The ratio of plasma tyrosine plus phenylalanine ( tyrosine precursor ) to amino acids competing for brain uptake ( free-tryptophan , leucine , isoleucine , valine , methionine , threonine , and lysine ) increased 2.5-fold from rest in TYR and remained elevated throughout exercise ( P < 0.001 ) , whereas it declined in PLA from rest to preexercise ( P = 0.004 ) .


Time-trial power output ( P = 0.869 ) and performance ( 34.8 6.5 and 35.2 8.3 min in TYR and PLA , respectively ; P = 0.4167 ) were similar between trials .


Thermal sensation ( P > 0.05 ) , RPE ( P > 0.05 ) , core temperature ( P = 0.860 ) , skin temperature ( P = 0.822 ) , and heart rate ( P = 0.314 ) did not differ between trials .


These data indicate that acute tyrosine administration did not influence self-paced endurance exercise performance in the heat .


Plasma tyrosine availability is apparently not a key determinant of fatigue processes under these conditions .


The aim of this study was to investigate the effects of gonadotropin releasing hormone analog ( GnRHa ) therapy on normalized testicular atrophy index ( TAIn ) using gonadorelin before and after orchiopexy .


62 infants with 87 undescended testes ( UDT ) were prospectively assigned to two homogeneous groups according to age , position of UDT and TAIn .


The patients were randomized to receive either orchiopexy alone or orchiopexy combined with GnRHa as nasal spray at 1.2 mg daily for 4 weeks before surgery and 4 weeks after surgery .


Surgical approaches were relative to the position of the UDT : Shoemakers technique in proximal-UDT and Bianchi technique in distal-UDT .


All the patients were evaluated clinically and sonographically 1 month before surgery , at the time of surgery , 1 month , 6 months and 5 years after surgery .


Ultrasound data in our study have shown a statistically significant decrease of TAIn in children given additional HT only after 5 years of follow-up , in unilateral cases and in the entirety of treated patients ; in bilateral cases this difference was not statistically significant .


Patients with a TAIn > 20 % treated with preoperative and post-operative GnRHa therapy have a significant increase in testicular volume after 5 years of follow-up , as shown by the relative reduction of TAIn values .


To improve the translation of public health evidence into practice , there is a need to increase practitioner involvement in initiative development , to place greater emphasis on contextual knowledge , and to address intervention processes and outcomes .


Evidence that demonstrates the need to reduce childhood fire-related injuries is compelling but its translation into practice is inconsistent and limited .


With this knowledge the Keeping Children Safe programme developed an `` Injury Prevention Briefing ( IPB ) '' using a 7 step process to combine scientific evidence with practitioner contextual knowledge .


The IPB was designed specifically for children 's centres ( CCs ) to support delivery of key fire safety messages to parents .


This paper reports the findings of a nested qualitative study within a clustered randomised controlled trial of the IPB , in which staff described their experiences of IPB implementation to aid understanding of why or how the intervention worked .


Interviews were conducted with key staff at 24 CCs participating in the two intervention arms : 1 ) IPB supplemented by initial training and regular facilitation ; 2 ) IPB sent by post with no facilitation .


Framework Analysis was applied to these interview data to explore intervention adherence including ; exposure or dose ; quality of delivery ; participant responsiveness ; programme differentiation ; and staff experience of IPB implementation .


This included barriers , facilitators and suggested improvements .


83 % of CCs regarded the IPB as a simple , accessible tool which raised awareness , and stimulated discussion and behaviour change .


15 CCs suggested minor modifications to format and content .


Four levels of implementation were identified according to content , frequency , duration and coverage .


Most CCs ( 75 % ) achieved ` extended ' or ` essential ' IPB implementation .


Three universal factors affected all CCs : organisational change and resourcing ; working with hard to engage groups ; additional demands of participating in a research study .


Six specific factors were associated with the implementation level achieved : staff engagement and training ; staff continuity ; adaptability and flexibility ; other agency support ; conflicting priorities ; facilitation .


CCs achieving high implementation levels increased from 58 % ( no facilitation ) to 92 % with facilitation .


Incorporating service provider perspectives and scientific evidence into health education initiatives enhances potential for successful implementation , particularly when supplemented by ongoing training and facilitation .


To determine whether the insulin resistance that exists in metabolic syndrome ( MetS ) patients is modulated by dietary fat composition .


Seventy-five patients were randomly assigned to one of four diets for 12 wk : high-saturated fatty acids ( HSFAs ) , high-MUFA ( HMUFA ) , and two low-fat , high-complex carbohydrate ( LFHCC ) diets supplemented with long-chain n-3 ( LFHCC n-3 ) PUFA or placebo .


At the end of intervention , the LFHCC n-3 diet reduced plasma insulin , homeostasis model assessment of insulin resistance , and nonsterified fatty acid concentration ( p < 0.05 ) as compared to baseline Spanish habitual ( BSH ) diet .


Subcutaneous white adipose tissue ( WAT ) analysis revealed decreased EH-domain containing-2 mRNA levels and increased cbl-associated protein gene expression with the LFHCC n-3 compared to HSFA and HMUFA diets , respectively ( p < 0.05 ) .


Moreover , the LFHCC n-3 decreased gene expression of glyceraldehyde-3-phosphate dehydrogenase with respect to HMUFA and BSH diets ( p < 0.05 ) .


Finally , proteomic characterization of subcutaneous WAT identified three proteins of glucose metabolism downregulated by the LFHCC n-3 diet , including annexin A2 .


RT-PCR analysis confirmed the decrease of annexin A2 ( p = 0.027 ) after this diet .


Our data suggest that the LFHCC n-3 diet reduces systemic insulin resistance and improves insulin signaling in subcutaneous WAT of MetS patients compared to HSFA and BSH diets consumption .


The outcomes of acute cardiovascular symptom presentations are potentially modifiable with the use of biomarkers to accelerate accurate diagnosis .


This randomized trial tested troponin and B-type natriuretic peptide before hospital guidance in patients with acute cardiovascular symptoms .


Patients with either chest pain or shortness of breath were randomized to usual care or biomarkers analyzed using a point-of-care device in the ambulance .


The primary end point was time to final disposition ( discharge from the emergency department or admission to hospital ) .


The trial was stopped prematurely because of less than expected enrollment of patients of interest and no difference in the primary end point .


We randomized 491 patients ; 480 formed the final cohort .


Patients were 49 % male ; median age 70 years ; 42 % had previous acute coronary syndrome ; and 28 % diabetes .


The B-type natriuretic peptide level before hospital arrival was 100 pg/mL in 36.4 % .


Troponin was > 0.03 ng/mL in 13.4 % ; 3.6 % had troponin > 0.1 ng/mL .


After adjudication , 16 % had acute coronary syndrome , 6.5 % acute heart failure , 3.3 % angina , and 74.2 % another diagnosis .


The primary end point was 9.2 ( interquartile range , 7.3-11 .1 ) hours in the biomarker group and 8.8 ( interquartile range , 6.3-12 .1 ) hours in the usual care group ( P = 0.6 ) .


None died in the ambulance or in the emergency department : all-cause 30-day mortality was 2.1 % ( usual care ) and 1.7 % ( biomarker ) .


To our knowledge , this is the first randomized trial of biomarkers before hospital arrival to guide emergency management of suspected acute cardiovascular disease which showed no benefit and was terminated early because of futility .


The results have important implications for the use of biomarkers in emergency management of heart disease and for the design of future randomized trials on this important topic .


Medication-overuse headache ( MOH ) is a common problem in primary care .


Brief intervention ( BI ) has successfully been used for detoxification from overuse of alcohol and drugs .


The aim of this pilot study was to develop and test methodology , acceptability and logistics for a BI for MOH in primary care .


Observational feasibility study of an intervention in a Norwegian general practice population.Six general practitioners ( GPs ) were recruited .


A screening questionnaire for MOH was sent to all 18-50 year old patients on these GPs ` list .


GPs were taught BI , which was applied to MOH patients as follows : Severity of dependence scale ( SDS ) scores were collected and individual feedback was given of the relationship between the SDS , medication overuse and headache .


Finally , advice to reduce medication was given .


Patients were invited to a headache interview three months after the BI .


Main outcomes were feedback from GPs/patients about the feasibility and logistics of the study design , screening/recruitment process , BI and headache interviews .


Efficacy and patient-related outcomes were not focused .


The patients reported a high degree of acceptability of the methodology .


The GPs reported the BI to be feasible to implement within a busy practice and to represent a new and improved instrument for communication with MOH patients .


The BI requires further testing in a randomised controlled trial ( RCT ) in order to provide evidence of efficacy .


This feasibility study will be used to improve the BI for MOH and the design of a cluster-RCT .


ClinicalTrials.gov : NCT01078012 ( Initially registered as controlled efficacy trial but changed to observational study ) .


To observe the effects of intra-operative combined dosing of dezoxine and dexmedetomidine on sedation , analgesia and the incidence of untoward events during and after surgery in teenagers undergoing horizontal concomitant strabismus surgery .


For this prospective and randomized trial , approval was obtained from the Ethical Committee and informed consent from their parents .


A total of 60 patients aged 10-16 years undergoing strabismus surgery at Second Affiliated Hospital from September to December 2013 were collected .


The treatment group received an intravenous dose of dezoxine 0.1 mgkg ( -1 ) at 15 minutes before surgery .


And another intravenous injection of dexmedetomidine was administered at 0.4 gkg ( -1 ) h ( -1 ) until the end of the first ocular muscle correcting .


The control group received the same volume of normal saline .


Observational parameters including visual analogue scale ( VAS ) , Ramsay scores , self-rating anxiety scale ( SAS ) , heart rate ( HR ) , blood pressure and the incidence of untoward events such as nausea and vomiting or arrhythmia were recorded .


The VAS pain scores in the treatment group at T2-T5 decreased significantly versus the control group ( P < 0.05 ) .


The Ramsay scores in the treatment group at T2-T3 increased and significantly differences existed with the control group ( P < 0.05 ) .


SAS scores showed significant differences between pre-operative and post-operative periods in the treatment group ( P < 0.05 ) .


The treatment group has shorter operative duration with 5 cases of dragging pain in the treatment group versus 25 in the control group ( P < 0.05 ) .


During dragging reflex , HR was lower in the control group at T2 and T3 .


There were significant differences with the control group ( P < 0.05 ) .


A combination of dezoxine and dexmedetomidine provide multiple benefits for patients undergoing strabismus surgery .


Compared with simple local anesthesia , it effectively attenuates pain and anxiety and provides mild sedation and better cooperation during strabismus surgery .


Eicosapentaenoic acid ( EPA ) , which may reduce the risk for coronary heart disease ( CHD ) , can be synthesized at low rates from - linolenic acid ( ALA ) .


The rate-limiting step for this conversion is the 6-desaturation of ALA into stearidonic acid ( SDA ) .


Thus providing oils rich in SDA may increase endogenous synthesis of EPA , which may subsequently lower serum triacylglycerol concentrations , an effect frequently observed after EPA supplementation .


We therefore studied the effects of Echium oil on serum triacylglycerol concentrations and the omega-3 index , which correlate negatively with the risk for CHD .


A randomized , double-blind , placebo-controlled crossover trial was conducted , in which 36 healthy overweight and slightly obese subjects daily received 10 g of Echium oil ( providing 1.2 g of SDA ) or a high oleic acid sunflower oil ( HOSO ) as control for 6 weeks , with a washout period of at least 14 days .


Four subjects dropped out .


Differences between periods were tested for statistical significance ( P < 0.05 ) using a paired t-test .


Serum triacylglycerol and other lipid concentrations were not significantly affected by consumption of Echium oil compared with HOSO .


Echium oil significantly increased percentage of EPA in red blood cell ( RBC ) membranes with 0.14 0.25 % ( mean s.d. ) compared with HOSO ( P = 0.02 ) .


No significant effects on docosahexaenoic acid in RBC membranes or on the omega-3 index were found .


In healthy overweight and slightly obese subjects , an increased intake of SDA from Echium oil does not lower serum triacylglycerol concentrations .


Despite an increase in the percentage of EPA in RBC membranes , the omega-3 index was not changed .


Huai Qi Huang ( HQH ) is a compound Chinese herbal medicine that contains Trametes robiniophila murr , wolfberry fruit , and Polygonatum .


In the present study , we investigated the effects of HQH on patients with mild immunoglobulin A nephropathy ( IgAN ) through a prospective randomized controlled study .


Forty-five adults diagnosed with IgAN according to renal pathology , who had hematuria or/and proteinuria ( 2 g/day ) , were randomly assigned to receive HQH or no treatment for 12 weeks .


Twenty-four hour urinary protein excretion and hematuria were measured at Weeks 0 , 4 , 8 , and 12 .


The rate of complete remission of proteinuria and hematuria was evaluated .


Any adverse events induced by HQH were also observed during the treatment period .


Twenty-four hour urinary protein excretion was significantly reduced by HQH treatment compared with that in the control group at Weeks 8 and 12 .


A much higher rate of complete remission of proteinuria was observed in the HQH group than in control group at Week 12 .


HQH administration also obviously reduced the extent of hematuria compared with that in the control group at Week 12 .


HQH treatment dramatically increased the rate of complete remission of hematuria compared with that in control group at Weeks 8 and 12 .


No obvious adverse events caused by HQH were observed .


HQH could be a new conservative therapy for IgAN patients who can not tolerate steroids and immunosuppressive agents .


The relapse rate after discontinuing treatment still needs further investigation .


Extracranial carotid and vertebral artery dissection is an important cause of stroke , especially in young people .


In some observational studies it has been associated with a high risk of recurrent stroke .


Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown .


We compared their efficacy in the Cervical Artery Dissection in Stroke Study ( CADISS ) , with the additional aim of establishing the true risk of recurrent stroke .


We did this randomised trial at hospitals with specialised stroke or neurology services ( 39 in the UK and seven in Australia ) .


We included patients with extracranial carotid and vertebral dissection with onset of symptoms within the past 7 days .


Patients were randomly assigned ( 1:1 ) by an automated telephone randomisation service to receive antiplatelet drugs or anticoagulant drugs ( specific treatment decided by the local clinician ) for 3 months .


Patients and clinicians were not masked to allocation , but investigators assessing endpoints were .


The primary endpoint was ipsilateral stroke or death in the intention-to-treat population .


The trial was registered with EUDract ( 2006-002827-18 ) and ISRN ( CTN44555237 ) .


We enrolled 250 participants ( 118 carotid , 132 vertebral ) .


Mean time to randomisation was 365 days ( SD 191 ) .


The major presenting symptoms were stroke or transient ischaemic attack ( n = 224 ) and local symptoms ( headache , neck pain , or Horner 's syndrome ; n = 26 ) .


126 participants were assigned to antiplatelet treatment versus 124 to anticoagulant treatment .


Overall , four ( 2 % ) of 250 patients had stroke recurrence ( all ipsilateral ) .


Stroke or death occurred in three ( 2 % ) of 126 patients versus one ( 1 % ) of 124 ( odds ratio [ OR ] 0335 , 95 % CI 0006-4233 ; p = 063 ) .


There were no deaths , but one major bleeding ( subarachnoid haemorrhage ) in the anticoagulant group .


Central review of imaging failed to confirm dissection in 52 patients .


Preplanned per-protocol analysis excluding these patients showed stroke or death in three ( 3 % ) of 101 patients in the antiplatelet group versus one ( 1 % ) of 96 patients in the anticoagulant group ( OR 0346 , 95 % CI 0006-4390 ; p = 066 ) .


We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection but stroke was rare in both groups , and much rarer than reported in some observational studies .


Diagnosis of dissection was not confirmed after review in many cases , suggesting that radiographic criteria are not always correctly applied in routine clinical practice .


Stroke Association .


The purpose of this study was to investigate the efficacy of eyelid cooling to reduce postoperative pain , edema , erythema , and hematoma after upper blepharoplasty .


After bilateral upper blepharoplasty in 38 consecutive patients , one eyelid per patient was randomized for cooling with an ice pack , and the other eyelid was left uncooled .


Pain was scored by the patients using a visual analogue scale ( 0 to 10 ) 1 hour and 1 day after surgery .


Degree of edema , erythema , and hematoma were scored by the patients on a four-point rating scale ( no , minimal , moderate , or severe ) 1 hour , 1 day , 1 week , and 2 months after surgery .


Light photography was obtained 1 week after surgery for scoring the degree of bruising on a four-point rating scale by a blinded observer .


Pain did not differ between cooled and uncooled eyelids on the day of surgery .


However , pain in cooled eyelids was significantly lower 1 day after surgery ( p = 0.046 ) , yet absolute pain scores were low ( median , 0 and 0.5 , on a scale of 10 ) .


Edema , erythema , or hematoma did not differ between cooled and uncooled eyelids on any of the time points studied .


Cooling of eyelids after upper blepharoplasty does not reduce edema , erythema , or hematoma of the eyelids , but reduces pain 1 day after surgery .


However , because the degree of pain seems clinically irrelevant and because the majority of patients indicate that they have no preference for cooling over noncooling , eyelid cooling after upper blepharoplasty as a rule of thumb can be abandoned .


Therapeutic , II .


There is limited evidence to support the use of facemasks in preventing infection for primary care professionals .


Negative effects on communication has been suggested when the physician wears a facemask .


As communication skills and doctor patient relationship are essential to primary care consultations , the effects of doctor 's facemask wearing were explored .


A randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients ' perception of doctors ' empathy , patient enablement and patient satisfaction .


Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong .


Patients ' views were gathered using the Consultation and Relational Empathy ( CARE ) Measure , Patient Enablement Instrument ( PEI ) and an overall satisfaction rating scale .


The effects of face mask wearing were investigated using multilevel ( hierarchical ) modelling .


1,030 patients were randomised to doctor-mask wearing consultations ( n = 514 ) and non mask wearing consultations ( n = 516 ) .


A significant and negative effect was found in the patients ' perception of the doctors ' empathy ( CARE score reduction -0.98 , p-value = 0.04 ) .


In the more established doctor-patient relationship , the effect of doctors ' mask wearing was more pronounced ( CARE score reduction -5.67 , p-value = 0.03 ) .


This study demonstrates that when doctors wearing a facemask during consultations , this has a significant negative impact on the patient 's perceived empathy and diminish the positive effects of relational continuity .


Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national , local or practice level .


This trial was registered on Chinese Clinical Trial Register ( ChiCTR ) .


Registration no. : ChiCTR-TTRCC-12002519 .


URL : http://www.chictr.org/en/proj/show.aspx?proj=3486 .


Due to administrative error , registration of trial did not take place until after the trial started on 1st August 2011 and registration number was released on 21st September 2012 .


Limited ankle joint dorsiflexion passive range of motion ( PROM ) has been associated with common chronic lower extremity conditions , and clinicians often instruct patients in stretching exercises to increase dorsiflexion .


However , little is known about how subtalar joint ( STJ ) position affects dorsiflexion at the midfoot/forefoot versus ankle/rearfoot during gastrocnemius stretching .


The purpose of this study was to determine if more dorsiflexion occurs at the ankle/rearfoot and less at the midfoot/forefoot during gastrocnemius stretching with the STJ positioned in supination versus pronation .


In this repeated measures design , 27 participants ( 23 females , 4 males ; mean age = 31.3 years , SD = 10.7 ) with current or recent history of lower extremity chronic conditions and less than 10 degrees ankle dorsiflexion measured with the knee in extension on the involved side ( s ) performed five 30-second gastrocnemius stretching trials in pronation and supination on each side in a randomly determined sequence .


A 7-camera Vicon Motion Analysis System and an AMTI force plate were used to measure midfoot/forefoot dorsiflexion , ankle/rearfoot dorsiflexion , knee extension , and normalized vertical ground reaction force .


Two-way repeated measures ANOVA revealed a significant increase in midfoot/forefoot dorsiflexion when stretching in pronation compared to supination ( P < .001 ) .


ANOVAs also demonstrated significantly more extension of the knee when stretching in supination compared to pronation ( P < .001 ) , and increased normalized vertical ground reaction force when stretching in supination compared to pronation ( P = .032 ) .


With the numbers available , no significant difference in ankle/rearfoot dorsiflexion when stretching in supination compared to pronation could be detected ( P > .05 ) .


Gastrocnemius stretching in pronation resulted in more dorsiflexion at the midfoot/forefoot than stretching in supination .


Clinicians may want to consider STJ position during gastrocnemius stretching to either facilitate or limit recruitment of dorsiflexion motion at the midfoot/forefoot .


Cryptococcal meningitis is the most common cause of adult meningitis in sub-Saharan Africa .


Raised intracranial pressure ( ICP ) is common in cryptococcosis .


Prior studies suggest elevated ICP is associated with mortality , and guidelines recommend frequent lumbar punctures ( LPs ) to control ICP .


However , the magnitude of the impact of LPs on cryptococcal-related mortality is unknown .


In sum , 248 individuals with human immunodeficiency virus ( HIV ) - associated cryptococcal meningitis , screened for the Cryptococcal Optimal ART Timing ( COAT ) trial in Uganda and South Africa , were observed .


Individuals received an LP to diagnose meningitis , and subsequent therapeutic LPs were recommended for elevated ICP ( > 250 mmH2O ) or new symptoms .


We compared survival , through 11 days , between individuals receiving at least 1 therapeutic LP with individuals not receiving therapeutic LPs .


The COAT trial randomized subjects at 7-11 days ; thus , follow-up stopped at time of death , randomization , or 11 days .


Seventy-five ( 30 % ) individuals had at least 1 therapeutic LP .


Individuals receiving therapeutic LPs had higher cerebrospinal fluid ( CSF ) opening pressures , higher CSF fungal burdens , and were more likely to have altered mental status at baseline than those with no therapeutic LPs .


Thirty-one deaths ( 18 % ) occurred among 173 individuals without a therapeutic LP and 5 deaths ( 7 % ) among 75 with at least 1 therapeutic LP .


The adjusted relative risk of mortality was 0.31 ( 95 % confidence interval : .12 -.82 ) .


The association was observed regardless of opening pressure at baseline .


Therapeutic LPs were associated with a 69 % relative improvement in survival , regardless of initial intracranial pressure .


The role of therapeutic LPs should be reevaluated .


Angiotensin-converting enzyme inhibitors ( ACEIs ) are currently used to control proteinuria in dogs with chronic kidney disease .


Renal diets ( RDs ) have beneficial effects in the management of azotemic dogs , but its role in proteinuric non-azotemic ( PNAz ) dogs has been poorly documented .


Administration of a RD to PNAz dogs treated with benazepril ( Be ) improves proteinuria control compared with the administration of a maintenance diet ( MD ) .


Twenty-two PNAz ( urine protein/creatinine ratio [ UPC ] > 1 ) dogs .


Randomized open label clinical trial design .


Dogs were assigned to group-MD ( 5.5 g protein/100 kcal ME ) / Be or to group-RD ( 3.7 g protein/100 kcal ME ) / Be group during 60 days .


Dogs with serum albumin ( Alb ) < 2 g/dL received aspirin ( 1 mg/kg/12 hours ) .


A physical examination , systolic blood pressure ( SBP ) measurement , complete blood count ( CBC ) , biochemistry panel , urinalysis , and UPC were performed at day 0 ( D0 ) and day 60 ( D60 ) .


At D0 , there were no significant differences between groups in the evaluated variables .


During the study , logUPC ( geometric mean ( 95 % CI ) and SBP ( meanSD mmHg ) significantly decreased ( paired t-test , P = 0.001 ) in Group-RD ( logUPC ( D0 ) = 3.16 [ 1.9-5 .25 ] ; UPC ( D60 ) = 1.20 [ 0.59-2 .45 ] ; SBP ( D0 ) = 160 17.2 ; SBP ( D60 ) = 151 15.8 ) , but not in Group-MD ( UPC ( D0 ) = 3.63 [ 2.69-4 .9 ] ; UPC ( D60 ) = 2.14 [ 0.76-6 .17 ] ; SBP ( D0 ) = 158 14.7 ; SBP ( D60 ) = 153 11.5 ) .


However , RM-ANOVA test did not confirm that changes were consequence of dietary modification .


Weight and Alb concentration did not change significantly in any group .


The administration of a RD to PNAz dogs treated with Be might help to control proteinuria and SBP compared with the administration of a MD , without inducing clinically detectable malnutrition , but more studies are warranted .


To assess the temporal patterns of late gastrointestinal ( GI ) and genitourinary ( GU ) radiotherapy toxicity and resolution rates in a randomised controlled trial ( All-Ireland Cooperative Oncology Research Group 97-01 ) assessing duration of neo-adjuvant ( NA ) hormone therapy for localised prostate cancer .


Node negative patients with > 1 of : PSA > 20 ng/mL , Gleason score 7 , and stage T3 or more , were included .


Follow-up , including toxicity assessment , was three-monthly in the early stages and yearly thereafter .


Median follow-up from the end of RT was 6.8 years .


In the interval between 90 days following the end of RT and the last toxicity assessment , GI and GU toxicity ( any grade ) was found in 50 % and 51 % of 240 and 241 patients , respectively .


For those who did develop toxicity , the median time from end of RT until the first development of any grade GI or GU toxicity was 1.2 years and 1.6 years , respectively , whilst median time to final resolution was 1.6 years and 2.2 years , respectively .


Grade 2 ( G2 ) or greater GI and GU toxicity occurred in 29 ( 12.1 % ) and 40 ( 16.6 % ) patients , respectively .


The proportion with unresolved G2 + GI and GU toxicity was 89 % and 79 % , respectively , in year 1 , 69 % and 65 % in year 2 , 59 % and 52 % in year 3 and 27 % and 32 % in year 5 .


Long-term toxicities continue to occur many years after NA hormone therapy and RT. .


The rate of occurrence does not appear to reduce within the time frame during which our patients were followed .


The percentage of patients suffering from G2 + toxicity at any time is however low .


Resolution of these toxicities continues for the duration of the follow-up .


A novel therapeutic management of osteoarthritis ( OA ) of the knee was assessed .


The study aimed to evaluate the effect of monthly sodium bicarbonate with a single ( SBCG1 ) or double dose ( SBCG2 ) of calcium gluconate injections on OA of the knee ; as well as the efficacy and safety of both SBCG interventions in the long term .


A double-blind parallel-group clinical trial with 74 knee OA patients was performed during 12months , both SBCG interventions were followed-up for another 6mo after intervention .


The outcome variables were the Western Ontario-McMaster University Osteoarthritis Index ( WOMAC ) , the Lequesne 's functional index and joint-space width changes from serial radiographs .


After 12months , group SBCG1 decreased -14.8 ( 95 % CI : -14.2 , -17.0 ) and group SBCG2 decreased -14.6 ( -16.9 , -12.4 ) in the global WOMAC score , the mean changes represent 80 % and 82 % lessened pain , respectively .


In the Lequesne Functional Index scale , SBCG1 decreased -11.9 ( -10.4 , -14.2 ) and SBCG2 decreased -11.9 ( -13.8 , -10.0 ) , representing 66 and 69 % of improvement .


Both mean scores were maintained after intervention discontinued .


SBCG2 improved the knees ' joint space width more than SBCG1 at 3 and 18months .


Both SBCG interventions were well tolerated after 12months of treatment


A solution of sodium bicarbonate and calcium gluconate is effective on reducing the symptoms associated with OA .


Its beneficial effect is maintained for one year of continuous monthly administration and at least for 6months after the administration is discontinued .


When the dose of calcium gluconate is increased , it prevents further narrowing of joint-space .


Clinicaltrials.gov NCT00977444 September 11 , 2009 .


Deprivation of parents might decrease self-esteem ( SE ) and result in affective and social incompatibility .


In this randomized control trial , we examined the effect of aerobics exercise on SE among female adolescents living with no natural family .


The sample consisted of all female adolescents aged 13 to 19 years ( n : 72 ) who were covered by Isfahan Welfare organization .


Participants were assigned into intervention and control groups by matched random sampling .


Intervention included 8 weeks of aerobics exercise .


Coppersmith SE inventory was administered before and after intervention as well as after one month follow-up .


No significant difference was seen between pre-SE scores of intervention ( 32.7 8.4 ) and control ( 33.0 6.7 ) groups ( t = .16 , P = .87 ) .


A significant difference was obtained in post-SE scores ( 40.2 5.7 versus 34.7 6.8 , t = 3.58 , P = .001 ) and in one month follow-up scores ( 36.4 5.2 versus 33.0 5.2 , t = 2.25 , P = .03 ) .


The results demonstrated a low level of pre-SE in both groups .


However , a significant improvement was seen in posttest of intervention group which persisted even one month after intervention .


It supports the use of aerobics for female adolescents deprived from family life .


To evaluate the effect of oral supplementation with omega-3 ( -3 ) fatty acids ( FAs ) in improving contrast sensitivity ( CS ) of patients with moderate meibomian gland dysfunction ( MGD ) .


In this prospective study , 60 patients with moderate MGD were allocated alternately to treatment and control groups .


Both groups received warm compresses , lid massage , and artificial tear substitutes .


The treatment group also received oral supplements of 1.2 g -3 FAs per day .


All parameters were recorded at baseline and at 12 weeks and included Ocular Surface Disease Index scores , CS testing at 3 , 6 , 12 , and 18 cycles per degree ( cpd ) , tear break-up time , Schirmer test I without anesthesia , corneal and conjunctival staining scores , and meibum quality and expressibility .


At the end of 12 weeks , significant improvement in CS was seen in the treatment group in 7 of the 8 testing conditions ( 3 , 6 , 12 , and 18 cpd photopic and 6 , 12 , and 18 cpd mesopic ) , whereas in the placebo group , significant improvement was seen only in 3 of the 8 testing conditions ( 3 cpd photopic , 6 and 18 cpd mesopic ) .


Ocular Surface Disease Index , tear break-up time , ocular surface staining , and meibum quality and expressibility improved significantly in both groups , but more so in the treatment group .


Schirmer scores showed no significant improvement in either group .


Oral supplementation with -3 FAs significantly improved CS under both photopic and mesopic testing conditions in patients with moderate MGD .


Tear film stability also improved significantly , whereas no effect was seen on aqueous tear production .


Concern about pain during placement of an intrauterine device ( IUD ) represents a barrier to use , especially among nulliparous women .


We hypothesized that nitroglycerin gel applied vaginally 30 min prior to IUD placement would reduce insertion-related pain .


We designed a randomized , double-blinded , placebo-controlled pilot study to evaluate the efficacy and tolerability of 0.5-mg nitroglycerin gel ( 1 mL ) or identical placebo gel applied vaginally in nulliparous women 30 min prior to IUD placement .


The study was limited to women who opted for the levonorgestrel-releasing intrauterine system .


Subjects completed a series of 100-mm visual analogue scales at several time points .


The primary outcome was subject-reported pain with passage of the IUD through the cervix .


Secondary outcomes included subject-reported pain at other time points , provider-reported ease of insertion , side effects , adverse events and need for additional dilation .


A total of 24 women were randomized .


Baseline characteristics were similar between groups .


The mean pain score with IUD deployment was 55.0 mm [ standard deviation ( SD ) = 29.7 mm ] in the placebo group and 57.4 mm ( SD 22.1 mm ) in the nitroglycerin group ( p = .82 ) .


There was no difference in ease of insertion reported by providers .


Two subjects required dilation , one in each group .


Vaginal administration of 0.5-mg nitroglycerin gel 30 min prior to IUD placement does not appear to decrease patient-reported procedural pain among nulliparous women or ease of insertion for providers .


Long-term clinical outcomes of everolimus-eluting stent ( EES ) compared with sirolimus-eluting stent ( SES ) have not been evaluated fully yet , especially whether EES implantation could positively affect late adverse events reported after SES implantation occurring > 1 year .


In this all-comer prospective multicenter randomized open-label trial , 3196 patients were assigned randomly to implant either EES ( n = 1596 ) or SES ( n = 1600 ) .


At 3 years , EES was noninferior to SES on the primary safety end point ( all-cause death or myocardial infarction ; 10.1 % versus 11.5 % ; noninferiority P < 0.001 ; and superiority P = 0.19 ) .


Cumulative incidence of definite stent thrombosis was low and was not significantly different between the 2 groups ( 0.5 % versus 0.6 % ; P = 0.81 ) .


There was no significant difference in the efficacy end point of target-lesion revascularization between the EES and SES groups ( 6.6 % versus 7.9 % ; P = 0.16 ) .


However , the cumulative incidence of target-lesion failure ( cardiac death/target-vessel myocardial infarction/ischemia-driven target-lesion revascularization ) was significantly lower in the EES group than in the SES group ( 8.8 % versus 11.4 % ; P = 0.01 ) .


By a landmark analysis at 1 year , the cumulative incidence of very late stent thrombosis and late target-lesion revascularization was not significantly different between the 2 groups ( 0.2 % versus 0.2 % ; P = 0.99 and 2.2 % versus 2.9 % ; P = 0.21 , respectively ) .


The efficacy and safety outcomes for this trial after EES implantation remained comparable with those after SES implantation through 3-year follow-up .


However , improvement of clinical outcome after EES implantation compared with SES implantation was suggested by the significantly lower cumulative incidences of target-lesion failure , which has been the most widely used primary end point in the stent-versus-stent trials .


http://www.clinicaltrials.gov .


Unique identifier : NCT01035450 .


Metamizole use has been limited because of its risk of agranulocytosis .


However , more recent literature seems to support its safety .


This prospective , randomised , double-blind study was conducted to compare the analgesic effects of intravenous metamizole or intravenous paracetamol in combination with morphine PCA during the first 24h following total hip arthroplasty .


One hundred ten consecutive patients were selected for study .


The two study groups were ( A ) metamizole , ( B ) paracetamol .


Postoperative pain therapy was provided by Morphine PCA pump .


In the first treatment group ( A group ) , all patients received intravenous metamizole 1.5 g every 8h during the first 24 postoperative hours .


In the second treatment group ( B group ) , all patients received intravenous paracetamol 1g every 8h during the first 24 postoperative hours .


Postoperative pain intensity was measured 1 , 2 , 3 , 4 , 6 , 8 , 10 , 14 , 18 , 22h after the end of surgery by a VAS .


Statistically significant differences in VAS pain values favoring metamizole were reported at 6-h ( p = 0.038 ) , 8-h ( p = 0.036 ) , 14-h ( p = 0.011 ) , 18-h ( p < 0.001 ) and 22-h ( p = 0.025 ) post-baseline .


Mean cumulative pain values were 17.9 for metamizole and 30.6 for paracetamol .


In this study , we have also shown excellent efficacy of paracetamol and metamizole combined with opioids , but metamizole proved to be a better analgesic than paracetamol .


It is also necessary to mention the financial aspect considering that intravenous paracetamol is about ten times more expensive than an equivalent analgesic doses of intravenous metamizole .


A malaria vaccine could be an important addition to current control strategies .


We report the safety and vaccine efficacy ( VE ) of the RTS , S/AS01 vaccine during 18 mo following vaccination at 11 African sites with varying malaria transmission .


6,537 infants aged 6-12 wk and 8,923 children aged 5-17 mo were randomized to receive three doses of RTS , S/AS01 or comparator vaccine .


VE against clinical malaria in children during the 18 mo after vaccine dose 3 ( per protocol ) was 46 % ( 95 % CI 42 % to 50 % ) ( range 40 % to 77 % ; VE , p < 0.01 across all sites ) .


VE during the 20 mo after vaccine dose 1 ( intention to treat [ ITT ] ) was 45 % ( 95 % CI 41 % to 49 % ) .


VE against severe malaria , malaria hospitalization , and all-cause hospitalization was 34 % ( 95 % CI 15 % to 48 % ) , 41 % ( 95 % CI 30 % to 50 % ) , and 19 % ( 95 % CI 11 % to 27 % ) , respectively ( ITT ) .


VE against clinical malaria in infants was 27 % ( 95 % CI 20 % to 32 % , per protocol ; 27 % [ 95 % CI 21 % to 33 % ] , ITT ) , with no significant protection against severe malaria , malaria hospitalization , or all-cause hospitalization .


Post-vaccination anti-circumsporozoite antibody geometric mean titer varied from 348 to 787 EU/ml across sites in children and from 117 to 335 EU/ml in infants ( per protocol ) .


VE waned over time in both age categories ( Schoenfeld residuals p < 0.001 ) .


The number of clinical and severe malaria cases averted per 1,000 children vaccinated ranged across sites from 37 to 2,365 and from -1 to 49 , respectively ; corresponding ranges among infants were -10 to 1,402 and -13 to 37 , respectively ( ITT ) .


Meningitis was reported as a serious adverse event in 16/5 ,949 and 1/2 ,974 children and in 9/4 ,358 and 3/2 ,179 infants in the RTS , S/AS01 and control groups , respectively .


RTS , S/AS01 prevented many cases of clinical and severe malaria over the 18 mo after vaccine dose 3 , with the highest impact in areas with the greatest malaria incidence .


VE was higher in children than in infants , but even at modest levels of VE , the number of malaria cases averted was substantial .


RTS , S/AS01 could be an important addition to current malaria control in Africa .


www.ClinicalTrials.gov NCT00866619 Please see later in the article for the Editors ' Summary .


The purpose of this study was to examine the osteotomy gap filling rate with new bone after open wedge high tibial osteotomy ( HTO ) without bone graft and the effects of smoking , lateral hinge fracture , and early full weight bearing .


A prospective series ( N = 70 ) of open wedge HTOs with the TomoFix plate ( DePuy Synthes , Umkirch , Germany ) was performed .


Radiologic follow-up examinations took place postoperatively , after 6 and 12 weeks , and after 6 , 12 , and 18 months to measure osteotomy gap filling at each follow-up .


Bone healing was compared in smokers versus nonsmokers who underwent open wedge HTOs with intact lateral hinges .


Fractured lateral hinges were classified according to the Takeuchi classification and separately analyzed regarding bone healing .


Patients were randomly assigned to undergo early ( 11 days ) or standard ( 6 weeks ) full-weight-bearing rehabilitation .


A delay in the osteotomy gap filling rate between smokers and nonsmokers could be observed at all follow-up periods , but differences were not significant .


A fracture of the lateral hinge was found in 39 % of the patients .


A type I fracture was observed in 14 % of patients , a type II fracture was observed in 13 % , and a type III fracture was found in 6 % .


The highest increase in the osteotomy gap filling rate was observed between 12 weeks and 6 months after surgery in patients with intact lateral hinges .


For patients with unstable type II fractures , the highest increase in the gap filling rate was delayed until 6 to 12 months .


Early full weight bearing had no effect on the gap filling rate in any of the patient groups evaluated .


This study shows that osteotomy gap filling after open wedge HTO is delayed in smokers and in patients in whom opening of the gap resulted in unstable lateral hinge fractures .


Early full weight bearing did not have a significant effect on the gap filling rate .


Level III , prognostic study .


To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used .


This was a prospective randomized clinical trial .


Of the 73 patients included in the study , 36 and 37 were randomized to undergo BAL or endotracheal aspiration ( EA ) , respectively .


Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures .


The 28-day mortality rate was similar in the BAL and EA groups ( 25.0 % and 37.8 % , respectively ; p = 0.353 ) .


There were no differences between the groups regarding the duration of mechanical ventilation , antibiotic therapy , secondary complications , VAP recurrence , or length of ICU and hospital stay .


Initial antibiotic therapy was deemed appropriate in 28 ( 77.8 % ) and 30 ( 83.3 % ) of the patients in the BAL and EA groups , respectively ( p = 0.551 ) .


The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups ( appropriate therapy : 35.7 % vs. 43.3 % ; p = 0.553 ; and inappropriate therapy : 62.5 % vs. 50.0 % ; p = 1.000 ) .


Previous use of antibiotics did not affect the culture yield in the EA or BAL group ( p = 0.130 and p = 0.484 , respectively ) .


In the context of this study , the management of VAP patients , based on the results of quantitative endotracheal aspirate cultures , led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures .


( Brazilian Registry of Clinical Trials -- ReBEC ; identification number RBR-86DCDX [ http://www.ensaiosclinicos.gov.br] ) .


Primary Sjgren syndrome is a systemic autoimmune disease characterized by mouth and eye dryness , pain , and fatigue .


Hydroxychloroquine is the most frequently prescribed immunosuppressant for the syndrome .


However , evidence regarding its efficacy is limited .


To evaluate the efficacy of hydroxychloroquine for the main symptoms of primary Sjgren syndrome : dryness , pain , and fatigue .


From April 2008 to May 2011 , 120 patients with primary Sjgren syndrome according to American-European Consensus Group Criteria from 15 university hospitals in France were randomized in a double-blind , parallel-group , placebo-controlled trial .


Participants were assessed at baseline , week 12 , week 24 ( primary outcome ) , and week 48 .


The last follow-up date for the last patient was May 15 , 2012 .


Patients were randomized ( 1:1 ) to receive hydroxychloroquine ( 400 mg/d ) or placebo until week 24 .


All patients were prescribed hydroxychloroquine between weeks 24 and 48 .


The primary end point was the proportion of patients with a 30 % or greater reduction between weeks 0 and 24 in scores on 2 of 3 numeric analog scales ( from 0 [ best ] to 10 [ worst ] ) evaluating dryness , pain , and fatigue .


At 24 weeks , the proportion of patients meeting the primary end point was 17.9 % ( 10/56 ) in the hydroxychloroquine group and 17.2 % ( 11/64 ) in the placebo group ( odds ratio , 1.01 ; 95 % CI , 0.37-2 .78 ; P = .98 ) .


Between weeks 0 and 24 , the mean ( SD ) numeric analog scale score for dryness changed from 6.38 ( 2.14 ) to 5.85 ( 2.57 ) in the placebo group and 6.53 ( 1.97 ) to 6.22 ( 1.87 ) in the hydroxychloroquine group .


The mean ( SD ) numeric analog scale score for pain changed from 4.92 ( 2.94 ) to 5.08 ( 2.48 ) in the placebo group and 5.09 ( 3.06 ) to 4.59 ( 2.90 ) in the hydroxychloroquine group .


The mean ( SD ) numeric analog scale for fatigue changed from 6.26 ( 2.27 ) to 5.72 ( 2.38 ) in the placebo group and 6.00 ( 2.52 ) to 5.94 ( 2.40 ) in the hydroxychloroquine group .


All but 1 patient in the hydroxychloroquine group had detectable blood levels of the drug .


Hydroxychloroquine had no efficacy in patients with anti-SSA autoantibodies , high IgG levels , or systemic involvement .


During the first 24 weeks , there were 2 serious adverse events in the hydroxychloroquine group and 3 in the placebo group ; in the last 24 weeks , there were 3 serious adverse events in the hydroxychloroquine group and 4 in the placebo group .


Among patients with primary Sjgren syndrome , the use of hydroxychloroquine compared with placebo did not improve symptoms during 24 weeks of treatment .


Further studies are needed to evaluate longer-term outcomes .


clinicaltrials.gov Identifier : NCT00632866 .


To determine whether plasma sclerostin levels are affected by applying whole-body vibration treatments .


Following a pilot study , the pretsent prospective , randomized , controlled single-blind study was performed on 16 healthy volunteer women ( ages 20 to 40 years ) .


Subjects were randomly divided into 2 groups , and whole-body vibration was applied to the treatment group but not to the controls .


The plasma sclerostin levels were measured before the treatment and at the 10th minute after whole-body vibration on the 1st , 2nd , and 5th days of application .


The plasma sclerostin level measured at 10 min after the whole-body vibration treatment increased 91 % ( P = 0.024 ) on the 1st day and decreased 31.5 % ( P = 0.03 ) on the 5th day in the whole-body vibration group .


In the control group , there was no change in the plasma sclerostin level at any time .


A progressive increase in baseline plasma sclerostin levels during the 5 days of vibration sessions was also found .


Our study demonstrated that whole-body vibration can change plasma sclerostin levels , and that this change is detectable 10 min after whole-body vibration treatments .


Knowing family history is important for understanding cancer risk , yet communication within families is suboptimal .


Providing strategies to enhance communication may be useful .


Four hundred ninety women were recruited from urban , safety-net , hospital-based primary care women 's health clinics .


Participants were randomized to receive the KinFact intervention or the control handout on lowering risks for breast/colon cancer and screening recommendations .


Cancer family history was reviewed with all participants .


The 20-minute KinFact intervention , based in communication and behavior theory , included reviewing individualized breast/colon cancer risks and an interactive presentation about cancer and communication .


Study outcomes included whether participants reported collecting family history , shared cancer risk information with relatives , and the frequency of communication with relatives .


Data were collected at baseline , 1 , 6 , and 14 months .


Overall , intervention participants were significantly more likely to gather family cancer information at follow-up ( odds ratio [ OR ] : 2.73 ; 95 % confidence interval [ CI ] : 2.01 , 3.71 ) and to share familial cancer information with relatives ( OR : 1.85 ; 95 % CI : 1.37 , 2.48 ) .


Communication frequency ( 1 = not at all ; 4 = a lot ) was significantly increased at follow-up ( 1.67 vs. 1.54 ) .


Differences were not modified by age , race , education , or family history .


However , effects were modified by pregnancy status and genetic literacy .


Intervention effects for information gathering and frequency were observed for nonpregnant women but not for pregnant women .


Additionally , intervention effects were observed for information gathering in women with high genetic literacy , but not in women with low genetic literacy .


The KinFact intervention successfully promoted family communication about cancer risk .


Educating women to enhance their communication skills surrounding family history may allow them to partner more effectively with their families and ultimately their providers in discussing risks and prevention .


The use of drug-eluting stents ( DES ) in patients at high risk of bleeding or thrombosis has not been prospectively studied ; limited data are available in patients who have a low restenosis risk .


This study sought to compare a hydrophilic polymer-based , second-generation zotarolimus-eluting stent ( ZES ) with a unique drug fast-release profile versus bare-metal stents ( BMS ) under similar durations of dual-antiplatelet therapy ( DAPT ) .


We randomly assigned 1,606 patients with stable or unstable symptoms , and who on the basis of thrombotic bleeding or restenosis risk criteria , qualified as uncertain candidates for DES , to receive ZES or BMS .


DAPT duration was on the basis of patient characteristics , rather than stent characteristics , and allowed for a personalized 1-month dual antiplatelet regimen .


The primary endpoint was the risk of 1-year major adverse cardiovascular events ( MACE ) , which included death , myocardial infarction ( MI ) , or target vessel revascularization ( TVR ) .


Median DAPT duration was 32 days ( interquartile range [ IQR ] : 30 to 180 days ) and did not differ between the groups .


In the ZES group , 140 patients ( 17.5 % ) reached the primary endpoint , compared with 178 patients ( 22.1 % ) in the BMS group ( hazard ratio : 0.76 ; 95 % confidence interval : 0.61 to 0.95 ; p = 0.011 ) as a result of lower MI ( 2.9 % vs. 8.1 % ; p < 0.001 ) and TVR rates ( 5.9 % vs. 10.7 % ; p = 0.001 ) in the ZES group .


Definite or probable stent thrombosis was also significantly reduced in ZES recipients ( 2.0 % vs. 4.1 % ; p = 0.019 ) .


Compared with BMS , DES implantation using a stent with a biocompatible polymer and fast drug-eluting characteristics , combined with an abbreviated , tailored DAPT regimen , resulted in a lower risk of 1-year MACE in uncertain candidates for DES implantation .


( Zotarolimus-eluting Endeavor Sprint Stent in Uncertain DES Candidates [ ZEUS ] Study ; NCT01385319 ) .


The purpose of the present study was to assess the influence of electrode insertion length on cochlear implant ( CI ) performance .


Prospective randomized allocation of CI patients to receive either a standard ( 26.4 mm ) - or medium ( 20.9 mm ) - length electrode array .


The processing strategy and electrode insertion number were held constant .


The postoperative testing audiologist was blinded to the map details and array .


Tertiary referral center .


Thirteen adult CI candidates randomized to receive the standard - ( n = 7 ) or medium-length ( n = 6 ) electrode array .


Unilateral CI using standard - or medium-length array from the same implant system .


Speech perception was assessed with HINT sentences in quiet and steady-state noise ( SNR , +10 ) and CNC words in quiet at defined intervals .


Quality of life was assessed using the Hearing Device Satisfaction Survey and the Abbreviated Profile of Hearing Aid Benefit ( APHAB ) .


Music perception was assessed using the Musical Sounds In Cochlear implants ( MuSIC ) test .


Postoperative electrode insertion angle was assessed using reconstructed computed tomographic images .


Interim analysis necessitated discontinuation of subject enrollment by the institutional review board .


There was a trend ( p = 0.07 ) for improved speech perception performance among standard array patients .


This difference was significant when the standard array group was increased retrospectively .


Quality of life and music perception differences were not apparent between groups .


Longer electrode insertions ( and greater insertion angles ) appear to offer better speech perception performance in the early postactivation period when using the same implant system .


To compare the differences in the clinical efficacy on neurogenic bladder after spinal cord injury ( SCD between the matrix needling technique combined with rehabilitation training and rehabilitation training in the patients .


Sixty patients of SCI neurogenic bladder were randomized into an observation group ( 29 cases ) and a control group ( 31 cases ) .


In the control group , the conventional rehabilitation therapy , the intermittent catheterization and bladder function training were adopted , once every day , for 4 weeks totally .


In the observation group , on the basic treatment of the rehabilitation as the control group , the matrix needling technique and acupuncture at sanyin points were applied .


The treatment of 8 days made one session , at the interval of 2 days , continuously for 3 sessions , meaning 4 weeks totally .


The bladder function score , residual urine volume and bladder capacity were compared before and after treatment in the two groups .


The bladder function score was reduced after treatment as compared with that before treatment in either group ( both P < 0.05 ) .


The score in the observation group was lower than that in the control group after treatment ( P < 0.05 ) .


No matter which spinal segment was injured , the residual urine volume after treatment was reduced as compared with that before treatment and the bladder capacity was increased ( P < 0.05 ) .


The residual urine volume in the observation group was less than that in the control group after treatment and the bladder capacity was more increased ( P < 0.05 ) .


The conventional rehabilitation program in combination with the matrix needling technique and acupuncture at sanyin points achieve the significant efficacy on SCI neurogenic bladder .


Numerous uremic solutes are derived from the action of colon microbes .


Two such solutes , indoxyl sulfate and p-cresol sulfate , have been associated with adverse outcomes in renal failure .


This study tested whether increasing dietary fiber in the form of resistant starch would lower the plasma levels of these solutes in patients on hemodialysis .


Fifty-six patients on maintenance hemodialysis were randomly assigned to receive supplements containing resistant starch ( n = 28 ) or control starch ( n = 28 ) daily for 6 weeks in a study conducted between October 2010 and May 2013 .


Of these , 40 patients ( 20 in each group ) completed the study and were included in the final analysis .


Plasma indoxyl sulfate and p-cresol sulfate levels were measured at baseline and week 6 .


Increasing dietary fiber for 6 weeks significantly reduced the unbound , free plasma level of indoxyl sulfate ( median -29 % [ 25th percentile , 75th percentile , -56 , -12 ] for fiber versus -0.4 % [ -20 , 34 ] for control , P = 0.02 ) .


The reduction in free plasma levels of indoxyl sulfate was accompanied by a reduction in free plasma levels of p-cresol sulfate ( r = 0.81 , P < 0.001 ) .


However , the reduction of p-cresol sulfate levels was of lesser magnitude and did not achieve significance ( median -28 % [ -46 , 5 ] for fiber versus 4 % [ -28 , 36 ] for control , P = 0.05 ) .


Increasing dietary fiber in hemodialysis patients may reduce the plasma levels of the colon-derived solutes indoxyl sulfate and possibly p-cresol sulfate without the need to intensify dialysis treatments .


Further studies are required to determine whether such reduction provides clinical benefits .


Falls are a major public health concern with at least one third of people aged 65 years and over falling at least once per year , and half of these will fall repeatedly , which can lead to injury , pain , loss of function and independence , reduced quality of life and even death .


Although the causes of falls are varied and complex , the age-related loss in muscle power has emerged as a useful predictor of disability and falls in older people .


In this population , the requirements to produce explosive and rapid movements often occurs whilst simultaneously performing other attention-demanding cognitive or motor tasks , such as walking while talking or carrying an object .


The primary aim of this study is to determine whether dual-task functional power training ( DT-FPT ) can reduce the rate of falls in community-dwelling older people .


The study design is an 18-month cluster randomised controlled trial in which 280 adults aged 65 years residing in retirement villages , who are at increased risk of falling , will be randomly allocated to : 1 ) an exercise programme involving DT-FPT , or 2 ) a usual care control group .


The intervention is divided into 3 distinct phases : 6 months of supervised DT-FPT , a 6-month ` step down ' maintenance programme , and a 6-month follow-up .


The primary outcome will be the number of falls after 6 , 12 and 18 months .


Secondary outcomes will include : lower extremity muscle power and strength , grip strength , functional assessments of gait , reaction time and dynamic balance under single - and dual-task conditions , activities of daily living , quality of life , cognitive function and falls-related self-efficacy .


We will also evaluate the cost-effectiveness of the programme for preventing falls .


The study offers a novel approach that may guide the development and implementation of future community-based falls prevention programmes that specifically focus on optimising muscle power and dual-task performance to reduce falls risk under ` real life ' conditions in older adults .


In addition , the ` step down ' programme will provide new information about the efficacy of a less intensive maintenance programme for reducing the risk of falls over an extended period .


Australian New Zealand Clinical Trials Registry : ACTRN12613001161718 .


Date registered 23 October 2013 .


To evaluate the effects of a non-pharmacologic electro-acupuncture method at different acupoints on labor pain management .


Nulliparous women under the maternity care of the Department of Obstetrics and Gynecology of Sir Run Run Shaw Hospital were recruited and allocated into two experimental groups ( EX-B2 group and SP6 group ) and one control group , each with 60 eligible participants .


Visual analog scale ( VAS ) was used to assess the pain during active phase of labor before and 30 , 60 , 120 min after intervention .


The duration of active phase , the duration of second stage of labor , the duration of third stage of labor , use of oxytocin , neonatal birth weight , neonatal Apgar score at 1 and 5 min were considered as secondary outcomes of this study .


After 30 min intervention , the mean VAS scores of both EX-B2 group and SP6 group were significantly decreased compared with the control group ( P < 0.01 ) ; however , no significant difference was observed between the two experimental groups ( P > 0.05 ) .


After 60 and 120 min intervention , the mean VAS scores of EX-B2 group were significantly lower than SP-6 group ( P < 0.05 ) .


Both EX-B2 group and SP6 group had significant lower VAS scores after interventions and shorter time used in active phase of labor than the control group ( P < 0.05 ) .


The study revealed that the application of electro-acupuncture at EX-B2 and SP6 acupoints could be used as a non-pharmacologic method to reduce labor pain and shorten the duration of active phase of labor .


Models of addictive behaviors postulate that implicit alcohol-related memory associations and biased interpretation processes contribute to the development and maintenance of alcohol misuse and abuse .


The present study examined whether alcohol-dependent patients ( AP ) show an alcohol-related interpretation bias .


Second , the relationship between the interpretation bias and levels of harmful drinking was investigated .


The sample included 125 clinically diagnosed AP and 69 clinically diagnosed control patients ( CP ) who had either a mood or an anxiety disorder .


Participants completed a booklet containing 12 open-ended ambiguous scenarios .


Seven scenarios were alcohol-relevant , and 5 were emotionally relevant , that is , panic - or depression-relevant .


Participants were asked to read each scenario and to generate a continuation .


In addition , the Alcohol Use Disorder Identification Test ( AUDIT ) and Beck Depression Inventory were administered .


Logistic multivariate multilevel analyses revealed that AP ' probability of generating an alcohol-related continuation on all 3 scenario types was higher than that of CP .


Moreover , alcohol-related interpretation biases were positively associated with levels of harmful drinking ( i.e. , AUDIT scores ) .


These findings are the first to show that AP show an alcohol-related interpretation bias , which generalizes to other ambiguous emotionally relevant contexts , and therefore advance our understanding of the role of implicit biased alcohol-related memory associations and interpretation processes .


Previous research has indicated positive effects of early developmental intervention ( EDI ) on the development of children in developing countries .


Few studies , however , have examined longitudinally when differential treatment effects may be observed and whether differential outcomes are associated with exposure to different risk factors and country of implementation .


Also , birth asphyxia as a risk condition has not been well studied .


To address these limitations , we conducted a randomized controlled trial to test the hypothesis that there will be differential developmental trajectories favoring those who receive EDI versus a health education intervention in children in rural areas of India , Pakistan , and Zambia .


Children with and without birth asphyxia were randomized to EDI or control intervention , which was implemented by parents who received training in biweekly home visits initiated before child age 1 month and continuing until 36 months .


Development was assessed in 376 children at ages 12 , 24 , and 36 months using the Bayley Scales of Infant Development and Ages & Stages Questionnaire administered by evaluators blind to intervention assignment and risk condition .


Longitudinal mixed model analysis indicated that EDI resulted in better development over 36 months in cognitive abilities , regardless of risk condition , maternal resources , child gender , or country .


Psychomotor development and parent-reported general development showed similar trends as for cognitive abilities , but were not statistically different between intervention conditions .


Developmental differences were observed first at 36 months of age .


Early developmental intervention has promise for improving development in children across developing countries when exposed to various risk conditions .


EDI should be one prominent approach used to begin to address long-term outcomes and intergenerational transmission of poverty .


The aim of this randomized controlled study was to compare the postoperative analgesic efficacy of intraperitoneal bupivacaine versus levobupivacaine in patients undergoing laparoscopic cholecystectomy .


We randomly divided 90 patients undergoing elective laparoscopic cholecystectomy into 3 groups .


A dose of 0.125 % bupivacaine ( Group B ) 80 ml or 0.125 % levobupivacaine ( Group L ) 80 ml or 0.09 % NaCl ( Group P ) 80 ml was instilled intraperitoneally at the end of the procedure , before removal of the trocars .


All patients had a standard anesthetic .


Tramadol was administered intravenously via a patient controlled analgesia pump as a rescue analgesic in all patients .


Postoperative pain scores were assessed at 30 minutes , 1 , 2 , 4 , 6 , 12 and 24 hours after surgery by using a visual analog scale .


The primary end point of this study was to compare tramadol consumption of the three groups at the postoperative 24 h. Total tramadol consumption , first analgesic requirement time and adverse effects were recorded .


Group B experienced significantly less pain ( P < 0.01 ) than the placebo group at 6 h , 12 h and 24 h postoperatively during rest .


Group L registered significantly lower visual analog scale scores ( p < 0.01 ) than the placebo group at 12 h during rest .


During movement , visual analog scale pain scores were lower in group B than Group P ( P < 0.01 ) .


Additionally , total tramadol consumption was significantly lower in Group B than the other groups .


First analgesic requirement time was shorter in the placebo group compared with group B and group L ( P < 0.05 ) .


There was no significant difference between the groups with respect to right shoulder pain , total nausea and vomiting .


Intraperitoneal instillation of bupivacaine 0.125 % 80 ml ( 100 mg ) is more effective than levobupivacaine 0.125 % 80 ml ( 100 mg ) in reducing the postoperative pain after laparoscopic cholecystectomy .


To evaluate the diagnostic performance of three-dimensional ( 3D ) MR maximum intensity projection ( MIP ) in the assessment of synovitis of the hand and wrist in rheumatoid arthritis ( RA ) compared to 3D contrast-enhanced magnetic resonance imaging ( CE-MRI ) .


Twenty-five patients with RA underwent MR examinations .


3D MR MIP images were derived from the enhanced images .


MR images were reviewed by two radiologists for the presence and location of synovitis of the hand and wrist .


The diagnostic sensitivity , specificity and accuracy of 3D MIP were , respectively , calculated with the reference standard 3D CE-MRI .


In all subjects , 3D MIP images yielded directly and clearly the presence and location of synovitis with just one image .


Synovitis demonstrated high signal intensity on MIP images .


The k-values for the detection of articular synovitis indicated excellent interobserver agreements using 3D MIP images ( k = 0.87 ) and CE-MR images ( k = 0.91 ) , respectively .


3D MIP demonstrated a sensitivity , specificity and accuracy of 91.07 % , 98.57 % and 96.0 % , respectively , for the detection of synonitis .


3D MIP can provide a whole overview of lesion locations and a reliable diagnostic performance in the assessment of articular synovitis of the hand and wrist in patients with RA , which has potential value of clinical practice .


Cabozantinib is an oral , small-molecule tyrosine kinase inhibitor that targets vascular endothelial growth factor receptor ( VEGFR ) as well as MET and AXL , each of which has been implicated in the pathobiology of metastatic renal-cell carcinoma or in the development of resistance to antiangiogenic drugs .


This randomized , open-label , phase 3 trial evaluated the efficacy of cabozantinib , as compared with everolimus , in patients with renal-cell carcinoma that had progressed after VEGFR-targeted therapy .


We randomly assigned 658 patients to receive cabozantinib at a dose of 60 mg daily or everolimus at a dose of 10 mg daily .


The primary end point was progression-free survival .


Secondary efficacy end points were overall survival and objective response rate .


Median progression-free survival was 7.4 months with cabozantinib and 3.8 months with everolimus .


The rate of progression or death was 42 % lower with cabozantinib than with everolimus ( hazard ratio , 0.58 ; 95 % confidence interval [ CI ] 0.45 to 0.75 ; P < 0.001 ) .


The objective response rate was 21 % with cabozantinib and 5 % with everolimus ( P < 0.001 ) .


A planned interim analysis showed that overall survival was longer with cabozantinib than with everolimus ( hazard ratio for death , 0.67 ; 95 % CI , 0.51 to 0.89 ; P = 0.005 ) but did not cross the significance boundary for the interim analysis .


Adverse events were managed with dose reductions ; doses were reduced in 60 % of the patients who received cabozantinib and in 25 % of those who received everolimus .


Discontinuation of study treatment owing to adverse events occurred in 9 % of the patients who received cabozantinib and in 10 % of those who received everolimus .


Progression-free survival was longer with cabozantinib than with everolimus among patients with renal-cell carcinoma that had progressed after VEGFR-targeted therapy .


( Funded by Exelixis ; METEOR ClinicalTrials.gov number , NCT01865747 . )


Low-dose ketamine infusion ( blood concentration around 100 ng/mL ) during surgery reduces the incidence of postoperative shivering after remifentanil-based anesthesia .


We hypothesized that perioperative infusion of very low-dose ketamine ( blood concentration around 40 ng/mL ) during remifentanil-based anesthesia may also prevent the development of remifentanil-induced shivering during the 2-hour period after the end of anesthesia .


Fifty female patients scheduled to undergo laparoscopic cystectomy or oophorectomy were assigned to one of two groups : ( 1 ) ketamine group , in which the patients received ketamine infusion ( 0.1 mg/kg/hour ) from induction of anesthesia to emergence from anesthesia ; and ( 2 ) control group , in which the patients received saline infusion from induction up till emergence from anesthesia .


Anesthesia was induced and maintained by target-controlled infusion of propofol ( estimated blood concentration : 2-4 g/mL ) and infusion of remifentanil , at 0.2-0 .3 g/kg/minute .


Patients were observed for shivering from the end of anesthesia to 120 minutes after anesthesia .


The time point at which the patient began to shiver was recorded and assigned to one of four time periods : at emergence , from emergence to 30 minutes after anesthesia , from 30 minutes to 60 minutes after anesthesia , and > 60 minutes after anesthesia .


During the 120-minute observation period , the number of patients who shivered was higher in the ketamine group than the in control group ( 18 vs. 8 , ketamine group vs. control group , p = 0.01 ) .


The time period during which patients began to shiver was different between the two groups ( 1 patient , 4 patients , and 13 patients vs. 3 patients , 2 patients , and 3 patients at emergence , from emergence to 30 minutes , and from 30 minutes to 60 minutes after anesthesia , respectively ; ketamine group vs. control group , p = 0.007 ) .


Intraoperative infusion of very low-dose ketamine during remifentanil-based anesthesia may increase the incidence of postoperative shivering .


We assessed whether a brief alcohol intervention would lead to reduced alcohol use and sexually transmitted infection ( STI ) / HIV incidence and related sexual risk behaviors among moderate drinking female sex workers .


A randomized controlled intervention trial was conducted with 818 female sex workers affiliated with the AIDS , Population , Health , and Integrated Assistance II project in Mombasa , Kenya .


Eligible women were hazardous or harmful drinkers who scored between 7 and 19 ( full range , 1-40 ) on the Alcohol Use Disorders Identification Test .


Intervention participants received 6 counseling sessions approximately monthly .


The equal-attention control group received 6 nutrition sessions .


Participants were followed for 6 and 12 months after the intervention , with at least 86 % retention at both time points .


We used general linear models in intention-to-treat analyses , adjusting for recruitment setting and HIV status at enrollment .


There was a statistically significant reduction in alcohol use and binge drinking at 6 and 12 months , with intervention participants reporting less than one third of the odds of higher levels of drinking than the control group .


The intervention did not impact laboratory-confirmed STI/HIV incidence , self-reported condom use , or sexual violence from nonpaying partners .


However , the odds of reporting sexual violence from clients was significantly lower among intervention than control participants at both 6 and 12 months .


We found that a brief alcohol intervention can reduce self-reported alcohol consumption among a nondependent and non-treatment-seeking population most at risk for HIV .


More attention is needed to understand the pathway from drinking to sexual behavior and STI/HIV acquisition .


WHO recommends referral to hospital for possible serious bacterial infection in young infants aged 0-59 days .


We aimed to assess whether oral amoxicillin treatment for fast breathing , in the absence of other signs , is as efficacious as the combination of injectable procaine benzylpenicillin-gentamicin .


In a randomised , open-label , equivalence trial at five sites in DR Congo , Kenya , and Nigeria , community health workers followed up all births in the community , identified unwell young infants , and referred them to study nurses .


We randomly assigned infants with fast breathing as a single sign of illness or possible serious bacterial infection , whose parents did not accept referral to hospital , to receive either injectable procaine benzylpenicillin-gentamicin once per day or oral amoxicillin treatment twice per day for 7 days .


A person who was off-site generated randomisation lists using computer software .


Trained health professionals gave injections , but outcome assessors were masked to group allocations .


The primary outcome was treatment failure by day 8 after enrolment , defined as clinical deterioration , development of a serious adverse event including death , persistence of fast breathing on day 4 , or recurrence up to day 8 .


The primary analysis was per protocol and we used a prespecified similarity margin of 5 % to assess equivalence between regimens .


This study is registered with the Australian New Zealand Clinical Trials Registry , number ACTRN12610000286044 .


From April 4 , 2011 , to March 29 , 2013 , we enrolled 2333 infants aged 0-59 days with fast breathing as the only sign of possible serious bacterial infection at the five study sites .


We assigned 1170 infants to receive injectable procaine benzylpenicillin-gentamicin and 1163 infants to receive oral amoxicillin .


In the per-protocol analysis , from which 137 infants were excluded , we included 1061 ( 91 % ) infants who fulfilled predefined criteria of adherence to treatment and adequate follow-up in the injectable procaine benzylpenicillin-gentamicin group and 1145 ( 98 % ) infants in the oral amoxicillin group .


In the procaine benzylpenicillin-gentamicin group , 234 infants ( 22 % ) failed treatment , compared with 221 ( 19 % ) infants in the oral amoxicillin group ( risk difference -26 % , 95 % CI -60 to 08 ) .


Four infants died within 15 days of follow-up in each group .


We detected no drug-related serious adverse events .


Young infants with fast breathing alone can be effectively treated with oral amoxicillin on an outpatient basis when referral to a hospital is not possible .


Bill & Melinda Gates Foundation grant to WHO .


To analyze the impact of weight loss before and during chemoradiation on survival outcomes in patients with locally advanced head and neck cancer .


From 07/1994 -07 / 2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiation therapy alone or the same radiation therapy combined with two cycles of concomitant cisplatin .


The primary endpoint was time to any treatment failure ( TTF ) ; secondary endpoints were locoregional recurrence-free survival ( LRRFS ) , distant metastasis-free survival ( DMFS ) and overall survival ( OS ) .


Patient weight was measured 6 months before treatment , at treatment start and treatment end .


The proportion of patients with > 5 % weight loss was 32 % before , and 51 % during treatment , and the proportion of patients with > 10 % weight loss was 12 % before , and 17 % during treatment .


After a median follow-up of 9.5 years ( range , 0.1 - 15.4 years ) weight loss before treatment was associated with decreased TTF , LRRFS , DMFS , cancer specific survival and OS in a multivariable analysis .


However , weight loss during treatment was not associated with survival outcomes .


Weight loss before and during chemoradiation was commonly observed .


Weight loss before but not during treatment was associated with worse survival .


To compare the effects of sprint training with or without ball carry on the sprint performance of elite rugby league players .


Twenty-four elite rugby league players were divided into a ball-carry group ( BC ; n = 12 ) and a no-ball-carry group ( NBC ; n = 12 ) .


The players of the BC group were required to catch and carry the ball under 1 arm during each sprint , whereas the NBC group performed sprints without carrying a ball .


The 8-wk training intervention took place during the precompetitive phase of the season and consisted of 2 sessions/wk .


Sprint performance was measured before and after the training intervention with 40-m linear sprints performed under 2 conditions : with and without ball carry .


Split times of 10 , 20 , and 40 m were recorded for further analysis .


A 3-way ( group time condition ) factorial ANOVA was performed to compare changes in sprint performance with and without the ball , before and after the training intervention for both BC and NBC training groups Results : The BC and NBC groups experienced similar improvements in 10 - , 20 - , and 40-m sprint times and accelerations , regardless of the condition under which the sprint tests were performed ( P = .19 ) .


Sprint training while carrying a rugby ball is as effective as sprint training without carrying a rugby ball for improving the sprint performance of elite rugby league players .


ADHD affects between 2 % and 8 % of college students and is associated with broad functional impairment .


No prior randomized controlled trials with this population have been published .


The present study is a pilot randomized controlled trial evaluating dialectical behavior therapy ( DBT ) group skills training adapted for college students with ADHD .


Thirty-three undergraduates with ADHD between ages 18 and 24 were randomized to receive either DBT group skills training or skills handouts during an 8-week intervention phase .


ADHD symptoms , executive functioning ( EF ) , and related outcomes were assessed at baseline , post-treatment , and 3-month follow-up .


Participants receiving DBT group skills training showed greater treatment response rates ( 59-65 % vs. 19-25 % ) and clinical recovery rates ( 53-59 % vs. 6-13 % ) on ADHD symptoms and EF , and greater improvements in quality of life .


DBT group skills training may be efficacious , acceptable , and feasible for treating ADHD among college students .


A larger randomized trial is needed for further evaluation .


The Respiratory Infections in Andean Peruvian Children ( RESPIRA-PERU ) study enrolled children who participated in a community-cluster randomized trial of improved stoves , solar water disinfection , and kitchen sinks ( IHIP trial ) and children from additional Andean households .


We quantified the burden of influenza-associated acute respiratory illness ( ARI ) in this household-based cohort .


From May 2009 to September 2011 , we conducted active weekly ARI surveillance in 892 children age < 3 years , of whom 272 ( 30.5 % ) had participated in the IHIP trial .


We collected nasal swabs during ARI , tested for influenza and other respiratory viruses by RT-PCR , and determined influenza incidence and risk factors using mixed-effects regression models .


The overall incidence of influenza-associated ARI was 36.6 / 100 child-years ; incidence of influenza A , B , and C was 20.5 , 8.7 , and 5.2 / 100 child-years , respectively .


Influenza C was associated with fewer days of subjective fever ( median 1 vs. 2 ) and malaise ( median 0 vs. 2 ) compared to influenza A. Non-influenza ARI also resulted in fewer days of fever and malaise , and fewer healthcare visits than influenza A-associated ARI .


Influenza incidence varied by calendar year ( 80 % occurred in the 2010 season ) and IHIP trial participation .


Among households that participated in the IHIP trial , influenza-associated ARI incidence was significantly lower in intervention than in control households ( RR 0.40 , 95 % CI : 0.20-0 .82 ) .


Influenza burden is high among Andean children .


ARI associated with influenza A and B had longer symptom duration and higher healthcare utilization than influenza C-associated ARI or non-influenza ARI .


Environmental community interventions may reduce influenza morbidity .


Traffic-related air pollution may contribute to cardiovascular morbidity .


In urban areas , exposures during physical activity are of interest owing to increased breathing rates and close proximity to vehicle emissions .


We conducted a cross-over study among 53 healthy non-smoking women in Montreal , Canada during the summer of 2013 .


Women were exposed to traffic pollutants for 2-hours on three separate occasions during cycling on high and low-traffic routes as well as indoors .


Personal air pollution exposures ( PM ( 2.5 ) , ultrafine particles ( UFP ) , black carbon , NO , and O ) were evaluated along each route and linear mixed-effects models with random subject intercepts were used to estimate the impact of air pollutants on acute changes in blood pressure , heart rate variability , and micro-vascular function in the hours immediately following exposure .


Single and multi-pollutant models were examined and potential effect modification by mean regional air pollution concentrations ( PM ( 2.5 ) , NO , and O ) was explored for the 24-hour and 5-day periods preceding exposure .


In total , 143 exposure routes were completed .


Each interquartile increase ( 10,850 / cm ) in UFP exposure was associated with a 4.91 % ( 95 % CI : -9.31 , -0.512 ) decrease in reactive hyperemia index ( a measure of micro-vascular function ) and each 24 ppb increase in O exposure corresponded to a 2.49 % ( 95 % CI : 0.141 , 4.84 ) increase in systolic blood pressure and a 3.26 % ( 95 % CI : 0.0117 , 6.51 ) increase in diastolic blood pressure 3-hours after exposure .


Personal exposure to PM ( 2.5 ) was associated with decreases in HRV measures reflecting parasympathetic modulation of the heart and regional PM ( 2.5 ) concentrations modified these relationships ( p < 0.05 ) .


In particular , stronger inverse associations were observed when regional PM ( 2.5 ) was higher on the days prior to the study period .


Regional PM ( 2.5 ) also modified the impact of personal O on the standard deviation of normal to normal intervals ( SDNN ) ( p < 0.05 ) : a significant inverse relationship was observed when regional PM ( 2.5 ) was low prior to study periods and a significant positive relationship was observed when regional PM ( 2.5 ) was high .


Exposure to traffic pollution may contribute to acute changes in blood pressure , autonomic and micro-vascular function in women .


Regional air pollution concentrations may modify the impact of these exposures on autonomic function .


This trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure ( HF ) rehospitalization or death .


HF patients ( n = 198 ) were randomly assigned to standard care or standard care plus multidisciplinary group clinics .


The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6 , where multidisciplinary professionals engaged patients in HF self-management skills .


Data were collected prospectively for 12 months beginning after completion of the first 4 group clinic appointments ( 2 months post randomization ) .


The intervention was associated with greater adherence to recommended vasodilators ( P = 0.04 ) .


The primary outcome ( first HF-related hospitalization or death ) was experienced by 22 ( 24 % ) in the intervention group and 30 ( 28 % ) in standard care .


The total HF-related hospitalizations , including repeat hospitalizations after the first time , were 28 in the intervention group and 45 among those receiving standard care .


The effects of treatment on rehospitalization varied significantly over time .


From 2 to 7 months post randomization , there was a significantly longer hospitalization-free time in the intervention group ( Cox proportional hazard ratio = 0.45 ( 95 % confidence interval , 0.21-0 .98 ; P = 0.04 ) .


No significant difference between groups was found from month 8 to 12 ( hazard ratio = 1.7 ; 95 % confidence interval , 0.7-4 .1 ) .


Multidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway .


Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits .


http://www.clinicaltrials.gov .


Unique identifier : NCT00439842 .


Racotumomab-alum is an anti-idiotype vaccine targeting the NeuGcGM3 tumor-associated ganglioside .


This clinical trial was conducted to provide a preliminary estimate of efficacy and safety of racotumomab as switch maintenance for patients with advanced non-small cell lung cancer ( NSCLC ) .


Patients with stage IIIb/IV NSCLC who have at least stable disease after first-line chemotherapy were randomized 1:1 to racotumomab-alum ( 5 immunizations every 2 weeks and re-immunizations every 4 weeks ) or placebo .


Treatment was administered beyond progressive disease , until severe performance status worsening or toxicity .


At progression , only five patients per group received further anticancer therapy .


The primary endpoint was overall survival ( OS ) .


One-hundred and seventy-six patients were randomized to racotumomab-alum ( n = 87 ) and placebo ( n = 89 ) .


Median OS was 8.23 and 6.80 months , respectively [ HR , 0.63 ; 95 % confidence interval ( CI ) , 0.46-0 .87 ; P = 0.004 ] .


Median progression-free survival ( PFS ) in vaccinated patients was 5.33 versus 3.90 months for placebo ( HR , 0.73 ; 95 % CI 0.53-0 .99 ; P = 0.039 ) .


The most common adverse events in the racotumomab-alum arm were burning and pain at the injection site , bone pain , and asthenia .


A high antibody response of IgM and IgG isotype against the NeuGcGM3 ganglioside was obtained .


Hyperimmune sera were able to specifically recognize and kill the NeuGcGM3-expressing L1210 cell line .


Patients who developed anti-NeuGcGM3 antibodies capable to bind and kill 30 % L1210 cells showed longer median survival times .


Switch maintenance with racotumomab-alum is an effective and a well-tolerated treatment option for patients with advanced NSCLC .


Patients with kidney disease have disordered bone and mineral metabolism , including elevated serum concentrations of fibroblast growth factor-23 ( FGF23 ) .


These elevated concentrations are associated with cardiovascular and all-cause mortality .


The objective was to determine the effects of the calcimimetic cinacalcet ( versus placebo ) on reducing serum FGF23 and whether changes in FGF23 are associated with death and cardiovascular events .


This was a secondary analysis of a randomized clinical trial comparing cinacalcet to placebo in addition to conventional therapy ( phosphate binders/vitamin D ) in patients receiving hemodialysis with secondary hyperparathyroidism ( intact parathyroid hormone 300 pg/mL ) .


The primary study end point was time to death or a first nonfatal cardiovascular event ( myocardial infarction , hospitalization for angina , heart failure , or a peripheral vascular event ) .


This analysis included 2985 patients ( 77 % of randomized ) with serum samples at baseline and 2602 patients ( 67 % ) with samples at both baseline and week 20 .


The results demonstrated that a significantly larger proportion of patients randomized to cinacalcet had 30 % ( 68 % versus 28 % ) reductions in FGF23 .


Among patients randomized to cinacalcet , a 30 % reduction in FGF23 between baseline and week 20 was associated with a nominally significant reduction in the primary composite end point ( relative hazard , 0.82 ; 95 % confidence interval , 0.69-0 .98 ) , cardiovascular mortality ( relative hazard , 0.66 ; 95 % confidence interval , 0.50-0 .87 ) , sudden cardiac death ( relative hazard , 0.57 ; 95 % confidence interval , 0.37-0 .86 ) , and heart failure ( relative hazard , 0.69 ; 95 % confidence interval , 0.48-0 .99 ) .


Treatment with cinacalcet significantly lowers serum FGF23 .


Treatment-induced reductions in serum FGF23 are associated with lower rates of cardiovascular death and major cardiovascular events .


URL : http://www.clinicaltrials.gov .


Unique identifier : NCT00345839 .


To determine whether demographic or clinical factors are associated with the outcome of office-based nasolacrimal duct probing for the treatment of congenital nasolacrimal duct obstruction ( NLDO ) .


In two multicenter prospective studies , 384 eyes of 304 children aged 6 to < 15 months with NLDO underwent a nasolacrimal duct probing performed in the office using topical anesthesia .


Treatment success , defined as no clinical signs of NLDO ( epiphora , increased tear lake , or mucous discharge ) and no reoperation , was assessed 1 month after probing in one study and 6 months after probing in the other study .


Data from both studies were pooled to evaluate associations between baseline characteristics and treatment success .


Office probing was successful in 75 % of eyes overall ( 95 % CI , 70 % -80 % ) .


The procedure was less successful in eyes of children with bilateral NLDO compared with unilateral NLDO ( 63 % vs 80 % ; relative risk = 0.78 [ 95 % CI , 0.66-0 .92 ] ) and in eyes that had 2 or 3 clinical signs of NLDO compared with one ( 71 % vs 83 % ; relative risk = 0.88 [ 95 % CI , 0.81-0 .96 ] ) .


Treatment success did not appear to be related to age , specific clinical signs of NLDO , prior treatment , or research study .


Performing nasolacrimal duct probing in the office successfully treats NLDO in the majority of cases in children aged 6 to < 15 months .


The success rate is lower with bilateral disease or when more than one clinical sign of NLDO is present .


Allergic rhinitis ( AR ) is caused by an IgE-mediated inflammatory reaction consequent to the exposure to causal allergen .


Resveratrol is a natural non-flavonoid polyphenol , exerting anti-inflammatory activity ; - glucan is a polysaccharide with immuno-modulatory properties .


Thus , this study aimed to investigate whether these combined compounds are able of relieving nasal symptoms in children with AR due to pollen allergy .


The present study was conducted as placebo-controlled , double-blinded , and randomized .


Globally , 68 children ( 36 males ; mean age 7.9 years ) were treated with resveratrol plus - glucan or placebo ( the diluent of active drug ) two sprays ( 100L/spray ) in each nostril three times/day for 2 months .


Nasal symptoms , including itching , sneezing , rhinorrhea , and obstruction , were assessed at baseline and after treatment .


Use of rescue medication , such as cetirizine syrup , was also evaluated .


ClinicalTrials.gov ID NCT02130440 .


Children treated with active drug achieved a significant reduction in all nasal symptoms : itching ( p = 0.0001 ) , sneezing ( p = 0.0009 ) , rhinorrhea ( p = 0.009 ) , and obstruction ( 0.002 ) as well as antihistamine use ( p = 0.003 ) .


Placebo did not affect nasal complaints and cetirizine use .


The intergroup analysis showed that active treatment was significantly superior to placebo about reduction of AR symptoms and rescue medication use .


The present preliminary study firstly showed that intranasal resveratrol plus carboxymethyl -- glucan is capable of significantly improving nasal symptoms in children with pollen-induced AR .


To compare 4 analgesic protocols in dogs undergoing stifle joint surgery .


Randomized , blinded , prospective clinical trial .


Animals-48 client-owned dogs that underwent stifle joint surgery .


Dogs undergoing tibial plateau leveling osteotomy were randomly assigned to receive a constant rate infusion of a combination of morphine , lidocaine , and ketamine ; a lumbosacral epidural with morphine and ropivacaine ; both treatments ( ie , constant rate infusion and lumbosacral epidural ) ; or only IM premedication with morphine .


Indices of cardiorespiratory function and isoflurane requirement were recorded at 5-minute intervals during anesthesia .


A validated sedation scoring system and the modified Glasgow composite measure pain score were used to assess comfort and sedation after surgery and anesthesia once the swallowing reflex returned and a body temperature of 36.7 C ( 98.1 F ) was attained .


Pain and sedation scores were acquired at 60-minute intervals for 4 hours , then at 4-hour intervals for 24 hours .


Dogs with a postoperative pain score > 5 of 24 were given morphine as rescue analgesia .


No differences in heart rate , respiratory rate , systolic arterial blood pressure , end-tidal Pco2 , end-tidal isoflurane concentration , and vaporizer setting were detected among groups .


No differences in pain score , sedation score , rescue analgesia requirement , or time to first rescue analgesia after surgery were detected .


Pain scores were similar among groups , and all 4 groups had similar rescue analgesia requirements and similar times to first administration of rescue analgesia .


All 4 analgesic protocols provided acceptable analgesia for 24 hours after stifle joint surgery .


The purpose of this study was to investigate the efficacy of a 1440-nm neodymium : yttrium-aluminum-garnet ( Nd : YAG ) laser on relieving pain in relation to the levels of inflammatory cytokine and neuropeptides in the root canal exudates of teeth with persistent symptomatic apical periodontitis .


Forty teeth with persistent symptomatic apical periodontitis were randomly assigned to treatment groups : group L , intracanal irradiation of 1440-nm Nd : YAG laser with a 300-m-diameter fiberoptic tip in addition to conventional root canal retreatment , and group C , conventional root canal re-treatment .


The degrees of both spontaneous pain and the pain on percussion before and after treatment were recorded , and root canal exudate samples were collected to quantify the associated levels of substance P , calcitonin gene-related peptide ( CGRP ) , and matrix metalloproteinase ( MMP ) -8 by immunoassay .


All of the measured parameters were significantly reduced in group L ( P < .05 ) , whereas the level of pain on percussion , CGRP , and MMP-8 were significantly reduced in group C ( P < .05 ) .


The 1440-nm Nd : YAG laser had significantly better effect on the relief of pain on percussion and the reduction of substance P , CGRP , and MMP-8 levels .


The visual analog scale scores of perceived pain correlated with pain-related neuropeptides and inflammatory cytokine levels in root canal exudates .


The 1440-nm Nd : YAG laser irradiation via fiberoptic tip to the teeth with persistent apical periodontitis provided promising consequences of pain and inflammation modulation .


Improving the treatment of advanced peritonitis via use in therapy antihypoxant Reamberin and hepatoprotector Remaxol , nutritional support , sanitation laparoscopic abdominal cavity .


A total of 232 children aged 1 to 15 years with generalized purulent peritonitis treated at the children 's surgical departments of Samara from 2001 to 2014 .


A study group comprised 148 patients who used the optimized pathogenetic therapy .


In the study group was allocated two groups : 64 patients in the pathogenetic therapy that used antihypoxant reamberin , and 84 children in the treatment of which reamberin and hepatoprotector remaxol .


All the children of the main group received nutritional support ( trophic feedings ) , used in the surgical treatment of abdominal laparoscopic sanitation .


Comprehensive survey includes the study of the dynamics of the level of white blood cells , leukocyte index on Kalf-Caliph , erythrocyte sedimentation rate , temperature , total albumin concentration , transaminase levels .