The experiment was conducted from November 2011 to May 2012 at the University Hospital Basel ( Switzerland ) with 42 medical students in a master 's program .


All participants analyzed a standardized case ( a patient with a subcapital fracture of the fifth metacarpal bone ) based on a radiological image , photographs of the hand , and textual descriptions , and were asked to consult a remote surgical specialist via a smartphone .


Participants were randomly assigned to 3 experimental conditions/groups .


In group 1 , the specialist provided verbal explanations ( speech only ) .


In group 2 , the specialist provided verbal explanations and displayed the radiological image and the photographs to the participants ( speech and images ) .


In group 3 , the specialist provided verbal explanations , displayed the radiological image and the photographs , and annotated the radiological image by drawing structures/angle elements ( speech , images , and image annotation ) .


To assess knowledge recall , participants were asked to write brief summaries of the case ( verbally represented knowledge ) after the consultation and to re-analyze the diagnostic images ( visually represented knowledge ) .


To assess knowledge transfer , participants analyzed a similar case without specialist support .


Data analysis by ANOVA found that participants in groups 2 and 3 ( images used ) evaluated the support provided by the specialist as significantly more positive than group 1 , the speech-only group ( group 1 : mean 4.08 , SD 0.90 ; group 2 : mean 4.73 , SD 0.59 ; group 3 : mean 4.93 , SD 0.25 ; F2 ,39 = 6.76 , P = .003 ; partial ( 2 ) = 0.26 , 1 - = .90 ) .


However , significant positive effects on the recall and transfer of visually represented medical knowledge were only observed when the smartphone-based communication involved the combination of speech , images , and image annotation ( group 3 ) .


There were no significant positive effects on the recall and transfer of visually represented knowledge between group 1 ( speech only ) and group 2 ( speech and images ) .


No significant differences were observed between the groups regarding verbally represented medical knowledge .


The results show ( 1 ) the value of annotation functions for digital and mobile technology for interclinician communication and medical informatics , and ( 2 ) the use of guided noticing ( the integration of speech , images , and image annotation ) leads to significantly improved knowledge gains for visually represented knowledge .


This is particularly valuable in situations involving complex visual subject matters , typical in clinical practice .


This study investigated whether maintenance temozolomide ( TMZ ) after definitive therapy for locally advanced non-small-cell lung cancer ( NSCLC ) could decrease the incidence of brain metastasis ( BM ) .


Eligible patients included those with stage IIIA , IIIB , or IV ( for stage IV , only with malignant pleural/pericardial effusion ) NSCLC with no BM at diagnosis and stable disease , partial response , or complete response after first-line chemotherapy using at least 2 agents .


Patients were randomized to observation or TMZ ( 75 mg/m ( 2 ) for 21 consecutive days followed by a 7-day rest for up to 6 cycles or progression ) .


The primary end point was incidence of radiographically diagnosed BM within 12 months from day 1 of first-line chemotherapy .


Secondary end points included overall survival ( OS ) , time to progression , incidence of BM at first progression , and toxicity .


The study was closed early on the basis of a futility analysis ; 45 of 53 enrolled patients were evaluable from an original target of 100 .


No difference was noted in the incidence of BM at 1 year in the TMZ and observation groups ( 18 % and 13 % , respectively ) , in median time to progression ( 11.7 and 10.7 months , respectively ) , or in median OS ( 27.1 and 22.5 months , respectively ) .


Common Terminology Criteria for Adverse Events grade 3 or 4 adverse events were 46 % in the TMZ group and 19 % in the observation group .


TMZ monotherapy does not appear to decrease the incidence of BM in patients with locally advanced NSCLC .


These results considered in the context of the existing literature have implications for future clinical trial design .


The international multicentre FAME Study ( n = 1,005 ) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention ( PCI ) guided by fractional flow reserve ( FFR ) measurement compared with angiography guidance alone ( ANGIO ) .


We determined the cost-effectiveness and the public health/budget impact for Australia .


We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data .


We used Australian utilities ( EQ-5D ) and costs to calculate quality-adjusted life years ( QALYs ) and incremental cost-effectiveness adopting the societal perspective .


The public health and budget impact from the payer 's perspective was based on Australian PCI registries .


Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method ( n = 5,000 samples ) .


The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year .


Over a two-year time horizon , the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings .


Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions .


FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events , improves QALYs and is cost-saving in the Australian health care system .


This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography ( NCE 4D MRA ) with signal targeting with alternative radiofrequency ( STAR ) spin labeling and variable flip angle ( VFA ) sampling in the assessment of dural arteriovenous fistula ( DAVF ) in the transverse sinus .


Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3T .


One patient was examined twice , once before and once after the interventional treatment .


All patients also underwent digital subtraction angiography ( DSA ) and/or contrast-enhanced magnetic resonance angiography ( CEMRA ) .


For the acquisition of NCE 4D MRA , a STAR spin tagging method was used , and a VFA sampling was applied in the data readout module instead of a constant flip angle .


Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus .


The results were compared with those from DSA and/or CEMRA .


All patients underwent NCE 4D MRA without any difficulty .


Among seven patients with patent DAVFs , all cases showed an early visualization of the transverse sinus on NCE 4D MRA .


Except for one case , the type of DAVF of NCE 4D MRA was agreed with that of reference standard study .


Cortical venous reflux ( CVR ) was demonstrated in two cases out of three patients with CVR .


NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus .


Further technical developments should aim at improvements of spatial and temporal coverage .


Non-cystic fibrosis bronchiectasis is characterized by the irreversible dilatation of the medium-sized bronchi as a result of airway injury from recurrent or chronic inflammation and lower respiratory tract infections .


Bronchiectasis airways are commonly colonized with bacterial species .


Infections of the airways play important role in bronchiectasis exacerbations .


The non-specific prevention of recurrent airway infections by immunostimulating agents has gained growing interest .


OM-85 , consisting of extracts of eight kinds of bacteria important in respiratory infections , could support the respiratory tract resistance to the pathogens .


OM-85 has been shown to be a benefit by decreasing the risk of acute exacerbation of chronic obstructive pulmonary disease ( COPD ) in several perspective clinical trials .


Exacerbation of bronchiectasis substantially contributes to a more rapid decline in lung function , reduced quality of life , and healthcare costs .


In this context , we plan to conduct a clinical trial to investigate the PReventive effect of OM-85 on Bronchiectasis Exacerbation in Chinese patients ( iPROBE ) .


This study is designed as a prospective , randomized , double blind , placebo-controlled multicenter trial .


A total of 244 patients with bronchiectasis , who have had at least one exacerbation of bronchiectasis in the previous year , will be included .


The subjects will randomly receive two courses of 7 mg of OM-85 or a matching placebo .


The treatment dose of OM-85 will be one daily capsule taken orally for 10 days each month for 3 consecutive months at the beginning of the study , followed by 3 months of no drug .


This schedule will repeat until the patient has been seen for one year .


We will investigate whether long-term treatment with an oral immunostimulant ( OM-85 ) could decrease exacerbations of bronchiectasis over a one-year period .


We will also assess other relevant outcomes , including the rate of event-based exacerbation , lung function parameters , and total scores judged by the St George 's respiratory questionnaire , Leicester cough questionnaire , and inflammatory index .


We hope that this study will provide new information on the preventive effects of OM-85 on bronchiectasis exacerbations and will address a knowledge gap for this understudied disease .


This study is registered at http://www.clinicaltrials.gov ( identifier NCT01968421 ) on 19 October 2013 .


Dipeptidyl peptidase ( DPP ) -4 inhibitors and sulfonylureas may have different effects on islet function .


We designed a new two-step hyperglycemic clamp to further compare the effects of sitagliptin , saxagliptin , and glimepiride on - cell function and the incretin effect .


The present study was a four-way cross-over open label randomized study .


Twelve healthy male subjects were administered a single dose of sitagliptin ( 100mg ) , saxagliptin ( 5mg ) , glimepiride ( 2mg ) or blank control 2h before undergoing a two-step hyperglycemic clamp ( Step 1 : only intravenous glucose was administered ; Step 2 : i.v. glucose loading was combined with oral glucose consumption ) .


Two-phase insulin secretion , glucagon secretion , and incretin levels were measured during the clamp .


In Step 1 , with i.v. glucose only , there were no differences between the effects of the three drugs on insulin secretion , except that saxagliptin increased second-phase insulin secretion more than glimepiride ( P = 0.007 ) .


In Step 2 , oral glucose consumption led to an approximate two fold increase in insulin secretion and both gliptins significantly increased first-phase insulin secretion compared with glimepiride ( P = 0.003 for both ) .


Saxagliptin further increased second-phase insulin secretion compared with glimepiride ( P = 0.005 ) and sitagliptin ( P < 0.001 ) .


Both gliptins significantly decreased glucagon secretion and increased active glucagon-like peptide-1 ( GLP-1 ) compared with glimepiride , especially in Step 2 .


The two-step hyperglycemic clamp appears to be a precise method to assess - cell function by taking the effect of incretins into consideration .


The oral glucose consumption adds to the i.v. glucose infusion , amplifying the differences in the effects of DPP-4 inhibitors and glimepiride on insulin secretion .


Exercise induces oxidative stress and causes adaptations in antioxidant defenses .


The aim of the present study was to determine the effects of a 2-month diet supplementation with docosahexaenoic acid ( DHA ) on the pro-oxidant and antioxidant status of peripheral blood mononuclear cells ( PBMCs ) during football training and after acute exercise .


Fifteen male football players , in a randomized double-blind trial , ingested a beverage enriched with DHA or a placebo for 8 weeks .


Blood samples were collected in basal conditions before and after the training period and after an acute and intense exercise .


The training season increased the carbonyl and nitrotyrosine index but decreased the malondialdehyde ( MDA ) levels .


Basal catalase activity decreased in both groups after 8 weeks of training , whereas glutathione peroxidase activity increased mainly in the placebo group .


Protein levels of uncoupling proteins ( UCP2 and UCP3 ) and inducible nitric oxide synthase significantly increased after the training period .


Acute exercise induced redistribution in the number of circulating cells , increased the MDA levels and nitrotyrosine index , and decreased the levels of nitrate .


Acute exercise also increased PBMCs reactive oxygen species ( ROS ) production after immune stimulation .


Diet supplementation with DHA significantly increased the UCP3 levels after training and the superoxide dismutase protein levels after acute exercise , and reduced the production of ROS after acute exercise .


Docosahexaenoic acid increased the antioxidant capabilities while reducing the mitochondrial ROS production in a regular football training period and reduced the oxidative damage markers in response to acute exercise .


Prospective randomized study .


To compare autologous bone marrow concentrate mixed with allograft cancellous bone to iliac crest autograft in lumbar fusions .


Bone marrow has been shown to be a rich source of osteoprogenitor cells .


Osteoprogenitor cells have been shown in animals , and some human studies , to have potential in use as a bone graft substitute .


Twenty-five patients underwent from 1 - to 3-level lumbar fusions .


One patient was lost to follow-up .


On one half of the spine , allograft plus autologous bone marrow concentrate was used , whereas on the other half , autologous iliac crest bone was used .


Cellular analysis , consisting of nucleated cell count , mononuclear cell count , CD34 + count , and colony-forming-units-fibroblast count , was done on marrow aspirates and concentrates .


At 1 year postoperation , computed tomographic scans of the fusions were evaluated on a blinded basis by 2 neuroradiologists independent of each other .


Radiographical fusion was the primary outcome measure .


There was no statistical difference in fusion scores between allograft and autograft in the lateral gutters , interbody cages , or facet joints .


There was a positive trend between CD34 + counts and radiographical fusion .


The study shows equivalence between cancellous allograft mixed with bone marrow concentrate and autologous iliac crest bone for lumbar fusions .


2 .


Platinum-resistant ovarian cancer ( PROC ) constitutes a therapeutic dilemma with limited efficacy from traditional cytotoxic agents .


Based on prior data suggesting that scheduling alterations of platinum would increase activity , the aim of the present study was to assess the potential therapeutic benefit of phenoxodiol ( PXD ) , a novel biomodulator shown to have chemoresistance reversing potential , when combined with weekly AUC2-carboplatin in PROC patients .


A multicenter randomized double-blind placebo controlled phase-III-study was conducted to compare oral PXD plus AUC2-carboplatin ( group 1 ) versus placebo plus AUC2-carboplatin ( group 2 ) weekly in PROC patients .


The primary end point was progression-free-survival ( PFS ) .


Secondary objectives included overall survival ( OS ) , response rates , duration of response and quality of life .


The study was terminated early 14 April 2009 , after recruitment of 142 patients due to feasibility and recruitment challenges .


A total of 142 patients were randomized .


The groups were well balanced in terms of important baseline characteristics .


The median PFS for group 1 was 15.4 weeks [ 95 % confidence interval ( CI ) 11.1-21 .0 ] versus 20.1 weeks for group 2 ( 95 % CI = 13.1-33 .4 ) ; P = 0.3 .


The objective response rate and median survival in group 1 versus group 2 was 0 % versus 1 % and 38.3 weeks ( 95 % CI 32.0-45 .3 ) versus 45.7 weeks ( 95 % CI 35.6-58 .0 ) , respectively .


PXD appeared to be well tolerated .


The main reason for dose modification in both groups was hematologic toxicity .


Orally delivered PXD showed no evidence of clinical activity , when combined with weekly AUC2-carboplatin in PROC .


In addition , single-agent weekly AUC2-carboplatin appeared to be inactive by response criteria in a homogenously defined population of PROC .


This has implications for the design of future studies .


Left-ventricular ejection fraction ( LVEF ) is regarded as a strong predictor for morbidity and mortality in heart failure patients .


The aim of the analysis was to assess the relationship between pre-implant LVEF and outcome of patients with advanced heart failure who received cardiac resynchronization therapy ( CRT ) .


We analysed the two-year follow-up of 366 patients who had been enrolled in the MASCOT study which included NYHA class III/IV patients with a class I CRT indication .


Pre-implant LVEF was stratified by tertile .


The boundaries for pre-implant LVEF were < 22 % ( n = 128 ; 18.2 + / - 3.1 % ; T ( low ) ) , 22 % to 28 % ( n = 121 ; 25.4 + / - 1.4 % ; T ( middle ) ) and > 28 % ( n = 117 ; 32.6 + / - 3.9 % ; T ( high ) ) for each tertile.Two-year post-implant LVEF was 32.0 + / - 11.5 % ( T ( low ) ) , 33.7 + / - 10.8 % ( T ( middle ) ) and 36.4 + / - 9.9 % ( T ( high ) ) .


T ( Iow ) had a greater increase between pre - and post-implant LVEF compared to T ( middle ) ( P = 0.03 ) and T ( high ) ( P = 0.0001 ) .


NYHA class improved similarly among the three groups as well as the quality of life score .


No significant differences were detected between the three groups for all-cause mortality , cardiac death , all-cause hospitalization , and hospitalization due to worsening heart failure .


Symptomatic heart failure patients with a wide QRS complex and a severe impaired LV function had a better improvement of their pre-implant LVEF than patients with a more preserved LVEF .


This may be one reason that in these patient groups long-term morbidity and mortality were not related to their pre-implant LVEF .


Pre-implant LVEF was in symptomatic CRT patients not predictive for their long-term cardiovascular morbidity and mortality .


To examine the antihypertensive effect of the synthetic analogue of the endogenous nitric oxide donors in patients with grades 2-3 hypertension and uncomplicated hypertensive crisis ( HC ) .


The study included 30 male patients aged 35 to 73 years ( mean age 55.5 10.8 years ) .


All the patients had grades 2-3 essential or secondary hypertension .


Thirteen ( 43.3 % ) patients were observed to have signs of HC ; 17 ( 56.7 % ) patients had persistent blood pressure ( BP ) elevation .


A dinitrosyl iron complex was injected in a dose of 1.5 or 3 mg per kg of body weight .


The purpose of its administration was to lower BP by at least 20 % of its baseline level .


No significant side effects associated with the administration of the test drug were recorded when the clinical trial protocol was implemented .


All the patients reported fever and facial hyperemia during and 10-20 minutes after injection .


They all ( 100 % ) showed efficient blood pressure reduction of at least 20 % of the baseline level .


Blood pressure changes were similar when the agent was administered in doses of 1.5 or 3 mg/kg .


At 6-8 minutes after the drug was injected , there was a maximal decrease in blood pressure , then its gradual rise and stabilization at a lower level than the baseline one within the following 8 hours .


There were no significant differences in the magnitude of a blood pressure reduction after administration of 1.5 and 3 mg/kg .


The findings suggest that the dinitrosyl iron complex is highly effective in treating uncomplicated HC .


The antihypertensive effect of the drug persists for 8 hours after its injection , which is very important during prehospital therapy .


The drug is well tolerated by patients and causes an insignificant number of side effects .


1 .


Determine whether stress in preterm infants , measured with salivary cortisol , decreases after five days of Kangaroo Care ( KC ) compared to five days of Standard Care ( SC ) .


2 .


To determine whether kangaroo care provides sustainable pain relief beyond the period of skin-to-skin holding .


Preterm infants ( n = 38 ) born at 27-30 weeks gestational age were randomized to either the KC or the SC group and received the allocated intervention starting on day of life ( DOL ) five and continuing for five days .


Salivary cortisol was collected on DOL five and again on DOL ten .


Differences were analyzed using repeated measures ANOVA and t tests .


Pain during nasal suctioning over five days was assessed using the Premature Infant Pain Profile ( PIPP ) .


Adequate saliva samples for salivary cortisol were collected for 13 KC infants and 11 SC infants .


There was no main effect of group ( p = 0.49 ) , but there was a significant main effect of age ( DOL five versus DOL ten ) , with salivary cortisol levels decreasing in both groups ( p = 0.02 ) .


Pain scores for both groups ( n = 38 ) indicted mild to moderate pain during suctioning , with no significant difference in pain scores between groups .


KC did not affect salivary cortisol levels in preterm neonates , but levels in both the KC and SC groups decreased over time from DOL five to ten .


Salivary cortisol may vary with age of infant .


Infants experience pain during routine suctioning and may require pain management .


Dexamethasone ( DEXA ) is commonly used to reduce brain swelling during neurosurgical procedures .


DEXA , however , has many side-effects that can increase the risks of post-operative complications .


In contrast , progesterone ( PRO ) has fewer side-effects and has been found to be neuroprotective on traumatic brain injury ( TBI ) .


Whether PRO may be used as an alternative to DEXA during routine procedures has not been fully explored .


To compare the effects of DEXA and PRO on surgical brain injury ( SBI ) .


Seventy-five adult male Sprague Dawley rats were randomized into five groups : ( 1 ) SBI + drug vehicle ( peanut oil , 1ml kg ( -1 ) ) ; ( 2 ) SBI + DEXA ( 1mg kg ( -1 ) ) ; ( 3 ) SBI + low-dose PRO ( 10mg kg ( -1 ) ) ; ( 4 ) SBI + high-dose PRO ( 20mg kg ( -1 ) ) ; and ( 5 ) sham SBI + drug vehicle .


Magnetic resonance imaging study and assessments of brain water content ( BWC ) , blood-brain barrier ( BBB ) permeability , cellular inflammatory responses and matrix metalloproteinase 9 ( MMP-9 ) expression were conducted .


This model consistently resulted in increased BWC and BBB disruption .


PRO reduced astrocyte and microglia responses and attenuated brain oedema with preservation of BBB .


A significant down-regulation of MMP-9 expression occurred in the PRO 20 group .


PRO is as effective as DEXA in reducing brain oedema and inflammation following SBI ; 10mg kg ( -1 ) of PRO was demonstrated to be more effective in relieving acute cellular inflammatory responses .


To assess in multiple sclerosis ( MS ) the effect of intense immunosuppression followed by autologous hematopoietic stem cells transplantation ( AHSCT ) vs mitoxantrone ( MTX ) on disease activity measured by MRI .


We conducted a multicenter , phase II , randomized trial including patients with secondary progressive or relapsing-remitting MS , with a documented increase in the last year on the Expanded Disability Status Scale , in spite of conventional therapy , and presence of one or more gadolinium-enhancing ( Gd + ) areas .


Patients were randomized to receive intense immunosuppression ( mobilization with cyclophosphamide and filgrastim , conditioning with carmustine , cytosine-arabinoside , etoposide , melphalan , and anti-thymocyte globulin ) followed by AHSCT or MTX 20 mg every month for 6 months .


The primary endpoint was the cumulative number of new T2 lesions in the 4 years following randomization .


Secondary endpoints were the cumulative number of Gd + lesions , relapse rate , and disability progression .


Safety and tolerability were also assessed .


Twenty-one patients were randomized and 17 had postbaseline evaluable MRI scans .


AHSCT reduced by 79 % the number of new T2 lesions as compared to MTX ( rate ratio 0.21 , p = 0.00016 ) .


It also reduced Gd + lesions as well as the annualized relapse rate .


No difference was found in the progression of disability .


Intense immunosuppression followed by AHSCT is significantly superior to MTX in reducing MRI activity in severe cases of MS. These results strongly support further phase III studies with primary clinical endpoints .


The study was registered as EUDRACT No. 2007-000064-24 .


Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality .


We aimed to assess the feasibility , effectiveness , and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries .


In this 18-month , cluster-randomised trial , we randomly assigned ( 1:1 ) rural and semi-urban clusters within six countries ( Argentina , Guatemala , India , Kenya , Pakistan , and Zambia ) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids .


The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight ( a proxy for preterm birth ) across the clusters .


Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes .


This trial is registered with ClinicalTrials.gov , number NCT01084096 .


The ACT trial took place between October , 2011 , and March , 2014 ( start dates varied by site ) .


51 intervention clusters with 47,394 livebirths ( 2520 [ 5 % ] less than 5th percentile for birthweight ) and 50 control clusters with 50,743 livebirths ( 2258 [ 4 % ] less than 5th percentile ) completed follow-up .


1052 ( 45 % ) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids , compared with 215 ( 10 % ) of 2062 in control clusters ( p < 00001 ) .


Among the less-than-5th-percentile infants , 28-day neonatal mortality was 225 per 1000 livebirths for the intervention group and 232 per 1000 livebirths for the control group ( relative risk [ RR ] 096 , 95 % CI 087-106 , p = 065 ) and suspected maternal infection was reported in 236 ( 10 % ) of 2361 women in the intervention group and 133 ( 6 % ) of 2094 in the control group ( odds ratio [ OR ] 167 , 133-209 , p < 00001 ) .


Among the whole population , 28-day neonatal mortality was 274 per 1000 livebirths for the intervention group and 239 per 1000 livebirths for the control group ( RR 112 , 102-122 , p = 00127 ) and suspected maternal infection was reported in 1207 ( 3 % ) of 48,219 women in the intervention group and 867 ( 2 % ) of 51,523 in the control group ( OR 145 , 133-158 , p < 00001 ) .


Despite increased use of antenatal corticosteroids in low-birthweight infants in the intervention groups , neonatal mortality did not decrease in this group , and increased in the population overall .


For every 1000 women exposed to this strategy , an excess of 35 neonatal deaths occurred , and the risk of maternal infection seems to have been increased .


Eunice Kennedy Shriver National Institute of Child Health and Human Development .


This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain .


30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day ( n = 15 ) or in control receiving weekly email-based information on general health ( n = 15 ) .


Electromyography ( EMG ) from the splenius and upper trapezius was recorded during a normal workday .


Adherence to training and control interventions were 86 % and 89 % , respectively .


Compared with control , training increased isometric muscle strength 6 % ( P < 0.05 ) and decreased neck/shoulder pain intensity by 40 % ( P < 0.01 ) .


The frequency of periods with complete motor unit relaxation ( EMG gaps ) decreased acutely in the hours after training .


By contrast , at 10-week follow-up , training increased average duration of EMG gaps by 71 % , EMG gap frequency by 296 % and percentage time below 0.5 % , and 1.0 % EMGmax by 578 % and 242 % , respectively , during the workday in m. splenius .


While resistance training acutely generates a more tense muscle activity pattern , the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain .


To observe the curative effect of acupuncture intervention combined with hyperbaric oxygen chamber treatment for delayed encephalopathy in 32 carbon monoxide ( CO ) poisoning patients .


A total of 62 CO poisoning encephalopathy patients were randomized into control group ( n = 30 ) and acupuncture group ( n = 32 ) .


Patients of the two groups were all treated with medicines ( energy mixture solution , hormones , brain cell activators , calcium ion blockers , anti-inflammatory agents , etc. ) and hyperbaric oxygen treatment ( oxygen-inhaling for 90 min/time ) .


Moreover , patients of the acupuncture group received acupuncture stimulation of bilateral Taixi ( KI 3 ) , Xuanzhong ( GB 39 ) , Hegu ( LI 4 ) , Taichong ( LR 3 ) , and Fengchi ( GB 20 ) .


All the treatments were conducted once daily for 30 days .


The therapeutic effect of the treatments for neurological function was assessed by NIH Stroke Scale ( NIHSS , 34 points in total ; including 15 items as consciousness , horizontal eye movement , visual power , visual field , facial muscular motion , limb movement , coordination movement , sensory and language levels , etc. ) .


After the treatment , of the 30 and 32 cases in the control and acupuncture groups , 1 and 4 were cured , 3 and 8 experienced marked improvement , 4 and 11 were improved , and 22 and 9 invalid , with the effective rates being 26.1 % and 72.3 % , respectively .


The therapeutic effect of the acupuncture group was significantly superior to that of the control group ( P < 0.05 ) .


The average NIHSS score was 5.01 + / - 0.72 in the acupuncture group , being significantly lower than that ( 8.30 + / - 0.45 ) in the control group ( P < 0.05 ) .


Acupuncture treatment can effectively strengthen the efficacy of hyperbaric oxygen therapy in the treatment of delayed encephalopathy caused by carbon monoxide poisoning .


Results of randomised controlled trials of newborn ( age 1-3 days ) vitamin A supplementation have been inconclusive .


The WHO is coordinating three large randomised trials in Ghana , India , and Tanzania ( Neovita trials ) .


We present the findings of the Neovita trial in Ghana .


This study was a population-based , individually randomised , double-blind , placebo-controlled trial in the Brong Ahafo region of Ghana .


The trial participants were infants aged at least 2 h , identified at home or facilities on the day of birth or in the next 2 days , able to feed orally , and likely to stay in the study area for at least 6 months .


They were randomly assigned ( ratio 1:1 ) to receive either one oral dose of vitamin A ( 50,000 IU ) or placebo immediately after recruitment .


The research team and parents of the infants were masked to treatment assignment .


Follow-up home visits were undertaken every 4 weeks , when data were recorded for deaths , facility use , and care seeking .


The primary outcome was post-supplementation mortality to 6 months of age .


Analysis was by intention to treat .


Potential adverse events were recorded at 1 and 3 days after supplementation .


This trial is registered with the Australian New Zealand Clinical Trials Registry ( ANZCTR ) CTRN12610000582055 .


We assessed 26,414 livebirths for eligibility between Aug 16 , 2010 , and Nov 7 , 2011 .


We recruited 22,955 newborn infants , with 11,474 randomly assigned to receive vitamin A and 11,481 to receive placebo .


Loss to follow-up was low with vital status at 6 months of age reported for 22,698 ( 989 % ) infants .


We recorded 278 post-supplementation deaths to 6 months of age in the vitamin A group ( mortality risk 245 in 1000 supplemented infants ) and 248 deaths in the placebo group ( mortality risk 218 per 1000 supplemented infants ) , relative risk ( RR ) 112 ( 95 % CI 095-133 ; p = 0183 ) and risk difference ( RD ) 266 ( 95 % CI -125 to 657 ; p = 018 ) .


Adverse events within 3 days of supplementation did not differ by trial group .


122 infants died in the first 3 days after supplementation ; 70 ( 06 % ) in the vitamin A and 52 ( 05 % ) in the placebo group ( risk ratio [ RR ] 135 , 95 % CI 094-193 , p = 0102 ) .


53 infants were reported to have a bulging fontanelle ; 32 ( 03 % ) in the vitamin A group and 21 ( 02 % ) in the placebo group ( RR 153 , 088-262 , p = 0130 ) .


The results of this trial do not support inclusion of newborn vitamin A supplementation as a child survival strategy in Ghana .


Bill & Melinda Gates Foundation grant to the WHO .


To assess the efficacy of two embolic agents in the treatment of symptomatic uterine leiomyomas .


A randomized , prospective , single-center study enrolled 60 women with symptomatic uterine leiomyomas .


Uterine artery embolization ( UAE ) with spherical polyvinyl alcohol ( SPVA ) microspheres ( n = 30 ; 700-900 m and 900-1 ,200 m ; near-stasis or stasis endpoint ) and tris-acryl gelatin ( TAG ) microspheres ( n = 30 ; 500-700 m ; `` pruned-tree '' endpoint ) was performed .


Infarction rates were calculated for the dominant tumor and for small ( < 2 cm ) and large ( > 2 cm ) nondominant tumors .


The primary endpoint was tumor infarction at 24 hours measured by contrast-enhanced magnetic resonance imaging assessed by a blinded reviewer .


Baseline characteristics were similar between groups .


The primary endpoint was similar in both treatments ( 91 % dominant tumor infarction ; SPVA .


86.2 % ; TAG , 93.3 % , P = .35 ) .


Complete infarction ( 100 % ) was also similar between arms at 24 hours and 3 months .


Symptom severity was reduced and quality of life improved equally at 3 and 12 months in each treatment group .


Complications were minor in both groups .


Uterine leiomyoma infarction at 24 hours and 3 months after treatment with SPVA or TAG microspheres was comparable when using near-stasis as a procedural endpoint with SPVA microspheres .


Symptom relief was maintained for as long as 12 months for both embolic agents .


Whereas routine prophylaxis for venous thromboembolism ( VTE ) is frequently utilized in the West , Asian physicians employ it much less often , based on its recorded rarity amongst their patients .


This study was designed to examine the incidence of VTE and to determine the optimal method of thromboembolic prophylaxis following gastrectomy for cancer .


In this prospective , randomized trial , patients were assigned to either an intermittent pneumatic compression ( IPC ) only or an IPC plus enoxaparin .


The primary end point of this study was to determine the VTE incidence rate within 30 days of surgery .


A history with physical examinations for VTE and a serum d-dimer test was scheduled on postoperative days ( POD ) 0 , 1 , 4 , and 7 .


Duplex ultrasonography ( DUS ) was performed as an objective test for deep vein thrombosis at POD 4 .


An interim analysis was performed to determine if it was ethical to continue the study .


This clinical trial was registered at www.clinicaltrials.gov ( NCT01448746 ) .


Among the 220 patients , 3 ( all from the IPC group ) were diagnosed with VTE ; these cases were asymptomatic , having been detected only on DUS 4 days after surgery .


Postoperative bleeding occurred in 12 cases , among which 11 patients were in the IPC plus enoxaparin group .


This interim analysis showed a higher incidence of VTE in the IPC group but a higher bleeding rate in the IPC plus enoxaparin group .


We expect that this study , once completed , will provide information key to the determination of the optimal method for preventing VTE in Korean gastric cancer patients .


A number of trials have shown improved radiological alignment following total knee arthroplasty using computer-assisted surgery ( CAS ) compared with conventional surgery .


Few studies , however , have looked at functional outcomes .


We prospectively studied a cohort of 107 patients that underwent TKA by a single surgeon .


Patients were randomised into 3 groups : computer-assisted surgery for both the femur and the tibia , intramedullary guides for both the femur and the tibia , and an intramedullary guide for the femur and an extramedullary guide for the tibia .


Patients were followed-up post-operatively with the Short Form Health Survey ( SF-12 ) and Oxford Knee Score ( OKS ) questionnaires .


At a median follow-up of 46 months ( range 30-69 months ) , there was a trend towards higher OKS results in the CAS group , with a mean score of 40.6 in the CAS group compared to 37.6 in the extramedullary group and 36.8 in the intramedullary group .


The difference seen in the OKS between CAS and the conventional groups had a significant unadjusted p-value ( 0.024 ) , and approached significance when adjusted for age and sex ( 0.054 ) .


There was a significant improvement in the OKS when the mechanical axis was within 3 of neutral , versus those outside this range ( median of 41.0 compared to 38.3 , p = 0.045 ) .


This study shows that clinically significant differences are being seen in functional scores of patients treated with CAS versus conventional guides , at medium-term follow up .


Our findings reinforce the tenet that a coronal mechanical axis of within 3 of neutral equates to significantly better functional outcomes .


We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations .


One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia ( TEA group ) or lumbar epidural analgesia ( LEA group ) .


In both groups , epidural catheters were administered .


Hemodynamic measurements , visual analog scale scores at rest ( VAS-R ) and after coughing ( VAS-C ) , analgesic consumption , and side effects were compared at 0 , 2 , 4 , 8 , 16 , and 24 hours postoperatively .


The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2 , 4 , 8 , and 16 hours after surgery ( for VAS-R , P = 0.001 , P = 0.01 , P = 0.008 , and P = 0.029 , respectively ; and for VAS-C , P = 0.035 , P = 0.023 , P = 0.002 , and P = 0.037 , respectively ) .


Total 24-hour analgesic consumption was different between groups ( 175 + / - 20 mL versus 185 + / - 31 mL ; P = 0.034 ) .


The comparison of postoperative complications revealed that the incidence of hypotension ( 21/57 , 36.8 % versus 8/63 , 12.7 % ; P = 0.002 ) , bradycardia ( 9/57 , 15.8 % versus 2/63 , 3.2 % ; P = 0.017 ) , atelectasis ( 1/57 , 1.8 % versus 7/63 , 11.1 % ; P = 0.04 ) , and the need for intensive care unit ( ICU ) treatment ( 0/57 , 0 % versus 5/63 , 7.9 % ; P = 0.03 ) were lower in the TEA group in comparison to the LEA group .


TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile .


Gemifloxacin is a synthetic fluoroquinolone antimicrobial agent , which has potent activity against most Gram-negative and Gram-positive organisms .


It is indicated for the treatment of community-acquired pneumonia and acute bacterial exacerbation of chronic bronchitis .


The aim of this study was to assess the clinical potential of a new gemifloxacin 200 mg intravenous formulation by comparing its pharmacokinetic characteristics with those of the branded Factive ( ) gemifloxacin tablet .


A single-dose , open-label , randomized-sequence , two-period crossover study was performed with 17 healthy male volunteers .


The two treatment periods were separated by a 1-week washout period .


Blood samples were taken for up to 48 h post-dose .


Plasma gemifloxacin concentrations were determined by a validated high-performance liquid chromatography-tandem mass spectrometry method .


To calculate the pharmacokinetic parameters , noncompartmental analysis was performed .


The two formulations were considered to be pharmacokinetically equivalent if the 90 % confidence intervals ( CIs ) of the log-transformed ratios ( intravenous/oral formulations ) of the area under the plasma concentration-time curve ( AUC ) from time zero to the time of the last measurable concentration ( AUClast ) and the AUC from time zero to infinity ( AUC ) were within the standard bioequivalence range ( 0.8-1 .25 ) .


Safety and tolerability were evaluated on the basis of physical examinations , vital signs , electrocardiograms , clinical laboratory tests and adverse event monitoring .


Seventeen subjects were enrolled , and 15 subjects completed the study .


Sixteen subjects received intravenous 200 mg gemifloxacin and 15 received oral 320 mg gemifloxacin .


The 15 subjects in the pharmacokinetic analysis set had a mean ( standard deviation [ SD ] ) age , height and weight of 27.2 ( 5.3 ) years , 173.5 ( 4.4 ) cm and 67.3 ( 7.4 ) kg , respectively .


Both formulations had similar pharmacokinetic profiles .


For the intravenous formulation , the mean ( SD ) AUClast , AUC and maximum plasma concentration ( C max ) values were 9.12 ( 4.03 ) gh/mL , 9.26 ( 4.07 ) gh/mL and 2.90 ( 1.65 ) g/mL , respectively , while these values for the oral formulation were 9.44 ( 3.34 ) gh/mL , 9.60 ( 3.49 ) gh/mL and 2.03 ( 0.95 ) g/mL , respectively .


For the intravenous and oral formulations , the median ( range ) time to reach C max ( t max ) values were 0.9 ( 0.7-1 .0 ) and 1.0 ( 0.5-2 .0 ) h , respectively .


The mean relative bioavailability was 68.99 % .


The 90 % CI of the ratios of the log-transformed values of AUClast and AUC was 0.82-1 .07 .


There were no serious adverse events .


The intravenous and oral formulations were associated with treatment-emergent adverse event incidences of 63 % ( 10/16 ) and 13 % ( 2/15 ) , respectively .


After the intravenous formulation was administered , application site pain and paraesthesia were the most frequently reported adverse events ( 31 and 25 % , respectively ) .


All adverse events resolved spontaneously without treatment .


Intravenous 200 mg and oral 320 mg formulations of gemifloxacin are equivalent in terms of AUC following a single dose in healthy male subjects .


To explore the changes of goiter prevalence of children living in areas with high iodine in drinking water after removing iodized salt from their diet .


Three towns with median water iodine of 150 - 300 g/L were selected randomly in Hengshui city of Hebei province of China .


A total of 452 and 459 children in the 3 towns were randomly selected to measure thyroid volume by ultrasound before and after removing iodized salt , respectively .


Their goiter status was judged using the criteria of age-specific thyroid volume recommended by the WHO .


After removing iodized salt , the overall goiter prevalence in the three towns significantly decreased from 24.56 % ( 111/452 ) to 5.88 % ( 27/459 ) ( P < 0.01 ) .


The goiter prevalence in 8 , 9 and 10 year-old children decreased respectively from 33.70 % ( 31/92 ) , 23.32 % ( 45/193 ) and 20.96 % ( 35/167 ) to 6.10 % ( 10/164 ) , 5.52 % ( 9/163 ) and 6.06 % ( 8/132 ) .


The goiter prevalence in boys and girls decreased from 27.05 % ( 66/244 ) and 21.63 % ( 45/208 ) to 6.66 % ( 15/226 ) and 5.15 % ( 12/233 ) , respectively .


The decreases in children 's goiter prevalence across gender and age group were all significant .


Children 's goiter prevalence decreased significantly after removing iodized salt from their diet for about one and half years in the HIA in Hebei province .


To observe the clinical effect and safety of Sulfasalazine ( SASP ) combined with ZHUANG medicine mediated thread moxibustion ( ZMMTM ) for patients with mild and moderate ulcerative colitis ( UC ) .


A total of 46 UC patients were randomly and equally divided into moxibustion group ( SASP combined with ZMMTM ) and SASP medication group .


Patients of both groups were treated by oral administration of SASP ( 1 g , tid ) for six weeks .


For patients of the moxibustion group , ZMMTM was applied to points Tianshu ( ST 25 ) , Qihai ( CV 6 ) , Guanyuan ( CV 4 ) , and Dachangshu ( BL 25 ) , once a day , for 20 times .


The therapeutic effect was assessed according to Schroeder and colleagues ' method ( 1987 ) , scores of Baron ' s endoscope scale ( 0 - 9 scoring standards , 1964 ) , 0 - 3 scoring standards of activity indexes ( including 4 items of diarrhea , hemorrhage , mucosal appearance and doctors ' evaluation ) , respectively .


Of the two 32 UC patients in the medication and moxibustion groups , 6 and 9 had a complete remission in their symptoms , 6 and 7 experienced a remarkable improvement , 5 and 6 were effective , and 6 and 1 was invalid , with the effective rates being 73.91 % and 95.65 % , respectively .


Following the treatment , both endoscopic score and activity index in the moxibustion group were significantly lower than those of the medication group ( P < 0.05 ) .


ZMMTM combined with medication is significantly superior to simple medication in relieving clinical symptoms of mild and moderate UC patients .


Any differences observed between natural glucagon-like peptide-1 ( GLP-1 ) and studies obtained with analogues might call for renewed considerations concerning the use and design of such analogues .


Thus , we aimed to evaluate the dose-response relationship of recombinant glucagon-like peptide-1 ( 7-36 ) amide ( rGLP-1 ) administered by continuous subcutaneous infusion ( CSCI ) in subjects with type 2 diabetes .


We compared the efficacy and safety of three doses of recombinant GLP-1 , ranging from 1.25 to 5.0 pmol/kg/min ( pkm ) and placebo , given by continuous subcutaneous infusion over 3months in combination with metformin and sulphonylurea ( SU ) , to lower haemoglobin A1c ( HbA1c ) , fasting plasma glucose and weight in 95 type 2 diabetes patients with inadequate glycaemic control .


The mean decreases in HbA1c at endpoint ( week 12 ) were significantly greater for all three rGLP-1 dose groups when each was compared with the placebo group , with the greatest decrease occurring in the 5.0 pkm dose group ( -1.3 % , s.d. 0.18 , p < 0.001 ) .


The mean decreases in fasting plasma glucose from baseline to endpoint were significantly greater for all three rGLP-1 dose groups than for the placebo group , with the greatest decrease occurring in the 5.0 pkm dose group ( -26.0 mg/dl , s.d. 8.5 , p = 0.02 ) .


Body weight was significantly reduced by 1.8 kg ( s.d. 1.3 ) in the 1.25 pkm dose group only ( p = 0.04 ) .


Administration of rGLP-1 by CSCI over a 12-week period in combination with metformin and an SU had a dose dependent effect in lowering HbA1c and fasting plasma glucose .


However , administration of rGLP-1 by CSCI may be less effective with respect to lowering of body weight compared with the daily and once weekly analogues .


BMS-820836 , a novel triple monoamine reuptake inhibitor , is an experimental monotherapy for sufferers of major depressive disorder who have had an inadequate response to an existing antidepressant treatment .


This study was conducted to evaluate the safety and tolerability , pharmacokinetics ( PK ) , and serotonin transporter ( SERT ) and dopamine transporter ( DAT ) occupancy for single doses of BMS-820836 in healthy subjects .


Healthy subjects were assigned to seven BMS-820836 dose panels ( 0.025 , 0.1 , 0.5 , 1 , 2 , 3 , and 5 mg ; n = 8 each ) , in which subjects were randomly allocated 3:1 to a single BMS-820836 dose or matched placebo .


Serial blood samples were collected on Days 1 , 2 , 3 , 4 , 7 , and 14 to characterize the PK of BMS-820836 .


Following evaluation of the maximum tolerated dose , SERT occupancy was determined by applying [ ( 11 ) C ] DASB positron emission tomography ( PET ) after single-dose BMS-820836 ( 0.5 or 3 mg ; n = 3 each ) and DAT occupancy by applying [ ( 11 ) C ] PE2I PET after single-dose BMS-820836 ( 3 mg ; n = 6 ) .


Single oral doses of BMS-820836 ( 0.025-3 mg ) were generally safe and well tolerated .


BMS-820836 had a median T max of 5.0-7 .2 h and a mean apparent terminal T 1/2 of 34-57 h. Mean striatal SERT occupancies were 19 9 % and 82 8 % after single doses of 0.5 and 3 mg BMS-820836 , respectively .


The mean striatal DAT occupancy was 19 9 % after a single 3 mg BMS-820836 dose .


Single doses of BMS-820836 have meaningful SERT and DAT occupancy and demonstrate an acceptable safety and tolerability profile in healthy control subjects .


To evaluate the safety and efficacy of the novel tenofovir prodrug , tenofovir alafenamide ( TAF ) , as part of a single-tablet regimen ( STR ) for the initial treatment of HIV-1 infection .


Phase 2 , randomized , double-blind , double-dummy , multicenter , active-controlled study .


Antiretroviral naive adults with HIV-1 RNA 5000 copies per milliliter and a CD4 count 50 cells per microliter were randomized 2:1 to receive an STR of elvitegravir/cobicistat/emtricitabine / tenofovir alafenamide ( E/C/F / TAF ) or elvitegravir/cobicistat/emtricitabine / tenofovir disoproxil fumarate ( E/C/F / TDF ) , plus placebo for 48 weeks .


Patients on both E/C/F / TAF ( n = 112 ) and E/C/F / TDF ( n = 58 ) had high rates of virologic suppression ( < 50 HIV copies per milliliter ) at week 24 ( 86.6 % ; 89.7 % ) and at week 48 ( 88.4 % ; 87.9 % ) , and had similar improvements in CD4 at week 48 ( 177 ; 204 ) , respectively .


Both treatments were well tolerated , and most adverse events were self-limiting and of mild to moderate severity .


Compared with patients on E/C/F / TDF , patients on E/C/F / TAF had smaller reductions in estimated creatinine clearance ( -5.5 vs. -10.1 mL/min , P = 0.041 ) , significantly less renal tubular proteinuria , and smaller changes in bone mineral density for hip ( -0.62 % vs. -2.39 % , P < 0.001 ) and spine ( -1.00 % vs. -3.37 % , P < 0.001 ) .


Patients on E/C/F / TAF had higher increases in total cholesterol , low-density lipoprotein , and high-density lipoprotein , but the total cholesterol/high-density lipoprotein ratio was unchanged for both .


Treatment-naive patients given the STR that contained either TAF or TDF achieved a high rate of virologic success .


Compared with those receiving TDF , patients on E/C/F / TAF experienced significantly smaller changes in estimated creatinine clearance , renal tubular proteinuria , and bone mineral density .


Large-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention ( PCI ) is not necessary .


However , it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring .


This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients .


Acute coronary syndrome ( ACS ) patients ( n = 384 ) who received high-risk , complex PCI were randomized into two groups .


PCI in the two types of lesions described below was defined as high-risk , complex PCI : lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis .


The patients in the conventionally treated group received standard dual antiplatelet therapy .


The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography ( TEG ) platelet mapping : If inhibition of platelet aggregation ( IPA ) induced by arachidonic acid ( AA ) was less than 50 % the aspirin dosage was raised to 200 mg/d ; if IPA induced by adenosine diphosphate ( ADP ) was less than 30 % the clopidogrel dosage was raised to 150 mg/d , for three months .


The primary efficacy endpoint was a composite of myocardial infarction , emergency target vessel revascularization ( eTVR ) , stent thrombosis , and death in six months .


This study included 384 patients ; 191 and 193 in the conventionally treated group and platelet function monitoring guided group , respectively .


No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups .


In the platelet function monitoring guided group , the mean IPA induced by AA and ADP were ( 69.2 24.5 ) % ( range , 4.8 % to 100.0 % ) and ( 51.4 29.8 ) % ( range , 0.2 % to 100.0 % ) , respectively .


The AA-induced IPA of forty-three ( 22.2 % ) patients was less than 50 % and the ADP-induced IPA of fifty-seven ( 29.5 % ) patients was less than 30 % ; therefore , their drug dosages were adjusted .


The TEG was rechecked one to four weeks after PCI , and the results indicated that the IPAs had significantly improved ( P < 0.01 ) .


However , no significant differences were found in the rates of the primary efficacy endpoint .


Rates in the conventionally treated group and platelet function monitoring guided group were 4.7 % and 5.2 % , respectively ( hazard ratio : 1.13 ; P = 0.79 ) .


An antiplatelet therapy guided by TEG monitored platelet function could not improve clinical efficacy even in ACS patients treated with high-risk complex PCI .


This study was conducted to determine the effect of oral midazolam ( OM ) or intranasal dexmedetomidine ( IND ) on the EC50 of sevoflurane for successful laryngeal mask airway placement in children .


We hypothesize that premedication with either agent might reduce the sevoflurane EC50 for laryngeal mask airway placement in children to a similar extent .


Fifty-two American Society of Anesthesiologists ( ASA ) I children ( aged 1-6 years ) scheduled for general anesthesia with laryngeal mask airway were randomized to one of the three groups : group M received 0.5 mg kg ( -1 ) OM with honey and intranasal saline , group D received 2 g kg ( -1 ) IND along with oral honey , and group P received oral honey and intranasal saline at least 30 min prior to induction of anesthesia .


Anesthesia was induced with incremental sevoflurane up to 8 % in 100 % O2 .


A predetermined target endtidal sevoflurane ( ETsevo ) concentration ( 2 % in the first child of all three groups ) was sustained for 10 min before the attempt of laryngeal mask airway insertion by adjusting dial concentration .


No intravenous anesthetic or neuromuscular blockade was used .


ETsevo was increased/decreased ( step size 0.2 % ) using Dixon 's and Massey 's up and down method in next patient depending upon previous patient 's response .


Placement of the laryngeal mask airway without movement , coughing , biting , or bucking was considered as successful .


EC50 of sevoflurane was calculated as the average of the crossover midpoints in each group , which was further confirmed by probit analysis .


The EC50 of sevoflurane for laryngeal mask airway placement after OM ( 1.66 0.31 ) and IND ( 1.57 0.14 ) premedications was significantly lower than the placebo group ( 2.00 0.17 , P < 0.0001 ) .


The EC95 ( 95 % CI ) derived from probit regression analysis was 2.34 % ( 2.22-2 .51 % ) with OM , 1.88 % ( 1.77-2 .04 % ) with IND , and 2.39 % ( 2.25-2 .35 % ) with placebo group .


Oral midazolam and IND premedications significantly reduce the sevoflurane EC50 for laryngeal mask airway insertion in children by 17 % and 21 % , respectively .


To evaluate the safety of different doses of subconjunctival bevacizumab and their effects on the recurrence rate after primary pterygium excision .


This prospective randomized placebo-controlled clinical study was conducted on 59 eyes ( 59 patients ) .


The visual acuity , refractive astigmatism , horizontal length of the pterygium , and recurrence risk factors were recorded .


There were no statistically significant differences between the groups for age , sex , horizontal length of pterygium , preoperative visual acuity , astigmatism , and recurrence risk factors .


The pterygium was excised from the conjunctival side and then peeled off the cornea .


The bare sclera was covered with a rotational conjunctival flap from the superonasal area .


After surgery , Group 1 ( 22 patients ) , Group 2 ( 17 patients ) and Group 3 ( 20 patients ) received 7.5 mg bevacizumab , 2.5 mg bevacizumab , and Balanced Salt Solution ( BSS ) subconjunctivally , respectively .


Postoperatively , horizontal length of corneal epithelial defect , conjunctival congestion , and lacrimation were checked on the first and seventh day .


The rate of recurrence ( > 1.5 mm fibrovascular overgrowth on the cornea ) at month 6 was compared between the groups .


There were no statistically significant differences between the groups for all measured variables except for moderate conjunctival congestion on the first postoperative day which was more common in the bevacizumab groups ( P = 0.002 ) .


Four eyes in Groups 1 ( 20 % ) and 2 ( 26.7 % ) and 3 in Group 3 ( 15.8 % ) experienced recurrence ( p = 0.73 ) .


All recurrences occurred at month 3 and subsequently thereafter .


In our study , perioperative injections of subconjunctival bevacizumab had no effect on primary pterygium recurrence and were not associated with any specific local complications .


Although many malaria control programmes in sub-Saharan Africa use indoor residual spraying with long-lasting insecticidal nets ( LLINs ) , the two studies assessing the benefit of the combination of these two interventions gave conflicting results .


We aimed to assess whether the addition of indoor residual spraying to LLINs provided a significantly different level of protection against clinical malaria in children or against house entry by vector mosquitoes .


In this two-arm cluster , randomised , controlled efficacy trial we randomly allocated clusters of Gambian villages using a computerised algorithm to LLINs alone ( n = 35 ) or indoor residual spraying with dichlorodiphenyltrichloroethane plus LLINs ( n = 35 ) .


In each cluster , 65-213 children , aged 6 months to 14 years , were surveyed at the start of the 2010 transmission season and followed in 2010 and 2011 by passive case detection for clinical malaria .


Exposure to parasite transmission was assessed by collection of vector mosquitoes with both light and exit traps indoors .


Primary endpoints were the incidence of clinical malaria assessed by passive case detection and number of Anopheles gambiae sensu lato mosquitoes collected per light trap per night .


Intervention teams had no role in data collection and the data collection teams were not informed of the spray status of villages .


The trial is registered at the ISRCTN registry , number ISRCTN01738840 .


LLIN coverage in 2011 was 3510 ( 93 % ) of 3777 children in the indoor residual spraying plus LLIN group and 3622 ( 95.5 % ) of 3791 in the LLIN group .


In 2010 , 7845 children were enrolled , 7829 completed passive case detection , and 7697 ( 98 % ) had complete clinical and covariate data .


In 2011 , 7009 children remained in the study , 648 more were enrolled , 7657 completed passive case detection , and 7545 ( 98.5 % ) had complete data .


Indoor residual spraying coverage per cluster was more than 80 % for both years in the indoor residual spraying plus LLIN group .


Incidence of clinical malaria was 0.047 per child-month at risk in the LLIN group and 0.044 per child-month at risk in the indoor residual spraying plus LLIN group in 2010 , and 0.032 per child-month at risk in the LLIN group and 0.034 per child-month at risk in the indoor residual spraying plus LLIN group in 2011 .


The incident rate ratio was 1.08 ( 95 % CI 0.80-1 .46 ) controlling for confounders and cluster by mixed-effect negative binomial regression on all malaria attacks for both years .


No significant difference was recorded in the density of vector mosquitoes caught in light traps in houses over the two transmission seasons ; the mean number of A gambiae sensu lato mosquitoes per trap per night was 6.7 ( 4.0-10 .1 ) in the LLIN group and 4.5 ( 2.4-7 .4 ) in the indoor residual spraying plus LLIN group ( p = 0.281 in the random-effects linear regression model ) .


We identified no significant difference in clinical malaria or vector density between study groups .


In this area with high LLIN coverage , moderate seasonal transmission , and susceptible vectors , indoor residual spraying did not provide additional benefit .


UK Medical Research Council .


The purpose of the study was to examine changes in quality of life measures in patients who have undergone an intensive exercise program following a single level microdiskectomy .


Randomized controlled trial with blinded examiners .


The study was conducted in outpatient physical therapy clinics .


Ninety-eight participants ( 53 male , 45 female ) who had undergone a single-level lumbar microdiskectomy allocated to receive exercise and education or education only .


A 12-week periodized exercise program of lumbar extensor strength and endurance training , and mat and upright therapeutic exercises was administered .


Quality of life was tested with the Short Form 36 ( SF-36 ) .


Measurements were taken 4-6 weeks postsurgery and following completion of the 12-week intervention program .


Since some participants selected physical therapy apart from the study , analyses were performed for both an as-randomized ( two-group ) design and an as-treated ( three-group ) design .


In the two-group analyses , exercise and education resulted in a greater increase in SF-36 scales , role physical ( 17.8 vs. 12.1 ) and bodily pain ( 13.4 vs. 8.4 ) , and the physical component summary ( 13.2 vs. 8.9 ) .


In the three-group analyses , post-hoc comparisons showed exercise and education resulted in a greater increase in the SF-36 scales , physical function ( 10.4 vs. 5.6 ) and bodily pain ( 13.7 vs. 8.2 ) , and the physical component summary ( 13.7 vs. 8.9 ) when compared with usual physical therapy .


An intensive , progressive exercise program combined with education increases quality of life in patients who have recently undergone lumbar microdiskectomy .


To analyze the impact of the eSET followed by single-embryo cryotransfer versus double embryo transfer in older women ( < 38 years ) without taking into account embryo quality .


This is a prospective randomised clinical trial performed on 194 couples attempting a first IVF cycle in a Public Hospital in Spain .


The women in Group 1 received eSET plus a single-embryo cryotransfer , and those in Group 2 received a double embryo transfer ( DET ) .


In the intention-to-treat analysis , the cumulative live birth delivery rate in the eSET group was similar to the results obtained for the DET group ( 45.2 % vs. 41.8 % ; p = 0.60 ) .


The rate of multiple gestation was significantly lower in the eSET group than in the DET group ( 0 % vs. 26.4 % ; p < 0.05 ) .


The findings obtained in the per-protocol analysis were similar to those obtained in the intention-to-treat analysis .


The per-protocol analysis revealed no significant differences in the rate of implantation ( 29.8 % in eSET vs. 29.7 % in DET ; p = 0.98 ) , in cumulative pregnancy rates per transfer ( 49.1 % in eSET vs. 46.9 % in DET ; p = 0.80 ) or in the cumulative live birth delivery rate ( 38.6 % in eSET vs. 42.2 % in DET ; p = 0.69 ) .


In the cycles with eSET , there were no twin pregnancies ( 0 % in eSET vs. 27.6 in DET ; p < 0.05 ) .


For women aged under 38 years with good prognosis , without taking embryo quality as a criterion for inclusion , an eSET policy can be applied , achieving acceptable cumulative clinical pregnancy rates and birth rates .


To evaluate the effect of nursing intervention on the quality of life of patients with advanced schistosomiasis .


A total of 226 cases of advanced schistosomiasis were randomly divided into a control group and an experimental group ( 113 cases each ) .


The patients in the control group received the conventional nursing , while the patients in the experimental group received the conventional nursing plus other interventions such as the health education , psychological counseling and diet guidance .


The complications and scores of life quality of the patients in the 2 groups were observed and compared .


The awareness of knowledge about the disease improved from 67.7 % to 98.9 % , the incidence of complications decreased from 28.3 % to 13.3 % , and the scores of life quality improved significantly in the experimental group , which were much better than those in the control group .


The nursing intervention on the quality of life of patients with advanced schistosomiasis is effective .


Mentorship within academic institutions influences research productivity ; no published studies have addressed whether encouragement on a national level would have similar effects .


We studied whether contact by a journal 's editorial board members would affect submission rates or journal selection by authors .


Authors of potentially publishable conference materials presented at national conferences sponsored by the Society of Teachers of Family Medicine were randomized to receive an invitation to submit work to Family Medicine or to receive no contact .


After 2 years , we surveyed authors regarding whether a manuscript had been attempted and , if completed , where it had been submitted and eventually published .


A total of 345 submissions were reviewed , 72 met inclusion criteria , and 41 authors responded to the survey ( 57 % ) .


There were no differences in demographics , scholarly activity in general , or faculty status between study groups .


There was no significant difference in whether manuscripts based on targeted projects had been written , completed , submitted , or published .


There was a significant difference in where manuscripts were submitted with the inviting journal receiving proportionately more submissions from the group of authors that had been contacted ( 90 % Contacted group , 43 % No-Contact ) .


Simple encouragement from editorial board members of a national peer-reviewed journal in the form of a single e-mail invitation did not increase the scholarly production of authors .


Encouragement may , however , increase the likelihood that completed works are submitted to the inviting journal , which is a useful finding for journals interested in soliciting scholarly works of interest .


The objective of this multicenter , randomized study was to investigate the efficacy of the hydrophilic resorbable film PREVADH in preventing postoperative adhesions following myomectomy .


Women scheduled for laparotomic myomectomy with intramural and/or subserous myomas of > 60mm in diameter , and who wished to preserve fertility , were eligible .


Patients were randomized immediately prior to abdominal wall closure to receive either hydrophilic resorbable film applied directly to the incisions ( P-Group , n = 33 ) or 500mL Ringer 's lactate solution instilled into the pelvic cavity ( R-Group , n = 28 ) .


Incidence , severity , and extent of postoperative adhesions to the uterine incisions and adnexal and abdominopelvic adhesions were assessed during second-look laparoscopy 10-20 weeks after the initial surgery .


Unedited videotapes of this second-look procedure were reviewed by two blinded independent surgeons .


Fifty-four patients ( P-Group , n = 28 ; R-Group , n = 26 ) underwent second-look laparoscopy .


Significantly fewer P-Group patients developed adhesions to uterine incisions than R-Group patients ( 43 % vs. 92 % , P = 0.001 ) .


Adhesions , which were confirmed by independent reviewers , were found in significantly fewer P-Group sites than R-Group sites ( 29 % vs. 76 % , P = 0.001 ) .


No serious adverse events related to the barriers used or adhesion-related complications were reported in either group .


The hydrophilic resorbable anti-adhesion film PREVADH significantly reduced adhesion incidence and severity after laparotomic myomectomy .


NCT01388907 ( www.clinicaltrials.gov ) .


Elevated plasma concentrations of liver function tests are prevalent in patients with chronic heart failure ( HF ) .


Little is known about liver function in patients with acute HF .


We aimed to assess the prevalence and prognostic value of serial measurements of liver function tests in patients admitted with acute decompensated HF .


We investigated liver function tests from all 234 patients from the Relaxin for the Treatment of Patients With Acute Heart Failure study at baseline and during hospitalization .


The end points were worsening HF through day 5 , 60-day mortality or rehospitalization , and 180-day mortality .


Mean age was 70 10 years , 56 % were male , and most patients were in New York Heart Association functional class III/IV ( 73 % ) .


Abnormal liver function tests were frequently found for alanine transaminase ( ALT ; 12 % ) , aspartate transaminase ( AST ; 21 % ) , alkaline phosphatase ( 12 % ) , and total bilirubin ( 19 % ) , and serum albumin ( 25 % ) and total protein ( 9 % ) were decreased .


In-hospital changes were very small .


On a continuous scale , baseline ALT and AST were associated with 180-day mortality ( hazard ratios [ HRs ; per doubling ] 1.52 [ P = .030 ] and 1.97 [ P = .013 ] , respectively ) and worsening HF through day 5 ( HRs [ per doubling ] 1.72 [ P = .005 ] and 1.95 [ P = .008 ] , respectively ) .


Albumin was associated with 180-day mortality ( HR 0.86 ; P = .001 ) but not with worsening HF ( HR 0.95 ; P = .248 ) .


Total protein was associated with only worsening HF ( HR 0.91 ; P = .004 ) .


Abnormal liver function tests are often present in patients with acute HF and are associated with an increased risk for mortality , rehospitalization , and in-hospital worsening HF .


To evaluate the effects of epinephrine ( 1:200,000 ) in the epidural space on the incidence of blood vessel injury by epidural catheter insertion for cesarean section .


Prospective observational study .


University-affiliated teaching hospital .


Four hundred laboring women with singleton cephalic presentations at term who underwent cesarean section and requested continuous epidural analgesia .


Predistension of 5 mL of isotonic sodium chloride solution containing epinephrine ( 1:200,000 ) or 5 mL of isotonic sodium chloride solution through an epidural needle before catheter insertion .


Cases with bloody fluid in the epidural needle or catheter during catheter insertion , aspiration of frank blood from the epidural catheter , and blood noted in the caudal end of the epidural catheter upon removal were recorded .


Eight parturients were excluded from the analysis for technical reasons .


There were no significant differences between patients in the 2 groups with respect to cases with bloody fluid in the epidural needle during catheter insertion ( 7.6 % vs 9.8 % , P = .44 ) , the epidural catheter during catheter placement ( 6.0 % vs 6.7 % , P = .80 ) , aspiration of frank blood in the epidural catheter ( 1.0 % vs 1.0 % , P = .98 ) , and blood noted in the caudal end of the epidural catheter upon removal ( 27.3 % vs 30.4 % ; P > .49 ) .


Twenty-five micrograms of epinephrine ( 1:200,000 ) in the epidural space does not reduce the incidence of blood vessel injury induced by insertion of an epidural catheter .


The incidence of vaccine-preventable disease is increasing .


Several guidelines recommend annual influenza vaccination for patients with inflammatory bowel disease .


Using the Business Objects database of Clalit Health Services in the Tel Aviv district we identified all patients older than 18 years with a diagnosis of Crohn 's disease ( CD ) on December 31 , 2005 .


This cohort was followed until December 31 , 2012 .


Subjects without inflammatory bowel disease older than 50 years served as controls .


The uptake of annual influenza vaccination was recorded .


The study included 515 patients with CD ( 267 [ 51.8 % ] men , age 48.9 17.5 years , disease duration 142.7 56.9 months ) and 2960 controls ( 1262 [ 42.6 % ] men , P < 0.01 , age 68.9 11.1 years , P < 0.01 ) .


The mean number of influenza vaccines received from 2006 to 2012 was 2.08 2.46 and 3.40 2.71 in CD and controls , respectively ( P < 0.01 ) .


Uptake was higher in patients with CD aged 50 to 59 years and 60 to 69 years , compared with controls ( 0.45 0.04 versus 0.24 0.01 , P < 0.01 and 0.64 0.06 versus 0.50 0.01 , P = 0.04 , respectively ) .


Vaccination uptake increased significantly over time in both groups ( P < 0.01 ) .


Predictors of vaccination in CD included age , female sex , immunosuppression , and cardiovascular disease .


Uptake of influenza vaccination in CD has increased over the past 7 years , and among subjects older than 50 years , uptake remains higher in age-matched controls .


Nevertheless , overall uptake remains low , particularly in young males .


Environmental enteric dysfunction ( EED ) is an acquired syndrome of impaired gastrointestinal mucosal barrier function that is thought to play a key role in the pathogenesis of stunting in early life .


It has been conceptualized as an adaptive response to excess environmental pathogen exposure .


However , it is clinically similar to other inflammatory enteropathies , which result from both host and environmental triggers , and for which immunomodulation is a cornerstone of therapy .


In this pilot double-blind randomized placebo-controlled trial , 44 children with severe acute malnutrition and evidence of EED were assigned to treatment with mesalazine or placebo for 28 days during nutritional rehabilitation .


Primary outcomes were safety and acceptability of the intervention .


Treatment with mesalazine was safe : there was no excess of adverse events , evidence of deterioration in intestinal barrier integrity or impact on nutritional recovery .


There were modest reductions in several inflammatory markers with mesalazine compared to placebo .


Depression of the growth hormone -- insulin-like growth factor-1 axis was evident at enrollment and associated with inflammatory activation .


Increases in the former and decreases in the latter correlated with linear growth .


Intestinal inflammation in EED is non-essential for mucosal homeostasis and is at least partly maladaptive .


Further trials of gut-specific immunomodulatory therapies targeting host inflammatory activation in order to optimize the growth benefits of nutritional rehabilitation and to address stunting are warranted .


Funded by The Wellcome Trust .


Registered at Clinicaltrials.gov NCT01841099 .


Attenuating postreperfusion syndrome during orthotopic liver transplant is very important for transplant anesthesiologists because of the syndrome 's complications .


Oxygen-derived free radicals play an important role in the genesis of postreperfusion syndrome , but the effect of mannitol ( a free radical scavenger ) on attenuating the syndrome is unclear.OBJECTIVES-To investigate the effectiveness of infusing mannitol during the anhepatic phase in preventing postreperfusion syndrome , as indicated by postreperfusion cardiac output and central venous oxygen saturation .


In a randomized clinical trial , 53 patients who had undergone orthotopic liver transplant were allocated to 2 groups .


During the anhepatic phase , patients in the mannitol group received 1g/kg mannitol , whereas those in the control group received physiological saline .


Mean arterial pressure , cardiac output , and central venous oxygen saturation were measured before and after the portal vein was declamped .


Serum levels of sodium and potassium were recorded at baseline and after portal vein declamping.Setting-Shiraz Organ Transplant Center , Shiraz , Iran .


In the mannitol group , no significant change was found in mean arterial pressure , cardiac output , and central venous oxygen saturation before and after declamping of the portal vein ( P = .78 , P = .59 , and P = .83 , respectively ) .


However , after declamping in the control group , mean arterial pressure , cardiac output , and central venous oxygen saturation were significantly lower than before declamping ( P = .003 , P = .001 , and P < .001 , respectively ) .


No significant change in serum levels of sodium and potassium from baseline to after declamping were found in either group .


Infusion of mannitol 1 g/kg during the anhepatic phase was effective in attenuating postreperfusion syndrome without stress about hyperkalemia or hyponatremia during anesthesia .


Prior studies have found that smokers with STEMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers , phenomenon defined as `` the smoker 's paradox '' .


Still poorly explored is the impact of cigarette smoking in patients undergoing primary percutaneous coronary intervention .


Aim of the current study was to evaluate the impact of cigarette smoking on scintigraphic infarct size in STEMI patients undergoing primary PCI .


Our population is represented by 830 STEMI patients undergoing primary PCI .


Infarct size was evaluated at 30 days by technetium-99m-sestamibi .


Smoking was associated with younger age ( p < 0.001 ) , a lower prevalence of female gender ( p < 0.001 ) , hypertension ( p < 0.001 ) , diabetes ( p = 0.003 ) , shorter ischemia time ( p = 0.037 ) , but higher rates of previous PCI ( p = 0.016 ) .


No differences were observed in other clinical or angiographic characteristics .


In particular , smoking did not affect the rate of postprocedural TIMI 3 flow .


As shown in Fig. 1 , smoking did not affect infarct size ( 12.5 % [ 3.3 % -23.7 % ] vs 12.7 % [ 4.9 % -25.9 % ] , p = 0.12 ) .


Similar results were observed in subanalyses according to infarct location ( anterior STEMI , p int = 0.33 ) , gender ( p int = 0.95 ) age , ( p Int = 0.96 ) , diabetes ( p int = 0.85 ) .


The absence of any impact of smoking on infarct size was confirmed after correction for baseline characteristics , such as age , gender , hypertension , diabetes , previous PCI , ischemia time ( OR [ 95 % CI ] = 0.80 [ 0.59-1 .09 ] , p = 0.15 ) .


This study shows that among STEMI patients undergoing primary PCI smoking status does not affect infarct size .


Continuous intraoperative norepinephrine infusion combined with restrictive deferred hydration improves surgical field visibility , and significantly decreases intraoperative blood loss and postoperative complications in patients undergoing radical cystectomy and urinary diversion .


We determined whether the intraoperative fluid regimen would affect functional results ( continence and erectile function ) 1 year after orthotopic ileal bladder substitution .


We analyzed a subgroup of 93 patients who received an ileal orthotopic bladder substitute .


The subgroup was part of a randomized trial in 167 patients initially allocated to continuous norepinephrine administration starting with 2 g/kg per hour combined with 1 ml/kg per hour initially and 3 ml/kg per hour crystalloid infusion after cystectomy ( norepinephrine/low volume group of 51 ) or a standard crystalloid infusion of 6 ml/kg per hour throughout surgery ( 42 controls ) .


We prospectively assessed daytime and nighttime continence , and erectile function 1 year postoperatively in the 93-patient subgroup .


Daytime continence was reported by 44 of 51 patients ( 86 % ) in the norepinephrine/low volume group and by 27 of 42 controls ( 64 % ) ( p = 0.016 ) , and nighttime continence was reported by 38 ( 75 % ) and 25 ( 60 % ) , respectively ( p = 0.077 ) .


Erectile function recovery was reported by 26 of 33 preoperatively potent patients ( 79 % ) in the norepinephrine/low volume group and by 11 of 29 controls ( 38 % ) ( p = 0.002 ) .


Patients who undergo radical cystectomy and orthotopic bladder substitution with continuous norepinephrine infusion and restrictive hydration during surgery have significantly better daytime continence and erectile function 1 year postoperatively .


Women with depression in pregnancy are faced with difficult treatment decisions .


Untreated , antenatal depression has serious negative implications for mothers and children .


While antidepressant drug treatment is likely to improve depressive symptoms , it crosses the placenta and may pose risks to the unborn child .


Transcranial direct current stimulation is a focal brain stimulation treatment that improves depressive symptoms within 3 weeks of treatment by inducing changes to brain areas involved in depression , without impacting any other brain areas , and without inducing changes to heart rate , blood pressure or core body temperature .


The localized nature of transcranial direct current stimulation makes it an ideal therapeutic approach for treating depression during pregnancy , although it has never previously been evaluated in this population .


We describe a pilot randomized controlled trial of transcranial direct current stimulation among women with depression in pregnancy to assess the feasibility of a larger , multicentre efficacy study .


Women over 18 years of age and between 14 and 32 weeks gestation can be enrolled in the study provided they meet diagnostic criteria for a major depressive episode of at least moderate severity and have been offered but refused antidepressant medication .


Participants are randomized to receive active transcranial direct current stimulation or a sham condition that is administered in 15 30-minute treatments over three weeks .


Women sit upright during treatment and receive obstetrical monitoring prior to , during and after each treatment session .


Depressive symptoms , treatment acceptability , and pregnancy outcomes are assessed at baseline ( prior to randomization ) , at the end of each treatment week , every four weeks post-treatment until delivery , and at 4 and 12 weeks postpartum .


Transcranial direct current stimulation is a novel therapeutic option for treating depression during pregnancy .


This protocol allows for assessment of the feasibility of , acceptability of and adherence with a clinical trial protocol to administer this treatment to pregnant women with moderate to severe depression .


Results from this pilot study will guide the development of a larger multicentre trial to definitively test the efficacy and safety of transcranial direct current stimulation for pregnant women with depression .


Clinical Trials Gov NCT02116127 .


To compare the analgesic effect of ultrasound-guided Transversus Abdominis Plane ( TAP ) block versus Continuous Wound Infusion ( CWI ) with levobupivacaine after caesarean delivery .


We recruited parturients undergoing elective caesareans for this multicenter study .


Following written informed consent , they received a spinal anaesthetic without intrathecal morphine for their caesarean section .


The postoperative analgesia was randomized to either a bilateral ultrasound guided TAP block ( levobupivicaine = 150 mg ) or a CWI through an elastomeric pump for 48 hours ( levobupivacaine = 150 mg the first day and 12.5 mg/h thereafter ) .


Every woman received regular analgesics along with oral morphine if required .


The primary outcome was comparison of the 48-hour area under the curve ( AUC ) pain scores .


Secondary outcomes included morphine consumption , adverse events , and persistent pain one month postoperatively .


Recruitment of 120 women was planned but the study was prematurely terminated due to the occurrence of generalized seizures in one patient of the TAP group .


By then , 36 patients with TAP and 29 with CWI had completed the study .


AUC of pain at rest and during mobilization were not significantly different : 50 [ 22.5-80 ] in TAP versus 50 [ 27.5-130 ] in CWI ( P = 0.4 ) and 190 [ 130-240 ] versus 160 [ 112.5-247 .5 ] ( P = 0.5 ) , respectively .


Morphine consumption ( 0 [ 0-20 ] mg in the TAP group and 10 [ 0-32 .5 ] mg in the CWI group ( P = 0.09 ) ) and persistent pain at one month were similar in both groups ( respectively 29.6 % and 26.6 % ( P = 0.73 ) ) .


In cases of morphine-free spinal anesthesia for cesarean delivery , no difference between TAP block and CWI for postoperative analgesia was suggested .


TAP block may induce seizures in this specific context .


Consequently , such a technique after a caesarean section can not be recommended .


ClinicalTrials.gov NCT01151943 .


The objective was to determine whether adding a self-regulatory intervention ( SRI ) focused on self-monitoring of spontaneous physical activity ( SPA ) and sedentary behavior to a standard weight loss intervention improved maintenance of lost weight .


Older ( 65-79 years ) , obese ( BMI = 30-40 kg/m ( 2 ) ) adults ( n = 48 ) were randomized to a 5-month weight loss intervention involving a hypocaloric diet ( DIET ) and aerobic exercise ( EX ) with or without the SRI to promote SPA and decrease sedentary behavior ( SRI+DIET+EX compared with DIET+EX ) .


Following the weight loss phase , both groups transitioned to self-selected diet and exercise behavior during a 5-month follow-up .


Throughout the 10-months , the SRI+DIET+EX group utilized real-time accelerometer feedback for self-monitoring .


There was an overall group by time effect of the SRI ( P < 0.01 ) ; DIET+EX lost less weight and regained more weight than SRI+DIET+EX .


The average weight regain during follow-up was 1.3 kg less in the SRI+DIET+EX group .


Individuals in this group maintained approximately 10 % lower weight than baseline compared with those in the DIET+EX group whom maintained approximately 5 % lower weight than baseline .


Addition of a SRI , designed to increase SPA and decrease sedentary behavior , to a standard weight loss intervention enhanced successful maintenance of lost weight .


Phenylephrine infusion is used to reduce hypotension during spinal anesthesia for cesarean delivery .


A prophylactic fixed rate infusion regimen may not improve hemodynamic control ; a variable rate regimen adjusted in response to changes in arterial blood pressure and heart rate may allow more accurate maintenance of baseline blood pressure .


We hypothesized that a combination of crystalloid solution coload with a variable rate phenylephrine infusion and phenylephrine rescue boluses may be associated with fewer physician interventions needed to maintain maternal systolic blood pressure within 20 % of baseline and greater hemodynamic stability than crystalloid solution coload with phenylephrine rescue boluses alone .


In this prospective , double-blind study , 80 patients received a coload with 15 mL/kg lactated Ringer 's solution immediately after the initiation of spinal anesthesia .


Patients were randomized to receive a prophylactic variable rate phenylephrine infusion starting at 0.75 g/kg/min ( group P ) or infusion of normal saline ( group S ) .


Maternal systolic blood pressure was maintained within 20 % of baseline with rescue phenylephrine boluses using a preset algorithm .


During the predelivery period , the number of physician interventions ( primary outcome ) , hemodynamic performance , nausea/vomiting , and umbilical cord blood gas values were compared between the groups .


One patient from group S was excluded due to protocol violation .


Therefore , group P included 40 patients and group S 39 patients .


The median ( range ) number of physician interventions needed to maintain maternal hemodynamics within the target range ( 0 [ 0-6 ] vs 3 [ 0-9 ] , difference in median : 3 , 95 % confidence interval of difference : 2-4 ) and incidence of hypotension ( 8/40 [ 20 % ] vs 35/39 [ 90 % ] ) were lower in group P compared with group S ( P < 0.001 ) .


Group P had a higher incidence of hypertension compared with group S ( 6/40 [ 15 % ] vs 0/39 [ 0 % ] , P = 0.026 ) .


The median performance error was closer to baseline ( P < 0.001 ) with a smaller median absolute performance error ( P = 0.001 ) in group P versus group S.


In group P , 4/40 ( 10 % ) patients had nausea/vomiting compared with 17/39 ( 44 % ) in group S ( P = 0.001 ) .


The number needed to treat was 1.4 women to prevent 1 case of hypotension , and 3 women to prevent 1 case of nausea/vomiting ; the rate of hypertension was 1 case per 6.7 women treated .


Neonatal outcomes were not different between the 2 groups .


Prophylactic variable rate phenylephrine infusion and rescue phenylephrine bolus dosing is more effective than relying on rescue phenylephrine bolus dosing with respect to limiting clinician workload and maternal symptoms during spinal anesthesia for cesarean delivery .


The aim of this study is to describe implementation of a randomized controlled trial of community-based participatory research ( CBPR ) approaches to increase park use and physical activity across 33 diverse neighborhoods in Los Angeles .


Fifty parks were randomly assigned based on park size , facilities and programs , and neighborhood socio-demographic characteristics to : park director ( PD , 17 parks ) ; PD and park advisory board of interested community members ( PD+PAB , 16 parks ) ; and no-intervention control ( 17 parks ) arms .


Between 2007 and 2012 , PDs and PABs from the 33 intervention parks participated in community engagement , baseline assessment , marketing training , intervention design and implementation , and follow-up assessment .


Intervention parks ( PD and PD+PAB ) invested in new and diversified signage , promotional items , outreach or support for group activities like fitness classes and walking clubs , and various marketing strategies .


Scaling up CBPR methods across parks in 33 diverse neighborhoods was challenging .


Working with departmental management and established structures for community input ( PABs ) and park policy ( PDs ) facilitated implementation and sustainability .


Scaling up CBPR methods across diverse communities involved tradeoffs .


CBPR is useful for tailoring research and enhancing community impact and sustainability , but more work is needed to understand how to conduct multi-site trials across diverse settings using CBPR .


Posterior-cruciate-ligament-retaining ( PCR ) and posterior-cruciate-ligament-stabilized ( PS ) arthroplasties are two major common practices in total knee arthroplasty ( TKA ) .


The hypothesis of the present study was that compared with the PCR technique , the PS technique is associated with a higher amount of postoperative blood loss and greater need for blood transfusion in cemented TKA .


In this prospective , randomized study , 100 patients diagnosed with primary knee osteoarthritis were randomly assigned to either the PCR group ( Group I ) or the PS group ( Group II ) .


The exclusion criteria were rheumatological joint disease , previous knee surgery , anticoagulant therapy and hypertension .


There were no significant differences in age , body mass index and gender , between the groups .


The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on postoperative days 1 , 3 and 5 .


The postoperative suction drainage and blood transfusion volumes were also recorded .


There were no statistically significant differences in haemoglobin or haematocrit levels between the groups on postoperative days 1 , 3 and 5 .


There were also no statistically significant differences in the total measured blood loss volume , postoperative drainage amounts or transfusion rates between the groups .


Use of the PS technique during cemented TKA does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion in general .


The clinical relevance of this study is that the difference in blood loss between the PCR and PS techniques does not need to be considered by surgeons when performing TKA .


Radical retropubic prostatectomy ( RRP ) is associated with an increased risk of intraoperative blood loss and the necessity of transfusions .


This prospective randomised clinical study evaluates the influence of thoracic epidural analgesia ( TEA ) on blood loss in RRP .


235 patients were randomised : TEA in group 1 ( n = 116 ; general anaesthesia + TEA ) comprised continuous administration of 0.25 % bupivacaine , while group 2 ( n = 119 ; general anaesthesia alone ) received intravenous analgesia with fentanyl ( intubation : 2 g/kg ; maintenance : 0.1-0 .3 mg ) .


A restrictive infusion regimen ( < 1,000 ml until specimen removal ) was administered in both groups .


Blood loss , infusion rates and anaesthesiological parameters were recorded and analysed using regression models and analyses of variance .


Haemoglobin difference between the pre - and the first postoperative day ( group 1 : 3.35 1.16 g/dl ; group 2 : 3.56 1.42 g/dl ; p = 0.19 ) , overall blood loss ( group 1 : 665 431.5 ml ; group 2 : 705 881 ml ; p = 0.73 ) and transfusion rates ( 0.4 % intraoperatively ; 2.55 % postoperatively ; p = 1.0 ) did not show group differences .


In regression analysis blood loss was influenced by preoperative haemoglobin levels ( p < 0.0001 ) , patients ' weight ( p = 0.018 ) and duration of the operation ( p = 0.017 ) .


This study did not demonstrate a direct impact of TEA on intraoperative blood loss and transfusion rates in RRP .


Further randomised clinical trials are needed to evaluate an impact of the different anaesthetic procedures presented alone or in combination on blood loss .


Currently , short-axis out-of-plane ( SA-OOP ) and long-axis in-plane ( LA-IP ) ultrasound techniques are used to guide radial artery cannulation .


In this study , we compared the success rate of a modified SA-OOP technique with that of traditional LA-IP .


One hundred sixty-four patients who were to undergo liver surgery or splenic resection under general anesthesia were included .


Using a sealed envelope method , patients were randomly divided into 2 groups : the modified SA-OOP or the LA-IP ultrasound guidance approaches .


The number of cannula insertion attempts until success was recorded in both groups .


The primary end point to compare the groups was the rate of cannula insertion successes on the first attempt .


The secondary end points were also recorded and compared : insertion failure rate , inner diameter of the radial artery , depth of artery from the skin , ultrasonic location time , cannulation time , and vascular complications including thrombosis , hematoma , edema , and vasospasm .


The cannula insertion success rate on the first attempt was significantly higher in the modified SA-OOP group compared with the LA-IP group ( proportion difference 15.7 % , 95 % confidence interval [ CI ] , 0.6 % -30.7 % , P = 0.0158 ) .


However , the insertion failure rate was not different between groups ( 95 % CI , -17.7 % to 12.8 % , P = 0.4969 ) .


The ultrasonic location time was significantly decreased in the modified SA-OOP group compared with the LA-IP group ( mean difference -9.5 seconds , 95 % CI , -10.6 to -8.5 seconds , P < 0.0001 ) .


However , there was no significant difference between groups for cannulation time ( 95 % CI , -0.6 to 7.6 seconds , P = 0.1152 ) , depth of artery ( 95 % CI , -0.07 to 0.57 mm , P = 0.1050 ) , and the diameter of the radial artery ( 95 % CI , -0.30 to 0.03 mm , P = 0.1153 ) .


The modified SA-OOP technique may improve the success rate of cannula insertion into the radial artery on the first attempt .


Chemotherapy-induced diarrhea ( CID ) is a relatively common adverse event in the treatment of patients with colorectal cancer .


The LAR for Chemotherapy-Induced Diarrhea ( LARCID ) trial evaluated the efficacy and safety of long-acting release octreotide ( octreotide LAR ) for the prevention of CID in this population .


Patients with colorectal cancer starting adjuvant or first-line treatment with a chemotherapy combination containing fluorouracil , capecitabine , and/or irinotecan were randomly assigned to receive octreotide LAR 30 mg intramuscularly every 4 weeks ( experimental arm ) or the physician 's treatment of choice in case of diarrhea ( control arm ) .


A total of 139 patients were randomly assigned , most of whom received fluorouracil - and oxaliplatin-containing chemotherapy regimens .


The rate of diarrhea was 76.1 % in the experimental group ( n = 68 ) and 78.9 % in the control group ( n = 71 ) .


Treatment with octreotide LAR did not prevent or reduce the severity of CID .


Treatment choices for diarrhea management included loperamide in the majority of patients .


No benefit from octreotide LAR was identified in terms of need for diarrhea treatment , opioids , or intravenous hydration or in the rate of hospitalization or quality of life .


This study could not prove the efficacy of octreotide LAR in the prevention of CID .


Treatment with rituximab may be accompanied by a systemic cytokine release .


We studied the effects of a single dose of rituximab on cytokine levels in transplant patients and examined the underlying mechanism .


Twenty renal transplant recipients ( 10 rituximab-treated , 10 placebo-treated ) were recruited from a randomized clinical trial .


Rituximab or placebo was infused during surgery , and blood samples were taken before , during , and after surgery and analyzed for interleukin ( IL ) -2 , IL-4 , IL-6 , IL-10 , IL-12 , IL-17 , interferon - , macrophage inflammatory protein ( MIP ) -1 , transforming growth factor - , and tumor necrosis factor - .


in vitro , healthy donor peripheral blood mononuclear cells , purified B cells , monocytes , natural killer ( NK ) cells , or combinations thereof were incubated with rituximab , rituximab-F ( ab ' ) 2 , or medium and MIP-1 , IL-10 , interferon - , and tumor necrosis factor - levels were measured in the supernatant .


Rituximab-treated patients had higher serum levels of IL-10 ( 101 35 pg/mL vs 41 9 pg/mL ; P < 0.01 ) and MIP-1 ( 950 418 pg/mL vs 125 32 pg/mL ; P < 0.001 ) compared to placebo-treated patients at 2 hours after start of infusion .


There was no difference in the level of other cytokines .


In vitro , the addition of rituximab , but not rituximab-F ( ab ' ) 2 fragments , only led to significantly increased levels of MIP-1 in co-cultures of B and NK cells .


Levels of MIP-1 were higher in patients with a high affinity Fc-receptor compared to those with a lower affinity FcRIIIa ( 1356 184 pg/mL vs 679 273 pg/mL ; P < 0.01 ) .


In addition to B-cell depletion , rituximab can modulate the immune response by inducing cytokine secretion , especially IL-10 and MIP-1 .