While no ovicidal effect was observed , fluralaner exerted a larvicidal effect at exceptionally low concentrations ( 6.25 ng/mL ) .


In the simulated flea-infested home environment , flea-control efficacy on fluralaner-treated dogs was > 99 % at every time point measured for 12 weeks .


No adverse events were observed in fluralaner-treated dogs .


Fluralaner completely controls egg laying , larval development and flea reproduction even at sub-insecticidal concentrations .


Oral treatment of dogs with fluralaner is highly effective for eliminating fleas in a simulated flea-infested home environment .


It is difficult to improve negative symptoms and cognitive impairments in schizophrenia .


A previous pilot study has shown that minocycline , a semi-synthetic second-generation tetracycline , is effective in treating for negative and/or cognitive symptoms in schizophrenia .


The present study was designed to examine the efficacy and safety of minocycline for the treatment of negative symptoms and cognitive impairments in patients with schizophrenia .


Ninety-two patients with early stage schizophrenia treated with risperidone entered this 16-week , double blind , randomized , placebo-controlled clinical trial .


Subjects were randomly assigned to receive minocycline ( 200mg per day ) or the placebo .


The primary outcome was evaluated using the Scale for the Assessment of Negative Symptoms ( SANS ) .


Secondary outcomes included the response rate of SANS , the Positive and Negative Syndrome Scale ( PANSS ) , the Clinical Global Impression Scale ( CGI ) , and cognitive tests .


Subjects receiving minocycline had greater improvements on SANS total scores and PANSS negative subscale scores ( P < 0.001 ) when compared with those receiving the placebo .


Rates of treatment response ( 43.6 % ) in the minocycline group were significantly higher than those in the placebo group ( 10.0 % ) after 16weeks of treatment .


There was no significant difference between the seven cognitive domains ( P > 0.05 ) , except for the attention domain ( P = 0.044 ) .


The addition of minocycline to atypical antipsychotic drugs in early schizophrenia had significant efficacy on negative symptoms but had a slight effect on the attention domains of patients with schizophrenia .


It may be considered as a new adjunct treatment for negative symptoms of schizophrenia .


Clinical trials.gov identifier : NCT01493622 .


Advance care planning ( ACP ) provides patients with the ability to make their decisions known about how they would like to be treated if they lose capacity .


Medical practitioners have a key role to play in providing information on ACP to their patients .


This research explores their knowledge and attitudes to advance care planning and how this affects their practice .


The objective of this study is to assess the NSW medical practitioners ' knowledge and self-reported practice of ACP .


A postal survey of a random sample of 650 general practitioners plus 350 medical specialists from specialties most often involved in end-of-life decisions was conducted .


Respondents ' work location post codes were subsequently used to assign respondents to one of the eight NSW Area Health Services .


The main outcome measures were medical practitioners ' knowledge of and practice pertaining to ACP .


Thirty-four per cent of specialists ( n = 110 ) and 24 % of general practitioners ( n = 150 ) responded ; the majority of respondents had heard of all ACP options .


However , respondents ' understanding of the uses and legal requirements of the relevant ACP options vary widely .


Respect for patient wishes expressed in advance directives is reassuringly high .


The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons .


Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues .


Low response rate , relating to only one legal jurisdiction , means results may not be generalisable .


The aim of this single - blind , multicenter , parallel , randomized controlled trial was to evaluate the effectiveness of the application of a high-fluoride toothpaste on root caries in adults .


Adult patients ( n = 130 , = 74 , = 56 ; mean age SD : 56.9 12.9 ) from three participating centers , diagnosed with root caries , were randomly allocated into two groups : Test ( n = 64 , = 37 , = 27 ; lesions = 144 ; mean age : 59.0 12.1 ; intervention : high-fluoride toothpaste with 5000 ppm F ) , and Control ( n = 66 , = 37 , = 29 ; lesions = 160 ; mean age : 54.8 13.5 ; intervention : regular-fluoride toothpaste with 1350 ppm F ) groups .


Clinical examinations and surface hardness scoring of the carious lesions were performed for each subject at specified time intervals ( T0 - at baseline before intervention , T1 - at 3 months and T2 - at 6 months after intervention ) .


Mean surface hardness scores ( HS ) were calculated for each patient .


Statistical analyses comprised of two-way analysis of variance and post hoc comparisons using the Bonferroni-Dunn correction .


At T0 , there was no statistical difference between the two groups with regard to gender ( P = 0.0682 , unpaired t-test ) , or age ( P = 0.9786 , chi-squared test ) , and for the overall HS ( Test group : HS = 3.4 0.61 ;


HS = 3.4 0.66 ; P = 0.8757 , unpaired t-test ) .


The anova revealed significantly better HS for the test group than for the control groups ( T1 : Test group : HS = 2.9 0.67 ;


HS = 3.1 0.75 ; T2 : Test group : HS = 2.4 0.81 ;


HS = 2.8 0.79 ; P < 0.0001 ) .


However , the interaction term time-point * group was not significant .


The application of a high-fluoride containing dentifrice ( 5000 ppm F ) in adults , twice daily , significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing ( 1350 ppm F ) toothpastes .


Study on quality of life of asymptomatic HIV infected persons with traditional Chinese medical , which can provide the clinical basis for improving the quality of life .


This study applied a randomized , double-blind , and placeb-parallel control designed method to select 1 200 persons in the asymptomatic period of HIV infection as the subjects .


The subjects were randomly divided into the treatment group and the control group at the ratio of about 2:1 .


According to the results of monthly differential diagnosis of TCM , the test group and the control group were given homologue Chinese drugs preparations and model Chinese drugs .


The total study period was 18 months .


Using PRO scale and the world health organization AIDS determination of quality of life short scale form ( WHOQOL-HIV-BREF ) to investigate asymptomatic HIV infected persons , according to different times , we calculated the total score and each domain score of quality of life of the treatment group and control group , we did statistical analysis .


Form the PRO scale , we can see that the treatment group showed a trend of stability , compared with the control group with significant statistical difference ( P < 0.05 ) after 6 months ; from the WHOQOL-HIV scale analysis , we can see that compared with before treatment , the quality of life of the treatment group was increased , the difference was significant ( P < 0.05 ) , but the quality of life of the control quality of life was decreased , the differences was significant ( P < 0.05 ) .


Dialectical therapy of Chinese medicine can significantly improve the patient 's quality of life , which can provide the basis for the prevention and control policy formulation and implementation with asymptomatic HIV infected persons .


Molecular pathology tests are often carried for clinicopathological diagnosis and pathologists have established large collections of formalin-fixed , paraffin-embedded tissue ( FFPE ) banks .


However , extraction of DNA from FFPE is a laborious and challenging for researchers in clinical laboratories .


The aim of this study was to compare two widely used DNA extraction methods : using a QIAamp DNA FFPE kit from Qiagen and a Cobas Sample Preparation Kit from Roche , and evaluated the effect of the DNA quality on molecular diagnostics .


DNA from FFPE non-small cell lung carcinoma tissues including biopsy and surgical specimens was extracted with both QIAamp DNA FFPE and Cobas Sample Preparation Kits and EGFR mutations of non-small cell lung carcinomas were detected by real-time quantitative PCR using the extracted DNA .


Our results showed that DNA extracted by QIAamp and Cobas methods were both suitable to detect downstream EGFR mutation in surgical specimens .


Howover , Cobas method could yield more DNA from biopsy specimens , and gain much better EGFR mutation results .


Proximal attachment site complications continue to occur after endovascular repair of abdominal aortic aneurysms ( EVAR ) , specifically type Ia endoleak and endograft migration .


EndoAnchors ( Aptus Endosystems , Sunnyvale , Calif ) were designed to enhance endograft proximal fixation and sealing , and the current study was undertaken to evaluate the potential benefit of this treatment .


During the 23-month period ending in December 2013 , 319 subjects were enrolled at 43 sites in the United States and Europe .


EndoAnchors were implanted in 242 patients ( 75.9 % ) at the time of an initial EVAR procedure ( primary arm ) and in 77 patients with an existing endograft and proximal aortic neck complications ( revision arm ) .


Technical success was defined as deployment of the desired number of EndoAnchors , adequate penetration of the vessel wall , and absence of EndoAnchor fracture .


Procedural success was defined as technical success without a type Ia endoleak at completion angiography .


Values are expressed as mean standard deviation and interquartile range .


The 238 male ( 74.6 % ) and 81 female ( 25.4 % ) subjects had a mean age of 74.1 8.2 years .


Aneurysms averaged 58 13 ( 51-63 ) mm in diameter at the time of EndoAnchor implantation ( core laboratory measurements ) .


The proximal aortic neck averaged 16 13 ( 7-23 ) mm in length ( 42.7 % < 10mm and 42.7 % conical ) and 27 4mm ( 25-30mm ) in diameter ; infrarenal neck angulation was 24 15 ( 13-34 ) degrees .


The number of EndoAnchors deployed was 5.8 2.1 ( 4-7 ) .


Technical success was achieved in 303 patients ( 95.0 % ) and procedural success in 279 patients ( 87.5 % ) , 217 of 240 ( 89.7 % ) and 62 of 77 ( 80.5 % ) in the primary and revision arms , respectively .


There were 29 residual type Ia endoleaks ( 9.1 % ) at the end of the procedure .


During mean follow-up of 9.3 4.7 months , 301 patients ( 94.4 % ) were free from secondary procedures .


Among the 18 secondary procedures , eight were performed for residual type Ia endoleaks and the others were unrelated to EndoAnchors .


There were no open surgical conversions , there were no aneurysm-related deaths , and no aneurysm ruptured during follow-up .


Use of EndoAnchors to treat existing and acute type Ia endoleaks and endograft migration was successful in most cases .


Prophylactic use of EndoAnchors in patients with hostile aortic neck anatomy appears promising , but definitive conclusions must await longer term follow-up data .


Meals with a low glycemic index ( GI ) and rich in fiber could be beneficial with regard to postprandial metabolic profile and satiety .


The aim of this study was to investigate the effect of 4 breakfasts with a different GI and amount of fiber on postprandial plasma glucose , insulin , and appetite in patients with type 2 diabetes .


This randomized 4-intervention crossover trial included 14 patients [ 7 men ; ages 65.8 5.2 y ; glycated hemoglobin : 6.6 0.9 % ; BMI ( in kg/m ( 2 ) ) : 27.2 3.1 ] .


Dietary interventions were as follows : breakfasts with a high GI ( 60.4 0.1 % ) and high fiber ( 6.0 0.3 g ) ( HGI-HF ) , a high GI ( 60.9 1.7 % ) and low fiber ( 2.5 0.4 g ) ( HGI-LF ) , a low GI ( 37.7 0.1 % ) and high fiber ( 6.2 0.3 g ) ( LGI-HF ) , and a low GI ( 39.8 1.3 % ) and low fiber ( 2.0 0.1 g ) ( LGI-LF ) .


Plasma glucose , insulin , and total ghrelin were evaluated postprandially ( 0-180 min ) .


A visual analog scale was used to assess appetite .


Data were analyzed by generalized estimating equations and post hoc least significant difference ( LSD ) tests .


Data are reported as means SDs .


The area under the curve ( AUC ) [ mean ( 95 % CI ) ; P for LSD tests ] for plasma glucose ( mmol/L min ) was higher after patients consumed the HGI-LF breakfast [ 9.62 ( 8.39 , 10.84 ) ] than after the LGI-HF breakfast [ 8.95 ( 7.71 , 10.18 ) ] ( P 0.05 ) .


Insulin AUC ( IU/mL min ) after patients consumed the HGI-LF meal [ 65.72 ( 38.24 , 93.19 ) ] was higher than after the HGI-HF meal [ 57.24 ( 32.44 , 82.04 ) ] ( P 0.05 ) .


The other observed difference was higher insulin AUC after the consumption of the LGI-LF breakfast [ 61.54 ( 36.61 , 86.48 ) ] compared with the AUC after the LGI-HF breakfast [ 54.16 ( 31.43 , 76.88 ) ] ( P 0.05 ) .


Plasma ghrelin decreased in comparison with baseline only after patients consumed the LGI-HF and LGI-LF breakfasts ( P 0.05 ) .


Subjective satiety did not differ between breakfasts .


Plasma glucose , insulin , and ghrelin responses were least favorable when patients with type 2 diabetes consumed a breakfast with a high GI and low fiber , which suggests that reducing the GI or increasing the fiber content or both of breakfasts may be a useful strategy to improve the postprandial metabolic profile of these patients .


This trial was registered at clinicaltrials.gov as NCT01410292 .


To investigate the feasibility and effect of early removal of the urethral catheter after transurethral plasma kinetic resection of the prostate ( PKRP ) in the treatment of benign prostatic hyperplasia ( BPH ) .


We equally randomized 128 BPH patients treated by PKRP to an experimental group and a control group , urethral catheters removed at 1 -2 days for the former and at 5 -7 days for the latter .


We compared the relevant indexes and clinical effects between the two groups .


The baseline data were not significantly different between the two groups .


Compared with the controls , the experimental group showed a significantly shorter postoperative hospital stay ( [ 6.8 + / - 1.9 ] d vs [ 3.7 + / - 1.5 ] d , P < 0.05 ) and lower infection rate ( 25.0 % vs 10.9 % , P < 0.05 ) .


All the patients were followed up for 3 -6 months postoperatively .


At 3 months after surgery , both the experimental and the control groups showed remarkable improvement in the International Prostatic Symptoms Scores ( 4.9 + / - 2.2 vs 5.3 + / - 2.3 ) , maximum urine flow rate ( [ 21.5 + / - 5.6 ] ml/s vs [ 19.1 + / -4.9 ] ml/s ) , and residual urine ( [ 16.8 + / - 10.3 ] ml vs [ 18.9 + / - 12.3 ] ml ) , but with no significant differences between the two ( P > 0.05 ) , and no significant differences were observed in postoperative complications ( P > 0.05 ) .


Early removal of the urethral catheter after PKRP , with its advantages of shorter postoperative hospital stay , lower infection rate , and no influence on the long-term effect , deserves to be recommended as a routine method in the treatment of BPH .


No previous studies have validated the use of portable monitoring ( PM ) for the diagnosis of obstructive sleep apnea ( OSA ) in morbidly obese individuals .


Our aim was to investigate the accuracy of PM for detecting respiratory events in morbidly obese patients that will be undergoing bariatric surgery .


This was a prospective study involving patients with body mass index ( BMI ) 35 kg/m ( 2 ) who were recruited from the Sleep Clinic of Universidade Federal de So Paulo .


Sleep-disordered breathing ( SDB ) was evaluated during full-night polysomnography ( PSG ) .


PM use was randomized and used on two consecutive nights : ( 1 ) at home ( STDHome ) and ( 2 ) at the sleep laboratory with PSG ( PSG_STDLab ) .


Although 58 participants initially underwent the recordings , 26 ( 45 % ) were excluded because of technical problems .


The patients ' mean age was 42.910.9 ( SD ) years , and 56 % were female .


The mean BMI was 40.85.2 kg/m ( 2 ) .


All patients had high risk for OSA , as defined by the Stop-Bang questionnaire , and the mean apnea-hypopnea index ( AHI ) was 46.930.4 / h.


The intraclass coefficient of the correlation between AHI_PSG and AHI_STDLab was r = 0.92 ( p = 0.0001 ) ; the intraclass coefficient for AHI_PSG and AHI_STDHome was r = 0.84 ( p = 0.0001 ) .


The Kappa index was 0.87 ( p > 0.0001 ) for severe cases .


The sensitivity and the positive predictive value increased with the disease severity .


A Bland-Altman analysis showed good agreement between the investigated methods .


PM is an efficacious method for diagnosing OSA in obese patients who have a high clinical probability of the disease .


The method displays good sensitivity and specificity in severe cases ; nevertheless , the high rate of data loss must be taken into account .


There is evidence to support the use of lipid-based nutrient supplements ( LNSs ) to promote child growth and development in low-income countries , but there is also a concern regarding the safety of using iron-fortified products in malaria-endemic areas .


The objective of this study was to test the hypothesis that 6 - to 18-mo-old rural Malawian children receiving iron-containing ( 6 mg/d ) LNSs would not have excess morbidity compared with infants receiving no supplementation .


A randomized controlled trial allocated 840 children to receive daily supplementation with 54 g/d LNS with milk protein base ( milk-LNS ) , 54 g/d LNS with soy protein base ( soy-LNS ) , 71 g/d corn-soy blend ( CSB ) , or no supplementation from 6 to 18 mo of age .


Morbidity was compared using a non-inferiority margin set at 20 % excess morbidity in supplemented groups compared with the nonsupplemented group .


Baseline characteristics were similar across groups .


The proportion of days with febrile illness between 6 and 18 mo was 4.9 % , and there were no differences between the groups : 4.9 % ( 95 % CI : 4.3 , 5.5 % ) , 4.5 % ( 95 % CI : 3.9 , 5.1 % ) , 4.7 % ( 95 % CI : 4.1 , 5.3 % ) , and 5.5 % ( 95 % CI : 4.7-6 .3 % ) in the milk-LNS , soy-LNS , CSB , and control groups , respectively .


The proportion of days with respiratory problems and diarrhea between 6 and 18 mo also did not differ between groups .


Compared with controls , the incident rate ratio ( 95 % CI ) for clinical malaria was 0.80 ( 0.59 , 1.09 ) , 0.77 ( 0.56 , 1.06 ) , and 0.79 ( 0.58 , 1.08 ) in milk-LNS , soy-LNS , and CSB , respectively , with 95 % CIs confirming non-inferiority .


The incidence of febrile episodes , diarrhea , respiratory problems or admission to hospital , prevalence of malaria parasitemia throughout the follow-up , and mean change in hemoglobin concentration from baseline were also similar between the groups .


Daily supplementation with 54 g of milk-based or soy protein-based LNS or 71 g of CSB did not result in increases in malaria or respiratory morbidity in children in a malaria-endemic setting .


However , we could not conclude whether LNSs did or did not increase diarrheal morbidity .


This trial was registered at clinicaltrials.gov as NCT00524446 .


To investigate the rate of operative success in excision of nonpalpable lymph nodes with metastatic disease achieved with radioguided occult lesion localization ( ROLL ) and intraoperative ultrasonography ( IOUS ) in patients with papillary thyroid cancer ( PTC ) .


Twenty consecutive PTC patients with nonpalpable lymph nodes with metastatic disease localized in previously operated fields were randomized to receive ROLL ( n = 11 ) or IOUS ( n = 9 ) .


Nodes were excised along with adjacent soft tissue to accomplish a compartment-oriented dissection .


The duration of operation , rate of postoperative complications , pre - and postoperative serum thyroglobulin ( Tg ) levels , and the findings of postoperative neck ultrasonography and postablation scan were recorded in all patients .


Measures of operative success included a postoperative Tg level < 50 % of preoperative Tg level and no abnormal lesions on postoperative imaging .


Histopathologic examination confirmed the excision of all preoperatively identified metastatic nodes .


Additional nodes also were excised ( 2.3 3.3 per specimen in the ROLL group and 1.6 1.8 per specimen in the IOUS group ) , 23 % of which were metastatic .


No postoperative complications occurred in either group .


The duration of operation was similar in the 2 groups ( P = .4 ) .


Postoperative imaging confirmed the clearance of suspicious nodes in all patients .


The rate of operative success in ROLL and IOUS group were 100 % and 89 % , respectively .


In patients with recurrent PTC , a high rate of operative success in excision of nonpalpable metastatic lymph nodes was achieved by both ROLL and IOUS .


We recommend compartment-oriented dissection ; this approach may maximize the removal of metastatic nodes not identified by preoperative imaging .


Extensive blood loss after total knee arthroplasty ( TKA ) may be a potential problem since it leads to anaemia , increased need for transfusion and prolonged hospitalization .


Aim of this study was to investigate the effects of postoperative knee flexion after TKA on blood loss and the need for transfusion .


One hundred consecutive patients undergoing primary TKA from 2012 to 2013 were randomizely divided into two groups .


In one group , the knee was extended for the first 6 h after surgery , whereas in the other was flexed at 90 for the same time .


Two doses of endovenous tranexamic acid were administered in all subjects .


Patients were homogeneous for all the possible confounding factors .


Calculated blood loss was 846 197 ( ml ) in the flexion group and 1,242 228 ( ml ) in the extension group ( p < 0.05 ) .


Drop of haemoglobin levels at 24 h in the study group and the control group was 1.9 0.8 ( g/dl ) and 3.0 0.5 ( g/dl ) , respectively ( p < 0.01 ) .


Drop of haematocrit at 24 h was 4.5 0.2 ( % ) in the flexion group and 6.7 0.3 ( % ) in the extension group ( p < 0.05 ) .


Blood transfusion was necessary in 5 patients in the control group and was not necessary in any patient of the study group .


Average knee flexion at day 7 was 105 4 in the flexion group and 98 7 in the extension group .


Knee flexion at 90 after TKA , associated with the intraoperative use of tranexamic , acid is an effective method to reduce blood loss and the need for blood transfusion .


The routine use of the present protocol is effective in reducing social costs and length of hospitalization of TKA procedures .


Around 150,000 people each year attend hospitals in England due to self-harm , many of them more than once .


Over 5,000 people die by suicide each year in the UK , a quarter of them having attended hospital in the previous year because of self-harm .


Self-harm is a major identifiable risk factor for suicide .


People receive variable care at hospital ; many are not assessed for their psychological needs and little psychological therapy is offered .


Despite its frequent occurrence , we have no clear research evidence about how to reduce the repetition of self-harm .


Some people who have self-harmed show less active ways of solving problems , and brief problem-solving therapies are considered the most promising psychological treatments .


This is a pragmatic , individually randomised , controlled , feasibility study comparing interpersonal problem-solving therapy plus treatment-as-usual with treatment-as-usual alone , for adults attending a general hospital following self-harm .


A total of 60 participants will be randomised equally between the treatment arms , which will be balanced with respect to the type of most recent self-harm event , number of previous self-harm events , gender and age .


Feasibility objectives are as follows : a ) To establish and field test procedures for implementing the problem-solving intervention ; b ) To determine the feasibility and best method of participant recruitment and follow up ; c ) To assess therapeutic delivery ; d ) To assess the feasibility of obtaining the definitive trial 's primary and secondary outcomes ; e ) To assess the perceived burden and acceptability of obtaining the trial 's self-reported outcome data ; f ) To inform the sample size calculation for the definitive trial .


The results of this feasibility study will be used to determine the appropriateness of proceeding to a definitive trial and will allow us to design an achievable trial of interpersonal problem-solving therapy for adults who self-harm .


Current Controlled Trials ( ISRCTN54036115 ) .


To compare the efficacy and safety between liposome-paclitaxel plus carboplatin ( LPC ) and paclitaxel plus carboplatin ( PC ) as first-line treatment for advanced non-small cell lung cancer ( NSCLC ) .


Totally 54 chemotherapy-naive NSCLC patients were equally and randomly assigned into LPC group and PC group .


Liposome-paclitaxel was injected on D1 at a dosage of 175 mg/m ( 2 ) ; the same dose and administration with paclitaxel injection in the PC group for a maximum of 2 cycles .


The efficacy and adverse reactions after 2 cycles of chemotherapy were compared between these two groups .


The overall response rate ( CR+PR ) was 44.4 % in the LPC group and 33.3 % in the PC group after 2 cycles of chemotherapy respectively ( P = 0.577 ) .


In the LPC group and PC group , the incidences of myelodepression was 81.5 % and 63.0 % , respectively ( P = 0.080 ) , gastrointestinal toxicity was 96.3 % and 77.8 % respectively ( P = 0.100 ) , and allergic reactions was 0 and 11.1 % , respectively ( P = 0.000 ) .


The median time to progression was 6 months and 5 months , respectively ( P = 0.420 ) .


LPC group has the same efficacy with PC group and less adverse reactions than PC group .


The Trastuzumab for Gastric Cancer phase III trial demonstrated that combining trastuzumab with chemotherapy significantly improved overall survival compared with chemotherapy alone in HER2-positive advanced gastric or gastroesophageal junction cancer .


We report health-related quality of life ( HRQoL ) and quality-adjusted time without symptoms of disease or toxicity ( Q-TWiST ) results from this trial .


Patients were randomized to receive six cycles of chemotherapy given every 3 weeks ( capecitabine or fluorouracil , plus cisplatin ) either alone or combined with administration of trastuzumab every 3 weeks until disease progression .


At each clinical visit , HRQoL was assessed using two European Organization for Research and Treatment of Cancer quality of life questionnaires , QLQ-C30 and QLQ-STO22 .


Q-TWiST methodology was applied retrospectively using the clinical data and utility coefficients .


Trastuzumab plus chemotherapy prolonged time to 10 % definitive deterioration in all QLQ-C30 and QLQ-STO22 scores , including QLQ-C30 global health status versus chemotherapy alone , from 6.4 months to 10.2 months .


In addition , trastuzumab plus chemotherapy extended Q-TWiST by 2.42 months compared with chemotherapy alone .


Compared with chemotherapy alone , trastuzumab plus chemotherapy prolongs time to deterioration of HRQoL and increases quality-adjusted survival in patients with HER2-positive gastric or gastroesophageal junction cancer .


Verification of proper placement of an intravenous catheter may not always be simple .


We evaluated the auscultation technique for this purpose .


Twenty healthy volunteers were randomized for 18G catheter inserted intravenously either in the right ( 12 ) or left arm ( 8 ) , and subcutaneously in the opposite arm .


A standard stethoscope was placed over an area approximately 3 cm proximal to the tip of the catheter in the presumed direction of the vein to grade on a 0-6 scale the murmur heard by rapidly injecting 2 mL of NaCl 0.9 % solution .


The auscultation was evaluated by a blinded staff anesthesiologist .


All 20 intravenous injection were evaluated as flow murmurs , and were graded an average 5.65 ( 0.98 ) , whereas all 20 subcutaneous injections were evaluated as either crackles or no sound , and were graded an average 2.00 ( 1.38 ) , without negative results .


Sensitivity was calculated as 95 % .


Specificity and Kappa could not be calculated due to an empty false-positive group .


Being simple , handy and noninvasive , we recommend to use the auscultation technique for verification of the proper placement of an intravenous catheter when uncertain of its position .


Data obtained in our limited sample of healthy subjects need to be confirmed in the clinical setting .


Tai Chi is the Chinese traditional medicine exercise for mind-body health .


The objective of this study is to investigate the effect of Tai Chi Chuan ( TCC ) exercise on the proliferative and cytolytic/tumoricidal activities of peripheral blood mononuclear cells ( PBMCs ) in postsurgical non-small cell lung cancer ( NSCLC ) patients .


Patients ( n = 27 ) were randomly divided into the control group ( n = 13 ) and the TCC group ( n = 14 ) .


TCC group participated in Tai Chi 24-type exercise for 16weeks , 60-min every time , and three times a week .


Peripheral blood was collected and PBMCs isolated before and after the 16-week TCC , PBMC proliferation and co-culture of PBMCs with the NSCLC cell line A549 were performed for proliferation and cell cytolysis assays .


Analysis of NKT cells , NK cells , and CD123 + and CD11c + dendritic cells were also performed .


( 1 ) After 16-week of TCC , cell proliferation increased significantly as compared with the control .


( 2 ) PBMCs from the TCC group also demonstrated enhanced cytolytic/oncolytic activity against A549 cells .


( 3 ) Significant differences were also found in NK cell percentage at t = 16weeks , post-pre changes of NKT and DC11c between groups .


Regular Tai Chi exercise has the promise of enhancing PBMC proliferative and cytolytic activities in NSCLC patients .


Our results affirm the value of a future trial with a larger scale and longer duration for cancer survivors .


ChiCTR-TRC-11001404 .


Perimenopausal women can experience rapid bone loss at skeletal sites with both cortical and cancellous bone , increasing the prevalence of osteoporosis following menopause .


We conducted a 12-month randomized placebo-controlled trial evaluating the effects of alendronate 70 mg with 2800 IU cholecalciferol administered once per week for 12 months in comparison with placebo and cholecalciferol .


The primary end-point was the percentage change in the lumbar spine bone mineral density ( BMD ) from baseline to 12 months .


Secondary end-points were the change in BMD at the femoral neck and changes in biochemical markers of bone turnover .


Forty-five women were recruited to participate in the study .


Five subjects withdrew from the study before randomization for unrelated reasons .


Forty subjects were randomly allocated to the alendronate and placebo groups .


The mean lumbar spine MD in women treated with alendronate increased by 3.66 % ( mean paired difference , d = 0.032 ; 0.008 SE ) at 12 months , compared with a reduction of 3.33 % ( d = -0.030 ; 0.008 SE ) in the control group ( P < 0.001 ) .


In the femoral neck , the mean BMD in the alendronate group increased by 2.07 % ( d = 0.014 ; 0.009 SE ) at 12 months , compared with a reduction of 1.87 % ( d = -0.014 ; 0.008 SE ) in the control group ( P = 0.046 ) .


There were no differences in BMD between the alendronate and placebo groups at the total hip sites after 12 months .


At 12 months , both bone-specific alkaline phosphatase and urinary N-telopeptide were significantly reduced , by 37.79 % ( d = -9.90 ; 1.92 SE ) and 27.21 % ( d = -11.68 ; 4.80 SE ) respectively , in the alendronate group ; in the control group , these levels increased ( P < 0.001 ) .


Weekly treatment with alendronate 70 mg and cholecalciferol 2800 IU increases BMD and decreases bone turnover in perimenopausal women .


To evaluate the effect of body position on the cardiorespiratory indicators of preterm newborns receiving nasal continuous positive airway pressure ( CPAP ) .


Analytical , observational , prospective , cross-sectional , randomised crossover study was carried out on sixteen newborns that received nasal CPAP .


The infants had a mean gestational age of 29.7 2 weeks and birthweight of 1353 280 g. Cardiorespiratory indicators ( respiratory rate , heart rate and oxygen saturation ) were evaluated in each infant in the supine , prone and right and left lateral decubitus positions at intervals of 10 min over a period of 60 min .


The cardiorespiratory indicators were similar and within the normal range in the four decubitus positions .


There was no difference in respiratory or heart rate between body positions .


Although they showed desirable values , oxygen saturation was significantly lower in left lateral decubitus ( 96.6 1.7 % ) when compared to the supine ( 97.1 1.3 % ) and prone positions ( 97.4 1.1 % ) ( p = 0.00 ) and was also significantly lower in right lateral decubitus ( 96.9 1.4 % ) when compared to the prone position ( p = 0.00 ) .


We found no preferential decubitus position for preterm newborns receiving nasal CPAP , the supine position may be a choice , but the left and right lateral positions were less advantageous in terms of oxygen saturation .


General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others .


In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs ' role security and therapeutic commitment and , in addition , which professional related factors influenced the impact of the implementation programme .


In a cluster randomised controlled trial , 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group .


The tailored , multi-faceted programme included combined physician , organisation , and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs .


The control group was mailed the national guideline and patients received feedback letters .


Questionnaires were completed before and 12 months after start of the programme .


We performed linear multilevel regression analysis to evaluate effects of the implementation programme .


Participating GPs were predominantly male ( 63 % ) and had received very low levels of alcohol related education before start of the study ( 0.4 h ) .


The programme increased therapeutic commitment ( p = 0.005 ; 95 % - CI 0.13 - 0.73 ) but not role security ( p = 0.58 ; 95 % - CI -0.31 - 0.54 ) .


How important GPs thought it was to improve their care for problematic alcohol consumption , and the GPs ' reported proportion of patients asked about alcohol consumption at baseline , contributed to the effect of the programme on therapeutic commitment .


A tailored , multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs ' therapeutic commitment towards patients with alcohol-related problems , but failed to improve GPs ' role security .


How important GPs thought it was to improve their care for problematic alcohol consumption , and the GPs ' reported proportion of patients asked about alcohol consumption at baseline , both increased the impact of the programme on therapeutic commitment .


It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme , to see whether the programme is effective on short term but faded out on the longer term .


ClinicalTrials.gov Identifier : NCT00298220 .


Standardized training via simulation as an educational adjunct may lead to a more rapid and complete skill achievement .


The authors hypothesized that simulation training will also enhance performance in transesophageal echocardiography image acquisition among anesthesia residents .


A total of 42 clinical anesthesia residents were randomized to one of two groups : a control group , which received traditional didactic training , and a simulator group , whose training used a transesophageal echocardiography-mannequin simulator .


Each participating resident was directed to obtain 10 commonly used standard views on an anesthetized patient under attending supervision .


Each of the 10 selected echocardiographic views were evaluated on a grading scale of 0 to 10 , according to predetermined criteria .


The effect of the intervention was assessed by using a linear mixed model implemented in SAS 9.3 ( SAS Institute Inc. , Cary , NC ) .


Residents in the simulation group obtained significantly higher-quality images with a mean total image quality score of 83 ( 95 % CI , 74 to 92 ) versus the control group score of 67 ( 95 % CI , 58 to 76 ) ; P = 0.016 .


On average , 71 % ( 95 % CI , 58 to 85 ) of images acquired by each resident in the simulator group were acceptable for clinical use compared with 48 % ( 95 % CI , 35 to 62 ) in the control ; P = 0.021 .


Additionally , the mean difference in score between training groups was the greatest for the clinical anesthesia-1 residents ( difference 24 ; P = 0.031 ; n = 7 per group ) and for those with no previous transesophageal echocardiography experience ( difference 26 ; P = 0.005 ; simulator n = 13 ; control n = 11 ) .


Simulation-based transesophageal echocardiography education enhances image acquisition skills in anesthesiology residents .


To describe associations between total and regional body fat mass loss and reduction of systemic levels of inflammation ( C-reactive protein ( CRP ) and interleukin-6 ( IL-6 ) ) in obese , older adults with osteoarthritis ( OA ) , undergoing intentional weight loss .


Data come from a single-blind , 18-month , randomized controlled trial in adults ( age : 65.6 6.2 ; Body mass index ( BMI ) : 33.6 3.7 ) with knee OA .


Participants were randomized to diet-induced weight loss plus exercise ( D + E ; n = 150 ) , diet-induced weight loss-only ( D ; n = 149 ) , or exercise-only ( E ; n = 151 ) .


Total body and region-specific ( abdomen and thigh ) fat mass were measured at baseline and 18 months .


High-sensitivity CRP and IL-6 were measured at baseline , six and 18 months .


Intervention effects were assessed using mixed models and associations between inflammation and adiposity were compared using logistic and mixed linear regression models .


Intentional total body fat mass reduction was associated with significant reductions in log-adjusted CRP ( = 0.06 ( 95 % CI = 0.04 , 0.08 ) mg/L ) and IL-6 ( = 0.02 ( 95 % CI = 0.01 , 0.04 ) pg/mL ) .


Loss of abdominal fat volume was also associated with reduced inflammation , independent of total body fat mass ; although models containing measures of total adiposity yielded the best fit .


The odds of achieving clinically desirable levels of CRP ( < 3.0 mg/L ) and IL-6 ( < 2.5 pg/mL ) were 3.8 ( 95 % CI = 1.6 , 8.9 ) and 2.2 ( 95 % CI = 1.1 , 4.6 ) , respectively , with 5 % total weight and fat mass loss .


Achievement of clinically desirable levels of CRP and IL-6 more than double with intentional 5 % loss of total body weight and fat mass .


Global , rather than regional , measures of adiposity are better predictors of change in inflammatory burden .


NCT00381290 .


To explore the effect of cognitive behavioral therapy ( CBT ) in combination with systemic family therapy ( SFT ) on mild to moderate postpartum depression and sleep quality .


249 primiparous women with mild to moderate postpartum depression were recruited and randomly assigned to a control group ( n = 128 ) , which received conventional postpartum care , or to a psychological intervention group ( n = 121 ) , which received conventional postpartum care combined with psychological intervention .


The Edinburgh Postnatal Depression Scale ( EPDS ) and Pittsburgh Sleep Quality Index ( PSQI ) were employed to evaluate depression and sleep quality , respectively .


104 patients in the intervention group and 109 in the control group completed the study .


After intervention , the EPDS score , PSQI score , sleep quality score , sleep latency score , sleep duration score , habitual sleep efficiency score , sleep disturbance score , and daytime dysfunction score were significantly lower in the intervention group than in the control group .


The EPDS and PSQI scores of each group at different time points after intervention were markedly decreased compared with those before intervention , and the reduction in the intervention group was more evident than that in the control group .


CBT in combination with SFT can improve depression and sleep quality in patients with mild to moderate postpartum depression .


Cytomegalovirus ( CMV ) and Epstein-Barr virus ( EBV ) infections are a significant cause of morbidity and mortality in transplant recipients and are often transmitted from the donor organ .


In a pilot prospective , randomized , double-blinded , placebo-controlled trial , we studied whether 14 days of pretransplant donor treatment with valganciclovir ( valG ) versus placebo reduced donor-to-recipient transmission , making posttransplant recipient prophylaxis more effective in reducing EBV and CMV disease .


Seventeen D + R - donor-recipient pairs were enrolled : 7 and 10 donors were randomized to valG and placebo , respectively .


At study initiation , no donor had detectable CMV replication , five had EBV replication ( two in valG , three in placebo group ) : EBV replication was undetectable during valG treatment , but resumed on stopping valG .


Valganciclovir was tolerated without side effects or leukopenia .


All recipients received routine posttransplant viral prophylaxis with valG .


For recipients , viremia-free survival time , incidence , range , peak , and duration of CMV and EBV viremia were not significantly different between groups .


There was no disease in the valG group but two serious viral diseases occurred in the placebo group ( one CMV ; one EBV-related posttransplant lymphoproliferative disorder ) .


In the case of posttransplant lymphoproliferative disorder , the EBV DNA from the donor 's oral wash and the recipient 's lymphoid tissue biopsy had identical latent membrane protein 1 ( LMP-1 ) sequence variations from the reference EBV strain , making it highly probable that the recipient 's virus was of donor origin .


Based on this pilot trial , we recommend an adequately powered study to determine if pretransplant donor treatment with valG can reduce posttransplant CMV and EBV disease with merely routine posttransplant recipient viral prophylaxis .


To study the efficacy of traditional Thai massage ( TTM ) versus conventional physical therapy ( PT ) programs in treating muscle spasticity , functional ability , anxiety , depression , and quality of life ( QoL ) in Thai stroke patients .


This randomized controlled trial with a blinded assessor was carried out at the Department of Rehabilitation Medicine , Siriraj Hospital ( Bangkok , Thailand ) .


The study included 50 stroke ( onset 3 months ) outpatients experiencing spasticity at the elbow or knee muscles at a grade of 1 + on the modified Ashworth Scale who were 50 years old and able to communicate .


The subjects were randomly allocated to the treatment group receiving TTM ( 24 subjects ) or the control group receiving the PT program ( 26 subjects ) .


Both groups received treatment ( either TTM or PT ) twice a week for 6 weeks .


Spasticity grade , functional ability , anxiety , depression , and QoL were measured at Week 0 and Week 6 .


At Week 6 , the percentage of patients whose modified Ashworth Scale score had decreased by at least one grade was not statistically significant between the two groups .


Both TTM and PT groups experienced a significant increase in functional ability and QoL , but no difference was found between the groups .


Anxiety and depression scores showed a decreasing trend in the TTM group .


This preliminary report showed no evidence that TTM differed from the PT program in decreasing spasticity .


However , both interventions may relieve spasticity , increase functional ability , and improve QoL after 6 weeks .


Only TTM can decrease anxiety and depression scores .


Further studies with adequate sample size are necessary .


To investigate the effects of an active and a passive recovery protocol on physiological responses and performance between 2 heats in sprint cross-country skiing .


Ten elite male skiers ( 223 y , 1844 cm , 797 kg ) undertook 2 experimental test sessions that both consisted of 2 heats with 25 min between start of the first and second heats .


The heats were conducted as an 800-m time trial ( 6 , > 3.5 m/s , ~ 205 s ) and included measurements of oxygen uptake ( VO2 ) and accumulated oxygen deficit .


The active recovery trial involved 2 min standing/walking , 16 min jogging ( 58 % 5 % of VO2peak ) , and 3 min standing/walking .


The passive recovery trial involved 15 min sitting , 3 min walk/jog ( ~ 30 % of VO2peak ) , and 3 min standing/walking .


Blood lactate concentration and heart rate were monitored throughout the recovery periods .


The increased 800-m time between heat 1 and heat 2 was trivial after active recovery ( effect size [ ES ] = 0.1 , P = .64 ) and small after passive recovery ( ES = 0.4 , P = .14 ) .


The 1.2 % 2.1 % ( mean90 % CL ) difference between protocols was not significant ( ES = 0.3 , P = .3 ) .


In heat 2 , peak and average VO2 was increased after the active recovery protocol .


Neither passive recovery nor running at ~ 58 % of VO2peak between 2 heats changed performance significantly .


To examine the role of acupuncture in the treatment of diabetic painful neuropathy ( DPN ) using a single-blind , placebo-controlled RCT and to collect data that would be required in a future definitive study of the efficacy of acupuncture in DPN .


45 patients were allocated to receive a 10-week course either of real ( 53 % ) or sham ( 47 % ) acupuncture .


Five standardised acupuncture points on the lower limb of each leg were used in the study : LR3 , KI3 , SP6 , SP10 and ST36 .


Outcome measures included the Leeds Assessment of Neuropathic Symptoms and Signs ( LANSS ) scale , lower limb pain ( Visual Analogue Scale , VAS ) ; Sleep Problem Scale ( SPS ) ; Measure Yourself Medical Outcome Profile ( MYMOP ) ; 36-item Short Form 36 Health Survey and resting blood pressure ( BP ) .


Over the 10-week treatment period , small improvements were seen in VAS -15 ( -26 to -3.5 ) , MYMOP -0.89 ( -1.4 to -0.3 ) , SPS -2.5 ( -4.2 to -0.82 ) and resting diastolic BP -5.2 ( -10.4 to -0.14 ) in the true acupuncture group .


In contrast , there was little change in those receiving sham acupuncture .


A moderate treatment effect in favour of active acupuncture was detected in MYMOP scores -0.66 ( -0.96 to -0.35 ) but non-significant effect sizes in LANSS Pain Scale -0.37 ( -2.2 to 1.4 ) , resting diastolic BP -0.50 ( -3.0 to 1.99 ) and the SPS -0.51 ( -2.2 to 1.16 ) .


We have demonstrated the practicality and feasibility of acupuncture as an additional treatment for people with DPN .


The treatment was well tolerated with no appreciable side effects .


Larger randomised trials are needed to confirm the clinical and cost-effectiveness of acupuncture in the treatment of DPN .


ISRCTN number : 39740785 .


Hyaluronic acid ( HA ) fillers and poly-L-lactic acid ( PLA ) fillers are frequently used to correct facial wrinkles .


To compare the efficacy and safety of a novel injectable poly-L-lactic acid ( PLA ) filler and a well-studied biphasic HA filler for the treatment of moderate to severe nasolabial folds .


In this multicentre , randomized , evaluator-blinded , comparative study , subjects were randomized for injections with PLA or HA into both nasolabial folds .


Efficacy was determined by calculating the change in Wrinkle Severity Rating Scale ( WSRS ) relative to baseline .


Local safety was assessed by reported adverse events .


At week 24 , mean improvement in WSRS from baseline was 2.09 0.68 for the PLA side and 1.54 0.65 for the HA side .


Both injections were well tolerated , and the adverse reactions were mild and transient in most cases .


PLA provides noninferior efficacy compared with HA 6 months after being used to treat moderate to severe nasolabial folds .


To explore , using MRI , the disease-modifying effect of strontium ranelate ( SrRan ) treatment on cartilage volume loss ( CVL ) and bone marrow lesions ( BMLs ) in a subset of patients from a Phase III clinical trial in knee osteoarthritis ( OA ) ( SrRan Efficacy in Knee OsteoarthrItis triAl ( SEKOIA ) ) .


Patients with primary symptomatic knee OA were randomised to receive either SrRan 1g/day or 2g/day or placebo ( SEKOIA study ) .


A subset of these patients had MRIs at baseline , 12 , 24 and 36months to assess the knee cartilage volume and BMLs .


Missing values were imputed and the analyses were adjusted according to Bonferroni .


In this MRI subset , the distribution of patients ( modified intention-to-treat ; n = 330 ) was 113 , 105 and 112 for SrRan 1g/day , 2g/day and placebo , respectively .


The groups were fairly balanced at baseline regarding demographics , clinical symptoms or imaging characteristics .


Treatment with SrRan 2g/day significantly decreased CVL on the plateaus at 12 ( p = 0.002 ) and 36 ( p = 0.003 ) months compared with placebo .


Of note , in the medial femur and plateau , SrRan 1g/day , but not SrRan 2g/day , had more CVL than placebo .


In patients with BML in the medial compartment at baseline , the BML score at 36months was decreased in both treatment groups compared with the placebo group ( SrRan 1g/day , p = 0.002 and SrRan 2g/day p = 0.001 , respectively ) , and CVL significantly decreased with SrRan 2g/day ( p = 0.023 ) in the plateau compared with placebo .


In knee OA patients , treatment with SrRan 2g/day was found to have beneficial effects on structural changes by significantly reducing CVL in the plateau and BML progression in the medial compartment .


Relative adrenal insufficiency ( RAI ) has been reported as a predictor of mortality in septic patient ; however , its effects on mortality and outcomes for critically ill patients remain debatable .


The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation ( RSI ) and factors associated with the onset of RAI .


A prespecified ancillary study of KETASED , a randomized prospective multicenter trial , was conducted .


Three hundred ten patients who underwent RSI in an out-of-hospital setting had baseline cortisol and adrenocorticotropic hormone response test measurements within 24 hours of intensive care unit admission and were included .


The mean ( SD ) age was 55 ( 19 ) years , with a mean ( SD ) Sequential Organ Failure Assessment score of 9 ( 4 ) .


Two hundred forty-seven ( 69 % ) patients presented with RAI .


Baseline characteristics were similar between patients with and without RAI , except for the use of etomidate as a sedative agent ( 63 % of patients with RAI vs 21 % , P < .001 ) , and history of chronic kidney disease .


There was no difference in terms of 28-day mortality between the 2 groups ( 21 % vs 19 % , P = .65 ) and in terms of other 28-day prognosis end points .


In critically ill patients who require RSI , RAI is common and is not associated with worsened outcomes in our cohort .


The aim of the present study was to evaluate the effect of Erythrinamu lungu on the control of dental anxiety in patients who had under gone bilateral extraction of asymptomatic , impacted mandibular third molars .


In a randomized , double-blind , crossover study , 30 healthy volunteers ( 5 men and 25 women , over 18 years of age ) , received either 500mg of E.mulungu ( MulunguMatusa ) or 500 mg of placebo , p.o. , one hour before surgical procedure .


The level ofanxiety was assessed through questionnaire sand physical parameters , such as blood pressure , heart rate andoxygen saturation .


Data were analyzed by Chi-square test , ANOVA ( Tukey test ) and Friedman with significance level of 5 % .


A higher preference ( Chi-square , p = 0.0062 ) for E. mulungu was observed for both genders .


Volunteers with higher anxiety levels tended to to prefer E. mulungu .


No statistically significant differences were verified in blood pressure ( one-way ANOVA , p = 0.1259 ) , heart rate ( Friedman , p > 0.05 ) and oxygen saturation ( Friedman , p = 0.7664 ) among periods and types of treatments .


E. mulungu showed an anxiolytic effect without significant changes in physiological parameters .


It could be considered as an alternative to control the anxiety in adult patients undergoing mandibular thirdmolars surgery .


It is well recognized that low-density lipoprotein cholesterol ( LDL-C ) - lowering therapy is effective for primary and secondary prevention of cerebrovascular/cardiovascular disease .


Ezetimibe , an inhibitor of the Niemann-Pick C1-Like 1 cholesterol transporter , is a relatively new drug for LDL-C-lowering therapy in addition to statins .


However , comparison between an aggressive LDL-C-lowering therapy with a combination of statin and ezetimibe versus a standard LDL-C-lowering therapy with statin alone is still unclear in terms of their effects on stabilization and volume regression of coronary plaque .


The ZIPANGU ( Ezetimibe clinical investigation for the regression of intracoronary plaque evaluated by angioscopy and ultrasound ) study is aimed at comparing these two types of therapy based on indices of plaque characteristics using non-obstructive coronary angioscopy and intravascular ultrasound .


The study is a multi-center , prospective , randomized , open-label , blinded-endpoint trial .


Through a centralized enrollment method , patients will be allocated to either monotherapy with atorvastatin alone or to combination therapy with atorvastatin ( maximum : 20mg/day ) and ezetimibe ( 10mg/day ) .


The target LDL-C level will be < 100mg/dL for the monotherapy group and < 70mg/dL for the combination therapy group .


At the baseline and the follow-up period of 9 months , non-obstructive coronary angioscopy and intravascular ultrasound will be performed to compare the changes in plaque color and volume between the two groups .


The ZIPANGU study will clarify whether combination therapy with statins and ezetimibe is better for stabilizing coronary plaque as secondary prevention than monotherapy by statins alone .


The study will give new insights into lipid-lowering guidelines in Japan .


BK virus reactivation in kidney transplant recipients can lead to progressive allograft injury .


Reduction of immunosuppression remains the cornerstone of treatment for active BK infection .


Fluoroquinolone antibiotics are known to have in vitro antiviral properties , but the evidence for their use in patients with BK viremia is inconclusive .


The objective of the study was to determine the efficacy of levofloxacin in the treatment of BK viremia .


Enrollment in this prospective , multicenter , double-blinded , placebo-controlled trial occurred from July 2009 to March 2012 .


Thirty-nine kidney transplant recipients with BK viremia were randomly assigned to receive levofloxacin , 500 mg daily , or placebo for 30 days .


Immunosuppression in all patients was adjusted on the basis of standard clinical practices at each institution .


Plasma BK viral load and serum creatinine were measured monthly for 3 months and at 6 months .


At the 3-month follow-up , the percentage reductions in BK viral load were 70.3 % and 69.1 % in the levofloxacin group and the placebo group , respectively ( P = 0.93 ) .


The percentage reductions in BK viral load were also equivalent at 1 month ( 58 % versus and 67.1 % ; P = 0.47 ) and 6 months ( 82.1 % versus 90.5 % ; P = 0.38 ) .


Linear regression analysis of serum creatinine versus time showed no difference in allograft function between the two study groups during the follow-up period .


A 30-day course of levofloxacin does not significantly improve BK viral load reduction or allograft function when used in addition to overall reduction of immunosuppression .


The aim of the study was to determine whether infliximab use and other potential predictors are associated with decreased prevalence and severity of depression in pediatric patients with Crohn disease ( CD ) .


A total of 550 ( n = 550 ) youth ages 9 to 17 years with biopsy-confirmed CD were consecutively recruited as part of a multicenter randomized controlled trial .


Out of the 550 , 499 patients met study criteria and were included in the analysis .


At recruitment , each subject and a parent completed the Children 's Depression Inventory ( CDI ) .


A child or parent CDI score 12 was used to denote clinically significant depressive symptoms ( CSDS ) .


Child and parent CDI scores were summed to form total CDI ( CDIT ) .


Infliximab use , demographic information , steroid use , laboratory values , and Pediatric Crohn 's Disease Activity Index ( PCDAI ) were collected as the potential predictors of depression .


Univariate regression models were constructed to determine the relations among predictors , CSDS , and CDIT .


Stepwise multivariate regression models were constructed to predict the relation between infliximab use and depression while controlling for other predictors of depression .


Infliximab use was not associated with a decreased proportion of CSDS and CDIT after adjusting for multiple comparisons .


CSDS and CDIT were positively associated with PCDAI , erythrocyte sedimentation rate , and steroid dose ( P < 0.01 ) and negatively associated with socioeconomic status ( SES ) ( P < 0.001 ) .


In multivariate models , PCDAI and SES were the strongest predictors of depression .


Disease activity and SES are significant predictors of depression in youth with Crohn disease .


To compare curative effect between complete denture with lingualized occlusion and anatomic occlusion on temporomandibular joint disorders ( TMD ) of aged edentulous patients with severe residual alveolar ridge resorption .


Seventy aged edentulous patients with severe residual alveolar ridge resorption were recruited in this study and randomly assigned into two groups , thirty-five each .


In Group A , patients received complete denture with lingualized occlusion , and in Group B , patients received complete denture with anatomic occlusion .


The condition of TMD was examined and recorded by the same TMD specialist at baseline , 3 months and 6 months following denture delivery .


The recovery effect of TMD was evaluated according to Fricton Index .


Related data were analyzed statistically with t-test and rank sum test .


Three months following denture delivery , the craniomandibular index ( CMI ) decrease value was ( 0.064 0.022 ) in group A , and was significantly higher than that in group B ( 0.043 0.018 ) ( P < 0.01 ) .


Six months following denture delivery , the CMI decrease value was ( 0.084 0.020 ) in group A , and was significantly higher than that in group B ( 0.070 0.021 ) ( P = 0.011 < 0.05 ) .


Complete denture with lingualized occlusion may be more conducive to the remission of TMD for aged edentulous patients with severe residual alveolar ridge resorption .


To describe the design of the study aiming to examine intensive targeted cognitive rehabilitation of attention in the acute ( < 4months ) and subacute rehabilitation phases ( 4-12 months ) after acquired brain injury and to evaluate the effects on function , activity and participation ( return to work ) .


Within a prospective , randomised , controlled study 120 consecutive patients with stroke or traumatic brain injury were randomised to 20 hours of intensive attention training by Attention Process Training or by standard , activity based training .


Progress was evaluated by Statistical Process Control and by pre and post measurement of functional and activity levels .


Return to work was also evaluated in the post-acute phase .


Primary endpoints were the changes in the attention measure , Paced Auditory Serial Addition Test and changes in work ability .


Secondary endpoints included measurement of cognitive functions , activity and work return .


There were 3 , 6 and 12-month follow ups focussing on health economics .


The study will provide information on rehabilitation of attention in the early phases after ABI ; effects on function , activity and return to work .


Further , the application of Statistical Process Control might enable closer investigation of the cognitive changes after acquired brain injury and demonstrate the usefulness of process measures in rehabilitation .


The study was registered at ClinicalTrials.gov Protocol .


NCT02091453 , registered : 19 March 2014 .


Non-dependent alcohol and substance use patterns are prevalent among men who have sex with men ( MSM ) , yet few effective interventions to reduce their substance use are available for these men .


We evaluated whether an adapted brief counseling intervention aimed at reducing HIV risk behavior was associated with secondary benefits of reducing substance use among episodic substance-using MSM ( SUMSM ) .


326 episodic SUMSM were randomized to brief Personalized Cognitive Counseling ( PCC ) intervention with rapid HIV testing or to rapid HIV testing only control .


Both arms followed over 6 months .


Trends in substance use were examined using GEE Poisson models with robust standard errors by arm .


Reductions in frequency of use were examined using ordered logistic regression .


In intent-to-treat analyses , compared to men who received rapid HIV testing only , we found men randomized to PCC with rapid HIV testing were more likely to report abstaining from alcohol consumption ( RR = 0.93 ; 95 % CI = 0.89-0 .97 ) , marijuana use ( RR = 0.84 ; 95 % CI = 0.73-0 .98 ) , and erectile dysfunction drug use ( EDD ; RR = 0.51 ; 95 % CI = 0.33-0 .79 ) over the 6-month follow-up .


PCC was also significantly associated with reductions in frequency of alcohol intoxication ( OR = 0.58 ; 95 % CI = 0.36-0 .90 ) over follow-up .


Furthermore , we found PCC was associated with significant reductions in number of unprotected anal intercourse events while under the influence of methamphetamine ( RR = 0.26 ; 95 % CI = 0.08-0 .84 ) .


The addition of adapted PCC to rapid HIV testing may have benefits in increasing abstinence from certain classes of substances previously associated with HIV risk , including alcohol and EDD ; and reducing alcohol intoxication frequency and high-risk sexual behaviors concurrent with methamphetamine use .


To assess the effect of overnight insulin pump suspension in an automated predictive low glucose suspend system on morning blood glucose and ketone levels in an attempt to determine whether routine measurement of ketone levels is useful when a closed-loop system that suspends insulin delivery overnight is being used .


Data from an in-home randomized trial of 45 individuals with type 1 diabetes ( age range 15-45 years ) were analyzed , evaluating an automated predictive low glucose pump suspension system in which blood glucose , blood ketone , and urine ketone levels were measured on 1,954 mornings .


One or more pump suspensions occurred during 744 of the 977 intervention nights ( 76 % ) .


The morning blood ketone level was 0.6 mmol/L after 11 of the 744 nights ( 1.5 % ) during which a pump suspension occurred and 2 of the 233 nights ( 0.9 % ) during which there was no suspension compared with 11 of 977 control nights ( 1.1 % ) .


The morning blood ketone level was 0.6 mmol/L after only 2 of 159 nights ( 1.3 % ) with a pump suspension exceeding 2 h. Morning fasting blood glucose level was not a good predictor of the presence of blood ketones .


Routine measurement of blood or urine ketones during use of an automated pump suspension system using continuous glucose monitoring , whether threshold based or predictive , is not necessary .


Recommendations for checking ketone levels should be no different when a patient is using a system with automated insulin suspension than it is for conventional diabetes self-management .


This randomised double-blind placebo-controlled study evaluated the addition of cediranib , an inhibitor of vascular endothelial growth factor receptors 1-3 , to standard carboplatin/paclitaxel chemotherapy in advanced non-small cell lung cancer .


Eligible patients received paclitaxel ( 200mg/m ( 2 ) ) and carboplatin ( area under the concentration time curve 6 ) intravenously every 3 weeks .


Daily oral cediranib/placebo 20mg was commenced day 1 of cycle 1 and continued as monotherapy after completion of 4-6 cycles of chemotherapy .


The primary end-point of the study was overall survival ( OS ) .


The trial would continue to full accrual if an interim analysis ( IA ) for progression-free survival ( PFS ) , performed after 170 events of progression or death in the first 260 randomised patients , revealed a hazard ratio ( HR ) for PFS of 0.70 .


The trial was halted for futility at the IA ( HR for PFS 0.89 , 95 % confidence interval [ CI ] 0.66-1 .20 , p = 0.45 ) .


A final analysis was performed on all 306 enrolled patients .


The addition of cediranib increased response rate ( [ RR ] 52 % versus 34 % , p = 0.001 ) but did not significantly improve PFS ( HR 0.91 , 95 % CI 0.71-1 .18 , p = 0.49 ) or OS ( HR 0.94 , 95 % CI 0.69-1 .30 , p = 0.72 ) .


Cediranib patients had more grade 3 hypertension , diarrhoea and anorexia .


The addition of cediranib 20mg daily to carboplatin/paclitaxel chemotherapy increased RR and toxicity , but not survival .


Physical activity interventions designed for Latinas have shown short-term behavior change , but longer-term change and maintenance is rarely measured .


To assess physical activity change at 12 months , following 6-month tapered completion of an RCT of a physical activity intervention for Latinas .


Two hundred sixty-six underactive ( < 60 minutes/week physical activity ) Latinas were randomized to an individually tailored , culturally and linguistically adapted physical activity intervention , or a wellness contact control .


Participants received the materials through the mail for 6 months , then received booster doses at 8 , 10 , and 12 months .


Minutes per week of moderate to vigorous physical activity were measured by the 7-Day Physical Activity Recall interview at baseline and 6 and 12 months .


Data were collected at Brown University between 2009 and 2013 , and analyses were conducted in 2013 .


At 12 months , increases in moderate to vigorous physical activity were significantly greater in the intervention than in the wellness group ( mean difference = 52 minutes/week , SE = 9.38 , p < 0.01 ) , with both groups showing slight increases in moderate to vigorous physical activity from 6 to 12 months .


Intervention participants were also more likely to meet national moderate to vigorous physical activity guidelines ( OR = 3.14 , p = 0.01 ) .


The intervention was more effective than the wellness control at 12 months , and physical activity increases from baseline to 6 months were maintained , suggesting the intervention may lead to sustainable behavior change .


This study is registered at Clinicaltrials.gov NCT01583140 .


To identify the preoperative characteristics and compare operative variables and postoperative outcomes in adult patients with pectus excavatum undergoing thoracoscopic repair using different bar stabilizers or open surgical repair .


31 patients were randomly divided into 3 groups : group A was 9 patients who underwent a modified Ravitch repair , group B was 11 patients who underwent video-assisted thoracoscopic repair using metal stabilizers , and group C was 11 patients who underwent video-assisted thoracoscopic repair using absorbable stabilizers .


Preoperative , intraoperative , and postoperative variables and mortality were compared among groups .


In all groups , preoperative variables were well-matched for age , sex , and Haller index .


Operative time was significantly longer in group A.


The postoperative length of hospital stay was significantly shorter in group A. Postoperative complications occurred in 7 ( 22.6 % ) patients , mostly in groups B and C. All patients were satisfied with the cosmetic result .


Repair of pectus excavatum in adult patients can be performed effectively either through an open surgical technique or thoracoscopy , with no intraoperative complications and excellent immediate results , but video-assisted thoracoscopic repair using metallic or absorbable bar stabilizers gives a better cosmetic result ; however , absorbable bar stabilizers are more vulnerable and break more easily than metal stabilizers .


A sildenafil tablet formulation as a PDE-5 inhibitor is widely used for the treatment of erectile dysfunction .


Recently , a fine granular formulation of sildenafil was developed by a domestic Korean pharmaceutical company .


This study was performed to compare the bioavailability of sildenafil fine granules with that of sildenafil tablets for assessing bioequivalence in 40 healthy male volunteers .


This was an open-label , randomized sequence , single-dose , two-period , and two-treatment crossover study .


Half of the volunteers received a single dose of sildenafil fine granule 50 mg and then sildenafil tablet 50 mg after a 7-day washout period .


The remaining half of volunteers received the tablet first and the the granule with the same washout period .


10 - mL blood samples were serially sampled to measure the concentrations of sildenafil and the N-desmethyl metabolite .


Tolerability was assessed during the study .


The pharmacokinetic parameters of sildenafil were similar between granular and tablet formulations .


The 90 % CI of geometric mean ratios ( sildenafil granule/tablet ) for the pharmacokinetic parameters of sildenafil were within 0.8 1.25 , as a bioequivalent acceptable range ; 1.111 ( 90 % CI , 1.002 - 1.231 ) for maximum plasma concentration ( Cmax ) and 1.092 ( 1.019 - 1.117 ) for area under the concentration - time curve from time zero to time of last measurable concentration ( AUClast ) .


Also , the 90 % CI of geometric mean ratios for Cmax and AUClast of the metabolite were within 0.8 - 1.25 .


Both formulations were well tolerated by volunteers .


This study confirmed that sildenafil granules and sildenafil tablet are bioequivalent with regards to pharmacokinetics of sildenafil and N-desmethyl sildenafil .


The epidemics of food insecurity , malnutrition , and human immunodeficiency virus ( HIV ) frequently overlap .


HIV treatment programs increasingly provide nutrient-dense ready-to-use supplementary foods ( RUSFs ) to patients living with HIV and food insecurity , but in the absence of wasting , it is not known if RUSF confers benefit above less costly food commodities .


We performed a randomized trial in rural Haiti comparing an RUSF with less costly corn-soy blend plus ( CSB + ) as a monthly supplement to patients with HIV infection who were on antiretroviral therapy ( ART ) < 24 months prior to study start .


We compared 6 - and 12-month outcomes by ration type in terms of immunologic response , body mass index ( BMI ) , adherence to ART , general health quality of life , household food insecurity , and household wealth .


A cohort of 524 patients with HIV receiving ART was randomized and followed over time .


Median CD4 cell count at baseline was 339 cells/L ( interquartile range [ IQR ] , 197-475 cells/L ) for the CSB + group , and 341 cells/L ( IQR , 213-464 / L ) for the RUSF group .


Measured outcomes improved from baseline over time , but there were no statistically significant differences in change for BMI , household wealth index , hunger , general health perception score , or adherence to ART by ration type at 6 or 12 months .


The RUSF group had higher CD4 count at 12 months , but this was also not statistically significant .


In 12 months of follow-up , there was no statistically significant difference in outcomes between those receiving RUSF-based compared with CSB + - based rations in a cohort of HIV-infected adults on ART in rural Haiti .


To study if low dose Unfractionated heparin ( UFH ) is as effective and safe as Low-molecular weight heparin ( LMWH ) and also economical as a prophylactic agent for venous thromboembolism in medically ill patients .


A prospective double blind randomised controlled trial consisting of 92 patients fulfilling the inclusion criteria who were admitted to Bangalore Baptist Hospital , Bengaluru , between March 2008 and July 2009 were randomised to receive Unfractionated heparin ( UFH ) or Low-molecular weight heparin ( LMWH ) .


The result based on intention to treat ( ITT ) analysis with best outcome scenario : in the UFH arm there were 47 ( 97.9 % ) patients who had not developed DVT/PE as compared to 42 ( 95.5 % ) in the LMWH arm .


The difference in proportion of patients who had not developed DVT/PE between UFH and LMWH was 2.4 % ( -5.0 , 9.8 ) .


The results based on per protocol analysis : In the UFH arm there were 44 ( 97.8 % ) patients who had not developed DVT/PE as compared to 39 ( 95.1 % ) in the LMWH arm .


The difference in proportion of patients who had not developed DVT/PE between the UFH and LMWH arm was 2.7 % ( -5.2 , 10.5 ) .


Patients on UFH had higher major bleeding complications 4 ( 8.9 % ) as compared to 0 in LMWH arm .


But with respect to other complications like thrombocytopenia ( HIT ) and mild or minimal bleeding both arms were comparable .


This study has demonstrated that low dose UFH is as effective as LMWH as a prophylactic agent for venous thromboembolism in medically ill patients and economical also .


Previous studies have shown that treatment with ergocalciferol in patients with CKD stage 3 + 4 is not effective with less than 33 % of patients achieving a 25-OH vitamin D target of > 30 ng/ml .


The aim of this study was to test the response to cholecalciferol in CKD .


We attempted to replete 25-OH vitamin D to a target level of 40-60 ng/ml using the response to treatment and PTH suppression as an outcome measure .


This retrospective cohort study identified patients ( Stages 2-5 and Transplant ) from 2001-2010 who registered at the Chronic Kidney Disease Clinic .


Patients received cholecalciferol 10,000 IU capsules weekly as initial therapy .


When levels above 40 ng/ml were not achieved , doses were titrated up to a maximum of 50,000 IU weekly .


Active vitamin D analogs were also used in some Stage 4-5 CKD patients per practice guidelines .


Patients reaching at least one level of 40 ng/mL were designated RESPONDER , and if no level above 40 ng/mL they were designated NON-RESPONDER .


Patients were followed for at least 6 months and up to 5 years .


352 patients were included with a mean follow up of 2.4 years .


Of the CKD patients , the initial 25-OH vitamin D in the NON-RESPONDER group was lower than the RESPONDER group ( 18 vs. 23 ng/ml ) ( p = 0.03 ) .


Among all patients , the initial eGFR in the RESPONDER group was significantly higher than the NON-RESPONDER group ( 36 vs. 30 ml/min/1 .73 m2 ) ( p < 0.001 ) .


Over time , the eGFR of the RESPONDER group stabilized or increased ( p < 0.001 ) .


Over time , the eGFR in the NON-RESPONDER group decreased toward a trajectory of ESRD .


Proteinuria did not impact the response to 25-OH vitamin D replacement therapy .


There were no identifiable variables associated with the response or lack of response to cholecalciferol treatment .


CKD patients treated with cholecalciferol experience treatment resistance in raising vitamin D levels to a pre-selected target level .


The mechanism of vitamin D resistance remains unknown and is associated with progressive loss of eGFR .


Proteinuria modifies but does not account for the vitamin D resistance .


The clinical outcomes for patients with worsening chronic heart failure ( WCHF ) remain exceedingly poor despite contemporary evidence-based therapies , and effective therapies are urgently needed .


Accumulating evidence supports augmentation of cyclic guanosine monophosphate ( cGMP ) signalling as a potential therapeutic strategy for HF with reduced or preserved ejection fraction ( HFrEF and HFpEF , respectively ) .


Direct soluble guanylate cyclase ( sGC ) stimulators target reduced cGMP generation due to insufficient sGC stimulation and represent a promising method for cGMP enhancement .


The phase II SOluble guanylate Cyclase stimulatoR in heArT failurE Study ( SOCRATES ) programme consists of two randomized , parallel-group , placebo-controlled , double-blind , multicentre studies , SOCRATES-REDUCED ( in patients with LVEF < 45 % ) and SOCRATES-PRESERVED ( in those with LVEF 45 % ) , that will explore the pharmacodynamic effects , safety and tolerability , and pharmacokinetics of four dose regimens of the once-daily oral sGC stimulator vericiguat ( BAY 1021189 ) over 12 weeks compared with placebo .


These studies will enrol patients stabilized during hospitalization for HF at the time of discharge or within 4 weeks thereafter .


The primary endpoint in SOCRATES-REDUCED is change in NT-proBNP at 12 weeks .


The primary endpoints in SOCRATES-PRESERVED are change in NT-proBNP and left atrial volume at 12 weeks .


SOCRATES will be the first programme to enrol specifically both inpatients and outpatients with WCHF and patients with reduced or preserved ejection fraction .


Results will inform the benefits of pursuing subsequent event-driven clinical outcome trials with sGC stimulators in this patient population .


Tranversus-abdominis plane ( TAP ) block is a novel technique alternative to central neural blockade in providing analgesia to the anterior abdominal wall .


As such , we compared the analgesic efficacy of TAP block with low thoracic-epidural analgesia ( TEA ) in ischemic heart disease patients after abdominal laparotomy .


Forty-four American Society of Anesthesiologists physical status ( ASA ) III patients , 59-75 years of age and undergoing elective upper abdominal surgery under general anesthesia , were assigned randomly to receive either continuous low TEA or intermittent administration of local anesthetic in TAP block .


Supplemental analgesia was provided with intravenous morphine with patient-controlled-analgesia .


Morphine consumption and pain intensity using verbal rating scale ( VRS ) at rest and coughing over the first 48 h were recorded .


Whereas all patients in the TAP group required morphine , 16 ( 72.2 % ) patients in TEA group received morphine postoperatively ( p = 0.021 ) .


Morphine consumed on day 1 and day 2 was 11.5 mg ( 7.5-12 .3 mg ) and 7 mg ( 4.5-8 mg ) for the TEA group , while in the TAP group , it was 18 mg ( 16-19 mg ) and 11 mg ( 10-13 mg ) , respectively ( p < 0.001 ) .


Time for first request of morphine was 311.2 18.5 min in the TEA group versus 210 22.2 min in the TAP group ( p < 0.001 ) .


VRS at rest and cough were lower in the TEA group compared with the TAP group at 1 , 6 , 12 , 18 , 24 , 36 and 48 h ( p < 0.001 ) .


Incidence of hypotension and ephedrine administration were significantly higher in the TEA group than in the TAP group ( p = 0.007 ) .


Low TEA reduced morphine consumption and provided a higher analgesic efficacy compared with TAP block after laparotomy in ischemic heart disease patients .


Bronchiolitis is one of the most common and costly respiratory diseases in infants and young children .


Previous studies have shown a potential benefit of nebulized hypertonic saline ; however , its effect in the emergency department ( ED ) setting is unclear .


To compare the effect of nebulized 3 % hypertonic saline vs 0.9 % normal saline on admission rate and length of stay in infants with bronchiolitis .


We conducted a double-blind , randomized clinical trial during 3 consecutive bronchiolitis seasons from March 1 , 2008 , through April 30 , 2011 .


We recruited a convenience sample of patients younger than 24 months with a primary diagnosis of viral bronchiolitis presenting to the ED of 2 urban free-standing tertiary children 's hospitals .


We excluded patients who were premature ( gestational age , < 34 weeks ) or who had chronic pulmonary disease , immune deficiency , cardiac disease , or previous episodes of wheezing or inhaled bronchodilator use .


Of eligible patients who were approached , 161 ( 26.6 % ) declined to participate .


Patients received 4 mL of 3 % sodium chloride ( hypertonic saline [ HS group ] ) or 0.9 % sodium chloride ( normal saline [ NS group ] ) inhaled as many as 3 times in the ED .


Those admitted received the assigned medication every 8 hours until discharge .


All treatment solutions were premedicated with albuterol sulfate .


Hospital admission rate , length of stay for admitted patients , and Respiratory Distress Assessment Instrument score .


A total of 197 patients were enrolled in the NS group and 211 in the HS group .


Admission rate in the 3 % HS group was 28.9 % compared with 42.6 % in the NS group ( adjusted odds ratio from logistic regression , 0.49 [ 95 % CI , 0.28-0 .86 ] ) .


Mean ( SD ) length of stay for hospitalized patients was 3.92 ( 5.24 ) days for the NS group and 3.16 ( 2.11 ) days for the HS group ( P = .24 ) .


The Respiratory Distress Assessment Instrument score decreased after treatment in both groups ; however , we found no significant difference between groups ( P = .35 ) .


Hypertonic saline given to children with bronchiolitis in the ED decreases hospital admissions .


We can detect no significant difference in Respiratory Distress Assessment Instrument score or length of stay between the HS and NS groups .


clinicaltrials.gov Identifier : NCT00619918 .


This study aimed to examine diabetes self-care ( DSC ) patterns in low-income African American and Latino patients with Type 2 diabetes , and identify patient-related , biomedical/disease-related , and psychosocial correlates of DSC .


We performed cross-sectional analysis of survey data from African Americans and Latinos aged 18 years with Type 2 diabetes ( n = 250 ) participating in a diabetes self-management intervention at 4 primary care clinics .


The Summary of Diabetes Self-Care Activities captured the subcomponents of healthy eating , physical activity , blood sugar testing , foot care , and smoking .


Correlates included patient-related attributes , biomedical/disease-related factors , and psychosocial constructs , with their multivariable influence assessed with a 3-step model building procedure using regression techniques .


Baseline characteristics were as follows : mean age of 53 years ( SD = 12.4 ) ; 69 % female ; 53 % African American ; 74 % with incomes below $ 20,000 ; and 60 % with less than a high school education .


DSC performance levels were highest for foot care ( 4.5 / 7 days ) and lowest for physical activity ( 2.5 / 7 days ) .


Across racial/ethnic subgroups , diabetes-related distress was the strongest correlate for DSC when measured as a composite score .


Psychosocial factors accounted for 14 % to 33 % of variance in self-care areas for both racial/ethnic groups .


Patient characteristics were more salient correlates in Hispanic/Latinos when examining the self-care subscales , particularly those requiring monetary resources .


Important information is provided on specific DSC patterns in a sample of ethnic/racial minorities with Type 2 diabetes .


Significant correlates found may help with identification and intervention of patients who may benefit from strategies to increase self-care adherence .


Indications for home treatment for specific diagnoses in child and adolescent psychiatry have not yet been evaluated .


In a recent intervention study ( primary outcome : length of stay ) , 92 patients aged 5 to 17 years were randomized into an intervention group ( early discharge followed by home treatment in combination with inpatient treatment , where needed ) and a control group ( regular length inpatient treatment ) .


The aim of this explorative analysis was to retrieve additional information on what works for whom .


Outcome parameters were as follows : Childrens Global Assessment Scale ( CGAS ) , Health of the Nation Outcome Scales for Children and Adolescents ( HoNOSCA ) , Strengths and Difficulties Questionnaire ( SDQ ) and Columbia Impairment Scale ( CIS ) at T1 ( within 14 days after intake ) , T2 ( end of treatment ) and T3 ( 8.4-month follow-up ) .


Multiple regression was used to investigate the association between diagnoses , treatment setting , age , sex , and improvement in both groups .


In children externalizing disorders were predominant , whereas in adolescents internalizing disorders were prominent .


Patients improved equally under both types of treatment .


Home treatment , however , was rated by the patients to be significantly more effective in adolescents ( SDQ p = .017 ) , boys ( CIS p = .009 , SDQ p < .001 ) , and with externalizing disorders ( SDQ p = .005 ) .


Home treatment may be considered an alternative to inpatient treatment , especially in boys with externalizing disorders .


To evaluate the efficacy of Fuzhenghuayu capsule for the prevention of oesophageal variceal bleeding in patients with liver cirrhosis .


A multicentre randomized placebo-controlled trial was conducted .


A total of 181 liver cirrhosis patients were enrolled in the study and randomly assigned to different groups according to the level of oesophageal variceal bleeding .


Patients with light oesophageal varices received Fuzhenghuayu capsule or a placebo .


Patients with medium to heavy oesophageal varices received either Fuzhenghuayu capsule alone , Fuzhenghuayu capsule plus propranolol , or propranolol plus a placebo .


Patients with a history of oesophageal variceal bleeding received either Fuzhenghuayu capsule plus propranolol , propranolol alone , or a placebo .


For all patients , the treatment lasted 2 years .


The primary end point of the study was oesophageal variceal bleeding .


The secondary end points were liver cancer , death by any cause , and liver transplantation .


Risk of bleeding and survival were statistically assessed .


The median follow-up time was 50 months .


The patients with small oesophageal varices who were treated with Fuzhenghuayu capsule showed a significantly higher cumulative probability of bleeding than their counterparts treated with the placebo ( 3.4 % vs. 23.7 % , x = 4.829 , P = 0.028 ) .


The patients with medium to heavy oesophageal varices and no history of oesophageal variceal bleeding who were treated with Fuzhenghuayu capsule plus propranolol showed a remarkably higher cumulative probability of bleeding than their counterparts treated with propranolol alone ( 15.2 % vs. 43.6 % , x = 6.166 , P = 0.013 ) .


There were no significant differences between the patients treated with Fuzhenghuayu capsule alone and those treated with propranolol alone ( P = 0.147 ) or the patients treated with Fuzhenghuayu capsule plus propranolol and those treated with Fuzhenghuayu capsule alone ( P = 0.147 ) .


The patients with history of oesophageal variceal bleeding who were treated with Fuzhenghuayu capsule showed significantly higher cumulative probability of bleeding and median time of bleeding than their counterparts treated with propranolol alone ( 44.0 % vs. 24.2 % and 40.00 17.92 months vs. 7.00 2.35 months ; x = 4.433 , P = 0.035 ) .


There were no significant differences in the cumulative probability of liver cancer and survival among all of the groups .


Fuzhenghuayu capsule can decrease the cumulative probability of bleeding in cirrhotic patients with light oesophageal varices .


For cirrhosis patients with a history of oesophageal variceal bleeding , the combination of Fuzhenghuayu capsule plus propranolol can decrease the cumulative probability of bleeding with median or heavy varices .


The periodic health check-up has been a fundamental part of routine medical practice for decades , despite a lack of consensus regarding its value in health promotion and disease prevention .


A large-scale Danish population-based preventive programme ` Check your health ' was developed based on available evidence of screening and successive accepted treatment , prevention for diseases and health promotion , and is closely aligned with the current health care system.The objective of the ` Check your health ' [ CORE ] trial is to investigate effectiveness on health outcomes of a preventive health check offered at a population-level to all individuals aged 30-49 years , and to establish the cost-effectiveness .


The trial will be conducted as a pragmatic household-cluster randomised controlled trial involving 10,505 individuals .


All individuals within a well-defined geographical area in the Central Denmark Region , Denmark ( DK ) were randomised to be offered a preventive health check ( Intervention group , n = 5250 ) or to maintain routine access to healthcare until a delayed intervention ( Comparison group , n = 5255 ) .


The programme consists of a health examination which yields an individual risk profile , and according to this participants are assigned to one of the following interventions : ( a ) referral to a health promoting consultation in general practice , ( b ) behavioural programmes at the local Health Centre , or ( c ) no need for follow-up .


The primary outcomes at 4 years follow-up are : ten-year-risk of fatal cardiovascular event ( Heart-SCORE model ) , physical activity level ( self-report and cardiorespiratory fitness ) , quality of life ( SF12 ) , sick leave and labour market attachment .


Cost-effectiveness will be evaluated according to life years gained , direct costs and total health costs .


Intention to treat analysis will be performed .


Results from the largest Danish health check programme conducted within the current healthcare system , spanning the sectors which share responsibility for the individual , will provide a scientific basis to be used in the development of systems to optimise population health in the 21st century .


The trial has registered at ClinicalTrials.gov with an ID : NCT02028195 ( 7 .


March 2014 ) .


The randomized , double-blind Third International Study on Syncope of Uncertain Etiology ( ISSUE-3 ) showed that dual-chamber permanent pacing was effective in reducing the recurrence of syncope in patients 40 years with severe asystolic , probably neurally mediated syncope ( NMS ) , documented by implantable loop recorder ( ILR ) .


Analysis in ISSUE-3 was performed according to the intention-to-treat principle .


In the present study , we performed an on-treatment analysis , which included additionally those non-randomized patients followed up in the ISSUE registry to evaluate in a better manner the effectiveness of cardiac pacing therapy .


Initially , 504 patients received an ILR , 162 ( 32 % ) patients had a diagnosis consistent with NMS within a mean observation period of 15 11 months : 99 ( 19 % ) patients had documentation of syncope with 3 s asystole or 6 s asystole without syncope .


Sixty patients affected by asystolic NMS received cardiac pacing therapy and 86 ( 33 asystolic and 53 non-asystolic NMS ) were untreated ; 16 patients were lost to follow-up .


Paced and unpaced groups had similar clinical characteristics .


During subsequent follow-up , syncope recurred in 10 paced ( 17 % ) and in 40 non-paced ( 46 % ) patients .


At 21 months , the estimated product-limit syncope recurrence rates were 27 % [ 95 % confidence interval ( CI ) 15-47 ] and 54 % ( 95 % CI 43-67 ) , respectively ( P = 0.01 ) .


With cardiac pacing , the risk of recurrence was reduced by 57 % ( hazard ratio = 0.43 , 95 % CI = 0.2-0 .8 ) .


Complications of pacemaker therapy were haemothorax at implantation in one patient and lead dislodgement that required correction in two patients .


Permanent cardiac pacing is effective in reducing recurrence of syncope in patients 40 years with severe asystolic possible NMS with a few complications .


The study shows that 61 % of patients with a diagnosis of NMS made by ILR received a pacemaker but 5.1 ILRs had to be implanted to find one patient who finally had a pacemaker implanted .


In the literature , data concerning the relationship between breast cancer and HLA class II gene polymorphisms are limited , so the aim of this study was to determine if HLA-DQB1 and HLA-DRB1 MHC class-II alleles may confer susceptibility or resistance to the disease among Jordanian females .


This case control study enrolled 56 Royal Hospital breast cancer patients and 60 age matched healthy controls , all of whom provided blood samples ( 2011-2013 ) .


A questionnaire was filled after signing a consent form and DNA was extracted , nucleic acids being amplified for assessment of HLA-DQB1 and HLA-DRB1 alleles by muliplex INNO-LiPA and allele typing carried out by reverse hybridization .


Comparison of HLA-DQB1 and HLA-DRB1 allele distributions was carried out with paired t-test and chi-square statistics .


Risk factors were assessed by odd ratios with 95 % confidence intervals .


A significant negative correlation was observed between HLADQB1 * 02 alleles and breast cancers ( p = 0.013 ) .


No significant associations were observed among HLADQB1 * 03 , 04 , 05 and 06 or among HLA-DRB1 * 01 , 03 , 04 , 07 , 08 , 10 , 11 , 13 , 14 and 15 .


HLADQB1 * 02 alleles may provide positive protection against breast tumor risk among Jordanians , but not HLADQB1 * 03 , 04 , 05 and 06 or HLA-DRB1 * 01 , 03 , 04 , 07 , 08 , 10 , 11 , 13 , 14 and 15 alleles .


Intuitive eating is an eating approach that emphasizes increased focus on internal hunger and fullness cues to regulate eating behavior ; thus , successful intuitive eating should curb the influence of environmental factors such as plate and portion size on consumption .


The current study examined whether self-reported levels of intuitive eating moderated the influence of portion size on college students ' food consumption during an afternoon meal of pasta and tomato sauce .


Participants ( N = 137 , 63.5 % female ) were randomly assigned to either a large plate ( 12-inch ) or small plate ( 8-inch ) external cue condition .


All participants fasted for four daytime hours , completed the Intuitive Eating Scale , and then were asked to rate a meal of pasta and tomato sauce on different dimensions of taste .


Participants were told that they could eat as much pasta as they would like .


Higher levels of intuitive eating were associated with greater food consumption .


At the mean level of intuitive eating , participants ate more pasta in the large plate condition .


Furthermore , the influence of plate size on food consumption increased as levels of intuitive eating increased .


Individuals who report high levels of intuitive eating may be more likely to eat an objectively larger amount of food in a permissive food environment , and may have implications for eating approaches that promote eating in response to internal hunger and fullness cues .


Lactate measurement has been used to identify critical medical illness and initiate early treatment strategies .


The prehospital environment offers an opportunity for very early identification of critical illness and commencement of care .


The investigators hypothesized that point-of-care lactate measurement in the prehospital aeromedical environment would : ( 1 ) identify medical patients with high mortality ; ( 2 ) influence fluid , transfusion , and intubation ; and ( 3 ) increase early central venous catheter ( CVC ) placement .


Critically ill , medical , nontrauma patients who were transported from September 2007 through February 2009 by University of Massachusetts ( UMass ) Memorial LifeFlight , a university-based emergency medical helicopter service , were eligible for enrollment .


Patients were prospectively randomized to receive a fingerstick whole-blood lactate measurement on an alternate-day schedule .


Flight crews were not blinded to results .


Flight crews were asked to inform the receiving attending physician of the results .


The primary endpoint was the ability of a high , prehospital lactate value [ > 4 millimoles per liter ( mmol/L ) ] to identify mortality .


Secondary endpoints included differences in post-transport fluid , transfusion , and intubation , and decrease in time to central venous catheter ( CVC ) placement .


Categorical variables were compared between groups by Fisher 's Exact Test , and continuous variables were compared by t-test .


Patients ( N = 59 ) were well matched for age , gender , and acuity .


In the lactate cohort ( n = 20 ) , mean lactate was 7 mmol/L [ Standard error of the mean , SEM = 1 ] .


Initial analysis revealed that prehospital lactate levels of 4 mmol/L did show a trend toward higher mortality with an odds ratio of 2.1 ( 95 % CI , 0.3-13 .8 ) .


Secondary endpoints did not show a statistically significant change in management between the lactate and non lactate groups .


There was a trend toward decreased time to post-transport CVC in the non lactate faction .


Prehospital aeromedical point-of-care lactate measurement levels 4 mmol/L may help stratify mortality .


Further investigation is needed , as this is a small , limited study .


The initial analysis did not find a significant change in post-transport management .


Online interventions have emerged as a popular strategy to promote healthy behaviors .


Currently , there is little agreement about how to capture online intervention engagement .


It is also uncertain who engages with weight-related online interventions and how engagement differs by demographic and weight characteristics .


The objectives of this study were to ( 1 ) characterize how pregnant women engaged with features of an online intervention to prevent excessive gestational weight gain , ( 2 ) identify demographic and weight status subgroups of women within the sample , and ( 3 ) examine differences in use of intervention features across the demographic and weight status subgroups .


A sample of racially and socioeconomically diverse pregnant women from a northeastern US city was assigned to the intervention group in a randomized controlled trial to prevent excessive gestational weight gain ( n = 1014 ) .


The intervention website included these features : weight-gain tracker , health-related articles , blogs , physical activity and diet goal-setting tools , and local resources .


Engagement variables were created to capture the amount , consistency , and patterns of feature use across pregnancy using latent class analysis .


Demographic/weight status subgroups were also created using latent class analysis .