To determine the effect of active recovery ( AR ) , passive rest ( PR ) , and cold-water immersion ( CWI ) after 90 min of intensive cycling on a subsequent 12-min time trial ( TT2 ) and the applied pacing strategy in TT2 .


After a maximal test and familiarization trial , 9 trained male subjects ( age 22 3 y , VO2max 62.1 5.3 mL min-1 kg-1 ) performed 3 experimental trials in the heat ( 30C ) .


Each trial consisted of 2 exercise tasks separated by 1 h.


The first was a 60-min constant-load trial at 55 % of the maximal power output followed by a 30-min time trial ( TT1 ) .


The second comprised a 12-min simulated time trial ( TT2 ) .


After TT1 , AR , PR , or CWI was applied for 15 min .


No significant TT2 performance differences were observed , but a 1-sample t test ( within each condition ) revealed different pacing strategies during TT2 .


CWI resulted in an even pacing strategy , while AR and PR resulted in a gradual decline of power output after the onset of TT2 ( P .046 ) .


During recovery , AR and CWI showed a trend toward faster blood lactate ( [ BLa ] ) removal , but during TT2 significantly higher [ BLa ] was only observed after CWI compared with PR ( P = .011 ) .


The pacing strategy during subsequent cycling performance in the heat is influenced by the application of different postexercise recovery interventions .


Although power was not significantly altered between groups , CWI enabled a differently shaped power profile , likely due to decreased thermal strain .


Longitudinal assessment of bone marrow lesions ( BMLs ) in knee osteoarthritis ( KOA ) by MRI is usually performed using semi-quantitative grading methods .


Quantitative segmentation methods may be more sensitive to detect change over time .


The purpose of this study was to evaluate and compare the validity and sensitivity to detect changes of two quantitative MR segmentation methods for measuring BMLs in KOA , one computer assisted ( CAS ) and one manual ( MS ) method .


Twenty-two patients with KOA confined to the medial femoro-tibial compartment obtained MRI at baseline and follow-up ( median 334 days in between ) .


STIR , T1 and fat saturated T1 post-contrast sequences were obtained using a 1.5 T system .


The 44 sagittal STIR sequences were assessed independently by two readers for quantification of BML .


The signal intensities ( SIs ) of the normal bone marrow in the lateral femoral condyles and tibial plateaus were used as threshold values .


The volume of bone marrow with SIs exceeding the threshold values ( BML ) was measured in the medial femoral condyle and tibial plateau and related to the total volume of the condyles/plateaus .


The 95 % limits of agreement at baseline were used to determine the sensitivity to change .


The mean threshold values of CAS and MS were almost identical but the absolute and relative BML volumes differed being 1319 mm3/10 % and 1828 mm3/15 % in the femur and 941 mm3/7 % and 2097 mm3/18 % in the tibia using CAS and MS , respectively .


The BML volumes obtained by CAS and MS were significantly correlated but the tissue changes measured were different .


The volume of voxels exceeding the threshold values was measured by CAS whereas MS included intervening voxels with normal SI.The 95 % limits of agreement were narrower by CAS than by MS ; a significant change of relative BML by CAS was outside the limits of -2.0 % -4.7 % whereas the limits by MS were -6.9 % -8.2 % .


The BML changed significantly in 13 knees using CAS and in 10 knees by MS.


CAS was a reliable method for measuring BML and more sensitive to detect changes over time than MS. The BML volumes measured by the two methods differed but were significantly correlated .


Investigate the hypnotic effects of repeated doses of neurokinin-1 receptor antagonist , vestipitant , in primary insomnia .


Randomized , double-blind , placebo-controlled 28-day parallel-group study .


Eleven sleep centers in Germany .


One hundred sixty-one patients with primary insomnia .


Patients received vestipitant ( 15 mg ) or placebo for 28 days ; 2-night polysomnographic assessment occurred on nights 1/2 and 27/28 .


Wake after sleep onset ( WASO ) was improved on nights 1/2 and 27/28 ( ratio , vestipitant versus placebo [ 95 % confidence interval ] : 0.76 [ 0.65 , 0.90 ] , P = 0.001 and 0.79 [ 0.65 , 0.96 ] , P = 0.02 , respectively ) , demonstrating maintenance of the effect following repeated dosing .


Latency to persistent sleep was shorter with vestipitant on nights 1/2 ( P = 0.0006 versus placebo ) , but not on nights 27/28 .


Total sleep time ( TST ) improved with vestipitant ( nights 1/2 : P < 0.0001 , nights 27/28 : P = 0.02 versus placebo ) .


Next-day cognitive function tests demonstrated no residual effects of vestipitant ( P > 0.05 versus placebo ) .


Adverse events ( AEs ) occurred in 25 % of vestipitant patients versus 22 % for placebo .


Headache was the most common AE ( 8 % of vestipitant patients versus 9 % for placebo ) .


Vestipitant improved sleep maintenance in patients with primary insomnia , with no associated next-day cognitive impairment .


The effects on wake after sleep onset and total sleep time were maintained following repeated dosing .


There are effective treatments of trichotillomania ( TTM ) , but access to expert providers is limited .


This study tested a stepped care model aimed at improving access .


Participants were 60 ( 95 % women , 75 % Caucasian , 2 % Hispanic ) adults ( M = 33.18 years ) with TTM .


They were randomly assigned to immediate versus waitlist ( WL ) conditions for Step 1 ( 10 weeks of web-based self-help via StopPulling.com ) .


After Step 1 , participants chose whether to engage in Step 2 ( 8 sessions of in-person habit reversal training [ HRT ] ) .


In Step 1 , the immediate condition had a small ( d = .21 ) but significant advantage , relative to WL , in reducing TTM symptom ratings by interviewers ( masked to experimental condition but not to assessment point ) ; there were no differences in self-reported TTM symptoms , alopecia , functional impairment , or quality of life .


Step 1 was more effective for those who used the site more often .


Stepped care was highly acceptable : Motivation did not decrease during Step 1 ; treatment satisfaction was high , and 76 % enrolled in Step 2 .


More symptomatic patients self-selected into HRT , and on average they improved significantly .


Over one third ( 36 % ) made clinically significant improvement in self-reported TTM symptoms .


Considering the entire stepped care program , participants significantly reduced symptoms , alopecia , and impairment , and increased quality of life .


For quality of life and symptom severity , there was some relapse by 3-month follow-up .


Stepped care is acceptable , and HRT was associated with improvement .


Further work is needed to determine which patients with TTM can benefit from self-help and how to reduce relapse .


Exercise programs targeting muscle strength and balance can reduce falls .


The study aimed to compare the Otago Exercise Program ( OEP ) , originally designed as supervised home training ( HT ) , with the same programme performed as GT , on functional balance and muscle strength , mobility , fall efficacy and self-reported health .


A single-blind randomized controlled trial with assessments at baseline ( T1 ) , following the 12-week intervention ( T2 ) , and 3 months following intervention ( T3 ) , was performed .


125 people , mean age 82.5 ( SD = 5.7 ) years , 73 % women , referred to a Falls Outpatient Clinic , participated .


74 % had fallen , and 37 % had a fall-related hospital stay during the previous year .


OEP supervised by physiotherapists was performed as GT twice weekly or as HT three times a week , for 12 weeks .


Total exercise time was comparable between groups .


The primary outcome was the Berg Balance Scale assessed at T2 .


From T1-T2 , Berg Balance Scale improved significantly more in the GT group than in the HT group ( mean group difference in change of 3.2 points , 95 % CI = 0.7-5 .8 , p = 0.014 ) .


Of the secondary outcomes , the 30-second sit-to-stand test ( p = 0.004 ) , and physical health measured by the Short Form-36 ( p = 0.004 ) , improved significantly more for the GT group .


Change in mobility measured by the Timed Up and Go test , mental health by the Short Form-36 , and fall efficacy by the Fall Efficacy Scale International did not differ between groups .


The 30-second sit-to-stand test and the Timed Up and Go , but not the Berg Balance Scale , was still better in the GT group at T3 .


In fall-prone home-dwelling older people , the OEP performed as GT is more effective for improving functional balance , muscle strength and physical health , but not fall efficacy and mental health than when performed as HT .


The OEP provided as GT should be considered in this population .


This was a prospective , randomized controlled clinical study .


To determine the efficacy of absorbable gelatin sponge in reducing blood loss , as well as shortening the length of hospital stay in patients undergoing multilevel posterior lumbar spinal surgery .


Absorbable gelatin sponge is reported to decrease postoperative drain output and the length of hospital stay after multilevel posterior cervical spine surgery .


However , there is a dearth of literature on prospective study of the efficacy of absorbable gelatin sponge in reducing postoperative blood loss , as well as shortening the length of hospital stay in patients undergoing multilevel posterior lumbar spinal surgery .


A total of 82 consecutive patients who underwent multilevel posterior lumbar fusion or posterior lumbar interbody fusion between June 2011 and June 2012 were prospectively randomized into one of the 2 groups according to whether absorbable gelatin sponge for postoperative blood management was used or not .


Demographic distribution , total drain output , blood transfusion rate , the length of stay , the number of readmissions , and postoperative complications were analyzed .


Total drain output averaged 173 mL in the study group and 392 mL in the control group ( P = 0.000 ) .


Perioperative allogeneic blood transfusion rate were lower in the Gelfoam group ( 34.1 % vs. 58.5 % , P = 0.046 ) ; moreover , length of stay in patients with the use of absorbable gelatin sponge ( 12.58 d ) was significantly shorter ( P = 0.009 ) than the patients in the control group ( 14.46 d ) .


No patient developed adverse reactions attributable to the absorbable gelatin sponge .


Application of absorbable gelatin sponge at the end of multilevel posterior lumbar fusion can significantly decrease postoperative drain output and length of hospital stay .


The haemostatic system plays an important role in the process of cancer development and spread .


Anticoagulants , mainly low molecular weight heparins , could prolong survival in cancer patients , particularly in patients with lung cancer , beyond prevention of thromboembolic events .


In a multicenter , investigator-initiated , open-label , randomized , sequential study , 38 patients with newly-diagnosed , limited-stage small-cell lung cancer were randomized to receive standard chemoradiotherapy or the same therapy plus 3,500 IU daily of bemiparin for a maximum of 26 weeks .


The primary outcome was progression-free survival .


The study was terminated early due to slow recruitment .


Median progression-free survival was 272 days with chemoradiotherapy alone and 410 days in the bemiparin group ; hazard ratio , 2.58 ( 95 % confidence interval [ CI ] , 1.15-5 .80 ) ; p = 0.022 .


Median overall survival was 345 days with chemoradiotherapy alone and 1133 days in the bemiparin group ; hazard ratio , 2.96 ( 95 % CI , 1.22-7 .21 ) ; p = 0.017 .


The rate of tumor response was similar in both study arms .


There was no significant between-group difference in the rates of major bleeding .


Toxicity related with the experimental treatment was minimal .


The addition of bemiparin to first line therapy with chemoradiotherapy significantly increases survival in patients with newly-diagnosed , limited-stage small-cell lung cancer .


( Funded by the Instituto Cientfico y Tecnolgico , University of Navarra .


ClinicalTrials.gov identifier : NCT00324558 ) .


To evaluate and compare the results of bipedicle conjunctival flap ( CF ) and cryopreserved amniotic membrane graft ( AMG ) in the treatment of non-viral infectious keratitis resistant to medical treatment .


This prospective randomised interventional study included 40 eyes of 40 patients with resistant non-viral infectious keratitis .


Twenty eyes received CF and 20 eyes received AMG .


In the CF group , there were 12 eyes with fungal keratitis , 7 eyes with bacterial keratitis and 1 eye with Acanthamoeba keratitis .


In the AMG group there were 13 eyes with fungal keratitis , 5 eyes with bacterial keratitis and 2 eyes with Acanthamoeba keratitis .


In the CF group , three ulcers had descemetocele and four ulcers were perforated .


In the AMG group , four ulcers had descemetocele and two ulcers were perforated .


In CF , 360 peritomy was done and a bipedicle CF from the upper conjunctiva was dissected from Tenon 's capsule , mobilised to cover the cornea and sutured to episclera .


In AMG , one or two layers of AM were trimmed to fit the ulcer and sutured to the cornea .


The follow-up period was 6months .


Successful results were observed in 18/20 eyes ( 90 % ) in each group .


Postoperatively , no significant differences between the two groups were found regarding success rate ( p = 1.0 ) , epithelialisation time ( p = 0.75 ) or visual acuity improvement ( p = 0.84 ) .


CF and AMG are effective in treatment-resistant infectious keratitis .


They could restore ocular surface integrity and provide metabolic and mechanical support for corneal healing .


For large corneal perforation , it may be better to use another procedure such as penetrating keratoplasty to restore ocular integrity .


Reductions on the clearance from plasma of chylomicrons are associated with atherosclerosis .


Statins improve the removal from plasma of chylomicrons in a dose dependent manner .


There is controversy whether ezetimibe modifies the plasma clearance of chylomicrons .


Effects of ezetimibe alone or in combination with simvastatin were compared with low and high dose of the latter , upon the kinetics of a chylomicron-like emulsion in coronary heart disease ( CHD ) patients .


25 CHD patients were randomized for treatment with ezetimibe 10 mg ( group 1 ) or simvastatin 20 mg ( group 2 ) with progression to ezetimibe + simvastatin 10/20 mg or simvastatin 80 mg , respectively .


Kinetic studies were performed at baseline and after each treatment period of 6 weeks .


The fractional catabolic rates ( FCR ) of the emulsion labeled with ( 14 ) C-CE and ( 3 ) H-TG , that represent respectively chylomicron remnant and triglyceride removal , were calculated .


Comparisons were made by ANOVA .


The ( 14 ) CE-FCR in group 1 were 0.005 0.004 , 0.011 0.008 and 0.018 0.005 min ( -1 ) and in group 2 were 0.004 0.003 , 0.011 0.008 and 0.019 0.007 min ( -1 ) respectively at baseline , after 6 and 12 weeks ( p < 0.05 vs. baseline , and 6 vs. 12 weeks ) .


The ( 3 ) H-TG-FCR in group 1 were 0.017 0.011 , 0.024 0.011 and 0.042 0.013 min ( -1 ) and in group 2 were 0.016 0.009 , 0.022 0.009 and 0.037 0.012 min ( -1 ) at baseline , after 6 and 12 weeks ( p < 0.05 vs. baseline , and 6 vs. 12 weeks ) .


There were no differences between groups in time .


Both treatments increased similarly the removal from plasma of chylomicron and remnants in CHD patients .


Many older adults are both highly sedentary ( that is , spend considerable amounts of time sitting ) and physically inactive ( that is , do little physical activity ) .


This protocol describes an exploratory trial of a theory-based behaviour change intervention in the form of a booklet outlining simple activities ( ` tips ' ) designed both to reduce sedentary behaviour and to increase physical activity in older adults .


The intervention is based on the ` habit formation ' model , which proposes that consistent repetition leads to behaviour becoming automatic , sustaining activity gains over time .


The intervention is being developed iteratively , in line with Medical Research Council complex intervention guidelines .


Selection of activity tips was informed by semi-structured interviews and focus groups with older adults , and input from a multidisciplinary expert panel .


An ongoing preliminary field test of acceptability among 25 older adults will inform further refinement .


An exploratory randomized controlled trial will be conducted within a primary care setting , comparing the tips booklet with a control fact sheet .


Retired , inactive and sedentary adults ( n = 120 ) aged 60 to 74 years , with no physical impairments precluding light physical activity , will be recruited from general practices in north London , UK .


The primary outcomes are recruitment and attrition rates .


Secondary outcomes are changes in behaviour , habit , health and wellbeing over 12 weeks .


Data will be used to inform study procedures for a future , larger-scale definitive randomized controlled trial .


Current Controlled Trials ISRCTN47901994 .


Mexico has the highest adult overweight and obesity prevalence in the Americas ; 23.8 % of children < 5 years old are at risk for overweight and 9.7 % are already overweight or obese .


Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social ( IMSS ) clinics .


We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care .


We recruited 306 parent-child pairs : 168 intervention , 138 usual care .


Children were 2-5 years old with WHO body mass index ( BMI ) z-score 0-3 .


We measured children 's height and weight and parents reported children 's diet and physical activity at baseline and 3 and 6-month follow-up .


We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values .


93 ( 55 % ) intervention and 96 ( 70 % ) usual care families completed 3 and 6-month follow-up .


At 3 months , intervention v. usual care children increased vegetables by 6.3 servings/week ( 95 % CI , 1.8 , 10.8 ) .


In stratified analyses , intervention participants with high program adherence ( 5-6 sessions ) decreased snacks and screen time and increased vegetables v. usual care .


No further effects on behavioral outcomes or BMI were observed .


Transportation time and expenses were barriers to adherence .


90 % of parents who completed the post-intervention survey were satisfied with the program .


Although satisfaction was high among participants , barriers to participation and retention included transportation cost and time .


In intention to treat analyses , we found intervention effects on vegetable intake , but not other behaviors or BMI .


ClinicalTrials.gov NCT01539070.Comisin Nacional de Investigacin Cientfica del IMSS : 2009-785-120 .


The aim of this study is to evaluate dentoskeletal effects of Herbst and Twin Block ( TB ) appliance therapies in Skeletal Class II malocclusion .


Herbst group consisted of 11 girls and 9 boys ( mean age = 12.74 1.43 years ) , TB group comprised of 10 girls and 10 boys ( mean age = 13.0 1.32 years ) , and control group included 9 girls and 11 boys ( mean age = 12.17 1.47 years ) .


Mean treatment/observation times were 15.81 5.96 months for Herbst , 16.20 7.54 months for TB , and 15.58 3.13 months for control group .


Pre-treatment ( T0 ) and post-treatment ( T1 ) lateral cephalograms were traced using a modified Pancherz 's cephalometric analysis .


Inter-group differences were evaluated with one-way analysis of variance , and intra-group differences were assessed with paired samples t-test at the P < 0.05 level .


In control group , all sagittal and vertical skeletal measurements increased as a result of continuing growth .


However , skeletal discrepancy and overjet remained unchanged .


After functional appliance therapy , greater increases were recorded in TB group for all mandibular skeletal measurements compared with those in control group .


Upper dental arch distalization and lower incisor protrusion were significant in Herbst group , compared with control .


All face height measurements increased after functional appliance therapy .


In TB group , the treatment effects were mainly due to mandibular skeletal changes .


Both skeletal and dental changes contribute to Class II correction with Herbst appliance therapy .


Herbst appliance may be especially useful in Skeletal Class II patients with maxillary dentoalveolar protrusion and mandibular dentoalveolar retrusion , whereas TB appliance may be preferred for skeletal mandibular retrognathy patients .


Neuropsychological interventions have been mainly applied with clinical populations , in spite of the need of preventing negative changes across life span .


Among the few studies of cognitive stimulation in elderly , surprisingly there is no enough research comparing direct and indirect active stimulation programs .


This study aims to verify wheter there are differences between two cognitive interventions approaches in older adults : a structured Working Memory ( WM ) Training Program versus a Poetry-based Stimulation Program .


Fourteen older adults were randomly assigned to participate into one of the two intervention groups .


The assessed neurocognitive components were attention , episodic and working memory , communicative and executive functions .


WM Training activities were based on Baddeley 's model ; Poetry-based Stimulation Program was composed by general language activities .


Data were analyzed with one-way ANCOVA with Delta scores and pre and post-training tests raw scores .


WM group improved performance on WM , inhibition , and cognitive flexibility measures , while Poetry group improved on verbal fluency and narrative discourse tasks .


Both approaches presented benefits ; however WM Training improved its target function with transfer effects to executive functions , being useful for future studies with a variety of dementias .


Poetry-based Stimulation also improved complex linguistic abilities .


Both approaches may be helpful as strategies to prevent dysfunctional aging changes .


Caregiver involvement is critical in ensuring optimal adolescent asthma management .


The study investigated whether multisystemic therapy ( MST ) , an intensive home-based family therapy , was superior to family support for changing beliefs regarding asthma-related positive parenting among caregivers of African-American youth with poorly controlled asthma .


The relationship between parenting beliefs and asthma management at the conclusion of the intervention was also assessed .


A randomized controlled trial was conducted with 167 adolescents with moderate-to-severe , persistent , poorly controlled asthma and their primary caregivers .


Families were randomly assigned to MST or family support ( FS ) , a home-based family support condition .


Data were collected at baseline and 7-month posttest .


Changes in caregiver ratings of importance and confidence for engaging in asthma-related positive parenting were assessed through questionnaire .


Illness management was assessed by the Family Asthma Management System Scale .


Participation in MST was associated with more change in caregiver beliefs as compared with FS for both importance ( t = 2.39 , p = .02 ) and confidence ( t = 2.04 , p = .04 ) .


Caregiver beliefs were also significantly related to youth controller medication adherence at the conclusion of treatment ( importance : r = .21 , p = .01 ; confidence : r = .23 , p = .004 ) .


Results support the effectiveness of MST for increasing parental beliefs in the value of asthma-related positive parenting behaviors and parental self-efficacy for these behaviors among families of minority adolescents with poorly controlled asthma .


To evaluate the effect of moderate intensity aerobic exercise ( 40 % -60 % of Heart Rate Reserve ( HRR ) ) on diabetic peripheral neuropathy .


A parallel-group , randomized controlled trial was carried out in a tertiary health care setting , India .


The study comprised of experimental ( moderate intensity aerobic exercise and standard care ) and control groups ( standard care ) .


Population with type 2 diabetes with clinical neuropathy , defined as a minimum score of seven on the Michigan Diabetic Neuropathy Score ( MDNS ) , was randomly assigned to experimental and control groups by computer generated random number tables .


RANOVA was used for data analysis ( p < 0.05 was significant ) .


A total of 87 patients with DPN were evaluated in the study .


After randomization there were 47 patients in the control group and 40 patients in the experimental group .


A comparison of two groups using RANOVA for anthropometric measures showed an insignificant change at eight weeks .


For distal peroneal nerve 's conduction velocity there was a significant difference in two groups at eight weeks ( p < 0.05 ) , Degrees of freedom ( Df ) = 1 , 62 , F = 5.14 , and p = 0.03 .


Sural sensory nerve at eight weeks showed a significant difference in two groups for conduction velocity , Df = 1 , 60 , F = 10.16 , and p = 0.00 .


Significant differences in mean scores of MDNS were also observed in the two groups at eight weeks ( p value significant < 0.05 ) .


Moderate intensity aerobic exercises can play a valuable role to disrupt the normal progression of DPN in type 2 diabetes .


Regular physical activity is known to help prevent and treat numerous non-communicable diseases .


Smartphone applications ( apps ) have been shown to increase physical activity in primary care but little is known regarding the views of patients using such technology or how such technology may change behaviour .


To explore patients ' views and experiences of using smartphones to promote physical activity in primary care .


This qualitative study was embedded within the SMART MOVE randomised controlled trial , which used an app ( Accupedo-Pro Pedometer ) to promote physical activity in three primary care centres in the west of Ireland .


Taped and transcribed semi-structured interviews with a purposeful sample of 12 participants formed the basis of the investigation .


Framework analysis was used to analyse the data .


Four themes emerged from the analysis : transforming relationships with exercise ; persuasive technology tools ; usability ; and the cascade effect .


The app appeared to facilitate a sequential and synergistic process of positive change , which occurred in the relationship between the participants and their exercise behaviour ; the study has termed this the ` Know-Check-Move ' effect .


Usability challenges included increased battery consumption and adjusting to carrying the smartphone on their person .


There was also evidence of a cascade effect involving the families and communities of participants .


Notwithstanding technological challenges , an app has the potential to positively transform , in a unique way , participants ' relationships with exercise .


Such interventions can also have an associated cascade effect within their wider families and communities .


The failure of subacromial decompression may be attributed to persistent symptoms of acromioclavicular joint ( ACJ ) arthritis , while inferior clavicular spurs of the ACJ may be associated with failed healing of repaired rotator cuffs .


To evaluate the clinical effectiveness of arthroscopic distal clavicle resection ( DCR ) in patients with rotator cuff tears and concomitant asymptomatic radiological ACJ arthritis .


Randomized controlled trial ; Level of evidence , 1 .


A total of 78 patients with rotator cuff tears in addition to radiological and asymptomatic ACJ arthritis who were scheduled for arthroscopic rotator cuff repair were prospectively randomized into 2 groups .


Patients underwent arthroscopic rotator cuff repair with acromioplasty .


Patients in group 1 ( 39 patients ) underwent additional arthroscopic DCR , while patients in group 2 ( 39 patients ) did not .


Clinical outcomes of the 2 groups were compared using the visual analog scale ( VAS ) for pain , range of motion , Constant score , and American Shoulder and Elbow Surgeons ( ASES ) score up to at least 24 months .


The structural integrity of repaired rotator cuffs was assessed using ultrasonography , computed tomography arthrography , or MRI at least 6 months after surgery .


To evaluate ACJ instability , weighted stress radiography of the ACJ was studied at 6 and 12 months postoperatively .


Patients in both groups showed significant improvement in the VAS score and all functional scores at final follow-up ( mean , 29.2 months ; range , 24-46 months ) without significant differences between the 2 groups ( P > .05 ) .


Results ( mean SD ) for preoperative group 1/group 2 and postoperative group 1/group 2 were as follows , respectively : 7.2 1.8 / 6.1 1.9 ( P = .02 ) and 0.6 1.8 / 0.6 0.9 ( P = .97 ) for the VAS score , 74.1 5.7 / 73.8 8.0 ( P = .87 ) and 96.3 5.7 / 95.7 4.6 ( P = .77 ) for the Constant score , and 47.0 10.3 / 50.8 14.1 ( P = .22 ) and 91.5 15.5 / 94.5 11.8 ( P = .55 ) for the ASES score .


Failed cuff healing occurred in 9 patients ( 23 % ) in group 1 and 10 patients ( 26 % ) in group 2 , with no significant difference ( P = .95 ) .


In group 1 , there were 2 patients ( 5.0 % ) with ACJ subluxation on weighted stress radiography at 6 months postoperatively .


These patients complained of gross protrusion and ACJ tenderness .


Preventive arthroscopic DCR in patients with rotator cuff tears and concomitant asymptomatic radiological ACJ arthritis did not result in better clinical or structural outcomes , and it did lead to symptomatic ACJ instability in some patients .


Preventive arthroscopic DCR is not recommended in patients with radiological but asymptomatic ACJ arthritis .


Further long-term follow-up is needed to confirm the development of symptoms in ACJ arthritis .


A prospective double-blind randomized control trial ( RCT ) to evaluate the benefit of a combinatorial , five gene pharmacogenomic test and interpretive report ( GeneSight ) for the management of psychotropic medications used in the treatment of major depression in an outpatient psychiatric practice .


Depressed adult outpatients were randomized to a treatment as usual ( TAU , n = 25 ) arm or a pharmacogenomic-informed GeneSight ( n = 26 ) arm .


Subjects were blinded to their treatment group and depression severity was assessed by blinded study raters .


Within two days of enrollment , clinicians of subjects in the guided group received the GeneSight report that categorized each of 26 psychotropic medications within a green , yellow , or red `` bin '' based on the relationship of each medication to a subject 's pharmacokinetic and pharmacodynamic combinatorial gene variant profile .


Antidepressant medication changes began within 2 weeks after baseline assessments .


Depression severity was assessed by blinded study raters using the HAMD-17 , PHQ-9 , QIDS-SR , and QIDS-CR administered 4 , 6 , and 10 weeks after baseline assessment .


Between-group trends were observed with greater than double the likelihood of response and remission in the GeneSight group measured by HAMD-17 at week 10 .


Mean percent improvement in depressive symptoms on HAMD-17 was higher for the GeneSight group over TAU ( 30.8 % vs 20.7 % ; p = 0.28 ) .


TAU subjects who had been prescribed medications at baseline that were contraindicated based on the individual subject 's genotype ( i.e. , red bin ) had almost no improvement ( 0.8 % ) in depressive symptoms measured by HAMD-17 at week 10 , which was far less than the 33.1 % improvement ( p = 0.06 ) in the pharmacogenomic guided subjects who started on a red bin medication and the 26.4 % improvement in GeneSight subjects overall ( p = 0.08 ) .


Pharmaco-genomic-guided treatment with GeneSight doubles the likelihood of response in all patients with treatment resistant depression and identifies 30 % of patients with severe gene-drug interactions who have the greatest improvement in depressive symptoms when switched to genetically suitable medication regimens .


To determine the relation between time to surgery ( TTS ) after neoadjuvant chemoradiotherapy ( nCRT ) and pathologically complete response ( pCR ) , surgical outcome , and survival in patients with esophageal cancer .


Standard treatment for potentially curable esophageal cancer is nCRT plus surgery after 4 to 6 weeks .


In rectal cancer patients , evidence suggests that prolonged TTS is associated with a higher pCR rate and possibly with better survival .


We identified patients treated with nCRT plus surgery for esophageal cancer between 2001 and 2011 .


TTS ( last day of radiotherapy to day of surgery ) varied mainly for logistical reasons .


Minimal follow-up was 24 months .


The effect of TTS on pCR rate , postoperative complications , and survival was determined with ( ordinal ) logistic , linear , and Cox regression , respectively .


In total , 325 patients were included .


Median TTS was 48 days ( p25-p75 = 40-60 ) .


After 45 days , TTS was associated with an increased probability of pCR [ odds ratio ( OR ) = 1.35 per additional week of TSS , P = 0.0004 ] and a small increased risk of postoperative complications ( OR = 1.20 , P < 0.001 ) .


Prolonged TTS had no effect on disease-free and overall survivals ( HR = 1.00 and HR = 1.06 per additional week of TSS , P = 0.976 and P = 0.139 , respectively ) .


Prolonged TTS after nCRT increases the probability of pCR and is associated with a slightly increased probability of postoperative complications , without affecting disease-free and overall survivals .


We conclude that TTS can be safely prolonged from the usual 4 to 6 weeks up to at least 12 weeks , which facilitates a more conservative wait-and-see strategy after neoadjuvant chemoradiotherapy to be tested .


Overnight lens wear is associated with increased lens contamination and risk of developing a corneal infiltrate or infectious event .


Antibacterial lenses have been proposed as a potential strategy for reducing lens contamination .


A proof-of-principle study was conducted to investigate what effect control of potential pathogens , through the use of antibiotic eye drops , would have on the incidence of corneal infiltrative events ( CIEs ) and on the ocular microbiota and lens contamination .


This is a prospective , open-label , controlled , parallel-group , 1-month clinical study in which 241 subjects were dispensed with lotrafilcon A silicone hydrogel lenses for 30 days of continuous wear .


Subjects were randomized into either test ( moxifloxacin 0.5 % ) or control ( rewetting solution ) group .


One drop was instilled into each eye on waking and before sleeping , while lenses were on-eye .


Follow-ups were conducted after one night and 1 month .


Lid margin swabs were taken at baseline and at 1 month and worn lenses were aseptically collected at 1 month .


The incidence of CIEs was not significantly different between the test ( 2.6 % ) and control ( 3.9 % ) groups ( p = 0.72 ) .


Microorganism levels from the test group swabs were significantly lower than those from the control group ( p = 0.001 ) .


Gram-positive bacteria were less frequently recovered from lower lid swabs from the test group ( 39.6 % vs. 66.0 % [ p < 0.001 ] , test vs. control , respectively ) or from contact lens samples ( 1.9 % vs. 10.5 % [ p = 0.015 ] , test vs. control , respectively ) , but there was no difference in gram-negative bacteria ( GNB ) .


Corneal infiltrative events were associated with higher levels of lens contamination ( p = 0.014 ) and contamination of lenses with GNB ( CIE : 7.3 % vs. 0.6 % [ p = 0.029 ] , GNB contamination vs. no GNB contamination , respectively ) .


Twice-daily antibiotic instillation during continuous wear of lenses did not significantly influence the rate of inflammatory events .


Corneal infiltrative events were associated with higher levels of lens contamination in general and with contamination by GNB specifically .


We aimed to investigate the effect of electroacupuncture at Zusanli ( ST36 ) and Sanyinjiao ( SP6 ) on adrenocortical function in patients with etomidate anesthesia .


We randomly divided 80 patients who underwent elective surgery into 4 groups : group etomidate ( ETO ) , group etomidate + electroacupuncture ( ETO+EA ) , group etomidate + sham acupuncture ( ETO+SEA ) , and group propofol ( PRO ) .


The patients in group ETO , ETO+EA , and ETO+SEA were induced with etomidate and sufentanil and maintained with intravenous infusion of etomidate and remifentanil .


Group PRO was induced with propofol and sufentanil and maintained with propofol and remifentanil .


Group ETO+EA received electro-acupuncture stimulation at Zusanli and Sanyinjiao throughout the operation , while group ETO+SEA received electro-acupuncture stimulation at non-acupoints .


We recorded the values of MAP , HR , BIS , CVP , cortisol , ACTH , epinephrine , norepinephrine , and arterial blood gas during the perioperative period .


Cortisol concentrations were significantly higher at all times except T0 in group ETO+EA compared with group ETO .


The ACTH concentrations were lower in group ETO+EA than that in group ETO at point T3 .


Electroacupuncture at ST 36 and SP 6 can mitigate the adrenal cortical inhibition induced by etomidate and can reduce the secretion of catecholamines during surgery .


The main component in tocotrienols ( T3 ) from barley ( Hordeum vulgare L. ) is - T3 , the vitamer with the highest bioavailability , while palm oil T3 is particularly rich in - T3 .


Unlike tocopherols , T3 are known for their cholesterogenesis-inhibiting , neuroprotective and anticarcinogenic properties .


In this study the oral bioavailabilities of T3 from barley oil ( 3.98 mgday ) and T3 from palm oil ( 3.36 mgday ) in nanoemulsified formulations ( NE ) and self-emulsifying systems ( SES ) were compared using hen 's eggs as a bioindicator .


In addition , the transfer efficiencies of barley oil T3 and palm oil T3 into egg yolk were compared , as well as their effects on egg cholesterol levels .


Nanoemulsification led to T3 levels ( 132.9 g per egg ) higher than with non-emulsified barley oil ( 112.8 g per egg ) and barley oil SES ( 116.7 g per egg ) owing to the high proportions of - T3 ( 99-117g per egg ) , which has a particularly high transfer efficiency ( 4.32-6 .75 % ) .


T3 contents of eggs from hens fed barley oil supplements ( 112-132g per egg ) were significantly higher than those of eggs from hens fed palm oil supplements ( 70-78g per egg ) .


Addition of barley and palm oils to laying hen feed decreased egg yolk cholesterol by 4 and 6 % respectively .


Results from this animal study may help to establish T3 from barley as a dietary supplement and to develop nutritionally improved hen 's eggs .


We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes .


4119 ACCORD Trial participants randomised to target HbA1c < 6.0 % ( 42 mmol/mol ) for 4.0 1.2 years were systematically transitioned to target HbA1c 7.0-7 .9 % ( 53-63 mmol/mol ) and followed for an additional 1.1 0.2 years .


Characteristics of participants with HbA1c < 6.5 % ( 48 mmol/mol ) or 6.5 % at transition were compared .


Changes in BMI and glucose-lowering medications were compared between those ending with HbA1c < 6.5 % vs 6.5 % .


Poisson models were used to assess the independent effect of attaining HbA1c < 6.5 % before transition on ending with HbA1c < 6.5 % .


Participants with pre-transition HbA1c < 6.5 % were older with shorter duration diabetes and took less insulin but more non-insulin glucose-lowering agents than those with higher HbA1c .


A total of 823 participants achieved a final HbA1c < 6.5 % , and had greater post-transition reductions in BMI , insulin dose and secretagogue and acarbose use than those with higher HbA1c ( p < 0.0001 ) .


HbA1c < 6.5 % at transition predicted final HbA1c < 6.5 % ( crude RR 4.9 [ 95 % CI 4.0 , 5.9 ] ; RR 3.9 [ 95 % CI 3.2 , 4.8 ] adjusted for demographics , co-interventions , pre-intervention HbA1c , BMI and glucose-lowering medication , and post-transition change in both BMI and glucose-lowering medication ) .


Progressively lower pre-transition HbA1c levels were associated with a greater likelihood of maintaining a final HbA1c of < 6.5 % .


Follow-up duration was not associated with post-transition rise in HbA1c .


Time-limited intensive glycaemic management using a combination of agents that achieves HbA1c levels below 6.5 % in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed .


Despite amiodarone 's established safety profile in the setting of heart failure , it is unknown whether its impact on cardiovascular outcomes in patients with atrial fibrillation is modulated by left ventricular function .


A pooled analysis of 3,307 patients ( age 68.0 0.2 years ; 31.1 % female ) enrolled in AFFIRM and AF-CHF trials was conducted to assess the effect of rhythm control with amiodarone on cardiovascular outcomes , according to left ventricular systolic function .


In amiodarone-treated patients ( N = 1,107 ) , freedom from recurrent atrial fibrillation was 84 % and 45 % at 1 and 5 years , respectively , with no differences according to left ventricular function ( P = 0.8754 ) .


Similarly , the adjusted proportion of time spent in atrial fibrillation ( 15.0 1.8 % ) did not vary according to ventricular function ( P = 0.6094 ) .


Over 40.0 0.3 months of follow-up , 1,963 ( 59.4 % ) patients required at least one hospitalization , 1,401 ( 42.6 % ) of whom had cardiovascular-related hospitalizations .


Adjusted all-cause and cardiovascular hospitalization rates were similar with amiodarone versus rate control in all patients and in subgroups with and without severe left ventricular dysfunction .


A total of 729 ( 22.0 % ) patients died , 498 ( 15.1 % ) from cardiovascular causes .


Adjusted all-cause and cardiovascular mortality rates were similar with amiodarone versus rate control overall and in subgroups with and without severe left ventricular dysfunction .


Amiodarone 's efficacy in maintaining sinus rhythm and reducing the burden of atrial fibrillation is similar in the presence or absence of severe left ventricular dysfunction .


Rhythm control with amiodarone is associated with comparable hospitalization and mortality rates to rate control in patients with and without left ventricular dysfunction .


Although ablative fractional laser is the gold standard for acne scars , evidence is still lacking for other types of scars .


To evaluate the efficacy and safety of the ablative fractional 10,600-nm CO2 laser in the treatment of various scar types .


The authors performed an intraindividual single-blinded randomized controlled split-lesion trial .


Adult patients received 3 laser treatments at 8-week intervals for scars existing at least 1 year .


Primary end points were the Physician Global Assessment ( PhGA ) and the assessment of adverse effects .


Twenty-five consecutive patients with atrophic ( 52 % ) or hypertrophic ( 48 % ) scars located mainly on the body ( 84 % ) were included in the study .


At 6-month follow-up of 21 patients , the PhGA showed no statistically significant difference between the treated and untreated side of the scar ( p = .70 ) .


Persistent erythema , postinflammatory pigmentary changes , and scarring after ulceration ( n = 3 ) were observed as side effects .


In this trial involving various types of scars , the efficacy of ablative fractional CO2 laser could not be confirmed .


The authors presume that different types of scars have a different response to treatment .


Future studies should aim to identify the type of scars that may benefit from ablative fractional laser therapy .


Left ventricular dysfunction ( LVD ) is a complex , multifactorial condition , caused by mechanical , neurohormonal , and genetic factors .


We have previously observed association of renin-angiotensin-aldosterone system ( RAAS ) , matrix metalloproteinases ( MMPs ) and inflammatory pathway genes with LVD .


Therefore the present study was undertaken to identify the combination of genetic variants and their possible interactions contributing towards genetic susceptibility to LVD in the background of coronary artery disease ( CAD ) .


The study included 230 healthy controls and 510 consecutive patients with angiographically confirmed CAD .


Among them , 162 with reduced left ventricle ejection fraction ( LVEF45 % ) were categorized as having LVD .


We analyzed 11 polymorphisms of RAAS , MMPs and inflammatory pathways .


Single locus analysis showed that AT1 A1166C ( p value < 0.001 ; OR = 3.67 ) , MMP9 R668Q ( p value = 0.007 ; OR = 3.48 ) and NFKB1-94 ATTG ins/del ( p value = 0.013 ; OR = 2.01 ) polymorphisms were independently associated with LVD when compared with both non-LVD patients and healthy controls .


High-order gene-gene interaction analysis , using classification and regression tree ( CART ) and multifactor dimensionality reduction ( MDR ) revealed that AT1 A1166C and NFKB1-94 ATTG ins/del polymorphisms jointly increased the risk of LVD to great extent ( p-value = 0.001 ; OR = 8.55 ) and best four-factor interaction model consisted of AT1 A1166C , MMP7 A-181G , MMP9 R668Q and NFKB1-94 ATTG ins/del polymorphisms with testing accuracy of 0.566 and cross validation consistency ( CVC ) = 9/10 ( permutation p < 0.001 ) showed increased risk for LVD respectively .


AT1 A1166C independently and in combination with MMP9 R668Q and NFKB1-94 ATTG ins/del polymorphisms plays important role in conferring genetic susceptibility to LVD in CAD patients .


Percutaneous treatment of complex coronary bifurcation lesions remains challenging , even in the drug-eluting stent era .


We sought to evaluate the baseline and 9 months intravascular ultrasound ( IVUS ) analysis of the Axxess stent , a self-expanding , Biolimus A9-eluting , and dedicated bifurcation stent .


We enrolled the first 76 patients from selected sites of the 302 patients large DIVERGE trial ( a prospective , single-arm , multicenter trial evaluating the safety and efficacy of the Axxess stent ) .


Both baseline and 9 months IVUS images were collected for serial two-dimensional ( 2D ) and 3D analysis .


A minimal amount and a low percentage of neointimal volume index were seen in the Axxess stent at 9 months ( 0.40.6 mm ( 3 ) / mm and 4.35.2 % , respectively ) .


Vessel , lumen , and stent volume indices increased significantly ( respectively , 17.03.6 to 18.93.7 mm ( 3 ) / mm , P < 0.0001 ; 7.32.0 to 9.22.5 mm ( 3 ) / mm , P < 0.0001 ; and 7.42.0 to 9.62.6 mm ( 3 ) / mm , P < 0.0001 ) .


This resulted in minimum lumen area ( MLA ) enlargement ( 6.11.9 to 7.22.3 mm ( 2 ) , P < 0.0001 ) , whereas peristent plaque area decreased ( 8.72.5 to 8.52.1 mm ( 3 ) / mm , P = 0.016 ) .


At 9 months , 16 ( 26 % ) incomplete stent apposition ( ISA ) persisted from baseline , while six resolved ( 9.7 % ) .


Only one ( 2 % ) ISA was late acquired .


In the additional distal sirolimus-eluting stents , MLA decreased from 4.31.1 to 4.11.2 mm ( 2 ) ( P = 0.04 ) at 9 months for the main branch , and from 3.41.2 to 3.21.2 mm ( 2 ) ( P = 0.09 ) for the side branch .


The dedicated bifurcation Axxess stent system demonstrates significant stent volume increase with minimal neointimal formation and a low incidence of late-acquired ISA at 9 months .


The efficacy and safety of collagenase clostridium histolyticum ( CCH ) in patients with Dupuytren 's contracture ( DC ) was demonstrated in a program including two pivotal phase 3 clinical trials ( CORD I and II ) which included patients with a broad range of disease severity .


This analysis assessed the efficacy and safety of CCH in the subpopulation of DC patients with up to two joints affected and moderate disease according to British Society of Surgery of the Hand classification .


This was in support of a resubmission to the Scottish Medicines Consortium .


A post-hoc analysis that included data from patients with up to two joints affected and moderate disease treated with CCH during the randomized and open-label phases of CORD I and II .


Of 362 patients who received CCH during the two trials , 58 had one or two joints affected and moderate disease .


Sixty-seven joints were treated ; 49 patients received treatment for one joint , and 9 patients received treatment for two joints .


Each patient received an average of 1.62 injections of CCH per joint .


Of 65 evaluable joints , 82 % met the primary endpoint of clinical success ( reduction in contracture to 5 of full extension 30 days after the last injection ) .


This was similar if only primary joints were considered ( 81 % achieved clinical success ) .


Recurrence at 12 months ( increase in joint contracture to 20 in the presence of a palpable cord in joints that had attained clinical success ) was observed in 3.8 % of joints .


Reported adverse events were mild to moderate in intensity ; none resulted in discontinuation .


CORD I and II show that CCH is well tolerated and effective in the treatment of DC in a broad population .


The present analysis suggests that CCH has particular value in patients with moderate severity disease and up to two joints affected .


This analysis used data from both the randomized and open-label phases of CORD I and II ; therefore , it is not possible to present comparative data for this subpopulation .


As this was a post-hoc analysis in a relatively small patient subpopulation , statistical comparisons with the full population were not considered appropriate .


Furthermore , the small sample size means that additional subgroup analyses , for example of patients by previous treatment or number of injections administered , are not appropriate .


Nevertheless , the data presented demonstrate that CCH is both well tolerated and effective in this population when managed by appropriately trained individuals .


International guidelines recommend use of targeted temperature management following resuscitation from out-of-hospital cardiac arrest .


This treatment , however , is often neglected or delayed .


To determine whether multifaceted quality improvement interventions would increase the proportion of eligible patients receiving successful targeted temperature management .


A network of 6 regional emergency medical services systems and 32 academic and community hospitals serving a population of 8.8 million people providing post arrest care to out-of-hospital cardiac arrest .


Comparing interventions improve the implementation of targeted temperature management post out-of-hospital cardiac arrest through passive ( education , generic protocol , order set , local champions ) versus additional active quality improvement interventions ( nurse specialist providing site-specific interventions , monthly audit-feedback , network educational events , internet blog ) versus no intervention ( baseline standard of care ) .


The primary process outcome was proportion of eligible patients receiving successful targeted temperature management , defined as a target temperature of 32-34C within 6 hours of emergency department arrival .


Secondary clinical outcomes included survival and neurological outcome at hospital discharge .


Four thousand three hundred seventeen out-of-hospital cardiac arrests were transported to hospital ; 1,737 ( 40 % ) achieved spontaneous circulation , and 934 ( 22 % ) were eligible for targeted temperature management .


After accounting for secular trends , patients admitted during the passive quality improvement phase were more likely to achieve successful targeted temperature management compared with those admitted during the baseline period ( 25.7 % passive vs 9.0 % baseline ; odds ratio , 2.76 ; 95 % CI , 1.76-4 .32 ; p < 0.001 ) .


Active quality improvement interventions conferred no additional improvements in rates of successful targeted temperature management ( 26.9 % active vs 25.7 % passive ; odds ratio , 0.96 ; 95 % CI , 0.63-1 .45 ; p = 0.84 ) .


Despite a significant increase in rates of successful targeted temperature management , survival to hospital discharge was unchanged .


Simple quality improvement interventions significantly increased the rates of achieving successful targeted temperature management following out-of-hospital cardiac arrest in a large network of hospitals but did not improve clinical outcomes .


To investigate the efficacy and adverse effect of DCF regimen with subsequent S-1 maintenance chemotherapy in patients with advanced gastric cancer ( AGC ) .


Sixty AGC patients without disease progression after 4 to 6 cycles of DCF regimen as the first-line chemotherapy were randomized into maintenance group and control group ( 30 patients each ) .


The patients in the maintenance group received maintenance chemotherapy with S-1 ( 40 mg/m ( 2 ) , twice daily for 14 days ; 21 days for a treatment cycle ) until disease progression or with intolerant toxicity , and those in the control group received optimal supportive care .


The response rate ( CR+PR ) was 33.3 % in the maintenance group , significantly higher than that in the control group ( 3.33 % , P < 0.05 ) , and the disease control rate ( CR+PR+SD ) also differed significantly between the two groups ( 73.3 % vs 46.7 % , P < 0.05 ) .


The median time to progression was 7.9 months in the maintenance group and 6.8 months in the control group , with median overall survival time of 13.8 and 11.7 months , respectively ( P > 0.05 ) .


The most common adverse effect in the maintenance group included nausea , vomiting , leucocytopenia , and hand-foot syndrome ; no death occurred in relation to the therapy .


S-1 maintenance chemotherapy , with a tolerable toxicity profile , can improve the RR , DCR and median time to progression in AGC patients who respond to DCF regimen , but its efficacy still awaits further evaluation .


Those affected by advanced fibrotic interstitial lung diseases ( ILDs ) have considerable unmet symptom and psychological needs .


Case conferencing has been proposed to address these issues , but requires evaluation .


To obtain preliminary information on the impact of a case conference intervention delivered in the home ( Hospital2Home ) on palliative care concerns of patients and their carers , and to evaluate feasibility and acceptability .


Hospital2Home was trialled at a specialist centre using a Phase II fast-track randomised controlled trial with qualitative interviews .


The primary outcome for effect was mean change from baseline of Palliative Care Outcome Scale ( POS ) ( a measure of symptoms and concerns ) at 4weeks .


Secondary outcomes included symptom control , quality of life , consent and recruitment rates and percentage of patients in the fast-track group receiving case conferences within 14days .


53 patients were recruited ( 26 fast-track , 27 controls ) .


Mean ( SD ) POS scores at 4weeks were -5.7 ( 7.5 ) fast-track vs -0.4 ( 8.0 ) control , ( mean change difference between the two arms was -5.3 ( 95 % CI -9.8 to -0.7 ) independent t test p = 0.02 ) ; effect size ( 95 % CI ) -0.7 ( -1.2 to -0.1 ) .


The secondary outcomes of quality of life , anxiety and depression were superior in the fast-track arm , and none were worse .


Qualitative findings corroborate these data .


Recruitment was successful and 53/67 ( 79 % ) of eligible patients consented .


6/25 ( 24 % ) had case conferences within 14days .


Community case conferences improve palliative symptoms and quality of life after 4weeks .


Hospital2Home for the most part is both feasible and acceptable .


It now requires further testing in multicentre trials .


NCT01450644 .


To compare the efficacy of mitiglinide and sitagliptin , alone or in combination , on postprandial excursion and glycemic variability assessed by continuous glucose monitoring ( CGM ) in a single-day treatment setting .


This was a post hoc analysis of a randomized crossover study comparing the efficacy of sitagliptin , mitiglinide and the combination of these two drugs .


Twenty-four hour CGM was performed before and after a single-day treatment with each drug alone or in combination .


Mean glucose levels were decreased in all groups .


The average of three postprandial glucose excursions AUC ( average of all three 4-h postprandial periods throughout the day ) ( AUCpp-average ) decreased in the mitiglinide and combination treatment groups , but not in the sitagliptin group .


The lowering effect on AUCpp-average was greater in patients given mitiglinide ( -47 mg/dl , p < 0.001 ) or combination treatment ( -66 mg/dl , p < 0.001 ) compared with sitagliptin alone ( -18 mg/dl ) .


The reduction in mean amplitude of glycemic excursion was greater with mitiglinide ( -29.3 mg/dl , p < 0.001 ) and combination treatment ( -28.3 mg/dl , p < 0.01 ) than with sitagliptin alone ( -8.9 mg/dl ) .


Mitiglinide or combination treatment resulted in lower glycemic variability and postprandial glucose excursion than sitagliptin alone ; however , the results of this single-day pharmacodynamics study can not be generalized to a clinical setting .


Patients undergoing coronary bypass grafting ( CABG ) are at higher risk if they suffer from atrial fibrillation ( AF ) .


It was suggested that performing CABG without the use of cardiopulmonary bypass ( off-pump ) would reduce perioperative risk .


We assessed the influence of preoperative AF on outcome in a randomized cohort of patients above the age of 75 undergoing either on-pump or off-pump CABG .


The German Off-Pump Coronary Artery Bypass grafting in the Elderly trial , a randomized , controlled multicentre trial conducted at 12 German institutions , enrolled 2303 patients between 2008 and 2011 .


The presence of AF was recorded at admission and discharge .


There was no record on the rhythm status during hospital stay .


AF at admission was present in 5 % in the on-pump ( 121/1158 ) and 5 % in the off-pump ( 112/1145 ) group .


The number of patients with AF at discharge was not different between these two groups ( 10 % on pump , 10 % off pump ) .


As expected , AF patients had worse preoperative conditions , which had a negative impact on outcome : The combined end-point of death , infarction , stroke , dialysis and revascularization occurred more often ( 13 vs 8 % , P = 0.008 ) and 30-day mortality was significantly higher ( 6 vs 2 % , P = 0.003 ) in AF patients .


However , the operative technique used for CABG did not affect these outcome parameters .


AF at admission is a significant risk factor for elderly patients undergoing coronary bypass grafting .


However , this risk is not altered by performing bypass grafting off pump .


The purpose is to determine whether patching during carotid endarterectomy ( CEA ) affects the perioperative and long-term risks of restenosis , stroke , death , and myocardial infarction as compared with primary closure .


We identified all patients who were randomized and underwent CEA in Carotid Revascularization Endarterectomy versus Stenting Trial .


CEA patients who received a patch were compared with patients who underwent CEA with primary closure without a patch .


We compared periprocedural and 4-year event rates , 2-year restenosis rates , and rates of reoperation between the 2 groups .


We further analyzed results by surgeon specialty .


There were 1151 patients who underwent CEA ( 753 [ 65 % ] with patch and 329 [ 29 % ] with primary closure ) .


We excluded 44 patients who underwent eversion CEA and 25 patients missing CEA data ( 5 % ) .


Patch use differed by surgeon specialty : 89 % of vascular surgeons , 6 % of neurosurgeons , and 76 % of thoracic surgeons patched .


Comparing patients who received a patch versus those who did not , there was a significant reduction in the 2-year risk of restenosis , and this persisted after adjustment by surgeon specialty ( hazard ratio , 0.35 ; 95 % confidence interval , 0.16-0 .74 ; P = 0.006 ) .


There were no significant differences in the rates of periprocedural stroke and death ( hazard ratio , 1.58 ; 95 % confidence interval , 0.33-7 .58 ; P = 0.57 ) , in immediate reoperation ( hazard ratio , 0.6 ; 95 % confidence interval , 0.16-2 .27 ; P = 0.45 ) , or in the 4-year risk of ipsilateral stroke ( hazard ratio , 1.23 ; 95 % confidence interval , 0.42-3 .63 ; P = 0.71 ) .


Patch closure in CEA is associated with reduction in restenosis although it is not associated with improved clinical outcomes .


Thus , more widespread use of patching should be considered to improve long-term durability .


http://www.clinicaltrials.gov .


Unique identifier : NCT00004732 .


Both acute myocardial ischemia and reperfusion contribute to cardiomyocyte death in ST-elevation myocardial infarction ( STEMI ) .


The final infarct size is the principal determinant of subsequent clinical outcome in STEMI patients .


In a proof-of-concept phase II trial , the administration of cyclosporine prior to primary percutaneous coronary intervention ( PPCI ) has been associated with a reduction of infarct size in STEMI patients .


CIRCUS is an international , prospective , multicenter , randomized , double-blinded , placebo-controlled trial .


The study is designed to compare the efficacy and safety of cyclosporine versus placebo , in addition to revascularization by PPCI , in patients presenting with acute anterior myocardial infarction within 12 hours of symptoms onset and initial TIMI flow 1 in the culprit left anterior descending coronary artery .


Patients are randomized in a 1:1 fashion to 2.5 mg/kg intravenous infusion of cyclosporine or matching placebo performed in the minutes preceding PCI .


The primary efficacy end point of CIRCUS is a composite of 1-year all-cause mortality , rehospitalization for heart failure or heart failure worsening during initial hospitalization , and left ventricular adverse remodeling as determined by sequential transthoracic echochardiography .


Secondary outcomes will be tested using a hierarchical sequence of left ventricular ( LV ) ejection fraction and absolute measurements of LV volumes .


The composite of death and rehospitalization for heart failure or heart failure worsening during initial hospitalization will be further assessed at three years after the initial infarction .


Recruitment lasted from April 2011 to February 2014 .


The CIRCUS trial has recruited 975 patients with acute anterior myocardial infarction .


The 12-months results are expected to be available in 2015 .


The CIRCUS trial is testing the hypothesis that cyclosporine in addition to early revascularization with PPCI compared to placebo in patients with acute anterior myocardial infarction reduces the incidence of death , heart failure and adverse LV remodeling at one-year follow-up .


Patients with frequent asthma exacerbations resulting in emergency department ( ED ) visits are at increased risk for future exacerbations .


We examined the ability of 1 dose of benralizumab , an investigational antiinterleukin 5 receptor monoclonal antibody , to reduce recurrence after acute asthma exacerbations .


In this randomized , double-blind , placebo-controlled study , eligible subjects presented to the ED with an asthma exacerbation , had partial response to treatment , and greater than or equal to 1 additional exacerbation within the previous year .


Subjects received 1 intravenous infusion of placebo ( n = 38 ) or benralizumab ( 0.3 mg/kg , n = 36 or 1.0 mg/kg , n = 36 ) added to outpatient management .


The primary outcome was the proportion of subjects with greater than or equal to 1 exacerbation at 12 weeks in placebo vs the combined benralizumab groups .


Other outcomes included the time-weighted rate of exacerbations at week 12 , adverse events , blood eosinophil counts , asthma symptom changes , and health care resource utilization .


The proportion of subjects with greater than or equal to 1 asthma exacerbation at 12 weeks was not different between placebo and the combined benralizumab groups ( 38.9 % vs 33.3 % ; P = .67 ) .


However , compared with placebo , benralizumab reduced asthma exacerbation rates by 49 % ( 3.59 vs 1.82 ; P = .01 ) and exacerbations resulting in hospitalization by 60 % ( 1.62 vs 0.65 ; P = .02 ) in the combined groups .


Benralizumab reduced blood eosinophil counts but did not affect other outcomes , while demonstrating an acceptable safety profile .


When added to usual care , 1 dose of benralizumab reduced the rate and severity of exacerbations experienced over 12 weeks by subjects who presented to the ED with acute asthma .


The aim was to study the impact of dietary intervention on the properties of paraffin-stimulated saliva , and on dental caries .


At 7 months of age 1062 infants ( 540 intervention ; 522 controls ) started in the prospective , randomized Special Turku Intervention Project ( STRIP ) aimed at restricting the child 's saturated fat and cholesterol intake to prevent atherosclerosis of adult age ( www.clinicaltrials.gov NCT 00223600 ) .


At 3 years of age , every fifth child was invited to an oral sub-study , and 148 ( 78 boys ) children attended .


At 6 , 9 , 12 and 16 years of age 135 , 127 , 114 and 88 children were restudied , respectively .


Dietary intakes of carbohydrates , protein , saturated fat , calcium , phosphate , and fibre were regularly recorded using 4-day food records .


Height and weight were regularly monitored .


Paraffin-stimulated saliva samples were collected at 6 , 9 , 12 and 16 years of age , and analyzed for flow rate , buffer capacity , calcium , phosphate and proteins .


Dental health was recorded and expressed as d3mft/D3MFT , and as time of caries onset .


Dietary intakes of calcium , phosphate and fibre , and salivary flow rate increased with time in both groups ( p < 0.001 , GLM for repeated measures ) .


Fibre intake and salivary flow rate were higher in the intervention than in the control group ( p = 0.042 and p = 0.0394 , respectively , GLM for repeated measures ) .


There were no correlations between dietary intakes and salivary concentrations of calcium or phosphate .


Children who did not have caries experience ( d3mft/D3MFT = 0 ) during the entire follow-up had higher salivary calcium than those who had caries already at 3 years of age .


The association between salivary calcium and caries onset was significant up to 12 years of age .


Toothbrushing frequency was statistically significantly associated with caries-onset at ages 6 ( gamma statistic 0.457 , p = 0.046 ) and 12 years ( gamma statistic 0.473 , p = 0.019 ) .


The current long-term dietary intervention increased children 's paraffin-stimulated salivary flow rate .


The concentration of salivary calcium was directly correlated to dental health .


Higher salivary flow rate in the intervention group is believed to be due to higher fibre intake in the intervention group .


Dulaglutide and liraglutide , both glucagon-like peptide-1 ( GLP-1 ) receptor agonists , improve glycaemic control and reduce weight in patients with type 2 diabetes .


In a head-to-head trial , we compared the safety and efficacy of once-weekly dulaglutide with that of once-daily liraglutide in metformin-treated patients with uncontrolled type 2 diabetes .


We did a phase 3 , randomised , open-label , parallel-group study at 62 sites in nine countries between June 20 , 2012 , and Nov 25 , 2013 .


Patients with inadequately controlled type 2 diabetes receiving metformin ( 1500 mg/day ) , aged 18 years or older , with glycated haemoglobin ( HbA1c ) 70 % or greater ( 53 mmol/mol ) and 100 % or lower ( 86 mmol/mol ) , and body-mass index 45 kg/m ( 2 ) or lower were randomly assigned to receive once-weekly dulaglutide ( 15 mg ) or once-daily liraglutide ( 18 mg ) .


Randomisation was done according to a computer-generated random sequence with an interactive voice response system .


Participants and investigators were not masked to treatment allocation .


The primary outcome was non-inferiority ( margin 04 % ) of dulaglutide compared with liraglutide for change in HbA1c ( least-squares mean change from baseline ) at 26 weeks .


Safety data were collected for a further 4 weeks ' follow-up .


Analysis was by intention to treat .


This study is registered with ClinicalTrials.gov , number NCT01624259 .


We randomly assigned 599 patients to receive once-weekly dulaglutide ( 299 patients ) or once-daily liraglutide ( 300 patients ) .


269 participants in each group completed treatment at week 26 .


Least-squares mean reduction in HbA1c was -142 % ( SE 005 ) in the dulaglutide group and -136 % ( 005 ) in the liraglutide group .


Mean treatment difference in HbA1c was -006 % ( 95 % CI -019 to 007 , pnon-inferiority < 00001 ) between the two groups .


The most common gastrointestinal adverse events were nausea ( 61 [ 20 % ] in dulaglutide group vs 54 [ 18 % ] in liraglutide group ) , diarrhoea ( 36 [ 12 % ] vs 36 [ 12 % ] ) , dyspepsia ( 24 [ 8 % ] vs 18 [ 6 % ] ) , and vomiting ( 21 [ 7 % ] vs 25 [ 8 % ] ) , with similar rates of study or study drug discontinuation because of adverse events between the two groups ( 18 [ 6 % ] in each group ) .


The hypoglycaemia rate was 034 ( SE 144 ) and 052 ( 301 ) events per patient per year , respectively , and no severe hypoglycaemia was reported .


Once-weekly dulaglutide is non-inferior to once-daily liraglutide for least-squares mean reduction in HbA1c , with a similar safety and tolerability profile .


Eli Lilly and Company .


Intense physical exercise provoke muscle damage , that in sedentary people can increase cardiovascular risk .


Phlebodium decumanum ( PD ) has shown to have immunomodulator effects in models of moderate intense physical activities in well conditioned groups .


To evaluate the PD effects during eccentric exercise , as a model of muscle inflammation protocol , on a sedentary population with cardiovascular risk .


This is an experimental , double-blind , multigroup randomized study .


Experimental Group 1 ( n = 17 ) received PD , 9 doses of 400 mg ( total amount 3.6 g ) every 8 hours during 3 days , and Control Group 2 ( n = 16 ) received a placebo .


All the subjects performed two treadmill ergoespirometry tests : first , a modified Bruce protocol to discard ischemic responses during exercise and to evaluate VO2max before the experimental phase ; and second , with an eccentric protocol ( 14 % descending ramp test ) during 10 minutes in stable state at 70-80 % VO2max , as experimental inflammatory protocol.We compared intra and inter groups to evaluate differences in the pre and post-test differences results on blood muscle damage variables .


The study shown statistically significant differences in all pre-post intra-groups results in muscle damage variables ( CK , LDH and Myoglobin , but not in Cardiac Troponin ) , and in functional lower-limb test ( SJand CMJ ) .


The comparison of inter-group results shown less muscle damage and less functional lower-limb deterioration in Group 1 compared with Control group , with statistical significance in both cases .


Differences in handgrip dynamometry were no statistically significant .


The eccentric exercise protocol in that study has proven to be a good model to induce muscle and functional damage in sedentary people .


Short PD treatment has shown to reduce muscle and functional acute damages compared with placebo control group in this specific population .


Stair climbing is a challenging task to the elderly being the task with the first complaint in patients with mild to moderate knee osteoarthritis .


Stair climbing results in around six times more compressive load transmitted through the knee joint than walking on level ground .


The purpose of this study was to assess whether lateral wedge insoles would reduce medial compartment knee loading when ascending and descending stairs in patients with medial knee osteoarthritis .


Eight patients with medial knee osteoarthritis were tested in random order with and without a pair of 5 off-the-shelf lateral wedge insoles for two separate activities ( stair ascent and stair descent ) .


Kinematic and kinetic data were collected for the lower extremity using a sixteen camera motion capture system and two force plates .


Primary outcome measures were the external knee adduction moment and the knee adduction angular impulse .


During stair ascent and descent , lateral wedge insoles significantly ( P < 0.05 ) reduced the 1st peak external knee adduction moment in early stance ( ascent 6.8 % , descent 8.4 % ) , the trough in mid stance ( ascent 13 % , descent 10.7 % ) , 2nd peak in the late stance ( ascent 15 % , descent 8.3 % ) and the knee adduction angular impulse compared to the control ( standard shoe ) with large effect sizes ( 0.75-0 .95 ) .


In this first study on stairs , lateral wedge insoles consistently reduced the overall magnitude of medial compartment loading during stair ascent and descent .


Further research is needed to determine the relationship of this with clinical results when ascending and descending stairs with lateral wedge insoles .


Previous studies have shown that in psychotherapy alliance is a predictor of symptomatic change , even while accounting for the temporal precedence between alliance and symptoms .


However , the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result , rather than the cause , of symptomatic change .


The current prospective study examined whether the alliance predicts outcomes in psychopharmacology , while controlling for previous symptomatic change throughout the course of treatment .


Data from a psychopharmacological randomized controlled trial for the treatment of adult major depression ( n = 42 ) , including the patients ' rating of the alliance with the physicians , were analyzed .


Multilevel models controlling for autoregressive lag of the dependent variable were used in all analyses to examine the effect of alliance on outcome .


The effect of alliance on outcome , while controlling for prior symptomatic levels , was significant and restricted to the middle phase of treatment ( week 4 , p = 0.005 ) , when most of the reductions in symptoms were observed .


Exploratory analyses of the differences between placebo and medication conditions suggest that the differences between the patients in their average alliance levels predicted a greater reduction in symptoms in the placebo compared to the medication conditions ( p = 0.008 ) .


The main limitation is the small cohort size .


The findings suggest an effect of alliance on outcome in psychopharmacology , which is not merely the result of previous symptomatic levels .


This effect may be more robust in conditions that do not include active treatment ( placebo ) , possibly serving as a compensatory effect .


To assess tear cytokine levels and clinical outcomes in moderate and severe meibomian gland dysfunction ( MGD ) after 2 months of treatment with topical loteprednol etabonate and eyelid scrubs with warm compresses vs eyelid scrubs with warm compresses alone .


Randomized controlled trial .


Patients with moderate and severe MGD were randomized into 2 groups : topical loteprednol etabonate and eyelid scrubs with warm compresses ( Group I , 34 eyes ) or eyelid scrubs with warm compresses ( Group II , 36 eyes ) .


We evaluated cytokine levels , tear film break-up time ( TBUT ) , corneal and conjunctival fluorescein staining , biomicroscopic examination of lid margins and meibomian glands , and the Ocular Surface Disease Index before initiating treatment and 1 month and 2 months after treatment .


There were significant decreases in the levels of interleukin ( IL ) -6 , IL-8 , and IL-1 in Group I , and IL-6 and IL-8 in Group II .


Moreover , the observed decreases of these cytokines in Group I were attributed to a remarkable decrease between treatment and 1 month after treatment .


In Group I , there were improvements in all of the clinical outcomes , with prominent improvement in TBUT , corneal and conjunctival fluorescein staining , and meibum quality after 1 month of treatment , compared with Group II .


An improvement in meibomian gland expressibility and MGD stage reduction were more remarkable in Group I.


Topical loteprednol etabonate and eyelid scrubs with warm compresses were tolerated and efficacious for the treatment of moderate and severe MGD .


We suggest that such beneficial effects could manifest after 1 month .


Women with primary ovarian insufficiency have significantly lower serum estradiol and T levels compared with regularly menstruating women .


They also have significantly reduced bone mineral density ( BMD ) .


The objective of the study was to evaluate the efficacy of hormone replacement in maintaining BMD in these young women .


This was a randomized , double-blind , single-center , placebo-controlled clinical trial at the National Institutes of Health clinical center ( Bethesda , Maryland ) .


Young women with primary ovarian insufficiency participated in the study .


We compared the effect of estradiol and progestin replacement ( n = 72 ) vs estradiol , progestin , and T replacement ( n = 73 ) on BMD .


We also compared findings with a contemporaneous control group of normal women ( n = 70 ) .


All patients received transdermal estradiol ( 100 g/d ) plus oral medroxyprogesterone acetate 10 mg/d ( 12 d/mo ) for a 3-month run-in period before being randomized in a double-blinded fashion to the addition of transdermal T ( 150 g/d ) or placebo .


Change in BMD at the femoral neck was measured by dual-energy x-ray absorptiometry .


At screening , patients had significantly lower femoral neck BMD compared with control women ( 0.77 vs 0.81 g/cm ( 2 ) , P = .001 ) and did not differ in body mass index , age at menarche , or education level .


Normal control women lost femoral neck BMD over the study period , whereas patients on estradiol and progestin therapy gained BMD ; and at the end of the study period , femoral neck BMD of patients on estradiol and progestin therapy did not differ from that of control women ( 0.80 g/cm ( 2 ) in both groups , P = .9 ) .


The addition of T showed no further benefit ( percentage change in BMD 3.9 vs 2.4 , respectively , P = .9 ) .


Nonetheless , using a repeated-measures model , the T group achieved a mean BMD in the femoral neck 0.015 g/cm ( 2 ) higher than the placebo group at 3 years ( 95 % confidence interval -0.005 to 0.034 , P = .13 ) .


Similar findings were observed in the lumbar spine BMD as well .


Long-term physiological transdermal estradiol replacement in combination with oral medroxyprogesterone acetate restores mean femoral neck BMD to normal in young women with spontaneous 46 , XX primary ovarian insufficiency .


However , the addition of physiological transdermal T replacement did not provide additional benefit .


Medical education today frequently includes standardized patient ( SP ) encounters to teach history-taking , physical exam , and communication skills .


However , traditional wall-mounted cameras , used to record video for faculty and student feedback and evaluation , provide a limited view of key nonverbal communication behaviors during clinical encounters .


In 2013 , 30 second-year medical students participated in an end-of-life module that included SP encounters in which the SPs used Google Glass to record their first-person perspective .


Students reviewed the Google Glass video and traditional videos and then completed a postencounter , self-evaluation survey and a follow-up survey about the experience .


Google Glass was used successfully to record 30 student/SP encounters .


One temporary Google Glass hardware failure was observed .


Of the 30 students , 7 ( 23 % ) reported a `` positive , nondistracting experience '' ; 11 ( 37 % ) a `` positive , initially distracting experience '' ; 5 ( 17 % ) a `` neutral experience '' ; and 3 ( 10 % ) a `` negative experience . ''


Four students ( 13 % ) opted to withhold judgment until they reviewed the videos but reported Google Glass as `` distracting . ''


According to follow-up survey responses , 16 students ( of 23 ; 70 % ) found Google Glass `` worth including in the [ clinical skills program ] , '' whereas 7 ( 30 % ) did not .


Google Glass can be used to video record students during SP encounters and provides a novel perspective for the analysis and evaluation of their interpersonal communication skills and nonverbal behaviors .


Next steps include a larger , more rigorous comparison of Google Glass versus traditional videos and expanded use of this technology in other aspects of the clinical skills training program .


Metabolic syndrome ( MetS ) has become an important public concern due to its increasing prevalence .


An altered fatty acid composition has been associated with MetS , but the Mediterranean diet has been shown to have a protective effect .


The aim of the present study was to analyze the influence of a Mediterranean dietary pattern , as assessed by the biomarkers of food supplied , on the plasma fatty acid composition and its relation with MetS after 1 year of intervention .


A total of 424 subjects were randomly selected from the PREDIMED randomized dietary trial after completing a 1-year intervention program .


Participants aged 55 to 80 years and at high risk of cardiovascular disease were randomly assigned to three dietary interventions : Mediterranean diet supplemented with virgin olive oil or nuts , or a low-fat diet .


After 1 year of intervention participants in the virgin olive oil group showed significantly increased plasma concentrations of palmitic and oleic acids , but reduced proportions of margaric , stearic , and linoleic acids .


In turn , subjects in the nut group showed significantly increased levels of palmitic , linoleic , and - linolenic acids , but reduced proportions of myristic , margaric , palmitoleic , and dihommo -- linoleic acids .


Increases in the biomarkers of foods supplied to the Mediterranean diet groups , i.e. , oleic and - linolenic acids , were beneficially associated with the incidence , reversion and prevalence of MetS .


No weight changes were observed among participants .


The nut and olive oil diets induced a fatty acid composition that has been shown to be beneficial in the face of MetS .


Therefore , a Mediterranean diet rich in fats of vegetable origin may be a useful tool for the management of MetS without the need for concerns over weight gain due to its high fat content .


Controlled-Trials .


com ISRCTN35739639 .


To assess the expediency of psychotherapy in patients with essential hypertension ( EH ) from clinical and economic standpoints .


Seventy-five ( 37 men , 38 women ) with grades 1-2 EH ( blood pressure ( BP ) was 140/90 to 179/109 mm Hg ) and the verified psychosomatic background of the disease ) were examined and randomized into 2 groups ( the mean age in Groups 1 and 2 was 48.5 3.69 and 47.5 4.2 years , respectively ) .


All the patients received medical therapy using the same regimen ; however , Group 1 patients had additionally psychotherapy .


The decrease in BP and the average number of visits required to reach goal BP were estimated as a criterion for therapeutic effectiveness .


A pharmacoeconomic analysis of antihypertensive therapy was made in each group .


The average cost for 24 weeks was 349.67 rbl per person in Group 1 and 435.9 rbl in Group 2 , which was 19.78 % cheaper .


The costs of reductions in systolic-BP ( SBP ) and diastolic BP ( DBP ) were also lower in Group 1 ( -22.108 and -39.534 rbl , respectively ) .


At the same time , goal BP was achieved more rapidly in Group 1 ( in Groups 1 and 2 , the reduction in SBP was 5.28 and 3.38 mm Hg weekly and that in DBP was 2.51 and 1.73 mm Hg weekly , respectively ) .


This makes it possible to lower a physicians ' load and to save timing budget ( p > 0.032 ) .


The treatment policy in Group 1 surpassed that in Group 2 in the rate of BP normalization and the number of required visits to a physician and showed significant economic benefits .


The Fas apoptotic pathway has been implicated in type 2 diabetes and cardiovascular disease .


Although a polymorphism ( rs7138803 ; G > A ) near the Fas apoptotic inhibitory molecule 2 ( FAIM2 ) locus has been related to obesity , its association with other cardiovascular risk factors and disease remains uncertain .


We analyzed the association between the FAIM2-rs7138803 polymorphism and obesity , blood pressure and heart rate in 7,161 participants ( 48.3 % with type 2 diabetes ) in the PREDIMED study at baseline .


We also explored gene-diet interactions with adherence to the Mediterranean diet ( MedDiet ) and examined the effects of the polymorphism on cardiovascular disease incidence per diabetes status after a median 4.8-year dietary intervention ( MedDiet versus control group ) follow-up .


We replicated the association between the FAIM2-rs7138803 polymorphism and greater obesity risk ( OR : 1.08 ; 95 % CI : 1.01-1 .16 ; P = 0.011 ; per-A allele ) .


Moreover , we detected novel associations of this polymorphism with higher diastolic blood pressure ( DBP ) and heart rate at baseline ( B = 1.07 ; 95 % CI : 0.97-1 .28 bmp in AA vs G-carriers for the whole population ) , that remained statistically significant even after adjustment for body mass index ( P = 0.012 ) and correction for multiple comparisons .


This association was greater and statistically significant in type-2 diabetic subjects ( B = 1.44 : 95 % CI : 0.23-2 .56 bmp ; P = 0.010 for AA versus G-carriers ) .


Likewise , these findings were also observed longitudinally over 5-year follow-up .


Nevertheless , we found no statistically significant gene-diet interactions with MedDiet for this trait .


On analyzing myocardial infarction risk , we detected a nominally significant ( P = 0.041 ) association in type-2 diabetic subjects ( HR : 1.86 ; 95 % CI :1.03 -3.37 for AA versus G-carriers ) , although this association did not remain statistically significant following correction for multiple comparisons .


We confirmed the FAIM2-rs7138803 relationship with obesity and identified novel and consistent associations with heart rate in particular in type 2 diabetic subjects .


Furthermore , our results suggest a possible association of this polymorphism with higher myocardial infarction risk in type-2 diabetic subjects , although this result needs to be replicated as it could represent a false positive .


Public health strategies to lower cardiovascular disease ( CVD ) risk involve reducing dietary saturated fatty acid ( SFA ) intake to 10 % of total energy ( % TE ) .


However , the optimal type of replacement fat is unclear .


We investigated the substitution of 9.5-9 .6 % TE dietary SFAs with either monounsaturated fatty acids ( MUFAs ) or n-6 ( -6 ) polyunsaturated fatty acids ( PUFAs ) on vascular function and other CVD risk factors .


In a randomized , controlled , single-blind , parallel-group dietary intervention , 195 men and women aged 21-60 y from the United Kingdom with moderate CVD risk ( 50 % above the population mean ) followed one of three 16-wk isoenergetic diets ( % TE target compositions , total fat : SFA : MUFA : n-6 PUFA ) that were rich in SFAs ( 36:17:11:4 , n = 65 ) , MUFAs ( 36:9:19:4 , n = 64 ) , or n-6 PUFAs ( 36:9:13:10 , n = 66 ) .


The primary outcome measure was flow-mediated dilatation ; secondary outcome measures included fasting serum lipids , microvascular reactivity , arterial stiffness , ambulatory blood pressure , and markers of insulin resistance , inflammation , and endothelial activation .


Replacing SFAs with MUFAs or n-6 PUFAs did not affect the percentage of flow-mediated dilatation ( primary endpoint ) or other measures of vascular reactivity .


Of the secondary outcome measures , substitution of SFAs with MUFAs attenuated the increase in night systolic blood pressure ( -4.9 mm Hg , P = 0.019 ) and reduced E-selectin ( -7.8 % , P = 0.012 ) .


Replacement with MUFAs or n-6 PUFAs lowered fasting serum total cholesterol ( -8.4 % and -9.2 % , respectively ) , low-density lipoprotein cholesterol ( -11.3 % and -13.6 % ) , and total cholesterol to high-density lipoprotein cholesterol ratio ( -5.6 % and -8.5 % ) ( P 0.001 ) .


These changes in low-density lipoprotein cholesterol equate to an estimated 17-20 % reduction in CVD mortality .


Substitution of 9.5-9 .6 % TE dietary SFAs with either MUFAs or n-6 PUFAs did not significantly affect the percentage of flow-mediated dilatation or other measures of vascular function .


However , the beneficial effects on serum lipid biomarkers , blood pressure , and E-selectin offer a potential public health strategy for CVD risk reduction .


This trial was registered at www.clinicaltrials.gov as NCT01478958 .


Tobacco and cannabis use are both highly prevalent worldwide .


Their co-use is also common in adults and adolescents .


Despite this frequent co-occurrence , cessation from both substances is rarely addressed in randomized clinical trials .


Given evidence that tobacco use may increase during cannabis cessation attempts , and additionally that tobacco users have poorer cannabis cessation outcomes , we explored tobacco outcomes , specifically cigarette smoking , from an adolescent cannabis cessation trial that tested the efficacy of N-acetylesteine ( NAC ) .


Cannabis-dependent adolescents ( ages 15-21 ; n = 116 ) interested in cannabis treatment were randomized to NAC ( 1200mg bid ) or matched placebo for 8 weeks .


Participants did not need to be cigarette smokers or be interested in smoking cessation to qualify for inclusion .


Approximately 59 % of enrolled participants were daily and non-daily cigarette smokers , and only differed from non-smoking participants on the compulsion sub-scale of the Marijuana Craving Questionnaire .


Among cigarette smokers who were retained in the study , there was no change in cigarettes per day for either NAC or placebo groups during the eight-week treatment phase .


Being a cigarette smoker did not appear to influence the effects of NAC on cannabis abstinence , though there was a trend in the placebo group of poorer cannabis outcomes for cigarette smokers vs. non-smokers .


No evidence was found of compensatory cigarette smoking during this cannabis cessation trial in adolescents .


Further work assessing interventions to reduce both cannabis and tobacco use in this population is greatly needed .


The aim was to develop a method for the purpose of localizing epilepsy related hemodynamic foci for patients suffering intractable focal epilepsy using task-free fMRI alone .


We studied three groups of subjects : patients with intractable focal epilepsy , healthy volunteers performing motor tasks , and healthy volunteers in resting state .


We performed spatial independent component analysis ( ICA ) on the fMRI alone data and developed a set of IC selection criteria to identify epilepsy related ICs .


The method was then tested in the two healthy groups .


In seven out of the nine surgery patients , identified ICs were concordant with surgical resection .


Our results were also consistent with presurgical evaluation of the remaining one patient without surgery and may explain why she was not suitable for resection treatment .


In the motor task study of ten healthy subjects , our method revealed components with concordant spatial and temporal features as expected from the unilateral motor tasks .


In the resting state study of seven healthy subjects , the method successfully rejected all components in four out of seven subjects as non-epilepsy related components .


These results suggest the lateralization and localization value of fMRI alone in presurgical evaluation for patients with intractable unilateral focal epilepsy .


The proposed method is noninvasive in nature and easy to implement .


It has the potential to be incorporated in current presurgical workup for treating intractable focal epilepsy patients .


In vitro studies rank walnuts ( Juglans regia ) among the plant foods high in antioxidant capacity , but whether the active constituents of walnuts are bioavailable to humans remains to be determined .


The intention of this study was to examine the acute effects of consuming walnuts compared to refined fat on meal induced oxidative stress .


At issue is whether the ellagitannins and tocopherols in walnuts are bioavailable and provide postprandial antioxidant protection .


A randomized , crossover , and controlled-feeding study was conducted to evaluate a walnut test meal compared to one composed of refined ingredients on postprandial serum antioxidants and biomarkers of oxidative status in healthy adults ( n = 16 ) with at least 1 week between testing sessions .


Following consumption of a low phenolic diet for one day and an overnight fast , blood was sampled prior to the test meals and at intervals up to 24 hours post ingestion and analyzed for total phenols , malondiadehyde ( MDA ) , oxidized LDL , ferric reducing antioxidant power ( FRAP ) , hydrophilic and lipophilic oxygen radical absorbance capacity ( ORAC ) , uric acid , catechins and urinary excretion of phenylacetate metabolites and of urolithin A.


Mixed linear models demonstrated a diet effect ( P < 0.001 ) for plasma - tocopherol but not for - tocopherol with the walnut meal .


Following the walnut test meal , the incremental 5 hour area under the curve ( AUC ( 0-5h ) ) was reduced 7.4 % for MDA , increased 7.5 % for hydrophilic and 8.5 % for lipophilic ORAC and comparable for total phenols , FRAP and uric acid .


Oxidized LDL was reduced at 2 hours after the walnut meal .


Plasma concentrations of gallocatechin gallate ( GCG ) , epicatechin gallate ( ECG ) and epicallocatechin gallate ( EGCG ) increased significantly at 1 hour after the walnut test meal .


Quantities of urolithin-A excreted in the urine were significantly higher following the walnut meal .


Compared to the refined control meal , the walnut meal acutely increased postprandial - tocopherol and catechins and attenuated some measures of oxidative stress .


Observational studies have indicated that differences in the composition of human milk and infant formula yield benefits in cognitive development and early growth for breastfed infants .


The objective was to test the hypothesis that feeding an infant formula with reduced energy and protein densities and supplemented with bovine milk fat globule membrane ( MFGM ) reduces differences in cognitive development and early growth between formula-fed and breastfed infants .


In a prospective , double-blind , randomized controlled trial , 160 infants < 2 mo of age were randomly assigned to be fed an MFGM-supplemented , low-energy , low-protein experimental formula ( EF ) or a standard formula ( SF ) until 6 mo of age .


The energy and protein contents of the EF and SF were 60 and 66 kcal/100 mL and 1.20 and 1.27 g/100 mL , respectively .


A breastfed reference ( BFR ) group consisted of 80 infants .


At 12 mo of age , the cognitive score ( mean SD ) on testing with the Bayley Scales of Infant and Toddler Development , Third Edition , was significantly higher in the EF group than in the SF group ( 105.8 9.2 compared with 101.8 8.0 ; P = 0.008 ) but was not significantly different from that in the BFR group ( 106.4 9.5 ; P = 0.73 ) .


The EF group ingested larger volumes of formula than did the SF group ( 864 174 compared with 797 165 mL/d ; P = 0.022 ) , fully compensating for the lower energy density .


No significant differences in linear growth , weight gain , body mass index , percentage body fat , or head circumference were found between the EF and SF groups .


MFGM supplementation to infant formula narrows the gap in cognitive development between breastfed and formula-fed infants .


Between 2 and 6 mo of age , formula-fed term infants have the capacity to upregulate their ingested volumes when the energy density of formula is reduced from 66 to 60 kcal/100 mL .


We present the final results of the effect of lung cancer screening with low-dose CT on the smoking habits of participants in a 5-year screening trial .


The Danish Lung Cancer Screening Trial ( DLCST ) was a 5-year screening trial that enrolled 4104 subjects ; 2052 were randomised to annual low-dose CT ( CT group ) and 2052 received no intervention ( control group ) .


Participants were current and ex-smokers ( 4weeks abstinence from smoking ) with a tobacco consumption of 20 pack years .


Smoking habits were determined annually .


Missing values for smoking status at the final screening round were handled using two different models .


There were no statistically significant differences in annual smoking status between the CT group and control group .


Overall the ex-smoker rates ( CT + control group ) significantly increased from 24 % ( baseline ) to 37 % at year 5 of screening ( p < 0.001 ) .


The annual point prevalence quit rate increased from 11 % to 24 % during the five screening rounds ; the ex-smokers ' relapse rate remained stable , around 11 % , across the same period .


Screening with low-dose CT had no extra effect on smoking status compared with the control group , but overall the screening programme probably promoted smoking cessation .


The DLCST is registered in Clinical Trials.gov Protocol Registration System ( identification no .


NCT00496977 ) .


Data suggest that capnography is a more sensitive measure of ventilation than standard modalities and detects respiratory depression before hypoxemia occurs .


We sought to determine if adding capnography to standard monitoring during sedation of children increased the frequency of interventions for hypoventilation , and whether these interventions would decrease the frequency of oxygen desaturations .


We enrolled 154 children receiving procedural sedation in a pediatric emergency department .


All subjects received standard monitoring and capnography , but were randomized to whether staff could view the capnography monitor ( intervention ) or were blinded to it ( controls ) .


Primary outcome were the rate of interventions provided by staff for hypoventilation and the rate of oxygen desaturation less than 95 % .


Seventy-seven children were randomized to each group .


Forty-five percent had at least 1 episode of hypoventilation .


The rate of hypoventilation per minute was significantly higher among controls ( 7.1 % vs 1.0 % , P = .008 ) .


There were significantly fewer interventions in the intervention group than in the control group ( odds ratio , 0.25 ; 95 % confidence interval [ CI ] , 0.13-0 .50 ) .