This was a randomized clinical trial to determine whether Nordic pole walking ( NPW ) is more effective in improving walking distance than a standard home exercise programme ( HEP ) in patients with intermittent claudication .


Fifty-two patients with stable claudication were allocated randomly to a standard HEP or NPW group , and asked to complete three 30-min walks per week for 12 weeks .


Claudication distance ( CD ) and maximum walking distance ( MWD ) were measured at 0 ( baseline ) , 4 , 8 and 12 weeks .


Patients in the NPW group were tested with ( NPW + ) and without ( NPW - ) poles .


For NPW + , CD increased immediately from a median ( range ) of 124 ( 71-248 ) m to 148 ( 116-426 ) m , and MWD from 248 ( 149-900 ) to 389 ( 194-1099 ) m ( P = 0.004 and P < 0.001 respectively ) .


By 12 weeks , CD had further increased to 199 ( 118-550 ) m and MWD had more than doubled to 538 ( 250-1750 ) m ( P < 0.001 and P = 0.001 ) .


For NPW - , CD at 12 weeks had increased significantly to 151 ( 100-328 ) m and MWD to 400 ( 200-900 ) m ( P < 0.001 and P = 0.006 respectively ) .


At 12 weeks the changes in the standard HEP group were not significant , despite excellent compliance : CD from 107 ( 56-332 ) to 153 ( 59-321 ) m and MWD from 355 ( 92-600 ) to 334 ( 149-874 ) m ( P = 0.030 and P = 0.260 respectively ) .


A 12-week exercise programme using Nordic poles significantly improved walking distance in claudicants compared with a standard HEP .


ISRCTN78168304 ( http://www.controlled-trials.com ) .


To evaluate whether an electronic health record ( EHR ) reminder improves rates of screening for type 2 diabetes in women with prior gestational diabetes .


We randomly allocated primary care providers ( by clinic site ) to a reminder for type 2 diabetes screening within the EHR or to usual care .


Women with previous gestational diabetes mellitus were identified through an automated search of laboratory results and the problem list .


We compared rates of screening during the study period ( 2010-2012 ) in women at intervention sites with those at control sites .


With a sample size of 850 participants , we had 80 % power to detect a 15 % difference in screening rates .


We included 847 individuals seen at a participating clinic during the study period , of whom 471 were at a reminder clinic and 376 were at a control clinic .


A similar proportion of women were screened for type 2 diabetes in both groups ( n = 265 , 56.3 % of the reminder group compared with n = 206 , 54.8 % of the control group , P = .67 ; adjusted odds ratio [ OR ] 1.04 , 95 % confidence interval [ CI ] 0.79-1 .38 ) .


Patient characteristics associated with risk for diabetes including body mass index ( adjusted OR per kg/m 1.05 , 95 % CI 1.01-1 .08 ) and race ( adjusted OR for nonwhite race 2.14 , 95 % CI 1.57-2 .92 ) were significantly associated with screening .


A simple EHR reminder did not increase the rate of diabetes screening in women with prior gestational diabetes mellitus .


ClinicalTrials.gov , www.clinicaltrials.gov , NCT01288144 .


I.


This is a prospective , randomized , single-blind study .


We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents .


Fifty intellectually disabled , American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study .


Patients were randomized to receive either 2 g kg ( -1 ) remifentanil ( Group 1 , n = 25 ) or a combination of 2 g kg ( -1 ) remifentanil and 1 mg kg ( -1 ) lidocaine ( Group 2 , n = 25 ) .


To evaluate intubation conditions , Helbo-Hansen scoring system was used .


In patients who scored 2 points or less in all scorings , intubation conditions were considered acceptable , however if any of the scores was greater than 2 , intubation conditions were regarded unacceptable .


Mean arterial pressure , heart rate and peripheral oxygen saturation ( SpO2 ) were recorded at baseline , after opioid administration , before intubation , and at 1 , 3 , and 5 min after intubation .


Acceptable intubation parameters were achieved in 24 patients in Group 1 ( 96 % ) and in 23 patients in Group 2 ( 92 % ) .


In intra-group comparisons , the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values ( p = 0.000 ) CONCLUSION : By the addition of 2 g/kg remifentanil during sevoflurane induction , successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction .


Also worth noting , the addition of 1mg/kg lidocaine to 2 g/kg remifentanil does not provide any additional improvement in the intubation parameters .


Global tuberculosis ( TB ) control may require mass vaccination with a new TB vaccine , such as a recombinant bacille Calmette Guerin ( BCG ) or attenuated Mycobacterium tuberculosis ( MTB ) .


The safety profile of live mycobacterial vaccines in latently infected adults with prior infant BCG vaccination is unknown .


Evaluate safety and reactogenicity of BCG revaccination , with or without isoniazid ( INH ) pretreatment , in adults with latent MTB infection ( LTBI ) .


Eighty-two healthy , HIV uninfected , South African adults , with a BCG scar and tuberculin skin test ( TST ) diameter 15 mm , were randomized to receive 6 months of INH , starting either before , or 6 months after , intradermal revaccination with BCG Vaccine SSI ( Statens Serum Institut , Copenhagen ) .


Safety and reactogenicity data are reported through 3 months post BCG revaccination .


Baseline characteristics were similar between treatment arms .


Mean baseline TST diameter was 20 4 mm .


Seventy-two subjects received BCG revaccination .


Injection site erythema ( 68 % ) and induration ( 86 % ) peaked 1 week after revaccination .


Ulceration ( 76 % ) peaked at 2 weeks , and resolved by 3 months in all but 3 subjects .


Diameter of ulceration was > 10mm in only 8 % , but a residual scar was common ( 85 % ) .


No regional lymphadenitis or serious morbidity related to BCG was seen .


Reactogenicity was not affected by INH pretreatment .


BCG revaccination of MTB infected adults is safe , well tolerated , and reactogenicity is similar to that of primary BCG vaccination .


Clinical trials of live recombinant BCG or attenuated MTB vaccines may be considered in latently infected adults , with or without INH pretreatment ( ClinicalTrials.gov identifier : NCT01119521 ) .


Oral nonsteroidal antiinflammatory medications ( NSAIDs ) have been shown to reduce pain with first-trimester surgical abortion compared to placebo , but it is unclear if one NSAID is better than another .


Some providers administer intramuscular ketorolac , though data regarding its efficacy in abortion are limited .


This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester surgical abortion .


This was a randomized , double-blind , controlled trial .


Women undergoing first-trimester surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen , 800 mg given 60-90 min preprocedure , or intramuscular ketorolac , 60 mg given 30-60 min preprocedure .


The primary outcome was pain with uterine aspiration on a 21-point , 0-100 , numerical rating scale .


Secondary outcomes included pain with cervical dilation , postoperative pain and patient satisfaction .


Ninety-four women were enrolled ; 47 were randomized to ibuprofen and 47 to ketorolac .


The groups did not differ with regards to demographics , reproductive history or Depression Anxiety Stress Scale scores .


Mean pain scores for suction curettage did not differ between groups ( 52.3 vs. 56.2 , p = .53 ) .


There was also no difference in pain with cervical dilation ( 41.6 vs. 45.4 , p = 0.48 ) or postoperative pain ( 22.3 vs. 15.0 p = .076 ) , though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection ( 30.4 vs. 15.6 , p < .001 ) .


Satisfaction with pain control did not differ significantly by group .


Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion .


Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester surgical abortion , is more expensive and causes patients significant arm discomfort .


Its use should therefore be reserved for patients who can not tolerate oral NSAIDs .


To study the effect of urapidil combined with phentolamine in the management of hypertension during extracorporeal circulation .


Ninety patients undergoing aortic and mitral valve replacement were randomly divided into 3 equal groups to receive treatment with phentolamine ( group A ) , urapidil ( group B ) , or both ( group C ) during extracorporeal circulation .


The mean arterial pressure ( MAP ) before and after drug administration , time interval of two administrations , spontaneous recovery of heart beat after aorta unclamping , ventricular arrhythmia , changes of ST-segment 1 min after the recovery of heart beat , ante-parallel cycle time , aorta clamping time , post-parallel cycle time , dopamine dose after cardiac resuscitation , and perioperative changes of plasma TNF - and IL-6 levels were recorded .


There was no significant difference in MAP between the 3 groups before or after hypotensive drug administration ( P > 0.05 ) .


The time interval of two hypotensive drug administrations was longer in group C than in groups A and B ( P < 0.05 ) .


The incidence of spontaneous recovery of heart beat after aorta unclamping , incidence of ventricular arrhythmia , changes of ST-segment 1 min after the recovery of heart beat , ante-parallel cycle time , aorta clamping time , and post-parallel cycle time were all comparable between the 3 groups .


The dose of dopamine administered after cardiac resuscitation was significantly larger in group B than in groups A or group C ( P < 0.05 ) .


The plasma levels of TNF - and IL-6 were significantly increased after CPB and after the operation in all the groups , but were lowed in group C than in groups A and B at the end of CPB and at 2 h and 12 after the operation .


Urapidil combined with phentolamine can control hypertension during extracorporeal circulation without causing hypotension .


Eptifibatide is indicated during percutaneous coronary intervention ( PCI ) with continuation for 18-24 hours post procedure but is associated with bleeding .


We examined the efficacy and safety of shorter post-PCI eptifibatide infusions in high-risk non-ST-segment elevation acute coronary syndrome ( NSTE ACS ) patients .


EARLY ACS patients treated with PCI and eptifibatide were grouped by post-procedure infusion duration : < 10 , 10-13 , 13-17 , and 17-25 ( per protocol ) hours .


Adjusted estimated event rates for 96-hour death/myocardial infarction ( MI ) / recurrent ischaemia requiring urgent revascularization ( RIUR ) , 30-day death/MI , post-PCI packed red blood cell ( PRBC ) transfusion , and GUSTO ( Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries ) moderate/severe bleeding were obtained using inverse-propensity weighting to account for informative censoring of infusions .


Among 3271 eptifibatide-treated PCI patients , there were 66 96-hour death/MI/RIUR events , 94 30-day death/MI events , 127 PRBC transfusions , and 115 GUSTO moderate/severe bleeds .


Compared with per protocol , patients receiving post-PCI infusions < 10 hours had similar adjusted estimated rates of 96-hour death/MI/RIUR ( absolute difference 0.021 higher ; 0.040 vs. 0.019 , 95 % CI -0.023 to 0.064 ; p = 0.35 ) and 30-day death/MI ( 0.020 higher ; 0.046 vs. 0.026 , 95 % CI -0.021 to 0.062 ; p = 0.34 ) .


There were also no differences in ischaemic outcomes between infusions of 10-17 hours and per-protocol infusions .


Adjusted estimated rates of PRBC transfusion were higher for the < 10-hour infusion group compared with per protocol ( 0.048 higher ; 0.079 vs. 0.031 , 95 % CI 0.005 to 0.091 , p = 0.03 ) but were similar for other groups .


Adjusted GUSTO moderate/severe bleeding rates were similar to per-protocol rates for all groups .


In high-risk NSTE ACS patients , post-PCI eptifibatide infusions < 18 hours were not associated with worse ischaemic outcomes .


Shorter eptifibatide infusions in this population may be feasible .


Residual anastomoses after fetoscopic laser surgery for twin-to-twin transfusion syndrome ( TTTS ) may lead to severe postoperative complications , including recurrent TTTS and twin anemia-polycythemia sequence ( TAPS ) .


A novel technique ( Solomon technique ) using laser coagulation of the entire vascular equator was recently investigated in a randomized controlled trial ( Solomon trial ) and compared with the Standard selective laser technique .


The aim of this secondary analysis was to evaluate the occurrence and characteristics of residual anastomoses in placentas included in the Solomon trial .


International multicenter randomized controlled trial in TTTS , randomized 1:1 ratio to either the Solomon laser technique or Standard laser technique .


At time of laser , surgeons recorded whether they considered the procedure to be complete .


Placental dye injection was performed after birth in the participating centers to evaluate the presence of residual anastomoses .


A total of 151 placentas were included in the study .


The percentage of placentas with residual anastomoses in the Solomon group and Standard group was 19 % ( 14/74 ) and 34 % ( 26/77 ) , respectively ( P = .04 ) .


The percentage of placentas with residual anastomoses in the subgroup of cases where the procedure was recorded as complete was 8/65 ( 12 % ) and 22/69 ( 32 % ) in the Solomon group and Standard group , respectively ( P < .01 ) .


The Solomon laser technique reduces the risk of residual anastomoses .


However , careful follow-up remains essential also after the Solomon technique , as complete dichorionization is not always achieved .


Visual stimulation increases the blood flow in the posterior cerebral artery ( PCA ) , which supplies blood to the visual cortex by neurovascular coupling ( NVC ) .


Relative contributions of vasodilatation and pressor response on NVC during dynamic exercise are still unknown .


We measured the blood flow velocity in the PCA ( PCAv ) by transcranial Doppler ultrasound flowmetry during rest and exercise in 14 healthy males while they performed 12-min submaximal leg-cycle exercises at mild - , moderate - , and high-intensity , which corresponded to heart rates of 120 , 140 , and 160 bpm , respectively .


NVC was estimated as the relative change in PCAv from 20 s eye-closing to the peak response during 40 s looking at a reversed checkerboard .


Conductance index was calculated for evaluating vasodilatation as pressure divided by blood flow .


In response to visual stimulation , a magnitude of vasodilatation was significantly decreased under the moderate-intensity , while pressor response was significantly suppressed under the high-intensity exercises , compared with the control condition .


Conversely , peak response to visual stimulation in PCAv was not affected by exercise intensity though relative and absolute responses were significantly lower in the moderate - and high-intensity exercises than the control .


It is suggested that the contributions of pressor response and vasodilatation were modified by exercise intensity , partly playing a role for stabilizing the peak response of PCAv with visual stimulation during dynamic exercise .


Chronic stable angina pectoris ( CSAP ) is a common cardiovascular condition that endangers a patient 's life quality and longevity .


As demonstrated in several clinical trials , acupuncture is attested to be effective for CSAP .


Current trials are not adequate enough to provide high-quality evidence for clinical decision making , as a result of inadequate methodology design and small sample size .


Notably , stark controversy toward acupoint specificity also exists in the clinical acupuncture trials for CSAP .


Therefore , we designed the present study as a randomized controlled trial primarily to investigate the effectiveness of acupuncture in addition to routine care among patients with CSAP .


Meanwhile , we examined whether acupoint on the disease-affected meridian ( DAM ) is superior to either acupoint on the non-affected meridian ( NAM ) or non-acupoint ( NA ) , to further investigate the meridian-based characteristics of acupoint specificity .


This study was a multicenter , assessor and statistician blinded , randomized controlled trial in China .


In this study , 404 participants in sum will be randomly assigned to four groups through central randomization in a 1:1:1:1 ratio .


The whole study period is 20 weeks including a 4-week baseline period , a 4-week treatment period and a 12-week follow-up .


Participants in the DAM group receive acupuncture stimulation at acupoints on the disease-affected meridian , and three different control groups will undergo acupuncture stimulation at the NAM , the non-acupoint and no intervention respectively , in addition to basic treatment .


Participants in the acupuncture groups will receive 12 sessions of acupuncture treatment over 4 weeks , while the wait-listed ( WL ) group would receive free acupuncture treatment after the completion of the study .


The outcome measures in this trial include the frequency of angina attack during 4 weeks as the primary outcome and eight other secondary outcomes .


This trial will provide new and relatively high-quality evidence in acupuncture treatment for CSAP .


Moreover , this trial may further validate the meridian-based characteristics of acupoint specificity by comparing the strength of acupoints on the disease-affected meridian versus that of the non-affected meridian , to further inspire optimization of acupuncture therapy for CSAP .


Clinical Trials.gov NCT01686230 .


A pragmatic , randomized , controlled , single-blinded trial in Dutch general practice .


Assessing the costs and cost-effectiveness of adding segmental epidural steroid injections to care as usual in radiculopathy in general practice .


Lumbosacral radicular syndrome ( radiculopathy ) is a benign , generally self-limiting but painful condition caused by a herniated lumbar intervertebral disc , which results in an inflammatory process around the nerve root .


Segmental epidural steroid injections could lessen pain .


Low back pain and sciatica form a large financial burden on national health care systems .


Improving pain treatment could lower costs to society by diminishing loss of productivity .


Patients with acute radiculopathy were included by general practitioners .


All patients received usual care .


Patients in the intervention group received one segmental epidural steroid injection containing 80 mg of triamcinolone as well .


Follow-up was performed using postal questionnaires at 2 , 4 , 6 , 13 , 26 , and 52 weeks .


Main outcomes were pain , disability and costs .


Economic evaluation was performed from a societal perspective with a time horizon of 1 year .


Sixty-three patients were included in the analysis .


Mean total costs were 4414 or $ 5985 in the intervention group and 5121 or $ 6943 in the control group .


This difference was mostly due to loss of productivity .


The point estimate for the incremental cost-effectiveness ratio was -730 or - $ 990 ( 1-point diminishment on the numerical rating scale back pain score in 1 patient in the course of 1 yr would save 730 or $ 990 ) .


Bootstrapping showed a 95 % confidence interval of -4476 to 951 or - $ 6068 to $ 1289 .


The cost-effectiveness acceptability curve showed that without additional investment the probability that epidural steroids are cost-effective is more than 80 % .


The effect on pain and disability of epidural steroids in lumbosacral radicular syndrome is small but significant , and at lower costs with no reported complications or adverse effects .


Segmental epidural steroid injections could be considered by policy makers as an additional treatment option .


We studied whether a 6-month group-mediated cognitive behavioral ( GMCB ) intervention for peripheral artery disease ( PAD ) participants , which promoted home-based walking exercise , improved 6-minute walk and other outcomes at 12-month follow-up , 6 months after completing the intervention , compared to a control group .


We randomized PAD participants to a GMCB intervention or a control group .


During phase I ( months 1 to 6 ) , the intervention used group support and self-regulatory skills during weekly on-site meetings to help participants adhere to home-based exercise .


The control group received weekly on-site lectures on topics unrelated to exercise .


Primary outcomes were measured at the end of phase I.


During phase II ( months 7 to 12 ) , each group received telephone contact .


Compared to controls , participants randomized to the intervention increased their 6-minute walk distance from baseline to 12-month follow-up , ( from 355.4 to 381.9 m in the intervention versus 353.1 to 345.6 m in the control group ; mean difference = +34.1 m ; 95 % confidence interval [ CI ] = +14.6 , +53.5 ; P < 0.001 ) and their Walking Impairment Questionnaire ( WIQ ) speed score ( from 36.1 to 46.5 in the intervention group versus 34.9 to 36.5 in the control group ; mean difference = +8.8 ; 95 % CI = +1.6 , +16.1 ; P = 0.018 ) .


Change in the WIQ distance score was not different between the 2 groups at 12-month follow-up ( P = 0.139 ) .


A weekly on-site GMCB intervention that promoted home-based walking exercise intervention for people with PAD demonstrated continued benefit at 12-month follow-up , 6 months after the GMCB intervention was completed .


ClinicalTrials.gov .


Unique identifier : NCT00693940 .


To evaluate the use of the Roux loop on the postoperative course in patients submitted for gastroenteroanastomosis ( GE ) .


Non-jaundiced patients ( n = 41 ) operated on in the Department of General and Transplant Surgery in Lodz , between January 2010 and December 2011 were enrolled .


The tumor was considered unresectable when liver metastases or major vascular involvement were confirmed .


Patients were randomized to receive Roux ( n = 21 ) or conventional GE ( n = 20 ) on a prophylactic basis .


The mean time to nasogastric tube withdrawal in Roux GE group was shorter ( 1.4 0.75 vs 2.8 1.1 , P < 0.001 ) .


Time to starting oral liquids , soft diet and regular diet were decreased ( 2.3 0.86 vs 3.45 1.19 ; P < 0.001 ; 3.3 0.73 vs 4.4 1.23 , P < 0.001 and 4.5 0.76 vs 5.6 1.42 , P = 0.002 ; respectively ) .


The Roux GE group had a lower use of prokinetics ( 10 mg thrice daily for 2.2 1.8 d vs 3.7 2.6 d , P = 0.044 ; total 62 49 mg vs 111 79 mg , P = 0.025 ) .


The mean hospitalization time following Roux GE was shorter ( 7.7 d vs 9.6 d , P = 0.006 ) .


Delayed gastric emptying ( DGE ) was confirmed in 20 % after conventional GE but in none of the patients following Roux GE .


Roux gastrojejunostomy during open abdomen exploration in patients with unresectable pancreatic cancer is easy to perform , decreases the incidence of DGE and lowers hospitalization time .


In the Mexican-American population , the prevalence of Type 2 diabetes mellitus ( T2DM ) is as high as 50 % of the population .


This randomized controlled clinical trial was designed to elucidate how treatment of periodontal disease affects HbA1c values in this population .


One hundred and fifty-four T2DM patients with periodontal disease were enrolled in the study .


The test group was treated with scaling and root planing ( SRP ) ; the control group received oral hygiene instructions .


At baseline and 4-6 weeks after therapy , a complete periodontal examination was performed .


Blood was collected at baseline and 4 months later for HbA1c levels .


One hundred and twenty-six individuals completed the study .


Baseline mean SD HbA1c for the test and control groups were 9.0 2.3 % and 8.4 2.0 % respectively .


Non-significant difference in HbA1c reductions ( 0.6 2.1 % and 0.3 1.7 % ) was found between test and control groups at 4 months .


Comparisons of the periodontal clinical parameters between the test and control groups found significant differences with improved results in the test subjects .


No statistically significant differences were found in the changes of HbA1c levels between test and control groups .


Non-surgical periodontal therapy improved the magnitude of change in periodontal parameters as compared to the control subjects .


ClinicalTrials.gov Identifier : NCT01128374 .


The study aimed at comparing the fixed tapering dose and the symptom-triggered regimens of lorazepam for alcohol detoxification .


We carried out a prospective , randomized , double blind controlled trial involving 63 consecutive consenting male patients admitted with diagnosis of uncomplicated alcohol withdrawal .


The patients were randomized into two groups based on the type of lorazepam dosage : symptom-triggered ( n = 33 ) and fixed tapering dose regimens ( n = 30 ) .


Alcohol withdrawal symptoms were rated on CIWA-Ar ( Clinical Institute Withdrawal Assessment - Alcohol revised ) .


The main outcome measures were the total amount and duration of lorazepam treatment and the incidence of adverse events or complications .


The mean lorazepam dose administered in the symptom-triggered group was significantly lower than in the fixed tapering dose group ( 9.5 versus 19.9 mg , P < 0.001 ) and for a significantly shorter duration of time ( 47.8 versus 146 h , P < 0.001 ) with more significant results for higher initial CIWA-Ar scores .


There were no significant differences between both the groups in terms of the incidence of complications like seizures or delirium tremens .


Symptom-triggered lorazepam treatment for alcohol withdrawal resulted in administration of lower total doses of medication for a shorter duration of treatment and was as safe as the fixed tapering dose .


Peripheral intravenous catheterization in children is challenging , and success rates vary greatly .


We conducted a pragmatic randomized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the standard approach in achieving successful catheter placement on the first attempt .


We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012 .


We stratified them by age ( 3 yr and > 3 yr ) and randomly assigned them to undergo the procedure with the standard approach , or with the help of either ultrasound or near-infrared vascular imaging .


The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt .


The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the standard approach group ( differences in proportions -3.9 % , 95 % confidence interval [ CI ] -14.2 % to 6.5 % , for ultrasound imaging ; -8.7 % , 95 % CI -19.4 % to 1.9 % , for near-infrared imaging ) .


Among children 3 years and younger , the difference in success rates relative to standard care was also not significant for ultrasound imaging ( -9.6 % , 95 % CI -29.8 % to 10.6 % ) , but it was significantly worse for near-infrared imaging ( -20.1 % , 95 % CI -40.1 % to -0.2 % ) .


Among children older than 3 years , the differences in success rates relative to standard care were smaller but not significant ( -2.3 % , 95 % CI -13.6 % to 9.0 % , for ultrasound imaging ; -4.1 % , 95 % CI -15.7 % to 7.5 % , for near-infrared imaging ) .


None of the pairwise comparisons were statistically significant in any of the outcomes .


Neither technology improved first-attempt success rates of peripheral intravenous catheterization in children , even in the younger group .


These findings do not support investment in these technologies for routine peripheral intravenous catheterization in children .


ClinicalTrials.gov , no .


NCT01133652 .


The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate ( MPA ) in treatment of simple endometrial hyperplasia to preserve fertility in young women .


Forty-five patients referred to Shahid Sadoughi gynecology clinics from 2009 until 2011 who suffered from abnormal vaginal bleeding or endometrial thickness , that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled .


The patients were divided randomly into two groups .


First group including 22 women receive ten mg MPA , for ten days during a month for three months .


All cases were followed by interview , endometrial curetage , and vaginal sonography .


Serum level of estradiol was checked before and after treatment .


At the end of the study , biopsy was retaken in 41 patients .


All the patients were under observation by two gynecologists .


Age range of patients was 20 to 42 years .


Mean body mass index ( BMI ) in the MPA and letrozole groups was 29.13 + / - 4.8 and 25.42 + / - 4.2 , respectively .


Fifty and 34.8 percent of cases had history of obesity or polycystic ovarian syndrome ( PCOS ) in MPA and letrozole groups , respectively .


Forty-one selected cases ( 20 of the MPA and 21 of the letrozole groups ) continued the treatment for three months .


The endometrial thicknesses decreased in both groups .


Serum estradiol level also decreased in both groups .


The most common complication in the MPA and letrozole groups was headache ( 27.3 % ) and flashing and dizziness , respectively .


The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing .


In women suffering from simple endometrial hyperplasia without atypia , letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA .


In both groups , there was no simple hyperplasia report in curettage report following treatment .


It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type .


Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia : cases candidate for medical treatment .


To confirm the effect and safety of letrozole , more studies with larger samples are recommended .


Obstructive Sleep Apnea ( OSA ) is a common medical problem in adults that is becoming increasingly recognized in children .


It occurs in the pediatric age group , from newborns to teens .


More recently , many specialists have estimated OSA prevalence to be between 5 and 6 % .


However , in syndromic children , the prevalence of OSA can be from 50 to 100 % , having a significant effect on their Quality-of-Life .


As they are a challenging population for management , it is essential to evaluate them thoroughly before planning appropriate intervention .


To compare the efficacy of Adenotonsillectomy ( T&A ) and Continuous Positive Airway Pressure ( CPAP ) in syndromic children [ Down syndrome ( DS ) and Mucopolysaccharidoses ( MPS ) ] with Obstructive Sleep Apnea ( OSA ) .


In a prospective , randomized , cohort comparative study , 124 syndromic children ( DS and MPS ) aged between 6 and 12 years were recruited from a private MPS support group and the Down Syndrome Society , Chennai .


A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram ( PSG ) , Epworth Sleepiness Scale-Children ( ESS-C ) and Quality-of-Life ( QOL ) tool OSA-18 .


The children with positive PSG who consented for the study ( n = 80 ) were randomly distributed to two groups , T&A group & CPAP group .


The children were followed up with repeat PSG , clinical evaluation , ESS-C and Quality-of-Life ( QOL ) tool OSA-18 for a period of 1 year .


Follow-up was available for 73 syndromic children .


Both the groups , T&A group and CPAP group , showed statistically significant ( p < 0.05 ) improvement in Apnea-Hypoapnea Index ( AHI ) , ESS-C , QOL from the intervention .


In our study , T&A showed equal outcome compared to CPAP .


The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of 1 year .


On average , T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group of syndromic children .


During laparoscopic cholecystectomy ( LCHE ) , the insufflation with warmed and humidified carbon dioxide ( CO2 ) may reduce postoperative pain .


The aim of the study was to evaluate the positive effects of heated and humidified carbon dioxide gas on patients with regard to postoperative pain after LCHE .


This is a prospective , randomized , double-blinded , controlled clinical trial .


148 patients ( female = 98 , male = 50 ) scheduled for elective LCHE were randomized into two groups : receiving either heated humidified carbon dioxide , or standard gas .


Intraoperative core temperature was measured .


The perioperative management was identical for both groups .


Postoperative pain intensity was assessed using a visual analog pain scale , and the amount of analgesic consumption was recorded .


The postoperative pain management was also standardized and equal for both groups .


67 out of 148 received standard gas ( group A ) , and 81 received warmed , humidified gas ( group B ) .


The groups were comparable demographically .


The amount of analgesic consumption was recorded .


Intraoperative core temperature was significant higher in group B than in group A. Pain was significantly less in group B ( p = 0.025 ) 6h postoperatively .


On the first postoperative day , no significant difference in pain between the two groups was detectable ( p = 0.437 ) .


The use of warmed and humidified carbon dioxide during LCHE reduces postoperative pain at the day of operation .


Existing theories suggest that the mother-infant relationship has a potentially significant effect on long-term adult mental health , but there are few empirical data to support this view .


Even fewer prior studies have examined the specific dynamics of the mother-infant relationship and their association with adult mental health .


A total of 1752 inner-city infants born between 1960 and 1965 were followed prospectively as a part of the Collaborative Perinatal Project ( CPP ) and the Johns Hopkins Pathways to Adulthood Study .


Multiple observations of development and an extensive adult interview were performed .


Maternal behavior was observed and systematically rated at the infant 's 4-month pediatric neurological evaluation and at 8 months by a developmental psychologist .


Factor analysis was used to organize the maternal behavior variables into different types of dysfunctional mother-infant relationships .


Adult mental health was assessed at the follow-up interview , when the infant had reached the age of 27-33 years , by the General Health Questionnaire ( GHQ ) and self-perception of current mental health .


There was a significant association between unsupportive maternal behavior at 8 months and subsequent poor adult mental health ( Fisher 's exact test , p = 0.026 ) .


There was no association between overly involved maternal behavior and poor mental health as an adult .


After adjustment for potential confounding variables , the elevated rates of poor adult mental health in children of mothers who exhibited unsupportive maternal behavior at 8 months persisted ( OR = 1.41 [ 95 % CI = 1.00-1 .97 ] , p < 0.05 ) .


Infants who experience unsupportive maternal behavior at 8 months have an increased risk for developing psychological sequelae later in life .


Low back pain is a common , highly debilitating condition , whose severity is variable .


This study evaluated the efficacy of treatment with Ga-Al-As diode laser ( 980nm ) with a large diameter spot ( 32cm ( 2 ) ) , in association with exercise therapy , in reducing pain .


The present study aimed to evaluate the pain reduction efficacy of treatment with the Ga-Al-As diode laser ( 980nm ) in combination with exercise therapy , in patients with chronic low back pain ( CLBP ) .


This study evaluated 100 patients with CLBP ( mean age 60 years ) who were randomly assigned to two groups .


The laser plus exercises group ( Laser + EX : 50 patients ) received low-level laser therapy ( LLLT ) with a diode laser , 980nm , with a specific handpiece [ 32cm ( 2 ) irradiation spot size , power 20W in continuous wave ( CW ) , fluence 37.5 J/cm ( 2 ) , total energy per point 1200J ] thrice weekly , and followed a daily exercise schedule for 3 weeks ( 5 days/week ) .


The exercises group ( EX : 50 patients ) received placebo laser therapy plus daily exercises .


The outcome was evaluated on the visual analogue pain scale ( VAS ) , before and after treatment .


At the end of the 3 week period , the Laser + EX group showed a significantly greater decrease in pain than did the EX group .


There was a significant difference between the two groups , with average VAS scores of 3.96 ( Laser + EX group ) and 2.23 ( EX group ) .


The Student 's t test demonstrated a statistically significant difference between the two groups , at p < 0.001 .


This study demonstrated that the use of diode laser ( 980nm ) with large diameter spot size , in association with exercise therapy , appears to be effective .


Such treatment might be considered a valid therapeutic option within rehabilitation programs for nonspecific CLBP .


Caffeine use is on the rise among children and adolescents .


Previous studies from our laboratory reported gender differences in the effects of caffeine in adolescents .


The purpose of this study was to test the hypotheses that gender differences in cardiovascular responses to caffeine emerge after puberty and that cardiovascular responses to caffeine differ across the phases of the menstrual cycle .


To test these hypotheses , we examined heart rate and blood pressure before and after administration of placebo and 2 doses of caffeine ( 1 and 2 mg/kg ) in prepubertal ( 8 - to 9-year-olds ; n = 52 ) and postpubertal ( 15 - to 17-year-olds ; n = 49 ) boys ( n = 54 ) and girls ( n = 47 ) by using a double-blind , placebo-controlled , dose-response design .


There was an interaction between gender and caffeine dose , with boys having a greater response to caffeine than girls .


In addition , we found interactions between pubertal phase , gender , and caffeine dose , with gender differences present in postpubertal , but not in prepubertal , participants .


Finally , we found differences in responses to caffeine across the menstrual cycle in post-pubertal girls , with decreases in heart rate greater in the midluteal phase and blood pressure increases greater in the midfollicular phase of the menstrual cycle .


These data suggest that gender differences in response to caffeine emerge after puberty .


Future research will determine the extent to which these gender differences are mediated by physiological factors , such as steroid hormones , or psychosocial factors , such as more autonomy and control over beverage purchases .


To assess the efficacy and safety of oral azithromycin compared with oral doxycycline in patients with meibomian gland dysfunction ( MGD ) who had failed to respond to prior conservative management .


110 patients ( > 12years old ) with MGD were randomly assigned to receive either oral 5-day azithromycin ( 500mg on day 1 and then 250mg/day ) or 1-month doxycycline ( 200mg/day ) .


They also continued eyelid warming/cleaning and artificial tears .


A score comprising five symptoms and seven signs ( primary outcome ) was recorded prior to treatment and at 1week , and 1 and 2months after treatment .


Total score was the sum of both scores at each follow-up .


Side effects were recorded and overall clinical improvement was categorised as excellent , good , fair or poor based on the percentage of change in the total score .


Symptoms and signs improved significantly in both groups ( p = 0.001 ) .


While improvement of symptoms was not different between the groups , bulbar conjunctival redness ( p = 0.004 ) and ocular surface staining ( p = 0.01 ) were significantly better in the azithromycin group .


The azithromycin group showed a significantly better overall clinical response ( p = 0.01 ) .


Mild gastrointestinal side effects were not significantly different between the groups except for the second visit , when the doxycycline group had significantly more side effects ( p = 0.002 ) .


Although both oral azithromycin and doxycycline improved the symptoms of MGD , 5-day oral azithromycin is recommended for its better effect on improving the signs , better overall clinical response and shorter duration of treatment .


NCT01783860 .


The novel arthritis-specific Work Productivity Survey ( WPS ) was developed to estimate patient productivity limitations associated with arthritis within and outside the home , which is an unmet need in psoriatic arthritis ( PsA ) .


The WPS has been validated in rheumatoid arthritis .


This report assesses the discriminant validity , responsiveness and reliability of the WPS in adult-onset PsA .


Psychometric properties were assessed using data from the RAPID-PsA trial ( NCT01087788 ) investigating certolizumab pegol ( CZP ) efficacy and safety in PsA .


WPS was completed at baseline and every 4 weeks until Week 24 .


Validity was evaluated at baseline via known-groups defined using first and third quartiles of patients ' Disease Activity Score 28 based on C-reactive protein ( DAS28 ( CRP ) ) , Health Assessment Questionnaire-Disability Index ( HAQ-DI ) , Short Form-36 ( SF-36 ) items and PsA Quality of Life ( PsAQoL ) scores .


Responsiveness and reliability were assessed by comparing WPS mean changes at Week 12 in American College of Rheumatology 20 % improvement criteria ( ACR20 ) or HAQ-DI Minimal Clinically Important Difference ( MCID ) 0.3 responders versus non-responders , as well as using standardized response means ( SRM ) .


All comparisons were conducted on the observed cases in the Randomized Set , regardless of the randomization group , using a non-parametric bootstrap-t method .


Compared with patients with a better health state , patients with a worse health state had on average 2 to 6 times more household work days lost , more days with reduced household productivity , more days missed of family/social/leisure activities , more days with outside help hired and a significantly higher interference of arthritis per month .


Among employed patients , those with a worse health state had 2 to 4 times more workplace days lost , more days with patient workplace productivity reduced , and a significantly higher interference of arthritis on patient workplace productivity versus patients with a better health state .


WPS was also responsive to clinical changes , with responders having significantly larger improvements at Week 12 in WPS scores versus non-responders .


The effect sizes for changes in productivity in ACR20 or HAQ-DI MCID responders were moderate ( 0.5 < SRM < 0.8 ) or small .


These analyses demonstrate the validity , responsiveness and reliability of the WPS , as an instrument for the measurement of patient productivity within and outside the home in an adult-onset PsA population .


Insulin degludec/insulin aspart ( IDegAsp ) is a soluble co-formulation of IDeg and IAsp .


This pan-Asian , 26-week trial investigated efficacy and safety of IDegAsp vs biphasic insulin aspart 30 ( BIAsp 30 ) in Asian adults with type 2 diabetes ( T2DM ) , inadequately controlled on once - or twice-daily ( BID ) basal , premixed or self-mixed insulin .


Participants ( mean age 59.8 years , HbA1c 8.4 % , FPG 7.9 mmol/L , BMI 25.4 kg/m ( 2 ) ) were randomised 2:1 to BID IDegAsp ( n = 282 ) or BIAsp 30 ( n = 142 ) and continued existing metformin treatment .


Insulins were administered with breakfast and main evening meal , titrated to a pre-breakfast and pre-main evening meal self-measured plasma glucose target of 4-5 mmol/L .


IDegAsp achieved the primary endpoint of non-inferiority to BIAsp 30 for mean change in HbAc ( estimated treatment difference [ ETD ] IDegAsp-BIAsp 30 : 0.05 % points [ 95 % CI -0.10 ; 0.20 ] ) .


IDegAsp was superior in lowering fasting plasma glucose ( FPG ) ( ETD -1.06 mmol/L , 95 % CI -1.43 ; -0.70 , p < 0.001 ) , and resulted in a lower final mean daily insulin dose ( 0.79 U/kg vs 0.99 U/kg , estimated rate ratio [ RR ] 0.79 , 95 % CI 0.73 ; 0.85 , p < 0.0001 ) .


Rates of overall confirmed and severe hypoglycaemia were similar between treatments , while rate of nocturnal confirmed hypoglycaemia was numerically ( p = ns ) lower with IDegAsp .


During the maintenance period there was a trend ( p = ns ) towards lower hypoglycaemia rates for IDegAsp .


In Asian adults with T2DM , IDegAsp BID effectively improves long-term glycaemic control , and compared to BIAsp 30 , provides superior reductions in FPG with a lower dose , and numerically less nocturnal hypoglycaemia .


While neuromodulation through unihemispheric repetitive transcranial magnetic stimulation ( rTMS ) has shown promise for the motor recovery of stroke patients , the effectiveness of the coupling of different rTMS protocols remains unclear .


We aimed to test the long-term efficacy of this strategy with different applying sequences and to identify the electrophysiological correlates of motor improvements to the paretic hand .


In our sham-controlled , double-blinded parallel study , 48 stroke patients ( 2-6 months poststroke ) were randomly allocated to three groups .


Group A underwent 20-session rTMS conditioning initiated with 10-session 1 Hz rTMS over the contralesional primary motor cortex ( M1 ) , followed by 10-session intermittent theta burst stimulation ( iTBS ) consequently over the ipsilesional M1 ; Group B underwent the same two paradigms but in reverse ; and Group C received sham stimulation that was identical to Group A.


We tested cortical excitability and motor assessments at the baseline , postpriming rTMS , postconsequent rTMS , and at 3-months follow-up .


Group A manifested greater improvement than Group B in Fugl-Meyer Assessment ( FMA ) , Wolf Motor Function testing ( WMFT ) score , and muscle strength ( P = 0.001-0 .02 ) post the priming rTMS .


After the consequent rTMS , Group A continued to present a superior outcome than Group B in FMA ( P = 0.015 ) and WMFT score ( P = 0.008 ) with significant behavior-electrophysiological correlation .


Conditioning the contralesional M1 prior to ipsilesional iTBS was found to be optimal for enhancing hand function , and this effect persisted for at least 3 months .


Early modulation within 6 months poststroke rebalances interhemispheric competition and appears to be a feasible time window for rTMS intervention .


To clarify the usefulness of protein-sparing modified formula diet in obese type 2 diabetic patients , the effects of partial use of formula diet on weight reduction and changes in related metabolic variables , and the improving rates of risk factors per 1 % body weight reduction , were compared with those of conventional subcaloric diet .


Obese patients [ BMI > 25 kg/m ] with diabetic mellitus were randomly assigned to a low-caloric diet with partial use of formula diet group ( FD , n = 119 ) and a conventional low-caloric diet group ( CD , n = 110 ) .


Subjects in FD took one pack of formula diet ( MicroDiet , 240 kcal/pack ) in place of one of three daily low-caloric meals for 24 weeks .


Total daily calorie prescribed was same .


Weight reduction was greater in FD than in CD ( week 24 : -3.5 vs -1.4 kg ; all p < 0.001 ) .


Systolic blood pressure decreased significantly only in FD .


HbA1c reduction was greater in FD than in CD .


HDL-cholesterol increased significantly more in FD than in CD ( week 24 : +2.8 vs. +0.6 mg/dl , p < 0.001 ) .


Among several improving rates ( % ) of risk factors/1 % body weight reduction , those of HbA1c at weeks 16 and 24 , triglyceride at week 8 and HDL-cholesterol at week 24 , were significantly higher in FD than CD .


Doses of sulfonylurea and thiazolidinedione were significantly decreased in FD than in CD .


Partial use of formula diet was much more effective in reducing body weight , and also in improving coronary risk factors than conventional diet in part due to reduced body weight through decreased energy diet intake and due to dietary composition of the formula diet .


The management of patients with refractory immune thrombocytopenia ( ITP ) is challenging , as there is no standard treatment option .


The aim of this study was to investigate the efficacy of recombinant human thrombopoietin ( rhTPO ) in combination with cyclosporin A ( CsA ) for the management of patients with corticosteroid-resistant primary ITP .


Thirty-six patients with corticosteroid-resistant ITP were randomly divided into an observation group and control group .


In the observation group , 19 patients received subcutaneous injection of rhTPO at a dose of 1 g/kg ( 300 U/kg ) once daily up to day 14 .


Simultaneously they also received oral CsA at a dose of 1.5-2 .0 mg/kg twice daily for three months .


In the control group , rhTPO alone was administered subcutaneously at 1 g/kg once daily in the other 17 ITP patients for 14 consecutive days and then the treatment was withdrawn .


There was no significant difference in the response rate at the end of the first week after treatment initiation between the observation group and the control group ( 63.2 % vs. 58.8 % , P > 0.05 ) , neither was there at the end of the second week ( 89.5 % vs. 94.1 % , P > 0.05 ) .


However , the relapse rate in the observation group was significantly lower than that in control group at the end of the first ( 17.7 % vs. 50.0 % , P < 0.05 ) , second ( 29.4 % vs. 68.8 % , P < 0.05 ) and the third month ( 29.4 % vs. 87.5 % , P < 0.01 ) .


In addition , rhTPO plus CsA were well tolerated and adverse events recorded were mild .


Combination therapy with rhTPO and CsA was effective in the management of patients with corticosteroidresistant ITP , with a relatively short time to response and low recurrence rate .


It might be considered as a potential secondline treatment regimen for ITP .


To compare the efficacy of glycerin suppository versus no suppository in preterm very-low-birthweight neonates for improving feeding tolerance .


Randomized controlled trial .


Level III neonatal unit from Mumbai , India .


50 very-low-birthweight ( birth weight between 1000 to 1500 grams ) preterm ( gestational age between 28 to 32 weeks ) neonates randomized to glycerine suppository ( n = 25 ) or no intervention ( n = 26 ) .


Glycerin suppository ( 1g ) once a day from day-2 to day-14 of life or no suppository , along with intermittent oral feeds and standardized care .


Time required to achieve full enteral feeds ( 180 mL/kg/d ) .


Baseline characteristics of neonates like gestational age , birthweight , gender and age at the time of introduction of feeds were comparable in both groups .


The mean ( SD ) duration to reach full enteral feed was 11.90 ( 3.1 ) days in glycerin suppository group and was not significantly different ( P = 0.58 ) from control group , [ 11.33 ( 3.57 ) days ] .


Glycerin suppository group regained birth weight 2 days earlier than control group but this difference was not significant ( P = 0.16 ) .


There was no significant difference in duration of hospital stay or occurrence of necrotizing enterocolitis amongst the two study groups .


Once daily application of glycerin suppository does not accelerate the achievement of full feeds in preterm very-low-birthweight neonates .


Hypokalaemia is frequently encountered in the daily clinical practices of a paediatric cardiac intensive care unit ( PCICU ) .


It is a strong independent predictor of mortality in patients with heart failure .


Thus , prompt potassium replacement therapy holds pivotal importance in therapy for hypokalaemia .


Although intravenous potassium replacement ( IVPR ) in hypokalaemia is the preferred route in most intensive care settings , it is associated with known safety risks and can lead to arrhythmias , cardiac arrest and death if inappropriately administered .


Enteral potassium replacement ( EPR ) , with its superior safety profile , may be a better alternative to IVPR .


Primary outcome To compare the efficacy EPR and IVPR for treatment of hypokalaemia .


Secondary outcome measures include a comparison of adverse effects ( hyperkalaemia , diarrhoea , gastrointestinal bleeds , nausea and vomiting ) after EPR and IVPR and a comparison of the number of dose/s required to achieve resolution of hypokalaemia for each episode of hypokalaemia .


The Enteral Versus Intravenous Potassium Supplementation trial is designed as a randomised , controlled , non-blinded trial with two arms .


Intervention arms will be block randomised on alternate weeks for IVPR and EPR .


Recruited patients will receive treatment accordingly .


For analysis , the percentage change in serum potassium levels in mEq/L after each event of potassium replacement in both arms will be used as an end point to compare the efficacy EPR and IVPR for treatment of hypokalaemia .


The study will be conducted at the PCICU at the Aga Khan University Hospital , Karachi .


This study has been approved by the Ethics Review Committee and Clinical Trials Unit at The Aga Khan University with respect to scientific content and compliance with applicable research and human subjects regulations .


This trial is registered at Clinical Trials.Gov .


NCT02015962 .


Low-intensity exercise applied in anorexia nervosa patients has been shown to have a harmless effect on body composition and to effect short-term improvements in muscular strength and agility .


The aim of this study was to determine the effects of a high-intensity resistance training program designed for adolescents to improve strength and agility in anorexia nervosa restricting-type patients ( AN-R ) .


From a total of 36 female patients with AN-R , one group ( intervention , n = 18 ) underwent a supervised high-intensity resistance training program lasting 8 weeks , and the other group with no exercise ( control , n = 18 ) .


Body weight , body mass index , whole-body muscular strength , and agility were assessed before , after , and 4 weeks after training ( detraining ) .


Leg-press , bench-press , and lateral row tests improved significantly ( p < 0.001 ) after 8 weeks of training compared with controls .


Improvements were maintained after the detraining period .


The training program also showed beneficial effects on agility .


A high-intensity resistance training program adapted to the recommendations for adolescents in AN-R patients was effective and safe , improving muscular strength in the whole body and the ability to perform daily tasks .


However , long-term maintenance of gains seems to be linked to the continuance of training or the use of a maintenance program .


Depression is highly prevalent within individuals diagnosed with schizophrenia , and is associated with an increased risk of suicide .


There are no current evidence based treatments for low mood within this group .


The specific targeting of co-morbid conditions within complex mental health problems lends itself to the development of short-term structured interventions which are relatively easy to disseminate within health services .


A brief cognitive intervention based on a competitive memory theory of depression , is being evaluated in terms of its effectiveness in reducing depression within this group .


This is a single blind , intention-to-treat , multi-site , randomized controlled trial comparing Positive Memory Training plus Treatment as Usual with Treatment as Usual alone .


Participants will be recruited from two NHS Trusts in Southern England .


In order to be eligible , participants must have a DSM-V diagnosis of schizophrenia or schizo-affective disorder and exhibit at least a mild level of depression .


Following baseline assessment eligible participants will be randomly allocated to either the Positive Memory Training plus Treatment as Usual group or the Treatment as Usual group .


Outcome will be assessed at the end of treatment ( 3-months ) and at 6-month and 9-month post randomization by assessors blind to group allocation .


The primary outcome will be levels of depression and secondary outcomes will be severity of psychotic symptoms and cost-effectiveness .


Semi-structured interviews will be conducted with all participants who are allocated to the treatment group so as to explore the acceptability of the intervention .


Cognitive behaviour therapy is recommended for individuals diagnosed with schizophrenia .


However , the number of sessions and length of training required to deliver this intervention has caused a limit in availability .


The current trial will evaluate a short-term structured protocol which targets a co-morbid condition often considered of primary importance by service users .


If successful the intervention will be an important addition to current initiatives aimed at increasing access to psychological therapies for people diagnosed with severe mental health problems .


Current Controlled Trials .


ISRCTN99485756 .


Registered 13 March 2014 .


Manual thrombus aspiration ( TA ) is effective to reduce the thrombus burden during primary percutaneous coronary intervention for ST-elevation myocardial infarction .


The objective of this study is to assess the impact of manual TA on stent implantation during primary percutaneous coronary intervention .


Population of the EXAMINATION trial ( n = 1498 ) was divided into 2 groups according to the use of TA .


Immediate angiographic results , primary patient-oriented end point ( combination of all-cause death , myocardial infarction , and any revascularization ) and secondary device-oriented end point ( combination of cardiac death , target vessel myocardial infarction , and clinically driven target lesion revascularization ) , definite/probable stent thrombosis , and major/minor bleeding were evaluated at 2 years .


A total of 976 ( 65.2 % ) patients were classified into TA group and 522 ( 34.8 % ) patients into nonthrombus aspiration group .


Manual TA was most frequently used in patients with worse initial thrombolysis in myocardial infarction flow .


The TA group received less number of stents implanted ( 1.35 0.62 versus 1.45 0.71 , P = 0.005 ) with bigger size ( 3.25 0.44 versus 3.11 0.46 mm , P < 0.001 ) compared with the nonthrombus aspiration group .


A higher rate of direct stenting ( 69.2 % versus 43.3 % , P < 0.001 ) with lower rate of postdilatation ( 13.0 % versus 18.0 % , P < 0.009 ) was also present in the TA group compared with the nonthrombus aspiration group .


At 2-year follow-up , no differences in clinical end point were observed between groups .


Manual TA during primary percutaneous coronary intervention is associated with a higher rate of direct stenting , a lower rate of postdilatation , and larger and less stents in comparison with conventional primary percutaneous coronary intervention .


Conversely , manual TA had no apparent impact on clinical outcomes at long-term follow-up .


http://www.clinicaltrials.gov .


Unique identifier : NCT00828087 .


Subclinical doses of propofol produce anterograde amnesia , characterized by an early failure of memory consolidation .


It is unknown how propofol affects the amygdala-dependent emotional memory system , which modulates consolidation in the hippocampus in response to emotional arousal and neurohumoral stress .


We present an event-related functional magnetic resonance imaging study of the effects of propofol on the emotional memory system in human subjects .


Thirty-five healthy subjects were randomized to receive propofol , at an estimated brain concentration of 0.90 g ml ( -1 ) , or placebo .


During drug infusion , emotionally arousing and neutral images were presented in a continuous recognition task , while blood-oxygen-level-dependent activation responses were acquired .


After a drug-free interval of 2 h , subsequent memory for successfully encoded items was assessed .


Imaging analysis was performed using statistical parametric mapping and behavioural analysis using signal detection models .


Propofol had no effect on the stereotypical amygdalar response to emotional arousal , but caused marked suppression of the hippocampal response .


Propofol caused memory performance to become uncoupled from amygdalar activation , but it remained correlated with activation in the posterior hippocampus , which decreased in proportion to amnesia .


Propofol is relatively ineffective at suppressing amygdalar activation at sedative doses , but abolishes emotional modulation and causes amnesia via mechanisms that commonly involve hyporesponsiveness of the hippocampus .


These findings raise the possibility that amygdala-dependent fear systems may remain intact even when a patient has diminished memory of events .


This may be of clinical importance in the perioperative development of fear-based psychopathologies , such as post-traumatic stress disorder .


NCT00504894 .


Four randomized studies show that adjuvant radiotherapy ( RT ) lowers the risk of subsequent ipsilateral breast events ( IBEs ) after breast-conserving surgery ( BCS ) for ductal carcinoma in situ ( DCIS ) by approximately 50 % after 10 to 15 years .


We present 20 years of follow-up data for the SweDCIS trial .


Between 1987 and 1999 1,046 women were randomly assigned to RT or not after BCS for primary DCIS .


Results up to 2005 have been published , and we now add another 7 years of follow-up .


All breast cancer events and causes of death were registered .


There were 129 in situ and 129 invasive IBEs .


Absolute risk reduction in the RT arm was 12.0 % at 20 years ( 95 % CI , 6.5 to 17.7 ) , with a relative risk reduction of 37.5 % .


Absolute reduction was 10.0 % ( 95 % CI , 6.0 to 14.0 ) for in situ and 2.0 % ( 95 % CI , -3.0 to 7.0 ) for invasive IBEs .


There was a nonstatistically significantly increased number of contralateral events in the RT arm ( 67 v 48 events ; hazard ratio , 1.38 ; 95 % CI , 0.95 to 2.00 ) .


Breast cancer-specific death and overall survival were not influenced .


Younger women experienced a relatively higher risk of invasive IBE and lower effect of RT. .


The hazard over time looked different for in situ and invasive IBEs .


Use of adjuvant RT is supported by 20-year follow-up .


Modest protection against invasive recurrences and a possible increase in contralateral cancers still call for a need to find groups of patients for whom RT could be avoided or mastectomy with breast reconstruction is indicated .


Surgical incision closure , as well as total joint replacement itself , plays a key role in the overall outcome of an arthroplasty procedure .


Uncomplicated wound healing is the essential condition of successful rehabilitation and the patient 's return to normal activities .


Although there are many innovative suturing techniques which offer advantages , their safety is still being discussed .


The aim of this prospective non-blind randomised study was to evaluate wound healing and complications in relation to skin incision closure with either conventional suture or metal staples .


A total of 72 patients , 21 men and 51 women , who underwent a standard primary total knee arthroplasty ( TKA ) at our department in the period from January till June 2013 , were evaluated .


They were allocated to two groups by random assignment based on the patient 's date of birth ( even or odd day of birth ) .


In group 1 ( n = 39 ) skin was closed using metal staples ( Leukosan Skin Stapler ) , in group 2 ( n = 33 ) , conventional continuous Donati suture was used .


The groups , previously assessed as independent and comparable in terms of age , gender and BMI , were compared in the following criteria : suturing time , duration of wound drainage , wound healing , complications , resuturing when necessary , and their relation to the body mass index , skin plica thickness and co-morbidities potentially complicating soft tissue healing .


The differences were statistically evaluated by parametric and non-parametric tests , i.e. , the median test , ( 2 ) - test , Student 's t-test , Fisher 's exact test and Pearson 's correlation coefficient .


The statistical significance of differences was set at a level of 0.05 .


A significant difference ( p < 0.005 ) between the groups was found in suturing time ; the median time for staples was 81 sec in comparison with 290 sec for conventional suture .


In both groups , staples or sutures were removed on the 12 th postoperative day and there was no difference in wound drainage ( median time , 5 days ; p = 0.891 for both ) .


Treatment for late discharge was required in two sutured wounds ( 6.1 % ) and in three stapled wounds ( 7.7 % ) .


One of the latter was due to early deep wound infection , which later resulted in revision TKA .


The groups did not differ in the values of either BMI or plica thickness ( Pearson 's r ) .


Views on alternative suture techniques for skin closure in orthopaedic surgery vary .


In this study , the use of metal staples or conventional suture is compared between two groups of patients undergoing TKA , i.e. , the same type of procedure .


The advantage of staples involves a quick and simple application but , as reported , removal may be more painful with staples than with stitches , and much depends on the technique of staple application .


The continuous suture technique may produce skin strangulation at wound margins , which will complicate healing .


Staples minimise this risk and are therefore commonly used in TKA surgery .


However , only very few studies comparing these two suture techniques in TKA patients have been published .


Correctly performed skin suturing by means of metal staples is not associated with a higher complication rate and is therefore a simple , rapid , efficient and economical alternative to the conventional suture technique .


Fluid overload in infants can result from inappropriate volume expansion ( VE ) .


The aim of this work was to evaluate the beneficial values of Transoesophageal Doppler TED in intraoperative fluid guidance versus standard clinical monitoring parameters in infants undergoing Kasai operation .


Forty infants scheduled for Kasai procedure were randomly allocated into two groups ( Doppler and clinical group ) .


In Doppler group decided to provide VE ( 10-30 m1/kg of Hydroxyethyl starches HES ) when the index stroke volume decreased by 15 % from the baseline value , in clinical group , hemodynamic variables triggering colloid administration mean arterial blood pressure ( MAP ) less than 20 % below baseline or central venous pressure ( CVP ) < 5 cmH2O in both groups : Ringer 's acetate was infused at constant rate ( 6 m 1/kg/h ) .


Standard and TED-derived data were recorded before and after VE .


Follow up the postoperative outcome and hospital stay .


There were significantly lower mean volume of HES ( 42.85 3.93 versus 84 14.29 ml ) and percent of infants required it ( 30 % versus 90 % ) associated with earlier tolerance to oral feeding ( 2 0.66 versus 3.4 0.51 ) , shorter hospital stay ( 5.30 0.47 versus 6.7 [ symbols : see text ] days ) and lower rate of chest infection ( 15 % versus 30 % ) in Doppler group than clinical group .


There was no difference between the two studied groups regarding heart rate , MAP .


TED guided intraoperative fluid intake in infants undergoing Kasai operation optimize fluid consumption and improve outcome associated with shorter hospital stay .


High sodium intake during infancy and early childhood can change salt preference and blood pressure trajectories across life , representing a modifiable cardiovascular risk factor .


Describing young children 's sodium intake is important for informing effective targets for sodium reduction .


This study aimed to describe food sources and demographic and behavioral correlates of sodium intake in 295 young Australian children using three unscheduled 24-hour recalls ( when children were 9 and then 18 months of age ) with mothers participating within an existing randomized controlled trial , the Melbourne Infant Feeding Activity and Nutrition Trial ( InFANT ) Program .


Differences in individual-level and family-level demographic and behavioral variables were assessed across tertiles of sodium density ( mg/1 ,000 kcal ) .


Descriptive statistics were used to describe food-group contributions to total energy and sodium intakes at both ages .


Mean sodium intake was 486 mg ( standard deviation = 232 mg ) at 9 months and had more than doubled to 1,069 mg ( standard deviation = 331 mg ) at 18 months of age .


Fifty-four percent of children at 18 months exceeded the Recommended Daily Upper Level for sodium intake , with bread , cheese , breakfast cereal , soup , and mixed dishes all important sources of sodium at both ages .


Yeast extracts , processed meats , and bread products became important additional sources at 18 months .


A greater proportion of children in the highest sodium-density tertile had ceased breastfeeding and had commenced solids at an earlier age .


The key food sources of sodium for children younger than 2 years are those that contribute to the whole population 's high salt burden and highlight the essential role governments and food industry must play to reduce salt in commonly consumed foods .


Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia .


The aim of this trial was to evaluate the effect of a pre - and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline .


This was a single-center , prospective , randomized controlled trial in which patients with hip fracture were randomized to treatment in an acute geriatric ward or standard orthopedic ward .


Inclusion and randomization took place in the Emergency Department at Oslo University hospital .


The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings .


Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale ( CDR ) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer 's Disease battery ( CERAD ) .


Secondary outcomes were pre - and postoperative delirium , delirium severity and duration , mortality and mobility ( measured by the Short Physical Performance Battery ( SPPB ) ) .


Patients were assessed four and twelve months after surgery by evaluators blind to allocation .


A total of 329 patients were included .


There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards ( mean 54.7 versus 52.9 , 95 % confidence interval for the difference -5.9 to 9.5 ; P = 0.65 ) .


There was also no significant difference in delirium rates ( 49 % versus 53 % , P = 0.51 ) or four month mortality ( 17 % versus 15 % , P = 0.50 ) between the intervention and the control group .


In a pre-planned sub-group analysis , participants living in their own home at baseline who were randomized to orthogeriatric care had better mobility four months after surgery compared with patients randomized to the orthopedic ward , measured with SPPB ( median 6 versus 4 , 95 % confidence interval for the median difference 0 to 2 ; P = 0.04 ) .


Pre - and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture .


The intervention had , however , a positive effect on mobility in patients not admitted from nursing homes .


ClinicalTrials.gov NCT01009268 Registered November 5 , 2009 .


Shockwave was shown to enhance the healing of anterior cruciate ligament ( ACL ) reconstruction in rabbits .


This study evaluated the effect of extracorporeal shockwave therapy ( ESWT ) on ACL reconstruction in human subjects .


We hypothesized that ESWT may improve human ACL reconstruction .


Fifty-three patients were randomized into two groups with 26 patients in ESWT group and 27 patients in control group .


The ESWT group underwent single-bundle hamstring autograft ACL reconstruction and received ESWT immediately after surgery .


The control group underwent ACL surgery without ESWT .


Both groups received the same rehabilitation postoperatively .


The evaluations included Lysholm score , IKDC score and KT-1000 , radiograph , bone mineral density , and magnetic resonance imaging .


ESWT group showed significantly better Lysholm score than control group at 1 and 2y postoperatively ( P < 0.001 and 0.001 , respectively ) .


No significant difference was noted in IKDC score between the two groups ( P = 0.080 and 0.076 , respectively ) .


The KT-1000 values were significantly better in ESWT group than control group at 2y postoperatively ( P = 0.027 ) .


The tibia tunnel on X-ray was significantly smaller in ESWT group compared with control group at 2y ( P = 0.018 ) .


The bone mineral density values showed no discernable difference between the two groups at 6mo and 2y ( P = 0.522 and 0.984 , respectively ) .


On magnetic resonance imaging , ESWT group showed significant decrease in tibia tunnel enlargement at 6mo and 2y compared with the control group ( P = 0.024 and < 0.001 , respectively ) .


ESWT significantly improves the subjective Lysholm score and decreases the middle 1/3 tibia tunnel enlargement after single hamstring autograft ACL reconstruction .


The objective was to compare the effectiveness of repositioning every 2 or 4 h for preventing pressure ulcer development in patients in intensive care unit under mechanical ventilation ( MV ) .


This was a pragmatic , open-label randomized clinical trial in consecutive patients on an alternating pressure air mattress ( APAM ) requiring invasive MV for at least 24 h in a university hospital in Spain .


Eligible participants were randomly assigned to groups for repositioning every 2 ( n = 165 ) or 4 ( n = 164 ) h.


The primary outcome was the incidence of a pressure ulcer of at least grade II during ICU stay .


A pressure ulcer of at least grade II developed in 10.3 % ( 17/165 ) of patients turned every 2 h versus 13.4 % ( 22/164 ) of those turned every 4 h ( hazard ratio [ HR ] 0.89 , 95 % confidence interval [ CI ] 0.46-1 .71 , P = 0.73 ) .


The composite end point of device-related adverse events was recorded in 47.9 versus 36.6 % ( HR 1.50 , CI 95 % 1.06-2 .11 , P = 0.02 ) , unplanned extubation in 11.5 versus 6.7 % ( HR 1.77 , 95 % CI 0.84-3 .75 , P = 0.13 ) , and endotracheal tube obstruction in 36.4 versus 30.5 % , respectively ( HR 1.44 , 95 % CI 0.98-2 .12 , P = 0.065 ) .


The median ( interquartile range ) daily nursing workload for manual repositioning was 21 ( 14-27 ) versus 11 min/patient ( 8-15 ) ( P < 0.001 ) .


A strategy aimed at increasing repositioning frequency ( 2 versus 4 h ) in patients under MV and on an APAM did not reduce the incidence of pressure ulcers .


However , it did increase device-related adverse events and daily nursing workload .


To compare the bond strength to human primary dentin of a self-adhesive light-curing resin composite , a self-etch adhesive and a glass-ionomer cement by means of microshear bond strength ( pSBS ) test and scanning electron microscopic ( SEM ) observations .


75 human primary molars were sectioned to obtain a 2 mm-thick slab of mid-coronal dentin , randomly divided into three groups ( n = 25 ) .


Nine conical frustum-shaped buildups were constructed on the occlusal surface of each dentin slab using a self-adhesive light-curing resin composite ( Vertise Flow ; Group 1 ) , bonding agent ( Optibond All-in-One ; Group 2 ) combined with resin composite ( Premise Flow ) and a glass-ionomer cement ( Ketac-Fil ; Group 3 ) .


After thermocycling , specimens were subjected to microSBS test .


All debonded specimens were observed at SEM .


Data were analyzed by a mixed model and chi-square test .


The bond strength measured in Group 1 ( 9.0 + / - 4.5 MPa ) was significantly lower than that one recorded in Group 2 ( 20.2 + / -12.5 MPa ) although it was significantly higher than the one recorded in Group 3 ( 4.8 + / - 2.3 MPa ) .


Failures were mainly adhesive in all groups .


This study examined potential predictors of nurses ' intentions to work during the 2009 influenza A ( H1N1 ) pandemic .


A questionnaire was mailed to a random sample of 1,200 nurses chosen from all RNs and LPNs registered with the Maine State Board of Nursing during the second wave of the flu pandemic .


Of the 735 respondents , 90 % initially indicated that they intended to work during a flu pandemic .


Respondents were significantly more likely to work if provided with adequate personal protective equipment ( PPE ) but significantly less likely without adequate PPE or if they feared family members could become ill with pandemic flu .


They were also significantly less likely to work if assigned to direct care of a flu patient ; if a colleague were quarantined for or died of pandemic flu ; if they feared their own family members might die of pandemic flu ; if they themselves were ill for any reason ; if a family member or loved one were sick at home and needed care ; if they lacked a written family protection plan ; or if certain incentives were offered : antiviral medication or vaccine for nurse and family , double pay , or free room and board at work .


About 7 % of RNs reported that they would not be willing to work during a flu pandemic , regardless of incentives or other factors .


An inverse relationship was found between the perceived level of threat posed by a flu pandemic and nurses ' willingness to work .


To maintain an adequate nursing workforce during a flu pandemic , employers should ensure that policies and procedures include providing adequate PPE for nurses and safeguarding the health of nurses and their families .


The level of perceived threat is likely to affect the proportion of nurses willing to work .


Some nurses will not work during a flu pandemic no matter what protections and incentives are offered ; efforts intended to force or entice all nurses to work are unlikely to succeed .


Psychological treatments for posttraumatic stress disorder ( PTSD ) are usually delivered once or twice a week over several months .


It is unclear whether they can be successfully delivered over a shorter period of time .


This clinical trial had two goals : to investigate the acceptability and efficacy of a 7-day intensive version of cognitive therapy for PTSD and to investigate whether cognitive therapy has specific treatment effects by comparing intensive and standard weekly cognitive therapy with an equally credible alternative treatment .


Patients with chronic PTSD ( N = 121 ) were randomly allocated to 7-day intensive cognitive therapy for PTSD , 3 months of standard weekly cognitive therapy , 3 months of weekly emotion-focused supportive therapy , or a 14-week waiting list condition .


The primary outcomes were change in PTSD symptoms and diagnosis as measured by independent assessor ratings and self-report .


The secondary outcomes were change in disability , anxiety , depression , and quality of life .


Evaluations were conducted at the baseline assessment and at 6 and 14 weeks ( the posttreatment/wait assessment ) .


For groups receiving treatment , evaluations were also conducted at 3 weeks and follow-up assessments at 27 and 40 weeks after randomization .


All analyses were intent-to-treat .


At the posttreatment/wait assessment , 73 % of the intensive cognitive therapy group , 77 % of the standard cognitive therapy group , 43 % of the supportive therapy group , and 7 % of the waiting list group had recovered from PTSD .


All treatments were well tolerated and were superior to waiting list on nearly all outcome measures ; no difference was observed between supportive therapy and waiting list on quality of life .


For primary outcomes , disability , and general anxiety , intensive and standard cognitive therapy were superior to supportive therapy .


Intensive cognitive therapy achieved faster symptom reduction and comparable overall outcomes to standard cognitive therapy .


Cognitive therapy for PTSD delivered intensively over little more than a week was as effective as cognitive therapy delivered over 3 months .


Both had specific effects and were superior to supportive therapy .


Intensive cognitive therapy for PTSD is a feasible and promising alternative to traditional weekly treatment .


Modafinil is a medication licensed for the treatment of narcolepsy .


However , it has been reported that healthy individuals without wakefulness disorders are using modafinil off-label to enhance cognitive functioning .


Although some studies have reported that modafinil improves cognitive task performance in healthy volunteers , numerous other studies have failed to detect cognitive enhancing effects of modafinil on several well-established neuropsychological tasks .


Interestingly , several clinical and preclinical studies have found that improved cognitive task performance by modafinil is accompanied by slower response times .


This observation raises the question as to whether this slowing of response time in healthy volunteers is a necessary and sufficient condition for cognitive enhancement with modafinil .


The aim of the current experiment was to explore this question by investigating the effects of modafinil on the Hayling Sentence Completion Test ( HSCT ) .


Sixty-four healthy volunteers received either a single dose ( 200 mg ) of modafinil ( n = 32 ) or placebo ( n = 32 ) in a randomized , double-blind , placebo-controlled , parallel group study in which the principal outcome measures were response latencies on the response initiation and response inhibition sections of the HSCT .


Participants dosed with modafinil had significantly longer mean response latencies on the HSCT for both the response initiation and response inhibition compared to participants dosed with placebo .


However , participants in both groups made a similar number of errors on each of these measures , indicating that modafinil did not enhance the accuracy of performance of the task relative to placebo .


This study demonstrated that administration of single 200 mg doses of modafinil to healthy individuals increased the latency of responses in the performance of the HSCT , a task that is highly sensitive to prefrontal executive function , without enhancing accuracy of performance .


This finding may provide important clues to defining the limitations of modafinil as a putative cognitive enhancer .


ClinicalTrials.gov NCT02051153 .


Subjects with diabetes mellitus ( DM ) develop gait dysfunction contributing to falls , reluctance to perform activities and injuries .


Neuropathic pain ( NeP ) related to diabetic peripheral neuropathy ( DPN ) is associated with increased gait variability that may contribute to gait dysfunction .


We used a portable device ( GaitMeter ) and related gait and balance measures to measure gait parameters in painful DPN ( PDPN ) subjects prior to and during analgesia .


Our hypothesis was that PDPN subjects would have decreased gait step variability when receiving pharmacological relief of NeP .


DPN subjects with at least moderate NeP were assessed in a randomized , double-blind crossover study of pregabalin versus placebo .


The outcome measure was variability in step length and step velocity .


Testing for Timed Get-Up-and-Go Test , Tinetti Mobility Scales , Sway Testing , a Physiological Profile Approach , and fall-related surveys were also performed .


DPN severity was quantified using the Utah Early Neuropathy Score .


PDPN subjects developed increased , rather than decreased , step length and step velocity variability during pregabalin treatment .


There were no significant differences between cohorts for other physiological gait and balance testing .


Non-significant NeP relief occurred in the pregabalin phase of study as compared with placebo .


There was a negative relationship for step length with pain severity .


Analgesia did not decrease gait variability in PDPN patients , and in fact , increased gait variability was seen during pregabalin treatment .


Other important relationships of gait dysfunction with PDPN should be sought .


It has been suggested that off-pump coronary artery bypass grafting ( CABG ) surgery reduces myocardial ischemia-reperfusion injury , postoperative systemic inflammatory response , and oxidative stress .


The aim of this study was to measure serum malondialdehyde ( MDA ) , high-sensitivity C-reactive protein ( hs-CRP ) , M30 , and M65 levels and to investigate the relationship between M30 levels and oxidative stress and inflammation in patients undergoing on-and off-pump CABG surgery .


Fifty patients were randomly assigned to on-pump or off-pump CABG surgery ( 25 patients off-pump and 25 on-pump CABG surgery ) , and blood samples were collected prior to surgery , and 30 minutes , 60 minutes , 6 hours , and 24 hours after CABG surgery .


Compared to the on-pump group , serum MDA levels at 30 minutes , 60 minutes , 6 hours , and 24 hours after the CABG surgery were significantly lower in the off-pump group ( P = .001 , P = .001 , P = .001 , and P = .001 , respectively ) .


Serum M30 levels were found to be elevated in both groups , returning to baseline at 24 hours .


When compared to baseline , the hs-CRP level reached its peak at 24 hours at 13.285.32 mg/dL in the on-pump group , and 15.444.02 mg/dL in the off-pump group .


CABG surgery is associated with an increase in inflammatory markers and serum M30 levels , indicating epithelial/endothelial apoptosis in the early period .


To determine the efficacy of a 14-day regimen of esomeprazole 20 mg for the treatment of frequent heartburn in subjects who are likely to self-treat with over-the-counter medications without consulting a health care provider .


Adults with frequent heartburn 2 days per week in the past 4 weeks were randomly assigned to 14-day double-blind treatment with esomeprazole 20 mg once daily or placebo in 2 identical multicenter studies ( ClinicalTrials.gov identifiers : NCT01370525 , NCT01370538 ) .


The primary efficacy outcome was percentage of heartburn-free 24-hour days across 14 days .


Secondary efficacy outcomes included heartburn resolution , defined as heartburn 2 days over 14 days , and percentages of subjects reporting 1 day with heartburn in the first and final weeks of treatment .


Subjects recorded data in daily self-assessment diaries .


The percentage of heartburn-free 24-hour days over 14 days was significantly higher ( P < 0.0001 ) in subjects receiving esomeprazole 20 mg compared with placebo in study 1 ( N = 331 ; 46.13 % vs. 33.07 % , respectively ) and study 2 ( N = 320 ; 48.00 % vs 32.75 % , respectively ) .


Significantly more subjects treated with esomeprazole 20 mg had heartburn resolution over 14 days and in the first and final weeks compared with placebo .


Within the first 4 days , the proportion of subjects with heartburn-free days was significantly greater with esomeprazole 20 mg versus placebo .


Treatment was generally well tolerated , with a safety pattern consistent with the known profile for esomeprazole .


A 14-day regimen of esomeprazole 20 mg once daily was effective for treating frequent heartburn in subjects who are likely to self-treat with over-the-counter medications .


In 2002 , the Danish Cancer Society opened a rehabilitation centre in which cancer patients were offered a free , six-day , multidimensional residential course .


Our previous studies of the effects of this course at one and six months of follow-up showed no positive effect on distress .


We investigated long-term effects at 12 months of follow-up and whether subgroups with fewer psychosocial resources received more benefit from the intervention than patients with better resources .


In two Danish counties , 507 patients with breast , prostate , colon or rectum cancer diagnosed within the past two years who had completed primary treatment were randomised to a six-day , multidimensional residential rehabilitation course or to standard care .


Of these , 208 patients received the allocated intervention and 244 received the allocated control condition and were included in the analyses .


Patients in both groups completed questionnaires at baseline and at one , six and 12 months of follow-up , including the ` Profile of Mood States short form ' , the ` General Self-efficacy ' scale and a question on emotional support .


At 12 months of follow-up , 179 participants in the intervention group and 195 in the control group provided data .


No effect of the intervention was found on distress at 12 months of follow-up , even in subgroups with fewer psychosocial resources at baseline , i.e. greater baseline distress , poorer self-efficacy and less emotional support .


Multidimensional rehabilitation programmes may not be effective in the treatment of distress .


During the past few decades , studies of psychotherapy or psycho-education in cancer patients have shown small to moderate effects .


More focused rehabilitation programmes may be more effective .


To verify the technical feasibility of low contrast volume ( 40 mL ) run-off CT angiography ( run-off CTA ) with the individual scan time optimization based on double-level test bolus technique .


A prospective study of 92 consecutive patients who underwent run-off CTA performed with 40 mL of contrast medium ( injection rate of 6 mL/s ) and optimized scan times on a second generation of dual-source CT. .


Individual optimized scan times were calculated from aortopopliteal transit times obtained on the basis of double-level test bolus technique -- the single injection of 10 mL test bolus and dynamic acquisitions in two levels ( abdominal aorta and popliteal arteries ) .


Intraluminal attenuation ( HU ) was measured in 6 levels ( aorta , iliac , femoral and popliteal arteries , middle and distal lower-legs ) and subjective quality ( 3-point score ) was assessed .


Relations of image quality , test bolus parameters and arterial circulation involvement were analyzed .


High mean attenuation ( HU ) values ( 468 ; 437 ; 442 ; 440 ; 342 ; 274 ) and quality score in all monitored levels was achieved .


In 91 patients ( 0.99 ) the sufficient diagnostic quality ( score 1-2 ) in aorta , iliac and femoral arteries was determined .


A total of 6 patients ( 0.07 ) were not evaluable in distal lower-legs .


Only the weak indirect correlation of image quality and test-bolus parameters was proved in iliac , femoral and popliteal levels ( r values : -0.263 , -0.298 and -0.254 ) .


The statistically significant difference of the test-bolus parameters and image quality was proved in patients with occlusive and aneurysmal disease .


We proved the technical feasibility and sufficient quality of run-off CTA with low volume of contrast medium and optimized scan time according to aortopopliteal transit time calculated from double-level test bolus .


Clopidogrel therapy has recently been shown to reduce cardiovascular events in patients with stable vascular disease .


This benefit may be due to effects not exclusively related to platelet aggregation .


The aim of this study was to evaluate the effect of clopidogrel therapy on microvascular endothelial function in subjects with stable coronary artery disease ( CAD ) .


Forty subjects with stable CAD were randomised to clopidogrel therapy ( 75mg/day ) or control .


Blood and endothelial function testing occurred at baseline , one week and three months following randomisation .


Microvascular endothelial function was assessed via reactive hyperaemic index ( RHI ) .


Platelet function was assessed by adenosine diphosphate ( ADP ) - induced whole blood aggregation and the VerifyNow system .


Plasma markers of endothelial function ( asymmetric dimethylarginine , ADMA ) and oxidative stress ( myeloperoxidase , MPO ) were also tested .


The primary endpoint was endothelial function assessment ( RHI ) at three months .


At one week RHI increased by 2010 % in the clopidogrel group ; this effect was maintained at three months ( 219 % increase from baseline ; P < 0.01 ) .


A significant decrease in ADP-induced platelet aggregation and P2Y12 reaction units was observed in the clopidogrel therapy group ( P < 0.01 ) .


There was no correlation between endothelial function and platelet function testing in the clopidogrel therapy group .


Clopidogrel therapy is associated with improved microvascular endothelial function in patients with stable CAD .


This effect is independent of its effects on ADP-induced platelet reactivity .


To investigate if adding Caphosol ( ) , a mouthwash solution , to oral cryotherapy ( OC ) further protects against oral mucositis ( OM ) , a toxic painful complication to high dose chemotherapy .


The study was a randomised , controlled , study design .


Patients 16 years scheduled for allogeneic stem cell transplantation were included consecutively and randomised to experimental group receiving OC combined with Caphosol ( ) ( n = 20 ) or control group receiving OC only ( n = 20 ) .


OC was given from start to end of HDCT .


Caphosol ( ) , from day 0 to day 21 .


There were no significant differences regarding age or gender between the groups .


Mucositis was assessed with the World Health Organisation ( WHO ) grading scale .


Pain was assessed with a 10 cm visual analogue scale ( VAS ) from 0 = no pain to 10 = worst imaginable pain .


Start and duration of therapy with pain relieving drugs , serum C-reactive protein values , and number of days of hospitalisation were collected from the medical records .


Data on OM , oral pain , use of i.v. opioids and total parenteral nutrition were collected during 22 days .


There was no significant difference between the groups on OM , oral pain , use of i.v. opioids or TPN between the groups .


The study showed no additional effect of combining Caphosol ( ) with OC .


The health benefits of exercise are well established .


However , the relationship between exercise volume and intensity and health benefits remains unclear , particularly the benefits of low-volume and intensity exercise .


The primary purpose of this investigation was , therefore , to examine the dose-response relationship between exercise volume and intensity with derived health benefits including volumes and intensity of activity well below international recommendations .


Generally healthy , active participants ( n = 72 ; age = 44 13 years ) were assigned randomly to control ( n = 10 ) or one of five 13-week exercise programs : ( 1 ) 10-min brisk walking 1/week ( n = 10 ) , ( 2 ) 10-min brisk walking 3/week ( n = 10 ) , ( 3 ) 30-min brisk walking 3/week ( n = 18 ) , ( 4 ) 60-min brisk walking 3/week ( n = 10 ) , and ( 5 ) 30-min running 3/week ( n = 14 ) , in addition to their regular physical activity .


Health measures evaluated pre - and post-training including blood pressure , body composition , fasting lipids and glucose , and maximal aerobic power ( VO2max ) .


Health improvements were observed among programs at least 30 min in duration , including body composition and VO2max : 30-min walking 28.8-34 .5 mL kg ( -1 ) min ( -1 ) , 60-min walking 25.1-28 .9 mL kg ( -1 ) min ( -1 ) , and 30-min running 32.4-36 .4 mL kg ( -1 ) min ( -1 ) .


The greater intensity running program also demonstrated improvements in triglycerides .


In healthy active individuals , a physical activity program of at least 30 min in duration for three sessions/per week is associated with consistent improvements in health status .


Obesity-related comorbidities frequently contribute to acute illness .


Obesity interventions during hospitalization are not often utilized but may be effective .


To examine whether inpatient weight loss intervention with postdischarge follow-up results in weight loss at 6 months when compared to control .


Prospective , randomized controlled trial .


Academic medical center in Chicago , Illinois .


Obese adult inpatients .


Intervention subjects viewed a weight education video , underwent personalized counseling , and set specific weight loss , dietary , and fitness goals prior to discharge .


All participants were followed by phone over the subsequent 6 months .


The trial was unblinded to participants , physicians , and investigators .


Primary outcome was weight change between groups at 6 months .


Weight change from baseline and waist-to-hip ratios ( WHR ) were also assessed .


For 176 participants in the intention-to-treat analysis , mean baseline weight for the intervention group was 107.7 kg ( standard deviation [ SD ] = 16.7 ) and 105.1 kg ( SD = 17.4 ) for controls .


Mean weight loss at 6 months was 1.08 kg ( SD = 4.33 ) for intervention subjects and 1.35 kg ( SD = 3.65 ) among controls .


There was no significant difference in weight loss between groups at 6 months ( P = 0.26 ) .


As-treated analysis yielded similar results .


There were no differences in WHRs between the intervention and control at 6 months ( 0.04 vs 0.04 , P = 0.59 ) .


We found no difference in weight loss between the intervention and control groups at 6 months .


The purpose of this study was to determine the acceptability of peer - and health-professional-led self-management education using the Stanford Program with Australian veterans and their partners .


The 6-week program taught problem-solving and decision-making skills to activate healthful behaviors , including action-planning and goal-setting .


The evaluation included a participant and facilitator postprogram questionnaire ; group interview ; and alcohol , posttraumatic stress disorder , anxiety , depression , anger , relationship , and quality-of-life measures as part of a randomized controlled study .


Participants included 25 male veterans with comorbid alcohol dependency , psychiatric and medical conditions , and 18 female partners ( n = 43 ) , 61.5 % of who reported a chronic condition .