Ten participants with type 2 diabetes were recruited for this randomized crossover study .


Metformin or placebo was given for 28 days , followed by the alternate treatment for 28 days .


On the last 2 days of each condition , participants were assessed during a non-exercise day and a subsequent exercise day .


Aerobic exercise took place in the morning and blood samples were taken in the subsequent hours ( before and after lunch ) .


Aerobic exercise did not increase total plasma glucagon-like peptide-1 ( GLP-1 ) or glucose-dependent insulinotropic polypeptide ( GIP ) in the pre - or post-lunch periods ( all p > 0.1 ) .


GLP-1 was higher in the pre-lunch ( p = 0.016 ) and post-lunch ( p = 0.018 ) periods of the metformin conditions compared with the placebo .


Total plasma GIP was higher in the pre-lunch period ( p = 0.05 ) , but not in the post-lunch period ( p = 0.95 ) , with metformin compared with placebo .


In contrast to our hypothesis , aerobic exercise did not acutely increase total GLP-1 and GIP levels in patients with type 2 diabetes .


Metformin , independent of exercise , significantly increased total plasma GLP-1 and GIP concentrations in these patients .


The aim of this study was to investigate the effects of two exercise programs on lower extremity function in patients with juvenile idiopathic arthritis .


Thirty patients with juvenile idiopathic arthritis participated in this study .


Pain , passive range of motion , muscle strength , balance , and functional abilities were assessed with the Numeric Rating Scale , goniometer , handheld dynamometer , Flamingo Balance Test , Functional Reach Test , 10-meter walking test , 10-stair climbing test , and Childhood Health Assessment Questionnaire .


Participants were randomly assigned to the strengthening exercise group ( group 1 , n = 15 ) or the proprioceptive-balance exercise group ( group 2 , n = 15 ) .


Intragroup analysis showed statistically significant improvements in all outcome measures except muscle strength in the hip and ankle after strengthening exercises in group 1 .


However , statistically significant improvements were found in all outcome measures after the proprioceptive-balance exercises in group 2 .


Intergroup analysis showed statistically significant improvement in all outcome measures in group 2 except for the Numeric Rating Scale , Childhood Health Assessment Questionnaire , and passive range of motion scores and hip extension and knee flexion muscle strengths .


This study demonstrates that exercise treatment significantly improves musculoskeletal symptoms in patients with juvenile idiopathic arthritis .


However , balance-proprioceptive exercises prove to be effective more than strengthening exercises for improving lower extremity function such as walking , climbing stairs , and balance in patients with juvenile idiopathic arthritis .


A high-frequency steady-state visual evoked potential ( SSVEP ) has been suggested for the reduction of eye fatigue for SSVEP-based brain-computer interfaces ( BCIs ) .


However , the poor performance of high-frequency SSVEP requires a novel stimulus of better performance even with low eye fatigue .


As an alternative to the high-frequency SSVEP , we explore the SSVEP response to an amplitude-modulated stimulus ( AM-SSVEP ) to verify its availability for brain-computer interfaces ( BCIs ) .


An amplitude-modulated stimulus was generated as the product of two sine waves at a carrier frequency ( fc ) and a modulating frequency ( fm ) .


The carrier frequency was higher than 40 Hz to reduce eye fatigue , and the modulating frequency ranged around the - band ( 9-12 Hz ) to utilize low-frequency harmonic information .


Four targets were used in combinations of three different modulating frequencies and two different carrier frequencies in the offline experiment , and two additional targets were added with one additional modulating and one carrier frequency in online experiments .


In the AM-SSVEP spectra , seven harmonic components were identified at 2fc , 2fm , fcfm , fc3fm , and 2fc-4fm .


Using an optimized combination of the harmonic frequencies , online experiments demonstrated that the accuracy of the AM-SSVEP was equivalent to that of the low-frequency SSVEP .


Furthermore , subject evaluation indicated that an AM stimulus caused lower eye fatigue and less sensing of flickering than a low-frequency stimulus , in a manner similar to a high-frequency stimulus .


The actual stimulus frequencies of AM-SSVEPs are in the high-frequency band , resulting in reduced eye fatigue .


Furthermore , AM-SSVEPs can utilize both fundamental stimulus frequencies and non-integer harmonic frequencies including low frequencies for SSVEP recognition .


The feasibility of AM-SSVEP with high BCI performance and low eye fatigue was confirmed through offline and online experiments .


AM-SSVEPs combine the advantages of both low - and high-frequency SSVEPs -- high power and low eye fatigue , respectively .


AM-SSVEP-based BCI systems exploit these advantages , making them promising for application in practical BCI systems .


The use of supplemental oxygen in the setting of suspected acute myocardial infarction ( AMI ) is recommended in international treatment guidelines and established in prehospital and hospital clinical routine throughout the world .


However , to date there is no conclusive evidence from adequately designed and powered trials supporting this practice .


Existing data are conflicting and fail to clarify the role of supplemental oxygen in AMI .


A total of 6,600 normoxemic ( oxygen saturation [ SpO2 ] 90 % ) patients with suspected AMI will be randomly assigned to either supplemental oxygen 6 L/min delivered by Oxymask ( MedCore Sweden AB , Kista , Sweden ) for 6 to 12 hours in the treatment group or room air in the control group .


Patient inclusion and randomization will take place at first medical contact , either before hospital admission or at the emergency department .


The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry will be used for online randomization , allowing inclusion of a broad population of all-comers .


Follow-up will be carried out in nationwide health registries and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies .


The primary objective is to evaluate whether oxygen reduces 1-year all-cause mortality .


Secondary end points include 30-day mortality , major adverse cardiac events , and health economy .


Prespecified subgroups include patients with confirmed AMI and certain risk groups .


In a 3-month pilot study , the study concept was found to be safe and feasible .


The need to clarify the uncertainty of the role of supplemental oxygen therapy in the setting of suspected AMI is urgent .


The DETO2X-AMI trial is designed and powered to address this important issue and may have a direct impact on future recommendations .


Despite the intensive global efforts to control intestinal parasitic infections , the prevalence of soil-transmitted helminth ( STH ) infections is still very high in many developing countries particularly among children in rural areas .


A randomized , double-blind , placebo-controlled trial was conducted on 250 Aboriginal schoolchildren in Malaysia to investigate the effects of a single high-dose of vitamin A supplementation ( 200,000 IU ) on STH reinfection .


The effect of the supplement was assessed at 3 and 6 months after receiving interventions ; after a complete 3-day deworming course of 400 mg/daily of albendazole tablets .


Almost all children ( 98.6 % ) were infected with at least one STH species .


The overall prevalence of ascariasis , trichuriasis and hookworm infection was 67.8 % , 95.5 % and 13.4 % , respectively .


Reinfection rates of Ascaris , Trichuris and hookworm were high ; at 6 months , assessment reached 80 % of the prevalence reported before treatment .


There were no significant differences in the reinfection rates and intensities of STH between vitamin A supplemented-children and those who received placebo at 3 and 6 months ( p > 0.05 ) .


Vitamin A supplementation showed no protective effect against STH reinfection and this could be due to the high endemicity of STH in this community .


Long-term interventions to reduce poverty will help significantly in reducing this continuing problem and there is no doubt that reducing intestinal parasitic infection would have a positive impact on the health , nutrition and education of these children .


This trial was registered at clinicaltrials.gov as NCT00936091 .


Diet and lifestyle modification is commonly used in constipation management .


As there is a dearth of studies on this topic in Malaysia , we aim to elucidate the relations between stool patterns , dietary intake and physical activity levels among adults with functional constipation .


From a database collected via surveys at public events , a convenience sample of 100 adults diagnosed with Rome II-defined functional constipation was enrolled in this cross-sectional study .


After severity assessment using the Chinese Constipation Questionnaire , subjects completed 2-week bowel movement diaries to determine stool frequency , consistency and output .


Dietary intake and physical activity levels were assessed twice using three-day 24-hour diet recalls and International Physical Activity Questionnaire , respectively .


Ninety subjects who completed the study were included in the analysis .


Mean weekly stool frequency was 3.9 + / - 1.9 times , consistency score was 2.6 + / - 0.6 ( range 1.0-4 .0 ) , output was 11.0 + / - 6.3 balls ( 40 mm diameter ) and severity score was 10.3 + / - 3.3 ( range 5.0-22 .0 ) .


Mean daily dietary intakes were : energy 1,719 + / - 427kcal , dietary fibre 15.0 + / - 4.9 g and fluid 2.5 + / - 0.8 L.


The majority of subjects were physically inactive .


Stool frequency and output were positively associated with dietary fibre ( r ( s ) = 0.278 , P < 0.01 ; r ( s ) = 0.226 , P < 0.05 ) and fluid intake ( r ( s ) = 0.257 , P < 0.05 ; OR = 3.571 , 95 % CI [ 1.202-10 .609 ] ) .


Constipation severity was associated with higher physical activity levels ( OR = 2.467 , 95 % CI [ 1.054-5 .777 ] ) .


Insufficient intake of dietary fibre and fluid are associated with aggravated constipation symptoms .


Further studies are necessary to confirm usefulness of dietary intervention in treatment of constipation as dietary factors alone may not influence overall severity and stool consistency , an integral element of constipation .


Patients with CKD have a high prevalence of cardiovascular disease associated with or exacerbated by inactivity .


This randomized , controlled study investigated whether a renal rehabilitation exercise program for patients with stages 3 or 4 CKD would improve their physical function and quality of life .


In total , 119 adults with CKD stages 3 and 4 were randomized , and 107 of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual care plus guided exercise two times per week for 12 weeks ( 24 sessions ) .


Physical function was determined by three well established performance-based tests : 6-minute walk test , sit-to-stand test , and gait-speed test .


Health-related quality of life was assessed by the RAND 36-Item Short Form Health Survey .


At baseline , no differences in self-reported level of activity , 6-minute walk test , and sit-to-stand test scores were observed between the usual care ( n = 48 ) and renal rehabilitation exercise ( n = 59 ) groups , although baseline gait-speed test score was higher in the renal rehabilitation exercise group ( P < 0.001 ) .


At follow-up , the renal rehabilitation exercise group but not the usual care group showed significant improvements in the 6-minute walk test ( +210.4266.0 ft [ 19 % improvement ] versus -10219.9 ft ; P < 0.001 ) , the sit-to-stand test ( +26.927 % of age prediction [ 29 % improvement ] versus +0.712.1 % of age prediction ; P < 0.001 ) , and the RAND-36 physical measures of role functioning ( P < 0.01 ) , physical functioning ( P < 0.01 ) , energy/fatigue levels ( P = 0.01 ) , and general health ( P = 0.03 ) and mental measure of pain scale ( P = 0.04 ) .


The renal rehabilitation exercise regimen was generally well tolerated .


A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages 3 and 4 .


Longer follow-up is needed to determine if these findings will translate into decreased mortality rates .


Youth in war-affected regions are at risk for poor psychological , social , and educational outcomes .


Effective interventions are needed to improve mental health , social behavior , and school functioning .


This randomized controlled trial tested the effectiveness of a 10-session cognitive-behavioral therapy ( CBT ) - based group mental health intervention for multisymptomatic war-affected youth ( aged 15-24 years ) in Sierra Leone .


War-affected youth identified by elevated distress and impairment via community screening were randomized ( stratified by sex and age ) to the Youth Readiness Intervention ( YRI ) ( n = 222 ) or to a control condition ( n = 214 ) .


After treatment , youth were again randomized and offered an education subsidy immediately ( n = 220 ) or waitlisted ( n = 216 ) .


Emotion regulation , psychological distress , prosocial attitudes/behaviors , social support , functional impairment , and posttraumatic stress disorder ( PTSD ) symptoms were assessed at pre - and postintervention andat 6-month follow-up .


For youth in school , enrollment , attendance , and classroom performance were assessed after 8 months .


Linear mixed-effects regressions evaluated outcomes .


The YRI showed significant postintervention effects on emotion regulation , prosocial attitudes/behaviors , social support , and reduced functional impairment , and significant follow-up effects on school enrollment , school attendance , and classroom behavior .


In contrast , education subsidy was associated with better attendance but had no effect on mental health or functioning , school retention , or classroom behavior .


Interactions between education subsidy and YRI were not significant .


YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement andbehavior , suggesting potential to prepare war-affected youth for educational and otheropportunities .


Clinical trial registration information-Trial of the Youth Readiness Intervention ( YRI ) ; http://clinicaltrials.gov; NCT01684488 .


Images depicting morbidly obese models [ i.e. body mass index ( BMI ) > 40 ] often accompany media articles about the health risks of being overweight ( i.e. BMI 25-30 ) .


Little is known about the effect of this mismatch on people 's understanding of risk , and perceptions of message relevance .


In total , 563 participants ( 291 overweight/obese and 272 healthy weight ) were randomly allocated to read a health message about the risk of heart disease posed by being overweight , presented alongside ( i ) a photo of an overweight model , ( ii ) a morbidly obese model or ( iii ) no photo .


Between-group differences in the primary outcomes of message relevance , and the body size perceived to be ` at risk ' , were assessed , and the potential moderating effects of motivation , weight concern and existing risk knowledge explored .


Overweight and obese participants in the exaggerated ( morbidly obese ) image condition interpreted health risks to relate to a larger body size than those who saw no image ( F ( 2 , 290 ) = 4.06 , P = 0.02 ) .


There was no experimental effect on perceived personal relevance ( F ( 2 , 290 ) = 0.25 , P = 0.38 ) .


No significant moderation effects were detected , and there was no effect of study condition in healthy weight participants for either outcome .


The findings suggest that the use of morbidly obese models in messages regarding the health risks of being overweight may undermine the impact of these messages among those who they most aim to reach ; the reader may perceive a reduced risk of being ` only ' overweight , and that a higher weight is needed for the negative effects of excess weight to occur .


To evaluate the anti-spasticity effects of anodal transcranial direct current stimulation ( tDCS ) in individuals with spastic cerebral palsy ( CP ) .


Forty-six children and adolescents with cerebral palsy were randomly assigned to either active ( 1 mA anodal ) or sham ( placebo ) tDCS over the left primary motor cortex ( Ml ) on five consecutive days .


Both group also received routine physical therapy .


Measures of spasticity and passive range of motion ( PROM ) were administered before treatment , immediately after treatment , and at 24 - and 48-hours follow-up .


Participants assigned to active tDCS treatment evidenced significantly more pre - to immediately post-treatment reductions in spasticity than participants assigned to the sham ( p = 0.004 , p < O. 001l , andp = 0.004 for shoulder wrist , and fingers respectively ) and these improvement in spasticity maintainedfor at least 48 hours for wrist joints ( p = 0.023 ) .


There was only one participant in the active tDCS condition developed erythematous rash .


However , all participants tolerated the tDCS well without any serious adverse events .


Anodal tDCS appeared to reduce CP-relatedspasticity ( but not PROM ) in the short term .


Researches examine the long term benefits of this intervention on spasticity are warranted .


The aim of this study was to evaluate the effect of dietary omega-3 fatty acid ( O3FA ) supplementation on dry eye symptoms , tear film tests , and conjunctival impression cytology in patients with contact lens wear-associated dry eye .


In this randomized , double-blind , multicentric trial , contact lens wearers ( n = 496 ) were randomized to receive either O3FAs or placebo capsules ( corn oil ) twice daily for 6 months .


Subjects underwent examinations at baseline , 3 months , and 6 months .


At each visit , a questionnaire of dry eye symptoms and lens wear comfort was administered .


Subjects further underwent measurement of tear film break-up time ( TBUT ) and a Schirmer test .


Conjunctival impression cytology was performed by the transfer method .


Improvement in symptoms and lens wear comfort were primary outcome measures .


Changes from baseline in TBUT , Schirmer , and Nelson grade at 6 months were secondary outcome measures .


The mean improvement in symptom score in the O3FA group was 4.7 2 ( 2.0 ) as compared with 0.5 2 ( 0.9 ) in the placebo group ( P < 0.0001 ) .


Lens wear comfort levels improved significantly ( P < 0.0001 ) from baseline .


There was a significant increase in TBUT [ 3.3 2 ( 1.5 ) ] and Nelson grade [ 0.7 2 ( 0.6 ) ] in the O3FA group ( P < 0.0001 ) as compared with 0.3 2 ( 0.6 ) and 0.1 2 ( 0.4 ) in the placebo group ( P = 0.164 and 0.094 , respectively ) .


However , the magnitude of increase in Schirmer score [ 2.0 2 ( 1.5 ) ] was relatively small ( P = 0.08 ) .


The results of this study point toward benefits of orally administered O3FAs in alleviating dry eye symptoms , improving lens wear comfort , and cytological changes in contact lens wearers .


To evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion ( ROM ) , head repositioning accuracy , and balance in patients with chronic cervicogenic dizziness .


Randomized controlled trial with 12-week follow-up using blinded outcome assessment .


University School of Health Sciences .


Participants ( N = 86 ; mean age SD , 62.0 12.7 y ; 50 % women ) with chronic cervicogenic dizziness .


Participants were randomly assigned to 1 of 3 groups : sustained natural apophyseal glides ( SNAGs ) with self-SNAG exercises , passive joint mobilization ( PJM ) with ROM exercises , or a placebo .


Participants each received 2 to 6 treatments over 6 weeks .


Cervical ROM , head repositioning accuracy , and balance .


SNAG therapy resulted in improved ( P .05 ) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks .


Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks .


There was a greater improvement ( P < .01 ) after SNAGs than PJM in extension ( mean difference , -7.5 ; 95 % confidence interval [ CI ] , -13 to -2.0 ) and right rotation ( mean difference , -6.8 ; 95 % CI , -11.5 to -2.1 ) posttreatment .


Manual therapy had no effect on balance or head repositioning accuracy .


SNAG treatment improved cervical ROM , and the effects were maintained for 12 weeks after treatment .


PJM had very limited impact on cervical ROM .


There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness .


In early postpartum haemorrhage ( PPH ) , a low concentration of fibrinogen is associated with excessive subsequent bleeding and blood transfusion .


We hypothesized that pre-emptive treatment with fibrinogen concentrate reduces the need for red blood cell ( RBC ) transfusion in patients with PPH .


In this investigator-initiated , multicentre , double-blinded , parallel randomized controlled trial , we assigned subjects with severe PPH to a single dose of fibrinogen concentrate or placebo ( saline ) .


A dose of 2 g or equivalent was given to all subjects independent of body weight and the fibrinogen concentration at inclusion .


The primary outcome was RBC transfusion up to 6 weeks postpartum .


Secondary outcomes were total blood loss , total amount of blood transfused , occurrence of rebleeding , haemoglobin < 58 g litre ( -1 ) , RBC transfusion within 4 h , 24 h , and 7 days , and as a composite outcome of ` severe PPH ' , defined as a decrease in haemoglobin of > 40 g litre ( -1 ) , transfusion of at least 4 units of RBCs , haemostatic intervention ( angiographic embolization , surgical arterial ligation , or hysterectomy ) , or maternal death .


Of the 249 randomized subjects , 123 of 124 in the fibrinogen group and 121 of 125 in the placebo group were included in the intention-to-treat analysis .


At inclusion the subjects had severe PPH , with a mean blood loss of 1459 ( sd 476 ) ml and a mean fibrinogen concentration of 4.5 ( sd 1.2 ) g litre ( -1 ) .


The intervention group received a mean dose of 26 mg kg ( -1 ) fibrinogen concentrate , thereby significantly increasing fibrinogen concentration compared with placebo by 0.40 g litre ( -1 ) ( 95 % confidence interval , 0.15-0 .65 ; P = 0.002 ) .


Postpartum blood transfusion occurred in 25 ( 20 % ) of the fibrinogen group and 26 ( 22 % ) of the placebo group ( relative risk , 0.95 ; 95 % confidence interval , 0.58-1 .54 ; P = 0.88 ) .


We found no difference in any predefined secondary outcomes , per-protocol analyses , or adjusted analyses .


No thromboembolic events were detected .


We found no evidence for the use of 2 g fibrinogen concentrate as pre-emptive treatment for severe PPH in patients with normofibrinogenaemia .


ClinicalTrials.gov : http://clinicaltrials.gov/show/NCT01359878 .


Published protocol : http://www.trialsjournal.com/content/pdf/1745-6215-13-110.pdf .


The therapeutic outcomes of low-level laser therapy ( LLLT ) on closed bone fractures ( CBFs ) in the wrist and hand were investigated in this controlled study .


Animal research has confirmed that LLLT increases osteocyte quantity ; however , little research has been conducted to determine the effect of LLLT on the treatment of human bone fractures .


In this study , the therapeutic outcomes of administering 830nm LLLT to treat CBFs in the wrist or hand were examined .


Fifty patients with CBFs in the wrist and hand , who had not received surgical treatment , were recruited and randomly assigned to two groups .


The laser group underwent a treatment program in which 830nm LLLT ( average power 60mW , peak power 8W , 10Hz , 600sec , and 9.7 J/cm ( 2 ) per fracture site ) was administered five times per week for 2 weeks .


Participants in a placebo group received sham laser treatment .


The pain , functional disability , grip strength , and radiographic parameters of the participants were evaluated before and after treatment and at a 2-week follow-up .


After treatment and at the follow-up , the laser group exhibited significant changes in all of the parameters compared with the baseline ( p < 0.05 ) .


The results of comparing the two groups after treatment and at the follow-up indicated significant between-group differences among all of the parameters ( p < 0.05 ) .


LLLT can relieve pain and improve the healing process of CBFs in the human wrist and hand .


Oral antibiotics use in infants in developing countries is challenging because liquid formulations are often unavailable .


However , dissolving solid formulation of drugs in water poses a risk of gastrointestinal infection .


Although mother 's milk may be a potential vehicle , no evidence exists to indicate that antibiotics dissolved in human milk are bioequivalent to those dissolved in water .


Therefore , we compared pharmacokinetic parameters of an orally administered antibiotic , amoxicillin , dissolved in human milk , to those of water-dissolved amoxicillin .


A pharmacokinetic study was conducted in 16 healthy adult volunteers in a randomised crossover design .


Marketed amoxicillin powder for suspension was dissolved in either human milk or water at a final concentration of 50 mg/mL , and 10 mL was given orally in a fasting state .


Timed blood samples were obtained and plasma amoxicillin was quantified using liquid chromatography-mass spectrometry .


Results showed that pharmacokinetic parameters , including area-under-the-curve , Cmax and half-life of the water-based and milk-based amoxicillin administration were not significantly different .


90 % CIs of the ratios of these parameters in concomitant breast milk administration to those of water were within 89 % and 116 % , suggesting they are bioequivalent ( defined as a range between 80 % and 125 % ) .


We conclude that oral administration of amoxicillin dissolved in human milk at 50 mg/mL results in pharmacokinetics profiles comparable to amoxicillin dissolved in water .


Pharmaceutical interactions between amoxicillin and breast milk are unlikely , suggesting no need to modify dosing schedules .


Patients with stroke suffer from nutrition impairments and often rely on enteral nutrition ( EN ) , which is associated with respiratory complications such as regurgitation and aspiration .


To evaluate the incidence of regurgitation and aspiration in patients with severe stroke infused with different volumes of EN .


A randomized controlled trial was conducted on 210 patients with severe stroke undergoing EN therapy .


Patients were randomly assigned into two groups .


Subjects in the treatment group received EN with an initial rate defined according to the total volume and the infusion rate was adjusted based on gastric residual volume ( GRV ) assessed every 4 hours .


Subjects of the control group received EN without monitoring the GRV and reached the target infusion volume within 72 hours .


The incidence of reflux and aspiration was recorded .


The incidences of regurgitation and aspiration were significantly lower in treatment group ( 6.3 % and 7.9 % , respectively ) than control group ( 18.8 % and 17.5 % , respectively ) .


In the treatment group , 1 patient developed regurgitation while 2 developed aspiration when EN was 500 mL .


When EN increased to 1000 mL , 2 patients developed regurgitation and 2 developed aspiration , and 5 patients developed regurgitation and 6 had aspiration when EN was 1500 mL .


There was no significant difference in the risk of reflux and aspiration when total volume of EN increased from 500 to 1500 mL .


During EN therapy for patients with stroke , using feeding pump with a continuous infusion for 20 hours and adjusting infusion rate based on GRV could reduce the incidence of respiratory complications .


Acute decompensated heart failure ( ADHF ) is associated with significant morbidity and mortality but the relationship between LVEF and outcomes is unclear .


We explored the association between LVEF and 30 and 180day mortality in 7007 ADHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure ( ASCEND-HF ) trial .


We explored the association between LVEF and 30 and 180 day mortality in 7007 ADHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure ( ASCEND-HF ) trial .


LVEF was analysed both as a continuous variable and according to three categories : < 40 % ( LowEF ) , 40-50 % [ intermediate EF ( IntEF ) ] , and > 50 % [ preserved ejection fraction ( PresEF ) ] .


Of the patients in the trial , 4474 ( 78.7 % ) had LowEF , 674 ( 11.9 % ) had IntEF , and 539 ( 9.5 % ) had PresEF .


The unadjusted 30 and 180 day mortality was similar for LowEF ( 3.7 % , 12.3 % ) , IntEF ( 3.4 % , 13.1 % ) , and PresEF ( 4.3 % , 14.1 % ) , respectively ( P > 0.05 ) .


After multivariable adjustment , the hazard ratio ( HR ) for 180 day mortality remained similar for the LowEF [ HR 0.96 , 95 % confidence interval ( CI ) 0.75-1 .24 ; P = 0.77 ] and IntEF ( 0.91 , 95 % CI 0.66-1 .3 ; P = 0.58 ) compared to PresEF patients .


By contrast , when LVEF was evaluated as a continuous measure , it exhibited a U-shaped pattern with mortality .


After matching for age and sex , the mortality risk attributed to LVEF was attenuated , as the LVEF increased as a continuous variable over 35 % .


However , in patients with EF < 35 % , the mortality risk continue to increase as the LVEF declined .


Among patients with ADHF , the unadjusted mortality rates are similar across LVEF strata .


However , after accounting for key patient variables , the mortality risk increases as EF falls below 35 % .


These data will be useful in planning future studies of ADHF .


www.clinicaltrials.gov identifier : NCT00475852 .


Two randomized intraoperative radiation therapy trials for early-stage breast cancer were recently published .


The ELIOT Trial used electrons ( IOERT ) , and the TARGIT-A Trial Update used 50-kV X-rays ( IORT ) .


These studies were compared for similarities and differences .


The results were analyzed and used to determine which patients might be suitable for single-dose treatment .


The primary sources of data were the ELIOT Trial and TARGIT-A Trial , as well as a comprehensive analysis of the peer-reviewed literature of accelerated partial breast irradiation ( APBI ) using 50-kV X-rays or electrons .


Studies published or presented prior to March 2014 were analyzed for efficacy , patient restrictions , complications , and outcome .


With a median follow-up of 5.8 years , the 5-year recurrence rates for ELIOT versus EBRT patients were 4.4 and 0.4 % , respectively , p = 0.0001 .


A low-risk ELIOT group was identified with a 5-year recurrence rate of 1.5 % .


With a median follow-up of 29months , the 5-year recurrence rates for the TARGIT-A versus EBRT patients were 3.3 and 1.3 % , respectively , p = 0.042 .


With 5.8 years of median follow-up , IOERT appears to have a subset of low risk women for whom IOERT is acceptable .


With 29months of median follow-up the results of IORT with 50-kV devices are promising , but longer follow-up data are required .


At the current time , single-fraction IOERT or IORT patients should be treated under strict institutional protocols .


Advantages of using efavirenz as part of treatment for children infected with human immunodeficiency virus ( HIV ) include once-daily dosing , simplification of co-treatment for tuberculosis , preservation of ritonavir-boosted lopinavir for second-line treatment , and harmonization of adult and pediatric treatment regimens .


However , there have been concerns about possible reduced viral efficacy of efavirenz in children exposed to nevirapine for prevention of mother-to-child transmission .


To evaluate whether nevirapine-exposed children achieving initial viral suppression with ritonavir-boosted lopinavir-based therapy can transition to efavirenz-based therapy without risk of viral failure .


Randomized , open-label noninferiority trial conducted at Rahima Moosa Mother and Child Hospital , Johannesburg , South Africa , from June 2010 to December 2013 , enrolling 300 HIV-infected children exposed to nevirapine for prevention of mother-to-child transmission who were aged 3 years or older and had plasma HIV RNA of less than 50 copies/mL during ritonavir-boosted lopinavir-based therapy ; 298 were randomized and 292 ( 98 % ) were followed up to 48 weeks after randomization .


Participants were randomly assigned to switch to efavirenz-based therapy ( n = 150 ) or continue ritonavir-boosted lopinavir-based therapy ( n = 148 ) .


Risk difference between groups in ( 1 ) viral rebound ( ie , 1 HIV RNA measurement of > 50 copies/mL ) and ( 2 ) viral failure ( ie , confirmed HIV RNA > 1000 copies/mL ) with a noninferiority bound of -0.10 .


Immunologic and clinical responses were secondary end points .


The Kaplan-Meier probability of viral rebound by 48 weeks was 0.176 ( n = 26 ) in the efavirenz group and 0.284 ( n = 42 ) in the ritonavir-boosted lopinavir group .


Probabilities of viral failure were 0.027 ( n = 4 ) in the efavirenz group and 0.020 ( n = 3 ) in the ritonavir-boosted lopinavir group .


The risk difference for viral rebound was 0.107 ( 1-sided 95 % CI , 0.028 to ) and for viral failure was -0.007 ( 1-sided 95 % CI , -0.036 to ) .


We rejected the null hypothesis that efavirenz is inferior to ritonavir-boosted lopinavir ( P < .001 ) for both end points .


By 48 weeks , CD4 cell percentage was 2.88 % ( 95 % CI , 1.26 % -4.49 % ) higher in the efavirenz group than in the ritonavir-boosted lopinavir group .


Among HIV-infected children exposed to nevirapine for prevention of mother-to-child transmission and with initial viral suppression with ritonavir-boosted lopinavir-based therapy , switching to efavirenz-based therapy compared with continuing ritonavir-boosted lopinavir-based therapy did not result in significantly higher rates of viral rebound or viral failure .


This therapeutic approach may offer advantages in children such as these .


clinicaltrials.gov Identifier : NCT01146873 .


White rice is the main staple for the majority in the world .


The effects of protein , fat and vegetables on the glycaemic and insulinaemic responses to a white rice-based meal have not been reported .


The aim of this study was to determine the effect of co-ingesting a high-protein food ( breast chicken ) , a fat ( ground nut oil ) , a leafy vegetable or all three on the glycaemic and insulinaemic responses of white rice in healthy adults .


This was a randomized crossover trial conducted at the Clinical Nutrition Research Centre in Singapore .


Twelve healthy volunteers were given five test meals ( white rice alone , white rice with chicken , white rice with oil , white rice with vegetable and white rice with chicken , oil and vegetable ) once and the reference food ( glucose solution ) three times in a random order at 1-week intervals .


Capillary blood samples were then drawn serially for 3 h , and glucose and insulin were analysed .


The glycaemic response ( GR ) to white rice with chicken breast , ground nut oil and vegetable was significantly lower than to white rice alone .


The glycaemic index ( GI ) of pure white rice was 96 , whereas combined with chicken breast , ground nut oil and vegetable , it was 50 .


The addition of oil delayed the peak glucose response and reduced the iAUC , resulting in a GI value of 67 .


The addition of chicken and vegetable resulted in a GI value of 73 and 82 , respectively .


The insulinaemic index ( II ) of the white rice-based meals varied between 54 and 89 .


Chicken breast in the meal increased the insulinaemic response and decreased the GR .


White rice II was lower than the glucose control , which indicated that the former was not as insulinogenic as the latter .


White rice with vegetable had the lowest II .


Co-ingesting chicken , oil or vegetable with white rice considerably influences its glycaemic and insulinaemic responses .


Co-ingesting white rice with all three components attenuates the GR to a greater degree than when it is eaten with any single one of them , and that this is not at the cost of an increased demand for insulin .


Few trials have compared different approaches to cardiovascular disease prevention among Pacific Asian ( PA ) populations .


The Cluster Randomized Usual Care versus Caduet Investigation Assessing Long-term-risk ( CRUCIAL ) trial demonstrated that a proactive multifactorial intervention ( PMI ) approach ( based on single-pill amlodipine/atorvastatin ) resulted in a greater reduction in calculated Framingham 10-year coronary heart disease ( CHD ) risk compared with usual care ( UC ) among hypertensive patients with additional risk factors .


One-third of CRUCIAL patients resided in the PA region .


The aim of this subanalysis was to compare two approaches to cardiovascular risk factor management ( PMI versus UC ) among patients residing in PA and non-PA regions .


This subanalysis of the CRUCIAL trial compared treatment-related changes in calculated CHD risk among patients residing in PA and non-PA regions .


Sensitivity analyses were conducted among men and women and those with and without diabetes .


Overall , 448 patients ( 31.6 % ) resided in the PA region and 969 patients ( 68.4 % ) resided in non-PA regions .


The PMI approach was more effective in reducing calculated CHD risk versus UC in both PA ( -37.1 % versus -3.5 % ; P < 0.001 ) and non-PA regions ( -31.1 % versus -4.2 % ; P < 0.001 ) ; region interaction P = 0.131 .


PA patients had slightly greater reductions in total cholesterol compared with non-PA patients .


PA patients without diabetes had slightly greater reductions in CHD risk compared with non-PA patients .


Treatment effects were similar in men and women and those with diabetes .


The PMI approach was more effective in reducing calculated Framingham 10-year CHD risk compared with UC among men and women with and without diabetes residing in the PA and non-PA region .


Evidences from cultured cells and animal models of ischemia suggest that lithium has neuroprotective and neurotrophic effects and may play a desirable role in reducing infarct volume and even improving the brain insults from stroke .


The aim of this study was to evaluate the efficacy of lithium in early motor recovery of patients after ischemic stroke .


Eighty patients with first ever stroke , allocated randomly in lithium , 300 mg twice daily , or placebo .


Treatment was initiated 48 hours after stroke and continued for 30 days .


Modified National Institute of Health Stroke Scale ( mNIHSS ) and hand subsection of Fugl-Meyer Assessment ( hFMA ) were used to evaluate impairment on the fifth and 30th day of treatment .


Sixty-six subjects ( 32 subjects in the lithium group and 34 subjects in the placebo group ) completed the study .


There were no significant differences in the improvement in mNIHSS ( P = 0.40 ) and hFMA ( P = 0.07 ) after 30 days .


However , a subgroup analysis showed that patients with cortical strokes in the lithium group had significantly better improvement in both mNIHSS and hFMA in comparison to the placebo group ( P = 0.003 ) .


Approximately 44 % ( n = 14 ) of patients in the lithium group , mainly from the cortical stroke subgroup , regained more than 25 % of full function based on hFMA , whereas this rate in the placebo group was 14.7 % ( n = 5 ; P = 0.009 ) .


The observed discrete difference between the lithium group and the placebo group in the cortical stroke subgroup may suggest an enhanced motor recovery after stroke by using an early treatment with a low dose of lithium carbonate .


However , a larger trial with more patients with cortical stroke is needed to investigate this effect better .


Fitzpatrick 's classification is the most common way of assessing skin UV sensitivity .


The study aim was to investigate how self-estimated and actual UV sensitivity , as measured by phototest , are associated with attitudes towards sunbathing and the propensity to increase sun protection , as well as the correlation between self-estimated and actual UV sensitivity .


A total of 166 primary healthcare patients filled-out a questionnaire investigating attitudes towards sunbathing and the propensity to increase sun protection .


They reported their skin type according to Fitzpatrick , and a UV sensitivity phototest was performed .


Self-rated low UV sensitivity ( skin type III-VI ) was associated with a more positive attitude towards sunbathing and a lower propensity to increase sun protection , compared to high UV sensitivity .


The correlation between the two methods was weak .


The findings might indicate that individuals with a perceived low but in reality high UV sensitivity do not seek adequate sun protection with regard to skin cancer risk .


Furthermore , the poor correlation between self-reported and actual UV sensitivity , measured by phototest , makes the clinical use of Fitzpatrick 's classification questionable .


Intracerebral hemorrhage causes 15 % of strokes annually in the United States , and there is currently no effective therapy .


This is a clinical trial designed to study the safety , feasibility , and efficacy of a protocol of targeted temperature management to moderate hypothermia in intracerebral hemorrhage patients .


The targeted temperature management after intracerebral hemorrhage trial is a prospective , single-center , interventional , randomized , parallel , two-arm ( 1:1 ) phase-II clinical trial with blinded end-point ascertainment .


Intracerebral hemorrhage patients will be randomized within 18h of symptom onset to either 72h of targeted temperature management to moderate hypothermia ( 32-34C ) followed by a controlled rewarming at of 005-01C per hour or 72h of targeted temperature management to normothermia ( 36-37C ) using endovascular or surface cooling .


The primary outcome is the development of serious adverse events possibly and probably related to treatment .


Secondary outcomes include in-hospital neurological deterioration between day 0-7 , in-hospital mortality , functional outcome measured by the modified Rankin scale at discharge and 90 days , and effect of treatment allocation on cerebral edema and hematoma volume .


Intracerebral hemorrhage remains the most severe form of stroke with limited options to improve survival .


As the early resuscitation phase in the intensive care unit represents the greatest opportunity for impact on clinical outcome , it also appears to be the most promising window of opportunity to demonstrate a benefit when investigating aggressive treatments .


More research of novel therapies to improve outcomes after intracerebral hemorrhage is desperately needed .


The results of the targeted temperature management after intracerebral hemorrhage clinical trial may provide additional information on the applicability of targeted temperature management after intracerebral hemorrhage .


The debate about whether energy consumed in liquid form is more obesogenic than energy consumed in solid form remains equivocal .


We aimed to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in childhood adiposity .


Our analyses included 8-year-old Australian children ( n = 158 ) participating in the Childhood Asthma Prevention Study .


Dietary information was collected using three 24-h recalls at age 9 years .


Multivariate linear regression was used to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in body mass index ( BMI ) Z-score from ages 8 to 11.5 years ( BMIz ( 8-11 .5 y ) ) and percentage body fat ( % BF ) at age 11.5 years ( % BF ( 11.5 y ) ) .


Substitution models were used to evaluate the effects of substituting other beverage types for sugar-sweetened beverages ( SSB ) .


Liquid energy intake ( 1 MJ day ( -1 ) ) was more closely associated with both BMIz ( 8-11 .5 y ) ( = 0.23 , P = 0.02 ) and % BF ( 11.5 y ) ( = 2.31 % , P = 0.01 ) than solid energy intake ( BMIz ( 8-11 .5 y ) : = 0.12 , P = 0.01 and % BF ( 11.5 y ) : = 0.80 % , P = 0.07 ) .


SSB consumption ( 100 g day ( -1 ) ) was directly associated with BMIz ( 8-11 .5 y ) ( = 0.08 , P = 0.02 ) and % BF ( 11.5 y ) ( = 0.92 % , P = 0.004 ) , whereas diet drinks ( 100 g day ( -1 ) ) were inversely associated with BMIz ( 8-11 .5 y ) ( = 0.18 , P = 0.02 ) .


Substitution of 100 g of SSB by 100 g of water or diet drink , but not other beverages , was inversely associated with both BMIz ( 8-11 .5 y ) and % BF ( 11.5 y ) ( P < 0.01 ) .


Our findings indicate that liquid energy is more obesogenic than solid energy .


In particular , SSB , but not other beverage types , are a significant predictor of childhood adiposity and replacing SSB with water can have long-term beneficial effects on childhood adiposity .


- blockers are the standard treatment for myocardial infarction ( MI ) based on evidence from the pre-thrombolytic era .


The aim of this study was to examine the effect of - blocker treatment in patients with acute MI and preserved systolic function in the era of percutaneous coronary intervention ( PCI ) .


We analysed a multicentre registry and identified 3019 patients who presented with acute MI between 2004 and 2009 .


Patients were treated with PCI , had left ventricular EFs 50 % according to echocardiograms that were performed during the index PCI , and were alive at the time of discharge .


The association between - blocker use after discharge and mortality ( all-cause death and cardiac death ) within 3 years was examined .


Patients who were not treated with - blockers ( n = 595 ) showed higher rates of all-cause death and cardiac death compared to patients treated with - blockers ( 10.8 % vs 5.7 % , p < 0.001 , 7.6 % vs 2.6 % , p < 0001 ) .


The multivariate Cox proportional hazards model showed that - blocker treatment was associated with a significant reduction in all-cause death ( adjusted HR 0.633 , 95 % CI 0.464 to 0.863 ; p = 0.004 ) and cardiac death ( adjusted HR 0.47 , 95 % CI 0.32 to 0.70 ; p < 0.001 ) .


Comparable results were obtained after propensity score matching .


- blocker treatment was associated with reduced long term mortality in patients with acute MI and preserved systolic function who received PCI .


We have found that hydrogen ( dihydrogen [ H2 ] ) decreases plasma low-density lipoprotein ( LDL ) cholesterol levels and improves high-density lipoprotein ( HDL ) function in patients with potential metabolic syndrome in a before-after self-controlled study .


The purpose of this study was to further characterize the effects of H2-rich water ( 0.9 L/day ) on the content , composition , and biological activities of plasma lipoproteins on patients with hypercholesterolemia and their underlying mechanisms in a double-blinded , randomized , and placebo-controlled trial .


This was a case-control study .


The setting was the Zhoudian community , Tai'an , China .


A total of 68 patients with untreated isolated hypercholesterolemia were randomly allocated to either drinking H2-rich water ( n = 34 ) or placebo water ( n = 34 ) for 10 weeks .


HDL isolated from the H2 group showed an increased ability to promote the ATP-binding cassette transporter A1-mediated cholesterol efflux ex vivo .


Plasma pre -- HDL levels were up-regulated although there were no changes in plasma HDL-cholesterol levels .


Moreover , other HDL functions , assessed in protection against LDL oxidation , inhibition of oxidized-LDL-induced inflammation , and protection of endothelial cells from oxidized-LDL-induced apoptosis , were all significantly improved by H2 treatment .


In addition , H2 treatment increased the effective rate in down-regulating plasma levels of total cholesterol ( 47.06 % vs 17.65 % ) and LDL cholesterol ( 47.06 % vs 23.53 % ) .


Western blot analysis revealed a marked decrease in apolipoprotein B100 and an increase in apolipoprotein M in plasma of the H2 group .


Finally H2 treatment resulted in a significant reduction in the levels of several inflammatory and oxidative stress indicators in whole plasma and HDL particles .


H2 activates ATP-binding cassette transporter A1-dependent efflux , enhances HDL antiatherosclerotic functions , and has beneficial lipid-lowering effects .


The present findings highlight the potential role of H2 in the regression of hypercholesterolemia and atherosclerosis .


Persistent muscle weakness after anterior cruciate ligament ( ACL ) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition ( AMI ) .


Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI , thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL .


To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy ( ice bag ) , daily exercises , or both .


Cross-sectional study .


Laboratory .


A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI .


The patients attended 4 supervised visits over a 2-week period .


They were randomly assigned to receive 20 minutes of knee-joint cryotherapy , 1 hour of therapeutic rehabilitation exercises , or cryotherapy followed by exercises .


We measured quadriceps Hoffmann reflex , normalized maximal voluntary isometric contraction torque , central activation ratio using the superimposed-burst technique , and patient-reported outcomes before and after the intervention period .


After the 2-week intervention period , patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques ( P = .002 , Cohen d effect size = 1.4 ) compared with those who received cryotherapy alone ( P = .16 , d = 0.58 ) or performed exercise alone ( P = .16 , d = 0.30 ) .


After ACL reconstruction , patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone .


Organ dysfunction consequent to infection ( ` severe sepsis ' ) is the leading cause of admission to an intensive care unit ( ICU ) .


In both animal models and early clinical studies the calcium channel sensitizer levosimendan has been demonstrated to have potentially beneficial effects on organ function .


The aims of the Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis ( LeoPARDS ) trial are to identify whether a 24-hour infusion of levosimendan will improve organ dysfunction in adults who have septic shock and to establish the safety profile of levosimendan in this group of patients .


This is a multicenter , randomized , double-blind , parallel group , placebo-controlled trial .


Adults fulfilling the criteria for systemic inflammatory response syndrome due to infection , and requiring vasopressor therapy , will be eligible for inclusion in the trial .


Within 24 hours of meeting these inclusion criteria , patients will be randomized in a 1:1 ratio stratified by the ICU to receive either levosimendan ( 0.05 to 0.2 g.kg.min or placebo for 24 hours in addition to standard care .


The primary outcome measure is the mean Sequential Organ Failure Assessment ( SOFA ) score while in the ICU .


Secondary outcomes include : central venous oxygen saturations and cardiac output ; incidence and severity of renal failure using the Acute Kidney Injury Network criteria ; duration of renal replacement therapy ; serum bilirubin ; time to liberation from mechanical ventilation ; 28-day , hospital , 3 and 6 month survival ; ICU and hospital length-of-stay ; and days free from catecholamine therapy .


Blood and urine samples will be collected on the day of inclusion , at 24 hours , and on days 4 and 6 post-inclusion for investigation of the mechanisms by which levosimendan might improve organ function .


Eighty patients will have additional blood samples taken to measure levels of levosimendan and its active metabolites OR-1896 and OR-1855 .


A total of 516 patients will be recruited from approximately 25 ICUs in the United Kingdom .


This trial will test the efficacy of levosimendan to reduce acute organ dysfunction in adult patients who have septic shock and evaluate its biological mechanisms of action .


Current controlled trials ISRCTN12776039 ( 19 September 2013 ) .


To assess the efficacy and safety of Wuji Powder ( WP ) and a small dose aripiprazole in treatment of antipsychotic drug-induced phlegm dampness type amenorrhea .


Seventy female schizophrenic patients with antipsychotic drug-induced galactorrhea-amenorrhea syndrome ( GAS ) were recruited and randomly assigned to the treatment group and the control group , 35 in each group .


All patients received antipsychotic drug therapy .


Patients in the treatment group additionally took WP , while those in the control group took aripiprazole ( at the daily dose of 5 mg , once daily ) .


The therapeutic course for all was 4 weeks .


Prolactin levels and obesity indices [ body weight , waist aircumstance , body mass index ( BMI ) and waist-hit ratio ( WHR ) ] were determined before and after treatment .


The efficacy was evaluated .


The treatment course was completed in 95.71 % of patients .


The total effective rate of the 33 patients of the treatment group was 93.94 % ( 31/33 ) , while it was 91.18 % ( 31/34 ) in the 34 patients of the control group .


There was no difference in the total effective rate between the two groups ( P > 0.05 ) .


Prolactin levels in both group after treatment were significantly lower than those of the baseline ( P < 0.01 ) .


There was no significant difference in prolactin levels between the two groups after treatment ( P > 0.05 ) .


Compared with before treatment , body weight , BMI , waist circumstance , and waist-hip ratio obviously decreased after treatment , showing significant difference when compared with the control group ( P < 0.05 ) .


There was no significant difference in body weight , BMI , waist circumstance , and waist-hip ratio in the control group between before and after treatment ( P > 0.05 ) .


Both WP and aripiprazole could lower high prolactin levels of schizophrenics with phlegm dampness type amenorrhea .


They showed equivalent efficacy .


But WP showed more obvious effect in reducing obesity indices .


The long-term efficacy and safety of canagliflozin , a sodium glucose co-transporter 2 inhibitor , was evaluated over 104weeks in patients aged 55-80years with type 2 diabetes mellitus ( T2DM ) inadequately controlled on a stable antihyperglycaemic agent regimen .


In this randomized , double-blind , phase III study , patients received canagliflozin 100 or 300mg or placebo once daily during a 26-week core period ( N = 714 ) and a 78-week extension period ( n = 624 ) .


Efficacy endpoints at week 104 included change from baseline in glycated haemoglobin ( HbA1c ) , fasting plasma glucose ( FPG ) and systolic blood pressure , and percent change from baseline in body weight and fasting plasma lipids .


Safety was assessed by adverse event ( AE ) reports .


At week 104 , canagliflozin 100 and 300mg were associated with reductions in HbA1c versus placebo ( -0.32 and -0.43 % vs 0.17 % , respectively ; overall mean baseline , 7.7 % ) and more patients achieved HbA1c < 7.0 % with canagliflozin 100 and 300mg than with placebo ( 35.8 and 41.9 % vs 20.3 % , respectively ) .


Reductions in FPG , body weight and systolic blood pressure , and increases in high-density lipoprotein cholesterol ( HDL-C ) and low-density lipoprotein cholesterol ( LDL-C ) were seen with canagliflozin compared with placebo .


The overall incidence rates of AEs over 104weeks were 88.0 , 89.8 and 86.1 % with canagliflozin 100 and 300mg and placebo , respectively ; serious AE rates were low across treatment groups .


The incidence rates of urinary tract infections , genital mycotic infections and osmotic diuresis - and volume depletion-related AEs were higher with canagliflozin than with placebo .


Canagliflozin improved glycaemic control , reduced body weight and systolic blood pressure , and was generally well tolerated in patients aged 55-80years with T2DM over 104weeks .


Thalidomide use in cutaneous sarcoidosis is based on data from small case series or case reports .


The objective of this study was to evaluate the efficacy and safety of thalidomide in severe cutaneous sarcoidosis .


This study consisted of a randomized , double-bind , parallel , placebo-controlled , investigator-masked , multicenter trial lasting 3 months and an open-label study from month 3 to month 6 .


Adults with a clinical and histologic diagnosis of cutaneous sarcoidosis were included in nine hospital centers in France .


Patients were randomized 1:1 to oral thalidomide ( 100 mg once daily ) or to a matching oral placebo for 3 months .


In the course of an open-label follow-up from month 3 to month 6 , all patients received thalidomide , 100 mg to 200 mg daily .


The proportions of patients with a partial or complete cutaneous response at month 3 , based on at least a 50 % improvement in three target lesions scored for area and infiltration , were compared across randomization groups .


The intent-to-treat population included 39 patients .


None of them had a complete cutaneous response .


Four out of 20 patients in the thalidomide group ( 20 % ) vs four out of 19 patients in the placebo group ( 21 % ) had a partial cutaneous response at month 3 ( difference in proportion of -1 % [ 95 % CI , -26 % to +24 % ] for thalidomide vs placebo , P = 1.0 ) .


Eight patients with side effects were recorded in the thalidomide group vs three in the placebo group .


We observed a large number of adverse event-related discontinuations in patients taking thalidomide in the first 3 months ( four patients with thalidomide , zero with placebo ) and in the 3 following months ( five patients ) .


At a dose of 100 mg daily for 3 months , our results do not encourage thalidomide use in cutaneous sarcoidosis .


ClinicalTrials.gov ; No. : NCT0030552 ; URL : www.clinicaltrials.gov .


To assess whether medical record documentation reflects actual home practices regarding the administration of preventive medications to urban children with persistent asthma .


Baseline data from a prompting asthma intervention were used for this cross-sectional analysis .


As part of the larger study , we enrolled children ( 2-12 years ) with persistent asthma in the waiting room at 12 primary care offices ( 2009-2012 ) .


Prior to their visit with a healthcare provider , caregivers reported information regarding their child 's asthma symptom severity and current preventive medications ( i.e. name and frequency of use ) .


We compared caregiver-reported medication information with medical record data to determine the rate of complete concordance , defined as total consistency between the prescribed medication data documented in the medical record and parent report describing how the child is actually using the medication at home .


According to 310 completed medical record reviews , 194 ( 62 % ) children had a current prescription for a daily preventive asthma medication .


Of these children , 110 ( 57 % ) had caregivers who reported complete concordance .


Those reporting complete concordance were more likely to have children with greater symptom severity , including fewer symptom-free days in the prior two weeks ( 6.9 vs. 8.7 , p = 0.018 ) , and 1 asthma-related hospitalization in the prior year ( 16 % vs. 6 % , p = 0.042 ) .


Medical records may poorly reflect actual home practices and providers should specifically inquire about medication use and barriers to adherence at the time of an office visit to promote guideline-based , consistent treatment for children with persistent asthma .


To determine the pathological mechanism and prevent heart-renal syndrome after heart valve replacement surgery .


A total of 46 patients were admitted for selective valve replacement , and divide into 3 groups randomly : a control group ( Con , n = 16 ) , a remote ischemic perconditioning ( RIPerC ) group ( n = 15 ) and a remote ischemic postconditioning ( RIPostC ) group ( n = 15 ) .


The serum creatinine ( SCr ) , blood urea nitrogen ( BUN ) , serum heme oxygennase-1 ( HO-1 ) , serum iron and urinary neutrophil gelatinase associated lipocalin ( NGAL ) level in the 3 groups were compared preoperatively and 6 , 12 , 24 , 48 h after aortic cross-release .


Compared with the preoperative level , the SCr , BUN , urinary NGAL , serum iron ( 6 and 12 h ) and serum HO-1 values were significantly increased after the heart valve replacement surgery in the control patients , RIPreC and RIPostC groups ( P < 0.05 ) .


Compared with the control group , the serum HO-1 was significantly increased at 6 , 12 , 24 , 48 h after the heart valve replacement surgery in both the RIPerC and RIPostC groups ( P < 0.05 ) ; the SCr , BUN , urinary NGAL and serum iron values were decreased at 6 , 12 , 24 , 48 h after the heart valve replacement surgery in both the RIPerC and RIPostC groups ( P > 0.05 ) .


Abnormal change in urinary NGAL , serum iron and HO-1 can be used as early warning indicators of acute kidney injury when cardio-renal syndrome occurrs among patients under heart valve replacement surgery .


Remote ischemic conditioning plays a preventive role in the occurrence of cardio-renal syndrome and renal protection .


The autobiographical Implicit Association Test ( aIAT ) is a variant of the Implicit Association Test reportedly capable of detecting an individual 's concealed autobiographical event with very high accuracy .


A previous attempt to utilize this measurement technique for the identification of cocaine users rendered an alarming rate of false positives .


In this study , we aimed to explore the potential reasons behind the measurement 's inaccuracy .


Two versions of the cocaine aIAT were devised with different category labels ( descriptive ` guilty/innocent ' and self-referenced ` as if you were/were not ' ) .


Forty-one cocaine abstinent participants ( 43.9 % male ; mean age = 28.17 7.36 ) were randomly assigned to one of the two conditions .


Self-declared cocaine abstinence was confirmed for the 12-month period preceding data collection through hair analysis .


Participants were also administered bespoke implicit and explicit cocaine user attitude measures , the self-esteem IAT and the Rosenberg self-esteem scale .


The category labels which elicited self-referenced knowledge showed low accuracy ( 19 % ) compared to the 65 % of the ` guilty/innocent ' labels proposed by original authors .


The self-referenced aIAT version significantly correlated with the self-concept measures .


The aIAT outcomes were independent from attitudes toward cocaine users .


Category labels play an influential role in determining the test 's accuracy , demonstrating that participants ' propositional knowledge and self-concept are involved during test performance .


The aIAT does not appear to tap directly into an individual 's implicit memory when relevant memory is not available .


Although the test can not be recommended for detecting drug use , further research should investigate underlying mechanisms and other potentials of the technique .


To prospectively compare the achieved thickness and consistency of LASIK flaps created with a 60 - and 150-kHz femtosecond laser .


One hundred twenty eyes of 60 patients with myopia were treated with LASIK .


One eye had flap created by the Intralase FS 60-kHz femtosecond laser ( Abbott Medical Optics , Abbott Park , IL ) and the fellow eye was treated with the IntraLase iFS 150-kHz femtosecond laser ( Abbott Medical Optics ) .


Eyes were randomized according to ocular dominance .


Flap morphology and measurements were taken with anterior segment optical coherence tomography ( AS-OCT ) at the 1-month postoperative visit .


AS-OCT showed similar regular planar morphologies in both groups .


The mean thickness of the flaps in the FS 60 group was significantly higher than that of the iFS 150 group ( 105.4 3.9 m vs 103.9 4.8 m , P = .009 ) .


The mean deviation from targeted flap thickness was not significantly different between the two groups .


The Intralase iFS 150-kHz femtosecond laser creates flaps of similar thickness and uniformity to the Intralase FS 60-kHz femtosecond laser .


Periprosthetic bone cysts are a known finding after total ankle replacement ( TAR ) .


The significance of cysts is uncertain , but they may threaten the long-term survival of the implant .


The aim of this prospective study was to evaluate the diagnostic accuracy of weight-bearing digital radiography compared with 3D weight-bearing multiplanar reconstructed ( MPR ) fluoroscopic imaging when diagnosing periprosthetic bone cysts in patients who have undergone TAR .


Forty-two consecutive patients with a Scandinavian Total Ankle Replacement ( STAR ) were consecutively enrolled and underwent digital radiography and 3D MPR imaging in the same session .


All 3D MPR images were interpreted in a blinded fashion , specifically with regard to the presence and extent of periprosthetic bone cysts .


Cysts were measured in three planes whenever possible .


Interrater and intrarater reliability was assessed by using Cohen kappa test , and comparisons between the two modalities were performed with the Wilcoxon signed-rank and McNemar tests .


Significantly more cysts were detected on 3D MPR ( 74 vs 55 ) ( p = 0.03 ) , with the mean size of cysts detected by 3D MPR significantly larger than that of cysts diagnosed on digital radiography ( 1545 mm ( 3 ) vs 253 mm ( 3 ) ) ( p < 0.0001 ) .


Statistical analysis based on the presence or absence of cysts in individual patients did not show a significant difference between 3D MPR and digital radiography ( p = 0.23 ) .


The data imply that cysts are better detected and more accurately measured with 3D fluoroscopic MPR imaging compared with digital radiography , which underestimates not only the presence but also the extent of periprosthetic cysts .


Oxidative stress and systemic inflammation are highly prevalent in patients undergoing maintenance hemodialysis ( MHD ) and are linked to excess cardiovascular risk .


This study examined whether short-term supplementation with pomegranate juice and extract is safe and well tolerated by MHD patients .


The secondary aim was to assess the effect of pomegranate supplementation on oxidative stress , systemic inflammation , monocyte function , and blood pressure .


Prospective , randomized , crossover , pilot clinical trial ( NCT01562340 ) .


The study was conducted from March to October 2012 in outpatient dialysis facilities in the Seattle metropolitan area .


Twenty-four patients undergoing MHD ( men , 64 % ; mean age , 6114years ) were randomly assigned to receive pomegranate juice or extract during a 4-week intervention period .


After a washout period , all patients received the alternative treatment during a second 4-week intervention period .


Patients assigned to receive pomegranate juice received 100mL of juice before each dialysis session .


Patients assigned to receive pomegranate extract were given 1,050 mg of extract daily .


The main outcome measures were safety and tolerability of pomegranate juice and extract .


Additional secondary outcomes assessed included serum lipids , laboratory biomarkers of inflammation ( C-reactive protein and interleukin 6 ) and oxidative stress ( plasma F2 isoprostanes and isofurans ) , monocyte cytokine production , and predialysis blood pressure .


Both pomegranate juice and extract were safe and well tolerated by study participants .


Over the study period , neither treatment had a significant effect on lipid profiles , plasma C-reactive protein , interleukin 6 , F2-isoprostane or isofuran concentrations , predialysis systolic or diastolic blood pressure nor changed the levels of monocyte cytokine production .


Both pomegranate juice and extract are safe and well tolerated by patients undergoing MHD but do not influence markers of inflammation or oxidative stress nor affect predialysis blood pressure .


Lipid-based nutrient supplements ( LNSs ) offer a vehicle to improve children 's diets in low-income countries where complementary foods are typically deficient in essential nutrients .


Sustained acceptability by the intended users is essential for achieving growth-promoting effects .


We aimed to determine the sustained acceptability of LNSs among 6 - to 18-mo-old children in Malawi .


In the context of a trial testing the growth-promoting effect of different formulations and doses of LNSs , we delivered LNSs to the homes of the children biweekly according to the randomization protocol .


We defined acceptability to include adherence to feeding recommendations and mothers ' experiences of feeding LNSs to their child .


We conducted brief interviews each week with the mothers .


At 2 time points we conducted knowledge , attitudes , and practices ( KAP ) interviews .


In addition , we conducted repeated in-depth interviews with a subset of mothers .


Of the 1612 children who received the LNS intervention , we analyzed adherence data from 1478 ( 91.7 % ) children and KAP data at 2 time points ( child 's age of 12 and 18 mo ) from 839 ( 52.1 % ) of the children .


The mean SD overall adherence ( proportion of days when the study child reportedly consumed LNSs considering only those weeks when the supplement had been successfully delivered to the home ) was 92.4 9.6 % , and there was no difference between children receiving milk-containing or milk-free LNSs .


There was also no increasing or decreasing trend over time in any of the groups .


Sharing and deviation from other feeding recommendations were common .


Maternal experiences were mostly very positive .


The acceptability of LNS products was good and was sustained for 12 mo in this rural Malawian population .


However , sharing of the products with family members and deviation from other feeding recommendations were frequent , which means that individually targeted children were likely to receive less than the intended dose of the LNS .


This trial was registered at clinicaltrials.gov as NCT00945698 .


To compare the patients ' compliance with and the efficacy of existing treatments for Helicobacter pylori eradication , including moxifloxacin-based triple therapy , sequential treatment and the standard treatment .


Patients with H.pylori infection were randomly assigned to three therapy groups .


The triple therapy ( MML ) group was given moxifloxacin 400mg/day , metronidazole 500mg b.i.d. and lansoprazole 30mg b.i.d. for 10 days .


The sequential treatment ( AL-CML ) group was administrated amoxicillin 1g b.i.d. and lansoprazole 30mg b.i.d. for the first 5 days , followed by clarithromycin 500mg b.i.d. , metronidazole 500mg b.i.d. and lansoprazole 30mg b.i.d. for the second 5 days .


The standard treatment ( CAL ) group received amoxicillin 1g b.i.d. , clarithromycin 500mg b.i.d. and lansoprazole 30mg b.i.d. for 14 days .


The eradication rates were evaluated by per-protocol ( PP ) analysis and intention-to-treat ( ITT ) analysis .


The eradication rates were 87.1 , 85.9 and 85.2 % by PP analysis and 87.1 , 84.9 and 84.2 % by ITT analysis in the MML , AL-CML and CAL group , respectively , and patients ' compliance rates were 98.2 , 96.5 and 97.1 % , respectively .


There were no significant differences in treatment efficacy and compliance rates in the MML , AL-CML and CAL groups ( P > 0.05 ) .


The present study revealed that standard triple therapy , sequential therapy and moxifloxacin-based triple therapy are all effective treatment regimens in terms of H.pylori eradication rates and compliance with therapy in Turkey .


Treatment of patients with drug-eluting stent ( DES ) in-stent restenosis ( ISR ) remains a major challenge .


This study evaluated the comparative efficacy of drug-eluting balloons ( DEB ) and everolimus-eluting stents ( EES ) in patients presenting with DES-ISR .


The study design of this multicenter randomized clinical trial assumed superiority of EES for the primary endpoint , in-segment minimal lumen diameter at the 6 - to 9-month angiographic follow-up .


A total of 309 patients with DES-ISR from 23 Spanish university hospitals were randomly allocated to DEB ( n = 154 ) or EES ( n = 155 ) .


At late angiography ( median 247 days ; 90 % of eligible patients ) , patients in the EES arm had a significantly larger minimal lumen diameter ( 2.03 0.7 mm vs. 1.80 0.6 mm ; p < 0.01 ) ( absolute mean difference : 0.23 mm ; 95 % CI : 00.7 to 0.38 ) , net lumen gain ( 1.28 0.7 mm vs. 1.01 0.7 mm ; p < 0.01 ) , and lower percent diameter stenosis ( 23 22 % vs. 30 22 % ; p < 0.01 ) and binary restenosis rate ( 11 % vs. 19 % ; p = 0.06 ) , compared with patients in the DEB arm .


Consistent results were observed in the in-lesion analysis .


At the 1-year clinical follow-up ( 100 % of patients ) , the main clinical outcome measure ( composite of cardiac death , myocardial infarction , and target vessel revascularization ) was significantly reduced in the EES arm ( 10 % vs. 18 % ; p = 0.04 ; hazard ratio : 0.58 ; 95 % CI : 0.35 to 0.98 ) , mainly driven by a lower need for target vessel revascularization ( 8 % vs. 16 % ; p = 0.035 ) .


In patients with DES-ISR , EES provided superior long-term clinical and angiographic results compared with DEB .


( Restenosis Intra-Stent of Drug-Eluting Stents : Drug-Eluting Balloon vs Everolimus-Eluting Stent [ RIBS IV ] ; NCT01239940 ) .


The aim of the present study was to evaluate whether the order of complementary feeding in relation to breast-feeding affects breast milk , semisolid , or total energy intake in infants .


The present study was designed as a randomized crossover trial .


The study was conducted in a tertiary care hospital .


The study participants were 25 healthy infants between the ages of 7 and 11 months who were exclusively breast-fed for at least 6 months and were now receiving complementary foods for at least 1 month in addition to breast-feeding .


Infants were randomized to follow a sequence of either complementary feeding before breast-feeding ( sequence A ) or complementary feeding after breast-feeding ( sequence B ) for the first day ( 24 hours ) of the study period using simple randomization .


For the next day , the sequence was reversed for each child .


All babies received 3 actively fed complementary food meals per day ( morning , afternoon , and evening ) .


A semisolid study diet was prepared in the hospital by cooking rice and pulse with oil using a standard method , ensuring the energy density of at least 0.6 kcal/g .


The infants were allowed ad libitum breast-feeding during the observation period .


Semisolid intake was directly measured and breast milk intake was quantified by test weighing method .


Energy intake from complementary foods was calculated from the product of energy density of the diet served on that day and the total amount consumed .


The total energy intake and energy intake from breast milk and complementary foods between the 2 sequences were compared .


The mean ( standard deviation ) energy intake from breast milk during 12 hours of daytime by following sequence A ( complementary feeding before breast-feeding ) was 132.0 ( 67.4 ) kcal in comparison with 135.9 ( 56.2 ) kcal in sequence B , which was not statistically different ( P = 0.83 ) .


The mean ( standard deviation ) energy consumed from semisolids in sequences A and B was also comparable ( 88.6 [ 75.5 ] kcal vs. 85.5 [ 89.7 ] kcal ; P = 0.58 ) .


The total energy intake during daytime in sequence A was 220.6 ( 96.2 ) kcal in comparison with 221.5 ( 94.0 ) kcal in sequence B , which was also comparable ( P = 0.97 ) .


The results related to energy intake through breast milk and total energy intake were not different when insensible losses during feeding were adjusted in both groups .


Altering the sequence of complementary feeding in relation to breast-feeding does not affect total energy intake .


Our objective was to determine the interrelationships of interleukin ( IL ) -6 receptor inhibition with haemoglobin , acute-phase reactants and iron metabolism markers ( including hepcidin ) in patients with rheumatoid arthritis ( RA ) .


Data of patients receiving tocilizumab or placebo in the MEASURE study were analysed .


We investigated associations at baseline and during tocilizumab treatment among haemoglobin , parameters of haemoglobin and iron homeostasis [ ferritin , total iron-binding capacity ( TIBC ) , hepcidin , haptoglobin ] , IL-6 and acute-phase reactants [ C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR ) ] to identify statistical correlates of rise in haemoglobin level .


At baseline , CRP and haptoglobin were inversely correlated ( modestly ) with haemoglobin levels .


After treatment with tocilizumab , CRP , hepcidin , ferritin and haptoglobin levels fell alongside increases in TIBC and haemoglobin .


The falls in CRP , hepcidin and haptoglobin levels in the first 2 weeks correlated with a week 12 rise in TIBC and haemoglobin .


Inflammatory anaemia improves in patients with RA treated with tocilizumab .


This improvement correlates with the degree of suppression of systemic inflammation , reduction in hepcidin and haptoglobin and increase in iron-binding capacity .


These clinical data provide evidence of a role for IL-6 signalling in the inflammatory anaemia of RA .


In randomized clinical studies , over 11,800 children , 12 months to 6 years of age , were administered ProQuad ( ) , a combination measles , mumps , rubella , and varicella vaccine ( MMRV ) .


This paper describes the safety following a 2-dose regimen of MMRV administered to children in the second year of life .


Safety data from five clinical studies were combined for all children who were scheduled to receive two doses of MMRV 3-6 months apart .


All vaccinated children were followed for safety following each dose of MMRV .


Of 3112 children who received a first dose of MMRV , 2780 ( 89.3 % ) received a second dose of MMRV .


Overall , 70.5 % and 57.7 % of children reported 1 adverse experiences following first and second doses of MMRV , respectively .


Injection-site redness was statistically significantly higher postdose 2 than postdose 1 , while injection-site pain/tenderness was statistically significantly higher postdose 1 compared to postdose 2 .


Rashes were statistically significantly lower postdose 2 compared to postdose 1 .


Ten febrile seizures ( 8 postdose 1 , 2 postdose 2 ) were reported following MMRV vaccination .


The incidence of febrile seizures postdose 1 of MMRV was 0.26 % ( 8/3019 ) compared to 0.07 % ( 2/2695 ) postdose 2 of MMRV .


Administration of two doses of MMRV has an acceptable safety profile in children 12 to 23 months of age .


There is a small increase in the risk of febrile seizures following the first dose of MMRV as compared to the component vaccines , but the risk for any individual child is relatively low .


To evaluate the cost-effectiveness of treating patients with acute coronary syndromes ( ACS ) for 12 months with ticagrelor compared with generic clopidogrel in Sweden and Denmark .


Decision-analytic model to estimate lifetime costs , life-expectancy , and quality-adjusted life years ( QALYs ) with ticagrelor and clopidogrel .


Event rates , healthcare resource use , and health-related quality of life during 12 months of therapy were estimated from the PLATelet inhibition and patient Outcomes ( PLATO ) trial .


Beyond 12 months , quality-adjusted survival and costs were estimated conditional on events occurring during the 12 months of therapy .


When available , country-specific data were employed in the analysis .


Incremental cost-effectiveness ratios are presented from a healthcare perspective and a broader societal perspective including costs falling outside the healthcare sector in 2010 local currency .


The cost per QALY with ticagrelor compared with generic clopidogrel was SEK 25 022 and DKK 26 892 for Sweden and Denmark , respectively , from a healthcare perspective .


The cost per QALY from a broader societal perspective was SEK 24 290 and DKK 25 051 for Sweden and Denmark , respectively .


The cost per QALY of treating ACS-patients with ticagrelor compared with generic clopidogrel is below the conventional thresholds of cost-effectiveness in Sweden and Denmark .


To evaluate the effectiveness of a food safety map as an educational method with English language learners .


English language learner community members ( n = 73 ) were assigned randomly to participate in 1 of 3 experimental conditions : food safety map , cooking class , and control .


Participants in the food safety map and cooking class conditions completed a pre-education demographic and cooking history questionnaire , a post-education knowledge and intention questionnaire , and a 2-week post-cooking and food safety habits assessment .


Participants in the control group received no educational training but completed the pre - and 2-week post-education assessments .


The cooking class and the map class were both effective in increasing food safety knowledge .


Specifically , by comparing with the control group , they significantly increased participants ' knowledge of safely cooking large meat ( [ df = 2 , n = 66 ] = 40.87 ; P < .001 ; V * = .79 ) and correctly refrigerating cooked food ( [ df = 2 , n = 73 ] = 24.87 , P < .001 ; V * = .58 ) .


The two class types generated similar positive educational effects on boosting food safety behavioral intention ( measured right after the class ) .


The data collected 2 weeks after the classes suggested that individuals who took the classes followed the suggested food behaviors more closely than those in the control group ( P < .01 ) .


The food safety map is simple to use and prepare , beneficial for oral and visual learners , and inexpensive .


Compared with a food safety cooking class , the map produces similar learning and behavioral outcomes .


Despite a general lack of understanding of the underlying mechanisms , cold water immersion ( CWI ) is widely used by athletes for recovery .


This study examined the physiological merit of CWI for recovery from high-intensity exercise by investigating if the placebo effect is responsible for any acute performance or psychological benefits .


Thirty males ( mean SD : age , 24 5 yr ; VO2 peak , 51.1 7.0 mL kg ( -1 ) min ( -1 ) ) performed an acute high-intensity interval training session , comprised of 4 30-s sprints , immediately followed by one of the following three 15-min recovery conditions : CWI ( 10.3 C 0.2 C ) , thermoneutral water immersion placebo ( TWP ) ( 34.7 C 0.1 C ) , or thermoneutral water immersion control ( TWI ) ( 34.7 C 0.1 C ) .


An intramuscular thermistor was inserted during exercise and recovery to record muscle temperature .


Swelling ( thigh girth ) , pain threshold/tolerance , interleukin 6 concentration , and total leukocyte , neutrophil , and lymphocyte counts were recorded at baseline , postexercise , postrecovery , and 1 , 24 , and 48 h postexercise .


A maximal voluntary isometric contraction ( MVC ) of the quadriceps was performed at the same time points , with the exception of postexercise .


Self-assessments of readiness for exercise , fatigue , vigor , sleepiness , pain , and belief of recovery effectiveness were also completed .


Leg strength after the MVC and ratings of readiness for exercise , pain , and vigor were significantly impaired in TWI compared with those in CWI and TWP which were similar to each other .


A recovery placebo administered after an acute high-intensity interval training session is superior in the recovery of muscle strength over 48 h as compared with TWI and is as effective as CWI .


This can be attributed to improved ratings of readiness for exercise , pain , and vigor , suggesting that the commonly hypothesized physiological benefits surrounding CWI are at least partly placebo related .


To compare the clinical effectiveness of two implant systems : Way Milano and Kentron ( Geass , Pozzuolo del Friuli , UD , Italy ) .


A total of 64 patients requiring at least two single crowns or partial fixed dental prostheses supported by a maximum of three implants had their sites randomised according to a split-mouth design to receive both implant systems at six centres .


Patients were followed up for 1 year after initial loading .


Outcome measures were : prosthesis/implant failures ; any complication ; peri-implant marginal bone level changes ; and clinician preference .


In total 71 Way Milano and 73 Kentron implants were placed .


Six patients dropped-out before the 1-year follow-up , but all remaining patients were followed up to 1 year post-loading .


No Way Milano implant failed , whereas three Kentron implants failed before loading .


Two complications were reported , one for each implant type .


There were no statistically significant differences for prosthesis/implant failures ( difference in proportions = 0.05 , P = 0.25 ; 95 % CI -0.02 to 0.13 ) and complications ( difference in proportions = 0 , P = 1.0 , 95 % CI -0.07 to 0.07 ) between the implant systems .


Three operators preferred Way Milano implants whereas the other three had no preference .


At implant placement ( baseline ) bone levels were higher for Way Milano implants ( 0.27 mm ) than for Kentron implants ( 0.41 mm ) .


Both groups gradually lost statistically significant amounts of periimplant marginal bone at 4 months after loading and at 1 year after loading .


One year after loading , Way Milano implants lost an average of 0.73 mm peri-implant bone compared with 0.84 mm of Kentron implants .


Marginal bone level changes were not statistically significant different for Way Milano compared to Kentron implants at 4 months ( -0.16 mm , 95 % CI -0.30 , 0.01 ; P = 0.0606 ) and 1 year ( -0.09 mm , 95 % CI -0.26 , 0.09 ; P = 0.3407 ) after loading .


No statistically significant differences were observed between the two implant types , although three Kentron implants failed versus none of the Way Milano type .


Longer follow-up of wider patient populations are needed to better understand whether there is an effective advantage with one of the two implant designs .


The risks and benefits of initiating antiretroviral treatment ( ART ) at high CD4 cell counts have not been reliably quantified .


The Strategic Timing of AntiRetroviral Treatment ( START ) study is a randomized international clinical trial that compares immediate with deferred initiation of ART for HIV-positive individuals with CD4 cell counts above 500cells/L .


We describe the demographics , HIV-specific characteristics and medical history of this cohort .


Data collected at baseline include demographics , HIV-specific laboratory values , prior medical diagnoses and concomitant medications .


Baseline characteristics were compared by geographical region , gender and age .


START enrolled 4685 HIV-positive participants from 215 sites in 35 countries .


The median age is 36 years [ interquartile range ( IQR ) 29-44 years ] , 27 % are female , and 45 % self-identify as white , 30 % as black , 14 % as Latino/Hispanic , 8 % as Asian and 3 % as other .


The route of HIV acquisition is reported as men who have sex with men in 55 % of participants , heterosexual sex in 38 % , injecting drug use in 1 % and other/unknown in 5 % .


Median time since HIV diagnosis is 1.0 year ( IQR 0.4-3 .0 years ) and the median CD4 cell count and HIV RNA values at study entry are 651cells/L ( IQR 584-765cells / L ) and 12,754 HIV RNA copies/mL ( IQR 3014-43 ,607 copies/mL ) , respectively .


START has enrolled a diverse group of ART-nave individuals with high CD4 cell counts who are comparable to the HIV-positive population from the regions in which they were enrolled .


The information collected with this robust study design will provide a database with which to evaluate the risks and benefits of early ART use for many important outcomes .


Umbilical cord blood ( UCB ) is an important source of hematopoietic stem cells ( HSCs ) .


However , the concentration of cells in cord blood units is limited and this may represent the main restriction to their therapeutic clinical use .


The percentage of metabolically active stem cells provides a measure of the viability of cells in an UCB sample .


It follows that an active cellular metabolism causes a proliferation in stem cells , offering an opportunity to increase the cellular concentration .


A high cell dose is essential when transplanting cord stem cells , guaranteeing , in the receiving patient , a successful outcome.This study is designed to evaluate the impact of docosahexaenoic acid ( DHA ) supplementation in pregnant women , in order to increase the quantity and viability of the cells in UCB samples .


The metabolic demand of DHA increases in the course of pregnancy and reaches maximum absorption during the third trimester of pregnancy .


According to these observations , this trial will be divided into two different experimental groups : in the first group , participants will be enrolled from the 20th week of estimated stage of gestation , before the maximum absorption of DHA ; while in the second group , enrolment will start from the 28th week of estimated stage of gestation , when the DHA request is higher .


Participants in the trial will be divided and randomly assigned to the placebo group or to the experimental group .


Each participant will receive a complete set of capsules of either placebo ( 250 mg of olive oil ) or DHA ( 250 mg ) , to take one a day from the 20th or from the 28th week , up to the 40th week of estimated gestational age .


Samples of venous blood will be taken from all participants before taking placebo or DHA , at the 20th or at the 28th week , and at the 37th to 38th week of pregnancy to monitor the level of DHA .


Cell number and cellular viability will be evaluated by flow cytometry within 48 hours of the UCB sample collection .


International Standard Randomised Controlled Trial Number Register : ISRCTN58396079 .


Registration date : 8 October 2013 .


Hotel-based sex workers in Bangladesh have high rates of sexually transmissible infections ( STIs ) , high client turnover and low condom use .


Two monthly clinic-based strategies were compared : periodic presumptive treatment ( PPT ) and enhanced syndromic management ( ESM ) - one round of presumptive treatment followed by treatment based on assessment and laboratory tests .


A randomised controlled trial compared PPT and ESM by prevalence and incidence , behaviour , retention , cost and STI incidence and prevalence .


Demographic , behavioural and clinical data were collected from women at two clinics in Dhaka .


All women received presumptive treatment and were randomised to receive PPT or ESM at nine monthly visits .


In total , 549 women ( median age : < 20 years ) were enrolled .


At baseline , the prevalence of chlamydia ( Chlamydia trachomatis ) and gonorrhoea ( Neisseria gonorrhoeae ) was 41 % ( ESM : 41 % ; PPT : 42 % ) .


After 9 months , chlamydia and gonorrhoea decreased to 7 % overall , ( ESM : 7.4 % ; PPT : 6.8 % ) .


At each visit , 98 % of women receiving ESM met the therapy criteria and were treated .


Retention was low ( 50 % ) .


Total costs were 50 % lower per visit for each woman for PPT ( ESM : $ 11.62 v. PPT : $ 5.80 ) .


The number of sex work sessions was reduced from 3.3 to 2.5 ( P < 0.001 ) , but income did not change .


Coercion was reduced but condom use at last sex did not change significantly .


Monthly PPT and ESM were effective approaches for STI control .


PPT offered a feasible , low-cost alternative to ESM .


Educational aspects led to a reduction in coercion and fewer sessions .


Implementation studies are needed to improve condom use and retention .


Due to fragmented mental , somatic , and social healthcare services , it can be hard to engage into care older patients with severe mental illness ( SMI ) .


In adult mental health care , assertive community treatment ( ACT ) is an organizational model of care for treating patients with SMI who are difficult to engage .


So far all outcome studies of assertive community treatment have been conducted in adults .


In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual ( TAU ) .


Sixty-two outpatients ( 60 years and older ) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group ( 32 to ACT for elderly patients and 30 to TAU ) .


Primary outcomes included number of patients who had a first treatment contact within 3 months , the number of dropouts ( i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months ) ; and patients ' psychosocial functioning ( HoNOS65 + scores ) during 18 months follow-up .


Secondary outcomes included the number of unmet needs and mental health care use .


Analyses were based on intention-to-treat .


Of the 62 patients who were randomized , 26 were lost to follow-up ( 10 patients in ACT for elderly patients and 16 in TAU ) .


Relative to patients with TAU , more patients allocated to ACT had a first contact within three months ( 96.9 versus 66.7 % ; X2 ( df = 1 ) = 9.68 , p = 0.002 ) .


ACT for elderly patients also had fewer dropouts from treatment ( 18.8 % of assertive community treatment for elderly patients versus 50 % of TAU patients ; X2 ( df = 1 ) = 6.75 , p = 0.009 ) .


There were no differences in the other primary and secondary outcome variables .


These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully .


NTR1620 .


The aim of this study was to analyse effects of a comprehensive continuum of care ( intervention group ) on frail older persons ' life satisfaction , as compared to those receiving usual care ( control group ) .


The intervention included geriatric assessment , case management , interprofessional collaboration , support for relatives and organising of care-planning meetings in older persons ' own homes .


Improvements in older persons ' subjective well-being have been shown in studies including care planning and coordination by a case manager .


However , effects of more complex continuum of care interventions on frail older persons ' life satisfaction are not well explored .


Randomised controlled study .


The validated LiSat-11 scale was used in face-to-face interviews to assess older persons ' life satisfaction at baseline and at three , six and 12 months after the baseline .


The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three-month , three - to six-month as well as six - to 12-month follow-ups .


Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care , between 6 and 12 month follow-ups , for satisfaction regarding functional capacity , psychological health and financial situation .


A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons ' satisfaction with functional capacity , psychological health and financial situation .


Frail older persons represent a great proportion of the persons in need of support from the health care system .


Health care professionals need to consider continuum of care interventions ' impact on life satisfaction .


As life satisfaction is an essential part of older persons ' well-being , we propose that policy makers and managers promote comprehensive continuum of care solutions .


To evaluate the changes of vascular endothelial growth factor ( VEGF ) plasma levels after intravitreal injections of aflibercept or ranibizumab in patients with exudative age-related macular degeneration ( AMD ) .


Thirty-eight patients with exudative AMD were included in this randomised , prospective study .


Nineteen patients were randomised to treatment with intravitreal aflibercept ( 2.0 mg ) and 19 to intravitreal ranibizumab ( 0.5 mg ) .


The concentration of VEGF was measured by ELISA just before the injection , after 7 days and 1 month .


Twenty-two age - and sex-matched healthy patients without chorioretinal diseases served as control .


The median baseline plasma VEGF concentration was 61.0 pg/ml in the control group , 43.0 pg/ml in the aflibercept group and 59.0 pg/ml in the ranibizumab group ( p = 0.127 ) .


Seven days after intravitreal injection of aflibercept plasma levels were significantly reduced to values below the minimum detectable dose ( MDD ) in 17 of 19 patients ( 89.5 % ) resulting in a median VEGF concentration of < 9 pg/ml ( p < 0.001 ) .


The reduction persisted throughout 1 month with values below the MDD in 5 of 19 patients ( 26.3 % ) and a median measurement of 17.0 pg/ml ( p < 0.001 ) .


In patients treated with ranibizumab no significant effects could be observed with a baseline VEGF of 59.0 pg/ml , 54.0 pg/ml at 7 days ( p = 0.776 ) and 58.5 pg/ml at 4 weeks of follow-up ( p = 0.670 ) .


After intravitreal aflibercept injection , the systemic VEGF levels were significantly reduced throughout the observational period of 4 weeks .


No significant systemic effects of intravitreal ranibizumab on plasma VEGF were observed .


A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide , social and educational impairment , and mental health problems in adulthood .


A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms .


The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined .


A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial ( trial registration -- ISRCTN 19083628 ) comparing classroom-based CBT with usual school provision of Personal Social and Health Education .


Per-student cost of intervention was estimated from programme records .