Whereas both trained groups ( MP and PP ) showed statistically significant improvement in TS using the trained hand at all assessment points after the training , only MP participants were able to transfer the performance gains from the TS to the URS and from the trained hand to the untrained opposite hand .


Children were able to learn the FOS through MP or PP with a similar level of performance .


Unlike PP , MP allowed for the transfer of performance gain to the URS and to the opposite hand , suggesting that the internal representations developed by MP were effector-independent .


Renal dysfunction ( RD ) is associated with poor outcome in systolic heart failure ( HF ) .


Left ventricular ejection fraction ( LVEF ) is not depressed to a greater extent in patients with RD compared to patients with normal renal function , but it is relatively unknown whether other measures of myocardial function are impaired by RD. .


The objective of the present study is to evaluate whether RD in systolic HF is associated with excessive impairment of myocardial function , evaluated by strain analysis and cardiac biomarkers .


Patients with LVEF < @ % were enrolled from an outpatient HF clinic .


The patients underwent advanced echocardiography .


Glomerular filtration rate was estimated by the CKD-EPI equation ( eGFR ) and patients grouped by eGFR : eGFR group-I , @ ml/min/@ @ m ( @ ) ; eGFR group-II , @-@ ml/min/@ @ m ( @ ) ; and eGFR group-III , @ ml/min/@ @ m ( @ ) .


Multivariate regression models were developed to evaluate the associations between eGFR groups , echocardiographic measures and cardiac biomarkers .


A total of @ patients participated in the study .


Median age was @ years , @ % were female ; LVEF was @ % .


Patients with a low eGFR were older ( P < @ ) , but there were no differences in frequency of atrial fibrillation , hypertension , diabetes and ischemic heart disease between eGFR groups ( P > @ for all ) .


RD was associated with impaired global longitudinal strain ( P = @ ) , increased E/e ' ( P = @ ) , larger left atria ( P = @ ) and increased levels of proANP ( P < @ ) , NT-proBNP ( P < @ ) and troponin I ( P = @ ) after adjustment for traditional confounders .


Echocardiographic measures and biomarkers reflecting different aspects of myocardial function are impaired in systolic HF patients with RD and the increased mortality risk in these patients may partly be explained by a depressed cardiac function .


Previously , in a @-week , randomised , double-blind , placebo-controlled core study comprising three phases ( @-week dose confirmation , @-week open-label dose optimisation and @-month maintenance of effect ) in adults with attention-deficit/hyperactivity disorder ( ADHD ) , methylphenidate modified-release long-acting formulation ( MPH-LA ) at @-@ mg/day controlled ADHD symptoms as well as decreased functional impairment with a good tolerability profile ( NCT@ ) .


Here , we report the long-term efficacy and safety from a @-week , open-label extension phase of the same study ( NCT@ ) .


Patients in the extension study ( n = @ ) initiated treatment with MPH-LA ( @ mg/day ) , up-titrated in increments of @ mg/week to reach individual patient 's daily optimal dose of @-@ mg .


Adverse events ( AEs ) and serious adverse events ( SAEs ) were reported at the end of extension study for events monitored from ( @ ) maintenance of effect phase baseline ( core study ; @ months ) and ( @ ) extension study baseline ( @ months ) .


Mean changes in DSM-IV ADHD Rating Scale ( DSM-IV ADHD RS ) and Sheehan Disability Scale ( SDS ) total scores are reported for both the timelines .


Efficacy was also evaluated using clinician-rated instruments , namely Clinical Global Impression-Improvement Scale ( CGI-I ) and Clinical Global Impression-Severity Scale ( CGI-S ) .


No unexpected AEs were reported in the extension study .


Incidence of SAEs reported during @ months and @ months were similar ( @ % ) , and no deaths were reported .


No SAEs were considered attributable to the drug at the end of @ months .


There were no reports of patients with QT , QTcB or QTcF > @ ms. The mean improvement in DSM-IV ADHD RS and SDS total scores at the end of @ months were @ and @ points , respectively ; and at the end of @ months were @ and @ , respectively .


The proportion of patients with improvement in CGI-S scale was @ % and @ % at the end of @ and @ months , respectively .


Overall , @ % of patients showed clinical improvement in CGI-I scale at the end of @ months .


In adult patients with ADHD , use of MPH-LA up to @ year continued to be well tolerated while maintaining the clinical efficacy .


To investigate the efficiency of total knee arthroplasty ( TKA ) for varus osteoarthritic knees with tibial bone resection determined by lateral tibiofemoral joint @ flexional gap measurement .


Between March and June @ , @ patients ( @ knees ) with varus osteoarthritic knees underwent TKA .


All patients were randomly divided into traditional osteotomy group ( control group , @ cases ) and lateral tibiofemoral joint @ flexional gap measurement resection group ( trial group , @ cases ) .


There was no significant difference in gender , age , affected side , body mass index and preoperative knee society score ( KSS ) , range of motion ( ROM ) of the knee , anatomic tibiofemoral angle ( ATFA ) , patellar tilt angle , posterior condylar offset ( PCO ) , and joint line height between @ groups ( P > @ ) .


The bone resection thickness of the distal femoral lateral condyle , femoral posterior lateral condyle , and lateral tibial plateau were measured ; and the X-ray films were taken to measure and compare ATFA , patellar tilt angle , PCO , and joint line height after TKA .


The knee function recovery was evaluated with KSS score and ROM of the knee .


The bone resection thickness of the lateral tibial plateau and distal femoral lateral condyle in trial group was significantly smaller than that in control group ( P < @ ) ; while the bone resection thickness of the femoral posterior lateral condyle was significantly bigger than that in control group ( P < @ ) .


The @ mm polyethylene insert was used in @ cases of the trial group and in @ cases of the control group , showing significant difference ( Z = -@ , P = @ ) .


All the patients were followed up @-@ months ( mean , @ months ) .


Radiography at @ weeks after TKA indicated that the ATFA , patellar tilt angle , and joint line height had no significant difference between @ groups ( P > @ ) ; the PCO of trial group was significantly lower than that of control group ( P < @ ) .


The KSS score and ROM of the knee at @ months after operation were significantly improved when compared with preoperative ones in @ groups ( P < @ ) , and trial group was significantly better than control group ( P < @ ) .


It was an effective method to determine bone resection thickness using lateral tibiofemoral joint @ flexional gap measurement in TKA for varus osteoarthritic knees , which can reduce the bone resection thickness of the tibial plateau and distal femoral lateral condyle and restore the joint line and PCO with better early recovery of the knee function .


The aim of the present study was to evaluate the reduction in bacterial loading uing MTAD as an irrigating solution in pulpectomized primary teeth .


A randomized , controlled clinical trial was performed that included primary teeth with pulp necrosis .


Sixty necrotic canals were included , @ irrigated with MTAD ( experimental group ) and @ with @ % Na@Cl solution ( control group ) ; in all cases , @ microbiological samples from within the canals were taken with sterile paper points , the first after the canal opening and before the first irrigation , and the second after instrumentation and final irrigation , before obturation .


All samples were evaluated by Agar plate method .


The results were statistically analyzed by student ` t ' test .


After analyzing samples before and after irrigation in the control group ( NaOCl ) , we found a significant decrease of bacterial load ( p = < @ ) .


The same occurred in the MTAD group samples ( p = < @ ) .


When both groups were compared post irrigation , a statistically significant difference was observed in favor of MTAD .


MTAD can be suggested as an alternative irrigant for pulpectomy of necrotic teeth .


To describe the imaging standards , grading protocol and baseline characteristics of polypoidal choroidal vasculopathy ( PCV ) from the EVEREST study .


In a prospective , multicentre study , confocal scanning laser ophthalmoscope indocyanine green angiography ( ICGA ) was performed using a standardised imaging protocol .


All images were graded using standardised , calibrated equipment by fellowship-trained ophthalmologists at the Central Reading Center .


Sixty-one patients with PCV were included in the study .


ICGA characteristics included : nodular appearance stereoscopically ( @ eyes , @ % ) , hypofluorescent halo ( @ , @ % ) , abnormal vascular network ( @ , @ % ) and pulsation of the polyps ( @ , @ % ) .


Colour fundus photography revealed orange subretinal nodules ( @ , @ % ) and massive submacular haemorrhage ( @ , @ % ) .


The mean area of the PCV lesion was @ mm ( @ ) ( range , @-@ @ mm ( @ ) ) .


The vascular channels filled within @-@ @ s ( mean : @ s ) while the mean filling time for polyps was @ s ( range , @-@ @ s ) .


Patients with massive submacular haemorrhage were less likely to have abnormal vascular channels seen on ICGA ( @ % vs @ % for those without massive haemorrhage , p = @ ) .


The imaging and grading protocols and baseline characteristics of a multicentre , randomised controlled trial of PCV are described in detail , and may serve as reference for future randomised , controlled trials on PCV .


To evaluate attainment of diabetes-related quality measures with canagliflozin @ mg , canagliflozin @ mg , and sitagliptin @ mg in patients with type @ diabetes mellitus .


This post hoc analysis used pooled data from two @-week , randomized , double-blind , phase @ clinical trials that evaluated the comparative efficacy of canagliflozin and sitagliptin .


One trial evaluated patients on metformin at baseline with add-on canagliflozin @ mg , canagliflozin @ mg , or sitagliptin @ mg ; the other trial evaluated patients on metformin and a sulfonylurea at baseline with add-on canagliflozin @ mg or sitagliptin @ mg .


Individual diabetes-related quality measures , including glycated hemoglobin ( A@C ) , blood pressure ( BP ) , low-density lipoprotein cholesterol ( LDL-C ) , body mass index ( BMI ) , and change in body weight , were assessed .


At baseline , the proportions of patients meeting criteria for all quality measures were similar between groups .


At @ weeks , compared with sitagliptin @-mg treatment , canagliflozin @ mg demonstrated either comparable or superior glycemic control .


Additionally , canagliflozin @ mg versus sitagliptin @ mg demonstrated superior attainment of BP , BMI , and weight-related quality measures ; no difference was seen with respect to LDL-C .


At @ weeks , compared with sitagliptin @-mg treatment , canagliflozin @ mg demonstrated superior glycemic control at all thresholds of A@C , and superior BP , BMI , and weight-related quality measures ; there was no difference in LDL-C quality measure attainment .


We evaluated the comparative efficacy of canagliflozin @ mg , canagliflozin @ mg , and sitagliptin @ mg on quality measure attainment after @ weeks of treatment .


Compared with sitagliptin @ mg , canagliflozin @ mg demonstrated comparable or superior attainment of diabetes-related quality measures .


Compared with sitagliptin @ mg , canagliflozin @ mg demonstrated superior diabetes-related quality measure attainment , including glycemic , BP , and weight-related quality measures ; there was no difference in LDL-C quality measure attainment between either dosage of canagliflozin and the @-mg dosage of sitagliptin .


This study aimed to determine the effect of topical lidocaine on Penetration-Aspiration Scale ( PAS ) scores and patient comfort and tolerance of flexible endoscopic evaluation of swallowing ( FEES ) examinations in dysphagic patients .


Adults with dysphagia referred for swallowing evaluation were recruited to participate in consecutive nonanesthetized and then anesthetized FEES examinations .


Under endoscopic visualization , participants consumed @ swallows consisting of graduated volumes of milk , pudding , and cracker in each condition and recorded their discomfort and tolerance in the @ conditions .


Penetration-Aspiration Scale scores were assigned in blinded fashion for each swallow .


Twenty-five adults participated in the study .


Although there was no statistically significant effect of anesthesia on PAS scores ( P = @ ) , the odds of a higher PAS score were @ % higher during anesthetized swallows .


The anesthetized condition yielded significantly less discomfort and pain during the examination , significantly less pain and discomfort during insertion and removal of the endoscope , and significantly greater overall tolerance than the nonanesthetized condition .


The use of topical lidocaine during FEES may impair swallowing ability in patients with dysphagia , but this result does not achieve statistical significance .


Topical nasal anesthesia significantly reduces subjective pain and discomfort and improves tolerance during FEES .


A prospective , randomized comparison of shock wave lithotripsy , retrograde intrarenal surgery and miniperc for the treatment of @ to @ cm radiolucent lower calyceal renal calculi was done to evaluate the safety and efficacy of these procedures .


Patients with a single @ to @ cm radiolucent lower calyceal renal stone who underwent treatment between January @ and May @ were included in study .


They were randomized to shock wave lithotripsy , retrograde intrarenal surgery and miniperc groups .


Patient demographic profiles , success and re-treatment rates , auxiliary procedures and complications were analyzed .


A total of @ patients were enrolled in each of the shock wave lithotripsy , retrograde intrarenal surgery and miniperc groups .


Three , @ and @ patients , respectively , were excluded from final analysis due to a matrix stone diagnosis .


Mean procedure and fluoroscopy times were significantly greater in the miniperc group than in the other groups .


Hospital stay ( @ days vs @ hours and @ days , p = @ ) and the blood transfusion rate ( @ % vs @ % and @ % , p = @ ) were significantly higher for miniperc vs shock wave lithotripsy and retrograde intrarenal surgery , respectively .


The re-treatment rate ( @ % vs @ % and @ % , p < @ ) and the auxiliary procedure rate ( @ % vs @ % and @ % , p = @ ) were significantly greater for shock wave lithotripsy than for retrograde intrarenal surgery and miniperc , respectively .


The @-month stone-free rate of shock wave lithotripsy , retrograde intrarenal surgery and miniperc was @ % ( @ of @ patients ) , @ % ( @ of @ ) and @ % ( @ of @ ) , respectively ( p = @ ) .


Miniperc and retrograde intrarenal surgery were more effective than shock wave lithotripsy to treat @ to @ cm radiolucent lower calyceal renal calculi in terms of a better stone-free rate , and lesser auxiliary and re-treatment rates .


However , miniperc resulted in more complications , greater operative time and radiation exposure , and a longer hospital stay .


Blood biomarkers are increasingly used to diagnose , guide therapy in , and risk-stratify community-acquired pneumonia ( CAP ) patients in emergency departments ( EDs ) .


How pre-analytic factors affect these markers ' initial levels in this population is unknown .


In this secondary analysis of consecutive ED patients with CAP from a large multicentre antibiotic stewardship trial , we used adjusted multivariate regression models to determine the magnitude and statistical significance of differences in mean baseline concentrations of five biomarkers ( procalcitonin -LSB- PCT -RSB- , C-reactive protein -LSB- CRP -RSB- , white blood cells count -LSB- WBC -RSB- , proadrenomedullin -LSB- ProADM -RSB- , copeptin ) associated with six pre-analytic factors ( antibiotic or corticosteroid pretreatment , age , gender , chronic renal failure or chronic liver insufficiency ) .


Of @ CAP patients ( median age @ years , @ % male ) , @ % had antibiotic pretreatment , @ % , corticosteroid pretreatment , @ % , chronic renal failure , @ % chronic liver insufficiency .


Differences associated with pre-analytic factors averaged @ % @ % ; the three largest statistically significant changes ( @ % confidence interval ) were : PCT , +@ % ( +@ % to +@ % , p = @ ) with liver insufficiency ; ProADM , +@ % ( +@ % to +@ % , p < @ ) with age above median ; CRP , -@ % ( -@ % to -@ % , p = @ ) with steroid pretreatment .


In post hoc sensitivity analyses , reclassification statistics showed that these factors did not result in significant changes of biomarker levels across clinically used cut-off ranges .


Despite statistically significant associations of some pre-analytic factors and biomarker levels , a clinically relevant influence seems unlikely .


Our observations reinforce the concept of using biomarkers in algorithms with widely-separated cut-offs and overruling criteria considering the entire clinical picture .


Malaria prophylaxis is recommended for persons with sickle cell disease ( SCD ) , but the value of this has been questioned .


The aim of this study was to find out whether intermittent preventive treatment ( IPT ) with a fixed-dose combination of mefloquine-artesunate ( MQAS ) or sulfadoxine-pyrimethamine plus amodiaquine ( SPAQ ) was more effective than daily proguanil for malaria prevention in subjects with SCD .


Patients with SCD were randomized to receive daily treatment with proguanil or IPT with either MQAS or SPAQ once every @ months at routine clinic visits .


Patients were followed up for @ months .


A total of @ patients with SCD were studied , with @ in each group .


Adherence to the IPT regimens was excellent , but @ % of patients took < @ % of their daily doses of proguanil .


IPT was well tolerated ; the most common side effects were vomiting and abdominal pain .


Protective efficacy against malaria , compared with daily proguanil , was @ % ( @ % confidence interval , @ % -@ % ) for MQAS and @ % ( @ % -@ % ) for SPAQ .


There were fewer outpatient illness episodes in children who received IPT than those who received proguanil .


IPT with MQAS administered to patients with SCD during routine clinic visits was well tolerated and more effective in preventing malaria than daily prophylaxis with proguanil .


To compare the clinical effectiveness of a newly developed cognitive behavioural self-management manual delivered by specialist heart failure nurses or the same programme followed by the patient on their own , in terms of readmissions/admissions to hospital for any reason within a @ month period , patient health related quality of life , self-management and carer quality of life .


Pragmatic , open parallel group , randomised controlled trial .


Open access heart failure diagnostic clinics and primary care .


@ patients with a definitive diagnosis of symptomatic heart failure ( LVSD ) as defined by ECHO , clinical diagnosis or coronary angiography were eligible for the study .


A newly developed nurse facilitated , cognitive behavioural self-management programme was developed and was delivered either by a heart failure nurse or by the patient on their own .


Patient admission/readmission to hospital for any reason within a @ month period following randomisation .


Secondary outcomes were : participant health related quality of life as measured by the Minnesota Living with Heart Failure questionnaire , the Hospital , Anxiety and Depression Scale , the European self-care form .


There was no evidence of a difference between the groups in whether or not a patient was re-admitted to hospital during the @ month follow-up period ( p = @ ) .


There was no evidence of a difference between the treatment groups in the mean MLHF scores over time ( p = @ ) , the European self-care questionnaire ( p = @ ) or the mean HAD anxiety score ( p = @ ) .


However , when adjusted for baseline scores the self-management group had a statistically significant higher HADS depression score at @ months ( p = @ ) .


There was no evidence of a difference in admissions/readmission to hospital between patients who undertook a brief heart failure self-management programme facilitated by a specialist heart failure nurse and those also receiving care from a specialist nurse who followed the programme on their own .


For advanced gastrointestinal stromal tumour ( GIST ) patients who are responding to imatinib mesylate , the role of surgery has not been formally demonstrated .


This multicenter randomised controlled trial was designed to assess whether surgery to treat residual disease for patients with recurrent/metastatic GISTs responding to imatinib mesylate ( IM ) improved progression free survival ( PFS ) compared with IM treatment alone .


Between @ and @months after starting IM for recurrent/metastatic GISTs , eligible patients were randomised to two arms : Arm A ( surgery for residual disease ) and Arm B ( IM treatment alone ) .


In Arm A ( @pts ) , surgery was performed to remove residual macroscopic lesions as completely as possible , and IM treatment continued after surgery .


In Arm B ( @pts ) , IM was given alone at a dose of @mg per day until disease progression .


The primary end-point was PFS measured from the date IM started .


This study was registered in the ChiCTR registry with the ID number ChiCTR-TRC-@ .


This randomised trial was closed early due to poor accrual .


Only @ patients were enrolled as opposed to @ patients planned .


@-year PFS was @ % in the surgery arm and @ % in the IM-alone arm ( P = @ ) .


Median overall survival ( mOS ) was not reached in the surgery arm and @months in patients with IM-alone arm ( P = @ ) .


While no significant differences were observed in the two arms , this study suggests that surgical removal of the metastatic lesion may improve the outcome of advanced GIST patients and should stimulate additional research on this topic .


The aim of this study was to compare the effects of low-volume , high-intensity aerobic interval training ( HAIT ) on maximal oxygen consumption ( VOmax ) , left ventricular ( LV ) mass , and heart rate recovery ( HRR ) with high-volume , moderate-intensity continuous aerobic training ( CAT ) in sedentary adults .


Twenty-four healthy but sedentary male adults ( aged @ @ years ) participated in an @-week , @-day a week , supervised exercise intervention .


They were randomly assigned to either HAIT ( @ min , @ kcal per exercise session ) or CAT ( @ min , @ kcal ) .


VOmax , LV mass ( @T-MRI ) , and HRR at @ min ( HRR-@ ) and @ min ( HRR-@ ) after maximal exercise were measured pre - and post-intervention .


Changes in VOmax during the @-week intervention were significant ( P < @ ) in both groups ( HAIT , @ @ ml kg ( -@ ) min ( -@ ) , @ @ % ; CAT , @ @ ml kg ( -@ ) min ( -@ ) , @ @ % ) , while the VOmax improvement in HAIT was greater ( P = @ ) than in CAT .


LV mass in HAIT increased ( @ @ g , @ @ % , P = @ ) , but not in CAT ( @ @ g , @ @ % , P = @ ) .


While changes in HRR-@ were not significant in either group , change in HRR-@ for HAIT ( @ @ bpm , @ @ % , P < @ ) was greater ( P = @ ) than for CAT ( @ @ bpm , @ @ % , P = @ ) .


This study suggests that HAIT has potential as a time-efficient training mode to improve cardiorespiratory capacity and autonomic nervous system function in sedentary adults .


To investigate short - and long-term effects of real-time monitoring medication use combined with short message service ( SMS ) reminders for missed doses on refill adherence to oral anti-diabetic medication .


A randomized controlled trial with two intervention groups and one control group involving @ participants with Type@ diabetes with suboptimal adherence .


For @months , participants in the SMS group ( n = @ ) were monitored and received SMS reminders if they missed their medication .


Participants in the non-SMS group ( n = @ ) were only monitored .


The control group ( n = @ ) was not exposed to any intervention .


Primary outcome measure was refill adherence to oral anti-diabetic medication .


Multi-level regression analyses were performed to examine intervention effects on adherence between and within groups after @ and @years of follow-up .


At baseline , mean refill adherence was comparable between the groups .


After @year , adherence in the SMS group was significantly higher than in the control group ( @ % vs. @ % ; P < @ ) and showed a significant improvement from baseline ( +@ % ; P < @ ) .


Mean adherence in the non-SMS group reached @ % ( +@ % ; P < @ ) , but did not differ from the control group ( P = @ ) .


After @years , the improved adherence in the SMS group persisted and remained significantly higher than in the control group ( @ % vs. @ % ; P < @ ) , contrary to the non-SMS group whose adherence approached baseline level again ( @ % ) .


This study shows the long-term effectiveness of real-time medication monitoring combined with SMS reminders in improving refill adherence .


This new reminder system can strengthen the self-management of people with diabetes .


Rheumatoid arthritis ( RA ) , as a common systemic inflammatory autoimmune disease , affects approximately @ in @ individuals .


Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA .


Xinfeng Capsule , a patent Chinese herbal medicine , has been used in the treatment of RA in recent years .


Despite its reported clinical efficacy , there are no large-sample , multicenter , randomized trials that support the use of Xinfeng Capsule for RA .


Therefore , we designed a randomized , double-blind , multicenter , placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA .


This is a @-week , randomized , placebo-controlled , double-blind , multicenter trial on the treatment of RA .


The participants will be randomly assigned to the experimental group and the control group at a ratio of @:@ .


Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo ( imitation leflunomide ) .


The control group will receive leflunomide and an herbal placebo ( imitation Xinfeng Capsule ) .


The American College of Rheumatology ( ACR ) Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule .


The primary outcome measure will be the percentage of study participants who achieve an ACR @ % response rate ( ACR@ ) , which will be measured every @ weeks after randomization .


Secondary outcomes will include the ACR@ and ACR@ responses , the side effects of the medications , the Disease Activity Score @ , RA biomarkers , quality of life , and X-rays of the hands and wrists .


The first four of the secondary outcomes will be measured every @ weeks and the others will be measured at baseline and after @ weeks of treatment .


The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA .


Despite rehabilitation programmes offered to all patients with newly diagnosed type @ diabetes in Denmark , a number of patients either never accomplish good diabetes regulation or the regulation deteriorates with time .


Therefore , new approaches are needed .


The aim of the present study is to examine whether telemedicine conferences with a nurse can contribute to achieving good diabetes control among patients with poorly regulated type @ diabetes .


A total of @ patients with type @ diabetes who have formerly undergone a rehabilitation programme are randomized to either telemedicine intervention or usual care .


The intervention lasts for @ weeks and consists of monthly videoconferences with a nurse from a health-care centre as an add-on to usual care .


Blood sugar , blood pressure and weight are regularly self-monitored and measurements are automatically transferred to a database .


Glycaemic control ( HbA@c level ) is examined at baseline , @ weeks , @ weeks and @ weeks ( six months post intervention ) .


Blood pressure , weight , waist/hip ratio , quality of life , physical activity , lipids , creatinine and haemoglobin are examined at baseline and after @ weeks .


The study will examine whether telemedicine technology can contribute to achieving good diabetes regulation .


Different aspiration techniques to retrieve bronchoalveolar lavage fluid ( BALF ) affect sample quality in healthy dogs .


Studies evaluating these techniques in dogs with respiratory disease are lacking .


To compare sample quality of BALF acquired by manual aspiration ( MA ) and suction pump aspiration ( SPA ) .


Eighteen client-owned dogs with respiratory disease .


Randomized , blinded prospective clinical trial .


Manual aspiration was performed with a @-mL syringe attached directly to the bronchoscope biopsy channel and SPA was performed with a maximum of @ mmHg negative pressure applied to the bronchoscope suction valve using the suction trap connection .


Both aspiration techniques were performed in each dog on contralateral lung lobes , utilizing @ mL/kg lavage volumes per site .


Samples of BALF were analyzed by percentage of retrieved infusate , total nucleated cell count ( TNCC ) , differential cell count , semiquantitative assessment of slide quality , and diagnosis score .


Data were compared by paired Student 's t-test , Wilcoxon signed-rank test , chi-squared test , and ANOVA .


Cohen 's kappa coefficient was used to assess agreement .


The percentage of retrieved BALF ( P = @ ) was significantly higher for SPA than MA .


Substantial agreement was found between cytologic classification of BALF obtained with MA and SPA ( kappa = @ ) .


There was no significant difference in rate of definitive diagnosis achieved with cytologic assessment between techniques ( P = @ ) .


Suction pump aspiration , compared to MA , improved BALF retrieval , but did not significantly affect the rate of diagnostic success of bronchoalveolar lavage ( BAL ) in dogs with pulmonary disease .


As a Chinese Traditional Medicine product , Kuntai capsule could improve the peri-menopausal symptoms in postmenopausal women .


But it is still not clear whether Kuntai capsule has a good effect on alleviating peri-menopausal symptoms induced by gonadotropin releasing hormone agonist ( GnRH-a ) treatment .


The purpose of this study was to investigate the clinical effectiveness and safety of Kuntai capsule , on peri-menopausal symptoms in endometriosis ( EMS ) patients , with postoperative GnRH-a treatment .


Ninety EMS ovarian cyst women with postoperative GnRH-a administration were enrolled in the study , and were randomly divided into Kuntai group , Tibolone group , or blank Control group .


The therapeutic strategy in Kuntai group was @ Kuntai capsules tid , po for @ weeks after the first GnRH-a injection , while Tibolone @ mg qd , po for @ weeks in Tibolone group .


There was no drug addition in Control group .


Climacteric complaints were evaluated by Kupperman menopausal index ( KMI ) and hot flash/sweating score .


Liver and renal functions , lipid profile , serum sex hormone levels and endometrial thickness were measured , and the frequency of adverse events in Kuntai and Tibolone groups was recorded .


( @ ) Before GnRH-a therapy , the baseline parameter results were comparable in the three groups ( P > @ ) .


( @ ) After GnRH-a therapy , KMI and hot flash/sweating scores in all the three groups increased significantly ( P < @ ) .


At the @ th week after GnRH-a therapy , KMI and hot flash/sweating score results were as follows : Control group > Kuntai group > Tibolone group ( P < @ ) ; at the @ th and @ th week after GnRH-a therapy , KMI and hot flash/sweating score in Control group were significantly higher than the other two groups ( P < @ ) , and no significant difference was identified between Kuntai and Tibolone group ( P > @ ) .


( @ ) No statistical change took place in the liver and renal functions and lipid profile in all the three groups after the treatment ( P > @ ) .


( @ ) The posttherapeutic serum follicle-stimulating hormone ( FSH ) , luteinizing hormone ( LH ) and estradiol ( E@ ) level and endometrial thickness decreased significantly in all the three groups ( P < @ ) .


After therapy , serum E@ level in Tibolone group was obviously higher than the other two groups ( P < @ ) , while FSH and LH levels were obviously lower ( P < @ ) .


( @ ) The incidence of vaginal bleeding , breast distending pain in Tibolne group was obviously higher than Kuntai group ( P < @ ) .


Kuntai capsule is effective on the peri-menopausal symptoms induced by postoperative GnRH-a administration to EMS patients , although its clinical effect might be a few weeks later than Tibolone .


Kuntai capsule might be a little safer than Tibolone tablet .


The purpose of this clinical investigation was to evaluate the effectiveness of a marketed whitening chewing gum compared to a no-gum control in preventing the formation of extrinsic stains on the teeth of stain-forming subjects when chewed over a @-week period of regular unsupervised use in conjunction with daily tooth brushing .


This was a single-center , examiner-blind , randomized , @-week crossover clinical trial .


Stain-forming ( after smoking or drinking coffee or tea ) adults , starting with a stain-free baseline , either chewed the test gum ( Orbit White ) unsupervised four times per day , @ minutes/chew , or used no gum along with daily brushing with a commercially available toothbrush and dentifrice for @ weeks .


At the crossover , all procedures were repeated with subjects assigned the opposite treatment .


Extrinsic stain was measured at six and @ weeks by both the Lobene Stain Index ( LSI ) and the Modified Lobene Stain Index ( MLSI ) using separate experienced examiners .


After @ weeks , LSI stain scores showed a significant @ % reduction ( p = @ ) in new stain formation for subjects using the test chewing gum along with tooth brushing versus tooth brushing alone ( no-gum control ) .


The corresponding MLSI stain scores demonstrated a @ % reduction ( p < @ ) in the formation of extrinsic stain on the teeth .


The overall findings of this clinical study demonstrated that regular use of Orbit White chewing gum , soon after smoking or drinking coffee or tea , will supplement daily tooth brushing in preventing unsightly stains from forming on the anterior teeth compared to brushing alone .


To evaluate the effectiveness and safety of cervical arthroplasty and anterior cervical discectomy fusion methods .


The randomised clinical trial was conducted at the neurosurgical clinic of University of Harran , Turkey , between February @ and January @ .


The patients had single level disc disorder between C@-C@ levels .


Before surgery , all of the patients had taken medical treatment with no improvement .


Surgery was conducted with anterior approach , and disc prosthesis or polyetheretherketone cage for fusion were applied after patients were randomly divided into two groups .


For preoperative and postoperative clinical evaluations Neck Disability Index and Visual Analogue Scale were used .


Surgical results were evaluated according to Odom 's criterion , and ` excellent ' and ` good ' results were accepted as successful .


P < @ was taken as statistically significant .


Of the @ patients in the study , @ ( @ % ) were treated with Anterior Cervical Discectomy and Fusion , and @ ( @ % ) with Cervical Disc Arthroplasty .


There were no statistical differences between postoperative mean Visual Analogue Scale score ( p < @ ) and Neck Disability Index scores ( p < @ ) in the two groups .


Average decrease in lordosis angle was @ degree in Arthroplasty group , while it was @ degree in the Fusion group .


Postoperative adjacent segment degeneration was not detected in either group .


Anterior Cervical Discectomy and Fusion , and Cervical Disc Arthroplasty are safe and successful methods for the treatment of single level cervical disc disease .


Although the latter is a relatively new technique performed with increased frequency , but its superiority is still uncertain .


The objective of study was to develop an accurate and reproducible HPLC method for determination of piracetam in human plasma and to evaluate pharmacokinetic parameters of @ mg piracetam .


A simple , rapid , accurate , precise and sensitive high pressure liquid chromatography method has been developed and subsequently validated for determination of piracetam .


This study represents the results of a randomized , single-dose and single-period in @ healthy male volunteers to assess pharmacokinetic parameters of @ mg piracetam tablets .


Various pharmacokinetic parameters were determined from plasma for piracetam and found to be in good agreement with previous reported values .


The data was analyzed by using Kinetica version @ according to non-compartment model of pharmacokinetic analysis and after comparison with previous studies , no significant differences were found in present study of tested product .


The major pharmacokinetic parameters for piracetam were as follows : t@/@ was ( @ @ ) h ; Tmax value was ( @ @ ) h ; Cmax was ( @ @ ) g/mL ; the AUC ( @ - ) was ( @ @ ) gh/mL .


AUMC ( @ - ) was ( @ @ ) g. ( h ) ( @ ) / mL ; Ke was ( @ @ ) h ; MRT was ( @ @ ) h ; Vd was ( @ @ L ) .


A rapid , accurate and precise high pressure liquid chromatography method was developed and validated before the study .


It is concluded that this method is very useful for the analysis of pharmacokinetic parameters , in human plasma and assured the safety and efficacy of piracetam , can be effectively used in medical practice .


To evaluate the efficacy of mindfulness meditation for the treatment of chronic insomnia .


Three-arm , single-site , randomized controlled trial .


Academic medical center .


Fifty-four adults with chronic insomnia .


Participants were randomized to either mindfulness-based stress reduction ( MBSR ) , mindfulness-based therapy for insomnia ( MBTI ) , or an eight-week self-monitoring ( SM ) condition .


Patient-reported outcome measures were total wake time ( TWT ) from sleep diaries , the pre-sleep arousal scale ( PSAS ) , measuring a prominent waking correlate of insomnia , and the Insomnia Severity Index ( ISI ) to determine remission and response as clinical endpoints .


Objective sleep measures were derived from laboratory polysomnography and wrist actigraphy .


Linear mixed models showed that those receiving a meditation-based intervention ( MBSR or MBTI ) had significantly greater reductions on TWT minutes ( @ vs @ ) , PSAS ( @ vs @ ) , and ISI ( @ vs @ ) from baseline-to-post compared to SM .


Post hoc analyses revealed that each intervention was superior to SM on each of the patient-reported measures , but no significant differences were found when comparing MBSR to MBTI from baseline-to-post .


From baseline to @-month follow-up , MBTI had greater reductions in ISI scores than MBSR ( P < @ ) , with the largest difference occurring at the @-month follow-up .


Remission and response rates in MBTI and MBSR were sustained from post-treatment through follow-up , with MBTI showing the highest rates of treatment remission ( @ % ) and response ( @ % ) at the @-month follow-up .


Mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia .


To determine the effect of nurse-implemented transitional care ( TC ) on readmission and mortality rates in Chinese individuals with chronic heart failure ( CHF ) in Hong Kong .


Single-center randomized controlled trial of TC versus usual care ( UC ) .


University-affiliated hospital in Hong Kong .


Hospitalized Chinese individuals with CHF ( N = @ ; aged @ @ , @ % male ) .


The TC group received a predischarge visit , two home visits , and then regular telephone calls over @ months to provide self-care education and support , optimized health surveillance , and facilitation in use of community services .


Primary endpoints were event-free survival , all-cause hospital readmission , and mortality during the @-month follow-up .


Secondary endpoints were length of hospital stay , self-care , and health-related quality of life ( HRQL ) .


Data were analyzed using survival analysis and generalized estimating equations , following an intention-to-treat principle .


Survival analysis indicated no significant differences in event-free survival , hospital readmission , or mortality between the TC and UC groups , although the TC group had a lower hospital readmission rate at @ weeks ( @ % vs @ % , P = @ ) and lower mortality at @ months ( @ % vs @ % , P = @ ) .


The TC group also had a shorter hospital stay ( P = @ ) and significantly better self-care and HRQL .


Because of attrition , sensitivity analyses were conducted to examine whether the intention-to-treat assumption affected the results .


Per-protocol population analyses ( hazard ratio ( HR ) = @ , @ % confidence interval ( CI ) = @-@ @ ) and worst-case-scenario analysis ( HR = @ , @ % CI = @-@ @ ) suggested a lower mortality risk in the TC group .


The translation of individual-centered nurse-implemented TC to the Chinese culture and healthcare context of Hong Kong appears beneficial .


To investigate the mechanism of action of tranexamic acid ( TXA ) in bleeding trauma patients , we examined the timing of its effect on mortality .


We hypothesised that if TXA reduces mortality by decreasing blood loss , its effect should be greatest on the day of the injury when bleeding is most profuse .


However , if TXA reduces mortality via an anti-inflammatory mechanism its effect should be greater over the subsequent days .


Exploratory analysis , including per-protocol analyses , of data from the CRASH-@ trial , a randomised placebo controlled trial of the effect of TXA on mortality in @,@ trauma patients with , or at risk of , significant bleeding .


We examined hazard ratios ( HR ) and @ % confidence intervals for all-cause mortality , deaths due to bleeding and non-bleeding deaths , according to the day since injury .


The CRASH-@ trial is registered as ISRCTN@ and ClinicalTrials.gov NCT@ .


The effect of TXA on mortality is greatest for deaths occurring on the day of the injury ( HR all-cause mortality = @ , @ to @ ) .


This survival benefit is only evident in patients in whom treatment is initiated within @ hours of their injury ( HR @ hours = @ , @ to @ ; HR > @ hours = @ , @ to @ ) .


Initiation of TXA treatment within @ hours of injury reduced the hazard of death due to bleeding on the day of the injury by @ % ( HR = @ , @ to @ ) .


TXA treatment initiated beyond @ hours of injury appeared to increase the hazard of death due to bleeding , although the estimates were imprecise .


Early administration of tranexamic acid appears to reduce mortality primarily by preventing exsanguination on the day of the injury .


Photoperiod is known to cause physiological changes in seasonal mammals , including changes in body weight , physical activity , reproductive status , and adipose tissue gene expression in several species .


The objective of this study was to determine the effects of day length on the adipose transcriptome of cats as assessed by RNA sequencing .


Ten healthy adult neutered male domestic shorthair cats were used in a randomized crossover design study .


During two @-wk periods , cats were exposed to either short days ( @ hr light :@ hr dark ) or long days ( @ hr light :@ hr dark ) .


Cats were fed a commercial diet to maintain baseline body weight to avoid weight-related bias .


Subcutaneous adipose biopsies were collected at wk @ of each period for RNA isolation and sequencing .


A total of @ million sequences ( @ million/sample ) were generated by Illumina sequencing .


A total of @ mRNA transcripts were differentially expressed between short day - and long day-housed cats .


@ annotated transcripts were up-regulated by short days , while @ annotated transcripts were down-regulated by short days .


Another @ un-annotated transcripts were also different between groups .


Adipose tissue of short day-housed cats had greater expression of genes involved with cell growth and differentiation ( e.g. , myostatin ; frizzled-related protein ) , cell development and structure ( e.g. , cytokeratins ) , and protein processing and ubiquitination ( e.g. , kelch-like proteins ) .


In contrast , short day-housed cats had decreased expression of genes involved with immune function ( e.g. , plasminogen activator inhibitor @ ; chemokine ( C-C motif ) ligand @ ; C-C motif chemokine @ ; T-cell activators ) , and altered expression of genes associated with carbohydrate and lipid metabolism .


Collectively , these gene expression changes suggest that short day housing may promote adipogenesis , minimize inflammation and oxidative stress , and alter nutrient metabolism in feline adipose tissue , even when fed to maintain body weight .


Although this study has highlighted molecular mechanisms contributing to the seasonal metabolic changes observed in cats , future research that specifically targets and studies these biological pathways , and the physiological outcomes that are affected by them , is justified .


The purpose of this study was to investigate the effect of lutein on systemic complement activation in elderly individuals .


Seventy patients with signs of early age-related macular degeneration ( AMD ) were included in this study .


All subjects were randomly assigned to receive a @ mg daily dose of lutein or a placebo for a time period of @ year .


EDTA blood was collected before and at various time-points during the study ( @ , @ , @ and @ months ) .


The plasma level of the soluble complement membrane attack complex sC@b-@ was measured by ELISA .


We found a significant @ ng/ml monthly decrease in the plasma sC@b-@ concentration in the lutein group ( p < @ ) , resulting in a decrease from @ ng/ml at baseline to @ ng/ml at @ months .


For the placebo group , we found a significant @ ng/ml monthly increase in plasma sC@b-@ concentration ( p = @ ) , resulting in an increase from @ ng/ml at baseline to @ ng/ml at @ months .


Lutein supplementation inhibits the systemic activation of the complement system , which provides further functional evidence for the reported beneficial effects of this carotenoid in the management of AMD .


Tuberculosis ( TB ) is common among HIV-infected individuals in many resource-limited countries and has been associated with poor survival .


We evaluated morbidity and mortality among individuals first starting antiretroviral therapy ( ART ) with concurrent active TB or other AIDS-defining disease using data from the `` Prospective Evaluation of Antiretrovirals in Resource-Limited Settings '' ( PEARLS ) study .


PARTICIPANTS WERE CATEGORIZED RETROSPECTIVELY INTO THREE GROUPS ACCORDING TO PRESENCE OF ACTIVE CONFIRMED OR PRESUMPTIVE DISEASE AT ART INITIATION : those with pulmonary and/or extrapulmonary TB ( `` TB '' group ) , those with other non-TB AIDS-defining disease ( `` other disease '' ) , or those without concurrent TB or other AIDS-defining disease ( `` no disease '' ) .


Primary outcome was time to the first of virologic failure , HIV disease progression or death .


Since the groups differed in characteristics , proportional hazard models were used to compare the hazard of the primary outcome among study groups , adjusting for age , sex , country , screening CD@ count , baseline viral load and ART regimen .


@ of @ participants ( @ % ) in the `` TB '' group , @ of @ ( @ % ) in the `` other disease '' group , and @ of @ ( @ % ) in the `` no disease '' group experienced a primary outcome event ( p = @ ) .


This difference reflected higher mortality in the TB group : @ ( @ % ) , @ ( @ % ) and @ ( @ % ) participants died , respectively ( p < @ ) .


The adjusted hazard ratio comparing the `` TB '' and `` no disease '' groups was @ ( @ % confidence interval : @-@ @ ; p = @ ) for the primary outcome and @ ( @-@ @ ; p < @ ) for death .


Active TB at ART initiation was associated with increased risk of mortality in HIV-@ infected patients .


To compare the clinical efficacy in the treatment of post-stroke shoulder-hand syndrome between floating-needle therapy and conventional acupuncture on the basis of rehabilitation training .


One hundred cases of post-stroke shoulder-hand syndrome were randomized into a floating-needle group and an acupuncture group , @ cases in each one .


The passive and positive rehabilitation training was adopted in the two groups .


Additionally , in the floating-needle group , the floating-needle therapy was used .


The needle was inserted at the site @ to @ cm away from myofasical trigger point ( MTrP ) , manipulated and scattered subcutaneously , for @ min continuously .


In the acupuncture group , the conventional acupuncture was applied at Jianqian ( EX-UE ) , Jianyu ( LI @ ) , Jianliao ( TE @ ) , etc. .


The treatment was given once every two days , @ times a week , and @ days of treatment were required .


The shoulder hand syndrome scale ( SHSS ) , the short form McGill pain scale ( SF-MPQ ) and the modified Fugl-Meyer motor function scale ( FMA ) were used to evaluate the damage severity , pain and motor function of the upper limbs before and after treatment in the two groups .


The clinical efficacy was compared between the two groups .


SHSS score , SF-MPQ score and FMA score were improved significantly after treatment in the two groups ( all P < @ ) , and the improvements in the floating-needle group were superior to those in the acupuncture group ( all P < @ ) .


The total effective rate was @ % ( @/@ ) in the floating-needle group , which was better than @ % ( @/@ ) in the acupuncture group ( P < @ ) .


The floating-needle therapy combined with rehabilitation training achieves a satisfactory efficacy on post-stroke shoulder-hand syndrome , which is better than the combined therapy of conventional acupuncture and rehabilitation training .


To prospectively determine the feasibility of low-iodine-load and low-tube-voltage computed tomographic ( CT ) angiographic imaging of the kidney and to evaluate the opacification and image quality compared with moderate-iodine-load and high-iodine-load techniques .


Institutional review board approval and written informed consent was obtained .


One hundred thirteen consecutive patients randomly underwent three protocols for dual-phase renal CT angiographic imaging : high-iodine-load ( @ mg iodine per kilogram of body weight at @ kVp ) ; moderate-iodine-load ( @ mg iodine per kilogram of body weight at @ kVp ) ; and low-iodine-load ( contrast agent injection initially prepared at @ mg iodine per kilogram of body weight but stopped immediately after bolus-tracking trigger at @ kVp ) scanning .


CT numbers of vessels and kidneys were measured .


CT numbers and signal-to-noise ratio ( SNR ) were compared with one-way analysis of variance and posthoc Tukey-Kramer test and depiction of vessels and image noise , with Kruskal-Wallis test and pair-wise Mann-Whitney test with Bonferroni correction .


Mean iodine weight administered was significantly reduced in order of low - ( @ g ) , moderate - ( @ g ) , and high-iodine-load ( @ g ) protocols ( P < @ ) .


Mean CT numbers of abdominal aorta , renal artery , and renal cortex in first phase were significantly lower with high-iodine-load protocol ( @ , @ , and @ HU , respectively ) than with moderate - ( @ , @ , and @ HU , respectively ; P = @ -@ ) or low-iodine-load ( @ , @ , and @ HU , respectively ; P = @ -@ ) protocol .


Mean CT number of renal vein in second phase was significantly lower with low-iodine-load protocol ( @ HU ) than with moderate - ( @ HU ; P < @ ) or high-iodine-load ( @ HU ; P = @ ) .


Mean SNR of renal medulla in second phase was significantly lower ( P = @ ) with moderate-iodine-load protocol ( mean SNR , @ ) than with high-iodine-load protocol ( mean SNR , @ ) .


No significant difference in image quality grades was found between high-iodine-load ( mean grade , @-@ @ ) , moderate-iodine-load ( mean grade , @-@ @ ) , and low-iodine-load ( mean grade , @-@ @ ) protocols ( P = @ -@ ) .


Combined application of low-iodine-load , bolus tracking with saline flushing , and low-tube-voltage scanning is feasible and resulted in substantial reduction of iodine dose for renal CT angiographic imaging without compromising image quality .


Transendocardial stem cell injection ( TESI ) with mesenchymal stem cells improves remodeling in chronic ischemic cardiomyopathy , but the effect of the injection site remains unknown .


To address whether TESI exerts its effects at the site of injection only or also in remote areas , we hypothesized that segmental myocardial scar and segmental ejection fraction improve to a greater extent in injected than in noninjected segments .


Biplane ventriculographic and endocardial tracings were recorded .


TESI was guided to @ sites in infarct-border zones .


Sites were mapped according to the @-myocardial segment model .


As a result , @ segments were analyzed in @ patients before and @ months after TESI .


Segmental early enhancement defect ( a measure of scar size ) was reduced by TESI in both injected ( -@ @ % ; n = @ ; P < @ ) and noninjected segments ( -@ @ % ; n = @ ; P < @ ; between-group comparison P < @ ) .


Conversely , segmental ejection fraction ( a measure of contractile performance ) improved in injected scar segments ( @ @-@ @ @ % ; P = @ ) but not in noninjected scar segments ( @ @-@ @ @ % ; P = @ ; between-group comparison P < @ ) .


Furthermore , segmental ejection fraction in injected scar segments improved to a greater degree in patients with baseline segmental ejection fraction < @ % ( @ @-@ @ @ % ; n = @ ; P = @ ) , versus < @ % ( @ @-@ @ @ % ; n = @ ; P = @ , between-group comparison P < @ ) .


These findings illustrate a dichotomy in regional responses to TESI .


Although scar size reduction was evident in all scar segments , scar size reduction and ventricular functional responses preferentially occurred at the sites of TESI versus non-TESI sites .


Furthermore , improvement was greatest when segmental left ventricular dysfunction was severe .


To assess the effectiveness of recombinant human ( rh ) IL-@ to increase platelets count in patients suffering from Dengue fever ( DF ) .


Randomized double blind placebo control study .


Farooq Hospital , Lahore , from July to October @ .


Forty hospitalized patients suffering from Dengue fever having platelets count @ per micro liter were randomly categorized into two groups , rhIL-@ ( test ) and distilled water ( placebo ) groups .


The efficacy outcomes ( as indicated by step up in platelets count at @ hours ) for the treatment group were compared with the outcomes for the placebo group .


The data revealed that the increase in platelet response with recombinant human interleukin @ , @ mg subcutaneously is significantly more brisk than the placebo group .


The platelets response in patients with severe thrombocytopenia was greater in the treatment group ( @ % ) at @ hours as compared to the placebo group ( @ % ) ( p = @ ) .


Response rate was slightly greater among males ( @/@ , @ % ) than females ( @/@ , @ % ) ; moreover , three-fourth ( @ % ) female responders were in the placebo group , compared to half ( @ % ) male responders in the treatment group .


Results of the study suggest that treatment of severe thrombocytopenia accompanying DF with recombinant human interleukin@ may be a useful therapeutic option .


People with chronic obstructive pulmonary disease lead sedentary lives and could benefit from increasing their physical activity .


The purpose of this study was to determine if an exercise-specific self-efficacy enhancing intervention could increase physical activity and functional performance when delivered in the context of @ months of upper body resistance training with a @-month follow-up .


IN THIS RANDOMIZED CONTROLLED TRIAL , SUBJECTS WERE ASSIGNED TO : exercise-specific self-efficacy enhancing intervention with upper body resistance training ( SE-UBR ) , health education with upper body resistance training ( ED-UBR ) , or health education with gentle chair exercises ( ED-Chair ) .


Physical activity was measured with an accelerometer and functional performance was measured with the Functional Performance Inventory .


Forty-nine people with moderate to severe chronic obstructive pulmonary disease completed @ months of training and provided valid accelerometry data , and @ also provided accelerometry data at @ months of follow-up .


The self-efficacy enhancing intervention emphasized meeting physical activity guidelines and increasing moderate-to-vigorous physical activity .


Differences were observed in light physical activity ( LPA ) after @ months of training , time by group interaction effect ( P = @ ) .


The SE-UBR group increased time spent in LPA by +@ minutes/day and the other groups decreased time spent in LPA by -@ minutes/day and -@ minutes/day .


Changes in LPA were not sustained at @-month follow-up .


There were no significant changes in moderate-to-vigorous physical activity , sedentary time , or functional performance .


Subjects spent most of their waking hours sedentary : @ % @ % for SE-UBR , @ % @ % for ED-UBR , and @ % @ % for ED-Chair .


The self-efficacy enhancing intervention produced a modest short-term increase in LPA .


Further work is needed to increase the magnitude and duration of effect , possibly by targeting LPA .


Inhaled endotoxin induces airways ` neutrophilia , in human .


TNF-a being a key cytokine in the response to endotoxin , the effect of anti-TNF on the endotoxin-induced neutrophilic response was evaluated among healthy volunteers .


Among a population of @ healthy subjects , an induced-sputum was collected @ weeks before , and @ hours after an inhalation of @ mcg endotoxin ( E. coli @ : B@ ) .


Then , the subjects were randomized into @ parallel groups treated with control , oral methylprednisolone @ mg/day during @ days or anti-TNF ( adalimumab , Humira , Abbott ) @ mg s.c. .


One week later , an induced-sputum was sampled , @ hours after an inhalation of endotoxin .


After endotoxin inhalation , the number of total cells , neutrophils and macrophages was significantly increased ( p < @ ) .


Compared to the response to endotoxin among the control group , anti-TNF inhibited the endotoxin-induced neutrophil influx , both in relative ( @ ( @ ) % versus @ ( @ ) % , p < @ ) and in absolute values ( @ ( @-@ ) cells/mcL versus @ ( @-@ ) cells/mcL , p < @ ) .


The endotoxin-induced neutrophilic response was not significantly modified among the control group and oral corticosteroid group .


While oral corticosteroid had no effect , anti-TNF inhibited the neutrophil influx in sputum , induced by inhalation of endotoxin , in human subject .


The endotoxin model could be an early predictor of clinical efficacy of novel therapeutics .


A previously published study demonstrated a pharmacogenetic association between the minor alleles of @ VEGFR@ single nucleotide polymorphisms ( SNPs ) and greater improvement in visual acuity ( VA ) to treatment with ranibizumab , an anti-vascular endothelial growth factor ( VEGF ) drug , in patients with neovascular age-related macular degeneration ( AMD ) .


We evaluated whether this association was replicated among patients who participated in the Comparison of AMD Treatments Trials ( CATT ) or the Alternative Treatments to Inhibit VEGF in Patients with Age-Related Choroidal Neovascularisation ( IVAN ) trial .


Cohort studies within randomized clinical trials .


Eight hundred thirty-five patients participating in CATT and @ patients participating in IVAN .


Each patient was genotyped for the SNPs rs@ and rs@ in the VEGFR@ gene .


Mean change in VA from baseline to @ year after initiation of treatment with ranibizumab or bevacizumab .


Differences in VA response between the patient group homozygous for the minor allele of each SNP and the other genotype groups were evaluated with analysis of variance .


Differences in VA response by the number of minor alleles present for either SNP or both combined were evaluated with tests of linear trend .


Analyses were conducted separately for CATT and IVAN participants and with both the studies combined .


No statistically significant difference in mean change in VA was identified between genotypes of either SNP ( P @ ) .


Furthermore , a stepwise analysis failed to show a significant interaction for either SNP based on the number of minor alleles present .


The lack of association was similar in both the CATT and IVAN cohorts and whether the analysis combined patients treated with either ranibizumab or bevacizumab or when restricted to patients treated with ranibizumab only .


The CATT and IVAN data do not support a pharmacogenetic association between the @VEGFR@ SNPs , rs@ and rs@ , and change in VA in response to anti-VEGF therapy in patients with neovascular AMD .


Amiodarone is used commonly for pharmacological cardioversion of atrial fibrillation ( AF ) , but it is limited by moderate efficacy and delayed action .


Ranolazine and amiodarone are markedly synergistic in suppressing experimental AF in vitro , yet the clinical efficacy of ranolazine combined with amiodarone for AF conversion has only undergone minimal investigation .


This prospective , single-blinded , randomized study compared the safety and efficacy of ranolazine added to amiodarone vs. amiodarone alone for conversion of recent-onset AF .


We enroled @ patients ( @ @ years , @ % male ) with recent-onset ( < @ h duration ) AF who were eligible for pharmacological cardioversion .


Patients received either @ h amiodarone infusion ( loading dose @ mg/kg followed by maintenance dose of @ mg/h ; n = @ ) , or amiodarone infusion at the same dosage plus a single oral dose of ranolazine @ mg ( n = @ ) .


Patients in the amiodarone plus ranolazine group compared with the amiodarone-only group showed significantly higher conversion rates at @ h ( @ vs. @ % , respectively ; P = @ ) and at @ h ( @ vs. @ % ; P = @ ) , and shorter time to conversion ( @ @ vs. @ @ h ; P = @ ) .


Subgroup analysis identified higher @ h conversion in patients with left atrial ( LA ) diameter > @ mm who received the combination treatment vs. amiodarone alone ( @ vs. @ % ; P = @ ) , whereas the efficacy of the two interventions did not differ among patients with LA diameter @ mm ( P = @ ) .


There was modest QT prolongation in both the groups , no serious adverse reactions , and no pro-arrhythmic events .


Addition of ranolazine to amiodarone was safe and well tolerated in this study , and it demonstrated efficacy superior to amiodarone alone for conversion of recent-onset AF .


These findings may have clinical implications by offering a simple therapeutic manoeuvre to enhance amiodarone 's effectiveness for conversion of AF .


QVA@ is an inhaled fixed-dose combination therapy under development for the treatment of chronic obstructive pulmonary disease ( COPD ) .


It combines indacaterol ( a longacting @-agonist ) with glycopyrronium ( a longacting muscarinic antagonist ) as a dual bronchodilator .


We aimed to compare the efficacy , safety , and tolerability of QVA@ versus salmeterol-fluticasone ( SFC ) over @ weeks in patients with moderate-to-severe COPD .


In this multicentre double-blind , double-dummy , parallel-group study , @ patients ( age @ years or older , Global Initiative for Chronic Obstructive Lung Disease -LSB- GOLD -RSB- stages II-III , without exacerbations in the previous year ) were randomly assigned ( @:@ ; via automated , interactive response technology and stratified for smoking status ) to once-daily QVA@ @/@ g or twice-daily SFC @/@ g for @ weeks .


Efficacy was assessed in the full analysis set ( randomised patients who received at least one dose of study drug ) ; safety was assessed in all patients who received at least one dose of study drug .


The primary endpoint was to demonstrate the superiority of QVA@ compared with SFC for the standardised area under the curve from @ to @ h post dose for forced expiratory volume in @ second ( FEV@ AUC@-@h ) after @ weeks of treatment .


This trial was registered at ClinicalTrial.gov , NCT@ .


Between March @ , @ , and March @ , @ , @ patients were randomly assigned to receive QVA@ and @ to receive SFC. At week @ , FEV@ AUC@-@h was significantly higher with QVA@ than with SFC ( treatment difference @ L ; @ % CI @-@ ; p < @ ) .


Overall incidence of adverse events ( including COPD exacerbations ) was @ % ( @ of @ ) for the QVA@ group and @ % ( @ of @ ) for the SFC group .


Incidence of serious adverse events was similar between treatment groups ( QVA@ , @ of @ -LSB- @ % -RSB- ; SFC @ of @ -LSB- @ % -RSB- ) ; COPD worsening was the most frequent serious adverse event ( one of @ -LSB- @ % -RSB- and three of @ -LSB- @ % -RSB- , respectively ) .


Once-daily QVA@ provides significant , sustained , and clinically meaningful improvements in lung function versus twice-daily SFC , with significant symptomatic benefit .


These results indicate the potential of dual bronchodilation as a treatment option for non-exacerbating symptomatic COPD patients .


Though current hospital paging systems are neither efficient ( callbacks disrupt workflow ) , nor secure ( pagers are not Health Insurance Portability and Accountability Act -LSB- HIPAA -RSB- - compliant ) , they are routinely used to communicate patient information .


Smartphone-based text messaging is a potentially more convenient and efficient mobile alternative ; however , commercial cellular networks are also not secure .


To determine if augmenting one-way pagers with Medigram , a secure , HIPAA-compliant group messaging ( HCGM ) application for smartphones , could improve hospital team communication .


Eight-week prospective , cluster-randomized , controlled trial


Stanford Hospital


Three inpatient medicine teams used the HCGM application in addition to paging , while two inpatient medicine teams used paging only for intra-team communication .


Baseline and post-study surveys were collected from @ control and @ HCGM team members .


When compared with paging , HCGM was rated significantly ( P < @ ) more effective in : ( @ ) allowing users to communicate thoughts clearly ( P = @ ) and efficiently ( P = @ ) and ( @ ) integrating into workflow during rounds ( P = @ ) and patient discharge ( P = @ ) .


Overall satisfaction with HCGM was significantly higher ( P = @ ) .


@ % of HCGM team respondents said they would recommend using an HCGM system on the wards .


Smartphone-based , HIPAA-compliant group messaging applications improve provider perception of in-hospital communication , while providing the information security that paging and commercial cellular networks do not .


Evidence of a beneficial effect of exercise training on mediators of vascular disease is accumulating in chronic kidney disease ( CKD ) , but its effect on vascular function in vivo still has to be established .


The present study was designed to investigate whether a formal aerobic exercise training program improves peripheral endothelial function in patients with CKD stages @ to @ .


Randomized controlled trial with a parallel-group design .


@ patients with CKD stages @ to @ without established cardiovascular disease were randomly assigned to either an exercise training program or usual care .


@ patients completed the study ( exercise training , @ ; usual care , @ ) .


The @-month home-based aerobic training program consisted of @ daily cycling sessions of @ minutes each at a target heart rate , calculated as @ % of the heart rate achieved at the anaerobic threshold .


Patients in the usual-care group were given standard therapy .


The primary outcome was peripheral endothelial function .


Secondary outcomes were aerobic capacity , arterial stiffness , numbers of endothelial ( EPCs ) and osteogenic progenitor cells ( OPCs ) , migratory function of circulatory angiogenic cells , and health-related quality of life .


Endothelial function was assessed with flow-mediated dilation of the brachial artery , aerobic capacity by peak oxygen uptake ( VO ( @peak ) ) , arterial stiffness by carotid-femoral pulse wave velocity , numbers of EPCs and OPCs by flow cytometry , circulatory angiogenic cell function by an in vitro migratory assay , and quality of life by the Kidney Disease Quality of Life-Short Form questionnaire .


Exercise training significantly improved VO ( @peak ) and quality of life , but not in vivo vascular function ( flow-mediated dilation and carotid-femoral pulse wave velocity ) or cellular markers for vascular function ( EPC and OPC count and circulatory angiogenic cell migratory function ) .


Short duration and intermittent nature of the exercise intervention .


In patients with CKD stages @ to @ without overt cardiovascular disease , @ months of aerobic exercise training improved VO ( @peak ) and quality of life , without altering endothelial function or arterial stiffness .


To determine the most efficient route and timing of oxytocin administration for active management of the third stage of labor .


A prospective randomized study was done at one center in Ankara , Turkey , between January and October @ .


Women with a singleton pregnancy ( > @ weeks ) who had a live vaginal birth were randomly allocated to four groups : iv-A ( intravenous oxytocin after delivery of the fetus ) , iv-B ( when anterior shoulder seen ) , im-A ( intramuscular oxytocin after delivery ) , and im-B ( when anterior shoulder seen ) .


Postpartum blood loss within the first hour , hemoglobin , hematocrit , and duration of the third stage were compared .


A total of @ eligible women were recruited ; @ were assigned to each group .


Postpartum blood loss , prepartum and postpartum hemoglobin and hematocrit , and need for additional uterotonics were similar among groups ( P > @ ) .


The duration of the third stage of labor and changes in hemoglobin and hematocrit were significantly reduced in group iv-B ( P < @ ) .


Among women not exposed to oxytocin before delivery , postpartum blood loss was significantly lower in group iv-B ( P = @ ) .


Labor augmentation was related to significantly increased postpartum blood loss in all groups except iv-A .


Although postpartum blood loss was similar in all groups , early intravenous administration seemed to have beneficial effects .


ClinicalTrials.gov : NCT@ .


Stroke is the second-leading cause of death in low - and middle-income countries , but use of evidence-based therapies for stroke prevention in such countries , especially those in Africa , is extremely poor .


This study is designed to enhance the implementation and sustainability of secondary stroke-preventive services following hospital discharge .


The primary study aim is to test whether a Chronic Care Model-based initiative entitled the Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke ( THRIVES ) significantly improves blood pressure control after stroke .


This prospective triple-blind randomized controlled trial will include a cohort of @ patients with a recent stroke discharged from four medical care facilities in Nigeria .


The culturally sensitive , system-appropriate intervention comprises patient report cards , phone text messaging , an educational video , and coordination of posthospitalization care .


The primary outcome is improvement of blood pressure control .


Secondary endpoints include control of other stroke risk factors , medication adherence , functional status , and quality of life .


We will also perform a cost analysis of THRIVES from the viewpoint of government policy-makers .


We anticipate that a successful intervention will serve as a scalable model of effective postdischarge chronic blood pressure management for stroke in sub-Saharan Africa and possibly for other symptomatic cardiovascular disease entities in the region .


Postoperative surgical site infections are one of the most frequent complications after open abdominal surgery , and triclosan-coated sutures were developed to reduce their occurrence .


The aim of the PROUD trial was to obtain reliable data for the effectiveness of triclosan-coated PDS Plus sutures for abdominal wall closure , compared with non-coated PDS II sutures , in the prevention of surgical site infections .


This multicentre , randomised controlled group-sequential superiority trial was done in @ German hospitals .


Adult patients ( aged @ years ) who underwent elective midline abdominal laparotomy for any reason were eligible for inclusion .


Exclusion criteria were impaired mental state , language problems , and participation in another intervention trial that interfered with the intervention or outcome of this trial .


A central web-based randomisation tool was used to randomly assign eligible participants by permuted block randomisation with a @:@ allocation ratio and block size @ before mass closure to either triclosan-coated sutures ( PDS Plus ) or uncoated sutures ( PDS II ) for abdominal fascia closure .


The primary endpoint was the occurrence of superficial or deep surgical site infection according to the Centers for Disease Control and Prevention criteria within @ days after the operation .


Patients , surgeons , and the outcome assessors were masked to group assignment .


Interim and final analyses were by modified intention to treat .


This trial is registered with the German Clinical Trials Register , number DRKS@ .


Between April @ , @ , and Oct @ , @ , @ patients were randomly assigned to intervention groups ( @ to PDS Plus , and @ to PDS II ) , of whom @ ( @ PDS Plus and @ PDS II ) were analysed by intention to treat .


The study groups were well balanced in terms of patient and procedure characteristics .


The occurrence of surgical site infections did not differ between the PDS Plus group ( @ -LSB- @ % -RSB- of @ ) and the PDS II group ( @ -LSB- @ % -RSB- of @ ; OR @ , @ % CI @-@ ; p = @ ) .


Serious adverse events also did not differ between the groups-@ of @ ( @ % ) patients treated with PDS Plus had at least one serious adverse event , compared with @ of @ ( @ % ) patients treated with PDS II ; p = @ ) .


Triclosan-coated PDS Plus did not reduce the occurrence of surgical site infection after elective midline laparotomy .


Innovative , multifactorial strategies need to be developed and assessed in future trials to reduce surgical site infections .


Tonsillectomy is the oldest and most frequently performed surgical procedure practiced by ear , nose , and throat physicians .


In this study , our aim was to compare the analgesic effects of peritonsillar , rectal , as well as intravenous infiltration of ketamine and intravenous tramadol hydrochloride infiltration for postoperative pain relief and sedation after tonsillectomy in children .


This randomized controlled study evaluated the effects of peritonsillar , intravenous , and rectal infiltration of ketamine in children undergoing adenotonsillectomy .


One hundred twenty children who were categorized under American Society of Anesthesiologists classes I to II were randomized to @ groups of @ members each .


Group @ received intravenous ( IV ) ketamine ( @ mg/kg ) , group @ received rectal ketamine ( @ mg/kg ) , group @ received local peritonsillar ketamine ( @ mg/kg ) , and the control group received IV tramadol hydrochloride infiltration ( @ mg/kg ) .


Children 's Hospital of Eastern Ontario Pain Scale scores and Wilson sedation scale were recorded at minutes @ , @ , @ , @ as well as hours @ , @ , and @ postoperatively .


The patients were interviewed on the day after the surgery to assess the postoperative pain and sedation .


All the routes of infiltration of ketamine were as effective as those of tramadol hydrochloride ( P > @ ) .


A statistically significant difference was observed between IV infiltrations and all groups during the assessments at hours @ and @ .


The analgesic efficacy of IV ketamine was found especially higher at hours @ and @ ( P ( @ ) = @ , P ( @ ) = @ ) .


Perioperative , low-dose IV , rectal , or peritonsillar ketamine infiltration provides efficient pain relief without any adverse effects in children who would undergo adenotonsillectomy .


To compare the long-term clinical safety between two drug-eluting stents with different healing characteristics in the Patient Related Outcomes with Endeavour ( E-ZES ) vs. Cypher ( C-SES ) Stenting Trial ( PROTECT ) .


At @ years , there was no difference in the primary outcome of definite or probable stent thrombosis or in the other main secondary clinical outcomes consisting of the composite of death or myocardial infarction ( MI ) .


Prespecified @-year clinical follow-up was analysed .


Patient Related OuTcomes with Endeavour vs. Cypher Stenting Trial was a prospective , open-label randomized-controlled superiority trial powered to look at differences in long-term clinical safety , including stent thrombosis .


Dual antiplatelet therapy ( DAPT ) was prescribed for @ months and up to @ months based on current guidelines .


Patient Related OuTcomes with Endeavour vs. Cypher Stenting Trial enrolled @ patients undergoing elective or emergency PCI to E-ZES or C-SES .


There was no difference in DAPT usage between the two groups up to @ years .


At @-year follow-up , the primary outcome occurred in @ % of E-ZES vs. @ % of C-SES patients -LSB- HR @ ( @ % CI @-@ @ ) , P = @ -RSB- .


The composite of all-cause death or large MI occurred in @ % of E-ZES vs. @ % of C-SES-treated patients -LSB- HR @ ( @ % CI @-@ @ ) , P = @ -RSB- .


Drug-eluting coronary stents with different healing characteristics demonstrated different late safety profiles : after @ years , compared with C-SES , E-ZES reduced the risk of stent thrombosis and the risk of the composite endpoints of death or MI .


Appropriately powered large-scale trials with long-term follow-up are critical to determine clinical safety and efficacy of permanently implanted coronary stents .


This trial is registered with ClinicalTrials.gov , number NCT@ .


This @-arm crossover study compared the relative bioavailability of two dovitinib ( TKI@ ) formulations -LSB- anhydrate clinical service form ( CSF ) capsule and monohydrate final market image ( FMI ) tablet ; Arm @ -RSB- and determined the effect of food on dovitinib exposure ( Arm @ ) .


Patients with advanced solid tumors , excluding breast cancer , were enrolled in @ of the @ arms of the study .


Patients in Arm @ were randomized to a single @-mg dose of CSF capsule or FMI tablet followed by @ days of rest and @ mg of the other formulation .


Patients in Arm @ received @ mg of FMI tablet daily and were randomized to follow @ of @ meal sequences , each with @ prandial conditions : low fat ( LF ) , high fat ( HF ) , or no meal ( NM ) .


In Arm @ ( n = @ ) , @ patients were evaluable .


FMI tablet compared with CSF capsule showed only slight reductions in the adjusted geometric means for area under the plasma concentration-time curve ( AUClast ; @ % ) and maximum plasma concentration ( C max ; @ % ) .


HF meal versus NM showed a @ % decrease in the adjusted geometric mean for AUClast and an @ % decrease for C max .


Comparison of LF meal versus NM showed a @ % decrease for AUClast and a @ % decrease for C max .


Common adverse events suspected to be study drug related included vomiting , diarrhea , nausea , and fatigue .


Dovitinib FMI tablet had similar systemic exposure to the CSF capsule and was not affected by food .


In a published study on cervical cancer , @-beam IMRT was inferior to single arc VMAT .


Here we compare @ , @ , and @ beam IMRT with single and dual arc VMAT .


For each of @ patients , automated plan generation with the in-house Erasmus-iCycle optimizer was used to assist an expert planner in generating the five plans with the clinical TPS .


For each patient , all plans were clinically acceptable with a high and similar PTV coverage .


OAR sparing increased when going from @ to @ to @ IMRT beams , and from single to dual arc VMAT .


For all patients , @ and @ beam IMRT were superior to single and dual arc VMAT , with substantial variations in gain among the study patients .


As expected , delivery of VMAT plans was significantly faster than delivery of IMRT plans .


Often reported increased plan quality for VMAT compared to IMRT has not been observed for cervical cancer .


Twenty and @ beam IMRT plans had a higher quality than single and dual arc VMAT .


For individual patients , the optimal delivery technique depends on a complex trade-off between plan quality and treatment time that may change with introduction of faster delivery systems .


Depression is common in heart failure ( HF ) and associated with adverse outcomes .


Randomized comparisons of the effectiveness of HF care strategies by patients ' mood are scarce .


We therefore investigated in a randomized trial a structured collaborative disease management programme ( HeartNetCare-HF ; HNC ) recording mortality , morbidity , and symptoms in patients enrolled after hospitalization for decompensated systolic HF according to their responses to the @-item Patient Health Questionnaire ( PHQ-@ ) during an observation period of @ days .


Subjects scoring < @/@ were categorized as non-depressed/depressed , and those ignoring the questionnaire as PHQ-deniers .


Amongst @ participants ( @years , @ % female ) , @ ( @ % ) were depressed , @ ( @ % ) non-depressed , and @ ( @ % ) PHQ-deniers .


The composite endpoint of mortality and re-hospitalization was neutral overall and in all subgroups .


However , HNC reduced mortality risk in both depressed and non-depressed patients -LSB- adjusted hazard ratios ( HRs ) @ , @ % confidence interval ( CI ) @-@ @ , P = @ , and @ , @ % CI @-@ @ , P = @ , respectively -RSB- , but not in PHQ-deniers ( HR @ , @ % CI @-@ @ , P = @ ; P = @ for homogeneity of HRs ) .


Average frequencies of patient contacts in the HNC arm were @ in non-depressed patients , @ in depressed patients , and @ in PHQ-deniers ( P < @ ) .


Early after decompensation , HNC reduced mortality risk in non-depressed and even more in depressed subjects , but not in PHQ-deniers .


This suggests that differential acceptability and chance of success of care strategies such as HNC might be predicted by appropriate assessment of patients ' baseline characteristics including psychological disposition .


These post-hoc results should be reassessed by prospective evaluation of HNC in larger HF populations .


Generalized anxiety and panic disorders are a burden on the society because they are costly and have a significant adverse effect on quality of life .


The aim of this study was to evaluate the cost-utility of a collaborative stepped care intervention for panic disorder and generalized anxiety disorder in primary care compared to care as usual from a societal perspective .


The design of the study was a two armed cluster randomized controlled trial .


In total @ primary care practices in the Netherlands participated in the study .


Eventually , @ patients were included ( @ collaborative stepped care , @ care as usual ) .


Baseline measures and follow-up measures ( @ , @ , @ and @ months ) were assessed using questionnaires .


We applied the TiC-P , the SF-HQL and the EQ-@D respectively measuring health care utilization , production losses and health related quality of life .


The average annual direct medical costs in the collaborative stepped care group were @ Euro ( @ % C.I. , @ to @ ) compared to @ ( @ % C.I. , @ to @ ) in the care as usual group .


The average quality of life years ( QALYs ) gained was @ higher in the collaborative stepped care group , leading to an incremental cost effectiveness ratio ( ICER ) of @ Euro per QALY .


Inclusion of the productivity costs , consequently reflecting the full societal costs , decreased the ratio even more .


The study showed that collaborative stepped care was a cost effective intervention for panic disorder and generalized anxiety disorder and was even dominant when a societal perspective was taken .


Despite anecdotal reports of voice impairment in quadriplegia , the exact nature of these impairments is not well described in the literature .


This article details objective and subjective voice assessments for people with quadriplegia at baseline and after a respiratory-targeted singing intervention .


Randomized controlled trial .


Twenty-four participants with quadriplegia were randomly assigned to a @-week program of either a singing intervention or active music therapy control .


Recordings of singing and speech were made at baseline , @ weeks , @weeks , and @ months postintervention .


These deidentified recordings were used to measure sound pressure levels and assess voice quality using the Multidimensional Voice Profile and the Perceptual Voice Profile .


Baseline voice quality data indicated deviation from normality in the areas of breathiness , strain , and roughness .


A greater percentage of intervention participants moved toward more normal voice quality in terms of jitter , shimmer , and noise-to-harmonic ratio ; however , the improvements failed to achieve statistical significance .


Subjective and objective assessments of voice quality indicate that quadriplegia may have a detrimental effect on voice quality ; in particular , causing a perception of roughness and breathiness in the voice .


The results of this study suggest that singing training may have a role in ameliorating these voice impairments .


Medications to control intraocular pressure ( IOP ) are frequently preserved using benzalkonium chloride ( BAK ) , which can negatively affect the ocular surface .


Data are needed to assess efficacy and safety of prostaglandin drugs preserved with and without BAK .


The present study compared the efficacy and safety of BAK-free travoprost @ % ( TRAV ) and BAK @ % - preserved bimatoprost @ % ( BIM ) during late-day time points in patients with open-angle glaucoma or ocular hypertension .


This was a @-week , phase @ , randomized , investigator-masked , crossover study .


@ patients with IOP @ and < @ mmHg were randomized @:@ to receive once-daily TRAV or BIM for @ weeks followed by an additional @-week crossover period .


IOP was measured at the end of each treatment period at @ , @ , and @ pm .


TRAV was considered noninferior to BIM if the upper limit of the @ % CI of the between-group difference in mean IOP was @ mmHg .


Adverse events were assessed throughout the study .


One patient discontinued due to allergic conjunctivitis , and @ patients with missing data were excluded ; @ patients were included in the per-protocol population ( mean SD age , @ @ years ; TRAV/BIM , n = @ ; BIM/TRAV , n = @ ) .


After @ weeks , mean IOP with TRAV ( @ @ mmHg ; change from baseline , -@ mmHg ) was similar to BIM ( @ @ mmHg ; change from baseline , -@ mmHg ) ; the between-group difference was @ mmHg ( @ % CI , -@ to @ ) .


Thus , noninferiority of TRAV versus BIM was demonstrated .


Mean IOP at each time point and mean and percentage IOP change from baseline were not significantly different between treatments .


All treatment-emergent adverse events were mild to moderate .


The incidences of mild ocular hyperemia with TRAV and BIM were @ % and @ % , respectively ; moderate hyperemia was observed in @ % of patients receiving BIM .


Late-day IOP-lowering efficacy of BAK-free TRAV was noninferior to that of BAK @ % - preserved BIM ; both reduced baseline IOP by @ % .


Both treatments were well tolerated , although a higher incidence of moderate ocular hyperemia was observed with BIM .


Most electronic health record ( EHR ) systems have the capability of generating a printed after-visit summary ( AVS ) , but there has been little research on optimal content .


We conducted a qualitative study and a randomized trial to understand the effect of AVS content on patient recall and satisfaction .


Adult primary care patients ( n = @ ) with at least @ chronic condition were randomly assigned to @ AVS content conditions : minimum , intermediate , maximum , or standard AVS .


Demographics and health literacy were measured at an index clinic visit .


Recall and satisfaction were measured by telephone @ days and @ to @ weeks after the clinic visit .


Average age was @ years ; @ % of patients were female , @ % were Hispanic , and @ % were African American , and @ % had adequate health literacy .


Average medication recall accuracy was @ % at @ days and @ % at @ weeks , with no significant difference among groups at either time .


Satisfaction with AVS content was high and did not differ among groups .


Recall of specific content categories was low and unrelated to group assignment .


Health literacy was unrelated to recall and satisfaction .


Primary care patients like to receive an AVS , but the amount of information included does not affect content recall or satisfaction with the information .


Adequate serum @-hydroxyvitamin D concentrations , -LSB- @ ( OH ) D -RSB- , are required for optimal bone health , and low levels are associated with chronic diseases .


We investigated whether @ candidate single nucleotide polymorphisms ( SNPs ) in vitamin D and calcium pathway genes ( GC , DHCR@ , CYP@R@ , CYP@B@ , CYP@A@ , VDR , and CASR ) are associated with -LSB- @ ( OH ) D -RSB- or modify the increase in -LSB- @ ( OH ) D -RSB- from vitamin D@ supplementation .


Baseline and year @ -LSB- @ ( OH ) D -RSB- measurements from a randomized controlled trial conducted at @ clinical centers in the United States .


A total of @ healthy non-Hispanic white participants aged @-@ years .


Vitamin D@ ( @ IU/d ) , calcium carbonate ( @ mg/d elemental ) , both , or placebo .


Genotype main effects and interactions with vitamin D@ treatment estimated using multiple linear regression .


The baseline serum -LSB- @ ( OH ) D -RSB- was @ @ ng/mL ( mean SD ) .


Associations with baseline levels were discovered for SNPs in CYP@A@ ( rs@ , rs@ ) and confirmed for SNPs in GC and CYP@R@ .


After @ year , -LSB- @ ( OH ) D -RSB- increased on average by @ @ ng/mL on vitamin D@ treatment and decreased by @ @ ng/mL on placebo .


The increase in -LSB- @ ( OH ) D -RSB- due to vitamin D@ supplementation was modified by genotypes at rs@ near CYP@R@ , rs@ near CYP@A@ , and rs@ near VDR .


The increase in -LSB- @ ( OH ) D -RSB- attributable to vitamin D@ supplementation may vary according to common genetic differences in vitamin D @-hydroxylase ( CYP@R@ ) , @-hydroxylase ( CYP@A@ ) , and the vitamin D receptor ( VDR ) genes .


These findings have implications for achieving optimal vitamin D status and potentially for vitamin D-related health outcomes .


The purpose of this study was to evaluate postoperative pain levels after arthroscopic elbow surgery under general anesthesia and to determine whether an axillary nerve block provides additional pain management benefits compared with a portal site injection of local anesthetic .


Thirty-six patients undergoing arthroscopic elbow surgery under general anesthesia were randomized to either a study group receiving axillary nerve block ( Ax group ) or a control group receiving portal site injections of local anesthetic ( Lo group ) .


During the first @ hours after surgery , pain visual analog scale ( VAS ) scores ( @-@ ) , total amount of oral analgesics required , and patient satisfaction were assessed .


Among all @ patients , mean pain VAS scores at rest were @ , @ , and @ for the first @-hour period and at @ and @ hours after surgery , respectively .


The mean pain VAS scores during physiotherapy were @ and @ at @ and @ hours postoperatively , respectively .


No intergroup differences were observed between the Ax and Lo groups at any time point after surgery ( P value range , @ to @ ) .


The mean number of loxoprofen tablets required during the @-hour study period was @ in the Ax group and @ in the Lo group ( P = @ ) .


The Ax and Lo groups had mean overall patient satisfaction scores of @ and @ , respectively ( P = @ ) .


Postoperative pain levels after arthroscopic elbow surgery could be well managed with oral analgesics and local anesthetic .


An axillary nerve block was not found to provide any postoperative pain control benefits .


To evaluate the benefit of aerobic exercise on colonic transit time ( CTT ) for psychiatric inpatients in a closed ward .


Sixty consecutive adult inpatients of the Somang Hospital Psychiatry Unit ( Eumsung-gun , South Korea ) , without CTT-related diseases or drug therapies , were recruited for study from March to June of @ .


Upon enrollment , the patients were randomly assigned to partake in a @-wk instructor-led group aerobic exercise program ( exercise group ; n = @ ) or to maintain their ordinary daily activities ( control group ; n = @ ) .


The exercise program was structured as @ min warm-up ( stretching ) , @ min exercise , and @ min cool-down ( stretching ) for three days each week .


The exercise sessions consisted of walking only in week one and aerobics from weeks two to @ , with increasing intensity ( @ % heart rate reserve ( HRR ) for weeks one to four , @ % HRR for weeks five to eight , and @ % HRR for weeks nine to @ ) .


CTT was measured before ( baseline ) and after ( week @ ) the exercise program , in duplicate ( on days four and seven ) , using abdominal radiography and the multiple radio-opaque marker technique .


Changes in the exercising patients ' CTT and weight - , cardiovascular - and fitness-related parameters were statistically assessed .


The study dropout rate was @ % , with @ patients in the exercise group and @ patients in the control group completing the study .


At week @ , the exercise group showed decreases in body weight ( mean SE ) baseline : @ @ vs study-end : @ @ ; P < @ ) and body mass index ( BMI ) ( @ @ vs @ @ ; P < @ ) , but the extent of change was not significantly different from that experienced by the control group ( body weight : @ @ vs @ @ ; BMI : @ @ vs @ @ ) .


However , the exercise group showed significant improvements in leg muscle strength ( baseline : @ @ vs study-end : @ @ ; P < @ ) , cardio-respiratory endurance ( @ @ vs @ @ ; P < @ ) , and leg muscle elasticity and power output ( @ @ vs @ @ ; P < @ ) .


The exercise group showed an exercise-induced reduction in total CTT ( baseline : @ @ vs @ @ ) , which was significantly different from that experienced by the control group over the @-wk period ( @ @ vs @ @ ; P = @ ) ; however , the exercise-induced decreases in CTT involving the three colonic segments examined ( right , left and recto-sigmoid ) showed no significant differences from the control group .


A @-wk aerobic exercise program can benefit psychiatric inpatients by increasing intestinal motility , possibly decreasing risk of metabolic - and cardiovascular-related disease .


Reported rates of hypoglycemia in patients with type @ diabetes mellitus are lower with glimepiride as compared to glyburide .


The aim of this study was to determine whether physiologic differences in counterregulatory neuroendocrine and metabolic mechanisms during hypoglycemia provide a basis for the observed clinical differences between glimepiride and glyburide .


Non-diabetic volunteers ( age @years , BMI @kg/m ( @ ) ) were studied in a single-blind fashion during separate @day randomized protocols consisting of @h hyperinsulinemic ( @pmol/kg/min ) euglycemic ( @ mmol ) and hypoglycemic ( @ mmol/L ) clamps .


Individuals received biologically equivalent doses of glimepiride ( @mg ) or glyburide ( @mg ) @h prior to each glucose clamp ( n = @ ) as well as a control group of placebo studies .


Glucose kinetics were calculated using D-Glucose-@-@d@ .


Insulin and C-peptide levels were increased ( p < @ ) during euglycemia in both sulfonylurea groups as compared to placebo .


However , despite equivalent hypoglycemia , insulin and C-peptide levels were higher ( p < @ ) only after glyburide .


Glucagon responses and endogenous glucose production ( EGP ) were decreased ( p < @ ) during hypoglycemia following glyburide administration as compared to glimepiride .


Glyburide reduced ( p < @ ) norepinephrine responses during euglycemic clamps .


In addition combined epinephrine and norepinephrine responses during hypoglycemia were reduced ( p < @ ) following glyburide as compared to placebo .


Leptin levels fell by a greater amount ( p < @ ) during hypoglycemia with both sulfonylureas as compared to placebo .


In summary , glimepiride and glyburide can both similarly increase insulin and C-peptide levels during hyperinsulinemic euglycemia .


However , during moderate hyperinsulinemic hypoglycemia ( @ mmol/L ) glyburide resulted in increased C-peptide and insulin , but blunted glucagon , sympathetic nervous system and EGP responses .


We conclude that glyburide can acutely reduce key neuroendocrine and metabolic counterregulatory defenses during hypoglycemia in healthy individuals .


Tobramycin inhalation is an accepted treatment of chronic pseudomonal infection in cystic fibrosis ( CF ) patients .


Twice daily inhalation is efficacious , but time-consuming .


In this randomized , open-label , multicentre , two-period , crossover study , @ patients with CF and chronic Pseudomonas aeruginosa ( PA ) infection received two tobramycin nebuliser solutions : T@/eFlow or TNS/PARI LC PLUS .


The primary objective was to demonstrate the equivalence of both treatments with respect to pharmacokinetics ( area under the concentration-time curve and maximum concentration in plasma ) .


Secondary endpoints were tobramycin sputum pharmacokinetics , reduction in PA colony forming units , improvement of lung function , incidence of adverse drug reactions and reduction of inhalation times .


Tobramycin plasma AUC and Cmax were lower after administration of T@ than after TNS .


The study failed to demonstrate systemic bioequivalence of the two treatments .


After T@ administration , tobramycin sputum AUC and Cmax achieved higher values than after TNS .


Changes in efficacy parameters from baseline were similar .


Safety profiles were not different or unexpected .


Inhalation time per inhalation was shorter during treatment with T@ .


The lower systemic drug burden and the higher local drug deposition together with a comparable efficacy/safety profile and a shorter inhalation time render T@/eFlow an attractive treatment option for CF patients .


( www.controlled-trials.com/ISRCTN@ ) .


Luseogliflozin is a novel sodium glucose cotransporter @ inhibitor for type @ diabetes mellitus ( T@DM ) treatment .