Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea .


This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients .


It was a randomized , single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting .


In group 1 ( IS ) ( n = 32 ) , three sessions of incentive spirometry ( IS ) were performed within one hour before induction of anesthesia .


In group 2 ( DB ) ( n = 34 ) , patients were subjected to deep breathing sessions in a similar manner .


All patients received preoxygenation ( 100 % ) by mask for 3 min , followed by rapid-sequence induction of anesthesia using fentanyl , thiopental , and suxamethonium and endotracheal intubation .


Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed 95 % hemoglobin saturation ( SpO 2 ) by pulse oxymetry .


Positive pressure ventilation was resumed at the end .


We observed for hemodynamic changes , apnea time , and SpO 2 ( 100 % ) recovery time on resuming ventilation .


Arterial blood gas samples were taken before intervention , after IS or DB , after preoxygenation , and at the end of apnea .


One-way analysis of variance ( ANOVA ) , X 2 test , Kaplan-Meier graph , and log-rank tests were applied to compare the two study groups .


Oxygenation level in group 1 ( 265 76.7 mmHg ) patients was significantly ( P < 0.001 ) higher than in group 2 ( 221 61.8 mmHg ) at the end of preoxygenation .


The apnea time ( median : lower bound - upper bound Confidence Interval apnea time ) ( 272:240 -279 s ) in group 1 ( IS ) patients was significantly higher P < 0.05 ) than in group 2 ( 180:163 -209 s ) patients .


Saturation recovery time ( 35:34 -46 s ) in group 1 ( IS ) patients was also quicker than in group 2 patients ( 48:44 -58 s ) .


IS in the preoperative period is superior to deep breathing sessions for improving apnea tolerance during induction of anesthesia in abdominal sepsis patients .


Amino acid ( AA ) metabolism is altered in type 2 diabetes ( T2D ) , and fasting levels of - hydroxybutyrate ( - HB ) , a biomarker for insulin resistance , have been suggested to track AA metabolism .


We investigated the changes in AA and - HB induced by a mixed-meal tolerance test ( MTT ) and the effects of sitagliptin treatment .


Forty-seven T2D patients [ 56 7 years , body mass index ( BMI ) 29.9 4.2 kg/m ( 2 ) ] were randomized to sitagliptin ( 100 mg/day , 6 weeks ) or placebo .


Seven age - and BMI-matched non-diabetic subjects served as control ( CT ) .


During a 5-h MTT , branched-chain AA ( BCAA ) peaked earlier in T2D than CT [ 75 ( 25 ) vs. 62 ( 3 ) mmol/l h over 2 h , median ( interquartile range ) , p = 0.05 ] , and rose higher [ 5-h increment : 31 ( 23 ) vs. 19 ( 24 ) mmol/l h , p = 0.05 ] .


Fasting - HB was higher [ 7.5 ( 2.7 ) vs. 5.9 ( 1.3 ) g/ml , p = 0.04 T2D vs. CT ] , and its meal-induced increments were larger [ 24 ( 99 ) vs. -41 ( 86 ) g/ml h , p = 0.006 ] .


Plasma non-esterified fatty acids ( NEFA ) declined during MTT , but their increments were greater in patients ( 53 16 vs. 35 10 mEq/l h , p = 0.005 ) .


Compared to placebo , both BCAA [ -6.4 ( 21.1 ) vs. 0.0 ( 48.0 ) mmol/l h , p = 0.01 ] and - HB increments [ -114 ( 250 ) vs. 114 ( 428 ) g/ml h , p = 0.002 ] decreased with sitagliptin , and meal-induced NEFA suppression was improved .


Changes in BCAA and - HB were reciprocally related to changes in insulin sensitivity ( = -0.37 and -0.43 , p 0.01 ) .


T2D is associated with a hyperaminoacidaemic response to MTT , which circulating - HB levels track .


Sitagliptin-induced glycaemic improvement was associated with reductions in BCAA and - HB excursions and better NEFA suppression , in parallel with improved insulin sensitivity , confirming that - HB is a readout of metabolic overload .


Cardiac resynchronization therapy ( CRT ) improves hemodynamic function , as well as reduces hospitalizations and mortality among patients with systolic dysfunction , QRS prolongation , and heart failure .


The magnitude of the hemodynamic response is associated with improved outcomes , so optimization of this parameter is a goal of therapy .


The purpose of this study was to evaluate the effect of left ventricular ( LV ) electrical delay , as assessed by the QLV interval , on the acute hemodynamic response to CRT .


This study included 31 patients undergoing biventricular ICD placement .


At implant , invasive LV dP/dt was measured by a micromanometer catheter during biventricular ( BV ) or LV only pacing .


Both atrial sensing ( AS ) and atrial pacing ( AP ) modes were evaluated at 5 different AV delays , tested in randomized order .


The QLV interval was measured at the LV pacing site .


Compared with intrinsic rhythm , CRT increased LV dP/dtmax by 9.5 8.8 % with BV pacing and 10.0 9.2 % with LV pacing ( P = 0.38 ) during AS .


With AP , CRT increased LV dP/dtmax by 16.0 10.8 % and 15.3 11.1 % , respectively ( P = 0.47 ) .


QLV was strongly correlated with the hemodynamic response in all pacing configurations .


Multivariate analysis showed that with BV pacing QLV was an independent predictor of the hemodynamic response with a 1.7 % increase in % LV dP/dt for every 10 milliseconds prolongation of QLV .


LV electrical delay is a strong predictor of the acute hemodynamic response to CRT .


This relationship is independent of pacing mode .


The quality of life depends on physical , psychological and social factors that are evidently influenced by the individual 's actions , prospect , attitude and behavior .


Heart disease is one of the most imperative health problems in the world .


Studies showed that exercise-based rehabilitation for patients with coronary artery disease effectively lowers the rate of cardiac death .


The intent of this study was to determine the effects of physical activity on the life quality of cardiovascular patients after coronary artery bypass graft .


This randomized clinical trial was performed on two groups of coronary artery patients of Yazd Afshar hospital .


All the 70 participants were post surgery coronary artery patients who were divided into two groups .


Data was collected by two questionnaires : A personal information questionnaire and a quality of life questionnaire ( SF = 36 ) .


Data of both groups was collected in the first and fourth month after the discharge from surgery and sessions were analyzed by SPSS 16 and by using T-test and Chi-square .


Results displayed that after the intervention , all the categories of the components of the quality of life were increased except for general health .


There was no significant differentiation between these statuses in the control group and the premier grades about the components of the social function ( 88.98 out of 100 ) .


The comparison of total scores of the quality of life before the intervention showed the quality of life of both groups one month after surgery was not significant ( p = 75 % ) , but in four months after surgery , the distinction between the mean grade scores of the intervention , the group was considerable ( p = 0.0001 ) .


The comparison of the total scores of the quality of life indicated an increase in the scores of the quality of life in the intervention group after the exercise .


There is extensive evidence of health inequality across ethnic groups .


Inequity is a complex social phenomenon involving several underlying factors , including ethnic discrimination .


In the field of health care , it has been established that ethnic discrimination stems partially from bias or prejudice on the part of doctors .


Indeed , it has been hypothesized that patient ethnicity may affect doctors ' social cognition , thus modifying their social interactions and decision-making processes .


General practitioners ( GPs ) are the primary access point to health care for ethnic minority groups .


In this study , we examine whether patient ethnicity affects the relational and decisional features of doctoring .


The sample was made up of 171 Belgian GPs , who were each randomly allocated to one of two experimental conditions .


One group were given a hypertension vignette case with a Belgian patient ( non-minority patient ) , while the other group were given a hypertension vignette case with a Moroccan patient ( minority patient ) .


We evaluated the time devoted by GPs to examining medical history ; time devoted by GPs to examining socio-relational history ; cardiovascular risk assessments by GPs ; electrocardiogram ( ECG ) recommendations by GPs , and drug prescriptions by GPs .


We observed that for ethnic minority patients , GPs prescribed more drugs and devoted less time to examining socio-relational history .


Neither cardiovascular risk assessments nor ECG recommendations were affected by patient ethnicity .


GPs who were very busy devoted less time to examining medical history when dealing with minority patients .


We found no evidence that GPs discriminated against ethnic minority patients when it came to medical decisions .


However , our study did identify a risk of drugs being used inappropriately in some ethnic-specific encounters .


We also observed that , with ethnic minority patients , GPs engage less in the relational dimension of doctoring , particularly when working within a demanding environment .


In general practice , the quality of the relationship between doctor and patient is an essential component of the effective management of chronic illness .


Our research highlights the complexity of ethnic discrimination in general practice , and the need for further studies .


To observe the clinical effect of acupuncture on acute heart failure ( AHF ) patients .


Totally 60 patients who were diagnosed as AHF were assigned to the acupuncture group and the control group , 30 in each group .


Those in the control group received inotropic agents , preload and afterload reducing therapy , anti-infection and so on .


Besides , those in the acupuncture group received needling at relative points , once daily for 5 consecutive days .


The mean arterial pressure ( MAP ) , heart rate ( HR ) , cardiac index ( CI ) , stroke volume index ( SI ) , left ventricle working index ( LCWI ) were monitored by thermodilution pulse-indicated continuous cardiac output ( PiCCO ) technique .


Changes of the aforesaid data were compared between before and after treatment .


The ICU length of stay , readmission rate , and the 28-day mortality were also compared between the two groups .


After 5 days of the treatment , CI , SI , and LCWI increased more obviously ( P < 0.01 ) , HR and MAP decreased significantly ( P < 0.05 ) .


Of them , CI , SI , and LCWI increased more obviously in the acupuncture group ( P < 0.05 ) .


There was no obvious difference in HR or MAP between the two groups ( P > 0.05 ) .


Compared with the first day of admission in the same group , CI , SI , and LCWI obviously increased in the acupuncture group from the second day ( P < 0.05 ) .


HR started to decrease since the fourth day ( P < 0.05 ) , and MAP began to decrease until the fifth day ( P < 0.05 ) .


CI , SI , and LCWI started to increase in the control group from the third day ( P < 0.05 ) ; HR and MAP both began to decrease since the fifth day ( P < 0.05 ) .


Compared with the control group , the ICU length of stay was obviously shortened in the acupuncture group ( P < 0.05 ) .


The readmission rate and the 28-day mortality rate were lower than those of the control group ( P < 0.05 ) .


The combination of acupuncture and Western medical therapy might strengthen acute heart failure patients ' heart functions , elevate the therapeutic effect , and improve the prognosis .


To explore the effect of acupuncture at HT7 on heart rate variability ( HRV ) in healthy volunteers .


120 subjects were divided into four groups using a random number table .


The following groups of acupuncture interventions were used : HT7 verum acupuncture ; HT7 non-penetrating sham acupuncture ; acupuncture at a sham point ; and no acupuncture .


HRV was recorded 10min before , during and after each stimulation using an Actiheart ECG recorder .


The HT7 verum acupuncture group had higher very-low frequency , low frequency and high frequency components of HRV compared with the control groups during but not after acupuncture .


The HT7 verum acupuncture group also had higher SD of normal intervals compared with the sham needling and no acupuncture control groups .


Our preliminary study suggests , subject to limitations , that acupuncture at HT7 could affect cardiac autonomic neural regulation in healthy subjects , manifest as increased HRV , most likely via the parasympathetic system .


ChiCTR-TRC-08000302 .


Intraoperative radiation therapy ( IORT ) is an emerging option for partial breast radiotherapy in select women with early stage breast cancer .


We assessed short-term clinical and sonographic findings after breast conservation ( BCT ) and IORT .


An IRB-approved , single institution retrospective chart review was conducted of patients ( pts ) treated with BCT/IORT from 1/2011 to 6/2012 .


Follow-up clinical breast exams and ultrasounds ( US ) obtained 6 and 12 months after BCT/IORT were retrospectively reviewed by a single breast radiologist ( JD ) for sonographic findings .


P values were calculated using McNemar 's test , Wilcoxon Rank Sum Test , and Chi-square .


Seventy-one pts underwent BCT/IORT and 38 pts had an US .


All 38 pts had a seroma , 10/38 ( 26 % ) pts were symptomatic .


Eighteen pts had deep tissue closure ( DTC ) of the lumpectomy cavity with 5/18 ( 28 % ) DTC pts being symptomatic at follow-up versus 5/33 ( 15 % ) without DTC ( P = 0.296 ) .


At 6 months , DTC resulted in smaller seroma cavity volumes compared to those without DTC ( P = 0.03 ) .


Presence of a seroma is commonplace post BCT/IORT ; symptomatic seromas are uncommon .


DTC generated smaller seromas .


Longer follow-up with serial US performed in all BCT/IORT pts could be considered to document natural progression/regression of symptoms and seromas .


To evaluate the sustained efficacy of 2-year sublingual immunotherapy ( SLIT ) and 1 year after 2-year SLIT in children with allergic rhinitis ( AR ) .


This study is a randomized , open and prospective trial .


One hundred twenty children ( between 4 and 11 years old ) suffering from AR duo to mite were chosen from November , 2008 to June , 2009 in department of otolaryngology in our hospital divided into two groups : 60 underwent 2-year course of SLIT and one year follow-up combined with 3-year drug therapy as SLIT group ; 60 received only drug therapy as control group .


The patients were evaluated at three time points ( baseline , end of SLIT and 1 year after SLIT discontinuation ) regarding symptom scores including total nasal symptom score ( TNSS ) , sneezing , rhinorrhoea , nasal obstruction , nasal itching and total medication scores ( TMS ) and adverse reaction .


( 1 ) At the end of SLIT , the symptom scores excepting sneezing and total medication scores in SLIT group are obviously lower than those in control group ( P < 0.01 ) .


At 1 year after SLIT discontinuation , all of the score including sneezing ( P < 0.05 ) in SLIT group are lower than those of control group .


( 2 ) At the end of SLIT and 1 year after SLIT discontinuation , all of the scores are lower than those at baseline in SLIT group ( P < 0.01 ) ; the scores were no different in SLIT group between the end of SLIT and 1 year after SLIT discontinuation ( P > 0.05 ) .


But at the end of SLIT and 1 year after SLIT discontinuation , TMS was higher than it at baseline in control group ( P < 0.01 ) .


At 1 year after SLIT discontinuation , nasal obstruction score was higher than it at baseline ( P < 0.05 ) .


SLIT can obviously improve the AR and the efficacy can sustain after 1-year SLIT discontinua tion .


Drug increased in 3 years without SLIT .


This report summarizes the first studies on individual placement and support ( IPS ) in the field of physical medicine and rehabilitation ( PM&R ) and discusses adaptation of the model .


Research related to the implementation and evaluation of the use of IPS in the VA System of Spinal Cord Injury Care is reviewed .


Results suggest that IPS was more effective than traditional vocational rehabilitation .


With physical disabilities , the model needs adaptation with respect to integration , disclosure , and job development while following the core principles .


Special consideration is needed with respect to caseload size and transportation issues .


Published results from the Spinal Cord Injury Vocational Integration Program ( SCI-VIP ) study and clinical field observations .


IPS can be successfully adapted to physical medicine and rehabilitation .


To compare functional outcomes of 7-year-old ( school-age ) children born small for gestational age ( SGA ; ie , a birth weight z score -1 SD ) , with appropriate for gestational age ( AGA ) peers , born moderately preterm or full term .


Data were collected as part of the Longitudinal Preterm Outcome Project study , a community-based , prospective cohort study of 336 AGA and 42 SGA born children ( median gestational age 35 weeks , range 31-41 ) .


Of the SGA children , 32 were moderately preterm , 10 were full term ; of the AGA , these numbers were 216 and 120 , respectively .


At 6.9 years , we assessed intelligence , verbal memory , attention , visuomotor integration , and motor skills and we collected the parent-reported executive functioning .


We compared the outcomes of the SGA children with those of their AGA peers .


The performance of SGA children was similar to that of their AGA peers , except for attention control which was abnormal more often in SGA children ( OR 3.99 , 95 % CI 1.32-12 .12 ) .


The IQ of SGA children was 3 points lower , but this difference failed to reach significance .


At school age , children born SGA have a greater risk of abnormal test scores on attention control than children born AGA , independent of gestational age .


Their motor and many other cognitive functions are similar .


The impact of these outcomes seems limited .


Nevertheless , the consequences for school performance deserve attention .


The aim of this study was to compare high-flow nasal cannula ( HFNC ) and conventional O2 therapy ( OT ) in paediatric cardiac surgical patients ; the primary objective of the study was to evaluate whether HFNC was able to improve PaCO2 elimination in the first 48 h after extubation postoperatively .


We conducted a randomized , controlled trial in pediatric cardiac surgical patients under 18 months of age .


At the beginning of the weaning of ventilation , patients were randomly assigned to either of the following groups : OT or HFNC .


Arterial blood samples were collected before and after extubation at the following time points : 1 , 6 , 12 , 24 and 48 h.


The primary outcome was comparison of arterial PaCO2 postextubation ; secondary outcomes were PaO2 and PaO2/fractional inspired oxygen ( FiO2 ) ratio , rate of treatment failure and need of respiratory support , rate of extubation failure , rate of atelectasis , simply to complications and the length of paediatric cardiac intensive care unit stay .


Demographic and clinical variables were comparable in the two groups .


Analysis of variance for repeated measures showed that PaCO2 was not significantly different between the HFNC and OT groups ( P = 0.5 ) , whereas PaO2 and PaO2/FiO2 were significantly improved in the HFNC group ( P = 0.01 and P = 0.001 ) .


The rate of reintubation was not different in the two groups ( P = 1.0 ) , whereas the need for noninvasive respiratory support was 15 % in the OT group and none in the HFNC group ( P = 0.008 ) .


HFNC had no impact on PaCO2 values .


The use of HFNC appeared to be safe and improved PaO2 in paediatric cardiac surgical patients .


In contrast to conventional ( CONV ) neuromuscular electrical stimulation ( NMES ) , the use of `` wide-pulse , high-frequencies '' ( WPHF ) can generate higher forces than expected by the direct activation of motor axons alone .


We aimed at investigating the occurrence , magnitude , variability and underlying neuromuscular mechanisms of these `` Extra Forces '' ( EF ) .


Electrically-evoked isometric plantar flexion force was recorded in 42 healthy subjects .


Additionally , twitch potentiation , H-reflex and M-wave responses were assessed in 13 participants .


CONV ( 25Hz , 0.05 ms ) and WPHF ( 100Hz , 1ms ) NMES consisted of five stimulation trains ( 20s on-90s off ) .


K-means clustering analysis disclosed a responder rate of almost 60 % .


Within this group of responders , force significantly increased from 4 % to 16 % of the maximal voluntary contraction force and H-reflexes were depressed after WPHF NMES .


In contrast , non-responders showed neither EF nor H-reflex depression .


Twitch potentiation and resting EMG data were similar between groups .


Interestingly , a large inter - and intrasubject variability of EF was observed .


The responder percentage was overestimated in previous studies .


This study proposes a novel methodological framework for unraveling the neurophysiological mechanisms involved in EF and provides further evidence for a central contribution to EF in responders .


There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography ( CT ) or ultrasonography .


In this multicenter , pragmatic , comparative effectiveness trial , we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician ( point-of-care ultrasonography ) , ultrasonography performed by a radiologist ( radiology ultrasonography ) , or abdominal CT. .


Subsequent management , including additional imaging , was at the discretion of the physician .


We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure .


Secondary outcomes were serious adverse events , related serious adverse events ( deemed attributable to study participation ) , pain ( assessed on an 11-point visual-analogue scale , with higher scores indicating more severe pain ) , return emergency department visits , hospitalizations , and diagnostic accuracy .


A total of 2759 patients underwent randomization : 908 to point-of-care ultrasonography , 893 to radiology ultrasonography , and 958 to CT. .


The incidence of high-risk diagnoses with complications in the first 30 days was low ( 0.4 % ) and did not vary according to imaging method .


The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group ( P < 0.001 ) .


Serious adverse events occurred in 12.4 % of the patients assigned to point-of-care ultrasonography , 10.8 % of those assigned to radiology ultrasonography , and 11.2 % of those assigned to CT ( P = 0.50 ) .


Related adverse events were infrequent ( incidence , 0.4 % ) and similar across groups .


By 7 days , the average pain score was 2.0 in each group ( P = 0.84 ) .


Return emergency department visits , hospitalizations , and diagnostic accuracy did not differ significantly among the groups .


Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT , without significant differences in high-risk diagnoses with complications , serious adverse events , pain scores , return emergency department visits , or hospitalizations .


( Funded by the Agency for Healthcare Research and Quality . )


Emerging evidence suggests modulating the microbiota in the large bowel of patients with chronic kidney disease ( CKD ) through pre - and/probiotic supplementation may inhibit the development of key nephrovascular toxins .


To date , quality intervention trials investigating this novel treatment in CKD are lacking .


The aim of SYNERGY is to assess the effectiveness of synbiotics ( co-administration of pre - and probiotics ) as a potential treatment targeting the synthesis of uremic toxins , specifically , indoxyl sulphate ( IS ) and p-cresyl sulphate ( PCS ) .


Thirty-seven patients with moderate to severe CKD ( Stage IV and V , pre-dialysis ) will be recruited to a double-blind , placebo-controlled , randomised cross-over trial .


Patients will be provided with synbiotic therapy or placebo for 6 weeks , with a 4week washout before cross-over .


The primary outcome is serum IS , total and free ( unbound ) concentrations , measured using ultra-performance liquid chromatography .


Secondary outcomes include serum PCS , total and free ( unbound ) concentrations ; cardiovascular risk , measured by serum lipopolysaccharides , serum trimethylamine-N-oxide ( TMAO ) and inflammation and oxidative stress markers ; kidney damage , measured by 24hour proteinuria and albuminuria , estimated glomerular filtration rate and renal tubule damage ( urinary kidney injury molecule-1 ) ; patients ' self assessed quality of life ; and gastrointestinal symptoms .


In addition , the effects on the community structure of the stool microbiota will be explored in a subset of patients to validate the mechanistic rationale underpinning the synbiotic therapy .


IS and PCS are two novel uremic toxins implicated in both cardiovascular disease ( CVD ) and progression of CKD .


Preliminary studies indicate that synbiotic therapy maybe a promising strategy when considering a targeted , tolerable and cost-efficient therapy for lowering serum IS and PCS concentrations .


This trial will provide high quality ` proof-of-concept ' data to elucidate both the efficacy of synbiotic therapy for lowering the toxins and whether reductions in serum IS and PCS translate into clinical benefits .


Considering the potential of pre - and probiotics to not only shift toxin levels , but to also impede CVD and CKD progression , SYNERGY will provide vital insight into the effectiveness of this innocuous nutritional therapy .


Universal Trial Number : U1111-1142-4363 .


Australian New Zealand Clinical Trials Registry Number : ACTRN12613000493741 , date registered : 2nd May 2013 .


Profound side-effects following intrathecal use of local anesthetics as the sole drugs of choice make spinal anesthesia for open appendicectomy uncommon .


The aim of this study was to evaluate the effectiveness of intra-operative analgesia produced by intrathecal tramadol and fentanyl during bupivacaine spinal anesthesia for open appendicectomy .


A prospective randomized study was performed .


A total of 186 American Society of Anesthesiologists 1 or 11 patients scheduled for emergency open appendicectomy were analyzed .


Group FB ( n = 62 ) received intrathecal fentanyl 25 g plus 3 ml of 0.5 % hyperbaric bupivacaine , Group SB ( n = 62 ) received 0.5 ml normal saline plus 3 ml of 0.5 % hyperbaric bupivacaine and Group TB ( n = 62 ) received intrathecal tramadol 25 mg plus 3 ml of 0.5 % hyperbaric bupivacaine .


Visual analog scale scores and frequency of subjective symptoms among patients in the three groups formed the primary outcome measure of this study .


Effective intraoperative sensory block was achieved in 100 % of patients in group FB and TB while 29 ( 46.8 % ) patients in group SB had ineffective sensory block ( P = 0.0001 ) .


The pain free period was significantly longer in patients in Group FB than Group SB and TB .


Mean time for Group FB with regard to first analgesic request was 304.73 67.91 min , Group SB was 146.59 36.62 and Group TB was 238.39 61.28 min .


Incidence of complications were comparable among the three groups .


This study showed that intrathecal tramadol ( 25 mg ) can safely replace intrathecal fentanyl ( 25 g ) in the management of visceral pain and discomfort during subarachnoid block for appendicectomy .


Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease .


The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation ( RYGB ) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone .


Eighty-one obese women scheduled for RYGB were included in the study .


They were randomized to RYGB or RYGB in conjunction with omentectomy .


Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively .


The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors .


Two-year weight loss was profound but unaffected by omentectomy .


Before intervention , there were no clinical or metabolic differences between the two groups .


The difference in primary outcome measure , insulin sensitivity , was not significant between the non-omentectomy ( 6.71.6 mg/kg body weight/minute ) and omentectomy groups ( 6.61.5 mg/kg body weight/minute ) after 2 years .


Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly .


Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors .


The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable .


NCT01785134 .


Convulsive Status Epilepticus ( CSE ) is a common neurological emergency with patients presenting with prolonged epileptic activity .


Sub-optimal management is coupled with high morbidity and mortality .


Continuous electroencephalogram ( EEG ) monitoring is considered essential by the National Institute for Health and Care Excellence ( NICE ) in the management of Convulsive Refractory Status Epilepticus ( CRSE ) .


The aim of this research was to determine current clinical practice in the management of CRSE amongst adults in intensive care units ( ICU ) in the UK and establish if the use of a standardised protocol requires re-enforcement within trusts .


75 randomly selected UK NHS Trusts were contacted and asked to complete a questionnaire in addition to providing their protocol for CRSE management in ICU .


55 ( 73 % ) trusts responded .


While 31 ( 56 % of responders ) had a protocol available in ICU for early stages of CSE , just 21 ( 38 % ) trusts had specific guidelines if CRSE occurred .


Only 23 ( 42 % ) trusts involved neurologists at any stage of management and just 18 ( 33 % ) have access to continuous EEG monitoring .


This study identifies significant inconsistency in the management of CSE in ICU 's across the UK .


A minority of ICU units have a protocol for CRSE or access to continuous EEG monitoring despite it being considered fundamental for management and supported by NICE guidance .


Controlling hypertension rates and maintaining normal blood pressure , particularly in resource-constrained settings , represent ongoing challenges of effective and affordable implementation in health care .


One of the strategies being largely advocated to improve high blood pressure calls for salt reduction strategies .


This study aims to estimate the impact of a population-level intervention based on sodium reduction and potassium increase - in practice , introducing a low-sodium , high-potassium salt substitute - on adult blood pressure levels .


The proposed implementation research study includes two components : Phase 1 , an exploratory component , and Phase 2 , an intervention component .


The exploratory component involves a triangle taste test and a formative research study designed to gain an understanding of the best implementation methods .


Phase 2 involves a pragmatic stepped wedge trial design where the intervention will be progressively implemented in several clusters starting the intervention randomly at different times .


In addition , we will evaluate the implementation strategy using a cost-effectiveness analysis .


This is the first project in a Latin-American setting to implement a salt substitution intervention at the population level to tackle high blood pressure .


Data generated and lessons learnt from this study will provide a strong platform to address potential interventions applicable to other similar low - and middle-income settings .


This study is registered in ClinicalTrials.gov NCT01960972 .


To investigate bladder and intestinal function recovery and quality of sexual life after laparoscopic nerve-sparing radical hysterectomy ( LNRH ) for treatment of early invasive cervical carcinoma .


Subjects included patients who underwent radical hysterectomy by laparotomy who were randomly assigned to 2 groups : 30 patients who underwent LNRH and 35 classical laparoscopic radical hysterectomy ( LRH ) .


We assessed the patients general clinical information , surgical characteristics , pathological findings , and adjuvant therapies .


A urodynamic study was used to assess bladder function .


Intestinal function recovery and quality of sexual life were evaluated by questionnaire .


No significant differences were found in age , surgery characteristics , pathological findings , adjuvant therapies , and main adverse effects between the 2 groups .


The mean duration of the postoperative catheterization ( DPC ) in group LNRH was shorter than that in group LRH ( P < 0.001 ) .


The maximum flow rate , maximum cystometric capacity , maximum detrusor pressure and urinary complications in group LNRH were better than those in group LRH .


The quality of sexual life evaluated according to the female sexual function index ( FSFI ) was better in group LNRH than in those who underwent LRH .


The intestinal function of patients in group LNRH also recovered better compared with patients in group LRH .


Omega-3 fatty acids in free fatty acid form have enhanced bioavailability , and plasma levels are less influenced by food than for ethyl ester forms .


The aim was to evaluate the safety and lipid-altering efficacy in subjects with severe hypertriglyceridemia of an investigational pharmaceutical omega-3 free fatty acid ( OM3-FFA ) containing eicosapentaenoic acid and docosahexaenoic acid .


This was a multinational , double-blind , randomized , out-patient study .


Men and women with triglycerides ( TGs ) 500 mg/dL , but < 2000 mg/dL , took control ( olive oil [ OO ] 4 g/d ; n = 99 ) , OM3-FFA 2 g/d ( plus OO 2 g/d ; n = 100 ) , OM3-FFA 3 g/d ( plus OO 1 g/d ; n = 101 ) , or OM3-FFA 4 g/d ( n = 99 ) capsules for 12 weeks in combination with the National Cholesterol Education Program Therapeutic Lifestyle Changes diet .


Fasting serum TGs changed from baseline by -25.9 % ( P < .01 vs OO ) , -25.5 % ( P < .01 vs OO ) , and -30.9 % ( P < .001 vs OO ) with 2 , 3 , and 4 g/d OM3-FFA , respectively , compared with -4.3 % with OO .


Non-high-density lipoprotein cholesterol ( non-HDL-C ) , total cholesterol-to-HDL-C ratio , very low-density lipoprotein cholesterol , remnant-like particle cholesterol , apolipoprotein CIII , lipoprotein-associated phospholipase A2 , and arachidonic acid were significantly lowered ( P < .05 at each OM3-FFA dosage vs OO ) ; and plasma eicosapentaenoic acid and docosahexaenoic acid were significantly elevated ( P < .001 at each OM3-FFA dosage vs OO ) .


With OM3-FFA 2 and 4 g/d ( but not 3 g/d ) , low-density lipoprotein cholesterol was significantly increased compared with OO ( P < .05 vs OO ) .


High-sensitivity C-reactive protein responses with OM3-FFA did not differ significantly from the OO response at any dosage .


Fewer subjects reported any adverse event with OO vs OM3-FFA , but frequencies across dosage groups were similar .


Discontinuation due to adverse event , primarily gastrointestinal , ranged from 5 % to 7 % across OM3-FFA dosage groups vs 0 % for OO .


OM3-FFA achieved the primary end point for TG lowering and secondary end point of non-HDL-C lowering at 2 , 3 , and 4 g/d in persons with severe hypertriglyceridemia .


This trial was registered at www.clinicaltrials.gov as NCT01242527 .


High levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine , resulting in severe undertreatment of mental health problems in this patient group .


Screening tools can be used to increase case identification , however , screening alone does not necessarily translate into better mental health for the patient .


Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals .


This study investigates whether a stepped care model , combining screening , doctor consultation and professional psycho-oncological service in a structured way , improves the emotional wellbeing of cancer patients .


This study is a cluster randomized trial with two parallel groups ( intervention vs. care as usual ) , set in an academic hospital .


Participants are cancer patients , a total of 1,000 at baseline .


The intervention consists of stepped psychosocial care .


Step one : screening for distress , step two : feedback of screening results to the doctor in charge of the patient and consultation with the patient , and step three : based on a shared patient-doctor decision , either transferal to the consultation liaison ( CL ) service or not .


The outcome will be emotional well-being half a year after baseline , ascertained with the Hospital Anxiety and Depression Scale .


Randomization will be done by the cluster randomization of wards .


Mental health problems not only cause emotional suffering but also direct and indirect costs .


This calls for timely and adequate psychosocial support , especially as we know that such support is effective .


However , not every cancer patient can and must be treated by a mental health professional .


Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible .


It is the hope of the STEPPED CARE trial that this model is both effective and efficient , and that it can be implemented in other hospitals as well , if proven to be effective .


Clinical Trials Register ( Clinicaltrials.gov ) identifier : NCT01859429 registration date 17 May 2013 .


Low-dose clarithromycin has been recommended for the treatment of chronic rhinosinusitis without nasal polyps .


However , it is uncertain whether a high dose of clarithromycin is more effective than a low dose .


Forty-three chronic rhinosinusitis patients were randomised to low-dose or high-dose clarithromycin groups , and clinical efficacy was evaluated .


Pre - and post-treatment measures included : nasal symptom assessment , endoscopic inspection ( Lund-Kennedy system ) , a quality of life questionnaire ( the Sino-Nasal Outcome Test 20 ) and examination of cytokine levels ( interleukin-5 and -8 ) in nasal secretions .


The high dose of clarithromycin was significantly better in terms of clinical efficacy than the low dose for the treatment of chronic rhinosinusitis ( p < 0.025 ) .


Significant differences in nasal cytokine levels ( interleukin-5 and -8 ) were also observed between the low-dose and high-dose groups after short-term clarithromycin treatment ( p < 0.025 ) .


Short-term , high-dose clarithromycin appears to be more effective for the treatment of chronic rhinosinusitis than low-dose clarithromycin .


Iron deficiency , associated with a decline in cognitive function , is the most common nutritional deficiency globally .


The present study aimed to identify the impact of weekly iron supplements on the attention function of female students from a high school in North Khorasan Province , Iran .


This was a blind , controlled , clinical trial study , involving 200 female students who were chosen using the stratified randomised sampling method .


First , laboratory studies were performed to detect iron consumption limitations .


Next , the 200 students were divided randomly and equally into case and control groups .


The case group was treated with 50 mg of ferrous sulfate twice a week for 16 weeks .


We compared both groups ' data on attention , iron status and erythrocyte indices .


Questionnaires were used to collect demographic data , while clinical data was collected using complete blood count and Toulouse-Piron tests .


Data was analysed using descriptive statistics , as well as paired and independent t-tests .


The mean attention scores of the case and control groups were 104.8 7.0 and 52.7 9.6 , respectively ( p < 0.001 ) .


The mean haemoglobin levels of the two groups were 12.5 0.9 and 11.2 1.0 , respectively ( p < 0.001 ) .


Compared to the control group , the attention scores and haemoglobin concentrations of the case group were found to be improved by approximately 90 % and 10 % , respectively .


Oral iron supplements ( 50 mg twice a week for 16 weeks ) were able to improve the attention span and haematologic indices of female high school students .


The aim of the present study was to evaluate the effect of applying electroencephalogram ( EEG ) biofeedback ( neurobiofeedback ) or electromyographic ( EMG ) biofeedback to conventional occupational therapy ( OT ) on improving hand function in stroke patients .


This study was designed as a preliminary clinical trial .


Thirty patients with stroke were entered the study .


Hand function was evaluated by Jebsen Hand Function Test pre and post intervention .


Patients were allocated to 3 intervention cohorts : ( 1 ) OT , ( 2 ) OT plus EMG-biofeedback therapy , and ( 3 ) OT plus neurofeedback therapy .


All patients received 10 sessions of conventional OT .


Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy , respectively .


EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis ( APB ) muscle .


Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery .


Hand function was improved significantly in the 3 groups .


The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery .


Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training .


Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT .


Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy .


Prospective longitudinal study .


To explore the working mechanism of manual therapy , we investigated whether 3 cervical spine variables were mediators of the effect of manual therapy on headache frequency .


Background Manual therapy has been shown to reduce headache frequency in participants with chronic tension-type headache ( CTTH ) .


To what extent specific elements of treatment contribute to the effectiveness of manual therapy in CTTH is unknown .


One hundred eighty-two participants with CTTH participated in a prospective longitudinal study : 142 underwent manual therapy and 40 participants received usual care by their general practitioner .


Regression analysis was performed according to the steps described by Baron and Kenny , and the proportion of mediated effect was estimated for 3 potential mediators : ( 1 ) cervical range of motion , ( 2 ) neck flexor endurance , and ( 3 ) forward head posture .


Outcome was defined as a 50 % or greater reduction in headache days .


Neck flexor endurance mediated 24.5 % of the effect of manual therapy .


Cervical range of motion and forward head posture showed no mediated effect .


Increased neck flexor endurance appears to be a working mechanism of manual therapy .


This finding supports isometric training of neck flexors in participants with CTTH .


Trial registered with Netherlands Trial Register ( TR 1074 ) .


ADHD is prevalent in adults and frequently associated with impairment and distress .


While medication is often the first line of treatment a high proportion of people with the condition are not fully treated by medication alone , can not tolerate medication or do not wish to take it .


Preliminary studies suggest that psychosocial approaches are a promising adjunctive or alternative treatment option .


To date , individual cognitive-behaviour therapy ( CBT ) has been found to be efficacious in three randomized controlled trials ( RCTs ) .


There is a need for more RCTs to be carried out in order to replicate these results in different sites , to further investigate the acceptability and feasibility of CBT in this population and to further develop CBT approaches based on a psychological model .


This randomized controlled trial investigates the efficacy of individual , formulation-based CBT when added to treatment-as-usual as compared with treatment as usual alone .


Sixty patients with a diagnosis of adult ADHD attending a specialist clinic are randomly allocated to 1 of 2 treatments , ` Treatment as Usual ' ( TAU ) or TAU plus 16 sessions individual CBT ( TAU + CBT ) .


In the TAU + CBT , the first 15 sessions take place over 30 weeks with a 16th ` follow-up ' session at 42 weeks .


Outcomes are assessed at 30 weeks and 42 weeks following randomization .


The two primary outcomes are self-rated ADHD symptoms and functioning ( occupational and social ) .


Secondary outcomes include distress , mood , ADHD-related cognitions , ADHD-related behaviours and informant-rated ADHD symptoms .


The primary analysis will include all participants for whom data is available and will use longitudinal regression models to compare treatments .


Secondary outcomes will be analysed similarly .


The results of the study will provide information about a ) whether CBT adds benefit over and above TAU for ADHD and , b ) if CBT is found to be efficacious , potential mechanisms of change and predictors of efficacy .


Current Controlled Trials ISRCTN03732556 , assigned 04/11/2010 .


Nebulisers aid the treatment of respiratory diseases , including asthma , but they require electricity and are often cost-prohibitive for low - and middle-income countries .


The aim of this study was to compare a low-cost , human-powered nebuliser compressor with an electric nebuliser compressor for the treatment of mild to moderate asthma exacerbations in adults and children .


This was a non-blinded , parallel-group , equivalence study , with 110 subjects between 6 and 65 years of age , conducted in the emergency department of a district hospital in Ilopango , El Salvador .


Participants were assigned by random allocation to receive a 2.5-mg dose of salbutamol from the experimental human-powered nebuliser or the electric nebuliser control .


All assigned participants completed treatment and were included in analysis .


The study was not blinded as this was clinically unfeasible ; however , data analysis was blinded .


The mean improvement in peak flow of the experimental and control groups was 37.5 ( 95 % confidence interval ( CI ) 26.7-48 .2 ) l/min and 38.7 ( 95 % CI , 26.1-51 .3 ) l/min , respectively , with a mean difference of 1.3 ( 95 % CI , -15.1 to 17.7 ) l/min .


The mean improvement in percent-expected peak flow for the experimental and control groups was 12.3 % ( 95 % CI , 9.1-15 .5 % ) and 13.8 % ( 95 % CI , 9.8-17 .9 % ) , respectively , with a mean difference of 1.5 % ( 95 % CI , -3.6 to 6.6 % ) .


The human-powered nebuliser compressor is equivalent to a standard nebuliser compressor for the treatment of mild-to-moderate asthma .


( Funded by the Opus Dean 's Fund , Marquette University College of Engineering ; ClinicalTrials.gov NCT01795742 . )


Idiopathic pulmonary fibrosis ( IPF ) is a chronic , devastating , interstitial lung disease , with few therapeutic options .


IPF is characterized by pulmonary restriction , dyspnea , hypoxemia , exercise intolerance and poor quality of life ( QOL ) .


We aimed to examine the effect of exercise training ( ET ) on clinical outcomes in IPF patients .


A randomized controlled study included thirty-two IPF patients ( aged 68 8 years ) who were allocated either to the ET group ( n = 15 ) , participating in a 12-week , twice-weekly 60-min supervised ET-based pulmonary rehabilitation program , or to a control group ( n = 17 ) continuing with regular medical treatment alone .


Cardiopulmonary exercise test , 6-min walking distance ( 6MWD ) test , 30-second chair-stand test , pulmonary function tests , dyspnea and QOL were assessed at baseline and at the end of the 12-week intervention .


Significant differences were observed between the ET and the control groups in raw mean deltas ( = post - - pre-intervention ) : 6MWD , 81 m , p < 0.001 ; VO2 peak , 2.6 ml/kg/min , p = 0.002 ; work rate , 22 W , p < 0.001 ; anaerobic threshold , 3.1 ml/kg/min , p < 0.001 , and FVC % predicted , 6 % , p = 0.038 .


Dyspnea , QOL and 30-second chair-stand were also improved significantly following the program .


ET improves exercise tolerance , functional capacity , pulmonary function , dyspnea and QOL in patients with IPF , suggesting a short-term treatment efficacy for clinical improvement , and should be considered the standard care for IPF .


There is concern regarding the administration of iodinated contrast to patients with impaired renal function because of the increased risk of contrast-induced nephropathy .


Evaluate image quality and feasibility of a protocol with a reduced volume of iodinated contrast and utilization of dual-energy coronary CT angiography ( DECT ) vs a standard iodinated contrast volume coronary CT angiography protocol ( SCCTA ) .


A total of 102 consecutive patients were randomized to SCCTA ( n = 53 ) or DECT with rapid kVp switching ( n = 49 ) .


Eighty milliliters and 35 mL of iodinated contrast were administered in the SCCTA and DECT cohorts , respectively .


Two readers measured signal and noise in the coronary arteries ; signal-to-noise ratio ( SNR ) and contrast-to-noise ratio ( CNR ) were calculated .


A 5-point signal/noise Likert scale was used to evaluate image quality ; scores of < 3 were nondiagnostic .


Agreement was assessed through kappa analyses .


Demographics and radiation dose were not significantly different ; there was no difference in CNR between both cohorts ( P = .95 ) .


A significant difference in SNR between the groups ( P = .02 ) lost significance ( P = .13 ) when adjusted for body mass index .


The median Likert score was inferior for DECT for reader 1 ( 3.6 0.6 vs 4.3 0.6 ; P < .001 ) but not reader 2 ( 4.1 0.6 vs 4.3 0.5 ; P = .06 ) .


Agreement in diagnostic interpretability in the DECT and SCCTA groups was 91 % ( 95 % confidence interval , 86 % -100 % ) and 96 % ( 95 % confidence interval , 90 % -100 % ) , respectively .


DECT resulted in inferior image quality scores but demonstrated comparable SNR , CNR , and rate of diagnostic interpretability without a radiation dose penalty while allowing for > 50 % reduction in contrast volume compared with SCCTA .


Myostatin is a negative regulator of muscle growth .


Androgen deprivation ( ADT ) is associated with muscle loss and increased body fat , and currently available therapies have limited efficacy to treat this complication .


The antimyostatin peptibody ( AMG 745/Mu-S ) markedly attenuated muscle loss and decreased fat accumulation in orchiectomized mice .


The objective of the study was to evaluate the safety , pharmacokinetics , and muscle efficacy of AMG 745 in men undergoing ADT for nonmetastatic prostate cancer .


This was a randomized , blinded , placebo-controlled , multiple-dose , phase 1 study of AMG 745 given for 28 days .


The end point of percentage change from baseline in lean body mass ( LBM ) as assessed by dual x-ray absorptiometry was prespecified .


Rates of adverse events ( AMG 745 vs placebo ) were the following : diarrhea ( 13 % vs 9 % ) , fatigue ( 13 % vs 4 % ) , contusion ( 10 % vs 0 % ) , and injection site bruising ( 6 % vs 4 % ) .


Exposure increased linearly from 0.3 mg/kg to 3 mg/kg .


AMG 745 significantly increased LBM in the 3 mg/kg vs the placebo groups on day 29 by 2.2 % ( 0.8 % SE , P = 0.008 ) ; in exploratory fat mass analysis , a decrease of -2.5 % ( 1.0 % SE , P = 0.021 ) was observed .


Pharmacodynamic changes in muscle and fat were maintained at follow-up , 1 month after day 29 .


Four weekly s.c. doses of AMG 745 were well tolerated and were associated with increased LBM and decreased fat in the men receiving ADT for nonmetastatic prostate cancer .


RESULTS support further investigation of AMG 745 in clinical settings with muscle loss and atrophy .


To evaluate the efficacy of a single intravitreal injection of ocriplasmin 125 g across relevant subpopulations of patients with symptomatic vitreomacular adhesion ( VMA ) / vitreomacular traction ( VMT ) , including when associated with macular hole .


Two multicenter , randomized , placebo-controlled , double-masked , 6-month studies .


A total of 652 randomized patients ( 464 receiving ocriplasmin ; 188 receiving placebo ) .


A single intravitreal injection of ocriplasmin 125 g or placebo in the study eye .


Prespecified subgroup analyses were conducted to evaluate the effects on the proportion of patients with nonsurgical resolution of focal VMA at day 28 , nonsurgical full-thickness macular hole ( FTMH ) closure at month 6 , and categoric improvement in best-corrected visual acuity ( BCVA ) at month 6 .


Resolution of VMA at day 28 was achieved more often in younger patients ( < 65 years ) , eyes without epiretinal membrane , eyes with FTMH , phakic eyes , and eyes with a focal VMA 1500 m. Eyes with FTMH width 250 m were more likely to achieve nonsurgical FTMH closure .


Categoric 2-line and 3-line improvement in BCVA occurred more often in younger patients ( < 65 years ) and in patients with a lower baseline BCVA ( < 65 letters ) .


Treatment differences in favor of ocriplasmin were generally observed across each subgroup of subpopulations studied .


Subgroup analyses confirmed the positive effect of ocriplasmin across relevant subpopulations .


Unhealthy dietary behaviours are one of the key risk factors for many lifestyle-related diseases worldwide .


This randomised controlled trial aimed to increase the level of fruit , vegetable and fibre intake and decrease the fat and sugar consumption of mothers with young children ( 0-5 years ) via the playgroup setting .


Playgroups located in 60 neighbourhoods in Perth , Western Australia were randomly assigned to an intervention ( n = 249 ) or control group ( n = 272 ) .


Those in the intervention group received a 6-month multi-strategy primarily home-based physical activity and nutrition program ( data is only presented on dietary behaviours ) .


Data on dietary consumption was collected via the Fat and Fibre Barometer and frequency of serves of fruit and vegetable and cups of soft drink , flavoured drink and fruit juice .


The effects of the intervention on continuous outcome measures were assessed using analysis of variance ( ANOVA ) , after adjusting for mother 's age and the corresponding variables .


The outcomes of the intervention were positive with the intervention group showing statistically significant improvements , when compared to the control group in the overall consumption of fat and fibre ( p < 0.0005 ) ; of fibre ( p < 0.0005 ) - fruit and vegetables ( p < 0.0005 ) , wholegrain ( p = 0.002 ) : and fat ( p = 0.005 ) - dairy products ( p = 0.006 ) and lean meat and chicken ( p = 0.041 ) .


There were no significant changes in the consumption of sweet drinks .


This intervention was successful in improving dietary intake in the intervention group participants .


The moderate positive outcomes indicate that playgroups potentially provide quite a viable setting to recruit , engage and retain this hard to reach group of mothers of young children in programs that support the adoption of health-enhancing behaviours .


This adds valuable information to this under researched area .


Australian and New Zealand Clinical Trials Registry ACTRN12609000718246 .


Noninvasive positive-pressure ventilation ( NPPV ) using intelligent volume-assured pressure support ( iVAPS ) combines volume - and pressure-preset NPPV and therefore uses a variation of inspiratory positive airway pressures .


The effect of iVAPS on sleep quality in stable hypercapnic patients with chronic obstructive pulmonary disease ( COPD ) has not been determined .


In this randomized , open-label , two-treatment , two-period , crossover study , patients were randomized to receive high-intensity ( HI ) - NPPV and then iVAPS or iVAPS and then HI-NPPV .


Patients were studied in hospital for 2 consecutive nights , employing full polysomnography ( PSG ) , transcutaneous partial pressure of CO2 ( PtcCO2 ) monitoring , blood gas analysis and a visual analog scale ( VAS ) - based sleep questionnaire .


After discharge , patients used HI-NPPV and iVAPS at home , each for 6 weeks .


They had to answer a VAS question concerning sleep every morning , and were telephoned weekly and asked additional questions .


At the end of each treatment period , they were visited at home for the determination of blood gases and treatment adherence , and to change the NPPV mode .


Fourteen patients were enrolled .


In-hospital PSG measurements showed no difference in sleep quality between iVAPS and HI-NPPV .


At home , patients reported more restful sleep during iVAPS than HI-NPPV ( p = 0.04 ) .


Blood gases during spontaneous breathing at home did not differ with iVAPS and HI-NPPV , and there was a greater decrease in PtcCO2 during iVAPS than during HI-NPPV ( p = 0.003 ) .


Although sleep quality in hospital was not different between iVAPS and HI-NPPV , COPD patients with chronic hypercapnic respiratory failure reported a trend towards more restful sleep at home with iVAPS .


In addition , nocturnal hypercapnia was effectively treated with iVAPS .


As the population ages , the relative and absolute number of age-associated diseases such as dementia will increase .


Evaluation of the suitability and intake of medication and pharmacological treatment is an important aspect of care for people with dementia , especially if they live at home .


Regular medication reviews and systematic cooperation between physicians and pharmacists are not common in routine care .


Medication management ( MM ) , based on such a comprehensive home medication review could help to reduce drug-related problems and costs .


The present article presents a medication management specifically for the application in the ambulatory setting and describes its implementation as part of a larger trial .


A home medication review ( HMR ) and MM is implemented as part of the DelpHi study , a population based prospective , cluster-randomized controlled intervention study to test the efficacy and efficiency of the implementation of a collaborative care model in primary care .


people with dementia ( PWD ) and their caregivers are recruited by the patient 's general practitioner .


Inclusion criteria are a positive screening result for dementia , living at home and regular intake of drugs .


PWD are asked to specify their regular pharmacy which is asked to participate in the study , too .


a comprehensive HMR is conducted as computer-assisted personal interview by specifically qualified Dementia Care Manager ( DCM ) at the people 's home .


It includes detailed information about drugs taken , their storage , administration , adherence and adverse events .


The MM is conducted in cooperation between DCM , pharmacist and general practitioner and consists of a pharmaceutical evaluation , pharmaceutical recommendations and their application .


Pharmacists are trained and provided with regularly updated information .


The MM is designed to give information and recommendations concerning antidementia drugs , occurrence of drug related problems , intake of anticholinergic drugs , potentially clinically relevant drug-drug-interactions , adverse drug events and medication adherence .


The DelpHi-approach for medication management employs comprehensive instruments and procedures in the primary care setting under routine care conditions , and this approach should be useful in improving pharmacotherapy as part of the comprehensive treatment and care for people with dementia .


The trial is registered at ClinicalTrials.gov , number NCT01401582 .


Currently , there are over 400 smoking cessation smartphone apps available , downloaded an estimated 780,000 times per month .


No prior studies have examined how individuals engage with specific features of cessation apps and whether use of these features is associated with quitting .


Using data from a pilot trial of a novel smoking cessation app , we examined : ( i ) the 10 most-used app features , and ( ii ) prospective associations between feature usage and quitting .


Participants ( n = 76 ) were from the experimental arm of a randomized , controlled pilot trial of an app for smoking cessation called `` SmartQuit , '' which includes elements of both Acceptance and Commitment Therapy ( ACT ) and traditional cognitive behavioral therapy ( CBT ) .


Utilization data were automatically tracked during the 8-week treatment phase .


Thirty-day point prevalence smoking abstinence was assessed at 60-day follow-up .


The most-used features - quit plan , tracking , progress , and sharing - were mostly CBT .


Only two of the 10 most-used features were prospectively associated with quitting : viewing the quit plan ( p = 0.03 ) and tracking practice of letting urges pass ( p = 0.03 ) .


Tracking ACT skill practice was used by fewer participants ( n = 43 ) but was associated with cessation ( p = 0.01 ) .


In this exploratory analysis without control for multiple comparisons , viewing a quit plan ( CBT ) as well as tracking practice of letting urges pass ( ACT ) were both appealing to app users and associated with successful quitting .


Aside from these features , there was little overlap between a feature 's popularity and its prospective association with quitting .


Tests of causal associations between feature usage and smoking cessation are now needed .


This multicenter , phase 3 trial evaluated oral lubiprostone for constipation associated with non-methadone opioids in patients with chronic noncancer-related pain .


Adults with opioid-induced constipation ( OIC ; < 3 spontaneous bowel movements [ SBMs ] per week ) were randomized 1:1 to double-blind lubiprostone 24g or placebo twice daily for 12 weeks .


The primary end point was the overall SBM response rate .


Responders had at least moderate response ( 1 SBM improvement over baseline frequency ) in all treatment weeks with available observed data , as well as full response ( 3 SBMs per week ) for at least 9 of the 12 treatment weeks .


In total , 431 patients were randomized ; 212 each received lubiprostone and placebo , and 7 were not treated .


Overall , the SBM response rate was significantly higher for patients treated with lubiprostone vs. placebo ( 27.1 vs. 18.9 % , respectively ; P = 0.030 ) .


Overall mean change from baseline in SBM frequency was significantly greater with lubiprostone vs. placebo ( 3.2 vs. 2.4 , respectively ; P = 0.001 ) .


The median time to first SBM was significantly shorter with lubiprostone vs. placebo ( 23.5 vs. 37.7 h , respectively ; P = 0.004 ) .


Compared with placebo , the patients treated with lubiprostone exhibited significant improvements in straining ( P = 0.004 ) , stool consistency ( P < 0.001 ) , and constipation severity ( P = 0.010 ) .


No significant differences were observed in quality-of-life measures or the use of rescue medication ; however , the percentage of patients who used rescue medication was consistently lower in the lubiprostone group than in the placebo group at months 1 ( 34.9 vs. 37.7 % ) , 2 ( 23.4 vs. 26.6 % ) , and 3 ( 20.5 vs. 22.0 % ) .


Adverse events ( AEs ) > 5 % were diarrhea , nausea , vomiting , and abdominal pain ( lubiprostone : 11.3 , 9.9 , 4.2 , and 7.1 % , respectively ; placebo , 3.8 , 4.7 , 5.2 , and 0 % , respectively ) .


None of the serious AEs ( lubiprostone , 3.3 % ; placebo , 2.8 % ) were related to lubiprostone .


Lubiprostone significantly improved symptoms of OIC and was well tolerated in patients with chronic noncancer pain .


Strength training and neuromuscular electrical stimulation ( NMES ) improve lower-limb muscle function in dyspnoeic individuals with chronic obstructive pulmonary disease ( COPD ) .


However , high-frequency NMES ( HF-NMES ) and strength training have never been compared head-to-head ; and effects of low-frequency NMES ( LF-NMES ) have never been studied in COPD .


Therefore , the optimal training modality to improve lower-limb muscle function , exercise performance and other patient-related outcomes in individuals with severe COPD remains unknown .


To study prospectively the efficacy of HF-NMES ( 75Hz ) , LF-NMES ( 15Hz ) or strength training in severely dyspnoeic individuals with COPD with quadriceps muscle weakness at baseline .


120 individuals with COPD ( FEV1 : 331 % predicted , men : 52 % , age : 64.80.8 years ) were randomised to HF-NMES , LF-NMES or strength training as part of a comprehensive inpatient pulmonary rehabilitation programme .


No treadmill walking or stationary cycling was provided .


Groups were comparable at baseline .


Quadriceps muscle strength increased after HF-NMES ( +10.8 Newton-metre ( Nm ) ) or strength training ( +6.1 Nm ; both p < 0.01 ) , but not after LF-NMES ( +1.4 Nm ; p = 0.43 ) .


Quadriceps muscle endurance , exercise performance , lower-limb fat-free mass , exercise-induced symptoms of dyspnoea and fatigue improved significantly compared with baseline after HF-NMES , LF-NMES or strength training .


The increase in quadriceps muscle strength and muscle endurance was greater after HF-NMES than after LF-NMES .


HF-NMES is equally effective as strength training in severely dyspnoeic individuals with COPD and muscle weakness in strengthening the quadriceps muscles and thus may be a good alternative in this particular group of patients .


HF-NMES , LF-NMES and strength training were effective in improving exercise performance in severely dyspnoeic individuals with COPD and quadriceps weakness .


NTR2322 .


Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition .


Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid ( PUFA ) content and low n-3 PUFA , with no stipulated requirements for preformed long-chain n-3 PUFA .


The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact , with and without fish oil supplementation , on children 's PUFA status during treatment of severe acute malnutrition .


This randomized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were randomized to receive i ) RUTF with standard composition ; ii ) RUTF with elevated short chain n-3 PUFA ; or iii ) RUTF with elevated short chain n-3 PUFA plus fish oil capsules .


Participants were followed-up for 3 months .


The primary outcome was erythrocyte PUFA composition .


Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil .


Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or standard RUTF alone : 3 months after enrollment , DHA content was 6.3 % ( interquartile range 6.0-7 .3 ) , 4.5 % ( 3.9-4 .9 ) , and 3.9 % ( 2.4-5 .7 ) of total erythrocyte fatty acids ( P < 0.001 ) , respectively , while eicosapentaenoic acid ( EPA ) content was 2.0 % ( 1.5-2 .6 ) , 0.7 % ( 0.6-0 .8 ) , and 0.4 % ( 0.3-0 .5 ) ( P < 0.001 ) .


RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes .


PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA .


Clinical and growth implications of revised formulations need to be addressed in large clinical trials .


Clinicaltrials.gov NCT01593969 .


Registered 4 May 2012 .


Recent studies have reported beneficial effects of probiotics on maternal glycemia in healthy pregnant women .


Obesity significantly increases risk of impaired glucose tolerance in pregnancy , but glycemic effects of probiotics in this specific obstetric group require additional investigation .


The aim of the Probiotics in Pregnancy Study was to investigate the effect of a probiotic capsule on maternal fasting glucose in obese pregnant women .


In this placebo-controlled , double-blind , randomized trial , 175 pregnant women with an early pregnancy body mass index ( BMI ; in kg/m ) from 30.0 to 39.9 were recruited from antenatal clinics at the National Maternity Hospital , Dublin , Ireland .


Exclusion criteria were BMI < 30.0 or > 39.9 , prepregnancy or gestational diabetes , age < 18 y , multiple pregnancy , and fetal anomaly .


Women were randomly assigned to receive either a daily probiotic or a placebo capsule from 24 to 28 wk of gestation in addition to routine antenatal care .


The primary outcome was the change in fasting glucose between groups from preintervention to postintervention .


Secondary outcomes were the incidence of gestational diabetes and neonatal anthropometric measures .


In 138 women who completed the study ( 63 women in the probiotic group ; 75 women in the placebo group ) , mean ( SD ) early pregnancy BMI was 33.6 2.6 , which differed significantly between probiotic ( 32.9 2.4 ) and placebo ( 34.1 2.7 ) groups .


With adjustment for BMI , the change in maternal fasting glucose did not differ significantly between treated and control groups [ -0.09 0.27 compared with -0.07 0.39 mmol/L ; P = 0.391 ; B = -0.05 ( 95 % CI : -0.17 , 0.07 ) ] .


There were also no differences in the incidence of impaired glycemia ( 16 % in the probiotic group compared with 15 % in the placebo group ; P = 0.561 ) , birth weight ( 3.70 kg in the probiotic group compared with 3.68 kg in the placebo group ; P = 0.723 ) , or other metabolic variables or pregnancy outcomes .


A secondary analysis of 110 women , excluding antibiotic users and poor compliers , also revealed no differences in maternal glucose or other outcomes between groups .


Probiotic treatment of 4 wk during pregnancy did not influence maternal fasting glucose , the metabolic profile , or pregnancy outcomes in obese women .


Employment has been identified as an important part of substance abuse treatment and is a predictor of treatment retention , treatment completion , and decreased relapse .


Although employment interventions have been designed for substance abusers , few interventions have focused specifically on drug-involved offenders .


The purpose of this study was to examine employment outcomes for drug-involved offenders who received a tailored employment intervention .


In a randomized controlled trial , baseline and follow-up data were collected from 500 drug-involved offenders who were enrolled in a drug court program .


Participants were randomly assigned to drug court as usual ( control group ) or to the employment intervention in addition to drug court .


Intent-to-treat analyses found that the tailored intervention was associated only with more days of paid employment at follow-up ( 210.1 vs. 199.9 days ) .


When focusing on those with greater employment assistance needs , a work trajectory analyses , which took into account participants ' pre-baseline employment pattern ( negative or positive ) , revealed that intervention group participants had higher rates of employment ( 82.1 % vs. 64.1 % ) , more days paid for employment ( 188.9 vs. 157.0 days ) , and more employment income ( $ 8623 vs. $ 6888 ) at follow-up than control group participants .


The present study adds to the growing substance abuse and employment literature .


It demonstrates the efficacy of an innovative employment intervention tailored for drug-involved offenders by showing positive changes in 12-month employment outcomes , most strongly for those who have not had recent employment success .


Reported response rates of transitional cell carcinoma ( TCC ) in dogs to piroxicam in combination with either mitoxantrone or carboplatin are similar ; however , it is unknown whether either drug might provide superior duration of response .


To determine if the progression-free interval ( PFI ) of dogs with TCC treated with mitoxantrone and piroxicam was different than that of dogs receiving carboplatin and piroxicam .


The hypothesis was that the efficacy of mitoxantrone is no different from carboplatin .


Fifty dogs with TCC without azotemia .


Prospective open-label phase III randomized study .


Either mitoxantrone or carboplatin was administered every 3 weeks concurrently with piroxicam with restaging at 6-week intervals .


Twenty-four dogs received carboplatin and 26 received mitoxantrone .


Response was not different between groups ( P = .56 ) .


None of the dogs showed complete response .


In the mitoxantrone group , there were 2 ( 8 % ) partial responses ( PR ) and 18 ( 69 % ) dogs with stable disease ( SD ) .


In the carboplatin group , there were 3 PR ( 13 % ) and 13 ( 54 % ) dogs with SD .


The PFI was not significantly different between groups ( mitoxantrone = 106 days ; carboplatin = 73.5 days ; P = .62 ; hazard ratio 0.86 ; 95 % confidence interval 0.47-1 .56 ) .


Dogs with prostatic involvement experienced a shorter survival ( median , 109 days ) compared to dogs with urethral , trigonal , or apically located tumors ; this difference was significant ( median 300 , 190 , and 645 days , respectively ; P = .005 ) .


This study did not detect a different in outcome in dogs with TCC treated with either mitoxantrone or carboplatin in combination with piroxicam .


Computerized decision support systems ( CDSSs ) are increasingly used to improve quality of care .


There is evidence for moderate to large effects from randomized controlled trials ( RCTs ) , but evidence on their effectiveness when implemented at a national level is lacking .


In the Netherlands , the Dutch College of General Practitioners ( NHG ) initiated their successful guideline program already 30years ago .


NHGDoc , a CDSS based on these NHG guidelines , covering multiple disease areas for general practice , was developed in 2006 with the aim to improve quality of primary care .


In this paper , a protocol is presented to evaluate the uptake and effects of NHGDoc .


A cluster RCT will be conducted among 120 general practices in the Netherlands .


Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules ( control arm ) or the regular modules plus an additional module on heart failure ( intervention arm ) .


The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure .


The effect evaluation will focus on performance indicators ( e.g. , prescription behavior ) as well as on patient outcomes ( e.g. , hospital admissions ) relevant in the domain of heart failure .


Additionally , a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc .


Results of this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care .


Whereas the trial focuses on a specific domain of care-heart failure-conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care , particularly as this study also explores the factors contributing to the system 's uptake and effectiveness .


Clinical trials NCT01773057 .


The purpose of this study was to compare the utility of 2 surgical models for obstetric anal sphincter repair for improving resident knowledge , confidence level , and repair technique .


Third - and fourth-year obstetrics and gynecology residents at LAC + USC Medical Center performed simulated anal sphincter repair on both sponge and beef tongue surgical models .


Resident knowledge , confidence , technical skill , and preference were assessed after each model was performed .


Both models significantly improved resident confidence ( sponge , P = 0.017 ; tongue , P = 0.016 ) and knowledge ( 60 % correct before intervention vs. 92 % correct after intervention , P < 0.001 ) .


There was no difference detected between the 2 models .


All participants preferred the tongue model to the sponge model .


When performing both models , performing the tongue model after the sponge model resulted in a further increase in confidence ( P = 0.008 ) CONCLUSIONS : Both models are excellent tools to aid in resident teaching of obstetric anal sphincter repair and significantly increase residents ' knowledge and confidence .


The purpose of this study was to determine whether the SPRINT definition of a `` critical-sized defect '' ( fracture gap at least 1 cm in length and involving over 50 % of the cortical diameter ) was accurate , to discern which factors predict reoperation in patients with these defects , and to compare the patient-based outcomes of these patients with patients without a critical defect .


Therapeutic Cohort Study .


Level 1 and level 2 trauma centers .


Thirty-seven patients in the SPRINT trial with a critical-sized defect participated .


We evaluated these patients for planned and unplanned secondary intervention to gain union .


Additionally , we evaluated which other factors predicted the need for reoperation .


Finally , the 37 patients with a critical defect were compared with the larger cohort of patients without a defect with respect to demographics , mechanism of injury , fracture characteristics , and patient-based outcome .


Revision surgery for tibial nonunion .


Of the 37 patients with a large fracture gap , 7 patients had a planned secondary procedure .


Of the remaining 30 patients in whom the attending surgeon adopted a `` watch and wait '' strategy , 14 patients ( 47 % ) never required additional surgery to gain union .


Additional surgery to gain union was less likely in patients treated with a reamed nail ( P = 0.04 ) and in female patients ( P = 0.04 ) .


Patients with a critical-sized defect were more likely to have a high-energy mechanism of injury ( P = 0.001 ) , AO-OTA fracture type 42 B or C ( P < 0.001 ) , and location involving the middle third of the tibia ( P = 0.02 ) .


The 12-month SF-36 physical component summary score in patients with a critical-sized defect was 38.2 10.5 ( mean SD ) compared with 43.3 10.7 in those without a critical defect ( P = 0.02 , difference = 5.2 , 95 % confidence interval = 0.8-9 .6 ) .


Tibial diaphyseal defects of > 1 cm and > 50 % cortical circumference healed without additional surgery in 47 % of cases .


This definition of a critical-sized defect is not `` critical . ''


However , as compared with the overall cohort of tibial fractures , patients with these bone defects had a higher rate of reoperation and worse patient-based outcomes .


Further investigation is required to determine which factors predict union in this challenging fracture to avoid unnecessary secondary surgery .


Prognostic level I. See instructions for authors for a complete description of levels of evidence .


Overweight and obesity are associated with an increased risk of morbidity .


Mindfulness training could be an effective strategy to optimize lifestyle behaviors related to body weight gain .


The aim of this study was to evaluate the effectiveness of a worksite mindfulness-based multi-component intervention on vigorous physical activity in leisure time , sedentary behavior at work , fruit intake and determinants of these behaviors .


The control group received information on existing lifestyle behavior - related facilities that were already available at the worksite .


In a randomized controlled trial design ( n = 257 ) , 129 workers received a mindfulness training , followed by e-coaching , lunch walking routes and fruit .


Outcome measures were assessed at baseline and after 6 and 12 months using questionnaires .


Physical activity was also measured using accelerometers .


Effects were analyzed using linear mixed effect models according to the intention-to-treat principle .


Linear regression models ( complete case analyses ) were used as sensitivity analyses .


There were no significant differences in lifestyle behaviors and determinants of these behaviors between the intervention and control group after 6 or 12 months .


The sensitivity analyses showed effect modification for gender in sedentary behavior at work at 6-month follow-up , although the main analyses did not .


This study did not show an effect of a worksite mindfulness-based multi-component intervention on lifestyle behaviors and behavioral determinants after 6 and 12 months .


The effectiveness of a worksite mindfulness-based multi-component intervention as a health promotion intervention for all workers could not be established .


Intralesional antigen therapy has been used in the treatment of anogenital warts ( AGWs ) , but it has not been compared with existing therapies .


Evidence of its efficacy is not strong .


To compare the efficacy and safety of intralesional Mycobacterium w ( Mw ) vaccine with that of imiquimod , 5 % , cream in the treatment of AGWs , as well as changes in human papillomavirus ( HPV ) -6 and HPV-11 viral loads .


A double-blind randomized clinical trial was conducted in New Delhi , India , between February 2009 and July 2012 and included a 3-month follow-up .


Of 159 patients with AGWs who were screened , 89 were randomized .


Patients received either imiquimod , 5 % , cream and an intralesional vehicle ( imiquimod group : 44 patients ) or vehicle cream and intralesional Mw vaccine ( Mw group : 45 patients ) .


The primary end point was complete clinical remission of visible AGWs .


Secondary measures included the percentage of reduction in the surface area of AGWs and viral load for HPV-6 and HPV-11 .


Viral load was measured by real-time quantitative polymerase chain reaction .


In the intention-to-treat analysis , 59 % ( n = 26 ) of the patients in the imiquimod group and 67 % ( n = 30 ) of those in the Mw group had complete resolution ( P = .52 ) .


Eighteen HPV genotypes , including high-risk genotypes , were detected , with no significant differences between the treatment groups ( all P > .05 ) .


There was a significant decline in the mean viral loads of HPV-6 ( from 0.011108 to 0.00000154108 copies/mg of tissue ; P = .003 ) and HPV-11 ( from 0.121108 to 0.017108 copies/mg of tissue ; P = .03 ) after treatment in the Mw group but only in the viral load of HPV-6 ( from 1.41108 to 0.004108 copies/mg of tissue ; P = .01 ) in the imiquimod group .


There was no recurrence of AGWs in patients with complete clearance at the 3-month follow-up and no serious adverse events .


Imiquimod , 5 % , and the Mw vaccine were equally effective in achieving clinical and virologic clearance for HPV-6 .


A significant decline in the HPV-11 viral load was achieved only with the Mw vaccine .


Efficacy and safety of intralesional Mw vaccine is comparable to that of imiquimod , 5 % , in treatment of AGWs .


ctri.nic.in Identifier : CTRI/2009/091 / 000055 .


The present study investigated whether cilostazol can eliminate adverse smoking outcome after percutaneous coronary intervention ( PCI ) .


A total of 914 patients with successful drug-eluting stent ( DES ) implantation were randomly assigned to dual antiplatelet therapy ( DAT ; aspirin and clopidogrel , n = 457 ) or to triple antiplatelet therapy ( TAT ; DAT with cilostazol , n = 457 ) .


The effect of smoking on 2-year major adverse cardio/cerebrovascular events ( MACCE ) in both the TAT and DAT groups was evaluated .


Total MACCE were not significantly different between the 2 anti-platelet regimens ( 9.8 % in TAT vs. 11.4 % in DAT groups , P = 0.45 ) , but the adverse effects of smoking on clinical outcome were different between DAT vs. TAT .


Current smokers had a higher prevalence of MACCE than non-smokers in the DAT group ( 16.7 % vs. 9.5 % , P = 0.04 ) .


In the TAT group , however , the adverse effect of smoking was abolished ( 9.2 % vs. 10.1 % , P = 0.85 ) .


Regarding the effects of smoking on the antiplatelet effects of DAT or TAT , post-treatment platelet reactivity ( in P2Y12 reaction units ; PRU ) in current smokers was not significantly lower than that in non-smokers in the DAT group , whereas , in the TAT group , it was significantly lower than that of non-smokers ( 18988 vs. 21689 PRU , P = 0.01 ) .


Adverse clinical effects of smoking may be eliminated by the addition of cilostazol to DAT after DES implantation .


This may be due to the stimulation of cilostazol 's antiplatelet effects by smoking .


The purpose of this study was to test the comparative effectiveness of three variations of an online-based health promotion program for improving health and employment outcomes in a sample of Vocational Rehabilitation consumers .


A total of 222 VR consumers participated in a randomized trial of three health promotion variations and provided baseline , 2 - , 4 - , and 6-month data .


Data were analyzed using repeated measures ANOVA .


The three health promotion variations included ( a ) FACTSHEETS-a series of four electronic factsheets ; ( b ) HPE-an online interactive health promotion website that included health behavior content and tailored action planning , and ( c ) HPE + MI-the online health promotion website plus two 30-minute calls with a trained motivational interviewer .


Contrary to expectations , evidence did not support between-group differences based on intervention intensity .


In fact , the Factsheet , HPE , and HPE + MI participants all experienced significant reductions in secondary conditions , F ( 2.85 , 489 ) = 7.808 , p < .001 , HRQoL symptom days , F ( 2.7 , 495 ) = 4.795 , p = .004 ; and significant improvements in healthy lifestyle behaviors , F ( 2.6 , 495 ) = 3.66 , p = .017 over the 6-month study period .


Although this study did not include a control group , a control group from another study with a similar population did not experience similar outcomes .


People with disabilities experience significantly higher rates of secondary health conditions and lower employment rates than people without disabilities .


The combination of these factors signifies the need for health promotion programming outside the work setting .


Muscle glycogen has been well established as the primary metabolic energy substrate during physical exercise of moderate - to high-intensity and has accordingly been implicated as a limiting factor when such activity is sustained for a prolonged duration .


However , the role of this substrate during repeated exercise after limited recovery is less clear , with ongoing debate regarding how recovery processes can best be supported via nutritional intervention .


The aim of this project is to examine the causes of fatigue during repeated exercise bouts via manipulation of glycogen availability through nutritional intervention , thus simultaneously informing aspects of the optimal feeding strategy for recovery from prolonged exercise .


The project involves two phases with each involving two treatment arms administered in a repeated measures design .


For each treatment , participants will be required to exercise to the point of volitional exhaustion on a motorised treadmill at 70 % of previously determined maximal oxygen uptake , before a four hour recovery period in which participants will be prescribed solutions providing 1.2 grams of sucrose per kilogram of body mass per hour of recovery ( g.kg-1 .


h-1 ) relative to either a lower rate of sucrose ingestion ( that is , 0.3 g.kg-1 .


h-1 ; Phase I ) or a moderate dose ( that is , 0.8 g.kg-1 .


h-1 ) rendered isocaloric via the addition of 0.4 g.kg-1 .


h-1 whey protein hydrolysate ( Phase II ) ; the latter administered in a double blind manner as part of a randomised and counterbalanced design .


Muscle biopsies will be sampled at the beginning and end of recovery for determination of muscle glycogen resynthesis rates , with further biopsies taken following a second bout of exhaustive exercise to determine differences in substrate availability relative to the initial sample taken following the first exercise bout .


Phase I will inform whether a dose-response relationship exists between carbohydrate ingestion rate and muscle glycogen availability and/or the subsequent capacity for physical exercise .


Phase II will determine whether such effects are dependent on glycogen availability per se or energy intake , potentially via protein mediated mechanisms .


ISRCTN87937960 .


Case series suggest that laparoscopic peritoneal lavage might be a promising alternative to sigmoidectomy in patients with perforated diverticulitis .


We aimed to assess the superiority of laparoscopic lavage compared with sigmoidectomy in patients with purulent perforated diverticulitis , with respect to overall long-term morbidity and mortality .


We did a multicentre , parallel-group , randomised , open-label trial in 34 teaching hospitals and eight academic hospitals in Belgium , Italy , and the Netherlands ( the Ladies trial ) .


The Ladies trial is split into two groups : the LOLA group comparing laparoscopic lavage with sigmoidectomy and the DIVA group comparing Hartmann 's procedure with sigmoidectomy plus primary anastomosis .


The DIVA section of this trial is still underway but here we report the results of the LOLA section .


Patients with purulent perforated diverticulitis were enrolled for LOLA , excluding patients with faecal peritonitis , aged older than 85 years , with high-dose steroid use ( 20 mg daily ) , and haemodynamic instability .


Patients were randomly assigned ( 2:1:1 ; stratified by age [ < 60 years vs 60 years ] ) using secure online computer randomisation to laparoscopic lavage , Hartmann 's procedure , or primary anastomosis in a parallel design after diagnostic laparoscopy .


Patients were analysed according to a modified intention-to-treat principle and were followed up after the index operation at least once in the outpatient setting and after sigmoidoscopy and stoma reversal , according to local protocols .


The primary endpoint was a composite endpoint of major morbidity and mortality within 12 months .


This trial is registered with ClinicalTrials.gov , number NCT01317485 .


Between July 1 , 2010 , and Feb 22 , 2013 , 90 patients were randomly assigned in the LOLA section of the Ladies trial when the study was terminated by the data and safety monitoring board because of an increased event rate in the lavage group .


Two patients were excluded for protocol violations .


The primary endpoint occurred in 30 ( 67 % ) of 45 patients in the lavage group and 25 ( 60 % ) of 42 patients in the sigmoidectomy group ( odds ratio 128 , 95 % CI 054-303 , p = 058 ) .


By 12 months , four patients had died after lavage and six patients had died after sigmoidectomy ( p = 043 ) .


Laparoscopic lavage is not superior to sigmoidectomy for the treatment of purulent perforated diverticulitis .


Netherlands Organisation for Health Research and Development .


To compare the laser spot quality between the conventional slit lamp pattern laser ( PASCAL ) and the navigated pattern laser ( NAVILAS ) for panretinal photocoagulation ( PRP ) .


Prospective randomized interventional trial of 73 eyes ( 51 patients ) with high-risk proliferative diabetic retinopathy .


Eyes underwent PRP using 30-ms pulse duration with either PASCAL ( 16 eyes ) or NAVILAS laser ( 21 eyes ) , or 100-ms pulse duration with either PASCAL ( 16 eyes ) or NAVILAS laser ( 20 eyes ) .


Fundus color images of all quadrants were taken 5 minutes after treatment .


Laser burn size ( major and minor diameter and area ) and ellipticity ( ratio of minor to major axis ) were analyzed across the retina .


Treatment time and pain were compared between both groups .


The burn size variation in navigated laser 30 ms , 100 ms , and conventional pattern 30 ms and single-spot 100 ms laser was 22 % , 24 % , 21 % , and 35 % , respectively .


The variation of the laser burn area near the arcade for NAVILAS and for PASCAL was 29 % and 22 % , respectively ( P < 0.01 ) .


Closer to the equator , burns from the NAVILAS showed even smaller variation of 15 % compared with 25 % with PASCAL ( P < 0.005 ) .


Laser spots from PASCAL exhibited an increasing elliptical shape toward the periphery , whereas NAVILAS laser spots tended to be more uniform all over the retina .


Average treatment duration and pain experience was less with navigated laser compared with pattern laser ( P 0.05 ) .


Navigated laser treatment achieves more uniform laser burns with less pain during shorter treatment duration in comparison with conventional pattern laser .


In patients with chronic tension-type headache ( CTTH ) changes in pressure pain in the cervical region are associated with peripheral or central sensitization .


It is hypothesized that an increase of isometric strength of neck flexors would lead to a decrease of pressure pain in CTTH , as an expression of reduced peripheral or central sensitization


In this study we aimed to analyze the correlation between change in isometric strength of the neck flexors and change in pressure pain scores ( PPS ) in patients with CTTH .


Comparative analysis of data from previous study .


Primary healthcare center .


Data from 145 patients with CTTH who underwent a manual therapy program including isometric strength training of the neck flexors were analyzed at 8 and 26 weeks post-treatment .


PPS were measured as a total of pain scores on a numeric rating scale ( score 0 to 10 ) on application of a pressure stimulus of 3kg/cm at 8 cervical - and suboccipital muscles .


Isometric strength of the neck flexors was measured in seconds .


Correlations were computed between changes in PPS and isometric neck flexor strength .


Isometric strength of neck flexors scored significantly different compared to baseline measurement ( mean 30.0 seconds , sd :25.2 ) , and increased with a mean difference of 17.33 seconds ( 95 % CI : 20.61 to 14.05 ) at 8 weeks and 19.18 seconds ( 95 % CI : 23.48 to 14.87 ) at 26 weeks .


Similarly , compared to PPS baseline measurement ( 31.6 points , sd :18.6 ) , mean difference in PPS was significantly decreased at 8 and 26 weeks : -11.3 points ( 95 % CI : -8.77 to -13.83 ) and -11.15 points ( 95 % CI : -8.31 to -13.99 ) .


There is a negative correlation between changes in PPS and changes in isometric strength of neck flexors which is weak at 8 weeks ( r = -0.243 , P = 0.004 ) and moderate at 26 weeks ( r = -0.318 , P < 0.000 ) .


Correlational analysis .


Decrease in PPS correlates with increases in isometric strength of neck flexors in patients with CTTH in short - and long-term .


Patients with ischemic left ventricular dysfunction have higher operative risk with coronary artery bypass graft surgery ( CABG ) .


However , those whose early risk is surpassed by subsequent survival benefit have not been identified .


This study sought to examine the impact of anatomic variables associated with poor prognosis on the effect of CABG in ischemic cardiomyopathy .


All 1,212 patients in the STICH ( Surgical Treatment of IsChemic Heart failure ) surgical revascularization trial were included .


Patients had coronary artery disease ( CAD ) and ejection fraction ( EF ) of 35 % and were randomized to receive CABG plus medical therapy or optimal medical therapy ( OMT ) alone .


This study focused on 3 prognostic factors : presence of 3-vessel CAD , EF below the median ( 27 % ) , and end-systolic volume index ( ESVI ) above the median ( 79 ml/m ( 2 ) ) .


Patients were categorized as having 0 to 1 or 2 to 3 of these factors .


Patients with 2 to 3 prognostic factors ( n = 636 ) had reduced mortality with CABG compared with those who received OMT ( hazard ratio [ HR ] : 0.71 ; 95 % confidence interval [ CI ] : 0.56 to 0.89 ; p = 0.004 ) ; CABG had no such effect in patients with 0 to 1 factor ( HR : 1.08 ; 95 % CI : 0.81 to 1.44 ; p = 0.591 ) .


There was a significant interaction between the number of factors and the effect of CABG on mortality ( p = 0.022 ) .


Although 30-day risk with CABG was higher , a net beneficial effect of CABG relative to OMT was observed at > 2 years in patients with 2 to 3 factors ( HR : 0.53 ; 95 % CI : 0.37 to 0.75 ; p < 0.001 ) but not in those with 0 to 1 factor ( HR : 0.88 ; 95 % CI : 0.59 to 1.31 ; p = 0.535 ) .


Patients with more advanced ischemic cardiomyopathy receive greater benefit from CABG .


This supports the indication for surgical revascularization in patients with more extensive CAD and worse myocardial dysfunction and remodeling .


( Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [ STICH ] ; NCT00023595 ) .


Hypertension and overweight are prevalent problems in type 2 diabetic patients .


The purpose of this study was to assess the effects of long term regular aerobic exercise training on blood pressure ( BP ) as well as body mass index ( BMI ) in type 2 diabetes mellitus ( T2DM ) .


In a randomized , controlled trial , 60 patients with T2DM aged 40-65 years were randomly divided in two groups ( 30 subjects in exercise group and 30 subjects in control group ) .


Supervised exercise program was performed three times per week for 3 years .


Finally , 28 patients who completed the optimal sessions , entered in statistical analysis .


Systolic and diastolic blood pressure ( SBP , DBP ) had no significant changes in control group ( respectively 127.4812.79 to 129.288.52 and 78.908.06 to 77.555.95 ) .


These changes were statistically significant in the exercise group ( respectively 132.5714.82 to 118.0012.48 and 82.899.19 to 74.006.57 ; P < 0.001 ) .


Furthermore , the BMI of exercise group reduced significantly ( 285.26 to 26.424.36 ; P < 0.001 ) in comparison with control group that showed a significant increase in terms of this variable ( 30.024.79 to 31.054.84 ; P < 0.05 ) .