Patients in the LC group received 4 g/day of intravenous L-carnitine , while patients in the CT group were injected with saline .


Blood pressure ( BP ) , anthropometric characteristics , markers of liver function , metabolic indices ( plasma glucose , lipid profiles , uric acid , free fatty acid and insulin ) and hypersensitivity C-reactive protein were measured .


Perceived hunger was recorded daily by self-rating visual analogue scales .


Fatigue was evaluated by Wessely and Powell scores .


In contrast to the CT group , total cholesterol , alanine aminotransferase , systolic and diastolic BP did not change significantly in the LC group after prolonged fasting .


There were significant differences in weight loss ( LC -4.6 0.9 vs. CT -3.2 1.1 kg , P = 0.03 ) , and waist circumference ( LC -5.0 2.2 vs. CT -1.7 1.16 cm , P < 0.001 ) , waist hip ratio ( LC -0.023 0.017 vs. CT 0.012 0.01 , P < 0.001 ) , insulin concentration ( LC -9.9 3.58 vs. CT -6.32 3.44 U/mL , P = 0.046 ) , and - glutamyltransferase concentration ( LC -7.07 6.82 vs. CT -2.07 4.18 , P = 0.024 ) .


Perceived hunger scores were significantly increased ( P < 0.05 ) in the CT group during starvation , which was alleviated with L-carnitine administration in the LC group .


Physical fatigue ( LC -3.2 3.17 vs. CT 1.8 2.04 , P < 0.001 ) and fatigue severity ( LC -11.6 8.38 vs. CT 8.18 7.32 , P < 0.001 ) were significantly reduced in the LC group but were aggravated in the CT group .


Intravenous L-carnitine can ameliorate fasting-induced hunger , fatigue , cholesterol abnormalities and hepatic metabolic changes and facilitate fasting-induced weight loss in MetS patients .


ChiCTR-TNRC-12002835 .


Caustic substance ingestion in childhood is a public health issue in developing countries , and several management protocols have been proposed to prevent the resulting esophageal strictures .


The role of corticosteroids in preventing corrosive-induced strictures is controversial .


Our aim was to study the influence of high doses of corticosteroids in preventing esophageal strictures .


Eighty-three children with a mean age of 4.10 6 2.63 years and with grade IIb esophageal burns ( an esophagogastroscopy was performed within 2448 hours of injury ) due to corrosive substance ingestion were enrolled in our study between 2005 and 2008 .


Forty-two children ( study group ) received methylprednisolone ( 1 g/1 .73 m2 per day for 3 days ) , ranitidine , ceftriaxone , and total parenteral nutrition .


Forty-one children ( control group ) were administered the same regimen excluding methylprednisolone .


Stricture development was compared between groups based on endoscopic and radiologic findings .


During the endoscopic examination , stricture development was observed in 4 patients ( 10.8 % ) in the study group and in 12 patients ( 30 % ) in the control group .


The difference was statistically significant ( P = .038 ) .


The stricture development rate in the upper gastrointestinal system with barium meal was 14.3 % and 45.0 % in the study and control groups , respectively .


The difference was statistically significant ( P = .004 ) .


The duration of total parenteral nutrition was shorter in the study group compared with the control group ( P = .001 ) .


High doses of methylprednisolone were well tolerated in the study group without any side effects .


High doses of methylprednisolone used for the management of grade IIb esophageal burns may reduce stricture development .


To study the protective effects of Dongchongxiacao ( Cordyceps ) ( DCXC ) on contrast-induced nephropathy ( CIN ) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography .


A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rater ( eGFR ) was 60 mL/min 1.73 in2 , were divided randomly into three groups , basic treatment group ( n = 41 ) , standard DCXC therapy group ( n = 39 , 2-g corbrin capsules , 3 times/d , 3 days before and after angiography ) , and intensive DCXC therapy group ( n = 40 , 3-g corbrin capsules , 3 times/d , 3 days before and after angiography ) .


Serum creatinine ( cr ) and eGFR were assessed at the time of admission to hospital , and on days 1 , 2 and 3 after angiography .


Urine neutrophil-gelatinase-associated-lipo - calin ( NGAL ) , kidney injury molecule-1 ( KIM-1 ) and interleukin-18 ( IL-18 ) were measured before angiography and at day 1 after angiography for all patients .


The primary end point was the prevalence of CIN .


The secondary end point was a 25 % or greater reduction in eGFR .


CIN occurred in 11 of 120 patients ( 9.17 % ) .


The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group ( P < 0.05 ) , with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group ( P < 0.01 ) .


Compared with the basic treatment group , a lower proportion of patients in the DCXC treatment groups had an eGFR decrease of 25 % or greater ( P < 0.05 ) ; patients with an eGFR decrease of 25 % or greater accounted for an even lower proportion in the intensive DCXC therapy group ( P < 0.01 ) .


Within 1 day of the procedure , urine levels of KIM-1 , NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group ( P < 0.05 ) .


DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography , with intensive DCXC therapy being more effective .


Carotid intima-media thickness ( CIMT ) is a marker for atherosclerosis .


Adult post-coarctectomy patients ( CoA ) demonstrate an increased cardiovascular risk and increased CIMT compared to controls .


This study evaluates the effect of high dose statins on the change in CIMT and cardiovascular risk .


We designed a multicenter , prospective , randomized , open label trial with blinded endpoint ( PROBE design ) to evaluate the effect of three year treatment with atorvastatin 80 mg on CIMT and cardiovascular risk .


Primary endpoint was CIMT measured by B mode ultrasonography .


Secondary endpoints were mortality and morbidity due to cardiovascular disease and serum lipids .


155 patients ( 36.3 11.8 years , 96 ( 62 % ) male ) were randomized ( atorvastatin = 80 , no treatment = 75 ) .


There was no significant effect of atorvastatin on the change in CIMT ( treatment effect -0.005 , 95 % CI , -0.039 -0.029 ; P = 0.76 ) .


A significant effect on serum cholesterol and LDL levels was found ( - 0.71 , 95 % CI , - 1.16 to - 0.26 ; P = 0.002 vs - 0.66 , 95 % CI - 1.06 to - 0.26 ; P = 0.001 ) .


There was no difference in secondary outcome measures .


Baseline CIMT was higher in hypertensive compared to normotensive CoA .


( 0.69 0.16 mm vs 0.61 0.98 mm ; P = 0.002 ) .


Hypertension ( = 0.043 , P = 0.031 ) was the strongest determinant CIMT .


Three year treatment with atorvastatin does not lead to a reduction of CIMT and secondary outcome measures , despite a decrease in total cholesterol and LDL levels .


Hypertensive CoA demonstrate the highest CIMT and the largest CIMT progression .


Blood pressure control should be the main focus in CoA to decrease cardiovascular risk .


The problem of image quality in a large number of upper airway obstructed patients is the superimposition of the airway over the bone of the spine on the AP view .


This problem was resolved by increasing KVp to high KVp technique and adding extra radiographic filters ( copper filter ) to reduce the sharpness of the bone and increase the clarity of the airway .


However , this raises a concern that patients might be receiving an unnecessarily higher dose of radiation , as well as the effectiveness of the invented filter compared to the traditional filter .


To evaluate the level of radiation dose that patients receive with the use of multi-layer filter compared to non-filter and to evaluate the image quality of the upper airways between using the radiographic filter ( multi-layer filter ) and the traditional filter ( copperfilter ) .


The attenuation curve of both filter materials was first identified .


Then , both the filters were tested with Alderson Rando phantom to determine the appropriate exposure .


Using the method described , a new type of filter called the multi-layer filter for imaging patients was developed .


A randomized control trial was then performed to compare the effectiveness of the newly developed multi-layer filter to the copper filter .


The research was conducted in patients with upper airway obstruction treated at Queen Sirikit National Institute of Child Health from October 2006 to September 2007 .


A total of 132 patients were divided into two groups .


The experimental group used high kVp technique with multi-layer filter , while the control group used copper filter .


A comparison of film interpretation between the multi-layer filter and the copper filter was made by a number of radiologists who were blinded to both to the technique and type of filter used .


Patients had less radiation from undergoing the kVp technique with copper filter and multi-layer filter compared to the conventional technique , where no filter is used .


Patients received approximately 65.5 % less radiation dose using high kVp technique with multi-layer filter compared to the conventional technique , and 25.9 % less than using the traditional copper filter 45 % of the radiologists who participated in this study reported that the high kVp technique with multi-layer filter was better for diagnosing stenosis , or narrowing of the upper airways .


33 % reported that , both techniques were equal , while 22 % reported that the traditional copper filter allowed for better details of airway obstruction .


These findings showed that the multi-layered filter was comparable to the copper filter in terms of film interpretation .


Using the multi-layer filter resulted in patients receiving a lower dose of radiation , as well as similar film interpretation when compared to the traditional copper filter .


The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis ( CBTH ) to control fatigue in patients with breast cancer undergoing radiotherapy .


We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group .


Patients ( n = 200 ) were randomly assigned to either the CBTH ( n = 100 ; mean age , 55.59 years ) or attention control ( n = 100 ; mean age , 55.97 years ) group .


Fatigue was measured at four time points ( baseline , end of radiotherapy , 4 weeks , and 6 months after radiotherapy ) .


Fatigue was measured using the Functional Assessment of Chronic Illness Therapy ( FACIT ) - Fatigue subscale and Visual Analog Scales ( VASs ; Fatigue and Muscle Weakness ) .


The CBTH group had significantly lower levels of fatigue ( FACIT ) at the end of radiotherapy ( z , 6.73 ; P < .001 ) , 4-week follow-up ( z , 6.98 ; P < .001 ) , and 6-month follow-up ( z , 7.99 ; P < .001 ) assessments .


Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment ( z , 5.81 ; P < .001 ) and at the 6-month follow-up ( z , 4.56 ; P < .001 ) , but not at the 4-week follow-up ( P < .07 ) .


Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment ( z , 9.30 ; P < .001 ) and at the 6-month follow-up ( z , 3.10 ; P < .02 ) , but not at the 4-week follow-up ( P < .13 ) .


The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer .


CBTH is noninvasive , has no adverse effects , and its beneficial effects persist long after the last intervention session .


CBTH seems to be a candidate for future dissemination and implementation .


The use of mobile phone technologies for health promotion and disease prevention has advanced rapidly in recent years .


Text4baby is a theory-based mobile health ( mHealth ) program in which text messages are delivered to pregnant women and new mothers to improve their health care beliefs and behaviors and improve health status and clinical outcomes .


Recent evaluations of Text4baby have found that it improves targeted health attitudes and beliefs , but effects on behavior have not yet been determined .


In this study , investigators aimed to evaluate Text4baby in the military women 's population .


Investigators conducted a randomized controlled trial at Madigan Army Medical Center in Tacoma , Washington , from December 2011 through September 2013 .


All participants were pregnant women first presenting for care at Madigan .


Investigators conducted a baseline assessment using a 24-item , self-administered online survey of attitudes and behaviors related to Text4baby message content .


Participants were randomized to Text4baby plus usual care ( intervention ) or usual care alone ( control ) .


Investigators analyzed treatment effects of Text4baby on short-term targeted outcomes 4 weeks post enrollment .


For this study , 943 patients were randomized and completed a baseline assessment .


The average patient age was 28 years and nearly 70 % self-identified as Caucasian .


48.7 % of enrollees ( 459/943 ) completed the first follow-up assessment .


Higher rates of single and working/in-school patients dropped out of the intervention arm of the study , and we adjusted for this finding in subsequent models .


However , while investigators were unable to re-survey these participants , only 1.9 % of Text4baby enrollees ( 18/943 ) dropped the service during the study period .


Adjusted and unadjusted logistic generalized estimating equation models were developed to assess intervention effects on measured outcomes .


In the model adjusting for age , marital status , having had a previous baby , and race/ethnicity , there was a significant effect of Text4baby intervention exposure on increased agreement with belief in the importance of taking prenatal vitamins ( OR 1.91 , 95 % CI 1.08-3 .34 , P = .024 ) .


All of these attitudes had been targeted by at least one text message during the 4-week evaluation period examined in this study .


In unadjusted models , there was a significant effect of intervention exposure on belief in the importance of visiting a health care provider to be a healthy new mother ( OR 1.52 , 95 % CI 1.01-2 .31 , P = .046 ) and in the health risks of alcohol during pregnancy ( OR 2.06 , 95 % CI 1.00-4 .31 , P = .05 ) .


No behavioral effects of the intervention were observed in this analysis .


Text4baby is a promising program that offers lessons for future mHealth activities .


This large-scale study demonstrated initial effects of the program on attitudes and beliefs targeted by the messages received by women during the study period .


Results confirm previous findings from Text4baby studies and other mHealth research .


Future analyses will examine dosage effects of the intervention on behaviors and clinical outcomes .


The influence of rehabilitation on the outcomes after arthroscopic rotator cuff repair remains unknown .


The purpose of this study was to compare clinical results and tendon healing rates following arthroscopic rotator cuff repair utilizing two distinct rehabilitation protocols .


Over a thirty-month period , 124 patients under the age of sixty-five years underwent arthroscopic repair of a full-thickness rotator cuff tear measuring < 30 mm in width .


Postoperatively , patients were randomized either to a traditional rehabilitation program with early range of motion or to an immobilization group with delayed range of motion for six weeks .


Clinical outcomes assessment included visual analog pain scale score , American Shoulder and Elbow Surgeons ( ASES ) score , Simple Shoulder Test ( SST ) , relative Constant score , and strength measurements at six , twelve , and twenty-four months .


Tendon integrity was assessed with ultrasonography at a minimum of twelve months postoperatively .


There were no significant differences in patient age , tear size , or measures of preoperative function between groups at baseline .


Final clinical follow-up was available for 114 subjects ( 92 % ) .


Active elevation and external rotation were better in the traditional rehabilitation group at three months .


No significant differences were seen in functional scores , active motion , and shoulder strength between rehabilitation groups at later time points .


Functional outcomes plateaued at six or twelve months except for the relative Constant score , which improved up to twenty-four months following surgery .


Ninety-two percent of the tears were healed , with no difference between rehabilitation protocols ( p = 0.46 ) .


Arthroscopic repair of small and medium full-thickness rotator cuff tears results in reliable improvements in clinical outcomes and a high rate of tendon integrity using a double-row repair technique in patients under the age of sixty-five years .


There is no apparent advantage or disadvantage of early passive range of motion compared with immobilization with regard to healing or functional outcome .


Micronutrients play an important role in immune function .


To our knowledge , there have been no comprehensive studies on the role of micronutrient supplementation in children with tuberculosis .


We assessed the effect of micronutrient supplementation in children treated with antituberculosis therapy ( ATT ) .


A randomized , double-blind , placebo-controlled trial that used a 2 2 factorial design was undertaken at 2 teaching hospitals in Delhi .


Children with newly diagnosed intrathoracic tuberculosis were enrolled , and they received ATT together with daily supplementation for 6 mo with either zinc alone , micronutrients without zinc , micronutrients in combination with zinc , or a placebo .


Main outcomes were weight gain and an improvement in a chest X-ray ( CXR ) lesion assessed at 6 mo of treatment .


A total of 403 children were enrolled and randomly assigned .


A microbiological diagnosis of tuberculosis was confirmed in 179 children ( 44.4 % ) .


The median ( 95 % CI ) increase in weight-for-age z score at 6 mo was not significantly different between subjects who received micronutrients [ 0.75 ( 0.66 , 0.84 ) ] and those who did not receive micronutrients [ 0.76 ( 0.67 , 0.85 ) ] and between subjects who received zinc [ 0.76 ( 0.68 , 0.85 ) ] and those who did not receive zinc [ 0.75 ( 0.66 , 0.83 ) ] .


An improvement in CXR was observed in 285 children , but there was no difference between those receiving zinc and no zinc or between those receiving micronutrients and no micronutrients after 6 mo of ATT .


However , children who received micronutrients had a faster gain in height over 6 mo than did those who did not receive micronutrients ( height-for-age z score = 0.08 ; P = 0.014 ) .


Micronutrient supplementation did not modify the weight gain or clearance of lesions on CXR in children with intrathoracic tuberculosis .


However , micronutrient supplementation during treatment may improve height gain in children with intrathoracic tuberculosis .


This trial was registered at clinicaltrials.gov as NCT00801606 .


To modify the Prostate Cancer Prevention Trial risk calculator ( PCPTRC ) to predict low - vs high-grade ( Gleason grade7 ) prostate cancer and incorporate percent free-prostate-specific antigen ( PSA ) .


Data from 6664 Prostate Cancer Prevention Trial placebo arm biopsies ( 5826 individuals ) , where prostate-specific antigen and digital rectal examination results were available within 1 year before the biopsy and PSA was 10 ng/mL , were used to develop a nominal logistic regression model to predict the risk of no vs low-grade ( Gleason grade < 7 ) vs high-grade cancer ( Gleason grade7 ) .


Percent free-PSA was incorporated into the model based on likelihood ratio analysis of a San Antonio Biomarkers of Risk cohort .


Models were externally validated on 10 Prostate Biopsy Collaborative Group cohorts and 1 Early Detection Research Network reference set .


Of all the Prostate Cancer Prevention Trial biopsies , 5468 ( 82.1 % ) were negative for prostate cancer , 942 ( 14.1 % ) detected low-grade , and 254 ( 3.8 % ) detected high-grade disease .


Significant predictors were ( log base 2 ) PSA ( odds ratio for low-grade vs no cancer , 1.29 * ; high-grade vs no cancer , 2.02 * ; high-grade vs low-grade cancer , 1.57 * ) , digital rectal examination ( 0.96 , 1.49 * , 1.55 * , respectively ) , age ( 1.02 * , 1.05 * , 1.03 * , respectively ) , African American race ( 1.13 , 2.83 * , 2.51 * , respectively ) , prior biopsy ( 0.63 * , 0.81 , 1.27 , respectively ) , and family history ( 1.31 * , 1.25 , 0.95 , respectively ) , where * indicates P value < .05 .


The new PCPTRC 2.0 either with or without percent free-PSA ( also significant by the likelihood ratio method ) validated well externally .


By differentiating the risk of low - vs high-grade disease on biopsy , PCPTRC 2.0 better enables physician-patient counseling concerning whether to proceed to biopsy .


Phosphatidylinositol-3-kinase delta ( PI3K ) mediates B-cell receptor signaling and microenvironmental support signals that promote the growth and survival of malignant B lymphocytes .


In a phase 1 study , idelalisib , an orally active selective PI3K inhibitor , showed antitumor activity in patients with previously treated indolent non-Hodgkin 's lymphomas .


In this single-group , open-label , phase 2 study , 125 patients with indolent non-Hodgkin 's lymphomas who had not had a response to rituximab and an alkylating agent or had had a relapse within 6 months after receipt of those therapies were administered idelalisib , 150 mg twice daily , until the disease progressed or the patient withdrew from the study .


The primary end point was the overall rate of response ; secondary end points included the duration of response , progression-free survival , and safety .


The median age of the patients was 64 years ( range , 33 to 87 ) ; patients had received a median of four prior therapies ( range , 2 to 12 ) .


Subtypes of indolent non-Hodgkin 's lymphoma included follicular lymphoma ( 72 patients ) , small lymphocytic lymphoma ( 28 ) , marginal-zone lymphoma ( 15 ) , and lymphoplasmacytic lymphoma with or without Waldenstrm 's macroglobulinemia ( 10 ) .


The response rate was 57 % ( 71 of 125 patients ) , with 6 % meeting the criteria for a complete response .


The median time to a response was 1.9 months , the median duration of response was 12.5 months , and the median progression-free survival was 11 months .


Similar response rates were observed across all subtypes of indolent non-Hodgkin 's lymphoma , though the numbers were small for some categories .


The most common adverse events of grade 3 or higher were neutropenia ( in 27 % of the patients ) , elevations in aminotransferase levels ( in 13 % ) , diarrhea ( in 13 % ) , and pneumonia ( in 7 % ) .


In this single-group study , idelalisib showed antitumor activity with an acceptable safety profile in patients with indolent non-Hodgkin 's lymphoma who had received extensive prior treatment .


( Funded by Gilead Sciences and others ; ClinicalTrials.gov number , NCT01282424 . )


PRONOUNCE compared the efficacy and safety of pemetrexed + carboplatin followed by pemetrexed ( Pem + Cb ) with paclitaxel + carboplatin + bevacizumab followed by bevacizumab ( Pac + Cb + Bev ) in patients with advanced nonsquamous non-small-cell lung cancer ( NSCLC ) .


Patients 18 years of age with stage IV nonsquamous NSCLC ( American Joint Committee on Cancer v7 .0 ) , and Eastern Cooperative Oncology Group performance status 0/1 were randomized ( 1:1 ) to four cycles of induction Pem + Cb ( pemetrexed , 500 mg/m , carboplatin , area under the curve = 6 ) followed by Pem maintenance or Pac + Cb + Bev ( paclitaxel , 200 mg/m , carboplatin , area under the curve = 6 , and bevacizumab , 15 mg/kg ) followed by Bev maintenance in the absence of progressive disease or discontinuation .


The primary objective was progression-free survival ( PFS ) without grade 4 toxicity ( G4PFS ) .


Secondary end points were PFS , overall survival ( OS ) , overall response rate ( ORR ) , disease control rate ( DCR ) , and safety .


Resource utilization was also assessed .


Baseline characteristics of the patients randomized to Pem + Cb ( N = 182 ) and Pac + Cb + Bev ( N = 179 ) were well balanced between the arms .


Median ( months ) G4PFS was 3.91 for Pem + Cb and 2.86 for Pac + Cb + Bev ( hazard ratio = 0.85 , 90 % confidence interval , 0.7-1 .04 ; p = 0.176 ) ; PFS , OS , ORR , or DCR did not differ significantly between the arms .


Significantly more drug-related grade 3/4 anemia ( 18.7 % versus 5.4 % ) and thrombocytopenia ( 24.0 % versus 9.6 % ) were reported for Pem + Cb .


Significantly more grade 3/4 neutropenia ( 48.8 % versus 24.6 % ) , grade 1/2 alopecia ( 28.3 % versus 8.2 % ) , and grade 1/2 sensory neuropathy were reported for Pac + Cb + Bev .


Number of hospitalizations and overall length of stay did not differ significantly between the arms .


Pem + Cb did not produce significantly better G4PFS compared with Pac + Cb + Bev .


Pem + Cb was not superior in PFS , OS , ORR , or DCR compared with Pac + Cb + Bev .


Both regimens were well tolerated , although , toxicity profiles differed .


Hamstring injuries are the most common muscle injury in male amateur soccer players and have a high rate of recurrence , often despite extensive treatment and long rehabilitation periods .


Eccentric strength and flexibility are recognised as important modifiable risk factors , which have led to the development of eccentric hamstring exercises , such as the Nordic hamstring exercise .


As the effectiveness of the Nordic hamstring exercise in reducing hamstring injuries has never been investigated in amateur soccer players , the aim of this study is to investigate the effect of this exercise on the incidence and severity of hamstring injuries in male amateur soccer players .


An additional aim is to determine whether flexibility is associated with hamstring injuries .


Cluster-randomised controlled trial with soccer teams as the unit of cluster .


Dutch male amateur soccer players , aged 18-40years , were allocated to an intervention or control group .


Both study groups continued regular soccer training during 2013 , but the intervention group additionally performed the Nordic hamstring exercise ( 25 sessions over 13weeks ) .


Primary outcomes are the incidence of initial and recurrent hamstring injury and injury severity .


Secondary outcomes are hamstring-and-lower-back flexibility and compliance .


Compliance to the intervention protocol was also monitored .


Eccentric hamstring strength exercises are hypothesised to reduce the incidence of hamstring injury among male amateur soccer players by 70 % .


The prevention of such injuries will be beneficial to soccer players , clubs , football associations , health insurance companies and society .


NTR3664 .


To evaluate computed tomography ( CT ) perfusion for assessment of early treatment response after transarterial radioembolization of patients with liver malignancy .


Dynamic contrast-enhanced CT liver perfusion was performed before and 4 weeks after transarterial radioembolization in 40 patients ( 25 men and 15 women ; mean age , 64 y 11 ; range , 35-80 y ) with liver metastases ( n = 27 ) or hepatocellular carcinoma ( HCC ) ( n = 13 ) .


Arterial perfusion ( AP ) of tumors derived from CT perfusion and tumor diameters were measured on CT perfusion before and after transarterial radioembolization .


Success of transarterial radioembolization was evaluated on morphologic follow-up imaging ( median follow-up time , 4 mo ) based on Response Evaluation Criteria in Solid Tumors ( Version 1.1 ) .


CT perfusion parameters before and after transarterial radioembolization for different response groups were compared .


Kaplan-Meier curves were plotted to illustrate overall 1-year survival rates .


Liver metastases showed significant differences in AP before and after transarterial radioembolization in responders ( P < .05 ) but not in nonresponders ( P = .164 ) .


In HCC , AP values before and after transarterial radioembolization were not significantly different in responders and nonresponders ( P = .180 and P = .052 ) .


Tumor diameters were not significantly different on CT perfusion before and after transarterial radioembolization in responders and nonresponders with liver metastases and HCC ( P = .654 , P = .968 , P = .148 , P = .164 ) .


In patients with significant decrease of AP in liver metastases after transarterial radioembolization , 1-year overall survival was significantly higher than in patients showing no reduction of AP .


CT perfusion showed early reduction of AP in liver metastases responding to transarterial radioembolization ; tumor diameter remained unchanged early after treatment .


No significant early treatment response to transarterial radioembolization was found in patients with HCC .


In patients with liver metastases , a decrease of AP after transarterial radioembolization was associated with a higher 1-year overall survival rate .


To assess the intraocular penetration of 0.5 % moxifloxacin hydrochloride into aqueous humour after oral and topical administration .


A prospective , interventional study of 42 patients scheduled to undergo cataract surgery was carried out .


Out of the 42 subjects , 21 were randomly categorised into Group I and received one drop of 0.5 % topical moxifloxacin four times , at 15min intervals starting 75min before the surgery .


Another 21 subjects were categorised into Group II and all subjects in this group were administered a single tablet of 400mg of moxifloxacin , 12h before the surgery .


Estimation of moxifloxacin in aqueous samples was carried out using high-performance liquid chromatography .


Results were analysed using Student unpaired ` t ' test and analysis of variance .


The value of p < 0.05 was considered to be significant .


Mean aqueous concentration of moxifloxacin attained in the oral group ( n = 21 ) was 0.5040.30 g/mL while that in the topical group ( n = 21 ) was 2.040.72 g/mL , and this difference in levels was statistically significant ( p < 0.005 ) .


The levels attained by both the groups well exceeded the MIC90 ( minimum inhibitory concentration of antibiotic required to inhibit growth of 90 % of bacteria strains ) levels for most of the organisms causing endophthalmitis .


Penetration of moxifloxacin in aqueous in both the groups was not affected by gender , intraocular pressure or comorbidities significantly .


However , aqueous levels were found to be higher among the younger subjects within the topical group .


Moxifloxacin has an impressive spectrum of coverage and this pharmacokinetic study reinforces its potential as a prophylactic drug against intraocular infections , given the high aqueous levels post topical administration .


To evaluate the postoperative analgesic effect and postoperative nausea and vomiting ( PONV ) after using epidural low-dose morphine-soaked microfibrillar collagen sponge ( MMCS ) , as compared with placebo .


A prospective randomized double-blind placebo-controlled study was performed on patients under-going single-level posterior lumbar spinal decompression and instrumented fusion at the Department of Orthopedic Surgery , Siriraj Hospital , between August 2012 and December 2013 .


Patients were randomly allocated into two groups to receive either an epidural MMCS or an epidural normal saline-soaked microfibrillar collagen sponge ( placebo ) .


Intensity ofpain , PONV and total amount of morphine were recorded at 4 , 24 , 48 , and 72 hours , postoperatively .


The analgesic effect was enhanced significantly in the epidural MMCS group , as the amount ofmorphine used was statistically less than in the placebo group at 4 and 24 hours ( p < 0.05 ) .


A single low-dose epidural MMCS is effectiveforpain control after posterior lumbar spinal surgery with a low incidence of PONV .


Massive resources are expended every year on cross-cultural communication training for physicians .


Such training is a focus of continuing medical education nationwide and is part of the curriculum of virtually every medical school in America .


There is a pressing need for evidence regarding the effects on patients of cross-cultural communication training for physicians .


There is a need to understand the added benefit of such training compared to more general communication .


We know of no rigorous study that has assessed whether cross-cultural communication training for physicians results in better health outcomes for their patients .


The current study aims to answer this question by enhancing the Physician Asthma Care Education ( PACE ) program to cross cultural communication ( PACE Plus ) , and comparing the effect of the enhanced program to PACE on the health outcomes of African American and Latino/Hispanic children with asthma .


A three-arm randomized control trial is used to compare PACE Plus , PACE , and usual care .


Both PACE and PACE Plus are delivered in two , two-hour sessions over a period of two weeks to 5-10 primary care physicians who treat African American and Latino/Hispanic children with asthma .


One hundred twelve physicians and 1060 of their pediatric patients were recruited who self-identify as African American or Latino/Hispanic and experience persistent asthma .


Physicians were randomized into receiving either the PACE Plus or PACE intervention or into the control group .


The comparative effectiveness of PACE and PACE Plus on clinician 's therapeutic and communication practices with the family/patient , children 's urgent care use for asthma , asthma control , and quality of life , and parent/caretaker satisfaction with physician performance will be assessed .


Data are collected via telephone survey and medical record review at baseline , 9 months following the intervention , and 21 months following the intervention .


This study aims to reduce disparities in asthma outcomes among African American and Latino/Hispanic children through cross-cultural communication training of their physicians and assessing the added value of this training compared to general communication .


The results of this study will provide important information about the value of cross-cultural training in helping to address persistent racial disparities in outcomes .


ClinicalTrials.gov : NCT01251523 December 1 , 2010 .


Isothiocyanates in cruciferous vegetables modulate signaling pathways critical to carcinogenesis , including nuclear factor kappa-light-chain-enhancer of activated B cells ( NF-B ) , a central regulator of inflammation .


Glutathione S-transferase ( GST ) M1 and GSTT1 metabolize isothiocyanates ; genetic variants may result in differences in biologic response .


The objective of this study was to test whether consumption of cruciferous or cruciferous plus apiaceous vegetables altered serum concentrations of interleukin ( IL ) -6 , IL-8 , C-reactive protein ( CRP ) , tumor necrosis factor ( TNF ) , and soluble TNF receptor ( sTNFR ) I and II , and whether this response was GSTM1/GSTT1 genotype dependent .


In a randomized crossover trial , healthy men ( n = 32 ) and women ( n = 31 ) aged 20-40 y consumed 4 14-d controlled diets : basal ( vegetable-free ) , single-dose cruciferous ( 1xC ) [ 7 g vegetables/kg body weight ( BW ) ] , double-dose cruciferous ( 2xC ) ( 14 g/kg BW ) , and cruciferous plus apiaceous ( carrot family ) ( 1xC + A ) vegetables ( 7 and 4 g/kg BW , respectively ) , with a 21-d washout period between each intervention .


Urinary isothiocyanate excretion was also evaluated as a marker of systemic isothiocyanate exposure .


Fasting morning blood and urine samples were collected on days 0 and 14 and analyzed .


IL-6 concentrations were significantly lower on day 14 of the 2xC and 1xC + A diets than with the basal diet [ -19 % ( 95 % CI : -30 % , -0.1 % ) and -20 % ( 95 % CI : -31 % , -0.7 % ) , respectively ] .


IL-8 concentrations were higher after the 1xC + A diet ( +16 % ; 95 % CI : 4.2 % , 35.2 % ) than after the basal diet .


There were no effects of diet on CRP , TNF - , or sTNFRI or II .


There were significant differences between GSTM1-null/GSTT1 + individuals for several biomarkers in response to 1xC + A compared with basal diets ( CRP : -37.8 % ; 95 % CI : -58.0 % , -7.4 % ; IL-6 : -48.6 % ; 95 % CI : -49.6 % , -12.0 % ; IL-8 : 16.3 % ; 95 % CI : 6.7 % , 57.7 % ) and with the 2xC diet compared with the basal diet ( IL-8 : -33.2 % ; 95 % CI : -43.0 % , -1.4 % ; sTNFRI : -7.5 % ; 95 % CI : -12.7 % , -2.3 % ) .


There were no significant reductions in biomarker concentrations in response to diet among GSTM1 + / GSTT1 + or GSTM1-null/GSTT1-null individuals .


Twenty-four-hour urinary isothiocyanate excretion was not associated with any of the inflammation markers overall ; however , IL-6 was inversely associated with total isothiocyanate excretion in GSTM1-null/GSTT1-null individuals ( = -0.12 ; 95 % CI : -0.19 , -0.05 ) .


In this young , healthy population , consumption of cruciferous and apiaceous vegetables reduced circulating IL-6 ; however , results for other biomarkers of inflammation were not consistent .


Frailty is a highly prevalent condition in old age leading to vulnerability and greater risk of adverse health outcomes and disability .


Detecting and tackling frailty at an early stage can prevent disability .


The purpose of this study is to evaluate the effectiveness of a multifactorial intervention program to modify frailty parameters , muscle strength , and physical and cognitive performance in people aged 65 years or more .


It also assesses changes from baseline in falls , hospitalizations , nutritional risk , disability , institutionalization , and home-care .


The current study is a randomised single-blind , parallel-group clinical trial , with a one and a half year follow-up , conducted in eight Primary Health Care Centres located in the city of Barcelona .


Inclusion criteria are to be aged 65 years or older with positive frailty screening , timed get-up-and-go test between 10 to 30 seconds , and Cognition Mini-Exam ( MEC-35 ) of Lobo greater than or equal to 18 .


A total of 352 patients have been equally divided into two groups : intervention and control .


Sample size calculated to detect a 0.5 unit difference in the Short Physical Performance Battery ( Common SD : 1.42 , 20 % lost to follow-up ) .


In the intervention group three different actions on frailty dimensions : rehabilitative therapy plus intake of hyperproteic nutritional shakes , memory workshop , and medication review are applied to sets of 16 patients .


Participants in both intervention and control groups receive recommendations on nutrition , healthy lifestyles , and home risks.Evaluations are blinded and conducted at 0 , 3 , and 18 months .


Intention to treat analyses will be performed .


Multivariate analysis will be carried out to assess time changes of dependent variables .


It is expected that this study will provide evidence of the effectiveness of a multidisciplinary intervention on delaying the progression from frailty to disability in the elderly .


It will help improve the individual 's quality of life and also reduce the rates of falls , hospital admissions , and institutionalizations , thus making the health care system more efficient .


This preventive intervention can be adapted to diverse settings and be routinely included in Primary Care Centres as a Preventive Health Programme .


ClinicalTrials.gov PRS : NCT01969526 .


Date of registration : 10/21/2013 .


According to a recent report from the European Brain Council and the European Colleague of Neuropsychopharmacology the one year prevalence of some kind of mental disorder is around 27 % among the adult population in Europe .


Research has shown a lack of mental health literacy in the population in general and it is thus important to find ways to improve the public 's knowledge and skills to provide first hand support to people with mental disorders .


Mental Health First Aid ( MHFA ) is a training program that has shown positive changes in knowledge and helping behavior .


This study investigates if MHFA training in a Swedish context provides a sustained improvement in knowledge about mental disorders , a better ability to be helpful in contacts with people who are ill and if it changes attitudes in a positive direction .


The introduction of the training program was made in accordance with the constructor 's instructions .


Participants were mainly public sector employees from a county in the west of Sweden .


The study was a randomized controlled trial with an experiment group ( n = 199 ) and a control group ( n = 207 ) placed on a waiting list during a 6-month follow-up .


A two-year follow-up was conducted for participants ( n = 155 ) from both the intervention and waiting list group who had completed the training and during the follow-up been in contact with persons with mental disorders .


The intervention group improved in knowledge as well as in confidence in providing help for someone in need .


The two-year follow-up showed that the improvements were to a great extent maintained .


Mental Health First Aid might raise the level of awareness of mental disorders and have an influence on the number of people who can receive professional treatment for their problems .


Olive oil ( OO ) consumption is associated with cardiovascular disease prevention because of both its oleic acid and phenolic contents .


The capacity of OO phenolics to protect against low-density lipoprotein ( LDL ) oxidation is the basis for a health claim by the European Food Safety Authority .


Proteomic biomarkers enable an early , presymptomatic diagnosis of disease , which makes them important and effective , but understudied , tools for primary prevention .


We evaluated the impact of supplementation with OO , either low or high in phenolics , on urinary proteomic biomarkers of coronary artery disease ( CAD ) , chronic kidney disease ( CKD ) , and diabetes .


Self-reported healthy participants ( n = 69 ) were randomly allocated ( stratified block random assignment ) according to age and body mass index to supplementation with a daily 20-mL dose of OO either low or high in phenolics ( 18 compared with 286 mg caffeic acid equivalents per kg , respectively ) for 6 wk .


Urinary proteomic biomarkers were measured at baseline and 3 and 6 wk alongside blood lipids , the antioxidant capacity , and glycation markers .


The consumption of both OOs improved the proteomic CAD score at endpoint compared with baseline ( mean improvement : -0.3 for low-phenolic OO and -0.2 for high-phenolic OO ; P < 0.01 ) but not CKD or diabetes proteomic biomarkers .


However , there was no difference between groups for changes in proteomic biomarkers or any secondary outcomes including plasma triacylglycerols , oxidized LDL , and LDL cholesterol .


In comparison with low-phenolic OO , supplementation for 6 wk with high-phenolic OO does not lead to an improvement in cardiovascular health markers in a healthy cohort .


Non-steroidal anti-inflammatory drugs ( NSAIDs ) may cause gastrointestinal damage in dogs .


To determine the extent to which lansoprazole , liquorice extract , and a herbal solution exhibit protective effects on colonic mucosa when administered to dogs concurrently with the NSAIDs carprofen or robenacoxib .


Thirty-five healthy beagle dogs ( 15 male and 20 female ) aged 13-14 weeks and weighing 4.3-5 .5 kg at the beginning of the experiment were included .


Endoscopy and biopsy of the caudal gastrointestinal tract were performed pretreatment and on the last day of a 21-day treatment period with ( 1 ) oral carprofen ; ( 2 ) carprofen and the proton-pump inhibitor lansoprazole ; ( 3 ) carprofen , liquorice extract , and a herbal solution that contained extracts of thyme , icelandic lichen , hyssop , and saponariae root ; ( 4 ) robenacoxib ; ( 5 ) robenacoxib and lansoprazole ; ( 6 ) robenacoxib , liquorice extract , and herbal solution ; or ( 7 ) an empty gelatin capsule .


Statistical analyses were performed with the Kruskal-Wallis , Cochran 's Q , and chi-squared test with p < 0.05 considered significant .


Both carprofen and robenacoxib tested damaged the colonic mucosa with most severe microscopic lesions following administration of robenacoxib with lansoprazole .


The risk of histopathological lesions in the colon increased most rapidly in robenacoxib with lansoprazole ( absolute risk increase -0.85 ) similar to robenacoxib only ( -0.75 ) , whereas the best result was recorded following the plant remedies together with carprofen ( -0.15 ) and the plant remedies together with robenacoxib ( -0.2 ) .


Concurrent administration of liquorice extract and an herbal solution with robenacoxib was associated with decreased severity of the NSAID-induced mucosal lesions .


To compare 2 different training paradigms , massed vs interval training , when novice students learn a surgical procedure , myringotomy with ventilation tube insertion , on a validated surgical simulator .


Medical students were randomized into 2 training groups : the interval group ( n = 19 ) was trained to perform the procedure in 5 trials/d over 3 days , and the massed group ( n = 21 ) was trained to perform the procedure in 15 trials all in 1 session .


One week later , all students were tested in 5 additional final trials .


Pre - and posttest surveys were administered .


Academic medical center .


Forty medical students : 19 students in the interval group were compared with 21 students in the massed group .


Time to complete the procedure and number and type of error made were recorded and compared between groups .


Pre - and poststudy surveys examined confidence levels working under a microscope and with the procedure .


Students in both groups had a significant decrease in time between practice and final trials .


In the final 5 trials , there was no difference in average time to complete the procedure between the massed and interval training groups .


No difference was observed in the number of errors committed per trial between initial and final trials ( both groups ) or between massed and interval training groups .


The students ' confidence levels significantly increased across the trials , regardless of group .


Surgical training improves proficiency , but method of training had little impact on proficiency in performing a simulated surgical procedure in this setting .


The incretin hormone , glucagon-like peptide-1 , promotes myocardial glucose uptake and may improve myocardial tolerance to ischemia .


Endogenous glucagon-like peptide-1 ( 7-36 ) is augmented by pharmacological inhibition of dipeptidyl peptidase-4 .


We investigated whether chronic dipeptidyl peptidase-4 inhibition by sitagliptin protected against ischemic left ventricular dysfunction during dobutamine stress in patients with type 2 diabetes mellitus and coronary artery disease .


A total of 19 patients with type 2 diabetes mellitus underwent dobutamine stress echocardiography with tissue Doppler imaging on 2 separate occasions : the first ( control ) while receiving oral hypoglycemic agents , and the second after the addition of sitagliptin ( 100 mg once daily ) for 4 weeks .


Sitagliptin increased plasma glucagon-like peptide-1 ( 7-36 ) levels and , at peak stress , enhanced both global ( ejection fraction , 70.57.0 versus 65.78.0 % ; P < 0.0001 ; mitral annular systolic velocity , 11.72.6 versus 10.92.3 cm/s ; P = 0.01 ) and regional left ventricular function , assessed by peak systolic velocity and strain rate in 12 paired , nonapical segments .


This was predominantly because of a cardioprotective effect on ischemic segments ( strain rate in ischemic segments , -2.270.65 versus -1.980.58 s ( -1 ) ; P = 0.001 ) , whereas no effect was seen in nonischemic segments ( -2.190.48 versus -2.180.54 s ( -1 ) ; P = 0.87 ) .


At 30 minutes recovery , dipeptidyl peptidase-4 inhibition mitigated the postischemic stunning seen in the control scan .


The addition of dipeptidyl peptidase-4 inhibitor therapy with sitagliptin to the treatment regime of patients with type 2 diabetes mellitus and coronary artery disease is associated with a sustained improvement in myocardial performance during dobutamine stress and a reduction in postischemic stunning .


URL : http://www.isrctn.org .


Unique identifier ISRCTN61646154 .


Several reports have investigated amino acid administration in premature infants during the early postnatal phase .


Most of these previous studies , however , have only evaluated short-term in-hospital outcomes .


Our aim was to describe long-term outcomes in premature infants previously subjected to different nutritional regimens in a randomized controlled trial .


The primary outcome was survival without major disabilities , and the secondary outcomes included anthropometry and mental development .


Infants born < 32 weeks ' gestation and < 1500 g were randomized to receive glucose ( n = 69 ) or glucose with 2.4 g kg ( -1 ) day ( -1 amino acids ) ( n = 63 ) from birth .


From postnatal day 3 onward , the nutritional intake was similar .


At 2 years of corrected age , the surviving infants were assessed for neurodevelopmental outcome and anthropometry .


Ninety-seven percent of the surviving infants were examined at follow-up , with no overall effect on survival without major disabilities .


Boys , however , had a normal outcome significantly more often if amino acids were administered from birth onward ( crude odds ratio 3.8 , 95 % confidence interval 1.3-11 .4 ) and following adjustment for confounders ( odds ratio 6.2 , 95 % confidence interval 1.0-38 .0 ) .


The secondary outcomes exhibited no differences in anthropometric data .


The mental developmental index was lower in the small number of girls who survived without major disabilities following the early administration of amino acids .


In this hypothesis-generating outcome study , premature boys , but not girls , benefited from amino acid administration directly following birth .


The observed lower mental developmental index in a subgroup of girls , however , warrants further studies .


Exercise may improve psychosocial distress in patients with cancer ; however , few studies have examined the effects of different types or doses of exercise , or whether exercise effects are related to baseline depression levels .


In a multicenter trial in Canada , we randomized 301 patients with breast cancer initiating chemotherapy to thrice weekly , supervised exercise consisting of either a standard dose of 25 to 30 minutes of aerobic exercise ( STAN ; n = 96 ) , a higher dose of 50 to 60 minutes of aerobic exercise ( HIGH ; n = 101 ) , or a combined dose of 50 to 60 minutes of aerobic and resistance exercise ( COMB ; n = 104 ) .


The primary endpoint was depression assessed by the Center for Epidemiological Studies-Depression scale at baseline , twice during chemotherapy , and postchemotherapy .


Secondary endpoints were anxiety , perceived stress , and self-esteem .


Repeated measures ANOVA indicated that neither HIGH [ mean difference = -0.9 ; 95 % confidence interval ( CI ) , +0.0 to -1.8 ; P = 0.061 ] nor COMB ( mean difference = -0.4 ; 95 % CI , +0.5 to -1.3 ; P = 0.36 ) was superior to STAN for managing depressive symptoms .


In a planned subgroup analysis , there was a significant interaction with baseline depression levels ( P interaction = 0.027 ) indicating that COMB and HIGH were effective for managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline .


Compared with a standard volume of aerobic exercise , higher volumes of exercise did not help manage depressive symptoms in unselected patients with breast cancer receiving chemotherapy , but they were effective in patients with clinical levels of depressive symptoms at baseline .


A phase III exercise trial targeting depressed patients with breast cancer is warranted .


To investigate the topical effect of dorzolamide versus ketorolac on retinitis pigmentosa ( RP ) and Usher 's syndrome ( US ) macular edema .


Prospective , randomized and interventional study .


A total of 28 eyes of 18 patients were included .


Five eyes had US , 23 had RP .


Fifteen eyes were allocated to ketorolac tromethamine 0.5 % ( 4 drops daily regimen ) and 13 eyes to dorzolamide hydrochloride 2 % ( 3 drops daily regimen ) treatment groups .


Snellen 's best-corrected visual acuity ( BCVA ) , foveal thickness ( FT ) and foveal zone thickness ( FZT ) measured by Stratus optical coherence tomography ( OCT ) were evaluated at baseline , 1 , 3 , 6 and 12 months after treatment .


Patients assigned to ketorolac had a baseline BCVA of 0.37 0.17 logMAR which improved at the end of 1 year to 0.28 0.16 ( p = 0.02 ) .


Three eyes ( 20 % ) of 2 patients improved by 7 letters or more .


Mean FT and FZT did not change significantly during the study follow-up .


After 1 year of treatment , 4 eyes ( 27 % ) of 3 patients showed an improvement of at least 16 % of FT and 11 % of FZT .


Patients assigned to dorzolamide had a baseline BCVA of 0.48 0.34 logMAR which improved in the first 6 months ( 0.40 0.30 ; p = 0.01 ) , with a decrease at 1 year ( 0.42 0.27 ; p = 0.20 ) .


Seven eyes ( 54 % ) of 5 patients had an improvement of 7 letters or more .


Mean FT and FZT did not change significantly either .


After 1 year of treatment , 3 eyes ( 23 % ) of 2 patients showed an improvement of at least 16 % on FT and 11 % on FZT .


RESULTS suggest that dorzolamide and ketorolac might improve visual acuity and therefore be of interest in selected cases .


No relationship between retinal thickness fluctuation and visual acuity was found .


Sample size was a limitation to the study .


Public health research on sedentary behavior ( SB ) in youth has heavily relied on accelerometers .


However , it has been limited by the lack of consensus on the most accurate accelerometer cut-points as well as by unknown effects caused by accelerometer position ( wrist vs. hip ) and output ( single axis vs. multiple axes ) .


The present study systematically evaluates classification accuracy of different Actigraph cut-points for classifying SB using hip and wrist-worn monitors and establishes new cut-points to enable use of the 3-dimensional vector magnitude data ( for both hip and wrist placement ) .


A total of 125 children ages 7-13 yrs performed 12 randomly selected activities ( from a set of 24 different activities ) for 5 min each while wearing tri-axial Actigraph accelerometers on both the hip and wrist .


The accelerometer data were categorized as either sedentary or non-sedentary minutes using six previously studied cut-points : 100 counts-per-minute ( CPM ) , 200 CPM , 300 CPM , 500 CPM , 800 CPM and 1100 CPM .


Classification accuracy was evaluated with Cohen 's Kappa ( ) and new cut-points were identified from Receiver Operating Characteristic ( ROC ) .


Of the six cut-points , the 100 CPM value yielded the highest classification accuracy ( = 0.81 ) for hip placement .


For wrist placement , all of the cut-points produced low classification accuracy ( ranges of from 0.44 to 0.67 ) .


Optimal sedentary cut-points derived from ROC were 554.3 CPM ( ROC-AUC of 0.99 ) for vector magnitude for hip , 1756 CPM ( ROC-AUC of 0.94 ) for vertical axis for wrist , and 3958.3 CPM ( ROC-AUC of 0.93 ) for vector magnitude for wrist placement .


The 100 CPM was supported for use with vertical axis for hip placement , but not for wrist placement .


The ROC-derived cut-points can be used to classify youth SB with the wrist and with vector magnitude data .


Fractional non-ablative lasers keep the epidermis intact , while fractional ablative lasers remove it , making them theoretically more effective .


To evaluate the clinical and histological alterations induced by fractional photothermolysis for treating photoaging , comparing the possible equivalence of multiple sessions of 1540nm Erbium , to one session of 2940nm Erbium .


Eighteen patients ( mean age 55.9 ) completed the treatment with three sessions of 1540nm fractional Erbium laser on one side of the face ( 50 mJ/mB , 15ms , 2 passes ) , and one session of 2940nm on the other side ( 5mJ/mB , 0.25 ms , 2 passes ) .


Biopsies were performed before and 3 months after treatment .


Clinical , histological and morphometric evaluations were carried out .


All patients presented clinical improvement with no statistically significant difference ( p > 0.05 ) between the treated sides .


Histopathology revealed a new organization of collagen and elastic fibers , accompanied by edema , which was more evident with the 2940nm laser .


This finding was confirmed by morphometry , which showed a decrease in collagen density for both treatments , with a statistical significance for the 2940nm laser ( p > 0.001 ) .


Three 1540nm sessions were clinically equivalent to one 2940nm session .


The edema probably contributed to the positive results after three months , togheter with the new collagen and elastic fibers organization .


The greater edema after the 2940nm session indicates that dermal remodeling takes longer than with 1540nm .


It is possible that this histological superiority relates to a more prolonged effect , but a cohort longer than three months is needed to confirm that supposition .


We examine effects of school support as a structural HIV prevention intervention for adolescent female orphans in Zimbabwe after 5years .


Three hundred twenty-eight orphan adolescent girls were followed in a clustered randomized controlled trial from 2007 to 2010 .


The experimental group received school fees , uniforms , and school supplies and were assigned a school-based `` helper . ''


In 2011-2012 , the control group received delayed partial treatment of school fees only .


At the final data point in 2012 , survey , HIV , and Herpes Simplex Virus Type 2 ( HSV-2 ) biomarker data were collected from approximately 88 % of the sample .


Bivariate and multivariate analyses were conducted on end point outcomes , controlling for age , religious affiliation , and baseline socioeconomic status .


The two groups did not differ on HIV or HSV-2 biomarkers .


The comprehensive 5-year intervention continued to reduce the likelihood of marriage , improve school retention , improve socioeconomic status ( food security ) , and marginally maintain gains in quality of life , even after providing school fees to the control group .


Paying school fees and expenses resulted in significant improvements in life outcomes for orphan adolescent girls .


Biological evidence of HIV infection prevention , however , was not observed .


Our study adds to the growing body of research on school support as HIV prevention for girls in sub-Saharan Africa , but as yet , no clear picture of effectiveness has emerged .


Elevated plasma homocysteine concentrations are a risk factor for osteoporotic fractures .


Lowering homocysteine with combined vitamin B-12 and folic acid supplementation may reduce fracture risk .


This study [ B-vitamins for the PRevention Of Osteoporotic Fractures ( B-PROOF ) ] aimed to determine whether vitamin B-12 and folic acid supplementation reduces osteoporotic fracture incidence in hyperhomocysteinemic elderly individuals .


This was a double-blind , randomized , placebo-controlled trial in 2919 participants aged 65 y with elevated homocysteine concentrations ( 12-50 mol/L ) .


Participants were assigned to receive daily 500 g vitamin B-12 plus 400 g folic acid or placebo supplementation for 2 y. Both intervention and placebo tablets also contained 600 IU vitamin D3 .


The primary endpoint was time to first osteoporotic fracture .


Exploratory prespecified subgroup analyses were performed in men and women and in individuals younger than and older than age 80 y. Data were analyzed according to intention-to-treat and per-protocol principles .


Osteoporotic fractures occurred in 61 persons ( 4.2 % ) in the intervention group and 75 persons ( 5.1 % ) in the placebo group .


Osteoporotic fracture risk was not significantly different between groups in the intention-to-treat analyses ( HR : 0.84 ; 95 % CI : 0.58 , 1.21 ) or per-protocol analyses ( HR : 0.81 ; 95 % CI : 0.54 , 1.21 ) .


For persons aged > 80 y , in per-protocol analyses , osteoporotic fracture risk was lower in the intervention group than in the placebo group ( HR : 0.27 ; 95 % CI : 0.10 , 0.74 ) .


The total number of adverse events ( including mortality ) did not differ between groups .


However , 63 and 42 participants in the intervention and placebo groups , respectively , reported incident cancer ( HR : 1.56 ; 95 % CI : 1.04 , 2.31 ) .


These data show that combined vitamin B-12 and folic acid supplementation had no effect on osteoporotic fracture incidence in this elderly population .


Exploratory subgroup analyses suggest a beneficial effect on osteoporotic fracture prevention in compliant persons aged > 80 y. However , treatment was also associated with increased incidence of cancer , although the study was not designed for assessing cancer outcomes .


Therefore , vitamin B-12 plus folic acid supplementation can not be recommended at present for fracture prevention in elderly people .


The B-PROOF study was registered with the Netherlands Trial Register ( trialregister.nl ) as NTR1333 and at clinicaltrials.gov as NCT00696414 .


To assess the role of migraine history in the development of postoperative nausea and vomiting ( PONV ) in patients undergoing general and combined general-epidural anaesthesia .


127 women with oncogynecological pathology were randomized into 3 groups according to anaesthesia method .


Patients of the group C ( comparative group ; n = 43 ; 18 with migraine ) received general anaesthesia .


Patients of the Group CA ( n = 40 ; 19 with migraine ) received combined general-epidural anaesthesia .


Patients of the group D ( n = 44 ; 19 with migraine ) received general anaesthesia with adding of Droperidolum .


All patients received standard prophylactics of PONV - Ondansetronum 8 mg and dexamethasone 8 mg intravenous .


In the group C a PONV occurred in 15 of 43 women ( 34.9 % ) .


PONV occurred in 6 of 18 women with migraine ( 33.3 % ) and in 9 of 25 women without migraine ( 36 % ) .


In the group CA a PONV occurred in 10 of 40 women ( 25 % ) .


PONV occurred in 8 of 19 women with migraine ( 42.1 % ) and in 2 of 21 women without migraine ( 9.5 % ; p = 0.036 in comparison with group C ) .


In the group D a PONV occurred in 8 of 44 women ( 18.2 % ) .


PONV occurred in 1 of 19 women with migraine ( 5.3 % p = 0.03 in comparison with group C and p = 0.008 with group CA ) and in 7 of 25 women without migraine ( 28 % ; there was no significant difference with groups C and CA ) .


Migraine history is a significant risk factor of PONV .


Epidural component of anaesthesia does not effect on frequency of PONV in women with migraine , but Droperidolum use allows increasing the frequency of PONV .


Mobile technologies have wide-scale reach and disseminability , but no known studies have examined mobile technologies as a stand-alone tool to improve obesity-related behaviors of at-risk youth .


To test a 12-week mobile technology intervention for use and estimate effect sizes for a fully powered trial .


Fifty-one low-income , racial/ethnic-minority girls aged 9-14 years were randomized to a mobile technology ( n = 26 ) or control ( n = 25 ) condition .


Both conditions lasted 12 weeks and targeted fruits/vegetables ( FVs ; Weeks 1-4 ) ; sugar-sweetened beverages ( SSBs ; Weeks 5-8 ) , and screen time ( Weeks 9-12 ) .


The mobile intervention prompted real-time goal setting and self-monitoring and provided tips , feedback , and positive reinforcement related to the target behaviors .


Controls received the same content in a written manual but no prompting .


Outcomes included device utilization and effect size estimates of FVs , SSBs , screen time , and BMI .


Data were collected and analyzed in 2011-2012 .


Mobile technology girls used the program on 63 % of days and exhibited trends toward increased FVs ( +0.88 , p = 0.08 ) and decreased SSBs ( -0.33 , p = 0.09 ) .


The adjusted difference between groups of 1.0 servings of FVs ( p = 0.13 ) and 0.35 servings of SSBs ( p = 0.25 ) indicated small to moderate effects of the intervention ( Cohen 's d = 0.44 and -0.34 , respectively ) .


No differences were observed for screen time or BMI .


A stand-alone mobile app may produce small to moderate effects for FVs and SSBs .


Given the extensive reach of mobile devices , this pilot study demonstrates the need for larger-scale testing of similar programs to address obesity-related behaviors in high-risk youth .


Preliminary studies have suggested the efficacy of sublingual tablets of house dust mite ( HDM ) extracts in adults with allergic rhinitis .


We sought to assess the efficacy and safety of 2 doses of HDM sublingual tablets over 1 treatment year and the subsequent immunotherapy-free year .


Adults with HDM-associated allergic rhinitis were randomized in a double-blind , placebo-controlled study to receive 500 index of reactivity ( IR ) tablets , 300IR tablets , or placebo administered once daily for 1 year and were followed for the subsequent year .


The primary efficacy variable was the Average Adjusted Symptom Score over the year 1 primary period ( ie , October 1 to December 31 ) .


Symptoms and rescue medication scores , onset of action , patient-reported outcomes , and safety were secondary variables .


The same end points were evaluated during the immunotherapy-free year .


The primary efficacy end point was analyzed by using analysis of covariance .


Five hundred nine participants were randomized , and 427 continued in the immunotherapy-free year .


Both the 500IR and 300IR HDM sublingual tablets significantly reduced mean Average Adjusted Symptom Scores compared with placebo by -20.2 % ( P = .0066 ) and -17.9 % ( P = .0150 ) , respectively .


Efficacy of both doses was maintained during the treatment-free follow-up phase .


The onset of action was at 4 months .


Participants ' global evaluation of treatment success was significantly higher in the 500IR and 300IR groups compared with the placebo group ( P = .0206 and P = .0001 , respectively ) .


Adverse events were generally application-site reactions .


There were no reports of anaphylaxis .


Twelve months of treatment with 500IR and 300IR sublingual tablets of HDM allergen extracts was efficacious and well tolerated .


Efficacy was maintained during the treatment-free follow-up year .


Advanced imaging may refine patient selection for ischemic stroke treatment but delays to acquire and process the imaging have limited implementation .


We examined the feasibility of imaging selection in clinical practice using fully automated software in the EXTEND trial program .


CTP and perfusion-diffusion MRI data were processed using fully-automated software to generate a yes/no ` mismatch ' classification that determined eligibility for trial therapies .


The technical failure/mismatch classification error rate and time to image and treat with CT vs. MR-based selection were examined .


In a consecutive series of 776 patients from five sites over six-months the technical failure rate of CTP acquisition/processing ( uninterpretable maps ) was 34 % ( 26/776 , 95 % CI 22-49 % ) .


Mismatch classification was overruled by expert review in an additional 90 % ( 70/776 , 95 % CI 71-113 % ) due to artifactual ` perfusion lesion ' .


In 154 consecutive patients at one site , median additional time to acquire CTP after non-contrast CT was 65min .


Subsequent RAPID processing time varied from 3-10min across 20 trial centers ( median 5min 20s ) .


In the EXTEND trial , door-to-needle times in patients randomized on the basis of CTP ( n = 47 ) were median 78min shorter than MRI-selected ( n = 16 ) patients ( P < 0001 ) .


Automated CTP-based mismatch selection is rapid , robust in clinical practice , and associated with faster treatment decisions than MRI .


This technological advance has the potential to improve the standardization and reproducibility of interpretation of advanced imaging and extend use to practice settings beyond highly specialized academic centers .


home visits and telephone calls are two often used approaches in transitional care , but their differential economic effects are unknown .


to examine the differential economic benefits of home visits with telephone calls and telephone calls only in transitional discharge support .


cost-effectiveness analysis conducted alongside a randomised controlled trial ( RCT ) .


patients discharged from medical units randomly assigned to control ( control , N = 210 ) , home visits with calls ( home , N = 196 ) and calls only ( call , N = 204 ) .


cost-effectiveness analyses were conducted from the societal perspective comparing monetary benefits and quality-adjusted life years ( QALYs ) gained .


the home arm was less costly but less effective at 28 days and was dominating ( less costly and more effective ) at 84 days .


The call arm was dominating at both 28 and 84 days .


The incremental QALY for the home arm was -0.0002 / 0.0008 ( 28/84 days ) , and the call arm was 0.0022 / 0.0104 ( 28/84 days ) .


When the three groups were compared , the call arm had a higher probability being cost-effective at 84 days but not at 28 days ( home : 53 % , call : 35 % ( 28 days ) versus home : 22 % , call : 73 % ( 84 days ) ) measuring against the NICE threshold of 20,000 .


the original RCT showed that the bundled intervention involving home visits and calls was more effective than calls only in the reduction of hospital readmissions .


This study adds a cost perspective to inform policymakers that both home visits and calls only are cost-effective for transitional care support , but calls only have a higher chance of being cost-effective for a sustained period after intervention .


We conducted a phase 1 trial in patients with locally advanced cervical cancer by injecting 0.5 ml of the CK2-antagonist CIGB-300 in two different sites on tumours to assess tumour uptake , safety , pharmacodynamic activity and identify the recommended dose .


Fourteen patients were treated with intralesional injections containing 35 or 70 mg of CIGB-300 in three alternate cycles of three consecutive days each before standard chemoradiotherapy .


Tumour uptake was determined using ( 99 ) Tc-radiolabelled peptide .


In situ B23/nucleophosmin was determined by immunohistochemistry .


Maximum tumour uptake for CIGB-300 70-mg dose was significantly higher than the one observed for 35 mg : 16.1 8.9 vs 31.3 12.9 mg ( P = 0.01 ) .


Both , AUC24h and biological half-life were also significantly higher using 70 mg of CIGB-300 ( P < 0.001 ) .


Unincorporated CIGB-300 diffused rapidly to blood and was mainly distributed towards kidneys , and marginally in liver , lungs , heart and spleen .


There was no DLT and moderate allergic-like reactions were the most common systemic side effect with strong correlation between unincorporated CIGB-300 and histamine levels in blood .


CIGB-300 , 70 mg , downregulated B23/nucleophosmin ( P = 0.03 ) in tumour specimens .


Intralesional injections of 70 mg CIGB-300 in two sites ( 0.5 ml per injection ) and this treatment plan are recommended to be evaluated in phase 2 studies .


To determine whether circular plastic wound edge protectors ( CWEPs ) significantly reduce the rate of surgical site infections ( SSIs ) in comparison to standard surgical towels in patients undergoing laparotomy .


SSIs cause substantial morbidity , prolonged hospitalization , and costs and remain one of the most frequent surgical complications .


CWEPs have been proposed as a measure to reduce the incidence of SSIs .


In this randomized controlled , multicenter , 2-arm , parallel-group design , patient - and observer-blinded trial patients undergoing open elective abdominal surgery were assigned to either intraoperative wound coverage with a CWEP or standard coverage with surgical towels .


Primary endpoint was superiority of intervention over control in terms of the incidence of SSIs within a 30-day postoperative period .


Between September 2010 and November 2012 , 608 patients undergoing laparotomy were randomized at 16 centers across Germany .


Three patients in the device group and 11 patients in the control group did not undergo laparotomy .


Patients ' and procedural characteristics were well balanced between the 2 groups .


Forty-eight patients discontinued the study prematurely , mainly because of relaparotomy ( control , n = 9 ; intervention , n = 9 ) and death ( control , n = 4 ; intervention , n = 7 ) .


A total of 79 patients experienced SSIs within 30 days of surgery , 27 of 274 ( 9.9 % ) in the device group and 52 of 272 ( 19.1 % ) in the control group ( odds ratio = 0.462 , 95 % confidence interval : 0.281-0 .762 ; P = 0.002 ) .


Subgroup analyses indicate that the effect could be more pronounced in colorectal surgery , and in clean-contaminated/contaminated surgeries .


Our trial shows that CWEPs are effective at reducing the incidence of SSIs in elective and clean or clean-contaminated open abdominal surgery .


To evaluate the curative effect of external application of the Chinese drug , Sanjierupi Gao , on mastalgia caused by mammary gland hyperplasia .


This randomized , double-blinded , and placebo controlled study enrolled 260 patients with mammary gland hyperplasia from five hospitals .


Patients were randomly and equally divided into a Sanjierupi Gao treatment group and a placebo control group .


An adhesive plaster was applied to the most painful area on either breast for 7 h a day .


Treatment lasted for two menstrual cycles without application during menstruation .


Mastalgia was used as the main index of curative effect .


The change before and after treatment in days of mastalgia , the time to alleviate pain , pain extent , and severe pain scores were observed .


Compared to the control group , the treatment group had significantly fewer days of mastalgia ( P < 0.01 ) , a significantly lower severe pain score ( P < 0.01 ) , and significantly less subjective pain and tenderness ( P < 0.05 and P < 0.01 , respectively ) .


Three days before the follow-up visit , the pain score in the treatment group was significantly lower than that in the control group ( P < 0.05 ) .


A non-parametric test was used to compare the time to alleviate mastalgia between the two groups and found no statistical difference ( Z = -0.313 , P = 0.754 ) .


Application of Sanjierupi Gao can decrease mastalgia duration in patients with mammary gland hyperplasia during menstruation and alleviate the extent of mastalgia .


The time to alleviate pain is psychologically influenced .


To compare the effect of two manual therapy techniques , mobilization with movement ( WB-MWM ) and talocrural manipulation ( HVLA ) , for the improvement of ankle dorsiflexion in people with chronic ankle instability ( CAI ) over 48 h.


Randomized controlled clinical trial .


University research laboratory .


Fifty-two participants ( mean SD age , 20.7 3.4 years ) with CAI were randomized to WB-MWM ( n = 18 ) , HVLA ( n = 19 ) or placebo group ( n = 15 ) .


Weight-bearing ankle dorsiflexion measured with the weight-bearing lunge .


Measurements were obtained prior to intervention , immediately after intervention , and 10 min , 24 h and 48 h post-intervention .


There was a significant effect time ( F4 ,192 = 20.65 ; P < 0.001 ) and a significant time group interactions ( F8 ,192 = 6.34 ; P < 0.001 ) .


Post hoc analysis showed a significant increase of ankle dorsiflexion in both WB-MWM and HVLA groups with respect to the placebo group with no differences between both active treatment groups .


A single application of WB-MWM or HVLA manual technique improves ankle dorsiflexion in people with CAI , and the effects persist for at least two days .


Both techniques have similar effectiveness for improving ankle dorsiflexion although WB-MWM demonstrated greater effect sizes .


This cross-sectional study examined whether growth parameters were associated with epilepsy in children living in a rural community in sub-Saharan Africa ( SSA ) .


A cross-sectional study was performed in the Hai District Demographic Surveillance Site ( HDSS ) , Tanzania in which 6-14 year old children with epilepsy ( CWE ) were identified .


Age matched controls were randomly selected from the Hai census database for comparison .


Anthropometric measurements were used to assess the nutritional status of the children and body mass index ( BMI ) calculated .


Associations between social , demographic and nutritional factors and epilepsy were assessed using multivariable logistic regression .


112 CWE were identified and were compared with 113 controls .


There was no significant difference in the BMI between cases and controls ( T-test , p-value of 0.117 ) .


Amongst cases , there were no significant associations between BMI and motor difficulties , antiepileptic drug use , cognitive or behavioural problems , early-onset epilepsy or seizure frequency .


In the whole group , BMI was significantly associated with socio-economic status ( p = 0.037 ) and age .


There was no significant difference found between CWE and matched controls with respect to nutritional status .


This suggests that there is no causal association between under nutrition and epilepsy in this community .


Nutritional assessment is still important as part of the comprehensive care of CWE .


The objective of this study was to evaluate the effects of an exercise program focusing on muscle stretching and endurance training on the 12-month incidence of low back pain ( LBP ) in office workers .


A 12-month prospective cluster-randomized controlled trial was conducted in healthy office workers with lower-than-normal trunk extension flexibility or trunk muscle endurance .


Healthy office workers ( n = 563 ) were randomly assigned at the cluster level into either intervention ( n = 282 ) or control ( n = 281 ) groups .


Participants in the intervention group received an exercise program that included daily stretching exercise and twice-a-week muscle endurance training .


Those in the control group received no intervention .


The 12-month incidence of LBP was the primary outcome .


Secondary outcome were pain intensity , disability level , and quality of life and health status .


Analyses were performed using the Cox proportional hazard models .


Over the 12-month follow-up , 8.8 % of participants in the intervention group and 19.7 % in the control group developed incidence of LBP .


Hazard rate ratios showed a protective effect of the exercise program for LBP ( HR = 0.37 , 95 % CI 0.22-0 .64 ) after adjusting for biopsychosocial factors .


There was no significant difference in pain intensity , disability , and quality of life and health status between those who reported incidence of LBP in the intervention and control groups .


An exercise program consisting of muscle stretching and endurance training is an effective intervention to reduce incident LBP for office workers with lower-than-normal trunk extension flexibility or trunk muscle endurance .


Surgical treatment for displaced proximal humeral fractures is widely used .


However , there are very few randomized controlled studies comparing surgical treatment to conservative treatment , and the evidence is debated .


The aim of this study was to describe patients with displaced proximal humeral fractures in a 2-years extension of a randomized controlled trial , their functional outcome and quality of life .


Patients from a single-center randomized controlled study of fifty patients aged 60 or above with displaced proximal humeral fracture ( AO/OTA group B2 or C2 ) were randomized to surgical or conservative treatment .


Surgery was performed with an angular stable implant .


The main outcome was Constant score at 2-year follow-up .


Secondary outcomes were an ASES self-assessment form , the 15D quality of life assessment and radiographs at 2 years .


A marked improvement of shoulder function and health-related quality of life for both surgically and conservatively treated patients occurs between 6 and 12 months .


Almost no change was observed between 1 and 2 year .


There were no significant differences between the two treatments at 2-year follow-up .


In this randomized controlled trial , surgical treatment proved no better results than conservative treatment for patients with displaced proximal humeral fracture at 2-year follow-up .


Workers without a permanent employment contract represent a vulnerable group within the working population .


Mental disorders are a major cause of sickness absence within this group .


Common mental disorders are stress-related , depressive and anxiety disorders .


To date , little attention has been paid to effective return to work interventions for this type of sick-listed workers .


Therefore , a participatory supportive return to work program has been developed .


It combines elements of a participatory return to work program , integrated care and direct placement in a competitive job.The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual .


The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months.The program strongly involves the sick-listed worker in the identification of obstacles for return to work and possible solutions , resulting in a consensus based action plan .


This plan will be used as a starting point for the search of suitable competitive employment with support of a rehabilitation agency .


During this process the insurance physician of the sick-listed worker contacts other caregivers to promote integrated care.Workers eligible to participate in this study have no permanent employment contract , have applied for a sickness benefit at the Dutch Social Security Agency and are sick-listed between two and fourteen weeks due to mental health problems.The primary outcome measure is the duration until first sustainable return to work in a competitive job .


Outcomes are measured at baseline and after three , six , nine and twelve months .


If the participatory supportive return to work program proves to be cost-effective , the social security system , the sick-listed worker and society as a whole will benefit .


A cost-effective return to work program will lead to a reduction of costs related to sickness absence .


For the sick-listed worker a cost-effective program results in earlier sustainable return to work , which can be associated with both social and health benefits .


The trial registration number and date is NTR3563 , August 7 , 2012 .


Mounting evidence suggests that high-fidelity mannequin-based ( HFMBS ) and computer-based simulation are useful adjunctive educational tools for advanced cardiac life support ( ACLS ) instruction .


We sought to determine whether access to a supplemental , online computer-based ACLS simulator would improve students ' performance on a standardized Mega Code using high-fidelity mannequin based simulation ( HFMBS ) .


Sixty-five third-year medical students were randomized .


Intervention group subjects ( n = 29 ) each received a two-week access code to the online ACLS simulator , whereas the control group subjects ( n = 36 ) did not .


Primary outcome measures included students ' time to initiate chest compressions , defibrillate ventricular fibrillation , and pace symptomatic bradycardia .


Secondary outcome measures included students ' subjective self-assessment of ACLS knowledge and confidence .


Students with access to the online simulator on average defibrillated ventricular fibrillation in 112 seconds , whereas those without defibrillated in 149.9 seconds , an average of 38 seconds faster [ p < .05 ] .


Similarly , those with access to the simulator paced symptomatic bradycardia on average in 95.14 seconds whereas those without access paced on average 154.9 seconds a difference of 59.81 seconds [ p < .05 ] .


On a subjective 5-point scale , there was no difference in self-assessment of ACLS knowledge between the control ( mean 3.3 ) versus intervention ( mean 3.1 ) [ p-value = .21 ] .


Despite having outperformed the control group subjects in the standardized Mega Code test scenario , the intervention group felt less confident on a 5-point scale ( mean 2.5 ) than the control group .


( mean 3.2 ) [ p < .05 ] .


The reduction in time to defibrillate ventricular fibrillation and to pace symptomatic bradycardia among the intervention group subjects suggests that the online computer-based ACLS simulator is an effective adjunctive ACLS instructional tool .


Studies comparing operative with nonoperative treatment of a stable burst fracture of the thoracolumbar junction in neurologically intact patients have not shown a meaningful difference at early follow-up .


To our knowledge , longer-term outcome data have not before been presented .


From 1992 to 1998 , forty-seven consecutive patients with a stable thoracolumbar burst fracture and no neurological deficit were evaluated and randomized to one of two treatment groups : operative treatment ( posterior or anterior arthrodesis ) or nonoperative treatment ( a body cast or orthosis ) .


We previously reported the results of follow-up at an average of forty-four months .


The current study presents the results of long-term follow-up , at an average of eighteen years ( range , sixteen to twenty-two years ) .


As in the earlier study , patients at long-term follow-up indicated the degree of pain on a visual analog scale and completed the Roland and Morris disability questionnaire , the Oswestry Disability Index ( ODI ) questionnaire , and the Short Form-36 ( SF-36 ) health survey .


Work and health status were obtained , and patients were evaluated radiographically .


Of the original operatively treated group of twenty-four patients , follow-up data were obtained for nineteen ; one patient had died , and four could not be located .


Of the original nonoperatively treated group of twenty-three patients , data were obtained for eighteen ; two patients had died , and three could not be located .


The average kyphosis was not significantly different between the two groups ( 13 for those who received operative treatment compared with 19 for those treated nonoperatively ) .


Median scores for pain ( 4 cm for the operative group and 1.5 cm for the nonoperative group ; p = 0.003 ) , ODI scores ( 20 for the operative group and 2 for the nonoperative group ; p < 0.001 ) and Roland and Morris scores ( 7 for the operative group and 1 for the nonoperative group ; p = 0.001 ) were all significantly better in the group treated nonoperatively .


Seven of eight SF-36 scores also favored nonoperative treatment .


While early analysis ( four years ) revealed few significant differences between the two groups , at long-term follow-up ( sixteen to twenty-two years ) , those with a stable burst fracture who were treated nonoperatively reported less pain and better function compared with those who were treated surgically .


To evaluate the role of sonography ( US ) in assessing hypopharyngeal carcinoma when compared with CT. .


A randomized prospective study was performed on 40 biopsy-proven cases of hypopharyngeal carcinoma.Contrast-enhanced CT of the neck was performed in all patients , followed by US .


Sonographic identification of any tumor extension into the extralaryngeal soft tissues , postcricoid space , subglottis , thyroid gland , esophagus , and across the midline was recorded .


US observations and CT findings were compared and then correlated with the histopathologic findings in 14 operative cases .


In the remaining 26 inoperable cases , US was compared only with CT. .


Our cohort was composed of 38 men and 2 women ranging in age from 36 to 59 years .


In a subset of 14 operative patients , US had a sensitivity of 71.4 % ( 10/14 ) , while CT achieved a sensitivity of 92.8 % ( 13/14 ) , and the difference was not statistically significant ( p > 0.05 ) .


US and CT findings concurred in 67.5 % ( 27/40 ) of cases .


Even though small tumors are difficult to visualize , US can play a significant role in the assessment of tumor extension within and beyond the larynx , especially when cross-sectional imaging is either unavailable or unaffordable .


We investigated the effects of the fatty acid-bile acid conjugate 3-arachidyl-amido , 7-12-dihydroxy , 5-cholan-24-oic acid ( Aramchol ; Trima Israel Pharmaceutical Products Ltd , Maabarot , Israel ) in a phase 2 trial of patients with nonalcoholic fatty liver disease ( NAFLD ) .


We performed a randomized , double-blind , placebo-controlled trial of 60 patients with biopsy-confirmed NAFLD ( 6 with nonalcoholic steatohepatitis ) at 10 centers in Israel .


Patients were given Aramchol ( 100 or 300 mg ) or placebo once daily for 3 months ( n = 20/group ) .


The main end point was the difference between groups in the change in liver fat content according to magnetic resonance spectroscopy .


The secondary end points focused on the differences between groups in alterations of liver enzyme levels , levels of adiponectin , homeostasis model assessment scores , and endothelial function .


No serious or drug-related adverse events were observed in the 58 patients who completed the study .


Over 3 months , liver fat content decreased by 12.57 % 22.14 % in patients given 300 mg/day Aramchol , but increased by 6.39 % 36.27 % in the placebo group ( P = .02 for the difference between groups , adjusted for age , sex , and body mass index ) .


Liver fat content decreased in the 100-mg Aramchol group , by 2.89 % 28.22 % , but this change was nonsignificant ( P = .35 ) , indicating a dose-response relationship ( P for trend = .01 ) .


Groups given Aramchol had nonsignificant improvements over time in endothelial function and levels of alanine aminotransferase and adiponectin , but homeostasis model assessment scores did not change .


The appropriateness of a single daily dose was confirmed by pharmacokinetic analysis .


Three months ' administration of the fatty acid-bile acid conjugate Aramchol is safe , tolerable , and significantly reduces liver fat content in patients with NAFLD .


The reduction in liver fat content occurred in a dose-dependent manner and was associated with a trend of metabolic improvements , indicating that Aramchol might be used for the treatment of fatty liver disease .


ClinicalTrials.gov number : NCT01094158 .


The 5-HT4 receptor agonist prucalopride is a prokinetic drug which improves colonic motility .


Animal data and in vitro studies suggest that prucalopride also affects gastric and esophageal motor function .


We aimed to assess the effect of prucalopride on gastric emptying , esophageal motility , and gastro-esophageal reflux in man .


In this double-blind , placebo-controlled , randomized , crossover study , we included 21 healthy volunteers who received 4mg prucalopride or placebo per day for 6days .


We performed high-resolution manometry ( HRM ) followed by 120-min HRM-pH-impedance monitoring after a standardized meal , ambulatory 24-h pH-impedance monitoring , and gastric emptying for solids .


Prucalopride decreased ( median [ IQR ] ) total acid exposure time ( 3.4 [ 2.5-5 .6 ] vs 1.7 [ 0.8-3 .5 ] % , p < 0.05 ) .


The total number of reflux events was unaffected by prucalopride , however , the number of reflux events extending to the proximal esophagus was reduced by prucalopride ( 15.5 [ 9.8-25 .5 ] vs 10.5 [ 5.3-17 .5 ] , p < 0.05 ) .


Furthermore , prucalopride improved acid clearance time ( 77.5 [ 47.8-108 .8 ] vs 44.0 [ 30.0-67 .8 ] s , p < 0.05 ) .


Prucalopride did not affect the number of transient lower esophageal sphincter ( LES ) relaxations or their association with reflux events .


Esophageal motility and basal pressure of the LES were not affected by prucalopride .


Prucalopride increased gastric emptying ( T1/2 ; 32.7 [ 27.9-44 .6 ] vs 49.8 [ 37.7-55 .0 ] min , p < 0.05 ) and decreased residue after 120min ( 8.8 [ 4.4-14 .8 ] vs 2.7 [ 1.3-5 .4 ] % , p < 0.05 ) .


Prucalopride reduces esophageal acid exposure and accelerates gastric emptying in healthy male volunteers .


These findings suggest that the drug could be effective for treatment of patients with reflux disease and functional dyspepsia .


The primary therapeutic goals in ulcerative colitis ( UC ) are to maintain excellent quality of life ( QOL ) by treating flare-ups when they occur , and preventing flare-ups .


Since stress can trigger UC flare-ups , we investigated the efficacy of mindfulness-based stress reduction ( MBSR ) to reduce flare-ups and improve QOL .


Patients with moderately severe UC , in remission , were randomized to MBSR or time/attention control .


Primary outcome was disease status .


Secondary outcomes were changes in markers of inflammation and disease activity , markers of stress and psychological assessments .


55 subjects were randomized .


Absence of flares , time to flare and severity of flare over 1 year were similar between the two groups .


However , post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress ( 30 vs. 70 % ; p < 0.001 ) .


MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group ( p = 0.04 ) .


Furthermore , MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare ( p < 0.01 ) .


MBSR did not affect the rate or severity of flare-ups in UC patients in remission .


However , MBSR might be effective for those with high stress reactivity ( high perceived stress and urinary cortisol ) during remission .


MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL .


Further studies are needed to identify a subset of patients for whom MBSR could alter disease course .


Monitoring patient-reported symptoms is necessary to adjust and improve supportive care during chemotherapy .


Continuing advances in computerized approaches to symptom monitoring can enhance communication about unrelieved symptoms between patients and oncology providers and may facilitate intensified symptom treatment .


An automated IT-based telephone monitoring system was developed to enable oncology providers to receive and act on alert reports from patients about unrelieved symptoms during chemotherapy treatment .


Daily , 250 participants ( randomized to treatment or attentional control ) were asked to call the automated system to report presence , severity , and distress for common chemotherapy-related symptoms ( 1-10 scale if present ) .


For the treatment group , symptoms exceeding preset thresholds for moderate-to-severe intensity levels generated emailed alert reports to both the patient 's oncologist and oncology nurse .


Patients reported high satisfaction and ease of use of the automated system .


Over 80 % of providers reported usefulness of the symptom alert reports .


Ten monitored symptoms resulted in , on average , nine moderate-to-severe intensity alerts per patient over 45 study days .


However , providers rarely contacted patients after receiving alerts .


There were no significant differences in change of symptom severity between the two groups ( mean difference = 0.06 , p = 0.58 ) .


Despite patients ' use of a daily symptom monitoring system and providers ' receipt of information about unrelieved symptoms of moderate-to-severe intensity , oncology physicians and nurses did not contact patients to intensify symptom treatment nor did symptoms improve .


Further research is indicated to determine if oncology providers initiated follow-up to intensify symptom treatment , whether symptom outcomes would improve .


To compare the influence of femtosecond lenticule extraction ( FLEx ) and small incision lenticule extraction ( SMILE ) on corneal nerve density and the ocular surface for equivalent degrees of correction of myopia .


Sixty eyes of 30 patients ( 8 males and 22 females , mean age : 31.0 6.0 years ) were included in the study .


The patients underwent FLEx in 1 eye and SMILE in the other eye by random assignment .


Subbasal nerve density was measured using confocal microscopy preoperatively and at 1 week , 1 and 3 months , and 1 year postoperatively .


Ocular surface parameters such as Schirmer 's test results , tear film break-up time , and corneal sensation were performed preoperatively and at 1 and 3 months postoperatively .


In the FLEx group , subbasal nerve density was 18,390 6,090 m/mm ( 2 ) preoperatively and 5,770 3,490 m/mm ( 2 ) at 1 year postoperatively ( P < .001 , Dunnett 's test ) .


In the SMILE group , subbasal nerve density was 16,810 6,220 m/mm ( 2 ) preoperatively and 11,870 8,200 m/mm ( 2 ) at 1 year postoperatively ( P = .21 ) .


The decrease in corneal nerve density was significantly less after SMILE than after FLEx at all postoperative visits ( Mann-Whitney U test , P < .05 ) .


FLEx resulted in a significant decrease in Schirmer 's test results , tear film break-up time , and corneal sensation at all postoperative visits , whereas SMILE induced no significant changes in these parameters ( P > .05 ) .


There was less damage to the sub-basal nerve plexus of the cornea and less effect on the ocular surface parameters after SMILE than after FLEx .


To compare statics characteristics between anterior transpedicular screws ( ATPS ) system and vertebral body screws ( VBS ) system in lower cervical spine .


Sixteen fresh cervical specimens were collected and dissected into 32 different units ( functional spinal unit , FSU ) , 8 units in C3 ,4 , C4 ,5 , C5 ,6 and C6 ,7 each .


The subjects were randomly divided into group A and B.


The anterior transpedicular screw-plate system and anterior vertebral body screw-plate system were implanted separately in group A and B. Then , the maximum axial pull out strength was tested and compared between two fixation system .


Maximum pull out strength was ( 604.68 + / - 48.76 ) N in group A and ( 488.24 + / - 32.42 ) N in group B , and there was significant difference between two groups ( t = 2.147 , P < 0.05 ) .


There was no statistically significant difference in all FSU between anterior transpedicular screws system and vertebral body screws system ( F ( A ) = 2.27 , F ( B ) = 2.05 , P > 0.05 ) .