We sought to quantify a simulated edema-induced pressure within a fiberglass short arm cast and to determine the effectiveness of different cast-cutting methods for pressure reduction .


We hypothesized that cast cutting could eliminate all clinically relevant pressure and Ace wrap would insignificantly increase pressure .


Skin surface pressure under fiberglass short arm casts was measured on ninety wrists from forty-five volunteers randomly assigned to one cast-cutting method : single-cut ( cast bivalve and Ace wrap ) , double-cut ( cast bivalve , spread , and Ace wrap ) , or triple-cut ( cast bivalve , spread , Webril cut , and Ace wrap ) .


Each wrist was immobilized in a cast in the neutral position with one roll of @-inch ( @-cm ) cotton Webril and one roll of @-inch ( @-cm ) fiberglass .


Each fiberglass short arm cast contained an empty intravenous fluid bag in which we infused air .


This simulated edema , which generated a skin surface pressure , which was measured by a pressure transducer .


Each cast-cutting method significantly reduced ( p < @ ) the skin surface pressure from the average maximum of @ mm Hg in a non-fracture setting .


Prior to Ace wrapping , there was a reduction in skin surface pressure of @ % for the single-cut method , @ % for the double-cut method , and @ % for the triple-cut method .


Ace wrap significantly increased skin surface pressure ( p < @ ) , lessening the effectiveness of cast cutting .


There was an overall reduction in skin surface pressure of @ % for the single-cut method , @ % for the double-cut method , and @ % for the triple-cut method .


Throughout our study , women had significantly higher skin surface pressure than men ( p < @ ) ; the average maximum was @ mm Hg for women and @ mm Hg for men .


The single-cut method provides the greatest pressure reduction , but only the triple-cut method eliminated all relevant skin surface pressure .


Ace wrapping a cut cast noticeably increased skin surface pressure .


In volunteers without a fracture , only the triple-cut method is effective enough to eliminate clinically relevant skin surface pressure .


Ace wrap should be applied with caution after the cast is cut .


The specific effect on pressure reduction in a patient who requires some soft-tissue pressure to maintain fracture reduction was not studied .


To observe the efficacy of Danzhi Xiaoyao Pill ( DXP ) in anovulation infertility patients with polycystic ovary syndrome ( PCOS ) of pathogenic fire derived from stagnation of Gan-qi ( PFDSG ) complicated insulin resistance ( IR ) .


Sixty PCOS patients were randomly assigned to two group , the integrative medical treatment group ( Group A ) and the Western medical treatment group ( Group B ) , @ cases in each group .


All patients took Metformin and Diane-@ .


Those in Group A took DXP additionally .


The therapeutic course for all was @ menstrual cycles .


After treatment the ovulation was induced by oral administration of letrozole or injection of menotropins ( HMG ) .


The therapeutic efficacy was compared between the two groups .


The levels of insulin , luteinizing hormone , and testosterone were obviously lower after treatment than before treatment in the two groups ( P < @ ) .


There was no statistical difference between the two groups after treatment .


There was no statistical difference in body mass index ( BMI ) between the two groups before and after treatment ( P > @ ) .


Better effects were obtained in Group A in improving symptoms such as agitation and irritability , fullness in the chest and hypochondrium , swollen pain in the breast before menstruation , bitter and dry mouth , oligomenorrhea , abnormal color and amount of menstruation , and pulse and tongue ( P < @ , P < @ ) .


The ovulation rate was @ % ( @/@ cases ) in Group A , obviously higher than that in Group B ( @ % , @/@ cases ) .


The clinical pregnancy rate was @ % ( @/@ cases ) in Group A , obviously higher than that in Group B ( @ % , @/@ cases ) , showing statistical difference ( P < @ ) .


DXP could improve the ovulation rate and the pregnancy rate in anovulation infertility patients with PCOS complicated IR .


It also could significantly improve Chinese medical syndromes , showing obvious advantages over using Western medicine alone .


Thoracentesis is one of the bedside procedures most commonly associated with iatrogenic complications , particularly pneumothorax .


Various risk factors for complications associated with thoracentesis have recently been identified , including an inexperienced operator ; an inadequate or inexperienced support team ; the lack of a standardized protocol ; and the lack of ultrasound guidance .


We sought to determine whether ultrasound-guided thoracentesis can reduce the risk of pneumothorax and improve outcomes ( fewer procedures without fluid removal and greater volumes of fluid removed during the procedures ) .


In our comparison of thoracentesis with and without ultrasound guidance , all procedures were performed by a team of expert pulmonologists , using the same standardized protocol in both conditions .


A total of @ participants were randomly allocated to undergo thoracentesis with or without ultrasound guidance ( n = @ per group ) .


The primary outcome was pneumothorax following thoracentesis .


Secondary outcomes included the number of procedures without fluid removal and the volume of fluid drained during the procedure .


Pneumothorax occurred in @ of the @ patients who underwent ultrasound-guided thoracentesis and in @ of the @ patients who underwent thoracentesis without ultrasound guidance , the difference being statistically significant ( p = @ ) .


Fluid was removed in @ of the @ procedures performed with ultrasound guidance and in @ of the @ procedures performed without it .


The mean volume of fluid drained was larger during the former than during the latter ( @ @ mL vs. @ @ mL ) , the difference being statistically significant ( p = @ ) .


Ultrasound guidance increases the yield of thoracentesis and reduces the risk of post-procedure pneumothorax .


( Chinese Clinical Trial Registry identifier : ChiCTR-TRC-@ -LSB- http://www.chictr.org/en/] ) .


To assess the efficacy of intra-articular sodium hyaluronate , administred once weekly for @ weeks ( @ injections ) in Moroccan patients with knee osteoarthritis over @-month period .


We prospectively studied the outcome of @ patients with painful knee osteoarthritis in grade @ , @ and @ on ACR radiological criteria in our rheumatology clinic in Morocco .


Group @ : @ patients were treated with @-weekly injections of intra-articular sodium hyaluronate ( @ % ; @,@-@ ,@ MDa ) .


Group @ : @ patients treated with symptomatic slow-acting drugs for osteoarthritis ( SYSADOA ) .


The efficacy parameters were Visual Analogue Scale ( VAS ) and Lequesne index .


In group @ : @/@ were female , a mean age of patients was @ ( @ ) years , and a mean Body Mass Index ( BMI ) was @ ( @ ) kg/m@ .


In group @ : @/@ were female , a mean age of patients was @ ( @ ) years , and a mean of BMI was @ ( @ ) kg/m@ .


Before treatment in group @ , the mean of VAS was @ cm ( @ ) , and of Lequesne index @ ( @ ) .


At @ and @ months after the third injection of sodium hyaluronate , there was a significant improvement from baseline of Lequesne index and VAS ( P = @ ) .


In group @ before treatment , the mean of VAS was @ cm ( @,@ ) , and of Lequesne index @ ( + @ ) , but the improvement from baseline at @ and @ months of treatment was lower than group @ .


The results of this prospective study , showed the efficacy of @-weekly injections of sodium hyaluronate in the treatment of knee osteoarthritis in Moroccan patients over a @-month period .


The aim of this study was to evaluate the effects of a standardized exercise program on sports enjoyment and leisure-time spending in adolescents with congenital heart disease and to know what the moderating impact of their baseline health behavior and disease knowledge is .


Included were @ patients , aged @ to @ , with surgical repair for tetralogy of Fallot or with a Fontan circulation for single-ventricle physiology , of @ participating centers of pediatric cardiology in The Netherlands .


They were randomly allocated , stratified for age , gender , and type of congenital heart disease to a @-week period with either : ( @ ) three times per week standardized exercise training or ( @ ) care as usual ( randomization ratio @:@ ) .


At baseline and after @ weeks , participants completed Web-based questionnaires and were interviewed by phone .


Primary analyses tested changes from baseline to follow-up in sports enjoyment and leisure-time spending in the exercise group vs. control group .


Secondary analyses concerned the moderating influence of baseline health behavior and disease knowledge on changes from baseline to follow-up , and comparison with normative data .


At follow-up , the exercise group reported a decrease in passive leisure-time spending ( watching television and computer usage ) compared with controls .


Exercise training had no effect on sports enjoyment and active leisure-time spending .


Disease knowledge had a moderating effect on improvement in sports enjoyment , whereas health behavior did not .


Compared with normative data , patients obtained similar leisure time scores and lower frequencies as to drinking alcohol and smoking .


Exercise training decreased passive , but not active , leisure-time spending .


It did not influence sports enjoyment .


A recent randomized trial demonstrated that concurrent chemoradiotherapy ( CCRT ) with weekly cisplatin and gemcitabine , followed by two adjuvant cycles of cisplatin and gemcitabine improved survival for advanced cervical cancer patients .


An Asian Gynecologic Oncology Group ( AGOG ) study was designed to determine whether only adding gemcitabine in the chemoradiation phase without adjuvant chemotherapy could improve survival .


Between March @ and March @ , @ eligible patients with International Federation of Obstetrics and Gynecology stage III/IVA cervical cancer or stage I/II with positive pelvic/para-aortic nodal metastasis were enrolled .


Thirty-seven patients were randomized to arm C ( weekly cisplatin @mg/m ( @ ) ) and @ patients were randomized to arm CG ( weekly cisplatin @mg/m ( @ ) and gemcitabine @mg/m ( @ ) ) , for six cycles .


Six eligible patients were excluded before the beginning of treatment .


An interim analysis showed superimposable progression-free ( PFS ) and overall survival ( OS ) , a decision of closing accrual was made .


A @-year PFS was similar in both arms ( arm C @ % vs. arm CG @ % , p = @ ) , and a @-year OS was @ % in arm C vs. @ % in arm CG ( p = @ ) , but crossed over at @years .


Grade @-@ hematological toxicities , including neutropenia ( p = @ ) and thrombocytopenia ( p = @ ) , were more frequent in arm CG than arm C.


Despite limitation in power , it suggests that only adding gemcitabine at the CCRT phase does not provide substantially superior results , but treatment toxicities could increase .


Further studies are required to determine the role of post-CCRT adjuvant chemotherapy in advanced cervical cancer .


Coformulated elvitegravir , cobicistat , emtricitabine , and tenofovir disoproxil fumarate ( tenofovir ) might be a safe and efficacious switch option for virologically suppressed patients with HIV who have neuropsychiatric side-effects on a non-nucleoside reverse transcriptase inhibitor ( NNRTI ) or who are on a multitablet NNRTI-containing regimen and want a regimen simplification .


We assessed the non-inferiority of such a switch compared with continuation of an NNRTI-containing regimen .


STRATEGY-NNRTI is a @ week , international , multicentre , randomised , open-label , phase @b , non-inferiority trial enrolling adults ( @ years ) with HIV-@ and plasma HIV RNA viral load below @ copies per mL for at least @ months on an NNRTI plus emtricitabine and tenofovir regimen .


With a computer-generated randomisation sequence , we randomly allocated participants ( @:@ ; blocks of six , stratified by efavirenz use at screening ) to switch to coformulated elvitegravir , cobicistat , emtricitabine , and tenofovir ( switch group ) or continue the NNRTI plus emtricitabine and tenofovir regimen ( no-switch group ) .


Key eligibility criteria included no history of virological failure and an estimated glomerular filtration rate of @ mL per min or greater .


The primary endpoint was the proportion of participants with plasma viral loads below @ copies per mL at week @ based on a snapshot algorithm with a non-inferiority margin of @ % ( assessed by modified intention to treat ) .


This trial is ongoing and is registered at ClinicalTrials.gov , number NCT@ .


Between Dec @ , @ , and Dec @ , @ , we randomly allocated @ participants to treatment : @ participants in the switch group and @ participants in the no-switch group received treatment and were included in the modified intention-to-treat population .


At week @ , @ ( @ % ) of @ participants in the switch group and @ ( @ % ) of @ participants in the no-switch group maintained plasma viral loads below @ copies per mL ( difference @ % , @ % CI -@ to @ ; p = @ ) .


We detected no treatment-emergent resistance in either group .


Safety events leading to discontinuation were uncommon in both groups : six ( @ % ) of @ participants in the switch group and one ( @ % ) of @ in the no-switch group .


Coformulated elvitegravir , cobicistat , emtricitabine , and tenofovir seems to be efficacious and well tolerated in virologically suppressed adults with HIV and might be a suitable alternative for patients on an NNRTI with emtricitabine and tenofovir regimen considering a regimen modification or simplification .


To observe the effect of xuebijing Injection ( XI ) on perioperative coagulation and inflammatory reaction in senile patients receiving total hip arthroplasty ( THA ) .


Totally eighty patients receiving THA at Luoyang Orthopedics Hospital , @ to @ years old , were randomly assigned to the control group ( @ cases ) and the treatment group ( @ cases ) .


All patients received routine perioperative therapies .


Those in the treatment group received XI ( adding @ mL XI in @ mL normal saline , @ min each time ) .


XI was continually injected after THA , twice daily for @ successive days .


Blood samples were harvested on the morning of the @nd admission day ( TO ) , immediately after operation ( T@ ) , on the morning of the @rd day after operation ( T@ ) , and on the morning of the @th day after operation ( T@ ) to detect prothrombin time ( PT ) , thrombin time ( TT ) , activated partial thromboplastin time ( APTT ) , levels of FIB and D-dimer ( D-D ) , changes of white blood cell ( WBC ) , neutrophils ( N ) , C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR ) , and IL-@ .


Complications of surgery were compared between the two groups .


There was no statistical difference in operation time , intraoperative blood loss , and blood transfusion between the two groups ( P > @ ) .


Compared with TO in the same group , WBC , N , CRP , ESR , IL-@ , PT , TT , and D-D all increased in the control group at T@-T@ ( P < @ ) ; APTT increased at T@-T@ ( P < @ ) ; FIB increased at T@-T@ ( P < @ ) .


WBC , N , IL-@ , PT , and D-D all increased in the treatment group at T@-T@ ( P < @ ) ; CRP and ESR increased at T@-T@ ( P < @ ) ; TT increased at T@-T@ ( P < @ ) ; APTT and FIB increased at T@ ( P < @ ) .


Compared with the control group at the same time period , WBC , N , CRP , and IL-@ all decreased in the treatment group at T@-T@ ( P < @ ) , ESR decreased at T@-T@ ( P < @ ) ; PT and TT decreased at T@-T@ ( P < @ ) ; FIB and D-D decreased at T@-T@ ( P < @ ) .


The occurrence of each complication was significantly lower in the treatment groups than in the control group .


XI could improve the perioperative high coagulation state of senile THA patients , inhibit inflammatory reactions , and reduce complications .


The purpose of this study was to evaluate the @-year follow-up ( FU ) data of the THUNDER ( Local Taxan With Short Time Contact for Reduction of Restenosis in Distal Arteries ) .


The THUNDER trial was the first study to investigate the treatment of femoropopliteal arteries with a paclitaxel-coated balloon ( PCB ) .


In @ patients , femoropopliteal arteries were treated with PCB , with angioplasty with paclitaxel in contrast medium , or no paclitaxel ( control ) .


The primary endpoint was @-month late lumen loss ( LLL ) .


Secondary endpoints included freedom from target lesion revascularization ( TLR ) , binary restenosis rate , and amputation .


The @-year FU compares outcomes in patients treated with PCB and control subjects .


Additionally , LLL at @ months and TLR up to @-year FU were analyzed in terms of sex and lesion length .


Over the @-year period , the cumulative number of patients with TLR remained significantly lower in the PCB group ( @ % ) than in the control group ( @ % , p = @ ) .


In the small group of patients with angiographic and duplex sonographic follow-up , PCB was associated with a lower rate of binary restenosis ( @ % vs. @ % ; p = @ ) .


No signs of aneurysm formation or constrictive fibrosis were detected .


Whereas LLL at @-month FU did not differ between men and women in the PCB group , the TLR rate was lower in men than in women at @-year FU .


A benefit of PCB treatment in terms of LLL and TLR was seen independent of lesion length .


The reduced TLR rate following PCB treatment was maintained over the @-year FU period .


No signs of drug-related local vessel abnormalities were detected .


( Thunder Trial-Local Taxan With Short Time Contact for Reduction of Restenosis in Distal Arteries -LSB- THUNDER -RSB- ; NCT@ ) .


Evaluate efficacy/safety of olmesartan medoxomil ( OM ) / amlodipine ( AML ) / hydrochlorothiazide ( HCTZ ) in Hispanic/Latino adults with hypertension .


Randomized , double-blind , @-week , parallel-group study followed by a @-week open-label extension phase .


Clinical sites ( @ ) in the United States and Puerto Rico .


Individuals > or = @ years of age with mean seated blood pressure ( BP ) > or = @/@ or > or = @/@ mm Hg divided into Hispanic/Latino ( @ ) and non-Hispanic/Latino ( @ ) subgroups .


Participants were randomized to OM @/AML @ mg , OM @/HCTZ @ mg , AML @/HCTZ @ mg , or OM @/AML @/HCTZ @ mg during the double-blind phase .


During the open-label extension , all participants received OM @/AML @/HCTZ @ mg ; participants not reaching BP goal within @ weeks were randomly titrated to OM @/AML @/HCTZ @ mg or OM @/AML @/HCTZ @ mg , then to OM @/AML @ / HCTZ @ mg after another @ weeks .


Change in mean seated diastolic BP ( SeDBP ) from baseline ( double-blind phase ) .


Triple-drug therapy vs the dual therapies resulted in greater mean reduction in SeBP ( Hispanic/Latino : @ / @ mm Hg vs @-@ @ / @-@ @ mm Hg ; non-Hispanic/Latino : @ / @ mm Hg vs @-@ @ / @-@ @ mm Hg ) and enabled more participants to reach BP goal ( Hispanic/Latino : @ % vs @ % -@ % ; non-Hispanic/Latino : @ % vs @ % -@ % ) irrespective of ethnicity .


The efficacy of triple-drug therapy in achieving BP goal was sustained long-term ( @-week open-label extension period ) in Hispanic/Latino ( @ % ) and non-Hispanic / Latino ( @ % ) participants .


Triple-drug therapy was well tolerated in Hispanic/Latino and non-Hispanic/Latino participants .


In this study , OM/AML/HCTZ was an effective treatment option in Hispanic / Latino patients with hypertension .


Schizophrenia is understood to be a heterogeneous brain condition with overlapping symptom dimensions .


The negative symptom dimension , with its protean cognitive manifestations , responds poorly to treatment , which can be a particular challenge in countries where clozapine therapy is not available .


Preliminary data indicate that minocycline may be beneficial adjunct in the treatment of schizophrenia : positive , negative , and cognitive symptoms.In this study we aim to assess the efficacy of adjunctive minocycline to alleviate symptoms of schizophrenia in patients who have failed to respond to a therapeutic trial of antipsychotic medications .


The study is a parallel group , double-blind , randomized , placebo-controlled trial .


Participants will be adults ( aged @ years and above ) with first episode or relapse episode of schizophrenia of under @ years ' duration .


Patients who failed to show adequate therapeutic response to at least one antipsychotic medication given for a minimum of @ weeks will be recruited from a psychiatry hospital in Addis Ababa and a psychiatry clinic in Butajira , Ethiopia .


A total of @ participants ( @ in each arm ) will be required to detect a five-point mean difference between the intervention arms adjusting for baseline symptom severity , at @ % power and @ % confidence .


Patients in the intervention arm will receive minocycline ( @ mg/day orally ) added on to the regular antipsychotic medications participants are already on .


Those in the placebo arm will receive an inactive compound identical in physical appearance to minocycline .


Intervention will be offered for @ weeks .


Diagnosis will be established using the operational criteria for research ( OPCRIT ) .


Primary outcome measure will be a change in symptom severity measured using the positive and the negative syndrome scale for schizophrenia ( PANSS ) .


Secondary outcome measures will include changes in severity of negative symptoms , proportion achieving remission , and level of functioning .


Whether changes are maintained post intervention will also be measured ( PANSS ) .


Key assessment for the primary outcome will be conducted at the end of trial ( week @ ) .


One post-intervention assessment will be conducted @ weeks after the end of intervention ( week @ ) to determine sustainability of change .


Owing to the great absorption capability of the pleura for transudates , the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal .


In an a priori pilot study , we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies .


Thus , chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak .


This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy .


Seventy-two consecutive patients undergoing straightforward lobectomy were randomized into two groups .


Patients with conditions affecting postoperative drainage and with persisting air leaks beyond the third postoperative day were excluded .


Drains were removed if the pleural fluid to blood protein ratio ( PrRPl/B ) was @ , regardless of its daily draining amount in the study arm ( Group S ; n = @ ) , and patients in the control arm ( Group C ; n = @ ) had their tubes removed if daily drainage was @ ml regardless of its protein content .


Patients were discharged home immediately or the following morning after removal of the last drain .


All cases were followed up regarding the development of symptomatic pleural effusions and hospital readmissions for a redrainage procedure .


Demographic and clinical characteristics as well as the pattern of decrease in PrRPl/B were the same between groups .


The mean PrRPl/B was @ and @ ( @ % CI = @-@ @ and @-@ @ ) on the first postoperative day , and it remarkably dropped down to @ and @ ( @ % CI = @-@ @ and @-@ @ ) on the second day in Groups S and C , respectively , and remained below @ on the third day ( repeated-measures of ANOVA design , post hoc ` within-group ' comparison of the first postoperative day versus second and third days ; P < @ ) .


Eleven of @ ( @ % ) and @ of @ ( @ % ) patients ' chest tubes were , respectively , removed on the first and second postoperative days in Group S , but only two of @ ( @ % ) and ten of @ ( @ % ) patients , respectively , had their chest tubes removed in Group C ( two-tailed Fisher 's exact test , P = @ and @ for the first and the second postoperative days , respectively ) .


On the third postoperative day , daily drainage remained @ ml in @ ( @ % ) patients , among whom , @ ( @ % ) would have their chest tubes removed on the PrRPl/B value in Group C. However , drains could not be removed due to the high protein content of draining fluid despite the acceptable volume of daily drainage in only three ( @ % ) of @ cases in Group S ( McNemar 's paired proportions test , P = @ ) .


The mean chest tube removal time ( @ @ vs @ @ days ; P < @ ) and the median hospital stay -LSB- @ days ( IQR : @-@ ) vs @ days ( IQR : @-@ ) , P < @ -RSB- were significantly shorter in Group S. None of the patients required a redrainage procedure due to a persistent and symptomatic pleural effusion .


Regardless of the daily drainage , chest tubes can safely be removed earlier than anticipated in most patients after lobectomy if the protein content of the draining fluid is low .


Phosphodiesterase type-@ inhibitors ( PDE@Is ) are first-line therapies for erectile dysfunction ( ED ) .


Sildenafil ( SIL ) and vardenafil ( VAR ) are approved for as-needed ( PRN ) dosing ; tadalafil ( TAD ) is approved for both PRN and once-a-day ( OaD ) dosing for ED .


Recent evidence suggests that TAD-OaD may be effective as therapy in men with an incomplete response to PRN-PDE@I therapy .


This study evaluated whether TAD-OaD provides similar efficacy in men with ED who had previously demonstrated a partial response to PRN-PDE@I therapy .


In this randomized , double-blind , placebo-controlled trial , men with a @ month ED history received SIL @mg , TAD @mg , or VAR @mg during a @ week open-label lead-in period .


Those with International Index of Erectile Function - Erectile Function ( IIEF-EF ) domain scores < @ following lead-in treatment completed a @ week washout period , then randomized to TAD @ mg up-titrated to @mg , TAD @mg , or placebo ( PBO ) OaD for @ weeks .


MAIN OUTCOME MEASURES obtained from patients treated with TAD-OaD were compared to PBO-treated patients .


Additionally , results of treatment with TAD-OaD were compared to results obtained from @ week PRN-PDE@I therapy to determine whether OaD and PRN regimens provided comparable efficacy .


NCT@ .


International Index of Erectile Function ( IIEF ) domain scores ; Sexual Encounter Profile ( SEP ) questions @-@ .


Endpoint data was obtained from @ men ( @ TAD ; @ PBO ) .


RESULTS for all IIEF and SEP measures were significantly better for TAD-OaD ( p < @ for all ) compared to PBO and were comparable to those observed during PRN-PDE@I treatment .


TAD @ mg and TAD @mg OaD therapy were safe and generally well tolerated .


Tadalafil once daily is a viable alternative to as-needed PDE@I therapy in men with ED .


Key limitations include the lack of a PRN PDE@I study group during the double-blind period , and that many more patients took tadalafil than sildenafil or vardenafil during the PRN period .


Hepatic encephalopathy ( HE ) is associated with a poor prognosis in patients with advanced liver disease .


Probiotics alter the intestinal microbiota with non-urease-producing organisms that reduce production of ammonia .


We investigated the efficacy of probiotics for the primary prophylaxis of HE .


We conducted a prospective trial at a tertiary care referral institute in New Delhi , India , from January @ through March @ , of patients with cirrhosis without overt HE ( age , @ @ y ; @ men and @ women ) ; @ were Child-Turcotte-Pugh ( CTP ) class A , @ were CTP class B , and @ were CTP class C. Subjects were assigned randomly to groups given probiotics ( @ @ ( @ ) colony-forming units , @ times daily ; n = @ , @ with minimal HE ) or no test article ( control , n = @ ; @ with minimal HE ) .


All subjects underwent psychometric analyses , critical flicker fusion ( CFF ) threshold assessments , glucose hydrogen breath tests to identify small intestinal bacterial overgrowth ( SIBO ) , and lactulose hydrogen breath tests to measure orocecal transit time ( OCTT ) .


The primary end point was the development of overt HE .


At baseline , subjects in each group had comparable CTP score , model for end-stage liver disease scores , CFF assessments , psychometric hepatic encephalopathy scores , and OCTT .


After a mean follow-up period of @ @ weeks for patients given probiotics and @ @ weeks for controls , @ patients given probiotics and @ controls died ( P = @ ) .


Three months of probiotic administration significantly reduced levels of arterial ammonia , SIBO , and OCTT ; increased psychometric hepatic encephalopathy scores ; and increased CFF thresholds , compared with baseline .


Seven subjects in the probiotic group and @ controls developed overt HE ( P < @ ; hazard ratio for controls vs probiotic group , @ ; @ % confidence interval , @-@ @ ) .


Psychometric hepatic encephalopathy scores , CTP scores , and SIBO correlated with the development of overt HE .


In a prospective , randomized controlled trial , probiotics were found to be effective in preventing HE in patients with cirrhosis .


Trial registration No : CTRI/@/@ / @ .


We sought to compare weight loss in the first @ weeks postpartum among women with gestational diabetes mellitus ( GDM ) treated with metformin or placebo , a promising therapy to reduce later risk of progression to diabetes mellitus .


We conducted a pilot , randomized trial of metformin vs placebo in postpartum women with GDM .


Women with pre-GDM , unable to tolerate metformin , resumed on insulin or oral hypoglycemic agent , delivered < @ weeks ' gestation , or with a body mass index < @ kg/m ( @ ) were excluded .


Women were randomized to either metformin @ mg daily for @ days , then metformin @ mg twice a day for the next @ weeks or placebo prescribed in a similar frequency .


The subject , health care provider , and research staff were blinded to the treatment .


The primary outcome was weight change from delivery to @ weeks postpartum .


Secondary outcomes included the percentage of women achieving their self-reported prepregnancy weight , reported medication adherence , adverse effects , and satisfaction .


Differences in weight change between groups were determined by Wilcoxon rank sum test and in achieving prepregnancy weight by ( @ ) test .


Of @ women randomized , @ ( @ % ) completed the @ weeks ; @ ( @ % ) were randomized to metformin and @ ( @ % ) to placebo .


Metformin and placebo groups were similar in median weight loss ( @ kg -LSB- range , -@ to @ -RSB- vs @ kg -LSB- range , -@ to @ -RSB- , P = @ ) and percentage of women achieving reported prepregnancy weight ( @ vs @ % , P = @ ) .


Self-reported adherence in taking > @ % of medication was @ % at @ weeks and @ % at @ weeks .


Nausea , diarrhea , and hypoglycemia were reported in approximately @-@ % of women and @-@ % reported dissatisfaction with the medication .


Women with GDM lost approximately @ kg by @ weeks ' postpartum .


This was similar in both groups and resulted in < @ % of women achieving their prepregnancy weight .


Although the reported adherence and satisfaction with the medication was high , adverse effects were reported with nearly @ in @ women including nausea , diarrhea , and hypoglycemia .


Contrary to expectation , we found no evidence of benefit from metformin .


However , longer treatment periods and larger studies with minimal attrition may be warranted .


Prophylactic use of fresh frozen plasma ( FFP ) in critically ill patients with a coagulopathy is common .


However , a lack of evidence of efficacy has resulted in a call for trials on the benefit of FFP in these patients .


To date , conducting a trial on this subject has not been successful .


Recently , a multi-center randomised trial was stopped prematurely due to slow inclusion .


To assess clinicians ' opinions regarding a trial on prophylactic administration of FFP in coagulopathic critically ill patients who need to undergo an intervention .


A survey among @ intensivists who all participated in a randomised trial on the risks and benefits of FFP in critically ill patients .


Response rate was @ % .


Majority of respondents indicated that international normalised ratio ( INR ) should be assessed before insertion of a central venous catheter ( CVC ) ( @ % ) , chest tube ( @ % ) or tracheostomy ( @ % ) .


Reasons to withhold transfusion of FFP to non-bleeding critically ill patients are risk of transfusion-related acute lung injury ( TRALI ) ( @ % ) , fluid overload ( @ % ) and allergic reaction ( @ % ) .


Although , the majority of respondents expressed the opinion that the trial was clinically relevant , @ % indicated that @ patient subgroups should have been excluded from participation .


Intensivists express the need for more evidence on the prophylactic use of FFP in coagulopathic critically ill patients .


However , lack of knowledge about FFP and personal beliefs about the preferable transfusion strategy among clinicians , resulted in premature termination of a clinical trial on this topic .


The rate of adherence to regular colonoscopy screening in individuals at increased familial risk of colorectal cancer ( CRC ) is suboptimal , especially among rural and other geographically underserved populations .


Remote interventions may overcome geographic and system-level barriers .


We compared the efficacy of a telehealth-based personalized risk assessment and communication intervention with a mailed educational brochure for improving colonoscopy screening among at-risk relatives of patients with CRC .


Eligible individuals age @ to @ years who were not up-to-date with risk-appropriate screening and were not candidates for genetic testing were recruited after contacting patients with CRC or their next of kin in five states .


Enrollees were randomly assigned as family units to either an active , personalized intervention that incorporated evidence-based risk communication and behavior change techniques , or a mailed educational brochure .


The primary outcome was medically verified colonoscopy within @ months of the intervention .


Of the @ eligible and randomly assigned at-risk relatives , @ % completed the outcome assessments within @ months ; @ % of those in the personalized intervention group and @ % of those in the comparison group obtained a colonoscopy .


In an intent-to-treat analysis , the telehealth group was almost three times as likely to get screened as the low-intensity comparison group ( odds ratio , @ ; @ % CI , @ to @ ; P < @ ) .


Persons residing in rural areas and those with lower incomes benefitted at the same level as did urban residents .


Remote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with CRC .


In the ongoing GEnotipo , Fenotipo y Ambiente de la HiperTensin Arterial en UruguaY ( GEFA-HT-UY ) study , we applied standardized epidemiological methods to determine complex phenotypes including blood pressure ( BP ) .


In this report , we present the quality control of the conventionally measured BP .


Three trained observers measured BP five times consecutively in the seated position at each of two home visits and one clinic visit according to the guidelines of the European Society of Hypertension .


On @ December @ , @ single BP readings in @ participants were available for analysis .


Fewer BP readings than the five planned per contact occurred only at one home visit .


Among observers , the frequency of identical consecutive readings for systolic or diastolic BP varied from @ to @ % .


The occurrence of odd readings ranged from @ to @ % .


Only @ % of the systolic and diastolic BP readings ended on zero ( expected @ % ) .


At home visits , there was a progressive decline in BP from the first to the fifth reading .


The average of the five BP readings also decreased from the first to the second home visit ( -@ / -@ mmHg ) .


Our study highlighted the necessity to implement a stringent quality control of the conventionally measured BP .


The procedures set up in the GEFA-HT-UY study are resulting in a well-defined BP phenotype , which is consistent with that in other population studies .


The purpose of this study was to determine whether @ g/kg oral ivermectin is able to kill Ixodes scapularis nymphs and adult female ticks feeding on humans .


Ten study subjects each wore @ ostomy bags , the one containing @ I scapularis nymphs , and the other containing @ I scapularis adult females .


Twenty-four hours after the ostomy bags were attached , study subjects received either @ g/kg ivermectin or placebo .


Thirty hours after the ivermectin or placebo was consumed , the ticks were removed , and mortality determined in a double-blinded manner .


Eleven percent of the I scapularis nymphs attached in the ivermectin group compared with @ % in the placebo .


Mortality for the I scapularis nymphs that attached at the time of removal was @ % in the ivermectin group and @ % in the placebo group .


Mortality for the I scapularis nymphs @ days after removal was @ % in the ivermectin group and @ % for the placebo .


Three percent of the I scapularis adults attached in the ivermectin group compared with @ % in the placebo group .


Mortality for I scapularis adults was @ % on day @ and @ % on day @ for both the ivermectin and placebo groups .


There were statistically insignificant differences in the mortality rates between I scapularis nymphs and adults exposed to ivermectin or placebo .


There were a high number of ticks that died in both groups but the data do not support our hypothesis that ivermectin can kill I scapularis .


The study was not designed to determine whether it could prevent the transmission of tick-borne illness .


The goal was to investigate the effects of Brain Wave Vibration ( BWV ) , a meditation practised in a class involving rhythmic movements of the head , neck and body practised with related yoga-style exercises , and to isolate the rhythmic effects .


A randomised controlled trial was conducted with assessments pre - and post-trial and immediately before and after each session .


Thirty-one healthy adults were assessed for mood , sleep , mindfulness , health and well-being , and pre - and post-class activation-deactivation .


Participants were randomly assigned to either BWV in toto or a control group having similar yoga exercises without the rhythmic components .


Participants completed eight to twelve @-min classes of BWV or control training over @-@ weeks .


To control for expectation participants were told only that the aim was to compare two subtly different styles of Korean yoga .


The BWV group had comparatively greater improvements in sleep duration and efficiency , although they had higher baseline inefficiency , and post-trial they had better global sleep and well-being and fewer illness symptoms , and better tiredness and energy post-class .


Both groups benefitted in mood , mindfulness and vitality post-trial with improved tension and calmness post-class .


The participants of both interventions had better mood and well-being on the whole following the trial and were more relaxed immediately after a class .


However , BWV training was unique in its benefits to sleep , health , well-being , energy and tiredness , warranting further research .


To assess the efficacy of a hypotensive prophylactic medication in preventing intraocular pressure ( IOP ) changes after intravitreal injections , and the effect of occurrence of vitreous reflux on the variation of IOP .


A total of @ intravitreal injections of anti-vascular endothelial growth factor drugs ( @ mL ) were randomly distributed into @ groups : in group @ ( n = @ ) , no prophylactic IOP-lowering medication was used ; in group @ ( n = @ ) , a fixed combination of brimonidine and timolol was instilled @ minutes before the injection .


The IOP was measured before and @ , @ , and @ minutes after the injection .


The presence of vitreous reflux was recorded .


Despite significantly reducing the IOP by ~ @ mm Hg , prophylactic medication did not prevent a transient IOP rise .


A total of @ % of injections showed vitreous reflux , and those patients experienced much lower initial spikes .


Indeed , only @ % out of @ injections above @ mm Hg within @ minute after injection showed vitreous reflux .


Only one case showed an IOP > @ mm Hg at @ minutes , and none at @ minutes postinjection .


The IOP normalization rates over time were similar in all groups within @ minutes .


Prophylactic medication instilled @ minutes before the injection was not effective in preventing a pressure rise after intravitreal injections .


Vitreous reflux decreased significantly the spike figures compared to injections with no reflux .


To explore the anesthetic effect of preemptive analgesia of frequency acupoint electrical stimulation on painless-induced abortion as well as its effect on anesthetics dosage .


Ninety cases of early pregnancy who selected painless-induced abortion were randomly divided into two groups , @ cases in each group .


Frequency acupoint electrical stimulation at Ciliao ( BL @ ) and Shenshu ( BL @ ) , disperse-densewave , @ Hz/@ Hz in frequency for @ to @ min , was applied in the group A , which was followed by intravenous anesthesia of propofol .


The intravenous anesthesia of propofol was applied in the group B.


The blood pressure ( BP ) , heart rate ( HR ) and SpO@ before , during and after surgery , anesthetic effect and dosage , waking time and adverse events were observed in the two groups .


The BP and HR during and after the surgery in the group A were not statistically different from those before the surgery ( all P > @ ) .


The BP was reduced and HR was slowed down during the surgery in the group B , which was significantly different from those before the surgery as well as those in the group A ( all P < @ ) .


The dosage of propofol was ( @ - +@ ) mg in the group A. obviously less than ( @ + / - @ ) mg in the group B ( P < @ ) .


The waking time was ( @ + / - @ ) min in the group A , obviously less than ( @ + / - @ ) min in the group B ( P < @ ) .


As for anesthetic effect , the incidence of Grade I in the group A was more than the group B ( P < @ ) .


The adverse events , including nausea , vomiting and contractions pain in the group A were evidently less than those in the group B ( all P < @ ) .


The preemptive analgesia of frequency acupoint electrical stimulation could significantly improve anesthetic effect of painless-induced abortion , reduce dosage of anesthetics , shorten waking time of surgery and guarantee the safety of surgery .


Attentional retraining ( AR ) is a potential new treatment for addiction .


AR trains addicts to attend away from drug-related cues , thereby reducing exposure to drug cues and reducing craving .


We examined the utility of delivering AR to smokers on a personal digital assistant ( PDA ) in the natural environment .


Smokers ( N = @ ) not seeking to quit were randomly assigned to an AR group or a control group ( i.e. , a group with no training ) .


They carried a PDA with them for one week .


They were prompted to complete four assessments daily , including three attentional retrainings ( AR group ) or three control trainings ( control group ) , and one evaluation of attentional bias .


AR was implemented using a modified visual probe task .


Attentional bias was assessed using a standard visual probe task on the PDA .


The AR group completed an average of @ attentional retrainings and the control group completed an average of @ control trainings .


As hypothesized , attentional bias declined over the week in the AR group , but not in the control group , Group Day interaction , F ( @ , @ ) = @ , p = @ .


AR also reduced craving ratings following a briefly presented picture containing smoking and nonsmoking features , group main effect , F ( @ , @ ) = @ , p = @ .


AR did not significantly influence smoking behavior .


AR can be administered on a mobile device in the natural environment , and AR can reduce attentional bias and craving .


Complicated grief ( CG ) is a debilitating condition , most prevalent in elderly persons .


However , to our knowledge , no full-scale randomized clinical trial has studied CG in this population .


To determine whether complicated grief treatment ( CGT ) produces greater improvement in CG and depressive symptoms than grief-focused interpersonal psychotherapy ( IPT ) .


Randomized clinical trial enrolling @ individuals @ years or older ( mean -LSB- SD -RSB- age , @ -LSB- @ -RSB- years ) scoring at least @ on the Inventory of Complicated Grief ( ICG ) .


Participants were recruited from the New York metropolitan area from August @ , @ , through January @ , @ , and randomized to receive CGT or IPT .


The main outcome was assessed at @ weeks after baseline , with interim measures collected at @ , @ , and @ weeks after baseline .


Sixteen sessions of CGT ( n = @ ) or IPT ( n = @ ) delivered approximately weekly .


Rate of treatment response , defined as a rating from an independent evaluator of much or very much improved on the Improvement subscale of the Clinical Global Impression Scale .


Both treatments produced improvement in CG symptoms .


Response rate for CGT ( @ individuals -LSB- @ % -RSB- ) was more than twice that for IPT ( @ -LSB- @ % -RSB- ) ( relative risk , @ -LSB- @ % CI , @-@ @ -RSB- ; P < @ ) , with the number needed to treat at @ .


Secondary analyses of CG severity and CG symptom and impairment questionnaire measures confirmed that CGT conferred a significantly greater change in illness severity ( @ individuals -LSB- @ % -RSB- in the CGT group vs @ -LSB- @ % -RSB- in the IPT group were still at least moderately ill -LSB- P = @ -RSB- ) , rate of CG symptom reduction ( @ ICG points per week for CGT vs @ points per week for IPT -LSB- t@ = @ ; P < @ -RSB- ) , and the rate of improvement in CG impairment ( @ work and Social Adjustment Scale points per week with CGT and @ points per week with IPT -LSB- t@ = @ ; P = @ -RSB- ) .


Results were not moderated by participant age .


Complicated grief treatment produced clinically and statistically significantly greater response rates for CG symptoms than a proven efficacious treatment for depression ( IPT ) .


Results strongly support the need for physicians and other health care providers to distinguish CG from depression .


Given the growing elderly population , the high prevalence of bereavement in aging individuals , and the marked physical and psychological impact of CG , clinicians need to know how to treat CG in older adults .


To evaluate the clinical application of a dosing algorithm by genotypes in prediction of warfarin maintenance dose in Chinese patients with pulmonary thromboembolism .


During October @ and August @ , @ inpatients or outpatients with pulmonary embolism in Beijing Anzhen Hospital , were enrolled by the inclusion criteria .


The patients included @ males and @ females .


The clinical data and blood samples were collected .


The fluorescent PCR genotyping method was used to detect the genotypes of vitamin K epoxy compounds reductase complex subunit @ ( VKORC@ ) and cytochrome P@ enzyme @C@ ( CYP@C@ ) .


According to the random number table , the patients were randomly divided into a study group and a control group .


In the study group , the first @ doses of warfarin were prescribed according to the predicted warfarin dose , while in the control group the drug was prescribed according to the dose estimated empirically by clinicians .


Warfarin was adjusted until it reached a stable dose according to the INR value , and the following-up lasted for @ days .


AT the end of follow-up , the percentage of patients who obtained a stable dose in the study group and the control group was @ % ( n = @ ) and @ % ( n = @ ) , respectively .


The mean time to reach a stable dose in the study group and the control group was ( @ @ ) and ( @ @ ) days , and the median time was ( @ @ ) days and ( @ @ ) days , the difference between the @ groups being statistically significant ( ( @ ) = @ , P < @ ) .


The incidence of side effects of the study group was lower than that of the control group , and the time to the occurrence of side effects in study group was longer .


The average predicted dose of the @ patients who reached a stable dose was ( @ @ ) mg/d , and the average effective dose was ( @ @ ) mg/d , the average predicted dose being lower than the actual dose ( @ @ ) mg/d , but the difference was not significant ( t = -@ , P > @ ) .


The warfarin stable dose prediction algorithm , containing genetic factors and non-heritage factors , can significantly shorten the adjustment time to reach warfarin stable dose , and reduce the incidence of side effects , and is clinically applicable .


It has been suggested that magnesium deficiency is associated with the triggering of acute phase response , which may contribute to type @ diabetes and cardiovascular disease risk .


We undertook this study to determine whether oral magnesium supplementation modifies serum levels of high-sensitivity C-reactive protein ( hsCRP ) in apparently healthy subjects with prediabetes and hypomagnesemia .


A total of @ men and non-pregnant women aged @-@ year , with new diagnosis of prediabetes ( glucose @ < @ mmol/L and/or post-load glucose @ < @ mmol/L ) and hypomagnesemia ( serum magnesium levels < @ mmol/L ) were enrolled in a clinical double-blind placebo-controlled trial and randomly allocated to receive either magnesium chloride ( @ mL of MgCl@ @ % solution ) or NaHCO@ @ % solution , once daily for @ months .


At basal conditions , anthropometric and biochemical variables were similarly distributed in both groups .


At the end of follow-up , participants who received magnesium chloride showed higher serum magnesium levels ( @ @ vs. @ @ mmol/L , p = @ ) and lower hsCRP levels ( @ @ vs. @ @ nmol/L , p = @ ) compared with participants in the control group .


Oral magnesium supplementation decreases hsCRP levels in apparently healthy subjects with prediabetes and hypomagnesemia .


Chronic low back pain ( cLBP ) is a significant public health problem , being the primary cause of work absenteeism , as well as affecting sufferers ' quality of life , in industrialized society .


International guidelines recommend intensive multidisciplinary approaches for patients with cLBP .


However , these costly and time-consuming programs can only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements .


Lighter programs may be an alternative to full time hospital-based programs with valuable results in terms of disability and occupational activity for cLBP patients .


It is therefore important to define both what the determining components of management to improve activity restriction are and how to treat a larger number of patients more effectively at a lower cost .


The aim of this study is to compare three programs with various levels of intensity and multidisciplinary .


This paper describes the protocol for a prospective , randomized , controlled , clinical trial in working aged patients with cLBP .


Three treatment strategies are compared : ( @ ) intensive and multidisciplinary program conducted in a rehabilitation center ; ( @ ) less intensive outpatient program conducted by a private physiotherapist ; ( @ ) mixed strategy combining the same out program with a multidisciplinary intervention .


The primary outcome of the trial is the impact of the mixed strategy on being able to work compared to hospital centered-program and out program .


The secondary outcome is the impact of the mixed strategy on quality of life and social ability compared to the two others programs .


The intervention part of the trial programs will take @ weeks and observational follow-up will take @ months .


The sample size will be @ participants ( @ for each arm ) .


The project has been approved by the Ethical Committee of Angers Hospital , France .


On the hypothesis that a multidisciplinary approach is the key feature to programs success in reducing social and occupational impairment in cLBP patients , we suggest that it is possible to achieve the same results with less intensive strategies if a multidisciplinary approach is maintained .


To compare the safety and efficacy of isotonic versus hypotonic maintenance fluid in children .


Randomized controlled trial .


Tertiary-level teaching hospital .


@ children ( age @ to @ years ) who were admitted and anticipated to receive intravenous fluid for the next @ hours .


Hypotonic fluid ( Standard maintenance volume as @ % NaCl in @ % dextrose ) or Isotonic fluid ( @ % Standard maintenance volume as @ % NaCl solution in @ % dextrose ) .


Primary : Incidence of hyponatremia .


Secondary : Serum sodium , serum osmolality , blood sugar , blood urea , serum creatinine , serum potassium , serum chloride , pH , urine output , change in weight , morbidity and death .


At @ hours , hyponatremia was noted in @ ( @ % ) patients in the isotonic and @ ( @ % ) in hypotonic group ( P = @ ) .


At @ hours , hyponatremia was noted in @ ( @ % ) and @ ( @ % ) patients in isotonic and hypotonic group , respectively ( P = @ ) .


There was significant change in sodium levels in both isotonic ( P = @ ) and hypotonic ( P < @ ) intervention groups .


The peak fall in mean serum sodium level was noted at @ hours ( -@ , @ % CI : -@ , -@ mEq/L ; P < @ ) in hypotonic group .


In isotonic group , there was significant increase between @ and @ hours ( @ , @ % CI : @ , @ mEq/L ; P = @ ) .


Reduced volume isotonic fluid results in fewer episodes of hyponatremia than hypotonic fluid in sick children during the first @ hours of intravenous fluid therapy .


In the current study , we compared measures of treatment outcome and engagement for Latino and non-Latino White patients receiving a cognitive behavioral therapy ( CBT ) program delivered in primary care .


Participants were @-@ years old and recruited from @ clinics at @ different sites to participate in a randomized controlled trial for anxiety disorders , which compared the Coordinated Anxiety Learning and Management ( CALM ) intervention ( consisting of CBT , medication , or both ) with usual care .


Of those participants who were randomized to the intervention arm and selected CBT ( either alone or in combination with medication ) , @ were Latino and @ were non-Latino White ; the majority of the Latino participants received the CBT intervention in English ( n = @ ) .


Blinded assessments of clinical improvement and functioning were administered at baseline and at @ , @ , and @ months after baseline .


Measures of engagement , including attendance , homework adherence , understanding of CBT principles , and commitment to treatment , were assessed weekly during the CBT intervention .


Findings from propensity-weighted linear and logistic regression models revealed no statistically significant differences between Latinos and non-Latino Whites on symptom measures of clinical improvement and functioning at almost all time points .


There were significant differences on @ of @ engagement outcomes , namely , number of sessions attended and patients ' understanding of CBT principles .


These findings suggest that CBT can be an effective treatment approach for Latinos who are primarily English speaking and likely more acculturated , although continued attention should be directed toward engaging Latinos in such interventions .


To investigate the clinical effects of modified dachengqi tang ( DCQT ) on promoting gastrointestinal motility in post-operative esophageal cancer patients .


Sixty postoperative esophageal cancer patients were enrolled and randomly assigned to the modified treatment group or the control group ( @ patients in each group ) .


Patients in the treatment group were given DCQT made from decocted herbs and administered via nasojejunal tube at a dosage of @ mL .


Gastrointestinal motility was assessed by recording time for recovery of bowel sounds , flatus , defecation , and the total amount of gastric drainage during the first three postoperative days .


Plasma motilin ( MTL ) and vasoactive intestinal peptide ( VIP ) were measured one hour before and three days after surgery .


Compared with the control group , the times to first bowel sound , flatus , and defecation were significantly shorter and there was less gastric drainage in the treatment group ( P < @ , P < @ , P < @ , and P < @ , respectively ) .


In the treatment group , postoperative plasma MTL was significantly higher ( P < @ ) and VIP was significantly lower than those in the control group ( P < @ ) .


There was no difference found in either MTL or VIP from before to after operation in the treatment group ( P > @ ) .


MTL was significantly lower and VIP was higher postoperatively in the control group , compared to before surgery ( P < @ ) .


Modified DCQT effectively improved decreased gastrointestinal motility in postoperative esophageal cancer patients by increasing MTL and reducing VIP .


Critically ill patients with respiratory failure undergoing bronchoscopy have an increased risk of hypoxaemia-related complications .


Previous studies have shown that in awake , hypoxaemic patients non-invasive ventilation ( NIV ) is helpful in preventing gas exchange deterioration during bronchoscopy .


An alternative and increasingly used means of oxygen delivery is its application via high-flow nasal cannula ( HFNC ) .


This study was conducted to compare HFNC with NIV in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy .


Prospective randomised trial randomising @ critically ill patients with hypoxaemic respiratory failure to receive either NIV or HFNC during bronchoscopy in the intensive care unit .


After the initiation of NIV and HFNC , oxygen levels were significantly higher in the NIV group compared to the HFNC group .


Two patients were unable to proceed to bronchoscopy after the institution of HFNC due to progressive hypoxaemia .


During bronchoscopy , one patient on HFNC deteriorated due to intravenous sedation requiring non-invasive ventilatory support .


Bronchoscopy was well tolerated in all other patients .


There were no significant differences between the two groups regarding heart rate , mean arterial pressure and respiratory rate .


Three patients in the NIV group and one patient in the HFNC group were intubated within @ hours after the end of bronchoscopy ( P = @ ) .


The application of NIV was superior to HFNC with regard to oxygenation before , during and after bronchoscopy in patients with moderate to severe hypoxaemia .


In patients with stable oxygenation under HFNC , subsequent bronchoscopy was well tolerated .


Surgical ablation ( SA ) is commonly used in atrial fibrillation ( AF ) patients undergoing cardiac surgery .


However , its effect has been established in few randomized studies .


To assess the complete atrial fibrillation free ( AF-free ) survival in randomized study assessing the effects of additional concomitant SA of AF in patients primarily indicated for other cardiac surgery .


The PRAGUE-@ study was a prospective randomized study comparing the effect of adding SA to other cardiac surgery .


We examined the data from the PRAGUE-@ trial and grouped patients according to complete AF-free survival .


All patients had regular check-ups at @ , @ , @ months , some of them with Holter recordings , and a final check-up at @ months with Holter recording .


One hundred ninety-four patients were analyzed ; @ originally randomized to surgery with adding SA ( SA group ) and @ without it ( non-SA group ) .


Complete AF-free status was found in @ patients from the SA group ( @ % ) and @ patients ( @ % ) from the non-SA group ( p < @ ) .


In a multivariate logistic regression , the SA group was associated with a greater chance for complete AF-free survival ( OR @ , p < @ ) .


In the multivariate analysis of the SA group , history of myocardial infarction ( OR @ , p < @ ) and a higher EuroSCORE ( OR @ , p @ ) were independently associated with a lower probability of AF-free survival .


Complete AF-free survival following SA was present in almost one half of patients .


Patients with a history of myocardial infarction and higher EuroSCOREs were less likely to benefit from an add-on SA procedure .


To compare the efficacy of autologous blood injection versus corticosteroid injection for lateral epicondylitis .


@ men and @ women ( mean age , @ years ) presenting with lateral epicondylitis were randomised to receive either autologous blood injection ( @ ml of autologous venous blood mixed with @ ml of @ % prilocaine hydrochloride ) or corticosteroid injection ( @ ml of @ mg methylprednisolone acetate mixed with @ ml of @ % prilocaine hydrochloride ) given by a single physician .


Patients were assessed before ( day @ ) and after ( days @ , @ , and @ ) treatment for elbow pain ( using a visual analogue scale -LSB- VAS -RSB- ) , function ( using the patient-rated tennis elbow evaluation -LSB- PRTEE -RSB- questionnaire ) , and grip strength ( using a hydraulic hand dynamometer ) .


Patients were followed up at @ months by telephone to assess elbow pain using the VAS .


No complications ( infection , skin atrophy , neurovascular damage , or tendon rupture ) were noted .


@ patients reported increased pain for up to @ days after autologous blood injection .


In both groups , the VAS score for elbow pain , PRTEE score , and grip strength improved significantly after treatment ( p = @ ) , but the pattern of improvement differed .


Compared with autologous blood injection , corticosteroid injection improved all @ scores at a faster rate over the first @ days ( p = @ ) , and then started to decline slightly until day @ .


After autologous blood injection , all @ scores improved steadily and were eventually better ( p = @ ) .


If a @ % decrease in PRTEE is defined as complete recovery , @ ( @ % ) of patients with autologous blood injection and @ ( @ % ) of patients with corticosteroid injection achieved complete recovery ( p = @ ) .


Autologous blood injection was more effective over the follow-up period than corticosteroid injection in improving pain , function , and grip strength .


It is recommended as a first-line injection treatment because it is simple , cheap , and effective .


Among CT scanners , @-row instruments feature decreased photon energy and yield strong contrast enhancement .


Consequently , the contrast medium ( CM ) dose can be reduced .


The results of low-tube-voltage coronary CT angiography ( CCTA ) performed on @-row scanners have not been adequately assessed .


We evaluated the effects of a low-contrast-dose protocol on the image quality of CCTA using @ kVp tube voltage , iterative reconstruction ( IR ) , and a @-row scanner .


We randomly assigned @ patients ( mean body weight , @ @ kg ) to @ of @ CCTA protocols .


Under protocol A , @ were scanned using a conventional @-kVp protocol and a standard CM dose ( @ mg iodine/kg body weight -LSB- mgI/kg -RSB- ) .


Another @ underwent scanning at @ kVp with a @ % CM dose reduction ( @ mgI/kg ; protocol B ) .


Under protocol C , the remaining @ patients were scanned at @ kVp with a @ % CM dose reduction ( @ mgI/kg ) .


The @ and @ kVp images were processed with IR .


Images obtained under the @ protocols were subjected to quantitative and qualitative analysis .


The amount of CM used in protocol A , B , and C was @ @ , @ @ , and @ @ mL , respectively .


Mean CT attenuation of the coronary arteries tended to be higher under protocol B than the other @ protocols .


The contrast-to-noise ratio was significantly higher under protocol B.


The mean visual scores were significantly higher for protocols A and B than protocol C.


The mean effective radiation dose was significantly lower under the @-kVp protocol .


With a @-row scanner and our refined CM injection and timing protocol , it is technically feasible to obtain sufficient vascular enhancement with a reduction in the CM and/or radiation dose at @-kVp CCTA with IR .


Evaluate the sensitivity and specificity of pelvic ultrasound ( US ) and abdominopelvic computed tomography ( CT ) for the identification of ovarian torsion in women presenting to the emergency department with acute lower abdominal or pelvic pain .


This is a retrospective study of @ cases of ovarian torsion and @ control patients , all of whom had both US and CT performed in the emergency department .


Two radiologists who were blinded to clinical data interpreted all studies as ( @ ) demonstrating an abnormal ovary or not , and ( @ ) suggestive of torsion or not .


Sensitivity , specificity and interobserver variation were calculated for each imaging modality .


Pelvic US was interpreted as demonstrating an abnormal ovary in @ % of ovarian torsion cases by reader @ , and in @ % by reader @ , whereas CT was interpreted as revealing an abnormal ovary in @ % of torsion cases by both readers .


Pelvic US for ovarian torsion was @ % sensitive ( @ % CI , @-@ @ % ) and @ % specific ( @ % CI , @-@ @ % ) for reader @ , while @ % sensitive ( @ % CI , @-@ @ % ) and @ % specific ( @ % CI , @-@ @ % ) for reader @ .


Interobserver agreement for pelvic US was fair ( Kappa = @ ) .


Abdominopelvic CT for ovarian torsion was @ % sensitive ( @ % CI , @-@ @ % ) and @ % specific ( @ % CI , @-@ @ % ) for reader @ , while @ % sensitive ( @ % CI , @-@ @ % ) and @ % specific ( @ % CI , @-@ @ % ) for reader @ .


Interobserver agreement was excellent ( Kappa = @ ) .


The diagnostic performance of CT is not shown to be significantly different from that of US in identifying ovarian torsion in this study .


These results suggest that when CT demonstrates findings of ovarian torsion , the performance of another imaging exam ( i.e. US ) that delays therapy is unlikely to improve preoperative diagnostic yield .


Previous research reveals an association between traumatic stress and an increased risk for numerous diseases , including cancer .


At the molecular level , stress may increase carcinogenesis via increased DNA damage and impaired DNA repair mechanisms .


We assessed DNA breakage in peripheral blood mononuclear cells from individuals with post-traumatic stress disorder ( PTSD ) and measured the cellular capacity to repair single-strand breaks after exposure to ionizing X-radiation .


We also investigated the effect of psychotherapy on both DNA breakage and DNA repair .


In a first study we investigated DNA breakage and repair in @ individuals with PTSD and @ controls .


Controls were subdivided into @ trauma-exposed subjects and @ individuals without trauma exposure .


In a second study , we analysed the effect of psychotherapy ( Narrative Exposure Therapy ) on DNA breakage and repair .


Thirty-eight individuals with PTSD were randomly assigned to either a treatment or a waitlist control condition .


Follow-up was performed @ months and @ year after therapy .


In study @ we found higher levels of basal DNA breakage in individuals with PTSD and trauma-exposed subjects than in controls , indicating that traumatic stress is associated with DNA breakage .


However , single-strand break repair was unimpaired in individuals with PTSD .


In study @ , we found that psychotherapy reversed not only PTSD symptoms , but also DNA strand break accumulation .


Our results show - for the first time in vivo - an association between traumatic stress and DNA breakage ; they also demonstrate changes at the molecular level , i.e. , the integrity of DNA , after psychotherapeutic interventions .


Postoperative pain remains an important challenge after scoliosis surgery in children .


Opioids are the mainstay of treatment , and adult studies demonstrate gabapentin as a useful adjunct to opioids in the management of postoperative pain .


Adolescent patients undergoing idiopathic scoliosis surgery were randomized to receive a single preoperative dose of gabapentin @mg or placebo .


The primary outcome measure was total morphine consumption in mgkg ( -@ ) between @ and @h postoperatively .


Secondary outcome measures included time to first rescue analgesia , pain intensity scores at rest and with movement , incidence of nausea , vomiting , pruritus , sedation , dizziness , presence of persisting pain symptoms , and patient satisfaction .


Cumulative opioid consumption was calculated at each time point : @ , @ , @ , @ , @ , @ , and @h .


The gabapentin group used @ mgkg ( -@ ) of morphine at @h , @ mgkg ( -@ ) at @h , @ mgkg ( -@ ) at @h , and @ mgkg ( -@ ) at @h .


The placebo group used @ mgkg ( -@ ) of morphine at @h , @ mgkg ( -@ ) at @h , @ mgkg ( -@ ) at @h , and @ mgkg ( -@ ) at @h .


There was no statistically significant reduction in opioid consumption in the patients receiving gabapentin .


There were no significant differences in secondary outcomes .


A single preoperative dose of gabapentin did not show a significant difference in opioid consumption or pain scores in adolescents undergoing idiopathic scoliosis surgery .


This study is the first pediatric randomized controlled trial to assess the effectiveness of a single dose of gabapentin on morphine consumption and analgesia following major surgery .


To evaluate transient , large visual acuity ( VA ) decreases , termed sporadic vision loss , during anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration ( AMD ) .


Cohort within a randomized clinical trial .


setting : Comparison of Age-Related Macular Degeneration Treatments Trials ( CATT ) .


study population : Total of @ CATT patients .


main outcome measures : Incidence of sporadic vision loss and odds ratio ( OR ) for association with patient and ocular factors .


Sporadic vision loss was a decline of @ letters from the previous visit , followed by a return at the next visit to no more than @ letters worse than the visit before the VA loss .


There were @ sporadic vision loss events in @ of @ patients ( @ % ) .


Mean VA at @ years for those with and without sporadic vision loss was @ ( @/@ ) and @ ( @/@ ) letters , respectively ( P < @ ) .


Among patients treated pro re nata , no injection was given for @ % ( @/@ ) of sporadic vision loss events .


Multivariate analysis demonstrated that baseline predictors for sporadic vision loss included worse baseline VA ( OR @ , @ % confidence interval -LSB- CI -RSB- :@ -@ for @/@ compared with @/@ ) , scar ( OR @ , @ % CI :@ -@ ) , intraretinal foveal fluid on optical coherence tomography ( OR @ , @ % CI :@ -@ ) , and medical history of anxiety ( OR @ , @ % CI :@ -@ ) and syncope ( OR @ , @ % CI :@ -@ ) .


Refraction decreased the likelihood of sporadic vision loss ( OR @ , @ % CI : @-@ @ ) .


Approximately @ % of CATT patients had sporadic vision loss .


Baseline predictors included AMD-related factors and factors independent of AMD .


These data are relevant for clinicians in practice and those involved in clinical trials .


This study sought to evaluate the safety and effectiveness of drug-eluting stents ( DES ) compared to bare-metal stents ( BMS ) for patients with large coronary vessels .


Randomized trials have demonstrated that DES reduce the risk of target vessel revascularization ( TVR ) compared to BMS .


This benefit is less pronounced as artery diameter increases .


Whether DES are superior to BMS for larger coronary arteries in the setting of routine clinical practice is unknown .


We analyzed data from @ patients undergoing de novo lesion PCI with reference vessel diameter greater than or equal to @ mm in the NHLBI Dynamic Registry according to whether they were treated with DES or BMS .


Patients were followed for @ years for the occurrence of cardiovascular events .


At @-year follow-up , rates of TVR at @ years were similar and low in both groups ( @ % vs. @ % , P = @ ) .


After adjustment for differences in baseline characteristics , the adjusted hazard ratio for @-year MI for DES was @ ( @ % CI @-@ @ , P = @ ) , for TVR at @ years @ ( @ % CI @-@ @ , P = @ ) and for mortality @ ( @ % CI @-@ @ , P = @ ) .


In our study of the unrestricted use of DES for patients with lesions in larger diameter coronary arteries , first generation DES did not reduce @-year risk of TVR .


Our findings do not support the preferred use of DES over BMS for patients with lesions located in arteries > @ mm .


It is unknown whether secondary generation DES can offer better outcome compared to BMS in large coronary vessels .


Further study on this issue is warranted .


Informal caregivers play an important role in hospital-at-home schemes .


However they may increase their burden , especially chronic diseases , like COPD .


In the absence of clear differences in effectiveness and cost-effectiveness between hospital-at-home and usual hospital care , informal caregiver preferences play an important role .


This study investigated informal caregiver strain , satisfaction and preferences for place of treatment with a community-based hospital-at-homes scheme for COPD exacerbations .


The study was part of a larger randomised controlled trial .


By randomisation , patients were allocated to usual hospital care or hospital-at-home , which included discharge at day @ of admission , followed by home treatment with homes visits by community nurses until day @ of treatment .


Patients allocated to usual hospital care received care as usual in the hospital and were discharged at day @ .


Patients were asked if they had an informal caregiver and who this was .


Patients and their caregivers were followed for @ days .


Informal caregiver strain was assessed with the caregiver strain index .


Satisfaction and preference were assessed using questionnaires .


All measurements were performed at the end of the @-day treatment and the end of the @-days follow-up .


Of the @ patients , @ had an informal caregiver , of whom three-quarter was the patients ' spouse .


There was no significant difference in caregiver strain between hospital-at-home and usual hospital care at both time points ( mean difference at T +@ days @ @ % CI -@ to @ , p = @ ; mean difference at T +@ days @ @ % CI -@ to @ , p = @ ) .


At the end of the @-day treatment , @ % ( N = @ ) of caregivers of patients allocated to hospital treatment and @ % ( N = @ ) of caregivers of patients allocated to home treatment preferred home treatment , if they could choose .


Caregivers were satisfied with the treatment the patient received within hospital-at-home .


There were no differences in caregiver strain between the community-based hospital-at-home scheme and usual hospital care .


Most caregivers were satisfied with the treatment .


In addition to other outcomes , our results support the wider implementation of hospital-at-home for COPD exacerbations .


To evaluate a new format of a summary , which presents research from synthesized evidence to patients and the public .


We conducted a randomized controlled trial in @ members of the public from five countries ( Canada , Norway , Spain , Argentina , and Italy ) .


Participants received either a new summary format ( a plain language summary -LSB- PLS -RSB- ) or the current format used in Cochrane systematic reviews .


The new PLS presents information about the condition and intervention , a narrative summary of results , and a table of results with absolute numbers for effects of the intervention and quality of the evidence using Grading of Recommendations Assessment , Development , and Evaluation .


With the new PLS , more participants understood the benefits and harms and quality of evidence ( @ % vs. @ % , P < @ ) ; more answered each of the five questions correctly ( P @ for four questions ) ; and they answered more questions correctly , median @ ( interquartile range -LSB- IQR -RSB- : @-@ ) vs. @ ( IQR : @-@ ) , P < @ ) .


Better understanding was independent of education level .


More participants found information in the new PLS reliable , easy to find , easy to understand , and presented in a way that helped make decisions .


Overall , participants preferred the new PLS .


This new PLS format for patients and the public is a promising tool to translate evidence from synthesized research .


To observe the clinical effect of Gushenyutai plaster administered at the Guanyuan ( CV @ ) acupoint on male infertility associated with semen non-liquefaction .


Sixty-two male patients with infertility caused by semen non-liquefaction were randomized into a treatment and control group .


The control group received comprehensive therapy , which included oral administration of clarithromycin sustained release tablets , hip bath with Zhongyaoxiaoyan granules , prostate massage , and transurethral microwave treatment .


The treatment group was administered Gushenyutai plaster in addition to the comprehensive therapy .


Both groups were treated for @ weeks .


After treatment , the clinical effect and pregnancy rate were assessed and compared between the two groups .


The effective rate of the treatment group was significantly higher than that of the control group ( @ % vs @ % , P < @ ) and the pregnancy rates of the treatment group and control groups were @ % and @ % , respectively ( P < @ ) .


The effect of Gushenyutai plaster plus comprehensive therapy was better than that of the comprehensive therapy alone on male infertility induced by semen non-liquefaction .


To evaluate the efficacy of sodium butyrate enemas ( NABUREN ) in prostate cancer radiation therapy ( RT ) in reducing the incidence , severity , and duration of acute RT-induced proctitis .


@ patients , randomly allocated to @ of @ groups ( rectal sodium butyrate @ g , @ g , or @ g daily or placebo ) , were treated with NABUREN during and @ weeks after RT. .


The grade of proctitis was registered in a daily diary .


The correlation between NABUREN and proctitis was investigated through ( @ ) statistics .


The toxicity endpoints considered were as follows : total number of days with grade @ proctitis ( G@ ) ; total number of days with grade @ proctitis ( G@ ) ; G@ and G@ proctitis lasting at least @ and @ consecutive days starting from week @ ( G@ +@ d , G@ +@ d ) ; damaging effects of RT on rectal mucosa as measured by endoscopy .


The relationship between endpoints and pretreatment morbidities , hormonal therapy , presence of diabetes or hypertension , abdominal surgery , or hemorrhoids was investigated by univariate analysis .


The patients were randomly allocated to the @ arms .


No difference in the distribution of comorbidities among the arms was observed ( P > @ ) .


The mean G@ and G@ proctitis were @ and @ for placebo and @ and @ for the NABUREN group , respectively .


No favorable trend in reduction of incidence , severity , and duration of G@ and G@ proctitis was observed with NABUREN use .


In univariate analysis , G@ +@ d toxicity was found to be related to hemorrhoids ( P = @ ) , and a slight correlation was found between G@ proctitis and hormonal therapy ( P = @ ) .


The RT effects on rectal mucosa as based on endoscopic assessment were mainly related to diabetes ( P < @ ) .


Endoscopy data at @ week showed no significant difference between the placebo and butyrate arms .


The other investigated endpoints were not correlated with any of the clinical risk factors analyzed .


There was no evidence of efficacy of NABUREN in reducing the incidence , severity , and duration of acute radiation proctitis .


There was a correlation between some endpoints and clinical risk factors .


Phenylalanine , which is an essential aromatic amino acid , is either used for protein synthesis or irreversibly hydroxylated to tyrosine .


The provision of optimal amounts of dietary phenylalanine is not only important for growth and development but might also influence catecholamine synthesis and release rates .


The current recommended aromatic amino acid requirement for infants aged @-@ mo is based on the amino acid content of human milk .


We quantified the requirements for phenylalanine in the presence of excess tyrosine ( @ or @ mg/kg per day for term and preterm infants , respectively ) for term and preterm neonates by using the indicator amino acid oxidation method with l - -LSB- @ - ( @ ) C -RSB- lysine @HCl as an indicator .


Hence , we determined the minimum obligatory phenylalanine requirement .


Fully enterally fed term and preterm infants received randomly graded amounts of phenylalanine ( @-@ mg/kg per day ) as part of an elemental formula .


Data are expressed as means SDs .


Twenty term ( birth weight : @ @ kg ; gestational age : @ @ wk ) and @ preterm ( birth weight : @ @ kg ; gestational age : @ @ wk ) Asian infants participated at a postnatal age of @ @ d.


In total , @ studies were performed .


The minimum obligatory phenylalanine requirement was @ mg/kg per day ( @ % CI : @-@ mg/kg per day ) and @ mg/kg per day ( @ % CI : @-@ mg/kg per day ) for term and preterm infants , respectively .


The determined mean phenylalanine-requirement estimates are lower than the contents of term and preterm formulas currently on the market .


This trial was registered at www.trialregister.nl as NTR@ .


Cryptococcal meningitis ( CM ) is a severe AIDS-defining illness with @-day case mortality as high as @ % in sub-Saharan Africa , despite treatment .


It is the leading cause of death in HIV patients in Asia and Africa.No major advance has been made in the treatment of CM since the @s .


The mainstays of induction therapy are amphotericin B and flucytosine , but these are often poorly available where the disease burden is highest .


Adjunctive treatments , such as dexamethasone , have had dramatic effects on mortality in other neurologic infections , but are untested in CM .


Given the high death rates in patients receiving current optimal treatment , and the lack of new agents on the horizon , adjuvant treatments , which offer the potential to reduce mortality in CM , should be tested.The principal research question posed by this study is as follows : does adding dexamethasone to standard antifungal therapy for CM reduce mortality ?


Dexamethasone is a cheap , readily available , and practicable intervention .


A double-blind placebo-controlled trial with parallel arms in which patients are randomised to receive either dexamethasone or placebo , in addition to local standard of care .


The study recruits patients in both Asia and Africa to ensure the relevance of its results to the populations in which the disease burden is highest .


The @-week mortality risk in the control group is expected to be between @ % and @ % , depending on location , and the target hazard ratio of @ corresponds to absolute risk reductions in mortality from @ % to @ % , or from @ % to @ % .


Assuming an overall @-week mortality of at least @ % in our study population , recruitment of @ patients will be sufficient to observe the expected number of deaths .


Allowing for some loss to follow-up , the total sample size for this study is @ patients .


To generate robust evidence across both continents , we aim to recruit roughly similar numbers of patients from each continent .


The primary end point is @-week mortality .


Ethical approval has been obtained from Oxford University 's Tropical Research Ethics Committee ( OxTREC ) , and as locally mandated at each site .


To investigate whether electro-acupuncture or physical exercise influence serum anti-Mllerian hormone ( AMH ) , antral follicle count ( AFC ) or ovarian volume in women with polycystic ovary syndrome ( PCOS ) .


Secondary analyses of a prospective , randomized controlled clinical trial .


University Hospital , Sweden .


Seventy-four women with PCOS recruited from the general population .


Women with PCOS were randomized to @ weeks of electro-acupuncture ( @ treatments ) , exercise ( at least three times/week ) , or no intervention .


Serum AMH recorded at baseline , after @ weeks of intervention , and at follow up at @ weeks .


AFC , and ovarian volume assessed by magnetic resonance imaging at baseline and at follow up at @ weeks .


After @ weeks of intervention , serum levels of AMH were significantly decreased in the electro-acupuncture group by @ % ( p < @ ) , and differed from the change in the exercise group .


AMH remained decreased by @ % ( p = @ ) also at follow up at @ weeks , but did not differ from the exercise or the no intervention groups .


There was a decrease by @ % ( p = @ ) in ovarian volume between baseline and follow up in the electro-acupuncture group , and by @ % ( p = @ ) in AFC in the physical exercise group .


No other variables were affected .


This study is the first to demonstrate that acupuncture reduces serum AMH levels and ovarian volume .


Physical exercise did not influence circulating AMH or ovarian volume .


Despite a within-group decrease in AFC , exercise did not lead to a between-group difference .


To evaluate outcomes of a registered nurse-led care management intervention for disabled Medicaid beneficiaries with high health care costs .


Washington State Department of Social and Health Services Client Outcomes Database , @-@ .


In a randomized controlled trial with intent-to-treat analysis , outcomes were compared for the intervention ( n = @ ) and control groups ( n = @ ) .


A quasi-experimental subanalysis compared outcomes for program participants ( n = @ ) and propensity score-matched controls ( n = @ ) .


Administrative data were linked to describe costs and use of health services , criminal activity , homelessness , and death .


In the intent-to-treat analysis , the intervention group had higher odds of outpatient mental health service use and higher prescription drug costs than controls in the postperiod .


In the subanalysis , participants had fewer unplanned hospital admissions and lower associated costs ; higher prescription drug costs ; higher odds of long-term care service use ; higher drug/alcohol treatment costs ; and lower odds of homelessness .


We found no health care cost savings for disabled Medicaid beneficiaries randomized to intensive care management .


Among participants , care management may have the potential to increase access to needed care , slow growth in the number and therefore cost of unplanned hospitalizations , and prevent homelessness .


These findings apply to start-up care management programs targeted at high-cost , high-risk Medicaid populations .


PROGRESS randomized chronic hepatitis C genotype @ patients with a baseline viral load @,@ IU/mL weighing @ kg to regimens of @ g/week for @ weeks or @ g/week for @ weeks followed by @ g/week for @ weeks peginterferon alfa-@a plus ribavirin .


This analysis explored pharmacokinetics and early viral kinetics ( VK ) and evaluates differences between groups .


Blood samples for pharmacokinetic and VK analyses were collected from @ patients enrolled in the PROGRESS study .


Mean peginterferon alfa-@a trough concentration at week @ was @ ng/mL for @ g and @ ng/mL for @ g. Early VK profiles suggested a trend towards an enhanced viral decline in the @ g groups with a mean decrease in HCV RNA at @ hours post first dose of @ log@ ( IU/mL ) compared with @ log@ ( IU/mL ) in the @ g groups .


Mean beta slope increased with dose , ranging from @ log@ IU/week at @ g to @ log@ IU/week at @ g.


Early viral de clines may be enhanced with the @ g dose .


These data may suggest the utility of high-dose peginterfer on alfa-@a plus direct-acting antivirals ( DAA ) in select difficult-to-treat populations .


This article reports the results of a community-based , culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss , waist circumference , diet and physical activity self-efficacy , and diet behaviors .


The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent .


The design was a randomized controlled trial ( N = @ ) comparing the effects of a @-month educational intervention with an attention control group .


The primary study outcome was weight loss .


Secondary outcomes included change in waist circumference , body mass index , diet self-efficacy , and physical activity self-efficacy .


There were significant intervention effects for weight , waist circumference , body mass index , and diet self-efficacy , with the intervention group doing better than the control group .


These effects did not change over time .


Findings support the conclusion that a community-based , culturally tailored intervention is effective in reducing diabetes risk factors in a @-month program .


Salsalate treatment has been shown to improve glucose homeostasis , but the mechanism remains unclear .


The aim of this study was to evaluate the effect of salsalate treatment on insulin action , secretion , and clearance rate in nondiabetic individuals with insulin resistance .


This was a randomized ( @:@ ) , single-blind , placebo-controlled study of salsalate ( @ g daily for @ weeks ) in nondiabetic individuals with insulin resistance .


All individuals had measurement of glucose tolerance ( @-g oral glucose tolerance test ) , steady-state plasma glucose ( SSPG ; insulin suppression test ) , and insulin secretion and clearance rate ( graded-glucose infusion test ) before and after treatment .


Forty-one individuals were randomized to salsalate ( n = @ ) and placebo ( n = @ ) .


One individual from each group discontinued the study .


Salsalate improved fasting ( % mean change -@ % -LSB- @ % CI -@ to -@ -RSB- vs. @ % -LSB- -@ to @ -RSB- , P = @ ) but not postprandial glucose concentration compared with placebo .


Salsalate also lowered fasting triglyceride concentration ( -@ % -LSB- -@ to -@ -RSB- vs. -@ % -LSB- -@ to @ -RSB- , P = @ ) .


Salsalate had no effect on SSPG concentration or insulin secretion rate but significantly decreased insulin clearance rate compared with placebo ( -@ % -LSB- -@ to -@ -RSB- vs. @ % -LSB- -@ to @ -RSB- , P < @ ) .


Salsalate was well tolerated , but four individuals needed a dose reduction due to symptoms .


Salsalate treatment in nondiabetic , insulin-resistant individuals improved fasting , but not postprandial , glucose and triglyceride concentration .


These improvements were associated with a decrease in insulin clearance rate without change in insulin action or insulin secretion .


Myringotomy and tympanostomy tube insertion ( MT ) is a common surgical procedure .


Although surgical simulation has proven to be an effective training tool , an anatomically sound simulation model for MT is lacking .


We developed such a model and assessed its impact on the operating room performance of senior medical students .


Prospective randomized trial .


A randomized single-blind controlled study of simulation training with the MT model versus no simulation training .


Each participant was randomized to either the simulation model group or control group , after performing an initial MT procedure .


Within two weeks of the first procedure , the students performed a second MT. All procedures were performed on real patients and rated with a Global Rating Scale by two attending otolaryngologists .


Time to complete the MT was also recorded .


Twenty-four senior medical students were enrolled .


Control and intervention groups did not differ at baseline on their Global Rating Scale score or time to complete the MT procedure .


Following simulation training , the study group received significantly higher scores ( P = @ ) and performed the MT procedure in significantly less time ( P = @ ) .


The control group did not improve their performance scores ( P > @ ) or the time to complete the procedure ( P > @ ) .


Our surgical simulation model shows promise for being a valuable teaching tool for MT for senior medical students .


Such anatomically appropriate physical simulators may benefit teaching of junior trainees .


Evidence concerning the importance of glucose lowering in the prevention of cardiovascular ( CV ) outcomes remains controversial .


Given the multi-faceted pathogenesis of atherosclerosis in diabetes , it is likely that any intervention to mitigate this risk must address CV risk factors beyond glycemia alone .


The SGLT-@ inhibitor empagliflozin improves glucose control , body weight and blood pressure when used as monotherapy or add-on to other antihyperglycemic agents in patients with type @ diabetes .


The aim of the ongoing EMPA-REG OUTCOME trial is to determine the long-term CV safety of empagliflozin , as well as investigating potential benefits on macro - / microvascular outcomes .


Patients who were drug-nave ( HbA@c @ % and @ % ) , or on background glucose-lowering therapy ( HbA@c @ % and @ % ) , and were at high risk of CV events , were randomized ( @:@:@ ) and treated with empagliflozin @ mg , empagliflozin @ mg , or placebo ( double blind , double dummy ) superimposed upon the standard of care .


The primary outcome is time to first occurrence of CV death , non-fatal myocardial infarction , or non-fatal stroke .


CV events will be prospectively adjudicated by an independent Clinical Events Committee .


The trial will continue until @ confirmed primary outcome events have occurred , providing a power of @ % to yield an upper limit of the adjusted @ % CI for a hazard ratio of < @ with a one-sided of @ , assuming equal risks between placebo and empagliflozin ( both doses pooled ) .


Hierarchical testing for superiority will follow for the primary outcome and key secondary outcomes ( time to first occurrence of CV death , non-fatal myocardial infarction , non-fatal stroke or hospitalization for unstable angina pectoris ) where non-inferiority is achieved .


Between Sept @ and April @ , @ clinical sites randomized and treated @ patients ( @ % from Europe , @ % from North America , and @ % from Asia ) .


At baseline , the mean age was @ years , BMI @ kg/m@ , HbA@c @ % , and eGFR @ ml/min/@ @ m@ .


The study is expected to report in @ .


EMPA-REG OUTCOME will determine the CV safety of empagliflozin in a cohort of patients with type @ diabetes and high CV risk , with the potential to show cardioprotection .


The clinical effects of osteoporosis include pain , fractures , and physical disability , causing a loss of independence and necessitating long-term care .


Whereas the effects of exercise therapy in decreasing body mass index and preventing fractures are well established , there is no consensus on back pain and quality of life in women with osteoporosis .


The aim of this study was to determine the efficacy of a brief course of rehabilitation , comprising group-adapted physical exercises , with regard to back pain , disability , and quality of life in women with postmenopausal osteoporosis who had no evidence of fractures .


The enrolled patients were randomized into two groups : the treatment group underwent ten sessions of rehabilitative exercises , and the control group received an instructional booklet with descriptions and figures of exercises that were to be performed at home .


Sixty patients completed the trial and assessments , including a @-month follow-up .


The treatment was effective versus the control group , significantly improving pain ( Visual Analogue Scale : p < @ at the end of the treatment and at the follow-up ; McGill Pain Questionnaire : p = @ at the follow-up ) , disability ( Oswestry Disability Questionnaire : p < @ at the end and follow-up ) , and quality of life ( Shortened Osteoporosis Quality of Life Questionnaire : p = @ at the end of treatment ; p = @ at follow-up ) .


Our results suggest that group rehabilitation reduces back pain and improves functional status and quality of life in women with postmenopausal osteoporosis , maintaining these outcomes for @ months .


The use of physical exercises might strengthen the habit to training .


To assess the role that treatment response plays in a randomized controlled trial of an antidepressant among people with spinal cord injury ( SCI ) diagnosed with major depressive disorder ( MDD ) in explaining quality of life ( QOL ) , assessed both globally as life satisfaction and in terms of physical and mental health-related QOL .


Multivariable analyses were conducted , controlling for demographic , neurologic , and participatory factors and perceived functional limitations .


Rehabilitation centers .


Of the @ persons who were randomized into the Project to Improve Symptoms and Mood after Spinal Cord Injury randomized controlled trial , @ participated in this study .


All participants were between the ages of @ and @ years , at least @ month post-SCI , met the Diagnostic and Statistical Manual of Mental Disorders , @th edition , criteria for MDD , and completed the core measures used in this study .


Not applicable .


The Satisfaction with Life Scale and the physical and mental component summary scores of the Medical Outcomes Study @-Item Short-Form Health Survey .


Reduction in depressive symptoms over the course of a @-week trial was predictive of increased QOL , which was measured as life satisfaction and mental well-being , within the context of other explanatory factors .


However , reduction in symptoms did not explain differences in physical well-being among those with MDD .


Perceived functional disability explained all @ indices of QOL .


Greater recognition has been given to QOL outcomes as endpoints of clinical trials because these often reflect participants ' reported outcomes .


Our findings support the association of QOL to the reduction of depression symptoms among trial participants .


This association differs depending on how QOL is defined and measured , with stronger relations observed with life satisfaction and mental well-being among those diagnosed with MDD .


The lack of association between depression and physical well-being may be explained by participants ' subjective interpretation of physical well-being after SCI and their expectations and perceptions of improved physical health-related QOL based on the use of assistive technology .


Consistent with our findings , pain is likely to play a role in decreasing physical QOL among those with incomplete injuries .


Practicing caution is suggested in using physical well-being as an endpoint in trials among people with SCI .


This randomized , double-blind , placebo-controlled trial evaluated intraperitoneal ( IP ) lidocaine administration and intravenous ( IV ) lidocaine infusion for postoperative pain control after laparoscopic cholecystectomy ( LC ) .