Pakistan 's Lady Health Workers Programme ( LHW-P ) covers about 60 % of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers .


An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors ( LHSs ) is a key determinant of this problem .


Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs .


Ultimately , community case management ( CCM ) of childhood pneumonia and diarrhoea will improve .


NIGRAAN is a cluster-randomised trial in District Badin , Pakistan .


There are approximately 1100 LHWs supervised by 36 LHSs in Badin .


For this study , each LHS serves as a cluster .


All LHSs working permanently in Badin who regularly conduct and report field visits are eligible .


Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique .


Five LHWs from each LHSs are also randomly picked .


All 34 LHSs and 170 LHWs will be actively monitored .


The intervention consists of training to build LHS knowledge and skills , clinical mentorship and written feedback to LHWs .


Pre - and post-intervention assessments of LHSs , LHWs and community caregivers will be conducted via focus group discussions , in-depth interviews , knowledge assessment questionnaires , skill assessment scorecards and household surveys .


Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level .


NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia .


No significant harm to participants is anticipated .


The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally .


NIGRAAN is registered with the ` Australian New Zealand Clinical Trials Registry ' .


ACTRN12613001261707 .


To evaluate and compare peri-implant health , marginal bone loss and success of immediate and delayed implant placement for rehabilitation with full-arch fixed prostheses .


The present study was a prospective , randomized , single-blind , clinical preliminary trial .


Patients were randomized into two treatment groups .


In Group A implants were placed immediately post-extraction and in Group B six months after extraction .


The following control time-points were established : one week , six months and twelve months after loading .


Measurements were taken of peri-implant crevicular fluid volume , plaque index , gingival retraction , keratinized mucosa , probing depth , modified gingival index and presence of mucositis .


Implant success rates were evaluated for the two groups .


The study sample included fifteen patients ( nine women and six men ) with a mean average age of 63.7 years .


One hundred and forty-four implants were placed : 76 placed in healed sites and 68 placed immediately .


At the moment of prosthetic loading , keratinized mucosa width and probing depth were higher in immediate implants than delayed implants , with statistically significant differences .


However , after six and twelve months , differences between groups had disappeared .


Bone loss was 0.54 0.39 mm for immediate implants and 0.66 0.25 mm for delayed implants ( p = 0.201 ) .


No implants failed in either group .


The present study with a short follow-up and a small sample yielded no statistically significant differences in implant success and peri-implant marginal bone loss between immediate and delayed implants with fixed full-arch prostheses .


Peri-implant health showed no statistically significant differences for any of the studied parameters ( crevicular fluid volume , plaque index , gingival retraction , keratinized mucosa , probing depth , modified gingival index and presence of mucositis ) at the twelve-month follow-up .


To observe the effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation .


91 cases , who was going to receive amputated finger replantation , were randomly divided into group A ( n = 48 ) and B ( n = 43 ) .


PCIA ( patient-controlled intravenous analgesia ) was set immediately after operation in group A ( fentanyl 1.0 mg + tropisetron 4.0 mg + 10 mg + dexmedetomidine 200 microg + saline 100 ml ) and group B ( same as group A except dexmedetomidine ) .


Background infusion is 2 ml/h with a bolous of 0.5 ml and lockout time is 15 min .


postoperative VAS score , Ramsay score , condition of replanted fingers and other adverse events at the 0-6 h , 6-12 h , 12-24 h and 24-48 h were recorded and analyzed .


The age , sex , height , weight , amputated time ( Ts ) , revascularized time ( Tt ) in the two groups were not statistically different ( P > 0.05 ) .


Postoperative VAS score in the two groups was significantly different at the 0-6 h , 6-12 h , 12-24 h and 24-48 h ( P < 0.05 ) , but Ramsay score was not ( P > 0.05 ) .


The highest and lowest postoperative VAS score and Ramsay score were markedly different between two groups ( P < 0.05 ) .


3 of the 60 fingers in group A experienced vascular crisis and 2 underwent vascular explore surgery .


13 of 56 fingers in group B occurred vascular crisis , and 10 underwent vascular explore surgery , showing significant difference between the two groups ( P < 0.05 ) .


PCIA adverse reactions showed no difference between the two groups ( P > 0.05 ) .


Bradycardia and hypotension did n't happen in any patients in the two groups .


4 weeks after surgery , the survival rate was 96.7 % ( 58/60 ) in group A , and 83.9 % ( 47/56 ) in group B ( P < 0.05 ) .


Postoperative analgesia with dexmedetomidine as an adjuvant can increase the survival rate of replantation fingers with high safety .


Trabectedin binds to the minor groove of DNA and blocks DNA repair machinery .


Preclinical data have shown that trabectedin also modulates the transcription of the oncogenic fusion proteins of translocation-related sarcomas .


We aimed to assess the efficacy and safety of trabectedin as second-line therapy or later for patients with advanced translocation-related sarcoma .


We did a multicentre randomised open-label study in Japan .


Eligible patients had pathological diagnosis of translocation-related sarcoma , were aged 19 years or older , were unresponsive or intolerant to standard chemotherapy regimens , no more than four previous chemotherapy regimens , Eastern Cooperative Oncology Group performance status 0 or 1 , adequate bone marrow reserve , renal and liver functions , and had measurable lesions .


Patients were randomly assigned ( 1:1 ) by the minimisation method to receive either trabectedin ( 12 mg/m ( 2 ) given via a central venous line over 24 h on day 1 of a 21 day treatment cycle ) or best supportive care , which was adjusted centrally by pathological subtype .


Investigators , patients , and the sponsor were unmasked to the treatment assignment .


Progression-free survival and objective responses were assessed by a masked central radiology imaging review .


Efficacy was assessed by masked central radiology imaging review .


The primary endpoint was progression-free survival for the full analysis set population .


Follow-up is ongoing for the patients under study treatment .


The study is registered with Japan Pharmaceutical Information Center , number JapicCTI-121850 .


Between July 11 , 2012 , and Jan 20 , 2014 , 76 patients were enrolled and allocated to receive either trabectedin ( n = 39 ) or best supportive care ( n = 37 ) .


After central review to confirm pathological subtypes , 73 patients ( 37 in the trabectedin group and 36 in the best supportive care group ) were included in the primary efficacy analysis .


Median progression-free survival of the trabectedin group was 56 months ( 95 % CI 41-75 ) and the best supportive care group was 09 months ( 07-10 ) .


The hazard ratio ( HR ) for progression-free survival of trabectedin versus best supportive care was 007 ( 90 % CI 003-014 and 95 % CI 003-016 ) by a Cox proportional hazards model ( p < 00001 ) .


The most common drug-related adverse events for patients treated with trabectedin were nausea ( 32 [ 89 % ] of 36 ) , decreased appetite ( 21 [ 58 % ] ) , decreased neutrophil count ( 30 [ 83 % ] ) , increased alanine aminotransferase ( 24 [ 67 % ] ) , and decreased white blood cell count ( 20 [ 56 % ] ) .


Trabectedin significantly reduced the risk of disease progression and death in patients with advanced translocation-related sarcoma after standard chemotherapy such as doxorubicin , and should be considered as a new therapeutic treatment option for this patient population .


Taiho Pharmaceutical Co. , Ltd. .


Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery .


Low-dose clonidine , which blunts central sympathetic outflow , may prevent perioperative myocardial infarction and death without inducing hemodynamic instability .


We performed a blinded , randomized trial with a 2-by-2 factorial design to allow separate evaluation of low-dose clonidine versus placebo and low-dose aspirin versus placebo in patients with , or at risk for , atherosclerotic disease who were undergoing noncardiac surgery .


A total of 10,010 patients at 135 centers in 23 countries were enrolled .


For the comparison of clonidine with placebo , patients were randomly assigned to receive clonidine ( 0.2 mg per day ) or placebo just before surgery , with the study drug continued until 72 hours after surgery .


The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days .


Clonidine , as compared with placebo , did not reduce the number of primary-outcome events ( 367 and 339 , respectively ; hazard ratio with clonidine , 1.08 ; 95 % confidence interval [ CI ] , 0.93 to 1.26 ; P = 0.29 ) .


Myocardial infarction occurred in 329 patients ( 6.6 % ) assigned to clonidine and in 295 patients ( 5.9 % ) assigned to placebo ( hazard ratio , 1.11 ; 95 % CI , 0.95 to 1.30 ; P = 0.18 ) .


Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension ( 2385 patients [ 47.6 % ] vs. 1854 patients [ 37.1 % ] ; hazard ratio 1.32 ; 95 % CI , 1.24 to 1.40 ; P < 0.001 ) .


Clonidine , as compared with placebo , was associated with an increased rate of nonfatal cardiac arrest ( 0.3 % [ 16 patients ] vs. 0.1 % [ 5 patients ] ; hazard ratio , 3.20 ; 95 % CI , 1.17 to 8.73 ; P = 0.02 ) .


Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction ; it did , however , increase the risk of clinically important hypotension and nonfatal cardiac arrest .


( Funded by the Canadian Institutes of Health Research and others ; POISE-2 ClinicalTrials.gov number , NCT01082874 . )


Right ventricular ( RV ) outflow tract obstruction ( RVOTO ) might protect the RV from adverse remodeling caused by significant pulmonary regurgitation ( PR ) in patients with repaired tetralogy of Fallot ( rTOF ) , but the underlying mechanisms and influences on exercise tolerance remain unclear .


This study sought to investigate the impacts from mild RVOTO on ventricular remodeling and exercise capacity in rTOF .


Eighty-five rTOF patients with a PR fraction 20 % were assessed with cardiac magnetic resonance , cardiopulmonary exercise test , and echocardiography .


Patients with a peak RVOT pressure gradient 20-50 mmHg were considered to have mild RVOTO ( n = 29 ) , while those with a gradient < 20 mmHg had isolated PR ( n = 56 ) .


Comparing to patients with isolated PR , patients with combined PR and mild RVOTO had smaller RV and RVOT dimension , better RV and left ventricular ( LV ) ejection fraction ( EF ) , and superior exercise capacity .


PR severity and RV mass/volume ratio were similar between these 2 groups .


LVEF coupled with RVEF only in patients with isolated PR .


In multivariate analysis , smaller RVOT dimension was independently related to smaller RV dimension ( P < .001 ) and higher RVEF ( P = .005 ) .


Furthermore , mild RVOTO was independently associated with higher peak oxygen consumption ( P = .014 ) and oxygen uptake efficiency slope ( P = .005 ) .


Patients with combined PR and mild RVOTO had better RV remodeling and exercise capacity compared to those with isolated PR .


Our findings confirm the benefits from mild residual RVOTO support a policy of conservative RVOTO relief at repair .


Muscle mitochondrial function can vary during fasting , but is lower during hyperinsulinaemia in insulin-resistant humans .


Ageing and hyperlipidaemia may be the culprits , but the mechanisms remain unclear .


We hypothesised that ( 1 ) insulin would fail to increase mitochondrial oxidative capacity in non-diabetic insulin-resistant young obese humans and in elderly patients with type 2 diabetes and ( 2 ) reducing NEFA levels would improve insulin sensitivity by raising oxidative capacity and lowering oxidative stress .


Before and after insulin ( 4 , 40 , 100 nmol/l ) stimulation , mitochondrial oxidative capacity was measured in permeabilised fibres and isolated mitochondria using high-resolution respirometry , and H2O2 production was assessed fluorimetrically .


Tissue-specific insulin sensitivity was measured with hyperinsulinaemic-euglycaemic clamps combined with stable isotopes .


To test the second hypothesis , in a 1-day randomised , crossover study , 15 patients with type 2 diabetes recruited via local advertisement were assessed for eligibility .


Nine patients fulfilled the inclusion criteria ( BMI < 35 kg/m ( 2 ) ; age < 65 years ) and were allocated to and completed the intervention , including oral administration of 750 mg placebo or acipimox .


Blinded randomisation was performed by the pharmacy ; all participants , researchers performing the measurements and those assessing study outcomes were blinded .


The main outcome measures were insulin sensitivity , oxidative capacity and oxidative stress .


Insulin sensitivity and mitochondrial oxidative capacity were ~ 31 % and ~ 21 % lower in the obese groups than in the lean group .


The obese participants also exhibited blunted substrate oxidation upon insulin stimulation .


In the patients with type 2 diabetes , acipimox improved insulin sensitivity by ~ 27 % and reduced H2O2 production by ~ 45 % , but did not improve basal or insulin-stimulated mitochondrial oxidative capacity .


No harmful treatment side effects occurred .


Decreased mitochondrial oxidative capacity can also occur independently of age in insulin-resistant young obese humans .


Insulin resistance is present at the muscle mitochondrial level , and is not affected by reducing circulating NEFAs in type 2 diabetes .


Thus , impaired plasticity of mitochondrial function is an intrinsic phenomenon that probably occurs independently of lipotoxicity and reduced glucose uptake .


Clinical Trials NCT00943059 FUNDING : This study was funded in part by a grant from the German Federal Ministry of Education and Research to the German Center for Diabetes Research ( DZD e.V. ) .


Hereditary angioedema ( HAE ) , caused by C1 inhibitor ( C1INH ) deficiency or dysfunction , is characterized by recurrent attacks of tissue swelling affecting multiple anatomic locations .


Recombinant human C1INH ( rhC1INH ) has been shown effective for acute treatment of HAE attacks .


To evaluate the efficacy and safety of rhC1INH ( 50 IU/kg to maximum 4,200 IU/treatment ) vs placebo in a larger HAE population .


Seventy-five patients experiencing peripheral , abdominal , facial , and/or oropharyngeal laryngeal attacks were randomized ( 3:2 ) to rhC1INH ( n = 44 ) or placebo ( saline ; n = 31 ) .


Efficacy was assessed bypatient responses on a Treatment Effect Questionnaire ( TEQ ) and visual analog scale ( VAS ) .


Safety also was evaluated .


Median ( 95 % confidence interval ) time to beginning of symptom relief at the primary attack location was 90 minutes ( 61-150 ) in rhC1INH-treated patients vs 152 minutes ( 93 , not estimable ) in placebo-treated patients ( P = .031 ) based on the TEQ and 75 minutes ( 60-105 ) vs 303 minutes ( 81-720 , P = .003 ) based on a VAS decrease of at least 20 mm .


Median time to minimal symptoms was 303 minutes ( 240-720 ) in rhC1INH-treated patients vs 483 minutes ( 300-1 ,440 ) in placebo-treated patients based on the TEQ ( P = .078 ) and 240 minutes ( 177-270 ) vs 362 minutes ( 240 , not estimable ; P = .005 ) , based on an overall VAS less than 20 mm .


Overall , rhC1INH was safe and well tolerated ; no thromboembolic events , anaphylaxis , or neutralizing antibodies were observed .


Relief of symptoms of HAE attacks was achieved faster with rhC1INH compared with placebo as assessed by the TEQ and VAS , with a positive safety profile .


Results are consistent with previous studies showing efficacy and safety of rhC1INH in patients with HAE .


Surgical interns are often not well prepared and have high anxiety about the execution of basic technical skills .


This study investigates whether a short preclinical course focusing on laparoscopic camera-navigating skills is useful in the preparation for internship .


Through randomization , an experimental group who attended a short laparoscopic training session and a control group were created .


Students ' interest for this training and their confidence for laparoscopic exposure during surgical internship were inquired .


During internship , camera-navigating skills were assessed by the operating surgeons ( using a validated global rating scale ) as well as by the students themselves ( using a 10-points Likert scale ) .


All research was performed in the Center for Surgical Technologies , Leuven , Belgium .


A total of 205 fifth-year medical students at the University of Leuven , Belgium .


Of the control group students , 80 % were interested in attending the training session .


There was no difference in confidence between experimental and control group .


According to the surgeons and students , there was a significant improvement in clinical performance from the first ( scores on global rating and Likert scales 50 % ) to the last procedure ( scores 70 % ) for both groups .


However , there was no difference in performance between groups .


Students are very interested in attending a preclinical laparoscopic training session .


However , trained students did not display higher confidence or better clinical performance during internship .


Even without previous training , students are fast to acquire the necessary skills during surgical internship .


The study was designed to investigate the effects of drenching with propylene glycol ( PG ) on body condition , serum metabolites and milk production during the transition period of dairy buffaloes .


Animals were randomly allocated to a control group ( n = 5 ) and a PG group of 10 buffaloes that were drenched with 500 ml of propylene glycol once daily from 10 ( 93 ) days prepartum until 2 weeks postpartum .


Ultrasound measurements of backfat thickness ( BFT ) were performed weekly , while blood samples were taken at -4 , -2 , 2 , 4 , 6 , and 8 weeks from parturition for estimation of hematological and biochemical metabolites .


At -4 , -3 , and -2 weeks from calving , BFT did not differ between the two groups , but decreased after calving and was higher for the control group than the PG group at weeks -1 and 1 .


Hematological analysis revealed insignificant changes between the two groups .


Serum concentrations of non-esterified fatty acids ( NEFA ) , - hydroxybutyric acid ( BHBA ) and glucose did not differ between the two groups before parturition .


At 2 and 4 weeks from parturition , NEFA was higher for the control group than the PG group .


Serum concentrations of BHBA were higher at 2 , 4 , 6 , and 8 weeks in control animals than in treated buffaloes .


In contrast , the glucose level was significantly increased in PG group when compared to the control group at week 2 postpartum ( p < 0.05 ) .


Serum concentrations of total cholesterol , triglycerides , total proteins , albumin , and globulins did not differ significantly between the two groups ( p > 0.05 ) .


Serum enzyme activities of aspartate aminotransferase and - glutamyl transferase were significantly higher in the control than in the PG group .


In treated buffaloes significantly ( p < 0.05 ) higher average 60-day milk yields were recorded ( 8.40.22 vs. 10.70.40 kg/day ) .


Milk composition did not differ between the two groups .


Drenching of dairy buffaloes with propylene glycol may reduce the risk of ketosis , improve the metabolic status , and increase the milk yield .


Spinal bone metastases are commonly diagnosed in cancer patients .


The consequences are pain both at rest and under exercise , impairment of activities of daily life ( ADL ) , reduced clinical performance , the risk of pathological fractures , and neurological deficits .


The aim of this randomized , controlled pilot trial was to investigate the feasibility of muscle-training exercises in patients with spinal bone metastases under radiotherapy .


Secondary endpoints were local control , pain response and survival .


This study was a prospective , randomized , monocentre , controlled explorative intervention trial to determine the multidimensional effects of exercises for strengthening the paravertebral muscles .


On the days of radiation treatment , patients in the control group were physically treated in form of respiratory therapy .


Sixty patients were randomized between September 2011 and March 2013 into one of the two groups : differentiated resistance training or physical measure with thirty patients in each group .


The resistance training of the paravertebral muscles was feasible in 83.3 % of patients ( n = 25 ) .


Five patients died during the first three months .


The exercise group experienced no measurable side effects .


`` Chair stand test '' in the intervention group was significant enhanced with additionally improved analgesic efficiency .


Patients in intervention group improved in pain score ( VAS , 0-10 ) over the course ( p < .001 ) , and was significant better between groups ( p = .003 ) after 3 months .


The overall pain response showed no significant difference between groups ( p = .158 ) There was no significant difference in overall and bone survival ( survival from first diagnosed bone metastases to death ) .


Our trial demonstrated safety and feasibility of an isometric resistance training in patients with spinal bone metastases .


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


N-acetylcysteine ( NAC ) or sodium bicarbonate ( NaHCO3 ) , singly or combined , inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury ( CI-AKI ) .


We asked whether intravenous isotonic saline and either NaHCO3 in 5 % dextrose or else a high dose of NAC in 5 % dextrose prevent CI-AKI in outpatients exposed to high-osmolal iodinated contrast medium more than does saline alone .


This completed prospective , parallel , superiority , open-label , controlled , computer-randomized , single-center , Brazilian trial ( NCT01612013 ) hydrated 500 adult outpatients ( 214 at high risk of developing CI-AKI ) exposed to ioxitalamate during elective coronary angiography and ventriculography .


From 1 hour before through 6 hours after exposure , 126 patients ( group 1 ) received a high dose of NAC and saline , 125 ( group 2 ) received NaHCO3 and saline , 124 ( group 3 ) received both treatments , and 125 ( group 4 ) received only saline .


Groups were similar with respect to age , gender , weight , pre-existing renal dysfunction , hypertension , medication , and baseline serum creatinine and serum cystatin C , but diabetes mellitus was significantly less prevalent in group 1 .


CI-AKI incidence 72 hours after exposure to contrast medium was 51.4 % ( 257/500 ) , measured as serum creatinine > ( baseline +0.3 mg/dL ) and/or serum cystatin C > ( 1.1 baseline ) , and 7.6 % ( 38/500 ) , measured as both serum creatinine and serum cystatin C > ( baseline +0.3 mg/dL ) or > ( 1.25 baseline ) .


CI-AKI incidence measured less sensitively was similar among groups .


Measured more sensitively , incidence in group 1 was significantly ( p < 0.05 ) lower than in groups 2 and 3 but not group 4 ; adjustment for confounding by infused volume equalized incidence in groups 1 and 3 .


We found no evidence that intravenous isotonic saline and either NaHCO3 or else a high dose of NAC prevent CI-AKI in outpatients exposed to high osmolal iodinated contrast medium more than does saline alone .


ClinicalTrials.gov NCT01612013 .


The purpose of this study was to examine the relative effectiveness of 2 forms of physical education instruction on students ' skill and technical performance , as well as content knowledge in 3 track and field events .


Students from 6 classes in 3 Portuguese schools completed 900-min units conducted under the auspices of sport education or a more traditional teacher-directed format .


Classes were randomly assigned to these conditions within each school .


Although both groups improved significantly from pretest to posttest , the sport education classes outperformed the traditional classes in both technique and skill execution .


Only the sport education group made significant improvements in content knowledge .


When the students in the traditional group were tested at the point in time where they would usually complete a unit of physical education ( 450 min ) , there were no significant improvements in any of the study 's variables .


The explanation given for the superior performance outcomes of the sport education classes lies in the nature of formal competition and team affiliation , which are cornerstones of this pedagogical model .


That is , students take their learning experiences more seriously than in traditional and often inauthentic classes .


In terms of content knowledge , the fact that sport education has a level of content-embedded accountability that holds students accountable for their officiating duties is postulated as a significant contributor to their increased understanding of rules and protocols of athletic events .


Obesity is a disorder often accompanied by a heightened state of systemic inflammation and immunoactivation .


The present randomized crossover trial aimed to investigate the efficacy of curcumin , a bioactive polyphenol with established anti-inflammatory and immunomodulatory effects , on the serum levels of a panel of cytokines and mediators in obese individuals .


Thirty obese individuals were randomized to receive curcumin at a daily dose of 1 g or a matched placebo for 4 weeks .


Following a 2-week wash-out period , each group was assigned to the alternate treatment regimen for another 4 weeks .


Serum samples were collected at the start and end of each study period .


Serum levels of IL-1 , IL-1 , IL-2 , IL-4 , IL-6 , IL-8 , IL-10 , VEGF , IFN , EGF , MCP-1 , and TNF were measured using a multiplex Biochip Array Technology based method .


Mean serum IL-1 ( P = 0.042 ) , IL-4 ( P = 0.008 ) , and VEGF ( P = 0.01 ) were found to be significantly reduced by curcumin therapy .


In contrast , no significant difference was observed in the concentrations of IL-2 , IL-6 , IL-8 , IL-10 , IFN , EGF , and MCP-1 .


The findings of the present trial suggested that curcumin may exert immunomodulatory effects via altering the circulating concentrations of IL-1 , IL-4 , and VEGF .


To explore the feasibility of subserosal injection of carbon nanoparticle via venous infusion needle to label lymph node and its application value in laparoscopic radical gastrectomy .


Forty patients with gastric cancer were randomly divided into two groups ( carbon nanoparticle group and control group ) .


Subserosal injection of carbon nanoparticle around the tumor was performed via venous infusion needle laparoscopically at the beginning of surgery in carbon nanoparticles group , while the patients routinely underwent laparoscopic radical gastrectomy in control group .


Results of harvested lymph nodes were compared between the two groups .


The perioperative complications and the side effect of carbon nanoparticle were also evaluated .


The average number of harvested lymph node in carbon nanoparticle group ( 31.77.6 ) was significantly higher than that in control group ( 19.86.1 , P < 0.05 ) .


The proportion of harvested small node ( < 5 mm ) in carbon nanoparticles group ( 61.0 % ) was higher than that in control group ( 43.3 % , P < 0.01 ) .


The mean harvest time in carbon nanoparticle group [ ( 23.54.8 ) min ] was shorter than that in control group [ ( 32.65.5 ) min , P < 0.05 ] .


The rate of black-dyed harvested lymph node was 61.9 % and the metastasis rate of black-dyed lymph node was 23.0 % in carbon nanoparticle group , which were significantly higher than those without black-dyed ( 6.2 % , P < 0.05 ) and those in control group ( 15.7 % , P < 0.05 ) .


The operative time and perioperative complications were not significantly different between the two groups , and no serious side effect caused by carbon nanoparticle was observed .


Subserosal injection of carbon nanoparticle via venous infusion needle to label lymph nodes during laparoscopic radical gastrectomy is safe and feasible .


It can increase the number of harvested lymph node , especially the small node .


In patients with severe community-acquired pneumonia , treatment failure is associated with excessive inflammatory response and worse outcomes .


Corticosteroids may modulate cytokine release in these patients , but the benefit of this adjunctive therapy remains controversial .


To assess the effect of corticosteroids in patients with severe community-acquired pneumonia and high associated inflammatory response .


Multicenter , randomized , double-blind , placebo-controlled trial conducted in 3 Spanish teaching hospitals involving patients with both severe community-acquired pneumonia and a high inflammatory response , which was defined as a level of C-reactive protein greater than 150 mg/L at admission .


Patients were recruited and followed up from June 2004 through February 2012 .


Patients were randomized to receive either an intravenous bolus of 0.5 mg/kg per 12 hours of methylprednisolone ( n = 61 ) or placebo ( n = 59 ) for 5 days started within 36 hours of hospital admission .


The primary outcome was treatment failure ( composite outcome of early treatment failure defined as [ 1 ] clinical deterioration indicated by development of shock , [ 2 ] need for invasive mechanical ventilation not present at baseline , or [ 3 ] death within 72 hours of treatment ; or composite outcome of late treatment failure defined as [ 1 ] radiographic progression , [ 2 ] persistence of severe respiratory failure , [ 3 ] development of shock , [ 4 ] need for invasive mechanical ventilation not present at baseline , or [ 5 ] death between 72 hours and 120 hours after treatment initiation ; or both early and late treatment failure ) .


In-hospital mortality was a secondary outcome and adverse events were assessed .


There was less treatment failure among patients from the methylprednisolone group ( 8 patients [ 13 % ] ) compared with the placebo group ( 18 patients [ 31 % ] ) ( P = .02 ) , with a difference between groups of 18 % ( 95 % CI , 3 % to 32 % ) .


Corticosteroid treatment reduced the risk of treatment failure ( odds ratio , 0.34 [ 95 % CI , 0.14 to 0.87 ] ; P = .02 ) .


In-hospital mortality did not differ between the 2 groups ( 6 patients [ 10 % ] in the methylprednisolone group vs 9 patients [ 15 % ] in the placebo group ; P = .37 ) ; the difference between groups was 5 % ( 95 % CI , -6 % to 17 % ) .


Hyperglycemia occurred in 11 patients ( 18 % ) in the methylprednisolone group and in 7 patients ( 12 % ) in the placebo group ( P = .34 ) .


Among patients with severe community-acquired pneumonia and high initial inflammatory response , the acute use of methylprednisolone compared with placebo decreased treatment failure .


If replicated , these findings would support the use of corticosteroids as adjunctive treatment in this clinical population .


clinicaltrials.gov Identifier : NCT00908713 .


To investigate whether melatonin administered intraoperatively reduced pain following laparoscopic cholecystectomy .


Randomized , placebo-controlled , double-blinded study .


Two surgical departments in Copenhagen .


44 women between 18 and 70 years of age , who were surgical candidates for laparoscopic cholecystectomy .


Patients were anesthetized by a standard protocol and received a standard multimodal postoperative analgesic regimen .


Patients undergoing surgery were admitted on the day of surgery and were discharged the day after surgery .


Ten mg of intravenous ( IV ) melatonin or placebo were administered at the time of surgical incision .


Pain was assessed by a set of questionnaires documenting `` pain at rest '' using a visual analog scale ( VAS ) .


The use of rescue medication was recorded .


Sleep quality and general well-being were measured on separate VAS scales .


Sleepiness was assessed by the Karolinska Sleepiness Scale .


Forty-four patients were included and randomized to the study .


Three patients did not complete the study .


No differences in VAS pain scores , sleep quality , general well-being , or sleepiness were found between the two groups in the postoperative period .


The use of postoperative rescue medication did not differ between the groups .


The use of 10mg of IV melatonin administered during laparoscopic cholecystectomy did not affect postoperative pain or use of analgesic medication .


To test the hypothesis that observation with early salvage radiotherapy ( SRT ) is not inferior to ` standard ' treatment with adjuvant RT ( ART ) with respect to biochemical failure in patients with pT3 disease and/or positive surgical margins ( SMs ) after radical prostatectomy ( RP ) .


To compare the following secondary endpoints between the two arms : patient-reported outcomes , adverse events , biochemical failure-free survival , overall survival , disease-specific survival , time to distant failure , time to local failure , cost utility analysis , quality adjusted life years and time to androgen deprivation .


The Radiotherapy - Adjuvant Versus Early Salvage ( RAVES ) trial is a phase III multicentre randomised controlled trial led by the Trans Tasman Radiation Oncology Group ( TROG ) , in collaboration with the Urological Society of Australia and New Zealand ( USANZ ) , and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group ( ANZUP ) .


In all , 470 patients are planned to be randomised 1:1 to either ART commenced at 4 months of RP ( standard of care ) or close observation with early SRT triggered by a PSA level of > 0.20 ng/mL ( experimental arm ) .


Eligible patients have had a RP for adenocarcinoma of the prostate with at least one of the following risk factors : positive SMs extraprostatic extension seminal vesicle involvement .


The postoperative PSA level must be 0.10 ng/mL .


Rigorous investigator credentialing and a quality assurance programme are designed to promote consistent RT delivery among patients .


Trial is currently underway , with 258 patients randomised as of 31 October 2013 .


International collaborations have developed , including a planned meta-analysis to be undertaken with the UK Medical Research Council/National Cancer Institute of Canada Clinical Trials Group RADICALS ( Radiotherapy and Androgen Deprivation In Combination with Local Surgery ) trial and an innovative psycho-oncology sub-study to investigate a patient decision aid resource .


On the current evidence available , it remains unclear if ART is equivalent or superior to observation with early SRT .


Brucellosis remains the most common zoonotic disease throughout the world and especially in Iran .


Several clinical trials have tested different therapeutic regimens for brucellosis , but few have assessed the optimal duration of treatment .


We performed a randomized controlled trial to compare a triple-drug regimen of doxycycline plus rifampicin for 6 weeks and streptomycin for the first 7 days with doxycycline plus rifampicin for 8 weeks and streptomycin for 7 days in patients with uncomplicated brucellosis in Arak , Iran .


The primary outcome measure for the treatment groups was the relapse rate measured at 1 , 3 , 6 , 12 , and 24 months after cessation of therapy .


Eligible patients were randomized to one of the 2 groups with 72 per arm .


We found no significant difference in the relapse rate for the 8-week treatment group compared to the 6-week group ( 9.7 % vs 13.9 % ) .


There were no significant differences between the 6-week and 8-week groups regarding the relapse rate , period between clinical presentation and beginning of treatment , and time of relapse .


Symptom resolution was achieved in all cases at a median 9.5 days and no cases experienced continuing symptoms after treatment .


Our trial found no significant difference between 6-week and 8-week regimens of doxycycline and rifampicin plus streptomycin for the first 7 days .


Further comparative studies with a large sample size should be implemented to achieve a consistent therapeutic regimen for uncomplicated brucellosis , to help identify those who may benefit from longer treatment , and to minimize adverse effects and unnecessary continuation of treatment .


The purpose of this randomized controlled trial was to evaluate the efficacy of the Dynamic SpineCor brace for early idiopathic scoliosis ( 15-30 ) compared to the natural evolution of the disease .


68 patients participated in this study ( 32 treated and 36 controls ) with at least 5 years follow-up .


The inclusion criteria were : 1 ) high risk of evolution : family history and/or proven progressive ; 2 ) no significant pathological malformation of the spine ; 3 ) initial Cobb angle between 15 and 30 ; 4 ) risser 0 , 1 or 2 .


Assessment of brace efficacy included the percentage of patients who have 5 or less curve progression and the percentage of patients who have 6 or more progression at skeletal maturity .


At five-year follow-up a correction was achieved in 50 % of treated patient and only in 9.5 % of controls , stabilization in 42.3 % treated and 47.7 % in controls and progression in 26.9 % for the treated group and 42.8 % for controls .


For the control patients we considered as a failure if the Cobb angle worsened by more then 5 from the original angle and the patient then received treatment .


The results 5 years after the treatment suggested that the SpineCor brace reduced the probability of the progression of early idiopathic scoliosis comparing with its natural history .


Moreover , the positive outcome appears to be maintained in the long term .


The hypothalamic-pituitary-adrenal ( HPA ) axis is a critical mediator linking stress to health .


Understanding how to modulate its reactivity could potentially help reduce the detrimental health effects of HPA axis activation .


Social evaluative threat is a potent activator of this system .


Access to control and coping responses can reduce its reactivity to pharmacological activation .


Compassionate or affiliative behaviors may also moderate stress reactivity .


Impact of these moderators on social evaluative threat is unknown .


Here , we tested the hypotheses that interventions to increase control , coping , or compassionate ( versus competitive ) goals could reduce HPA-axis response to social evaluative threat .


Healthy participants ( n = 54 ) were exposed to social evaluative threat using the Trier Social Stress Test ( TSST ) .


They were randomly assigned to receive one of four different instructions prior to the stressor : Standard TSST instructions ( SI ) , standard instructions with access to `` control '' ( SI Control ) , or one of two cognitive interventions ( CI ) that ( 1 ) increased familiarity and helped participants prepare coping strategies ( CI Coping ) , or ( 2 ) shifted goal orientation from self-promotion to helping others ( CI Compassionate Goals ) .


ACTH and cortisol were obtained before and after stress exposure via intravenous catheter .


Control alone had no effect .


CI Compassionate Goals significantly reduced ACTH and cortisol responses to the TSST ; CI Coping raised baseline levels .


Compassionate Goals reduced hormonal responses without reducing subjective anxiety , stress or fear , while increasing expression of pro-social intentions and focus on helping others .


Brief intervention to shift focus from competitive self-promotion to a goal orientation of helping-others can reduce HPA-axis activation to a potent psychosocial stressor .


This supports the potential for developing brief interventions as inoculation tools to reduce the impact of predictable stressors and lends support to growing evidence that compassion and altruistic goals can moderate the effects of stress .


The aim of the study was to establish the efficacy of anti VEGF ( Vascular Endothelial Growing Factor ) drugs in the treatment of wet form ARMD ( Age-Related Macular Degeneration ) in everyday clinical practice in the Department of Ophthalmology , Faculty Hospital , Hradec Krlov , Czech Republic , E.U. , in patients registered in the Czech national registry AMADEUS .


Retrospective study with 24 months follow-up period .


In the group were evaluated 143 eyes of 140 patients , out of them were 77 women ( 65.8 % ) , of average age 73.09 ( 71.69 - 74.48 ) years , and 40 men ( 34.2 % ) of average age 74 ( 58 - 85 ) years .


All of the patients were completely examined before the beginning of the treatment ; during the treatment were , except the standardized eye examination , in patients treated with ranibizumab the color fundus photography and Optical Coherence Tomography ( OCT ) with measuring of the central retinal thickness performed every three months at least .


The patients treated by pegaptanib were examined every six weeks before the drug application .


The fluorescence angiography ( FA ) was performed at the beginning of the treatment to establish the type and extension of the choroidal neovascularization and during the treatment in case of necessity to establish the activity of the choroidal neovascular membrane ( CNV ) .


The treatment by ranibizumab was in the regimen PRN ( pro re nata ) , and pegaptanib was applied every six months during the first year with the follow-up evaluation of the findings .


The treatment evaluations were performed at 12 and 24 months .


During the two years follow - up period , the authors noticed in patients treated with ranibizumab loss of 5.12 letters of ETDRS optotypes in case of mostly classical CNV , in occult CNV loss of 5.45 letters , and in minimally classical CNV loss of 2.83 letters .


In three evaluated eyes with classical CNV in patients treated with pegaptanib we noticed after 2 years loss of 6.67 letters , in eleven eyes with occult CNV we established loss of 9.91 letters , and in two eyes with minimally classical CNV the average best-corrected visual acuity ( BCVA ) remained unchanged .


The pegaptanib treatment results may be influenced by small number of evaluated patients .


The visual acuity changes during the two years treatment were not statistically significant .


We noticed the decrease of average CRT ( central retinal thickness ) in all types of CNV treated both with ranibizumab and pegaptanib after the two years follow up .


To reach these results , an average of 5.51 applications of ranibizumab and 9 applications of pegaptanib during the two years were used .


In the followed-up group we found , comparing to the natural course of neovascular form of ARMD , retarding of the BCVA decrease during the two years treatment with VEGF inhibitors in everyday clinical practice .


Better results were achieved with ranibizumab treatment , however the differences were not statistically significant .


Key words : age related macular degeneration , AMADEUS Czech national registry , ranibizumab , pegaptanib .


Acupuncture is a safe and well-tolerated treatment for pain relief .


Previous studies supported the effectiveness of several acupuncture techniques for postoperative pain .


The aim of this randomized , controlled trial was to evaluate the efficacy of acupuncture in reducing pain after thyroid surgery .


We randomized 121 patients to a control group ( undergoing only standard postoperative analgesic treatment with acetaminophen ) and an acupuncture group , undergoing also either electroacupuncture ( EA ) or traditional acupuncture ( TA ) .


Pain was measured according to intraoperative remifentanil use , acetaminophen daily intake , Numeric Rating Scale ( NRS ) , and McGill Pain Questionnaire on postoperative days ( POD ) 1-3 .


Acupuncture group required less acetaminophen than controls at POD 2 ( P = .01 ) and 3 ( P = .016 ) .


EA patients required less remifentanil ( P = .032 ) and acetaminophen than controls at POD 2 ( P = .004 ) and 3 ( P = .008 ) .


EA patients showed a trend toward better NRS and McGill scores from POD 1 to 3 compared with controls .


EA patients had a lower remifentanil requirement and better NRS and McGill scores than TA patients .


No differences occurred between TA patients and controls .


Acupuncture may be effective in reducing pain after thyroid surgery .


EA is more useful ; TA achieves no significant effects .


Overweight and obesity is a significant health concern during pregnancy .


Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity .


We conducted a randomised controlled trial , in which pregnant women with a body mass index25 kg/m2 , and singleton gestation between 10 ( +0 ) to 20 ( +0 ) weeks were recruited and randomised to Lifestyle Advice ( involving a comprehensive dietary and lifestyle intervention over their pregnancy ) or Standard Care .


Within the intervention group , we conducted a nested randomised trial in which a subgroup of women were further randomised to receive access to supervised group walking sessions in addition to the standard information presented during the intervention contacts ( the Walking group ) or standard information only .


The outcome measures were maternal dietary intake , ( including food groups , macronutrient and micronutrient intake , diet quality ( using the Healthy Eating Index ; HEI ) , dietary glycaemic load , and glycaemic index ) and maternal physical activity .


Women completed the Harvard Semi-Structured Food Frequency Questionnaire , and the Short Questionnaire to Assess Health-enhancing Physical Activity ( SQUASH ) , at trial entry , 28 and 36 weeks ' gestational age , and 4 months postpartum .


Analyses were performed on an intention-to-treat basis , using linear mixed effects models with adjustment for the stratification variables .


Women randomised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day , as well as increased consumption of fibre , and reduced percentage energy intake from saturated fats ( P < 0.05 for all ) .


Maternal HEI was significantly improved at both 28 ( 73.356.62 versus 71.867.01 ; adjusted difference in means 1.58 ; 95 % CI 0.89 to 2.27 ; P < 0.0001 ) and 36 ( 72.956.82 versus 71.177.69 ; adjusted difference in means 1.77 ; 95 % CI 1.01 to 2.53 ; P < 0.0001 ) weeks .


There were no differences in dietary glycaemic index or glycaemic load .


Women randomised to Lifestyle Advice also demonstrated greater total physical activity ( adjusted difference in means 359.76 metabolic equivalent task units ( MET ) minutes/week ; 95 % CI 74.87 to 644.65 ; P = 0.01 ) compared with women receiving Standard Care .


The supervised walking group was poorly utilised .


For women who are overweight or obese , antenatal lifestyle advice improves maternal diet and physical activity during pregnancy .


Please see related articles : http://www.biomedcentral.com/1741-7015/12/163 and http://www.biomedcentral.com/1741-7015/12/201 .


Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426 ) .


Although there are various therapeutic modalities to manage patients suffering from sacrococcygeal pilonidal sinus disease , there remains controversy over a standard method to treat such patients .


In this study the postoperative outcomes after three different surgical methods of wound repair in patients with sacrococcygeal pilonidal sinus were compared .


Patients were divided randomly into three different groups .


All of the patients underwent a wide excision of their pilonidal sinus ; the subsequent surgical wound was left open in the first group ( lay open group ) whereas it was repaired with a simple primary closure and a rhomboid flap in the second and third groups .


Variables including length of hospitalisation , time for wound healing , time off work , recurrence and surgical complications were evaluated .


A total of 60 patients with an average age of 27.61 years were studied , including 47 ( 78.3 % ) men and 13 ( 21.7 % ) women .


Postoperative hospitalisation time was significantly shorter in patients who were treated using the simple primary closure method than those with the rhomboid flaps .


However , there were no differences in terms of postoperative hospitalisation time between the lay open and simple primary groups or the lay open and rhomboid groups .


The period of absence from work was significantly shorter in patients who were managed by a simple primary closure or rhomboid flap technique comparing to those whose wound was left open ( p < 0.05 ) .


Complete wound healing had a significantly shorter course in the rhomboid flap and the simple primary closure techniques compared to those within the lay open group .


In terms of complications , postoperative infection and haemorrhage were more common in the lay open group than in the other two .


Recurrence was about 5 % in patients who were treated with the lay open method in an 18-month follow-up period ; however , no recurrence was observed in the other two groups .


Considering the earlier wound healing period , less days absent from work , lower complication levels and recurrence rates , the simple primary closure or rhomboid flap techniques appear to be better options to treat the subsequent wound after a wide excision of pilonidal sinus when compared to the lay open method .


The simple primary closure method causes no cosmetic disfiguration and the most promising option among the three techniques assessed .


The authors have declared that no conflict of interest exists .


In current literature the association between statin use and cataracts is inconsistent and controversial .


We sought to further examine the effect of statin use on the risk of cataract and need for surgical intervention in 2 North American populations .


This retrospective nested case-control study derived data from the British Columbia ( BC ) Ministry of Health databases from 2000-2007 and the IMS LifeLink database from 2001-2011 to form 2 patient cohorts .


The BC cohort was comprised of female and male patients ; 162,501 patients were matched with 650,004 control subjects .


The IMS LifeLink cohort was comprised of male patients aged 40-85 years ; 45,065 patients were matched with 450,650 control subjects .


Patients with statin use for > 1 year before the initial ophthalmology visit were identified .


Diagnosis and surgical management of cataract were followed .


Conditional logistic regression models were used to analyze data .


For the BC cohort , the crude rate ratio ( RR ) for use of any statin was 1.30 , and the adjusted RR was 1.27 ( 95 % confidence interval , 1.24-1 .30 ) .


The adjusted RRs for each individual statin were all statistically significant .


For the IMS LifeLink cohort , the crude RR for use of any statin was 1.13 , and the adjusted RR was 1.07 ( 95 % confidence interval , 1.04-1 .10 ) .


This study demonstrates that statin use is significantly associated with cataract requiring surgical intervention .


This relationship was consistent in both North American cohorts .


Further assessment of this relationship is recommended , especially because of increased statin use and the importance of acceptable vision in old age when cardiovascular disease is common .


Dental caries in young children is commonly untreated and represents a public health problem .


Dental caries in children is reported to affect their anthropometric outcomes , but the evidence is conflicting .


Some studies found no association , whereas others found that caries was associated with underweight or overweight .


The objective was to assess the relationship between dental caries status and height and weight in 6 - to 8-year-old Saudi children with high caries prevalence .


This study was a cross-sectional survey in schoolchildren aged 6 to 8 years attending military primary schools in Jeddah , Saudi Arabia .


Caries status was assessed by using the dmft ( decayed , missing , filled , teeth [ primary teeth ] ) index .


Height and weight were assessed by using z scores of height-for-age ( HAZ ) , weight-for-age ( WAZ ) , and BMI-for-age ( BAZ ) calculated by World Health Organization standardized procedures .


Relationships between caries and HAZ , WAZ , and BAZ were assessed by using regression models .


A total of 417 of the 436 eligible schoolchildren with complete data were included , with a response rate of 95.6 % .


Their mean dmft index was 5.7 4.2 .


There was an inverse linear relationship between caries status and children 's HAZ , WAZ , and BAZ and significantly lower anthropometric outcomes for children at each consecutive group with higher levels of caries .


The associations remained significant after adjusting for dental , social , and demographic variables .


The inverse linear association between dental caries and all anthropometric outcomes suggests that higher levels of untreated caries are associated with poorer growth in Saudi schoolchildren .


Inguinal hernia repair is one of the most common surgical procedures worldwide .


This procedure is increasingly performed with endoscopic techniques ( laparoscopy ) .


Many surgeons prefer to cover the hernia gap with a mesh to prevent recurrence .


The mesh must be fixed tightly , but without tension .


During laparoscopic surgery , the mesh is generally fixed with staples or tissue glue .


However , staples often cause pain at the staple sites , and they can cause scarring of the abdominal wall , which can lead to chronic pain .


We designed a trial that aims to determine whether mesh fixation with glue might cause less postoperative pain than fixation with staples during a transabdominal preperitoneal patch plastic repair .


The TISTA trial is a prospective , randomized , controlled , single-center trial with a two-by-two parallel design .


All patients and outcome-assessors will be blinded to treatment allocations .


For eligibility , patients must be male , 18 years old , and scheduled for laparoscopic repair of a primary inguinal hernia .


One group comprises patients with a unilateral inguinal hernia that will be randomized to receive mesh fixation with either tissue glue or staples .


The second group comprises patients with bilateral inguinal hernias .


They will be randomized to receive mesh fixation with tissue glue either on the right or the left side and with staples on the other side .


The primary endpoint will be pain under physical stress , measured at 24 h after surgery .


Pain will be rated by the patient based on a numeric rating scale from 0 to 10 , where 10 equals the worst pain imaginable .


A total of 82 patients will be recruited ( 58 patients with unilateral inguinal hernias and 24 patients with bilateral hernias ) .


This number is estimated to provide 90 % power for detecting a pain reduction of one point on a numeric rating scale , with a standard deviation of one .


Patients with bilateral hernias will receive two meshes , one fixed with glue , and the other fixed with staples .


This design will eliminate the inter-individual bias inherent in comparing pain measurements between two groups of patients .


ClinicalTrials.gov : NCT01641718 .


To examine the impact of providing fertility information on personal levels of fertility knowledge and intentions to delay childbearing .


Participants ( n = 69 young childless women ) were randomly assigned to either an experimental ( fertility-related ) or control ( alcohol-related ) informational intervention group .


Subsequent to the exposure to information , participants completed a questionnaire measuring fertility knowledge and intentions for reproduction .


We predicted that the provision of fertility-related information would result in greater fertility knowledge and less intention to delay childbearing among young childless women .


The young women exposed to the brief fertility information intervention were significantly more likely to respond correctly to questions testing their fertility knowledge , and reported less intention to delay childbearing than the young women in the control group .


This study provided evidence that providing fertility-related information contributes to greater reproductive knowledge and may affect childbearing intentions .


Future research is warranted to examine the influence of fertility information on reproductive decision-making within a theoretical framework in order to ensure that subsequent information interventions maximize their effectiveness .


Operators who extract cardiac devices are exposed to considerable irradiation and excess risk of radiation-induced disorders .


A dedicated radioprotection cabin was developed to offer complete protection against radiation .


This randomized study was designed to ascertain the protection against radiation conferred by a radioprotection cabin and the safety during extraction of cardiac devices .


Thirty-seven consecutive patients who presented with an indication for extraction of a cardiac device were randomly assigned to a standard extraction technique ( n = 19 ) , vs extraction with the use of a radiation protection cabin ( n = 18 ) .


Fluoroscopic exposure was compared using electronic dosimeters placed on the thorax , back , foot , and head of the operator .


The procedural times and total fluoroscopic exposure times and the complication rates were not significantly different between the 2 groups .


The mean dose of radiation delivered to the thorax and back was similar in both groups ( P = 0.3 and P = 0.8 , respectively ) .


In contrast , the mean doses of radiation delivered to the head and to the feet were respectively 68 and 390 times less in the cabin group than in the control group ( P < 0.001 ) .


The cabin offers nearly full body radioprotection and eliminates the need to wear a lead apron , without increasing procedural time or complication rate during cardiac device extraction .


Previous research on the effects of plain packaging has largely relied on self-report measures .


Here we describe the protocol of a randomized controlled trial investigating the effect of the plain packaging of cigarettes on smoking behavior in a real-world setting .


In a parallel group randomization design , 128 daily cigarette smokers ( 50 % male , 50 % female ) will attend an initial screening session and be assigned plain or branded packs of cigarettes to smoke for a full day .


Plain packs will be those currently used in Australia where plain packaging has been introduced , while branded packs will be those currently used in the United Kingdom .


Our primary study outcomes will be smoking behavior ( self-reported number of cigarettes smoked and volume of smoke inhaled per cigarette as measured using a smoking topography device ) .


Secondary outcomes measured pre - and post-intervention will be smoking urges , motivation to quit smoking , and perceived taste of the cigarettes .


Secondary outcomes measured post-intervention only will be experience of smoking from the cigarette pack , overall experience of smoking , attributes of the cigarette pack , perceptions of the on-packet health warnings , behavior changes , views on plain packaging , and the rewarding value of smoking .


Sex differences will be explored for all analyses .


This study is novel in its approach to assessing the impact of plain packaging on actual smoking behavior .


This research will help inform policymakers about the effectiveness of plain packaging as a tobacco control measure .


Current Controlled Trials ISRCTN52982308 ( registered 27 June 2013 ) .


In European countries , including Switzerland , as well as in many states worldwide , cannabis is the most widely used psychoactive substance after alcohol and tobacco .


Although approximately one in ten users develop serious problems of dependency , only a minority attends outpatient addiction counseling centers .


The offer of a combined web-based self-help and chat counseling treatment could potentially also reach those users who hesitate to approach such treatment centers and help them to reduce their cannabis use .


This paper presents the protocol for a three-armed randomized controlled trial that will test the effectiveness of a web-based self-help intervention in combination with , or independent of , tailored chat counseling compared to a waiting list in reducing or enabling the abstention from cannabis use in problematic users .


The primary outcome will be the weekly quantity of cannabis used .


Secondary outcome measures will include the number of days per week on which cannabis is used , the severity of cannabis use disorder , the severity of cannabis dependence , cannabis withdrawal symptoms , cannabis craving , the use of alcohol , tobacco , and other non-cannabis illicit drugs , changes in mental health symptoms , and treatment retention .


The self-help intervention will consist of 8 modules designed to reduce cannabis use based on the principles of motivational interviewing , self-control practices , and methods of cognitive behavioral therapy .


The two additional individual chat-counseling sessions in the additional chat condition will be based on the same therapy approaches and tailored to participants ' self-help information data and personal problems .


The predictive validity of participants ' baseline characteristics on treatment retention and outcomes will be explored .


To the best of our knowledge , this will be the first randomized controlled trial to test the effectiveness of online self-help therapy in combination or without chat counseling in reducing or enabling the abstention from cannabis use .


It will also investigate predictors of outcome and retention for these interventions .


This trial is registered at Current Controlled Trials and is traceable as ISRCTN59948178 .


Hypertrophic cardiomyopathy ( HCM ) is the most common cause of sudden death in the young , although not all patients eligible for sudden death prevention with an implantable cardioverter-defibrillator are identified .


Contrast-enhanced cardiovascular magnetic resonance with late gadolinium enhancement ( LGE ) has emerged as an in vivo marker of myocardial fibrosis , although its role in stratifying sudden death risk in subgroups of HCM patients remains incompletely understood .


We assessed the relation between LGE and cardiovascular outcomes in 1293 HCM patients referred for cardiovascular magnetic resonance and followed up for a median of 3.3 years .


Sudden cardiac death ( SCD ) events ( including appropriate defibrillator interventions ) occurred in 37 patients ( 3 % ) .


A continuous relationship was evident between LGE by percent left ventricular mass and SCD event risk in HCM patients ( P = 0.001 ) .


Extent of LGE was associated with an increased risk of SCD events ( adjusted hazard ratio , 1.46 / 10 % increase in LGE ; P = 0.002 ) , even after adjustment for other relevant disease variables .


LGE of 15 % of LV mass demonstrated a 2-fold increase in SCD event risk in those patients otherwise considered to be at lower risk , with an estimated likelihood for SCD events of 6 % at 5 years .


Performance of the SCD event risk model was enhanced by LGE ( net reclassification index , 12.9 % ; 95 % confidence interval , 0.3-38 .3 ) .


Absence of LGE was associated with lower risk for SCD events ( adjusted hazard ratio , 0.39 ; P = 0.02 ) .


Extent of LGE also predicted the development of end-stage HCM with systolic dysfunction ( adjusted hazard ratio , 1.80 / 10 % increase in LGE ; P < 0.03 ) .


Extensive LGE measured by quantitative contrast enhanced CMR provides additional information for assessing SCD event risk among HCM patients , particularly patients otherwise judged to be at low risk .


To determine whether umbilical cord milking ( UCM ) improves systemic blood flow and reduces neonatal morbidities compared with immediate cord clamping ( ICC ) .


Women admitted to a tertiary care center and delivering before 32 weeks ' gestation were randomized to receive UCM or ICC .


Three blinded serial echocardiograms were performed in the first 2 days of the infant 's life .


The primary outcome was measured systemic blood flow ( superior vena cava flow ) at each time point .


Of the 60 neonates who were enrolled and randomized , 30 were assigned to cord milking and 30 to ICC .


Neonates randomized to cord milking had greater measures of superior vena cava flow and right ventricular output in the first 6 hours and 30 hours of life .


Neonates receiving UCM also had greater serum hemoglobin , received fewer blood transfusions , fewer days on oxygen therapy , and less frequent use of oxygen at 36 weeks ' corrected postmenstrual age .


We demonstrate greater systemic blood flow with UCM in preterm neonates compared with ICC .


Future large prospective trials are needed to determine whether UCM reduces intraventricular hemorrhage and other long-term morbidities .


The use of ablative lasers based on the fractional approach is a novel strategy for the treatment of postoperative and acne scars in addition to wrinkles .


To evaluate and compare the efficacy of carbon dioxide ablative fractional laser ( AFL ) and the pulsed dye laser ( PDL ) for the improvement of surgical scars .


Fourteen Korean patients with surgical scars were enrolled for this study .


Half of each scar was treated with a 10,600-nm AFL and the contralateral half with the 595-nm PDL .


For early intervention of the postoperative scar , the laser treatments were begun after 2 weeks from the Mohs micrographic surgery .


Both PDL and AFL produced statistically significant improvements .


However , comparatively , there was no statistical difference between them .


In each variable , AFL was more effective than PDL in the improvement of pliability and thickness .


In contrast , PDL was superior to AFL in the improvement of vascularity and pigmentation .


Pulsed dye laser and AFL treatments for surgical scar provide significant improvement .


Pulsed dye laser was more effective in color of scar compared with AFL , which showed marked improvement in the contour of scar .


Overall improvement was not statistically different in the Vancouver Scar Scale .


Ivacaftor has shown a clinical benefit in patients with cystic fibrosis who have the G551D-CFTR mutation and reduced lung function .


Lung clearance index ( LCI ) using multiple-breath washout might be an alternative to and more sensitive method than forced expiratory volume in 1 s ( FEV1 ) to assess treatment response in the growing number of children and young adults with cystic fibrosis who have normal spirometry .


The aim of the study was to assess the treatment effects of ivacaftor on LCI in patients with cystic fibrosis , a G551D-CFTR mutation , and an FEV1 > 90 % predicted .


This phase 2 , multicentre , placebo-controlled , double-blind 22 crossover study of ivacaftor treatment was conducted in patients with cystic fibrosis , at least one G551D-CFTR allele , and an FEV1 > 90 % predicted .


Patients also had to have an LCI higher than 74 at screening , age of 6 years or older , and a weight higher than or equal to 15 kg .


Eligible patients were randomly allocated to receive one of two treatment sequences ( placebo first followed by ivacaftor 150 mg twice daily [ sequence 1 ] or ivacaftor 150 mg twice daily first followed by placebo [ sequence 2 ] ) of 28 days ' treatment in each period , with a 28-day washout between the two treatment periods .


Randomisation ( ratio 1:1 ) was done with block sizes of 4 , and all site personnel including the investigator , the study monitor , and the Vertex study team were masked to treatment assignment .


The primary outcome measure was change from baseline in LCI .


The study is registered at ClinicalTrials.gov , NCT01262352 .


Between February and November , 2011 , 21 patients were enrolled , of which 11 were assigned to the sequence 1 group , and 10 to the sequence 2 group .


20 of these patients received treatment and 17 completed the trial ( eight in sequence 1 group and 9 in sequence 2 group ) .


Treatment with ivacaftor led to significant improvements compared with placebo in LCI ( difference between groups in the average of mean changes from baseline at days 15 and 29 was -216 [ 95 % CI -288 to -144 ] ; p < 00001 ) .


Adverse events experienced by study participants were similar between treatment groups ; at least one adverse event was reported by 15 ( 79 % ) of 19 patients who received placebo and 13 ( 72 % ) of 18 patients who received ivacaftor .


No deaths occurred during study period .


In patients with cystic fibrosis aged 6 years or older who have at least one G551D-CFTR allele , ivacaftor led to improvements in LCI .


LCI might be a more sensitive alternative to FEV1 in detecting response to intervention in these patients with mild lung disease .


Vertex Pharmaceuticals Incorporated .


In elderly persons frailty and malnutrition are very common and can lead to serious health hazards such as increased mortality , morbidity , dependency , institutionalization and a reduced quality of life .


In Austria , the prevalence of frailty and malnutrition are increasing steadily and are becoming a challenge for our social system .


Physical training and adequate nutrition may improve this situation .


In this randomized controlled trial , 80 malnourished frail community-dwelling patients ( 65 years ) hospitalized at wards for internal medicine are recruited .


Additionally , 80 lay volunteers ( 50 years ) , named buddies are recruited and subsequently trained regarding health enhancing physical activity and nutrition in four standardized training sessions .


These buddies visit the malnourished frail persons at home twice a week for about one hour during an initial period of 10-12 weeks .


While participants allocated to the intervention group ( n = 40 ) receive intervention to improve their fluid intake , protein and energy intake , perform strength training and try to increase their baseline activities , the control group ( n = 40 ) only gets home visits without any intervention .


After 10-12 weeks , both , the intervention and the control group , receive the nutritional intervention and the physical training .


Health , nutritional and frailty status , physical fitness , body composition and chronic inflammation of buddies and frail persons are recorded before the intervention , after 10-12 weeks , 6 and 12 months .


To your knowledge this trial is the first of its kind to provide nutritional and physical activity interventions to malnourished frail community-dwelling persons by trained lay buddies , in which an improvement of the frail persons ' and the buddies ' health status is measured .


This study assesses the efficacy of such an intervention and may offer new perspectives for the management of frailty and malnutrition .


[ corrected ] ClinicalTrials.gov , NCT01991639 .


Hypertension remains a significant risk factor in cardiovascular morbidity and mortality .


The purpose of the present study was to investigate the effects of 8 weeks interval training programme on blood pressure , aerobic capacity ( VO max ) , indices of adiposity and marker of inflammation in black African men with essential hypertension .


Two hundred and forty five ( 245 ) male subjects with stage 1 and 2 ( systolic blood pressure [ SBP ] between 140-179 & diastolic blood pressure [ DBP ] between 90-109 mmHg ) essential hypertension were age matched and grouped into experimental and control groups .


The experimental ( n = 140 ; 58.90 7.35 years ) group involved in an 8 weeks interval training ( 60-79 % HRmax ) programme of between 45 and 60 minutes , while age-matched control hypertensive ( n = 105 ; 58.276.24 years ) group remain sedentary during this period .


All subjects in both groups were on antihypertensive drugs throughout the study period .


Cardiovascular parameters ( SBP , DBP ) & VO max and percent body fat [ % BF ] , waist to hip ratio [ WHR ] and C-reactive protein [ CRP ] were assessed .


Independent t-test and Pearson correlation test were used in data analysis .


Findings of the study revealed significant decreased effects of interval training programme on SBP , DBP , % BF , WHR and CRP and significant increased effect on VO max at p < 0.05 .


Also , changes in CRP as a result of exercise training significantly and positively correlated with changes in SBP , DBP , % BF , WHR , CRP and negatively correlated with VO max at p < 0.05 .


This article provides a description of the rationale , design , and methods of a multisite clinical trial which evaluates the potential benefits of an evidence-based psychosocial treatment , STAIR Narrative Therapy , among women with posttraumatic stress disorder ( PTSD ) related to interpersonal violence who are seeking services in public sector community mental health clinics .


This is the first large multisite trial of an evidence-based treatment for PTSD provided in the context of community settings that are dedicated to the treatment of poverty-level patient populations .


The study is enrolling 352 participants in a minimum of 4 community clinics .


Participants are randomized into either STAIR Narrative Therapy or Treatment As Usual ( TAU ) .


Primary outcomes are PTSD , emotion management and interpersonal problems .


The study will allow a flexible application of the protocol determined by patient need and preferences .


Secondary analyses will assess the relationship of outcomes to different patterns of treatment implementation for different levels of baseline symptom severity .


The article discusses the rationale and study issues related to the use of a flexible delivery of a protocol treatment and of the selection of treatment as it is actually practiced in the community as the comparator .


Clinicaltrials.gov identifier : NCT01488539 .


To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia .


Cluster randomized , investigator masked , controlled trial .


252 primary schools in two prefectures in western China , 2012-13 .


3177 of 19,934 children in fourth and fifth grades ( mean age 10.5 years ) with visual acuity < 6/12 in either eye without glasses correctable to > 6/12 with glasses .


3052 ( 96.0 % ) completed the study .


Children were randomized by school ( 84 schools per arm ) to one of three interventions at the beginning of the school year : prescription for glasses only ( control group ) , vouchers for free glasses at a local facility , or free glasses provided in class .


Spectacle wear at endline examination and end of year score on a specially designed mathematics test , adjusted for baseline score and expressed in standard deviations .


Among 3177 eligible children , 1036 ( 32.6 % ) were randomized to control , 988 ( 31.1 % ) to vouchers , and 1153 ( 36.3 % ) to free glasses in class .


All eligible children would benefit from glasses , but only 15 % wore them at baseline .


At closeout glasses wear was 41 % ( observed ) and 68 % ( self reported ) in the free glasses group , and 26 % ( observed ) and 37 % ( self reported ) in the controls .


Effect on test score was 0.11 SD ( 95 % confidence interval 0.01 to 0.21 ) when the free glasses group was compared with the control group .


The adjusted effect of providing free glasses ( 0.10 , 0.002 to 0.19 ) was greater than parental education ( 0.03 , -0.04 to 0.09 ) or family wealth ( 0.01 , -0.06 to 0.08 ) .


This difference between groups was significant , but was smaller than the prespecified 0.20 SD difference that the study was powered to detect .


The provision of free glasses to Chinese children with myopia improves children 's performance on mathematics testing to a statistically significant degree , despite imperfect compliance , although the observed difference between groups was smaller than the study was originally designed to detect .


Myopia is common and rarely corrected in this setting.Trial Registration Current Controlled Trials ISRCTN03252665 .


We designed and evaluated for feasibility an intervention-Yo Puedo-that addresses social network influences and socioeconomic opportunities in a neighborhood with substantial gang exposure and early childbearing .


Yo Puedo combined conditional cash transfers for completion of educational and reproductive health wellness goals with life skills sessions , and targeted youth 16-21 years of age and same-aged members of their social network .


We conducted a two-arm study with social networks randomized to the intervention or a standard services control arm .


We evaluated intervention uptake , adherence , and safety ; and assessed evidence of effects on behavioral outcomes associated with unintended pregnancy and sexually transmitted infection risk .


A total of 72 social networks composed of 162 youth enrolled , with 92 % retention over 6 months .


Seventy-two percent of youth randomized to the intervention participated in intervention activities : 53 % received at least one conditional cash transfer payment and 66 % came to at least one life skills session .


We found no evidence that cash payments financed illicit or high-risk behavior .


At 6 months , compared with controls , intervention participants had a lower odds of hanging out on the street frequently ( odds ratio [ OR ] , .54 ; p = .10 ) and a lower odds of reporting that their close friends had been incarcerated ( OR , .6 ; p = .12 ) .


They reported less regular alcohol use ( OR , .54 ; p = .04 ) and a lower odds of having sex ( OR , .50 ; p = .04 ) .


The feasibility evaluation of Yo Puedo demonstrated its promise ; a larger evaluation of effects on pregnancy and sustained behavioral changes is warranted .


To investigate the prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy .


Electrodiagnostic testing was performed on 38 patients with sciatica participating in a randomized trial comparing different physical therapy interventions .


Patients were grouped and analyzed according to the presence or absence of radiculopathy based on electrodiagnostic testing .


Longitudinal data analysis was conducted using multilevel growth modeling with ten waves of data collected from baseline through the treatment and post-treatment periods up to 6 months .


The primary outcome measure was changes in low back pain-related disability assessed using the Roland and Morris disability questionnaire ( RMDQ ) .


Patients with radiculopathy ( n = 19 ) had statistically significant and clinically meaningful improvements in RMDQ scores at every post-treatment follow-up occasion regardless of treatment received .


The final multilevel growth model revealed improvements in RMDQ scores in patients with radiculopathy at the 6-week ( -8.1 , 95 % CI -12.6 to -2.6 ; P = 0.006 ) and 6-month ( -4.1 , 95 % CI -7.4 to -0.7 ; P = 0.020 ) follow-up occasions compared to patients without radiculopathy .


Treatment group was not a significant predictive factor at any follow-up occasion .


An interaction between electrodiagnostic status and time revealed faster weekly improvements in RMDQ scores in patients with radiculopathy at the 6-week ( -0.72 , 95 % CI -1.4 to -0.04 ; P = 0.040 ) through the 16-week ( -0.30 , 95 % CI , -0.57 to -0.04 ; P = 0.028 ) follow-up occasions compared to patients without radiculopathy .


The presence of lumbosacral radiculopathy identified with electrodiagnostic testing is a favorable prognostic factor for recovery in low back pain-related disability regardless of physical therapy treatment received .


Loss of mechanical tension appears to be the major factor underlying decreased collagen synthesis in aged skin .


Numerous in vitro studies have shown the impact of mechanical forces on fibroblasts through mechanotransduction , which consists of the conversion of mechanical signals to biochemical responses .


Such responses are characterized by the modulation of gene expression coding not only for extracellular matrix components ( collagens , elastin , etc. ) but also for degradation enzymes ( matrix metalloproteinases [ MMPs ] ) and their inhibitors ( tissue inhibitors of metalloproteinases [ TIMPs ] ) .


A new device providing a mechanical stimulation of the cutaneous and subcutaneous tissue has been used in a simple , blinded , controlled , and randomized study .


Thirty subjects ( aged between 35 years and 50 years ) , with clinical signs of skin sagging , were randomly assigned to have a treatment on hemiface .


After a total of 24 sessions with Mcano-Stimulation , biopsies were performed on the treated side and control area for in vitro analysis ( dosage of hyaluronic acid , elastin , type I collagen , MMP9 ; equivalent dermis retraction ; GlaSbox ( ) ; n = 10 ) and electron microscopy ( n = 10 ) .


Furthermore , before and after the treatment , clinical evaluations and self-assessment questionnaire were done .


In vitro analysis showed increases in hyaluronic acid , elastin , type I collagen , and MMP9 content along with an improvement of the migratory capacity of the fibroblasts on the treated side .


Electron microscopy evaluations showed a clear dermal remodeling in relation with the activation of fibroblast activity .


A significant improvement of different clinical signs associated with skin aging and the satisfaction of the subjects were observed , correlated with an improvement of the sagging cheek .


Mcano-Stimulation is a noninvasive and safe technique delivered by flaps microbeats at various frequencies , which can significantly improve the skin trophicity .


Results observed with objective measurements , ie , in vitro assessments and electron microscopy , confirm the firming and restructuring effect clinically observed .


A double-blind RCT on the short-term efficacy of nicotine patches compared to placebo patches among Dutch adolescents was conducted .


The findings demonstrated that nicotine patches are efficacious for smoking cessation at end-of-treatment ; however , only in highly compliant participants .


We tested whether the effects of NRT also held in 6 - ( T7 ) and 12-month ( T8 ) follow-up assessments .


Adolescents aged 12-18 years , who smoked at least seven cigarettes a day and who were motivated to quit smoking were recruited at school yards and randomly assigned to either a nicotine patch ( n = 182 ) or a placebo patch ( n = 180 ) condition according to a computer generated list .


Participants ( N = 257 , age : 16.7 1.13 years ) attended an information meeting followed by a 6 - or 9-week treatment .


Smoking cessation , compliance , and potential covariates were measured by means of online questionnaires .


Smoking cessation at T8 was biochemically validated by saliva cotinine .


At T7 , 8.1 % and 5.7 % of participants were abstinent in the nicotine and placebo patch groups , respectively .


At T8 , abstinence was 4.4 % and 6.6 % , respectively .


Intention-to-treat analyses showed no significant effects of NRT on abstinence rates at T7 ( OR = 1.54 , 95 % CI = 0.57 , 4.16 ) and validated abstinence rates at T8 ( OR = 0.64 , 95 % CI = 0.21 , 1.93 ) neither after considering compliance nor after adjusting for covariates .


NRT fails in helping adolescents quit smoking at 6 - and 12-month follow-ups .


This finding suggests that a more intensive approach is needed to assist youngsters in their quit attempts .


The aim of this exploratory randomised controlled trial ( RCT ) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living ( ADL ) and thereby identifying the most effective interventions .


One hundred and seventy seven persons , 77-82 years old , living alone and without home help , were randomized to a control group ( CG ) , an individual intervention ( IG ) , an activity group ( AG ) , and a one-meeting discussion group ( DG ) .


All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement .


Data were collected by blinded research assistants at baseline , three , and 12 months .


Ordinal outcome data were converted , using Rasch measurement methods , to linear measures of leisure engagement and ADL ability .


Standardized between-group effect sizes , Cohen 's d , were calculated .


While all groups showed a decline in leisure engagement and ADL over time , the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months .


However , the effect sizes were small .


The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research .


Atherosclerotic renal-artery stenosis is a common problem in the elderly .


Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function , the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain .


We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone .


Participants were followed for the occurrence of adverse cardiovascular and renal events ( a composite end point of death from cardiovascular or renal causes , myocardial infarction , stroke , hospitalization for congestive heart failure , progressive renal insufficiency , or the need for renal-replacement therapy ) .


Over a median follow-up period of 43 months ( interquartile range , 31 to 55 ) , the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone ( 35.1 % and 35.8 % , respectively ; hazard ratio with stenting , 0.94 ; 95 % confidence interval [ CI ] , 0.76 to 1.17 ; P = 0.58 ) .


There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality .


During follow-up , there was a consistent modest difference in systolic blood pressure favoring the stent group ( -2.3 mm Hg ; 95 % CI , -4.4 to -0.2 ; P = 0.03 ) .


Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive , multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease .


( Funded by the National Heart , Lung and Blood Institute and others ; ClinicalTrials.gov number , NCT00081731 . )


Long-acting 2-agonists and leukotriene receptor antagonists are two principal agents that can be added to inhaled corticosteroids ( ICS ) for patients with asthma that is not adequately controlled by ICS alone .


The Gly16Arg genotype of the 2-adrenergic receptor ( ADRB2 ) gene may influence the bronchodilator effects of 2-agonists .


We hypothesized that differential responses to long-acting 2-agonists or leukotriene receptor antagonists might be determined partly by the Gly16Arg polymorphism in Japanese asthma patients .


This randomized , genotype-stratified , two-period crossover study included 80 patients with mild-to-moderate asthma ( 35 Arg/Arg and 45 Gly/Gly individuals ) .


The primary study outcome was the difference in peak expiratory flow ( PEF ) ( PEF , l/min ) by genotype after 16 weeks of treatment with salmeterol ( PEFsal ) or montelukast ( PEFmon ) .


In addition , multivariate analyses were used to identify independent factors that were predictive of responses to each treatment .


The mean PEFsal-PEFmon was 19.346.6 among Arg/Arg individuals and 16.851.5 among Gly/Gly individuals , indicating that the Gly16Arg genotype did not influence the differential bronchodilator effect of the two agents .


Multivariate analysis showed that higher peripheral eosinophil counts were associated with better response to salmeterol ( P < 0.05 ) .


The Gly16Arg genotype did not influence the differential bronchodilator effect of salmeterol or montelukast as an add-on therapy to ICS within 16 weeks of follow-up .


Higher peripheral eosinophil counts may be associated with better responses to salmeterol in combination with ICS .


To evaluate knowledge uptake from a parent-directed factsheet about managing pain during infant vaccinations , and the added influence of a pretest .


Solomon 4-group randomized controlled trial .


New mothers hospitalized after the birth of an infant were randomized to 1 of 4 groups : 2 included the intervention ( factsheet about pain management ) and 2 included the control ( information on another topic ) .


A pretest was given to 1 intervention and 1 control group .


Following maternal review of allocated information , posttests were administered in all groups .


Both control groups received the information after posttesting .


A follow-up telephone survey after 2 months measured knowledge retention and utilization of pain management interventions .


A total of 120 mothers participated ( July , 2012 to February , 2013 ) ; demographics did not differ among groups .


The 2 factsheet groups demonstrated more knowledge ( P < 0.05 ) about effective pain management ( mean without pretest : 5.6 [ SD = 2.0 ] ; with pretest : 6.9 [ 1.6 ] ) compared with the 2 control groups ( without pretest : 3.2 [ 2.2 ] ; with pretest : 3.4 [ 2.5 ] ) immediately after review ; and the factsheet and pretest group scored higher than the factsheet only group .


In groups with a prefactsheet baseline knowledge test , knowledge was higher at follow-up compared with baseline .


Follow-up knowledge and utilization of pain management interventions did not differ among groups .


The factsheet led to acute gains in knowledge and knowledge gains persisted after 2 months .


Acutely , knowledge was bolstered by the pretest .


These results can be used to guide future research and implementation of the factsheet .


This study investigated if a process-oriented training for health professionals will influence women 's use and reasons for using a nipple shield , the baby 's weight , and the duration of breastfeeding .


An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support .


Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given .


Data collection for control group A ( CGA ) ( n = 162 ) started before the intervention was initiated .


Data for control group B ( CGB ) ( n = 172 ) were collected simultaneously with those for the intervention group ( IG ) ( n = 206 ) .


The mothers responded to questionnaires at 3 days , at 3 months , and at 9 months postpartum .


The mothers ' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy , the babies had difficulty in grasping over the nipple , and the mothers had pain or wound on the nipple .


For the mothers in the IG group , there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration .


In contrast , the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields .


In the IG , there were no significant difference between the use of nipple shields and the babies ' weights at 3 or 9 months .


The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields ( p = 0.02 ) .


A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems , where the problems are remedied by the use of nipple shields .


Although radiotherapy ( RT ) provides potential benefits for patients with hepatocellular carcinomas ( HCCs ) that are unsuitable for operation , the specific role of adjuvant RT in HCC after hepatectomy remains ill defined .


The current study 's aim was to evaluate the safety and efficacy of adjuvant RT for centrally located HCCs after narrow-margin ( < 1 cm ) hepatectomy .


The study included 119 patients with centrally located HCCs who underwent narrow-margin hepatectomy between July 2007 and March 2012 .


Patients were prospectively randomized to receive adjuvant RT ( n = 58 ) or were assigned to a control group ( n = 61 ) .


Surgical outcomes , safety , and survival rates were evaluated .


Hepatectomy was successfully performed in all patients .


No cases of radiation-induced liver disease were observed .


One - , 3 - , and 5-year recurrence-free survival rates were 78.1 % , 56.5 % , and 36.9 % in the adjuvant RT group and 72.4 % , 40.1 % , and 16.0 % in the control group , respectively ( p = 0.06 , log-rank test ) .


Corresponding overall survival rates were 96.2 % , 72.6 % , 48.4 % , and 89.6 % , 74.5 % , 37.2 % , respectively ( p = 0.48 , log-rank test ) .


One - , 3 - , and 5-year recurrence-free survival rates in patients with small-diameter tumors ( 5 cm ) were 88.8 % , 67.4 % , 42.9 % in the adjuvant RT group and 82.3 % , 42.9 % , 21.5 % in the control group ( p = 0.03 , log-rank test ) .


Corresponding overall survival rates were 97.5 % , 75.3 % , 75.3 % , and 94.7 % , 84.1 % , 65.4 % , respectively ( p = 0.92 , log-rank test ) .


Adjuvant RT for centrally located HCCs after narrow-margin hepatectomy was technically feasible and relatively safe .


No significant between-group difference was observed in recurrence-free and overall survival .


The post-hoc subgroup comparison showed that adjuvant RT improved recurrence-free survival considerably , but not overall survival , in patients with small HCCs ( 5 cm ) .


More in-depth studies are needed to validate this finding .


To explore the optimized rehabilitation program in the treatment of post-stroke hemiplegia at the recovery stage .


Based on the randomized controlled principle , 60 patients were randomized into an rehabilita tion + massage group ( group A ) and an rehabilitation + acupuncture group ( group B ) , 30 cases in each one .


Bobath sport therapy and functional training were adopted in the two groups .


In the group A , the massage therapy was added .


The rolling method and palm-rubbing method were used on the affected side , the pressing , kneading and plucking methods were applied to Jianliao ( LI 15 ) , Jianzhen ( SI 9 ) , Quchi ( LI 11 ) , Huantiao ( GB 30 ) , Weizhong ( BL 40 ) , Chengshan ( BL 57 ) , Zusanli ( ST 36 ) and the other acu points ; and the nipping method was adopted at the twelve Jing-well points .


In the group B , acupuncture was applied to Baihui ( BL 20 ) , Jianliao ( LI 15 ) , Quchi ( LI 11 ) , Shousanli ( LI 10 ) , Huantiao ( GB 30 ) , Yanglingquan ( GB 34 ) , Jiexi ( ST 41 ) and the other acupoints .


The treatment was given once a day , 5 treatments a week in the two groups .


The efficacy was evaluated in 3 weeks .


Fugl-Meyer scale , Barthel index ( BI ) score , modified Rankin scale and stroke-specific quality of life ( SS-QOL ) were used to assess the limb motor function , the activity of daily life ( ADL ) , independent activity of life and the quality of life of the patients in the two groups before and after treatment .


Based on the total cost and benefit , the health economics evaluation was conducted in the patients of the two groups .


The treatments all improved the limb motor function ( group A : 26.00 ( 22 ) vs 37.00 ( 33 ) ; group B : 30.50 ( 21 ) vs 39.50 ( 36 ) ) , the independent activity of life , ADL ( group A : 43.50 + / - 22.25 vs 57.50 + / - 22.25 ; group B : 52.83 + / - 16.59 vs 66.67 + / - 12.82 ) and the quality of life ( group A : 122.23 + / - 30.00 vs 145.50 + / - 28.14 ; group B : 132.43 + / - 23.87 vs 151.47 + / - 22.37 ) in the patients of the two groups .


The differences in all the indices were significant statistically before and after treatment in the two groups ( all P < 0.05 ) .


Above indices after treatment were not different obviously between the two groups ( all P > 0.05 ) .


In terms of health economics , the expense was decreased by RMB 688.48 while BI was increased by every 5 score in group A in comparison with the group B.


Both the rehabilitation and massage therapy and the rehabilitation and acupuncture therapy improve the limb motor function and the quality of life in the patients of post-stroke hemiplegia .


The therapeutic efficacies are similar between the two therapeutic programs .


The program of rehabilitation and massage is more economical in the aspects of ADL improvement , being advantageous at simple operation and low cost .


Too few young people engage in behaviours that reduce the risk of morbidity and premature mortality , such as eating healthily , being physically active , drinking sensibly and not smoking .


This study sought to assess the efficacy and cost-effectiveness of a theory-based online health behaviour intervention ( based on self-affirmation theory , the Theory of Planned Behaviour and implementation intentions ) targeting these behaviours in new university students , in comparison to a measurement-only control .