Saturated fatty acid consumption has long been linked to an increased risk for CVD ; indeed , the consumption of saturated fat-free products is recommended as a means of reducing this risk .


However , the present results suggest that many individuals might not benefit from such general recommendations .


Genetic analysis of PPARA rs135549 might help identify those individuals who are more likely to benefit from reducing the saturated fatty acid content of their diet .


A significant waning of enterovirus 71 ( EV71 ) antibody titer after priming immunization with an inactivated EV71 vaccine implied the potential need for a booster dose .


In this randomized , double-blind , placebo-controlled clinical trial , we recruited participants who had received at least 1 dose of priming EV71 vaccine in an early phase 2 clinical trial that was conducted in healthy infants and children aged 6-35 months .


All participants were grouped according to the priming EV71 vaccine formulations ( 160U , 320U , and 640U with adjuvant and 640 U without adjuvant ) and then randomly assigned ( ratio , 2:1 ) to receive a booster dose of vaccine or placebo within each formulation group .


The primary end point was the geometric mean titer 28 days after the booster dose .


A total of 773 participants were enrolled .


Significantly greater immunological responses were induced by the booster shot of all 4 formulations of EV71 vaccine , compared with that induced by placebo ( P < .0001 ) .


The frequencies of adverse reactions were similar between vaccine and placebo groups within each formulation group .


A booster dose of EV71 vaccine 1 year after the priming EV71 immunization shows excellent immunogenicity and good safety profile .


Clinical Trials Registration : NCT01734408 .


The aim of the study was to estimate the cost-effectiveness of a weight management programme including elements of physical exercise and dietary restriction which are designed to help women lose excess weight gained during pregnancy in the vulnerable postnatal period and inhibit the development of behaviours which could lead to future excess weight gain and obesity .


A mathematical model based on a regression equation predicting change in weight over a fifteen year postnatal period was developed .


The model included programme effectiveness and resource data based on a randomized controlled trial of a weight management programme implemented in a postnatal population in the United States .


Utility and mortality data based on body mass index categories were also included .


The model adopted a National Health Service ( NHS ) and personal social services ( PSS ) perspective , a lifetime time horizon and estimated the cost effectiveness of a weight management programme against a no change comparator in terms of an incremental cost-effectiveness ratio ( ICER ) .


The baseline results show that the difference in weight between women who received the weight management programme and women who received the control intervention was 3.02 kg at six months and 3.53 kg at fifteen years following childbirth .


This results in an ICER of 7355 per quality adjusted life year ( QALY ) for women who were married at childbirth .


The estimated ICER would suggest that such a weight management programme is cost-effective at a NICE threshold of 20,000 per QALY .


However significant structural and evidence based uncertainty is present in the analysis .


Postnatal mental health problems , which are an international public health priority , are a suitable target for preventive approaches .


The financial burden of these disorders is borne across sectors in society , including health , early childhood , education , justice and the workforce .


This paper describes the planned economic evaluation of What Were We Thinking , a psychoeducational intervention for the prevention of postnatal mental health problems in first-time mothers .


The evaluation will be conducted alongside a cluster-randomised controlled trial of its clinical effectiveness .


Cost-effectiveness and costs-utility analyses will be conducted , resulting in estimates of cost per percentage point reduction in combined 30-day prevalence of depression , anxiety and adjustment disorders and cost per quality-adjusted life year gained .


Uncertainty surrounding these estimates will be addressed using non-parametric bootstrapping and represented using cost-effectiveness acceptability curves .


Additional cost analyses relevant for implementation will also be conducted .


Modelling will be employed to estimate longer term cost-effectiveness if the intervention is found to be clinically effective during the period of the trial .


Approval to conduct the study was granted by the Southern Health ( now Monash Health ) Human Research Ethics Committee ( 24 April 2013 ; 11388B ) .


The study was registered with the Monash University Human Research Ethics Committee ( 30 April 2013 ; CF12/1022 -2012000474 ) .


The Education and Policy Research Committee , Victorian Government Department of Education and Early Childhood Development approved the study ( 22 March 2012 ; 2012_001472 ) .


Use of the EuroQol was registered with the EuroQol Group ; 16 August 2012 .


The trial was registered with the Australian New Zealand Clinical Trials Registry on 7 May 2012 ( registration number ACTRN12613000506796 ) .


To examine the effects of `` Rusie Dutton '' on health and quality of life in menopausal women .


Menopausal women ( aged 45-59 ) were recruited and randomly allocated to 2 groups .


Rusie Dutton group ( n = 24 ) practiced Rusie Dutton conducted by Wat Pho Thai Traditional Massage School for 13 weeks .


The control group ( n = 26 ) was assigned to a waiting list and received no intervention .


BW , BMI , restingHR , BP , flexibility , VO2max , and MENQOL including vasomotor , physical , psychosocial and sexual domains were measured at the beginning and the end .


A paired-sample t-test and independent sample t-test were used for statistical analysis .


Significant improvement was found in all variables within group ( p < .05 ) in Rusie Dutton group , and a significant difference between groups was found ( p < .05 ) in all variables except BW and BMI .


Therefore , it is concluded that the traditional Thai exercise Rusie Dutton can promote health related physical fitness and QOL in menopausal women .


To compare cefazolin concentrations in biopsied tissue samples collected from surgically created wounds treated with negative pressure wound therapy to those collected from surgically created wounds treated with nonadherent dressings .


Prospective , controlled , experimental study .


Adult female spayed Beagles ( n = 12 ) .


Full thickness cutaneous wounds were created on each antebrachium ( n = 24 ) .


Immediately after surgery , cefazolin ( 22mg/kg intravenously [ IV ] ) was administered to each dog and continued every 8hours during the study .


The right wound was randomly assigned to group I or group II whereas the wound on the contralateral antebrachium was assigned to the other group .


Group I wounds were treated with negative pressure wound therapy ( NPWT ) and group II wounds were treated with nonadherent dressings for 3 days .


Dressings were changed and tissue biopsies obtained from wound beds at 24hours intervals for both groups .


Cefazolin wound tissue and plasma concentrations were measured by liquid chromatography mass spectrometry ( LC-MS/MS ) .


Blood samples for measuring plasma cefazolin concentrations were collected before biopsy sampling .


At the time of surgery and at each subsequent bandage change , wound beds were swabbed and submitted for aerobic and anaerobic culture .


After initiating cefazolin treatment , wound tissue antibiotic concentrations between treatment groups were not significantly different at any sampling time .


Similarly , after initiating cefazolin treatment , plasma cefazolin concentrations were not significantly different at any sampling time for individual dogs .


Using a canine experimental model , NPWT treatment of surgically created wounds does not statistically impact cefazolin tissue concentrations when compared with conventional nonadherent bandage therapy .


The objective of this study was to evaluate the influence of cardiopulmonary bypass ( CPB ) on endothelin-1 ( ET-1 ) expression in various circulation compartments in patients undergoing myocardial revascularization .


A total of 30 patients were randomized to undergo myocardial revascularization with ( CABG , n = 15 ) or without ( OPCAB , n = 15 ) CPB .


Samples were taken preoperatively , after establishing CPB and after CPB ( CABG group ) , prior to and after revascularization ( OPCAB group ) , and 6 and 24 h postoperatively .


Values of ET-1 were compared between groups at all time points and correlated with postoperative cardioselective enzyme values and clinical parameters .


In OPCAB group , ET-1 levels did not significantly vary between time points .


In CABG group , ET-1 levels were significantly elevated vs. baseline in arterial : ART-T2 vs. ART-T0 ( 1.83 1.81 vs. 0.76 1.07 fmol/mL , p = 0.05 ) , pulmonary : SG-T2 vs. SG-T0 ( 2.70 2.75 vs. 0.39 0.28 fmol/mL , p < 0.001 ) and SG-T3 vs. SG-T0 ( 1.56 0.28 vs. 0.39 0.28 fmol/mL , p < 0.001 ) , and coronary circulation CS-T2 vs. CS-T1 ( 1.12 0.49 vs. 0.27 0.09 fmol/mL , p = 0.01 ) .


ET-1 levels were significantly higher in CABG group in all vascular compartments : ART-T2 ( 1.83 1.81 vs. 0.17 0.16 fmol/mL , p = 0.02 ) , ART-T4 ( 0.99 0.56 vs. 0.24 0.12 fmol/mL , p = 0.01 ) , SG-T1 ( 0.59 0.15 vs. 0.25 0.13 fmol/mL , p = 0.01 ) , SG-T2 ( 2.70 2.75 vs. 0.30 0.24 fmol/mL , p = 0.004 ) , SG-T3 ( 1.56 0.28 vs. 0.35 0.31 fmol/mL , p < 0.001 ) , SG-T4 ( 1.34 0.11 vs. 0.34 0.16 fmol/mL , p < 0.001 ) , and CS-T2 ( 1.12 0.49 vs. 0.12 0.12 fmol/mL , p = 0.004 ) .


Coronary sinus ET-1 level after CPB ( CS-T2 ) in CABG group correlated positively with troponin-I level 24 h postoperatively ( r ( 2 ) = 0.802 , p = 0.02 ) CONCLUSION : Off-pump myocardial revascularization attenuates ET-1 expression in all investigated vascular compartments .


Elevated coronary ET-1 levels after CPB in CABG group correlate with troponin-I levels 24 h postoperatively .


To compare open and closed methods of the frontalis suspension operation with a silicone rod in the treatment of congenital blepharoptosis .


Forty-four cases with unilateral or bilateral congenital ptosis with a poor levator function of < 4 mm were divided randomly into two groups .


Each group underwent an eyelid crease incision operation ( open ) or a supralash stab incision ( closed ) .


Ptosis was measured by the difference between the upper eyelid margin reflex distance ( MRD ) of the affected eyelids of the unilateral and bilateral cases .


Frequent follow-up examinations were performed up to 12 months post-surgery .


Associated ophthalmologic findings showed that amblyopia , strabismus , wound discharge and knot dehiscence problems were present in 36.6 % , 27.3 % , 8.5 % and 8.5 % of the patients , respectively .


There was no significant difference between the abovementioned associated ophthalmic findings of the two operative methods studied ( P = 0.37 ) .


The difference in the surgical methods and MRD 3 , 6 and 12 months after operation did not reach statistical significance .


Similar results for good MRD ( 3 < MRD < 5 ) were found in closed ( 54.5 % , 12/22 ) and open ( 54.5 % , 12/22 ) methods , while 40.9 % ( 9/22 ) and 45.5 % ( 10/22 ) of cases were attributed to the under correction group in the closed and open methods , respectively .


In bilaterally operated cases , MRD was more symmetrical than in unilaterally operated eyes .


The symmetry of MRD and the eyelid crease was more prevalent in the open technique group .


The frontalis sling operation using a silicone rod exhibited better results , in terms of symmetry , in the open technique in comparison to the closed method .


Sepsis complication is a major cause of death in multiple trauma critically ill patients .


Defensin ( cysteine rich anti-microbial peptides ) , as an important component of immune system , might play an important role in this process .


There is also rising data on immunological effects of N-acetyl-cysteine ( NAC ) , a commonly used anti-oxidant in oxidative stress conditions and glutathione ( GSH ) deficiencies .


The aim of the present study was to evaluate the potential beneficial effects of NAC administration on multiple trauma patients with sepsis .


In a prospective , randomized controlled study , 44 multiple trauma critically ill patients who were mechanically ventilated and met the criteria of sepsis and admitted to the intensive care unit ( ICU ) were randomized into two groups .


Control group received all standard ICU therapies and NAC group received intravenous NAC 3 gr every 6 hours for 72 hours in addition to standard therapies .


Acute Physiology and Chronic Health Evaluation II ( APACHE II ) and Sequential Organ Failure Assessment ( SOFA ) scores , length of ICU stay , ICU mortality were recorded .


Levels of serum Immunoglobulin M ( IgM ) , Human - Defensin 2 ( HD2 ) and GSH were assessed at baseline and 24 , 72 , 120 hours after intervention .


During a period of 13-month screening , 44 patients underwent randomization but 5 patients had to be excluded .


21 patients in NAC group and 18 patients in control group completed the study .


For both groups the length of ICU stay , SOFA score and systemic oxygenation were similar .


Mortality rate ( 40 % vs. 22 % respectively , p = 0.209 ) and ventilator days ( MeanSD 19.8219.55 days vs. 13.8211.89 days respectively , p = 0.266 ) were slightly higher for NAC group .


IgM and GSH levels were similar between two groups ( p = 0.325 , 0.125 respectively ) , HD2 levels were higher for NAC group ( at day 3 ) .


High dose of NAC administration not only did not improve patients ' outcome , but also raised the risk of inflammation and was associated with increased serum creatinine .


The aim of this study was to examine proprioceptive performance in adults with hemiplegic cerebral palsy and the possibility that a home-based sensorimotor training program could improve proprioceptive performance .


This study is a preintervention/postintervention assessment of 12 adults participating in a home-based program consisting of targeted unilateral and bilateral reaching movements , hand manipulation tasks , tactile discrimination , and stereognosis .


It did not specifically include proprioceptive tasks .


Training sessions were 45 mins , 5 days per week , for 8 wks .


Limb position sense was assessed using three conditions : ipsilateral remembered ( same arm used for reference and matching targets ) , contralateral concurrent ( reference arm moved and held at target position while opposite arm matched reference position ) , and contralateral remembered ( reference arm moved to target position and then returned to start position before opposite arm matching position ) .


The participants demonstrated greater absolute and constant error when the more affected arm served as the reference arm , and matching was performed by the less affected arm , particularly in the contralateral remembered condition .


After training , the participants demonstrated less absolute error across matching tasks and no change in constant error .


The results suggest an important role for the reference arm in bilateral position matching tasks and the potential for improved proprioceptive performance after training in movement and unrelated sensory tasks .


Suicidal behaviours in adolescents are a major public health problem and evidence-based prevention programmes are greatly needed .


We aimed to investigate the efficacy of school-based preventive interventions of suicidal behaviours .


The Saving and Empowering Young Lives in Europe ( SEYLE ) study is a multicentre , cluster-randomised controlled trial .


The SEYLE sample consisted of 11,110 adolescent pupils , median age 15 years ( IQR 14-15 ) , recruited from 168 schools in ten European Union countries .


We randomly assigned the schools to one of three interventions or a control group .


The interventions were : ( 1 ) Question , Persuade , and Refer ( QPR ) , a gatekeeper training module targeting teachers and other school personnel , ( 2 ) the Youth Aware of Mental Health Programme ( YAM ) targeting pupils , and ( 3 ) screening by professionals ( ProfScreen ) with referral of at-risk pupils .


Each school was randomly assigned by random number generator to participate in one intervention ( or control ) group only and was unaware of the interventions undertaken in the other three trial groups .


The primary outcome measure was the number of suicide attempt ( s ) made by 3 month and 12 month follow-up .


Analysis included all pupils with data available at each timepoint , excluding those who had ever attempted suicide or who had shown severe suicidal ideation during the 2 weeks before baseline .


This study is registered with the German Clinical Trials Registry , number DRKS00000214 .


Between Nov 1 , 2009 , and Dec 14 , 2010 , 168 schools ( 11,110 pupils ) were randomly assigned to interventions ( 40 schools [ 2692 pupils ] to QPR , 45 [ 2721 ] YAM , 43 [ 2764 ] ProfScreen , and 40 [ 2933 ] control ) .


No significant differences between intervention groups and the control group were recorded at the 3 month follow-up .


At the 12 month follow-up , YAM was associated with a significant reduction of incident suicide attempts ( odds ratios [ OR ] 045 , 95 % CI 024-085 ; p = 0014 ) and severe suicidal ideation ( 050 , 027-092 ; p = 0025 ) , compared with the control group .


14 pupils ( 070 % ) reported incident suicide attempts at the 12 month follow-up in the YAM versus 34 ( 151 % ) in the control group , and 15 pupils ( 075 % ) reported incident severe suicidal ideation in the YAM group versus 31 ( 137 % ) in the control group .


No participants completed suicide during the study period .


YAM was effective in reducing the number of suicide attempts and severe suicidal ideation in school-based adolescents .


These findings underline the benefit of this universal suicide preventive intervention in schools .


Coordination Theme 1 ( Health ) of the European Union Seventh Framework Programme .


Bolus injections of intravenous propofol and remifentanil can be used in the tracheal intubation of infants and children , but relatively large doses are needed .


We hypothesised that addition of a small bolus of rocuronium would ensure good intubation conditions when modest propofol and remifentanil doses were used .


Seventy infants between 3 weeks and 4 months of age were randomised to receive either placebo or rocuronium .


Anaesthesia was induced with IV propofol , 3 ( 3-5 ) mg/kg [ median ( range ) ] .


Rocuronium ( 0.2 mg/kg ) or placebo was then injected , followed 15s later by 2g/kg remifentanil .


One anaesthetist attempted tracheal intubation 1min after the rocuronium/placebo injection and used the ` Copenhagen scoring system ' to assess intubation conditions .


The neuromuscular effect of 0.2 mg/kg rocuronium was recorded in another eight , already intubated , infants using thumb accelerometry during train-of-four stimulation of the ulnar nerve .


Intubation conditions were classified as ` poor ' in 14 of 34 ( 41 % ) patients given placebo and in 10 of 36 ( 28 % ) patients given rocuronium ( P = 0.32 ) .


There were four failed first attempts at intubation in the placebo group and none in the rocuronium group ( P = 0.051 ) .


Maximum neuromuscular depression occurred 4 ( 3-8 ) after injection of 0.2 mg/kg rocuronium .


Intubation conditions were poor in almost one third of the patients receiving propofol-remifentanil .


Adding a low-dose rocuronium did not significantly improve intubation conditions .


To compare the difference in the clinical efficacy on primary trigeminal neuralgia ( PTN ) between the comprehensive therapy of electroacupuncture ( EA ) at qi streets acupoints combined with spinal regulation method and medication with carbamazepine ( CBZ ) .


Sixty patients were randomized into a comprehensive therapy group ( 30 cases ) and a medication group ( 30 cases ) .


In the comprehensive therapy group , the acupoints at qi streets on the head such as Taiyang ( EX-HN 5 ) and Sishencong ( EX-HN 1 ) and those at qi streets on the chest and abdomen such as Shenshu ( BL 23 ) , Zhongwan ( CV 12 ) and Guanyuan ( CV 4 ) , etc. were selected .


After arrival of qi , EA was attached on 2 to 4 groups of acupoints .


After acupuncture , the spinal regulation method was applied .


This comprehensive therapy was given once a day .


In the medication group , CBZ was used for oral administration , 100 mg at the first time , twice a day , and 400 to 600 mg each day as the maintenance dose .


Separately , before and after treatment , in 2 and 6 months in follow-up , pain rating index ( PRI ) , life satisfaction index B ( LSI-B ) and hamilton depression scale ( HAMD ) were adopted to evaluate comprehensively the clinical efficacy in the two groups and compare the adverse reaction during the treatment between the two groups .


After treatment , the curative and markedly effective rate in the comprehensive therapy group was 76.7 % ( 23/30 ) , which was better than 63.3 % ( 19/30 ) in the medication group ( P < 0.01 ) .


The difference in PRI was not significant after treatment between the two groups ( all P > 0.05 ) .


In 2 and 6 months follow-up , PRI grade in the comprehensive therapy group was superior to that of the medication group ( both P < 0.05 ) .


After treatment and in follow-up , HAMD score was all reduced in the two groups ( P < 0.01 , P < 0.05 ) and the result in follow-up in the comprehensive therapy group was significant as compared with that in the medication group ( all P < 0.05 ) .


After treatment , LSI-B score was increased obviously in the two groups ( all P < 0.05 ) and the result in the comprehensive therapy group was better than that in the medication group ( P < 0.05 ) .


The incidence of adverse reaction in the comprehensive therapy group was 16.7 % ( 5/30 ) , which was lower than 30.0 % ( 9/30 , P < 0.01 ) in the medication group .


The comprehensive therapy of EA at qi streets acpoints combined with spinal regulation method achieves the long-term efficacy on PTN as compared with oral administration of CBZ in terms of the improvement of psychological condition , analgesia and life quality .


It is the safe , effective and stable therapy .


To evaluate the effectiveness of chest physiotherapy ( CPT ) , which provides slow and long expiratory flow and assisted cough techniques , in infants receiving outpatient care for acute wheezing episodes .


Forty-eight infants with moderate acute wheezing episodes were randomised to receive either salbutamol MDI with CPT ( n = 25 ) or without CPT ( n = 23 ) .


The clinical score and SpO2 levels were recorded , before and after treatment , in a blinded design .


The primary outcome was discharge after the first hour of treatment : clinical score 5/12 and SpO2 93 % .


Secondary outcomes were the number of admissions to hospital after the second hour , use of oral corticosteroid bursts and admissions to hospital on day seven .


There were no differences between children with and without CPT in discharge rate ( 92 % vs. 87 % ) , clinical score ( median [ IQR ] : 2.8 [ 2.2-3 .3 ] vs. 3.4 [ 2.8-4 .1 ] ) and SpO2 = ( 96.4 [ 95.7-97 .1 ] vs. 96.0 [ 94.9-96 .5 ] ) after the first hour of treatment or in the number of hospital admissions after the second hour .


No differences were observed at days seven and 28 following treatment .


There was no evidence of clinical benefits from these specific CPT techniques for infants receiving outpatient care for acute wheezing episodes .


- alanine ( BAl ) and NaHCO3 ( SB ) ingestion may provide performance benefits by enhancing concentrations of their respective physiochemical buffer counterparts , muscle carnosine and blood bicarbonate , counteracting acidosis during intense exercise .


This study examined the effect of BAl and SB co-supplementation as an ergogenic strategy during high-intensity exercise .


Eight healthy males ingested either BAl ( 4.8 g day ( -1 ) for 4 weeks , increased to 6.4 g day ( -1 ) for 2 weeks ) or placebo ( Pl ) ( CaCO3 ) for 6 weeks , in a crossover design ( 6-week washout between supplements ) .


After each chronic supplementation period participants performed two trials , each consisting of two intense exercise tests performed over consecutive days .


Trials were separated by 1 week and consisted of a repeated sprint ability ( RSA ) test and cycling capacity test at 110 % Wmax ( CCT110 % ) .


Placebo ( Pl ) or SB ( 300 mg kgbw ( -1 ) ) was ingested prior to exercise in a crossover design to creating four supplement conditions ( BAl-Pl , BAl-SB , Pl-Pl , Pl-SB ) .


Carnosine increased in the gastrocnemius ( n = 5 ) ( p = 0.03 ) and soleus ( n = 5 ) ( p = 0.02 ) following BAl supplementation , and Pl-SB and BAl-SB ingestion elevated blood HCO3 ( - ) concentrations ( p < 0.01 ) .


Although buffering capacity was elevated following both BAl and SB ingestion , performance improvement was only observed with BAl-Pl and BAl-SB increasing time to exhaustion of the CCT110 % test 14 and 16 % , respectively , compared to Pl-Pl ( p < 0.01 ) .


Supplementation of BAl and SB elevated buffering potential by increasing muscle carnosine and blood bicarbonate levels , respectively .


BAl ingestion improved performance during the CCT110 % , with no aggregating effect of SB supplementation ( p > 0.05 ) .


Performance was not different between treatments during the RSA test .


Glycated proteins ( advanced glycation endproducts , AGE ) in tissue are associated with degenerative diseases .


This study evaluated the role of sRAGE ( soluble receptor for advanced glycation endproducts ) , a decoy receptor of AGEs in blood , for the outcome of patients after coronary artery bypass grafting ( CABG ) .


A total of 90 patients undergoing CABG were analysed in two centres .


Perioperative blood samples were collected before surgery up to 1week postoperatively .


sRAGE was measured by ELISA .


Patients were subdivided regarding age ( < 64 versus > 70years , 14 % versus 35 % female ) , euroSCORE ( < 3 versus > 4 , 14 % versus 29 % female ) and sRAGE changes between sternotomy and end of the operation ( < 30 % versus > 45 % , 33 % versus 33 % female ) and subsequently analysed with respect of postoperative outcome parameters .


Preoperative sRAGE values did not correlate with the outcome of the patients .


sRAGE levels increase within 10min from 1,53996 to 5,311187 pg/ml after sternotomy , then returning to baseline levels within 2days after surgery .


Comparing the analysed possible risk factors age , euroSCORE and sRAGE changes , no difference was observed regarding 30-day mortality .


Age and the euroSCORE are superior with respect of tachyarrythmia , whereas sRAGE kinetics seems to be superior with respect of prolonged postoperative respiration time/stay in the intensive care unit or catecholamine support .


A prolonged , increased intraoperative sRAGE level is a new outcome predictor for patients undergoing CABG surgery , mutually complementary to the euroSCORE .


Scarce physical activity predicts shorter survival in dialysis patients .


However , the relationship between physical ( motor ) fitness and clinical outcomes has never been tested in these patients .


We tested the predictive power of an established metric of motor fitness , the Six-Minute Walking Test ( 6MWT ) , for death , cardiovascular events and hospitalization in 296 dialysis patients who took part in the trial EXCITE ( ClinicalTrials.gov Identifier : NCT01255969 ) .


During follow up 69 patients died , 90 had fatal and non-fatal cardiovascular events , 159 were hospitalized and 182 patients had the composite outcome .


In multivariate Cox models - including the study allocation arm and classical and non-classical risk factors - an increase of 20 walked metres during the 6MWT was associated to a 6 % reduction of the risk for the composite end-point ( P = 0.001 ) and a similar relationship existed between the 6MWT , mortality ( P < 0.001 ) and hospitalizations ( P = 0.03 ) .


A similar trend was observed for cardiovascular events but this relationship did not reach statistical significance ( P = 0.09 ) .


Poor physical performance predicts a high risk of mortality , cardiovascular events and hospitalizations in dialysis patients .


Future studies , including phase-2 EXCITE , will assess whether improving motor fitness may translate into better clinical outcomes in this high risk population .


Wire-guided cannulation has become a common biliary cannulation technique worldwide .


Different guidewires with various tip shapes and materials have been reportedly used for wire-guided cannulation .


However , there are apparently no studies reporting changes in the biliary cannulation rate according to the type of guidewire used .


We evaluated the effectiveness of the J-tip guidewire for biliary cannulation .


We conducted a prospective , multicenter , controlled study involving patients with a native papilla who required biliary cannulation .


We allocated the patients to the J-tip guidewire or angled-tip guidewire groups ( groups J and A , respectively ) .


If biliary cannulation was not achieved within 10min , the GW was changed and cannulation was continued .


Groups J and A consisted of 66 and 65 enrolled patients , respectively .


The biliary cannulation rate with a single guidewire for the first 10min was 84.8 % ( 56/66 ) for group J and 80.0 % ( 52/65 ) for group A.


The final success rate for biliary cannulation was 100 % in both groups .


The mean times necessary for biliary cannulation were 285.8 and 267.6 s in group J and group A , respectively .


The incidence rates of complications ( i.e. , all mild pancreatitis ) were 3.0 % ( 2/66 ) and 6.2 % ( 4/65 ) in group J and group A , respectively .


The mean amylase concentrations were 168.0 and 297.7 IU/L in group J and group A , respectively .


There were no significant differences in any results between both groups .


The biliary cannulation rate of the J-tip guidewire was not significantly different from those of standard guidewires .


Recent biomechanical evidence suggests that the meniscus-suture interface contributes the most displacement to the transtibial pull-out repair for meniscal root tears .


Therefore , optimization of surgical technique at the meniscus-suture interface may minimize displacement and improve the strength of meniscal root repairs .


The purpose of this study was to investigate the cyclic displacement and ultimate failure loads of 4 different meniscus-suture fixation techniques for posterior medial meniscal root repairs in human meniscus tissue .


The hypothesis was that there would be no significant difference between the two simple sutures ( TSS ) technique and 3 other techniques in cyclic displacement or ultimate failure load .


Controlled laboratory study .


A total of 32 fresh-frozen , human , medial meniscal transplant specimens were randomly assigned to 4 meniscus-suture fixation techniques used for transtibial pull-out repair in posterior medial meniscal root tears ( n = 8 per group ) .


The suture techniques studied were ( 1 ) TSS , ( 2 ) modified Mason-Allen ( MMA ) , ( 3 ) single double-locking loop ( S-DLL ) , and ( 4 ) double double-locking loop ( D-DLL ) .


The menisci were subjected to a cyclic tensioning protocol representative of postoperative rehabilitation ( 10-30 N for 1000 cycles ) and pulled to failure at a rate of 0.5 mm/s .


After 1000 cycles , the TSS group displaced the least ( mean SD , 1.78 0.64 mm ) , followed by the MMA ( 2.14 0.65 mm ) , D-DLL ( 2.97 0.57 mm ) , and S-DLL ( 3.81 0.78 mm ) groups .


After 100 , 500 , and 1000 cycles , suture displacements using the TSS and MMA techniques were not significantly different ( P > .13 ) , while the TSS technique resulted in significantly less displacement than the S-DLL and D-DLL ( P < .03 ) techniques .


The ultimate failure loads of the MMA ( 325 77 N ) and D-DLL ( 320 50 N ) techniques were significantly greater than those of the TSS ( 192 52 N ) and S-DLL ( 217 51 N ) techniques ( P < .05 ) .


The TSS and MMA fixation techniques were not significantly different , while the TSS was significantly better at resisting displacement when compared with the S-DLL and D-DLL stitch configurations .


The MMA and D-DLL techniques exhibited significantly greater failure loads than did the TSS and S-DLL techniques ; however , all techniques demonstrated ultimate failure loads above the currently accepted rehabilitation force threshold .


The TSS fixation technique combines the lowest technical difficulty and the ability to resist displacement at time zero .


The MMA technique , although more technically challenging , may provide an alternative means to resist displacement while enhancing the failure load .


Transcranial direct current stimulation ( tDCS ) of the primary motor cortex has been shown to modulate pain and trigeminal nociceptive processing .


Ten patients with classical trigeminal neuralgia ( TN ) were stimulated daily for 20minutes over two weeks using anodal ( 1mA ) or sham tDCS over the primary motor cortex ( M1 ) in a randomized double-blind cross-over design .


Primary outcome variable was pain intensity on a verbal rating scale ( VRS 0-10 ) .


VRS and attack frequency were assessed for one month before , during and after tDCS .


The impact on trigeminal pain processing was assessed with pain-related evoked potentials ( PREP ) and the nociceptive blink reflex ( nBR ) following electrical stimulation on both sides of the forehead before and after tDCS .


Anodal tDCS reduced pain intensity significantly after two weeks of treatment .


The attack frequency reduction was not significant .


PREP showed an increased N2 latency and decreased peak-to-peak amplitude after anodal tDCS .


No severe adverse events were reported .


Anodal tDCS over two weeks ameliorates intensity of pain in TN .


It may become a valuable treatment option for patients unresponsive to conventional treatment .


Type 2 diabetes , also known non-insulin-dependent diabetes , is the most prevalent type of the disease and involves defects in the secretion and action of insulin .


The aim of the proposed study is to evaluate the efficacy of pre-exercise low-level laser therapy ( LLLT ) on muscle performance of the quadriceps femoris in individuals with type 2 diabetes .


A double-blind , randomized , controlled clinical trial will be carried out in two treatment phases .


In the first phase , quadriceps muscle performance will be evaluated using an isokinetic dynamometer and the levels of creatine kinase and lactate dehydrogenase ( biochemical markers of muscle damage ) will be determined .


The participants will then be allocated to four LLLT groups through a randomization process using opaque envelopes : Group A ( 4 Joules ) , Group B ( 6 Joules ) , Group C ( 8 Joules ) and Group D ( 0 Joules ; placebo ) .


Following the administration of LLLT , the participants will be submitted to an isokinetic eccentric muscle fatigue protocol involving the quadriceps muscle bilaterally .


Muscle performance and biochemical markers of muscle damage will be evaluated again immediately after as well as 24 and 48hours after the experimental protocol .


One week after the last evaluation the second phase will begin , during which Groups A , B and C will receive the LLLT protocol that achieved the best muscle performance in phase 1 for a period of 4weeks .


At the end of this period , muscle performance will be evaluated again .


The protocol for this study is registered with the World Health Organization under Universal Trial Number U1111-1146-7109 .


The purpose of this randomized clinical trial is to evaluate the efficacy of pre-exercise LLLT on the performance of the quadriceps muscle ( peak torque , total muscle work , maximum power and fatigue index - normalized by body mass ) in individuals with DM-2 .


The study will support the practice of evidence-based to the use of LLLT in improving muscle performance in Individuals with DM-2 .


Data will be published after the study is completed .


Skin cancer survivors experience an increased risk for subsequent malignancies but the associated risk factors are poorly understood .


This study examined the risk of a new primary cancer following an initial skin cancer and assessed risk factors associated with second primary cancers .


All invasive cutaneous malignant melanomas ( CMM , N = 28 069 ) and squamous cell carcinomas ( SCC , N = 24 620 ) diagnosed in Norway during 1955-2008 were included .


Rates of new primary cancers in skin cancer survivors were compared to rates of primary malignancies in the general population using standardized incidence ratios ( SIR ) .


Discrete-time logistic regression models were applied to individual-level data to estimate cancer risk among those with and without a prior skin cancer , accounting for residential region , education , income , parenthood , marital status and parental cancer status , using a 20 % random sample of the entire Norwegian population as reference .


Further analyses of the skin cancer cohort were undertaken to determine risk factors related to subsequent cancers .


During follow-up , 9608 new primary cancers occurred after an initial skin cancer .


SIR analyses showed 50 % and 90 % increased risks for any cancer after CMM and SCC , respectively ( p < 0.01 ) .


The logistic regression model suggested even stronger increase after SCC ( 130 % ) .


The highest risk was seen for subsequent skin cancers , but several non-skin cancers were also diagnosed in excess : oral , lung , colon , breast , prostate , thyroid , leukemia , lymphoma and central nervous system .


Factors that were associated with increased risk of subsequent cancers include male sex , older age , lower residential latitude , being married and low education and income .


Parental cancer did not increase the risk of a subsequent cancer after SCC , but was a significant predictor among younger CMM survivors .


Our results provide information on shared environmental and genetic risk factors for first and later cancers and may help to identify individuals at high risk for subsequent cancers , which will be important as skin cancer incidence continues to rise .


The aim of this study was to evaluate the 6-month effect of a single automated thermodynamic treatment ( LipiFlow ) and implications of meibomian gland atrophy on treatment efficacy 6 months after application .


We analyzed the data of 26 subjects with meibomian gland dysfunction before and 6 months after treatment .


Investigated parameters included subjective symptoms , lipid layer thickness , meibomian gland assessment , tear osmolarity , corneal and conjunctival staining , lid margin parallel conjunctival folds , Schirmer test values , bulbar redness , tear meniscus height , meibomian gland atrophy , and noninvasive tear break-up time .


Subjective symptoms ( mean Ocular Surface Disease Index , 42 19 to 33 21 ; P = 0.004 , mean Standard Patient Evaluation of Eye Dryness 16 7 to 12 7 ; P = 0.0001 ) , lipid layer thickness ( 44.0 15.6 to 51.3 20.4 ; P = 0.014 ) , number of expressible glands ( 2.9 1.6 to 6.4 4.6 ; P < 0.0001 ) , lid margin parallel conjunctival folds ( 2.3 1.0 to 2.0 0.9 ; P = 0.04 ) , and bulbar redness ( 1.4 0.5 to 1.2 0.5 ; P = 0.0001 ) were all improved 6 months after treatment .


Symptomatic improvement was higher in patients with less severe meibomian gland atrophy compared with patients with more dropout at treatment .


There was no change of meibomian gland atrophy 6 months after treatment .


In summary , the results showed that a single thermodynamic treatment is effective in the treatment of meibomian gland dysfunction and that the effects last for at least 6 months .


We suggest performing meibography in every patient before treatment for better prediction of therapeutic effects .


The aging process involves a decline in immune functioning that renders elderly people more vulnerable to disease .


In residential programs for the aged , it is vital to diminish their risk of disease , promote their independence , and augment their psychological well-being and quality of life .


We performed a randomized controlled study , evaluating the ability of a relaxation technique based on Benson 's relaxation response to enhance psychological well-being and modulate the immune parameters of elderly people living in a geriatric residence when compared to a waitlist control group .


The study included a 2-week intervention period and a 3-month follow-up period .


The main outcome variables were psychological well-being and quality of life , biomedical variables , immune changes from the pre-treatment to post-treatment and follow-up periods .


Our findings reveal significant differences between the experimental and control groups in CD19 , CD71 , CD97 , CD134 , and CD137 lymphocyte subpopulations at the end of treatment .


Furthermore , there was a decrease in negative affect , psychological discomfort , and symptom perception in the treatment group , which increased participants ' quality of life scores at the three-month follow-up .


This study represents a first approach to the application of a passive relaxation technique in residential programs for the elderly .


The method appears to be effective in enhancing psychological well-being and modulating immune activity in a group of elderly people .


This relaxation technique could be considered an option for achieving health benefits with a low cost for residential programs , but further studies using this technique in larger samples of older people are needed to confirm the trends observed in the present study .


International Standard Randomised Controlled Trial Number Register ISRCTN85410212 .


This phase II , open-label study investigated intercalated combinations of eribulin and erlotinib in unselected patients with advanced non-small-cell lung cancer previously treated with platinum-based chemotherapies .


Eligible patients were randomized to eribulin mesylate 2.0 mg/m ( 2 ) on day 1 with erlotinib 150 mg on days 2-16 ( 21-day regimen ) or eribulin mesylate 1.4 mg/m ( 2 ) on days 1 and 8 with erlotinib 150 mg on days 15-28 ( 28-day regimen ) .


The primary end point was objective response rate ( ORR ) .


One hundred and twenty-three patients received 1 cycle of therapy ( 63 , 21-day regimen ; 60 , 28-day regimen ) .


ORRs were 13 % [ 95 % confidence interval ( CI ) 6 % -24 % ] and 17 % ( 95 % CI 8 % -29 % ) , and disease control rates were 48 % ( 95 % CI 35 % -61 % ) and 63 % ( 95 % CI 50 % -75 % ) for the 21 - and 28-day regimens , respectively .


The median progression-free survival and overall survival were similar with both regimens .


Both regimens were well tolerated with common grade 3 toxicities being neutropenia , asthenia/fatigue , and dyspnoea .


Sequential administration of erlotinib did not interfere with the pharmacokinetic profile of eribulin .


Intercalated combination of eribulin and erlotinib demonstrated modest activity and the addition of erlotinib did not appear to improve treatment outcome in an unselected population .


The 28-day regimen is suitable for further investigation .


Clinicaltrials.gov identifier : NCT01104155 .


There is evidence that new methods of noninvasive ventilation ( NIV ) support have significantly changed respiratory distress syndrome ( RDS ) management in preterm infants .


Further perspectives for neonatologists involve the assessment of different NIV strategies in terms of availability , effectiveness , and failure .


This study evaluates the efficacy of 2 different NIV strategies for RDS treatment in very low birth weight ( VLBW ) infants : nasal synchronized intermittent positive pressure ventilation ( NSIPPV ) , which is a modality of conventional ventilation with intermittent peak inspiratory pressure , and bilevel continuous positive airway pressure ( BiPAP ) , not synchronized , with 2 alternate levels of continuous positive airway pressure .


We conducted a 2-center randomized control study in 124 VLBW infants ( < 1500 g and < 32 weeks of gestational age ) with RDS who received NIV support ( NSIPPV , n = 62 ; BiPAP , n = 62 ) within 2 hours of birth .


We evaluated the performance of NIV strategies by selected primary outcomes ( failure rate and duration of ventilation ) and secondary outcomes .


The number of failures and duration of ventilation support did not differ between NSIPPV and BiPAP strategies ( P > .05 for both ) .


Moreover , no differences between groups were found regarding secondary outcomes ( P > .05 for all ) .


The present data show no statistically significant differences between NSIPPV and BiPAP strategies in terms of duration of ventilation and failures , suggesting that both NIV techniques are effective in the early treatment of RDS in VLBW infants .


Further randomized investigations on wider populations are needed to evaluate the effect of NIV techniques on long-term outcomes .


Among patients undergoing mitral-valve surgery , 30 to 50 % present with atrial fibrillation , which is associated with reduced survival and increased risk of stroke .


Surgical ablation of atrial fibrillation has been widely adopted , but evidence regarding its safety and effectiveness is limited .


We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation ( ablation group ) or no ablation ( control group ) during the mitral-valve operation .


Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure .


All patients underwent closure of the left atrial appendage .


The primary end point was freedom from atrial fibrillation at both 6 months and 12 months ( as assessed by means of 3-day Holter monitoring ) .


More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months ( 63.2 % vs. 29.4 % , P < 0.001 ) .


There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure ( 61.0 % and 66.0 % , respectively ; P = 0.60 ) .


One-year mortality was 6.8 % in the ablation group and 8.7 % in the control group ( hazard ratio with ablation , 0.76 ; 95 % confidence interval , 0.32 to 1.84 ; P = 0.55 ) .


Ablation was associated with more implantations of a permanent pacemaker than was no ablation ( 21.5 vs. 8.1 per 100 patient-years , P = 0.01 ) .


There were no significant between-group differences in major cardiac or cerebrovascular adverse events , overall serious adverse events , or hospital readmissions .


The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation , but the risk of implantation of a permanent pacemaker was also increased .


( Funded by the National Institutes of Health and the Canadian Institutes of Health Research ; ClinicalTrials.gov number , NCT00903370 . )


Coenzyme Q10 ( CoQ10 ) , an antioxidant that supports mitochondrial function , has been shown in preclinical Parkinson disease ( PD ) models to reduce the loss of dopamine neurons , and was safe and well tolerated in early-phase human studies .


A previous phase II study suggested possible clinical benefit .


To examine whether CoQ10 could slow disease progression in early PD .


A phase III randomized , placebo-controlled , double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria : the presence of a rest tremor , bradykinesia , and rigidity ; a modified Hoehn and Yahr stage of 2.5 or less ; and no anticipated need for dopaminergic therapy within 3 months .


Exclusion criteria included the use of any PD medication within 60 days , the use of any symptomatic PD medication for more than 90 days , atypical or drug-induced parkinsonism , a Unified Parkinson 's Disease Rating Scale ( UPDRS ) rest tremor score of 3 or greater for any limb , a Mini-Mental State Examination score of 25 or less , a history of stroke , the use of certain supplements , and substantial recent exposure to CoQ10 .


Of 696 participants screened , 78 were found to be ineligible , and 18 declined participation .


The remaining 600 participants were randomly assigned to receive placebo , 1200 mg/d of CoQ10 , or 2400 mg/d of CoQ10 ; all participants received 1200 IU/d of vitamin E.


Participants were observed for 16 months or until a disability requiring dopaminergic treatment .


The prospectively defined primary outcome measure was the change in total UPDRS score ( Parts I-III ) from baseline to final visit .


The study was powered to detect a 3-point difference between an active treatment and placebo .


The baseline characteristics of the participants were well balanced , the mean age was 62.5 years , 66 % of participants were male , and the mean baseline total UPDRS score was 22.7 .


A total of 267 participants required treatment ( 94 received placebo , 87 received 1200 mg/d of CoQ10 , and 86 received 2400 mg/d of CoQ10 ) , and 65 participants ( 29 who received placebo , 19 who received 1200 mg/d of CoQ10 , and 17 who received 2400 mg/d of CoQ10 ) withdrew prematurely .


Treatments were well tolerated with no safety concerns .


The study was terminated after a prespecified futility criterion was reached .


At study termination , both active treatment groups showed slight adverse trends relative to placebo .


Adjusted mean changes ( worsening ) in total UPDRS scores from baseline to final visit were 6.9 points ( placebo ) , 7.5 points ( 1200 mg/d of CoQ10 ; P = .49 relative to placebo ) , and 8.0 points ( 2400 mg/d of CoQ10 ; P = .21 relative to placebo ) .


Coenzyme Q10 was safe and well tolerated in this population , but showed no evidence of clinical benefit .


clinicaltrials.gov Identifier : NCT00740714 .


Historically , the preoperative consultation has consisted of a discussion between patient and surgeon .


There is a growing literature describing efforts to integrate multimedia into surgical patient education .


This study aimed to assess the efficacy of an educational video tutorial on early learning of information specific to patients undergoing shoulder arthroscopy when it was used as an adjunct to the standard preoperative consultation .


This study was a surgeon-blinded , randomized controlled trial involving 40 consecutive patients requiring shoulder arthroscopy .


After a preoperative consultation with an orthopaedic surgeon , patients were randomized in a 1:1 ratio to either a control group or a treatment group .


The treatment group viewed a 10-minute video , which covered the expected preoperative , intraoperative , and postoperative experience .


Immediately afterward , both groups completed a questionnaire measuring satisfaction and recall of information received .


All patients completed a second questionnaire at the first postoperative visit that assessed overall satisfaction with their experience .


Thirty-four patients were available for follow-up .


The video group ( N = 15 ) answered 87 % of the knowledge questions correctly , whereas the control group ( N = 19 ) answered only 56 % ( P = .000 ) .


There was stronger agreement in the video group that the preoperative consultation contained an appropriate amount of information ( P = .039 ) .


Postoperatively , there was agreement that the video was an effective preparation tool for all stages of the surgical experience .


However , there was no difference between the groups in satisfaction with their overall surgical experience .


Video can enhance patients ' operative experiences and improve their retained knowledge when it is used as an adjunct to the preoperative consultation .


Basic science , education methodology study , devices to improve learning .


Postoperative pulmonary complications are a burden for high-risk surgical patients with a risk of aspiration of subglottic secretions along the polyvinyl chloride cuff .


The introduction of a polyurethane cuff diminishes secretion leakage with a decreased rate of pneumonia .


The aim of the current analysis was to determine the time at which a polyurethane cuffed endotracheal tube might be advantageous to prevent aspiration in a setting of high-risk surgical patients .


The present investigation is based on published data obtained in postoperative cardiac surgical patients undergoing operation from 2006 to 2007 .


Cuff pressure was kept between 20 and 26 cmH2O intraoperatively and in the intensive care unit .


The current post hoc analysis determines ( 1 ) the discriminatory cutoff value of intubation duration for predicting postoperative pneumonia and ( 2 ) the potential factors associated with prolonged intubation .


Forty-three patients ( 32 % ) were diagnosed with early postoperative pneumonia .


Receiver operating characteristics analysis revealed a cutoff value of 16.6 hours for the duration of mechanical ventilation to discriminate patients with postoperative pneumonia .


A stepwise binary logistic regression analysis revealed that a polyvinyl chloride cuff was associated with a 10-fold increased risk for prolonged intubation .


The current analyses provide evidence that among cardiac surgical patients , mechanical ventilation more than 16.6 hours is associated with an increased likelihood of postoperative pneumonia .


To compare the effects of resistance training versus passive physical therapy on bone density in the metastatic bone during radiation therapy ( RT ) as combined treatment in patients with spinal bone metastases .


Secondly , to quantify pathological fractures after combined treatment .


In this randomized trial , 60 patients were allocated from September 2011 until March 2013 into one of the two groups : resistance training ( group A ) or passive physical therapy ( group B ) with thirty patients in each group during RT. .


Bone density in metastatic and non-metastatic vertebral bone was assessed at baseline , 3 and 6 months after RT. .


Bone density in all metastases increased significantly by 28.3 % ( IQR 11.4-139 .0 ) and 80.3 % ( IQR 32.6-250 .6 ) after 3 and 6 months in group A ( both p < 0.01 ) .


The bone density in group A was significantly increased compared to control group after 3 and 6months ( both p < 0.01 , median 59.7 ; IQR 21.1-98 .3 and median 62.9 ; IQR -9.7 to 161.7 ) .


The bone density data in group B showed no significant increase over the course of time ( p = 0.289 , median 5.5 , IQR 0.0-62 .2 and p = 0.057 , median 52.1 , IQR 0.0-162 .7 ) .


23.3 % of the patients in group A and 30.0 % of the patients in group B had pathological fractures , no fracture was assigned to intervention , and no difference between groups after 3 and 6 months was observed ( p = 0.592 and p = 0.604 ) .


Our trial demonstrated that resistance training concomitant to RT can improve bone density in spinal bone metastases .


This combined treatment is effective , practicable , and without side effects for patients .


Importantly , the pathological fracture rate in the intervention group was not increased .


The results offer a rationale for future large controlled investigations to confirm these findings .


Clinical trial identifier NCT01409720 .


Female sexual dysfunction ( FSD ) is a common problem that may be encountered in the interruption of normal sexual functioning in the sexual response cycle .


Women with a pelvic floor disorder who scored low on the Female Sexual Function Index ( FSFI ) showed an improvement in their sexual life following treatment by vaginal electrical stimulation ( VES ) .


The aim of this trial was to evaluate the effectiveness of VES in women with FSD without a predominant pelvic floor disorder or urinary incontinence .


Forty-two women with FSD were randomly allocated to VES and placebo groups .


Pelvic floor muscle ( PFM ) assessment and the FSFI questionnaire were performed at baseline and after the completion of sessions .


VES treatment was administered using a vaginal probe .


The probe was inserted , and a medium-frequency ( 50Hz ) alternating current was administered for a duty cycle of 5 seconds on followed by a 5-second rest .


Primary outcome measure was the improvement in FSFI score .


PFM assessments were performed according to the PERFECT scheme .


Total FSFI scores improved significantly in both the VES group and the control group .


Results show that in the VES group , there was an improvement in total score and FSFI domains that improved including arousal , desire , orgasm , and satisfaction .


Similarly , control group domains that improved were desire , arousal , and orgasm .


But there was no significant increase in satisfaction scores in the placebo group .


No significant changes in pain or lubrication domains were seen in either group .


Power , endurance , fast contractions , and repetitions were significantly improved in the VES group .


The lack of significant differences between the placebo and VES groups , except the satisfaction domain , puts into question the effectiveness of electrical stimulation as a monotherapy in treating primary FSD without pelvic floor disorder .


Muscle fatigue of the trunk extensor musculature plays a considerable role in chronic low back pain ( LBP ) .


The underlying physiology of fatigue is complex and not fully understood .


The Kinesio Taping ( KT ) supports damaged structures while allowing mobility and at the same time may influence some of the mechanisms associated with muscle fatigue such as blood flow and proprioception .


The aim of this study is to determine the influence of KT on the resistance to fatigue of the lumbar extensor musculature in a sample of young healthy subjects .


A randomized , controlled , doubled-blinded clinical trial was conducted .


Ninety nine healthy subjects were randomized in to the three arms of the study Kinesio Tape ( KT ) , placebo ( P ) and control ( C ) .


Directly after application of KT we measured lumbar extensor musculature endurance with the Biering-Sorensen test .


Subjects and researchers were blinded to the intervention .


Time achieved ( seconds ) was compared between groups with one-way ANOVA with confidence intervals of 95 % .


There were significant differences between the time achieved in the KT group versus the control group ( p < 0.05 ) .


The placebo group performed better than the control group but worse than the KT group , these were not significant in either case .


KT appears to improve the time to failure of the extensor muscle of the trunk obtained using the Biering-Sorensen test .


These findings suggest that KT influences processes that lead to muscle fatigue and that KT could be effective in the management of LBP .


To investigate the influence of different pressures of CO2 pneumoperitioneum on pathomorphism and function of intestines following laparoscopic gastrectomy ( LG ) .


Forty-eight gastric cancer patients were prospectively enrolled in the study .


Among them , 36 patients scheduled for elective LG were randomly assigned to low pressure group ( LP ) , middle pressure ( MP ) , and high pressure group ( HP ) with 12 cases in each group .


The CO2 pneumoperitoneum pressure was maintained at 8-10 mmhg in LP , 11-13 mmhg in MP , and 14-16 mmhg in HP .


The control group was open gastrectomy group ( OG ) in 12 cases .


The intestinal pathomorphism and level of plasma D-lactic acid before , during and after operation , and postoperative intestinal function of four groups were examined and compared .


There were no statistical differences in preoperative data among the four groups ( all P > 0.05 ) .


LG group was associated with a lower rate of surgical complications than OG ( 8.3 % vs. 41.7 % , P < 0.05 ) .


No obvious damage of intestinal mucosa was found in OG group .


Damage degree of intestinal mucosa after operation in LP , MP and HP groups was 0-1 , 1-2 , and 2-3 respectively .


There was significant change in intestinal pathomorphism after operation in both HP and MP groups .


The levels of D-lactic acid before operation were not significantly different among all the four groups , but increased significantly in each group after operation ( all P < 0.05 ) .


HP group had the highest level of plasma D-lactic acid and presented with delayed bowel sound return ( 4.5 d ) , time to first flatus ( 5.4 d ) , and intake ( 6.0 d ) as compared to the other 3 groups ( all P < 0.05 ) .


Laparoscopic radical gastrectomy is safe and minimally invasive .


Higher pneumoperitoneal pressure is harmful to the recovery of intestinal mucosa and function .


Therefore the pneumoperitioneum pressure should be maintained as low as possible under clear visualization during operation .


To determine the effectiveness of a short educational video and simulation on improvement of ultrasound ( US ) image acquisition and interpretation skills .


Prospective , randomized study .


University medical center .


28 anesthesia residents and community anesthesiologists with varied ultrasound experience were randomized to teaching video with interactive simulation or sham video groups .


Participants were assessed preintervention and postintervention on their ability to identify the sciatic nerve and other anatomic structures on static US images , as well as their ability to locate the sciatic nerve with US on live models .


Pretest written test scores correlated with reported US block experience ( Kendall tau rank r = 0.47 ) and with live US scanning scores ( r = 0.64 ) .


The teaching video and simulation significantly improved scores on the written examination ( P < 0.001 ) ; however , they did not significantly improve live US scanning skills .


A short educational video with interactive simulation significantly improved knowledge of US anatomy , but failed to improve hands-on performance of US scanning to localize the nerve .


To compare the rate of glove perforations and surgeon satisfaction when utilizing blunt surgical needles compared to conventional sharp surgical needles .


Patients undergoing Caesarean delivery were randomly assigned to the use of blunt or sharp surgical suture needles .


Surgical team members reported any known needlesticks or perforations of gloves and the primary surgeon completed a survey to gauge their satisfaction with the needles .


Glove perforation was assessed by suspending gloves and filling with water .


The chi-square test was used to assess categorical variables and the Mann-Whitney U-test was used to assess ordinal data .


A total 240 patients were enrolled into the study .


There was no statistically significant difference in the rate of glove perforation per case between groups assigned to sharp ( 24 % ) or blunt surgical needles ( 26 % ) .


( RR 1.05 , 95 % CI 0.68-1 .63 ) .


There were significant differences in the surgeon satisfaction surveys , with surgeons in the sharp needle group being more satisfied with the tissue penetration of the needle ( p < .001 ) , needle integrity ( p = .01 ) , force to penetrate tissue ( p < .001 ) and control of bleeding at the needle insertion site ( p = .001 ) .


Surveys from surgeons in the blunt needle group showed a statistically significant improvement in the perceived safety profile of the blunt needles ( p < .001 ) CONCLUSIONS : There was no significant difference in the rate of glove perforation between blunt and sharp surgical needles during Caesarean delivery .


Overall surgeons were more satisfied with the sharp surgical needles .


To estimate the effect of oral midazolam on patient pain and anxiety perception during first-trimester surgical abortion .


Between May and December 2013 , we conducted a randomized , double-blind , placebo-controlled trial .


Patients between 6 0/7 and 10 6/7 weeks of gestation received 10 mg oral midazolam or placebo 30-60 minutes before surgical abortion .


All patients received ibuprofen and a paracervical block .


We powered the study ( power = 80 % ; significance level = .025 ) to detect a 15-mm difference in our two a priori primary outcomes of pain and anxiety with uterine aspiration on a 100-mm visual analog scale .


Secondary outcomes were pain and anxiety at additional time points , memory , satisfaction , side effects , and adverse events .


Demographics were similar between groups ( placebo = 62 , midazolam = 62 ) .


Compared with those randomized to placebo , patients who received midazolam had significantly less anxiety preoperatively ( room entry : 51.4 mm compared with 34.5 mm , P < .001 ; positioning : 56.6 mm compared with 45.4 mm , P = .02 ) .


There was no difference in pain ( P = .28 ) or anxiety ( P = .14 ) during uterine aspiration or at other procedural time points .


A significantly greater number of patients in the midazolam group reported partial amnesia ( 31/61 compared with 16/61 , P = .005 ) and dizziness ( 30/61 compared with 18/61 , P = .03 ) .


Controlling for baseline differences , patients who received midazolam reported more postoperative sleepiness ( P < .001 ) and less postoperative nausea ( P = .004 ) .


There was no difference in overall satisfaction ( P = .88 ) .


Although oral midazolam reduces preprocedural anxiety , it does not reduce pain or anxiety with uterine aspiration during first-trimester surgical abortions .


ClinicalTrials.gov , www.clinicaltrials.gov , NCT01830881 .


I.


To determine whether the use of plasma rich in growth factors accelerates healing of the donor site in bone-tendon-bone anterior cruciate ligament ( ACL ) reconstruction ( patellar graft ) .


The use of the patellar graft presents post-operative problems such as anterior knee pain , which limits its use and leads to preference being taken for alternative grafts .


A double-blind , randomized , clinical trial was performed comparing two groups of patients who underwent ACL reconstruction using patellar tendon graft and comparing the use of plasma rich in growth factors at the donor site after graft harvest in terms of local regeneration by ultrasound assessment .


The plasma rich in growth factors group shows earlier donor site regeneration in comparison with the control group ( 2months earlier ) , with significant differences in the first 4months of the follow-up .


The application of plasma rich in growth factors shows accelerated tissue regeneration processes with respect to the control group .


This fact , together with the previously published with similar conclusions , can create a knowledge basis in order to set out new recovery guidelines following ACL reconstruction .


Therapeutic study , Level I.


Specific immunotherapy is the only treatment for the underlying allergic disease in patients with respiratory allergies .


The primary objective of this trial was to evaluate the efficacy and safety of two maintenance doses of immunologically enhanced , standardised quality ( SQ + ) grass subcutaneous immunotherapy ( SCIT ) [ 4,000 SQ + and 15,000 SQ + ; AVANZ ( ) Phleum pratense ( ALK ) ] compared with placebo .


This was a randomised , double-blind , placebo-controlled , phase II/III trial .


The primary evaluation was based on the combined rhinoconjunctivitis score during the entire grass pollen season .


Adult subjects with grass pollen-induced allergic rhinoconjunctivitis interfering with usual activities or sleep despite symptomatic medication use , were enrolled .


Four hundred and fifty subjects were randomised to receive either 4,000 SQ + ( n = 150 ) , 15,000 SQ + ( n = 152 ) or placebo ( n = 148 ) .


The average grass pollen exposure was 27 grains/m ( 3 ) / day .


No statistically significant differences between the active groups and the placebo group were found for clinical endpoints ( p > 0.05 ) .


Highly statistically significant ( p < 0.001 ) increases in IgG4 and IgE-blocking factor were found for both active groups versus placebo .


The most frequently reported adverse events were mild-to-moderate local injection-site reactions ; events were generally more frequent with 15,000 SQ + than with 4,000 SQ + and placebo .


The most common adverse events leading to premature discontinuation from the trial were anaphylactic reactions ( one subject from the placebo group and five subjects from the 15,000 SQ + group ) .


The inconclusive results were most probably influenced by a very low grass pollen season .


Other factors such as the extent of the pre-seasonal treatment could potentially have contributed .


The tolerability profile was acceptable for further development .


Pacing strategies have been reported to occur during continuous cyclical exercises .


However , currently no studies have examined if pacing takes place during repeated maximal voluntary muscle contractions ( MVCs ) .


Accordingly , the purpose of this study was to examine if informing subjects on the number of MVCs they would perform would affect force and root mean squared electromyography ( EMG ) , during similar fatiguing protocols .


Thirty well-trained male subjects completed three fatiguing protocols in a randomized order .


In the control condition participants were informed they would perform 12 MVCs , and then completed all 12 .


In the unknown condition they were not told how many MVCs they would perform , but were stopped after 12 .


Lastly , in the deception condition they were initially told they would perform only 6 MVCs , but after the 6 contractions they were asked to perform a few more repetitions and were stopped after 12 .


Compared to the unknown condition , subjects demonstrated greater forces ( p < 0.05 , ES = 0.35-1 .14 , 2-7 .5 % ) and biceps EMG ( p < 0.05 , ES = 0.6 , 6 % ) in the deception condition during the first six MVCs .


Additionally , under all conditions subjects applied greater forces in the last repetition ( # 12 ) relative to the previous one ( # 11 ) ( p < 0.06 , ES = 0.36-0 .5 , 2.8-3 .8 % ) .


The anticipation of performing a certain number of MVCs led the subjects to utilize different pacing strategies .


The results also question the assumption that subjects followed the instruction to exert maximal effort during repeated MVCs .


To examine the concurrent and predictive associations between the number of steps taken per day and clinical outcomes in patients with fibromyalgia ( FM ) .


A total of 199 adults with FM ( mean age 46.1 years , 95 % women ) who were enrolled in a randomized clinical trial wore a hip-mounted accelerometer for 1 week and completed self-report measures of physical function ( Fibromyalgia Impact Questionnaire-Physical Impairment [ FIQ-PI ] , Short Form 36 [ SF-36 ] health survey physical component score [ PCS ] , pain intensity and interference ( Brief Pain Inventory [ BPI ] ) , and depressive symptoms ( Patient Health Questionnaire-8 [ PHQ-8 ] ) as part of their baseline and followup assessments .


Associations of steps per day with self-report clinical measures were evaluated from baseline to week 12 using multivariate regression models adjusted for demographic and baseline covariates .


Study participants were primarily sedentary , averaging 4,019 1,530 steps per day .


Our findings demonstrate a linear relationship between the change in steps per day and improvement in health outcomes for FM .


Incremental increases on the order of 1,000 steps per day were significantly associated with ( and predictive of ) improvements in FIQ-PI , SF-36 PCS , BPI pain interference , and PHQ-8 ( all P < 0.05 ) .


Although higher step counts were associated with lower FIQ and BPI pain intensity scores , these were not statistically significant .


Step count is an easily obtained and understood objective measure of daily physical activity .


An exercise prescription that includes recommendations to gradually accumulate at least 5,000 additional steps per day may result in clinically significant improvements in outcomes relevant to patients with FM .


Future studies are needed to elucidate the dose-response relationship between steps per day and patient outcomes in FM .


Self-care acupressure might be successful in treating menstrual pain , which is common among young women .


There is a need for comparative effectiveness research with stakeholder engagement in all phases seeking to address the needs of decision-makers .


Our aim was to design a study on the effectiveness of additional self-care acupressure for menstrual pain comparing usual care alone using different methods of stakeholder engagement .


The study was designed using multiple mixed methods for stakeholder engagement .


Based on the results of a survey and focus group discussion , a stakeholder advisory group developed the study design .


Stakeholder engagement resulted in a two-arm pragmatic randomized trial .


Two hundred and twenty women aged 18 to 25 years with menstrual pain will be included in the study .


Outcome measurement will be done using electronic questionnaires provided by a study specific mobile application ( App ) .


Primary outcome will be the mean pain intensity at the days of pain during the third menstruation after therapy start .


Stakeholder engagement helped to develop a study design that better serves the needs of decision makers , including an App as a modern tool for both intervention and data collection in a young target group .


Clinicaltrials.gov identifier http://NCT01582724 .


The aim of the present randomized controlled trial was to determine the safety and efficacy of injectable demineralized bone matrix ( DBM ) gel combined with recombinant human bone morphogenetic protein-2 ( rhBMP-2 ) on alveolar ridge preservation after tooth extraction .


A total of 69 patients were randomly assigned to either a test group ( n = 35 ) or a control group ( n = 34 ) .


In the test group , DBM , together with rhBMP-2 ( 0.05 mg/mL ; rhBMP-2 / DBM ) was transplanted into the extraction sockets .


The control group received DBM alone .


The safety of rhBMP-2 / DBM was evaluated by oral examination , serum chemistry , and hematologic examination .


The radiographic changes in alveolar bone height and width were measured using computed tomography scans performed immediately after transplant and again 3 months thereafter .


Healing was uneventful in all subjects , with no anticipated adverse events and no clinically significant changes in the serum chemistry and hematologic findings .


No meaningful immune response was found among the study groups .


No significant difference was found in the radiographic changes of alveolar bone height and width ( P > .05 ) .


This new injectable biomaterial can be used easily and safely in clinical applications .


Sharing information with the team is critical in developing a shared mental model in an emergency , and fundamental to effective teamwork .


We developed a structured call-out tool , encapsulated in the acronym ` SNAPPI ' : Stop ; Notify ; Assessment ; Plan ; Priorities ; Invite ideas .


We explored whether a video-based intervention could improve structured call-outs during simulated crises and if this would improve information sharing and medical management .


In a simulation-based randomized , blinded study , we evaluated the effect of the video-intervention teaching SNAPPI on scores for SNAPPI , information sharing , and medical management using baseline and follow-up crisis simulations .


We assessed information sharing using a probe technique where nurses and technicians received unique , clinically relevant information probes before the simulation .


Shared knowledge of probes was measured in a written , post-simulation test .


We also scored sharing of diagnostic options with the team and medical management .


Anaesthetists ' scores for SNAPPI were significantly improved , as was the number of diagnostic options they shared .


We found a non-significant trend to improve information-probe sharing and medical management in the intervention group , and across all simulations , a significant correlation between SNAPPI and information-probe sharing .


Of note , only 27 % of the clinically relevant information about the patient provided to the nurse and technician in the pre-simulation information probes was subsequently learnt by the anaesthetist .


We developed a structured communication tool , SNAPPI , to improve information sharing between anaesthetists and their team , taught it using a video-based intervention , and provide initial evidence to support its value for improving communication in a crisis .


Persistent pain after inguinal herniorrhaphy is a disabling condition with a lack of evidence-based pharmacological treatment options .


This randomized placebo-controlled trial investigated the efficacy of a capsaicin 8 % cutaneous patch in the treatment of severe persistent inguinal postherniorrhaphy pain .


Forty-six patients with persistent inguinal postherniorrhaphy pain were randomized to receive either a capsaicin 8 % patch or a placebo patch .


Pain intensity ( Numerical Rating Scale [ NRS 0-10 ] ) was evaluated under standardized conditions ( at rest , during movement , and during pressure ) at baseline and at 1 , 2 and 3 months after patch application .


Skin punch biopsies for intraepidermal nerve fiber density ( IENFD ) measurements were taken at baseline and 1 month after patch application .


Quantitative sensory testing was performed at baseline and at 1 , 2 , and 3 months after patch application .


The primary outcome was comparisons of summed pain intensity differences ( SPIDs ) between capsaicin and placebo treatments at 1 , 2 and 3 months after patch application ( significance level P < 0.01 ) .


The maximum difference in SPID , between capsaicin and placebo treatments , was observed at 1 month after patch application , but the pain reduction was not significant ( NRS , mean difference [ 95 % CI ] : 5.0 [ 0.09 to 9.9 ] ; P = 0.046 ) .


No differences in SPID between treatments were observed at 2 and 3 months after patch application .


Changes in IENFD on the pain side , from baseline to 1 month after patch application , did not differ between capsaicin and placebo treatment : 1.9 [ -0.1 to 3.9 ] and 0.6 [ -1.2 to 2.5 ] fibers/mm , respectively ( P = 0.32 ) .


No significant changes in sensory function , sleep quality or psychological factors were associated with capsaicin patch treatment .


The study did not demonstrate significant differences in pain relief between capsaicin and placebo treatment , although a trend toward pain improvement in capsaicin treated patients was observed 1 month after patch application .


Clinicaltrialsregister.eu 2012-001540-22 ClinicalTrials.gov NCT01699854 .


The study 20050181 demonstrated significant improvements in progression-free survival ( PFS ) , objective response , and a nonsignificant trend toward increased overall survival ( OS ) with panitumumab-FOLFIRI versus FOLFIRI alone for second-line wild-type ( WT ) KRAS metastatic colorectal cancer ( mCRC ) .


Updated long-term data from a prespecified descriptive analysis are reported .


Patients receiving one prior mCRC treatment were randomly assigned ( 1:1 ) to panitumumab ( 6.0 mg/kg ) - FOLFIRI versus FOLFIRI every 2 weeks .


Co-primary end points ( PFS and OS ) were prospectively analyzed by tumor KRAS status .


One thousand one hundred and eighty-six patients were randomly assigned .


In patients with WT KRAS tumors , panitumumab-FOLFIRI significantly improved PFS versus FOLFIRI [ median 6.7 versus 4.9 months ; hazard ratio ( HR ) 0.82 [ 95 % confidence interval ( CI ) 0.69 , 0.97 ] ; P = 0.023 ] .


A trend toward longer OS was observed ( median 14.5 versus 12.5 months ; HR 0.92 [ 95 % CI 0.78 , 1.10 ] ; P = 0.37 ) .


Response rates improved from 10 % to 36 % ( P < 0.0001 ) .


From post hoc analyses in patients receiving prior oxaliplatin-bevacizumab , panitumumab-FOLFIRI improved PFS ( median 6.4 versus 3.7 months ; HR 0.58 [ 95 % CI 0.37 , 0.90 ] ; P = 0.014 ) .


PFS and OS appeared longer for worst-grade skin toxicity of 2-4 , versus 0-1 or FOLFIRI .


Safety results were as previously reported and consistent with the known toxicities with anti-epidermal growth factor receptor therapy .


These data confirm the primary efficacy and safety findings of this trial and support panitumumab-FOLFIRI as a second-line treatment of WT KRAS mCRC .


There is some evidence that individual-level job loss can lead to greater alcohol consumption and problems .


While other forms of economic loss were common during the recent recession , these are rarely investigated in studies of macroeconomic decline .


This study examined the relationship between types of economic loss in the 2008 to 2009 recession and alcohol outcomes , and whether this varied by gender and age .


Data are from the 2009 to 2010 U.S. National Alcohol Survey ( N = 5,382 ) .


We used multivariable regression to estimate associations between economic loss and alcohol volume , monthly drunkenness , negative drinking consequences , and alcohol dependence in the overall sample and within gender and age groups ( 18 to 29 , 30 to 49 , 50 + ) , controlling for demographic and alcohol history covariates .


In the overall sample , severe economic loss ( job or housing loss ) was positively associated with negative drinking consequences , alcohol dependence , and ( marginally ) drunkenness , whereas moderate loss ( loss of retirement savings , reduced work hours/wages , or trouble paying the rent/mortgage ) was unassociated with alcohol outcomes .


Important gender and age differences were observed .


Women reporting retirement loss , reduced hours/wages , and job loss consumed 41 to 70 % more alcohol than women unaffected by the recession , and men who experienced job loss and housing problems had increased risk for drunkenness , drinking consequences , and dependence .


Middle-aged Americans affected by partial or complete job loss and housing problems also had greater risk of drunkenness and alcohol-related problems , and older adults who lost retirement savings drank 42 % more alcohol than their peers unaffected by the recession .


With the exception of negative drinking consequences , young adult alcohol outcomes were largely unrelated to recessionary loss .


This study highlights the adverse effects of recession-induced economic losses on alcohol use and problems in demographic subgroups .


As men and middle-aged Americans were at risk for multiple , adverse alcohol outcomes , these groups may warrant special alcohol screening and intervention efforts in future macroeconomic crises .


Estimated effects of breast-feeding on childhood health vary between studies , possibly due to confounding by baseline maternal and child characteristics .


Possible time-dependent confounding has received little consideration .


Our aim was to evaluate the impact of such confounding .


We estimated the relationship between cumulative exclusive breast-feeding up to 6 months and wheezing , rash and body mass index ( BMI ) at 12 months [ in the Whistler cohort ( n = 494 ) and PROBIT ( n = 11,463 ) ] , and wheezing , rash , asthma , hay fever , eczema , allergy and BMI at age 6.5 years ( PROBIT ) .


We adjusted for time-dependent confounding by weight , length , rash , respiratory illness and day care attendance using marginal structural models ( MSMs ) .


Weight and day care attendance appeared potential time-dependent confounders , since these predicted breast-feeding status and were influenced by previous breast-feeding .


However , adjustment for time-dependent confounders did not markedly change the estimated associations .


For example , in PROBIT the adjusted increase in BMI at 12 months per 1-month increase in exclusive breast-feeding was 0.04 ( 95 % CI -0.09 to 0.01 ) using logistic regression and -0.06 ( 95 % CI -0.11 to -0.01 ) using MSM .


In Whistler , these estimates were each -0.05 ( 95 % CI -0.10 to 0.00 ) .


In two cohort studies , there was little evidence of time-dependent confounding by weight , length , rash , respiratory illness or day care attendance of the effects of breast-feeding on early childhood health .


Cryoballoon isolation of the pulmonary veins ( PVI ) is an effective and safe method in the treatment of patients with paroxysmal atrial fibrillation ( PAF ) .


The circular mapping catheter Achieve ( Medtronic Inc. , Minneapolis , USA ) can be introduced into the pulmonary vein ( PV ) through the inner lumen of the balloon catheter , allowing online mapping of the PV electrograms during ablation .


We prospectively compared the accuracy of this catheter in both available sizes to a standard circular mapping catheter ( SCMC ) in order to determine bidirectional PV block .


Patients with symptomatic PAF underwent cryoballoon ablation using either the Achieve 15-mm catheter ( group 1 , 15 patients ) or the Achieve 20 mm ( group 2 , 15 patients ) .


PV potentials were recorded using Achieve before , during , and after ablation , and exit block was obtained by pacing from inside the PV .


Accuracy of PV potential detection was controlled by a SCMC before and after ablation .


Rate of PV which could be isolated exclusively using the Achieve as guidewire was 98 % ( 59/60 ) in group 1 and 93 % ( 57/60 ) in group 2 .


Online signal recording during ablation was possible in 40 and 60 % of PV ( p = 0.037 ) , respectively .


Final Achieve diagnosis was accurate in 55/60 ( 92 % ) of the PVs and 12/15 ( 80 % ) of patients in group 1 and 60/60 ( 100 % ) of PV and 15/15 ( 100 % ) of patients in group 2 .


Stand-alone mapping using Achieve 15 mm resulted in a significant lack of diagnostic accuracy .


Achieve 20 mm provided excellent diagnostic accuracy comparable to a SCMC and should be preferentially used .


The aim of this study was to investigate the effect of magnesium administered before induction on the hemodynamic response and QT dispersion ( QTd ) related with intubation in hypertensive patients and to compare it with lidocaine .


Patients with essential hypertension who were under 65 years old , scheduled for elective surgery with a Mallampati score of I-II were included in the study .


Patients were randomly divided into three groups ; group M ( n = 20 ) received magnesium sulfate , group L was prescribed lidocaine , and group C ( control group ) received saline .


Standard 12-lead ECG readings were taken before the induction of anesthesia and at the first and fifth minutes following intubation .


There were no statistically significant differences between the groups in terms of age , sex and demographic characteristics .


There was no significant difference in the QT interval values before induction and 5 minutes after intubation in all groups .


In group M , QTd values were significantly lower at the first and fifth minutes than before induction .


There were no statistically significant differences in QTd values at different times in group L and group C.


QTd is not increased during tracheal intubation in hypertensive patients so there is no need for magnesium sulfate for these patients .


But as QTd has been shown to increase during tracheal intubation for coronary artery disease patients , magnesium sulfate might be useful for those patients although future studies are required to confirm this statement .


Cervical cancer screening coverage remains insufficient in most countries .


Our objective was to assess whether in-home vaginal self-sampling with a dry swab for high-risk human papillomavirus ( HR-HPV ) testing is effective and cost-effective in increasing participation in cervical cancer screening .


In March 2012 , 6000 unscreened women aged 30-65 years , living in a French region covered by a screening programme , who had not responded to an initial invitation to have a Pap smear were equally randomised to three groups : ` no intervention ' ; ` recall ' , women received a letter to have a Pap smear ; and ` self-sampling ' , women received a self-sampling kit to return to a centralised virology laboratory for PCR-based HPV testing .


Participation was higher in the ` self-sampling ' than in the ` no intervention ' group ( 22.5 % vs 9.9 % , P < 0.0001 ; OR 2.64 ) and ` recall ' group ( 11.7 % , P < 0.0001 ; OR 2.20 ) .


In the ` self-sampling ' group , 320 used the self-sampling kit ; for 44 of these women with positive HR-HPV test results , 40 had the recommended triage Pap smear .


The ICER per extra screened woman was 77.8 [ euro ] and 63.2 [ euro ] for the ` recall ' and ` self-sampling ' groups , respectively , relative to the ` no intervention ' group .


Offering an in-home , return-mail kit for vaginal self-sampling with a dry swab is more effective and cost-effective than a recall letter in increasing participation in cervical cancer screening .


Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat .


In this study , autologous platelet-rich plasma ( PRP ) , a concentrated bioactive blood component rich in cytokines and growth factors , was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management .


Forty patients ( 23 females and 17 males ) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone .


American Orthopedic Foot and Ankle Society ( AOFAS ) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection ( pretreatment = time 0 ) and at 3 , 6 , 12 , and 24 months following injection treatment .


Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis .


The cortisone group had a pretreatment average AOFAS score of 52 , which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months , then dropped to near baseline levels of 58 at 12 months , and continued to decline to a final score of 56 at 24 months .


In contrast , the PRP group started with an average pretreatment AOFAS score of 37 , which increased to 95 at 3 months , remained elevated at 94 at 6 and 12 months , and had a final score of 92 at 24 months .


PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis .


Level I , prospective randomized comparative series .


The optimal design for a cemented femoral stem remains a matter of debate .


Over time , the shape , surface finish and collar have all been modified in various ways .


A clear consensus has not yet emerged regarding the relative merits of even the most basic design features of the stem .


We undertook a prospective randomised trial comparing surface finish and the effect of a collar on cemented femoral component subsidence , survivorship and clinical function .


One hundred and sixty three primary total hip replacement patients were recruited prospectively and randomised to one of four groups to receive a cemented femoral stem with either a matt or polished finish , and with or without a collar .


At two years , although there was a trend for increased subsidence in the matt collarless group , this was not statistically significant ( p = 0.18 ) .


At a mean of 10.1 years follow-up , WOMAC scores for the surviving implants were good , ( Range of means 89-93 ) without significant differences .


Using revision or radiographic loosening as the endpoint , survivorship of the entire cohort was 93 % at 11 yrs , ( CI 87-97 % ) .


There were no significant differences in survivorship between the two groups with polished stems or the two groups with matt stems .


A comparison of the two collarless stems demonstrated a statistically significant difference in survivorship between polished ( 100 % ) and matt ( 88 % ) finishes ( p = 0.02 ) .


In the presence of a collar , surface finish did not significantly affect survivorship or function .


Between the two collarless groups a polished surface conferred an improved survivorship .


Despite the availability and demonstrated effectiveness of intensive combination treatment strategies ( ICTS ) for early rheumatoid arthritis ( RA ) , a discrepancy seems to exist between theoretical evidence and actual prescription in daily practice .


The purpose of this study was to explore and identify the factors influencing the prescription of ICTS .


This study involved rheumatologists and nurses participating in the Care for Rheumatoid Arthritis ( CareRA ) trial , a multicentre randomized controlled trial ( RCT ) comparing different ICTS for early RA with conventional disease-modifying anti-rheumatic drugs ( DMARDs ) plus step-down glucocorticoids ( GCs ) .


A qualitative study was carried out using individual semi-structured interviews .


Each interview was recorded , transcribed literally , and analysed thematically .


In addition , observations at outpatient clinics were used to clarify the interpretation of the results .


We interviewed 26 rheumatologists and six nurses and observed five outpatient visits .


Identified facilitators included available scientific evidence , personal faith in treatment strategy , staff support , and low treatment costs .


Rheumatologists had no doubts about the value of methotrexate ( MTX ) but some questioned the value of combination strategy , others the effectiveness and/or the dosage of individual compounds .


Additional barriers for prescribing ICTS included need for patient education , fear for patients ' preconceptions , concerns about applicability to the individual patient , difficulties with breaking routine , interference with organizational structures and processes , time constraints , and lack of financial support .


A heterogeneous set of factors highlights the complexity of prescribing ICTS for early RA in daily clinical practice .


Future improvement strategies should stimulate the facilitators while at the same time addressing the barriers .


The generalizability of these findings to other health care systems needs further examination .


Millions of women are afflicted with stress urinary incontinence .


Urinary incontinence is mentioned as one of the geriatric syndromes , together with pressure ulcers , functional decline , falls , and low self-esteem .


The aim of the present study was to determine the effect of pelvic muscle exercises on urinary incontinency and self - esteem of elderly females with stress urinary incontinency in Shiraz , Iran , 2013 .


In this interventional study , 50 old females aged 60-74 years were chosen among the members of Jahandidegan center , and they were asked to sign the informed consent form and complete the demographic questionnaire .


Then , Quid questionnaire was used for choosing the type of incontinence in the elderly females .


Next , the participants completed the ICIQ and self-esteem questionnaires .


Then , they were randomly assigned to case and control groups .


Each participant took part in 8 training classes .


Finally , the subjects filled the ICIQ and self-esteem questionnaires before and 2 months after the intervention .


The results is shown that after the intervention , ICIQ score has a significant difference between the two groups ( P = 0.001 ) .


Also , after the treatment , self-esteem average scores of studied unit indicated a significant statistical difference in experimental group .


In other words , the training sessions improved the score of self-esteem in the experimental group ( P < 0.001 ) versus control group ( P = 0.08 ) .


Pelvic muscle exercises were an empowerment mechanism for incontinent women in improving their quality of life and self-esteem , so recommended that such these exercising programs be used in elderly health care centers as a factor to improve health promotion of elderlies ` that are suffering from urinary incontinence .


Nutritional risk is relatively common in community-dwelling older people .


To objective of this study was to evaluate the effects of individual dietary counseling as part of a Comprehensive Geriatric Assessment on nutritional status among community-dwelling people aged 75 years or older .


Data were obtained from a subpopulation of participants in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly ( GeMS ) intervention study in 2004 to 2007 .


In the present study , the population consist 173 persons at risk of malnutrition in the year 2005 in an intervention ( n = 84 ) and control group ( n = 89 ) .


Nutritional status , body weight , body mass index , serum albumin were performed at the beginning of the study and at a two-year follow-up .


The nutritional screening was performed using the Mini Nutritional Assessment ( MNA ) test .


A increase in MNA scores ( 1.8 95 % confidence interval [ CI ] : 0.7 to 2.0 ) and in serum albumin ( 0.8 g/L , 95 % CI : 0.2 to 0.9 g/L ) were a significant difference between the groups .


Nutritional intervention , even dietary counseling without nutritional supplements , may improve nutritional status .


The purpose of this study was to evaluate whether posterior cruciate ligament reconstruction with the double-bundle ( DB ) technique improved stability of the knee compared with the single-bundle ( SB ) technique .


This prospective study included 50 patients who were randomized to undergo posterior cruciate ligament reconstruction by use of tibialis anterior grafts with either the SB technique ( 25 patients ) or DB technique ( 25 patients ) .


The group assignment was concealed before allocation with the use of sealed envelopes .


Posterior stability was evaluated with the KT-1000 arthrometer ( MEDmetric , San Diego , CA ) , and clinical outcomes were assessed with the Lysholm score , Tegner activity score , and International Knee Documentation Committee score ( both objective and subjective ) .


There were 22 patients in the SB group and 24 patients in the DB group with a minimum follow-up period of 2 years .


No differences were found between the 2 groups regarding patient demographic data and the duration from injury to operation ( P > .05 ) .


The Lysholm score was 88.0 4.2 ( range , 83 to 93 ) in the SB group and 89.8 3.8 ( range , 86 to 95 ) in the DB group , and there was no significant difference between the 2 groups ( P = .447 ) .


The Tegner activity score improved significantly to 6.2 0.9 ( range , 5 to 8 ) in the SB group and 6.8 1.2 ( range , 5 to 9 ) in the DB group .