To explore any differences in efficacy and safety outcomes between European ( EU ) ( n = @ ) and North American ( NA ) ( n = @ ) patients in the AFFIRM trial ( NCT@ ) .


Phase III , double-blind , placebo-controlled , multinational AFFIRM trial in men with metastatic castration-resistant prostate cancer ( mCRPC ) after docetaxel .


Participants were randomly assigned in a @:@ ratio to receive oral enzalutamide @mg/day or placebo .


The primary end point was overall survival ( OS ) in a post hoc analysis .


Enzalutamide significantly improved OS compared with placebo in both EU and NA patients .


The median OS in EU patients was longer than NA patients in both treatment groups .


However , the relative treatment effect , expressed as hazard ratio and @ % confidence interval , was similar in both regions : @ ( @ , @ ) for EU and @ ( @ , @ ) for NA .


Significant improvements in other end points further confirmed the benefit of enzalutamide over placebo in patients from both regions .


The tolerability profile of enzalutamide was comparable between EU and NA patients , with fatigue and nausea the most common adverse events .


Four EU patients ( @/@ enzalutamide-treated , @ % ) and one NA patient ( @/@ enzalutamide-treated , @ % ) had seizures .


The difference in median OS was related in part to the timing of development of mCRPC and baseline demographics on study entry .


This post hoc exploratory analysis of the AFFIRM trial showed a consistent OS benefit for enzalutamide in men with mCRPC who had previously progressed on docetaxel in both NA - and EU-treated patients , although the median OS was higher in EU relative to NA patients .


Efficacy benefits were consistent across end points , with a comparable safety profile in both regions .


Although opioids are widely used as analgesics in general anaesthesia , they have unpleasant side-effects and can delay postoperative recovery .


Acupuncture and related techniques are effective for acute and chronic pain , and reduces some side-effects .


We assessed the effect of transcutaneous electric acupoint stimulation ( TEAS ) on intra-operative remifentanil consumption and the incidences of anaesthesia-related side-effects .


Sixty patients undergoing sinusotomy were randomly assigned to TEAS or control group .


TEAS consisted of @ min of stimulation ( @-@ mA , @/@ Hz ) on the Hegu ( LI@ ) , Neiguan ( PC@ ) , and Zusanli ( ST@ ) before anaesthesia .


The patients in the control group had the electrodes applied , but received no stimulation .


Bispectral index was used to monitor the depth of anaesthesia .


Perioperative haemodynamics were recorded , and peripheral blood samples were collected to measure the levels of mediators of surgical stress .


The primary end point was intraoperative remifentanil consumption and the secondary endpoints were recovery quality and anaesthesia-related side-effects .


Patients in the TEAS group required @ % less remifentanil during surgery than controls -LSB- @ ( SD @ ) g kg ( -@ ) min ( -@ ) vs @ ( @ ) g kg ( -@ ) min ( -@ ) -RSB- .


There were no differences in intra-operative haemodynamics or surgical stress between groups .


However , the time to extubation and recall in the control group was @ ( @ ) min and @ ( @ ) min , respectively , significantly longer than that in the TEAS group ( P < @ ) .


TEAS also decreased the incidence of dizziness and pruritus within the first @ h after surgery ( P < @ ) .


The use of TEAS significantly reduced intra-operative remifentanil consumption and alleviated postoperative side-effects in patients undergoing sinusotomy .


Radial-head subluxation is an easily identified and treated injury .


We investigated whether triage nurses in the emergency department can safely reduce radial-head subluxation at rates that are not substantially lower than those of emergency department physicians .


We performed an open , noninferiority , cluster-randomized control trial .


Children aged @ years and younger who presented to the emergency department with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous @ hours were assigned to either nurse-initiated or physician-initiated treatment , depending on the day .


The primary outcome was the proportion of children who had a successful reduction ( return to normal arm usage ) .


We used a noninferiority margin of @ % .


In total , @ children were eligible for inclusion and @ were included in the final analysis .


Of the children assigned to receive physician-initiated care , @ % ( @/@ ) had a successful reduction performed by a physician .


Of the children assigned to receive nurse-treatment care , @ % ( @/@ ) had a successful reduction performed by a nurse .


The difference in the proportion of successful radial head subluxations between the groups was @ % ( @ % confidence interval -LSB- CI -RSB- @ % to @ % ) .


Noninferiority of nurse-initiated radial head subluxation was not shown .


In this trial , the rate of successful radial-head subluxation performed by nurses was inferior to the physician success rate .


Although the success rate in the nurse-initiated care group did not meet the non-inferiority margin , nurses were able to reduce radial head subluxation for almost @ % of children who presented with probable radial-head subluxation .


One in ten people aged between @ to @ years have a significant hearing impairment in their better hearing ear ( as defined by audiometric hearing thresholds ) .


However , it is becoming increasingly clear that the challenges faced by older listeners can not be explained by the audiogram alone .


The ability for people with hearing loss to use cognition to support speech perception allows for compensation of the degraded auditory input .


This in turn offers promise for new cognitive-based rehabilitative interventions .


Working memory is known to be highly associated with language comprehension and recent evidence has shown significant generalization of learning from trained working memory tasks to improvements in sentence-repetition skills of children with severe to profound hearing loss .


This evidence offers support for further investigation into the potential benefits of working memory training to improve speech perception abilities in other hearing impaired populations .


This is a double-blind randomized active controlled trial aiming to assess whether a program of working memory training results in improvements in untrained measures of cognition , speech perception and self-reported hearing abilities in adult hearing aid users aged ( @ to @ years ) with mild-to-moderate hearing loss hearing aid users , compared with an active control group who receive a placebo version of the working memory training program .


The present study aims to generate high-quality preliminary evidence for the efficacy of working memory training for adult hearing aid users with mild-to-moderate sensorineural hearing loss who are existing hearing aid users .


This trial addresses a number of gaps in the published literature assessing training interventions for people with hearing loss , and in the general literature surrounding working memory training , such as the inclusion of an active control group , participant and tester blinding , and increased transparency in reporting .


To investigate whether a responsive stimulation intervention delivered to caregivers of young children either alone or integrated with nutrition interventions would benefit parenting skills and emotional availability to promote children 's development and growth compared with either a nutrition intervention alone or the usual standard of care .


A cluster randomized factorial effectiveness trial was implemented in an impoverished community in Pakistan .


The @ trial arms were control ( usual standard of care ) , responsive stimulation ( responsive care and stimulation ) , enhanced nutrition ( education and multiple micronutrients ) , and a combination of both enriched interventions .


The @ intervention packages were delivered by community health workers to @ mother-infant dyads in the first @ years of life .


Parenting skills and emotional availability indexed by mother-child interaction , caregiving environment , knowledge and practices pertaining to early childhood care and feeding , and maternal depressive symptoms were assessed at multiple intervals .


An intention-to-treat factorial analysis was conducted .


Intervention groups were comparable at baseline .


Responsive stimulation significantly benefitted parenting skills with large effect sizes on mother-child interaction ( Cohen 's d @ ) , caregiving environment ( Cohen 's d @-@ @ ) , and knowledge and practices ( Cohen 's d @-@ @ ) compared with small-modest significant effects as a result of nutrition intervention on mother-child interaction and caregiving environment only ( Cohen 's d @ and @ , respectively ) .


The combined intervention had a small significant effect on decreasing maternal depressive symptoms over time ( Cohen 's d @-@ @ ) .


A responsive stimulation intervention can promote positive caregiving behaviors among impoverished families .


Additional research is needed on interventions to reduce maternal depressive symptoms .


To compare the efficacy of behavior activation ( BA ) + low vision rehabilitation ( LVR ) with supportive therapy ( ST ) + LVR to prevent depressive disorders in patients with age-related macular degeneration ( AMD ) .


Single-masked , attention-controlled , randomized , clinical trial with outcome assessment at @ months .


Patients with AMD and subsyndromal depressive symptoms attending retina practices ( n = @ ) .


Before randomization , all subjects had @ outpatient LVR visits , and were then randomized to in-home BA+LVR or ST+LVR .


Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals .


Supportive therapy is a nondirective , psychological treatment that provides emotional support and controls for attention .


The Diagnostic and Statistical Manual IV defined depressive disorder based on the Patient Health Questionnaire-@ ( primary outcome ) , Activities Inventory , National Eye Institute Vision Function Questionnaire-@ plus Supplement ( NEI-VFQ ) , and NEI-VFQ quality of life ( secondary outcomes ) .


At @ months , @ BA+LVR subjects ( @ % ) and @ ST+LVR subjects ( @ % ) developed a depressive disorder ( relative risk -LSB- RR -RSB- , @ ; @ % CI , @-@ @ ; P = @ ) .


In planned adjusted analyses the RR was @ ( @ % CI , @-@ @ ; P = @ ) .


A mediational analysis suggested that BA+LVR prevented depression to the extent that it enabled subjects to remain socially engaged .


In addition , BA+LVR was associated with greater improvements in functional vision than ST+LVR , although there was no significant between-group difference .


There was no significant change or between-group difference in quality of life .


An integrated mental health and low vision intervention halved the incidence of depressive disorders relative to standard outpatient LVR in patients with AMD .


As the population ages , the number of persons with AMD and the adverse effects of comorbid depression will increase .


Promoting interactions between ophthalmology , optometry , rehabilitation , psychiatry , and behavioral psychology may prevent depression in this population .


Both peripheral nerve blocks with sedation or general anesthesia can be used for total knee replacement surgery .


We compared these anesthetic techniques on the postoperative quality of recovery early in elderly patients .


In our study , @ patients who were @ years old and undergoing total knee replacement were randomized to peripheral nerve blocks ( PNBs ) - lumbar plexus and sciatic - with propofol sedation , or general anesthesia with combined propofol and remifentanil .


Blocks were performed using nerve stimulation and @ % ropivacaine .


All patients received postoperative multimodal analgesia .


Postoperative recovery was assessed at @ minutes , @ minutes , @ day , @ days , and @ days after surgery , with the Postoperative Quality of Recovery Scale , in physiological , nociceptive , emotive , modified activities of daily living , modified cognitive , and overall patient perspective domains .


Intraoperative blood pressure and heart rate were more stable with PNBs ( P < @ ) .


The recovery was better with PNBs in physiological ( P < @ ) , emotive ( depression and anxiety ) ( P < @ ) , nociceptive ( pain and nausea ) ( P < @ ) , modified cognitive ( P < @ ) , and all domains recovery ( P < @ ) , but not in activities of daily living ( P = @ ) .


Intraoperative drugs and the postoperative sulfentanil requirement of the PNBs group were lower ( all P < @ ) .


Differences were greatest early after surgery with equivalence by @ week .


Satisfaction was high and not different between groups ( P = @ ) .


Lumbar plexus and sciatic blocks with sedation facilitates faster postoperative recovery than general anesthesia , but not at @ week after total knee replacement in patients who were @ years or older .


The trial has been registered at ClinicalTrials.gov .


( NCT@ ) .


To perform a pilot study to assess the feasibility of performing a phase III trial of therapeutic hypothermia started early and continued for at least @ hours in children with severe traumatic brain injury .


Multicenter prospective randomized controlled phase II trial .


All eight of the PICUs in Australia and New Zealand and one in Canada .


Children @-@ years old with severe traumatic brain injury and who could be randomized within @ hours of injury .


The control group had strict normothermia to a temperature of @-@C for @ hours .


The intervention group had therapeutic hypothermia to a temperature of @-@C for @ hours followed by slow rewarming at a rate compatible with maintaining intracranial pressure and cerebral perfusion pressure .


Of @ children admitted to PICU with traumatic brain injury , @ ( @ % ) were eligible and @ ( @ % ) were recruited .


There were five major protocol violations ( @ % ) : three related to recruitment and consent processes and two to incorrect temperature management .


Rewarming took a median of @ hours ( @-@hr ) and was performed without compromise in the cerebral perfusion pressure .


There was no increase in any complications , including infections , bleeding , and arrhythmias .


There was no difference in outcomes @ months after injury ; in the therapeutic hypothermia group , four ( @ % ) had a bad outcome ( pediatric cerebral performance category , @-@ ) and three ( @ % ) died , whereas in the normothermia group , three ( @ % ) had a bad outcome and one ( @ % ) died .


Early therapeutic hypothermia in children with severe traumatic brain injury does not improve outcome and should not be used outside a clinical trial .


Recruitment rates were lower and outcomes were better than expected .


Conventional randomized controlled trials in children with severe traumatic brain injury are unlikely to be feasible .


A large international trials group and alternative approaches to trial design will be required to further inform practice .


To compare early visual function between patients undergoing phacoemulsification combined with multifocal and accommodative intraocular lens implantation .


A total of @ patients with age-related cataract undergoing phacoemulsification in our hospital were recruited for this study and randomly assigned into multifocal ( @ eyes ; ZAM@ group ) and accommodative ( @ eyes ; FLEX group ) intraocular lens groups .


Visual acuity and contrast sensitivity were statistically compared between the two groups .


No significant difference was found in uncorrected distant visual acuity between the ZMA@ and FLEX groups at @ week , or @ , @ , and @ months after operation ( all P > @ ) .


At postoperative @ months , no statistical significance was noted in distant and intermediate best-corrected visual acuity or in contrast sensitivity between the two groups ( all P > @ ) .


Patients in the ZMA@ group were superior to their counterparts in the FLEX group regarding near best corrected visual acuity , reading speed , and spectacle independence ( all P < @ ) .


ZMA@ and FLEX IOL implantation can provide excellent distant and intermediate visual acuity for patients with age-related cataract .


ZMA@ IOL is superior to FLEX in terms of near visual acuity .


A conformable self-expandable metallic stent was developed to overcome the limitation of previous self-expandable metallic stents .


The aim of this study was to evaluate outcomes after placement of conformable covered and uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction .


A single-blind , randomized , parallel-group , prospective study were conducted in @ medical centres between March @ and July @ patients with unresectable malignant gastroduodenal obstruction were assigned to a covered double-layered ( n = @ ) or uncovered unfixed-cell braided ( n = @ ) stent placement group .


Primary analysis was performed to compare re-intervention rates between two groups .


@ patients were analysed ( @ in the covered group and @ in the uncovered group ) .


Overall rates of re-intervention were not significantly different between the two groups : @/@ ( @ % ) in the covered group vs. @/@ ( @ % ) in the uncovered group , p = @ .


Stent migration was more frequent in the covered group than in the uncovered group ( p = @ ) .


The tumour ingrowth rate was higher in the uncovered group than in the covered group ( p = @ ) .


The rates of re-intervention did not significantly differ between the two stents .


Conformable covered double-layered and uncovered unfixed-cell braided stents were associated with different patterns of stent malfunction .


To observe the curative effect of Xinfeng Capsule ( XC ) in treatment of rheumatoid arthritis ( RA ) .


Recruited were @ active RA patients , who were randomly assigned to the normal control group and the treatment group , @ in each group .


All patients received the same routine anti-rheumatic treatment : Methotrexate @ mg per week ; Diclofenac @ mg when pain was obvious , twice daily .


Patients in the treatment group took XC @ tablets each time , thrice daily .


All treatment lasted for @ consecutive weeks .


Serum iron ( SI ) , serum ferritin ( SF ) , transferrin ( TRF ) ; and RA disease activity index ( DAS-@ ) were detected in all patients .


XC could improve HAQ , DAS-@ , hypersensitive C reactive protein ( hs-CRP ) , prostaglandins A ( PGA ) , erythrocyte sedimentation rate ( ESR ) , number of swelling joints , number of tender joints , and morning stiffness time in acute RA patients , showing statistical difference when compared with those of the control group ( P < @ , P < @ ) .


Compared with the control group , SI , SF , DAS-@ , and TRF significantly decreased in the treatment group ( P < @ ) .


XC could improve DAS-@ , and SI reserve in patients with active RA , and lower DAS-@ related indicators .


Our purpose was to evaluate ertapenem versus ceftriaxone/metronidazole for prophylaxis of surgical site infections ( SSIs ) following elective colorectal surgery in Chinese adult patients .


Eligible Chinese adults aged @-@ years scheduled to undergo elective colorectal surgery by laparotomy were randomized to receive a @ min infusion of @ g of ertapenem/metronidazole placebo or @ g of ceftriaxone/@ mg of metronidazole within @ h before initial incision .


The study endpoint was the proportion of patients with successful prophylaxis at @ weeks after treatment .


The primary analysis was based on the evaluable population ( PP population ) and the pre-specified non-inferiority margin was set at -@ % .


ClinicalTrials.gov : NCT@ .


Of @ patients randomized , @ ( @ ertapenem and @ ceftriaxone ) were eligible for inclusion in the PP population .


The proportions of patients with successful prophylaxis in the ertapenem and ceftriaxone groups were @ % ( @/@ ) and @ % ( @/@ ) , respectively .


The difference in the proportion of successful outcomes was @ % ( @ % CI -@ % , @ % ) .


Unexplained antibiotic use was the most frequent reason for prophylaxis failure in both groups -LSB- ertapenem @ % ( @/@ ) , ceftriaxone @ % ( @/@ ) ; difference @ % ; @ % CI -@ , @ -RSB- .


Pathogen species isolated from SSI sources were consistent with previously conducted studies and the product package insert .


The incidence of adverse events ( AEs ) was similar between the groups , with the most common AE being pyrexia -LSB- ertapenem @ % ( @/@ ) , ceftriaxone @ % ( @/@ ) -RSB- .


Ertapenem is as effective as ceftriaxone/metronidazole for SSI prophylaxis in patients undergoing elective colorectal surgery , and is well tolerated .


This study evaluates the safety and efficacy of specific sublingual immunotherapy ( SLIT ) against grass pollen allergens in patients > @ years of age with seasonal allergic rhinitis ( SAR ) and/or asthma .


This study sought to assess nasal symptoms during the grass pollen season , reduce medication use , and monitor adverse reactions during immunotherapy .


Seventy-eight @ - to @-year-old patients with SAR and a confirmed grass pollen allergy according to skin-prick tests , nasal provocation , and measurement of serum IgE were included in the study .


The patients were individually randomized to the active or placebo groups using a double-blind method .


A total of @ subjects in the SLIT group ( @ grass pollen mixture ) and @ subjects in the placebo group were monitored for @ years .


The patients were required to record each use of an antiallergy medication on a diary card .


Thirty-eight patients completed @ years ( preseasonal ) of SLIT , and @ subjects finished the placebo treatment in the same time period .


The total nasal symptom score decreased by @ % in the active group and @ % in the placebo group after SLIT .


This difference was only significant in the active group ( p < @ ) .


At the end of therapy , the total medication score of the active group decreased significantly by a maximum of @ % ( p < @ ) , whereas the total medication score of the placebo group had an insignificant decrease .


None of the study participants had systemic adverse reactions during the study period .


SLIT in elderly patients with a grass pollen allergy generated a significant clinical improvement in the active group compared with the placebo group for grass pollen season .


This therapy was well tolerated .


Comparison of duration of surgery , blood loss , complications , lenght of post-operative hospitalisation and post-operative morbidity in a group of patient operated for the diagnosis FtM transsexualism .


Retrospective clinical study .


In our set of patients were @ FtM transsexuals with caryotype @ XX and normal gynecological finding ( @ virgins ) .


They were operated on from @-@ at Department of Obstetrics and Gynecology The First Faculty of Medicine Charles University in Prague and Hospital Na Bulovce after at least of @ months of hormonal preparation .


We used following types of hysterectomy and bilateral adnexectomy : total abdominal hysterectomy from infraumbilical median laparotomy ( AHL ) or from suprapubic transverse incision - Pfannenstiel ( AH ) , laparoscopically assisted vaginal hysterectomy ( LAVH ) , total laparoscopic hysterectomy ( TLH ) .


In two patients TLH and colpectomy was performed in one setting .


In the @ AHL group the duration of the surgery was @ minute , blood loss was @ ml and the length of post-operative hospitalisation was @ days .


In the @ individualy of AH group the duration of the surgery was @ minute , blood loss was @ ml and the length of post-operative hospitalisation was @ days .


In @ patients of LAVH group the duration of the surgery was @ minute , blood loss @ ml and the length of post-operative hospitalisation was @ days .


In the TLH group ( @ pts ) the duration of the surgery was @ minutes , blood loss was @ ml and the length of post-operative hospitalisation was @ days .


In the @ TLH with colpectomy group the duration of the surgery was @ minute , blood loss was @ ml and the length of post-operative hospitalisation was @ days .


In one case a peroperative lesion of urinary bladder occured and once a conversion TLH to AH for a strong vaginal bleeding was necessary .


Among postoperative complication in one case subileus in AH group was diagnosed , once vaginal bleeding , once haematoma in the suture and one case of secondary healing .


Postoperative complication after TLH included @ times bleeding from vaginal suture , once haematoma in Douglas pouch , once seroma in the place of trocar insertion , once subileus .


Once ureter was injured and treated by the ureteral stent insertion .


Complication after AHL and LAVH were not recognised .


Total laparoscopic hysterectomy is the method of choice in the group of FtM transsexuals .


This technique could be used also in nuliparous women with long and narrow vagina .


Compared with laparotomic approach lower blood loss and shorter hospital stay was proved .


Earlier restitution of full activity is another advantage .


Musculus rectus abdominis flap can be used for phallus construction .


The only significant disadvantage is a longer duration of surgery .


Nocturia is a chronic , fluctuating disease that disrupts sleep and has a wide-ranging impact on quality of life .


Valid tools to measure the patient-reported impact of nocturia are essential for evaluating the value of treatment , but the available tools are suboptimal .


This study reports the development and validation of the Nocturia Impact Diary-an augmented form of the Nocturia Quality of Life questionnaire designed to be completed in conjunction with the widely used @-day voiding diary .


The process comprised three steps : Step @ : Development of a concept pool using the Nocturia Quality of Life questionnaire and data from relevant studies ; Step @ : Content validity study ; Step @ : Psychometric testing of construct validity , reliability , and sensitivity of the diary in a randomized , placebo-controlled study in patients with nocturia .


Step @ : Fourteen items and @ domains were included in the first draft of the diary .


Step @ : Twenty-three patients with nocturia participated in the cognitive debriefing study .


Items were adjusted accordingly , and the content validity was high .


Step @ : Fifty-six patients were randomized to desmopressin orally disintegrating tablet or placebo .


The diary demonstrated high construct validity , with good sensitivity and a good fit to Rasch model , as well as high internal consistency , discriminatory ability , and acceptable sensitivity to change .


Results indicated that the diary was unidimensional .


The Nocturia Impact Diary is a convenient , validated patient-reported outcome measure .


It should be used in conjunction with a voiding diary to capture the real-life consequences of nocturia and its treatment .


To investigate the introduction of case tariff fee remuneration - as required by the current system - and its influence on patient satisfaction with the provision of physiotherapeutic treatment in an acute hospital aligned on a holistic , interdisciplinary therapeutic approach .


Randomised controlled study with a total of @ patients were interviewed .


No case tariff fee system was used during the years @ to @ .


The data were compared with the results of interviews that took place during @ and @ ( use of DRGs ) .


The results of this study are based on the largest survey performed to date of patient satisfaction with physiotherapeutic treatment in acute care focusing on a holistic interdisciplinary approach .


In-patients being treated under DRG conditions were compared with a control group for whom the DRG system had not been applied .


The target parameter of the study , which took more than five years , was the determination of patient satisfaction with the physiotherapeutic interventions .


There were no significant differences between the two groups in respect of satisfaction with the physiotherapeutic treatments received .


Regarding the outcome parameter encouragement to take more exercise , a significant change could be demonstrated under DRG conditions .


Physiotherapeutic interventions play an important role in the provision of interdisciplinary care .


In particular , the holistic perception of the patient , the interdisciplinary approach to complex diseases , and the requirements of the DRG system on the care provider can exert a positive influence on outcome quality .


Performing regular exercise is known to manifest a number of health benefits that mainly relate to cardiovascular and muscular adaptations to allow for greater oxygen extraction and utilization .


There is increasing evidence that nutrient intake can affect the adaptive response to a single exercise bout , and that protein feeding is important to facilitate this process .


Thus , the exercise-nutrient interaction may potentially lead to a greater response to training .


The role of post-exercise protein ingestion in enhancing the effects of running-based endurance exercise training relative to energy-matched carbohydrate intervention remains to be established .


Additionally , the influence of immediate versus overnight protein ingestion in mediating these training effects is currently unknown .


The current protocol aims to establish whether post-exercise nutrient intake and timing would influence the magnitude of improvements during a prescribed endurance training program .


The project involves two phases with each involving two treatment arms applied in a randomized investigator-participant double-blind parallel group design .


For each treatment , participants will be required to undergo six weeks of running-based endurance training .


Immediately post-exercise , participants will be prescribed solutions providing @ grams per kilogram of body mass ( g kg ( -@ ) ) of whey protein hydrolysate plus @ g kg ( -@ ) sucrose , relative to an isocaloric sucrose control ( @ g kg ( -@ ) ; Phase I ) .


In Phase II , identical protein supplements will be provided ( @ + @ g kg ( -@ ) h ( -@ ) of whey protein hydrolysate and sucrose , respectively ) , with the timing of ingestion manipulated to compare immediate versus overnight recovery feedings .


Anthropometric , expired gas , venous blood and muscle biopsy samples will be obtained at baseline and following the six-week training period .


By investigating the role of nutrition in enhancing the effects of endurance exercise training , we will provide novel insight regarding nutrient-exercise interactions and the potential to help and develop effective methods to maximize health or performance outcomes in response to regular exercise .


We aimed to assess changes in myositis core set measures and ancillary clinical and laboratory data from the National Institutes of Health 's subset of patients enrolled in the Rituximab in Myositis trial .


Eighteen patients ( @ dermatomyositis , @ polymyositis , @ juvenile dermatomyositis ) completed more in-depth testing of muscle strength and cutaneous assessments , patient-reported outcomes , and laboratory tests before and after administration of rituximab .


Percentage change in individual measures and in the definitions of improvement ( DOIs ) and standardized response means were examined over @ weeks .


Core set activity measures improved by @-@ % from weeks @-@ and were sensitive to change .


Fifteen patients met the DOI at week @ , @ patients met a DOI @ % response , and @ met a DOI @ % response .


Muscle strength and function measures were more sensitive to change than cutaneous assessments .


Constitutional , gastrointestinal , and pulmonary systems improved @-@ % .


Patient-reported outcomes improved up to @ % .


CD@ + B cells were depleted in the periphery , but B cell depletion was not associated with clinical improvement at week @ .


This subset of patients had high rates of clinical response to rituximab , similar to patients in the overall trial .


Most measures were responsive , and muscle strength had a greater degree of change than cutaneous assessments .


Several novel assessment tools , including measures of strength and function , extra-muscular organ activity , fatigue , and health-related quality of life , are promising for use in future myositis trials .


Further study of B cell-depleting therapies in myositis , particularly in treatment-nave patients , is warranted .


Rapid diagnostic tests ( RDTs ) for malaria provide a practical alternative to light microscopy for malaria diagnosis in resource-limited settings .


Three-band RDTs incorporating two parasite antigens may have enhanced diagnostic specificity , relative to two-band RDTs with a single parasite antigen ( typically histidine-rich protein @ -LSB- HRP@ -RSB- ) .


Phase @ : @,@ children , two months to five years of age , admitted to a referral hospital in Jinja , Uganda , with acute febrile illness were enrolled .


A WHO highly rated three-band RDT was compared to light microscopy of thick peripheral blood films read by local expert microscopists.Phase @ : the three-band RDT was used as a screening tool for inclusion of patients in a clinical trial , and subjects with three positive RDT bands were tested by microscopy using blood samples drawn in parallel .


Discordant results were adjudicated by PCR .


Phase @ : @,@ children had both a RDT and peripheral blood smear performed .


The specificity of a RDT with all three bands positive was @ % ( @ % CI : @-@ % ) compared to @ % ( @ % CI : @-@ % ) for HRP@ alone .


The sensitivity was @ % ( @ % CI : @-@ % ) and @ % ( @ % CI : @-@ % ) for three-band positive RDT and HRP@ antigen , respectively .


@ patients ( @ % ) had a positive HRP@ band , but negative parasite lactate dehydrogenase ( pLHD ) band and negative peripheral smear , and @ ( @ % ) of these had received pre-treatment with anti-malarials , suggesting a false positive HRP@ result ( p = @ ) .


Phase @ : the positive predictive value ( PPV ) of the three-band RDT was @ % ( @ % CI @ % -@ % ) using microscopy as the reference standard .


However , microscopy-discordant results were shown to be positive for P. falciparum by PCR in all cases , suggesting that the PPV was in fact higher .


The pLDH antigen on three-band RDTs , used in combination with HRP@ , provides added diagnostic specificity for malaria parasitaemia and may be useful to distinguish acute infection from recently treated infection .


In situations where diagnostic specificity is desirable ( e.g. , for selection of malaria-infected participants in clinical trials ) , a three-band RDT should be considered in a sub-Saharan African setting .


Hydrochlorothiazide , an effective antihypertensive medication commonly prescribed to blacks , decreases urinary calcium excretion .


Blacks have significantly higher rates of hypertension and lower levels of @-hydroxyvitamin D. Thus , they are more likely to be exposed to vitamin D supplementation and thiazide diuretics .


The risk for hypercalcemia among blacks using vitamin D and hydrochlorothiazide is undefined .


We assessed the frequency of hypercalcemia in hydrochlorothiazide users in a post hoc analysis of a randomized , double-blind , dose-finding trial of @ blacks ( median age @ years ) assigned to either placebo , or @ , @ , or @ international units of cholecalciferol ( vitamin D@ ) daily for @ months during the winter ( @-@ ) .


Of the @ participants , @ reported hydrochlorothiazide use and had serum calcium levels assessed .


Additionally , a comparison convenience group of @ enrolled participants who were not taking hydrochlorothiazide had serum calcium measurements at @ months , but not at baseline .


At @ months , hydrochlorothiazide participants had higher calcium levels ( @ mg/dL , P < @ ) than nonhydrochlorothiazide participants , but only one participant in the hydrochlorothiazide group had hypercalcemia .


In contrast , none of the nonhydrochlorothiazide participants had hypercalcemia .


In a linear regression model adjusted for age , sex , @-hydroxyvitamin D at @ months , and other covariates , only hydrochlorothiazide use ( Estimate -LSB- SE -RSB- : @ -LSB- @ -RSB- , P = @ ) predicted serum calcium at @ months .


In summary , vitamin D@ supplementation up to @ IU in hydrochlorothiazide users is associated with an increase in serum calcium but a low frequency of hypercalcemia .


These findings suggest that participants of this population can use hydrochlorothiazide with up to @ IU of vitamin D@ daily and experience a low frequency of hypercalcemia .


This study determined whether the presence of nonsustained ventricular tachycardia ( NSVT ) was predictive of clinical events in MADIT-CRT ( multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy ) patients treated with CRT-defibrillator .


We analyzed @-hour Holters for the presence of NSVT .


Patients were then stratified by the etiology ( ischemic or nonischemic ) of cardiomyopathy .


The impact of NSVT on heart failure events ( HF ) , implantable cardioverter-defibrillator ( ICD ) therapy for rapid ventricular tachycardia ( VT ) or fibrillation ( VF ) , and reverse remodeling was determined .


At least a single episode of NSVT was recorded in @ ( @ % ) patients .


These patients had a higher burden of premature ventricular contractions , lower percentage of biventricular ( BiV ) pacing , and significantly less reduction in left ventricular end-diastolic and end-systolic volumes .


The risk of HF was significantly greater in patients with nonischemic cardiomyopathy and NSVT ( hazard ratio -LSB- HR -RSB- @ ; @ % confidence interval -LSB- CI -RSB- : @-@ @ ; P = @ ) .


The risk of rapid VT/VF was significantly greater ( in both ischemic and nonischemic patients ) when NSVT was observed ( HR @ ; @ % CI : @-@ @ ; P = @ in ischemic patients ; HR @ ; @ % CI : @-@ @ ; P < @ in nonischemic patients ) .


MADIT-CRT patients with NSVT had a high burden of ventricular ectopy , lower percentage of BiV pacing , and less reverse remodeling .


These patients had an increase in HF ( in nonischemic cardiomyopathy patients ) and rapid VT/VF ICD therapies ( in ischemic and nonischemic patients ) .


These findings may have implications for the management of nonsustained ventricular ectopy in CRT patients .


Postoperative esophageal strictures frequently recur .


We assessed the efficacy of injecting triamcinolone after bougie dilation in comparison to dilation alone .


In a double-blind randomized fashion , @ patients ( @ % male with mean age of @-years old ) with non-dilated esophagogastric complex strictures after esophagectomy with gastric pull-up were assigned to receive dilation alone ( control ) or @ mg of triamcinolone at the borders of the wall lacerations caused by the bougienage in each dilation session during the study follow-up .


Dysphagia and complications were assessed at @ , @ , and @ months .


Primary end-point was to be dysphagia-free .


After @ month of the beginning of therapy , @ patients in the steroid group were without dysphagia , in comparison to @ patient in the control group ( P = @ ) .


Six months after endoscopic therapy , @ % of the cases in the triamcinolone group versus none in the control group were dysphagia-free ( P = @ ) .


There was no perforation nor hemorrhage .


Injecting triamcinolone after every dilation session next to or at the borders of the lacerations caused by the dilators , results in a significant improvement or resolution of dysphagia .


Few publications of prospective studies have described patient outcomes in community-acquired bacterial pneumonia ( CABP ) - associated bacteremia .


Our objective , in performing this subgroup analysis , was to assess outcomes in subjects with CABP-associated bacteremia in @ randomized , double-blind clinical studies comparing treatment with ceftaroline fosamil versus ceftriaxone .


Our analysis summarizes baseline subject demographics , distribution of baseline pathogens isolated from blood cultures , clinical response rates at Day @ , and clinical cure rates at end of therapy and test of cure ( @ to @ days after end of therapy ) in subjects with bacteremic CABP in the ceFtarOline Community-acquired pneUmonia trial vS ceftriaxone in hospitalized patients ( FOCUS ) studies .


In the FOCUS studies , @ of @ patients in the ceftaroline fosamil-treated group and @ of @ patients in the ceftriaxone-treated group had CABP-associated bacteremia .


Baseline demographics were similar between groups .


Streptococcus pneumoniae was the most common baseline bloodstream isolate .


For subjects with CABP-associated bacteremia , clinical response/cure rates were similar at Day @ ( @ % vs @ % ) , end of therapy ( @ % vs @ % ) , and test of cure ( @ % vs @ % ) for ceftaroline fosamil and ceftriaxone , respectively .


In subjects with CABP-associated bacteremia , ceftaroline fosamil demonstrated similar clinical outcomes at Day @ , end of therapy , and test of cure compared with ceftriaxone .


To evaluate changes in anterior corneal topography after femtosecond laser-created clear corneal incisions ( CCIs ) .


Fondazione G.B. Bietti IRCCS , Rome , Italy .


Comparative case series .


Phacoemulsification was performed through a @ mm incision .


In the study group , a @-plane CCI was created using a @ kHz femtosecond laser .


In the control group , a single-plane angled CCI was created using disposable knives .


Placido disk corneal topography was performed preoperatively and @ week and @ month postoperatively .


Central curvature ( simulated keratometry -LSB- K -RSB- ) and local changes in anterior corneal topography at the CCI site were evaluated and compared between groups .


No significant changes in the mean simulated K values were found in either group postoperatively ( P > @ ) .


The preoperative to @-month postoperative mean simulated K ranged between @ diopters ( D ) @ ( SD ) and @ D in the study group and between @ D and @ D in the control group .


The method of CCI creation significantly influenced the changes in the anterior central topography during the first month postoperatively ( P < @ ) .


Greater steepening of the incision edges was found in the control group ( mean @ D to @ D ) than in the study group ( mean @ D to @ D ) .


The @ mm @-plane femtosecond CCIs induced slight changes in the anterior central corneal topography , similar to single-plane angled manual incisions .


Topographic differences between the femtosecond method and manual method were found at the CCI site .


Heavy-drinking smokers constitute a sizeable and hard-to-treat subgroup of smokers , for whom tailored smoking cessation therapies are not yet available .


The present study used a double-blind , randomized , @ medication design , testing varenicline alone ( VAR ; @ mg twice daily ) , low dose naltrexone alone ( L-NTX ; @ mg once daily ) , varenicline plus naltrexone , and placebo for effects on cigarette craving and subjective response to alcohol and cigarettes in a sample ( n = @ ) of heavy-drinking daily smokers ( @ cigarettes/day ) .


All participants were tested after a @-day titration period designed to reach a steady state on the target medication .


Testing was completed at @ h of nicotine abstinence , after consuming a standard dose of alcohol ( target breath alcohol concentration = @ g/dl ) and after smoking the first cigarette of the day .


The combination of VAR+L - NTX was superior to placebo , and at times superior to monotherapy , in attenuating cigarette craving , cigarette and alcohol `` high , '' and in reducing ad-lib consumption of both cigarettes and alcohol during the @-day medication titration period .


These preliminary findings indicate that clinical studies of the combination of VAR+L - NTX for heavy drinkers trying to quit smoking are warranted and may ultimately improve clinical care for this sizeable and treatment-resistant subgroup of smokers .


The Rapid Emergency Alert Communication in Health ( REACH ) Trial was a randomized control trial to systematically compare and evaluate the effectiveness of traditional and mobile communication modalities for public health agencies to disseminate time-sensitive information to health-care providers ( HCPs ) .


We conducted a sub-study to identify the communication channels by which HCPs preferred receiving public health alerts and advisories .


Enrolled HCPs were blindly randomized into four message delivery groups to receive time-sensitive public health messages by e-mail , fax , or short message service ( SMS ) or to a no-message control group .


Follow-up interviews were conducted @-@ days after the message .


In the final interview , additional questions were asked regarding HCP preferences for receiving public health alerts and advisories .


We examined the relationship between key covariates and preferred method of receiving public health alert and advisory messages .


Gender , age , provider type , and study site showed statistically significant associations with delivery method preference .


Older providers were more likely than younger providers to prefer e-mail or fax , while younger providers were more likely than older providers to prefer receiving messages via SMS .


There is currently no evidence-based research to guide or improve communication between public health agencies and HCPs .


Understanding the preferences of providers for receiving alerts and advisories may improve the effectiveness of vital public health communications systems and , in turn , may enhance disease surveillance , aid in early detection , and improve case finding and situational awareness for public health emergencies .


In head-to-head comparisons of coronary drug-eluting stents , the primary endpoint is traditionally assessed after @-@ months .


However , the optimum timepoint for this assessment remains unclear .


In this study , we assessed clinical outcomes at up to @ years ' follow-up in patients who received two different types of drug-eluting stents .


We undertook this multicentre , open-label , randomised superiority trial at five percutaneous coronary intervention centres in Denmark .


We randomly allocated @ eligible adult patients ( @ years of age ) with an indication for drug-eluting stent implantation to the zotarolimus-eluting Endeavor Sprint stent ( Medtronic , Santa Rosa , CA , USA ) or the sirolimus-eluting Cypher Select Plus stent ( Cordis , Johnson & Johnson , Warren , NJ , USA ) .


Randomisation of participants was achieved by computer-generated block randomisation and a telephone allocation service .


The primary endpoint of the SORT OUT III study was a composite of major adverse cardiac events-cardiac death , myocardial infarction , and target vessel revascularisation-at @ months ' follow-up .


In this study , endpoints included the occurrence of major adverse cardiac events and definite stent thrombosis at follow-up times of up to @ years .


Analysis was by intention to treat .


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


We randomly allocated @ patients to receive the zotarolimus-eluting stent and @ to the sirolimus-eluting stent .


At @-year follow-up , rates of major adverse cardiac events were similar in patients treated with both types of stents ( zotarolimus-eluting stents @/@ -LSB- @ % -RSB- vs sirolimus-eluting stents @/@ -LSB- @ % -RSB- ; odds ratio -LSB- OR -RSB- @ , @ % CI @-@ @ ; p = @ ) .


This finding was indicative of the directly contrasting results for rates of major adverse cardiac events at @-year follow up ( zotarolimus @/@ -LSB- @ % -RSB- vs sirolimus @/@ -LSB- @ % -RSB- ; OR @ , @ % CI @-@ @ ; p < @ ) compared with those at follow-up between @ and @ years ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ; OR @ , @ % CI @-@ @ ; p = @ ) .


At @-year follow-up , definite stent thrombosis was more frequent after implantation of the zotarolimus-eluting stent ( @/@ -LSB- @ % -RSB- ) than the sirolimus-eluting stent ( @/@ -LSB- @ % -RSB- ; OR @ , @ % CI @-@ @ ; p = @ ) , whereas the opposite finding was recorded for between @ and @ years ' follow-up ( zotarolimus-eluting stent @/@ -LSB- @ % -RSB- vs sirolimus-eluting stent @/@ -LSB- @ % -RSB- , OR @ , @ % CI @-@ @ ; p = @ ) .


@ of @ ( @ % ) target lesion revascularisations in the zotarolimus-eluting stent group occurred between @ and @ years ' follow-up , whereas @ of @ ( @ % ) of those in the sirolimus-eluting stent group occurred during this follow-up period .


The superiority of sirolimus-eluting stents compared with zotarolimus-eluting stents at @-year follow-up was lost after @ years .


The traditional @-year primary endpoint assessment therefore might be insufficient to predict @-year clinical outcomes in patients treated with coronary drug-eluting stent implantation .


Numerous studies indicate that the use of feeding tubes ( FT ) in persons with advanced cognitive impairment ( CI ) does not improve clinical outcomes or survival , and results in higher rates of hospitalization and emergency department ( ED ) visits .


It is not clear , however , whether such risk varies by resident level of CI and whether these ED visits and hospitalizations are potentially preventable .


The objective of this study was to determine the rates of ED visits , hospitalizations and potentially preventable ambulatory care sensitive ( ACS ) ED visits and ACS hospitalizations for long-stay NH residents with FTs at differing levels of CI .


We linked Centers for Medicare and Medicaid Services inpatient & outpatient administrative claims and beneficiary eligibility data with Minimum Data Set ( MDS ) resident assessment data for nursing home residents with feeding tubes in a @ % random sample of Medicare beneficiaries residing in US nursing facilities in @ ( n = @ ) .


Severity of CI was measured using the Cognitive Performance Scale ( CPS ) and categorized into @ groups : None/Mild ( CPS = @-@ , MMSE = @-@ ) , Moderate ( CPS = @-@ , MMSE = @-@ ) , Severe ( CPS = @-@ , MMSE = @-@ ) and Very Severe ( CPS = @ , MMSE = @-@ ) .


ED visits , hospitalizations , ACS ED visits and ACS hospitalizations were ascertained from inpatient and outpatient administrative claims .


We estimated the risk ratio of each outcome by CI level using over-dispersed Poisson models accounting for potential confounding factors .


Twenty-nine percent of our cohort was considered `` comatose '' and `` without any discernible consciousness '' , suggesting that over @,@ NH residents in the US with feeding tubes are non-interactive .


Approximately @ % of NH residents with FTs required an ED visit or hospitalization , with @ % of hospitalizations and @ % of ED visits being potentially preventable or for an ACS condition .


Severity of CI had a significant effect on rates of ACS ED visits , but little effect on ACS hospitalizations .


ED visits and hospitalizations are common in cognitively impaired tube-fed nursing home residents and a substantial proportion of ED visits and hospitalizations are potentially preventable due to ACS conditions .


This study was conducted to investigate the efficacy and safety of using a concurrent neoadjuvant chemoradiotherapy ( a XELOX regimen ) to treat adenocarcinoma of the gastroesophageal junction .


Seventy-six patients having resectable adenocarcinoma at the gastroesophageal junction ( T@/@ , N + , M@ ) were recruited to participate and randomly assigned to either a chemoradiotherapy group or a surgery group .


Patients in the chemoradiotherapy group were orally given capecitabine ( @,@ mg/m@ , twice daily for @ days , days @-@ ) and intravenous oxaliplatin ( @ mg/m@ on day @ ) for @ cycles .


Radiotherapy was performed with a total of @ Gy administered in @ sessions for @ weeks .


Patients in the surgery group received only surgical intervention .


In the concurrent chemoradiotherapy group , the overall response rate was @ % ( @/@ ) , tumor control rate was @ % and a pathological complete response was achieved in @ % ( @/@ ) .


The entire chemoradiotherapy group had R@ resections as did @ % of the surgery group ( @/@ ) ( P < @ ) .


In the concurrent chemoradiotherapy group , @ patients developed grade @ side effects .


Treatment was either discontinued or the dose adjusted .


Major hematological side effects in the chemoradiotherapy group included leukopenia , neutropenia , anemia and thrombocytopenia .


Nonhematological side effects included nausea , vomiting and appetite loss .


Chemoradiotherapy-related death was not observed .


Concurrent neoadjuvant chemoradiotherapy administration increased the rate of R@ resection and demonstrated favorable safety in patients with Siewert II or III adenocarcinoma at the gastroesophageal junction .


These results support the use of neoadjunctive chemoradiotherapy in the treatment of adenocarcinoma of the gastroesophageal junction .


In the @ American Heart Association guidelines , supraglottic devices ( SGDs ) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation .


Some SGDs can also serve as a means for tracheal intubation after successful ventilation .


The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs , aura-i ( aura-i ) , air-Q ( air-Q ) , i-gel ( i-gel ) , and Fastrack ( Fastrack ) , during cardiopulmonary resuscitation using a manikin .


Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression .


Insertion time and successful ventilation rate were measured .


For cases of successful ventilation , blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within @ s was recorded .


Chest compression did not decrease the ventilation success rate of the four intubating SGDs ( without chest compression ( success/total ) : air-Q , @/@ ; aura-i , @/@ ; i-gel , @/@ ; Fastrack , @/@ ; with chest compression : air-Q , @/@ ; aura-i , @/@ ; i-gel , @/@ ; Fastrack , @/@ ) .


Insertion time was significantly lengthened by chest compression in the i-gel trial ( P < @ ) , but not with the other three devices .


The blind intubation success rate with chest compression was the highest in the air-Q trial ( air-Q , @/@ ; aura-i , @/@ ; i-gel , @/@ ; Fastrack , @/@ ) .


This simulation study revealed the utility of intubating SGDs for airway management during chest compression .


To assess the effectiveness of a two-year school-based intervention , consisting of integrated and replicable physical activity and nutritional education on weight , fat percentage , cardiovascular risk factors , and blood pressure .


Six elementary schools in Reykjavik were randomly assigned to be either intervention ( n = @ ) or control ( n = @ ) schools .


Seven-year-old children in the second grade in these schools were invited to participate ( n = @ ) ; @ ( @ % ) underwent some or all of the measurements .


These @ children were followed up for two years .


Children in intervention schools participated in an integrated and replicable physical activity programme , increasing to approximately @ minutes of physical activity during school in the second year of intervention .


Furthermore , they received special information about nutrition , and parents , teachers , and school food service staff were all involved in the intervention .


Subjects .


@seven-year-old schoolchildren .


Blood pressure , obesity , percentage of body fat , lipid profile , fasting insulin .


Children in the intervention group had a @ mmHg increase in systolic blood pressure ( SBP ) and a @ mmHg increase in diastolic blood pressure ( DBP ) over the two-year intervention period , while children in the control group increased SBP by @ mmHg and DPB by @ mmHg .


These changes were not statistically significant .


Furthermore there were no significant changes in percentage body fat , lipid profile , or fasting insulin between the intervention and control schools .


A two-year school-based intervention with increased physical activity and healthy diet did not have a significant effect on common cardiovascular risk factors .


Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries , including heavily contaminated wounds requiring meticulous surgical debridement .


After being rendered surgical clean , these wounds are dressed and the patient transferred back to the UK for on-going treatment .


A dressing that would prevent wounds from becoming colonised during transit would be desirable .


The aim of this study was to establish whether using nanocrystalline silver dressings , as an adjunct to the initial debridement , would positively affect wound microbiology and wound healing compared to standard plain gauze dressings .


Patients were prospectively randomised to receive either silver dressings , in a nanocrystalline preparation ( Acticoat ) , or standard of care dressings ( plain gauze ) following their initial debridement in the field hospital .


On repatriation to the UK microbiological swabs were taken from the dressing and the wound , and an odour score recorded .


Wounds were followed prospectively and time to wound healing was recorded .


Additionally , patient demographic data were recorded , as well as the mechanism of injury and Injury Severity Score .


@ patients were recruited to the trial between February @ and February @ received current dressings and @ received the trial dressings .


Eleven patients were not swabbed .


There was no difference ( p = @ , Fishers ) in the primary outcome measure of wound colonisation between the treatment arm ( @/@ ) and the control arm ( @/@ ) .


Similarly time to wound healing was not statistically different ( p = @ , Mann-Whitney ) .


Wounds in the control group were scored as being significantly more malodorous ( p = @ , Mann-Whitney ) than those in the treatment arm .


This is the first randomised controlled trial to report results from an active theatre of war .


Performing research under these conditions poses additional challenges to military clinicians .


Meticulous debridement of wounds remains the critical determinant in wound healing and infection and this study did not demonstrate a benefit of nanocrystaline silver dressing in respect to preventing wound colonisation or promoting healing , these dressings do however seem to significantly reduce the unpleasant odour commonly associated with battlefield wounds .


The acute respiratory distress syndrome ( ARDS ) is a common devastating syndrome in intensive care unit in critically ill patients .


Continuous renal replacement therapy ( CRRT ) has been shown beneficial effects on oxygenation and survival in patients with ARDS .


However , it is still controversial about the timing of initiation of CRRT .


Fifty-three patients with ARDS admitted to intensive care unit in Zhejiang Provincial People 's Hospital , China from @ to @ were enrolled in the study .


The authors compared ventilation parameter , including PaO@/FIO@ , A-a gradient , positive end-expiratory pressure , plateau pressure , dynamic compliance and hemodynamic parameters , including central venous pressure , mean arterial pressure , cardiac index , extravascular lung water index , fluid balance between early initiation ( within @ hours after ARDS onset ) and late initiation of CRRT ( @ hours after ARDS onset ) groups .


The authors further investigated transforming growth factor ( TGF ) -@ level changes in serum and bronchoalveolar lavage fluid ( BALF ) by enzyme-linked immunosorbent assay during @ days of follow-up .


Significant improvement of oxygenation and shorter duration of mechanical ventilation were observed in early CRRT group during @-day follow-up .


In addition , TGF-@ concentrations in serum and BALF were significantly decreased in patients with early initiation of CRRT compared to those with late initiation of CRRT on day @ and day @ .


Furthermore , patients who died of ARDS had higher levels of TGF-@ in BALF than survivors .


Our findings showed that early initiation of CRRT is associated with favorable clinical outcomes in ARDS patients , which might be due to the reduced serum and BALF TGF-@ levels through CRRT .


However , large multi-center studies are needed to make further recommendations as to the optimal use of CRRT in ARDS patient populations .


The use of amphetamine-type stimulants ( ATS ) places a large burden on health services .


The aim was to evaluate the effectiveness of a self-guided Web-based intervention ( `` breakingtheice '' ) for ATS users over @ months via a free-to-access site .


We conducted a randomized trial comparing a waitlist control with a fully automated intervention containing @ modules derived from cognitive behavioral therapy and motivation enhancement .


The main outcome was self-reported ATS use in the past @ months assessed at @ - and @-month follow-ups using the Alcohol , Smoking , and Substance Involvement Screening Test ( ASSIST ) .


Secondary outcomes were help-seeking intentions ( general help-seeking questionnaire ) , actual help seeking ( actual help-seeking questionnaire ) , psychological distress ( Kessler @ ) , polydrug use ( ASSIST ) , quality of life ( European Health Interview Survey ) , days out of role , and readiness to change .


Follow-up data were evaluated using an intention-to-treat ( ITT ) analysis with a group by time interaction .


We randomized @ people ( intervention : n = @ ; control : n = @ ) .


At @ months , @ of @ ( @ % ) intervention and @ of @ ( @ % ) control participants provided data .


ATS scores significantly declined for both groups , but the interaction effect was not significant .


There were significant ITT time by group interactions for actual help seeking ( rate ratio -LSB- RR -RSB- @ ; d = @ ) and help-seeking intentions ( RR @ ; d = @ ) , with help seeking increasing for the intervention group and declining for the control group .


There were also significant interactions for days completely ( RR @ ) and partially ( RR @ ) out of role favoring the intervention group .


However , @ % ( @/@ ) of the intervention group did not complete even @ module .


This self-guided Web-based intervention encouraged help seeking associated with ATS use and reduced days out of role , but it did not reduce ATS use .


Thus , this program provides a means of engaging with some sections of a difficult-to-reach group to encourage treatment , but a substantial minority remained disengaged .


To investigate the treatment of benign positional paroxysmal vertigo of posterior semi-circular canal by Epley maneuver combined with Semont maneuver .


One hundred and fifty patients with benign positional paroxysmal vertigo of posterior semicircular canal were randomly divided into three groups : group A , B and C. Patients in group A were treated by Epley maneuver and patients in group B were treated by Semont maneuver .


Patients in group C were received the treatment of Epley maneuver combined with Semont ma - neuver .


We recorded the times of treatments in different groups respectively .


Statistics of treatment effects and follow-up studies with @ months after the recovery were assessed .


The cure rate of the canalith repositioning on the primary , secondary and tertiary treatment in group A was respective @ % ( @/@ ) and @ % ( @/@ ) and @ % ( @/@ ) , in group B was @ % ( @/@ ) and @ % ( @/@ ) and @ % ( @/@ ) , in group C was @ % ( @/@ ) and @ % ( @/@ ) and @ % ( @/@ ) .


The cure rate in group C is significantly higher than group A and group B ( @ = @ , P < @ ; @ = @ , P < @ ) .


@ months after recovery @ patients in group A , @ patients in group B and @ patient in group C were relapsed .


By the use of Epley maneuver combined with Semont maneuver in the treatment of benign positional paroxysmal vertigo of posterior semicircular canal , the primary cure rate was increased and the numbers of treatments were reduced and the relapse was decreased .


It is suitable to use Epley maneuver combined with Semont maneuver in the clinic .


To examine the feasibility and outcomes of video-based peer feedback through social networking to facilitate robotic surgical skill acquisition .


The acquisition of surgical skills may be challenging for novel techniques and/or those with prolonged learning curves .


Randomized controlled trial involving @ resident physicians performing the Tubes ( Da Vinci Intuitive Surgical , Sunnyvale , CA ) simulator exercise with versus without peer feedback of video-recorded performance through a social networking Web page .


Data collected included simulator exercise score , time to completion , and comfort and satisfaction with robotic surgery simulation .


There were no baseline differences between the intervention group ( n = @ ) and controls ( n = @ ) .


The intervention group showed improvement in mean scores from session @ to sessions @ and @ ( @ vs @ , P < @ , and @ vs @ , P < @ , respectively ) .


The intervention group scored significantly higher than controls at sessions @ and @ ( @ vs @ , P = @ , and @ vs @ , P = @ , respectively ) .


The mean time ( seconds ) to complete the task was shorter for the intervention group than for controls during sessions @ and @ ( @ vs @ , P = @ , and @ vs @ , P = @ , respectively ) .


At the study conclusion , feedback subjects were more comfortable with robotic surgery than controls ( @ % vs @ % , P = @ ) and expressed greater satisfaction with the learning experience ( @ % vs @ % , P = @ ) .


Of the intervention subjects , @ % found that peer feedback was useful and @ % found it effective .


Video-based peer feedback through social networking appears to be an effective paradigm for surgical education and accelerates the robotic surgery learning curve during simulation .


Olaparib is a poly ( ADP-ribose ) polymerase inhibitor and cediranib is an anti-angiogenic agent with activity against VEGF receptor ( VEGFR ) @ , VEGFR@ , and VEGFR@ .


Both oral agents have antitumour activity in women with recurrent ovarian cancer , and their combination was active and had manageable toxicities in a phase @ trial .


We investigated whether this combination could improve progression-free survival ( PFS ) compared with olaparib monotherapy in women with recurrent platinum-sensitive ovarian cancer .


In our randomised , open-label , phase @ study , we recruited women ( aged @ years ) who had measurable platinum-sensitive , relapsed , high-grade serous or endometrioid ovarian , fallopian tube , or primary peritoneal cancer , or those with deleterious germline BRCA@/@ mutations from nine participating US academic medical centres .


We randomly allocated participants ( @:@ ) according to permuted blocks , stratified by germline BRCA status and previous anti-angiogenic therapy , to receive olaparib capsules @ mg twice daily or the combination at the recommended phase @ dose of cediranib @ mg daily and olaparib capsules @ mg twice daily .


The primary endpoint was progression-free survival analysed in the intention-to-treat population .


The phase @ trial is no longer accruing patients .


An interim analysis was conducted in November , @ , after @ % of expected events had occurred and efficacy results were unmasked .


The primary analysis was performed on March @ , @ , after @ events ( @ % of those expected ) .


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


Between Oct @ , @ , and June @ , @ , we randomly allocated @ women to receive olaparib alone and @ to receive the combination of olaparib and cediranib .


Median PFS was @ months ( @ % CI @-not reached ) for the women treated with cediranib plus olaparib compared with @ months ( @ % CI @-@ ) for those treated with olaparib monotherapy ( hazard ratio @ , @ % CI @-@ ; p = @ ) .


Grade @ and @ adverse events were more common with combination therapy than with monotherapy , including fatigue ( @ patients in the cediranib plus olaparib group vs five patients in the olaparib monotherapy group ) , diarrhoea ( ten vs none ) , and hypertension ( @ vs none ) .


Cediranib plus olaparib seems to improve PFS in women with recurrent platinum-sensitive high-grade serous or endometrioid ovarian cancer , and warrants study in a phase @ trial .


The side-effect profile suggests such investigations should include assessments of quality of life and patient-reported outcomes to understand the effects of a continuing oral regimen with that of intermittent chemotherapy .


To compare the clinical efficacies of single segment transforaminal lumbar interbody fusion ( TLIF ) with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis .


A total of @ patients undergoing single segment TLIF were randomly divided into @ groups .


A cage was implanted into intervertebral space in group A patients while autogenous morselized bone in group B patients .


Operative duration , blood loss , length of stay and cost of hospitalization of two groups were recorded .


They were followed up at @ week , @ , @ months post-operation .


Oswestry disability index ( ODI ) , visual analogue scale ( VAS ) fusion rates , intervertebral space and foramen height restoration , lumbar lordosis and postoperative complications were compared between two groups .


No significant inter-group difference existed in operative duration , blood loss or length of stay .


However , the average hospitalization cost in group A were @ % higher than that of group B ( P < @ ) .


Both groups achieved excellent clinical outcomes within @ years .


ODI , VAS score improvement rates and postoperative complication rates were not statistically different .


Lumbar fusion rate was @ % in group A versus @ % in group B after @ years .


And there was no significant difference ( P > @ ) .


The heights of intervertebral space and foramen in group A achieved a better recovery than those of group B. Both groups had similar improvements of lumbar lordosis .


For degenerative lumbar spinal stenosis , usage of interbody cage is more effective in terms of recovery of intervertebral space and foraminal height compared with usage of bone graft .


However it brings no better clinical efficacy while the usage of autogenous morselized bone is more cost-effective .


Two grafting methods yield similar overall clinical outcomes .


To study the efficacy and safety of quetiapine-XR as monotherapy or adjunctive therapy to a mood stabilizer in acute bipolar I or II depression with comorbid generalized anxiety disorder ( GAD ) and other comorbidities .


The study was conducted from January @ to November @ .


The Mini-International Neuropsychiatric Interview was used to ascertain the diagnosis of DSM-IV bipolar disorder , GAD , and other Axis I disorders .


Eligible patients were randomly assigned to quetiapine-XR or placebo for up to @ weeks .


The Hamilton Depression Rating Scale-@ items ( HDRS-@ ) was used as a primary outcome to evaluate the difference between the @ groups using the change from baseline to end of study .


Last observation carried forward and mixed-effects modeling for repeated measures were used to analyze the primary and secondary outcome measures .


Of the @ patients screened , @ patients were randomized to receive quetiapine-XR ( n = @ ) or placebo ( n = @ ) .


Twenty-six patients in the quetiapine-XR and @ in the placebo group completed the study .


The mean quetiapine-XR dose was @ @ mg/d ( @-@ mg/d ) .


There was no significant difference between the @ groups in the change from baseline to end of study in HDRS-@ total score with an effect size of @ favoring quetiapine-XR .


There were also no significant differences between the @ groups in secondary efficacy and safety outcome measures .


Quetiapine-XR was not significantly superior to placebo in bipolar I or II depression with GAD and other comorbidities , suggesting that data from relatively `` pure '' bipolar patients may not be generalizable to a highly comorbid population .


This study determined the association of continuous glucose monitoring glucose ( CGM-glucose ) levels at different times of the day with improvement in glycated hemoglobin ( HbA@c ) levels .


The potential application of these data is to focus effort to improve glucose control in patients with type @ diabetes .


Data were analyzed from @ patients with type @ diabetes who were randomized to receive sensor-augmented pump therapy in the @-year STAR @ trial .


CGM-glucose values and HbA@c levels from baseline and after @ year were evaluated to determine associations of improvement in CGM-glucose at different times of the day with longitudinal improvement in HbA@c .


Improvement in HbA@c levels after @ year was related to improvement in mean CGM-glucose levels in daytime ( @ a.m.-midnight ) , overnight ( midnight-@ a.m. ) , and each mealtime period ( P < @ for each ) .


In multivariable analysis , only improvement in breakfast meal period was associated with improvement in HbA@c after @ year , explaining @ % of the HbA@c improvement using the partial R ( @ ) test .


Moreover , among those patients who only improved CGM-glucose in the overnight period there was an associated improvement in breakfast meal period CGM-glucose of @ @ mg/dL ( P < @ ) .


Breakfast period glucose improvement had the greatest effect on lowering HbA@c levels in patients with type @ diabetes .


Improving glucose control overnight resulted in subsequent improvement in the breakfast period .


Although glucose control should be improved at all times , methods to improve overnight and post-breakfast glucose levels may be of primary importance in improving glucose control in patients with type @ diabetes .


To evaluate yoga 's impact on inflammation , mood , and fatigue .


A randomized controlled @-month trial was conducted with two post-treatment assessments of @ breast cancer survivors assigned to either @ weeks of @-minute twice per week hatha yoga classes or a wait-list control .


The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-@ ( IL-@ ) , tumor necrosis factor alpha ( TNF - ) , and interleukin-@ ( IL-@ ) , and scores on the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) , the vitality scale from the Medical Outcomes Study @-item Short Form ( SF-@ ) , and the Center for Epidemiological Studies-Depression ( CES-D ) scale .


Immediately post-treatment , fatigue was not lower ( P > @ ) but vitality was higher ( P = @ ) in the yoga group compared with the control group .


At @ months post-treatment , fatigue was lower in the yoga group ( P = @ ) , vitality was higher ( P = @ ) , and IL-@ ( P = @ ) , TNF - ( P = @ ) , and IL-@ ( P = @ ) were lower for yoga participants compared with the control group .


Groups did not differ on depression at either time ( P > @ ) .


Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits ( P = @ ; P < @ ) , as well as vitality ( P = @ ; P = @ ) , but not depression ( P > @ ) than simple group assignment ; more frequent practice produced larger changes .


At @ months post-treatment , increasing yoga practice also led to a decrease in IL-@ ( P = @ ) and IL-@ ( P = @ ) production but not in TNF - production ( P > @ ) .


Chronic inflammation may fuel declines in physical function leading to frailty and disability .


If yoga dampens or limits both fatigue and inflammation , then regular practice could have substantial health benefits .


Topiramate has been shown to reduce drinking and heavy drinking in individuals with alcohol dependence whose goal was to stop drinking .


The authors evaluated the efficacy and tolerability of topiramate in heavy drinkers whose treatment goal was to reduce drinking to safe levels .


A total of @ individuals ( @ % men ) were randomly assigned to receive @ weeks of treatment with topiramate ( N = @ ) , at a maximal daily dose of @ mg , or matching placebo ( N = @ ) .


Both groups received brief counseling to reduce drinking and increase abstinent days .


It was hypothesized that topiramate-treated patients would be better able to achieve these goals , and it was predicted that based on prior research , the effects would be moderated by a single nucleotide polymorphism ( rs@ ) in GRIK@ , encoding the kainate GluK@ receptor subunit .


The rate of treatment completion was @ % and equal by treatment group .


Topiramate treatment significantly reduced heavy drinking days and increased abstinent days relative to placebo .


Patients receiving topiramate also had lower concentrations of the liver enzyme - glutamyl transpeptidase and lower scores on a measure of alcohol-related problems than the placebo group .


In a European American subsample ( N = @ ) , topiramate 's effect on heavy drinking days was significantly greater than that for placebo only in rs@ C-allele homozygotes .


These findings support the use of topiramate at a daily dose of @ mg to reduce heavy drinking in problem drinkers .


The moderator effect of rs@ , if validated , would facilitate the identification of heavy drinkers who are likely to respond well to topiramate treatment and provide an important personalized treatment option .


The pharmacogenetic findings also implicate the kainate receptor in the mechanism of topiramate 's effects on heavy drinking .


A response-adaptive randomization ( RAR ) trial design actively adjusts the ratio of participants assigned to each trial arm , favoring the better performing treatment by using outcome data from participants already in the trial .


Compared with a standard clinical trial , an RAR study design has the potential to improve patient participation in acute stroke trials .


This cross-sectional randomized survey included adult emergency department patients , age@ , without symptoms of stroke or other critical illness .


A standardized protocol was used , and subjects were randomized to either an RAR or standard hypothetical acute stroke trial .


After viewing the video describing the hypothetical trial ( http://youtu.be/cKIWduCaPZc ) , reviewing the consent form , and having questions answered , subjects indicated whether they would consent to the trial .


A multivariable logistic regression model was fitted to estimate the impact of RAR while controlling for demographic factors and patient understanding of the design .


A total of @ subjects ( @ standard and @ RAR ) were enrolled .


All baseline characteristics were balanced between groups .


There was significantly higher participation in the RAR trial ( @ % ) versus the standard trial ( @ % ) , absolute increase : @ % ( @ % confidence interval , @-@ @ ) .


The RAR group had a higher odds ratio of agreeing to research ( odds ratio , @ ; @ % confidence interval , @-@ @ ) while adjusting for patient level factors .


Trial designs were generally well understood by the participants .


The hypothetical RAR trial attracted more research participation than standard randomization .


RAR has the potential to increase recruitment and offer benefit to future trial participants .


Blood supplies in Greece are insufficient to meet the high transfusion needs arising from car accidents and treatment of thalassaemia .


This study was designed to determine Greeks ' opinions about blood donation , in order to identify the reasons for the lack of motivation to donate and allow experts to establish better recruitment campaigns for the enrichment of the donor pool , based on our findings .


The opinions of randomly selected Greek citizens ( n = @ ) about volunteer blood donation were assessed by means of a standardised , anonymous questionnaire .


The results were analysed using the ( @ ) test and Spearman 's correlation coefficient .


With regards to attitudes towards intention to donate , only @ % were indifferent , while @ % of the individuals believed that donating blood was an `` offer '' .


Reasons for not donating mainly involved safety ( @ % ) and fear ( @ % ) , whereas need ( @ % ) was the most fundamental positive motivation .


Of the people enrolled in the present study , @ % were active donors , @ % occasional donors , @ % rare donors and @ % non-donors .


The considerable percentages of occasional and rare donors in comparison with the low proportion of active donors in the Greek donor pool indicates that `` need '' is a more important motivation for blood donation than altruism in Greece .


These results could be useful for establishing advertising campaigns on blood donation and for a more direct approach to the population , aiming for a change in mentality in favour of active blood donation .


Angiotensin receptor antagonists ( ARBs ) improve outcomes in patients with heart failure ( HF ) with reduced left ventricular ejection fraction , but may induce hyperkalemia ( HK ) and/or a worsening of renal function ( WRF ) .


The incidence and risk factors of HK and its inter-relationship with WRF , as well as associations with clinical outcome ( death or admission for HF i.e. the primary outcome ) in @ HF patients enrolled in the double blind HEAAL trial ( losartan @ mg/d vs. @ mg/d ) were assessed .


Worsening of renal function was defined as a decrease in eGFR > @ % from baseline and HK as serum K > @ or > @ mmol/L .


Higher dose of losartan increased serum potassium .


Episodes of HK > @ mmol/L or WRF occurred at least once in about half of the patients .


WRF was associated with higher occurrence of HK ( HR @ ( @-@ @ ) ) and vice versa ( HR @ ( @-@ @ ) ) , but preceded HK in only about half of the events .


High dose losartan improved outcome despite more frequent WRF and HK , both being independently associated with adverse outcomes in multivariate analyses .


HK and WRF are common in HF patients .


Both can be predicted from baseline risk factors and are therefore potentially preventable .


Although associated with worse outcome , occurrence of any does not hinder the efficacy of high dose losartan .


HK was associated with WRF and worse outcomes .


Whether therapy targeting specifically HK may maximize the survival benefit derived from renin angiotensin aldosterone inhibitor use should be appropriately tested in future trials .


We aimed to investigate the effect of @ % and @ % oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section ( CS ) under spinal anesthesia .


Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study .


We allocated patients randomly to breathe @ % ( air group ) or @ % ( oxygen group ) oxygen from the time of skin incision until the end of the operation .


We collected maternal pre - and post-operative and umbilical artery ( UA ) blood samples .


Total antioxidant capacity ( TAC ) , total oxidant status ( TOS ) and the oxidative stress index ( OSI ) were measured .


Age , weight , height , parity , gestation week , spinal-skin incision time , skin incision-delivery time , delivery time , operation time , @ ( st ) and @ ( th ) minutes Apgar scores , and birth weight were similar between the groups ( p > @ for all comparisons ) .


There were no differences in preoperative TAC , TOS , or OSI levels between the groups ( p > @ for all comparisons ) .


Postoperative maternal TAC , TOS and OSI levels significantly increased in the oxygen group ( p = @ , < @ and @ , respectively ) ; umbilical artery TAC levels significantly increased in the oxygen group ( p = @ ) ; and umbilical artery TOS and OSI levels significantly increased in the air group ( p = @ and < @ , respectively ) .


The difference in impact on maternal and fetal oxidative stress of supplemental @ % compared to @ % oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia .


We compared the effects of preincisional peritonsillar infiltration of @ ml levobupivacaine hydrochloride ( @ mg/@ ml ) on bleeding during surgery and pain after tonsillectomy in patients aged @ years or older .


The study was conducted in @ adult patients who underwent tonsillectomy .


These patients were randomized to either the study group ( SG ) who received levobupivacaine infiltration to the peritonsillary fossae prior to surgery , or a control group ( CG ) treated with @ % sodium chloride infiltration to the peritonsillary fossae prior to incision .


The volume of intraoperative bleeding was recorded .


Pain was evaluated using a visual analogue scale ( VAS ) .


The first pain score was assessed immediately after arriving in the postoperative care unit .


VAS scores were subsequently re-assessed @ , @ , @ , @ , and @ hours postoperatively .


The first analgesic requirement was assessed @ hours postoperatively .


The pain relieving effect in the levobupivacaine group was statistically significant @ , @ , @ , and @ hours postoperatively ( p @ ) , but there was no difference in VAS scores between groups at the first and @-hour postoperative assessments .


There were no differences between the two groups regarding analgesic requirements .


The difference between the mean intraoperative blood loss in the SG and CG was statistically significant ( p @ ) .


No serious complications were observed in either group .


Preincisional levobupivacaine infiltration seems to be a safe and easily applied medication for postoperative pain control , and decreased the volume of intraoperative blood loss in adult patients after tonsillectomy .


Less than one-third of HIV-infected pregnant women eligible for combination antiretroviral therapy ( ART ) globally initiate treatment prior to delivery , with lack of access to timely CD@ results being a principal barrier .


We evaluated the effectiveness of an SMS-based intervention to improve access to timely antenatal ART .


We conducted a stepped-wedge cluster randomized trial of a low-cost programmatic intervention in @ antenatal clinics in Gaborone , Botswana .


From July @-April @ , @ clinics were randomly selected every @ weeks to receive an ongoing clinic-based educational intervention to improve CD@ collection and to receive CD@ results via an automated SMS platform with active patient tracing .


CD@ testing before @ weeks gestation and ART initiation before @ weeks gestation were assessed .


Three-hundred-sixty-six ART-nave women were included , @ registering for antenatal care under Intervention and @ under Usual Care periods .


Of CD@-eligible women , @ ( @ % ) women under Intervention and @ ( @ % ) women under Usual Care completed CD@ phlebotomy before @ weeks gestation , adjusted odds ratio ( aOR , adjusted for time that a clinic initiated Intervention ) @ ( @ % confidence interval -LSB- CI -RSB- @-@ @ , P = @ ) .


The SMS-based platform reduced time to clinic receipt of CD@ test result from median of @ to @ days ( P < @ ) , was appreciated by clinic staff , and was associated with reduced operational cost .


However , rates of ART initiation remained low , with @ ( @ % ) women registering under Intervention versus @ ( @ % ) women under Usual Care initiating ART prior to @ weeks gestation , aOR @ ( @ % CI @-@ @ , P = @ ) .


The augmented SMS-based intervention delivered CD@ results more rapidly and efficiently , and this type of SMS-based results delivery platform may be useful for a variety of tests and settings .


However , the intervention did not appear to improve access to timely antenatal CD@ testing or ART initiation , as obstacles other than CD@ impeded ART initiation during pregnancy .


To observe the clinical efficacy of nasal vestibule eczema by using beclomethasone dipropionate in combination with He-Ne laser therapy .


The @ cases of nasal vestibule eczema patients were randomly divided into treatment and control groups .


The control group received the rub beclomethasone dipropionate cream treatment one time per day .


The treatment group supplemented with He-Ne laser irradiation treatment on the basis of the control group on the same treatment , alsoone time per day .


Then the results were analyzed .


The total effective rate was @ % in treatment group , while @ % in the control group .


The difference between the two groups was statistically significant ( P < @ ) .


Beclomethasone dipropionate cream combined with He-Ne laser irradiation therapy on nasal vestibule eczema is significant , and easily to operate , with significant anti-inflammatory , anti-itch , analgesic effects .


Investigating the effects of lipid-lowering drugs on HDL subclasses has shown ambiguous results .


This study assessed the effects of ezetimibe , simvastatin , and their combination on HDL subclass distribution .


A single-center randomized parallel @-group open-label study was performed in @ healthy men free of cardiovascular disease with a baseline LDL-cholesterol of @ mg/dl ( @ mmol/l ) and a baseline HDL-cholesterol of @ mg/dl ( @ mmol/l ) .


They were treated with ezetimibe ( @ mg/day , n = @ ) , simvastatin ( @ mg/day , n = @ ) or their combination ( n = @ ) for @ days .


Blood was drawn before and after the treatment period .


HDL subclasses were determined using polyacrylamide gel-tube electrophoresis .


Multivariate regression models were used to determine the influence of treatment and covariates on changes in HDL subclass composition .


Baseline HDL subclasses consisted of @ % large , @ % intermediate and @ % small HDL .


After adjusting for baseline HDL subclass distribution , body mass index , LDL-C and the ratio triglycerides/HDL-C , there was a significant increase in large HDL by about @ percentage points ( P < @ ) and a decrease in intermediate HDL by about @ percentage points ( P < @ ) in both simvastatin-containing treatment arms in comparison to ezetimibe .


The parameters obtained after additional adjustment for the decrease in LDL-C indicated that about one third to one half of these effects could be explained by the extent of LDL-C-lowering .


In healthy men , treatment with simvastatin leads to favorable effects on HDL subclass composition , which was not be observed with ezetimibe .


Part of these differential effects may be due to the stronger LDL-C-lowering effects of simvastatin .


The aim of this study is to evaluate the effects of calisthenic exercises on balance , walking speed , fatigue , quality of life , and psychological status in patients with Multiple Sclerosis ( MS ) .


Forty patients diagnosed with MS were randomized into two exercise groups ( group @ = hospital-based , group @ = home-based ) .


Outcome measures including the MS International Quality of Life Scale , @-meter walking test , Berg Balance Scale , Fatigue Severity Scale and the Hospital Anxiety Depression Inventory were assessed at the baseline and at @-weeks .


Thirty-six participants completed the exercise programme ( hospital based = @ , home based = @ ) .


The mean age was @ @ years .


The mean duration of disease was @ @ years .


Hospital-based and home-based exercise groups had significant improvements in the balance , @-meter walking test , anxiety , and the quality of life after the @-week exercise programme .


There was a significant improvement in the hospital-based patients in terms of the depression scores .


No significant improvement was observed in terms of fatigue in any of the groups .


When both groups were compared , the improvement in the balance and depression scores of the hospital-based patients was significantly higher than the home-based patients .


Calisthenic exercises can be easily performed both at home and in hospital setting .


In patients with MS , calisthenic exercises performed at home or at the hospital may improve the balance , quality of life , and the functional and psychological status , while no significant effect has been observed on fatigue .


An intra-oral remineralization study was conducted to compare the ability of a dentifrice containing @ % arginine and calcium carbonate ( Pro-Argin Technology ) , and @ ppm fluoride as sodium monofluorophosphate ( MFP ) to remineralize acid-softened bovine enamel specimens compared to a silica-based dentifrice with @ ppm fluoride as MFP .


The intra-oral clinical study employed a double blind , two-treatment , crossover design , and used an upper palatal retainer to expose the enamel specimens to the oral environment during product use and periods of remineralization .


The retainer was designed to house three partially demineralized bovine enamel samples .


The study population was comprised of @ adults , ages @ to @ years .


The study consisted of two treatment phases with a washout period lasting seven ( + / - three ) days preceding each treatment phase .


A silica-based dentifrice without fluoride was used during the washout period .


The Test Dentifrice used in this study contained @ % arginine , calcium carbonate , and @ ppm fluoride as sodium monofluorophosphate ( MFP ) .


The Control Dentifrice was silica-based and contained @ ppm fluoride as MFP .


The treatment period consisted of a three-day lead-in period with the assigned product .


The panelists brushed two times per day during the three-day lead-in period with the assigned product .


On the fourth day , the panelists began brushing with the assigned product with the retainer in their mouth .


The panelists brushed for one minute , followed by a one-minute swish with the slurry and a rinse with @ ml of water in the morning , in the afternoon , and night with the retainer in the mouth .


The panelists brushed only their teeth and not the specimens directly .


Changes in mineral content before and after treatment were measured using a Knoop microhardness tester .


The results of the study showed that percent remineralization values for the Test Dentifrice and Control Dentifrice were @ % and @ % , respectively .


A statistical analysis showed that the Test Dentifrice was statistically significantly more effective at remineralizing acid-softened enamel in comparison to the Control Dentifrice ( p < @ ) .


This study demonstrated that the Test Dentifrice with @ % arginine , calcium carbonate , and @ ppm fluoride as MFP is highly effective treatment for promoting remineralization of enamel that has been softened by an erosive challenge .


Ritonavir-boosted atazanavir and darunavir are protease inhibitors that are recommended for initial treatment of HIV infection because each has shown better lipid effects and overall tolerability than ritonavir-boosted lopinavir .


The extent to which lipid effects and overall tolerability differ between treatments with atazanavir and darunavir and whether atazanavir-induced hyperbilirubinaemia may result in more favourable metabolic effects are issues that remain to be resolved .


A @-week randomized clinical trial was carried out .


The primary endpoint was change in total cholesterol at @ weeks .


Secondary endpoints were changes in lipids other than total cholesterol , insulin sensitivity , total bilirubin , estimated glomerular filtration rate , and CD@ and CD@ cell counts , and the proportion of patients with plasma HIV RNA < @ HIV-@ RNA copies/mL and study drug discontinuation because of adverse effects at @ weeks .


Analyses were intent-to-treat .


One hundred and seventy-eight patients received once-daily treatment with either atazanavir/ritonavir ( n = @ ) or darunavir/ritonavir ( n = @ ) plus tenofovir/emtricitabine .


At @ weeks , mean total cholesterol had increased by @ and @ mg/dL in the atazanavir/ritonavir and darunavir/ritonavir arms , respectively -LSB- estimated difference -@ mg/dL ; @ % confidence interval ( CI ) -@ to +@ mg/dL ; P = @ -RSB- .


However , the ratio of total to high-density lipoprotein ( HDL ) cholesterol tended to show a greater decrease with atazanavir/ritonavir compared with darunavir/ritonavir ( estimated difference -@ ; @ % CI -@ to +@ ; P = @ ) .


Total bilirubin significantly increased with atazanavir/ritonavir ( estimated difference +@ mg/dL ; @ % CI +@ to +@ mg/dL ; P < @ ) , but bilirubin changes were not associated with lipid changes .


Secondary endpoints other than total bilirubin were not significantly different between arms .


Atazanavir/ritonavir and darunavir/ritonavir plus tenofovir/emtricitabine did not show significant differences in total cholesterol change or overall tolerability at @ weeks .


However , there was a trend towards a lower total to HDL cholesterol ratio with atazanavir/ritonavir and this effect was unrelated to bilirubin .


Various healthcare interventions have been launched targeting the growing population of older people .


The objective of this study was to investigate the of a case management intervention for frail old people ( aged @ + years ) effects on healthcare utilization .


The study was conducted in a municipality in southern Sweden and included people aged @ + years who lived in their ordinary homes , were dependent in two or more activities of daily living ( ADL ) , and had at least two hospital admissions , or four physician visits , in the previous year .


One-hundred-fifty-three participants were randomly assigned to either an intervention ( n = @ ) or a control group ( n = @ ) .


The one-year intervention comprised home visits , at least once a month , by case managers .


Group differences were investigated @-@ and @-@ months before , and @-@ and @-@ months after , baseline .


The intervention group had , compared to the control group , significant lower mean number ( @ vs. @ , p = @ ) and proportion ( @ vs. @ % , p = @ ) of ED visits not leading to hospitalization @-@ months after baseline .


The intervention group also had a significantly lower mean number of visits to physicians in outpatient care @-@ months after baseline ( @ vs. @ , p = @ ) .


The effect on ED visits not leading to hospitalization meant that those in the control group were more likely to visit the ED for reasons that did not require hospitalization , suggesting that they may have been less monitored than the intervention group .


The intervention has the potential to reduce the burden on outpatient care and ED .


Intramuscular ( i.m. ) pethidine is used worldwide for labour analgesia and i.m. diamorphine usage has increased in the UK in the last @years .


This trial aims to ascertain the relative efficacy and adverse effects of diamorphine and pethidine for labour pain .


Prospective , parallel-arm randomised controlled trial with blinding of participants , care-givers and outcome assessors .


Maternity units in two District General Hospitals in the UK .


After written informed consent , @ women were randomised and recruited ( @ diamorphine , @ pethidine ) .


Inclusion criteria included women @years or older , established labour , singleton pregnancy , @-@weeks of gestation and weight @-@kg .


On request of i.m. analgesia , participants received either @mg pethidine or @ mg diamorphine based on computer-generated block randomisation .