Generally , elevations plateaued and remained within normal limits throughout Phase @ and LTE studies .


Exposure-response modeling demonstrated small , reversible effects of tofacitinib on mean SCr , and significant ( P < @ ) effects of CRP on model parameters .


Phase @ data confirmed that patients with higher baseline CRP or greater CRP decreases following tofacitinib treatment had the largest increases in SCr .


Across Phase @ and LTE studies , @ tofacitinib-treated patients had clinical acute renal failure ( ARF ) , predominantly in the setting of concurrent serious illness .


Tofacitinib treatment was associated with small , reversible mean increases in SCr that plateaued early .


The mechanism behind these SCr changes remains unknown , but may involve effects of tofacitinib on inflammation .


ARF occurred infrequently , was associated with concurrent serious illness , and was unrelated to prior SCr increases .


To assess safety up to @year of follow-up associated with prasugrel and clopidogrel use in a prospective cohort of patients with acute coronary syndromes ( ACS ) .


Between @ and @ , @ patients invasively managed for ACS were enrolled in the multicentre Swiss ACS Bleeding Cohort , among whom @ patients received either prasugrel or clopidogrel according to current guidelines .


Patients with ST-elevation myocardial infarction ( STEMI ) preferentially received prasugrel , while those with non-STEMI , a history of stroke or transient ischaemic attack , age @years , or weight < @kg received clopidogrel or reduced dose of prasugrel to comply with the prasugrel label .


After adjustment using propensity scores , the primary end point of clinically relevant bleeding events ( defined as the composite of Bleeding Academic Research Consortium , BARC , type @ , @ or @ bleeding ) at @year , occurred at a similar rate in both patient groups ( prasugrel/clopidogrel : @ % / @ % ) .


Stratified analyses in subgroups including patients with STEMI yielded a similar safety profile .


After adjusting for baseline variables , no relevant differences in major adverse cardiovascular and cerebrovascular events were observed at @year ( prasugrel/clopidogrel : cardiac death @ % / @ % , myocardial infarction @ % / @ % , revascularisation @ % / @ % , stroke @ % / @ % ) .


Of note , this study was not designed to compare efficacy between prasugrel and clopidogrel .


In this large prospective ACS cohort , patients treated with prasugrel according to current guidelines ( ie , in patients without cerebrovascular disease , old age or underweight ) had a similar safety profile compared with patients treated with clopidogrel .


Smoking rates , and associated negative health outcomes , are disproportionately high among people with mental illness compared to the general population .


Smoke-free policies within mental health hospitals can positively impact on patients ' motivation and self-efficacy to address their smoking .


However , without post-discharge support , preadmission smoking behaviours typically resume .


This protocol describes a randomised controlled trial that aims to assess the efficacy of linking mental health inpatients to community-based smoking cessation supports upon discharge as a means of reducing smoking prevalence .


Eight hundred participants with acute mental illness will be recruited into the randomised controlled trial whilst inpatients at one of four psychiatric inpatient facilities in the state of New South Wales , Australia .


After completing a baseline interview , participants will be randomly allocated to receive either : ` Supported Care ' , a multimodal smoking cessation intervention ; or ` Normal Care ' , consisting of existing hospital care only .


The ` Supported Care ' intervention will consist of a brief motivational interview and a package of self-help material for abstaining from smoking whilst in hospital , and , following discharge , @ weeks of motivational telephone-based counselling , @ weeks of free nicotine replacement therapy , and a referral to the Quitline .


Data will be collected at @ , @ and @ months post-discharge via computer-assisted telephone interview .


The primary outcomes are abstinence from smoking ( @-day point prevalence and prolonged cessation ) , and secondary outcomes comprise daily cigarette consumption , nicotine dependence , quit attempts , and readiness to change smoking behaviour .


If shown to be effective , the study will provide evidence in support of systemic changes in the provision of smoking cessation care to patients following discharge from psychiatric inpatient facilities .


The aim was to evaluate the feasibility and safety of early chest tube removal after complete video-assisted thoracic lobectomy ( CVATL ) .


Retrospective analysis was performed on effects of chest tube removal on patients with lung cancer after pulmonary lobectomy between November @ and October @ eligible patients included @ cases for CVATL and @ cases for open thoracic lobectomy .


Patients with CVATL were divided randomly into experimental group ( EG ) and control group ( CG ) , in which @ patients in EG had chest tube removal on the @ nd day after operation ; @ patients in CG had the tube removal when the drainage volume < @ ml/day .


Patients in open thoracic lobectomy group ( OG ) had the tubes removal as CG .


The drainage volumes of the @ st and @ nd @ h after operation , duration of chest tubes , cases of pain alleviation , and recurrent pleural effusions requiring reintervention were measured .


The average drainage volume of the @ st @ h after operation of CVATL group from EG and CG was significantly reduced than that in OG ( @ ml vs. @ ml , P < @ ) .


The average drainage volume of the @ nd @ h after operation of CG was significantly reduced than that in OG ( @ ml vs. @ ml , P < @ ) .


The average duration of chest tube of CG for @ days showed significant different compared with OG for @ days ( P < @ ) .


Chest tube removal in CVATL group increased more chest pain alleviation than OG ( @ % vs. @ % , P = @ ) .


The frequencies of recurrent pleural effusions requiring reintervention were @ % ( @/@ ) , @ % ( @/@ ) and @ % ( @/@ ) , respectively , which had no significant differences between three groups ( P = @ ) .


Complete video-assisted thoracic lobectomy brings less drainage volume after operation .


Early removal of chest tube in CVATL shows feasible and safe and demonstrates that it may reduce postoperative pain and help fast recovery .


To determine the clinical effectiveness of an exercise programme on self-reported hand activity performance in people with hand osteoarthritis ( OA ) .


In this randomized , controlled trial , participants with physician-confirmed hand OA were randomly allocated to a @-week exercise intervention ( group - and home-based ) or usual care .


The primary outcome was self-reported hand activity performance at @ months measured by the Functional Index for Hand Osteoarthritis ( FIHOA ) and a patient-generated measure of disability , the Patient-Specific Functional Scale ( PSFS ) .


Of @ randomized participants ( mean age @ ( standard deviation ( SD ) @ ) ; female @ % ) , @ ( @ % ) and @ ( @ % ) completed the @ - and @-month follow-ups .


The adjusted mean difference for the exercise vs control group was -@ points ( @ % confidence interval ( CI ) -@ , @ ) for the FIHOA score ( @-@ scale , @ = best ) and @ points ( @ % CI @ , @ ) for the PSFS score ( @-@ scale , @ = best ) .


Small significant mean differences in favour of the intervention group were found for hand pain , hand stiffness and disease activity , whereas no mean differences were observed in hand dexterity or maximal grip strength .


A significantly larger proportion in the intervention ( @ % ) vs control group ( @ % ) fulfilled the Outcome Measures in Rheumatological Clinical Trials-Osteoarthritis Research Society International ( OMERACT-OARSI ) responder criteria at @ months ( OR = @ , @ % CI @ , @ ) .


At the @-month follow-up , there were no significant group differences in any outcome .


The exercise programme was well tolerated among people with hand OA , but resulted only in small , beneficial short-term improvements on self-reported measures and not on most performance-based tests .


Future studies should address optimal grip strength exercises and dosage .


Systemic inflammation , endothelial dysfunction , and oxidative stress are involved in the pathogenesis of the metabolic syndrome ( MetS ) .


Epidemiological evidence supports an association between whole soy food consumption and reduced risk of cardiovascular disease ( CVD ) .


The objective of this randomized , controlled , cross-over study was to evaluate the effects of soy nut consumption on inflammatory biomarkers and endothelial function and to assess whether isoflavone metabolism to secondary products , equol , and/or O-desmethylangolensin ( ODMA ) , modifies these responses .


n = @ adults at cardiometabolic risk were randomly assigned to the order of two snack interventions , soy nuts , and macronutrient-matched control snack , for four weeks each , separated by a two week washout period .


Outcome measures included biomarkers of inflammation , oxidative stress , and glycemic control ( ELISA and clinical analyzers ) , endothelial function , and arterial stiffness ( peripheral arterial tonometry ( PAT ) ) , and isoflavone metabolites ( LC-MS/MS ) .


Results revealed that consuming soy nuts improved arterial stiffness as assessed by the augmentation index using PAT ( p = @ ) , despite lack of improvement in inflammatory biomarkers .


Addition of equol and/or ODMA production status as covariates did not significantly change these results .


Soy nuts when added to a usual diet for one month provide some benefit on arterial stiffness in adults at cardiometabolic risk .


The addition of PCV ( procarbazine , lomustine , and vincristine ) chemotherapy to radiotherapy ( RT ) for patients with WHO grade @ glioma improves progression-free survival ( PFS ) .


The effect of therapy intensification on cognitive function ( CF ) remains a concern in this population with substantial long-term survival .


A total of @ patients with WHO grade @ glioma age @ years with any extent of resection or age < @ years with subtotal resection/biopsy were randomly assigned to RT ( @ Gy ) or RT plus PCV .


We observed @ patients age < @ years with gross total resection .


CF was assessed by Mini-Mental State Examination ( MMSE ) at baseline and years @ , @ , @ , and @ .


Overall , few patients experienced significant decline in MMSE score .


There were no significant differences in the proportion of patients experiencing MMSE score decline between the randomized study arms at any time point .


Both study arms experienced a significant gain in average MMSE score longitudinally over time , with no difference between arms .


The MMSE is a relatively insensitive tool , and subtle changes in CF may have been missed .


However , the addition of PCV to RT did not result in significantly higher rates of MMSE score decline than RT alone through @ years of follow-up .


Patients in both randomly assigned arms experienced a statistically significant average MMSE score increase over time , with no difference between arms .


The addition of PCV chemotherapy to RT improves PFS without excessive CF detriment over RT alone for patients with low-grade glioma .


With use of EGFR tyrosine-kinase inhibitor monotherapy for patients with activating EGFR mutation-positive non-small-cell lung cancer ( NSCLC ) , median progression-free survival has been extended to about @ months .


Nevertheless , new strategies are needed to further extend progression-free survival and overall survival with acceptable toxicity and tolerability for this population .


We aimed to compare the efficacy and safety of the combination of erlotinib and bevacizumab compared with erlotinib alone in patients with non-squamous NSCLC with activating EGFR mutation-positive disease .


In this open-label , randomised , multicentre , phase @ study , patients from @ centres across Japan with stage IIIB/IV or recurrent non-squamous NSCLC with activating EGFR mutations , Eastern Cooperative Oncology Group performance status @ or @ , and no previous chemotherapy for advanced disease received erlotinib @ mg/day plus bevacizumab @ mg/kg every @ weeks or erlotinib @ mg/day monotherapy as a first-line therapy until disease progression or unacceptable toxicity .


The primary endpoint was progression-free survival , as determined by an independent review committee .


Randomisation was done with a dynamic allocation method , and the analysis used a modified intention-to-treat approach , including all patients who received at least one dose of study treatment and had tumour assessment at least once after randomisation .


This study is registered with the Japan Pharmaceutical Information Center , number JapicCTI-@ .


Between Feb @ , @ , and March @ , @ , @ patients were enrolled .


@ were randomly assigned to receive erlotinib and bevacizumab and @ to erlotinib alone , of whom @ patients in the erlotinib plus bevacizumab group and @ in the erlotinib alone group were included in the efficacy analyses .


Median progression-free survival was @ months ( @ % CI @-@ ) with erlotinib plus bevacizumab and @ months ( @-@ ) with erlotinib alone ( hazard ratio @ , @ % CI @-@ ; log-rank test p = @ ) .


The most common grade @ or worse adverse events were rash ( @ -LSB- @ % -RSB- patients in the erlotinib plus bevacizumab group vs @ -LSB- @ % -RSB- patients in the erlotinib alone group ) , hypertension ( @ -LSB- @ % -RSB- vs eight -LSB- @ % -RSB- ) , and proteinuria ( six -LSB- @ % -RSB- vs none ) .


Serious adverse events occurred at a similar frequency in both groups ( @ -LSB- @ % -RSB- patients in the erlotinib plus bevacizumab group and @ -LSB- @ % -RSB- patients in the erlotinib alone group ) .


Erlotinib plus bevacizumab combination could be a new first-line regimen in EGFR mutation-positive NSCLC .


Further investigation of the regimen is warranted .


Mitral regurgitant volume ( MRvol ) is an important index of the severity of mitral regurgitation ( MR ) , but MRvol measurement remains challenging .


With the development of probe technology and software , General Imaging @D Quantification ( GI @DQ ) allows the direct measurement of MR jet volume .


The aim of this study was to evaluate the feasibility and accuracy of MRvol by quantification of MR jet volume using GI @DQ .


Ninety-three patients were included , @ with functional MR and @ with mitral valve prolapse .


Patients with MR were also divided into those with central MR ( n = @ ) and those with eccentric MR ( n = @ ) .


MRvol was assessed using GI @DQ and the proximal isovelocity surface area ( PISA ) method .


MRvol using effective regurgitant orifice area by real-time three-dimensional echocardiography multiplied by the MR time-velocity integral was used as the reference method .


MRvol measured by GI @DQ and the PISA method had good correlation with MRvol by the reference method .


A significant underestimation of MRvol using GI @DQ and the PISA method was observed in the assessment of eccentric MR , but without a significant difference in the assessment of central MR.


Quantification of MRvol with GI @DQ was feasible .


Quantification of central MRvol using this methodology is accurate compared with the reference method .


Quantification of MRvol with GI @DQ has no significant difference from the currently recommended PISA method .


The occipito-posterior ( OP ) fetal head position during the first stage of labour occurs in @-@ % of cephalic presentations .


Most will spontaneous rotate in anterior position before delivery , but @-@ % of all births will persist in OP position for the third stage of labour .


Previous observations have shown that this can lead to an increase of complications , such as an abnormally long labour , maternal and fetal exhaustion , instrumental delivery , severe perineal tears , and emergency caesarean section .


Usual care in the case of diagnosis of OP position is an expectant management .


However , maternal postural techniques have been reported to promote the anterior position of the fetal head for delivery .


A Cochrane review reported that these maternal positions are well accepted by women and reduce back pain .


However , the low sample size of included studies did not allow concluding on their efficacy on delivery outcomes , particularly those related to persistent OP position .


Our objective is to evaluate the efficacy of maternal position in the management of OP position during the first stage of labour .


A randomised clinical trial is ongoing in the maternity unit of the Geneva University Hospitals , Geneva , Switzerland .


The unit is the largest in Switzerland with @,@ births/year .


The trial will involve @ women with a fetus in OP position , confirmed by sonography , during the first stage of the labour .


The main outcome measure is the position of the fetal head , diagnosed by ultrasound one hour after randomisation .


It is important to evaluate the efficacy of maternal position to correct fetal OP position during the first stage of the labour .


Although these positions seem to be well accepted by women and appear easy to implement in the delivery room , the sample size of the last randomised clinical trial published in @ to evaluate this intervention had insufficient power to demonstrate clear evidence of effectiveness .


If the technique demonstrates efficacy , it would reduce the physical and psychological consequences of complications at birth related to persistent OP position .


Retroperitoneal soft tissue sarcomas ( RPS ) are rare tumors that include several well-defined histologic subtypes .


Although surgery is the mainstay of curative therapy , no universally accepted recommendations concerning the best management have been developed to date .


Optimization of the initial approach is critical for maximizing patient outcomes .


An RPS Trans-Atlantic Working Group was established in @ .


The primary aim was to evaluate the current evidence critically and to develop a consensus document on the approach to this difficult disease .


The outcome applies to primary RPS that is nonvisceral in origin .


The evaluation included sarcomas of major veins ( inferior vena cava , renal vein , ovarian/testicular vein ) , undifferentiated pleomorphic sarcoma of the psoas , and ureteric leiomyosarcoma ( LMS ) .


It excluded desmoid , lipoma and angiomyolipoma , gastrointestinal stromal tumors , visceral sarcomas such as those arising from the gut or its mesentery , uterine LMS , prostatic sarcoma , paratesticular/spermatic cord sarcoma , Ewing 's sarcoma , alveolar/embryonal rhabdomyosarcoma , primitive peripheral neuro-ectodermal tumor , sarcoma arising from teratoma , carcinosarcoma , sarcomatoid carcinoma , clear cell sarcoma , radiation-induced sarcoma , paraganglioma , and malignant pheochromocytoma .


Management of RPS was evaluated from diagnosis to follow-up , and a level of evidence was attributed to each statement .


This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center .


The best chance of cure is at the time of primary presentation , and an individualized management plan should be made based on the statements included in this article .


International collaboration is critical for adding to the current knowledge .


A prospective registry will be set up .


To investigate the effects of Swedish massage with aromatic ginger oil ( SMGO ) on chronic low back pain and disability in older adults compared with traditional Thai massage ( TTM ) .


Randomized controlled trial .


Massage clinic in Ratchaburi province , Thailand .


@ patients were screened ; @ were eligible , and randomized to either SMGO ( n = @ ) or TTM ( n = @ ) .


Trained staff provided participants with a @-min SMGO or TTM twice a week for five weeks .


The Visual Analogue Scale ( VAS ) assessed immediate effect ( after each massage ) and the short form McGill Pain Questionnaire ( MPQ ) assessed effectiveness of massage in short-term ( six weeks ) and long-term ( @ weeks ) .


Disability improvement was measured by the Owestry Disability Questionnaire ( ODQ ) at baseline , short - and long-term .


Both SMGO and TTM led to significant improvements in pain intensity ( p < @ ) and disability ( p < @ ) across the period of assessments , indicating immediate , short - and long-term effectiveness .


SMGO was more effective than TTM in reducing pain ( p = @ ) and improving disability at short - and long-term assessments ( p = @ ) .


These findings suggest that the integration of either SMGO or TTM therapy as additional options to provide holistic care to older people with chronic low back pain could be considered by health professionals .


Further research into the use of ginger as an adjunct to massage therapy , particularly TTM , is recommended .


To determine whether @-week stenting of the pelvi-ureteric anastomosis of laparoscopic or robot-assisted pyeloplasty is as effective as @-week stenting , based on their respective success rates .


A total of @ patients with pelvi-ureteric junction obstruction were treated by Anderson-Hynes pyeloplasty and the anastomosis was stented using a @-F JJ catheter for either @ week ( @W series ) or @ weeks ( @W series ) , based on a randomisation protocol .


Postoperative follow-up was performed at @ months using intravenous urography ( IVU ) , at @ months using diuretic renography and at @ , @ and @ years using ultrasonography .


Statistical analysis was performed using a one-sided Z-test , Pearsons 's chi-squared test and a Wilcoxon rank sum test .


The primary outcome measure , success rate , which was defined as no obstruction on IVU and diuretic renography , was @ % in the @W series and not inferior to the success rate of @ % in the @W series ( P = @ ) .


The following secondary outcome measures were not significantly different between the @W and the @W series with regard to residual symptoms ( @ vs @ % ; P = @ ) , rate of complications ( @ vs @ % ; P = @ ) , need for synchronous robot-assisted pyelolithotomy ( @ vs @ % ; P = @ ) , improvement in split renal function ( @ vs @ % ; P = @ ) and duration of surgery ( @ vs @min ; P = @ ) .


Only length of hospital stay was significantly different ; this was shorter in the @W series ( @ vs @ days ; P = @ ) .


Stenting of the pelvi-ureteric anastomosis after laparoscopic or robot-assisted pyeloplasty for @ week is as effective as stenting for @ weeks .


Both procedures , laparoscopic or robot-assisted pyeloplasty have an excellent success rate .


We previously reported results of our on-line microsurgery training program , showing that residents who had access to our website significantly improved their cognitive and technical skills .


In this study , we report an objective means for expert evaluators to reliably rate trainees ' technical skills under the microscope , with the use of our novel global rating scale .


`` Microsurgery Essentials '' ( http://smartmicrosurgery.com ) is our on-line training curriculum .


Residents were randomly divided into @ groups : @ group reviewed this online resource and the other did not .


Pre - and post-tests consisted of videotaped microsurgical sessions in which the trainee performed `` microsurgery '' on @ different models : latex glove , penrose drain , and the dorsal vessel of a chicken foot .


The SMaRT ( Stanford Microsurgery and Resident Training ) scale , consisting of @ categories graded on a @-point Likert scale , was used to assess the trainees .


Results were analyzed with ANOVA and Student t test , with P less than @ indicating statistical significance .


Seventeen residents participated in the study .


The SMaRT scale adequately differentiated the performance of more experienced senior residents ( PGY-@ to PGY-@ , total average score = @ ) from less experienced junior residents ( PGY-@ to PGY-@ , total average score = @ , P < @ ) .


Residents who viewed themselves as being confident received a higher score on the SMaRT scale ( average score @ ) , compared to residents who were not as confident ( average score @ ) ( P < @ ) .


There were no significant differences in scoring among all @ evaluators ( P > @ ) .


Additionally , junior residents who had access to our website showed a significant increase in their graded technical performance by @ points when compared to residents who did not have access to the website who showed an improvement of only @ points ( P = @ ) .


Our SMaRT scale is valid and reliable in assessing the microsurgical skills of residents and other trainees .


Current trainees are more likely to use self-directed on-line education because of its easy accessibility and interactive format .


Our global rating scale can help ensure residents are achieving appropriate technical milestones .


To determine the efficacy of timolol @ % gel in preventing increased intraocular pressure ( IOP ) after uncomplicated cataract surgery .


In this prospective , double-blinded , randomized study were enrolled @ patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation .


After cataract surgery , @ patients received a single instillation of timolol @ % gel ( group A ) ; @ a single instillation of timolol @ % eyedrops ( group B ) ; and @ no treatment ( group C ) .


The IOP was measured before surgery ( T@ ) and @ minutes ( T@ ) , @ hours @ minutes ( T@ ) , @ hours @ minutes ( T@ ) , and @ hours @ minutes after surgery ( T@ ) .


The patients in groups A and B had lower mean IOP values than those in group C at T@ , T@ , and T@ ; IOP was higher at T@ and T@ than at T@ in the control group .


The IOP spikes in group C were higher than those observed in groups A and B : at T@ , they were observed in @ % of the patients in group A , @ % in group B , and @ % in group C ; and at T@ , in respectively @ % , @ % , and @ % ; and at T@ , in respectively @ % , @ % , and @ % .


Timolol @ % gel is as effective as timolol @ % eyedrops in reducing IOP and in limiting the occurrence of IOP spikes for up to @ hours after phacoemulsification .


To evaluate the effects of a breastfeeding intervention on primiparous mothers ' breastfeeding self-efficacy , breastfeeding duration and exclusivity at @ and @ weeks postpartum .


Few studies have examined the effects of breastfeeding self-efficacy on improved breastfeeding outcomes among primiparous mothers in China .


An experimental pre-test and posttest , two-group design was used in the study .


A total of @ participants were recruited to the study from a tertiary hospital in central China , from June-October @ .


An individualized , standardized nursing intervention based on the Self-Efficacy Theory was delivered to enhance mothers ' breastfeeding self-efficacy , breastfeeding duration and exclusivity at @ and @ weeks postpartum .


Participants were randomly assigned to an intervention or referent group .


Participants in the intervention group received three individualized , self-efficacy-enhancing sessions .


Participants in the referent group received standard care .


Participants in the intervention group showed significantly greater increases in breastfeeding self-efficacy , exclusivity and duration than participants in the control group at @ and @ weeks postpartum ( except for duration at @ weeks ) .


High baseline breastfeeding self-efficacy predicted higher breastfeeding self-efficacy later and more exclusive breast-feeding .


The findings in this study suggest that intervention aimed at increasing self-efficacy has a significant impact on maternal breastfeeding self-efficacy and short-term breastfeeding outcomes .


To examine risk moderation of an alcohol intervention targeting parents and adolescents .


A cluster randomized trial including @ Dutch early adolescents ( m = @ years , SD = @ ) and their parents randomized over four conditions : parent intervention , student intervention , combined parent-student intervention , and control group .


@ classes of @ high schools in The Netherlands ( @ ) .


Moderators at baseline ( adolescent : gender , educational level and externalizing behavior ; parent : educational level and heavy alcohol use ) were used to examine the differential effects of the interventions on onset of ( heavy ) weekly drinking at @-month follow-up .


The combined intervention effectively delayed the onset of weekly drinking in the general population of adolescents , and was particularly effective in delaying the onset of heavy weekly drinking in a higher-risk subsample of adolescents ( i.e. those attending lower levels of education and reporting higher levels of externalizing behavior ) .


Present and previous results have established the combined intervention to be universally effective in postponing weekly alcohol use among Dutch adolescents , with an added effect on postponing heavy weekly drinking in high risk subgroups .


Therefore , implementation of this intervention in the general population of schools in The Netherlands is advised .


Knowledge among critical care nurses and their adherence to evidence-based guidelines for preventing ventilator-associated pneumonia is reported to be low .


The aim of our study was to evaluate the effectiveness of human patient simulation ( HPS ) education in the nursing management of patients requiring mechanical ventilation .


A prospective , parallel , randomized controlled trial with repeated measurements was conducted in a @-bed adult mixed medical-surgical intensive care unit in Finland from February-October @ .


Thirty critical care nurses were allocated evenly to intervention and control groups ( n = @ each ) .


The effectiveness of HPS education was evaluated through the validated Ventilator Bundle Questionnaire and Ventilator Bundle Observation Schedule at baseline and repeated twice-after the clinical and simulation settings , respectivley .


After HPS education , the average skill scores ( Ventilator Bundle Observation Schedule ) in the intervention group increased significantly ( @ % -@ % of the total score ) in the final postintervention observation .


In the average skill scores , a linear mixed model identified significant time ( Pt < @ ) and group ( P ( g ) = @ ) differences and time-group interactions ( P ( t * g ) = @ ) between the study groups after the HPS education .


In contrast , the model did not identify any significant change over time ( P ( t ) = @ ) or time-group interactions ( P ( t ) = @ ) between groups in average knowledge scores ( Ventilator Bundle Questionnaire ) .


Our study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants ' factual knowledge .


Immediate breast reconstruction with an expander is a reasonable option for properly selected patients .


After reconstruction , patients have severe postoperative pain , which responds poorly to opioids .


Our aim was to evaluate if continuous wound infusion of a local anaesthetic into the surgical wound reduces postoperative pain , consumption of opioids and incidence of chronic pain compared to standard intravenous piritramide after primary breast reconstruction in breast carcinoma patients .


Altogether , @ patients were enrolled in our study ; one half in the group with wound infusion of a local anaesthetic , and the other half in the standard ( piritramide ) group .


Parameters measured included : pain intensity ( visual analogue scale ) , drug requirements , alertness , hospitalisation , side-effects and late complications .


A p-value of < @ was considered statistically significant .


In the recovery room , the test group reported less acute pain at rest ( P = @ ) and at activity ( P = @ ) , and on the day of the surgical procedure they reported less pain at activity ( P = @ ) .


Consumption of piritramide and metoclopramide was lower in this group ( P < @ ) , but their alertness after the surgical procedure was higher compared to the standard group ( P < @ ) .


After three months , the test group reported less chronic pain ( P = @ ) .


After primary tissue expander breast reconstruction , wound infusion of a local anaesthetic significantly reduces acute pain and enables reduced opioid consumption , resulting in less postoperative sedation and reduced need for antiemetic drugs .


Wound infusion of a local anaesthetic reduces chronic pain .


To explore whether poor initial insight during a first episode of mania with psychotic features was predictive of poor psychosocial and clinical outcomes at @ months .


Secondary analysis was performed on data collected during an @-week RCT comparing the efficacy of olanzapine versus chlorpromazine as an adjunct to lithium , and at @-month follow-up .


@ participants were divided into three groups ( no insight , partial insight , and full insight ) according to the insight item from the Young Mania Rating Scale ( YMRS ) .


Differences between these three groups were examined at baseline and at @ months on measures of symptoms ( YMRS , HAMD-@ , and CGI-S ) , and social and occupational functioning ( SOFAS ) .


Baseline differences between the three groups were determined using general linear models and chi-squared analyses .


Group differences from baseline to @-month follow-up were determined using repeated measures general linear models .


At baseline there were significant differences between the three insight groups in terms of mania and functioning , but at @ months all groups had improved significantly in terms of psychopathology , mania , depression and social and occupational functioning .


There were no significant differences between the three groups at study completion with respect to these domains .


The study was limited by the lack of availability of a more detailed rating scale for insight , and it did not account for the duration of untreated psychosis ( DUI ) .


Poor initial insight during a first episode of mania with psychotic features does not predict poor clinical and psychosocial outcome at @ months .


New surgical techniques and devices have been described that decrease post-tonsillectomy morbidities .


This study aimed to compare the two most popular tonsillectomy techniques .


Forty children underwent tonsillectomies using both the thermal welding and cold dissection techniques .


In each patient , one side was removed with thermal welding and the other was removed with cold dissection .


There was a significant decrease in intra-operative blood loss , and the mean operation time was significantly lower on the thermal welding side compared with the cold dissection side .


On the cold dissection side , tissue healing ( i.e. the rate of complete tissue healing ) was better and less pain was reported compared with the thermal welding side .


However , there were no significant differences between the two techniques in terms of throat pain scores on the @st , @rd or @th day post-operatively , or tissue healing scores on any of the post-operative days assessed .


Cold dissection resulted in better tissue healing and lower pain scores than thermal welding , but thermal welding was associated with less intra-operative blood loss and lower mean operation time than cold dissection .


Several probiotic strains have been shown to enhance human resistance to infectious disease .


It is speculated that these strains may impose this effect by excretion of anti-microbial components , by competing with pathogens for intestinal nutrients and/or mucosal adhesion sites or modulating the immune system .


A parallel , double-blind , placebo-controlled @-week intervention was performed in healthy males , to study the effect of a blend of probiotic bacteria ( Lactobacillus helveticus Rosell-@ , Lactobacillus rhamnosus Rosell-@ , Bifidobacterium longum ssp .


longum Rosell-@ ) and a probiotic yeast ( Saccharomyces cerevisiae var boulardii CNCM I-@ ) on enterotoxigenic Escherichia coli ( ETEC ) challenge .


Primary outcomes studied were fecal ETEC excretion and total fecal output per day .


Subjects were randomized to the probiotic ( @ @ ( @ ) colony-forming units ( CFUs ) ; twice daily ; n = @ ) or placebo group ( twice daily ; n = @ ) .


After @ weeks , subjects were orally challenged with a live attenuated ETEC ( @ @ ( @ ) CFU ) , previously demonstrated to induce mild , short-lived symptoms of a foodborne infection .


Before and after ETEC challenge , subjects collected @h fecal samples .


Compliance to study guidelines , stool consistency ( Bristol Stool Score ) , stool frequency , and frequency and severity of gastrointestinal ( GI ) complaints were recorded by the subjects on a Daily Record Questionnaire .


ETEC challenge induced a significant increase in fecal ETEC excretion in both groups .


However , a statistically significant increase in fecal output was only observed in the probiotic group .


ETEC challenge resulted in a decrease in the percentage of fecal dry weight , and an increase in reported Bristol Stool Score , stool frequency and GI complaints .


Dietary probiotics significantly decreased the percentage of fecal dry weight .


In addition , ETEC increased C-reactive protein , total secretory Immunoglobulin A ( IgA ) and Immunoglobulin G Colonization Factor Antigen II .


Dietary probiotics did not increase resistance to oral attenuated ETEC challenge in human subjects .


To investigate the impact of three different macular carotenoid formulations on macular pigment optical density and visual performance in subjects with early age-related macular degeneration .


Fifty-two subjects were supplemented and followed for @ months , @ of them were in intervention Group @ ( @ mg/day lutein and @ mg/day zeaxanthin ) ; @ in Group @ ( @ mg/day meso-zeaxanthin , @ mg/day lutein , and @ mg/day zeaxanthin ) ; and @ in Group @ ( @ mg/day meso-zeaxanthin , @ mg/day lutein , and @ mg/day zeaxanthin ) .


The macular pigment optical density was measured using customized heterochromatic flicker photometry , and visual function was assessed using corrected distance visual acuity and by letter contrast sensitivity .


A statistically significant increase in the macular pigment optical density was observed at all measured eccentricities in Group @ ( P @ ) and in Group @ ( P < @ , for all ) , but only at @ in Group @ ( P = @ ) .


Statistically significant ( P < @ ) improvements in letter contrast sensitivity were seen at all spatial frequencies ( except @ cycles per degree ) in Group @ , and at low spatial frequencies in Groups @ and @ .


Augmentation of the macular pigment optical density across its spatial profile and enhancements in contrast sensitivity were best achieved after supplementation with a formulation containing high doses of meso-zeaxanthin in combination with lutein and zeaxanthin .


In the PREDICT study , a randomised controlled trial comparing dexamethasone with prednisolone in patients with chronic inflammatory demyelinating polyradiculoneuropathy ( CIDP ) , almost a quarter of patients deteriorated soon after starting treatment .


The primary objective of this post-hoc analysis was to test the hypothesis that a focal demyelination pattern is associated with early deterioration after corticosteroid treatment and to explore whether various clinical characteristics are associated with deterioration after corticosteroid treatment .


Clinical outcome was categorised into early deterioration and non-early deterioration .


A neurophysiologist blinded for treatment outcome scored electrophysiological data into following categories : pure focal versus non-focal distribution of demyelination and no/minor versus moderate/severe sensory involvement .


Additionally , we compared electrophysiological and clinical baseline parameters , with emphasis on previously reported possible associations .


Early deterioration was found in @ out of @ patients ( @ % ) .


Ten patients had pure focal distribution of demyelination , of whom @ had early deterioration ; @ patients had non-focal distribution , of whom @ had early deterioration ( p = @ ) .


Higher mean median nerve sensory nerve conduction velocity ( SNCV ) was found in patients with early deterioration compared to patients with non-early deterioration ( @ and respectively @ m/s , p = @ ) .


Pure focal distribution of demyelination and lesser sensory electrophysiological abnormalities may be associated with early deterioration in CIDP patients treated with corticosteroids .


Although azacitidine ( AZA ) improves survival in patients with high-risk myelodysplastic syndrome , the overall response remains approximately @ % .


Entinostat is a histone deacetylase inhibitor that has been combined with AZA with significant clinical activity in a previous phase I dose finding study .


Open label phase II randomized trial comparing AZA @ mg/m ( @ ) / d given for @ days entinostat @ mg/m ( @ ) / d day @ and day @ .


All subtypes of myelodysplasia , chronic myelomonocytic leukemia , and acute myeloid leukemia with myelodysplasia-related changes were eligible for the study .


The primary objective was the rate of hematologic normalization ( HN ; complete remission + partial remission + trilineage hematological improvement ) .


One hundred forty-nine patients were analyzed , including @ patients with myelodysplastic syndrome and @ patients with acute myeloid leukemia .


In the AZA group , @ % ( @ % CI , @ % to @ % ) experienced HN and @ % ( @ % CI , @ % to @ % ) in the AZA + entinostat group .


Both arms exceeded the HN rate of historical control ( Cancer and Leukemia Group B @ trial ) , but only the AZA group fulfilled the primary objective of the study .


Rates of overall hematologic response were @ % and @ % , respectively .


Median overall survivals were @ months for the AZA group and @ months for the AZA + entinostat group .


The combination arm led to less demethylation compared with the monotherapy arm , suggesting pharmacodynamic antagonism .


Addition of entinostat to AZA did not increase clinical response as defined by the protocol and was associated with pharmacodynamic antagonism .


However , the prolonged administration of AZA by itself seems to increase HN rate compared with standard dosing and warrants additional investigation .


Periodic breathing ( PB ) during sleep and exercise in heart failure ( HF ) is related to respiratory acid-base status , CO@ chemosensitivity , and temporal dynamics of CO@ and O@ sensing .


We studied inhaled CO@ and acetazolamide to alter these factors and reduce PB .


We measured expired and arterial gases and PB amplitude and duration in @ HF patients during exercise before and after acetazolamide given acutely ( @ mg intravenously ) and prolonged ( @ hours , @ g orally ) , and we performed overnight polysomnography .


We studied CO@ inhalation ( @ % -@ % ) during constant workload exercise .


PB disappeared in @/@ and @/@ patients during @ % and @ % CO@ .


No changes in cardiorespiratory parameters were observed after acute acetazolamide .


With prolonged acetazolamide at rest : ventilation +@ @ L/min ( P = @ ) , tidal volume +@ @ L ( P = @ ) , respiratory rate +@ @ breaths/min ( NS ) , end-tidal PO@ +@ @ mm Hg ( P = @ ) , and end-tidal PCO@ -@ @ mm Hg ( P < @ ) .


At maximum exercise : Watts -@ % ( P < @ ) , VO@ -@ @ mL/min ( P = @ ) and VCO@ @ @ mL/min ( P < @ ) .


Among @ patients , PB disappeared in @ and @ subjects after acute and prolonged acetazolamide , respectively .


PB was present @ % @ , @ % @ , and @ % @ of exercise time before and after acute and prolonged acetazolamide , respectively .


Overnight apnea/hypopnea index decreased from @ @ to @ @ ( P = @ ) .


In HF , inhaled CO@ and acetazolamide reduce exercise PB with additional benefits of acetazolamide on sleep PB .


In the present study , `` Diabegon '' a poly-herbal preparation , with hypoglycemic activity , was evaluated for its preventive effect in metabolic syndrome subjects with type @ diabetes and also to reveal its side effects , on liver and kidney .


Type @ diabetic subjects with metabolic syndrome ( N = @ ) were categorized on the basis of age and fasting blood glucose .


The grouping was as follows : Group I ( @-@ yrs ) , Group II ( @-@ yrs ) , Group III > @ yrs , Group IV FBS < @ , Group V FBS > @ .


Each group was administered @ gm of diabegon daily .


Blood glucose levels , lipid profile , liver and kidney function of the subjects were regularly monitored within @ months of interval to @ months .


The reduction in fasting blood glucose level ranged from @ % ( P < @ ) to @ % ( P < @ ) after @ month of therapy whereas in postprandial blood glucose , the decrease ranged from @ % ( P < @ ) to @ % ( P < @ ) after @ month of therapy .


Overall reductions in the individual parameters of the metabolic syndrome subjects were significantly higher in Group I. Cholesterol level decreased from @ % to @ % ( P < @ ) , triglyceride levels decreased from @ % to @ % , VLDL and LDL levels reduced by @ % & @ % respectively after @ months of therapy .


The HDL-C level increased in all groups .


Moreover , diabegon administration for @ years exhibited no alteration in liver and kidney function tests , which indicate its non-toxicity .


Our study suggests that diabegon could be included as a preventive treatment in metabolic syndrome subjects with type @ diabetes especially for long term treatment as it efficiently shows anti-hyperglycemic and anti-lipidemic effects with no adverse impacts on the liver and kidney .


Diet may substantially alter prostate cancer initiation and progression .


However , large-scale clinical trials of diet modification have yet to be performed for prostate cancer .


The Men 's Eating and Living ( MEAL ) Study ( CALGB @ -LSB- Alliance -RSB- ) is investigating the effect of increased vegetable consumption on clinical progression in men with localized prostate cancer .


MEAL is a randomized , phase III clinical trial designed to test whether an intervention that increases vegetable intake will decrease the incidence of clinical progression in men with clinically localized prostate cancer on active surveillance .


We are randomizing @ patients to either a validated telephone-based diet counseling intervention or a control condition in which patients receive a published diet guideline .


The intervention will continue for two years .


The primary outcome variable is clinical progression defined by serum prostate-specific antigen ( PSA ) and pathological findings on follow-up prostate biopsy .


Secondary outcome variables include incidence of surgical and non-surgical treatments for prostate cancer , prostate-cancer related patient anxiety and health-related quality of life .


The MEAL Study is assessing the effectiveness of a high-vegetable diet intervention for preventing clinical progression in men with localized prostate cancer on active surveillance .


Current clinical assessments of motor function in Huntington 's Disease ( HD ) rely on subjective ratings such as the Unified Huntington 's Disease Rating scale ( UHDRS ) .


The ability to track disease progression using simple , objective , inexpensive , and robust measures would be beneficial .


One objective measure of motor performance is hand-tapping .


Over the last @ years we have routinely collected , using a simple device , the number of taps made by the right and left hand over @ seconds in HD patients attending our NHS clinics .


Here we report on a longitudinal cohort of @ patients , which includes patients at all stages of the disease on a wide range of drug therapies .


Hand tapping in these patients declines linearly at a rate of @ taps per year ( p < @ ; @ % CI = @ to @ taps ) , and for each additional year of age patients could perform @ fewer taps ( main effect of age : p = @ ; @ % CI = @ to @ ) .


Individual trajectories can vary widely around this average rate of decline , and much of this variation could be attributed to CAG repeat length .


Genotype information was available for a subset of @ patients , and for each additional repeat , patients could perform @ fewer taps ( p < @ ; @ % CI = @ to @ taps ) , and progressed at a faster rate of @ fewer taps per year ( CAG by time interaction : p = @ ; @ % CI = @ to @ taps ) .


In addition , for each unit decrease in Total Functional Capacity ( TFC ) within individuals , the number of taps decreased by @ ( @ % CI = @ to @ , p < @ ) .


Hand tapping is a simple , robust , and reliable marker of disease progression .


As such , this simple motor task could be a useful tool by which to assess disease progression as well therapies designed to slow it down .


Prostate cancer screening depends on a careful balance of benefits , in terms of reduced prostate cancer mortality , and harms , in terms of overdiagnosis and overtreatment .


We aimed to estimate the effect on overdiagnosis of restricting prostate specific antigen ( PSA ) testing by age and baseline PSA .


Estimates of the effects of age on overdiagnosis were based on population based incidence data from the US Surveillance , Epidemiology and End Results database .


To investigate the relationship between PSA and overdiagnosis , we used two separate cohorts subject to PSA testing in clinical trials ( n = @,@ and n = @,@ ) and a population-based cohort of Swedish men not subject to PSA-screening followed for @ years ( n = @,@ ) .


If PSA testing had been restricted to younger men , the number of excess cases associated with the introduction of PSA in the US would have been reduced by @ % , @ % and @ % for age cut-offs of @ , @ and @ , respectively .


The risk that a man with screen-detected cancer at age @ would not subsequently lead to prostate cancer morbidity or mortality decreased exponentially as PSA approached conventional biopsy thresholds .


For PSAs below @ ng/ml , the risk of a positive biopsy is @ ( @ % CI @ , @ ) times greater than subsequent prostate cancer mortality .


Prostate cancer overdiagnosis has a strong relationship to age and PSA level .


Restricting screening in men over @ to those with PSA above median ( > @ ng/ml ) and screening men over @ only in selected circumstances would importantly reduce overdiagnosis and change the ratio of benefits to harms of PSA-screening .


The purpose of the study was to compare the outcome of laparoscopic sacral colpocervicopexy with laparoscopic pectopexy .


Our aim was to show that the safety and effectiveness of the new technique is similar to the traditional technique .


We expected differences regarding defecation disorders .


We randomly assigned patients to two treatment groups : @ in the pectopexy and @ in the sacropexy group .


If necessary , the operative procedures were planned in a so-called multicompartment setting regarding the different pelvic floor disorders .


All defects were managed at the same time .


Eighty-one patients were examined @ to @ months after treatment ( mean follow-up @ months ) .


The long-term follow-up ( @ months for pectopexy and @ months for sacropexy ) showed a clear difference regarding de novo defecation disorders ( @ % in the pectopexy vs @ % in the sacropexy group ) .


The incidence of de novo stress urinary incontinence was @ % ( pectopexy ) vs @ % ( sacropexy ) .


The incidence of rectoceles ( @ % vs @ % ) was similar in both groups .


No de novo lateral defect cystoceles were found after pectopexy , whereas @ % were found after sacropexy .


The apical descensus relapse rates , @ % for pectopexy vs @ % for sacropexy , were not statistically significant .


The occurrence of de novo anterior defect cystoceles and rectoceles revealed no significant differences .


Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers clear practical advantages compared with laparoscopic sacropexy .


Because laparoscopic pectopexy does not reduce the pelvic space , it results in a zero percentage of defecation disorders .


The effect of dietary macronutrient composition on the rate of gestational weight gain among women in sub-Saharan Africa is unclear .


To examine the effect of macronutrient intake on the rate of gestational weight gain among HIV-negative women in Tanzania .


The weights of @,@ women were measured monthly from @ weeks of gestation to term .


Prenatal dietary intake was estimated as the cumulative average of multiple @-hour dietary recalls .


The association between energy intake and percentage of energy from carbohydrate , protein , and total fat and rate of weight gain ( grams per month ) was estimated from generalized estimating equation models .


Macronutrient effects were adjusted for total energy using the nutrient density model and maternal age , maternal height , maternal mid-upper-arm circumference , parity , marital status , maternal occupation , maternal education , household wealth , season , and treatment regimen assignment .


Body mass index ( BMI ) was considered as a confounder and a potential modifier of the effect of macronutrient intake on gestational weight gain .


A @ g/month increase in rate of weight gain was associated with every @-kcal increment in daily total energy intake ( @ % CI , @ to @ ; p = @ ) .


Analyses substituting @ % of energy from fat by protein showed that weight gain would decrease by @ g/month ( @ % CI , @ to @ ; p = @ ) ; substituting @ % of energy from carbohydrate by protein decreased gain by @ g/month ( @ % CI , @ to @ ; p = @ ) .


Baseline BMI did not modify these associations .


Further research on the effects of macronutrient composition on gestational weight gain is needed to inform the design of supplementation programs for women in developing countries .


Implementation of self-management support in traditional primary care settings has proved difficult , encouraging the development of alternative models which actively link to community resources .


Chronic kidney disease ( CKD ) is a common condition usually diagnosed in the presence of other co-morbidities .


This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage @ CKD .


In a pragmatic , two-arm , patient level randomised controlled trial @ patients with a diagnosis of stage @ CKD were recruited from @ general practices in Greater Manchester .


Patients were randomised to intervention ( @ ) or usual care ( @ ) .


Primary outcome measures were health related quality of life ( EQ-@D health questionnaire ) , blood pressure control , and positive and active engagement in life ( heiQ ) at @ months .


At @ months , mean health related quality of life was significantly higher for the intervention group ( adjusted mean difference = @ ; @ % CI = @ , @ ) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group ( adjusted odds-ratio = @ ; @ % CI = @ , @ ) .


Patients did not differ significantly in positive and active engagement in life .


The intervention group reported a reduction in costs compared with control .


An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage @ CKD compared with usual care .


However , further research is required to identify the mechanisms of action of the intervention .


To evaluate the efficacy and tolerability of a furazolidone-based quadruple rescue regimen in patients with previously failed Helicobacter pylori ( H.pylori ) eradication treatment .


A total of @ patients were recruited from July @ to June @ at Beijing Hospital and randomized into one of the following @-day treatment regimens : ( @ ) Esomeprazole @ mg twice daily , furazolidone @ mg twice daily , amoxicillin @ mg twice daily , bismuth salts @ mg thrice daily for @ days .


( @ ) Esomeprazole @ mg twice daily , levofloxacin @ mg daily , amoxicillin @ mg twice daily , bismuth salts @ mg thrice daily for @ days .


H.pylori status was re-assessed with the ( @ ) C-urea breath test at @ weeks after the end of therapy .


The intention-to-treat ( ITT ) and per-protocol ( PP ) H.pylori eradication rates were @ % ( @/@ ) and @ % ( @/@ ) in the furazolidone-based quadruple group , and @ % ( @/@ ) and @ % ( @/@ ) in the levofloxacin-based quadruple group respectively ( ( @ ) = @ , @ ; P = @ , @ ) .


The @-day furazolidone-based quadruple therapy is an efficacious rescue strategy in patients with previously failed eradication therapy .


TETRA ( terrestrial trunked radio ) is a digital radio communication standard , which has been implemented in several European countries and is used by public executives , transportation services , and by private companies .


Studies on possible impacts on the users ' health considering different exposure conditions are missing .


To investigate possible acute effects of electromagnetic fields ( EMF ) of two different levels of TETRA hand-held transmitter signals on cognitive function and well-being in healthy young males .


In the present double-blind cross-over study possible effects of short-term ( @ h ) EMF exposure of handset-like signals of TETRA ( @ MHz ) were studied in @ healthy male participants ( meanSD : @ years ) .


Individuals were tested on nine study days , on which they were exposed to three different exposure conditions ( Sham , TETRA @ W/kg and TETRA @ W/kg ) in a randomly assigned and balanced order .


Participants were tested in the afternoon at a fixed timeframe .


Attention remained unchanged in two out of three tasks .


In the working memory significant changes were observed in two out of four subtasks .


Significant results were found in @ out of @ tested parameters , four of them led to an improvement in performance .


Mood , well-being and subjective somatic complaints were not affected by TETRA exposure .


The results of the present study do not indicate a negative impact of a short-term EMF-effect of TETRA on cognitive function and well-being in healthy young men .


Theory suggests the uptake of a medical innovation is influenced by how potential adopters perceive innovation characteristics and by characteristics of potential adopters .


Innovation adoption is slow among the first @ % of individuals in a target group and then accelerates .


The Quality Initiative in Rectal Cancer ( QIRC ) trial assessed if rectal cancer surgery outcomes could be improved through surgeon participation in the QIRC strategy .


We tested if traditional uptake of innovation concepts applied to surgeons in the experimental arm of the trial .


The QIRC strategy included workshops , access to opinion leaders , intraoperative demonstrations , postoperative questionnaires , and audit and feedback .


For intraoperative demonstrations , a participating surgeon invited an outside surgeon to demonstrate optimal rectal surgery techniques .


We used surgeon timing in a demonstration to differentiate early and late adopters of the QIRC strategy .


Surgeons completed surveys on perceptions of the strategy and personal characteristics .


Nineteen of @ surgeons ( @ % ) requested an operative demonstration on their first case of rectal surgery .


Early and late adopters had similar perceptions of the QIRC strategy and similar characteristics .


Late adopters were less likely than early adopters to perceive an advantage for the surgical techniques promoted by the trial ( p = @ ) .


Most traditional diffusion of innovation concepts did not apply to surgeons in the QIRC trial , with the exception of the importance of perceptions of comparative advantage .


Target temperature management is recommended as a neuroprotective strategy after out-of-hospital cardiac arrest .


Potential effects of different target temperatures on cognitive impairment commonly described in survivors have not been investigated sufficiently .


The primary aim of this study was to evaluate whether a target temperature of @C compared with @C was favorable for cognitive function ; the secondary aim was to describe cognitive impairment in cardiac arrest survivors in general .


Study sites included @ cardiac arrest survivors originally randomized and stratified for site to temperature control at @C or @C within the Target Temperature Management trial .


Survival until @ days after the arrest was @ % ( @C , n = @/@ ; @C , n = @/@ ) .


Survivors were invited to a face-to-face follow-up , and @ cardiac arrest survivors ( @C , n = @/@C , n = @ ) were assessed with tests for memory ( Rivermead Behavioural Memory Test ) , executive functions ( Frontal Assessment Battery ) , and attention/mental speed ( Symbol Digit Modalities Test ) .


A control group of @ matched patients hospitalized for acute ST-segment-elevation myocardial infarction without cardiac arrest performed the same assessments .


Half of the cardiac arrest survivors had cognitive impairment , which was mostly mild .


Cognitive outcome did not differ ( P > @ ) between the @ temperature groups ( @C/@C ) .


Compared with control subjects with ST-segment-elevation myocardial infarction , attention/mental speed was more affected among cardiac arrest patients , but results for memory and executive functioning were similar .


Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when a temperature of @C and @C was targeted .


Cognitive impairment detected in cardiac arrest survivors was also common in matched control subjects with ST-segment-elevation myocardial infarction not having had a cardiac arrest .


Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases .


Many infections are transient but the virus may recur , persist , or become latent .


To date , there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions .


Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum .


Cryotherapy is considered one of the most established treatments for genital warts .


No comparative trials have been reported to date on the use of potassium hydroxide for genital warts .


A prospective , open-label , randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent , sexually active men .


Over a period of @ months , @ patients were enrolled .


They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy .


While response to therapy did not differ substantially between both treatment modalities , side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy .


In our study , potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile .


Topical @ % potassium hydroxide presents an effective , safe , and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts .


Hallux valgus with an increased intermetatarsal angle is usually treated with a proximal metatarsal osteotomy .


The proximal chevron osteotomy is commonly used but is technically difficult .


This study compares the proximal opening wedge osteotomy of the first metatarsal with the proximal chevron osteotomy for the treatment of hallux valgus with an increased intermetatarsal angle .


This prospective , randomized multicenter ( three-center ) study was based on the clinical outcome scores of the Short Form-@ , the American Orthopaedic Foot & Ankle Society forefoot questionnaire , and the visual analog scale for pain , activity , and patient satisfaction .


Subjects were assessed prior to surgery and at three , six , and twelve months postoperatively .


Surgeon preference was evaluated based on questionnaires and the operative times required for each procedure .


No significant differences were found for any of the patients ' clinical outcome measurements between the two procedures .


The proximal opening wedge osteotomy was found to lengthen , and the proximal chevron osteotomy was found to shorten , the first metatarsal .


The intermetatarsal angles improved ( decreased ) significantly , from @ @ to @ @ ( mean and standard deviation ) after a proximal opening wedge osteotomy and from @ @ to @ @ after a proximal chevron osteotomy ( p < @ for both ) .


Operative time required for performing a proximal opening wedge osteotomy is similar to that required for performing a proximal chevron osteotomy ( mean and standard deviation , @ @ minutes compared with @ @ minutes ; p = @ ) .


Opening wedge and proximal chevron osteotomies have comparable radiographic outcomes and comparable clinical outcomes for pain , satisfaction , and function .


The proximal opening wedge osteotomy lengthens , and the proximal chevron osteotomy shortens , the first metatarsal .


The proximal opening wedge osteotomy was subjectively less technically demanding and was preferred by the orthopaedic surgeons in this study .


Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence .


The recent SHARP trial clearly demonstrated that a reduction in low-density lipoprotein ( LDL ) cholesterol with a daily regimen of simvastatin plus ezetimibe safely reduced the incidence of major atherosclerotic events in patients with chronic kidney disease ( CKD ) .


We aimed to compare the efficacy of and adverse effects from statin uptitration versus statin in combination with ezetimibe since only a few studies have addressed this question .


This was a randomized , open-label , multicenter trial that included @ patients with CKD whose LDL cholesterol levels were not reduced below @ mg/dl despite a minimum dose of statin therapy .


Patients received double doses of statin or usual statin dose with the addition of ezetimibe @ mg daily .


The observation period was @ year during which time patients were checked regularly in clinic for adverse effects as well as for usual laboratory examinations .


The key prespecified outcome was the incidence of adverse effects , which included skeletal muscle complaints , myalgia , muscle weakness , and muscle cramps with and without elevated CK levels .


Increases in alanine transaminase ( ALT ) or aspartate transaminase ( AST ) levels > @ times the upper limit of normal ( ULN ) were considered clinically significant adverse effects .


Adverse events occurred in @/@ in the combination group and in @/@ in the statin uptitration group ( p < @ ) .


Moreover , in patients with CKD of stages @-@ , rates were @/@ in the combination group versus @/@ in the statin uptitration group ( p < @ ) .


No serious adverse effects such as rhabdomyolysis were noted in either group .


Serum creatinine levels remained essentially unchanged in both groups except in CKD stages @ and @ .


Reductions in LDL cholesterol were similar between the two groups at the start of and at the end of the study .


During the study , no atherosclerotic events were reported in either group .


When statin uptitration produces adverse effects such as myopathy , combination therapy with ezetimibe is recommended instead of statin alone .


Family-based treatment models that have shown effectiveness with juvenile offenders may also lead to reduced criminality in siblings of those offenders .


However , the lasting effects of such treatments on siblings have not been evaluated .


In the present study , the authors examined criminal outcomes for siblings of serious and violent juvenile offenders who had participated on average @ years earlier in a clinical trial of multisystemic therapy ( MST ; Borduin et al. , @ ) .


Participants were @ closest-in-age siblings of individuals who were originally randomized to MST or individual therapy ( IT ) during adolescence .


Arrest and incarceration data were obtained in middle adulthood when siblings were on average @ years old .


Intent-to-treat analyses showed that arrest rates were significantly lower for siblings in the MST condition than in the IT condition ( @ % vs. @ % , respectively ) .


In addition , siblings in the IT condition were about @ times as likely to be convicted of a felony and more than twice as likely to be sentenced to incarceration and probation .


The present study represents the longest follow-up to date of sibling participants in an MST clinical trial and demonstrates that the positive impact of an evidence-based treatment for serious and violent juvenile offenders can extend to other family members .


Implications of the authors ' findings for policymakers and service providers are discussed .


Community-acquired bacterial meningitis ( CABM ) is a life-threatening condition that is common among immunocompromised individuals .


Intravenous ceftriaxone , of which Rocephin ( ROC ) is the originator brand , is recommended as first-line therapy in South Africa .


Despite concerns regarding therapeutic equivalence with generic agents , this is the first study that has been conducted comparing clinical pharmacokinetics ( PK ) of a generic ceftriaxone formulation with the originator .


To compare the PK and safety of Aspen Ceftriaxone ( AC ) and ROC in the treatment of adult CABM.Methods .


A total of @ eligible patients were randomised @:@ to receive @ g of either medication twice daily for a duration based on the identity of the causative organism and their physician 's clinical judgment .


The primary endpoint of this study was the comparison of clinical PK , specifically the concentrations of each drug in the cerebrospinal fluid with corresponding paired plasma samples .


While this study was underpowered to assess efficacy , safety could be evaluated on the basis of reported adverse events .


The two patient groups were epidemiologically similar .


There were no statistically significant differences in PK between either agent , nor any difference with regard to safety .


AC can be considered as equivalent to ROC with regard to PK and safety in patients with CABM .


Although self-efficacy ( SE ) and outcome expectancy ( OE ) have been well researched as predictors of outcome , few studies have investigated changes in these variables across treatments .


We evaluated changes in OE and SE throughout treatment as predictors of outcomes in a large sample with panic disorder , generalized anxiety disorder , social anxiety disorder , or posttraumatic stress disorder .


We hypothesized that increases in SE and OE would predict reductions in anxiety and depression as well as improvement in functioning .


Participants ( mean age = @ years , SD = @ , @ % female , @ % white ) were recruited from primary care centers throughout the United States and were randomized to receive either Coordinated Anxiety Learning and Management ( CALM ) treatment - composed of cognitive behavioral therapy , psychotropic medication , or both - or usual care .


SE and OE ratings were collected at each session for participants in the CALM treatment ( n = @ ) and were entered into a structural equation model as predictors of changes in Brief Symptom Inventory , Anxiety Sensitivity Index , Patient Health Questionnaire ( PHQ ) , and Sheehan Disability Scale outcomes at @ , @ , and @ months after baseline .


The best-fitting models predict symptom levels from OE and SE and not vice versa .


The slopes and intercept of OE significantly predicted change in each outcome variable except PHQ-@ .


The slope and intercept of SE significantly predicted change in each outcome variable .


Over and above absolute level , increases in SE and OE were significant predictors of decreases in symptoms and increases in functioning .


Implications for treatment are discussed , as well as future directions of research .


To compare the efficacy of pelvic floor muscle exercise with the concentration therapy versus pelvic floor muscle exercise alone after radical prostatectomy .


One hundred thirty five patients were randomized into the intervention group that concentration therapy was added to Kegel exercise , and control group that was Kegel exercise only , using the stratified randomization ( stratified by taking the catheter off before and after discharge ) and type of surgery .


Incontinence was defined as a loss of urine equal or more than to @ grams in one-hour pad test , before and after the test in each sample group .


Follow-up results were obtained by phone visit at @ , @ , @ , @ , @ , @ , and @ weeks after surgery


In the intervention group , @ of @ cases ( @ % ) had continence in three months , compared to @ of @ ( @ % ) in the control group , with significant statistical difference ( p-value < @ ) .


The secondary result was the regularity in practicing .


It was @ % in total .


In the intervention group , @ of @ cases ( @ % ) practiced compared to @ of @ ( @ % ) in the control group , which was significant difference between the two groups .


Combined concentration therapy with Kegel exercise had significantly improved continence after radical prostatectomy


The purpose of this study was to determine the influence of self-tapping and self-drilling placement techniques on the stability of miniscrews .


We included @ orthodontic patients who received miniscrews ( @ screws ) .


Miniscrews measuring @ mm in diameter and @ mm in length were placed using the self-tapping ( @ patients , @ screws ) and self-drilling ( @ patients , @ screws ) methods .


We examined the success rates , placement torque values , Periotest ( Medizintechnik Gulden , Bensheim , Germany ) values , rates of root contact , and influence of root contact on mobility .


Cone-beam computed tomography was used to evaluate root contact .


Miniscrews that endured an orthodontic force for @ months or more were considered successful .


The success rates of the miniscrews were approximately @ % with either placement technique .


The placement torques were @ and @ N cm in the self-tapping and self-drilling miniscrews , respectively ( P > @ ) .


The Periotest values of the self-drilling method were significantly greater than those of the self-tapping method .


The Periotest values of the self-drilling miniscrews with root contact were significantly greater than those with no root contact .


Both placement techniques showed high stability in the maxillary bone , although the self-drilling miniscrews with root contact had greater mobility .


Special attention to root contact further improves the stability of the self-drilling miniscrews .


Treatment options for wild-type BRAF melanoma patients remain limited .


Selumetinib , a MEK @/@ inhibitor , suppresses pERK levels independent of BRAF and NRAS mutation status , and combination with docetaxel has demonstrated synergy in xenograft models .


The aim of this study was to assess the efficacy and safety of selumetinib plus docetaxel as first-line treatment in patients with wild-type BRAF advanced melanoma .


In this double-blind multicentre phase II trial patients with wild-type BRAF melanoma were randomized ( @:@ ) to docetaxel with selumetinib or placebo .


Docetaxel @ mg/m ( @ ) was administered intravenously every @ weeks up to six cycles .


Selumetinib @ mg or placebo was given orally twice daily until disease progression or unacceptable toxicity .


The primary end point was progression-free survival ( PFS ) .


Tumour NRAS mutation status was analysed retrospectively and correlated with treatment outcomes .


Eighty-three patients were randomized to docetaxel plus selumetinib ( n = @ ) or docetaxel plus placebo ( n = @ ) .


The PFS hazard ratio ( HR ) ( selumetinib : placebo ) was @ -LSB- @ % confidence interval ( CI ) @-@ @ ; P = @ -RSB- , with a median PFS of @ months ( @ % CI @-@ @ ) for docetaxel plus selumetinib and @ months ( @ % CI @-@ @ ) for docetaxel alone .


There was no significant difference in overall survival .


The objective response rate was @ % with selumetinib versus @ % with placebo ( P = @ ) .


In a retrospective subset analysis , NRAS mutation status did not affect significantly upon clinical outcomes in either arm .


The combination of docetaxel and selumetinib could be administered effectively to patients with metastatic melanoma , although the combination was less well tolerated than docetaxel alone .


The combination of docetaxel with selumetinib showed no significant improvement in PFS compared with docetaxel alone , although more patients showed a response to combination therapy .


We found no evidence to support using tumour NRAS mutation as a basis for selecting patients for combined MEK inhibitor and chemotherapy .


Cesarean delivery may reduce placental-fetal transfusion and thus increase the risk of early childhood anemia compared with vaginal delivery , but this notion has not been carefully studied in longitudinal cohorts .


The aim was to assess the association of cesarean delivery with anemia in infants and children in @ longitudinal Chinese birth cohorts from different socioeconomic settings .


Cohort @ was recruited from @ counties in northeastern China and cohort @ from @ counties or cities in southeastern China .


Cohort @ involved @,@ infants born during @-@ to mothers with early pregnancy baseline hemoglobin concentrations ranging from @ to @ g/L , whereas cohort @ involved @,@ children born during @-@ to mothers with baseline hemoglobin concentrations ranging from @ to @ g/L .


The main outcomes were anemia at @ and @ mo in cohort @ and at @ mo in cohort @ .


Multiple logistic regressions were used to estimate adjusted ORs of anemia for cesarean compared with vaginal delivery .


Stratified analyses were performed by pre - and postlabor cesarean delivery and according to maternal baseline hemoglobin concentration ( @ , @-@ , @-@ , and @ g/L ) .


Cesarean delivery was not associated with anemia at @ mo in cohort @ ( adjusted OR : @ ; @ % CI : @ , @ ) ; however , cesarean delivery was associated with increased anemia at @ mo in cohort @ ( adjusted OR : @ ; @ % CI : @ , @ ) and at @ mo in cohort @ ( adjusted OR : @ ; @ % CI : @ , @ ) .


The positive associations for anemia at @ and @ mo were consistent across maternal hemoglobin subgroups and persisted for cesarean delivery subtypes .


Cesarean delivery is likely associated with anemia in children , which suggests a possible need for exploring changes in obstetric care that might prevent anemia in cesarean-delivered children .


Nivolumab ( a programmed death @ -LSB- PD-@ -RSB- checkpoint inhibitor ) and ipilimumab ( a cytotoxic T-lymphocyte-associated antigen @ -LSB- CTLA-@ -RSB- checkpoint inhibitor ) have been shown to have complementary activity in metastatic melanoma .


In this randomized , double-blind , phase @ study , nivolumab alone or nivolumab plus ipilimumab was compared with ipilimumab alone in patients with metastatic melanoma .


We assigned , in a @:@:@ ratio , @ previously untreated patients with unresectable stage III or IV melanoma to nivolumab alone , nivolumab plus ipilimumab , or ipilimumab alone .


Progression-free survival and overall survival were coprimary end points .


Results regarding progression-free survival are presented here .


The median progression-free survival was @ months ( @ % confidence interval -LSB- CI -RSB- , @ to @ ) with nivolumab plus ipilimumab , as compared with @ months ( @ % CI , @ to @ ) with ipilimumab ( hazard ratio for death or disease progression , @ ; @ % CI , @ to @ ; P < @ ) , and @ months ( @ % CI , @ to @ ) with nivolumab ( hazard ratio for the comparison with ipilimumab , @ ; @ % CI , @ to @ ; P < @ ) .


In patients with tumors positive for the PD-@ ligand ( PD-L@ ) , the median progression-free survival was @ months in the nivolumab-plus-ipilimumab group and in the nivolumab group , but in patients with PD-L@-negative tumors , progression-free survival was longer with the combination therapy than with nivolumab alone ( @ months -LSB- @ % CI , @ to not reached -RSB- vs. @ months -LSB- @ % CI , @ to @ -RSB- ) .


Treatment-related adverse events of grade @ or @ occurred in @ % of the patients in the nivolumab group , @ % of those in the nivolumab-plus-ipilimumab group , and @ % of those in the ipilimumab group .


Among previously untreated patients with metastatic melanoma , nivolumab alone or combined with ipilimumab resulted in significantly longer progression-free survival than ipilimumab alone .


In patients with PD-L@-negative tumors , the combination of PD-@ and CTLA-@ blockade was more effective than either agent alone .


( Funded by Bristol-Myers Squibb ; CheckMate @ ClinicalTrials.gov number , NCT@ . )


Transcatheter aortic valve replacement ( TAVR ) is an option in certain high-risk surgical patients with severe aortic valve stenosis .


It is unknown whether TAVR can be safely introduced to lower-risk patients .


The NOTION ( Nordic Aortic Valve Intervention Trial ) randomized clinical trial compared TAVR with surgical aortic valve replacement ( SAVR ) in an all-comers patient cohort .


Patients @ years old with severe aortic valve stenosis and no significant coronary artery disease were randomized @:@ to TAVR using a self-expanding bioprosthesis versus SAVR .


The primary outcome was the composite rate of death from any cause , stroke , or myocardial infarction ( MI ) at @ year .


A total of @ patients were randomized at @ Nordic centers .


Mean age was @ years , and @ % were considered low-risk patients .


In the intention-to-treat population , no significant difference in the primary endpoint was found ( @ % vs. @ % ; p = @ for superiority ) .


The result did not change in the as-treated population .


No difference in the rate of cardiovascular death or prosthesis reintervention was found .


Compared with SAVR-treated patients , TAVR-treated patients had more conduction abnormalities requiring pacemaker implantation , larger improvement in effective orifice area , more total aortic valve regurgitation , and higher New York Heart Association functional class at @ year .


SAVR-treated patients had more major or life-threatening bleeding , cardiogenic shock , acute kidney injury ( stage II or III ) , and new-onset or worsening atrial fibrillation at @ days than did TAVR-treated patients .


In the NOTION trial , no significant difference between TAVR and SAVR was found for the composite rate of death from any cause , stroke , or MI after @ year .


( Nordic Aortic Valve Intervention Trial -LSB- NOTION -RSB- ; NCT@ ) .


Current guidelines suggest a fasting time of @ h for clear fluids , which is often exceeded in clinical practice , leading to discomfort , dehydration and stressful anaesthesia induction to patients , especially in the paediatric population .


Shorter fluid fasting might be a strategy to improve patient comfort but has not been investigated yet .


This prospective clinical trial compares gastric pH and residual volume after @ vs @ h of preoperative clear fluid fasting .


Children ( @-@ yr , ASA I or II ) undergoing elective procedures in general anaesthesia requiring tracheal intubation were randomized into group A with @ min or B with @ min preoperative clear fluid fasting .


To determine gastric pH and residual volume , the gastric content was sampled in supine , left and right lateral patient position using an oro-gastric tube after intubation .


Data are median ( interquartile range ) for group A or B ( P < @ ) .


In total , @ children aged @-@ @ yr were included ; gastric pH was determined in @ cases .


Patient characteristic data were similar between the two groups , except for gender ( @/@ males in group A/B ; P = @ ) .


Despite significantly shorter fasting times for clear fluids in group A compared with group B ( @/@ min ; P < @ ) , no significant difference was observed regarding gastric pH -LSB- @ ( @-@ @ ) / @ ( @-@ @ ) , P = @ -RSB- or residual volume -LSB- @ ( @-@ @ ) / @ ( @-@ @ ) ml kg ( -@ ) , P = @ -RSB- .


One hour clear fluid fasting does not alter gastric pH or residual volume significantly compared with @ h fasting .


The objective of this study was to explore the significance of assessing irreversible airway obstruction ( IAO ) in asthma patients by high-resolution computed tomography ( HRCT ) , biological markers in induced sputum , and exhaled nitric oxide ( FENO ) .


The study was conducted in @ patients with IAO , @ patients with reversible airway obstruction ( RAO ) , @ patients who did not have airway obstruction ( NAO ) , and @ healthy subjects serving as controls .


These patients received a step therapy for at least @ months based on the guidelines for the prevention and treatment of asthma .


After achieving complete or partial control of asthma , HRCT , lung function , FENO , and chemokine levels in induced sputum were measured .


The airway wall area ( WA ; % ) correlated with forced expiratory volume-@ ( FEV-@ ( L ) ; r = -@ , p < @ ) , and significant differences in bronchial wall thickening ( BWT ) of the LEVEL E generation airways were observed between the asthma and control groups ( p < @ ) .


FENO levels correlated with FEV-@ ( % ) in the IAO group ( r = @ , p = @ ) .


The levels of matrix metalloproteases-@ ( MMP-@ ) and tissue inhibitor of matrix metalloproteinase-@ ( TIMP-@ ) in asthma patients with IAO , RAO , and NAO were significantly higher than those in the controls ( p < @ ) .


The level of neutrophilia in the sputum from the IAO group was higher than that from the RAO , NAO and control groups .


Asthma patients with IAO have an increased BWT .


Airway measurements with HRCT scans appear to be valuable in the evaluation of airway remodeling in asthma patients with IAO .


To observe the difference in the therapeutic effects on knee osteoarthritis ( KOA ) among auricular electroacupuncture therapy plus isolated moxibustion with Lingxian herbal paste ( combined therapy ) , electroacupuncture ( EA ) and TDP irradiation .


Eighty-nine cases were randomized into three groups .


In the combined therapy group ( @ cases ) , the auricular electroacupuncture therapy was adopted together with the isolated moxibustion with Lingxian herbal paste .


The auricular points were xi ( AH@ ) , pizhixia ( AT@ ) , shenmen ( TF@ ) , etc. .


The Lingxian herbal paste was applied at Yanglingquan ( GB @ ) , Dubi ( ST @ ) , Zusanli ( ST @ ) , Neixiyan ( EX-LE @ ) , Heding ( EX-LE @ ) and Ashi points .


In EA group ( @ cases ) , EA was applied at the acupoints that were same as those in the isolated moxibustion with Lingxian herbal paste .


In TDP group ( @ cases ) , TDP irradiation was given at the affected knee .


The treatment was given once every day , @ treatments made one session and there was @ week at the interval among sessions .


Totally , @ sessions of treatment were required .


KOA clinical symptom and physical sign score and the single item pain symptom score of Lequesne index were observed before treatment and @ week after treatment in the patients of each group separately .


The efficacies were compared among the three groups .


One week after treatment , the total score of symptoms and physical signs of the patients in each group was reduced significantly as compared with that before treatment ( all P < @ ) .


The improvements in the symptoms and physical signs in the combined therapy group were better than those in the other two groups ( @ + / - @ vs @ + / - @ , @ + / - @ , both P < @ ) .


The improvement in pain in the combined therapy group was also better than that in the other two groups ( @ + / - @ vs @ + / - @ , P < @ ; @ + / - @ vs @ + / - @ , P < @ ) .


The curative rate in the combined therapy group was @ % ( @/@ ) , which was higher than @ % ( @/@ ) in EA group and @ % ( @/@ ) in TDP group separately ( both P < @ ) .


The overall efficacy in the combined therapy group was superior to the other two groups ( P < @ ) .


The auricular electroacupuncture therapy plus isolated moxibustion with Lingxian herbal paste is advantageous at the total score of the symptoms and physical signs and the overall efficacy in the patients of KOA as compared with EA at the local acupoints and local TDP irradiation .


The successful recruitment and retention of participants is integral to the translation of research findings .


We examined the recruitment and retention rates of racial/ethnic minority adolescents at a center involved in the National Institutes of Health Obesity Research for Behavioral Intervention Trials ( ORBIT ) initiative by the @ recruitment strategies used : clinic , informatics , and community .


During the @-month study , @ family dyads , each composed of an obese African American adolescent and a caregiver , enrolled in a @-month weight-loss intervention , a sequential multiple assignment randomized trial .


We compared recruitment and retention rates by recruitment strategy and examined whether recruitment strategy was related to dyad baseline characteristics .


Of the @ enrolled families , @ ( @ % ) were recruited through clinics , @ ( @ % ) through informatics , and @ ( @ % ) through community .


Of those recruited through community , @ % enrolled in the study , compared with @ % through clinics and @ % through informatics .


Active refusal rate was @ % .


Of the @,@ families identified for the study , @ passively refused to participate : @ ( @ % ) identified through informatics , @ ( @ % ) through community , and @ ( @ % ) through clinics .


Recruitment strategy was not related to the age of the adolescent , adolescent comorbidities , body mass index of the adolescent or caregiver , income or education of the caregiver , or retention rates at @ months , @ months , or @ months .


Study retention rate was @ % .


Using multiple recruitment strategies is beneficial when working with racial/ethnic minority adolescents , and each strategy can yield good retention .


Research affiliated with health care systems would benefit from the continued specification , refinement , and dissemination of these strategies .


To determine whether any tumor biomarkers could account for the survival advantage observed in the LNH @-@B trial among patients with diffuse large B-cell lymphoma ( DLBCL ) and low-intermediate risk according to the International Prognostic Index when treated with dose-intensive rituximab , doxorubicin , cyclophosphamide , vindesine , bleomycin , and prednisone ( R-ACVBP ) compared with standard rituximab , doxorubicin , cyclophosphamide , vincristine , and prednisone ( R-CHOP ) .


Using immunohistochemistry , expression of CD@ , BCL@ , MUM@ , MYC , and BCL@ and coexpression of MYC/BCL@ were examined .


The interaction effects between each biomarker and treatment arm on survival were studied in a restricted model and a full model incorporating clinical parameters .


Among the @ patients analyzed in the trial , @ tumors were evaluable for germinal center B-cell-like ( GCB ) / non-GCB subclassification according to the Hans algorithm .


Among all the biomarkers , only the interaction between the Hans algorithm and the treatment arm was significant for progression-free survival ( PFS ) and overall survival ( OS ) in univariable ( PFS , P = @ ; OS , P = @ ) and multivariable ( PFS , P = @ ; OS , P = @ ) analyses .


Non-GCB tumors predicted worse PFS ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; P = @ ) and OS ( HR , @ ; @ % CI , @ to @ ; P = @ ) among patients treated with R-CHOP compared with patients who received R-ACVBP , whereas there were no significant survival differences between these regimens among patients with GCB tumors .


The survival benefit related to R-ACVBP over R-CHOP is at least partly linked to improved survival among patients with non-GCB DLBCL .


Therefore , the Hans algorithm could be considered a theragnostic biomarker for selecting young patients with DLBCL who can benefit from an intensified R-ACVBP immunochemotherapy regimen .


Glucose , the conventional osmotic agent in peritoneal dialysis ( PD ) solutions , may contribute to atherogenic dyslipoproteinemia and increased cardiovascular risk .


To determine whether a low-glucose PD regimen may improve the serum lipid and lipoprotein profile in patients with diabetes .


A prospective , open-label , parallel group , multinational , randomized , controlled trial with a @-month follow-up , comprising @ patients with diabetes receiving PD .


Patients were randomized to a low-glucose PD regimen ( dextrose-based PD solution plus icodextrin , a starch polymer , and amino acids ) or a conventional PD regimen ( dextrose PD solutions ) .


Serum lipid and apolipoprotein profiles were determined at baseline and @ and @ months .


Serum triglycerides , very low-density-lipoprotein cholesterol , and apolipoprotein B ( apoB ) decreased significantly in the intervention group at both @ and @ months compared with baseline ( serum triglycerides : median change at @ months -@ mmol/L , P < @ , at @ months -@ mmol/L , P < @ ; very low-density-lipoprotein cholesterol : -@ mg/dL , P < @ ; -@ mg/dL , P < @ ; and apoB : -@ mg/dL , P < @ ; -@ mg/dL , P = @ , respectively ) and also compared with the control group .


In contrast , apoB levels increased significantly in the control group at @ and @ months compared with baseline ( @ mg/dL , P = @ ; @ mg/dL , P = @ , respectively ) .


Percentage of patients on lipid-lowering medications at baseline and intensity of therapy was equivalent in each group .


The apoB decrease was not affected by lipid-lowering medications in the intervention group .


A low glucose-PD regimen significantly improved the atherogenic lipoprotein phenotype compared with PD patients treated with a conventional glucose regimen .


Epidemiological studies have shown that low levels of dehydroepiandrosterone might increase the risk of developing metabolic syndrome .


The aim of this study was to evaluate whether dehydroepiandrosterone supplementation in schizophrenic patients treated with olanzapine would influence the anthropometric and biochemical parameters of metabolic syndrome .


Male schizophrenic patients ( no = @ ) participated in a twelve-week , randomized , double blind , placebo controlled study .


They received @ mg dehydroepiandrosterone ( DHEA ) or placebo as an augmentation of olanzapine treatment ( an average dosage @ mg/day ) .


Main outcomes of the study were changes in lipid profile , fasting glucose levels , body mass index and waist circumference values .


Forty five patients completed the study .


There were no major changes in the overall cholesterol value , HDL cholesterol , LDL cholesterol or triglycerides in either group .


The results of the repeated measures analysis of the system : fasting glucose level @x , ( at the beginning and end of the study ) , @x ( the study group and the control group ) , showed a significant interaction ( F = @ , df = @ p = @ ) .


The blood glucose level was decreased in the DHEA group .


Furthermore , increases in waist circumference ( delta = -@ , t = -@ ; df = @ ; p = @ ) and BMI value ( delta = -@ , t = -@ ; df = @ ; p = @ ) were observed in the placebo group .


Dehydroepiandrosterone supplementation results in stabilization of BMI , waist circumference and fasting glycaemia values in schizophrenic patients treated with olanzapine .


To confirm the insulin-like effect of dehydroepiandrosterone , long-term research concentrating on the evaluation of glucose metabolism has to be performed .


To assess the relief of migraine pain , especially in the acute phase , by comparing active treatment , ie , kinetic oscillation stimulation ( KOS ) in the nasal cavity , with placebo .


Exploratory trials testing the efficacy of KOS on migraine patients indicated that this treatment could be a fast-acting remedy for acute migraine pain .


Thirty-six patients were randomized @:@ using a placebo module to active or placebo treatment in this double-blinded parallel design study .


Treatment was administered with a minimally invasive inflatable tip oscillating catheter .


Symptom scores ( @-@ visual analog scale ) were obtained before treatment , every @ minutes during treatment , at @ minutes , @ , and @ hours post-treatment , as well as daily ( @-@ migraine pain scale ) from @ days pretreatment until Day @ post .


Thirty-five patients were evaluated ( active n = @ , placebo n = @ ) .


The primary end-point was the change in average pain score from before treatment to @ minutes after treatment .


Patients who received active treatment reported reduced pain , eg , average visual analog scale pain scores fell from @ before treatment to @ @ minutes after , while the corresponding scores for recipients of placebo fell from @ to @ .


The changes in pain scores differed between the @ treatments by @ points ( @ % confidence interval : @ , @ ) , P < @ .


Already @ minutes into the treatment , the difference ( @ points ) was significant ( P = @ ) .


The difference was likewise significant at @ hours post-treatment ( @ points , P < @ ) .


One patient experienced an adverse event ( a vasovagal reaction with full spontaneous recovery ) during placebo treatment .


KOS is an effective and safe treatment for acute migraine pain .


Melasma is a common disorder of facial hyperpigmentation that is often resistant to treatment .


To evaluate the efficacy of trichloroacetic acid ( TCA ) peeling in comparison with double frequency Q-switched neodymium-doped : yttrium aluminum garnet ( QS-Nd : YAG ) laser in the treatment of melasma .


Sixty-five adult Egyptian female patients with melasma were enrolled in this study .


Wood light was used for determination of the histological type of melasma .


The patients were divided into @ groups according to treatment modalities : peeling with different concentrations of TCA and double frequency QS-Nd : YAG laser .


Trichloroacetic acid peeling was performed every @ weeks up to @ sessions , whereas laser treatment was performed every month up to @ sessions .


Melasma area and severity index ( MASI ) score was used before and after treatment for evaluation .


Improvement percentage of MASI score was significantly higher among patients treated with TCA @ % ( p < @ ) .


Epidermal type of melasma was significantly improved compared with the dermal type ( p = @ ) .


Q-switched neodymium-doped : yttrium aluminum garnet laser showed the highest incidence of postinflammatory hyperpigmentation ( @ % ) .


Trichloroacetic acid peeling is effective in the treatment of melasma , TCA @ % was the most effective concentration .


Q-switched neodymium-doped : yttrium aluminum garnet laser is not recommended in the treatment of melasma because it was associated with the highest incidence of complications .