STSG take rates were comparable for both research groups ( p = 0.588 ) .


One year after wound closure , Glyaderm ( ) + STSG was significantly more elastic ( p = 0.003 ) than STSG alone .


Blinded observers scored Glyaderm ( ) treated wounds better in terms of scar quality .


The efficacy of Glyaderm ( ) as a suitable dermal substitute for full thickness wounds is attested .


Currently a procedure for simultaneous application of Glyaderm ( ) and STSG is adopted , allowing for further widespread use of Glyaderm ( ) .


Cardiac surgery has been shown to result in a significant decrease of the antioxidant selenium , which is associated with the development of multiorgan dysfunction and increased mortality .


Thus , a large-scale study is needed to investigate the effect of perioperative selenium supplementation on the occurrence of postoperative organ dysfunction .


We plan a prospective , randomized double-blind , multicenter controlled trial , which will be conducted in North and South America and in Europe .


In this trial we will include 1,400 high-risk patients , who are most likely to benefit from selenium supplementation .


This includes patients scheduled for non-emergent combined and/or complex procedures , or with a predicted operative mortality of 5 % according to the EuroSCORE II .


Eligible patients will be randomly assigned to either the treatment group ( bolus infusion of 2,000 g sodium selenite immediately prior to surgery , followed by an additional dosage of 2,000 g at ICU admission , and a further daily supplementation of 1,000 g up to 10 days or ICU discharge ) or to the control group ( placebo administration at the same time points ) .


The primary endpoint of this study is a composite of ` persistent organ dysfunction ' ( POD ) and/or death within 30 days from surgery ( POD + death ) .


POD is defined as any need for life-sustaining therapies ( mechanical ventilation , vasopressor therapy , mechanical circulatory support , continuous renal replacement therapy , or new intermittent hemodialysis ) at any time within 30 days from surgery .


The SUSTAIN-CSX study is a multicenter trial to investigate the effect of a perioperative high dosage sodium selenite supplementation in high-risk cardiac surgical patients .


This trial was registered at Clinicaltrials.gov ( identifier : NCT02002247 ) on 28 November 2013 .


Heart failure ( HF ) disproportionately affects Native Hawaiians and Other Pacific Islanders ( NHOPIs ) .


This study examines risk factors associated with left ventricular ejection fraction ( LVEF ) among 151 hospitalized NHOPI HF patients enrolled at a single tertiary care hospital between June 2006 and April 2010 .


Enrollment criteria : ( 1 ) NHOPI by self-identification .


( 2 ) Age 21 yrs .


( 3 ) Diagnosis of HF defined : ( a ) left ventricular ejection fraction ( LVEF ) 40 % or LVEF 60 % with abnormal diastolic function and ( b ) classic HF signs/symptoms .


LVEF was measured by echocardiography within 6 weeks of hospitalization .


Clinical measures , medical history , and questionnaires were assessed using standardized protocols .


Linear regression modeling was used to examine the association of significant correlates of LVEF , which were then included en bloc into the final model .


A P-value < .05 was considered statistically significant .


Of 151 participants , 69 % were men , mean age 54.3 13.5 years , blood pressure 112 20/69 15 mmHg , and body mass index ( BMI ) 36.9 9 kg/m ( 2 ) .


Twenty-five percent of participants were smokers , 45 % used alcohol and 23 % reported a history of methamphetamine use .


Clinically , 72 % had hypertension , 49 % were diabetic and 37 % had a prior myocardial infarction .


Nearly 60 % had moderate to severe LVEF ( < 35 % ) .


Higher LVEF was independently associated with female sex and greater BMI ( P < .04 ) while pacemaker/defibrillator and methamphetamine use was independently associated with lower LVEF ( P < .05 ) .


Methamphetamine use and BMI may be important modifiable risk factors associated with LVEF and may be important targets for improving HF morbidity and mortality .


The objective of the study was to evaluate the impact of doula support on first-trimester abortion care .


Women were randomized to receive doula support or routine care during first-trimester surgical abortion .


We examined the effect of doula support on pain during abortion using a 100 mm visual analog scale .


The study had the statistical power to detect a 20 % difference in mean pain scores .


Secondary measures included satisfaction , procedure duration , and patient recommendations regarding doula support .


Two hundred fourteen women completed the study : 106 received doula support , and 108 received routine care .


The groups did not differ regarding demographics , gestational age , or medical history .


Pain scores in the doula and control groups did not differ at speculum insertion ( 38.6 [ 26.3 mm ] vs 43.6 mm [ 25.9 mm ] , P = .18 ) or procedure completion ( 68.2 [ 28.0 mm ] vs 70.6 mm [ 23.5 mm ] , P = .52 ) .


Procedure duration ( 3.39 [ 2.83 min ] vs 3.18 min [ 2.36 min ] , P = .55 ) and patient satisfaction ( 75.2 [ 28.6 mm ] vs 74.6 mm [ 27.4 mm ] , P = .89 ) did not differ between the doula and control groups .


Among women who received doula support , 96.2 % recommended routine doula support for abortion and 60.4 % indicated interest in training as doulas .


Among women who did not receive doula support , 71.6 % of women would have wanted it .


Additional clinical staff was needed to provide support for 2.9 % of women in the doula group and 14.7 % of controls ( P < .01 ) .


Although doula support did not have a measurable effect on pain or satisfaction , women overwhelmingly recommended it for routine care .


Women receiving doula support were less likely to require additional clinic support resources .


Doula support therefore may address patient psychosocial needs .


The incidence of propofol injection pain during induction of general anesthesia varies from 28 % to 90 % .


This prospective , randomized , double-blind , placebo-controlled study evaluated the effect of dexmedetomidine ( DEX ) for reducing the incidence and severity of propofol injection pain .


Patients undergoing elective surgical procedures were randomly allocated into seven groups of 30 patients each .


Experimental treatments were intravenously administered over 10 min ( total volume 10 mL ) prior to intravenous propofol injection , as follows : group I , the control group , was given isotonic saline .


Patients in groups II , III , and IV received DEX 0.25 g/kg , 0.5 g/kg , or 1.0 g/kg , respectively , mixed with isotonic saline immediately before propofol injection .


Patients in groups V , VI , and VII received DEX as above , but 5 minutes before propofol injection .


Propofol consisted of 1 % long-chain triglyceride propofol ( 2.5 mg/kg ) injected at 1 mL/s .


Median propofol injection pain score was 0.00 ( IQR 0.00-3 .00 ) in patients who received 1.0 g/kg DEX 5 min before the propofol injection ( group VII ) , and only 1 patient ( of 30 ) in this group received a pain score > 2 .


The median pain score and number of patients with pain scores > 2 in group VII were both significantly less than in the control ( group I ; p = 0.000 , both ) .


There were no differences in either mean arterial pressure or heart rate at any time point after DEX injection among the groups .


Pretreatment with intravenous DEX 1 g/kg 5 min prior to injection of long-chain triglyceride propofol is effective and safe in reducing the incidence and severity of pain due to propofol injection .


Hyperkalemia is one of the most dreadful complications of chronic kidney disease ( CKD ) .


Medical management includes use of cation exchange resins to reduce the amount of excessive potassium from the body .


Sodium polystyrene sulphonate ( SPS ) and calcium polystyrene sulphonate ( CPS ) are currently used for hyperklemia of CKD all over the world .


The objective was to compare the efficacy and safety of two different cation exchange resins ( CPS and SPS ) in patients of CKD with hyperkalemia .


This randomized control trial was done at the Kidney Centre , Post Graduate Training Institute ( PGTi ) , Karachi , Pakistan between 15 January 2010 till 31st December 2010 to compare the efficacy and safety of , CPS and SPS in 97 CKD patients with hyperkalemia .


The subjects were divided in two groups .


Group-A received CPS while group-B received SPS .


The data included symptoms , food recall , physical signs of volume overload and electrolytes .


After receiving potassium binding resin for 3 days patients were evaluated for symptoms , weight gain , worsening of blood pressure and effect on electrolytes .


Adverse events were recorded in an event reporting form .


Average potassium level pre resin was 5.8 _ 0.26 in group-A and 5.80.6 in group-B , which reduced to 4.80.5 in group-A and 4.30.53 in group-B suggesting the efficacy of both drugs for treatment of hyperkalemia in CKD patients .


Systolic blood pressure remains stable in both the groups while an increase in diastolic blood pressure was noticed in group-B patients ( p-value 0.004 ) .


No major adverse effect occurred in both the groups .


Both CPS and SPS can be used effectively for reducing hyperkalemia of CKD .


CPS showed fewer side effects as compared to SPS .


The Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue Plasminogen Activator ( rt-PA ) in Acute Ischemic Stroke-Enhanced Regimen ( CLEAR-ER ) trial found that intravenous rt-PA plus eptifibatide ( combination arm ) in acute ischemic stroke ( AIS ) was safe and had a direction of effect that would justify a phase III trial .


CLEAR-ER had unanticipated imbalances between treatment groups .


We compared the rates of symptomatic intracranial hemorrhage ( sICH ) and good outcomes for combination therapy patients in the CLEAR-ER trial to a matched cohort of rt-PA patients from the National Institute of Neurological Disorders and Stroke ( NINDS ) trial .


CLEAR-ER was a multicenter , double-blind , randomized study ; rt-PA-eligible AIS patients were randomized to .6 mg/kg rt-PA plus eptifibatide ( 135 mcg/kg bolus and .75 mcg/kg/min two-hour infusion ) versus standard rt-PA ( .9 mg/kg ) .


For this analysis , we matched 1:1 CLEAR-ER combination therapy patients with rt-PA arm NINDS trial patients .


Patients were matched by age , gender , race , baseline modified Rankin Scale score , baseline National Institutes of Health Stroke Scale ( NIHSS ) score , and stroke onset to rt-PA time .


Fifty-four matches were made .


One ( 1.8 % ) sICH occurred in each group ( odds ratio [ OR ] 1.00 , 95 % confidence interval [ CI ] .01 -78.50 ) .


At 90days , 51.8 % of the CLEAR-ER group had good outcomes versus 46.3 % in the NINDS rt-PA group ( OR 1.30 , 95 % CI .57 -2.96 ) .


For subjects with baseline NIHSS score > 12 ( CLEAR-ER median NIHSS score ) , 38.5 % of the CLEAR-ER group had good outcomes versus 23.1 % in the NINDS group ( OR 2.33 , 95 % CI .60 -9.02 ) .


The safety and direction of effect of eptifibatide plus rt-PA were confirmed .


A phase III trial is needed to determine the efficacy of eptifibatide plus rt-PA for improving long-term outcomes after AIS .


We explore gender differences in older adults ' appraisals of positive and negative aspects of their marriages , examine how these appraisals relate to global marital satisfaction , and identify distinctive marital profiles associated with global satisfaction in men and women .


Data are from the Changing Lives of Older Couples Study ( n = 1,110 ) .


We used a variant of principal components analysis to generate marital quality profiles , based on one 's endorsement of positive and negative marital characteristics .


OLS regression was used to detect associations between marital profiles and global marital satisfaction .


Men offered more positive marital assessments than women , particularly on items reflecting positive treatment by one 's wife .


Three marital quality profiles emerged : Positive , Positive-Negative , and Negative .


Although marital satisfaction was best explained by positive appraisals in both genders , they were less important for men than for women .


The negative profile showed a tendency for a stronger prediction in men .


Prior studies show small differences in men 's and women 's global marital satisfaction .


Our work provides evidence that the presence and magnitude of such gender differences may vary based on the specific marital component considered .


We discuss ways that gender shapes marital interactions , expectations , and perceptions , and the implications of our results for the well-being of married older adults .


Ward rounds represent an important task in clinical settings .


Despite their importance , students show substantial deficits in ward round competencies ( e.g. physical examination , drug prescription , documentation ) .


Previously reported teaching methods such as ward round training with standardized patients or educational wards , however , are time-consuming and expensive .


To assess the effects of a structured on-ward supervision program for final-year students with specially trained supervising doctors focusing on ward round competencies .


A total of 36 medical students were randomly assigned to an intervention group ( IG ) and a control group ( CG ) .


During an eight-week-long training course , the intervention group ( IG ; n = 18 ) received structured ward round training while the control group ( CG ; n = 18 ) received on-ward training regarding how to take patient histories and perform physical examinations .


Ward round competencies were assessed using simulated ward round scenarios with objective checklist ratings and standardized patient ratings .


The IG achieved significantly more predefined learning goals compared to the CG .


Standardized patient ratings did not differ significantly between groups .


RESULTS provide evidence that the presented program is a feasible and efficient tool for teaching ward round skills at the bedside .


Further research should focus on cost effectiveness compared to alternative models .


Performance of transesophageal echocardiography ( TEE ) requires the psychomotor ability to obtain interpretable echocardiographic images .


The purpose of this study was to determine the effectiveness of a simulation-based curriculum in which a TEE simulator is used to teach the psychomotor skills to novice echocardiographers and to compare instructor-guided with self-directed online delivery of the curriculum .


After institutional review board approval , subjects inexperienced in TEE completed an online review of TEE material prior to a baseline pre-test of TEE psychomotor skills using the simulator .


Subjects were randomized to two groups .


The first group received an instructor-guided lesson of TEE psychomotor skills with the simulator .


The second group received a self-directed slide presentation of TEE psychomotor skills with the simulator .


Both lessons delivered identical information .


Following their respective training sessions , all subjects performed a post-test of their TEE psychomotor skills using the simulator .


Two assessors rated the TEE performances using a validated scoring system for acquisition of images .


Pre-test TEE simulator scores were similar between the two instruction groups ( 9.0 vs 5.0 ; P = 0.28 ) .


The scores in both groups improved significantly following training , regardless of the method of instruction ( P < 0.0001 ) .


The improvement in scores ( post-test scores minus pre-test scores ) did not differ significantly between instruction groups ( 12.5 vs 14.5 ; P = 0.55 ) .


There was strong inter-rater reliability between assessors ( = 0.98 ; 95 % confidence interval [ CI ] : 0.97 to 0.99 ) .


High-fidelity TEE simulators are an effective training adjunct for the acquisition of basic TEE psychomotor skills .


There was no difference in improvement between the different modalities of instruction .


Further research will examine the need for a faculty resource for a curriculum in which a simulator is used as an adjunct .


Complications due to hemodilution ( hematocrit value less than 22 % ) after cardiopulmonary bypass inevitably resulted with significantly greater intensive care requirements , long hospital stays , more operative costs , and increased mortality rates .


We tried to identify whether crystalloid cardioplegia is the strongest predictor of intraoperative hemodilution or not .


One hundred patients were included into this randomized prospective study .


Patients were divided into the two groups .


Crystalloid cardioplegia were given to the odd-numbered patients ( Group 1 , n = 50 patients ) and blood cardioplegia were given to the even-numbered patients ( Group 2 , n = 50 patients ) .


St. Thomas-II solution was used in Group-1 and Calafiore cold blood cardioplegia was in Group-2 .


Average intraoperative hematocrit value was 18.4 % 2.3 in crystalloid group 24.2 % 3.4 in blood cardioplegia group ( p < 0.001 ) .


The lowest hematocrit value was 15 % and 20 % in two groups respectively ( p < 0.001 ) .


In crystalloid group average intraoperative packed red blood cell ( RBC ) transfusion was 2.3 0.41 units , 0.7 0.6 units blood cardioplegia group ( p = 0.001 ) .


Average transfused RBC was 2.7 0.8 units in crystalloid group , 0.9 0.4 units blood cardioplegia group ( p < 0.001 ) .


Multivariate analyses confirmed age ( p = 0.005 , OR = 3.78 ) , female gender ( p = 0.003 , OR = 2.91 ) , longer cross-clamp time ( > 60 minutes ) ( p = 0.001 , OD = 0.97 ) , body surface area < 1.6 m2 ( p = 0.001 , OR = 6.01 ) and crystalloid cardioplegia ( p < 0.001 , OR = 0.19 ) as predictor of intraoperative hemodilution .


Crystalloid cardioplegia , compared to blood cardioplegia not only causes much more intra-operative hemodilution but also increases the blood transfusion requirement .


Hemodilution and increased transfusion increases the intensive care unit and hospital stay , in the early postoperative period .


High phytate ( HP ) consumption is a concern in developing countries because of the high prevalence of iron deficiency in these countries .


We investigated whether habitual consumption of an HP diet reduces the inhibitory effect of phytate on nonheme-iron absorption .


Thirty-two nonanemic females , 18-35 y of age , with normal body mass index but with suboptimal iron stores ( serum ferritin , 30 g/L ) , were matched for serum ferritin concentration and randomly assigned to HP and low-phytate ( LP ) groups , in a parallel design study .


Each subject consumed HP or LP foods with at least 2 of their daily meals for 8 wk , resulting in a change in phytate intake ( from 718 to 1190 mg/d in the HP group and 623 to 385 mg/d in the LP group ) .


The serum iron response over 4 h after a test meal containing 350 mg of phytate was measured at baseline and postintervention .


Ferritin , transferrin receptor , and hepcidin concentrations were measured at baseline and 8 wk .


Twenty-eight subjects completed the study ( n = 14 per group ) .


The serum iron response to the test meal increased in the HP group at postintervention , resulting in a 41 % increase in the area under the curve ( AUC ; P < 0.0001 ) .


However , no effect was observed in the LP group ( 21 % decrease in AUC ; P = 0.76 ) .


The postintervention serum iron response was lower ( P < 0.0001 ) in the LP group than in the HP group after controlling for the baseline serum iron response and hepcidin concentration , reflecting in a 64 % lower AUC .


We found that habitual consumption of an HP diet can reduce the negative effect of phytate on nonheme-iron absorption among young women with suboptimal iron stores .


Future studies are needed to explore possible mechanisms .


This trial was registered at clinicaltrials.gov as NCT02370940 .


The realization of the prostatic biopsies is a painful act .


The objective of our work was to compare the analgesic efficiency of the injection of the lidocaine at the level of periprostatics laterals and apical areas compared with the use of gel of lidocaine intrarectal associated with the taking of oral tramadol .


Between November 2007 and December 2009 , 60 patients admitted in the service of urology of the university hospital Mohammed VI of Marrakesh for prostatic biopsies were randomized in two groups .


The group 1 ( 30 patients ) received two tablets from tramadol 50mg with 10 mL of gel of lidocaine 2 % intrarectal while 30 patients of the group 2 received 10 mL from lidocaine 2 % injected at the level of periprostatics laterals and apicales .


The pain was estimated by a visual analog scale ( AVS ) at the introduction of the probe of echography ( AVS 1 ) , at the time of the biopsy ( AVS 2 ) and 20 minutes later ( AVS 3 ) .


There was no significant difference between both groups concerning AVS 1 means .


The average score of the pain was significantly lower in the group 2 for the AVS 2 and AVS 3 .


The periprostatics anesthesia assured a better control of the pain at the time of the prostatic biopsy and 20 minutes later , without increase of the complications .


We recommend it to decrease the pain and the discomfort related to this technique .


Necrotizing enterocolitis ( NEC ) is the most serious gastrointestinal problem in very low birth weight preterm infants .


Multiple risk factors activate the inflammatory cascade leading to high expressions of pro-inflammatory mediators causing bowel injury in NEC .


The anti-inflammatory effect of probiotics is due to the inhibition and reduction of inflammatory signal in intestinal epithelium .


To evaluate the efficacy of probiotics supplementation in the prevention of NEC among very low birth weight preterm infants .


A prospective randomized controlled trial .


All preterm infants with gestational age less than or equal to 34 weeks and birth weight less than or equal to 1,500 grams admitted in neonatal care unit , Queen Sirikit National Institute of Child Health during June 1st , 2012 and January 31th , 2013 were enrolled in this study .


They were randomized into two groups , study and control group .


Infants in the study group were fed Infloran ( Lactobacillus acidophilus 1 x 10 ( 9 ) and Bifidobacterium bifidum 1 x 10 ( 9 ) organisms ) dose 125 mg/kg/dose twice a day with breast milk or premature formula from the start of feeding until 6 weeks or discharge .


Infants in the control group were fed with either breast milk or premature formula alone .


The primary outcome was NEC stage 2 .


Sixty infants completed the study , 31 infants in the study group and 29 infants in the control group .


The baseline characteristic data of infants were similar except for more males in the present study group .


Incidence of NEC stage 2 were similar in both the groups , 3.2 vs. 3.4 % ( p = 0.74 ) .


There were no deaths during the study period .


Days to reach full feeding , 150 ml/kg/day , were no differences between the two groups , 12.03 5.49 days vs. 13.76 8.25 days ( p = 0.31 ) .


No adverse effects such as sepsis , flatulence or diarrhea were noted .


In this study , there was no difference in incidence of NEC stage 2 between the two groups .


No adverse effects of probiotics supplementation were observed .


Rasagiline is a selective , irreversible monoamine oxidase type B inhibitor , developed for the treatment of Parkinson 's disease .


In compliance with current regulatory requirements , rasagiline underwent a thorough QT/QTc ( TQT ) study to assess its potential to prolong cardiac repolarization .


The primary aim of this study was to evaluate the effects of clinical ( 1 mg/day ) and supratherapeutic ( 2 mg/day and 6 mg/day ) multiple oral doses of rasagiline on the baseline - and placebo-adjusted QTc interval ( delta delta QTc ( ddQTc ) ) .


Other electrocardiogram parameters , pharmacokinetic assessments , safety and tolerability as well as vital signs were investigated .


This was a five-arm , randomized , double-blind , placebo - and active-controlled , and parallel study in healthy subjects .


Moxifloxacin ( 400 mg ) positive control was included to demonstrate assay sensitivity .


247 of 250 randomized subjects completed the study .


Time-matched analysis of ddQTc yielded two-sided 90 % confidence intervals for all rasagiline doses below the 10 ms regulatory threshold , showing no effect on cardiac repolarization .


Concentration-effect analysis demonstrated no relationships between rasagiline ( and its metabolite 1-aminoindan ) , plasma concentrations , and ddQTc .


The pharmacokinetic profile of rasagiline was consistent with previous studies .


Adverse events were mild to moderate in intensity and were similar across all treatment groups .


There were no clinically significant changes in heart rate and systolic blood pressure .


This TQT study demonstrated a favorable cardiac safety profile of rasagiline .


Credible measures of disease incidence , trends and mortality can be obtained through surveillance using manual chart review , but this is both time-consuming and expensive .


ICD-10 discharge diagnoses are used as surrogate markers of infection , but knowledge on the validity of infections in general is sparse .


The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department ( ED ) , overall and related to sites of infection and patient characteristics .


We manually reviewed 5977 patients admitted to a medical ED in a one-year period ( September 2010-August 2011 ) , to establish if they were hospitalised with community-acquired infection .


Using the manual review as gold standard , we calculated the sensitivity , specificity , predictive values , and likelihood ratios of discharge diagnoses indicating infection .


Two thousand five hundred eleven patients were identified with community-acquired infection according to chart review ( 42.0 % , 95 % confidence interval [ 95 % CI ] : 40.8-43 .3 % ) compared to 2550 patients identified by ICD-10 diagnoses ( 42.8 % , 95 % CI : 41.6-44 .1 % ) .


Sensitivity of the ICD-10 diagnoses was 79.9 % ( 95 % CI : 78.1-81 .3 % ) , specificity 83.9 % ( 95 % CI : 82.6-85 .1 % ) , positive likelihood ratio 4.95 ( 95 % CI : 4.58-5 .36 ) and negative likelihood ratio 0.24 ( 95 % CI : 0.22-0 .26 ) .


The two most common sites of infection , the lower respiratory tract and urinary tract , had positive likelihood ratios of 8.3 ( 95 % CI : 7.5-9 .2 ) and 11.3 ( 95 % CI : 10.2-12 .9 ) respectively .


We identified significant variation in diagnostic validity related to age , comorbidity and disease severity .


ICD-10 discharge diagnoses identify specific sites of infection with a high degree of validity , but only a moderate degree when identifying infections in general .


The affect of the kidneys in elimination and degradation of intact incretin hormones and their truncated metabolites is unclear .


To evaluate elimination and degradation of glucose-dependent insulinotropic polypeptide ( GIP ) and glucagon-like peptide-1 ( GLP-1 ) in patients with dialysis-dependent kidney failure .


Twelve non-diabetic patients treated with chronic hemodialysis and 12 control subjects were examined in a double-blind , randomized , matched observational study at the Department of Nephrology , Rigshospitalet , University of Copenhagen , Denmark .


Over 4 separate study days , synthetic human GIP or GLP-1 was infused with or without concurrent inhibition of dipeptidyl peptidase 4 using sitagliptin or placebo .


Plasma concentrations of glucose , insulin , glucagon , and intact and total forms of GLP-1 or GIP were measured repeatedly .


Plasma half-life ( T1/2 ) , metabolic clearance rate ( MCR ) , area under curve , and volume of distribution for intact and metabolite levels of GLP-1 and GIP were calculated .


Fasting concentrations of intact GLP-1 and GIP were increased in dialysis patients ( P < .001 ) whereas fasting levels of GLP-1 and GIP metabolites did not differ between groups ( P > .738 ) .


MCRs of intact GLP-1 and GIP , and the GLP-1 metabolite were reduced in dialysis patients on the placebo day ( P < .009 ) , and T1/2 of intact and metabolite forms of GLP-1 and GIP were comparable between groups ( P > .121 ) .


Unexpectedly , degradation and elimination of the intact and metabolite forms of GLP-1 and GIP seemed preserved , although reduced , in patients with dialysis-dependent kidney failure .


To explore the effects of combined intervention with education and progressive muscle relaxation ( PMR ) on quality of life ( QoL ) , functional disability , and positive symptoms of patients with acute schizophrenia .


This randomized controlled study took place in an acute schizophrenia ward in Changsha , China .


Sixty-four patients with acute schizophrenia were randomly assigned to four groups : control , education , PMR , and education plus PMR .


QoL was assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form .


Functional disability was assessed with the Sheehan Disability Scale .


Severity of positive schizophrenia symptoms was assessed with the Scale for the Assessment of Positive Symptoms .


All patients were evaluated at baseline ( within 72 hours before the interventions ) and at the end of weeks 5 ( when the interventions ended ) and week 15 ( a 10-week follow-up after the interventions ) .


The sociodemographic and clinical characteristics of all four study groups were similar at baseline .


Repeated-measures analysis of variance showed significant differences among the interventions in improving QoL , functional disability , and positive symptoms over time in the patients .


Education and PMR alone resulted in sustained improvement of QoL during the intervention period and a 10-week follow-up but had no significant effects on functional disability or positive schizophrenia symptoms .


In contrast , combined intervention with education and PMR showed better effects on improving QoL than did education or PMR alone throughout the 15-week study .


It also statistically significantly improved functional disability and positive schizophrenia symptoms during the intervention period and led to sustained improvement of functional disability during the 10-week follow-up .


A combined intervention with education and PMR is effective in improving QoL , functional disability , and positive symptoms in patients with acute schizophrenia .


The combined intervention model could be a new paradigm of adjunctive treatment for acute schizophrenia .


To evaluate the impact of radiological expertise on screen result decisions in a CT lung cancer screening trial .


In the NELSON lung cancer screening trial , the baseline CT result was based on the largest lung nodule 's volume .


The protocol allowed radiologists to manually adjust screen results in cases of high suspicion of benign or malignant nodule nature .


Participants whose baseline CT result was based on a solid or part-solid nodule were included in this study .


Adjustments by radiologists at baseline were evaluated .


Histology was the reference for diagnosis or to confirm benignity and stability on subsequent CT examinations .


A total of 3,318 participants ( 2,796 male , median age 58.0 years ) were included .


In 195 participants ( 5.9 % ) the initial baseline screen result was adjusted by the radiologist .


Adjustment was downwards from positive or indeterminate to negative in two and 119 participants , respectively , and from positive to indeterminate in 65 participants .


None of these nodules turned out to be malignant .


In 9/195 participants ( 4.6 % ) the screen result was adjusted upwards from negative to indeterminate or indeterminate to positive ; two nodules were malignant .


In one in 20 cases of baseline lung cancer screening , nodules were reclassified by the radiologist , leading to a reduction of false-positive screen results .


Type 1 diabetes results from autoimmune targeting of the pancreatic cells , likely mediated by effector memory T ( Tem ) cells .


CD2 , a T cell surface protein highly expressed on Tem cells , is targeted by the fusion protein alefacept , depleting Tem cells and central memory T ( Tcm ) cells .


We postulated that alefacept would arrest autoimmunity and preserve residual cells in patients newly diagnosed with type 1 diabetes .


The T1DAL study is a phase 2 , double-blind , placebo-controlled trial in patients with type 1 diabetes , aged 12-35 years who , within 100 days of diagnosis , were enrolled at 14 US sites .


Patients were randomly assigned ( 2:1 ) to receive alefacept ( two 12-week courses of 15 mg intramuscularly per week , separated by a 12-week pause ) or a placebo .


Randomisation was stratified by site , and was computer-generated with permuted blocks of three patients per block .


All participants and site personnel were masked to treatment assignment .


The primary endpoint was the change from baseline in mean 2 h C-peptide area under the curve ( AUC ) at 12 months .


Secondary endpoints at 12 months were the change from baseline in the 4 h C-peptide AUC , insulin use , major hypoglycaemic events , and HbA1c concentrations .


This trial is registered with ClinicalTrials.gov , number NCT00965458 .


Of 73 patients assessed for eligibility , 33 were randomly assigned to receive alefacept and 16 to receive placebo .


The mean 2 h C-peptide AUC at 12 months increased by 0.015 nmol/L ( 95 % CI -0.080 to 0.110 ) in the alefacept group and decreased by 0.115 nmol/L ( -0.278 to 0.047 ) in the placebo group , and the difference between groups was not significant ( p = 0.065 ) .


However , key secondary endpoints were met : the mean 4 h C-peptide AUC was significantly higher ( mean increase of 0.015 nmol/L [ 95 % CI -0.076 to 0.106 ] vs decrease of -0.156 nmol/L [ -0.305 to -0.006 ] ; p = 0.019 ) , and daily insulin use ( 0.48 units per kg per day for placebo vs 0.36 units per kg per day for alefacept ; p = 0.02 ) and the rate of hypoglycaemic events ( mean of 10.9 events per person per year for alefacept vs 17.3 events for placebo ; p < 0.0001 ) was significantly lower at 12 months in the alefacept group than in the placebo group .


Mean HbA1c concentrations at week 52 were not different between treatment groups ( p = 0.75 ) .


So far , no serious adverse events were reported and all patients had at least one adverse event .


In the alefacept group , 29 ( 88 % ) participants had an adverse event related to study drug versus 15 ( 94 % ) participants in the placebo group .


In the alefacept group , 14 ( 42 % ) participants had grade 3 or 4 adverse events compared with nine ( 56 % ) participants in the placebo group ; no deaths occurred .


Although the primary outcome was not met , at 12 months , alefacept preserved the 4 h C-peptide AUC , lowered insulin use , and reduced hypoglycaemic events , suggesting efficacy .


Safety and tolerability were similar in the alefacept and placebo groups .


Alefacept could be useful to preserve - cell function in patients with new-onset type 1 diabetes .


Myopia has reached epidemic levels in parts of East and Southeast Asia .


However , there is no effective intervention to prevent the development of myopia .


To assess the efficacy of increasing time spent outdoors at school in preventing incident myopia .


Cluster randomized trial of children in grade 1 from 12 primary schools in Guangzhou , China , conducted between October 2010 and October 2013 .


For 6 intervention schools ( n = 952 students ) , 1 additional 40-minute class of outdoor activities was added to each school day , and parents were encouraged to engage their children in outdoor activities after school hours , especially during weekends and holidays .


Children and parents in the 6 control schools ( n = 951 students ) continued their usual pattern of activity .


The primary outcome measure was the 3-year cumulative incidence rate of myopia ( defined using the Refractive Error Study in Children spherical equivalent refractive error standard of -0.5 diopters [ D ] ) among the students without established myopia at baseline .


Secondary outcome measures were changes in spherical equivalent refraction and axial length among all students , analyzed using mixed linear models and intention-to-treat principles .


Data from the right eyes were used for the analysis .


There were 952 children in the intervention group and 951 in the control group with a mean ( SD ) age of 6.6 ( 0.34 ) years .


The cumulative incidence rate of myopia was 30.4 % in the intervention group ( 259 incident cases among 853 eligible participants ) and 39.5 % ( 287 incident cases among 726 eligible participants ) in the control group ( difference of -9.1 % [ 95 % CI , -14.1 % to -4.1 % ] ; P < .001 ) .


There was also a significant difference in the 3-year change in spherical equivalent refraction for the intervention group ( -1.42 D ) compared with the control group ( -1.59 D ) ( difference of 0.17 D [ 95 % CI , 0.01 to 0.33 D ] ; P = .04 ) .


Elongation of axial length was not significantly different between the intervention group ( 0.95 mm ) and the control group ( 0.98 mm ) ( difference of -0.03 mm [ 95 % CI , -0.07 to 0.003 mm ] ; P = .07 ) .


Among 6-year-old children in Guangzhou , China , the addition of 40 minutes of outdoor activity at school compared with usual activity resulted in a reduced incidence rate of myopia over the next 3 years .


Further studies are needed to assess long-term follow-up of these children and the generalizability of these findings .


clinicaltrials.gov Identifier : NCT00848900 .


Suicide-related behaviour among young people is of significant concern , yet little is known regarding the effectiveness of interventions designed to reduce risk among this population .


Of those interventions that have been tested , cognitive-behavioural therapy appears to show some promise among young people with suicidal ideation .


Internet-based interventions are becoming increasingly popular and have shown some effect in preventing and treating depression and anxiety in young people .


However , to date there are no randomised controlled trials examining the impact of Internet-based Cognitive Behavioural Therapy among suicidal youth .


This is a randomised controlled trial testing the effects of Internet-based cognitive-behavioural therapy among suicidal high school students who have sought help from the school wellbeing team .


The intervention comprises 8 modules of Cognitive Behavioural Therapy delivered online .


The study has a staggered , two-year recruitment phase and participants are assessed at baseline , post intervention and 12weeks later .


If effective the program has the ability to be readily adapted and delivered to a range of populations in a range of settings , at relatively little cost .


It can also be adapted for mobile applications .


ACTRN12613000864729 .


Date registered : 05/08/2013 .


Online formative assessment continues to be an important area of research and methods which actively engage the learner and provide useful learning outcomes are of particular interest .


This study reports on the outcomes of a two year study of medical students using formative assessment tools .


The study was conducted over two consecutive years using two different strategies for engaging students .


The Year 1 strategy involved voluntary use of the formative assessment tool by 129 students .


In Year 2 , a second cohort of 130 students was encouraged to complete the formative assessment by incorporating summative assessment elements into it .


Outcomes from pre and post testing students around the formative assessment intervention were used as measures of learning .


To compare improvement scores between the two years a two-way Analysis of Variance ( ANOVA ) model was fitted to the data .


The ANOVA model showed that there was a significant difference in improvement scores between students in the two years ( mean improvement percentage 19 % vs. 38.5 % , p < 0.0001 ) .


Students were more likely to complete formative assessment items if they had a summative component .


In Year 2 , the time spent using the formative assessment tool had no impact on student improvement , nor did the number of assessment items completed .


The online medium is a valuable learning resource , capable of providing timely formative feedback and stimulating student-centered learning .


However the production of quality content is a time-consuming task and careful consideration must be given to the strategies employed to ensure its efficacy .


Course designers should consider the potential positive impact summative components to formative assessment may have on student engagement and outcomes .


Estimate association between postpartum antiretroviral adherence and breast milk HIV-1 transmission .


Prospective cohort study .


Mother-infant pairs were randomized after delivery to immediately begin receiving 28 weeks of either triple maternal antiretrovirals ( zidovudine , lamivudine , and either nevirapine , nelfinavir , or lopinavir-ritonavir ) or daily infant nevirapine as part of the Breastfeeding , Antiretrovirals , and Nutrition ( BAN ) study .


Associations between postpartum antiretroviral adherence and rate of breast milk HIV-1 transmission were estimated using Cox models .


We measured adherence over four postpartum time intervals using pill count , suspension bottle weight , and maternal self-report .


Adherence was categorized and lagged by one interval .


Missing adherence measures were multiply imputed .


Infant HIV-1 infection was determined by DNA PCR every 2-6 weeks .


The primary endpoint was infant HIV-1 infection by 38 weeks of age among infants alive and uninfected at 5 weeks .


Analyses included 1479 mother-infant pairs and 45 transmission events .


Using pill count and bottle weight information , 22-40 % of mother-infant pairs at any given interval were less than 90 % adherent .


Having at least 90 % adherence was associated with a 52 % [ 95 % confidence interval ( CI ) 3-76 ] relative reduction in the rate of breast milk HIV-1 transmission , compared with having less than 90 % adherence when controlling for study arm , breastfeeding status , and maternal characteristics .


Complete case analysis rendered similar results ( n = 501 ; relative reduction 59 % , 95 % CI 6-82 ) .


Nonadherence to extended postpartum antiretroviral regimens in ` real world ' settings is likely to be higher than that seen in BAN .


Identifying mothers with difficulty adhering to antiretrovirals , and developing effective adherence interventions , will help maximize benefits of antiretroviral provision throughout breastfeeding .


The Fontan procedure has improved survival in children with functionally univentricular hearts .


With time , however , complications such as reduced exercise capacity are seen more frequently .


Exercise intolerance is multifactorial , but pulmonary vascular resistance probably plays a crucial role .


Elevated pulmonary vascular resistance has been associated with raised levels of endothelin-1 , which are common both before and after Fontan operations .


Treatment with endothelin-1 receptor antagonists could theoretically improve cardiopulmonary hemodynamics and exercise capacity .


The aim of this study was therefore to examine the efficacy and safety of bosentan in Fontan patients .


Seventy-five adolescents and adults were randomized 1:1 to 14 weeks of treatment with bosentan or placebo .


Cardiopulmonary exercise test , functional class , blood samples , and quality-of-life questionnaires were evaluated at baseline and at the end of treatment .


Sixty-nine patients ( 92 % ) completed the study .


Peak oxygen consumption increased 2.0 mLkg ( -1 ) min ( -1 ) ( from 28.7 to 30.7 mLkg ( -1 ) min ( -1 ) ) in the bosentan group compared with 0.6 mLkg ( -1 ) min ( -1 ) ( from 28.4 to 29.0 mLkg ( -1 ) min ( -1 ) ) in the placebo group ( P = 0.02 ) .


Cardiopulmonary exercise test time increased by 0.48 minute ( from 6.79 to 7.27 minutes ) versus 0.08 minute ( from 6.94 to 7.02 minutes ; P = 0.04 ) .


Nine bosentan-treated patients improved 1 functional class , whereas none improved in the placebo group ( P = 0.0085 ) .


Side effects were mild and occurred equally in both groups .


No serious adverse effects were seen , and no patients had liver enzyme levels above the 3-fold upper limit .


Bosentan improves exercise capacity , exercise time , and functional class in Fontan patients without serious adverse events or hepatotoxicity .


http://www.clinicaltrials.gov .


Unique identifier : NCT01292551 .


To compare the glycaemic effect of 75 gram and 30 gram of natural honey in a honey tolerance test with that of 75 gram glucose in type 2 diabetics .


The experimental study was conducted at the Jinnah Medical College Hospital , Karachi , and comprised 97 type 2 diabetic patients who came to the out-patient department between March and August 2011 .


The patients were randomly divided into 75 gram honey group ( group 1 ) , 30 gram honey group ( group 2 ) , and 75 gram glucose group ( group 3 ) .


Fasting blood samples were obtained as well as after 1 and 2 hour .


SPSS 11 was used for statistical analysis .


Of the 97 participants , 62 ( 64 % ) were females and 35 ( 36 % ) males.Their ages ranged from 25-68 years .


Mean rise in blood glucose after two hours in group 2 was 30 mg/dl ; group 1 , 85mg/dl , and group 3 , 170 mg/dl .


The difference was statistically significant ( p < 0.005 ) .


The glucose response was significantly lower at 2 hours in group 2 ( p < 0.001 ) compared to group 1 or group 2 .


A significant difference was also seen in group 1 and 3 ( p < 0.0001 ) .


The plasma glucose level in response to honey peaked at 60 min and showed a rapid decline compared to that of glucose , indicating a lower glycaemic response of honey .


A small proportion of patients 3 ( 10.7 % ) even showed a glucose lowering effect after low dose of honey .


Low dose of honey can be a valuable sugar substitute for patients with diabetes .


Little is known about learning/adherence after different baby massage teaching strategies .


We compared the learning/adherence after two strategies .


Twenty mothers from the group manual-course ( GMC ) and 20 from the group manual-orientations ( GMO ) received a booklet .


GMC participated in a course during the third trimester .


GMO received verbal instructions during the postpartum hospital stay .


Multiple-choice and practical tests assessed learning ( GMC : performing strokes on a doll ; GMO : on the baby ) .


Adherence was measured 3 months after childbirth .


No differences were found between the groups in learning/adherence .


Both teaching strategies showed similar and positive results .


Older adults can benefit from physical activity in numerous ways .


Physical activity is considered to be one of the few ways to influence the level of frailty .


Standardized exercise programs do not necessarily lead to more physical activity in daily life , however , and a more personalized approach seems appropriate .


The main objective of this study is to investigate whether a focused , problem-oriented coaching intervention ( ` Coach2Move ' ) delivered by a physiotherapist specializing in geriatrics is more effective for improving physical activity , mobility and health status in community-dwelling older adults than usual physiotherapy care .


In addition , cost-effectiveness will be determined .


The design of this study is a single-blind randomized controlled trial in thirteen physiotherapy practices .


Randomization will take place at the individual patient level .


The study population consists of older adults , 70 years of age , with decreased physical functioning and mobility and/or a physically inactive lifestyle .


The intervention group will receive geriatric physiotherapy according to the Coach2Move strategy .


The control group will receive the usual physiotherapy care .


Measurements will be performed by research assistants not aware of group assignment .


The results will be evaluated on the amount of physical activity ( LASA Physical Activity Questionnaire ) , mobility ( modified ` get up and go ' test , walking speed and six-minute walking test ) , quality of life ( SF-36 ) , degree of frailty ( Evaluative Frailty Index for Physical Activity ) , fatigue ( NRS-fatigue ) , perceived effect ( Global Perceived Effect and Patient Specific Complaints questionnaire ) and health care costs .


Most studies on the effect of exercise or physical activity consist of standardized programs .


In this study , a personalized approach is evaluated within a group of frail older adults , many of whom suffer from multiple and complex diseases and problems .


A complicating factor in evaluating a new approach is that it may not be automatically adopted by clinicians .


Specific actions are undertaken to optimize implementation of the Coach2Move strategy during the trial .


Whether or not these will be sufficient is a matter we will consider subsequently , using quality indicators and process analysis .


The Netherlands National Trial Register : NTR3527 .


To evaluate and compare the effects of two chest physiotherapy interventions in patients hospitalized due to acute bronchiolitis .


Prospective randomized study with a sample of 83 calls for 29 patients aged between 3 months and 1 year hospitalized for acute bronchiolitis .


Patients were distributed randomly into two groups : Group 1 , submitted to postural drainage , tapping and tracheal aspiration ; and Group 2 , submitted to postural drainage , expiratory acceleration flow and tracheal aspiration .


Assessments were made before and 10 and 60 minutes after the end of therapy .


Patients also underwent drug treatment .


The endpoint was to compare two physical therapy interventions as to clinical improvement in infants with acute bronchiolitis by means of oxygen saturation and the Respiratory Distress Assessment Instrument score .


The parents/guardians was requested to answer a questionnaire about the treatment applied before the last evaluation in order to measure their satisfaction related to the interventions made .


The groups were similar regarding the use of antibiotics and bronchodilators .


A greater number of patients used corticosteroids in Group 2 .


A relevant improvement was observed on Respiratory Distress Assessment Instrument score with physical therapy , with reduction of the score 10 minutes after interventions , and the same score 60 minutes later , with no differences between techniques applied .


There was no significant variation of pulse oximetry after chest physiotherapy .


Most items assessed by the questionnaire had satisfactory answers .


No differences were observed between groups regarding the items assessed ( time required to discharge from study , pulse oximetry in room air and disease severity according to the Respiratory Distress Assessment Instrument score ) .


Parents answered positively about the effects of therapy in the majority of items in the questionnaire , both for the expiratory acceleration flow technique and for tapping .


The present study was conducted to compare and evaluate the relative efficacy of enamel microabrasion ( using 18 % HCl ) and bleaching with McInnes solution in the esthetic improvement of fluorosed teeth and to check postoperative sensitivity .


30 children aged between 9-14yrs with a mild or moderate grade of fluorosis as classified according to Dean 's fluorosis index and who complained of objectionable esthetics were selected .


Split mouth study design was selected in our study .


Each subject had one of their maxillary central incisor randomly selected for Enamel microabrasion and the contra lateral maxillary central incisor for McInnes bleaching .


Esthetic improvement was assessed by comparing the pre and postoperative digital photographs .


During the evaluation session , the pre and postoperative photographs of 30 subjects were incorporated into a power point presentation and were projected side by side in a darkened room .


Four calibrated and blinded examiners , including a layman rated the photographs under standardized viewing conditions .


Esthetic improvement was assessed for both short and long term improvement .


The postoperative sensitivity was recorded for both the procedures immediately after treatment and at one , three and six months interval .


The results proved that both immediate and long term ( 6 month ) esthetic improvement achieved by McInnes bleaching were superior to enamel microabrasion .


There is a reduction in aesthetics of teeth in both the procedures after six months , which was very minimal in McInnes procedure and significant in enamel micro abrasion .


Postoperative sensitivity in both techniques were negligible .


The sensitivity observed were transient and subsided within an one-month post operatively .


None of the subjects reported sensitivity at one , three and six months intervals .


McInnes bleaching is a better procedure compared to enamel microabrasion in improving the appearance of fluorosed teeth .


Both techniques are conservative and safe .


The effectiveness of intermittent montelukast for wheeze in young children is unclear .


We aimed to assess whether intermittent montelukast is better than placebo for treatment of wheeze in this age group .


Because copy numbers of the Sp1-binding motif in the arachidonate 5-lipoxygenase ( ALOX5 ) gene promoter ( either 5/5 , 5/x , or x/x , where x does not equal 5 ) modifies response to montelukast in adults , we stratified by this genotype .


We did this multicentre , parallel-group , randomised , placebo-controlled trial between Oct 1 , 2010 , and Dec 20 , 2013 , at 21 primary care sites and 41 secondary care sites in England and Scotland .


Children aged 10 months to 5 years with two or more wheeze episodes were allocated to either a 5/5 or 5/x + x/x ALOX5 promoter genotype stratum , then randomly assigned ( 1:1 ) via a permuted block schedule ( size ten ) , to receive intermittent montelukast or placebo given by parents at each wheeze episode over a 12 month period .


Clinical investigators and parents were masked to treatment group and genotype strata .


The primary outcome was number of unscheduled medical attendances for wheezing episodes .


Analysis was by intention to treat .


This trial is registered with ClinicalTrials.gov , number NCT01142505 .


We randomly assigned 1358 children to receive montelukast ( n = 669 ) or placebo ( n = 677 ) .


Consent was withdrawn for 12 ( 1 % ) children .


Primary outcome data were available for 1308 ( 96 % ) children .


There was no difference in unscheduled medical attendances for wheezing episodes between children in the montelukast and placebo groups ( mean 20 [ SD 26 ] vs 23 [ 27 ] ; incidence rate ratio [ IRR ] 088 , 95 % CI : 077-101 ; p = 006 ) .


Compared with placebo , unscheduled medical attendances for wheezing episodes were reduced in children given montelukast in the 5/5 stratum ( 20 [ 27 ] vs 24 [ 30 ] ; IRR 080 , 95 % CI 068-095 ; p = 001 ) , but not in those in the 5/x + x/x stratum ( 20 [ 25 ] vs 20 [ 23 ] ; 103 , 083-129 ; p = 079 , pinteraction = 008 ) .


We recorded one serious adverse event , which was a skin reaction in a child allocated to placebo .


Our findings show no clear benefit of intermittent montelukast in young children with wheeze .


However , the 5/5 ALOX5 promoter genotype might identify a montelukast-responsive subgroup .


Medical Research Council ( UK ) and National Institute for Health Research .


Chronic Obstructive Pulmonary Disease ( COPD ) is a progressive airway disease characterised by neutrophilic airway inflammation or bronchitis .


Neutrophilic bronchitis is associated with both bacterial colonisation and lung function decline and is common in exacerbations of COPD .


Despite current available therapies to control inflammation , neutrophilic bronchitis remains common .


This study tested the hypothesis that azithromycin treatment , as an add-on to standard medication , would significantly reduce airway neutrophil and neutrophils chemokine ( CXCL8 ) levels , as well as bacterial load .


We conducted a randomised , double-blind , placebo-controlled study in COPD participants with stable neutrophilic bronchitis .


Eligible participants ( n = 30 ) were randomised to azithromycin 250 mg daily or placebo for 12 weeks in addition to their standard respiratory medications .


Sputum was induced at screening , randomisation and monthly for a 12 week treatment period and processed for differential cell counts , CXCL8 and neutrophil elastase assessment .


Quantitative bacteriology was assessed in sputum samples at randomisation and the end of treatment visit .


Severe exacerbations where symptoms increased requiring unscheduled treatment were recorded during the 12 week treatment period and for 14 weeks following treatment .


A sub-group of participants underwent chest computed tomography scans ( n = 15 ) .


Nine participants with neutrophilic bronchitis had a potentially pathogenic bacteria isolated and the median total bacterial load of all participants was 5.22107 cfu/mL .


Azithromycin treatment resulted in a non-significant reduction in sputum neutrophil proportion , CXCL8 levels and bacterial load .


The mean severe exacerbation rate was 0.33 per person per 26 weeks in the azithromycin group compared to 0.93 exacerbations per person in the placebo group ( incidence rate ratio ( 95 % CI ) : 0.37 ( 0.11,1.21 ) , p = 0.062 ) .


For participants who underwent chest CT scans , no alterations were observed .


In stable COPD with neutrophilic bronchitis , add-on azithromycin therapy showed a trend to reduced severe exacerbations sputum neutrophils , CXCL8 levels and bacterial load .


Future studies with a larger sample size are warranted .


Australian New Zealand Clinical Trials Registry ACTRN12609000259246 .


The purpose of this study was to evaluate fixation location and oculomotor characteristics of 15 patients with Leber congenital amaurosis ( LCA ) caused by RPE65 mutations ( RPE65-LCA ) who underwent retinal gene therapy .


Eye movements were quantified under infrared imaging of the retina while the subject fixated on a stationary target .


In a subset of patients , letter recognition under retinal imaging was performed .


Cortical responses to visual stimulation were measured using functional magnetic resonance imaging ( fMRI ) in two patients before and after therapy .


All patients were able to fixate on a 1 diameter visible target in the dark .


The preferred retinal locus of fixation was either at the anatomical fovea or at an extrafoveal locus .


There were a wide range of oculomotor abnormalities .


Natural history showed little change in oculomotor abnormalities if target illuminance was increased to maintain target visibility as the disease progressed .


Eleven of 15 study eyes treated with gene therapy showed no differences from baseline fixation locations or instability over an average of follow-up of 3.5 years .


Four of 15 eyes developed new pseudo-foveas in the treated retinal regions 9 to 12 months after therapy that persisted for up to 6 years ; patients used their pseudo-foveas for letter identification .


fMRI studies demonstrated that preservation of light sensitivity was restricted to the cortical projection zone of the pseudo-foveas .


The slow emergence of pseudo-foveas many months after the initial increases in light sensitivity points to a substantial plasticity of the adult visual system and a complex interaction between it and the progression of underlying retinal disease .


The visual significance of pseudo-foveas suggests careful consideration of treatment zones for future gene therapy trials .


( ClinicalTrials.gov number , NCT00481546 . )


Data on the protein requirements of elderly adults are limited , because it is impractical to conduct repeated nitrogen balance protocols in these vulnerable humans .


This study was designed to determine the dietary protein requirement of elderly women by using the recently developed minimally invasive indicator amino acid oxidation ( IAAO ) technique .


Six white women aged 80-87 y [ mean SEM : 82 1 y and body mass index ( in kg/m ) 26 2 ] completed a 3-d protocol 7 times .


Each woman consumed an adaptation diet for 2 d and on day 3 consumed a complete test diet with a crystalline amino acid mixture containing 1 of 7 protein intakes ( 0.1 , 0.3 , 0.6 , 0.9 , 1.2 , 1.5 , or 1.8 g kg d ) tested randomly .


A group-based protein requirement was assessed by using a nonlinear mixed model of protein intake and L - [ 1-C ] phenylalanine oxidation .


The breakpoint , at which there was no further decline in the rate of appearance of C in the breath , was used as an index of the mean protein requirement .


The mean protein requirement ( 95 % CI ) was 0.85 ( 0.60 , 1.09 ) g kg d.


This requirement is 29 % higher than the current Estimated Average Requirement ( EAR ) for adults of 0.66 g kg d based on the nitrogen balance technique , although the 95 % CI includes the current EAR .


The corresponding adequate protein allowance of 1.15 ( 0.77 , 1.54 ) g kg d is 44 % higher , although the 95 % CI includes the Recommended Dietary Allowance ( RDA ) of 0.80 g kg d.


Notwithstanding uncertainty about the validity of the use of the IAAO technique to assess protein requirements , the results of this study with octogenarian women suggest that the current EAR and RDA for elderly women may be underestimated .


The limitations of this short-term , noninvasive method underscore the need for new research that uses alternative experimental designs and measuring physiologic , morphologic , and health-related outcomes .


Physician-rating websites combine public reporting with social networking and offer an attractive means by which users can provide feedback on their physician and obtain information about other patients ' satisfaction and experiences .


However , research on how users evaluate information on these portals is still scarce and only little knowledge is available about the potential influence of physician reviews on a patient 's choice .


Starting from the perspective of prospective patients , this paper sets out to explore how certain characteristics of physician reviews affect the evaluation of the review and users ' attitudes toward the rated physician .


We propose a model that relates review style and review number to constructs of review acceptance and check it with a Web-based experiment .


We employed a randomized 2x2 between-subject , factorial experiment manipulating the style of a physician review ( factual vs emotional ) and the number of reviews for a certain physician ( low vs high ) to test our hypotheses .


A total of 168 participants were presented with a Web-based questionnaire containing a short description of a dentist search scenario and the manipulated reviews for a fictitious dental physician .


To investigate the proposed hypotheses , we carried out moderated regression analyses and a moderated mediation analysis using the PROCESS macro 2.11 for SPSS version 22 .


Our analyses indicated that a higher number of reviews resulted in a more positive attitude toward the rated physician .


The results of the regression model for attitude toward the physician suggest a positive main effect of the number of reviews ( mean [ low ] 3.73 , standard error [ SE ] 0.13 , mean [ high ] 4.15 , SE 0.13 ) .


We also observed an interaction effect with the style of the reviewif the physician received only a few reviews , fact-oriented reviews ( mean 4.09 , SE 0.19 ) induced a more favorable attitude toward the physician compared to emotional reviews ( mean 3.44 , SE 0.19 ) , but there was no such effect when the physician received many reviews .


Furthermore , we found that review style also affected the perceived expertise of the reviewer .


Fact-oriented reviews ( mean 3.90 , SE 0.13 ) lead to a higher perception of reviewer expertise compared to emotional reviews ( mean 3.19 , SE 0.13 ) .


However , this did not transfer to the attitude toward the physician .


A similar effect of review style and number on the perceived credibility of the review was observed .


While no differences between emotional and factual style were found if the physician received many reviews , a low number of reviews received lead to a significant difference in the perceived credibility , indicating that emotional reviews were rated less positively ( mean 3.52 , SE 0.18 ) compared to fact-oriented reviews ( mean 4.15 , SE 0.17 ) .


Our analyses also showed that perceived credibility of the review fully mediated the observed interaction effect on attitude toward the physician .


Physician-rating websites are an interesting new source of information about the quality of health care from the patient 's perspective .


This paper makes a unique contribution to an understudied area of research by providing some insights into how people evaluate online reviews of individual doctors .


Information attributes , such as review style and review number , have an impact on the evaluation of the review and on the patient 's attitude toward the rated doctor .


Further research is necessary to improve our understanding of the influence of such rating sites on the patient 's choice of a physician .


Subcutaneous ondansetron facilitated by recombinant human hyaluronidase PH20 ( rHuPH20 ) is an alternative for treating nausea/vomiting in patients who can not receive ondansetron by other routes of administration .


Based on preclinical results in minipigs , a Phase I study was designed to assess the tolerability and pharmacokinetic properties of subcutaneous ondansetron + rHuPH20 compared with intramuscular , intravenous , or oral ondansetron monotherapy in healthy volunteers .


In a crossover design , 3 minipigs were dosed with subcutaneous ondansetron 0.08 mg/kg + rHuPH20 , or as intramuscular or intravenous monotherapy , for the evaluation of plasma ondansetron concentrations and local tolerability .


In a randomized , open-label , 4-way crossover study , subjects received a randomized sequence of SC ondansetron 4 mg + rHuPH20 , or ondansetron monotherapy IM ( 4 mg ) , IV ( 4 mg ) , or PO ( 8 mg ) , over 4 daily visits .


Study participants included healthy volunteers aged 19 to 65 years with adequate venous access in both upper extremities and no history of QT-interval prolongation .


Primary tolerability end points ( administration-site observations , systemic adverse events [ AEs ] , and subject-assessed pain ) were assessed , and pharmacokinetic parameters ( AUC , Cmax , Tmax , t ) were computed to compare relative rate and extent of systemic exposure .


Results were described using summary statistics , and bioequivalence was determined with a linear mixed-effects model .


In the preclinical study , no adverse events or significant local reactions were observed .


The Cmax ( 45.8 ng/mL at 0.08 hour ) with subcutaneous administration + rHuPH20 was 83 % greater and was achieved 68 % faster than with intramuscular administration ( Cmax = 25 ng/mL at 0.25 hour ) .


In the clinical study , a total of 12 subjects ( 7 women , 5 men ; white majority ; mean age , 44.8 ) were randomized .


The majority of AEs were at the injection site , mild in severity , and transient .


After subcutaneous administration of ondansetron + rHuPH20 , geometric mean Cmax was 35 % higher than with intramuscular ondansetron , 43 % lower than with intravenous ondansetron , and 126 % higher than with oral ondansetron ( corrected for dose ) .


Bioequivalence tests demonstrated that systemic exposure after subcutaneous administration was similar to that after intramuscular or intravenous administration and significantly greater than that after oral administration .


Subcutaneous ondansetron + rHuPH20 was generally well-tolerated .


Subcutaneous dosing resulted in an extent of systemic exposure similar to that with intramuscular or intravenous dosing and greater than that with oral administration , and may be an option for clinical administration of ondansetron .


ClinicalTrials.gov identifier : NCT01572012 .


Pharmacokinetics , safety , and tolerability of GSK1265744 ( 744 ) and rilpivirine ( RPV ) ( TMC278 ) were assessed after repeat dosing of long-acting ( LA ) injectable formulations in healthy subjects .


Subjects received a 14-day lead-in of oral 744 ( 30 mg/d ) to assess safety and tolerability before injectable administration .


Subjects were randomized into 4 cohorts : 800 mg of 744 LA intramuscularly ( IM ) followed by 3 monthly doses of ( 1 ) 200 mg subcutaneously , ( 2 ) 200 mg IM , ( 3 ) 400 mg IM , or ( 4 ) a second injection of 800 mg IM after 12 weeks .


Cohorts 2 and 3 also received IM doses of RPV LA at months 3 ( 1200 mg ) and 4 ( 900 or 600 mg ) .


Pharmacokinetics and safety were assessed throughout the trial .


Forty-seven subjects enrolled ; 40 received 1 LA injection with 37 completing all planned injections .


Seven subjects discontinued 744 oral ( non-drug-related , n = 6 ; dizziness , n = 1 ) .


The 744 LA and RPV LA injections were generally well tolerated , with grade 1 injection site reactions most commonly reported .


Three subjects discontinued during injection phase ( consent withdrawn , n = 2 ; self-limited rash , n = 1 ) .


There were no grade 3 or 4 adverse events and no clinically significant trends in laboratory abnormalities , electrocardiograms , or vital signs .


All dose cohorts achieved therapeutically relevant plasma concentrations of each drug within 3 days with prolonged exposure over the dosing interval .


Plasma concentrations of 744 exceeded the protein-adjusted IC90 and RPV plasma concentrations and were comparable to steady-state oral RPV 25 mg/d .


These data support the potential application of dual-therapy 744 LA and RPV LA for treatment of HIV-1 infection .


Gluten ingestion leads to small intestinal mucosal injury in patients with celiac disease , necessitating strict life-long exclusion of dietary gluten .


Despite adherence to a gluten-free diet , many patients remain symptomatic and still have small intestinal inflammation .


In this case , nondietary therapies are needed .


We investigated the ability of ALV003 , a mixture of 2 recombinant gluten-specific proteases given orally , to protect patients with celiac disease from gluten-induced mucosal injury in a phase 2 trial .


We established the optimal daily dose of gluten to be used in a 6-week challenge study .


Then , in the intervention study , adults with biopsy-proven celiac disease were randomly assigned to groups given ALV003 ( n = 20 ) or placebo ( n = 21 ) together with the daily gluten challenge .


Duodenal biopsies were collected at baseline and after gluten challenge .


The ratio of villus height to crypt depth and densities of intraepithelial lymphocytes were the primary end points .


A daily dose of 2 g gluten was selected for the intervention study .


Sixteen patients given ALV003 and 18 given placebo were eligible for efficacy evaluation .


Biopsies from subjects in the placebo group showed evidence of mucosal injury after gluten challenge ( mean villus height to crypt depth ratio changed from 2.8 before challenge to 2.0 afterward ; P = .0007 ; density of CD3 ( + ) intraepithelial lymphocytes changed from 61 to 91 cells/mm after challenge ; P = .0003 ) .


However , no significant mucosal deterioration was observed in biopsies from the ALV003 group .


Between groups , morphologic changes and CD3 ( + ) intraepithelial lymphocyte counts differed significantly from baseline to week 6 ( P = .0133 and P = .0123 , respectively ) .


There were no statistically significant differences in symptoms between groups .


Based on a phase 2 trial , the glutenase ALV003 appears to attenuate gluten-induced small intestinal mucosal injury in patients with celiac disease in the context of an everyday gluten-free diet containing daily up to 2 g gluten .


Clinicaltrial.gov ,


NCT00959114 and NCT01255696 .


The purpose of this study is to validate the efficacy of intensive statin therapy for patients with atherosclerotic intracranial arterial stenosis ( AICAS ) .


In this study , we performed a single-center , randomized , single-blind , parallel-group clinical trial .


A total of 120 Chinese patients with AICAS were enrolled and randomly divided into three groups [ low-dose atorvastatin therapy ( LAT , 10mg/day ) , standard-dose atorvastatin therapy ( SAT , 20mg/day ) , and intensive-dose atorvastatin therapy ( IAT , 40mg/day ) groups ] in a 1:1:1 ratio .


Evaluation variables , including changes in serum lipid profiles , degree of stenosis , and perfusion-related parameters derived from computed tomography perfusion ( CTP ) imaging from baseline to weeks 26 and 52 , as well as the occurrence of cerebrovascular events during the study period , were used to compare the benefits of these three statin therapies .


After 52 weeks of treatment , improvement of serum lipid profiles , degree of stenosis , and perfusion-related parameters were all significantly better in the IAT group .


In addition , the cumulative probability of cerebrovascular events at 52 weeks was significantly lower in the IAT group than in the LAT group , although there was no statistical difference between the IAT group and the SAT group .


The proportion of patients experiencing any adverse event was similar among the three treatment groups .


Adverse events caused by IAT were generally mild ; no serious adverse events occurred throughout the entire period of study .


In conclusion , long-term use of IAT appears to be a safe and effective treatment at least for Chinese patients with AICAS .


Carbohydrate counting ( CHC ) is ack - nowledged by the American Diabetes Association ( ADA ) as an important tool .


To assess the efficacy of photographic educational materials to train adolescents with DM to perform CHC .


76 adolescents were randomly divided into two groups of CHC orientation : by means of photographic materials ( Photo ) or by a list of foods ( List ) .


One month afterwards , the participants were contacted via telephone to answer questions on CHC to reinforce the training ( Quiz ) .


Two days after taking the quiz , required the participants to visit an experimental kitchen to observe food portions in natura and to respond to a questionnaire on the weights in grams or carbohydrate equivalents of these portions .


Statistical significance was established at p < 0.05 .


54 adolescents completed the study ( 79.7 % female ) , with 51.8 % allocated to the Photo group and 48.1 % to the List group .


The mean age was 13.8 2.0 years old , and the mean body mass index ( BMI ) was 21.0 3.2 kg/m2 .


The participants had average of 7.9 1.5 years of schooling , while their parents had 8.0 3.8 years .


The knowledge of CHC was similar in both groups before the intervention .


After the intervention , the Photo group achieved a significantly higher hit difference on the CHC assessment test than the List group ( Photo : 2.5 vs List : 1.0 ; p = 0.03 ) .


The photographic educational material was more effective in helping adolescents with DM understand and learn to perform carbohydrate counting .


To investigate the gastric emptying of an oral supplement containing carbohydrate plus whey protein drunk before sedation for gastroscopy .


This is a randomized double-blind trial including adult patients ( ages 18-65 ) with a chief complaint of epigastric burning and who were candidates to elective gastroscopy .


After overnight fast subjects were randomized to drink 200 mL of an oral nutritional supplement containing maltodextrine in addition to whey protein 150 to 210 min before the gastroscopy ( intervention group , n = 12 ) or to undergo the endoscopic procedure with no supplement ( control group , n = 12 ) .


The residual gastric volume ( RGV ) suctioned and measured during the exam was the main endpoint of the study .


There were no complications during all exams .


The median ( range ) fasting time was greater ( P < 0.001 ) in control group ( 770 min , ranging from 660-917 min ) than in the study group ( 175 min ranging from 150 to 210 min ) .


The median ( range ) RGV was similar in between the two groups ( control group : 25 ( 10-70 ) mL versus intervention group : 10 ( 0-100 ) mL ; p = 0.32 ) .


Gastric emptying 150-210 min after the ingestion of an oral supplement containing carbohydrate plus whey protein is similar to an overnight fasting condition .


Although limited by the number of cases , the sedation for endoscopic procedures is safe with this fasting protocol .


To evaluate effects of an exercise program on health-related quality of life ( HRQoL ) in children and adolescents with tetralogy of Fallot ( ToF ) or a Fontan circulation .


Stratified , randomized , controlled intervention study conducted in five participating centers of pediatric cardiology in The Netherlands .


In total , 93 patients , aged 10-25 years , with surgical repair for tetralogy of Fallot or with a Fontan circulation for single-ventricle physiology were included .


They were randomly allocated with a ratio of 2:1 to : ( 1 ) a 12-week period with an exercise program for 3 times per week or ( 2 ) to a control group .


Randomization was stratified by age , gender , and cardiac diagnosis .


At baseline and follow-up after 12 weeks , all participants completed Web-based age-appropriate HRQoL questionnaires .


Primary analyses involved change in HRQoL during follow-up .


Secondary analyses concerned influence of cardiac diagnosis and comparison with normative data .


Forty-eight ( 86 % ) and 32 ( 86 % ) patients in the exercise-group and control-group respectively completed all questionnaires at baseline and follow-up .


Compared with the control-group , children , aged 10-15 years , in the exercise-group improved significantly on self-reported cognitive functioning , p < .05 , r = .30 , and parent-reported social functioning , p < .05 , r = .30 .


Youngsters aged 16-25 years did not change their HRQoL .


Cardiac diagnosis had no influence on pre/post changes .


Children and youngsters in this study reported comparable or better HRQoL than norm groups .


Participation in an exercise program improved HRQoL of children with ToF or a Fontan circulation , especially in those with low baseline QoL .


Heart failure ( HF ) is associated with changes in myocardial metabolism that lead to impairment of contractile function .


Trimetazidine ( TMZ ) modulates cardiac energetic efficiency and improves outcomes in ischemic heart disease .


We evaluated the effects of TMZ on left ventricular ejection fraction ( LVEF ) , cardiac metabolism , exercise capacity , O2 uptake , and quality of life in patients with nonischemic HF .


Sixty patients with stable nonischemic HF under optimal medical therapy were included in this randomized double-blind study .


Patients were randomized to TMZ ( 35 mg orally twice a day ) or placebo for 6 months .


LVEF , 6-minute walk test ( 6MWT ) , maximum O2 uptake in cardiopulmonary exercise test , different markers of metabolism , oxidative stress , and endothelial function , and quality of life were assessed at baseline and after TMZ treatment .


Left ventricular peak glucose uptake was evaluated with the use of the maximum standardized uptake value ( SUV ) by 18-fluorodeoxyglucose positron emission tomography ( ( 18 ) FDG-PET ) .


Etiology was idiopathic in 85 % and hypertensive in 15 % .


Both groups were similar in age , functional class , LVEF , and levels of N-terminal pro-B-type natriuretic peptide at baseline .


After 6 months of TMZ treatment , no changes were observed in LVEF ( 31 10 % vs 34 8 % ; P = .8 ) , 6MWT ( 443 25 m vs 506 79 m ; P = .03 ) , maximum O2 uptake ( 19.1 5.0 mL kg ( -1 ) min ( -1 ) vs 23.0 7.2 mL kg ( -1 ) min ( -1 ) ; P = .11 ) , functional class ( percentages of patients in functional classes I/II/III / IV 10/3753/0 vs 7/40/50 / 3 ; P = .14 ) , or quality of life ( 32 26 points vs 24 18 points ; P = .25 ) in TMZ versus placebo , respectively .


In the subgroup of patients evaluated with ( 18 ) FDG-PET , no significant differences were observed in SUV between both groups ( 7.0 3.6 vs 8.2 3.4 respectively ; P = .47 ) .


In patients with nonischemic HF , the addition of TMZ to optimal medical treatment does not result in significant changes of LVEF , exercise capacity , O2 uptake , or quality of life .


The aim of this study was to investigate the efficacy of catheter ablation in the treatment of persistent atrial fibrillation ( AF ) and the predictors of arrhythmia recurrence .


Absence of atrial tachyarrhythmia ( AT ) recurrence during a mid-term follow-up was correlated with several clinical and procedural characteristics in a population of 82 patients aged 20-70 years who had experienced at least one documented relapse of persistent AF during a single trial of antiarrhythmic drug therapy .


Electrophysiological success of ablation was declared when all identified PVs were isolated ( confirmation of entry and exit block ) .


Patients were followed for a maximum of 24 months after the blanking period with outpatient visits , ECG recordings , 24-hour Holter monitoring , and weekly transtelephonic monitoring for 30s .


Electrophysiological success was documented in 38/82 ( 46.3 % ) patients .


During a mean follow-up of 24.7 4.2 months , 69/82 ( 84.1 % ) patients presented at least one episode of AT after the 2 month blanking period .


According to univariate and multivariate logistic regression analyses , only an electrophysiologically successful ablation significantly correlated with the absence of documented AT relapse ( OR 5.32 , 95 % CL 1.02-27 .72 ; p = .0472 ) .


Mid-term outcome of a single procedure of catheter ablation without the adjunction of antiarrhythmic drug therapy is poor in patients with persistent AF .


Documented PV isolation is useful to increase the success rate of circumferential PV ablation even in persistent AF patients .


Delayed primary closure in cases of acute appendicitis is debated among the surgeons as to whether it decreases the rate of wound infection in comparison to primary closure .


The aim of this study was to find out the optimal method of wound closure in cases of perforated appendicitis .


This randomized control trial was conducted at the surgical units of Ayub Teaching Hospital Abbottabad from May to November 2012 .


A total of 158 patients having perforated appendicitis were included in the study .


They were randomly divided two groups .


The wounds were primarily closed in one group and left open with daily saline soaked dressing , to be closed on postoperative day 4 in case of the other group .


The main outcome measure was wound infection .


A wound was considered infected if it was discharging pus , was red and swollen on postoperative day 8th .


The method of wound closure was considered efficacious if there was no wound infection till 8th postoperative day .


A total of 158 patients , 56 ( 35.4 % ) male and 102 ( 64.6 % ) female were included in the study .


Primary closure group had a total number of 79 patients with 26 ( 32.9 % ) male and 53 ( 67.1 % ) female .


Delayed primary group had also a total number of 79 patients with 30 ( 38 % ) male and 49 ( 62 % ) female .


The mean age of patients in the primary closure group was 26.67 7.32 years while in the delayed primary group was 28.15 6.88 years .


In the entire series , 36 ( 22.8 % ) patients developed wound infection .


There was a significant association between wound infection and type of skin closure ( Delayed Primary Closure 6.3 % vs. Primary Closure 39.2 % , p < 0.000 ) .


Delayed Primary closure is the optimal management strategy in case of perforated appendicitis as it decreases the incidence of wound infection .


this study aimed to evaluate the efficacy of hand hygiene performed with two different soap formulations : 0.3 % Melaleuca alternifolia essential oil versus 0.5 % triclosan , and to compare them with two reference hygiene procedures : the official methodology procedure ( soft soap ) versus the draft version of the procedure ( soft soap + propan-2-ol ) .


using the European EN 1499 method , logarithmic reduction factors were determined for the number of colony forming units of Escherichia coli K12 before and after hand hygiene of 15 volunteer subjects , and compared using the one-tailed Wilcoxon test .


referring to the soft soap , there was no difference between the performance of soap with 0.3 % M. alternifolia and soap containing 0.5 % triclosan .


The soft soap + propan-2-ol proved to be more effective than the other hand hygiene procedures .


studies to verify the therapeutic efficacy of essential oil in hand hygiene can improve adherence to this practice .


To identify the effects of ingested anti-rotavirus immunoglobulin on enteric expressions of SIgA in pediatric rotavirus enteritis .


In this randomized , placebo controlled clinic trial , 100 patients of pediatric rotavirus enteritis who simultaneously received fluid replacement as basic therapy , were randomly divided into control and immunoglobulin treated groups .


The patients in experimental group were given `` ingested antirotavirus IgY '' .


Stool sample was collected at day 1 , 3 , 5 , 7 , 9 and 11 , the level of fecal SIgA was quantifies by radioimmunoassay kit , and fecal rotavirus shedding was detected by double-sandwich ELISA .


The frequency of diarrhea in immunoglobulin group was obviously less than that in control group ( P < 0.05 ) .


The mean course of diarrhea was ( 4.5 + / - 0.92 ) d in immunoglobulin group , and ( 5.8 + / - 1.68 ) d in control group ( P = 0.015 ) .


The fecal SIgA level in immunoglobulin group was higher than that in control group ( P < 0.05 ) .


The doubling time of SIgA level was the 3rd d in immunoglobulin group , and the 5th d in control group .


The fecal rotavirus shedding in immunoglobulin group was obviously lower than that in control group ( P < 0.05 ) .


Ingested anti-rotavirus immunoglobulin could promote the expression of enteric SIgA to remove rotavirus , achieving the benefit to release diarrhea in pediatric rotavirus enteritis .


This study sought to evaluate the efficacy and safety of long-term growth hormone ( GH ) replacement therapy in GH-deficient patients with chronic heart failure ( CHF ) .


Recent evidence indicates that growth hormone deficiency ( GHD ) affects as many as 40 % of patients with CHF , and short-term GH replacement causes functional benefit .


Whether long-term GH replacement also affects CHF progression is unknown .


The study is an extension of a previous randomized , controlled single-blind trial that screened 158 consecutive CHF patients ( New York Heart Association classes II to IV ) and identified 63 who had GHD by the growth hormone releasing hormone plus arginine test .


Fifty-six patients were randomized to receive either GH therapy or standard CHF therapy .


Patients were evaluated at baseline and after a 4-year follow-up .


The primary endpoint was peak oxygen consumption ( VO2 ) .


Secondary endpoints included left ventricular ( LV ) ejection fraction and volumes , serum amino terminal fragment of the pro-hormone brain-type natriuretic peptide , quality of life , and safety .


Seventeen patients in the GH group and 14 in the control group completed the study .


In the GH group , peak VO2 improved over the 4-year follow-up .


The treatment effect was 7.1 0.7 ml/kg/min versus -1.8 0.5 ml/kg/min in the GH and control groups , respectively .


At 4 years , LV ejection fraction increased by 10 3 % in the GH group , whereas it decreased by 2 5 % in control patients .


The treatment effect on LV end-systolic volume index was -22 6 ml and 8 3 ml/m ( 2 ) in the GH and control groups , respectively ( all p < 0.001 ) .


No major adverse events were reported in the patients who received GH .


Although this is a preliminary study , the finding suggests a new therapeutic approach to a large proportion of GHD patients with CHF .


It is well recognized that amounts of trans and saturated fats should be minimized in Western diets ; however , considerable debate remains regarding optimal amounts of dietary n-9 , n-6 , and n-3 fatty acids .


The objective was to examine the effects of varying n-9 , n-6 , and longer-chain n-3 fatty acid composition on markers of coronary heart disease ( CHD ) risk .


A randomized , double-blind , 5-period , crossover design was used .


Each 4-wk treatment period was separated by 4-wk washout intervals .


Volunteers with abdominal obesity consumed each of 5 identical weight-maintaining , fixed-composition diets with one of the following treatment oils ( 60 g/3000 kcal ) in beverages : 1 ) conventional canola oil ( Canola ; n-9 rich ) , 2 ) high-oleic acid canola oil with docosahexaenoic acid ( CanolaDHA ; n-9 and n-3 rich ) , 3 ) a blend of corn and safflower oil ( 25:75 ) ( CornSaff ; n-6 rich ) , 4 ) a blend of flax and safflower oils ( 60:40 ) ( FlaxSaff ; n-6 and short-chain n-3 rich ) , or 5 ) high-oleic acid canola oil ( CanolaOleic ; highest in n-9 ) .


One hundred thirty individuals completed the trial .


At endpoint , total cholesterol ( TC ) was lowest after the FlaxSaff phase ( P < 0.05 compared with Canola and CanolaDHA ) and highest after the CanolaDHA phase ( P < 0.05 compared with CornSaff , FlaxSaff , and CanolaOleic ) .


Low-density lipoprotein ( LDL ) cholesterol and high-density lipoprotein ( HDL ) cholesterol were highest , and triglycerides were lowest , after CanolaDHA ( P < 0.05 compared with the other diets ) .


All diets decreased TC and LDL cholesterol from baseline to treatment endpoint ( P < 0.05 ) .


CanolaDHA was the only diet that increased HDL cholesterol from baseline ( 3.5 1.8 % ; P < 0.05 ) and produced the greatest reduction in triglycerides ( -20.7 3.8 % ; P < 0.001 ) and in systolic blood pressure ( -3.3 0.8 % ; P < 0.001 ) compared with the other diets ( P < 0.05 ) .


Percentage reductions in Framingham 10-y CHD risk scores ( FRS ) from baseline were greatest after CanolaDHA ( -19.0 3.1 % ; P < 0.001 ) than after other treatments ( P < 0.05 ) .


Consumption of CanolaDHA , a novel DHA-rich canola oil , improves HDL cholesterol , triglycerides , and blood pressure , thereby reducing FRS compared with other oils varying in unsaturated fatty acid composition .


This trial was registered at www.clinicaltrials.gov as NCT01351012 .


To assess short - and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management , and to collect data to inform a larger , more definitive clinical trial .


This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 +0 and 19 +6 weeks ' gestation and 20 +0 and 23 +6 weeks ' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups .


Intention-to-treat analysis was used .


The study was conducted in four UK hospital-based fetal medicine units ( Liverpool Women 's NHS Trust , St Mary 's Hospital Manchester , Birmingham Women 's NHS Foundation Trust and Wirral University Hospitals Trust ) .


The participants were women with confirmed preterm prelabor rupture of membranes at 16 +0 to 24 +0 weeks ' gestation .


Women with multiple pregnancy , fetal abnormality or obstetric indication for immediate delivery were excluded .


Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was < 2cm or expectant management until 37 weeks ' gestation .


Short-term maternal , pregnancy and neonatal and long-term outcomes for the child were studied .


Long-term respiratory morbidity was assessed using validated respiratory questionnaires at 6 , 12 and 18 months of age and infant lung function test at around 12 months of age .


Neurodevelopment was assessed using the Bayley Scales of Infant Development , second edition ( BSID-II ) at corrected age of 2 years .


Fifty-eight women were randomized to the study .


Two babies were excluded from the analysis because of termination of pregnancy for lethal anomaly , leaving 56 participants ( 28 assigned to serial amnioinfusion and 28 to expectant management ) recruited between 2002 and 2009 .


There was no significant difference in perinatal mortality ( 19/28 vs 19/28 ; relative risk ( RR ) 1.0 ( 95 % CI , 0.70-1 .43 ) ) and maternal or neonatal morbidity .


The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 ( 7.1 % ) ; 4/28 ( 14.3 % ) in the amnioinfusion group and 0/28 in the expectant group ( RR 9.0 ( 95 % CI , 0.51-159 .70 ) ) .


This pilot study found no major differences in maternal , perinatal or pregnancy outcomes .


The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes .


It does , however , signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy survival is needed .


The pilot suggests that , with appropriate funding , such a study is feasible .


We investigated the risk of abdominal operation in patients with fatty liver and the risk of any cancer in first-degree relatives of patients with fatty liver .


We evaluated 105 patients with nonalcoholic fatty liver disease ( NAFLD ) , 121 patients with biopsy-proven hepatitis C ( 61 patients with fatty liver and 60 patients without fatty liver ) , 50 patients with inflammatory bowel disease ( IBD ) , and 109 patients with dyspepsia .


There was no difference in sex , mean age , and marital status among the groups except that patients with IBD were younger than the others ( p < 0.001 ) .


The frequency of cancer among family members was 18 % in IBD , 9 % in dyspepsia , 28 % in hepatitis C with steatosis , 21.5 % in hepatitis C without steatosis , and 27 % in NAFLD ( p = 0.006 ) .


Then , we divided the study group into two groups as follows : group 1 : ( IBD + dyspepsia + hepatitis C without steatosis ) and group 2 : ( hepatitis C with steatosis + NAFLD ) .


We found that the frequency of cancer was 16 % in group 1 versus 24.4 % in group 2 ( p = 0.037 ) .


We also investigated the risk of abdominal operation in patients with fatty liver .


The results were as follows : 33 % in group without fatty liver versus 43 % in group with fatty liver ( p = 0.043 ) .


Understanding the underlying causes of fatty liver forms might decrease the cancer frequency in the population and number of operations in patients with fatty liver .


Chronic kidney disease ( CKD ) is common and increasing in prevalence .


Cardiovascular disease ( CVD ) is a major cause of morbidity and death in CKD , though of a different phenotype to the general CVD population .


Few therapies have proved effective in modifying the increased CVD risk or rate of renal decline in CKD .


There are accumulating data that aldosterone receptor antagonists ( ARA ) may offer cardio-protection and delay renal impairment in patients with the CV phenotype in CKD .


The use of ARA in CKD has therefore been increasingly advocated .


However , no large study of ARA with renal or CVD outcomes is underway .


The study is a prospective randomised open blinded endpoint ( PROBE ) trial set in primary care where patients will mainly be identified by their GPs or from existing CKD lists .


They will be invited if they have been formally diagnosed with CKD stage 3b or there is evidence of stage 3b CKD from blood results ( eGFR 30-44mL / min/1 .73 m2 ) and fulfil the other inclusion/exclusion criteria .


Patients will be randomised to either spironolactone 25mg once daily in addition to routine care or routine care alone and followed-up for 36months .


BARACK D is a PROBE trial to determine the effect of ARA on mortality and cardiovascular outcomes ( onset or progression of CVD ) in patients with stage 3b CKD .


EudraCT : 2012-002672-13ISRTN : ISRCTN44522369 .


To assess changes in circulating incretin levels and body fat compositions with initial combination therapy with - glucosidase inhibitor and dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes ( T2D ) .


In this multicenter open-label 24-week trial , Japanese over-weight ( BMI 25 kg/m ( 2 ) ) patients with T2D not taking medication or taking metformin and/or sulfonylurea were randomly assigned to receive either 50mg of miglitol three times a day ( M , n = 14 ) , 50mg of sitagliptin once a day ( S , n = 14 ) , or a combination of both ( M+S , n = 13 ) .


Changes in plasma incretin levels during a meal tolerance test ( MTT ) and body fat composition with impedance method were evaluated .


During MTT , postprandial plasma glucose levels decreased more after M+S than after M or S , and postprandial serum insulin levels decreased significantly after M and M+S whereas they increased after S.


After M , active gastric inhibitory polypeptide ( aGIP ) decreased significantly at 30 min despite a significant increase at 120 min .


After S , aGIP levels increased significantly throughout the MTT .


After M+S , aGIP increased significantly at 0 and 120 min despite of significant decrease at 30 min .


M+S further enhanced postprandial active glucagon-like peptide-1 levels during MTT than S did .


Total body fat mass decreased significantly after M and M+S .


Visceral fat mass decreased significantly only after M+S .


Serum adiponectin increased significantly only after M+S .


In over-weight patients with T2D , M+S may have a beneficial effect on adiposity with relation to these different effects on two incretins .


To observe the effect differences on post-stroke dysphagia among acupoint injection combined with neural electrical stimulation , acupoint injection , neural electrical stimulation , and swallowing training respectively , so eligible intervention can be applied to this kind of disease .


One hundred and eight-three patients of post-stroke dysphagia were randomized into a comprehensive treatment group ( 42 cases ) , an acupoint injection group ( 44 cases ) , a neural electrical stimulation group ( 49 cases ) and a swallow training group ( 48 cases ) and were treated with the comprehensive therapy of acupoint injection and neural electrical stimulation , acupoint injection , neural electrical stimulation and swallowing training separately .


The treatments for 10 days made one session .


There were 3 days at the interval among treatment sessions and 3 sessions were required totally .


The cases in those treatment groups were blankly controlled with the other 47 patients of post-stroke dysphagia .


All the patients received basic rehabilitation treatment .