Scores of symptoms and signs after treatment were significantly improved in both groups ( all P < @ ) , and the observation group was better than the control group ( @ + / -@ vs @ + / -@ , P < @ ) .


Compare with those before the treatment , FINS , @hINS and HOMA-IR after the treatment were all decreased in both groups ( all P < @ ) .


The comparison between the two groups showed that differences of FIN had no statistic significance ( P > @ ) after the treatment , while both differences of @hINS and HOMA-IR had statistic significance -LSB- @hlNS : ( @ + / - @ ) pmol/L vs ( @ + / -@ ) pmol/L ; HOMA-IR : @ + / -@ vs @ + / -@ , both P < @ -RSB- .


The improvement of @hINS and HOMA-IR in the observation group was better than that of the control group .


Treatment of PCOS of damp-phlegm constitution with embedding therapy on back-shu points and front-mu points and needle-pricking therapy on Sifeng ( EX-UE @ ) have positive effect , which can effectively reduce the insulin resistance , meanwhile , reduce the side-effects of western medication .


To examine the use of handheld methodology to assess mechanical nociceptive threshold ( MNT ) on cows kept loose-housed .


Prospective randomized partial cross-over experimental study .


A one-factor ( test day ) design was used to evaluate MNT over time .


One hundred and fifteen healthy , loose-housed Danish Holstein cattle .


We evaluated intra-individual variation , inter-observer agreement and variation over time of MNT using two handheld devices and two stimulation sites .


Mechanical , ramped stimulations were performed with an algometer ( @ mm diameter steel probe , @-@ @ kgf ) or an electronic von Frey device ( plastic tip with diameter @ mm , @-@ gf ) .


Each cow received @-@ consecutive stimulations within a @ @ cm skin area on the dorsal or lateral aspect of the left third metatarsus until an avoidance reaction occurred .


We investigated the difference in precision -LSB- expressed as coefficient of variation ( CV ) -RSB- between the combinations of devices and stimulation sites .


The inter-observer agreement and the difference in MNT between test day @ , @ , @ , @ and @ were investigated for selected combinations .


Data were analysed in mixed models and Bland-Altman as relevant .


The CVs did not differ -LSB- range @-@ @ ( p = @ ) -RSB- .


Difference between observers ( @ % limits ) was @ kgf ( @ ) and @ gf ( @ ) for the algometer and von Frey device , respectively .


Mechanical nociceptive threshold increased from @ on test day one to @ gf on test day @ ( p < @ ) .


All methods showed a high degree of intra-individual variation , and no combination of device and stimulation site showed superior precision .


Mean difference between observers was low , and MNT was not consistent over time .


Further development of the methods is required before they can be used in research to investigate possible relations between claw lesions and hyperalgesia .


We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings .


A three-arm , quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana .


Mammography screening efforts included : @ ) enhanced care , @ ) health literacy-informed education of patients , and @ ) education plus nurse support .


Outcomes included mammography screening completion within @ months and incremental cost-effectiveness .


Overall , @,@ female patients ages @ and over who were eligible for routine mammography were recruited .


Baseline screening rates were < @ % .


Post intervention screening rates were @ % with enhanced care , @ % with health literacy-informed education and @ % with education and nurse support .


After adjusting for race , marital status , self-efficacy and literacy , patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care ; those additionally receiving nurse support were @-fold more likely to complete mammographic screening than those receiving the brief education ( @ % Confidence Interval @-@ @ , p = @ ) .


The incremental cost per additional women screened was $ @,@ for literacy-informed education with nurse support over literacy-informed education alone .


Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative , with nurse support and follow-up being the most effective option .


However , it is not likely to be cost-effective or affordable in resource-limited clinics .


Ingrown toenail ( IGTN ) is a common problem that can affect walking and can preclude daily activities .


To compare the safety and efficacy of lateral nail avulsion with phenolization ( LNAP ) versus sleeve ( nail tube splinting ) surgical techniques in the treatment of IGTN .


Patients older than @ years with IGTN were included .


Patients were evaluated for the duration and severity of pain , drainage , complete healing periods , recurrence rate , and overall success rate .


Assessment was performed at baseline and at @ , @ , and @ months .


Complications were noted .


A total of @ patients , including @ males ( @ % ) , were treated .


The mean age was @ @ years .


Thirty patients underwent LNAP , and @ underwent sleeve methods .


The surgical success rate , defined as > @ % improvement , was found to be @ % to @ % for both groups .


Recurrence was observed in only @ patient of each group .


None of the observed differences in healing , discharge , and recovery were statistically significant except in reporting shoe-wear discomfort , which was shorter in the sleeve group ( p < @ ) .


Postoperative pain experience was also noted to be less in the sleeve group ( p = @ ) .


Both methods , LNAP and sleeve , seem to be equally effective for the treatment of IGTNs .


Postoperative shoe-wearing discomfort and pain are shorter when the sleeve method was used .


Cilengitide is a selective v@ and v@ integrin inhibitor .


Data from phase @ trials suggest that it has antitumour activity as a single agent in recurrent glioblastoma and in combination with standard temozolomide chemoradiotherapy in newly diagnosed glioblastoma ( particularly in tumours with methylated MGMT promoter ) .


We aimed to assess cilengitide combined with temozolomide chemoradiotherapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter .


In this multicentre , open-label , phase @ study , we investigated the efficacy of cilengitide in patients from @ study sites in @ countries .


Eligible patients ( newly diagnosed , histologically proven supratentorial glioblastoma , methylated MGMT promoter , and age @ years ) were stratified for prognostic Radiation Therapy Oncology Group recursive partitioning analysis class and geographic region and centrally randomised in a @:@ ratio with interactive voice response system to receive temozolomide chemoradiotherapy with cilengitide @ mg intravenously twice weekly ( cilengitide group ) or temozolomide chemoradiotherapy alone ( control group ) .


Patients and investigators were unmasked to treatment allocation .


Maintenance temozolomide was given for up to six cycles , and cilengitide was given for up to @ months or until disease progression or unacceptable toxic effects .


The primary endpoint was overall survival .


We analysed survival outcomes by intention to treat .


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


Overall , @ patients were screened .


Of these patients , @ had tumour MGMT status tested ; @ patients had a methylated MGMT promoter , and @ were randomly assigned to the cilengitide ( n = @ ) or control groups ( n = @ ) between Oct @ , @ , and May @ , @ .


Median overall survival was @ months ( @ % CI @-@ ) in the cilengitide group and @ months ( @-@ ) in the control group ( hazard ratio @ , @ % CI @-@ , p = @ ) .


None of the predefined clinical subgroups showed a benefit from cilengitide .


We noted no overall additional toxic effects with cilengitide treatment .


The most commonly reported adverse events of grade @ or worse in the safety population were lymphopenia ( @ -LSB- @ % -RSB- in the cilengitide group vs @ -LSB- @ % -RSB- in the control group ) , thrombocytopenia ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , neutropenia ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , leucopenia ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , and convulsion ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) .


The addition of cilengitide to temozolomide chemoradiotherapy did not improve outcomes ; cilengitide will not be further developed as an anticancer drug .


Nevertheless , integrins remain a potential treatment target for glioblastoma .


The Cappella Sideguard ( CS ) sidebranch stent is a self-expanding , thin-strut , nitinol device with anatomic flaring at the sidebranch ostium designed to treat bifurcation lesions .


To evaluate the mechanism of long-term lumen patency of the novel , self-expanding CS sidebranch stent compared with a balloon-expandable stent in the main vessel .


We performed intravascular ultrasound postintervention and at follow-up in @ CS stents and in @ balloon-expandable drug-eluting stents deployed in the corresponding main vessel .


Thirteen patients also had optical coherence tomography ( OCT ) at follow-up to evaluate neointimal hyperplasia and strut coverage .


CS stent area at the sidebranch carina increased significantly from @ @ mm ( @ ) postintervention to @ @ mm ( @ ) at follow-up ( P < @ ) , resulting in no change in lumen area ( @ @ mm ( @ ) to @ @ mm ( @ ) , P = @ ) despite a neointimal area at follow-up of @ @ mm ( @ ) .


Volumetric changes were similar , and the distribution of neointimal hyperplasia peaked @-@ mm distal to the carina .


Change of lumen volume inversely correlated to the neointimal volume ( R = -@ , P < @ ) , but correlated positively to the change in stent volume ( R = @ , P < @ ) .


By OCT , most CS struts were covered ( @ % -LSB- @ , @ -RSB- ) at the bifurcation site , whereas @ % of floating DES struts that crossed the sidebranch were covered by smooth tissue with a similar texture compared with neointima .


Although neointimal hyperplasia accumulates within the CS stent mainly @-@ mm distal to the carina , the self-expanding CS stent may be effective in maintaining an adequate patency in the sidebranch by continued stent expansion noted at follow-up .


To examine upper limb physical function and adverse effects after axillary lymph node dissection ( ALND ) and sentinel lymph node biopsy ( SLNB ) in patients with breast cancer to identify impairments that can inform rehabilitation strategies .


Prospective longitudinal cohort .


Upper limb measurements were studied preoperatively and @ years after breast cancer treatment .


Hospital setting .


Two groups of patients with early-stage primary breast cancer ( N = @ ) : the ALND surgery group ( mean age , @y ) and the SLNB group ( mean age , @y ) .


Not applicable .


Arm lymphedema ( @ % increased arm volume relative to control arm volume ) , grip strength ( in kilograms ) , shoulder mobility , pain intensity during isometric shoulder abduction ( on a @-mm visual analog scale ) , and body mass index ( kg/m ( @ ) ) .


Parametric/nonparametric tests were used for hypothesized changes and differences , and regression analysis was used for confounding factors .


We observed more adverse effects in women treated with ALND than with SLNB after @ years ( P < @ ) : arm lymphedema ( @ % vs @ % ) , grip strength reduction ( @ % vs @ % ) , and shoulder abduction-provoked pain ( increase of @ % vs decrease of @ % ) .


The adverse effects were similar for affected and control upper limbs for all outcomes except arm lymphedema , which occurred only on the affected side .


Adverse effects in both affected and control/unaffected upper limb were observed after @-year follow-up in both ALND and SLNB groups , but a higher prevalence was observed in the ALND group .


Thus , women going through ALND surgery may benefit from further postoperative physical therapy , including resistance and strength exercise , focusing on pain management .


The aim of this study was to investigate whether directional steering through a novel @-contact electrode is safe and can modulate the thresholds for beneficial and side effects of stimulation .


The study is a single-center , performance and safety study .


Double-blind intraoperative evaluations of the thresholds for therapeutic benefit and for side effects were performed in @ patients with Parkinson disease while stimulating in randomized order in spherical mode and in @ different steering modes with the @-contact electrode , and in monopolar mode with a commercial electrode .


In addition , simultaneous recordings of local field potentials through all @ contacts were performed .


There were no adverse events related to the experimental device .


For @ of @ side effects ( @ % ) , the threshold could be increased by @ mA while steering in at least one direction in comparison to conventional spherical stimulation , thereby increasing the therapeutic window by up to @ mA .


Recording local field potentials through all @ electrode contacts yielded spatiotemporal information on pathologic neuronal activity .


Controlled steering of current through the brain may improve the effectiveness of deep brain stimulation ( DBS ) , allow for novel applications , and provide a tool to better explore pathophysiologic activity in the brain .


This study provides Class IV evidence that for patients with Parkinson disease , steering DBS current is well tolerated , increases the threshold for side effects , and may improve the therapeutic window of subthalamic nucleus DBS as compared with current standard spherical stimulation .


To explore the efficacy and safety of vitamin D ( VD ) in the treatment of idiopathic oligoasthenozoospermia .


This study included @ infertile men with idiopathic oligoasthenozoospermia , who were randomized to a VD and a control group of equal number , the former given oral VD @ IU/d and calcium @ mg/d , qd , while the latter administered oral vitamin E @ mg and vitamin C @ mg , tid .


After @ months of medication , we compared the semen parameters , adverse reactions , and pregnancy rate between the two groups .


After medication , the count of progressively motile sperm per ejaculate was increased from ( @ @ ) x @ ( @ ) to ( @ @ ) x @ ( @ ) ( P < @ ) and the proportion of progressively motile sperm from ( @ @ ) % to ( @ @ ) % ( P < @ ) in the VD group .


In comparison , the count of progressively motile sperm per ejaculate was elevated from ( @ @ ) x @ ( @ ) to ( @ @ ) x @ ( @ ) ( P > @ ) and the proportion of progressively motile sperm from ( @ @ ) % to ( @ @ ) % ( P > @ ) in the control group .


Pregnancy was achieved in @ cases ( @ % ) in the VD group , but only lease ( @ % ) in the control ( P < @ ) .


No adverse reactions were observed in either of the groups .


Vitamin D , as a safe option for the treatment of idiopathic oligoasthenozoospermia , can effectively improve the semen quality , especially the progressive sperm motility of the patient .


To evaluate the cost-effectiveness of medical yoga as an early intervention compared with evidence-based exercise therapy and self-care advice for non-specific low back pain .


Randomized controlled trial with a cost-effectiveness analysis .


A total of @ participants randomized into the medical yoga group ( n = @ ) , the exercise therapy group ( n = @ ) and the self-care advice group ( n = @ ) .


The health outcome measure EQ-@D was applied to measure quality of life data combined with cost data collected from treatment groups from baseline to @ months follow-up .


Outcome measure was health-related quality of life ( HRQL ) .


Incremental cost per quality adjusted life year ( QALY ) was also calculated .


Cost-effectiveness analysis was conducted primarily from the societal and employer perspectives .


Medical yoga is cost-effective compared with self-care advice if an employer considers the significant improvement in the HRQL of an employee with low back pain justifies the additional cost of treatment ( i.e. in this study EUR @ ) .


From a societal perspective , medical yoga is a cost-effective treatment compared with exercise therapy and self-care advice if an additional QALY is worth EUR @,@ .


Sensitivity analysis suggests that medical yoga is more cost-effective than its alternatives .


Six weeks of uninterrupted medical yoga thera-py is a cost-effective early intervention for non-specific low back pain , when treatment recommendations are adhered to .


Dyslipidaemia remains a significant risk factor for cardiovascular disease and additional lipid-modifying treatments are warranted to further decrease the cardiovascular disease burden .


We assessed the safety , tolerability and efficacy of a novel cholesterol esterase transfer protein ( CETP ) inhibitor TA-@ in patients with mild dyslipidaemia .


In this randomised , double-blind , placebo-controlled , parallel-group phase @ trial , we recruited patients ( aged @-@ years ) from @ sites ( hospitals and independent clinical research organisations ) in the Netherlands and Denmark with fasting LDL cholesterol levels between @ mmol/L and @ mmol/L , HDL cholesterol levels between @ and @ mmol/L and triglyceride levels below @ mmol/L after washout of lipid-lowering treatments .


Patients were randomly allocated ( @:@ ) by a computer-generated randomisation schedule to receive one of the following nine treatments : a once a day dose of @ mg , @ mg , @ mg , or @ mg TA-@ or matching placebo ; @ mg TA-@ plus @ mg atorvastatin ; @ mg TA-@ plus @ mg rosuvastatin or @ mg atorvastatin or @ mg rosuvastatin alone .


We overencapsulated statins to achieve masking .


The primary outcome was percentage change in LDL cholesterol and HDL cholesterol from baseline at week @ , analysed by intention to treat .


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


Between Aug @ , @ , and Jan @ , @ , @ patients were enrolled .


At week @ , LDL cholesterol levels were reduced by @ % in patients assigned to the @ mg dose , @ % in patients given the @ mg dose , @ % in those given the @ mg dose , and @ % in those given the @ mg dose ( p < @ ) .


LDL cholesterol levels were reduced by @ % in patients given @ mg TA-@ plus atorvastatin , and by @ % in patients given rosuvastatin plus @ mg TA-@ ( p < @ ) .


A daily dose of @ mg TA-@ increased HDL cholesterol levels by @ % , @ mg by @ % , @ mg by @ % , and @ mg dose by @ % ( p < @ ) .


In patients receiving @ mg TA-@ and @ mg atorvastatin HDL cholesterol levels increased by @ % and in patients receiving @ mg TA-@ and @ mg rosuvastatin by @ % .


We recorded no serious adverse events or signs of liver or muscle toxic effects .


TA-@ , a novel CETP inhibitor , is well tolerated and has beneficial effects on lipids and apolipoproteins in patients with mild dyslipidaemia .


A cardiovascular disease outcome trial is needed to translate these effects into a reduction of cardiovascular disease events .


Addition of viscous fiber to foods has been shown to significantly reduce postprandial glucose excursions .


However , palatability issues and the variability in effectiveness due to different methods of administration in food limits it use .


This study explores the effectiveness of a viscous fiber blend ( VFB ) in lowering postprandial glycemia using different methods of incorporation .


Two acute , randomized , controlled studies were undertaken : Study @ : Twelve healthy individuals ( mean SD , age : @ @years , body mass index -LSB- BMI -RSB- : @ @kg/m ( @ ) ) consumed @ different breakfasts .


All meals consisted of @g of available carbohydrate from white bread ( WB ) and @g margarine .


Zero , @ , @ , or @g of the VFB was baked into WB or mixed with the margarine .


Study @ : Thirteen healthy individuals ( mean SD , age : @ @years , BMI : @ @kg/m ( @ ) ) consumed @ test meals , consisting of @g of available carbohydrate from WB .


Six capsules containing either cornstarch or VFB were taken at @ different time points during the glucose tolerance test .


After obtaining a fasting finger-prick blood sample , volunteers consumed the test meal over a @-minute period .


Additional blood samples were taken at @ , @ , @ , @ , @ , and @ minutes from the start of the meal .


For study @ , an additional fasting sample was obtained at -@ minutes .


Study @ : Irrespective of VFB dose , glucose levels were lower at @ and @ minutes when VFB was mixed into the margarine compared to the control ( p < @ ) .


Incremental areas under the curve were significantly lower compared to control when @g of VFB was mixed into the margarine .


Study @ : There was no effect of the VFB on postprandial glucose levels when administered in capsules .


Incorporation of VFB into margarine was more effective in lowering postprandial glycemia than when the VFB was baked into bread and no effect when given in capsules .


Non-surgical therapies are needed to reduce the rate of progression of low-grade cervical intraepithelial neoplasia ( CIN @ ) to high grade CIN ( CIN @/@ ) .


The aim of this study was to assess the efficacy and safety of hexaminolevulinate ( HAL ) photodynamic therapy ( PDT ) in the treatment of patients with CIN @ .


This phase IIa prospective double-blind study randomized patients with CIN @ into three groups : HAL vaginal suppository , placebo vaginal suppository or follow-up only .


Patients in the first two groups received HAL or placebo suppositories @hours before illumination with @J/cm ( @ ) red coherent light ( @nm ) using a special light catheter .


All patients had a follow up including colposcopy , cytology and human papilloma virus ( HPV ) testing @ and @ months and additional biopsy @ months after PDT .


The main outcome measure was efficacy , defined as complete histologic remission @ months after PDT .


Secondary outcomes were histologic remission @ months and HPV eradication @ months after first PDT .


Seventy patients were randomized : @ to HAL , @ to placebo , @ to follow up only .


After @ months CIN lesions had cleared in @ % of patients in the HAL-PDT group compared to @ % in the combined control group ( per protocol population , P = @ ) .


Twenty-six patients ( @ % ) reported @ adverse events ( AEs ) , of which @ were mild or moderate .


Nineteen treatment-related AEs were reported by @ patients ( @ % ) in the HAL PDT group , one in the placebo PDT group ( @ % ) , and none in the follow-up group .


The most common adverse events were local discomfort including mild pain/cramping ( @ ) and leucorrhoea ( @ ) .


HAL PDT shows a favorable efficacy and safety profile and represents a promising alternative to observation and surgical procedures in patients with CIN @ .


Low back pain is a common and disabling condition leading to large health service and societal costs .


Although there are several treatment options for back pain little is known about how to improve patient choice in treatment selection .


The purpose of this study was to pilot a decision support package to help people choose between low back pain treatments .


This was a single-centred pilot cluster randomised controlled trial conducted in a community physiotherapy service .


We included adults with non-specific low back pain referred for physiotherapy .


Intervention participants were sent an information booklet prior to their first consultation .


Intervention physiotherapists were trained to enhance their skills in shared informed decision making .


Those in the control arm received care as usual .


The primary outcome was satisfaction with the treatment received at four months using a five-point Likert Scale dichotomised into `` satisfaction '' ( very satisfied or somewhat satisfied ) and `` non-satisfaction '' ( neither satisfied nor dissatisfied , somewhat dissatisfied or very dissatisfied ) .


We recruited @ participants .


In the control arm @ % of participants were satisfied with their treatment and in the intervention arm @ % .


The adjusted relative risk of being satisfied was @ ( @ % confidence interval @ to @ ) .


For most secondary outcomes the trend was towards worse outcomes in the intervention group .


For one measure ; the Roland Morris Disability Questionnaire , this difference was clinically important ( @ , @ % confidence interval @ to @ ) .


Mean healthcare costs were slightly lower ( @ saving per patient ) within the intervention arm but health outcomes were also less favourable ( @ fewer QALYs ) ; the estimated probability that the intervention would be cost-effective at an incremental threshold of @,@ per QALY was @ % .


We did not find that this decision support package improved satisfaction with treatment ; it may have had a substantial negative effect on clinical outcome , and is very unlikely to prove cost-effective .


That a decision support package might have a clinically important detrimental effect is of concern .


To our knowledge this has not been observed previously .


Decision support packages should be formally tested for clinical and cost-effectiveness , and safety before implementation .


Promising clinical outcomes have been reported with the combination of enamel matrix derivative ( EMD ) and allograft materials .


Direct comparison between EMD with a freeze-dried bone allograft ( FDBA ) and a demineralized FDBA ( DFDBA ) was evaluated in one case series study .


To date , no randomized controlled trial has been reported .


Therefore , a well-controlled randomized clinical trial was conducted to determine the relative efficacy of EMD/FDBA versus EMD/DFDBA when managing intrabony defects .


A randomized parallel trial was conducted in a private practice from April @ to October @ .


Sixty-nine patients were randomly assigned to one of three groups : EMD/FDBA ( EF ) intervention group ( n = @ ) , EMD/DFDBA ( ED ) intervention group ( n = @ ) , and EMD alone without graft material ( E ) as a negative control group ( n = @ ) .


All of the grafting material had minocycline added .


Each patient had an intrabony defect .


The primary outcomes were the absolute change in probing depth ( PD ) reduction and clinical attachment level ( CAL ) gain from baseline to @ - and @-year follow-up .


Intrabony defects were surgically treated with EMD/FDBA , EMD/DFDBA , or EMD alone .


Sixty-seven patients ( EF , n = @ : ED , n = @ ; E , n = @ ) were analyzed .


All groups demonstrated significant improvement in PD reduction and CAL gain from baseline .


The changes for PD were as follows ( mm , @ % confidence interval -LSB- CI -RSB- ) : at @ year : EF ( @ mm , @ to @ ) , ED ( @ mm , @ to @ ) , and E ( control ) ( @ mm , @ to @ ) ; at @ years : EF ( @ mm , @ to @ ) , ED ( @ mm , @ to @ ) , and E ( @ mm , @ to @ ) .


The changes for CAL were as follows ( mm , @ % CI ) : at @ year : EF ( @ mm , @ to @ ) , ED ( @ mm , @ to @ ) , and E ( @ mm , @ to @ ) ; at @ years : EF ( @ mm , @ to @ ) , ED ( @ mm , @ to @ ) , and E ( @ mm , @ to @ ) .


The intervention groups ( EF and ED ) showed better treatment outcomes than the control group at @ and @ years .


Statistically , the two bone-graft groups were not significantly different from each other at @ and @ years .


Both EMD/FDBA and EMD/DFDBA interventions resulted in greater soft tissue improvement at @ and @ years of follow-up compared to EMD alone .


Both graft materials worked well in managing deep intrabony defects when combined with EMD .


To test the hypothesis that chocolate consumption is associated with a lower risk of heart failure ( HF ) .


We prospectively studied @ @ men from the Physicians ' Health Study .


Chocolate consumption was assessed between @ and @ via a self-administered food frequency questionnaire and HF was ascertained through annual follow-up questionnaires with validation in a subsample .


We used Cox regression to estimate multivariable adjusted relative risk of HF .


During a mean follow-up of @ years there were @ new cases of HF .


The mean age at baseline was @ years .


Hazard ratios -LSB- @ % confidence intervals ( CI ) -RSB- for HF were @ ( ref ) , @ ( @-@ @ ) , @ ( @-@ @ ) , @ ( @-@ @ ) , and @ ( @-@ @ ) , for chocolate consumption of less than @/month , @-@ / week , @-@ / week , and @ + / week , respectively , after adjusting for age , body mass index ( BMI ) , smoking , alcohol , exercise , energy intake , and history of atrial fibrillation ( P for quadratic trend = @ ) .


In a secondary analysis , chocolate consumption was inversely associated with risk of HF in men whose BMI was < @kg/m ( @ ) -LSB- HR ( @ % CI ) = @ ( @-@ @ ) for consumption of @ + servings/week , P for linear trend = @ ) but not in those with BMI of @ + kg/m ( @ ) -LSB- HR ( @ % CI ) = @ ( @-@ @ ) , P for linear trend = @ , P for interaction = @ ) .


Our data suggest that moderate consumption of chocolate might be associated with a lower risk of HF in male physicians .


To assess the cardiovascular changes of a continuous rate infusion of lidocaine in calves anesthetized with xylazine , midazolam , ketamine and isoflurane during mechanical ventilation .


Prospective , randomized , cross-over , experimental trial .


A total of eight , healthy , male Holstein calves , aged @ @ months and weighing @ @ kg were included in the study .


Calves were administered xylazine followed by ketamine and midazolam , orotracheal intubation and maintenance on isoflurane ( @ % ) using mechanical ventilation .


Forty minutes after induction , lidocaine ( @ mg kg bolus ) or an equivalent volume of saline ( @ % ) was administered IV followed by a continuous rate infusion ( @ g kg minute ) of lidocaine ( treatment L ) or saline ( treatment C ) .


Heart rate ( HR ) , systolic , diastolic and mean arterial pressures ( SAP , DAP and MAP ) , central venous pressure ( CVP ) , mean pulmonary arterial pressure ( mPAP ) , pulmonary arterial occlusion pressure ( PAOP ) , cardiac output , end-tidal carbon dioxide ( Pe'CO @ ) and core temperature ( CT ) were recorded before lidocaine or saline administration ( Baseline ) and at @-minute intervals ( T@-T@ ) .


Plasma concentrations of lidocaine were measured in treatment L.


The HR was significantly lower in treatment L compared with treatment C.


There was no difference between the treatments with regards to SAP , DAP , MAP and SVRI .


CI was significantly lower at T@ in treatment L when compared with treatment C. PAOP and CVP increased significantly at all times compared with Baseline in treatment L.


There was no significant difference between times within each treatment and between treatments with regards to other measured variables .


Plasma concentrations of lidocaine ranged from @ to @ g mL during the CRI .


At the studied rate , lidocaine causes a decrease in heart rate which is unlikely to be of clinical significance in healthy animals , but could be a concern in compromised animals .


Antimicrobial prophylaxis is still a matter of debate in ear surgeries .


Previous studies have focused on prophylaxis in middle ear surgery alone without inclusion of mastoidectomy .


We therefore investigated efficacy of two regimes of antimicrobial prophylaxis in tympanoplasty with cortical mastoidectomy done for mild middle ear disease in chronic otitis media .


Prospective , randomized , controlled , double-blind study .


Patients undergoing tympanoplasty with cortical mastoidectomy were included and randomized into two study groups .


The group I patients received parenteral perioperative antimicrobials ; only group II patients received additional extended oral antimicrobials for @ days more postoperatively .


Primary outcomes evaluated were postaural wound infection and graft success , assessed weekly until @ month .


Adverse events and length of hospital stay were evaluated as secondary outcome .


Seventy-eight patients were randomized into group I ( n = @ ) and group II ( n = @ ) .


The two groups showed no difference in wound infection rate .


The graft success rate in both the group was comparable ( @ % in group I and @ % in group II , respectively ; P = @ ) .


The length of hospital stay was significantly longer ( P = @ ) in group II ( @ -LSB- @ -RSB- , mean -LSB- SD -RSB- ) as compared to group I ( @ -LSB- @ -RSB- ) .


During the first postoperative week , a significantly higher incidence of gastrointestinal disturbances were observed in group II ( @ -LSB- @ % -RSB- as compared to @ -LSB- @ % -RSB- in group I , P = @ ) .


The present study shows that there is no need of extended antimicrobial prophylaxis for tympanoplasty with cortical mastoidectomy done for mild middle ear disease .


An indiscriminate use of antimicrobials may lead to increase incidence of adverse events and prolonged hospital stay .


Acute on chronic liver failure ( AoCLF ) is associated with a high mortality rate .


Plasma exchange ( PE ) is useful to bridge AoCLF patients to liver transplantation .


The aim of this study was to assess the effects of PE on plasma ammonia levels ( PAL ) in AoCLF patients .


Seventy patients with AoCLF in @ groups ( PE plus standard medical treatment group , n = @ ; and standard medical treatment group , n = @ ) were enrolled in study .


PAL was detected on admission and on days @ , @ , @ , and @ during hospitalization .


All AoCLF patients showed PAL more than the upper limit of the normal range .


More dramatic decreased in the PE survivors ( form @ + / - @ to @ + / - @ , p < @ ) than the medical survivors ( form @ + / - @ to @ + / - @ , p < @ ) after @ days of treatment .


Furthermore , PAL after medical treatment were still higher than those of PE treatment in the survivors ( @ + / - @ vs. @ + / - @ , p < @ ) .


Among the non-survivors in the medical group , PAL remained at high levels throughout the examination period .


Importantly , an increased PAL associated with high mortality and reduced survival time of AoCLF patients .


Ammonia may be important in the pathogenesis of the AoCLF and PE may represent a reliable hepatic support device for AoCLF .


In Lynch syndrome , flat and diminutive adenomas are particularly prone to malignant transformation , but they can be missed by standard colonoscopy .


It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome .


We conducted a prospective , multicenter , randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy .


Standard colonoscopy was used first to detect visible lesions .


Colonoscopy with chromoscopy was then performed by a second gastroenterologist ( blinded to the findings of the first colonoscopy ) to detect additional lesions .


The primary end point was the number of patients in whom at least one adenoma was detected .


A total of @ eligible patients ( median age , @ years ) were enrolled at @ centers from July @ to August @ .


Significantly more patients with at least one adenoma were identified by chromocolonoscopy ( @/@ ( @ % ) ) than by standard colonoscopy ( @/@ ( @ % ) ; P < @ ) .


The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was @ % ( @/@ ) .


Overall , chromocolonoscopy plus colonoscopy detected a total of @ adenomas in @ patients ( mean number of adenomas detected per patient : @ vs. standard colonoscopy alone : @ ; P < @ ) .


The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome .


Several studies suggest that surgical manipulation of the intestine and increased intra-abdominal pressure promotes bacterial translocation ( BT ) .


This prospective randomized study has investigated the effect of surgery on BT in patients undergoing elective colectomy for colon cancer by comparing the laparoscopic with the open approach .


One hundred nineteen consecutive patients underwent colectomy for colon cancer : @ cases underwent open resection and @ cases underwent laparoscopic resection .


For bacterial identification , tissue samples were taken from the liver , spleen , and mesenteric lymph nodes .


The incidence of BT increased in laparoscopic and open group after bowel mobilization ( prior to ligation of the vascular pedicle ) , compared with the before mobilization ( P < @ ) .


There was not a statistically significant difference in BT value between the @ groups .


BT increase was observed during the open and laparoscopic resection for colon cancer , without significant statistical difference between the @ groups .


To investigate the effectiveness of exercise as treatment for vasomotor menopausal symptoms .


Three-group randomised controlled trial , two exercise interventions and a control group .


Primary Care , West Midlands UK .


Perimenopausal and postmenopausal women experiencing at least five hot flushes/night sweats per day and not taken MHT in previous @ months were recruited from @ general practices .


Participants in both exercise interventions groups were offered two face-to-face consultations with a physical activity facilitator to support engagement in regular exercise .


In addition , one exercise group received a menopause-specific information DVD and written materials to encourage regular exercise and the other exercise group was offered the opportunity to attend exercise social support groups in their communities .


Interventions lasted @ months .


The primary outcome was frequency of hot flushes/night sweats at @-month up .


Two hundred and sixty-one women were randomised ( n = @ per group ) .


Neither of the exercise intervention groups reported significantly less frequent hot flushes/night sweats per week than controls ( exercise-DVD versus control : -@ , @ % CI -@ to @ ; exercise-social support versus control : -@ , @ % CI -@ to @ ) .


This trial indicates that exercise is not an effective treatment for hot flushes/night sweats .


Contrary to current clinical guidance , women should not be advised that exercise will relieve their vasomotor menopausal symptoms .


To fully analyze and compare BMI among Han , Tibetan , and Uygur university students , to discuss the differences in their physical properties and physical health , and thus to provide some theoretical suggestions for the improvement of students ' physical health .


The cross-sectional random cluster sampling was used to investigate @ Han , Tibetan , and Uygur university students , aged @-@ in Northwest China , and their height and weight were measured to calculate BMI .


The BMI classification criteria for Chinese established by Work Group on Obesity in China ( WGOC ) were used for screening .


Han , Tibetan , and Uygur university students show low obesity rates but high overweight rates .


Han , Tibetan , and Uygur university students present a high rate of underweight , normal weight , and overweight , respectively .


Female Han students show higher underweight and normal weight rates , but lower overweight and obesity rates , than male Han students .


Female Tibetan students show higher normal weight rate , but lower overweight and obesity rates , than male Tibetan students .


BMI increases with age for male students but decreases with age for female students .


Male Uygur students show higher obesity rate than female Uygur students .


Tibetan and Uygur university students have higher BMI than other minorities in South China .


Although couples ' alcohol use has been associated with intimate partner aggression and poorer marital functioning , few studies have examined the proximal effects of alcohol on couple interactions .


The current experimental study examined the effects of alcohol , administered independently to male and female intimate partners , on positive and negative interaction behaviors within a naturalistic conflict resolution paradigm .


Married and cohabiting couples ( n = @ ) were recruited from the community and each partner randomly assigned to receive either alcohol ( target dose : @ mg/kg ) or no alcohol .


They engaged in two @-minute interactions regarding current disagreements in their relationship , one before and one after beverage administration .


Videotaped interactions were coded by trained observers using the Rapid Marital Interaction Coding System , and positive and negative interaction behaviors were analyzed using the Actor-Partner Interdependence Model .


Participants displayed decreased negativity and increased positivity following alcohol consumption when their partners were sober but no differences in negativity or positivity when their partners also consumed alcohol .


There were no gender differences .


Although participants with a history of perpetrating intimate partner aggression displayed more negativity , prior aggression did not interact with beverage condition .


The immediate effects of alcohol consumption on couple interaction behaviors appeared more positive than negative .


Contrary to hypotheses , congruent partner drinking had neither particularly positive nor particularly negative effects .


These unique findings represent a rare glimpse into the immediate consequences of alcohol consumption on couple interaction and stand in contrast to its delayed or long-term effects .


Colorectal cancer ( CRC ) screening is cost-effective but underused .


The objective of this study was to determine the cost-effectiveness of a mailed standard intervention ( SI ) and tailored navigation interventions ( TNIs ) to increase CRC screening use in the context of a randomized trial among primary care patients .


Participants ( n = @ ) were randomized either to a usual care control group ( n = @ ) , to an SI group ( n = @ ) , or to a TNI group ( n = @ ) .


The SI group was sent both colonoscopy instructions and stool blood tests irrespective of baseline preference .


TNI group participants were sent instructions for scheduling a colonoscopy , a stool blood test , or both based on their test preference , as determined at baseline ; then , they received a navigation telephone call .


Activity cost estimation was used to determine the cost of each intervention and to compute incremental cost-effectiveness ratios .


Statistical uncertainty within the base case was assessed with @ % confidence intervals derived from net benefit regression analysis .


The effects of uncertain parameters , such as the cost of planning , training , and involvement of those receiving `` investigator salaries , '' were assessed with sensitivity analyses .


Program costs of the SI were $ @ per participant .


The average cost of the TNI was $ @ per participant .


The TNI was more effective than the SI but substantially increased the cost per additional individual screened .


Decision-makers need to consider cost structure , level of planning , and training required to implement these @ intervention strategies and their willingness to pay for additional individuals screened to determine whether a tailored navigation would be justified and feasible .


Posterior wall fractures are one of the most common acetabular fractures .


However , only @ % of these fractures involve a single large fragment , and comminuted acetabular posterior wall fractures pose a particular surgical challenge .


The purpose of this study was to compare outcomes between patients who received fixation for comminuted posterior wall fracture using the Acetabular Tridimensional Memory Fixation System ( ATMFS ) and patients who underwent fixation with conventional screws and buttress plates ( Plates group ) .


Between April @ and May @ , @ consecutive patients who sustained a comminuted posterior wall fracture of acetabulum were treated with ATMFS or conventional screws and buttress plates .


Operative time , fluoroscopy time , blood loss , and any intra-operative complications were recorded .


Plain AP and lateral radiographs were obtained at all visits ( Matta 's criteria ) .


Modified Merle d' Aubigne-Postel score , and Mos SF-@ score were compared between groups .


Fifty patients were included in the analysis with @ in the ATMFS group and @ in the Plates group .


The mean follow-up time was @ months , ranging from @ to @ months .


All patients had fully healed fractures at the final follow-up .


There was no difference in clinical outcomes or radiological evaluations between groups .


Patients with comminuted posterior wall fractures of the acetabulum treated with the ATMFS or conventional screws and buttress plate techniques achieve a good surgical result .


Both techniques are safe , reliable , and practical .


Use of the ATMFS technique may reduce blood loss and improve rigid support to marginal bone impaction .


The use ATMFS may need additional support when fractures involve the superior roof .


Both valganciclovir and high-dose valacyclovir are recommended for cytomegalovirus prophylaxis after renal transplantation .


A head-to-head comparison of both regimens is lacking .


The objective of the study was to compare valacyclovir prophylaxis with valganciclovir , which constituted the control group .


In a randomized , open-label , single-center trial , recipients of renal transplants ( recipient or donor cytomegalovirus-seropositive ) were randomly allocated ( @:@ ) to @-month prophylaxis with valacyclovir ( @ g four times daily ) or valganciclovir ( @ mg daily ) .


Enrollment occurred from November of @ to April of @ .


The primary end points were cytomegalovirus DNAemia and biopsy-proven acute rejection at @ months .


Analysis was by intention to treat .


In total , @ patients were assigned to valacyclovir ( n = @ ) or valganciclovir prophylaxis ( n = @ ) .


Cytomegalovirus DNAemia developed in @ ( @ % ) of @ patients in the valacyclovir group and @ ( @ % ) of @ patients in the valganciclovir group ( adjusted hazard ratio , @ ; @ % confidence interval , @ to @ ; P = @ ) .


The incidence of cytomegalovirus disease was @ % with valacyclovir and @ % with valganciclovir prophylaxis ( adjusted hazard ratio , @ ; @ % confidence interval , @ to @ ; P = @ ) .


Significantly more patients with valacyclovir prophylaxis developed biopsy-proven acute rejection ( @ of @ -LSB- @ % -RSB- versus @ of @ -LSB- @ % -RSB- ; adjusted hazard ratio , @ ; @ % confidence interval , @ to @ ; P = @ ) .


The incidence of polyomavirus viremia was higher in the valganciclovir group ( @ % versus @ % ; adjusted hazard ratio , @ ; @ % confidence interval , @ to @ ; P = @ ) .


Valganciclovir shows no superior efficacy in cytomegalovirus DNAemia prevention compared with valacyclovir prophylaxis .


However , the risk of biopsy-proven acute rejection is higher with valacyclovir .


To assess the effects of using Chinese herbs in assisted reproductive technology .


Four hundred and thirty-three subjects aged less than @ years with infertility due to Fallopian tube or male-related factors who were willing to undertake in vitro fertilization and embryo transplantation were randomly allocated to a Chinese herb intervention group ( n = @ ) or a conventional treatment control group ( n = @ ) .


All subjects received one of four routine ultra-ovulation-promoting therapies at the Reproductive Center in the Third Hospital Affiliated to Beijing University according to their physician 's assessments .


The subjects in the intervention group received various Chinese herbs depending on their conventional treatment .


Endometrial thickness , number of acquired eggs , and rates of normal fertility , high-quality embryos , biochemical and clnical pregnancy of subjects were assessed in both groups .


The high-quality embryo rate of @ % , biochemical pregnancy rate of @ % , clinical pregnancy rate of @ % and endometrial thickness of ( @ + / - @ ) mm in the intervention group were all significantly higher than those in the control group -LSB- @ % , @ % , @ % , and ( @ + / - @ ) mm , respectively ; P < @ -RSB- .


The normal fertility rate of @ % in the Chinese herb group was also significantly superior to the @ % achieved in the control group ( P < @ ) .


There were no statistically significant differences ( P > @ ) in the average number of acquired eggs within a single cycle , incidence of excessive stimulation of ovary , rates of embryo transplantation or early abortion and birth of living babies between the two groups .


Our findings indicate that Chinese herbs increase endometrial thickness , improve the quality of fertility and embryo , and promote embryonic nidation , thus enhancing the success rate of in vitro fertilization/intracytoplasmic sperm injection-embryo transplantation cycle .


Using Chinese herbs improves the outcomes and safety of assisted reproductive technologies .


To compare the efficacy and safety of @ % diquafosol ophthalmic solution with those of @ % sodium hyaluronate ophthalmic solution in patients with dry eye in China and Singapore .


A total of @ patients with dry eye ( Schirmer 's test , @mm ; fluorescein and RB score , @ points ) from China and Singapore were randomised to receive either diquafosol ophthalmic solution ( diquafosol ) or sodium hyaluronate ophthalmic solution ( HA ) at @:@ ratio .


The fluorescein staining scores and rose bengal ( RB ) subjective symptom scores and tear film breakup time were evaluated before treatment and @ and @weeks after start of treatment .


In the diquafosol group , changes in fluorescein and RB scores compared with baseline at week @ or at the time of discontinuation were -@ and -@ , respectively .


Compared with the HA group , changes in fluorescein score were non-inferior and changes in RB score were superior ( p = @ ) .


In addition , diquafosol and HA improved tear film breakup time by @ and @ s , respectively ( no significant intergroup difference ) .


Adverse event onset rates were @ % ( @ of @ subjects ) and @ % ( @ of @ subjects ) in the diquafosol group and HA group , respectively , with borderline significant intergroup differences ( p = @ ) , while adverse drug reaction incidence rates were @ % ( @ of @ subjects ) and @ % ( @ of @ subjects ) , respectively ( p = @ ) .


Only mild adverse drug reactions ( > @ % ) in the form of eye discharge , itching or irritation were observed .


Diquafosol improved fluorescein staining score in a manner similar to HA , and significantly improved RB score compared with HA .


Epidural injections are the most common minimally invasive intervention used to manage low back pain with lumbosacral radicular pain .


It can be delivered through either transforaminal ( TF ) , interlaminar , or caudal approaches .


The TF approach is considered more efficacious than the interlaminar approach probably because of ventral epidural spread .


However , catastrophic complications reported with the TF approach have raised concerns regarding its use .


These concerns regarding the safety of the TF approach lead to the search for a technically better route with lesser complications with drug delivery into the ventral epidural space .


The parasagittal interlaminar ( PIL ) route is reported to have good ventral epidural spread .


However , there is a paucity of literature comparing the effectiveness of PIL with TF .


To compare effectiveness of PIL and TF epidural injections for managing low back pain with lumbosacral radicular pain .


Randomized , double-blind , active-control study .


Interventional pain management clinic in a tertiary care center in India .


Sixty-two patients were randomized to receive fluoroscopically guided epidural injection of methylprednisolone ( @ mg ) either through the PIL ( n = @ ) or TF ( n = @ ) approach .


Patients were evaluated for effective pain relief ( @ % from baseline ) by @ - @ visual analogue scale ( VAS ) and functional improvement by Modified Oswestry Disability Questionnaire ( MODQ ) at @ weeks , @ , @ , @ , @ , @ , and @ months .


Patients who failed to respond to the treatment or when the patient 's response deteriorated received additional injection of same injectate , dose , and approach .


Only if the pain returns should there be a maximum of @ injections .


Other outcome measures were overall VAS and MODQ , number of injections , and presence of ventral and perineural spread .


Effective pain relief ( @ % pain relief from baseline on VAS ) was observed in @ % ( @ % CI @ - @ % ) of patients in the TF group and @ % ( @ % CI @ - @ % ) of patients in the PIL ( P = @ ) group at @ months .


The pain relief survival period was comparable in both groups ( P = @ ) .


Significant reduction in VAS and improvement in MODQ were observed at all time points post-intervention compared to baseline ( P < @ ) in both groups .


On average , patients in the PIL group received @ and patients in the TF group received @ procedures annually .


The majority received injection at L@-L@ intervertebral level ( @ in TF and @ in PIL ) .


Ventral epidural spread was comparable in both groups ( PIL - @ % and TF - @ % ) .


No major complications were encountered in either group ; however , initial intravascular spread of contrast was observed in @ patients in the TF group .


Limitations included lack of documentation of adjuvant analgesic drug therapy and procedures performed by a single experienced interventionalist .


Epidural injection delivered through the PIL approach is equivalent in achieving effective pain relief and functional improvement to the TF approach for the management of low back pain with lumbosacral radicular pain .


The PIL approach can be considered a suitable alternative to the TF approach for its equivalent effectiveness , probable better safety profile , and technical ease .


In recent years , virtual reality has been introduced to neurorehabilitation , in particular with the intention of improving upper-limb training options and facilitating motor function recovery .


The proposed study incorporates a quantitative part and a qualitative part , termed a mixed-methods approach : ( @ ) a quantitative investigation of the efficacy of virtual reality training compared to conventional therapy in upper-limb motor function are investigated , ( @a ) a qualitative investigation of patients ' experiences and expectations of virtual reality training and ( @b ) a qualitative investigation of therapists ' experiences using the virtual reality training system in the therapy setting .


At three participating clinics , @ patients at least @ months after stroke onset will be randomly allocated to an experimental virtual reality group ( EG ) or to a control group that will receive conventional physiotherapy or occupational therapy ( @ sessions , @ minutes each , over the course of @ weeks ) .


Using custom data gloves , patients ' finger and arm movements will be displayed in real time on a monitor , and they will move and manipulate objects in various virtual environments .


A blinded assessor will test patients ' motor and cognitive performance twice before , once during , and twice after the @-week intervention .


The primary outcome measure is the Box and Block Test .


Secondary outcome measures are the Chedoke-McMaster Stroke Assessments ( hand , arm and shoulder pain subscales ) , the Chedoke-McMaster Arm and Hand Activity Inventory , the Line Bisection Test , the Stroke Impact Scale , the MiniMentalState Examination and the Extended Barthel Index .


Semistructured face-to-face interviews will be conducted with patients in the EG after intervention finalization with a focus on the patients ' expectations and experiences regarding the virtual reality training .


Therapists ' perspectives on virtual reality training will be reviewed in three focus groups comprising four to six occupational therapists and physiotherapists .


The interviews will help to gain a deeper understanding of the phenomena under investigation to provide sound recommendations for the implementation of the virtual reality training system for routine use in neurorehabilitation complementing the quantitative clinical assessments .


Cochlear implants ( CIs ) are typically activated @ to @ weeks after the surgery .


For some patients who live in remote areas , this waiting period could impose some personal and financial burdens .


The current study examined whether CI recipients can be safely and effectively fitted with their speech processor five days after their implantation .


Randomized controlled trial .


Tertiary referral center .


A total of @ patients ( @-@ yr of age ) undergoing traditional CI surgery were recruited to participate in this study .


Participants were divided into @ groups : an early-fit group whose devices were activated @ days after surgery and standard-fit group whose devices were activated using the recommended waiting period .


Measures of impedance and most comfortable levels were used to compare differences across the @ groups of patients .


Data were measured at the activation session and also at @ weeks after the initial session .


No adverse events were reported postoperatively .


Electrode impedances were significantly lower for the early-fit group than that for the standard-fit group in the initial activation session but not in the @-week follow-up session .


There were no significant differences between the @ groups in the stimulation fitting levels in any of the sessions .


The results presented in this article demonstrated that early activation for this sample did not seem to interfere with wound healing or with the fitting parameters suggesting that early activation should be considered as viable option to better serve CI patients ' individual needs .


The implications of geographical variation are unknown following adjustment for hospital length of stay ( LOS ) in heart failure ( HF ) trials that included patients whether or not they had systolic dysfunction .


We investigated regional differences in an international acute HF trial .


The PROTECT trial investigated @ patients with acute HF and renal dysfunction hospitalized at @ sites in @ countries with randomization to rolofylline or placebo .


We grouped enrolling countries into six regions .


Baseline characteristics , in-hospital management , and outcomes were explored by region .


The primary study outcome was @-day mortality or cardiovascular/renal hospitalization .


Secondary outcomes included @-day mortality .


Of @ patients , @ % were from Eastern Europe , @ % from Western Europe , @ % from Israel , @ % from North America , @ % from Russia , and @ % from Argentina .


Marked differences in baseline characteristics , HF phenotype , in-hospital diuretic and vasodilator strategies , and LOS were observed by region .


LOS was shortest in North America and Israel ( median @ days ) and longest in Russia ( median @ days ) .


Regional event rates varied significantly .


Following multivariable adjustment , region was an independent predictor of the risk of mortality/hospitalization at @ days , with the lowest risk in Russia ( hazard ratio @ , @ % confidence interval @-@ @ vs. Western Europe ) due to lower rehospitalization ; mortality differences were attenuated by @ days .


In an international HF trial , there were differences in baseline characteristics , treatments , LOS , and rehospitalization amongst regions , but little difference in longer term mortality .


Rehospitalization differences exist independent of LOS .


This analysis may help inform future trial design and should be externally validated .


Ipilimumab is an approved treatment for patients with advanced melanoma .


We aimed to assess ipilimumab as adjuvant therapy for patients with completely resected stage III melanoma at high risk of recurrence .


We did a double-blind , phase @ trial in patients with stage III cutaneous melanoma ( excluding lymph node metastasis @ mm or in-transit metastasis ) with adequate resection of lymph nodes ( ie , the primary cutaneous melanoma must have been completely excised with adequate surgical margins ) who had not received previous systemic therapy for melanoma from @ hospitals located in @ countries .


Patients were randomly assigned ( @:@ ) , centrally by an interactive voice response system , to receive intravenous infusions of @ mg/kg ipilimumab or placebo every @ weeks for four doses , then every @ months for up to @ years .


Using a minimisation technique , randomisation was stratified by disease stage and geographical region .


The primary endpoint was recurrence-free survival , assessed by an independent review committee , and analysed by intention to treat .


Enrollment is complete but the study is ongoing for follow-up for analysis of secondary endpoints .


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


Between July @ , @ , and Aug @ , @ , @ patients were randomly assigned to ipilimumab ( n = @ ) or placebo ( n = @ ) , all of whom were included in the intention-to-treat analyses .


At a median follow-up of @ years ( IQR @-@ ) , there were @ recurrence-free survival events ( @ in the ipilimumab group vs @ in the placebo group ) .


Median recurrence-free survival was @ months ( @ % CI @-@ ) in the ipilimumab group versus @ months ( @ % CI @-@ ) in the placebo group ( hazard ratio @ ; @ % CI @-@ ; p = @ ) ; @-year recurrence-free survival was @ % ( @ % CI @-@ ) in the ipilimumab group versus @ % ( @-@ ) in the placebo group .


The most common grade @-@ immune-related adverse events in the ipilimumab group were gastrointestinal ( @ -LSB- @ % -RSB- vs four -LSB- < @ % -RSB- in the placebo group ) , hepatic ( @ -LSB- @ % -RSB- vs one -LSB- < @ % -RSB- ) , and endocrine ( @ -LSB- @ % -RSB- vs none ) .


Adverse events led to discontinuation of treatment in @ ( @ % ) of @ patients who started ipilimumab ( @ -LSB- @ % -RSB- during the initial treatment period of four doses ) .


Five patients ( @ % ) died due to drug-related adverse events .


Five ( @ % ) participants died because of drug-related adverse events in the ipilimumab group ; three patients died because of colitis ( two with gastrointestinal perforation ) , one patient because of myocarditis , and one patient because of multiorgan failure with Guillain-Barr syndrome .


Adjuvant ipilimumab significantly improved recurrence-free survival for patients with completely resected high-risk stage III melanoma .


The adverse event profile was consistent with that observed in advanced melanoma , but at higher incidences in particular for endocrinopathies .


The risk-benefit ratio of adjuvant ipilimumab at this dose and schedule requires additional assessment based on distant metastasis-free survival and overall survival endpoints to define its definitive value .


To compare sedation outcomes for chloral hydrate ( CH ) and midazolam ( MD ) as sedative agents for diagnostic procedures in children .


A prospective , randomized , double-blinded study conducted between July @ and October @ , at the Pediatric Day Care Unit ( DCU ) , King Abdulaziz Medical City , Riyadh , Saudi Arabia .


After meeting the inclusion criteria and getting informed consent , patients were randomized , given the study drug , and monitored for sedation outcomes .


Two hundred and seventy-five patients who had @ sedation sessions for diagnostic procedures were included in the study .


Due to missing data , @ sedations were included in the final analysis ; @ in the CH and @ in the MD group .


Both groups were comparable with respect to demographic and baseline characteristics .


The CH compared to MD group , had a higher sedation success rate , shorter time to achieve sedation , shorter length of stay in DCU , and longer sedation duration .


In both study groups , patients who required a second dose tended to be older and heavier .


No major side effects were encountered .


The CH group had a significantly higher mean sedation scores at @ , @ , @ , and @ minutes .


Chloral hydrate compared to MD , had a shorter time to achieve sedation , a higher success rate , less need for a second dose , and decreased the time spent in the DCU .


Older and heavier patients are more likely to require a second dose of the study drug to be sedated .


Hapatitis B visus ( CHB ) - induced fibrosis is a precancerous condition of liver .


To explore the influence of Chongcao Preparation ( Chongcao Yigan Capsule ) on the function of intestinal flora and chemoprevention for patients with CHB-induced liver fibrosis .


A total of @ patients with CHB-induced liver fibrosis were randomly divided into control group treated with lamivudine ( LAM ) and research group added with Chongcao Yigan Capsule for totally @ weeks .


The changes of intestinal flora , secretory immunoglobin A ( SIgA ) , serum albumin ( ALB ) , prealbumin ( PALB ) , IgA and IgG at different time points in both groups were observed .


Before treatment , there was no significant difference between two groups in each index ( P > @ ) .


After treatment , the intestinal flora were evidently optimized in research group than treatment before ( P < @ or P < @ ) , and were apparently better than those in control group ( P < @ or P < @ ) ; SIgA was obviously increased and ALB , PALB , IgA and IgG were markedly improved in research group than treatment before ( P < @ or P < @ ) , and were significantly better than those in control group ( P < @ or P < @ ) .


Chongcao Yigan Capsule could regulate the intestinal flora , increase SIgA , serum ALB and PALB concentrations and significantly improve serum IgA and IgG as well as strengthen the immunological function and autologous repair capacity of patients with CHB-induced liver fibrosis .


Our objective was to evaluate the prevention of incisional hernia ( IH ) during the postoperative period of a midline laparotomy during elective surgery .


A controlled , prospective , randomized , and blind study was carried out .


The patients in group A ( mesh ) were fitted with a polypropylene mesh , to reinforce the standard abdominal wall closure .


The patients in group B ( non-mesh ) underwent a standard abdominal wall closure and were not fitted with the mesh .


In group A , @/@ his were diagnosed , whereas in group B the number was @/@ .


The Kaplan-Meier survival curves show that the likelihood of IH at @ months is @ % in group A compared with @ % in group B ( p < @ ) , which means that the differences are statistically significant .


Fitting a prophylactic supra-aponeurotic mesh prevents IH independently of other factors .


Ankle sprain is a frequently encountered traumatic injury in emergency departments and is associated with important health expenses .


However , the appropriate care of this traumatic injury remains a matter of debate .


We tested the hypothesis that compression stockings speed up recovery from ankle sprain .


Recent ( < @ hours ) cases of ankle sprain without other traumatic injury in patients aged between @ and @ years were included .


Patients were randomly allocated to placebo Jersey or class II compression stockings ( Venoflex ; Thuasne , Levallois-Perret , France ) .


The primary end point was the time to recovery of normal painless walking without requirement for analgesic drug .


Secondary end points were time to return to sport activity , pain , analgesic consumption , and ankle edema ( bimalleolar and midfoot circumferences ) .


We randomized @ patients and analyzed @ patients ( @ in the placebo group and @ in the compression group ) .


The median time to normal painless walking was not significantly decreased ( P = @ ) .


No significant differences were observed in pain , analgesic consumption , and bimalleloar and midfoot circumferences .


No safety issue was reported .


In the subgroup of patients with regular sport activity , the time to return to sport activity was shorter in patients treated with compression stockings ( P = @ ) .


Compression stockings failed to significantly modify the time to return to normal painless walking in ankle sprain .


A beneficial effect was observed only in a subgroup of patients , as compression stockings significantly decreased the time to return to sport activity .


With HIV treatment prolonging survival and HIV infection now managed as a chronic illness , quality of life ( QOL ) is important to evaluate in persons living with HIV ( PLWH ) .


We assessed at study entry the QOL of antiretroviral-nave PLWH with CD@ counts > @ cells/L in the Strategic Timing of AntiRetroviral Treatment ( START ) clinical trial .


QOL was assessed with : ( @ ) a visual analogue scale ( VAS ) for self-assessment of overall current health ; ( @ ) the Short-Form @-Item Version @ Health Survey ( ) ( SF-@V@ ) , for which responses are summarized into eight individual QOL domains plus component summary scores for physical health -LSB- the Physical Health Component Summary ( PCS ) -RSB- and mental health -LSB- the Mental Health Component Summary ( MCS ) -RSB- .


The VAS and eight domain scores were scaled from @ to @ .


Mean QOL measures were calculated overall and by demographic , clinical and behavioural factors .


A total of @ participants completed the VAS and @ the SF-@ .


The mean VAS score ( with standard deviation ) was @ .


Mean SF-@ domain scores were lowest for vitality ( @ ) and mental health ( @ ) , and highest for physical functioning ( @ ) and bodily pain ( @ ) .


Using multiple linear regression , PCS scores were lower ( P < @ ) for Asians , North Americans , female participants , older participants , and those with less education , longer duration of known HIV infection , alcoholism/substance dependence and body mass index @kg/m ( @ ) .


MCS scores were highest ( P < @ ) for Africans , South Americans and older participants , and lowest for female participants , current smokers and those with alcoholism/substance dependence .


In this primarily healthy population , QOL was mostly favourable , emphasizing that it is important that HIV treatments do not negatively impact QOL .


Self-assessed physical health summary scores were higher than mental health scores .


Factors such as older age and geographical region had different effects on perceived physical and mental health .


Mechanical chest compression devices have the potential to help maintain high-quality cardiopulmonary resuscitation ( CPR ) , but despite their increasing use , little evidence exists for their effectiveness .


We aimed to study whether the introduction of LUCAS-@ mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest .


The pre-hospital randomised assessment of a mechanical compression device in cardiac arrest ( PARAMEDIC ) trial was a pragmatic , cluster-randomised open-label trial including adults with non-traumatic , out-of-hospital cardiac arrest from four UK Ambulance Services ( West Midlands , North East England , Wales , South Central ) .


@ urban and semi-urban ambulance stations were selected for participation .


Clusters were ambulance service vehicles , which were randomly assigned ( @:@ ) to LUCAS-@ or manual CPR .


Patients received LUCAS-@ mechanical chest compression or manual chest compressions according to the first trial vehicle to arrive on scene .


The primary outcome was survival at @ days following cardiac arrest and was analysed by intention to treat .


Ambulance dispatch staff and those collecting the primary outcome were masked to treatment allocation .


Masking of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible .


The study is registered with Current Controlled Trials , number ISRCTN@ .


We enrolled @ eligible patients ( @ assigned to the LUCAS-@ group , @ assigned to the control group ) between April @ , @ and June @ , @ ( @ % ) patients in the LUCAS-@ group received mechanical chest compression , and @ ( < @ % ) patients in the control group received LUCAS-@ .


In the intention-to-treat analysis , @ day survival was similar in the LUCAS-@ group ( @ -LSB- @ % -RSB- of @ patients ) and in the manual CPR group ( @ -LSB- @ % -RSB- of @ patients ; adjusted odds ratio -LSB- OR -RSB- @ , @ % CI @-@ ) .


No serious adverse events were noted .


Seven clinical adverse events were reported in the LUCAS-@ group ( three patients with chest bruising , two with chest lacerations , and two with blood in mouth ) .


@ device incidents occurred during operational use .


No adverse or serious adverse events were reported in the manual group .


We noted no evidence of improvement in @ day survival with LUCAS-@ compared with manual compressions .


On the basis of ours and other recent randomised trials , widespread adoption of mechanical CPR devices for routine use does not improve survival .


The authors compared the reduction of migraine headache frequency , days , severity , and duration after surgical decompression versus avulsion of the zygomaticotemporal branch of the trigeminal nerve for treatment of temporal migraine headache .


Twenty patients with bilateral temporal migraine headache were randomized to undergo avulsion of the zygomaticotemporal branch of the trigeminal nerve on one side and decompression via fasciotomy and removal of the zygomaticotemporal artery on the other side .


Results were analyzed after a minimum of @ months of follow-up .


Nineteen patients completed the study .


The patients experienced greater than @ percent improvement in frequency , migraine days , severity , and duration in @ of the @ operative sites ( @ percent ) .


Complete elimination of symptoms was noted in @ of the @ operative sites ( @ percent ) .


In the decompression group , migraine frequency was reduced from @ to @ per month , migraine days from @ to @ , severity from @ to @ , duration from @ to @ hours , and Migraine Headache Index score from @ to @ .


In the neurectomy group , frequency decreased from @ to @ per month , migraine days from @ to @ , severity from @ to @ , migraine duration from @ to @ hours , and the Migraine Headache Index score from @ to @ .


There was no statistical significance in reduced migraine headache frequency , days , severity , and duration between the two groups .


Neurectomy and decompression of the zygomaticotemporal branch of the trigeminal nerve are both appropriate treatment for temporal migraine headache .


If decompression fails to provide sufficient relief , neurectomy is another option .


Therapeutic , I.


The success of ACL reconstruction is predicated on a variety of factors .


Tunnel placement plays one of the most significant roles in achieving knee kinematics and function .


The purposes of this study were to compare femoral tunnel position , angle , length and posterior wall blow-out after ACL reconstruction with hamstring tendons autograft through either a farmedial portal or an anteromedial portal technique .


We evaluated @ patients who underwent ACL reconstruction between January @ and July @ in our institute , in a prospective , randomised cohort study .


All the surgical procedures were performed by a sports fellowship-trained orthopaedic surgeon with experience in both portal reaming .


The operated knees were evaluated with @ mm fine CT scans of @-D CT between days @ and @ postoperatively .


According to the @-D CT measurements , the mean femoral tunnel length was significantly longer ( p < @ ) in the FAM group compared with the AM group .


The femoral bone tunnel length averaged @ @ mm versus @ @ mm ( p = @ ) in AM and the FAM groups , respectively .


The femoral tunnel position , as evaluated with use of the quadrant method , was more anterior in the FAM transportal technique group , and the difference between the two groups was significant ( p < @ ) .


FAM tranportal drilling of the femoral tunnel creates longer and anterior femoral tunnels with regard to the AM portal drilling techniques .


Additional studies with clinical outcomes are required for the clinical relevance of these techniques and to show which one is superior .


Level I , prospective randomised comparative cohort study .


Three-dimensional ( @D ) laparoscopes have been developed to maintain the perception of depth in the operating field .


Two-dimensional ( @D ) imaging relies on tactile feedback , visual cues , and previous experience .


The aim of this study was to test if @D laparoscopic vision is superior to @D laparoscopic vision in training novice operators in completing set laparoscopic tasks .


The study population consisted of @ interns and medical students .


The participants were randomized to completing tasks using a @D or @D system .


These included pegboard transfer ( PT ) , continuous suturing ( CS ) , and intracorporeal knot-tying ( IK ) .


The time to complete the task and number of errors made were recorded .


Following adjustment for potential confounders , time to complete CS and IK was significantly longer among participants who used the @D laparoscope compared with those who used the @D laparoscope ( CS , P < @ ; IK , P < @ ) .


This same effect was not demonstrated in time to perform PT ( PT , P = @ ) .


The @D laparoscope was associated with a significant increase in the number of errors on the IK task ( P < @ ) but not on the PT or CS tasks ( PT , P = @ ; CS , P = @ ) .


The @D system assists novice operators perform more complex laparoscopic tasks in a decreased amount of time and with fewer errors .


Office computer workers are at increased risk for neck/upper extremity ( UE ) musculoskeletal pain .


A seven-month office ergonomic intervention study evaluated the effect of two engineering controls plus training on neck/UE pain and mechanical exposures in @ computer workers , including a @-month follow-up period .


Participants were randomised into an intervention group , who received a keyboard/mouse tray ( KBT ) , touch pad ( TP ) for the non-dominant hand and keyboard shortcuts , and a control group who received keyboard shortcuts .


Participants continued to have available a mouse at the dominant hand .


Outcomes were pain severity , computer rapid upper limb assessment ( RULA ) , and hand activity level .


Prevalence ratios ( PRs ) evaluated intervention effects using dichotomised pain and exposure scores .


In the intervention group , the dominnt proximal UE pain PR = @ , @ % CI @ to @ and the dominant distal UE PR = @ , @ % CI @ to @ , postintervention .


The non-dominant proximal UE pain PR = @ , @ % CI @ to @ , while the non-dominant distal UE PR = @ , @ % CI @ to @ , postintervention .


Decreases in non-neutral postures were found in two RULA elements ( non-dominant UE PR = @ , @ % CI @ to @ and full non-dominant RULA PR = @ , @ % CI @ to @ ) of the intervention group .


Hand activity increased on the non-dominant side ( PR = @ , @ % CI @ to @ ) in this group .


While the intervention reduced non-neutral postures in the non-dominant UE , it increased hand activity in the distal region of this extremity .


To achieve lower hand activity , a KBT and TP used in the non-dominant hand may not be the best devices to use .


Brassica vegetable consumption may confer a protective effect against cancer , possibly attributable to their glucosinolates .


Glucobrassicin is a predominant glucosinolate and is the precursor of indole-@-carbinol ( I@C ) , a compound with anticancer effects .


However , objective assessments of I@C uptake from Brassica vegetables have not been successful .


We conducted a randomized , crossover trial to test whether @,@ ' - diindolylmethane ( DIM , a metabolite of I@C ) excreted in the urine after consumption of raw Brassica vegetables with divergent glucobrassicin concentrations is a marker of I@C uptake from such foods .


Twenty-five subjects were fed @ g of either raw `` Jade Cross '' Brussels sprouts ( high glucobrassicin concentration ) or `` Blue Dynasty '' cabbage ( low glucobrassicin concentration ) once daily for @ days .


All urine was collected for @ hours after vegetable consumption each day .


After a washout period , subjects crossed over to the alternate vegetable .


Urinary DIM was measured using a novel liquid chromatography-electrospray ionization-tandem mass spectrometry-selected reaction monitoring ( LC-ESI-MS/MS-SRM ) method with -LSB- ( @ ) H@ -RSB- DIM as internal standard .


Urinary DIM was consistently and significantly higher after Brussels sprouts feeding than after cabbage feeding , as evidenced by an average difference of @ pmol/mg creatinine ( @ % confidence interval , @-@ @ ; P = @ ) .


We have successfully quantified urinary DIM after uptake of I@C from food , and demonstrated that differences in glucobrassicin exposure are reflected in urinary DIM levels .


Our LC-ESI-MS/MS-SRM method and the results of our study indicate urinary DIM is a measure of I@C uptake from Brassica vegetables , a finding that can be utilized in prospective epidemiologic and chemoprevention studies .


This study seeks to investigate the effect of electrical stimulation ( ES ) at dorsal root ganglion ( DRG ) on disuse bone loss in a rat model .


Hindlimb unloading for @ days resulted in significant bone loss in rat tibia while rats with ES at DRG showed a significant reduced bone loss


Mechanical unloading induces osteoporosis in both human and animals .


Previous studies demonstrated that electrical stimulation ( ES ) to dorsal root ganglion ( DRG ) could trigger secretion of calcitonin gene-related peptide ( CGRP ) which plays an important role in bone modeling and remodeling .


This study seeks to investigate the effect of ES to DRG on disuse bone loss in a rat model .


Twenty-four rats were randomly assigned in three experimental groups : cage control ( CC ) , hindlimb unloading ( HU ) , and hindlimb unloading with ES ( HUES ) .


ES was applied via implantable micro-electrical stimulators ( IMES ) to right DRGs at vertebral levels L@-L@ in HUES group .


Hindlimb unloading for @ days resulted in @ % decrease in total bone mineral content ( BMC ) , @ % decrease in trabecular BMD and trabecular microarchitecture and connectivity were significantly deteriorated in the proximal tibia metaphysis in HU group , while rats with ES at DRG showed significant reduced bone loss that there was @ % increase in total BMC , @ % decrease in trabecular BMD , and significant improvement in trabecular microarchitecture .


There was a concurrent enhancement of expression of CGRP in stimulated DRGs .


The results confirm the effect of ES at DRG on enhancing CGRP expression and suggest potential applications of IMES for the prevention and treatment of disuse bone loss .


To assess the anti-plaque and anti-gingivitis effects of a dentifrice containing @ % triclosan , @ % copolymer and @ % ( @,@ ppm ) sodium fluoride in subjects with moderate plaque-induced gingivitis .


This was a single center , monadic study .


Subjects had at least @ teeth remaining in the functional dentition , excluding third molars .


Following a baseline examination for plaque , gingival inflammation and bleeding , @ qualified healthy adult males and females , ages @-@ were selected to participate in the study .


Dental prophylaxis was performed and subjects were provided with two tubes of toothpaste ( Colgate Total ) and a soft-bristle toothbrush ( Colgate Wave Toothbrush ) .


The subjects were instructed to brush twice daily using a modified Bass brushing technique .


At the end of the @ - to @-week period subjects returned for collection of clinical and subjective data .


@ subjects completed the study .


Both clinical and subjective reductions were significant .


The results showed statistically significant reductions in plaque index , gingival inflammation and bleeding on probing .


The overall conclusion was that Colgate Total was a comprehensive dentifrice that produced a significant reduction in gingivitis , plaque , and bleeding .


Antimicrobial-induced thrombocytopenia is frequently described in the literature among critically ill patients .


Several antimicrobials have been implicated , although experimental evidence to demonstrate causality is limited .


We report , using a randomized trial , the potential of antimicrobials to induce thrombocytopenia .


Randomized trial allocated patients to antimicrobial treatment according to standard - of-care ( SOC group ) or drug-escalation in case of procalcitonin increases ( high-exposure group ) .


Patients were followed until death or day @ .


Thrombocytopenia defined as absolute ( platelet count @ x @/L ) or relative ( @ % decrease in platelet count ) .


Analyses were performed in the two randomized groups and as a merged cohort .


Of the @ patients with platelet data available , @ % had absolute thrombocytopenia within the first @ hours after admission to intensive care unit and additional @ % developed this complication during follow-up ; @ % developed relative thrombocytopenia during follow-up .


Absolute and relative thrombocytopenia day @-@ was associated with increased mortality ( HR : @ -LSB- @ % CI : @ to @ -RSB- ; @ -LSB- @ % CI : @ to @ -RSB- , P < @ , respectively ) .


Patients in the high-exposure group received more antimicrobials including piperacillin/tazobactam , meropenem and ciprofloxacin compared with the SOC group , whereas cefuroxime was used more frequently in the SOC group ( p < @ ) .


Risk of absolute and relative thrombocytopenia ( RR : @ -LSB- @-@ @ -RSB- , p = @ ; @ -LSB- @-@ @ -RSB- , p = @ ; respectively ) , as well as absolute platelet count ( daily difference , high-exposure vs. SOC -@ -LSB- -@ -@ -RSB- , p = @ ) was comparable between groups .


In observational analyses , use of ciprofloxacin and piperacillin/tazobactam predicted risk of relative thrombocytopenia ( vs. cefuroxime , RR : @ -LSB- @-@ @ -RSB- ; @ -LSB- @-@ @ -RSB- , respectively ) , however only ciprofloxacin were associated with a reduction in absolute platelet count ( p = @ ) .


High exposure to broad-spectrum antimicrobials does not result in a reduction in thrombocytopenia in critically ill patients .


However , single use of ciprofloxacin , and less so piperacillin/tazobactam , may contribute to a lower platelet count .


Severe anemia ( SA , hemoglobin < @ g/dl ) is a leading cause of pediatric hospital admission in Africa , with significant in-hospital mortality .


The underlying etiology is often infectious , but specific pathogens are rarely identified .


Guidelines developed to encourage rational blood use recommend a standard volume of whole blood ( @ ml/kg ) for transfusion , but this is commonly associated with a frequent need for repeat transfusion and poor outcome .


Evidence is lacking on what hemoglobin threshold criteria for intervention and volume are associated with the optimal survival outcomes .


We evaluated the safety and efficacy of a higher volume of whole blood ( @ ml/kg ; Tx@ : n = @ ) against the standard volume ( @ ml/kg ; Tx@ : n = @ ) in Ugandan children ( median age @ months ( interquartile range ( IQR ) @ to @ ) ) for @-hour anemia correction ( hemoglobin > @ g/dl : primary outcome ) and @-day survival .


Median admission hemoglobin was @ g/dl ( IQR @ to @ ) .


Initial volume received followed the randomization strategy in @ ( @ % ) patients .


By @-hours , @ ( @ % ) children in the Tx@ arm had corrected SA compared to @ ( @ % ) in the Tx@ arm ; cause-specific hazard ratio = @ ( @ % confidence interval @ to @ , P = @ ) .


From admission to day @ there was a greater hemoglobin increase from enrollment in Tx@ ( global P < @ ) .


Serious adverse events included one non-fatal allergic reaction and one death in the Tx@ arm .


There were six deaths in the Tx@ arm ( P = @ ) ; three deaths were adjudicated as possibly related to transfusion , but none secondary to volume overload .


A higher initial transfusion volume prescribed at hospital admission was safe and resulted in an accelerated hematological recovery in Ugandan children with SA .


Future testing in a large , pragmatic clinical trial to establish the effect on short and longer-term survival is warranted .


The objective of this study was to test the hypothesis that topical tetracaine would be safe to use for @ hours and would not affect corneal healing , that patients would experience more pain relief , and that patients would perceive tetracaine to be more effective than saline eye drops for the treatment of pain caused by corneal abrasions .


The study was a @-month , prospective , double-blind , randomized trial of tetracaine versus saline set in the emergency department ( ED ) of a regional tertiary care teaching hospital .


A total of @ patients presenting with uncomplicated corneal abrasions were included in this study .


The intervention was either undiluted , preservative-free , topical tetracaine hydrochloride @ % or saline , applied up to every @ minutes while awake for @ hours .


Main safety outcome measures were repeat ED examinations at @ hours with fluorescein staining and slit-lamp examination , @-week and @-month telephone interviews with additional examinations as needed , and monitoring of charts for complications .


Secondary outcome measures were @-mm visual analogue scale ( VAS ) pain scores recorded every @ hours while awake for @ hours and patient-perceived overall effectiveness using a numeric rating scale ( NRS ) of @ to @ obtained during telephone interviews .


At least one follow-up encounter was completed on each of the @ patients .


No complications specifically attributed to topical anesthetic use occurred in the @ patients in the tetracaine group , and the binomial probability confidence interval ( CI ) of this occurring is @ to @ .


There was no significant difference in corneal healing as measured by the percentage of patients with persistent fluorescein uptake at @ hours between the two groups ( @ % vs. @ % , difference = @ % , @ % CI = -@ % to @ % , p = @ ) or persistent symptoms at @ hours ( @ % vs. @ % , difference = @ % , @ % CI = -@ % to @ % , p = @ ) .


There was no clinical difference in VAS pain scores between the groups .


Patients in the tetracaine group rated the study drugs ' overall effectiveness significantly higher on the NRS ( @ vs. @ ) compared to patients in the saline group ( difference = @ , @ % CI = @ to @ , p < @ ) .


Topical tetracaine used for @ hours is safe , and while there was no significant difference in patient VAS pain ratings over time , patient surveys on overall effectiveness showed that patients perceived tetracaine to be significantly more effective than saline .


Food insecurity is associated with deficits in child development and health , but little is known about how children 's specific food-insecurity experiences play out through nutritional and non-nutritional pathways that may compromise well-being .


This study used child self-reports of food insecurity to examine the types of food-insecurity experiences that were most prevalent and the relations between child food insecurity ( CFI ) , child diet , and child physical activity ( PA ) .


A total of @ fourth - and fifth-grade children whose schools participated in the Network for a Healthy California-Children 's PowerPlay !


campaign completed @-h diary-assisted recalls and surveys including items from the Child Food Security Assessment and questions about PA. .


Data were analyzed by using regression and logistic regression models .


CFI was present in @ % of the children and included experiences of cognitive , emotional , and physical awareness of food insecurity .


Greater levels of CFI were associated with higher consumption of energy , fat , sugar , and fiber and a diet lower in vegetables .


For instance , a child at the highest level of CFI , on average , consumed @ kJ/d ( @ kcal ) , @ g/d of sugar , and @ g/d of fat more than a food-secure child .


Higher CFI was associated with a marginally significant difference ( P = @ ) in minutes of PA ( @ min/d less for children at the highest level of CFI vs. those who were food secure ) and with significantly greater perceived barriers to PA. .


CFI is a troublingly frequent , multidomain experience that influences children 's well-being through both nutritional ( dietary ) and non-nutritional ( e.g. , PA ) pathways .


CFI may lead to poor-quality diet and less PA and their developmental consequences .


Practitioners should consider CFI when assessing child health and well-being and can do so by asking children directly about their CFI experiences .


Prenatal supplementation with docosahexaenoic acid ( DHA ) has been shown to increase birth size , but it is unclear whether these differences translate into improved postnatal growth .


We assessed the effect of prenatal supplementation with DHA on offspring weight , length , and body mass index ( BMI ) through @ mo of age .


We examined growth patterns ( height , weight , and BMI ) in a cohort of @ Mexican children whose mothers participated in a randomized , controlled trial of daily supplementation with @ mg/d of DHA or a placebo from week @-@ of gestation through delivery , with the use of a longitudinal multilevel model of growth .


Overall , means SDs of height - , weight - , and BMI-for-age z scores relative to WHO growth standards at @ mo were -@ @ , -@ @ and @ @ , respectively .


There were no significant differences by treatment group ( all P > @ ) for height , weight , or BMI at any age through @ mo. .


Similarly , DHA did not affect the average growth or the trajectories for these measures through @ mo. .


Prenatal DHA supplementation did not affect height , weight , or BMI through @ mo of age .


This trial was registered at clinicaltrials.gov as NCT@ .


This study investigates the clinical effects of autologous conditioned plasma ( ACP ) injections and low-level laser application as therapy options for chronic lateral epicondylitis .


A total of @ patients with chronic lateral epicondylitis were evaluated in this study ; @ of these patients received three ACP injections and the control group , with @ patients , received @ laser applications , with standardized physical therapy for all patients afterward .


Control examinations took place before treatment , after @ and @ mos , and in the @ yr final follow-up .


The control examination included the visual analog scale for pain and Disabilities of the Arm , Shoulder and Hand outcome measure scores .


The analysis at final follow-up after @ yr showed that both treatment options resulted in successful therapy outcome for the patients .


In total , @ % were successfully treated .


Successful treatment was defined as more than @ % improvement in the visual analog score and more than @ points in the Disabilities of the Arm , Shoulder and Hand score .


Both groups showed a significant improvement in time response .


This study demonstrates the beneficial effects of autologous proliferative therapies in the treatment of lateral epicondylitis .


The data show that laser application and ACP therapy lead to a clinical improvement in epicondylopathia .


Especially the new treatment with ACP can be highlighted as an alternative and as an easy-to-apply therapy option for clinical practice .


The purpose of the present study was to evaluate the effects of superimposed electromyostimulation ( E ) during cycling on myokines and markers of muscle damage , as E might be a useful tool to induce a high local stimulus to skeletal muscle during endurance training without performing high external workloads .


@ subjects participated in three experimental trials each lasting @ min in a randomized order .


@ ) Cycling ( C ) , @ ) Cycling with superimposed E ( C+E ) and @ ) E. Interleukin-@ ( IL-@ ) , brain-derived neurotrophic factor ( BDNF ) , creatine kinase ( CK ) and myoglobin were determined before ( pre ) and @ ' , @ ' , @ ' , @ ' and @h after each intervention .


Only C+E caused significant increases in levels of CK and myoglobin .


BDNF and IL-@ significantly increased after C and C+E , however increases for IL-@ were significantly higher after C+E compared to C.


The present study showed that superimposed E during cycling might be a useful tool to induce a high local stimulus to skeletal muscle even when performing low to moderate external workloads .


This effect might be due the activation of additional muscle fibers and mild eccentric work due to the concomitant activation of agonist and antagonist .


However the higher load to skeletal muscle has to be taken into account .


Energy drinks are beverages containing vasoactive metabolites , usually a combination of caffeine , taurine , glucuronolactone and sugars .


There are concerns about the safety of energy drinks with some countries banning their sales .


We determined the acute effects of a popular energy drink , Red Bull , on cardiovascular and hemodynamic variables , cerebrovascular parameters and microvascular endothelial function .


Twenty-five young non-obese and healthy subjects attended two experimental sessions on separate days according to a randomized crossover study design .


During each session , primary measurements included beat-to-beat blood pressure measurements , impedance cardiography and transcranial Doppler measurements for at least @min baseline and for @h following the ingestion of either @mL of the energy drink or @mL of tap water ; the endothelial function test was performed before and two hours after either drink .


Unlike the water control load , Red Bull consumption led to increases in both systolic and diastolic blood pressure ( p < @ ) , associated with increased heart rate and cardiac output ( p < @ ) , with no significant changes in total peripheral resistance and without diminished endothelial response to acetylcholine ; consequently , double product ( reflecting myocardial load ) was increased ( p < @ ) .


Red Bull consumption also led to increases in cerebrovascular resistance and breathing frequency ( p < @ ) , as well as to decreases in cerebral blood flow velocity ( p < @ ) and end-tidal carbon dioxide ( p < @ ) .


Our results show an overall negative hemodynamic profile in response to ingestion of the energy drink Red Bull , in particular an elevated blood pressure and double product and a lower cerebral blood flow velocity .


While darbepoetin alfa ( DA ) can be administered once monthly ( QM ) to maintain haemoglobin ( Hb ) concentrations in anaemic patients with chronic kidney disease not on dialysis ( CKD-ND ) , the QM use of DA for anaemia correction has not been previously investigated .


In this randomized , double-blind , non-inferiority , active-controlled study , adult subjects with CKD-ND , Hb levels < @g/dL , and not treated with an erythropoiesis-stimulating agent were randomized @:@ to receive DA every @ weeks ( Q@W ) or QM for @ weeks with initial doses of @ g/kg Q@W or @ g/kg QM .


Subjects were treated to target Hb levels of @-@g / dL and @g/dL increase from baseline .