use without evidence of next-day impairment , and greater sleep duration during at-home use .


Ageing populations may demand more blood transfusions , but the blood supply could be limited by difficulties in attracting and retaining a decreasing pool of younger donors .


One approach to increase blood supply is to collect blood more frequently from existing donors .


If more donations could be safely collected in this manner at marginal cost , then it would be of considerable benefit to blood services .


National Health Service ( NHS ) Blood and Transplant in England currently allows men to donate up to every 12 weeks and women to donate up to every 16 weeks .


In contrast , some other European countries allow donations as frequently as every 8 weeks for men and every 10 weeks for women .


The primary aim of the INTERVAL trial is to determine whether donation intervals can be safely and acceptably decreased to optimise blood supply whilst maintaining the health of donors .


INTERVAL is a randomised trial of whole blood donors enrolled from all 25 static centres of NHS Blood and Transplant .


Recruitment of about 50,000 male and female donors started in June 2012 and was completed in June 2014 .


Men have been randomly assigned to standard 12-week versus 10-week versus 8-week inter-donation intervals , while women have been assigned to standard 16-week versus 14-week versus 12-week inter-donation intervals .


Sex-specific comparisons will be made by intention-to-treat analysis of outcomes assessed after two years of intervention .


The primary outcome is the number of blood donations made .


A key secondary outcome is donor quality of life , assessed using the Short Form Health Survey .


Additional secondary endpoints include the number of ` deferrals ' due to low haemoglobin ( and other factors ) , iron status , cognitive function , physical activity , and donor attitudes .


A comprehensive health economic analysis will be undertaken .


The INTERVAL trial should yield novel information about the effect of inter-donation intervals on blood supply , acceptability , and donors ' physical and mental well-being .


The study will generate scientific evidence to help formulate blood collection policies in England and elsewhere .


Current Controlled Trials ISRCTN24760606 , 25 January 2012 .


A randomised crossover trial .


To determine the effects of a 6-week standing programme on bowel function in people with spinal cord injury .


Community , Australia and the United Kingdom .


Twenty community-dwelling people with motor complete spinal cord injury above T8 participated in a 16-week trial .


The trial consisted of a 6-week stand phase and a 6-week no-stand phase separated by a 4-week washout period .


Participants were randomised to one of two treatment sequences .


Participants allocated to the Treatment First group stood on a tilt table for 30min per session , five times per week for 6 weeks and then did not stand for the next 10 weeks .


Participants allocated to the Control First group did the opposite : they did not stand for 10 weeks and then stood for 6 weeks .


Participants in both groups received routine bowel care throughout the 16-week trial .


Assessments occurred at weeks 0 , 7 , 10 and 17 corresponding with pre and post stand and no-stand phases .


The primary outcome was Time to First Stool .


There were seven secondary outcomes reflecting other aspects of bowel function and spasticity .


There were three dropouts leaving complete data sets on 17 participants .


The mean ( 95 % confidence interval ) between-intervention difference for Time to First Stool was 0min ( -7 to 7 ) indicating no effect of regular standing on Time to First Stool .


Regular standing does not reduce Time to First Stool .


Further trials are required to test the veracity of some commonly held assumptions about the benefits of regular standing for bowel function .


To explore the effects of phytoestrogen ( PE ) on blood lipid and bone density in postmenopausal women .


A total of 75 menopausal women aged 50-70 years with estrogen reduction symptoms received an intake of soy protein containing 70 mg isoflavone daily in a year .


Their changes of blood fat , density lumbar bone and sex hormone level were compared with control group without an intake .


The changes of blood triglyceride ( TG ) , total cholesterol ( TC ) and low-density lipoprotein ( LDL ) in two groups before and after a year showed no statistical significance.High-density lipoprotein ( HDL ) decreased in control group while it had no significant change in the study group .


Bone densities in two groups showed a downward trend by an annual rate of 1 % -4 % , the changes in two groups showed no statistical significance.E2 increased slightly over basic value in the study group .


But it had no statistical significance .


The changes of follicle-stimulating hormone ( FSH ) in two groups were also similar .


The above soy protein preparation has no effect on hypothalamic-pituitary-ovarian axis and no stimulation on endometrium of uterus .


But it may improve the profile of HDL .


To understand degeneration of healthy sites and identify factors associated with disease progression in patients with chronic periodontitis .


Data on healthy sites from 163 American and Swedish subjects were analysed using two-three-state ( health , gingivitis , chronic periodontitis ) Markov models based on bleeding on probing ( BOP ) , and either clinical attachment level ( CAL ) + BOP or pocket depth ( PD ) + BOP .


In 2years , 10 % ( CAL+BOP ) and 3 % ( PD+BOP ) of healthy sites developed chronic periodontitis .


On average , healthy sites remained healthy for 32months before transiting in both models .


Most transitions ( 87-97 % ) from health were to the gingivitis state .


The expected duration of the gingivitis lesion was 4-5months and sites recovered with a high probability ( 96-98 % ) .


Disease severity as measured by number of sites with CAL/PD > 4mm at baseline and smoking , were associated with fast progression from health to chronic periodontitis within 6months as were gingival redness in the PD+BOP model only .


With age , the rate of disease progression to gingivitis decreased .


Transition probabilities for gingivitis and chronic periodontitis were higher with CAL+BOP than with PD+BOP .


Smoking and disease severity were significant predictors for fast progression .


To investigate changes in the pain-suppressing potency of 2 preoperatively applied topical nonsteroidal antiinflammatory drugs ( NSAIDs ) after photorefractive keratectomy ( PRK ) using a time-serial pain-scoring system .


Saeyan Eye Center , Seoul , South Korea .


Comparative case series .


Ninety-four patients were randomly assigned to 2 groups : ketorolac group ( ketorolac 0.5 % in 1 eye and ofloxacin 0.3 % in the other eye ) and diclofenac group ( diclofenac 0.1 % in 1 eye and ofloxacin 0.3 % in the other eye ) .


One drop of each ophthalmic drug was applied 3 times to each eye 30 minutes before PRK .


No other NSAID or steroid was prescribed until 4 days after PRK .


The patients were asked to score the postoperative pain in each eye with a visual analog scale at 6 , 18 , 24 , 36 , 48 , 72 , and 96 hours .


The natural peak of pain was located between 24 and 36 hours .


Initially , the degree of pain reduction was constant for both NSAIDs ; it dropped after 24 hours and 36 hours in the ketorolac group and the diclofenac group , respectively .


The postoperative time-serial pattern of the pain score changed in the diclofenac group but not in the ketorolac group compared with the pattern in the ofloxacin-treated eye .


The visual outcome was not affected by either NSAID , and significant complications were not noticed for a mean of 7 months .


The duration and pattern of the action may vary according to types of NSAIDs .


Preemptive topical diclofenac 0.1 % was a safe and effective method for post-PRK pain control .


No author has a financial or proprietary interest in any material or method mentioned .


Lower levels of vitamin D are associated with increased MS risk and with greater clinical and brain MRI activity in established relapsing MS.


The VIDAMS trial ( NCT01490502 ) is evaluating whether high-dose vitamin D supplementation reduces the risk of MS activity .


Eligibility criteria include diagnosis of RRMS , age 18 to 50 years , and Expanded Disability Status Scale 4.0 .


Disease duration and activity requirements depend on whether 2005 or 2010 criteria are used for diagnosis .


Enrollment is restricted based on prior MS therapy exposure and recent vitamin D use .


After completing a one-month run-in of glatiramer acetate , 172 patients will be randomized 1:1 to oral vitamin D ( 3 ) 5000 IU versus 600 IU daily .


Clinical visits occur every 12 weeks for 96 weeks .


Sixteen sites throughout the United States are participating in the trial .


Complete enrollment is expected by late 2014 , with follow-up through 2016 .


No interim analyses are planned .


The primary outcome for the trial is the proportion of patients experiencing a relapse in each group .


Other clinical , patient-reported , and MRI outcomes will be evaluated .


The VIDAMS trial will provide critical information about the safety and efficacy of vitamin D therapy in RRMS , with implications for MS patients worldwide .


The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation ( TENS ) in the management of pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section .


A hundred healthy women who underwent cesarean section under general anesthesia were randomly assigned to the placebo group ( Group 1 ) or the TENS group ( Group 2 ) , while 100 women who delivered by vaginal route without episiotomy were randomized into the placebo group ( Group 3 ) or the TENS group ( Group 4 ) .


The patients in Group 2 had statistically lower visual analog scale ( VAS ) and verbal numerical scale ( VNS ) scores than the patients in Group 1 ( p < 0.001 for both ) .


The patients in Group 4 had statistically lower VAS and VNS scores than the patients in Group 3 ( p = 0.022 and p = 0.005 , respectively ) .


The analgesic requirement at the eighth hour of cesarean section was significantly lower in the patients who were treated with TENS ( p = 0.006 ) .


The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo ( p = 0.830 ) .


TENS is an effective , reliable , practical and easily available modality of treatment for postpartum pain .


Childhood overweight has noticeable psychological and social consequences for the child and leads to an increased risk of mortality and morbidity later in life .


With the high prevalence of overweight in children and adolescents , it is important to identify effective approaches for the prevention and treatment of overweight in children and young individuals .


The primary aim of the study is to assess the effect of an intensive day-camp intervention on body mass index ( BMI ) in overweight children .


The Odense Overweight Intervention Study is a semi-blinded randomized controlled trial .


Overweight children from the Municipality of Odense , Denmark , were invited to participate in the trial .


Based on power calculations 98 participants were found to be sufficient to randomize in order to find an effect of minimum 1.5 BMI points .


Gender-stratified concealed block randomization with a ratio of 1:1 and random block sizes of two , four , and six ensured balance between study arms .


The intervention consisted of a six-week multi-component day camp including increased physical activity , healthy diet and health education followed by 46weeks of family-based habitual intervention .


The standard care arm was offered two weekly hours of physical activity training for six weeks .


The outcomes were measured at baseline and at six-week and 52-week follow-ups .


Furthermore , BMI will be assessed again at 48-month follow-up .


Test personnel were kept blinded .


The intervention effect will be evaluated using mixed model analyses .


During 2012 and 2013 , 115 children were enrolled in the study .


Fifty-nine children were randomized to the day-camp intervention arm and 56 to the standard intervention arm .


This study will provide novel information about the long-term health effects of an intense day-camp intervention program on overweight children , due to the design and the follow-up period .


Moreover , it will add to the knowledge on designing and implementing feasible camp settings for preventing overweight in children .


NCT01574352 at http://clinicaltrials.gov on the 8th of March 2012 .


To determine serum lipids in patients with age related macular degeneration from Pakistani population .


The study was a cross sectional , randomized and case-control .


Selected subjects ages were > or = 50 years and were normotensive , non-diabetic with no family history of any such disease and no complication of posterior ocular chamber other than age related macular degeneration ( AMD ) .


Controls were age matched healthy individuals with no symptoms of AMD .


Diagnosis of AMD was done through conventional diagnostic techniques by professional ophthalmologists .


Serum samples were analyzed for total cholesterol , triglycerides , LDL and HDL using commercially available kits .


Data were compared with Student 's t-test .


Pearson correlation was calculated for relationship between different parameters .


P < 0.05 was considered significant .


Compared to controls , AMD patients had significantly greater total cholesterol concentration ( p < 0.041 ) , and power HDL/LDL ratio ( p < 0.038 ) , while serum triglycerides , HDL and LDL were non-significantly different from control subjects .


Total cholesterol in AMD patients was significantly correlated with TG , LDL and HDL ( p < 0.0001 ) .


The study indicates that high cholesterol might be a predictor of AMD and can be a diagnostic parameter .


Postoperative morbidity is a major disadvantage after oral and maxillofacial ( OMF ) surgery , often caused by pain , trismus and swelling affecting patients ' quality of life .


The goal of this study was to examine the effect of kinesiologic taping ( KT ) on swelling , pain , trismus and patients ' satisfaction after OMF surgery .


Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment ( midface fractures n = 30 , mandibular fractures n = 26 , wisdom tooth removal n = 40 ) divided into treatment either with or without kinesiologic tape application .


Tape was applied directly after surgery and maintained for at least 5 d postoperatively .


Facial swelling was quantified at six specific points in time using a five-line measurement .


Pain and degree of mouth opening was measured .


Patients ' objective feeling and satisfaction was queried .


Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60 % during the first 2 d after surgery .


Evaluating all patients swelling was significantly lower in the KT treatment group ( T2 : 63.5 cm 4.3 ; T3 : 62.5 cm 4.2 ; T4 : 61.6 cm 4.2 ) than in the no-KT group ( T2 : 67.6 cm 5.0 ; T3 : 67.0 cm 5.0 ; T4 : 64.8 cm 4.8 ) at T2 ( p < 0.001 ) , T3 ( p < 0.001 ) , and T4 ( p = 0.001 ) .


VAS Pain values were scored significantly lower for the KT group ( T1 : 2.5 2.0 ( p = 0.006 ) ; T2 : 1.7 2.0 ( p < 0.001 ) ; T3 : 1.5 2.3 ( p = 0.004 ) ; T4 : 0.6 1.1 ( p = 0.001 ) compared to the no-KT group ( T1 : 3.8 2.5 ; T2 : 3.5 2.7 ; T3 : 2.9 2.2 ; T4 : 1.6 1.7 ) .


A statistically significant amelioration in mean mouth opening ability was observed in the KT group ( T1-BL : -0.08 cm 0.49 ( p = 0.025 ) ; T2-BL : 0.07 cm 0.59 ( p = 0.012 ) ; T3-BL : 0.20 0.63 ( p = 0.013 ) ; T4-BL : 0.42 0.59 ( p = 0.003 ) ) compared to the no-KT group ( T1-BL : -0.47 cm 0.86 ; T2-BL : -0.39 cm 0.84 ; T3-BL : -0.24 0.89 ; T4-BL : -0.13 1.02 ) .


KT after OMF surgery is a promising , simple , less traumatic , economical approach free from systemic adverse reaction upgrading patients ' quality of life .


We examined the effectiveness of technical training ( TT ) and quiet eye training ( QE ) on the performance of one-handed square knot tying in surgical residents .


Twenty surgical residents were randomly assigned to the 2 groups and completed pretest , training , retention , and transfer tests .


Participants wore a mobile eye tracker that simultaneously recorded their gaze and hand movements .


Dependent variables were knot tying performance ( % ) , QE duration ( % ) , number of fixations , total movement time ( s ) , and hand movement phase time ( s ) .


The QE training group had significantly higher performance scores , a longer QE duration , fewer fixations , faster total knot tying times , and faster movement phase times compared with the TT group .


The QE group maintained performance in the transfer test , whereas the TT group significantly decreased performance from retention to transfer .


QE training significantly improved learning , retention , and transfer of surgical knot tying compared with a traditional technical approach .


Both performance effectiveness ( performance outcome ) and movement efficiency ( hand movement times ) were improved using QE modeling , instruction , and feedback .


Postoperative nausea and vomiting ( PONV ) is one of the most common postsurgical complications .


Palonosetron , a 5-hydroxytryptamine receptor antagonist , is effective for PONV prevention .


Herein , we compared palonosetron and aprepitant ( a neurokinin-1 receptor antagonist ) for PONV prevention in patients indicated for laparoscopic gynaecologic surgery .


Ninety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general anaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral aprepitant in a double-blind randomised trial .


The primary efficacy end points included complete response ( visual analogue scale [ VAS ] nausea score < 4 and no use of rescue therapy ) 0-48 h after surgery .


Nausea severity ( 0-10 ) and use of rescue therapy were monitored for 0-48 h.


The secondary efficacy end points were the effect of aprepitant quantified using a 10-point VAS for pain , consumption of intravenous patient-controlled analgesia , and use of rescue analgesics .


Aprepitant was non-inferior to palonosetron in terms of complete response 0-48 hours after surgery ( 74 % vs. 77 % ) .


At 0 and 2 h after administration , the nausea severity with 40-mg aprepitant was significantly lesser than that with 0.075-mg palonosetron ( P < 0.05 ) .


At 6 and 24 h after administration , fentanyl consumption with 40-mg aprepitant was significantly lower than that with 0.075-mg palonosetron .


Greater amounts of rescue analgesics were required in the aprepitant group .


Palonosetron and aprepitant were both effective for PONV prevention in the patients indicated for laparoscopic gynaecologic surgery .


The drugs can be used in combination for multimodal therapy because they bind to different receptors .


More research is needed to evaluate the effects of aprepitant on pain management in humans .


The role that environmental factors , such as neighborhood socioeconomics , food , and physical environment , play in the risk of obesity and chronic diseases is not well quantified .


Understanding how spatial distribution of disease risk factors overlap with that of environmental ( contextual ) characteristics may inform health interventions and policies aimed at reducing the environment risk factors .


We evaluated the extent to which spatial clustering of extreme body mass index ( BMI ) values among a large sample of adults with diabetes was explained by individual characteristics and contextual factors .


We quantified spatial clustering of BMI among 15,854 adults with diabetes from the Diabetes Study of Northern California ( DISTANCE ) cohort using the Global and Local Moran 's I spatial statistic .


As a null model , we assessed the amount of clustering when BMI values were randomly assigned .


To evaluate predictors of spatial clustering , we estimated two linear models to estimate BMI residuals .


First we included individual factors ( demographic and socioeconomic characteristics ) .


Then we added contextual factors ( neighborhood deprivation , food environment ) that may be associated with BMI .


We assessed the amount of clustering that remained using BMI residuals .


Global Moran 's I indicated significant clustering of extreme BMI values ; however , after accounting for individual socioeconomic and demographic characteristics , there was no longer significant clustering .


Twelve percent of the sample clustered in extreme high or low BMI clusters , whereas , only 2.67 % of the sample was clustered when BMI values were randomly assigned .


After accounting for individual characteristics , we found clustering of 3.8 % while accounting for neighborhood characteristics resulted in 6.0 % clustering of BMI .


After additional adjustment of neighborhood characteristics , clustering was reduced to 3.4 % , effectively accounting for spatial clustering of BMI .


We found substantial clustering of extreme high and low BMI values in Northern California among adults with diabetes .


Individual characteristics explained somewhat more of clustering of the BMI values than did neighborhood characteristics .


These findings , although cross-sectional , may suggest that selection into neighborhoods as the primary explanation of why individuals with extreme BMI values live close to one another .


Further studies are needed to assess causes of extreme BMI clustering , and to identify any community level role to influence behavior change .


Monoclonal antibodies ( mAbs ) which potently neutralize a broad range of HIV isolates are potential microbicide candidates .


To date , topical application of mAbs in humans and their stability in vaginal secretions has not been studied .


To assess the pharmacokinetics and safety of the mAbs 2F5 , 4E10 and 2G12 when applied vaginally in women .


A randomized , double-blind , placebo-controlled phase 1 trial .


Twenty-eight healthy , sexually abstinent women administered 2.5 g of gel daily for 12 days containing either 10 or 20 mg/g of each mAb ( MABGEL ) or placebo .


Main clinical evaluations and sampling occurred at baseline , 1 , 8 , and 24 hours post-1st dose and 12 and 36 hours post-12th dose .


After adjustment for dilution factors , median levels of 2F5 , 4E10 and 2G12 in vaginal secretions at 1 hour post high-dose MABGEL were 7.74 , 5.28 and 7.48 mg/ml respectively .


Levels of 2F5 and 4E10 declined exponentially thereafter with similar estimated half-lives ( 4.6 and 4.3 hours ) .


In contrast , 2G12 levels declined more rapidly in the first 8 hours , with an estimated half-life of 1.4 hours during this period .


There was no evidence of systemic absorption .


There were no significant differences in local or systemic adverse event rates or vaginal flora changes ( by qPCR ) between active and placebo gel arms .


Whilst at least 1 adverse event was recorded in 96 % of participants , 95 % were mild and none were serious .


Vaginal application of 50 mg of each mAb daily was safe over a 12 day period .


Median mAb concentrations detected at 8 hours post dose were potentially sufficient to block HIV transmission .2 G12 exhibited more rapid elimination from the human vagina than 4E10 and 2F5 , likely due to poor stability of 2G12 in acidic human vaginal secretions .


Further research is needed to develop mAb-based vaginal microbicides and delivery systems .


ISRCTN 64808733 UK CRN Portfolio 6470 .


Agitation is common , persistent , and associated with adverse consequences for patients with Alzheimer disease .


Pharmacological treatment options , including antipsychotics are not satisfactory .


The primary objective was to evaluate the efficacy of citalopram for agitation in patients with Alzheimer disease .


Key secondary objectives examined effects of citalopram on function , caregiver distress , safety , cognitive safety , and tolerability .


The Citalopram for Agitation in Alzheimer Disease Study ( CitAD ) was a randomized , placebo-controlled , double-blind , parallel group trial that enrolled 186 patients with probable Alzheimer disease and clinically significant agitation from 8 academic centers in the United States and Canada from August 2009 to January 2013 .


Participants ( n = 186 ) were randomized to receive a psychosocial intervention plus either citalopram ( n = 94 ) or placebo ( n = 92 ) for 9 weeks .


Dosage began at 10 mg per day with planned titration to 30 mg per day over 3 weeks based on response and tolerability .


Primary outcome measures were based on scores from the 18-point Neurobehavioral Rating Scale agitation subscale ( NBRS-A ) and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change ( mADCS-CGIC ) .


Other outcomes were based on scores from the Cohen-Mansfield Agitation Inventory ( CMAI ) and the Neuropsychiatric Inventory ( NPI ) , ability to complete activities of daily living ( ADLs ) , caregiver distress , cognitive safety ( based on scores from the 30-point Mini Mental State Examination [ MMSE ] ) , and adverse events .


Participants who received citalopram showed significant improvement compared with those who received placebo on both primary outcome measures .


The NBRS-A estimated treatment difference at week 9 ( citalopram minus placebo ) was -0.93 ( 95 % CI , -1.80 to -0.06 ) , P = .04 .


Results from the mADCS-CGIC showed 40 % of citalopram participants having moderate or marked improvement from baseline compared with 26 % of placebo recipients , with estimated treatment effect ( odds ratio [ OR ] of being at or better than a given CGIC category ) of 2.13 ( 95 % CI , 1.23-3 .69 ) , P = .01 .


Participants who received citalopram showed significant improvement on the CMAI , total NPI , and caregiver distress scores but not on the NPI agitation subscale , ADLs , or in less use of rescue lorazepam .


Worsening of cognition ( -1.05 points ; 95 % CI , -1.97 to -0.13 ; P = .03 ) and QT interval prolongation ( 18.1 ms ; 95 % CI , 6.1-30 .1 ; P = .01 ) were seen in the citalopram group .


Among patients with probable Alzheimer disease and agitation who were receiving psychosocial intervention , the addition of citalopram compared with placebo significantly reduced agitation and caregiver distress ; however , cognitive and cardiac adverse effects of citalopram may limit its practical application at the dosage of 30 mg per day .


clinicaltrials.gov Identifier : NCT00898807 .


Oxidative stress plays an essential role in the pathogenesis of type 2 diabetes .


Anthocyanin , a natural antioxidant , has been reported to reduce oxidative stress and to attenuate insulin resistance and diabetes in animal models ; however , the translation of these observations to humans has not been fully tested .


This study was designed to investigate the effects of purified anthocyanins on dyslipidemia , oxidative status , and insulin sensitivity in patients with type 2 diabetes .


A total of 58 diabetic patients were given 160 mg of anthocyanins twice daily or placebo ( n = 29/group ) for 24 wk in a randomized , placebo-controlled , double-blind trial .


Participants and investigators were masked to treatment allocation .


Anthocyanin supplementation significantly decreased serum LDL cholesterol ( by 7.9 % ; P < 0.05 ) , triglycerides ( by 23.0 % ; P < 0.01 ) , apolipoprotein ( apo ) B-48 ( by 16.5 % ; P < 0.05 ) , and apo C-III ( by 11.0 % ; P < 0.01 ) and increased HDL cholesterol ( by 19.4 % ; P < 0.05 ) compared with placebo after the 24-wk intervention .


In addition , patients in the anthocyanin group showed higher total radical-trapping antioxidant parameter and ferric ion reducing antioxidant power values than did patients in the placebo group ( both P < 0.05 ) .


Serum concentrations of 8-iso-prostaglandin F2 , 13-hydroxyoctadecadienoic acid , and carbonylated proteins in patients in the anthocyanin group were significantly less than in patients in the placebo group ( 23.4 % , 25.8 % ; P < 0.01 and 20 % ; P = 0.022 , respectively ) .


Furthermore , supplementation with anthocyanin lowered fasting plasma glucose ( by 8.5 % ; P < 0.05 ) and homeostasis model assessment for insulin resistance index ( by 13 % ; P < 0.05 ) , and elevated serum adiponectin ( by 23.4 % ; P < 0.01 ) and - hydroxybutyrate ( by 42.4 % ; P = 0.01 ) concentrations compared with placebo supplementation .


These findings demonstrate that anthocyanin supplementation exerts beneficial metabolic effects in subjects with type 2 diabetes by improving dyslipidemia , enhancing antioxidant capacity , and preventing insulin resistance .


This trial was registered at www.clinicaltrials.gov as NCT02317211 .


Our aim was to evaluate the safety and efficacy of a low-intensity resistance training program combined with partial blow flow restriction ( BFR training ) in a cohort of patients with polymyositis ( PM ) and dermatomyositis ( DM ) .


In total , 13 patients with PM and DM completed a 12-week twice a week low-intensity ( that is , 30 % one-repetition-maximum ( 1RM ) ) resistance exercise training program combined with partial blood flow restriction ( BFR ) .


Assessments of muscle strength , physical function , quadriceps cross sectional ( CSA ) area , health-related quality of life , and clinical and laboratory parameters were assessed at baseline and after the intervention .


The BFR training program was effective in increasing the maximal dynamic strength in both the leg-press ( 19.6 % , P < 0.001 ) and knee-extension exercises ( 25.2 % P < 0.001 ) , as well as in the timed-stands ( 15.1 % , P < 0.001 ) and timed-up-and-go test ( -4.5 % , P = 0.002 ) .


Quadriceps CSA was also significantly increased after the intervention ( 4.57 % , P = 0.01 ) .


Similarly , all of the components of the Short Form-36 Health Survey , the Health Assessment Questionnaire scores , and the patient - and physician reported Visual Analogue Scale were significantly improved after training ( P < 0.05 ) .


Importantly , no clinical evidence or any other self-reported adverse event were found .


Laboratory parameters ( creatine kinase and aldolase ) were also unchanged ( P > 0.05 ) after the intervention .


We demonstrated that a 12-week supervised low-intensity resistance training program associated with partial blood flow restriction may be safe and effective in improving muscle strength and function as well as muscle mass and health-related quality of life in patients with PM and DM .


Clinicaltrials.gov NCT01501019 .


Registered November 29 , 2011 .


The aim of this hypothesis-generating pilot study was to assess prospectively the objective and subjective effects of treatment with quetiapine XR on sleep during early recovery from alcohol dependence ( AD ) .


Recovering subjects with AD and sleep disturbance complaints were treated with quetiapine XR ( n = 10 ) or matching placebo pills ( n = 10 ) for 8 weeks .


Polysomnography was used to assess sleep objectively , and the Insomnia Severity Index and Pittsburgh Sleep Quality Index were used to measure subjective insomnia .


Other assessment measures included the 10-minute psychomotor vigilance task ( for neurobehavioral functioning ) , the time-line follow-back measure ( for alcohol consumption ) , the Penn Alcohol Craving Scale ( for alcohol craving ) , the Patient Health Questionnaire-9 item scale ( for depressive symptoms ) , and the Beck Anxiety Inventory ( for anxiety symptoms ) .


Although there was no effect of quetiapine XR on sleep efficiency ( time spent asleep/total recording time ) , there was a pre-to-post reduction in wake after sleep onset time ( P = 0.03 ) and nonsignificant trends for increases in sleep onset latency ( SOL ) and stage 2 sleep time .


A time drug interaction was seen for the subjective insomnia , such that quetiapine XR-treated subjects reported greater initial improvement in their subjective insomnia , but the difference was not sustained .


There were no differences between treatment groups on other measures or medication compliance .


Quetiapine XR improves objective sleep continuity and transiently improves subjective insomnia early in recovery from AD .


Loss of phosphatase and tensin homologue ( PTEN ) function evaluated by loss of PTEN protein expression on immunohistochemistry ( IHC ) has been reported as both prognostic in metastatic colorectal cancer and predictive of response to anti-EGFR monoclonal antibodies although results remain uncertain .


Difficulties in the methodological assessment of PTEN are likely to be a major contributor to recent conflicting results .


We assessed loss of PTEN function in 51 colorectal cancer specimens using Taqman copy number variation ( CNV ) and IHC .


Two blinded pathologists performed independent IHC assessment on each specimen and inter-observer variability of IHC assessment and concordance of IHC versus Taqman CNV was assessed .


Concordance between pathologists ( PTEN loss vs no loss ) on IHC assessment was 37/51 ( 73 % ) .


In specimens with concordant IHC assessment , concordance between IHC and Taqman copy number in PTEN loss assessment was 25/37 ( 68 % ) .


Assessment PTEN loss in colorectal cancer is limited by the inter-observer variability of IHC , and discordance of CNV with loss of protein expression .


An understanding of the genetic mechanisms of PTEN loss and implementation of improved and standardized methodologies of PTEN assessment are required to clarify the role of PTEN as a biomarker in colorectal cancer .


This study was designed to investigate whether garlic powder tablets in adjunct to conventional medical treatment could have an effect on carotid intima-media thickness ( CIMT ) and plasma lipoproteins and lipids in patients with coronary artery disease ( CAD ) .


A randomized , placebo-controlled , clinical trial was conducted on 56 patients with CAD between the ages of 25 and 75 years .


The patients were randomly divided into two groups : garlic group ( n = 27 ) , receiving garlic powder tablet ( 1200 g allicin/tab ) twice daily and the placebo group ( n = 29 ) , receiving placebo for 3 months .


The rate of atherosclerosis progression was measured by B-mode ultrasonography as the increase in CIMT .


After 3 months of taking garlic tablets , CIMT values had minor variations ( 0.009 0.007 mm reduction from baseline ) , while in the placebo group , an increase in CIMT values was observed ( 0.04 0.01 mm increase from baseline ) .


After 3 months of treatment , mean CIMT difference from baseline was significantly differ between the two groups ( p < 0.001 ) .


Plasma lipids and lipoproteins ( total cholesterol , triglycerides , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , Apolipoprotein A1 and Apolipoprotein B ) did not differ between the two groups .


The results suggest that dry garlic powder tablet is superior to placebo in prevention of CIMT progression in patients with CAD and may be considered as an adjunct treatment for atherosclerosis .


Sedation or anaesthesia is recommended for all patients undergoing bronchoscopy unless absolute contraindications exist .


However , the widely used combination of propofol and opiates for moderate sedation ( MS ) in bronchoscopy results in a high incidence of hypoxaemia and a relatively high cough score during the procedure .


In this study , we evaluated the efficacy and safety of target-controlled infusion ( TCI ) of propofol and remifentanil , together with the use of high frequency jet ventilation ( HFJV ) , to achieve general anesthesia ( GA ) in diagnostic fibre-optic bronchoscopy .


A total of 92 consecutive patients scheduled for flexible bronchoscopy were randomly assigned to receive either MS using TCI-delivered propofol and remifentanil ( n = 46 ) , or GA using TCI-delivered propofol and remifentanil with HFJV ( n = 46 ) .


The following were compared between the MS and GA groups : incidence of hypoxaemia , cough score , haemodynamic parameters , partial pressure of carbon dioxide in arterial blood , duration of bronchoscopy and patient satisfaction score .


The average and minimum oxygen saturation values in the MS group were lower than those in the GA group .


The MS group showed a higher incidence of hypoxaemia .


There was no significant difference in the partial pressure of carbon dioxide between the two groups .


Cough score and duration of the bronchoscopy were markedly lower in the GA group , and patient satisfaction score was higher in the GA group .


GA , achieved via TCI-delivered propofol and remifentanil with HFJV , provides better conditions for diagnostic bronchoscopy - it decreases the occurrence of hypoxaemia , shortens the duration of bronchoscopy and increases patient satisfaction .


Prescription drug abuse has reached epidemic proportions .


Nonmedical prescription opioid use carries increasingly high costs .


Despite the need to cultivate efforts that are both effective and fiscally responsible , the cost-effectiveness of universal evidence-based-preventive-interventions ( EBPIs ) is rarely evaluated .


This study explores the performance of these programs to reduce nonmedical prescription opioid use .


Sixth graders from twenty-eight rural public school districts in Iowa and Pennsylvania were blocked by size and geographic location and then randomly assigned to experimental or control conditions ( 2002-2010 ) .


Within the intervention communities , prevention teams selected a universal family and school program from a menu of EBPIs .


All families were offered a family-based program in the 6th grade and received one of three school-based programs in 7th-grade .


The effectiveness and cost-effectiveness of each school program by itself and with an additional family-based program were assessed using propensity and marginal structural models .


This work demonstrates that universal school-based EBPIs can efficiently reduce nonmedical prescription opioid use .


Further , findings illustrate that family-based programs may be used to enhance the cost-effectiveness of school-based programs .


Universal EBPIs can effectively and efficiently reduce nonmedical prescription opioid use .


These programs should be further considered when developing comprehensive responses to this growing national crisis .


To examine the efficacy of telbivudine ( LdT ) + adefovir ( ADV ) vs continuation of lamivudine ( LAM ) + ADV in patients with LAM-resistant chronic hepatitis B ( CHB ) who show a suboptimal response to LAM + ADV.


This was a randomized , active-control , open-label , single-center , parallel trial .


All eligible patients were enrolled in this study in Severance Hospital , Yonsei University College of Medicine , Seoul , South Korea , between March 2010 and March 2011 .


Hepatitis Be antigen ( HBeAg ) - positive CHB patients whose serum hepatitis B virus ( HBV ) DNA remained detectable despite at least 6 mo of LAM + ADV therapy were included .


Enrolled patients were randomized to either switching to LdT ( 600 mg/d orally ) plus ADV ( 10 mg/d orally ) ( LdT + ADV group ) or to continuation with LAM ( 100 mg/d orally ) plus ADV ( 10 mg/d orally ) ( LAM + ADV group ) , and were followed for 48 wk .


One hundred and six patients completed the 48-wk treatment period .


Serum HBV DNA , HBeAg status , liver biochemistry and safety were monitored at baseline and week 12 , 24 , 36 and 48 .


The duration of prior LAM + ADV treatment was 18.3 ( LdT + ADV ) and 14.9 mo ( LAM + ADV ) , respectively ( P = 0.131 ) .


No difference was seen in baseline serum HBV DNA between the two groups [ 3.66 ( LdT + ADV ) vs 3.76 ( LAM + ADV ) log10 IU/mL , P = 0.729 ] .


At week 48 , although there was no significant difference in the mean reduction of serum HBV DNA from baseline between LdT + ADV group and LAM + ADV group ( -0.81 vs -0.47 log10 IU/mL , P = 0.167 ) , more patients in the LdT + ADV group had undetectable HBV DNA levels compared to those in the LAM + ADV group ( 30.2 % vs 11.5 % , P = 0.019 ) .


Three patients with LdT + ADV treatment and 2 patients with LAM + ADV treatment achieved HBeAg loss .


The patients in both groups tolerated the treatment well without serious adverse events .


The proportion of patients with estimated glomerular filtration rate 90 mL/min per 1.73 m ( 2 ) in the LdT + ADV group increased from 49.1 % ( 26/53 ) at baseline to 58.5 % ( 31/53 ) at week 48 , while that in the LAM + ADV group decreased from 37.7 % ( 20/53 ) at baseline to 30.2 % ( 16/53 ) at week 48 .


The switch to LdT + ADV in suboptimal responders to LAM + ADV showed a significantly higher rate of virologic response at week 48 .


These results suggest that LdT + ADV could be a therapeutic option for patients who are unable to use enofovir disoproxil fumarate for any reason .


The objective of this study was to assess the influence of lingual bar and lingual plate major connectors on plaque retention and gingival health among patients who presented in University College Hospital ( UCH ) , Ibadan , Nigeria .


This comparative intervention study was carried out among fifteen patients aged 28 to 60 years with Kennedy class III lower edentulous arch .


Two metal dentures with different major connector designs ( lingual plate and lingual bar ) were fabricated for each patient .


After professional scaling and polishing , a baseline score of the oral hygiene was done using the plaque index of Sillness and Loe and the gingival health using the gingival index of Loe and Sillness .


Each patient was randomly assigned either a denture with the plate or bar design to use for three months and then recalled for reassessment of oral hygiene and gingival health .


Professional scaling and polishing was done post removal and a new baseline assessment of oral hygiene and gingival health recorded .


The dentures were now exchanged and the second major connector design inserted .


Each patient was recalled for reassessment of the oral hygiene and gingival health after three months .


The level of plaque accumulation and gingival inflammation with the use of lingual plate and bar dentures were determined and compared .


There was no statistically significant difference in the mean plaque index score for the lingual bar design at three months and the mean plaque index score at three months for the lingual plate ( p > 0.05 ) .


However , a statistically significant lower mean gingival index score was noted three months post insertion for lingual bar designs when compared to plate designs .


Within the limitation of this study , better gingival health was noted with the bar designs when compared with the plate designs .


We evaluated the effect of an educational intervention administered to patients or/and physicians on the reduction in HbA ( 1c ) and achieving diabetic control in a high-risk primarily Black inner-city population .


The study was designed as a four-arm randomized clinical trial where an educational program on diabetes was offered to physicians only , patients only , and both physicians and their patients , while the fourth arm did not receive any instruction .


We built regression models at 24 months of follow-up to assess the likelihood of reaching glycemic goal as well as to measure the absolute reduction in HbA ( 1c ) controlling for arm assignment , insulin use , race , age , sex , smoking , insulin use , and having achieved blood pressure control .


Between April 2005 and July 2007 , there were 823 patients randomized into the study .


In multivariate analyses , the intervention group in which only patients received education showed a trend toward achieving a significant mean reduction in HbA ( 1c ) with 49 % ( P = .06 ) higher odds of reaching glycemic control and .12 ( P = .06 ) greater absolute percentage point drop in HbA ( 1c ) compared to the no education group .


Although our study reports positive results , it warrants a special emphasis on the behavior of the patient .


Study results bring attention to disease management programs such as peer support networks that empower the patients that shift some of the responsibility to them .


Hepatitis B virus ( HBV ) is a vaccine preventable infection yet vaccination rates are low among injection drug users ( IDUs ) despite the high risk of infection and longstanding recommendations to promote vaccination .


We sought to improve vaccination rates by reaching IDUs through syringe exchange programs ( SEPs ) in three U.S. cities .


IDUs were randomized in a trial comparing the standard HBV vaccination schedule ( 0 , 1 , and 6 months ) to an accelerated schedule ( 0 , 1 , and 2 months ) and participation data were analyzed to identify determinants of completion of the three-dose vaccine series .


Independent variables explored included sociodemographics , injection and syringe access behaviors , assessment of health beliefs , HBV-associated knowledge , and personal health status .


Covariates associated with completion of the three-dose vaccine series were accelerated vaccine schedule ( aOR 1.92 , 95 % CI 1.34 , 2.58 , p = < 0.001 ) , older age ( aOR 1.05 , 95 % CI 1.03 , 1.07 , p = < 0.001 ) , and poorer self-rated health score ( aOR 1.26 , 95 % CI 1.05 , 1.5 , p = 0.02 ) .


Completion was less likely for those getting syringes from SEP customers than for SEP customers ( OR 0.33 , 95 % CI 0.19 , 0.58 , p = < 0.001 ) .


SEPs should offer hepatitis vaccination in a manner that minimizes time between first and last visits by accelerating the dosing schedule .


Public health interventions should target younger , less healthy , and non-SEP customer participants .


Other health interventions at SEPs may benefit from similar approaches that reach out beyond regular SEP customers .


To examine the effect of low-volume sprint interval training ( SIT ) on the development ( part 1 ) and subsequent maintenance ( part 2 ) of aerobic fitness in soccer players .


In part 1 , 23 players from the same semiprofessional team participated in a 2-wk SIT intervention ( SIT , n = 14 , age 25 4 y , weight 77 8 kg ; control , n = 9 , age 27 6 y , weight 72 10 kg ) .


The SIT group performed 6 training sessions of 4-6 maximal 30-s sprints , in replacement of regular aerobic training .


The control group continued with their regular training .


After this 2-wk intervention , the SIT group was allocated to either intervention ( n = 7 , 1 SIT session/wk as replacement of regular aerobic training ) or control ( n = 7 , regular aerobic training with no SIT sessions ) for a 5-wk period ( part 2 ) .


Pre and post measures were the YoYo Intermittent Recovery Test Level 1 ( YYIRL1 ) and maximal oxygen uptake ( VO2max ) .


In part 1 , the 2-week SIT intervention had a small beneficial effect on YYIRL1 ( 17 % ; 90 % confidence limits 11 % ) , and VO2max ( 3.1 % ; 5.0 % ) compared with control .


In part 2 , 1 SIT session/wk for 5 wk had a small beneficial effect on VO2max ( 4.2 % ; 3.0 % ) , with an unclear effect on YYIRL1 ( 8 % ; 16 % ) .


Two weeks of SIT elicits small improvements in soccer players ' high-intensity intermittent-running performance and VO2max , therefore representing a worthwhile replacement of regular aerobic training .


The effectiveness of SIT for maintaining SIT-induced improvements in high-intensity intermittent running requires further research .


The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery ( VA ) .


This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks .


Ten healthy male participants aged 24 to 30 years ( mean , 26.8 years ) volunteered to participate in the study .


None of the participants had a history of disabling neck , arm , or headache pain within the last 6 months .


They did not have any current or history of neurologic symptoms .


In a neutral head position , physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation .


A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle , in each of the 4 conditions , and were used to provide a blood flow profile for one complete cardiac cycle .


Differences between flow ( in milliliters per second ) and velocity ( in centimeters per second ) variables were evaluated using repeated-measures analysis of variance .


The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities ( P = .14 ) or flows ( P = .19 ) throughout the conditions .


There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables .


There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations .


To investigate effects of perirenal space blocking ( PSB ) on gastrointestinal function in patients with severe acute pancreatitis ( SAP ) .


Forty patients with SAP were randomly allocated to receive PSB or no PSB ( NPSB ) .


All the SAP patients received specialized medical therapy ( SMT ) .


Patients in the PSB group received PSB + SMT when hospitalized and after diagnosis , whereas patients in the NPSB group only received SMT .


A modied gastrointestinal failure ( GIF ) scoring system was used to assess the gastrointestinal function in SAP patients after admission .


Pain severity ( visual analog scale , 0 to 100 ) was monitored every 24 h for 72 h.


Modified GIF score decreased in both groups during the 10-d study period .


The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was performed .


During the 72-h study period , pain intensity decreased in both groups .


The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points .


Patients in the PSB group had significantly lower incidences of hospital mortality , multiple organ dysfunction syndrome , systemic inflammatory response syndrome , and pancreatic infection , and stayed in the intensive care unit for a shorter duration .


However , no difference in terms of operation incidence was found between the two groups .


PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP .


Moreover , PSB administration could improve prognosis and decrease the mortality of SAP patients .


To examine the effect of a 12-week Tai Chi ( TC ) intervention on physical function and quality of life .


Single-blind , randomized controlled trial .


General community .


Community-dwelling survivors of stroke ( N = 145 ; 47 % women ; mean age , 70y ; time poststroke : 3y ; ischemic stroke : 66 % ; hemiparesis : 73 % ) who were aged 50 years and were 3 months poststroke .


Yang style 24-posture short-form TC ( n = 53 ) , strength and range of movement exercises ( SS ) ( n = 44 ) , or usual care ( UC ) ( n = 48 ) for 12 weeks .


The TC and SS groups attended a 1-hour class 3 times per week , whereas the UC group had weekly phone calls .


Physical function : Short Physical Performance Battery , fall rates , and 2-minute step test ; quality of life : Medical Outcomes Study 36-Item Short-Form Health Survey , Center for Epidemiologic Studies Depression Scale , and Pittsburgh Sleep Quality Index .


During the intervention , TC participants had two thirds fewer falls ( 5 falls ) than the SS ( 14 falls ) and UC ( 15 falls ) groups ( ( 2 ) = 5.6 , P = .06 ) .


There was a significant group by time interaction for the 2-minute step test ( F2 ,142 = 4.69 , P < .01 ) .


Post hoc tests indicated that the TC ( t53 = 2.45 , P = .02 ) and SS ( t44 = 4.63 , P < .01 ) groups had significantly better aerobic endurance over time , though not in the UC group ( t48 = 1.58 , P = .12 ) .


Intervention adherence rates were 85 % .


TC and SS led to improved aerobic endurance , and both are suitable community-based programs that may aid in stroke recovery and community reintegration .


Our data suggest that a 12-week TC intervention was more effective in reducing fall rates than SS or UC interventions .


Future studies examining the effectiveness of TC as a fall prevention strategy for community-dwelling survivors of stroke are recommended .


In this prospective , randomized , observer-blinded study , we compared double-injection ( DI ) ultrasound-guided supraclavicular block to a novel targeted intracluster-injection ( TII ) technique , whereby local anesthetic is injected inside the main and satellite neural clusters ( confluences of trunks and divisions of the brachial plexus ) .


Ninety patients were randomly allocated to receive a DI ( n = 45 ) or TII ( n = 45 ) technique for ultrasound-guided supraclavicular block .


The local anesthetic drug ( lidocaine 1.5 % with epinephrine 5 g/mL ) and total volume ( 32 mL ) were identical in all subjects .


In both groups , half the volume ( 16 mL ) was injected inside the main neural cluster .


For the DI technique , the second half ( 16 mL ) was deposited at the `` corner pocket '' ( intersection of the first rib and subclavian artery ) .


In contrast , for the TII technique , the remaining half was divided into equal aliquots and injected inside every single satellite cluster .


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


Due to a quicker onset ( mean standard deviation ( SD ) : 10.1 6.4 vs 18.5 8.3 minutes ; P < 0.0001 ) , the total anesthesia-related time was shorter with the TII technique ( 21.2 7.7 vs 27.7 9.0 minutes ; P = 0.001 ; 95 % confidence interval for the difference of the means : 2.90-10 .08 minutes ) .


There were 0 ( of 45 ) and 3 ( of 45 ) surgical failures for the TII and DI group , respectively .


Thus , the 2 methods achieved comparable rates of surgical anesthesia ( 93.3 % -100.0 % ; 95 % confidence interval for the difference of the success rates : -2.3 % to 17.9 % ) .


No intergroup differences were observed in block-related pain scores and adverse events .


The DI group required fewer needle passes ( median interquartile range : 4 2 vs 7 3 ; P < 0.0001 ) as well as shorter needling ( 8.4 2.9 vs 10.7 2.7 minutes ; P < 0.0001 ) and performance ( 9.0 3.2 vs 11.2 3.0 minutes ; P = 0.001 ) times .


Although DI and TII ultrasound-guided supraclavicular blocks seem to provide comparable success rates , we can not exclude the possibility that an intergroup difference of 17.9 % might have gone undetected .


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


Objectively measure the ability of facial reanimation surgery to normalize the appearance of facial paralysis using eye-tracking technology .


Prospective randomized controlled experiment .


An eye-tracker system was used to record the eye-movement patterns , called scanpaths , of 86 nave observers gazing at pictures of paralyzed faces ( House-Brackmann IV-VI ) , smiling and in repose ; before and after facial reanimation surgery ; as well as normal , nonparalyzed faces .


Observers gazed at each face for 10 seconds .


Fixation durations for all predefined facial areas of interest were analyzed using mixed-effects linear regression .


Observers spent the majority of time ( 6.6 of 10 seconds ) gazing in the central triangle region ( eyes , nose , and mouth ) of normal faces and paralyzed faces .


There were significant deviations in fixation within the central triangle of paralyzed faces as compared to normal faces .


Total fixation on the eyes remained conserved .


However , total nose fixation decreased and mouth fixation increased on paralyzed faces .


Facial reanimation surgery normalized many of the hemifacial gaze asymmetries caused by unilateral facial paralysis , and restored a normal distribution of gaze between the functional and paralyzed sides of the face and mouth .


There were objective differences in the way observers directed their attention to facial features when viewing normal and paralyzed faces .


After facial reanimation surgery , the attentional distraction caused by facial feature irregularities was reduced .


These findings are important additions to the emerging body of objective evidence indicating the effectiveness of reanimation surgery ; they also suggest opportunities to optimize reconstruction .


N/A .


Psychological interventions show greater efficacy when evaluated with distressed patients .


We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem-solving therapy ( PST ) , characteristics associated with enrolment , and time investment and challenges of implementing screening .


Three medical settings implemented screening of patients , directly after cancer treatment ( T1 ) and 2 months later ( T2 ) , using Hopkins Symptom Checklist-25 and one question about need for services .


Distressed patients indicating need for services were interviewed .


Eligible patients were offered the possibility to participate in the trial .


Consenting patients were randomized to PST or waitlist .


At T1 , 366 of 970 screened patients ( 37 % ) scored above the cutoff and at T2 , 208 of 689 screened patients ( 30 % ) .


At either or both T1 and T2 , 423 patients reported distress , of whom 215 indicated need for services .


Only 36 ( 4 % of 970 ) patients consented to trial participation .


Twenty-seven patients needed to be screened to recruit a single patient , with 17 h required for each patient recruited .


Barriers to screening were time constraints and negative attitudes of oncology staff towards screening .


Implementing screening proved inefficient for recruiting distressed cancer patients post-treatment to a randomized controlled trial on PST , with need for services being much less than anticipated .


Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients , which may lower generalizability .


An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated , funded staff assistance .


To compare the effects of combined oral contraceptives ( OCs ) containing cyproterone acetate and drospirenone in the treatment of polycystic ovary syndrome ( PCOS ) .


Fifty-two patients with PCOS were randomized in two groups : group A ( n = 26 ) received 0.035 mg ethinyl estradiol + 2 mg cyproterone acetate and group B ( n = 26 ) received 0.03 mg ethinyl estradiol + 3 mg drospirenone-containing OCs for 12 months .


Baseline clinical features including body mass index , waist to hip ratio ( WHR ) , and modified Ferriman-Gallwey ( mFG ) score were noted .


Baseline biochemical parameters included androgen profile , carbohydrate metabolism , lipid profile , and oxidative stress .


The percentages of changes for all parameters were compared .


The groups were comparable regarding the baseline characteristics .


WHR decreased significantly from baseline ( -4 % [ -31 to 35 ] ) in group B when compared to group A ( 0 % [ -11 to 14 ] ) ( P = 0.033 ) .


The total mFG score decreased significantly from baseline ( -35 % [ -71 to 10 ] ) in group A when compared to group B ( -18 % [ -72 to 30 ] ) ( P = 0.035 ) .


Changes in androgen hormone profile were comparable except DHEA-SO4 ( -32 % [ -53 to 15 ] in group B vs. -10 % [ -49 to 63 ] in group A ; P = 0.046 ) .


The effects of the drugs were similar regarding carbohydrate metabolism , lipid profile , and oxidative stress parameters .


Cyproterone acetate containing OCs seem to be more effective to treat clinical hirsutism in patients with PCOS after 12 months of treatment .


It is often difficult to enrol healthy volunteers into a randomized controlled trial ( RCT ) as there are barriers to participants ' proper understanding of a trial .


This study aimed to evaluate degrees of understanding of the informed consent ( IC ) process among healthy volunteers who participated in an RCT .


Additionally , factors associated with degree of understanding were investigated .


The J-START ( the Japan STrategic Anti-cancer Randomized controlled Trial ) is an RCT investigating the effectiveness of ultrasonography screening for breast cancer in women aged 40 to 49 years .


To evaluate participants ' understanding of the J-START , we administered questionnaires to 376 Japanese women on the day of enrolment at five study sites across Japan .


The respondents were asked to complete the anonymous questionnaire within 2 weeks .


We assessed objective understanding and perceived subjective understanding of IC using a Japanese version of the Quality of Informed Consent scale ( QuIC ) .


Then we analyzed the characteristics of women whose understanding was poor , and clarified the association between providing information and their understanding of the study protocol .


The average QuIC scores were 78.2 and 82.2 ( out of 100 each ) for objective and subjective understanding , respectively .


These are generally acceptable scores for participants ' understanding of an RCT .


However , there were four domains with low scores , indicating poor understanding : ( 1 ) experimental nature of the study , ( 2 ) potential risks or discomfort , ( 3 ) benefit to self , and ( 4 ) compensation .


Healthy volunteers generally well understood the J-START .


Nevertheless , there were some domains in need of improvement .


In order to facilitate participants ' understanding , it is necessary to provide training to reduce differences in information-providing procedures between medical centres and to endeavour to provide consistent information and conditions .


The J-START was registered with the University Hospital Medical Information Network Clinical Trial Registration ( UMIN-CTR ) , Japan ( registration number : UMIN000000757 ) , on July 1 , 2007 .


To determine the feasibility of using a 70-kVp protocol compared with a 120-kVp protocol for cerebral CT angiography .


An additional target was to investigate a possible reduction in the volume of contrast medium ( CM ) using the 70-kVp protocol .


Attenuation value and CNR for iodine were determined at various tube voltage settings using a phantom .


Sixty-nine volunteers were randomly assigned to one of three protocols : group A ( 120-kVp and CM 64 mL ) , group B ( 70-kVp and CM 64 mL ) , or group C ( 70-kVp and CM 40 mL ) .


The attenuation value , SNR , and CNR of cerebral arteries , subjective image quality , and radiation dose were compared among the groups .


The vascular attenuation , SNR , and CNR of group B were significantly higher than those of group A. Group C had a significantly higher vascular attenuation than group A. Groups B and C were significantly better than group A with respect to subjective image quality .


An effective dose of 70-kVp was 10 % lower than that of 120-kVp .


Using 70-kVp improved arterial enhancement , SNR , and CNR , and provided better subjective image quality , using a 10 % lower effective dose .


Furthermore , the 70-kVp protocol may both reduce volume of CM by 37.5 % and improve arterial enhancement .


Cerebral CT angiography at 70-kVp substantially improved vascular enhancement Subjective image quality was better at 70-kVp , with lower radiation dose The volume of contrast media can be substantially reduced at 70-kVp .


To better understand the implications of new-onset diabetes after transplant ( NODAT ) , we used our prospectively followed cohort of 628 adult primary kidney transplant recipients to determine the prognostic impact of pretransplant diabetes and NODAT .


The study cohort consisted of all participants in four randomised immunosuppression trials performed at our centre since May 2000 .


For each cause-specific hazard analysed , Cox stepwise regression was used to determine a multivariable model of significant baseline predictors ; the multivariable influence of having pretransplant diabetes and NODAT ( t ) ( the latter defined as a zero-one , time-dependent covariate ) was subsequently tested .


Similar analyses of estimated glomerular filtration rate ( eGFR ) at 36 and 60 months post transplant were performed using stepwise linear regression .


Finally , a repeated measures analysis of mean HbA1c as a function of diabetes category ( pretransplant diabetes vs NODAT ) and randomised trial ( first to fourth ) was performed .


Median follow-up was 56 months post transplant .


Patients with pretransplant diabetes comprised 23.4 % ( 147/628 ) , and 22.5 % ( 108/481 ) of the remaining patients developed NODAT .


Pretransplant diabetes had no prognostic influence on first biopsy-proven acute rejection and death-censored graft failure hazard rates , nor on eGFR , but was associated with significantly higher rates of death with a functioning graft ( DWFG ) ( p = 0.003 ) , DWFG due to a cardiovascular event ( p = 0.005 ) and infection that required hospitalisation ( p = 0.03 ) .


NODAT ( t ) had no unfavourable impact on any of these hazard rates nor on eGFR , with actuarial freedom from DWFG remaining at over 90 % among patients in pre - and post-NODAT states at 72 months post transplant/NODAT .


Mean HbA1c for patients in the first to fourth randomised trials , averaged across diabetes category , decreased by trial ( 7.28 % , 6.92 % , 6.87 % and 6.64 % [ 56.1 , 52.1 , 51.6 and 49.1 mmol/mol ] , respectively ; p = 0.02 ) .


Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant .


The aim of this study is to compare the effects of chest physiotherapy ( CPT ) and high-frequency chest wall oscillation ( HFCWO ) on lung function in lung transplant recipients .


Chest physiotherapy and HFCWO are routinely used after lung transplant to attenuate dyspnea , increase expiratory flow , and improve secretion clearance .


In a two-group experimental , crossover design with repeated-measures , 45 lung transplant recipients ( 27 single , 18 bilateral ; 64 % male ; mean age , 57 years ) were randomized to receive CPT at 10:00 AM and 2:00 PM followed by HFCWO at 6:00 PM and 10:00 PM ( n = 22 ) or vice versa ( n = 23 ) on postoperative day 3 .


Dyspnea ( modified Borg score ) , Spo2/FiO2 , and peak expiratory flow ( PEF ) were measured pre-treatment and post-treatment .


Data were analyzed using chi-square tests , t tests , and linear mixed effects models .


There was no statistically significant treatment effect for dyspnea or PEF in patients who received HFCWO versus CPT .


However , there was a significant treatment effect on the Spo2/FiO2 ratio ( p < 0.0001 ) .


Preliminary results suggest that lung function ( measured by Spo2/FiO2 ) improves with HFWCO after lung transplantation .


Although dyspnea and PEF did not differ significantly between treatment types , HFCWO may be an effective , feasible alternative to CPT .


Smoking-cessation counseling during pregnancy is important to prevent smoking-related harm in pregnant smokers and their children .


Therefore we evaluated the effects of an Inspectorate 's supervision programme on the provision of smoking-cessation counseling by midwifery practices in the Netherlands .


The supervision programme consisted of 3 elements : A ) A deadline was announced by which all practices should comply with professional norms on such counseling ( 2011 ) ; B ) A set of randomly selected practices were assessed using a questionnaire and a personal feedback report ( 2010 ) ; C ) Another set of randomly selected practices were assessed through a site visit and a personal feedback report ( 2012 ) .


Programme A was evaluated in a before-after study , Programmes B and C were evaluated in a randomized controlled trial ( RCT ) with only a post-intervention measurement .


Primary outcome was provision of smoking-cessation counseling through a minimal-intervention strategy ( V-MIS ) .


Linear and logistic regression models were used to analyze data from 233 primary-care midwifery practices .


A ) After announcement of the deadline , Dutch midwifery practices reported significantly more provision of smoking-cessation counseling .


For example , the use of V-MIS increased substantially from 28 % to 80 % ; B ) In practices that were assessed with a questionnaire , the provision of counseling improved partially compared to controls ; C ) The provision of counseling did not differ between practices that were visited and their controls .


While the training participation rate in counseling by midwifery practices did not differ between the intervention and control groups , the rate increased significantly in all practices after the start of the supervision programme .


The provision of smoking-cessation counseling improved spectacularly in Dutch midwifery practices .


Despite some limitations of our study , the Inspectorate 's supervision programme is likely to have contributed to the improvements in provision of counseling .


Predictors of asthma exacerbations , poor asthma control , or extreme - agonist overuse may be of clinical utility in the management of asthma .


To investigate characteristics that predict subsequent adverse outcomes in asthma .


An independent 24-week , randomized controlled trial of 303 adult patients with asthma who are at risk , which compared the efficacy of SMART ( single budesonide-formoterol inhaler as maintenance and reliever therapy ) with a fixed-dose regimen with salbutamol as reliever ( `` Standard '' ) .


Inhaled medication use was measured by electronic monitoring .


Baseline characteristics that were predictors of subsequent severe asthma exacerbations , poor asthma control ( Asthma Control Questionnaire -5 score 1.5 ) , and `` extreme '' - agonist overuse ( > 16 budesonide-formoterol actuations/d in SMART and > 32 salbutamol actuations/d in Standard ) were assessed by multivariate analyses .


FEV % predicted ( rate ratio [ RR ] 1.14 [ 95 % CI , 1.03-1 .27 ] per 10 % lower ) , more previous exacerbations ( RR 1.15 [ 95 % CI , 1.01-1 .31 ] ) , Standard therapy ( RR 1.62 [ 95 % CI , 1.07-2 .47 ] ) , and female sex ( RR 2.18 [ 95 % CI , 1.29-3 .67 ] ) were associated with future severe exacerbations .


Asthma Control Questionnaire -- 5 ( regression coefficient 0.20 [ 95 % CI , 0.13-0 .27 ] per 0.5 points higher ) and age ( regression coefficient 0.09 [ 95 % CI , 0.01-0 .17 ] per decade older ) were associated with future poorly controlled asthma .


Higher reliever use ( RR 1.63 [ 95 % CI , 1.36-1 .95 ] per categorical score in Asthma Control Questionnaire question no. 6 ) , Mori ethnicity ( RR 2.20 [ 95 % CI , 1.43-3 .38 ] ) and FEV % predicted ( RR 1.16 [ 95 % CI , 1.03-1 .31 ] per 10 % lower ) were associated with future extreme - agonist overuse .


Future severe asthma exacerbations , poor asthma control , and extreme - agonist overuse are predicted by different baseline clinical and demographic characteristics and management approaches in at-risk asthma .


Epidemiologically , there is a strong relationship between BMI and blood pressure ( BP ) levels .


We prospectively examined randomization to first-step chlorthalidone , a thiazide-type diuretic ; amlodipine , a calcium-channel blocker ; and lisinopril , an angiotensin-converting enzyme inhibitor , on BP control and cardiovascular outcomes in a hypertensive cohort stratified by baseline BMI [ kg/m ( 2 ) ; normal weight ( BMI < 25 ) , overweight ( BMI = 25-29 .9 ) , and obese ( BMI > 30 ) ] .


In a randomized , double-blind , practice-based Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial , 33,357 hypertensive participants , aged at least 55 years , were followed for an average of 4.9 years , for a primary outcome of fatal coronary heart disease or nonfatal myocardial infarction , and secondary outcomes of stroke , heart failure , combined cardiovascular disease , mortality , and renal failure .


Of participants , 37.9 % were overweight and 42.1 % were obese at randomization .


For each medication , BP control ( < 140/90 mmHg ) was equivalent in each BMI stratum .


At the fifth year , 66.1 , 66.5 , and 65.1 % of normal-weight , overweight , and obese participants , respectively , were controlled .


Those randomized to chlorthalidone had highest BP control ( 67.2 , 68.3 , and 68.4 % , respectively ) and to lisinopril the lowest ( 60.4 , 63.2 , and 59.6 % , respectively ) in each BMI stratum .


A significant interaction ( P = 0.004 ) suggests a lower coronary heart disease risk in the obese for lisinopril versus chlorthalidone ( hazard ratio 0.85 , 95 % confidence interval 0.74-0 .98 ) and a significant interaction ( P = 0.011 ) suggests a higher risk of end-stage renal disease for amlodipine versus chlorthalidone in obese participants ( hazard ratio 1.49 , 95 % confidence interval 1.06-2 .08 ) .


However , these results were not consistent among other outcomes .


BMI status does not modify the effects of antihypertensive medications on BP control or cardiovascular disease outcomes .


To evaluate the effect of a practice-based , culturally appropriate patient education intervention on blood pressure ( BP ) and treatment adherence among patients of African origin with uncontrolled hypertension .


Cluster randomised trial involving four Dutch primary care centres and 146 patients ( intervention n = 75 , control n = 71 ) , who met the following inclusion criteria : self-identified Surinamese or Ghanaian ; 20 years ; treated for hypertension ; SBP 140 mmHg .


All patients received usual hypertension care .


The intervention-group was also offered three nurse-led , culturally appropriate hypertension education sessions .


BP was assessed with Omron 705-IT and treatment adherence with lifestyle - and medication adherence scales .


139 patients ( 95 % ) completed the study ( intervention n = 71 , control n = 68 ) .


Baseline characteristics were largely similar for both groups .


At six months , we observed a SBP reduction of 10 mmHg - primary outcome - in 48 % of the intervention group and 43 % of the control group .


When adjusted for pre-specified covariates age , sex , hypertension duration , education , baseline measurement and clustering effect , the between-group difference was not significant ( OR ; 0.42 ; 95 % CI : 0.11 to 1.54 ; P = 0.19 ) .


At six months , the mean SBP/DBD had dropped by 10/5 .7 ( SD 14.3 / 9.2 ) mmHg in the intervention group and by 6.3 / 1.7 ( SD 13.4 / 8.6 ) mmHg in the control group .


After adjustment , between-group differences in SBP and DBP reduction were -1.69 mmHg ( 95 % CI : -6.01 to 2.62 , P = 0.44 ) and -3.01 mmHg ( -5.73 to -0.30 , P = 0.03 ) in favour of the intervention group .


Mean scores for adherence to lifestyle recommendations increased in the intervention group , but decreased in the control group .


Mean medication adherence scores improved slightly in both groups .


After adjustment , the between-group difference for adherence to lifestyle recommendations was 0.34 ( 0.12 to 0.55 ; P = 0.003 ) .


For medication adherence it was -0.09 ( -0.65 to 0.46 ; P = 0.74 ) .


This intervention led to significant improvements in DBP and adherence to lifestyle recommendations , supporting the need for culturally appropriate hypertension care .


Controlled-Trials .


com ISRCTN35675524 .


The primary aim of this study was to analyse two different methods of tonsil surgery , tonsillectomy ( TE ) and tonsillotomy ( TT ) , regarding post-operative dentofacial growth in children with tonsillar hypertrophy .


A secondary aim was to analyse these results in relation to cephalometric standards .


The study group consisted of 64 subjects ( 39 boys and 25 girls ) , mean age 4.8 years 4 months .


They were randomized to a complete removal of the pharyngeal tonsil , TE , ( n = 31 ) or a partial removal , TT , ( n = 33 ) .


Pre-operative and 2 years post-operative study material were obtained and analysed .


The results were compared with cephalometric standards .


Pre-operative , children with hypertrophic tonsils displayed an increased vertical relation ( P < 0.05 ) compared with cephalometric standards .


Post-operative , no significant difference could be detected between the two surgical procedures regarding dentofacial growth .


Mandibular growth with an anterior inclination was significant ( P < 0.001 / TE , P < 0.01 / TT ) for both groups .


An increased upper and lower incisor inclination was noted ( P < 0.01 / TE , TT ) .


The vertical relation decreased ( P < 0.001 / TE , P < 0.05 / TT ) as well as the mandibular angle ( P < 0.01 / TE , P < 0.001 / TT ) .


Reduction was also significant for the sagittal intermaxillar ( P < 0.001 / TE , TT ) relation .


These post-operative results , together with a more prognatic mandible ( P < 0.05 / TE , TT ) and chin ( P < 0.001 / TE , P < 0.01 / TT ) , might indicate a more horizontal direction of mandibular growth .


TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils .


This result should be considered when deciding upon surgical technique .


Whether sex-specific chest pain characteristics ( CPCs ) would allow physicians in the emergency department to differentiate women with acute myocardial infarction ( AMI ) from women with other causes of acute chest pain more accurately remains unknown .


OBJECTIVE To improve the management of suspected AMI in women by exploring sex-specific CPCs .


From April 21 , 2006 , through August 12 , 2012 , we enrolled 2475 consecutive patients ( 796 women and 1679 men ) presenting with acute chest pain to 9 emergency departments in a prospective multicenter study .


The final diagnosis of AMI was adjudicated by 2 independent cardiologists .


Treatment of AMI in the emergency department .


Sex-specific diagnostic performance of 34 predefined and uniformly recorded CPCs in the early diagnosis of AMI .


Acute myocardial infarction was the adjudicated final diagnosis in 143 women ( 18.0 % ) and 369 men ( 22.0 % ) .


Although most CPCs were reported with similar frequency in women and men , several CPCs were reported more frequently in women ( P < .05 ) .


The accuracy of most CPCs in the diagnosis of AMI was low in women and men , with likelihood ratios close to 1 .


Thirty-one of 34 CPCs ( 91.2 % ) showed similar likelihood ratios for the diagnosis of AMI in women and men , and only 3 CPCs ( 8.8 % ) seemed to have a sex-specific diagnostic performance with P < .05 for interaction .


These CPCs were related to pain duration ( 2-30 and > 30 minutes ) and dynamics ( decreasing pain intensity ) .


However , because their likelihood ratios were close to 1 , the 3 CPCs did not seem clinically helpful .


Similar results were obtained when examining combinations of CPCs ( all interactions , P .05 ) .


Differences in the sex-specific diagnostic performance of CPCs are small and do not seem to support the use of women-specific CPCs in the early diagnosis of AMI .


TRIAL REGISTRATION clinicaltrials.gov Identifier : NCT00470587 .


To improve mechanistic understanding , this pilot randomized controlled trial examined mediators of an exercise intervention effects on sleep in breast cancer survivors ( BCS ) .


Forty-six postmenopausal BCS ( Stage II , off primary treatment ) were randomized to a 3-month exercise intervention or control group .


Intervention included 160min/week of moderate intensity aerobic walking , twice weekly resistance training ( resistance bands ) , and six discussion groups ( to improve adherence ) .


Blinded assessments at baseline and post-intervention included sleep disturbance ( PSQI and PROMIS ) , objective sleep quality ( accelerometer ) , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , body composition , fatigue , and psychosocial factors .


Mediation was tested using Freedman-Schatzkin difference-in-coefficients tests .


When compared with control , the intervention group demonstrated a significant increase in PSQI sleep duration ( i.e. , fewer hours of sleep/night ) ( d = 0.73 , p = .03 ) .


Medium to large but non-significant standardized effect sizes were noted for PSQI daytime somnolence ( d = -0.63 , p = .05 ) and accelerometer latency ( d = -0.49 , p = .14 ) .


No statistically significant mediators were detected for PSQI sleep duration score or accelerometer latency .


Daytime somnolence was mediated by tumor necrosis factor-alpha ( mediated 23 % of intervention effect , p < .05 ) , interleukin ( IL ) -6 : IL-10 ( 16 % , p < .01 ) , IL-8 : IL-10 ( 26 % , p < .01 ) , and fatigue ( 38 % , p < .05 ) .


Mediating or enhancing relationships for several of the sleep outcomes were noted for accelerometer physical activity , PROMIS fatigue , exercise social support , and/or physical activity enjoyment .


Inflammation and psychosocial factors may mediate or enhance sleep response to our exercise intervention .


Further study is warranted to confirm our results and translate our findings into more effective interventions aimed at improving sleep quality in BCS .


Although the advantages of laparoscopic procedures has been well studied over the last two decade , laparoscopic appendectomy could not to be a standard therapy due to some disadvantages such as longer operative time and higher cost.The objective of our study is to re-evaluate the outcomes of laparoscopic versus open appendectomy with current data .


Between January 2012 and July 2012 , the data of the patients who had appendectomy were recorded prospectively .


Patients ' demographics , duration of procedure , length of hospital stay , need of analgesics , postoperative visual analogue scale scores and morbidity were assessed .


Of 241 patients , 120 ( 49.8 % ) underwent open and 121 ( 50.2 % ) laparoscopic appendectomy .


The operating time was similar for both groups ( p = 0.855 ) .


The visual analog scale scores of 1st ( p = 0.001 ) , 6th ( p = 0.001 ) and 12th ( p = 0.028 ) hours were higher in open the appendectomy group .


The total need of analgesics significantly was higher in open group ( p = 0.001 ) .


There was no statistical difference in terms of total morbidity rate between open and laparoscopic appendectomy groups ( p = 0.617 ) .


Two operative techniques are similar in terms of length of hospital stay , operative time , and postoperative complications .


Laparoscopic appendectomy reduces the need for analgesics and visual analog scale scores ; therefore , it should be considered as the gold standard for surgical treatment of acute appendicitis .


Antibiotic resistance has risen dramatically over the past years .


For individual patients , adequate initial antibiotic therapy is essential for clinical outcome .


Computer-assisted decision support systems ( CDSSs ) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines .


The aim of this study was to evaluate long-term effects after implementation of a CDSS .


This prospective ` before/after ' cohort study was conducted over four observation periods within 5 years .


One preinterventional period ( pre ) was compared with three postinterventional periods : directly after intensive implementation efforts ( post1 ) , 2 years ( post2 ) and 3 years ( post3 ) after implementation .


Five anaesthesiological-managed intensive care units ( ICU ) ( one cardiosurgical , one neurosurgical , two interdisciplinary and one intermediate care ) at a university hospital .


Adult patients with an ICU stay of > 48 h were included in the analysis .


1316 patients were included in the analysis for a total of 12,965 ICU days .


Implementation of a CDSS .