The compression technique recommendation for infant remains the 2-finger ( TF ) technique for lone rescuer and the 2-thumb-encircling hands technique for 2 rescuers .


We hypothesized that the TF technique can not result in an enough compression depth to meet the guideline requirements and that the 2-thumb-encircling hands technique will not affect the ventilation .


Crossover experimental study randomizes 27 health care providers to perform 2 sets of 5-minute cardiopulmonary resuscitation using a 30:2 compression/ventilation ratio to compare TF and 2-thumb-encircling hands techniques .


A Laerdal Resusci Baby QCPR manikin equipped with PC SkillReporting System was used for measuring and recording cardiopulmonary resuscitation data .


Data ( mean SD ) were analyzed by using a paired t test .


Significance was defined qualitatively as P .05 .


Mean compression depths were 39.25 3.06 cm in the TF technique and 42.37 1.15 cm in the 2-thumb-encircling hands technique , P < .001 .


Two-finger technique had significant lower fractions of correct hand position than 2-thumb-encircling hands technique ( 96.56 % 6.74 % vs 99.41 % 2.52 % , P < .05 ) .


The fatigue point appears much earlier in TF than in 2-thumb-encircling hands .


No difference was identified on ventilation between 2 groups .


The 2-thumb-encircling hands technique can produce a compression depth meeting the current guidelines recommendation without negative influence on ventilation , whereas the TF technique can not .


The 2-thumb-encircling hands technique generates a significant higher ratio of correct compression position than the TF technique .


Furthermore , the 2-thumb-encircling hands technique is less fatiguing than the TF technique .


To evaluate the biochemical changes associated with succinylcholine administration after pretreatment with rocuronium at different time intervals .


The prospective , randomised , single-blinded study was conducted at the Combined Military Hospital , Rawalpindi , from January to May 2010 .


Ninety male , aged 18-60 years , American Society of Anaesthesiology I or II patients undergoing elective inguinal herniotomy or external haemorrhoidectomy were included .


The patients were randomly divided into three equal groups .


Group A received a normal saline 5 ml as placebo 1 minute before succinylcholine ; Group B received rocuronium 0.06 mg/kg 1 intravenously minute before succinylcholine , while Group C received intravenous injection of rocuronium 0.06 mg/kg 5 minute before succinylcholine .


Venous blood samples for creatinine phosphokinase , lactate dehydrogenase and myoglobin plasma concentrations were obtained at 0 , 30 minutes , 6 hours and 24 hours after succinylcholine administration .


Mean serum creatinine phosphokinase and myoglobin concentrations were significantly decreased in Groups B and C compared to Group A at 30 minutes and 24 hours ( p < 0.05 ) .


However , no significant difference in the enzyme levels at any time interval was observed among the rocuronium groups .


There was a significant rise in lactate dehydrogenase concentrations at 6 hours and 24 hours in Group A compared to Groups B and C ( p < 0.05 ) .


Pretreatment with rocuronium effectively reduces the biochemical changes associated with succinylcholine-induced muscle fasciculations .


However , whether it is given 1 minute or 5 minutes before succinylcholine does not make much difference .


Obesity in children and adolescents is associated to a morbidity that has increased significantly .


It has become a public health problem around the world .


The objective of this paper was to evaluate the efficacy of the cognitive behavioral treatment strategy in the comprehensive management of obesity in adolescents .


Double blind , randomized , and controlled intervention study , of four months of follow-up , with a total of 115 obese adolescents , aged 12 to 16 years .


The intervention group received cognitive behavioral treatment strategy , as well as advise on diet and exercise .


At the same time , the control group only received advise on diet and exercise .


The percentage of adolescents who showed adherence to diet was 73.7 % versus 41.4 % , ( p = 0.0009 ) and to exercise , 61.4 % versus 19.0 % , ( p < 0.0005 ) ; compared with the control group , the intervention group was significantly higher .


A total of 10 adolescents ( 17.5 % ) in the intervention group and 26 ( 44.8 % ) in the control group dropped-out ( p = 0.003 ) .


Despite there were significant differences between groups , adolescents in the intervention group exhibited a higher and sustained decrease in body weight , body mass index , as well as in the body fat percentage .


The cognitive behavioral treatment strategy improves adherence and decreases desertion of the weight reduction program in adolescents .


The present study aimed to investigate the prevalence and correlates of dental caries in elderly population in northeast China .


A community-based , cross-sectional study among 2376 elderly subjects ( age : 65-74 years ) from nine urban areas and nine rural areas in three provinces of northeast China was conducted using multistage stratified random sampling per the World Health Organization oral health survey methodology .


Decayed-missing-filled teeth ( DMFT ) and decayed-filled teeth ( DFT ) indices were used to evaluate the prevalence of dental caries .


Face-to-face questionnaire survey on oral health was performed in a randomly selected subset ( n = 1197 ) .


T test and chi square test were employed to compare groups for continuous and categorical variables , respectively .


Multivariate logistic regression was used to estimate odds ratios ( ORs ) and corresponding confidence intervals ( CIs ) .


67.5 % of elderly subjects reported dental caries ( average DFT = 2.683.40 ) , and the prevalence was higher in urban areas ( P < 0.01 ) .


Missing teeth accounted for 80.72 % of DMFT , and filled teeth due to caries accounted for 2.08 % with a rate higher in urban areas ( P < 0.01 ) .


Logistic regression analysis indicated significant association among elderly population in urban areas ( OR 1.713 ; 95 % CI 1.337-2 .195 ) , smoking ( OR 1.779 ; 95 % CI 1.384-2 .288 ) , and individuals without dental insurance ( OR 2.050 ; 95 % CI 1.120-3 .754 ) with dental caries .


The prevalence of dental caries in the elderly population in northeast China is high .


The elderly from urban areas who smoke and who do not have a dental insurance are at a higher risk to develop dental caries .


To observe the short-term and long-term efficacies on primary dysmenorrhea treated with staging acupoint embedment therapy .


Seventy cases of primary dysmenorrhea were randomized into an embedment therapy group and a fenbid group , 35 cases in each one .


In the embedment therapy group , the embedment therapy was applied twice during the menstrual cycle , one treatment 3 days before menstruation and one treatment during the 12th-14th days of menstruation , respectively .


Guanyuan ( CV 4 ) , Zigong ( EX-CA 1 ) , Diji ( SP 8 ) and Ciliao ( BL 32 ) were the main acupoints in the treatment 3 days before menstruation .


Shenshu ( BL 23 ) , Ganshu ( BL 18 ) and Pishu ( BL 20 ) were the main acupoints in the treatment during menstruation .


In the fenbid group , fenbid was prescribed for oral administration , 0.3 g each time , twice a day , starting 3 days before menstruation till pain was relieved .


The treatment of one menstrual cycle was one session .


The continuous treatment of 3 menstrual cycles was required .


The short-term and long-term efficacies were evaluated at the end of the 3rd cycle and in 3 months after the treatment terminal .


The dysmenorrhea score was used to evaluate the efficacy .


Visual analogue scale ( VAS ) and SF-36 were for the assessment of pain degree and life quality .


( 1 ) The total effective rate was 91.4 % ( 32/35 ) in the embedment therapy group after the 3 menstrual cycles , which was better than 74.3 % ( 26/35 ) in the fenbid group ( P < 0.01 ) .


In the follow-up stage , the total effective rate was 91.4 % ( 32/35 ) in the embedment therapy group , which was better than 40.0 % ( 14/35 ) in the fenbid group ( P < 0.01 ) .


( 2 ) The differences were not significant in dysmenorrhea score and VAS score after the 1st and 2nd menstrual cycle treatments between the two groups ( all P > 0.05 ) .


In the 3rd menstrual cycle and the follow-up stage , the dysmenorrhea score and VAS score were reduced obviously in the embedment therapy group as compared with those in the fenbid group ( P < 0.05 , P < 0.01 ) .


The rebound effect occurred in the follow-up stage in the fenbid group .


( 3 ) In the 3rd menstrual cycle and the follow-up stage , the improvement in the total score of life quality of the embedment therapy group was superior apparently to the fenbid group ( P < 0.05 , P < 0.01 ) .


The staging acupoint embedment therapy achieves the superior short-term and long-term efficacies as compared with the oral administration of fenbid in the treatment of primary dysmenorrhea .


As the symptoms of dysmenorrhea and pain are relieved , the life quality is improved .


In-patient treatment ( IP ) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa , but it is costly , and the risks of relapse and readmissions are high .


Day patient treatment ( DP ) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home .


We investigated the safety and efficacy of DP after short inpatient care compared with continued IP .


For this multicentre , randomised , open-label , non-inferiority trial , we enrolled female patients ( aged 11-18 years ) with anorexia nervosa from six centres in Germany .


Patients were eligible if they had a body-mass index ( BMI ) below the tenth percentile and it was their first admission to hospital for anorexia nervosa .


We used a computer-generated randomisation sequence to randomly assign patients to continued IP or DP after 3 weeks of inpatient care ( 1:1 ; stratified for age and BMI at admission ) .


The treatment programme and treatment intensity in both study groups were identical .


The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness ( non-inferiority margin of 075 kg/m ( 2 ) ) .


Analysis was done by modified intention to treat .


This trial is registered with the International Standard Randomised Controlled Trial Number Register , number ISRCTN67783402 , and the Deutsches Register Klinischer Studien , number DRKS00000101 .


Between Feb 2 , 2007 , to April 27 , 2010 , we screened 660 patients for eligibility , 172 of whom we randomly allocated to treatment : 85 to IP and 87 to DP .


DP was non-inferior to IP with respect to the primary outcome , BMI at the 12-month follow-up ( mean difference 046 kg/m ( 2 ) in favour of DP ( 95 % CI , -011 to 102 ; pnon-inferiority < 00001 ) .


The number of treatment-related serious adverse events was similar in both study groups ( eight in the IP group , seven in the DP group ) .


Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation ; one patient in the DP attempted suicide 3 months after she was discharged .


DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission .


Thus , DP might be a safe and less costly alternative to IP .


Our results justify the broad implementation of this approach .


German Ministry for Education and Research .


Sleep disturbances are common among women in midlife ; prevalence increases among perimenopausal/postmenopausal women with vasomotor symptoms .


Paroxetine 7.5 mg is the only nonhormonal treatment that has been approved in the United States for moderate to severe vasomotor symptoms associated with menopause .


In two pivotal phase 3 studies evaluating its efficacy and safety , improvements in sleep disturbances were also prospectively evaluated .


Postmenopausal women with moderate to severe vasomotor symptoms were randomly assigned to paroxetine 7.5 mg ( n = 591 ) or placebo ( n = 593 ) once daily for 12 weeks ( both studies ) or 24 weeks ( 24-wk study ) .


Predefined assessments on weeks 4 , 12 , and 24 included number of nighttime awakenings attributed to vasomotor symptoms , sleep-onset latency , sleep duration , and sleep-related adverse events .


The two studies ' data for weeks 1 to 12 were pooled .


At baseline , participants reported a mean of 3.6 awakenings/night attributed to vasomotor symptoms .


Nighttime awakenings attributed to vasomotor symptoms were significantly reduced within 4 weeks of initiating paroxetine 7.5 mg treatment ( 39 % reduction vs 28 % for placebo ; P = 0.0049 ) , and reductions were sustained through 12 or 24 weeks of treatment .


Paroxetine 7.5 mg treatment also significantly increased nighttime sleep duration ( week 4 , +31 vs +16 min for placebo ; P = 0.0075 ) , but no significant between-group differences in sleep-onset latency or sleep-related adverse events such as sedation were observed .


In postmenopausal women treated for menopausal vasomotor symptoms , paroxetine 7.5 mg significantly reduces the number of nighttime awakenings attributed to vasomotor symptoms and increases sleep duration without differentially affecting sleep-onset latency or sedation .


The maximal calcium absorption in response to vitamin D has been proposed as a biomarker for vitamin D sufficiency .


The objective was to determine whether there is a threshold beyond which increasing doses of vitamin D , or concentrations of serum 25-hydroxyvitamin D [ 25 ( OH ) D ] , no longer increase calcium absorption .


This was a placebo-controlled , dose-response , randomized , double-blind study of the effect of vitamin D on calcium absorption in healthy postmenopausal women .


Seventy-six healthy postmenopausal women were randomly assigned to placebo or 800 IU ( 20 g ) , 2000 IU ( 50 g ) , or 4000 IU ( 100 g ) vitamin D for 8 wk .


The technique of dual isotopes of stable calcium was used with a calcium carrier to measure calcium absorption at baseline and after 8 wk .


Seventy-one women with a mean SD age of 58.8 4.9 y completed the study .


The mean calcium intake was 1142 509 mg/d and serum 25 ( OH ) D was 63 14 nmol/L at baseline .


A statistically significant linear trend of an increase in calcium absorption adjusted for age and body mass index with increasing vitamin D dose or serum 25 ( OH ) D concentration was observed .


A 6.7 % absolute increase in calcium absorption was found in the highest vitamin D group ( 100 g ) .


No evidence of nonlinearity was observed in the dose-response curve .


No evidence of a threshold of calcium absorption was found with a serum 25 ( OH ) D range from 40 to 130 nmol/L .


Calcium absorption in this range is not a useful biomarker to determine nutritional recommendations for vitamin D.


In the paediatric population , pain and distress associated with burn injuries during wound care procedures remain a constant challenge .


Although silver dressings are the gold standard for burn care in Australasia , very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically .


Therefore , for paediatric patients in particular , identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative .


This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat , Acticoat combined with Mepitel and Mepilex Ag dressings for acute , paediatric partial thickness burns .


Children aged 0 to 15 years with an acute partial thickness ( superficial partial to deep partial thickness inclusive ) burn injury and a burn total body surface area of 10 % will be eligible for the trial .


Patients will be randomised to one of the three dressing groups : ( 1 ) Acticoat or ( 2 ) Acticoat combined with Mepitel or ( 3 ) Mepilex Ag .


A minimum of 28 participants will be recruited for each treatment group .


Primary measures of pain , distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required .


Additional data collected will include infection status at each dressing change , physical function , scar outcome and scar management requirements , cost effectiveness of each dressing and staff perspectives of the dressings .


The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute , paediatric partial thickness burn injuries .


Australian New Zealand Clinical Trials Registry ACTRN12613000105741 .


To evaluate the efficacy of valproic acid ( VPA ) on visual function in patients with retinitis pigmentosa ( RP ) .


Thirty patients ( 60 eyes ) with typical RP were recruited for the study .


Of these , 15 patients received oral VPA ( 500mg once daily ) for a period of 1 year ( group 1 ) and the remaining 15 received no treatment ( group 2 ) and served as controls .


The effect of VPA on visual function was determined in terms of visual acuity , amplitude and implicit time in multifocal electroretinography ( mfERG ) , and visual evoked response ( VER ) performed at presentation and at the third month , sixth month , and 1 year in both groups .


Side effects of oral VPA were also monitored .


At 1-year follow-up , 14 of 15 patients in group 1 had improvement in median best corrected visual acuity ( BCVA ) from 1.8 [ Range ( R ) 1-3 ] at baseline to 1.3 ( R , 0.6-1 .3 ) ( P < 0.001 ) .


In contrast , there was a slight decrease in median BCVA from 1.8 ( 0.8 - 3 ) logarithm of the minimum angle of resolution ( logMAR ) at baseline to 1.83 ( P = 0.3 ) in the control arm .


There was also a statistically significant increase in improvement in amplitude and latency/implicit time in mfERG and VER in this group ( P < 0.001 ) .


However , no such improvement was observed in the control arm .


Thus , VPA seems to have a positive effect on the visual functions in RP patients .


Long-term studies evaluating the dose modifications , genetic analysis , and change in visual fields will add to our current knowledge .


Delirium is associated with poor outcomes following acute hospitalization .


The Geriatric Monitoring Unit ( GMU ) is a specialized five-bedded unit for acute delirium care .


It is modeled after the Delirium Room program , with adoption of core interventions from the Hospital Elder Life Program and use of evening light therapy to consolidate circadian rhythms and improve sleep in older inpatients .


This study examined whether the GMU program improved outcomes in delirious patients .


A total of 320 patients , including 47 pre-GMU , 234 GMU , and 39 concurrent control subjects , were studied .


Clinical characteristics , cognitive status , functional status ( Modified Barthel Index [ MBI ] ) , and chemical restraint-use data were obtained .


We also looked at in-hospital complications of falls , pressure ulcers , nosocomial infection rate , and discharge destination .


Secondary outcomes of family satisfaction ( for the GMU subjects ) were collected .


There were no significant demographic differences between the three groups .


Pre-GMU subjects had longer duration of delirium and length of stay .


MBI improvement was most evident in the GMU compared with pre-GMU and control subjects ( 19.218.3 , 7.511.2 , 15.118.0 , respectively ) ( P < 0.05 ) .


The GMU subjects had a zero restraint rate , and pre-GMU subjects had higher antipsychotic dosages .


This translated to lower pressure ulcer and nosocomial infection rate in the GMU ( 4.1 % and 10.7 % , respectively ) and control ( 1.3 % and 7.7 % , respectively ) subjects compared with the pre-GMU ( 9.1 % and 23.4 % , respectively ) subjects ( P < 0.05 ) .


No differences were observed in mortality or discharge destination among the three groups .


Caregivers of GMU subjects felt the multicomponent intervention to be useful , with scheduled activities voted the most beneficial in patient 's recovery from the delirium episode .


This study shows the benefits of a specialized delirium management unit for older persons .


The GMU model is thus a relevant system of care for rapidly `` graying '' nations with high rates of frail elderly hospital admissions , which can be easily transposed across acute care settings .


To study the value of contrast-enhanced ultrasound in tuberculous cervical lymph node biopsy .


Seventy-nine patients with cervical lymph node were divided into two groups .


The lymph nodes of group A were used as real-time ultrasound guided biopsy ; the lymph nodes of group B were contrast-enhanced ultrasound firstly to determine the target lymph node and the puncture point , then were detected with needle biopsy .


Group A : for the 23 lymph nodes of 23 patients , the rate of intact tissue was 52.1 % and the positive rate of pathological diagnosis was 73.9 % .


Group B : for the 56 lymph nodes of 56 patients , the rate of intact tissue was 98.2 % and the positive rate of pathological diagnosis was 100 % ( Chi square value was 23.37 and 12.31 , P < 0.05 ) .


The application of contrast-enhanced ultrasound before cervical lymph node biopsy can obviously improve the rate of intact tissue and the positive rate of pathological diagnosis .


Few safe and effective dietary supplements are available to promote weight loss .


We evaluated the safety and efficacy of glucomannan , a water-soluble fiber supplement , for achieving weight loss in overweight and moderately obese individuals consuming self-selected diets .


Participants were randomly assigned to take 1.33 grams of glucomannan or identically looking placebo capsules with 236.6 mL ( 8 ounces ) of water one hour before breakfast , lunch , and dinner for 8 weeks .


The primary efficacy outcome was change in body weight after 8 weeks .


Other efficacy outcomes were changes in body composition , hunger/fullness , and lipid and glucose concentrations .


Safety outcomes included gastrointestinal symptoms/tolerance and serum liver enzymes and creatinine levels .


A total of 53 participants ( 18-65 years of age ; BMI 25-35kg / m ) were enrolled and randomized .


The two groups did not differ with respect to baseline characteristics and compliance with the study supplement .


At 8 weeks , there was no significant difference between the glucomannan and placebo groups in amount of weight loss ( -.40 .06 and -.43 .07 , resp . )


or other efficacy outcomes or in any of the safety outcomes .


Glucomannan supplements administered over 8 weeks were well tolerated but did not promote weight loss or significantly alter body composition , hunger/fullness , or lipid and glucose parameters .


This trial is registered with NCT00613600 .


To assess daily functioning and geriatric conditions of older subjects suffering from heart failure ( HF ) as compared to the general population .


The data were collected as part of the nationwide PolSenior project ( 2007-2011 ) .


Of 4979 individuals ( age range 65-104 years ) , data on self-reported HF hospitalization were available for 4795 subjects ( 96 % ) .


Geriatric assessment ( GA ) included functional status ( ADL , Activities of Daily Living and IADL , Instrumental ADL scales ) , cognitive function , mood disorders , sensory organ impairment , falls and comorbidity .


Mean age SD of the study population was 73.8 6.5 years ; 62 % were female .


The proportion of subjects with HF hospitalizations increased from 8 % in subjects aged 65-69 years up to 13 % in the age group of 85-89 years , and decreased in nonagenarians ( 11 % ) .


Subjects with the HF hospitalization were older , used more drugs , and were characterized by a higher prevalence of comorbid conditions , mood disorders , hearing impairment and functional limitations .


In logistic regression , HF hospitalization increased the age-sex adjusted risk of disability by 40 % , both in ADL and IADL .


After adjustment to other clinical and geriatric conditions , HF hospitalization remained an independent predictor of disability in both ADL ( OR = 1.36 , 95 % CI : 1.00-1 .84 ) and IADL ( OR = 1.40 , 95 % CI : 1.01-1 .93 ) .


Older people who reported HF admissions had a higher number of comorbidities and geriatric conditions : mood disorders , hearing impairment and functional limitations .


Besides , in our study , HF hospitalization independently and significantly increased the risk of limitations in IADL and ADL .


Therefore , further studies are needed to evaluate the benefits of GA in patients with HF .


The course of swine influenza in pigs is reported to be similar to human influenza .


Occasionally abortions and other reproduction disorders have been associated with influenza A virus ( IAV ) infection in pigs .


Abortions may be a consequence of high fever , pro-inflammatory cytokines or transplacental transmission of the virus.The role of IAV in the complications observed during pregnancy has been scanty and the true importance of this agent as a cause of reproductive problems in swine is not known .


The aim was to determine the possible involvement of swine H1N2 IAV strain on reproductive disorders in pregnant gilts under experimental conditions .


The gestation length was from 113 to 116 days , no abortion or any other reproduction disorders were noted .


A PCR assay confirms the presence of IAV in the nasal swabs taken from inoculated gilts between 1 and 5 dpi .


In the nasal swabs from control gilts and newborn piglets , no IAV genetic material was found .


No viral RNA was detected in samples of blood taken from gilts and piglets , placentas , lungs and tracheas taken from piglets euthanized after delivery .


The significant decrease in the number and percentage of lymphocytes without leukopenia was observed at 4 dpi in inoculated gilts .


The percentage of granulocytes increased significantly at 4 dpi in inoculated pigs .


The concentration of IL-6 , IL-10 and TNF - were higher in inoculated gilts , while IL-4 and IFN - were not detected in the serum of any of animals .


The serum concentrations of C-reactive protein remained stable during study , while haptoglobin concentrations increased significantly after inoculation .


The results of the study indicate that infection of pregnant gilts with swine H1N2 IAV in the second month of pregnancy does not cause abortion and other reproduction disorders .


No evidence for transplacental transmission of swine H1N2 IAV was found .


However , due to subclinical course of influenza in the present experiment caution should be taken in extrapolating these results to the cases of acute influenza .


The other limitation is IAV diversity .


It can not be excluded that other subtypes of IAV could be associated to reproduction failure in pigs .


Although applying adhesive strips to a wound closure has been shown to have outcomes equivalent to those with cuticular suturing , it is unknown whether adhesive strips provide additional benefit compared with dermal suturing alone .


To determine whether the addition of adhesive strips to a wound closed with buried interrupted subcuticular sutures improves outcomes following wound closure .


A prospective , randomized split-wound intervention was conducted between November 14 , 2013 , and May 16 , 2014 , in patients who underwent cutaneous surgical procedures at the University of California , Davis , outpatient dermatology clinic .


Fifty-seven patients 18 years or older with postoperative defects of at least 3 cm , resulting from either Mohs micrographic surgical procedures or surgical excision , were screened for participation .


Nine patients were excluded and 48 were enrolled .


Half of each wound was randomized to receive buried interrupted subcuticular sutures and overlying adhesive strips and the other half received buried interrupted subcuticular sutures only .


At 3 months ' follow-up , each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale .


The total mean ( SD ) Patient Observer Scar Assessment Scale score for observers for the side that received a combination of adhesive strips and buried interrupted subcuticular suturing ( 12.3 [ 4.8 ] ) and the side that received sutures only ( 12.9 [ 6.3 ] ) did not differ significantly at 3 months ( P = .32 ) .


There was no significant difference in the total patient assessment scale score between the combination closure ( 14.0 [ 7.6 ] ) and sutures only ( 14.7 [ 7.6 ] ) sides at 3 months ( P = .39 ) .


There was also no significant difference between the 2 closure methods in terms of mean ( SD ) scar width ( both methods : 1.1 [ 0.8 ] mm , P = .89 ) at follow-up .


Combination closure with adhesive strips and buried interrupted subcuticular suturing was not significantly associated with improved overall scar assessment compared with buried interrupted subcuticular suturing alone when evaluated by blinded observers or the patients themselves .


Our results do not support the use of adhesive strips as a means to improve cosmetic outcomes or reduce scar width .


clinicaltrials.gov Identifier : NCT01979497 .


The aim of this study was to determine the effect of plant-based diets on weight loss .


Participants were enrolled in a 6-mo , five-arm , randomized controlled trial in 2013 in South Carolina .


Participants attended weekly group meetings , with the exception of the omnivorous group , which served as the control and attended monthly meetings augmented with weekly e-mail lessons .


All groups attended monthly meetings for the last 4 mo of the study .


Diets did not emphasize caloric restriction .


Overweight adults ( body mass index 25-49 .9 kg/m ( 2 ) ; age 18-65 y , 19 % non-white , and 27 % men ) were randomized to a low-fat , low-glycemic index diet : vegan ( n = 12 ) , vegetarian ( n = 13 ) , pesco-vegetarian ( n = 13 ) , semi-vegetarian ( n = 13 ) , or omnivorous ( n = 12 ) .


Fifty ( 79 % ) participants completed the study .


In intention-to-treat analysis , the linear trend for weight loss across the five groups was significant at both 2 ( P < 0.01 ) and 6 mo ( P < 0.01 ) .


At 6 mo , the weight loss in the vegan group ( -7.5 % 4.5 % ) was significantly different from the omnivorous ( -3.1 % 3.6 % ; P = 0.03 ) , semi-vegetarian ( -3.2 % 3.8 % ; P = 0.03 ) , and pesco-vegetarian ( -3.2 % 3.4 % ; P = 0.03 ) groups .


Vegan participants decreased their fat and saturated fat more than the pesco-vegetarian , semi-vegetarian , and omnivorous groups at both 2 and 6 mo ( P < 0.05 ) .


Vegan diets may result in greater weight loss than more modest recommendations .


To assess the safety and efficacy of pitavastatin in children and adolescents with hyperlipidemia .


A total of 106 children and adolescents with hyperlipidemia , ages 6 to 17 years , were enrolled in a 12-week randomized , double-blind , placebo-controlled study and randomly assigned to pitavastatin 1 mg , 2 mg , 4 mg , or placebo .


During a 52-week extension period , subjects were up-titrated from 1 mg pitavastatin to a maximum dose of 4 mg in an effort to achieve an optimum low-density lipoprotein cholesterol ( LDL-C ) treatment target of < 110 mg/dL ( 2.8 mmol/L ) .


Adverse events rates , including abnormal clinical laboratory variables , vital signs , and physical examination were assessed .


Compared with placebo , pitavastatin 1 , 2 , and 4 mg significantly reduced LDL-C from baseline by 23.5 % , 30.1 % , and 39.3 % , respectively , and in the open-label study 20.5 % of the subjects reached the LDL-C goal < 110 mg/dL ( 2.8 mmol/L ) .


No safety issues were evident .


Pitavastatin at doses up to 4 mg is well tolerated and efficacious in children and adolescents aged 6-17 years .


Registered with EudraCT 2011-004964-32 and EudraCT 2011-004983-32 .


Speech perception is the most important social task of the auditory system .


Consequently , speech audiometry is essential to evaluate hearing aid benefit .


The aim of the study was to describe the correlation between pure-tone hearing loss and speech perception .


In particular , pure-tone audiogram , speech audiogram , and speech perception with hearing aids were compared .


In a retrospective study , 102 hearing aid users with bilateral sensorineural hearing loss were included .


Pure-tone loss ( PTA ) was correlated to monosyllabic perception at 65 dB with hearing aid and with maximum monosyllabic perception with headphones .


Speech perception as a function of hearing loss can be represented by a sigmoid function .


However , for higher degrees of hearing loss , substantial deviations are observed .


Maximum monosyllabic perception with headphones is usually not achieved with hearing aids at standard speech levels of 65 dB .


For larger groups , average pure-tone hearing loss and speech perception correlate significantly .


However , prognosis for individuals is not possible .


In particular for higher degrees of hearing loss substantial deviations could be observed .


Speech performance with hearing aids can not be predicted sufficiently from speech audiograms .


Above the age of 80 , speech perception is significantly worse .


Hyperlipidemia occurs in up to 50 % of kidney transplant ( KT ) recipients who take everolimus ( EVL ) .


As a result of this , statins are the most commonly prescribed lipid-lowering drugs among these patients .


However , we are concerned whether there are any drug interactions between EVL and statins , because both of these drugs use the same pharmacokinetics pathway .


Therefore , we assessed the effects of concomitant use of EVL and atorvastatin .


In this randomized , open-label , crossover study , 20 KT patients were assigned ( 1:1 ) to receive EVL with or without 20 mg atorvastatin for 1 month .


One-month washout period was used before crossover .


Plasma EVL concentrations were measured by homogeneous particle-enhanced turbidimetric immunoassay .


Twelve-hour area under the time-concentration curve ( AUC0-12 ) of EVL was calculated with the use of whole-blood EVL concentrations from 10 different time points ( 0 , 0.5 , 1 , 1.5 , 2 , 2.5 , 4 , 6 , 8 , and 12 hours ) .


The mean ( SD ) AUC0-12 for EVL and EVL plus atorvastatin was 155.9 ( 41.6 ) ngh/mL and 151.3 ( 51.4 ) ngh/mL , respectively ( P > .05 ; paired t test ) .


No difference of EVL Cmax or Tmax was found after atorvastatin coadministration .


Even though the EVL AUC0-12 levels were not affected by atorvastatin coadministration in one-half of the subjects , for the rest of the patients , there were unpredictable changes in the EVL AUC0-12 levels .


This may be due to the high intrapatient variability of EVL drug concentration ( coefficient of variation ranges from 9.8 % to 34.1 % ) .


Coadministration of atorvastatin with EVL in KT recipients did not affect the pharmacokinetics of EVL .


Problem-based learning ( PBL ) involves discussions among students who resolve loosely-structured problems to facilitate learning .


In the PBL curriculum , faculty tutors are employed as facilitators for small groups of students .


Because of lack of time and staff shortage , the effectiveness of tutorless PBL has been discussed as an alternate option .


Sessions in which tutored and tutorless PBL groups are mixed were presented by 1st-year medical students , who experienced both tutored and tutorless groups alternately in the two sessions of a year .


To examine the effectiveness of tutored and tutorless PBL , written examination scores ( WES ) and self-contentment scores ( SCS ) were statistically analysed .


WES averages did not significantly differ between the tutored and tutorless groups ; however , a significantly greater variation was observed in WES in the tutorless group .


SCS averages tended to be higher in the tutored PBL than in tutorless PBL groups .


Students in these tutorless PBL groups performed well in their written examinations , whereas those in the tutored PBL groups , achieved this and reported better self-contentment with their learning experience .


Tutorless PBL sessions were considered to be comparable to tutored PBL sessions at least in the early stages .


Randomised , double-blind , placebo-controlled crossover trial of melatonin supplementation to people with complete tetraplegia .


To investigate the effect that 3mg melatonin supplementation has on objective and subjective sleep , quality of life and mood of people living with complete tetraplegia .


Austin Hospital Sleep Laboratory and participants ' homes , Melbourne , Victoria , Australia .


Two week run-in followed by 3 week nightly administration of 3mg melatonin or placebo , 2-week washout and further 3 week administration of the opposite treatment .


Four testing sessions were conducted ; the last nights of the run-in , treatment and washout periods .


Testing sessions involved recording full polysomnography , completing a questionnaire battery and collecting urine and blood samples .


The questionnaires assessed mood , sleep symptoms and health-related quality of life , and the urine and plasma samples assayed 6-sulphatoxymelatonin ( aMT6s ) and melatonin levels , respectively .


A sleep diary was completed throughout the study .


Eight participants ( mean ( s.d. ) : age 49.5 years ( 16 ) , postinjury 16.9 years ( 7.1 ) ) were recruited in which seven concluded the protocol .


Endogenous-circulating melatonin was significantly higher ( P < or = 0.01 ) following melatonin ( urine : 152.94 gh ( -1 ) ( 74.51 ) , plasma : 43,554.57 pM ( 33,527.11 ) ) than placebo ( urine : 0.86 gh ( -1 ) ( 0.40 ) , plasma : 152.06 pM ( 190.55 ) ) .


Subjective sleep improved significantly following melatonin specifically for duration of sleep per night and psychological wellbeing .


Objective sleep showed a significant increase in light sleep with melatonin , with all other sleep parameters being unchanged .


These results suggest that increasing melatonin in people with complete tetraplegia is beneficial , especially for subjective sleep .


Investigation of the pharmacokinetics of melatonin metabolism in this population is warranted .


This project is proudly supported by the Transport Accident Commission .


Intragastric creaming and droplet size of fat emulsions may affect intragastric behavior and gastrointestinal and satiety responses .


We tested the hypotheses that gastrointestinal physiologic responses and satiety will be increased by an increase in intragastric stability and by a decrease in fat droplet size of a fat emulsion .


This was a double-blind , randomized crossover study in 11 healthy persons [ 8 men and 3 women , aged 24 1 y ; body mass index ( in kg/m ( 2 ) ) : 24.4 0.9 ] who consumed meals containing 300-g 20 % oil and water emulsion ( 2220 kJ ) with 1 ) larger , 6-m mean droplet size ( Coarse treatment ) expected to cream in the stomach ; 2 ) larger , 6-m mean droplet size with 0.5 % locust bean gum ( LBG ; Coarse + LBG treatment ) to prevent creaming ; or 3 ) smaller , 0.4-m mean droplet size with LBG ( Fine + LBG treatment ) .


The participants were imaged hourly by using MRI and food intake was assessed by using a meal that participants consumed ad libitum .


The Coarse + LBG treatment ( preventing creaming in the stomach ) slowed gastric emptying , resulting in 12 % higher gastric volume over time ( P < 0.001 ) , increased small bowel water content ( SBWC ) by 11 % ( P < 0.01 ) , slowed appearance of the ( 13 ) C label in the breath by 17 % ( P < 0.01 ) , and reduced food intake by 9 % ( P < 0.05 ) compared with the Coarse treatment .


The Fine + LBG treatment ( smaller droplet size ) slowed gastric emptying , resulting in 18 % higher gastric volume ( P < 0.001 ) , increased SBWC content by 15 % ( P < 0.01 ) , and significantly reduced food intake by 11 % ( P < 0.05 , equivalent to an average of 411 kJ less energy consumed ) compared with the Coarse + LBG treatment .


These high-fat meals stimulated substantial increases in SBWC , which increased to a peak at 4 h at 568 mL ( range : 150-854 mL ; P < 0.01 ) for the Fine + LBG treatment .


Manipulating intragastric stability and fat emulsion droplet size can influence human gastrointestinal physiology and food intake .


This analysis aimed to perform a head-to-head comparison of 3 of the promising biomarkers of cardiovascular ( CV ) outcomes in heart failure ( HF ) - soluble ST2 ( sST2 ) , growth differentiation factor ( GDF ) -15 , and highly-sensitive troponin T ( hsTnT ) - and to evaluate the role of serial measurement of these biomarkers in patients with chronic HF .


sST2 , GDF-15 , and hsTnT are strongly associated with CV outcomes in HF .


This post-hoc analysis used data from a study in which 151 patients with chronic HF due to left ventricular systolic dysfunction were followed up over 10 months .


At each visit , N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) , sST2 , GDF-15 , and hsTnT were measured and any major CV events were recorded .


Baseline values of all 3 novel biomarkers independently predicted total CV events even after adjusting for clinical and biochemical characteristics , including NT-proBNP , with the best model including all 3 biomarkers ( p < 0.001 ) .


Adding serial measurement to the base model appeared to improve the model 's predictive ability ( with sST2 showing the most promise ) , but it is not clear whether this addition is a unique contribution .


However , when time-dependent factors were included , only sST2 serial measurement independently added to the risk model ( odds ratio : 3.64 ; 95 % confidence interval : 1.37 to 9.67 ; p = 0.009 ) and predicted reverse myocardial remodeling ( odds ratio : 1.22 ; 95 % confidence interval : 1.04 to 1.43 ; p = 0.01 ) .


In patients with chronic HF , baseline measurement of novel biomarkers added independent prognostic information to clinical variables and NT-proBNP .


Only serial measurement of sST2 appeared to add prognostic information to baseline concentrations and predicted change in left ventricular function .


( Use of NT-proBNP Testing to Guide Heart Failure Therapy in the Outpatient Setting ( PROTECT ) ] ; NCT00351390 ) .


Diabetes mellitus is associated with oxidative stress which impairs the platelet function .


Phyllanthus emblica extract a rich source of vitamin C plays an important role in scavenging free radicals .


The effect of vitamin C on platelet aggregation in healthy and coronary artery disease patients has been demonstrated .


The present study attempts to study the pharmacodynamic interactions of P. emblica extract with clopidogrel and ecosprin .


This was a randomized open label crossover study of 10 type II diabetic patients .


The dosage schedules were either single dose of 500 mg P. emblica extract or 75 mg clopidogrel or 75 mg ecosprin or 500 mg P. emblica +75 mg clopidogrel or 500 mg P. emblica +75 mg ecosprin .


After single dose study and washout period , patients received either 500 mg P. emblica extract twice daily or 75 mg clopidogrel or 75 mg ecosprin once daily or combinations for 10 days .


Platelet aggregation was measured at baseline and at 4h of treatment after single and multiple dose study along with recording of bleeding and clotting time .


After single and multiple dose administration of the three treatments and with combinations there was statistically significant decrease of platelet aggregation compared to baseline .


Further , the mean percent inhibition of platelet aggregation was significant , when compared between single and multiple doses of P. emblica .


The bleeding and clotting time was prolonged with single and multiple dose administration of all treatments compared to baseline .


All treatments were well tolerated .


P. emblica extract demonstrated significant antiplatelet activity with both single and multiple dose administration .


To compare the efficacy and safety of intramuscular meperidine injection with periprostatic nerve block ( PNB ) during transrectal ultrasound-guided prostate biopsy .


This study was carried out from July 2010 to June 2012 at the First Affiliated Hospital of Fujian Medical University , Fuzhou , Fujian , China .


This controlled , double-blinded , randomized study included 186 patients .


These patients were randomly assigned to 3 treatment groups : PNB by injection 10 minutes prior to the prostate biopsy ; intramuscular meperidine injection administered 30 minutes before the biopsy , and a control group ( n = 62 , each ) .


At the time of ultrasound probe insertion , during biopsy , and 30 minutes after biopsy , patients graded their level of pain on a 10-point visual analog scale ( VAS ) .


There was no statistical difference in clinical features of the 3 groups .


The patients administered meperidine had the minimum mean VAS score during probe insertion .


During the prostate biopsy , there was no significant difference in VAS scores between patients in the PNB and meperidine groups , and both were significantly lower than that of the control group .


The VAS scores recorded 30 minutes after biopsy were similar among the 3 groups .


Intramuscular meperidine injection is a safe and effective analgesic for use during transrectal ultrasound-guided prostate biopsy , and provides better analgesia than PNB during the probe insertion .


Dyschezia is a defecatory disorder that places a heavy burden on a patient 's quality of life .


Biofeedback is the recommended treatment in most cases .


The objective of our study was to test whether a CO2-releasing suppository for patients with dyschezia could be effective in improving biofeedback training results .


A randomized , double-blind , multicenter , placebo-controlled study was conducted in patients ( 18-75 years of age ) with dyschezia defined according to the modified Rome III criteria .


Patients were randomly assigned to either a CO2-releasing suppository or placebo suppository once per day for 21 days .


This was a multicenter trial .


A total of 122 patients were randomly assigned ( 62 intervention group and 60 placebo group ) .


The primary end point was the change from day 0 to day 21 in intensity of symptoms on the basis of a self-assessed dyschezia using a visual analog scale ( range , 0-100 ) .


Analyses were performed using intention-to-treat principles .


A greater reduction from baseline to day 21 in symptom visual analog scale score was observed in the intervention group ( -41.3 mm ) than in the control group ( -22.3 mm ) .


Some secondary efficacy parameters improved more in the intervention group , including the percentage of patients who improved 50 % , symptom intensity over 21 days , stool stains on underwear or pads , and need to practice manual maneuvers to facilitate defecation at day 21 .


At day 21 , rectal sensitivity in the intervention group ( 31.4 mL ) was lower than in the control group ( 39.1 mL ) .


There was a lower number of patients recruited than planned by the protocol .


The sponsor stopped the trial before the inclusion of 306 participants , with no intermediate analysis .


In addition , the main analysis conducted on the full analysis set population could have led to a statistical bias .


The results of this multicenter trial demonstrate the added benefits of a CO2-releasing suppository in patients with dyschezia who were treated by anorectal biofeedback training .


To investigate the effects of inhaler device technique education on improving inhaler technique in older people with asthma .


In a randomised controlled trial , device technique education was provided to a sample of 123 adults aged > 55 years who had a doctor diagnosis of asthma .


The active education group received one-on-one technique coaching , including observation , verbal instruction and physical demonstration at baseline .


The passive group received a device-specific instruction pamphlet only .


Inhaler technique , including the critical steps for each device type , was assessed and scored according to Australian National Asthma Council ( NAC ) guidelines .


Device technique was scored objectively at baseline and again at 3 and 12 months post education .


The majority of participants demonstrated poor technique at baseline .


Only 11 ( 21 % ) of the active intervention group and 7 ( 16 % ) of the passive group demonstrated 100 % correct technique .


By 3 months 26 ( 48 % ) of the active group achieved adequate technique .


Improvement in technique was observed in the active group at 3 months ( P < 0.001 ) and remained significant at 12 months ( P < 0.001 ) .


No statistically significant improvement was observed in the passive group .


The provision of active device technique education improves device technique in older adults .


Passive education alone fails to achieve any improvement in device technique .


We sought to determine whether empirical nesiritide or milrinone would improve the early postoperative course after Fontan surgery .


We hypothesized that compared with milrinone or placebo , patients assigned to receive nesiritide would have improved early postoperative outcomes .


In a single-center , randomized , double-blinded , placebo-controlled , multi-arm parallel-group clinical trial , patients undergoing primary Fontan surgery were assigned to receive nesiritide , milrinone , or placebo .


A loading dose of study drug was administered on cardiopulmonary bypass followed by a continuous infusion for 12 hours and 5 days after cardiac intensive care unit admission .


The primary outcome was days alive and out of the hospital within 30 days of surgery .


Secondary outcomes included measures of cardiovascular function , renal function , resource use , and adverse events .


Among 106 enrolled subjects , 35 , 36 , and 35 were randomized to the nesiritide , milrinone , and placebo groups , respectively , and all were analyzed based on intention to treat .


Demographics , patient characteristics , and operative factors were similar among treatment groups .


No significant treatment group differences were found for median days alive and out of the hospital within 30 days of surgery ( nesiritide , 20 [ minimum to maximum , 0-24 ] ; milrinone , 18 [ 0-23 ] ; placebo , 20 [ 0-23 ] ; P = 0.38 ) .


Treatment groups did not significantly differ in cardiac index , arrhythmias , peak lactate , inotropic scores , urine output , duration of mechanical ventilation , intensive care or chest tube drainage , or adverse events .


Compared with placebo , empirical perioperative nesiritide or milrinone infusions are not associated with improved early clinical outcomes after Fontan surgery .


http://www.clinicaltrials.gov .


Unique identifier : NCT00543309 .


To explore the application of optimal monochromatic images according to computed tomography ( CT ) values of conventional CT scans with high concentration contrast agent and the feasibility in guiding abdominal arteries imaging with low concentration contrast .


From March 2013 to February 2014 , 160 patients of suspected celiac disease with a body mass index ( BMI ) of > 25 kg/m ( 2 ) underwent spectral CT scan .


And they were randomly divided into two groups .


In group A ( n = 61 ) , 270 mgI/ml low concentrations of contrast agents and spectral CT imaging ; in group B ( n = 99 ) , 350 mgI/ml high concentrations of contrast agents and 120 kVp scan .


For CT values of the first measurement of abdominal aorta B group of patients , the average CT value was calculated .


The optimal monochromatic images of group A according to CT values of group B were reconstructed and 70 keV images ( group C ) also reconstructed .


The CT values of hepatic , splenic , right renal and superior mesenteric arteries were measured and contrast to noise ratios ( CNRs ) calculated .


CT values and CNR were compared through t test on independent samples .


P > 0.05 indicated no significant difference .


Mean CT value of abdominal aorta was ( 422 65 ) HU in group B. And optimal keV was ( 67 5 ) keV in group A. CT values of abdominal aorta and its branches showed no statistical significance ; the CNRs of abdominal aorta and its branches showed statistical significance .


The scoring consistency between two observers was excellent and the score ( 4.1 0.9 vs 4.2 0.7 ) showed no significant difference ( P > 0.05 ) .


GSI abdominal scans with low concentration contrast may obtain better image qualities compared to conventional CTA of high concentration .


And ( 67 5 ) keV is recommended .


Platelet transfusion is increasingly used in patients with traumatic intracranial hemorrhage ( ICH ) on aspirin therapy to minimize the progression of ICH .


We hypothesized ( null ) that platelet transfusion in this cohort of patients does not improve platelet function .


We performed a prospective interventional trail on patients with traumatic ICH on daily high-dose ( 325 mg ) aspirin therapy .


All patients received one pack of apheresis platelets .


Blood samples were collected before and 1 hour after platelet transfusion .


Platelet function was assessed using Verify Now Platelet Function Assay , and a cutoff of greater than 550 aspirin reaction units was used to define functioning platelets ( FP ) .


Twenty-eight patients were enrolled in the study .


On presentation , 79 % ( 22 of 28 ) of the patients had nonfunctioning platelets ( NFPs ) , and transfusion of platelets did not improve platelet function as 81 % ( 18 of 22 ) still had NFP .


Of the 22 patients , 4 converted from NFP to FP after transfusion .


There was no difference in the progression of ICH ( 37.5 % vs. 30 % , p = 0.7 ) or neurosurgical intervention ( 12.5 % vs. 15 % , p = 0.86 ) between patients with FP and NFP after platelet transfusion .


Administration of one pack of apheresis platelet did not improve platelet function .


In our study , progression of ICH and the need for neurosurgical intervention were independent of platelet function .


Further randomized clinical trials are required to assess both the dose dependence effect and role of platelet transfusion in patients on antiplatelet therapy with traumatic ICH .


Therapeutic study , level III .


To compare the short-term functional outcome after computer-assisted total knee arthroplasty ( TKA ) versus conventional TKA .


23 men and 67 women aged 48 to 80 years were randomised to undergo ( 1 ) conventional TKA using an intramedullary guide , ( 2 ) conventional TKA using an extramedullary guide , or ( 3 ) computer-assisted TKA .


Two senior surgeons performed all the TKAs using the same TKA system and the standard anteromedial arthrotomy with eversion of the patella .


Patients were assessed by physiotherapists before and 6 months and 2 years after TKA using the Short Form-36 Health Survey , Oxford Knee Score , and Knee Society Score .


Of the 90 patients , 67 and 70 were assessed at 6 months and 2 years after TKA , respectively .


No patient developed deep infection or required revision surgery .


Functional outcomes of the 3 groups did not differ significantly at the corresponding follow-ups .


Significant improvement in the functional outcome was not shown in patients treated with computer-assisted TKA , compared with conventional TKA .


Thus , computer-assisted TKA has limited additional short-term benefits .


Further studies with longer follow-up are required to examine the benefits of computer-assisted TKA .


We aim to characterize the effects on total body fat and distribution of a 1-year intensive lifestyle intervention ( ILI ) for weight loss in overweight and obese adults with type 2 diabetes and to examine whether changes in adipose tissue ( AT ) depots were associated with changes in metabolic biomarkers .


Participants were 54 females and 38 males ( age 57.8 6.7 years [ mean SD ] ; BMI 31.7 3.5 kg/m ( 2 ) ) enrolled in the Look AHEAD ( Action for Health in Diabetes ) trial randomized to ILI or diabetes support and education ( DSE ) from whom baseline and 1-year MRI measures of total AT ( TAT ) and regional ( arm , trunk , leg ) AT , including subcutaneous AT ( SAT ) , visceral AT ( VAT ) , and intermuscular AT ( IMAT ) , were acquired .


We tested whether mean changes in ILI and DSE were equal and , within groups , whether changes were different from zero .


Regression models tested whether changes in AT compartments were associated with metabolic variable changes .


Body weight changed -0.52 3.62 kg ( P = 0.31 ) in DSE and -7.24 5.40 kg ( P < 0.0001 ) in ILI .


Mean ILI changes were different from DSE ( P < 0.001 for TAT , SAT , and IMAT and P < 0.01 for VAT in females ) .


Within ILI , SAT and VAT decreased in males and females ( P < 0.0001 ) , but IMAT was unchanged ( 0.00 0.54 kg ; P = 0.99 ) .


In DSE , SAT and VAT did not change , but IMAT increased by 0.46 0.55 kg ( P < 0.001 ) .


Controlling for weight loss , reduction of specific AT depots was associated with improvement in metabolic biomarkers .


Weight loss of 7-10 % from an ILI over 1 year reduced SAT and VAT and prevented an increase in IMAT .


Reductions in AT depots were associated with improvements in biomarkers .


Psoriasis is a systemic inflammatory immune-mediated skin disease .


Recently a relationship with metabolic syndrome in terms of psoriasis severity and response to therapy was observed .


We performed an open-label randomized controlled study to evaluate the role of a nutraceutical containing Q10 coenzyme , Krill-oil , lipoic acid , resveratrol , Vitis vinifera seed oil , vitamin E and selenium in addition to etanercept therapy for patients affected by psoriasis and metabolic syndrome .


Forty patients were enrolled and divided into two arms , one receiving only etanercept , one other receiving also the neutraceutical .


After a period of 3 months ( T1 ) a second evaluation of the considered parameters was performed .


At T1 statistically significant differences were detected in HDL cholesterol and triglycerides values both comparing the two arms and in the nutraceutical arm .


Our results show that the dietary addiction of the nutraceutical to the etanercept therapy in patients affected by both psoriasis and metabolic syndrome could help to restore the normal lipid profile .


Sexual health problems such as unwanted pregnancy and sexually transmitted infection are important public health concerns and there is huge potential for health promotion using digital interventions .


Evaluations of digital interventions are increasingly conducted online .


Trial administration and data collection online offers many advantages , but concerns remain over fraudulent registration to obtain compensation , the quality of self-reported data , and high attrition .


This study addresses the feasibility of several dimensions of online trial design-recruitment , online consent , participant identity verification , randomization and concealment of allocation , online data collection , data quality , and retention at 3-month follow-up .


Young people aged 16 to 20 years and resident in the United Kingdom were recruited to the `` Sexunzipped '' online trial between November 2010 and March 2011 ( n = 2036 ) .


Participants filled in baseline demographic and sexual health questionnaires online and were randomized to the Sexunzipped interactive intervention website or to an information-only control website .


Participants were also randomly allocated to a postal request ( or no request ) for a urine sample for genital chlamydia testing and receipt of a lower ( 10/US $ 16 ) or higher ( 20/US $ 32 ) value shopping voucher compensation for 3-month outcome data .


The majority of the 2006 valid participants ( 90.98 % , 1825/2006 ) were aged between 18 and 20 years at enrolment , from all four countries in the United Kingdom .


Most were white ( 89.98 % , 1805/2006 ) , most were in school or training ( 77.48 % , 1545/1994 ) , and 62.81 % ( 1260/2006 ) of the sample were female .


In total , 3.88 % ( 79/2036 ) of registrations appeared to be invalid and another 4.00 % ( 81/2006 ) of participants gave inconsistent responses within the questionnaire .


The higher value compensation ( 20/US $ 32 ) increased response rates by 6-10 % , boosting retention at 3 months to 77.2 % ( 166/215 ) for submission of online self-reported sexual health outcomes and 47.4 % ( 118/249 ) for return of chlamydia urine samples by post .


It was quick and efficient to recruit young people to this online trial .


Our procedures for obtaining online consent , verifying participant identity , automated randomization , and concealment of allocation worked well .


The optimal response rate for the online sexual health outcome measurement was comparable to face-to-face trials .


Multiple methods of participant contact , requesting online data only , and higher value compensation increased trial retention at 3-month follow-up .


International Standard Randomized Controlled Trial Number ( ISRCTN ) : 55651027 ; http://www.controlled-trials.com/ISRCTN55651027 ( Archived by WebCite at http://www.webcitation.org/6LbkxdPKf ) .


We conducted a randomized trial to test the hypothesis that mother 's voice played through a pacifier-activated music player ( PAM ) during nonnutritive sucking would improve the development of sucking ability and promote more effective oral feeding in preterm infants .


Preterm infants between 34 0/7 and 35 6/7 weeks ' postmenstrual age , including those with brain injury , who were taking at least half their feedings enterally and less than half orally , were randomly assigned to receive 5 daily 15-minute sessions of either PAM with mother 's recorded voice or no PAM , along with routine nonnutritive sucking and maternal care in both groups .


Assignment was masked to the clinical team .


Ninety-four infants ( 46 and 48 in the PAM intervention and control groups , respectively ) completed the study .


The intervention group had significantly increased oral feeding rate ( 2.0 vs. 0.9 mL/min , P < .001 ) , oral volume intake ( 91.1 vs. 48.1 mL/kg/d , P = .001 ) , oral feeds/day ( 6.5 vs. 4.0 , P < .001 ) , and faster time-to-full oral feedings ( 31 vs. 38 d , P = .04 ) compared with controls .


Weight gain and cortisol levels during the 5-day protocol were not different between groups .


Average hospital stays were 20 % shorter in the PAM group , but the difference was not significant ( P = .07 ) .


A PAM using mother 's voice improves oral feeding skills in preterm infants without adverse effects on hormonal stress or growth .


To determine the safety and efficacy of cryopreserved packed red blood cell ( CPRBC ) transfusion in trauma patients .


Liquid packed red blood cells ( LPRBCs ) have an abbreviated shelf-life and worsening storage lesion with age .


CPRBCs are frozen 2 to 6 days after donation , stored up to 10 years , and are available for 14 days after thawing and washing .


CPRBCs can be utilized in diverse settings , but the effect on clinical outcomes is unknown .


We performed a prospective , randomized , double-blind study at 5 level 1 trauma centers .


Stable trauma patients requiring transfusion were randomized to young LPRBCs ( 14 storage days ) , old LPRBCs ( > 14 storage days ) , or CPRBCs .


Tissue oxygenation ( StO2 ) , biochemical and inflammatory mediators were measured , and clinical outcomes were determined .


Two hundred fifty-six patients with well-matched injury severity and demographics ( P > 0.2 ) were randomized ( 84 young , 86 old , and 86 CPRBCs ) .


Pretransfusion and final hematocrits were similar ( P > 0.68 ) .


Patients in all groups received the same number of units postrandomization ( 2 [ 1-4 ] ; P > 0.05 ) .


There was no difference in the change in tissue oxygenation between groups .


CPRBCs contained less 2-macrogobulin , haptoglobin , C-reactive protein , and serum amyloid P ( P < 0.001 ) .


Organ failure , infection rate , and mortality did not differ between groups ( P > 0.2 ) .


Transfusion of CPRBCs is as safe and effective as transfusion of young and old LPRBCs and provides a mechanism to deliver PRBCs in a wide variety of settings .


Halitosis is a common problem that affects a large portion of the population worldwide .


The origin of this condition is oral in 90 % and systemic in 10 % of cases .


The unpleasant odor is mainly the result of volatile sulfur compounds produced by Gram-negative bacteria .


However , it has recently been found that anaerobic Gram-positive bacteria also produce hydrogen sulfide ( H2S ) in the presence of amino acids , such as cysteine .


Light , both with and without the use of chemical agents , has been used to induce therapeutic and antimicrobial effects .


In photodynamic therapy , the antimicrobial effect is confined to areas covered by photosensitizing dye .


The aim of the present study is to evaluate the antimicrobial effect of photodynamic therapy on halitosis in adolescents through the analysis of volatile sulfur compounds measured using gas chromatography and microbiological analysis of coated tongue .


A quantitative clinical trial will be carried out involving 60 adolescents randomly divided into the following groups : group 1 will receive treatment with a tongue scraper , group 2 will receive photodynamic therapy applied to the posterior two-thirds of the dorsum of the tongue , and group 3 will receive combined treatment ( tongue scraper and photodynamic therapy ) .


Gas chromatography ( OralChromaTM ) and microbiological analysis will be used for the diagnosis of halitosis at the beginning of the study .


Post-treatment evaluations will be conducted at one hour and 24hours after treatment .


The statistical analysis will include the Shapiro-Wilk test for the determination of the distribution of the data .


If normal distribution is demonstrated , analysis of variance followed by Tukey 's test will be used to compare groups .


The Kruskal-Wallis test followed by the Student-Newman-Keuls test will be used for data with non-normal distribution .


Either the paired t-test or the Wilcoxon test will be used to compare data before and after treatment , depending on the distribution of the data .


The results of this trial will determine the efficacy of using photodynamic therapy alone or in combination with a tongue scraper to treat bad breath in adolescents .


The protocol for this study was registered with Clinical Trials ( registration number NCT02007993 ) on 10 December 2013 .


To compare efficacy , patient compliance , acceptability , satisfaction , safety , and adenoma detection rate of sodium phosphate tablets ( NaP , CLICOLON ( TM ) ) to a standard 4 L polyethylene glycol ( PEG ) solution for bowel cleansing for adults undergoing colonoscopy .


In this multicenter , randomized , prospective , investigator-blind study , the relatively young ( 19-60 years ) healthy outpatients without comorbidity were randomly assigned to one of two arms .


All colonoscopy were scheduled in the morning .


The NaP group was asked to take 4 tablets , 5 times the evening before and 4 tablets , 3 times early on the morning of the colonoscopy .


The PEG group was asked to ingest 2 L of solution the evening before and 2 L early in the morning of the procedure .


Adequacy of bowel preparation was scored using the Boston bowel preparation scale .


No significant differences were observed between the NaP group ( n = 158 ) and PEG group ( n = 162 ) in bowel cleansing quality ( adequate preparation 93.0 % vs 92.6 % , P = 0.877 ) , patient compliance ( P = 0.228 ) , overall adverse events ( 63.3 % vs 69.1 % , P = 0.269 ) , or adenoma detection rate ( 34.8 % vs 35.2 % , P = 0.944 ) .


Patient acceptability , satisfaction , and patient rating of taste were higher in the NaP group than in the PEG group ( P < 0.001 ) .


NaP tablets , compared with PEG solution , produced equivalent colon cleansing , did not cause more side effects , and had better patient acceptability and satisfaction in the relatively young ( age < 60 years ) healthy individuals without comorbidity .


An oral tablet formulation could make bowel preparation less burdensome , resulting in greater patient participation in screening programs .


This study compared the performance of two new bone-anchored hearing aids with older bone-anchored hearing aids that were not fully digital .


Fourteen experienced bone-anchored hearing aid users participated in this cross-over study .


Performance of their existing bone-anchored hearing aid was assessed using speech-in-noise testing and questionnaires .


Participants were then fitted with either a Ponto Pro or a BP100 device .


After four weeks of use with each new device , the same assessments were repeated .


Speech-in-noise testing for the 50 per cent signal-to-noise ratio ( the ratio at which 50 per cent of responses were correct ) showed no significant differences between the Ponto Pro and the BP100 devices ( p = 0.1 ) However , both devices showed significant improvement compared with the participants ' previous bone-anchored hearing aid devices ( p < 0.001 ) .


There were no significant differences between the two new devices in the questionnaire data .


Both fully digital bone-anchored hearing aids demonstrated superior speech processing compared with the previous generation of devices .


There were no substantial differences between the two digital devices in either objective or subjective tests .


Managing cardiovascular risk factors is important for reducing vascular complications in type 2 diabetes , even in individuals who have achieved glycemic control .


Nut consumption is associated with reduced cardiovascular risk ; however , there is mixed evidence about the effect of nuts on blood pressure ( BP ) , and limited research on the underlying hemodynamics .


This study assessed the effect of pistachio consumption on BP , systemic hemodynamics , and heart rate variability in adults with well-controlled type 2 diabetes .


We enrolled 30 adults ( 40 to 74 years ) with type 2 diabetes in a randomized , crossover , controlled feeding study .


After a 2-week run-in period , participants consumed a low-fat control diet ( 27 % fat ) containing low-fat/high-carbohydrate snacks and a moderate-fat diet ( 33 % fat ) containing pistachios ( 20 % of total energy ) for 4 weeks each , separated by a 2-week washout .


Following each diet period , we assessed BP , systemic hemodynamics , and heart rate variability at rest and during acute mental stress , and , in a subset of participants ( n = 21 ) , 24-hour ambulatory BP .


BP at rest and during stress did not differ between treatments .


The pistachio diet significantly reduced total peripheral resistance ( -3.72.9 % , P = 0.004 ) , increased cardiac output ( 3.12.3 % , P = 0.002 ) , and improved some measures of heart rate variability ( all P < 0.05 ) .


Systolic ambulatory BP was significantly reduced by 3.52.2 mm Hg ( P = 0.046 ) following the pistachio diet , with the greatest reduction observed during sleep ( -5.72.6 mm Hg , P = 0.052 ) .


A moderate-fat diet containing pistachios modestly improves some cardiovascular risk factors in adults with well-controlled type 2 diabetes .


www.clinicaltrials.gov .


Unique identifier : NCT00956735 .


To determine how symmetric ( proportionate ; SGR ) and asymmetric ( disproportionate ; AGR ) growth restriction influence growth and development in preterms from birth to 4 years .


This community-based cohort study of 810 children comprised 86 SGR , 61 AGR , and 663 non-growth restricted ( NGR ) preterms , born in 2002 and 2003 .


Symmetrical growth restriction was defined as a birth weight below the 16th percentile ( -1 SD ) compared with full-terms and a head circumference ( HC ) z score not exceeding the infant 's birth weight z score by > 1 SD .


Asymmetric growth restriction was defined as a HC z score exceeding that for by > 1 SD as a proxy of brain sparing .


Developmental delay was assessed by the Ages and Stages Questionnaire at 4 years .


Longitudinal gains in weight and height were similar for SGR and AGR children and less compared with NGR children .


At age 4 , z scores for weight were -1.1 for SGR and -0.7 for AGR children vs -0.3 for NGR children .


z scores for height were -0.8 and -0.5 vs. -0.2 .


HC gain were 2 cm more in SGR , but at 1 year , they were -0.2 vs. 0.2 ( AGR ) and 0.1 ( NGR ) .


Developmental delay increased with odds ratios of 2.5 ( 95 % confidence interval 1.1-6 .0 ) for SGR and 2.1 ( 95 % confidence interval 0.7-5 .9 ) for AGR .


Weight and height gains were similar for AGR and SGR children but poorer compared with NGR children .


SGR children caught up on HC .


Developmental delay was more likely in growth-restricted preterms independent of HC at birth .


Recent studies have assessed the therapeutic potential and drawbacks of mesenchymal stem cells ( MSCs ) .


The adverse reactions of intravenous transplantation of bone marrow ( BM ) - derived MSCs were examined at varying doses and frequencies of administration .


Nine healthy beagle dogs were purchased from a commercial laboratory .


The dogs were distributed equally ( n = 3 per group ) and randomly into three groups .


All dogs received allogeneic BM-derived MSCs : 210 once ( group A ) , 210 once ( group B ) , and 210 for three consecutive days ( group C ) .


Various laboratory examinations , multi-detector computed tomography features and histopathology were evaluated to clarify the clinical and diagnostic features of adverse reactions of MSCs administration , prior to receiving MSCs ( pre procedure ) and on days 1 , 3 , and 7 post transplantation .


Only one dog had clinical signs during and after MSCs transplantation .


Dogs receiving 210 MSCs showed increased numbers of lymphocytes but the total white blood cell counts were not elevated ( P < 0.01 ) .


Multi-detector computed tomography ( MDCT ) revealed pulmonary parenchymal changes in one dog and histopathologic examination revealed pulmonary parenchymal edema and hemorrhage in four dogs .


The presence of pulmonary thromboembolism was not detected in either examination .


We considered the presence of pulmonary edema and hemorrhage as possible adverse reactions after intravenous MSCs transplantation ; however these results should be cautiously interpreted .


Comparison of state-designated primary and comprehensive stroke centers ( PSCs and CSCs ) with regard to adherence to nationally accepted performance standards are scarce .


The objective of this study was to examine if a significant association exists between level of designation and fulfillment of Joint Commission ( JC ) stroke core measures .


A retrospective comparative data analysis of the New Jersey acute stroke registry for the calendar years 2010 and 2011 was performed .


JC core measures were compared by hospital level ( PSCs vs CSCs ) .


Adjusted odds ratios ( aOR ) were estimated for association between hospital levels and fulfillment of JC core measures .


Median door-to-thrombolytic time was also compared .


There were 36,892 acute stroke admissions .


PSCs had 60 % of the patients , whereas CSCs had 40 % .


Hemorrhagic stroke admissions were about 2 times more frequent at CSCs than PSCs ( 13.3 % and 7.1 % , respectively ) .


CSCs adhered better to 6 of the 8 JC measures than PSCs .


Of eligible patients , 19.5 % received thrombolytic therapy at CSCs compared to 9.6 % at PSCs , with a 44 % difference in provision of thrombolytic therapy ( aOR = 0.28 , 95 % confidence interval : 0.24-0 .34 ) .


Median door-to-thrombolytic drug times was 65 minutes at CSCs compared to 74.0 minutes at PSCs ( P < 0.0001 ) .


New Jersey state-designated CSCs are better at adhering to the JC core stroke measures and have shorter door-to-thrombolytic drug times .


The prevalence and correlates of dual-antiplatelet therapy ( DAPT ) use in stable coronary artery disease ( CAD ) are unknown .


In addition , whether prolonged DAPT may impact prognosis in stable CAD has not been studied in real-life conditions .


We studied 3,691 patients included in a prospective registry on stable CAD .


The patients were divided in 2 groups according to their antiplatelet therapy regimen at inclusion : patients treated with DAPT were compared with those treated with single-antiplatelet therapy ( SAPT ) .


The primary outcome was a composite of cardiovascular death , myocardial infarction , or stroke .


Altogether , 868 ( 24 % ) patients received DAPT .


Factors positively associated with DAPT use were persistent angina at inclusion , body mass index , myocardial infarction since 1 to 3 years , myocardial revascularization since 1 to 3 years , multivessel CAD , prior drug-eluting stent implantation , and prior aortic or peripheral intervention .


Factors negatively associated with DAPT use were age , prior coronary bypass , and left ventricular ejection fraction .


The rate of the primary outcome at 2 years was similar whether patients were treated with SAPT ( 4.6 % ) or DAPT ( 5.5 % ) ( P = .301 ) .


Similar rates were also observed after propensity score matching : 5.7 % when treated with SAPT versus 5.5 % when treated with DAPT ( P = .886 ) .


The rate of bleeding was similar between groups .


Our study shows that a significant proportion of stable CAD patients are treated with DAPT in modern practice .


Several correlates of DAPT were identified .


Although no increase in bleeding was observed , our results do not support the prescription of prolonged DAPT .


The objective of this study was to assess the efficacy and safety of alfuzosin 10 mg monotherapy or combined antihypertensive medication on blood pressure ( BP ) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia ( BPH/LUTS ) with or without antihypertensive medication .


This was a 3-month , multicenter , randomized , open-label study in 335 patients aged 45 years with a clinical diagnosis of BPH/LUTS by medical history and clinical examination , a total International Prostatic Symptom Score ( IPSS ) 8 points , a maximum flow rate > 5 mL/sec and 15 mL/sec , and a voided volume 120 mL .


Eligible subjects were randomized to receive alfuzosin 10 mg as monotherapy ( group 1 ) or alfuzosin 10 mg + antihypertensive combination therapy ( group 2 ) .


Based on baseline BP and hypertensive history with or without antihypertensive medications at first medical examination , group 1 was divided into two subgroups of normotensive and untreated hypertensive patients , and group 2 into two subgroups of controlled hypertensive and uncontrolled hypertensive patients .


The primary study outcomes were change in IPSS , BP , and heart rate from baseline .


Secondary outcomes were change in IPSS-quality of life score , maximum flow rate , average flow rate , voided volume , and post-voided volume .


The overall BP change was not significantly different between groups 1 and 2 ( systolic BP , P = 0.825 ; diastolic BP , P > 0.999 ) .


In patients with uncontrolled or untreated hypertension , alfuzosin 10 mg alone or combined with antihypertensive therapy significantly decreased systolic and diastolic BP .


The mean difference in total IPSS and IPSS-quality of life scores from baseline between groups 1 and 2 was 0.45 ( 95 % CI : -1.26 , 2.16 ) and 0.12 ( 95 % CI : -0.21 , 0.45 ) , respectively ( both P > 0.05 ) .


Maximum flow rate , average flow rate , voided volume , and post-voided volume at endpoint were numerically , but not significantly , changed from baseline ( all P > 0.05 ) .


This study shows that alfuzosin 10 mg is effective and well tolerated in patients with BPH/LUTS with or without antihypertensive medications .


However , in patients with uncontrolled or untreated hypertension , alfuzosin 10 mg alone or in combination with antihypertensive medication appears to decrease systolic and diastolic BP , and these patients should be warned about a decrease in BP on initiation of therapy .


In this phase 3 trial we evaluated the efficacy and safety of the interferon-free combination of ABT-450 with ritonavir ( ABT-450 / r ) , ombitasvir ( also known as ABT-267 ) , dasabuvir ( also known as ABT-333 ) , and ribavirin for the retreatment of HCV in patients who were previously treated with peginterferon-ribavirin .


We enrolled patients with HCV genotype 1 infection and no cirrhosis who had previously been treated with peginterferon-ribavirin and had a relapse , a partial response , or a null response .


Patients were randomly assigned in a 3:1 ratio to receive coformulated ABT-450 / r-ombitasvir ( at a once-daily dose of 150 mg of ABT-450 , 100 mg of ritonavir , and 25 mg of ombitasvir ) and dasabuvir ( 250 mg twice daily ) with ribavirin ( 1000 or 1200 mg daily ) or matching placebos during the 12-week double-blind period .


The primary end point was the rate of sustained virologic response 12 weeks after the end of study treatment .


The primary efficacy analysis compared this rate among patients assigned to the active regimen with a historical response rate ( 65 % ) among previously treated patients with HCV genotype 1 infection and no cirrhosis who had received retreatment with telaprevir and peginterferon-ribavirin .


A total of 394 patients received at least one study-drug dose .


In the active-regimen group , 286 of 297 patients had a sustained virologic response at post-treatment week 12 , for an overall rate of 96.3 % ( 95 % confidence interval , 94.2 to 98.4 ) .


This rate was noninferior and superior to the historical control rate .


Rates were 95.3 % among patients with a prior relapse ( 82 of 86 patients ) , 100 % among patients with a prior partial response ( 65 of 65 patients ) , and 95.2 % among patients with a prior null response ( 139 of 146 patients ) .


Pruritus occurred more frequently with the active regimen ( in 13.8 % of patients ) than with placebo ( 5.2 % , P = 0.03 ) .


Three patients in the active-regimen group ( 1.0 % ) discontinued the study drugs owing to adverse events .


Hemoglobin values of grade 2 ( 8.0 to < 10.0 g per deciliter ) and grade 3 ( 6.5 to < 8.0 g per deciliter ) occurred in 4.7 % and 0.3 % of patients in the active-regimen group , respectively .


Rates of response to a 12-week interferon-free combination regimen were more than 95 % among previously treated patients with HCV genotype 1 infection , including patients with a prior null response .


( Funded by AbbVie ; SAPPHIRE-II ClinicalTrials.gov number , NCT01715415 . )