This study was not able to evaluate the causal role of anxiety in meal intake among individuals with AN , as alprazolam did not alter anxiety symptoms .


These data further suggest that the therapeutic role for short-acting benzodiazepines in AN is likely limited .


Elevating the torso in a Head Elevated Ramped Position during caesarean delivery benefits the mother by improving comfort and ventilation while reducing reflux symptoms and providing a better airway position .


We hypothesised that using an elevation pillow for an elective caesarean delivery under combined spinal-epidural anaesthesia would not significantly increase the time to achieve a T4 block .


Following ethical approval and informed consent , 60 women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomised to one of three groups : Control - horizontal with a small pillow under the head ; Head Elevated Ramped Position - torso on an elevation pillow ; and Head Elevated Ramped Position with initial position horizontal .


Data collected were time to T4 , block height at 30 and 120 min , adequate block at 12 min , need for epidural supplementation , maternal comfort and airway position assessment .


Time to T4 among the three groups was not significantly different ( P = 0.14 ) .


However , there was a significant difference in achievement of block height of T4 at 12 min and greater need for epidural supplementation in the intervention groups compared to the control group ( P = 0.021 ) .


Non-inferiority analyses of time to T4 of both head elevated ramped positions were inconclusive about inferiority relative to the control .


Head Elevated Ramped Position was significantly more comfortable than control ( P = 0.007 ) .


Using the level of the external auditory meatus to the sternal notch as an indicator for ease of laryngoscopy , Head Elevated Ramped Position provided a significantly better position than control ( P < 0.001 ) .


Elevating the parturient undergoing elective caesarean delivery into the Head Elevated Ramped Position immediately or once the block had been established did not appear to significantly alter time to an adequate block height of T4 ; however , the need for epidural supplementation was greater in the intervention groups .


Cautious use of this novel position change can provide a more comfortable experience and provide a better airway position should conversion to general anaesthesia be required .


To observe the effect of pressing auricular points on myopia in children .


Myopic children aged 8-9 years were divided into two groups .


The Chinese herb Semen Vaccariae was used to stimulate the auricular points of CO10 , LO5 , TF4 , CO15 , CO12 , and CO13 for three treatment courses for the experimental group ( n = 39 ) , while the same therapy was not given to the control group ( n = 33 ) .


Binocular naked vision of the experimental group and the control group before and after the intervention was measured using a standard E visual.acuity chart .


There was no difference in the binocular naked vision between the experimental group and the control group before the intervention .


In contrast , there was significant improvement in binocular naked vision in the experimental group after the intervention compared with the control group ( P < 0.05 ) .


When combined with external medical application , non-invasive auricular therapy could improve the function of myopia in children .


Auricular pressing was well received by the children .


To study compliance to treatment and effectiveness of therapy in patients with axial spondyloarthritis ( ax-SpA ) in different observational regimes .


168 patients without TNF - therapy and BASDAI 4 were randomized into 3 groups .


96 of them were observed in a traditional manner , 26 visited a rheumatologist every 12 weeks , and 46 were counseled by phone once in 4 weeks .


In all these cases , rheumatologists collected data on the activity of the disease ( BASDAI , ASDAS , PASS , etc. ) and the effectiveness of therapy .


BASDAI in group 1 was 5.32 3.2 initially and 5.17 2.16 one year after onset of the study , ASDAS 3.45 2.1 and 3.1 1.1 respectively ( p > 0.05 ) .


In group 2 , BASDAI values were 5.21 3.0 and 4.77 2.2 ; ASDAS 3.42 2.9 and 2.79 2.6 respectively .


In group 3 , BASDAI values were 5.32 3.2 and 3.17 2.12 ; ASDAS 3.44 3.1 and 2.6 1.8 ; p < 0.05 for the differences between initial and subsequent values in groups 2 and 3 and final values for all groups .


Positive PASS was reached in 15 patients ( 57.69 % , n = 26 ) of group 3 , in 4 ones ( 20 % , n = 20 ) of group 2 , and in 0 ( 0 % ) patients of group 1 .


Five ( 19.23 % ) , 15 ( 75 % ) and 93 ( 96.87 % ) patients in groups 1 , 2 and 3 respectively wilfully ceased to take NSAID .


96 ( 100 % ) , 19 ( 95 % ) and 3 ( 11.5 % ) patients of these groups stated that they needed hospitalization .


Telephone monitoring of ax-SpA activity once in every 4 weeks revealed a better compliance with the treatment and results of therapy than active observation every 12 weeks or arbitrary monitoring .


To test different forms of private insurance coverage as mediators for racial disparities in onset , persistent level , and acceleration of functional limitations among Medicare age-eligible Americans .


Data come from 7 waves of the Health and Retirement Study ( 1996-2008 ) .


Onset and progression latent growth models were used to estimate racial differences in onset , level , and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996 .


Employer-provided insurance , spousal insurance , and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations .


In baseline models , African Americans had larger persistent level of limitations over time .


Although employer-provided , spousal provided , and market insurances were directly associated with lower persistent levels of limitation , only differences in market insurance accounted for the racial disparities in persistent level of limitations .


Results suggest private insurance is important for reducing functional limitations , but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans .


Ensuring adherence to treatment and retention is important in clinical trials , particularly in remote areas and minority groups .


We describe a novel approach to improve adherence , retention and clinical review rates of Indigenous children .


This descriptive study was nested within a placebo-controlled , randomised trial ( RCT ) on weekly azithromycin ( or placebo ) for 3-weeks .


Indigenous children aged 24-months hospitalised with acute bronchiolitis were recruited from two tertiary hospitals in northern Australia ( Darwin and Townsville ) .


Using mobile phones embedded within a culturally-sensitive approach and framework , we report our strategies used and results obtained .


Our main outcome measure was rates of adherence to medications , retention in the RCT and self-presentation ( with child ) to clinic for a clinical review on day-21 .


Of 301 eligible children , 76 ( 21 % ) families declined participation and 39 ( 13 % ) did not have access to a mobile phone .


186 Indigenous children were randomised and received dose one under supervision in hospital .


Subsequently , 182 ( 99 % ) children received dose two ( day-7 ) , 169 ( 93 % ) dose three ( day-14 ) and 180 ( 97 % ) attended their clinical review ( day-21 ) .


A median of 2 calls ( IQR 1-3 ) were needed to verify adherence .


Importantly , over 97 % of children remained in the RCT until their clinical endpoint at day-21 .


In our setting , the use of mobile phones within an Indigenous-appropriate framework has been an effective strategy to support a clinical trial involving Australian Indigenous children in urban and remote Australia .


Further research is required to explore other applications of this approach , including the impact on clinical outcomes .


ACTRN12608000150347 ( RCT component ) .


CD5 + B cells have been conceptualized as a possible surrogate for Breg cells .


The aim of the present study was to determine the utility of CD5 + B cells as biomarkers in antineutrophil cytoplasmic antibody-associated vasculitis ( AAV ) .


The absolute and relative numbers ( percentages ) of CD5 + B cells ( explanatory variables ) were measured longitudinally during 18 months in 197 patients randomized to receive either rituximab ( RTX ) or cyclophosphamide ( CYC ) followed by azathioprine ( AZA ) for the treatment of AAV ( Rituximab in ANCA-Associated Vasculitis [ RAVE ] trial ) .


Outcome variables included disease activity ( status of active disease versus complete remission ) , responsiveness to induction therapy , disease relapse , disease severity , and , in RTX-treated patients , relapse-free survival according to the percentage of CD5 + B cells detected upon B cell repopulation .


CD5 + B cell numbers were comparable between the treatment groups at baseline .


After an initial decline , absolute CD5 + B cell numbers progressively increased in patients in the RTX treatment arm , but remained low in CYC/AZA-treated patients .


In both groups , the percentage of CD5 + B cells increased during remission induction and slowly declined thereafter .


During relapse , the percentage of CD5 + B cells correlated inversely with disease activity in RTX-treated patients , but not in patients who received CYC/AZA .


No significant association was observed between the numbers of CD5 + B cells and induction treatment failure or disease severity .


The dynamics of the CD5 + B cell compartment did not anticipate disease relapse .


Following B cell repopulation , the percentage of CD5 + B cells was not predictive of time to flare in RTX-treated patients .


The percentage of peripheral CD5 + B cells might reflect disease activity in RTX-treated patients .


However , sole staining for CD5 as a putative surrogate marker for Breg cells did not identify a subpopulation of B cells with clear potential for meaningful clinical use .


Adequate phenotyping of Breg cells is required to further explore the value of these cells as biomarkers in AAV .


Hazelnut allergy in adults is often birch pollen related , whereas in children , non-pollen-related hazelnut allergy is more frequent .


To compare the differences in hazelnut allergy between children and adults with regard to severity , aetiology and diagnostic value of routinely available data .


Adults ( n = 120 ) who underwent a double-blind placebo-controlled food challenge ( DBPCFC ) for hazelnut were selected and compared to 151 hazelnut-challenged children from a previous study .


Univariate and multivariate logistic regression analyses were performed to build a prediction model .


The area under the curve ( AUC ) of the ROC curve was determined for level of hazelnut-specific IgE , skin prick test ( SPT ) and the prediction model .


Hazelnut allergy was confirmed by DBPCFC in 95/120 ( 79 % ) adults , 77 % had only subjective and 23 % objective symptoms , whereas in children , 63 % had objective symptoms to hazelnut .


Within the group of children , the frequency of severe hazelnut allergy was higher in younger than in older children .


A concomitant birch pollen allergy was more common in adults ( 82 % ) than in children ( 39 % ) with a hazelnut allergy .


A detailed history with allergic symptoms to previous ingestion of hazelnut had the highest diagnostic value in adults , while in children , SPT to hazelnut extract showed the highest level of discrimination between clinical reactivity and tolerance to hazelnut .


Hazelnut allergy differs between children and adults with respect to frequency of severity , aetiology and relevance of diagnostic parameters .


Therefore , age has to be taken into account in the diagnostic work-up of a hazelnut allergy .


Assisted living ( AL ) residents are at risk for cognitive and functional declines that eventually reduce their ability to care for themselves , thereby triggering nursing home placement .


In developing a method to slow this decline , the efficacy of Reasoning Exercises in Assisted Living ( REAL ) , a cognitive training intervention that teaches everyday reasoning and problem-solving skills to AL residents , was tested .


At thirteen randomized Midwestern facilities , AL residents whose Mini Mental State Examination scores ranged from 19-29 either were trained in REAL or a vitamin education attention control program or received no treatment at all .


For 3 weeks , treated groups received personal training in their respective programs .


Scores on the Every Day Problems Test for Cognitively Challenged Elders ( EPCCE ) and on the Direct Assessment of Functional Status ( DAFS ) showed significant increases only for the REAL group .


For EPCCE , change from baseline immediately postintervention was +3.10 ( P < 0.01 ) , and there was significant retention at the 3-month follow-up ( d = 2.71 ; P < 0.01 ) .


For DAFS , change from baseline immediately postintervention was +3.52 ( P < 0.001 ) , although retention was not as strong .


Neither the attention nor the no-treatment control groups had significant gains immediately postintervention or at follow-up assessments .


Post hoc across-group comparison of baseline change also highlights the benefits of REAL training .


For EPCCE , the magnitude of gain was significantly larger in the REAL group versus the no-treatment control group immediately postintervention ( d = 3.82 ; P < 0.01 ) and at the 3-month follow-up ( d = 3.80 ; P < 0.01 ) .


For DAFS , gain magnitude immediately postintervention for REAL was significantly greater compared with in the attention control group ( d = 4.73 ; P < 0.01 ) .


REAL improves skills in everyday problem solving , which may allow AL residents to maintain self-care and extend AL residency .


This benefit is particularly important given the growing population of AL residents at risk for cognitive and self-care decline .


We sought to investigate the clinical relevance of neuroforaminal patency and facet degeneration one year after anterior cervical discectomy and fusion ( ACDF ) .


Previous studies were characterized by imprecise techniques and fragmentary measurements , and most lacked reliable clinical data and correlation analyses .


Patients with cervical mono - or bi-level degenerative pathology were prospectively included .


Neuroforaminal size and segmental height were determined quantitatively , and the degree of facet degeneration was assessed qualitatively before and one year after the operation , by computed tomography .


Clinical data , such as the severity of neck and arm pain , were assessed on a visual analogue scale ( VAS ) from 0 to 10 , and neck disability index ( NDI ) was recorded before and one year after the operation .


Their correlation with radiological data was investigated .


Seventy-nine patients aged 53.311.3 years were included .


One year after surgery , median VAS pain intensity was still significantly improved ( neck , from 5 to 1 ; right arm , from 2 to 1 ; left arm , from 4 to 1 ) as was NDI ( from 40 to 20 ) .


Neuroforaminal size showed a reduction on both sides ( left , 0.02890.09 cm ( 2 ) ; right , 0.01490.08 cm ( 2 ) ) .


One year after the operation , segmental height decreased and facet degeneration increased from measures taken before the operation .


No correlations were found between neuroforaminal stenosis or the degree of facet degeneration and various clinical outcome parameters .


The decrease in segmental height one year after ACDF leads in turn to secondary neuroforaminal stenosis and progressive facet degeneration .


Of the various neuroforaminal variables used , none revealed a threshold value indicative of the presence or severity of radicular arm pain .


This absence of correlation between imaging and clinical information is important and should be considered when allocating patients for surgical interventions .


Inclusion in trials is selective , and thus results may not be generalizable to the general population .


The aim of this study was to investigate the external validity of randomized clinical trial outcomes for elderly breast cancer patients .


We compared characteristics and outcomes of breast cancer patients ( n = 1325 ) who participated in a randomized clinical trial ( Tamoxifen Exemestane Adjuvant Multinational trial ) with unselected breast cancer patients of corresponding age from the general population ( n = 1056 ) .


Dutch patients aged 65 years or older at diagnosis of hormone receptor-positive breast cancer without distant metastases , with either nodal involvement , a tumor greater than 3cm , or a 1 to 3cm histological grade III tumor , who completed local therapy were included .


Analyses were stratified by age ( 65-74 years ; 75 years ) .


Primary outcome was overall mortality .


Multivariable Cox proportional hazards models were used to assess the association between covariables and overall mortality .


All statistical tests were two-sided .


Irrespective of age , patients who participated in the trial had fewer comorbid diseases , a higher socioeconomic status , and smaller tumors ( all P < .001 ) .


In patients aged 65 to 74 years , those who participated in the trial had a similar overall mortality to patients from the general population ( multivariable hazard ratio [ HR ] = 1.08 ; 95 % confidence interval [ CI ] = 0.73 to 1.60 ) .


Alternatively , in patients aged 75 years or older , those who participated in the trial had a lower overall mortality ( multivariable HR = 0.72 ; 95 % CI = 0.55 to 0.95 ; P = .02 ) than patients in the general population .


Breast cancer trial participants aged 75 years or older do not represent elderly breast cancer patients of corresponding age from the general population , which hampers the external validity of a trial .


We previously developed and piloted a telephone-based intimacy enhancement ( IE ) intervention addressing sexual concerns of colorectal cancer patients and their partners in an uncontrolled study .


The current study tested the feasibility , acceptability , and preliminary efficacy of the IE intervention in a randomized , controlled trial .


Twenty-three couples were randomized to either the four-session IE condition or to a wait list control condition and completed sexual and relationship outcomes measures .


The IE intervention teaches skills for coping with sexual concerns and improving intimacy .


Feasibility and acceptability were assessed through enrollment and post-treatment program evaluations , respectively .


Effect sizes were calculated by comparing differences in average pre/post change scores across completers in the two groups ( n = 18 couples ) .


Recruitment and attrition data supported feasibility .


Program evaluations for process ( e.g. , ease of participation ) and content ( e.g. , relevance ) demonstrated acceptability .


Engaging in intimacy-building activities and communication were the skills rated as most commonly practiced and most helpful .


For patients , positive effects of the IE intervention were found for female and male sexual function , medical impact on sexual function , and self-efficacy for enjoying intimacy ( .58 ) ; no effects were found on sexual distress or intimacy and small negative effects for sexual communication , and two self-efficacy items .


For partners , positive IE effects were found for all outcomes ; the largest were for sexual distress ( .69 ) , male sexual function ( 1.76 ) , communication ( .97 ) , and two self-efficacy items ( .87 ) .


The telephone-based IE intervention shows promise for couples facing colorectal cancer .


Larger multi-site intervention studies are necessary to replicate findings .


Mobility assessment in Multiple Sclerosis ( MS ) is crucial for trials and individual patient counseling .


Up to now , standard tests as the Timed 25-Foot Walk ( T25FW ) are restricted by floor effects in mildly disabled patients .


The 3-meter Timed Tandem Walk ( TTW ) as a possibly more sensitive measure has not been investigated yet .


To investigate sensitivity and specificity of the TTW and T25FW to detect mild clinical impairment in a large cohort of MS patients .


We extracted T25FW , TTW and EDSS from our UMC patient database ( 2009-2012 ) .


After randomization into an explorative ( n = 497 ) and validation ( n = 228 ) cohort , we calculated change rates and performed ROC analyses of gait tests and EDSS including Functional System Scores .


Between disability stages of EDSS 0-2 .5 and EDSS 3.0-4 .0 , the mean TTW difference was 4s ( T25FW = 0.9 s ) .


The accuracy to separate between EDSS groups was moderate but identical for both tests ( ROC-AUC T25FW = 0.79 , TTW = 0.80 , p = 0.4 ) .


TTW had a higher sensitivity and specificity to differentiate between asymptomatic and symptomatic patients concerning FS motor/cerebellar scores ( ROC-AUC T25FW = 0.71 , TTW = 0.75 , p < 0.05 ) .


All hypotheses could be validated in the second cohort .


A 3-m Timed Tandem Walk is a standardized test that is easy to implement to detect impairment of the motor or cerebellar system in fully ambulatory MS patients .


Based on the complex-task character , TTW is a potential new outcome measure for MS mobility in mildly disabled patients and can act as easily accessible and significant additional information in patient counseling .


To examine the effect of a 1-time dose of pregabalin ( Lyrica ) on the perception of pain and analgesic consumption after oculofacial plastic surgery .


In this prospective , randomized , double-blind , placebo-controlled trial , patients presenting to the oculofacial plastic surgery service at University of Colorado Eye Center for functional eyelid surgery and who met the study criteria were consecutively enrolled between October 2011 and September 2012 .


Subjects were randomized to either placebo or 150 mg pregabalin administered 15 minutes to an hour prior to the procedure .


The procedure was then performed under the usual standard of care .


Postoperatively , study subjects recorded pain scores on visual analog scales ( range 0-100 ) at 1 to 2 hours , 2 to 4 hours , 8 to 12 hours , 20 to 28 hours , and 36 to 48 hours and the amount of acetaminophen consumed .


Data were analyzed with Statistical Analysis System software using mixed-effects linear models .


Fifty-two patients were enrolled .


Three patients were excluded due to incomplete follow up ( n = 2 ) and postoperative course requiring early unblinding ( n = 1 ) .


Twenty-six subjects were men .


Average age was 68 years ( range , 25-89 ) .


Eyelid procedures performed included blepharoplasty ( 18 ) , canthoplasty ( 11 ) , ptosis repair ( 15 ) , eyelid retraction repair ( 2 ) , pentagonal wedge resection ( 1 ) , and MOHS reconstruction ( 2 ) .


Twenty-six patients were randomized to receive pregabalin , while the remainder received placebo .


There was no significant difference in demographics between the 2 groups .


The pregabalin group reported pain scores that were 5.5 points lower on average compared with the placebo group ( p = 0.0307 ) .


Patients in the pregabalin group also consumed half as much acetaminophen ( 1.3 g ) on average as the placebo group ( 2.6 g ) during the postoperative period .


Pregabalin is effective in reducing postoperative pain after oculoplastic procedures when compared with placebo .


It may be a useful adjunct for pain control in selected patients .


Epidemiologic and preclinical data suggest that higher intake and serum levels of vitamin D and higher intake of calcium reduce the risk of colorectal neoplasia .


To further study the chemopreventive potential of these nutrients , we conducted a randomized , double-blind , placebo-controlled trial of supplementation with vitamin D , calcium , or both for the prevention of colorectal adenomas .


We recruited patients with recently diagnosed adenomas and no known colorectal polyps remaining after complete colonoscopy .


We randomly assigned 2259 participants to receive daily vitamin D3 ( 1000 IU ) , calcium as carbonate ( 1200 mg ) , both , or neither in a partial 22 factorial design .


Women could elect to receive calcium plus random assignment to vitamin D or placebo .


Follow-up colonoscopy was anticipated to be performed 3 or 5 years after the baseline examinations , according to the endoscopist 's recommendation .


The primary end point was adenomas diagnosed in the interval from randomization through the anticipated surveillance colonoscopy .


Participants who were randomly assigned to receive vitamin D had a mean net increase in serum 25-hydroxyvitamin D levels of 7.83 ng per milliliter , relative to participants given placebo .


Overall , 43 % of participants had one or more adenomas diagnosed during follow-up .


The adjusted risk ratios for recurrent adenomas were 0.99 ( 95 % confidence interval [ CI ] , 0.89 to 1.09 ) with vitamin D versus no vitamin D , 0.95 ( 95 % CI , 0.85 to 1.06 ) with calcium versus no calcium , and 0.93 ( 95 % CI , 0.80 to 1.08 ) with both agents versus neither agent .


The findings for advanced adenomas were similar .


There were few serious adverse events .


Daily supplementation with vitamin D3 ( 1000 IU ) , calcium ( 1200 mg ) , or both after removal of colorectal adenomas did not significantly reduce the risk of recurrent colorectal adenomas over a period of 3 to 5 years .


( Funded by the National Cancer Institute ; ClinicalTrials.gov number , NCT00153816 . )


To investigate the effectivity of pentoxifylline ( PTX ) and immunoglobulin M ( IgM ) - enriched intravenous immunoglobulin ( IVIG ) therapy in the treatment of neonatal sepsis ( NS ) , alone or in combination .


This was a prospective , double-blind , controlled study .


Newborns with suspicion of sepsis were enrolled in the study .


The patients were separated into four groups according to treatment protocol : Group 1 = placebo , Group 2 = pentoxifylline , Group 3 = IgM-enriched IVIG , and Group 4 = pentoxifylline + IgM-enriched IVIG .


Blood samples were taken for C-reactive protein , interleukin-6 , neutrophil CD64 expression , and tumor necrosis factor-alfa measurements immediately before treatment ( 1st day ) , and measurements were repeated on the 2nd and 4th days of the therapy .


A total of 204 patients , 51 in each group , were recruited into the study .


There were no significant differences for symptoms of sepsis among groups , except lethargy .


No significant differences were observed among the groups according to laboratory data .


Overall mortality rate was 8.8 % .


The rates of morbidities and mortality among study groups were similar .


PTX and IgM-enriched IVIG therapies , either alone or in combination , did not reduce the rates of morbidities and mortality in NS .


The objective of this randomized , examiner-blind , parallel , controlled clinical study was to compare the antiplaque/antigingivitis efficacy of an essential oil-containing mouthrinse ( EO ) to a new 0.075 % cetylpyridinium chloride mouthrinse ( CPC ) using a two-week experimental gingivitis model with a 5 % hydroalcohol rinse serving as the negative control .


After signing informed consents and completing baseline examinations , 185 subjects were randomized into three groups .


Subjects began supervised/recorded rinsing with 20 ml of their assigned rinse for 30 seconds twice daily for two weeks , with no mechanical oral hygiene permitted .


Baseline and two-week assessments were conducted as follows : Turesky Modification of the Quigley-Hein Plaque Index ( PI ) , Modified Gingival Index ( MGI ) , and the Gingival Bleeding Index ( BI ) .


Analysis of efficacy variables ( i.e. , mean PI , mean MGI , mean BI , and proportion of bleeding sites derived from the BI ) was performed using a one-way analysis of covariance ( ANCOVA ) .


Among the 182 subjects who completed the study , the EO rinse showed statistically significant reductions compared to the negative control within the range previously reported in this model ; PI = 36.5 % ( p < 0.001 ) and MGI = 17.5 % ( p < 0.001 ) .


A 43.2 % reduction in proportion of bleeding sites ( p < 0.001 ) was demonstrated .


Mean PI , MGI , and proportion of bleeding sites at two weeks were statistically significantly lower for the EO rinse compared to the CPC rinse ( p < 0.001 ) , showing 27.7 % , 11.9 % , and 30.0 % reductions , respectively .


An EO rinse provided superior antigingivitis/antiplaque efficacy compared to a 0.075 % CPC rinse in this short-term clinical trial , and demonstrated efficacy within the range shown in previous studies using this model .


Chinese women tend to have small and dense breasts and ultrasound is a common method for breast cancer screening in China .


However , its efficacy and cost comparing with mammography has not been evaluated in randomised trials .


At 14 breast centres across China during 2008-2010 , 13339 high-risk women aged 30-65 years were randomised to be screened by mammography alone , ultrasound alone , or by both methods at enrollment and 1-year follow-up .


A total of 12519 and 8692 women underwent the initial and second screenings , respectively .


Among the 30 cancers ( of which 15 were stage 0/I ) detected , 5 ( 0.72 / 1000 ) were in the mammography group , 11 ( 1.51 / 1000 ) in the ultrasound group , and 14 ( 2.02 / 1000 ) in the combined group ( P = 0.12 ) .


In the combined group , ultrasound detected all the 14 cancers , whereas mammography detected 8 , making ultrasound more sensitive ( 100 vs 57.1 % , P = 0.04 ) with a better diagnostic accuracy ( 0.999 vs 0.766 , P = 0.01 ) .


There was no difference between mammography and ultrasound in specificity ( 100 vs 99.9 % , P = 0.51 ) and positive predictive value ( 72.7 vs 70.0 % ; P = 0.87 ) .


To detect one cancer , the costs of ultrasound , mammography , and combined modality were $ 7876 , $ 45253 , and $ 21599 , respectively .


Ultrasound is superior to mammography for breast cancer screening in high-risk Chinese women .


To investigate the effects of the pre-emptive local infiltration of dexamethasone vs. levobupivacaine on postoperative pain and morbidity in pediatric adenotonsillectomy patients .


A total of 60 patients ( 32 males and 28 females ) , aged 3-14 years , were included in this double-blind prospective randomized controlled clinical study from September of 2011 until May of 2012 .


Patients admitted for adenotonsillectomies after informed consent was obtained from the parents , and randomized into three groups receiving either dexamethasone sodium phosphate ( Group 1 , mean age 5.9 1.6 ) , levobupivacaine with epinephrine ( Group 2 , mean age 6.1 2.6 ) , or saline ( Group 3 , mean age 6.0 3.4 ) .


Pain scores at the 1st , 4th , 8th , 12th , 16th , and 20th hours , and first , second , third and seventh days post-operatively were recorded by the parents using McGrath 's face scale .


The operation type , operation time and anesthesia time , the time of the first request for postoperative analgesia , and the total number of analgesic interventions were recorded .


Pain scores were revealed in this order : Group 1 ( steroid ) < Group 2 ( levobupivacaine ) < Group 3 ( saline ) at all times ( p = 0.000 ) .


The anesthesia times for Group 1 and Group 2 were different ( steroid vs. levobupivacaine ) , and the time to first analgesic was longer in Groups 1 ( steroid ) and 2 ( levobupivacaine ) than in Group 3 ( saline ) ( p < 0.000 ) .


The total number of analgesic interventions was lower in Group 1 ( steroid ) than in Group 2 ( levobupivacaine ) and Group 3 ( saline ) ( steroid vs. saline , p = 0.000 , and steroid vs. levobupivacaine , p < 0.05 ) .


Peritonsillar dexamethasone infiltration was more effective than both levobupivacaine and saline in reducing post-tonsillectomy pain .


It was proven to be a safe and effective method .


A safe , effective vaccine for breastfeeding infants born to HIV-1-positive mothers could complement antiretroviral therapy ( ART ) for prevention of mother-to-child transmission of HIV-1 .


To date , only a few HIV-1 vaccine candidates have been tested in infants .


A phase I/II randomized controlled trial PedVacc 002 was conducted to determine the safety and immunogenicity of a single , low dose of MVA.HIVA vaccine delivered intramuscularly to healthy 20-week-old infants born to HIV-1-positive mothers in Nairobi , Kenya .


Pregnant HIV-1-positive women in the 2nd/3rd trimester of gestation were enrolled , provided with ART and self-selected their infant-feeding modality .


Infants received nevirapine and cotrimoxazole prophylaxis .


At 20 weeks of age , eligible HIV-1-negative infants were randomized to vaccine versus no-treatment arms and followed to 48 weeks of age for assessments of vaccine safety , HIV-1-specific T-cell responses and antibodies to routine childhood vaccines .


Between February and November 2010 , 182 mothers were screened , 104 were eligible and followed on ART during pregnancy/postpartum , of whom 73 had eligible infants at 20 weeks postpartum .


Thirty-six infants were randomized to vaccine and 37 to no treatment .


Eighty-four percent of infants breastfed , and retention at 48 weeks was 99 % .


Adverse events were rare and similar between the two arms .


HIV-1-specific T-cell frequencies in interferon - ELISPOT assay were transiently higher in the MVA.HIVA arm ( p = 0.002 ) , but not above the threshold for a positive assay .


Protective antibody levels were adequate and similar between arms for all routine childhood vaccines except HBV , where 71 % of MVA.HIVA subjects compared to 92 % of control subjects were protected ( p = 0.05 ) .


This trial tested for the first time an MVA-vectored candidate HIV-1 vaccine in HIV-1-exposed infants in Africa , demonstrating trial feasibility and vaccine safety , low immunogenicity , and compatibility with routine childhood vaccinations .


These results are reassuring for use of the MVA vector in more potent prime-boost regimens .


To evaluate the effects of 0.5 % levobupivacaine at 37 C preheated from room temperature , on sensorial block , motor block , and haemodynamics in patients undergoing transurethral prostate resection ( TUR-P ) .


The patients were randomly allocated to two groups : Group I patients were injected with 3 mL 0.5 % levobupivacaine solution which had been kept at room temperature for at least 24 hours and Group II patients were injected with 3 mL 0.5 % levobupivacaine solution which had been kept at 37 C for at least 24 hours .


The patients were examined in terms of sensorial block , motor block , haemodynamic profile , and incidence of side effects .


No significant difference was found between the groups in terms of demographic data .


The time to reach T 10 sensory block and the time of starting motor block were found to be significantly shorter in Group II .


The duration of sensory block over T 10 and T 6 , the duration of L 1 regression , the duration of the sensory block , and the regression time of the motor blocks from 3 to 2 were found to be longer in Group II .


The use of 0.5 % levobupivacaine spinal anaesthesia heated to 37 C accelerated the start of sensory and motor block .


The complexity of pain after laparoscopic cholecystectomy ( LC ) needs multi-module analgesia .


Opioids are widely used for perioperative pain but associated with numerous adverse effects .


We investigated the effect of parecoxib administrated preoperatively and postoperatively for analgesia after ambulatory laparoscopic cholecystectomy .


120 patients scheduled for ambulatory LC with general anesthesia were randomly assigned to three groups : group A received 40 mg parecoxib injection 30-45 min before anesthesia induction and 4 ml saline injection when gallbladder was removed ; group B received 4 ml saline injection 30-45 min before anesthesia induction and 40 mg parecoxib injection when gallbladder was removed ; group C received 4 ml saline injection 30-45 min before anesthesia induction and the time when gallbladder was removed .


We recorded the time achieve to modified Aldrete 's score > 9 in the post-anesthesia care unit ( PACU ) and modified Post-Anesthetic Discharge Scoring System ( PADSS ) > 9 in ambulatory unit .


The visual analog scale ( VAS ) was used to assess the degree of the postoperative pain in the first 24 h , and the numbers of patients who need additional analgesic and postoperative adverse effects were also recorded .


Patients of group A had a shorter length of stay ( LOS ) in PACU compared to these of group B and group C ( 32.4 7.2 min vs. 39.1 10.4 min and 42.2 7.6 min , P < 0.05 ) .


Patients of group A also had a shorter discharge time compared to these of group B and group C ( 148.4 39.3 min vs. 187.9 47.7 min and 223.4 52.5 min , P < 0.05 ) .


Moreover , patients of group A experienced reduced pain intensity , less postoperative side effect , and less additional analgesic requirement .


Preoperative administration of parecoxib for postoperative analgesia provided significant effect on reducing PACU length of stay ( LOS ) and discharge time , and improving patient outcome after ambulatory LC .


Hyperglycemia is a marker of poor prognosis in severe brain injuries .


There is currently little data regarding the effects of intensive insulin therapy ( IIT ) on neurological recovery .


A sub-group analysis of the randomized-controlled CGAO-REA study ( NCT01002482 ) in surgical intensive care units ( ICU ) of two university hospitals .


Patients with severe brain injury , with an expected ICU length of stay 48 hours were included .


Patients were randomized between a conventional glucose management group ( blood glucose target between 5.5 and 9 mmol.L ( -1 ) ) and an IIT group ( blood glucose target between 4.4 and 6 mmol.L ( -1 ) ) .


The primary outcome was the day-90 neurological outcome evaluated with the Glasgow outcome scale .


A total of 188 patients were included in this analysis .


In total 98 ( 52 % ) patients were randomized in the control group and 90 ( 48 % ) in the IIT group .


The mean Glasgow coma score at baseline was 7 ( 4 ) .


Patients in the IIT group received more insulin ( 130 ( 68 to 251 ) IU versus 74 ( 13 to 165 ) IU in the control group , P = 0.01 ) , had a significantly lower morning blood glucose level ( 5.9 ( 5.1 to 6.7 ) mmol.L ( -1 ) versus 6.5 ( 5.6 to 7.2 ) mmol.L ( -1 ) , P < 0.001 ) in the first 5 days after ICU admission .


The IIT group experienced more episodes of hypoglycemia ( P < 0.0001 ) .


In the IIT group 24 ( 26.6 % ) patients had a favorable neurological outcome ( good recovery or moderate disability ) compared to 31 ( 31.6 % ) in the control group ( P = 0.4 ) .


There were no differences in day-28 mortality .


The occurrence of hypoglycemia did not influence the outcome .


In this sub-group analysis of a large multicenter randomized trial , IIT did not appear to alter the day-90 neurological outcome or ICU morbidity in severe brain injured patients or ICU morbidity .


Patients with Alzheimer 's disease ( AD ) exhibit significantly less macular pigment ( MP ) and poorer vision when compared to control subjects .


To investigate supplementation with the macular carotenoids on MP , vision , and cognitive function in patients with AD versus controls .


A randomized , double-blind clinical trial with placebo and active arms .


31 AD patients and 31 age-similar control subjects were supplemented for six months with either Macushield ( 10 mg meso-zeaxanthin [ MZ ] ; 10 mg lutein [ L ] ; 2 mg zeaxanthin [ Z ] ) or placebo ( sunflower oil ) .


MP was measured using dual-wavelength autofluorescence ( Heidelberg Spectralis ) .


Serum L , Z , and MZ were quantified by high performance liquid chromatography .


Visual function was assessed by best corrected visual acuity and contrast sensitivity ( CS ) .


Cognitive function was assessed using a battery of cognition tests , including the Cambridge Neuropsychological Test Automated Battery ( CANTAB ) ) .


Subjects on the active supplement ( for both AD and non-AD controls ) exhibited statistically significant improvement in serum concentrations of L , Z , MZ , and MP ( p < 0.001 , for all ) and also CS at ( p = 0.039 ) .


Also , for subjects on the active supplement , paired samples t-tests exhibited four significant results ( from five spatial frequencies tested ) in the AD group , and two for the non-AD group , and all indicating improvements in CS .


We found no significant changes in any of the cognitive function outcome variables measured ( p > 0.05 , for all ) .


Supplementation with the macular carotenoids ( MZ , Z , and L ) benefits patients with AD , in terms of clinically meaningful improvements in visual function and in terms of MP augmentation .


Limited data exist on cotrimoxazole prophylactic treatment ( CPT ) in pregnant women , including protection against malaria versus standard intermittent preventive therapy with sulfadoxine-pyrimethamine ( IPTp ) .


Using observational data we examined the effect of CPT in HIV-infected pregnant women on malaria during pregnancy , low birth weight and preterm birth using proportional hazards , logistic , and log binomial regression , respectively .


We used linear regression to assess effect of CPT on CD4 count .


Data from 468 CPT-exposed and 768 CPT-unexposed women were analyzed .


CPT was associated with protection against malaria versus IPTp ( hazard ratio : 0.35 , 95 % Confidence Interval ( CI ) : 0.20 , 0.60 ) .


After adjustment for time period this effect was not statistically significant ( adjusted hazard ratio : 0.66 , 95 % CI : 0.28 , 1.52 ) .


Among women receiving and not receiving CPT , rates of low birth weight ( 7.1 % versus 7.6 % ) and preterm birth ( 23.5 % versus 23.6 % ) were similar .


CPT was associated with lower CD4 counts 24 weeks postpartum in women receiving ( -77.6 cells / L , 95 % CI : -125.2 , -30.1 ) and not receiving antiretrovirals ( -33.7 cells / L , 95 % CI : -58.6 , -8.8 ) .


Compared to IPTp , CPT provided comparable protection against malaria in HIV-infected pregnant women and against preterm birth or low birth weight .


Possible implications of CPT-associated lower CD4 postpartum warrant further examination .


Diet might influence progression of hypertrophic cardiomyopathy ( HCM ) .


To investigate whether diet composition could alter clinical , biochemical , or echocardiographic variables in cats with HCM .


Twenty-nine cats with HCM ( International Small Animal Cardiac Health Council stage 1b ) examined at a university teaching hospital .


Randomized , placebo-controlled trial .


After physical examination , echocardiogram , and blood collection , cats were randomized to 1 of 3 diets , which varied in carbohydrate and fat content and ingredients .


Measurements were repeated after 6 months .


There were no significant differences among the 3 groups at baseline .


After 6 months , there were no significant changes in the primary endpoints , left ventricular free wall ( Group A , P = .760 ; Group B , P = .475 ; Group C , P = .066 ) or interventricular septal thickness in diastole ( Group A , P = .528 ; Group B , P = .221 ; Group C , P = .097 ) .


Group A had significant increases in BUN ( P = .008 ) and cholesterol ( P = .021 ) , while Group B had significant increases in BUN ( P = .008 ) , cholesterol ( P = .007 ) , and triglycerides ( P = .005 ) , and significant decreases in NT-proBNP ( P = .013 ) and hs-troponin I ( P = .043 ) .


Group C had significant decreases in body weight ( P = .021 ) , left atrial dimension ( P = .035 ) , interventricular septal thickness in systole ( P = .038 ) , and liver enzymes ( P = .034 -.038 ) .


These data suggest that diet might influence some clinical , biochemical , and echocardiographic variables in cats with HCM .


The purpose of this clinical investigation was to evaluate long-term results obtained with the combination of platelet pellet ( PP ) plus bioabsorbable barrier membrane ( BM ) and to compare this outcome with the results obtained using bioactive glass ( BG ) graft material with a BM .


Using a split mouth design , 11 chronic periodontitis patients ( power at least 80 % ) were randomly assigned to treatment with a combination of PP/GTR or BG/GTR in contra-lateral dentition areas .


Clinical attachment level ( CAL ) as the primary outcome variable , calculated as the sum of probing pocket depth ( PPD ) and gingival recession , and radiological alveolar bone level were recorded at baseline , 6 months and 5 years .


There were no statistical differences between test and control defects at baseline .


PPD reductions and CAL and radiological alveolar bone height gains were statistically significant between baseline and 6 months and between baseline and 5 years in both groups ( p < 0.01 ) .


Six months results of frequency distribution showed that 82 % of the defects attained 4 mm CAL gain in both groups , while 5 year results showed that 73 % of the defects attained 2 mm CAL gain < 4 mm in the PP/BM group and 55 % of the defects attained 2 mm CAL gain < 4 mm in the BG/BM group .


All parameters evaluated showed no significant differences between 6 months and 5 years in both groups ( p > 0.05 ) .


No statistically significant difference in any of the clinical parameters was observed at 6 months and 5 years between the groups ( p > 0.05 ) .


The long-term efficacy of platelet concentrate combined with a barrier membrane is similar with the combination of bioactive glass graft material and barrier membrane , suggesting that results obtained with both treatment approaches can be maintained over a period of 5 years .


Endothelin-1 contributes to endothelial dysfunction in patients with atherosclerosis and type 2 diabetes .


In healthy arteries the ETA receptor mediates the main part of the vasoconstriction induced by endothelin-1 whilst the ETB receptor mediates vasodilatation .


The ETB receptor expression is upregulated on vascular smooth muscle cells in atherosclerosis and may contribute to the increased vasoconstrictor tone and endothelial dysfunction observed in this condition .


Due to these opposing effects of the ETB receptor it remains unclear whether ETB blockade together with ETA blockade may be detrimental or beneficial .


The aim was therefore to compare the effects of selective ETA and dual ETA/ETB blockade on endothelial function in patients with type 2 diabetes and coronary artery disease .


Forearm endothelium-dependent and endothelium-independent vasodilatation was assessed by venous occlusion plethysmography in 12 patients before and after selective ETA or dual ETA/ETB receptor blockade .


Dual ETA/ETB receptor blockade increased baseline forearm blood flow by 3014 % ( P < 0.01 ) whereas selective ETA blockade did not ( 148 % ) .


Both selective ETA blockade and dual ETA/ETB blockade significantly improved endothelium-dependent vasodilatation .


The improvement did not differ between the two treatments .


There was also an increase in endothelium-independent vasodilatation with both treatments .


Dual ETA/ETB blockade did not significantly increase microvascular flow but improved transcutaneous pO2 .


Both selective ETA and dual ETA/ETB improve endothelium-dependent vasodilatation in patients with type 2 diabetes and coronary artery disease .


ETB blockade increases basal blood flow but does not additionally improve endothelium-dependent vasodilatation .


Human skin aging is a multifactorial and complex biological process affecting the different skin constituents .


Even if the skin aging mechanism is not yet fully unravelled is evident that epidermis loses the principal molecule responsible for binding and retaining water molecules , resulting in loss of skin moisture and accounting for some of the most striking alterations of the aged skin .


This Study investigated the cosmetic filling efficacy of Fillerina in decreasing the skin aging signs and in improving facial volume deficiencies .


A placebo-controlled , double-blind , randomized clinical trial was carried out on 40 healthy female subjects showing mild to moderate clinical signs of skin aging .


The effect of the treatment on skin surface and on face volumes was assessed both in the short-term ( 3 h after a single product application ) and in the long-term ( 7 , 14 , and 30 days after continuative daily use ) .


Three hours after a single application and after 7 , 14 , and 30 days of treatment the lips volume was increased by 8.5 % , 11.3 % , 12.8 % , and 14.2 % .


After 7 , 14 , and 30 days : ( 1 ) skin sagging of the face contours was decreased by -0.443 0.286 , -1.124 0.511 , and -1.326 0.649 mm , respectively ; ( 2 ) skin sagging of the cheekbones contours was decreased by -0.989 0.585 , -2.500 0.929 , and -2.517 0.927 mm , respectively ; ( 3 ) cheekbones volume was increased by 0.875 0.519 , 2.186 0.781 , and 2.275 0.725 mm , respectively ; ( 4 ) wrinkle volume was decreased by -11.3 % , -18.4 % , and -26.3 % , respectively ; and ( 5 ) wrinkle depth was decreased by -8.4 % , -14.5 % , and -21.8 % respectively .


This study demonstrated the positive filling effect of Fillerina in decreasing the clinical signs of skin aging and in improving the face volumes .


To examine bowel wall edema development in laparoscopic and open major visceral surgery .


In a prospective study , 47 consecutively operated patients with gastric and pancreatic resections were included .


Twenty-seven patients were operated in a conventional open procedure ( open group ) and 20 in a laparoscopic fashion ( lap group ) .


In all procedures , a small jejunal segment was resected during standard preparation , of which we measured the dry-wet ratio .


Furthermore , HE staining was performed for measuring of bowel wall thickness and edema assessment .


Mean value ( std ) of dry-wet ratio was significantly lower in the open than in the lap group ( 0.1690.017 versus 0.1790.015 ; p = 0.03 ) with the same amount of fluid administration in both groups and a longer infusion interval during laparoscopic surgery .


Subgroup analyses ( only pancreatic resections ) still showed similar results .


Histologic examination depicted a significantly larger bowel wall thickness in the open group .


Laparoscopic surgery does not seem to lead to the bowel wall edema observed to occur in open surgery regardless of the degree of intravenous fluid administration , thus supporting its use even in major visceral surgery .


Testing the ability to program IVF GnRH-antagonist cycles to avoid weekend oocyte retrieval .


Preliminary randomized clinical trial .


Patients presenting an indication for IVF or IVF-ICSI were assigned into either the Treatment Group - GnRH antagonist protocol , programmed to start stimulatory agents on a Friday , with oral 2mg estradiol valerate twice a day from the 2nd day of cycle until the first Friday to follow , or to the Control Group - long luteal GnRH agonist protocol .


The performance of 27 Treatment Group patients and 24 Control Group patients was analyzed .


Cycle dynamics were not clinically or statistically different except for a significant difference in the number of follicles measuring 18 mm on hCG administration day .


There were no differences in the number of aspirated ova , fertilization rates , embryo quality or number of embryos to be transferred .


Pregnancy rate was 41.7 % in the Treatment Group and 50 % in the Control Group ( P > 0.5 ) .


Only one patient assigned to the Treatment Group had a weekend retrieval .


Preliminary results demonstrate no compromise related to follicular estrogen programming in a GnRH antagonist protocol and provide reassurance regarding the ability to achieve programming goals .


Intimate partner violence ( IPV ) victimization is a prevalent issue among women residing in Mexico City .


Comprehensive and integrated health care provider ( HCP ) delivered programs in clinic-settings are needed , yet few have been evaluated in Latin America , including Mexico .


In addition , there has been minimal attention to interventions among lower income women presenting at settings outside of antenatal care clinics .


The current randomized controlled trial seeks to increase midlevel HCPs ' capacity , specifically nurses , who are often the first point of contact in this setting , to identify women presenting at health clinics with experiences of IPV and to assist these women with health risk mitigation .


Specific outcomes include changes in past-year IPV ( physical and/or sexual ) , reproductive coercion , safety planning , use of community resources , and quality of life .


Forty-two public health clinics in Mexico City were randomized to treatment or control clinics .


Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV , providing supportive referrals , and assessing for health and safety risks .


Nurses meeting eligibility criteria at control clinics received the standard of care which included a one-day training focused on sensitizing staff to IPV as a health issue and referral cards to give to women .


Women were screened for eligibility ( currently experiencing abuse in a heterosexual relationship , 18-44 years of age , non-pregnant or in first trimester ) by research assistants in private areas of waiting rooms in health clinics .


Consenting women completed a baseline survey and received the study protocol for that clinic .


In treatment clinics , women received the nurse delivered session at baseline and received a follow-up counseling session after three months .


Surveys are conducted at baseline , three months , and fifteen months from baseline .


This study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context .


Findings can be used to inform IPV programs and policies in Mexico City 's public health clinics .


NCT01661504 .


Japanese encephalitis ( JE ) is the most important cause of viral encephalitis in Asia .


In this randomized , open-label , multicenter trial in 550 children aged 12 to 18 months in Taiwan , children received one dose of JE-CV and one dose of MMR vaccine .


Vaccines were either administered separately 6 weeks apart ( Groups ` JE-CV ' and ` MMR ' , named after which vaccine was given first ) , or concomitantly ( Group ` Co-Ad ' ) .


JE neutralizing antibody titers were assessed using PRNT50 .


MMR antibody levels were determined by ELISA .


All groups had low seroprotection/seropositivity rates ( < 10 % ) before vaccination for all antigens .


Forty two days after vaccination , on either Study Day 42 or 84 , seroconversion rates for all antigens were high in all groups , irrespective of the order of vaccinations .


Seroconversion for JE ranged from 96.9 % in Group Co-Ad on D42 to 100 % in Group MMR .


Non-inferiority was demonstrated for all analyses as the lower bound of the 95 % CI of the difference in seroconversion rates between groups was above the pre-defined limit of -10.0 % .


The immune responses remained high for all antigens and well above the level of protection 12 months after vaccination in all groups .


There were no safety concerns .


JE-CV is safe and induces a strong protective immune response which persists over 1 year when co-administered with MMR vaccine .


Inguinal hernia is one of the most common diseases in the elderly .


Treatment of this pathology is exclusively surgical and relies almost always on the use of local anesthesia .


While in the past hernia surgery was carried out mainly by general anesthesia , in recent years there has been growing emphasis on the role of local anesthesia .


The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine to the same obtained by bupivacaine .


Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty .


Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity .


The study was conducted from March 2011 to March 2013 .


We collected data of eighty patients , male and female , aged between 65 and 86 years , who underwent inguinal hernioplasty with local anesthesia .


Evaluation of intra-operatively pain shows that minimal pain is the same in both groups .


Mild pain was more frequent in the group who used levobupivacaine .


Moderate pain was slightly more frequent in the group who used bupivacaine .


Only one reported intense pain .


Two drugs seem to have the same effect at a distance of six , twelve , eighteen and twentyfour hours .


Bupivacaine shows a significantly higher number of complications , as already demonstrated by previous studies .


Degree of satisfaction expressed by patients has been the same in the two groups .


Levobupivacaine group has shown a greater request for paracetamol while patients who experienced bupivacaine have showed a higher request of other analgesics .


Clinical efficacy of levobupivacaine and racemic bupivacaine are actually similar , when used under local intervention of inguinal hernioplasty .


In the field of ambulatorial surgery our working group prefers levobupivacaine for its fewer side effects and for its easy handling .


Spondylodesis in the operative management of lumbar spine diseases has been the subject of numerous studies over several decades .


The posterolateral fusion ( PLF ) with pedicle screw fixation is a commonly used procedure .


To determine whether the addition of bone marrow concentrate ( BMC ) to allograft bone increases fusion rate after instrumented posterior lumbar fusion .


The study was prospective , randomized , controlled , and blinded .


Eighty patients with degenerative disease of the lumbar spine underwent instrumented lumbar or lumbosacral PLF ( 22 men , 58 women ; body mass index less than 35 for a good visualization of the PLF in the X-rays ) .


In 40 cases , the PLF was done with spongious allograft chips alone ( Group I , age 62.7 years in average , range 47-77 years , level of fusion 1-2 ) .


In another 40 cases , spongious allograft chips were mixed with BMC ( Group II , age 58.5 years in average , range 42-80 , level of fusion 1-3 ) , including the mesenchymal stem cells ( MSCs ) .


Patients were scheduled for anteroposterior and lateral radiographs 12 and 24 months after the surgery and for computed tomography scanning 24 months after the surgery .


Fusion status and the degree of mineralization of the fusion mass were evaluated separately by two radiologists blinded to patient group affiliation .


The bony mass was judged as fused if there was uninterrupted bridging of well-mineralized bone between the transverse processes or sacrum , with trabeculation indicating bone maturation on least at one side of the spines .


In Group I at 12 months , the bone graft mass was assessed in X-rays as fused in no cases ( 0 % ) and at 24 months in four cases ( 10 % ) .


In Group II , 6 cases ( 15 % ) achieved fusion at 12 months and 14 cases ( 35 % ) at 24 months .


The statistically significant difference between both groups was proven for complete fusion at both 12 ( p = .041 ) and 24 months ( p = .011 ) .


Computed tomography scans showed that 16 cases ( 40 % ) in Group I and 32 cases ( 80 % ) in Group II had evidence of at least unilateral continuous bridging bone between neighboring vertebrae at 24 months ( p < .05 ) .


We have confirmed the hypothesis that the autologous BMC together with theallograft is a better alternative for PLF than the allograft alone .


The use of autologous MSCs in form of BMC in combination with allograft is an effective option to enhance the PLF healing .


There is controversy on whether lowering or restricting the level of sympathectomy can reduce compensatory sweating ( CS ) .


This study compared the results from sympathectomies performed to treat severe palmar hyperhidrosis using two distinct levels of T2-4 and T3-4 .


One hundred and sixteen patients with primary palmar hyperhidrosis were randomly allocated to undergo either T2-4 sympathectomy treatment ( T2-4 group ) or T3-4 sympathectomy treatment ( T3-4 group ) .


Follow-up data were collected using a telephone questionnaire to assess efficacy , side effects , overall satisfaction , and factors affecting CS and the degree of satisfaction .


There were no significant differences with respect to either CS or severe CS between the two treatment groups at 1 , 6 , or 12months of follow-up .


The total scores of the quality-of-life questionnaires after surgery were remarkably decreased compared with those before surgery in the two groups .


However , no significant differences in quality-of-life scores were found between the two groups before surgery , or at 1 , 6 , or 12months of follow-up .


Age was predictive of severe CS at 6months of follow-up ( P = 0.045 ) .


Severe CS was inversely associated with patient satisfaction at 1 , 6 , and 12months of follow-up .


The issue of whether lowering or restricting the level of sympathectomy reduces CS is controversial and needs more supportive evidence .


Age may be a predictive factor for severe CS at 6 and 12months of follow-up .


Severe CS is the only known factor that affects patient satisfaction , and family history may also be associated with patient satisfaction .


The aim of this randomized comparative trial ( RCT ) is to compare partial hepatectomy ( PH ) with transcatheter arterial chemoembolization ( TACE ) to treat patients with resectable multiple hepatocellular carcinoma ( RMHCC ) outside of Milan Criteria .


This RCT was conducted on 173 patients with RMHCC outside of Milan Criteria ( a solitary tumor up to 5 cm or multiple tumors up to 3 in number and up to 3 cm for each tumor ) who were treated in our centre from November 2008 to September 2010 .


The patients were randomly assigned to the PH group or the TACE group .


The primary outcome measure was overall survival ( OS ) from the date of treatment .


A multivariate Cox proportional hazards regression analysis was performed to assess the prognostic risk factors associated with OS .


The 1 - , 2 - , and 3-year OS rates were 76.1 % , 63.5 % , and 51.5 % , respectively , for the PH group compared with 51.8 % , 34.8 % , and 18.1 % , respectively , for the TACE group ( Log-rank test , ( 2 ) = 24.246 , p < 0.001 ) .


Multivariate Cox proportional hazards regression analysis revealed the type of treatment ( hazard ratio , 0.434 ; 95 % CI , 0.293 to 0.644 , p < 0.001 ) , number of tumor ( hazard ratio , 1.758 ; 95 % CI , 1.213 to 2.548 , p = 0.003 ) and gender ( hazard ratio , 0.451 ; 95 % CI , 0.236 to 0.862 , p = 0.016 ) were significant independent risk factors associated with OS .


PH provided better OS for patients with RMHCC outside of Milan Criteria than conventional TACE .


The number of tumor and gender were also independent risk factors associated with OS for RMHCC .


The US Food and Drug Administration adopted labeling for nicotine patches to allow use beyond the standard 8 weeks .


This decision was based in part on data showing increased efficacy for 24 weeks of treatment .


Few studies have examined whether the use of nicotine patches beyond 24 weeks provides additional therapeutic benefit .


To compare 8 ( standard ) , 24 ( extended ) , and 52 ( maintenance ) weeks of nicotine patch treatment for promoting tobacco abstinence .


We recruited 525 treatment-seeking smokers for a randomized clinical trial conducted from June 22 , 2009 , through April 15 , 2014 , through 2 universities .


Smokers received 12 smoking cessation behavioral counseling sessions and were randomized to 8 , 24 , or 52 weeks of nicotine patch treatment .


The primary outcome was 7-day point prevalence abstinence , confirmed with breath levels of carbon monoxide at 6 and 12 months ( intention to treat ) .


At 24 weeks , 21.7 % of participants in the standard treatment arm were abstinent , compared with 27.2 % of participants in the extended and maintenance treatment arms ( ( 2 ) ( 1 ) = 1.98 ; P = .17 ) .


In a multivariate model controlled for covariates , participants in the extended and maintenance treatment arms reported significantly greater abstinence rates at 24 weeks compared with participants in the standard treatment arm ( odds ratio [ OR ] , 1.70 [ 95 % CI , 1.03-2 .81 ] ; P = .04 ) , had a longer duration of abstinence until relapse ( = 21.30 [ 95 % CI , 10.30-32 .25 ] ; P < .001 ) , reported smoking fewer cigarettes per day if not abstinent ( mean [ SD ] , 5.8 [ 5.3 ] vs 6.4 [ 5.1 ] cigarettes per day ; = 0.43 [ 95 % CI , 0.06-0 .82 ] ; P = .02 ) , and reported more abstinent days ( mean [ SD ] , 80.5 [ 38.1 ] vs 68.2 [ 43.7 ] days ; OR , 1.55 [ 95 % CI , 1.06-2 .26 ] ; P = .02 ) .


At 52 weeks , participants in the maintenance treatment arm did not report significantly greater abstinence rates compared with participants in the standard and extended treatment arms ( 20.3 % vs 23.8 % ; OR , 1.17 [ 95 % CI , 0.69-1 .98 ] ; P = .57 ) .


Similarly , we found no difference in week 52 abstinence rates between participants in the extended and standard treatment arms ( 26.0 % vs 21.7 % ; OR , 1.33 [ 95 % CI , 0.72-2 .45 ] ; P = .36 ) .


Treatment duration was not associated with any adverse effects or adherence to the counseling regimen , but participants in the maintenance treatment arm reported lower adherence to the nicotine patch regimen compared with those in the standard and extended treatment arms ( mean [ SD ] , 3.94 [ 2.5 ] , 4.61 [ 2.0 ] , and 4.7 [ 2.4 ] patches/wk , respectively ; F2 ,522 = 6.03 ; P = .003 ) .


The findings support the safety of long-term use of nicotine patch treatment , although they do not support efficacy beyond 24 weeks of treatment in a broad group of smokers .


clinicaltrials.gov Identifier : NCT01047527 .


Preexposure prophylaxis ( PrEP ) with emtricitabine plus tenofovir disoproxil fumarate ( FTC/TDF ) or TDF alone reduces the risk of human immunodeficiency virus ( HIV ) acquisition .


Understanding the risk of antiretroviral resistance selected by PrEP during breakthrough infections is important because of the risk of treatment failure during subsequent antiretroviral use .


Within the largest randomized trial of FTC/TDF versus TDF as PrEP , plasma samples were tested for HIV with resistance mutations associated with FTC ( K65R and M184IV ) and TDF ( K65R and K70E ) , using 454 sequencing .


Of 121 HIV seroconverters , 25 received FTC/TDF , 38 received TDF , and 58 received placebo .


Plasma drug levels in 26 individuals indicated PrEP use during or after HIV acquisition , of which 5 had virus with resistance mutations associated with their PrEP regimen .


Among those with PrEP drug detected during infection , resistance was more frequent in the FTC/TDF arm ( 4 of 7 [ 57 % ] ) , compared with the TDF arm ( 1 of 19 [ 5.3 % ] ; P = .01 ) , owing to the FTC-associated mutation M184IV .


Of these cases , 3 had unrecognized acute infection at PrEP randomization , and 2 were HIV negative at enrollment .


These results suggest that resistance selected by PrEP is rare but can occur both with PrEP initiation during acute seronegative HIV infection and in PrEP breakthrough infections and that FTC is associated with a greater frequency of resistance mutations than TDF .


To follow children with juvenile idiopathic arthritis ( JIA ) who had completed at least 6 months of the TRial of Early Aggressive Therapy ( TREAT ) clinical study for an additional 2 years , describing safety of early aggressive treatment , disease activity , function , and duration of clinical inactive disease ( CID ) during followup .


Children were treated as per provider 's discretion .


Physician , patient/parent , and laboratory measures of disease status as well as safety information were collected at clinic visits every 3 months for up to 2 years .


Forty-eight children were followed for a mean of 28 months ( range 12-42 ) beyond the end of the TREAT study .


Half of patients were in CID for > 50 % of their followup time .


Overall , 88 % of patients achieved CID at > 1 study visit and 54 % achieved clinical remission while taking medication .


Six patients were in CID for the duration of the study , and , of those , 2 achieved a full year of clinical remission while not taking medication .


Active disease was mild : mean physician 's global assessment 2.4 , active joint count 3.5 , parent global evaluation 2.4 , Childhood Health Assessment Questionnaire 0.32 , erythrocyte sedimentation rate 19 mm/h , and morning stiffness 23 min .


There were no serious adverse events or adverse events reported at grade 3 or higher of Common Terminology Criteria for Adverse Events .


Early aggressive therapy in this cohort of patients with polyarticular JIA who had high initial disease activity was associated with prolonged periods of CID in the majority of patients during followup .


Those not in CID had low levels of disease activity .


The aim of the study was to investigate to what extent sweeping of the membranes contributes to cervical shortening and if cervical shortening is related to the time to onset of labor and duration of the active phase of labor


This prospective randomized clinical trial was performed at Baskent University between February and March 2011 .


Women were randomly assigned to receive membrane sweeping ( Sweeping Group ) ( n = 69 ) or no membrane sweeping ( Control Group ) ( n = 71 ) .


Cervical length was measured ( cervix1 ) in both groups by examiner 1 and the Bishop Score was determined in the control group and sweeping was performed in the sweeping group by examiner 2 .


Two days later the patients had another cervical length measurement ( cervix 2 ) by examiner 1 , blinded to the group and results of the examiner 2 .


t test , Mann-Whitney U test and Chi-square test were used for statistical analyses .


Cervix 1 was 27.4 + / - 8.4 mm and 29.6 + / - 8.9 mm ( p = 0.14 ) , cervix 2 was 23.3 + / - 8.8 mm and 23.8 + / - 8.5 mm ( p = 0.28 ) and cervical shortening was 5 + / - 4 mm and 5 + / -4 mm ( p = 0.446 ) , time to onset of labor was 6.3 + / - 4.6 and 5.7 + / - 4.7 ( p = 0.38 ) and duration of labor was 5.8 + / - 2.89 and 5.7 + / - 2.4 ( p = 0.82 ) for the sweeping and the control groups , respectively


Sweeping of the membranes does not reduce cervical length and does not shorten time to onset of labor and duration of the active phase of labor NCT 1309308 : Sweeping the Membranes , Cervical Length and Duration of Labor


Although dobutamine stress echocardiography ( DSE ) is performed in heart transplant patients , the safety profile of atropine administration in DSE in this setting is unclear .


We identified heart transplant patients who received atropine during DSE from January 1984 to August 2011 at our institution and compared them with a propensity-scored matched control group of heart transplant patients who underwent DSE without atropine .


Adverse events were defined as significant arrhythmias ( sinus arrest , Mobitz type II heart block , complete heart block , ventricular tachycardia , or ventricular fibrillation ) , hypotension requiring hospitalization , syncope or presyncope , myocardial infarction , and death .


Forty-five heart transplant patients ( median age 62 years , 82 % male ) received 0.2-1 mg atropine during DSE .


Of these , 1 patient ( 2.2 % ) developed temporary complete heart block .


No adverse events were identified in the control group of 154 patients who received dobutamine without atropine .


Our findings suggest that complete heart block can occur infrequently with the administration of atropine in heart transplant patients undergoing DSE .


Therefore , patients should be appropriately monitored for these adverse events during and after DSE .


Efficacy of intravenous ( IV ) volume expansion in preventing contrast-induced acute kidney injury ( CI-AKI ) is well known .


However , the role of oral hydration has not been well established .


The aim of this work was to evaluate the efficacy of oral hydration in preventing CI-AKI .


We prospectively randomized 225 patients undergoing coronary angiography and/or percutaneous coronary intervention in either oral hydration or IV hydration groups .


Patients who have at least one of the high-risk factors for developing CI-AKI ( advanced age , type 2 diabetes mellitus , anemia , hyperuricemia , a history of cardiac failure or systolic dysfunction ) were included in the study .


All patients had normal renal function or stage 1-2 chronic kidney disease .


Patients in the oral hydration group were encouraged to drink unrestricted amounts of fluids freely whereas isotonic saline infusion was performed by the standard protocol in the IV hydration group .


CI-AKI occurred in 8/116 patients ( 6.9 % ) in the oral hydration group and 8/109 patients ( 7.3 % ) in the IV hydration group ( p = 0.89 ) .


There was also no statistically significant difference between the two groups when different CI-AKI definitions were taken into account .


Oral hydration is as effective as IV hydration in preventing CI-AKI in patients with normal kidney function or stage 1-2 chronic kidney disease , and who also have at least one of the other high-risk factors for developing CI-AKI .


Motor imagery ( MI ) is assumed to enhance poststroke motor recovery , yet its benefits are debatable .


Brain-computer interfaces ( BCIs ) can provide instantaneous and quantitative measure of cerebral functions modulated by MI .


The efficacy of BCI-monitored MI practice as add-on intervention to usual rehabilitation care was evaluated in a randomized controlled pilot study in subacute stroke patients .


Twenty-eight hospitalized subacute stroke patients with severe motor deficits were randomized into 2 intervention groups : 1-month BCI-supported MI training ( BCI group , n = 14 ) and 1-month MI training without BCI support ( control group ; n = 14 ) .


Functional and neurophysiological assessments were performed before and after the interventions , including evaluation of the upper limbs by Fugl-Meyer Assessment ( FMA ; primary outcome measure ) and analysis of oscillatory activity and connectivity at rest , based on high-density electroencephalographic ( EEG ) recordings .


Better functional outcome was observed in the BCI group , including a significantly higher probability of achieving a clinically relevant increase in the FMA score ( p < 0.03 ) .


Post-BCI training changes in EEG sensorimotor power spectra ( ie , stronger desynchronization in the alpha and beta bands ) occurred with greater involvement of the ipsilesional hemisphere in response to MI of the paralyzed trained hand .


Also , FMA improvements ( effectiveness of FMA ) correlated with the changes ( ie , post-training increase ) at rest in ipsilesional intrahemispheric connectivity in the same bands ( p < 0.05 ) .


The introduction of BCI technology in assisting MI practice demonstrates the rehabilitative potential of MI , contributing to significantly better motor functional outcomes in subacute stroke patients with severe motor impairments .


Adequate maternal dietary protein intake is necessary for healthy pregnancy .


However , current protein intake recommendations for healthy pregnant women are based on factorial calculations of nitrogen balance data derived from nonpregnant adults .


Thus , an estimate of protein requirements based on pregnancy-specific data is needed .


The objective of this study was to determine protein requirements of healthy pregnant women at 11-20 ( early ) and 31-38 ( late ) wk of gestation through use of the indicator amino acid oxidation method .


Twenty-nine healthy women ( 24-37 y ) each randomly received a different test protein intake ( range : 0.22-2 .56 g kg ( -1 ) d ( -1 ) ) during each study day in early ( n = 35 observations in 17 women ) and late ( n = 43 observations in 19 women ) gestation ; 7 women participated in both early and late gestation studies .


The diets were isocaloric and provided energy at 1.7 resting energy expenditure .


Protein was given as a crystalline amino acid mixture based on egg protein composition , except phenylalanine and tyrosine , which were maintained constant across intakes .


Protein requirements were determined by measuring the oxidation rate of L - [ 1 - ( 13 ) C ] phenylalanine to ( 13 ) CO2 ( F ( 13 ) CO2 ) .


Breath and urine samples were collected at baseline and isotopic steady state .


Linear regression crossover analysis identified a breakpoint ( requirement ) at minimal F ( 13 ) CO2 in response to different protein intakes .


The estimated average requirement ( EAR ) for protein in early and late gestation was determined to be 1.22 ( R ( 2 ) = 0.60 ; 95 % CI : 0.79 , 1.66 g kg ( -1 ) d ( -1 ) ) and 1.52 g kg ( -1 ) d ( -1 ) ( R ( 2 ) = 0.63 ; 95 % CI : 1.28 , 1.77 g kg ( -1 ) d ( -1 ) ) , respectively .


These estimates are considerably higher than the EAR of 0.88 g kg ( -1 ) d ( -1 ) currently recommended by the Dietary Reference Intakes .


To our knowledge , this study is the first to directly estimate gestational stage-specific protein requirements in healthy pregnant women and suggests that current recommendations based on factorial calculations underestimate requirements .


This trial was registered at clinicaltrials.gov as NCT01784198 .


To evaluate the impact of concurrent treatments for substance use disorder and nicotine-dependence for stimulant-dependent patients .


A randomized , 10-week trial with follow-up at 3 and 6 months after smoking quit date conducted at 12 substance use disorder treatment programs between February 2010 and July 2012 .


Adults meeting DSM-IV-TR criteria for cocaine and/or methamphetamine dependence and interested in quitting smoking were randomized to treatment as usual ( n = 271 ) or treatment as usual with smoking-cessation treatment ( n = 267 ) .


All participants received treatment as usual for substance use disorder treatment .


Participants assigned to treatment as usual with concurrent smoking-cessation treatment received weekly individual smoking cessation counseling and extended-release bupropion ( 300 mg/d ) during weeks 1-10 .


During post-quit treatment ( weeks 4-10 ) , participants assigned to treatment as usual with smoking-cessation treatment received a nicotine inhaler and contingency management for smoking abstinence .


Weekly proportion of stimulant-abstinent participants during the treatment phase , as assessed by urine drug screens and self-report , was the primary outcome .


Secondary measures included other substance/nicotine use outcomes and treatment attendance .


There were no significant treatment effects on stimulant-use outcomes , as measured by the primary outcome and stimulant-free days , on drug-abstinence , or on attendance .


Participants assigned to treatment as usual with smoking-cessation treatment , relative to those assigned to treatment as usual , had significantly better outcomes for drug-free days at 6-month follow-up ( ( 2 ) ( 1 ) = 4.09 , P < .05 ) , with a decrease in drug-free days from baseline of -1.3 % in treatment as usual with smoking-cessation treatment and of -7.6 % in treatment as usual .


Participants receiving treatment as usual with smoking-cessation treatment , relative to those receiving treatment as usual , had significantly better outcomes on smoking point-prevalence abstinence ( 25.5 % vs 2.2 % ; ( 2 ) ( 1 ) = 44.69 , P < .001 ; OR = 18.2 ) .


These results suggest that providing smoking-cessation treatment to illicit stimulant-dependent patients in outpatient substance use disorder treatment will not worsen , and may enhance , abstinence from nonnicotine substance use .


ClinicalTrials.gov identifier : NCT01077024 .


High tibial osteotomy is a common procedure to treat symptomatic osteoarthritis of the medial compartment of the knee with varus alignment .


This is achieved by overcorrecting the varus alignment to 2-6 of valgus .


Various high tibial osteotomy techniques are currently used to this end .


Common procedures are medial opening wedge and lateral closing wedge tibial osteotomies .


The lateral closing wedge technique is a primary stable correction with a high rate of consolidation , but has the disadvantage of bone loss and change in tibial condylar offset .


The medial opening wedge technique does not result in any bone loss but needs to be fixated with a plate and may cause tibial slope and medial collateral ligament tightening .


A relatively new technique , the combined valgus high tibial osteotomy , claims to include the advantages of both techniques without bone loss .


Aim of this prospective randomized trial is to compare the lateral closing wedge with the combined wedge osteotomy in patients with symptomatic varus osteoarthritis of the knee .


A group of 110 patients with osteoarthritis of the medial compartment of the knee with 6-12 varus malalignment over 18 years of age are recruited to participate a randomized controlled trial .


Patients are randomized to undergo a high tibial osteotomy , with either a lateral closing wedge technique or a combined wedge osteotomy technique .


Primary outcome measure is achievement of an overcorrection of 4 valgus after one year of surgery , assessed by measuring the hip-knee-ankle angle .


Secondary objectives are radiological scores and anatomical changes after high tibial osteotomy ; pain , functional scores and quality of life will also be compared .


Combined high tibial osteotomy modification avoids metaphyseal tibial bone loss , decreasing transposition of the tibial condyle and shortening of the patellar tendon after osteotomy , even in case of great correction .


The clinical results of the combined wedge osteotomy technique are very promising .


Hypothesis is that the combined wedge osteotomy technique will achieve more accurate overcorrection of varus malalignment with fewer anatomical changes of the proximal tibia after one year .


Dutch Trial Registry ( Netherlands trial register ) : NTR3898 .


To prospectively evaluate the effect of listening to music and inhaling aroma oil on patients undergoing screening computed tomography colonography .


Two hundred and twenty four participants were randomly allocated to one of the four groups including : ( 1 ) combined music and aroma , ( 2 ) music alone , ( 3 ) aroma alone , and ( 4 ) control .


The visual analog scale for pain and a questionnaire were used for subjective outcomes .


We also used a pre-testpost-test design to compare the differences in blood pressure and heart rate as objective outcomes .


There were no statistical differences between the control group and other groups in the visual analog scale or changes in heart rate .


Changes in blood pressure were similar .


Participants reported good overall experiences .


There were no differences in terms of overall satisfaction , pain rating , willingness to repeat the computed tomography colonography procedure in the future , or preference between colonoscopy and computed tomography colonography .


More participants using music and/or aroma requested music and/or aroma during the next computed tomography colonography ( P < 0.0001 ) .


Although audio and olfactory intervention had little effect on perceived pain or discomfort and vital signs , participants who listened to music and inhaled aroma during the computed tomography colonography preferred music and aroma during the next computed tomography colonography .


To evaluate the effect of the dimensions of the uterine cavity in relation to the expulsion , or removal for displacement , of intrauterine devices ( IUDs ) MLCu375 and TCu380A .


A case-control study nested in a multicentre clinical trial .


Eighteen family planning clinics in China .


Forty-eight pairs of TCu380A users and 118 pairs of MLCu375 users .


The women were classified as cases if IUD expulsion or displacement occurred during the first year of follow-up after insertion .


One control was randomly selected for each case matched by IUD model , centre , age , service provider for insertion , and date of insertion .


Axial length of the uterine cavity ( LUC ) and the largest transverse diameter of the coronal section of the uterine cavity ( LTD ) were measured using abdominal ultrasound .


We used multivariate conditional logistic regressions to estimate the adjusted odds ratios ( aORs ) of expulsions or displacements among women with different sizes of uterine cavity according to the quartile of LUC and LTD , respectively .


Among MLCu375 users , women with LTD 27 mm had a higher risk of expulsion or displacement ( aOR 2.40 ; 95 % confidence interval , 95 % CI , 1.02-5 .63 ) , after adjusting for the volume of menstrual flow , dysmenorrhoea , parity , uterine position , MLCu375 type , and LUC .


Among TCu380A users , the association between LTD 37 mm and expulsion or displacement ( aOR 4.98 ; 95 % CI 1.01-22 .49 ) was statistically significant , after adjusting for LUC and potential confounding factors .


Our study suggests that LTD should be considered when making the decision of which IUD model to use .


Analysis of the prevalence of mouth cavity urealytic microflora and determination of the level of its enzymatic activity depending on concentration and amount of urea solution taken as a substrate .


62 randomly chosen patients at the age of 5-64 took part in the study .


Each of them rinsed the mouth with 50 ml of 1 % urea solution .


Before and after rinsing the concentration of ammonia in the mouth cavity air was measured .


In patients with highest and lowest activity of mouth cavity urealytic microflora a series of tests was carried out including mouth rinsing with urea solution in various concentrations and amounts and measuring ammonia concentration before and after rinsing .


Obtained results were analyzed using mathematical statistics methods .


It was found that in 91 % 1.8 % of randomly chosen patients ( p < 0.05 ) mouth cavity microflora showed apparent urease activity .


The lowest concentration ( 0.0625 % in 50 ml ) and volume ( 0.5 ml of 1 % solution ) levels of urea solution were obtained that can exert negative influence on the results of helicobacteriosis diagnosis by means of mouth cavity air analysis .


Urealytic microflora in the mouth cavity is very common and may constitute a factor that decreases the specificity of helicobacteriosis diagnosis by means of the methods based on detection of indicators of gas metabolites resulting from the enzymatic reaction in air samples taken from the mouth cavity after oral administration of urea .


Robotic guidance has been shown to facilitate motor skill acquisition , through altered sensorimotor control , in neurologically impaired and healthy populations .


To determine if robot-guided practice and online visual feedback availability primarily influences movement planning or online control mechanisms .


In this two-experiment study , participants first performed a pre-test involving reaches with or without vision , to obtain baseline measures .


In both experiments , participants then underwent an acquisition phase where they either actively followed robot-guided trajectories or trained unassisted .


Only in the second experiment , robot-guided or unassisted acquisition was performed either with or without online vision .


Following acquisition , all participants completed a post-test that was the same as the pre-test .


Planning and online control mechanisms were assessed through endpoint error and kinematic analyses .


The robot-guided and unassisted groups generally exhibited comparable changes in endpoint accuracy and precision .


Kinematic analyses revealed that only participants who practiced with the robot exhibited significantly reduced the proportion of movement time spent during the limb deceleration phase ( i.e. , time after peak velocity ) .


This was true regardless of online visual feedback availability during training .


The influence of robot-assisted motor skill acquisition is best explained by improved motor planning processes .


RAD51 , a central player in the response to DNA damage , has been suspected to contribute to tumour resistance to therapy .


A single-nucleotide polymorphism , RAD51 135G > C , in the untranslated region of the RAD51 gene elevates breast cancer risk among BRCA2 carriers .


In this study , it was investigated whether this polymorphism is related to prognosis of breast cancer and RAD51 protein expression and whether it is indicative of resistance to radiotherapy or cyclophosphamide/methotrexate/5-fluorouracil ( CMF ) chemotherapy .


We genotyped 306 patients with early breast cancer , who were randomised to receive post-operative radiotherapy or CMF chemotherapy , for the RAD51 135G > C polymorphism .


RAD51 protein expression was evaluated with immunohistochemistry .


15.4 % of the patients had at least one C-allele ( three were C homozygotes ) .


There was no correlation between genotype and protein expression .


Patients who were G homozygotes benefitted from radiotherapy with decreased risk of local recurrences ( RR = 0.32 , 95 % C.I. 0.16-0 .64 , p = 0.001 ) .


CMF chemotherapy reduced the risk of distant recurrence for patients carrying at least one C-allele ( RR = 0.29 , 95 % C.I. 0.10-0 .88 , p = 0.03 ) , whereas G homozygotes had no benefit from chemotherapy .


There was a significant interaction between chemotherapy and genotype ( p = 0.02 ) .


The results suggest that the RAD51 135G > C polymorphism predicts CMF chemotherapy effect in early breast cancer .


To evaluate the effects of a 12-week balance training programme on self-assessed function and disability in healthy community-dwelling older adults with self-perceived balance deficits and fear of falling .


A prospective , randomized controlled trial .


Stockholm County , Sweden .


A total of 59 community-dwelling older adults ( 42 women and 17 men ) aged 67-93 were randomized to either an intervention group ( n = 38 ) or to serve as controls ( n = 21 ) after baseline testing .


The intervention was a 12-week , three times per week , progressive , specific and individually adjusted group balance-training programme .


Self-perceived function and disability measured with Late Life Function and Disability Instrument .


The intervention group reported improvement in overall function ( p = 0.016 ) , as well as in basic ( p = 0.044 ) and advanced lower extremity function ( p = 0.025 ) compared with the control group .


The study showed no improvement in overall disability or upper extremity function .


This group balance training programme improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling .


To evaluate the impact on ovarian reserve between two different methods ofhemostasis after laparoscopic ovarian endometrioma excision .


A randomized controlled study was conducted from January to December 2013 in Thammasat University Hospital , Thailand .


Reproductive women , age 18-45years who underwent laparoscopic ovarian cystectomy were randomized in electrocoagulation and suture groups .


Clinical baseline data and ovarian reserve outcome ( anti-Mullerian hormone ( AMH ) ) were evaluated .


Fifty participants were recruited and randomized in two groups .


Electrocoagulation and suture groups consisted of 25 participants .


Baseline characteristics between 2 groups ( age , weight , BMI , height , cyst diameter , duration and estimated blood loss ) were not statistically different .


There were no significant difference of AMIH between electrocoagulation and suture group atpre-operative ( 2.902.26 vs. 2.522.37 ng/ml ) , 1 week ( 1.781.51 vs. 1.991.71 ng/ml ) , 1 month ( 1.761.50 vs. 2.091.62 ng/ml ) , 3 months ( 2.091.66 vs. 1.961.68 ng/ml ) and 6 months ( 2.111.84 vs 1.721.68 ng/ml ) , respectively .


However mean AMH ofboth groups significantly decreased since the first week of operation .


Effect oflaparoscopic ovarian surgery had significantly declined and sustained AMH level until 6 months .


Laparoscopic cystectomy of ovarian endometrioma has negative impact to ovarian reserve .


Either electroco - agulation or suture method had no different effects .


Implicit learning of intraoperative auditory stimuli during general anesthesia is very difficult to quantify but may require the presence of noxious stimulation .


We hypothesized that an anesthetic regimen with a low dose of opioid would enhance implicit memory , while a regimen with a high dose of opioid would not .


One hundred-twenty patients were randomized into 3 groups .


All patients were anesthetized with a target-controlled infusion of propofol and remifentanil , targeting a Bispectral Index ( BIS ) value of 50 .


The remifentanil effect-site concentration ( in ng/mL ) was always double that of propofol ( in g/mL ) in the first group and half of that in the second group .


Patients in these 2 groups were played a list of 20 words via headphones during surgery .


The third group served as control for memory tests and was not played any word during anesthesia .


BIS was recorded during word presentation .


No statistical difference was found among the 3 groups regarding 3 different memory tests although 67.5 % [ 50.7 % ; 80.9 % ] of the patients of the high-opioid group and 72.5 % [ 55.9 % ; 84.9 % ] of the low-opioid group had at least 1 episode of BIS > 60 .


We could not demonstrate the presence of implicit or explicit memorization under propofol-remifentanil anesthesia either with a low - or a high-dose opioid anesthetic regimen .


The mechanisms by which a ` Mediterranean diet ' reduces cardiovascular disease ( CVD ) burden remain poorly understood .


Lycopene is a potent antioxidant found in such diets with evidence suggesting beneficial effects .


We wished to investigate the effects of lycopene on the vasculature in CVD patients and separately , in healthy volunteers ( HV ) .


We randomised 36 statin treated CVD patients and 36 healthy volunteers in a 21 treatment allocation ratio to either 7 mg lycopene or placebo daily for 2 months in a double-blind trial .


Forearm responses to intra-arterial infusions of acetylcholine ( endothelium-dependent vasodilatation ; EDV ) , sodium nitroprusside ( endothelium-independent vasodilatation ; EIDV ) , and NG-monomethyl-L-arginine ( basal nitric oxide ( NO ) synthase activity ) were measured using venous plethysmography .


A range of vascular and biochemical secondary endpoints were also explored .


EDV in CVD patients post-lycopene improved by 53 % ( 95 % CI : +9 % to +93 % , P = 0.03 vs. placebo ) without changes to EIDV , or basal NO responses .


HVs did not show changes in EDV after lycopene treatment .


Blood pressure , arterial stiffness , lipids and hsCRP levels were unchanged for lycopene vs. placebo treatment groups in the CVD arm as well as the HV arm .


At baseline , CVD patients had impaired EDV compared with HV ( 30 % lower ; 95 % CI : -45 % to -10 % , P = 0.008 ) , despite lower LDL cholesterol ( 1.2 mmol/L lower , 95 % CI : -1.6 to -0.9 mmol/L , P < 0.001 ) .


Post-therapy EDV responses for lycopene-treated CVD patients were similar to HVs at baseline ( 2 % lower , 95 % CI : -30 % to +30 % , P = 0.85 ) , also suggesting lycopene improved endothelial function .


Lycopene supplementation improves endothelial function in CVD patients on optimal secondary prevention , but not in HVs .


ClinicalTrials.gov NCT01100385 .


The optimal regimen to prevent chemotherapy-induced nausea and vomiting ( CINV ) for patients undergoing high-dose chemotherapy and autologous stem-cell transplantation ( ASCT ) is unclear .


To evaluate the effect of aprepitant in addition to a standard regimen , we conducted this randomized , placebo-controlled phase III trial .


Patients with multiple myeloma were randomly assigned at a one-to-one ratio to receive either aprepitant ( 125 mg orally on day 1 and 80 mg orally on days 2 to 4 ) , granisetron ( 2 mg orally on days 1 to 4 ) , and dexamethasone ( 4 mg orally on day 1 and 2 mg orally on days 2 to 3 ) or matching placebo , granisetron ( 2 mg orally on days 1 to 4 ) , and dexamethasone ( 8 mg orally on day 1 and 4 mg orally on days 2 to 3 ) .


Melphalan 100 mg/m ( 2 ) was administered intravenously on days 1 to 2 .


ASCT was performed on day 4 .


The primary end point ( complete response ) was defined as no emesis and no rescue therapy within 120 hours of melphalan administration .


Quality of life was assessed by modified Functional Living Index-Emesis ( FLIE ) questionnaire on days -1 and 6 .


Overall , 362 patients were available for the efficacy analysis ( 181 in each treatment arm ) .


Significantly more patients receiving aprepitant reached the primary end point ( 58 % v 41 % ; odds ratio [ OR ] , 1.92 ; 95 % CI , 1.23 to 3.00 ; P = .0042 ) .


Absence of major nausea ( 94 % v 88 % ; OR , 2.37 ; 95 % CI , 1.09 to 5.15 ; P = .026 ) and emesis ( 78 % v 65 % ; OR , 1.99 ; 95 % CI , 1.25 to 3.18 ; P = .0036 ) within 120 hours was increased by aprepitant .


Mean total FLIE score ( standard deviation ) was 114 18 for aprepitant and 106 26 for placebo ( P < .001 ) .


The addition of aprepitant resulted in significantly less CINV and had a positive effect on quality of life .


This study compared transobturator tension-free vaginal tape ( TVT-O ) and Contasure-Needleless ( C-NDL ) at long-term follow-up .


Non-inferiority , prospective , single-centre , quasi-randomised trial started in September 2006 and finished in April 2011 to compare C-NDL with transobturator vaginal tape ( TVT-O ) mesh in the treatment of stress urinary incontinence ( SUI ) .


Epidemiological information , intraoperative and postoperative complications , subjective estimates of blood loss and pain levels were recorded .


We also analysed the postoperative stress test , the subjective impression of improvement using the Sandvik Severity Index and the quality of life during follow-up using the International Consultation on Incontinence Questionnaire-Short Form ( ICIQ-SF ) .


Two hundred and fifty-seven women with primary SUI were scheduled to receive TVT-O or C-NDL and were followed up at least 3 years after the procedure .


One hundred and eleven women in the C-NDL group ( 84.7 % ) had a negative stress test , compared with 54 women ( 88.9 % ) in the TVT-O group ( p = 0.0065 for the non-inferiority test ) .


The postoperative Sandvik Severity Index was 0 or better than the preoperative score in 90.7 % of patients in the C-NDL group and 95.4 % of patients in the TVT-O group ( p = 0.0022 ) .


The complication rate was similar in both groups .


There were significant differences ( p = 0.02 ) in postoperative pain within the TVT-O group .


The degree of satisfaction was not statistically significant between the two groups .


The outcomes for the C-NDL group were similar to those of the TVT-O group , adding the concept of `` single incision tape '' to the tension-free sling option .