However , it is not clear how best to treat patients with antibodies .


This trial will test a combined screening and treatment protocol in renal transplant recipients .


Recipients > 1 year post-transplantation , aged 18 to 70 with an estimated glomerular filtration rate > 30 mL/min will be randomly allocated to blinded or unblinded screening arms , before being screened for the presence of antibodies .


In the unblinded arm , test results will be revealed .


Those with antibodies will have biomarker-led care , consisting of a change in their anti-rejection drugs to prednisone , tacrolimus and mycophenolate mofetil .


In the blinded arm , screening results will be double blinded and all recruits will remain on current therapy ( standard care ) .


In both arms , those without antibodies will be retested every 8 months for 3 years .


The primary outcome is the 3-year kidney failure rate for the antibody-positive recruits , as measured by initiation of long-term dialysis or re-transplantation , predicted to be approximately 20 % in the standard care group but < 10 % in biomarker-led care .


The secondary outcomes include the rate of transplant dysfunction , incidence of infection , cancer and diabetes mellitus , an analysis of adherence with medication and a health economic analysis of the combined screening and treatment protocol .


Blood samples will be collected and stored every 4 months and will form the basis of separately funded studies to identify new biomarkers associated with the outcomes .


We have evidence that the biomarker-led care regime will be effective at preventing graft dysfunction and expect this to feed through to graft survival .


This trial will confirm the benefit of routine screening and lead to a greater understanding of how to keep kidney transplants working longer .


Current Controlled Trials ISRCTN46157828 .


Venipuncture is one of the most painful events for children in hospitals .


Valsalva maneuver ( VM ) decreases the incidence and severity of pain on venipuncture pain in adults .


This study was designed to evaluate VM as compared with Eutectic Mixture of Local Anesthetic ( EMLA ( ) ) cream for venipuncture pain in children .


In this study , we evaluated the effect of VM on venipuncture pain in children .


60 patients scheduled for elective surgery were randomly divided into three groups .


In Group V , children were punctured during VM .


In Group E , EMLA ( ) 5 % cream and in Group C ( control group ) vaseline was applied on the non-dominant hand 60 min before the venipuncture .


Patients made a pain assessment using visual analog score ( VAS ) .


Mean arterial pressure ( MAP ) , heart rate ( HR ) , and SpO2 measurements were obtained during the venous cannulation .


Respectively , the VAS was 2.15 1.95 for Group V and 1.00 0.79 for Group E and 2.55 2.74 for Group C.


A significant reduction in the severity of pain was observed in Group E.


The difference being statistically significant ( p < 0.05 ) , the VAS of Group V was higher than Group E but lower than Group C ( p > 0.05 ) .


On the basis of data from this study , the VM is a simple and a practical method to reduce venipuncture pain in children but not as effectively as EMLA ( ) .


Is a combination of standing , electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury ?


A multi-centre randomised trial with concealed allocation , assessor blinding and intention-to-treat analysis .


Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures .


All participants underwent a 6-week program .


The experimental group received tilt table standing , electrical stimulation and ankle splinting .


The control group received tilt table standing alone .


The primary outcome was passive ankle dorsiflexion with a 12Nm torque .


Secondary outcomes included : passive dorsiflexion with lower torques ( 3 , 5 , 7 and 9Nm ) ; spasticity ; the walking item of the Functional Independence Measure ; walking speed ; global perceived effect of treatment ; and perceived treatment credibility .


OUTCOME MEASURES were taken at baseline ( Week 0 ) , end of intervention ( Week 6 ) , and follow-up ( Week 10 ) .


The mean between-group differences ( 95 % CI ) for passive ankle dorsiflexion at Week 6 and Week 10 were -3 degrees ( -8 to 2 ) and -1 degrees ( -6 to 4 ) , respectively , in favour of the control group .


There was a small mean reduction of 1 point in spasticity at Week 6 ( 95 % CI 0.1 to 1.8 ) in favour of the experimental group , but this effect disappeared at Week 10 .


There were no differences for other secondary outcome measures except the physiotherapists ' perceived treatment credibility .


Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury .


ACTRN12608000637347 .


[ Leung J , Harvey LA , Moseley AM , Whiteside B , Simpson M , Stroud K ( 2014 ) Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury : a randomised trial.Journal of Physiotherapy60 : 201-208 ] .


The purpose of this study was to determine the cost implications of the Coronary Artery Bypass Graft Off or On Pump Revascularization Study ( CORONARY ) at 1 year .


Country-specific healthcare costs were obtained from public databases or local experts from each country in the CORONARY trial .


Purchasing power parities were applied to these costs of consumed healthcare resources .


Analyses of subgroups included in the CORONARY clinical trial were also conducted .


Costs are reported in US dollars .


After 1 year , the total cost per patient in the off-pump coronary artery bypass graft surgery ( CABG ) arm was $ 9,650 ( $ 9,216 to $ 10,285 ) compared with $ 9,583 ( $ 9,239 to $ 9,988 ) for the on-pump CABG arm ; that resulted in a nonsignificant increase of $ 68 ( - $ 575 to $ 710 ) .


Similar findings were noted for various subgroups .


There were also no differences due to late conversions .


The CORONARY trial demonstrated that off-pump CABG was clinically as safe and effective as on-pump CABG with no difference in costs .


Thus , the decision as to which method to choose is free from costs considerations and should be based on patient preference and surgeon expertise ( Coronary Artery Bypass Graft [ CABG ] Off or On Pump Revascularization Study [ CORONARY ] ; clinicaltrials.gov NCT00463294 ) .


Statin intolerance has been a major limitation in the use of statins , especially at higher doses .


New effective treatments are needed for lowering low-density lipoprotein cholesterol ( LDL-C ) in patients who can not tolerate daily statin doses .


ODYSSEY ALTERNATIVE ( NCT01709513 ) evaluates efficacy and safety of alirocumab , a fully human proprotein convertase subtilisin/kexin type 9 monoclonal antibody , in patients with well-documented statin intolerance and moderate to very high cardiovascular risk .


This is a phase 3 , multicenter , randomized , double-blind , double-dummy study in statin-intolerant patients .


Intolerance was defined as inability to take at least 2 different statins because of muscle-related adverse events ( AEs ) , 1 at the lowest approved starting dose .


Patients first received single-blind subcutaneous and oral placebo for 4 weeks , and were withdrawn if they developed muscle-related AEs after the placebo treatment .


Continuing patients were randomized ( 2:2:1 ratio ) to alirocumab 75 mg self-administered via single 1 mL prefilled pen every 2 weeks or ezetimibe 10 mg/day or atorvastatin 20 mg/day ( statin rechallenge ) , for 24 weeks .


Alirocumab dose was increased to 150 mg every 2 weeks ( also 1 mL ) at week 12 depending on week 8 LDL-C level .


The primary endpoint is percent change in LDL-C from baseline to week 24 by intent-to-treat analysis .


Muscle-related AEs were assessed by spontaneous patient reports and clinic queries .


A total of 314 patients have been randomized .


This is the first and only study of a new class of LDL-C-lowering agents in patients selected with a rigorously documented intolerance to statins , using a placebo run-in and statin control arm .


The optimal strategy for the reconstruction of the pancreas following pancreaticoduodenectomy ( PD ) is still debated .


The aim of this study was to compare the outcomes of isolated Roux loop pancreaticojejunostomy ( IRPJ ) with those of pancreaticogastrostomy ( PG ) after PD .


Consecutive patients submitted to PD were randomized to either method of reconstruction .


The primary outcome measure was the rate of postoperative pancreatic fistula ( POPF ) .


Secondary outcomes included operative time , day to resumption of oral feeding , postoperative morbidity and mortality , and exocrine and endocrine pancreatic functions .


Ninety patients treated by PD were included in the study .


The median total operative time was significantly longer in the IRPJ group ( 320min versus 300min ; P = 0.047 ) .


Postoperative pancreatic fistula developed in nine of 45 patients in the IRPJ group and 10 of 45 patients in the PG group ( P = 0.796 ) .


Seven IRPJ patients and four PG patients had POPF of type B or C ( P = 0.710 ) .


Time to resumption of oral feeding was shorter in the IRPJ group ( P = 0.03 ) .


Steatorrhea at 1 year was reported in nine of 42 IRPJ patients and 18 of 41 PG patients ( P = 0.029 ) .


Albumin levels at 1 year were 3.6 g/dl in the IRPJ group and 3.3 g/dl in the PG group ( P = 0.001 ) .


Isolated Roux loop PJ was not associated with a lower rate of POPF , but was associated with a decrease in the incidence of postoperative steatorrhea .


The technique allowed for early oral feeding and the maintenance of oral feeding even if POPF developed .


The increasing number of patients with implantable cardiac devices raises the need for more efficient outpatient follow-up care .


Due to technological progress in communication and transmission systems and in the implantable devices themselves , telemonitoring can be widely used as an important part of care for patients and devices .


Our objective was to evaluate the benefits of continuous remote monitoring using the BIOTRONIK Home Monitoring ( HM ) system compared to standard outpatient follow-ups .


198 patients with single - or dual-chamber implantable cardioverter-defibrillator ( ICD ) implanted for primary or secondary prevention of sudden cardiac death were randomized into a group of patients followed through standard outpatient visits ( HM - ) and a group telemonitored by the HM system ( HM + ) .


Planned and emergency visits , ICD-related hospitalizations , and delivered shocks and their appropriateness were evaluated in the respective groups .


A significant reduction was achieved in the number of planned ( by 48 % , p < 0.001 ) and total visits ( by 45 % , p < 0.001 ) during a three-year evaluation .


A comparable number of patients experienced one or more shocks .


Mortality rates were equivalent , as was the number of patients hospitalized in relation to their ICD .


However , there was a significant reduction in the number and proportion of inappropriate shocks delivered in the HM + patient group : by 80 % ( p = 0.002 ) in outpatient follow-up care and by 90 % ( p < 0.001 ) when multiple shocks requiring hospitalization were included .


The HM system was an effective and safe method of follow-up in patients with an implanted ICD .


Remote monitoring reduces the number of outpatient visits and inappropriate shocks .


Recent publications have shown an infection rate of 5-7 % for acetabular fractures treated with the Kocher-Langenbeck ( K-L ) approach .


Using metallic staples to close hip skin incisions has been considered the gold standard .


The purpose of this study was to answer the following : ( 1 ) will closure of a K-L incision after acetabular fracture surgery with a running subcuticular monocryl suture , then sealing the wound with 2-octyl cyanoacrylate ( OCA ) , result in a lower infection rate compared to metallic staple closure ?


( 2 ) Do incisions closed with subcuticular monocryl and OCA exhibit decreased drainage ?


( 3 ) Is there a cost difference between these two methods ?


In a prospective clinical study , 103 patients with acetabular fractures treated using the K-L approach were randomized into two groups : skin closure with metallic staples ( n = 52 ) versus subcuticular running monocryl suture sealed with OCA ( n = 51 ) .


Two postoperative deep infections ( 4 % ) in the staples group required multiple debridements ; no infections developed in the OCA group .


However , there was no statistical difference between the groups , ( p = 0.495 ) .


There was a statistically significant difference ( p = 0.032 ) comparing days from surgery to a dry incision favoring OCA ( 4.2 versus 5.85 days ) .


The patient charge was approximately $ 900 greater on average in the OCA group due to the increased time in the operating room required for the subcuticular closure .


Closure with OCA and subcuticular monocryl showed no clinical disadvantages and appears to have a clinical advantage when compared to standard metallic staple skin closure in acetabular fracture surgery .


However , additional patient costs may be incurred .


II .


The aim of this work was to investigate cardiorespiratory fitness in breast cancer patients at different time points of anti-cancer treatment .


Non-metastatic breast cancer patients ( n = 222 , mean age 55 years ) were categorized into four subgroups according to their treatment status .


Cardiopulmonary exercise testing ( CPET ) was used to measure patients ' cardiorespiratory fitness , including oxygen delivery and metabolic muscle function .


Testing was performed by bicycle ergometry , and maximal oxygen uptake ( VO2peak ) was measured .


Heart rate during exercise at 50 watts ( HR50 ) was assessed as a cardiocirculatory parameter and ventilatory threshold ( VT ) was used as an indicator of the O2 supply to muscle .


Analysis of covariance was used to estimate the impact of different cancer treatments on cardiorespiratory fitness with adjustment for clinical factors .


Submaximal measures were successfully assessed in 220 ( 99 % ) and 200 ( 90 % ) patients for HR50 and VT , while criteria for maximal exercise testing were met by 176 patients ( 79 % ) , respectively .


The mean VO2peak was 20.6 6.7 ml/kg/min , mean VT 10.7 2.9 ml/min/kg and mean HR50 112 16 beats/min .


Chemotherapy was significantly associated with decreased VO2peak , with significantly lower adjusted mean VO2peak among patients post adjuvant chemotherapy compared to patients with no chemotherapy or those who just started chemotherapy regime ( all p < 0.01 ) .


Patients post adjuvant chemotherapy reached only 63 % of the VO2peak level expected for their age - and BMI-category ( mean VO2peak 15.5 4.8 ml/kg/min ) .


Similarly , HR50 was significantly associated with treatment .


However , VT was not associated with treatment .


Breast cancer patients have marked and significantly impaired cardiopulmonary function during and after chemotherapy .


Hereby , chemotherapy appears to impair cardiorespiratory fitness by influencing the oxygen delivery system rather than impacting metabolic muscle function .


Our findings underline the need of exercise training in breast cancer patients to counteract the loss of cardiorespiratory fitness during the anti-cancer treatment .


The treatment of massive pulmonary embolisms with an associated cardiac arrest is controversial ; however , surgical thrombectomy with extracorporeal circulation ( ECC ) is an option for treatment .


It is difficult to remove all thromboembolic material .


Theoretically , retrograde blood perfusion through the lungs may be beneficial .


To investigate whether retrograde blood perfusion through the lungs during a thrombectomy is beneficial .


Twelve pigs were prepared for ECC .


Repetitive injections of preformed blood thrombi into the right atrium resulted in cardiac arrests .


ECC was established after 10 minutes of cardiac arrest , and after a sternotomy , the main pulmonary artery was incised and as much thrombotic material as possible was removed from the pulmonary arteries .


The pigs were randomised to ECC for one hour either with or without retrograde perfusion in the pulmonary circulation .


After one hour , the released material was removed from the pulmonary arteries , and the incision was sutured .


The pigs were weaned from the ECC .


After sacrificing the pigs , they were autopsied with special attention to the amount of remaining thrombi .


Additional histological analyses were performed with special attention to microembolisms , atelectases , and signs of tissue damage .


All of the pigs were weaned from the ECC .


The amount of the embolic material removed varied considerably , as did the amount removed after the retrograde or antegrade perfusion , and there was no significant difference between the two treatment modalities .


There were no signs of tissue damage in the lungs .


Retrograde lung perfusion was not generally beneficial in the treatment of massive pulmonary embolism in this setup ; however , it may be an option if only a modest amount of material is accessible in the pulmonary artery .


Infantile hemangiomas have a dramatic response to propranolol , a nonselective beta-blocker .


However , this treatment is not risk-free and many patients are excluded because of respiratory comorbidities .


Atenolol is a cardioselective beta-blocker that may have fewer adverse events .


We sought to evaluate the effectiveness of atenolol against propranolol in a noninferiority trial .


In all , 23 patients met the inclusion criteria and were randomized to receive either atenolol or propranolol .


Thirteen patients were treated with atenolol and 10 with propranolol .


Follow-up was made at baseline , 2 weeks , 4 weeks , and then monthly for 6 months .


Patients treated with atenolol had a complete response of 53.8 % and 60 % with propranolol , respectively .


These results were nonsignificant ( P = .68 ) .


Relevant adverse events were not reported .


The reduced number of patients could have influenced our results .


Atenolol appears to be as effective as propranolol .


We did not find significant differences between these results or any adverse events .


Erectile dysfunction is prevalent in men over 40 years , affecting their quality of life and that of their partners .


The aims of this study were : a ) To evaluate the internal reliability of the male erectile dysfunction specific quality of life ( MED-QoL ) scale and explore its factor structure.b ) To evaluate the effect of simvastatin on subscales of the MED-QoL in men over forty years with erectile dysfunction .


This is a double blind randomised controlled trial of 40 mg simvastatin or placebo given once daily for six months to men over forty years with untreated erectile dysfunction , who were not at high cardiovascular risk and were not on anti-hypertensive or lipid-lowering medication .


173 eligible men were recruited from 10 general practices in East of England .


Data were collected at two points over 30 weeks.We report on the factor structure of MED-QoL , the internal reliability of the scale and the derived subscales , and the effect of simvastatin on MED-QoL subscales .


An initial analysis of the MED-QoL items suggested that a number of items should be removed ( MED-QoL-R ) .


Exploratory factor analysis identified three subscales within the MED-QoL-R which accounted for 96 % of the variance , related to feelings of Control , initiating Intimacy , and Emotional response to erectile dysfunction .


The alpha value for the revised scale ( MED-Qol-R ) was > 0.95 and exceeded .82 for each subscale .


Regression analysis showed that patients in the placebo group experienced a significantly reduced feeling of Control over erectile dysfunction than those in the statin group .


Those in the placebo group had significantly lower Emotional response than those in the statin group at the close of trial , but there was no significant treatment effect on Intimacy .


Our revised MED-QoL-R identified three subscales .


Secondary analysis showed a significant improvement in sexual health related quality of life , specifically in relation to perception of control and emotional health in men with untreated erectile dysfunction given 40 mg simvastatin for six months .


Current Controlled Trials ISRCTN66772971 .


A high dose of continuous intravenous infusion of proton pump inhibitor ( PPI ) is the standard treatment for peptic ulcer bleeding .


The optimal dose for the prevention of bleeding after endoscopic submucosal dissection ( ESD ) is unclear .


The purpose of this study was to determine whether stronger acid suppression more effectively prevents bleeding and high risk ulcer stigma ( HRS ) after gastric ESD .


A total of 273 patients who underwent ESD were randomly assigned to one of two treatment groups : the continuous infusion group and the bolus injection group .


Second-look endoscopy was performed on the following day after ESD .


The incidences and risk factors of HRS identified by second-look endoscopy and delayed bleeding were analyzed .


There were no differences in the incidences of HRS and delayed bleeding between two treatment groups .


The incidence of HRS was 15.8 % ( 43/273 ) and the gross morphology ( flat or depressed ) was identified as a significant factor associated with HRS .


The incidence of delayed bleeding was 8.4 % ( 23/273 ) and the gross morphology ( flat ) and the presence of submucosal invasive cancer were identified as the associated risk factors for delayed bleeding .


The incidences of delayed bleeding and HRS identified by second-look endoscopy were not affected by PPI infusion methods .


Flat or depressed morphologic lesions and submucosal invasive cancer should be closely monitored .


Ultrasound ( US ) - guided needling with subacromial corticosteroid injection is more effective than extracorporeal shock wave therapy ( ESWT ) for function restoration and pain relief in patients with calcific tendinitis of the shoulder .


Fifty-four patients diagnosed with unilateral painful calcific tendinitis were randomly allocated to a US needling or ESWT group .


The US needling group underwent US-guided needling and received a subacromial corticosteroid injection .


The ESWT group received ESWT 3 times a week .


All patients were prospectively evaluated ; American Shoulder and Elbow Surgeons , Simple Shoulder Test , and visual analog scale for pain scores were recorded before the procedure and at 6 weeks , 12 weeks , 6 months , 12 months , and the last follow-up .


The size and morphology of the deposits were evaluated by radiography .


The average follow-up period was 23.0 months .


At last follow-up , the mean size of the deposits was significantly different between the 2 groups ( P = .001 ) ; it decreased to 0.5 mm from 14.8 mm in the US needling group and to 5.6 mm from 11.0 mm in the ESWT group .


There were also significant improvements in clinical outcomes in both groups after treatment ( P < .05 ) .


At 1-year follow-up , the US needling group had significantly better scores than the ESWT group with regard to the American Shoulder and Elbow Surgeons assessment ( 90.3 and 74.6 , respectively ; P = .001 ) , Simple Shoulder Test ( 83.3 and 70.8 , respectively ; P = .015 ) , and visual analog scale for pain ( 1.4 and 3.3 , respectively ; P = .003 ) .


The initial calcium deposit sizes and clinical outcomes were weakly correlated in both groups ( P > .05 ) .


Both treatment modalities for calcific tendinitis improved clinical outcomes and eliminated calcium deposits .


US-guided needling treatment , however , was more effective in function restoration and pain relief in the short term .


Meta-analyses suggest that an intravenous bolus or a high dose continuous infusion of somatostatin reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography ( ERCP ) .


Clinical guidelines , however , do not recommend this prophylaxis .


The aim of this randomized , double-blind clinical trial was to evaluate the effect of somatostatin on the incidence of post-ERCP pancreatitis .


Patients undergoing ERCP at a single center were randomized to either intravenous bolus of somatostatin followed by a short ( 4-hour ) continuous infusion , or to a similar placebo regimen .


The primary outcome was post-ERCP pancreatitis , defined as abdominal pain with an amylase level at least three times higher than the upper limit of normality 24 hours after the ERCP and requiring admission for at least 2 days .


A total of 510 patients were enrolled ( 255 patients per group ) and all completed follow-up .


The main indications for ERCP were choledocholithiasis ( 62 % ) , and biliary malignant stricture ( 31 % ) .


Post-ERCP pancreatitis occurred in 19 patients ( 7.5 % ) in the somatostatin group and 17 patients ( 6.7 % ) in the placebo group ( relative risk [ RR ] 1.12 , 95 % confidence interval [ 95 % CI ] 0.59-2 .1 ; P = 0.73 ) .


The number of cases of moderate or severe acute pancreatitis was similar in the somatostatin ( 2.4 % ) and the placebo ( 3.5 % ) groups ( RR 0.67 , 95 % CI 0.24-1 .85 , P = 0.43 ) .


No side effects were observed related to the use of somatostatin .


Administration of an intravenous bolus of somatostatin followed by a short continuous infusion does not reduce the incidence of post-ERCP pancreatitis .


Clinical Trials.gov number : NCT01060826 .


Prospective data to examine the association of homocysteine with age-related macular degeneration ( AMD ) are limited .


We examined the prospective relation of plasma homocysteine level and AMD in a large cohort of apparently healthy women .


We evaluated the relationship between baseline levels of plasma homocysteine and incident AMD among 27,479 female health professionals aged 40 years or older .


Main outcome measures were total AMD , defined as self-report documented by medical record evidence of an initial diagnosis after randomization , and visually significant AMD , defined as confirmed incident AMD with visual acuity 20/30 or worse attributable to this condition .


During an average 10 years of follow-up , a total of 452 cases of AMD , including 182 cases of visually significant AMD , were documented .


Women in the highest versus lowest quartile of plasma homocysteine had modestly , but statistically non-significant , increased risks of total AMD ( hazard ratio , HR , 1.24 , 95 % confidence interval , CI , 0.95-1 .63 ; p for trend 0.07 ) and visually significant AMD ( HR 1.41 , 95 % CI 0.92-2 .17 ; p for trend 0.052 ) in age - and treatment-adjusted analyses .


These prospective data from a large cohort of apparently healthy women do not support a strong role for homocysteine in AMD occurrence .


The number of therapeutic drugs available for the treatment of alcohol use disorders ( AUDs ) is limited , and a well-tolerated , self-administrable drug is much needed .


Subgroups of alcohol-dependent individuals , for example , individuals with heredity for AUD , may respond differently to pharmacological treatments , particularly to drugs affecting the serotonergic system in the brain .


Clinical observations and case reports indicate that mirtazapine , a widely used and well-tolerated antidepressant drug , which increases both noradrenaline and serotonin release but simultaneously blocks serotonergic ( 5-hydroxytryptamine ) 3 receptors , reduces alcohol consumption .


Moreover , drugs affecting serotonergic ( 5-hydroxytryptamine ) 3 receptors have been shown to work differently in individuals with heredity for AUD .


This double-blind , randomized , placebo-controlled , 2-armed clinical trial aimed to establish whether mirtazapine lowers alcohol consumption in male high consumers .


The study population was also subgrouped in accordance with heredity for AUD .


After 2 lead-in weeks of single-blind placebo , 59 males were randomly assigned to receive 8 weeks of treatment with 30-mg mirtazapine daily ( n = 29 ) or placebo ( n = 30 ) .


The main outcome was self-reported alcohol consumption ( drinks per day ) measured by an alcohol diary .


The alcohol consumption was calculated as weekly mean during the study period compared with baseline .


The data were analyzed in accordance with intention to treat and per protocol .


The results suggest that high consumers of alcohol with a heredity for AUD benefit from treatment with mirtazapine .


The results of this study did not support an advantage of mirtazapine over placebo on alcohol consumption in the intention-to-treat analysis .


However , mirtazapine could be an alternative to available treatments for alcohol dependence in patients with heredity for AUD .


This study assessed the efficacy of methylphenidate versus placebo for cancer-related fatigue reduction .


Other objectives were to analyze cytokine levels and to determine the effects of methylphenidate on other symptoms , cognitive function , work yield , and patients ' perceptions and preferences .


Patients were randomly assigned ( 1:1 ) to receive methylphenidate-placebo or placebo-methylphenidate for 4 weeks .


Patients crossed over after 2 weeks .


Wilcoxon signed rank tests and McNemar tests were used to assess continuous and categorical variables .


The primary efficacy endpoint was change in the level of worst fatigue on the Brief Fatigue Inventory ( BFI ) at the end of each 2-week period .


The mean baseline BFI score was moderate ( 5.7 ) .


Methylphenidate treatment did not affect patients ' worst level of fatigue or other symptoms .


Results from the Wechsler Adult Intelligence Scale Digit Symbol Test and the Hopkins Verbal Learning Test with BFI interference questions and BFI activity questions showed significant improvement in the methylphenidate-treated patients ' verbal learning , memory , visual perception , analysis , and scanning speed .


Patients treated with methylphenidate missed significantly fewer work hours owing to health reasons and worked significantly more hours .


After 4 weeks , 64 % of patients reported that methylphenidate improved their cancer-related fatigue , and 58 % wanted to continue treatment .


Significant difference in interleukin 6R ( positive ) , interleukin 10 ( negative ) , and tumor necrosis factor ( positive ) was noted between the methylphenidate and the placebo group .


Low-dose methylphenidate did not improve cancer-related fatigue .


Patients taking methylphenidate had better cognition and were able to work more hours .


Patients tolerated methylphenidate well , and the majority felt better and wanted to continue treatment .


A randomized study in 1999-2005 of mechanical bowel preparation ( MBP ) preceding colonic resection found no decrease in postoperative complications .


The aim of the present study was to evaluate the long-term effect of MBP regarding cancer recurrence and survival after colonic resections .


The cohort of patients with colonic cancer in the MBP study was followed up for 10 years .


Data were collected from registers run by the National Board of Health and Welfare .


Register data were validated against information in patient charts .


Cox proportional hazards model was used for multivariable analysis of factors predictive of cancer-specific survival .


Register analysis showed significantly fewer recurrences , and better cancer-specific and overall survival in the MBP group .


After validation , 839 of 1343 patients remained for analysis ( 448 MBP , 391 no MBP ) .


Eighty ( 179 per cent ) of 448 patients in the MBP group and 88 ( 225 per cent ) of 391 in the no-MBP group developed a cancer recurrence ( P = 0093 ) .


The 10-year cancer-specific survival rate was 841 per cent in the MBP group and 780 per cent in the no-MBP group ( P = 0019 ) .


Overall survival rates were 588 and 560 per cent respectively ( P = 0186 ) .


Patients receiving MBP before elective colonic cancer surgery had significantly better cancer-specific survival after 10 years .


Arm hemiparesis secondary to stroke is common and disabling .


We aimed to assess whether robotic training of an affected arm with ARMin -- an exoskeleton robot that allows task-specific training in three dimensions-reduces motor impairment more effectively than does conventional therapy .


In a prospective , multicentre , parallel-group randomised trial , we enrolled patients who had had motor impairment for more than 6 months and moderate-to-severe arm paresis after a cerebrovascular accident who met our eligibility criteria from four centres in Switzerland .


Eligible patients were randomly assigned ( 1:1 ) to receive robotic or conventional therapy using a centre-stratified randomisation procedure .


For both groups , therapy was given for at least 45 min three times a week for 8 weeks ( total 24 sessions ) .


The primary outcome was change in score on the arm ( upper extremity ) section of the Fugl-Meyer assessment ( FMA-UE ) .


Assessors tested patients immediately before therapy , after 4 weeks of therapy , at the end of therapy , and 16 weeks and 34 weeks after start of therapy .


Assessors were masked to treatment allocation , but patients , therapists , and data analysts were unmasked .


Analyses were by modified intention to treat .


This study is registered with ClinicalTrials.gov , number NCT00719433 .


Between May 4 , 2009 , and Sept 3 , 2012 , 143 individuals were tested for eligibility , of whom 77 were eligible and agreed to participate .


38 patients assigned to robotic therapy and 35 assigned to conventional therapy were included in analyses .


Patients assigned to robotic therapy had significantly greater improvements in motor function in the affected arm over the course of the study as measured by FMA-UE than did those assigned to conventional therapy ( F = 4.1 , p = 0.041 ; mean difference in score 0.78 points , 95 % CI 0.03-1 .53 ) .


No serious adverse events related to the study occurred .


Neurorehabilitation therapy including task-oriented training with an exoskeleton robot can enhance improvement of motor function in a chronically impaired paretic arm after stroke more effectively than conventional therapy .


However , the absolute difference between effects of robotic and conventional therapy in our study was small and of weak significance , which leaves the clinical relevance in question .


Swiss National Science Foundation and Bangerter-Rhyner Stiftung .


Severely injured patients experiencing hemorrhagic shock often require massive transfusion .


Earlier transfusion with higher blood product ratios ( plasma , platelets , and red blood cells ) , defined as damage control resuscitation , has been associated with improved outcomes ; however , there have been no large multicenter clinical trials .


To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma , platelets , and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio .


Pragmatic , phase 3 , multisite , randomized clinical trial of 680 severely injured patients who arrived at 1 of 12 level I trauma centers in North America directly from the scene and were predicted to require massive transfusion between August 2012 and December 2013 .


Blood product ratios of 1:1:1 ( 338 patients ) vs 1:1:2 ( 342 patients ) during active resuscitation in addition to all local standard-of-care interventions ( uncontrolled ) .


Primary outcomes were 24-hour and 30-day all-cause mortality .


Prespecified ancillary outcomes included time to hemostasis , blood product volumes transfused , complications , incidence of surgical procedures , and functional status .


No significant differences were detected in mortality at 24 hours ( 12.7 % in 1:1:1 group vs 17.0 % in 1:1:2 group ; difference , -4.2 % [ 95 % CI , -9.6 % to 1.1 % ] ; P = .12 ) or at 30 days ( 22.4 % vs 26.1 % , respectively ; difference , -3.7 % [ 95 % CI , -10.2 % to 2.7 % ] ; P = .26 ) .


Exsanguination , which was the predominant cause of death within the first 24 hours , was significantly decreased in the 1:1:1 group ( 9.2 % vs 14.6 % in 1:1:2 group ; difference , -5.4 % [ 95 % CI , -10.4 % to -0.5 % ] ; P = .03 ) .


More patients in the 1:1:1 group achieved hemostasis than in the 1:1:2 group ( 86 % vs 78 % , respectively ; P = .006 ) .


Despite the 1:1:1 group receiving more plasma ( median of 7 U vs 5 U , P < .001 ) and platelets ( 12 U vs 6 U , P < .001 ) and similar amounts of red blood cells ( 9 U ) over the first 24 hours , no differences between the 2 groups were found for the 23 prespecified complications , including acute respiratory distress syndrome , multiple organ failure , venous thromboembolism , sepsis , and transfusion-related complications .


Among patients with severe trauma and major bleeding , early administration of plasma , platelets , and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days .


However , more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours .


Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group , no other safety differences were identified between the 2 groups .


clinicaltrials.gov Identifier : NCT01545232 .


To evaluate factors that characterize employees who did not participate in a physical activity intervention in an occupational setting and assess how selective participation affects inferences from the data .


Employees were asked to complete a health risk appraisal .


The respondents were invited to participate in a physical activity intervention .


We compared predictors of sickness absence ( register data ) among all respondents and those who participated in the intervention , using Bayesian regression analysis .


Of 1116 employees , 817 ( 73 % ) responded , of whom 544 ( 67 % ) participated in the intervention .


Participants had better health behaviors and fewer health problems than those who did not participate .


The predictors of sickness absence in all respondents differed from those who participated in the intervention .


Selective participation may reduce the potential benefit of interventions and limit generalizability of findings .


To compare the clinical outcome of 6-mm and 10-mm long implants in partially edentulous posterior areas .


Twenty-four patients , with a partially edentulous area in the jaws with a height and width allowing the positioning of 2 to 3 adjacent 10 4.1 mm implants without any augmentation procedure , were randomly allocated according to a parallel group design to receive 6-mm long or 10-mm long implants .


A total of 54 implants were placed ( 26 6 mm and 28 10 mm implants ) .


Patients were restored 8 weeks after surgery and were followed for 5 years .


Outcome measures were prosthesis and implant survival , as well as marginal bone level changes and complications .


After 5 years , 18 patients were available .


One 6 mm implant failed during the healing period and its related prosthesis could not be placed .


No implants were lost after loading .


The 6 mm group registered 5 complications ( 1 mucositis , 3 prosthesis decementations and 1 chipping ) , while only 3 were registered in the 10 mm group ( 2 decementations and 1 chipping ) .


The difference in complications between the two groups was not statistically significant ( P = 0.39 ) .


Marginal bone loss at 5 years was 0.43 and 0.24 mm with the 6 mm and 10 mm groups , respectively ( not statistically significant ; difference between the two groups 0.19 mm ; SD 0.23 mm ; 95 % CI -0.34 ; 0.73 ; t test P = 0.42 ) .


Implant and prosthetic survival and success rates were similar between prostheses supported by 6-mm or 10-mm long implants .


To investigate the effects of Yiqibushenhuoxue decoction on stable chronic obstructive pulmonary disease ( COPD ) by observing its influences on patients ' quality of life and airway inflammation .


Seventy patients with stable COPD were randomly divided into a treatment group ( n = 35 ) treated with Yiqibushenhuoxue decoction plus Seretide and a control group ( n = 35 ) treated with Seretide only .


The dosage of Yiqibushenhuoxue decoction was 100 mL each time , twice a day , and the dosage of Seretide was salmeterol 50 microg/fluticasone 250 microg twice a day .


Both groups were treated for 12 weeks .


Before and after the treatment , St George 's respiratory disease questionnaire ( SGRQ ) scores , forced expiratory volume , and forced expiratory volume in 1 second/forced vital capacity ( FEV1 / FVC ) were measured .


The SGRQ scores in both groups were significantly lower than those before treatment ( P < 0.05 ) .


After treatment , the total SGRQ scores and each subscore in the treatment group were significantly lower than those in the control group ( P < 0.05 ) .


The percentage of the predicted FEV1 % and FEV1/FVC were higher in both groups , but no statistical differences were detected from before to after the treatment or between the two groups ( P > 0.05 ) .


Yiqibushenhuoxue decoction could significantly decrease the SGRQ scores in patients with stable COPD , which suggests that it is able to improve patient symptoms .


To explore the effect of clinical pathway of health education in patients with kidney transplantation .


A total of 116 patients with kidney transplantation were randomly divided into an experimental group and a control group ( n = 58 in each group ) .


The patients in the control group received traditional health education , and the patients in the experimental group experienced the clinical pathway of health education .


The effect of health education was assessed and compared .


There was significant difference in the effect of health education between the two groups ( P < 0.05 ) .


Clinical pathway of health education in patients after kidney transplantation can significantly improve the effect of health education .


Gait impairment is common in Parkinson 's disease ( PD ) and may result in greater energy expenditure , poorer walking economy , and fatigue during activities of daily living .


Auditory cueing is an effective technique to improve gait ; but the effects on energy expenditure are unknown .


To determine whether energy expenditure differs in individuals with PD compared with healthy controls and if auditory cueing improves walking economy in PD .


Twenty participants ( 10 PD and 10 controls ) came to the laboratory for three sessions .


Participants performed two , 6-minute bouts of treadmill walking at two speeds ( 1.12 msec-1 and 0.67 msec-1 ) .


One session used cueing and the other without cueing .


A metabolic cart measured energy expenditure and walking economy was calculated ( energy expenditure/power ) .


PD had worse walking economy and higher energy expenditure than control participants during cued and non-cued walking at the 0.67 msec-1 speed and during non-cued walking at the 1.12 msec-1 .


With auditory cueing , energy expenditure and walking economy worsened in both participant groups .


People with PD use more energy and have worse walking economy than adults without PD .


Walking economy declines further with auditory cuing in persons with PD .


Androgen deprivation therapy ( ADT ) is the foundation of treatment for men with metastatic prostate cancer and is now frequently incorporated into multimodality strategies for the curative treatment of locally advanced prostate cancer .


Nevertheless , the catabolic effects of ADT result in meaningful adverse effects on physiological and quality of life outcomes , which may , in turn , increase the risk of functional decline , frailty , cardiovascular disease , and metabolic syndrome .


Recent evidence demonstrates that lifestyle intervention promoting change in exercise and dietary behaviors is a promising approach , and may offset , or even reverse , the adverse effects accompanying ADT .


Unfortunately , the limited existing studies of the effects of exercise and dietary interventions targeting patients with prostate cancer on ADT are characterized by high attrition rates and poor postintervention maintenance of treatment effects .


Consequently , the Individualized Diet and Exercise Adherence Pilot Trial ( IDEA-P ) is designed to contrast the effects of a lifestyle intervention designed to promote independent self-management of exercise and dietary behavior with those of standard care disease management approach in the treatment of prostate cancer .


A total of 40 patients with prostate cancer undergoing ADT will be randomly assigned to lifestyle intervention or standard care .


Outcomes of interest in IDEA-P include changes in self-reported and objectively assessed physical function and physical activity , dietary behavior , body composition , muscular strength , and quality of life .


Outcomes will be obtained at baseline , 2-month , and 3-month assessments by trial personnel blinded to participants ' randomization assignment .


Findings from this study will establish the feasibility and preliminary efficacy of an innovative lifestyle intervention designed to promote progressively independent self-regulated exercise and dietary behavior change in the treatment of patients with prostate cancer undergoing ADT .


ClinicalTrials.gov NCT02050906 .


Metformin is the recommended first-line pharmacotherapy for patients with type 2 diabetes .


There is no consensus on the optimum second-line pharmacotherapy .


We compared the efficacy and safety of the sodium glucose cotransporter 2 inhibitor empagliflozin and the sulfonylurea glimepiride as add-on to metformin in patients with type 2 diabetes .


In this double-blind phase 3 trial , patients ( aged 18 years ) with type 2 diabetes and HbA1c concentrations of 7-10 % , despite metformin treatment and diet and exercise counselling , were randomly assigned in a 1:1 ratio with a computer-generated random sequence , stratified by HbA1c , estimated glomerular filtration rate ( eGFR ) , and region , to empagliflozin ( 25 mg once daily , orally ) or glimepiride ( 1-4 mg once daily , orally ) as add-on to metformin for 104 weeks .


Patients and investigators were masked to treatment assignment .


The primary endpoint was change from baseline in HbA1c levels at weeks 52 and 104 .


Differences in the primary endpoint were first tested for non-inferiority ( based on a margin of 03 % ) .


If non-inferiority was shown , differences in the primary endpoint at week 104 were then tested for superiority .


Analysis was done on the full-analysis set-ie , patients who were treated with at least one dose of study drug and had a baseline HbA1c value .


This study is registered with ClinicalTrials.gov , number NCT01167881 .


A 104-week extension is ongoing .


Between August , 2010 , and June , 2011 , 1549 patients were randomly assigned to receive empagliflozin ( n = 769 ) or glimepiride ( n = 780 ) ; four patients in the empagliflozin group did not receive the assigned treatment .


Empagliflozin was non-inferior to glimepiride at both timepoints .


At week 104 , adjusted mean difference in change from baseline in HbA1c with empagliflozin versus glimepiride was -011 % ( 95 % CI -019 to -002 ; p = 00153 for superiority ) .


Adverse events were reported in 661 ( 86 % ) patients treated with empagliflozin and 673 ( 86 % ) patients treated with glimepiride .


Severe adverse events were reported in 72 ( 9 % ) patients in the empagliflozin group and 68 ( 9 % ) in the glimepiride group .


Serious adverse events were reported in 119 ( 16 % ) patients in the empagliflozin group and 89 ( 11 % ) in the glimepiride group .


Confirmed hypoglycaemic adverse events ( plasma glucose 39 mmol/L or requiring assistance ) at week 104 were reported in 19 ( 2 % ) patients treated with empagliflozin and 189 ( 24 % ) patients treated with glimepiride .


Empagliflozin might be an effective and a well tolerated second-line treatment option for patients with type 2 diabetes who have not achieved good glycaemic control on metformin .


Boehringer Ingelheim and Eli Lilly .


Postprandial elevation of triglyceride-rich lipoproteins impairs endothelial function , which can initiate atherosclerosis .


We investigated the effects of bezafibrate on postprandial endothelial dysfunction and lipid profiles in patients with metabolic syndrome .


Ten patients with metabolic syndrome were treated with 400 mg/day bezafibrate or untreated for 4 weeks in a randomized crossover study .


Brachial artery flow-mediated dilation ( FMD ) and lipid profiles were assessed during fasting and after consumption of a standardized snack .


Serum triglyceride and cholesterol contents of lipoprotein fractions were analyzed by high-performance liquid chromatography .


Postprandial FMD decreased significantly and reached its lowest value 4 h after the cookie test in both the bezafibrate and control groups , but the relative change in FMD from baseline to minimum in the bezafibrate group was significantly smaller than that in the control group ( -29.05.9 vs. -42.96.2 % , p = 0.04 ) .


Bezafibrate significantly suppressed postprandial elevation of triglyceride ( incremental area under the curve ( AUC ) : 54465 vs. 1158283 mg h/dl , p = 0.02 ) and remnant lipoprotein cholesterol ( incremental AUC : 27.93.5 vs. 72.314.1 mg h/dl , p < 0.01 ) .


High-performance liquid chromatography analysis revealed that postprandial triglyceride content of the chylomicron and very low-density lipoprotein fractions was significantly lower in the bezafibrate group than in the control group ( p < 0.05 ) .


Bezafibrate significantly decreased postprandial endothelial dysfunction , and elevations of both exogenous and endogenous triglycerides in patients with metabolic syndrome , suggesting that bezafibrate may have vascular protective effects in these patients .


Unique Identifiers : UMIN000012557 .


To compare the therapeutic efficacy of recombinant human brain natriuretic peptide and prostaglandin E1 in the treatment of pulmonary hypertension after mitral valve replacement .


Sixty patients with postoperative pulmonary hypertension were divided randomly into 3 groups that received saline , prostaglandin E1 , and natriuretic peptide infusions for 12 hours each .


The hemodynamics data were monitored consecutively , and the levels of thromboxane A2 and cyclic guanosine monophosphate were detected pretreatment , after treatment , and 1 week after surgery .


The arterial pressure , pulmonary arterial pressure , and pulmonary capillary wedge pressure decreased 1hour after prostaglandin E1 treatment and rebounded after treatment discontinuation .


The pulmonary arterial pressure and pulmonary capillary wedge pressure in the natriuretic peptide group decreased 3 hours after treatment ; pulmonary arterial pressure decreased less than that of the prostaglandin group , and there was no evidence of hemodynamic rebound after treatment discontinuation .


The natriuretic peptide had no significant effects on arterial pressure .


In both the prostaglandin and natriuretic peptide groups , cyclic guanosine monophosphate increased after the treatment , which was even higher in the latter group .


Prostaglandin E1 could lead to the decrease of thromboxane A2 , which was not seen in the natriuretic peptide group .


Both brain natriuretic peptide and prostaglandin E1 can effectively reduce pulmonary hypertension ; however , natriuretic peptide has a slower and milder efficacy .


The effects of these 2 drugs in reducing thepulmonary arterial pressure may be mediated through different pathways .


Anemia is a common complication among chronic kidney disease patients on hemodialysis , occurring mostly due to erythropoietin deficiency .


This randomized noninferiority trial sought to compare the efficacy and safety of a new epoetin formulation developed by Bio-Manguinhos , a biologics manufacturer affiliated with the Brazilian government , with those of a commercially available product currently used in Brazil ( a biosimilar epoetin formulation ) .


The sample size needed to enable demonstration of noninferiority with a statistical power of 85 % for a between-group difference in hemoglobin levels of no more than 1.5 g/dL was calculated .


In total , 74 patients were randomly assigned to receive the epoetin formulation from Bio-Manguinhos ( n = 36 ) or the biosimilar epoetin formulation ( n = 38 ) in a double-blind fashion .


The inclusion criteria were current epoetin therapy and stable hemoglobin levels for at least 3 months prior to the study .


The primary and secondary outcomes were mean monthly hemoglobin levels and safety , respectively .


The dose was calculated according to international criteria and adjusted monthly in both groups according to hemoglobin levels and at the assistant physicians ' discretion .


Iron storage was estimated at baseline and once monthly .


Clinicaltrials.gov : NCT01184495 .


The study was conducted for 6 months after randomization .


The mean baseline hemoglobin levels were 10.91.2 and 10.961.2 g/dL ( p = 0.89 ) in the Bio-Manguinhos epoetin and biosimilar epoetin groups , respectively .


During the study period , there was no significant change in hemoglobin levels in either group ( p = 0.055 , ANOVA ) .


The epoetin from Bio-Manguinhos was slightly superior in the last 3 months of follow-up .


The adverse event profiles of the two formulations were also similar .


The epoetin formulations tested in this study are equivalent in efficacy and safety .


This study aims to compare the effectiveness of desloratadine monotherapy and desloratadine plus montelukast combination therapy on quality of life in patients with persistent allergic rhinitis .


This study consists of 40 patients ( 28 females , 12 males , mean age 29.8 years ; range 17 to 44 years ) referred to ear , nose , and throat outpatient clinic between May 2010 and September 2010 .


A six-week randomized , double-blind , cross-sectional study was performed in two arms : In group 1 , 20 patients received desloratadine ( 5 mg/d ) alone ; in group 2 , 20 patients received desloratadine ( 5 mg ) plus montelukast ( 10 mg ) combination therapy .


Quality of life was assessed on the day before starting treatment and on the last day of each treatment period using the Rhinoconjunctivitis Quality of Life Questionnaire and Nighttime Symptom Scores .


In group 1 , the mean quality of life scores before and after treatment were 3.17 and 2.43 , respectively .


In group 2 , the mean quality of life scores before and after treatment were 2.94 and 1.73 , respectively .


Desloratadine plus montelukast combination therapy may have a positive impact on quality of life , sleep symptoms in particular .


Our hypothesis was that deep anaesthesia , as estimated by a low target bispectral index ( BIS ) of 30-40 , would result in less postoperative pain than that achieved at a conventional depth of anaesthesia .


We undertook a randomized double-blind controlled study at two tertiary teaching hospitals in New Zealand ( 2010-1 ) recruiting 135 adult patients ASA I-II presenting for non-emergent surgery under general anaesthesia requiring tracheal intubation .


Anaesthesia was maintained with desflurane and a multimodal analgesia regimen comprising fentanyl infusion , i.v. paracetamol , and parecoxib .


Patients were randomly assigned to either a low BIS ( 30-40 ) group or a high BIS ( 45-60 ) group .


Desflurane concentrations were titrated to achieve these targets .


Postoperative pain was assessed by : the pain on awakening ( 0-10 , verbal rating scale , VRS ( awake ) ) in the post-anaesthetic care unit ; pain on activity at 20-24 h after operation ( VRS ( d1A ) ) ; and the rate of morphine patient-controlled analgesia ( PCA ) usage over the first 24 h.


There was no statistically significant difference between the two groups for any of the pain scores .


The median [ inter-quartile range ( IQR ) ] VRS ( awake ) was 4.0 ( 0-8 ) for the low and 4.0 ( 0-8 ) for the high BIS groups ( P = 0.56 ) .


The median ( IQR ) VRS ( d1A ) was 3.0 ( 1-5 ) for the low and 3.0 ( 1.5-4 .5 ) for the high BIS groups ( P = 0.83 ) .


The median PCA morphine consumption in the low BIS group was 0.61 mg h ( -1 ) ( 0.04-1 .5 ) vs 0.43 mg h ( -1 ) ( 0-1 .59 ) in the high BIS group ( P = 0.98 ) .


We conclude that there is no clinically useful analgesic effect of a deep anaesthesia regimen .


Poor adherence to treatment diminishes its individual and public health benefit .


Financial incentives , provided on the condition of treatment attendance , could address this problem .


Injecting drug users are a high-risk group for hepatitis B virus ( HBV ) infection and transmission , but adherence to vaccination programmes is poor .


We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy .


In our cluster randomised controlled trial , we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule ( vaccination days 0 , 7 , and 21 ) .


Clusters were randomly allocated 1:1:1 to provide vaccination without incentive ( treatment as usual ) , with fixed value contingency management ( three 10 vouchers ) , or escalating value contingency management ( 5 , 10 , and 15 vouchers ) .


Both contingency management schedules rewarded on-time attendance at appointments .


The primary outcome was completion of clinically appropriate HBV vaccination within 28 days .


We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window .


The trial is registered with Current Controlled Trials , number ISRCTN72794493 .


Between March 16 , 2011 , and April 26 , 2012 , we enrolled 210 eligible participants .


Compared with six ( 9 % ) of 67 participants treated as usual , 35 ( 45 % ) of 78 participants in the fixed value contingency management group met the primary outcome measure ( odds ratio 121 , 95 % CI 37-399 ; p < 00001 ) , as did 32 ( 49 % ) of 65 participants in the escalating value contingency management group ( 140 , 42-462 ; p < 00001 ) .


These differences remained significant with sensitivity analyses .


Modest financial incentives delivered in routine clinical practice significantly improve adherence to , and completion of , HBV vaccination programmes in patients receiving opioid substitution therapy .


Achievement of this improvement in routine clinical practice should now prompt actual implementation .


Drug treatment providers should employ contingency management to promote adherence to vaccination programmes .


The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown .


National Institute for Health Research ( RP-PG-0707-10149 ) .


To evaluate the effectiveness of a telephonic medication therapy management ( MTM ) service on reducing hospitalizations among home health patients .


Forty randomly selected , geographically diverse home health care centers in the United States .


Two-stage , randomized , controlled trial with 60-day follow-up .


All Medicare - insured home health care patients were eligible to participate .


Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention .


The MTM intervention consisted of the following : ( 1 ) initial phone call by a pharmacy technician to verify active medications ; ( 2 ) pharmacist-provided medication regimen review by telephone ; and ( 3 ) follow-up pharmacist phone calls at day seven and as needed for 30 days .


The primary outcome was 60-day all-cause hospitalization .


Data were collected from in-home nursing assessments using the OASIS-C .


Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients ' baseline risk of hospitalization , number of medications taken daily , and other OASIS-C data elements .


A total of 895 patients ( intervention n = 415 , control n = 480 ) were block-randomized to the intervention or usual care .


There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups ( Adjusted OR : 1.26 , 95 percent CI : 0.89-1 .77 , p = .19 ) .


For patients within the lowest baseline risk quartile ( n = 232 ) , the intervention group was three times more likely to remain out of the hospital at 60 days ( Adjusted OR : 3.79 , 95 percent CI : 1.35-10 .57 , p = .01 ) compared to the usual care group .


This MTM intervention may not be effective for all home health patients ; however , for those patients with the lowest-risk profile , the MTM intervention prevented patients from being hospitalized at 60 days .


Regular paracetamol is the recommended first-line analgesic for acute low-back pain ; however , no high-quality evidence supports this recommendation .


We aimed to assess the efficacy of paracetamol taken regularly or as-needed to improve time to recovery from pain , compared with placebo , in patients with low-back pain .


We did a multicentre , double-dummy , randomised , placebo controlled trial across 235 primary care centres in Sydney , Australia , from Nov 11 , 2009 , to March 5 , 2013 .


We randomly allocated patients with acute low-back pain in a 1:1:1 ratio to receive up to 4 weeks of regular doses of paracetamol ( three times per day ; equivalent to 3990 mg paracetamol per day ) , as-needed doses of paracetamol ( taken when needed for pain relief ; maximum 4000 mg paracetamol per day ) , or placebo .


Randomisation was done according to a centralised randomisation schedule prepared by a researcher who was not involved in patient recruitment or data collection .


Patients and staff at all sites were masked to treatment allocation .


All participants received best-evidence advice and were followed up for 3 months .


The primary outcome was time until recovery from low-back pain , with recovery defined as a pain score of 0 or 1 ( on a 0-10 pain scale ) sustained for 7 consecutive days .


All data were analysed by intention to treat .


This study is registered with the Australian and New Zealand Clinical Trial Registry , number ACTN 12609000966291 .


550 participants were assigned to the regular group ( 550 analysed ) , 549 were assigned to the as-needed group ( 546 analysed ) , and 553 were assigned to the placebo group ( 547 analysed ) .


Median time to recovery was 17 days ( 95 % CI 14-19 ) in the regular group , 17 days ( 15-20 ) in the as-needed group , and 16 days ( 14-20 ) in the placebo group ( regular vs placebo hazard ratio 099 , 95 % CI 087-114 ; as-needed vs placebo 105 , 092-119 ; regular vs as-needed 105 , 092-120 ) .


We recorded no difference between treatment groups for time to recovery ( adjusted p = 079 ) .


Adherence to regular tablets ( median tablets consumed per participant per day of maximum 6 ; 40 [ IQR 16-57 ] in the regular group , 39 [ 15-56 ] in the as-needed group , and 40 [ 15-57 ] in the placebo group ) , and number of participants reporting adverse events ( 99 [ 185 % ] in the regular group , 99 [ 187 % ] in the as-needed group , and 98 [ 185 % ] in the placebo group ) were similar between groups .


Our findings suggest that regular or as-needed dosing with paracetamol does not affect recovery time compared with placebo in low-back pain , and question the universal endorsement of paracetamol in this patient group .


National Health and Medical Research Council of Australia and GlaxoSmithKline Australia .


The aim of the present study was to investigate whether addition of transcutaneous electrical nerve stimulation ( TENS ) treatment improves the results of standard urotherapy in children with overactive bladder ( OAB ) symptoms .


Sixty-two children with symptoms of OAB and incontinence were included .


The children were randomized either to standard urotherapy treatment alone or a combination of standard urotherapy and TENS .


The effect variables were taken from a voiding-drinking diary : number of voiding , number of incontinence episodes , and maximum voided volume .


Both treatment groups had good treatment results , with no significant difference between the groups .


In the standard treatment group 13/28 ( 46 % ) were completely dry and 11/28 ( 40 % ) had a decrease in incontinence episodes , compared to 16/24 ( 67 % ) and 3/24 ( 13 % ) , respectively , in the standard + TENS group ( p = 0.303 ) .


The number of voiding decreased in two-thirds of the patients in both groups .


However , maximal voided volume only increased in the standard treatment group .


Subjectively 72 % and 80 % considered themselves significantly improved or free of symptoms .


Previous treatment was registered in 15/55 ( 27 % ) .


All efficacy variables decreased in those with previous treatment , but with no difference between the standard and standard + TENS treatment groups .


The only difference noted was when comparing the children without previous treatment in the groups : a significantly higher proportion were completely dry in the TENS group ( 12/18 [ 71 % ] versus 10/22 [ 48 % ] , p = 0.05 ) .


Our results showed no significant difference overall in treatment response to OAB symptoms between urotherapy only and urotherapy + TENS , whereas a tendency to difference was found in children without previous treatment .


Thus with good urotherapy support , TENS only seems to have marginal additional effects on OAB symptoms .


Pancreatic cancer is the sixth leading cause of cancer death with an increasing trend in China .


Dietary intake is believed to play an important role in pancreatic cancer carcinogenesis .


The aim of this paper was to evaluate associations between some dietary factors and risk of pancreatic cancer in a multi-centre case-control study conducted in China .


Cases ( n = 323 ) were ascertained from four provincial cancer hospitals .


Controls ( n = 323 ) were randomly selected from the family members of patients without pancreatic cancer in the same hospitals , 1:1 matched to cases by gender , age and study center .


Data were collected with a questionnaire by personal interview .


Odds ratios ( OR ) and 95 % confidence intervals ( 95 % CI ) were estimated using conditional logistic regression .


Tea intake ( OR = 0.49 ; 95 % CI : 0.30-0 .80 ) was associated with a half reduction in risk of pancreatic cancer .


Reduced vegetable consumption ( P trend : 0.04 ) was significant related to pancreatic cancer .


Although no significant association was found for meat and fruit , ORs were all above or below the reference group .


A protective effect was found for fruit ( OR = 1.73 for consumption of 1-2 times/week vs more than 3 times/week ; 95 % CI : 1.05-2 .86 ) .


A high intake of meat was associated to a higher risk of pancreatic cancer ( OR = 0.59 for consumption of 1-2 times / week vs. more than 3 times / week ; 95 % CI : 0.35-0 .97 ) .


The present study supports fruit consumption to reduce pancreatic cancer risk and indicates that high consumption of meat is related to an elevated risk .


Direct inverse relations with tea and vegetable intake were also confirmed .


Rapid treatment of acute coronary syndromes ( ACS ) is important ; causes of delay in emergency medical services care of ACS are poorly understood .


We performed an analysis of data from IMMEDIATE ( Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care ) , a randomized controlled trial of emergency medical services treatment of people with symptoms suggesting ACS , using hierarchical multiple regression of elapsed time .


Out-of-hospital ECGs were performed on 54,230 adults calling 9-1-1 ; 871 had presumed ACS , 303 of whom had ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention .


Women , participants with diabetes mellitus , and participants without previous cardiovascular disease waited longer to call 9-1-1 ( by 28 minutes , P < 0.01 ; 10 minutes , P = 0.03 ; and 6 minutes , P = 0.02 , respectively ) , compared with their counterparts .


Time from emergency medical services arrival to ECG was longer for women ( 1.5 minutes ; P < 0.01 ) , older individuals ( 1.3 minutes ; P < 0.01 ) , and those without a primary complaint of chest pain ( 3.5 minutes ; P < 0.01 ) .


On-scene times were longer for women ( 2 minutes ; P < 0.01 ) and older individuals ( 2 minutes ; P < 0.01 ) .


Older individuals and participants presenting on weekends and nights had longer door-to-balloon times ( by 10 , 14 , and 11 minutes , respectively ; P < 0.01 ) .


Women and older individuals had longer total times ( medical contact to balloon inflation : 16 minutes , P = 0.01 , and 9 minutes , P < 0.01 , respectively ; symptom onset to balloon inflation : 31.5 minutes for women ; P = 0.02 ) .


We found delays throughout ACS care , resulting in substantial differences in total times for women and older individuals .


These delays may impact outcomes ; a comprehensive approach to reduce delay is needed .


To evaluate and compare the efficacy and safety of Intranasal ( IN ) Dexmedetomidine , Midazolam and Ketamine in producing moderate sedation among uncooperative pediatric dental patients .


This randomized triple blind comparative study comprises of eighty four ASA grade I children of both sexes aged 4-14 years , who were uncooperative and could not be managed by conventional behavior management techniques .


All the children were randomized to receive one of the four drug groups Dexmedetomidine 1 microg / kg ( D1 ) , 1.5 microg/kg ( D2 ) , Midazolam 0.2 mg/kg ( M1 ) and Ketamine 5 mg/kg ( K1 ) through IN route .


These drug groups were assessed for efficacy and safety by gauging overall success rate and by monitoring vital signs , respectively .


The onset of sedation was significantly rapid with M1 and K1 as compared to D1 and D2 ( p = < 0.001 ) .


The overall success rate was highest in D2 ( 85.7 % ) followed by D1 ( 81 % ) , K1 ( 66.7 % ) and M1 ( 61.9 % ) , however , the difference among them was not statistically significant ( p = > 0.05 ) .


Even though all the vital signs were within physiological limits , there was significant reduction in pulse rate ( PR ) ( p = < 0.001 ) and systolic blood pressure ( SBP ) ( p = < 0.05 ) among D1 and D2 as compared to M1 and K1 .


D1 , D2 and K1 produced greater intra - and post-operative analgesia as compared to M1 .


There were no significant adverse effects with any group .


Dexmedetomidine , Midazolam and Ketamine , all the three drugs evaluated in the present study can be used safely and effectively through IN route in uncooperative pediatric dental patients for producing moderate sedation .


There are no medications approved for treating cannabis dependence or withdrawal .


The cannabis extract nabiximols ( Sativex ) , developed as a multiple sclerosis treatment , offers a potential agonist medication for cannabis withdrawal .


To evaluate the safety and efficacy of nabiximols in treating cannabis withdrawal .


A 2-site , double-blind randomized clinical inpatient trial with a 28-day follow-up was conducted in New South Wales , Australia .


Participants included 51 DSM-IV-TR cannabis-dependent treatment seekers .


A 6-day regimen of nabiximols ( maximum daily dose , 86.4 mg of 9-tetrahydrocannabinol and 80 mg of cannabidiol ) or placebo with standardized psychosocial interventions during a 9-day admission .


Severity of cannabis withdrawal and cravings ( Cannabis Withdrawal Scale ) , retention in withdrawal treatment , and adverse events .


Secondary outcomes include postwithdrawal cannabis use , health outcomes , and psychosocial outcomes .


Nabiximols treatment significantly reduced the overall severity of cannabis withdrawal relative to placebo ( F8 ,377.97 = 2.39 ; P = .01 ) , including effects on withdrawal-related irritability , depression , and cannabis cravings .


Nabiximols had a more limited , but still positive , therapeutic benefit on sleep disturbance , anxiety , appetite loss , physical symptoms , and restlessness .


Nabiximols patients remained in treatment longer during medication use ( unadjusted hazard ratio , 3.66 [ 95 % CI , 1.18-11 .37 ] ; P = .02 ) , with 2.84 the number needed to treat to achieve successful retention in treatment .


Participants could not reliably differentiate between nabiximols and placebo treatment ( 21 = 0.79 ; P = .67 ) , and those receiving nabiximols did not report greater intoxication ( F1 ,6 = 0.22 ; P = .97 ) .


The number ( F1 ,50 = 0.3 ; P = .59 ) and severity ( F1 ,50 = 2.69 ; P = .10 ) of adverse events did not differ significantly between groups .


Both groups showed reduced cannabis use at follow-up , with no advantage of nabiximols over placebo for self-reported cannabis use ( F1 ,48 = 0.29 ; P = .75 ) , cannabis-related problems ( F1 ,49 = 2.33 ; P = .14 ) , or cannabis dependence ( F1 ,50 < 0.01 ; P = .89 ) .


In a treatment-seeking cohort , nabiximols attenuated cannabis withdrawal symptoms and improved patient retention in treatment .


However , placebo was as effective as nabiximols in promoting long-term reductions in cannabis use following medication cessation .


The data support further evaluation of nabiximols for management of cannabis dependence and withdrawal in treatment-seeking populations .


anzctr.org.au Identifier : ACTRN12611000398909 .


According to the present evidences suggesting association between low testosterone level and prediction of reduced exercise capacity as well as poor clinical outcome in patients with heart failure , we sought to determine if testosterone therapy improves clinical and cardiovascular conditions as well as quality of life status in patients with stable chronic heart failure .


A total of 50 male patients who suffered from congestive heart failure were recruited in a double-blind , placebo-controlled trial and randomized to receive an intramuscular ( gluteal ) long-acting androgen injection ( 1mL of testosterone enanthate 250mg/mL ) once every four weeks for 12 weeks or receive intramuscular injections of saline ( 1mL of 0.9 % wt/vol NaCl ) with the same protocol .


The changes in body weight , hemodynamic parameters , and left ventricular dimensional echocardiographic indices were all comparable between the two groups .


Regarding changes in diastolic functional state and using Tei index , this parameter was significantly improved .


Unlike the group received placebo , those who received testosterone had a significant increasing trend in 6-walk mean distance ( 6MWD ) parameter within the study period ( P = 0.019 ) .


The discrepancy in the trends of changes in 6MWD between study groups remained significant after adjusting baseline variables ( mean square = 243.262 , F index = 4.402 , and P = 0.045 ) .


Our study strengthens insights into the beneficial role of testosterone in improvement of functional capacity and quality of life in heart failure patients .


Cytopenias are the most common HIV-associated hematological abnormality .


Cytopenias have been associated with several factors including sex , race/ethnicity , geographical location and comorbidities such as tuberculosis , hepatitis B infection , fever and oral candidiasis .


Cytopenias become more prevalent as HIV progresses and are often fatal .


Data from resource-limited settings about the prevalence and correlates of cytopenia are limited .


Therefore we conducted this cross-sectional study to assess the prevalence and correlates of cytopenia among adult AIDS patients at initiation of HAART in Uganda .


400 HIV-infected subjects who were HAART-nave or on HAART for6months were enrolled into the Multivitamins , HAART and HIV/AIDS Trial .


Anemia was defined according to WHO guidelines as any hemoglobin concentration < 12g/dl for non-pregnant females and < 13g/dl for males .


Leucopenia and thrombocytopenia were defined using study site laboratory reference ranges for lack of generally accepted definitions for these 2 cell lines as leucopenia if white blood cell count < 2.75109 cells/litre and thrombocytopenia if platelets < 125109 cells/litre for females and < 156109 cells/litre for males .


Univariate and bivariate analyses were done to describe the patient population and log-binomial regression was used to quantify the correlates of cytopenia .


Sixty five percent of the 400 subjects had at least one form of cytopenia .


Anemia occurred in 47.8 % , leucopenia in 24.3 % , thrombocytopenia in 8.3 % , bicytopenia in 21.9 % and only 2 had a pancytopenia .


Cytopenia was more prevalent in females ( prevalence ratio [ PR ] :1.33 , 95 % confidence interval [ CI ] :1.12 -1.59 ) ; CD4 count category 50 to < 200 ( PR : 0.75 , 95 % CI : 0.64 -0.88 ) and CD4 count category 200 to < 350 ( PR : 0.74 , 95 % CI : 0.59 - 0.92 ) compared to CD4 count category < 50 ; normal BMI ( PR : 0.82 , 95 % CI :0.68 -1.00 ) and overweight BMI ( PR : 0.64 , 95 % CI :0.50 - 0.82 ) compared to underweight BMI and those with a history or presence of oral candidiasis .


Cytopenias are a frequent complication in HIV-infected adults at initiation of HAART in Uganda .


The presence of any cytopenia was associated with female sex , decreasing CD4 count and decreasing body mass index .


Prospective studies in resource-limited settings on the trend in HIV-related cytopenias are needed .


Although balance is generally recognized to be an important feature in ensuring good performance in soccer , its link with functional performance remains mostly unexplored , especially in young athletes .


To investigate changes in balance induced by fatigue for unipedal and bipedal static stances in young soccer players .


Crossover study .


Biomechanics laboratory and outdoor soccer field .


Twenty-one male soccer players ( age = 14.5 0.2 years , height = 164.5 5.6 cm , mass = 56.8 6.8 kg ) .


Static balance was assessed with postural-sway analysis in unipedal and bipedal upright stance before and after a fatigue protocol consisting of a repeated sprint ability ( RSA ) test ( 2 15-m shuttle sprint interspersed with 20 seconds of passive recovery , repeated 6 times ) .


On the basis of the center-of-pressure ( COP ) time series acquired during the experimental tests , we measured sway area , COP path length , and COP maximum displacement and velocity in the anteroposterior and mediolateral directions .


Fatigue increased all sway values in bipedal stance and all values except COP velocity in the mediolateral direction in unipedal stance .


Fatigue index ( calculated on the basis of RSA performance ) was positively correlated with fatigue/rest sway ratio for COP path length and COP velocity in the anteroposterior and mediolateral directions for nondominant single-legged stance .


Fatigued players exhibited reduced performance of the postural-control system .


Participants with better performance in the RSA test appeared less affected by balance impairment , especially in single-legged stance .


We performed a proof of concept trial to evaluate relative safety and efficacy of Rhodiola rosea ( R. rosea ) versus sertraline for mild to moderate major depressive disorder .


We hypothesize that R. rosea would have similar therapeutic effects as sertraline but with less adverse events .


Phase II randomized placebo controlled clinical trial .


57 subjects were randomized to 12 weeks of standardized R. rosea extract , sertraline , or placebo .


Changes over time in Hamilton Depression Rating ( HAM-D ) , Beck Depression Inventory ( BDI ) , and Clinical Global Impression Change ( CGI/C ) scores among groups were examined using mixed-effects models .


Modest , albeit statistically non-significant , reductions were observed for HAM-D , BDI , and CGI/C scores for all treatment conditions with no significant difference between groups ( p = 0.79 , p = 0.28 , and p = 0.17 , respectively ) .


The decline in HAM-D scores was greater for sertraline ( -8.2 , 95 % confidence interval [ CI ] , -12.7 to -3.6 ) versus R. rosea ( -5.1 , 95 % CI : -8.8 to -1.3 ) and placebo ( -4.6 , 95 % CI : -8.6 to -0.6 ) .


While the odds of improving ( versus placebo ) were greater for sertraline ( 1.90 [ 0.44-8 .20 ] ; odds ratio [ 95 % CI ] ) than R. rosea ( 1.39 [ 0.38-5 .04 ] ) , more subjects on sertraline reported adverse events ( 63.2 % ) than R. rosea ( 30.0 % ) or placebo ( 16.7 % ) ( p = 0.012 ) .


Although R. rosea produced less antidepressant effect versus sertraline , it also resulted in significantly fewer adverse events and was better tolerated .


These findings suggest that R. rosea , although less effective than sertraline , may possess a more favorable risk to benefit ratio for individuals with mild to moderate depression .


Falls are common among older adults .


It is reported that approximately 60 % of residents of aged care facilities fall each year .


This is a major cause of morbidity and mortality , and a significant burden for health care providers and the health system .


Among community dwelling older adults , exercise appears to be an effective countermeasure , but data are limited and inconsistent among studies in residents of aged care communities .


This trial has been designed to evaluate whether the SUNBEAM program ( Strength and Balance Exercise in Aged Care ) reduces falls in residents of aged care facilities .


Is the program more effective and cost-effective than usual care for the prevention of falls ?


Single-blinded , two group , cluster randomized trial .


300 residents , living in 20 aged care facilities .


Progressive resistance and balance training under the guidance of a physiotherapist for 6 months , then facility-guided maintenance training for 6 months .


Usual care .


Number of falls , number of fallers , quality of life , mobility , balance , fear of falling , cognitive well-being , resource use , and cost-effectiveness .


Measurements will be taken at baseline , 6 months , and 12 months .


The number of falls will be analyzed using a Poisson mixed model .


A logistic mixed model will be used to analyze the number of residents who fall during the study period .


Intention-to-treat analysis will be used .


This study addresses a significant shortcoming in aged care research , and has potential to impact upon a substantial health care problem .


Outcomes will be used to inform care providers , and guide health care policies .


To evaluate the efficacy of early video-assisted thoracoscopic debridement in patients with the fibropurulent phase of parapneumonic empyema .


40 patients with parapneumonic empyema resistant to 2 weeks of antibiotic therapy , were randomly divided into 2 groups .


In group 1 ( 20 patients ) , antibiotic therapy and irrigation was continued , and in group 2 ( 20 patients ) , video-assisted thoracoscopic debridement was performed .


The 2 groups were compared in terms of therapeutic results .


The male/female ratio was 29/11 .


Group 1 included 16 men and 4 women with a mean age of 54 years , and mean hospital stay was 41 days .


Group 2 consisted of 14 men and 6 women with a mean age of 51 years , and mean hospital stay was 23 days .


Considering the therapeutic results , 12 patients in group 1 were cured by antibiotic therapy and irrigation , whereas 8 required decortication and pleurectomy with thoracotomy .


In group 2 , 18 patients were cured by video-assisted thoracoscopic debridement , and 2 underwent thoracotomy and decortication due to intraoperative bleeding .


A significant difference in therapeutic results was noted between the groups ( p = 0.028 ) .


Video-assisted thoracoscopic debridement provides a high success rate and less invasive treatment for the early stages of empyema .


Dyspepsia is common among end-stage renal disease ( ESRD ) patients and its association with delayed gastric emptying is not well established .


We assessed the association of dyspepsia with gastric emptying time in ESRD patients undergoing hemodialysis ( HD ) .


Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire ( PADYQ ) .


PADYQ 's scores 6 classified participants as dyspeptic .


The octanoic acid breath test using carbon was employed to assess the gastric emptying time .


Based on the test , time in minutes to metabolize the first half of the carbon in the test meal ( t1/2 ) was calculated .


Association of dyspepsia with gastric emptying time was tested by the correlation between PADYQ scores and t1/2 , and also by comparing t1/2 between dyspeptics and non-dyspeptics .


There were 34 ( 68.0 % ) dyspeptic patients .


Dyspepsia score was positively correlated with t1/2 ( r = 0.366 ; p = 0.009 ) .


Dyspeptics had longer t1/2 compared to non-dyspeptics , respectively , 238.0 92.9 versus 185.5 45.5 minutes ( p = 0.042 ) .


Delayed gastric emptying was associated with dyspepsia .


Prokinetic medications could have a role in preventing or relieving dyspeptic symptoms among HD patients .


Future research in larger samples is necessary to confirm this association .


To observe the clinical efficacy of Busuishengxue granules on non-severe aplastic anemia ( NSAA ) and investigate its effect on the mitogen-activated protein kinase/extracellular signal-regulated kinase ( MAPK/ERK ) pathway .


Sixty NSAA patients were divided equally into two groups .


Subjects in the experimental group were treated with Busuishengxue granules , and the control group with Zaizaoshengxue tablets .


The treatment course was 6 months and curative efficacy was compared between the two groups as well as with 10 healthy individuals .


Flow cytometry ( FCM ) was used to detect the intracellular concentration of Ca2 + ( [ Ca2 + ] i ) .


Western blotting was employed to detect the expression of enzymes in the MAPK/ERK pathway .


The efficacy of Busuishengxue granules was significantly better than that of Zaizaoshengxue tablets ( P < 0.05 ) .


Before treatment , expression of JNK , phospho-ERK 1/2 and p-JNK was higher , and [ Ca2 + ] i higher , than that of the control group ( P < 0.05 ) .


After treatment with Busuishengxue granules , expression of all enzymes related to signal transduction pathways in the blood cells of NSSA patients were altered to different degrees .


Busuishengxue granules had a better effect with regard to improving symptom scores , increasing the number of blood leukocytes , and increasing hemoglobin levels than Zaizaosh-engxue tablets , and they differed slightly in terms of increasing the number of platelets .


Manual wheelchairs ( MWCs ) can improve mobility and social participation for individuals who experience difficulty walking ; however , older adults receive little training for wheelchair use .


The Wheelchair Self-Efficacy Enhanced for Use ( WheelSeeU ) research program provides peer-led training that may positively influence wheelchair use while reducing clinician burden .


The purpose of this study is to evaluate the feasibility and clinical outcomes of WheelSeeU .


A randomized control trial ( RCT ) recruits and randomly assigns 40 MWC users ( 55 + years ) .


Feasibility indicators assessing process , resource , management , and treatment issues are measured , and clinical outcomes ( wheelchair skills , safety , confidence , mobility , social participation , quality of life , health utility ) are collected at three time points .


WheelSeeU provides an innovative approach for teaching wheelchair skills to an aging population that may improve wheelchair use and decrease clinician burden .


Since RCTs are expensive and challenging in rehabilitation , establishing feasibility prior to larger effectiveness trials is prudent .


Screening for Barrett 's esophagus ( BE ) and adenocarcinoma ( EAC ) is controversial , but interest remains in finding the optimal method .


Attitudes on screening within the community are unknown .


We aimed to assess these attitudes via a survey .


A mixed-mode survey was conducted in adults > 50 years to assess awareness regarding BE , willingness to participate in screening , and preferences regarding method of screening .


Methods evaluated were sedated endoscopy ( sEGD ) , unsedated transnasal endoscopy ( uTNE ) and video capsule ( VCE ) .


A total of 136 from 413 ( 33 % ) adults responded [ 47 % males , mean ( SD ) age 63 ( 10.2 ) years ] , and 26 % of responders knew of BE at baseline .


After reading the information on BE , 72 % were interested in screening .


A history of undergoing screening tests and GI symptoms were predictive of interest .


Unsedated techniques were preferred by 64 % ( VCE : 56 % and uTNE : 8 % ) versus sEGD ( 36 % ) .


The majority of adults were willing to undergo screening for BE/EAC , with a preference for unsedated techniques .


Nitric oxide donors , such as isosorbide dinitrate ointment ( ISDN ) , are considered as first-choice agents in the treatment of chronic anal fissure .


Injection with botulinum toxin A in the internal anal sphincter is often used as a second-line therapy , although it may give better results and fewer side effects than nitric oxide donors .


The aim of this randomized clinical trial was to investigate whether botulinum toxin A ( Dysport ) is more effective than ISDN in the primary treatment of chronic anal fissure .


From April 2005 until October 2009 , 60 patients ( 32 men ) with a median age of 42 ( 25-82 ) years were randomized to receive either ISDN 10 mg/ml ( 1 % ) ( n = 33 ) or injection with 60 units of Dysport ( n = 27 ) .


The primary end-point was the percentage of complete fissure healing after 8 weeks .


After a median of 9 weeks complete fissure healing was noted in 18 of 27 patients in the Dysport group and in 11 of 33 patients in the ISDN group ( P = 0.010 ) .


Absolute improvement of pain scores after 9 weeks was similar in both groups ( P = 0.733 ) .


Patients treated with Dysport had fewer side effects than patients treated with ISDN ( P = 0.028 ) .


Of the patients with a healed fissure , 28 % of the Dysport group and 50 % of the ISDN group had a recurrence within 1 year ( P = 0.286 ; hazard ratio 2.08 ; 95 % CI = 0.54-7 .97 ) .


Dysport is more effective than ISDN ointment and has fewer side effects in the primary treatment of chronic anal fissure .


The recurrence rate within 1 year in both treatment groups is high .


The authors prospectively assessed anxiety , depression , and behavior in children with standard-risk acute lymphoblastic leukemia ( SR-ALL ) during the first year of therapy and identified associated risk factors .


A cohort study was performed of 159 children ( aged 2 years-9 .99 years ) with SR-ALL who were enrolled on Children 's Oncology Group protocol AALL0331 at 31 sites .


Parents completed the Behavior Assessment System for Children , the General Functioning Scale of the Family Assessment Device , and the Coping Health Inventory for Parents at approximately 1 , 6 , and 12 months after diagnosis .


Overall , mean scores for anxiety , depression , aggression , and hyperactivity were similar to population norms .


However , more children scored in the at-risk/clinical range for depression than the expected 15 % at 1 month ( 21.7 % ; P = .022 ) , 6 months ( 28.6 % ; P < .001 ) , and 12 months ( 21.1 % ; P = .032 ) .


For anxiety , more children scored in the at-risk/clinical range at 1 month ( 25.2 % vs 15 % ; P = .001 ) , but then reverted to expected levels .


On adjusted analysis , unhealthy family functioning was found to be predictive of anxiety ( odds ratio [ OR ] , 2.24 ; P = .033 ) and depression ( OR , 2.40 ; P = .008 ) .


Hispanic ethnicity was associated with anxiety ( OR , 3.35 ; P = .009 ) .


Worse physical functioning ( P = .049 ) , unmarried parents ( P = .017 ) , and less reliance on social support ( P = .004 ) were found to be associated with depression .


Emotional distress at 1 month predicted anxiety ( OR , 7.11 ; P = .002 ) and depression ( OR , 3.31 ; P = .023 ) at 12 months .


Anxiety is a significant problem in a subpopulation of patients with SR-ALL immediately after diagnosis , whereas depression remains a significant problem for at least 1 year .


Children of Hispanic ethnicity or those with unhealthy family functioning may be particularly vulnerable .


These data suggest that clinicians should screen for anxiety and depression throughout the first year of therapy .


In a multicenter , prospectively randomized study we evaluated the 5-year outcomes of bacillus Calmette-Gurin alone compared to a combination of epirubicin and interferon-2b in the treatment of patients with T1 bladder cancer .


Transurethral resection was followed by a second resection and bladder mapping .


Stratification was for grade and carcinoma in situ .


Followup entailed regular cystoscopy and cytology during the first 5 years .


The end points assessed in this analysis were recurrence-free survival , time to treatment failure and progression , cancer specific survival and prognostic factors .


The study recruited 250 eligible patients .


The 5-year recurrence-free survival rate was 38 % in the combination arm and 59 % in the bacillus Calmette-Gurin arm ( p = 0.001 ) .


The corresponding rates for the other end points were not significantly different , as free of progression 78 % and 77 % , treatment failure 75 % and 75 % , and cancer specific survival 90 % and 92 % , respectively .


The type of treatment , tumor size and tumor status at second resection were independent variables associated with recurrence .


Concomitant carcinoma in situ was not predictive of failure of bacillus Calmette-Gurin therapy .


An independent factor for treatment failure was remaining T1 stage at second resection .


Bacillus Calmette-Gurin was more effective than the tested combination therapy .


The currently recommended management with second resection and 3-week maintenance bacillus Calmette-Gurin entails a low risk of cancer specific death .


More aggressive treatment in patients with infiltrative tumors at second resection might improve these results .


In particular , concomitant carcinoma in situ was not a predictive factor for poor outcome after bacillus Calmette-Gurin therapy .


The Le Fort I osteotomy ( L-I ) requires extensive dissection and manipulation of tissue , causing hemodynamic instability and an undesirable postoperative stress response .


This study aimed to clarify the most effective dose of remifentanil during L-I .


This study was designed as a prospective , randomized , controlled double-blinded study .


Patients ( American Society of Anesthesiologists physical status I to II ) undergoing L-I were randomly assigned to receive anesthesia with propofol and remifentanil under 3 remifentanil dose conditions : 0.25 g/kg/minute ( group 1 ) , 0.5 g/kg/minute ( group 2 ) , and 0.75 g/kg/minute ( group 3 ) .


All patients underwent L-I with propofol and remifentanil target-controlled anesthesia .


The study endpoints were mean arterial pressure ( MAP ) and heart rate .


Data were recorded before L-I ( 20-minute period before surgery ) , during L-I ( from the beginning of surgery to downfracture ) , and after L-I ( 20-minute period after downfracture ) .


Average age , gender , average body mass index , aimed maxillary position , average bispectral index , average surgery time , and average blood loss also were examined .


Data were analyzed using the Bartlett test and then 1-way analysis of variance with the Bonferroni multiple comparison test .


Data were obtained from 20 patients ( 9 men , 11 women ) .


The average operating times for groups 1 , 2 , and 3 were 53.1 , 46.7 , and 49minutes , respectively .


The age range was 18 to 46years ( average , 26.05 yr ) .


The rate of MAP increase from before to during L-I in group 1 was 10.8 % ( n = 7 ) .


The rate of MAP increase from before to during L-I in group 3 was 2.1 % ( n = 6 ) .


Group 3 showed a significantly lower rate of MAP increase during and after L-I compared with group 1 ( P < .05 ) .


Remifentanil administration at 0.75 g/kg/minute stabilized hemodynamics during L-I without major side effects .


Results indicated that the standard index of remifentanil administration during L-I should be 0.75 g/kg/minute when using oxygen , propofol , and remifentanil for general anesthesia .


The clamshell incision ( CI ) offers a better exposure than the left anterolateral thoracotomy ( LAT ) as a resuscitative thoracotomy .


Most surgeons will have to manage a heart wound only once or twice in their career .


The patient 's survival depends on how fast the surgeon can control the heart wound ; however , it is unclear which of the two incisions allows for faster control in the hands of inexperienced surgeons .


The aim of this study was to compare the time needed to access and control a standardized stab wound to the right ventricle , by inexperienced surgical trainees , by LAT or CI ; we hypothesized that the CI does not take longer than the LAT .


Sixteen residents were shown a video on how to perform both procedures .


They were randomly assigned to control a standardized stab wound of the right ventricle on perfused human cadavers by LAT ( n = 8 ) or CI ( n = 8 ) .


Access time ( skin to maximal exposure ) , control time ( maximal exposure until control of the heart wound ) and total time ( the sum of access and control times ) were recorded .


Total time was 6.62 min [ 3.20-8 .14 ] ( median [ interquartile range ] ) for LAT and 4.63 min [ 3.17-6 .73 ] for CI ( p = 0.46 ) .


Access time was 2.39 min [ 1.21-2 .76 ] for LAT and 2.33 min [ 1.58-4 .86 ] for CI ( p = 0.34 ) .


Control time was 4.16 min [ 2.32-5 .49 ] for LAT and 1.85 min [ 1.38-2 .23 ] for CI ( p = 0.018 ) .


The time needed from skin incision until cardiac wound control via CI was not longer than via LAT and the easier control of the cardiac wound when using CI was confirmed .


The number of total knee replacements performed each year is increasing .


Among the main impediments to functional recovery after these surgeries include postoperative edema , pain , lower limb muscle strength deficits , all of which point to a need to identify safe , effective postoperative rehabilitation modalities .


The aim of this paper was to evaluate the effectiveness of Kinesio Taping ( KT ) method in reducing postoperative pain , edema , and improved knee range of motion recovery after total knee replacement ( TKR ) operation in early postoperative rehabilitation period .


Randomized clinical trial .


Inpatient rehabilitation facility .


Ninety-four patients , who underwent primary TKR surgery .


Using simple randomization , participants were divided into KT group and control group .