Chemotherapy consisted of oxaliplatin @ mg/m ( @ ) intravenously over @ h and fluorouracil bolus @ mg/m ( @ ) intravenously over @ min , followed by a @ h infusion of fluorouracil @ mg/m ( @ ) repeated every @ weeks ( regimen one ) or oxaliplatin @ mg/m ( @ ) intravenously over @ h and oral capecitabine @ mg/m ( @ ) twice daily on days @-@ repeated every @ weeks ( regimen two ) .


Patients who had received adjuvant oxaliplatin could receive irinotecan @ mg/m ( @ ) intravenously over @ min with fluorouracil instead of oxaliplatin ( regimen three ) .


Cetuximab was given as an intravenous dose of @ mg/m ( @ ) every @ weeks with regimen one and three or a loading dose of @ mg/m ( @ ) followed by a weekly infusion of @ mg/m ( @ ) with regimen two .


The primary endpoint was progression-free survival .


This is an interim analysis , up to Nov @ , @ , when the trial was closed , having met protocol-defined futility criteria .


This trial is registered , ISRCTN@ .


@ KRAS exon @ wild-type patients were randomised to chemotherapy alone and @ to chemotherapy with cetuximab between Feb @ , @ , and Nov @ , @ patients in the chemotherapy alone group and @ in the chemotherapy plus cetuximab group were included in the primary analysis .


The median follow-up was @ months ( @ % CI @-@ @ ) in the chemotherapy alone group and @ months ( @-@ @ ) in the chemotherapy plus cetuximab group .


With an overall median follow-up of @ months ( @ % CI @-@ @ ) and @ ( @ % ) of @ required events observed , progression-free survival was significantly shorter in the chemotherapy plus cetuximab group than in the chemotherapy alone group ( @ months -LSB- @ % CI @-@ @ -RSB- vs @ months -LSB- @ % CI @-@ @ -RSB- , hazard ratio @ , @ % CI @-@ @ , p = @ ) .


The most common grade @ or @ adverse events were low neutrophil count ( @ -LSB- @ % -RSB- preoperatively in the chemotherapy alone group vs six -LSB- @ % -RSB- in the chemotherapy plus cetuximab group ; four -LSB- @ % -RSB- vs eight -LSB- @ % -RSB- postoperatively ) , embolic events ( six -LSB- @ % -RSB- vs eight -LSB- @ % -RSB- preoperatively ; two -LSB- @ % -RSB- vs three -LSB- @ % -RSB- postoperatively ) , peripheral neuropathy ( six -LSB- @ % -RSB- vs one -LSB- @ % -RSB- preoperatively ; two -LSB- @ % -RSB- vs four -LSB- @ % -RSB- postoperatively ) , nausea or vomiting ( four -LSB- @ % -RSB- vs six -LSB- @ % -RSB- preoperatively ; four -LSB- @ % -RSB- vs two -LSB- @ % -RSB- postoperatively ) , and skin rash ( two -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- preoperatively ; @ vs eight -LSB- @ % -RSB- postoperatively ) .


There were three deaths in the chemotherapy plus cetuximab group ( one interstitial lung disease and pulmonary embolism , one bronchopneumonia , and one pulmonary embolism ) and one in the chemotherapy alone group ( heart failure ) that might have been treatment related .


Addition of cetuximab to chemotherapy and surgery for operable colorectal liver metastases in KRAS exon @ wild-type patients results in shorter progression-free survival .


Translational investigations to explore the molecular basis for this unexpected interaction are needed but at present the use of cetuximab in this setting can not be recommended .


To determine whether mental practice of wrist movements during forearm immobilization maintains range of motion .


Randomized controlled trial .


Eighteen healthy young men aged between @ and @ years were assigned to either a control or a mental practice group .


Both groups were immobilized with a circular forearm cast for @ weeks to simulate a distal radial fracture .


The mental practice group received @ @-min , followed by @ @-min , sessions of supervised mental practice .


Consecutively , they were asked to perform @ min/day of self-guided imagery sessions , during which they mentally exercised motion sequences of the immobilized joint .


The training program followed the Mental Gait Training procedure .


The control group did no training .


Wrist movement was measured with a goniometer before and after immobilization .


Mental practice preserved dorsal extension and ulnar abduction .


The sedentary control group showed due to this variables a significant decrease after cast removal .


There was no significant change in palmar flexion and radial abduction in either group .


Despite the study limitations , these results suggest that mental practice may be useful in preventing loss of hand function associated with mid-term immobilization .


Because of the expected clinical benefits , the low cost and simple application of the intervention , the effects of mental practice in orthopedic rehabilitation of the upper extremity warrant further study .


To assess the effects of perioperative comprehensive supportive care interventions on outcome of Chinese esophageal cancer patients in a prospective study .


@ patients with primary esophageal carcinoma were randomized into an intervention group ( IG , n = @ ) and a control group ( CG , n = @ ) .


The Chinese version of symptom checklist-@ ( SCL-@ ) was adopted to assess their psychological status .


The interventions , including health education , psychological support , stress management , coping strategies and behavior training , were carried out in @ phases ( preoperative , postoperative I and postoperative II ) , and psychological effects were thereafter evaluated accordingly before surgery , and @ week , @ weeks and @ weeks post-surgery .


Medical costs were estimated at discharge .


Survival of patients was estimated each year post-surgery .


General health status and satisfaction-with-hospital were surveyed by a follow-up questionnaire @ years post-surgery .


All the subjects demonstrated higher scores in the preoperative phase than the normal range of Chinese population concerning @ psychological domains including somatization , obsessive-compulsive , depression , anxiety , hostility , phobic anxiety and paranoid ideation .


Although no significant difference was observed between the two groups at admission , the scores of IG , which tended to decrease at a faster rate , were generally lower than those of CG at weeks @ , @ and @ post-surgery .


The length of hospital stay and medical costs of IG were significantly less than those of CG and satisfaction-with-hospital was better .


However , there was no significant difference in @-year survival or health status between two groups .


Appropriate perioperative comprehensive supportive care interventions help to improve the psychological state of Chinese patients with esophageal carcinoma , to reduce health care costs and to promote satisfaction of patients and their families with hospital .


The assurance of high-quality spirometry testing remains a challenge .


Spirometry training consisted of standardized coaching followed by certification for @ spirometry-nave and @ spirometry-experienced research assistants .


Spirometry was performed before and after bronchodilator ( BD ) in random population samples of @ people aged @ years and older from @ sites in Canada .


using the hand-held EasyOne spirometer ( ndd Medical Technologies Inc. , Andover , MA , USA ) .


Pulmonary function quality assurance with over reading was conducted centrally in Vancouver : spirograms were reviewed and graded according to ATS/ERS standards with prompt feedback to the technician at each site .


Descriptive statistics were calculated for manoeuvre acceptability and repeatability variables .


A logistic regression model was constructed for the predictors of spirometry quality success .


@ % of test sessions achieved pre-determined quality standards for back extrapolated volume ( BEV ) , time to peak flow ( PEFT ) and end of test volume ( EOTV ) .


The mean forced expiratory time ( FET ) was @ seconds .


Then , @ % and @ % of all manoeuvres had FEV@ and FVC that were repeatable within @ ml and @ ml respectively .


Test quality was slightly better for post-BD test sessions compared with pre-BD for both groups of research assistants .


Independent predictors of acceptable test quality included participant characteristics : female sex , younger age , greater BD responsiveness ; but not study site or prior experience in completing spirometry by the technologist .


Good quality spirometry tests are attainable in large multicenter epidemiological studies by trained research assistants , irrespective of their prior experience in spirometry .


RECOVER ( NCT@ ) , a double-blind , placebo-controlled trial in patients with Parkinson 's disease ( PD ) and unsatisfactory early-morning motor symptom control , demonstrated significant improvements with rotigotine in early-morning motor function ( Unified Parkinson 's Disease Rating Scale -LSB- UPDRS -RSB- III ) , and nocturnal sleep disturbances ( modified Parkinson 's Disease Sleep Scale -LSB- PDSS-@ -RSB- ) , and improvements in nonmotor symptoms ( NMS ; Non-Motor Symptom Scale -LSB- NMSS -RSB- ) .


Post hoc analyses investigated the correlation between motor symptom and NMS severity in PD by evaluating associations between UPDRS III and both NMSS and PDSS-@ scores .


Categories were defined for UPDRS III , NMSS , and PDSS-@ total scores ; analyses were conducted for the full analysis set ( n = @ ) .


There was a trend toward increasing PDSS-@ and NMSS total and domain scores with increasing UPDRS III category at baseline and end of maintenance ( EoM ) .


Pearson correlation coefficients between UPDRS III and both NMSS and PDSS-@ total and domain scores were r = @-@ @ ( r ( @ ) = @-@ @ ) at baseline , r = @-@ @ ( r ( @ ) = @-@ @ ) at EoM , and r = -@ -@ ( r ( @ ) = @-@ @ ) for change from baseline to EoM .


There was only a small correlation between severity of early-morning motor symptoms and overall burden of NMS and nocturnal sleep disturbances in RECOVER , suggesting that motor symptoms and NMS originate , at least partly , from distinct pathophysiological pathways .


To evaluate a multistrain , high-dose probiotic in the prevention of eczema .


A randomised , double-blind , placebo-controlled , parallel group trial .


Antenatal clinics , research clinic , children at home .


Pregnant women and their infants .


Women from @weeks gestation and their infants to age @months received daily either the probiotic ( Lactobacillus salivarius CUL@ , Lactobacillus paracasei CUL@ , Bifidobacterium animalis subspecies lactis CUL@ and Bifidobacterium bifidum CUL@ ; total of @ ( @ ) organisms/day ) or matching placebo .


Diagnosed eczema at age @years .


Infants were followed up by questionnaire .


Clinical examination and skin prick tests to common allergens were done at @months and @years .


The cumulative frequency of diagnosed eczema at @years was similar in the probiotic ( @/@ , @ % ) and placebo arms ( @/@ , @ % ; OR @ , @ % CI @ to @ ) .


Among the secondary outcomes , the cumulative frequency of skin prick sensitivity at @years was reduced in the probiotic ( @/@ ; @ % ) compared with the placebo arm ( @/@ ; @ % ; OR @ , @ % CI @ to @ ) .


The statistically significant differences between the arms were mainly in sensitisation to cow 's milk and hen 's egg proteins at @months .


Atopic eczema occurred in @/@ ( @ % ) children in the probiotic arm and @/@ ( @ % ) in the placebo arm ( OR @ , @ % CI @ to @ ) .


The study did not provide evidence that the probiotic either prevented eczema during the study or reduced its severity .


However , the probiotic seemed to prevent atopic sensitisation to common food allergens and so reduce the incidence of atopic eczema in early childhood .


To estimate the prevalence of primary dysmenorrhoea among school girls and to compare the impact of exercise and hot water bottle on the occurrence and severity of primary dysmenorrhoea among the study population .


A cross sectional study was done to estimate the prevalence of dysmenorrhoea in two schools of Chandigarh , India .


For the Randomised Controlled Trial , group randomisation of the two schools was done into @ intervention groups ( exercise & hot water bottle groups ) .


@ girls in school @ and @ girls in school @ participated in the intervention .


Comparison of baseline Menstrual Distress Questionnaire ( MDQ ) scores & Visual Analogue Scale for Pain ( VASP ) scores were done with @st , @nd & @rd month post intervention scores using mean , standard deviation , t-test .


Prevalence of dysmenorrhoea was @ % .


Median age of the school girls was @ years .


The mean VASP score decreased from @ to @ ( P < @ ) and from @ to @ ( P < @ ) at @ months , in the exercise and hot water bottle group respectively .


The mean MDQ score decreased from @ to @ ( P < @ ) and from @ to @ ( P < @ ) at @ months , in the exercise and hot water bottle group respectively .


Both exercise & hot water bottle can be used in dysmenorrhoeic girls in home setting to provide relief from pain and menstrual distress .


The efficacy of lidocaine-prilocaine cream ( EMLA ( ) ) analgesia in the practice of hysterosalpingography is controversial .


This study provides new drill results and a new method of application in terms of mode , time and place .


The aim of the paper is to investigate the efficacy of @ % lidocaine @ mg-prilocaine @ mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography .


A randomized , double blinded , controlled study set in the general gynaecology clinic of a university teaching hospital between September @ and June @ .


One hundred successive patients programmed to undergo hysterosalpingography were randomized to either @ ml of EMLA ( @ ) cream or @ ml of placebo ( @ ) , placed endocervically and exocervically , @ min before hysterosalpingography .


Patients ' intensity of pain was assessed in four steps : at baseline ( speculum application ) , after application of Pozzi tenaculum and cannula on the uterine cervix , during cervical traction and after contrast medium injection , using a @-cm Visual Analogue Scale ( VAS ) immediately after the procedure .


The most painful step was also identified .


VAS was administered again at one-month follow-up visit .


NCT@ .


The contrast medium injection was the most painful step of hysterosalpingography in both groups ( EMLA @ , placebo @ , @ % CI : -@ to @ ) .


No differences were found between the two groups ( P = @ ) during this step .


When comparing the VAS scale after the application of Pozzi tenaculum and cannula ( EMLA @ , placebo @ , @ % CI : @-@ @ ) and after cervical traction ( EMLA @ , placebo @ , @ % CI : @-@ @ ) , significantly less pain was experienced by the EMLA group than the placebo group : P = @ and P = @ , respectively .


Endocervical and exocervical topical application of EMLA @ min before performing hysterosalpingography significantly reduced pain during cervical manipulation with tenaculum and cannula and during cervical traction , but did not reduce pain during injection of contrast that was the most painful step .


Inflammation is considered a key mediator of complications after cardiac surgery .


Sevoflurane has been shown to quench inflammation and to provide cardioprotection in preclinical studies .


Clinical studies using sevoflurane confirm this effect on inflammation but do not consistently show clinical benefits .


This paradox may indicate that the contribution of inflammation to postoperative sequalae is less than commonly thought or that systemic doses are too low in their local concentration .


To test the latter , we evaluated the effects of intramyocardial sevoflurane delivery .


Selective myocardial sevoflurane delivery was performed during aortic cross-clamping in patients undergoing valve surgery ( n = @ ) .


Results were compared with a control group not receiving sevoflurane ( n = @ ) .


A reference group ( n = @ ) was added to evaluate the effects of systemic sevoflurane delivery .


Paired arterial and myocardial venous blood samples were collected at various time points post-reperfusion .


Inflammatory mediators and myocardial cell damage were studied .


Intramyocardial delivery was superior to systemic delivery in attenuation of interleukin-@ and interleukin-@ ( -@ % and -@ % , respectively ; both P = @ ) .


Myocardial and systemic sevoflurane delivery effectively suppressed surgery-related inflammatory responses including postoperative C-reactive protein levels when compared with controls -LSB- @ ( @-@ ) ( P = @ ) and @ ( @-@ ) ( P = @ ) compared with @ ( @-@ ) mg litre ( -@ ) -RSB- .


Sevoflurane treatment did not reduce postoperative troponin T , creatine kinase , and creatine kinase-MB values .


This proof-of-concept study suggests that intramyocardial delivery compared with the systemic delivery of sevoflurane more strongly attenuates the systemic inflammatory response after cardiopulmonary bypass without reducing postoperative markers of myocardial cell damage .


To assess the long-term safety and efficacy of pramipexole as a once-daily ( q.d. ) extended-release oral formulation in early or advanced Parkinson 's disease ( PD ) .


In two double-blind ( DB ) studies of early PD and one of advanced PD,active-treatment arms received pramipexole immediate release ( IR ) or extended release ( ER ) , with exposure lasting up to @ weeks .


In open-label ( OL ) extensions that followed immediately , subjects took ER q.d. for up to @ weeks , with dosage adjustment permitted ( range @-@ @ mg q.d. ) .


Of @ subjects completing an early-PD DB study , @ entered the early-PD OL extension ; @ completed it .


Reported adverse events ( AEs ) with incidence @ % were somnolence ( @ % ) , peripheral edema ( @ % ) and back pain ( @ % ) .


Of @ subjects completing the advanced-PD DB study , @ entered the advanced-PD OL extension ; @ completed it .


Reported AEs with incidence @ % were dyskinesia ( @ % ) and somnolence ( @ % ) .


Impulse control disorders were identified by semi-structured interview in @ subjects ( @ % of @ ) .


In exploratory analyses , adjusted mean Unified Parkinson 's Disease Rating Scale ( UPDRS ) PartsII + III scores ( excluding ex-placebo recipients ) remained substantially improved from DB baseline scores prior to pramipexole introduction , at -@ and -@ points amongst ex-DB-ER and ex-DB-IR recipients after @ weeks of pramipexole ( @ DB plus @ OL ) in early PD , and -@ and -@ after up to @ weeks ( up to @ DB plus @ OL ) in advanced PD .


These results support the long-term safety and efficacy of pramipexole ER in early and advanced PD .


AEs were typical for dopaminergic medications , and UPDRS scores suggested sustained symptomatic benefit .


To examine the impact of telephone reinforcement ( TR ) on predictors of physical activity ( PA ) maintenance in older adults with osteoarthritis .


Mixed effects modeling was conducted of data from a randomized PA trial that used negotiated maintenance contracts , supplemented by TR , to test impact of TR on barriers , decisional balance , and stage of change at multiple points in time .


Participants who were referred to a PA program and received TR improved the most in barriers and decisional balance .


Participants who negotiated a tailored maintenance contract but did not receive TR improved the most in stage .


TR appears to positively affect perceptions around engagement , whereas negotiation positively impacts PA behavior .


Further research should examine the effectiveness of specific PA maintenance strategies .


To explore the long-term outcomes of CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) , a multidisciplinary cognitive behavioural treatment programme in persons with spinal cord injury .


Long-term follow-up pre-post-intervention design .


A total of @ subjects with a spinal cord injury and chronic neuropathic pain from @ Dutch rehabilitation centres .


Primary outcomes were pain intensity and pain-related disability ( Chronic Pain Grade questionnaire ) .


Secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Questionnaire ) .


Random coefficient analysis was used for the analyses of measurements before ( t@ ) , immediate post-intervention ( t@ ) , and @ ( t@ ) , @ ( t@ ) , and @ ( t@ ) months follow-up .


The analyses showed significant improvements on pain intensity ( t@-t@ and t@-t@ ) and pain-related disability ( t@-t@ , t@-t@ , and t@-t@ ) , anxiety and participation in activities ( t@-t@ , t@-t@ , and t@-t@ ) .


This exploratory study suggests that a multidisciplinary cognitive behavioural programme might have lasting improvements on pain intensity , pain-related disability , anxiety , and participation in activities in people with chronic neuropathic spinal cord injury pain and highlights the potential of such programmes .


Although Black heterosexual men ( BHM ) in the United States rank among those most affected by HIV , research about how safer sex messages shape their safer sex behaviors is rare , highlighting the need for innovative qualitative methodologies such as critical discursive psychology ( CDP ) .


This CDP study examined how : ( a ) BHM construct safer sex and masculinity ; ( b ) BHM positioned themselves in relation to conventional masculinity ; and ( c ) discursive context ( individual interview vs. focus group ) shaped talk about safer sex and masculinity .


Data included individual interviews ( n = @ ) and @ focus groups ( n = @ ) conducted with @ self-identified Black/African American heterosexual men , ages @ to @ .


Analyses highlighted @ main constructions : ( a ) condoms as signifiers of `` safe '' women ; ( b ) blaming women for STI/responsibility for safer sex ; ( c ) relationship/trust/knowledge ; ( d ) condom mandates ; and ( e ) public health safer sex .


Discourses positioned BHM in terms of conventional masculinity when talk denied men 's agency for safer sex and/or contraception , or positioned women as deceitful , or apathetic about sexual risk and/or pregnancy .


Notably , discourses also spotlighted alternative masculinities relevant to taking responsibility for safer sex or sexual exclusivity .


Discursive context , namely the homosocial nature of focus group discussions , shaped how participants conversed about safer sex , and masculinity but not the content of that talk .


In denying BHM 's responsibility for safer sex , BHM 's discourses about safer sex and masculinity often mirror public health messages , underscoring a critical need to sync these discourses to reduce sexual risk , and develop gender-transformative safer sex interventions for BHM .


Exercise has been shown to attenuate cigarette cravings during temporary smoking abstinence ; however , the mechanisms of action are not clearly understood .


The objectives of the study were to compare the effects of three exercise intensities on desire to smoke and explore potential neurobiological mediators of desire to smoke .


Following overnight abstinence , @ participants ( @ males , @-@ years ) completed three @ min sessions of light - , moderate - , or vigorous-intensity exercise on a cycle ergometer in a randomized crossover design .


Ratings of desire to smoke were self-reported pre - and post-exercise and heart rate variability was measured throughout .


Saliva and blood were analyzed for cortisol and noradrenaline in a sub-sample .


Exercise influenced desire to smoke ( F -LSB- @ , @ -RSB- = @ , p < @ ) , with reductions greatest immediately after vigorous exercise .


There were also significant time x exercise intensity interaction effects for heart rate variability and plasma noradrenaline ( F -LSB- @ , @ -RSB- = @ , p = @ ) , with a bias in noradrenaline occurring between light and vigorous conditions ( adjusted mean difference -LSB- SE -RSB- = @ ng/ml -LSB- @ -RSB- , p < @ ) at @ min post-exercise .


There was no interaction of time x exercise intensity for plasma and salivary cortisol levels .


These findings support the use of vigorous exercise to reduce cigarette cravings , showing potential alterations in a noradrenergic marker .


To investigate the pathogenesis of bloodstream infection by Staphylococcus epidermidis , using the molecular epidemiology , in high-risk neonates .


We conducted a prospective study of a cohort of neonates with bloodstream infection using central venous catheters for more than @h .


`` National Healthcare Safety Network '' surveillance was conducted .


Genotyping was performed by DNA fingerprinting and mecA genes and icaAD were detected by multiplex-PCR .


From April @ to April @ , the incidence of bloodstream infection and central venous catheter-associated bloodstream infection was @ and @ / @ catheter days , respectively , with S. epidermidis accounting for @ % of episodes .


Molecular analysis was used to document the similarity among six isolates of bloodstream infection by S. epidermidis from cases with positive blood and central venous catheter tip cultures .


Fifty percent of neonates had bloodstream infection not identified as definite or probable central venous catheter-related bloodstream infection .


Only one case was considered as definite central venous catheter-related bloodstream infection and was extraluminally acquired ; the remaining were considered probable central venous catheter-related bloodstream infections , with one probable extraluminally and another probable intraluminally acquired bloodstream infection .


Additionally , among mecA + and icaAD + samples , one clone ( A ) was predominant ( @ % ) .


A polyclonal profile was found among sensitive samples that were not carriers of the icaAD gene .


The majority of infections caused by S. epidermidis in neonates had an unknown origin , although @ % appeared to have been acquired intraluminally and extraluminally .


We observed a polyclonal profile between sensitive samples and a prevalent clone ( A ) between resistant samples .


We examined the effects of an intensive lifestyle intervention ( ILI ) , compared with a diabetes support and education ( DSE ) control intervention , on long-term changes in depression symptoms , antidepressant medication ( ADM ) use , and health-related quality of life ( HRQoL ) in overweight/obese individuals with type @ diabetes .


Look AHEAD was a multisite randomized controlled trial of @,@ overweight/obese participants assigned to ILI ( designed to produce weight loss ) or DSE and followed for a median of @ years .


The Beck Depression Inventory ( BDI ) was administered at baseline , annually at years @-@ , and again at year @ .


Mean BDI scores and incidence of BDI scores @ , indicative of likely mild or greater depression , were examined .


Annually through year @ , participants reported their ADM use and completed the Medical Outcomes Study Short Form @ ( SF-@ ) questionnaire , which yields physical component summary ( PCS ) and mental component summary ( MCS ) scores .


ILI significantly reduced the incidence of mild or greater depression symptoms ( BDI scores @ ) compared with DSE ( hazard ratio -LSB- HR -RSB- = @ ; @ % CI @-@ @ ; P = @ ) .


Although SF-@ PCS scores worsened over time in both groups , ILI participants reported better physical function than DSE throughout the first @ years ( all P values < @ ) .


There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-@ MCS scores .


ILI for overweight/obese patients with type @ diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL .


These findings should be considered when evaluating the potential benefits of ILIs .


To evaluate whether manual or electric vacuum aspiration results in greater immediate confirmation of completed abortion at less than @ weeks of gestation .


Five hundred pregnant women presenting for surgical abortion with mean gestational sac diameter of less than @ mm or no visible sac on ultrasonography were randomized to manual or electric vacuum aspiration .


Tissue examination was performed by operating physicians , not blinded to group assignment , and by trained medical assistants , blinded to group assignment .


Patients with no products of conception on gross inspection underwent repeat aspiration as necessary and serial human chorionic gonadotropin monitoring .


All patients were scheduled for follow-up visits .


The primary outcome was detection of products of conception in patients with subsequently confirmed completed abortion .


From April @ to October @ , @ patients were randomized to manual vacuum aspiration and @ to electric vacuum aspiration .


One hundred eighty-two ( @ % ) patients in the manual vacuum aspiration group had products of conception identified and subsequently confirmed completed abortion compared with @ ( @ % ) patients undergoing electric vacuum patients ( P = @ , relative risk @ , @ % confidence interval -LSB- CI -RSB- @-@ @ ) .


In pregnancies of sac size @ mm or less , including no visible sac , five of @ ( @ % ) patients undergoing manual vacuum aspiration had accurate identification of products of conception compared with four of @ ( @ % ) patients undergoing electric vacuum aspiration ( P = @ , relative risk @ , @ % CI @-@ @ ) .


Tissue reports of physicians and medical assistants had @ % concordance .


Seventy-nine ( @ % ) patients required human chorionic gonadotropin monitoring to confirm completed abortion .


There were seven ( @ % ) ongoing pregnancies , including four false-positive products of conception results and , among the latter , one presumed ectopic pregnancy .


Our study supports providing abortions to women who request them before @ weeks of gestation using either manual or electric vacuum aspiration .


Early aspiration is highly effective , although human chorionic gonadotropin monitoring may be necessary to confirm complete abortion .


Neck pain is a common musculoskeletal complaint responsive to manual therapies .


Doctors of chiropractic commonly use manual cervical distraction , a mobilization procedure , to treat neck pain patients .


However , it is unknown if clinicians can consistently apply standardized cervical traction forces , a critical step toward identifying an optimal therapeutic dose .


To assess clinicians ' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients .


An observational study nested within a randomized clinical trial .


Two research clinicians provided study interventions to @ participants with neck pain .


Clinician proficiency in delivering cervical traction forces within three specified ranges ( low force , less than @ N ; medium force , @-@ N ; and high force @-@ N ) .


Participants were randomly allocated to three force-based treatment groups .


Participants received five manual cervical distraction treatments over @ weeks while lying prone on a treatment table instrumented with force sensors .


Two clinicians delivered manual traction forces according to treatment groups .


Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback .


Peak traction force data were extracted and descriptively analyzed .


Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges @ % of the time without visual feedback and @ % of the time with visual feedback .


This study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients , enabling the capability to conduct force-based dose response clinical studies .


To compare the perioperative outcomes of patients with primary hepatic carcinoma treated with laparoscopic hepatectomy ( LH ) with those treated with open hepatectomy ( OH ) .


From January @ to August @ , @ patients with primary hepatic carcinoma were randomly divided into the LH group and OH group respectively , @ patients in each group .


And the incision length , blood loss , operative time , postoperative liver function , anus exhaust time , complications , length of postoperative hospital stay , and cost measures were compared .


LH could achieve shorter incision length , less blood loss , more rapid recovery in liver function and gastrointestinal function , and shorter postoperative hospital stay length compared with OH for primary hepatic carcinoma patients ( all P < @ ) .


However , LH could not significantly shorten operative time , and reduce postoperative complications and hospitalization cost ( all P > @ ) .


Compared with OH , LH could improve perioperative outcomes of primary hepatic carcinoma patients .


To develop and validate a self-efficacy measure of diabetes self-management , the Lifestyle Self-Efficacy Scale for Latinos with Diabetes ( LSESLD ) , designed for low-income , Spanish-speaking Latinos with diabetes .


Quantitative and qualitative methods .


Community health centers in central and western Massachusetts .


Low-income Latinos ( N = @ ) enrolled in a randomized diabetes self-management intervention trial .


Construct validity , internal consistency , sensitivity to change over time .


The LSESLD demonstrated good internal consistency ( Cronbach 's alpha = @ ) , reasonable construct validity ( moderate , significant associations between the LSESLD and validated measures of diabetes knowledge , dietary intake , physical activity , blood glucose self-monitoring , and HbA@c values ) , and sensitivity to intervention-related changes over time .


The LSESLD is a reliable and valid research instrument assessing self-efficacy related to diabetes self-management among low-income , Spanish-speaking populations .


Febrile neutropenia ( FN ) is a frequent , serious complication of intensive pediatric chemotherapy regimens .


The aim of this trial was to compare quality of life ( QOL ) between inpatient and outpatient intravenous antibiotic management of children and adolescents with low risk febrile neutropenia ( LRFN ) .


In this randomised non-blinded trial , patients between @ and @ years old , receiving low/moderate intensity chemotherapy were pre-consented and , on presentation to emergency ( ED ) with FN satisfying low risk criteria , randomised to either outpatient or inpatient care with intravenous cefepime @mg/kg ( @ hourly ) .


All patients continued antibiotics for at least @hours , until afebrile for @hours and demonstrating a rising absolute neutrophil count @/mm ( @ ) .


Several domains of QOL were examined by daily questionnaire .


Eighty-one patients presented to ED with @ episodes of fever .


Thirty-seven FN presentations involving @ patients were randomised to inpatient ( @ ) and outpatient ( @ ) management .


Combined QOL mean scores for parents were higher for the outpatient group and scores for three specific parent variables ( keeping up with household tasks/time spent with partner/time spent with other children ) were higher among outpatients .


There was no difference in parent confidence/satisfaction in care between groups .


Patients scored better in the outpatient group overall and for sleep and appetite .


The mean length of fever was equivalent between groups and there were no serious adverse events attributable to cefepime or outpatient care .


Outpatient cefepime management of LRFN provided significant benefit to parents and patients across several QOL domains and appeared both feasible and safe .


To observe the effect of Liandouqingmai recipe ( Chinese herbal medicine compound preparation ) on the quality of life ( QOL ) and inflammatory reaction of patients with coronary heart disease ( CHD ) .


A total of @ CHD patients were randomized into two groups : treatment group ( n = @ ) receiving standard treatment for CHD plus Liandouqingmai recipe , and control group ( n = @ ) receiving standard treatment only .


The control group contained @ normal healthy subjects .


Changes in hs-C-reactive protein ( CRP ) , peripheral blood leucocytes ( PBL ) , and interleukin ( IL ) -@ and IL-@ levels were measured .


The Seattle Angina Questionnaire ( SAQ ) was used to determine patient QOL before and after treatment for @ weeks .


Before treatment , SAQ scores -LSB- physical limitation ( PL ) , angina stability ( AS ) , angina frequency ( AF ) , treatment satisfaction ( TS ) , and disease perception ( DP ) -RSB- were not statistically different between groups .


After treatment , AS and DP levels of controls were significantly increased compared with the other groups , while PL , AS , AF , TS , and DP levels of the treatment group were significantly increased compared with controls .


Treatment group SAQ scores ( PL , AS , AF , TS , and DP ) were significantly higher than for controls .


CHD patient IL-@ and IL-@ levels were significantly higher than controls .


Before treatment , mean levels of IL-@ , hs-CRP and PBL of the two groups were not statistically different .


After treatment , mean levels of IL-@ , IL-@ , hs-CRP and PBL of the two groups were significantly decreased compared with their before treatment values , and levels of IL-@ , hs-CRP , and PBL of the treatment group were lower than controls .


Although mean IL-@ levels of both groups decreased , there was no significant difference in between-group and in-roup comparisons before and after treatment .


Mean levels of IL-@ and IL-@ in the normal group were lower than in CHD patients .


SAQ scores of QOL were negatively associated with the inflammatory index ( IL-@ / IL-@ ) , and there was a significant negative association of IL-@ with AS ( r = - @ , P < @ ) .


Inflammatory reactions in CHD patients are related to angina status .


Coadministration of CHD standard treatment and Liandouqingmai recipe increased patient SAQ scores by decreasing IL-@ , IL-@ , hs-CRP , and PBL levels in CHD patients , which might inhibit endothelial inflammation to improve patient QOL .


We investigated whether expression of epidermal growth factor receptor ( EGFR ) was associated with survival and disease control in this secondary analysis of a phase II trial of cetuximab + chemoradiation for stage III non-small cell lung cancer .


Patients received cetuximab weekly before and during radiation ( @ Gy/@ fractions/@ weeks ) with weekly carboplatin + paclitaxel .


We analyzed EGFR expression by immunohistochemistry ( IHC ) and fluorescence in situ hybridization ( FISH ) in pretreatment biopsy specimens and compared findings with overall and progression-free survival ( OS , PFS ) and time to progression ( TTP ) .


Specimens for IHC and FISH were collected from @ and @ of @ evaluable patients .


Pretreatment characteristics did not differ for patients with ( n = @ ) or without ( n = @ ) EGFR IHC data , or with ( n = @ ) or without ( n = @ ) FISH data .


However , patients without IHC data had worse OS ( HR = @ , P = @ ) , worse PFS ( HR = @ , P = @ ) , and worse TTP -LSB- HR = @ , P = @ -RSB- than those with IHC data .


EGFR protein expression was not related to pretreatment characteristics or OS ; FISH-positive disease was associated with better performance status but not with OS , PFS , or TTP .


Surprisingly , outcomes differed not by EGFR expression but by the availability of samples for analysis , underscoring the importance of obtaining biopsy samples in such trials .


To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes , peripheral neuropathy , and a history of similar prior ulceration .


Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape - and pressure-based orthoses ( experimental , n = @ ) or standard-of-care A@ orthoses ( control , n = @ ) .


Patients were followed for @ months , until a study end point ( forefoot plantar ulcer or nonulcerative plantar forefoot lesion ) or to study termination .


Proportional hazards regression was used for analysis .


There was a trend in the composite primary end point ( both ulcers and nonulcerative lesions ) across the full follow-up period ( P = @ ) in favor of the experimental orthoses .


This trend was due to a marked difference in ulcer occurrence ( P = @ ) but no difference in the rate of nonulcerative lesions ( P = @ ) .


At @ days , the ulcer prevention effect of the experimental orthoses was already significant ( P = @ ) when compared with control , and the benefit of the experimental orthoses with respect to the composite end point was also significant ( P = @ ) .


The hazard ratio was @ ( @ % CI @-@ @ ) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study .


We conclude that shape - and barefoot plantar pressure-based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses , but they did not significantly reduce nonulcerative lesions .


Inflammation and malnutrition are important features in patients with ESRD ; however , data on changes in these parameters over time are scarce .


This study aimed to gain insight into changes over time in serum albumin , body mass index , high-sensitivity C-reactive protein , and IL-@ in patients with ESRD and aimed to identify clinical risk factors for deterioration of these parameters .


Data were analyzed from the Convective Transport Study , a randomized controlled trial conducted from June @ to January @ , in which @ patients with chronic ESRD were randomized to either online hemodiafiltration or low-flux hemodialysis .


Albumin and body mass index were measured up to @ years and predialysis C-reactive protein and IL-@ were measured up to @ years in a subset of @ participants .


Rates of change in these parameters over time were estimated across strata of predefined risk factors with linear mixed-effects models .


Albumin and body mass index decreased and C-reactive protein and IL-@ increased over time .


For every incremental year of age at baseline , the yearly excess decline in albumin was @ g/dl ( -@ to -@ ; P < @ ) and the excess decline in body mass index was @ kg/m ( @ ) per year ( -@ to -@ ; P < @ ) .


In patients with diabetes mellitus , there was a yearly excess decline of @ g/dl in albumin ( -@ to -@ ; P = @ ) .


Compared with women , men had an excess decline of @ g/dl per year in albumin ( -@ to -@ ; P = @ ) and an excess increase of @ % per year in IL-@ ( @ % -@ % ; P = @ ) .


Despite guideline-based care , all inflammatory and nutritional parameters worsened over time .


The deterioration of some of these parameters was more pronounced in men , older patients , and patients with diabetes mellitus .


Special focus on the nutritional status of at-risk patients by individualizing medical care might improve their prognosis .


To investigate the efficacy and safety of domestic tiotropium inhalation capsule in patients with chronic obstructive pulmonary disease ( COPD ) with multi-center randomized clinical trial .


Patients with stable slight to moderate COPD were randomized into trial group ( n = @ ) with tiotropium @ pg Qd or control group ( n = @ ) with ipratropium @ g Qid for a treatment of four weeks .


The spirometry and scoring questionaire were recorded at different visits during the treatment .


Rescue medication consumption and adverse events were recorded .


Results Forced expiratory volume in @ s ( FEV@ ) of both groups increased obviously @ min and @ h after first dosing .


After four weeks treatments , FEV , and forced vital capacity ( FVC ) in both groups were improved obviously , and the improvement in tiotropium group was significantly higher than that ipratropium group .


COPD symptom scores were significantly reduced in both groups , and the improvement in tiotropium group was significantly better than that in ipratropium group .


There was no significant difference in rescue medication consumption between the two groups .


The ratios of adverse events were @ % and @ % in tiotropium and ipratropium group , respectively ( P = @ ) .


Domestic tiotropium inhalation capsule is efficient and safe in the treatment of COPD .


Telephone-delivered interventions to provide health counseling for complex chronic medical conditions are convenient , acceptable , and cost-effective .


However , little is known about which patients are reached , their characteristics , and who benefits most from telephone-delivered counseling .


This study examined whether baseline characteristics are predictive of being easily reached for a monthly , telephone-delivered behavioral intervention to improve treatment adherence in Veterans with uncontrolled hypertension .


Participants were to complete a telephone session once a month for @ months .


Participants completed an average of @ out of a possible @ sessions .


Participants who were unmarried , African American , unemployed , or younger or did not complete high school required significantly more call attempts per completed session .


Overall , telephone-delivered counseling is a feasible approach to reaching hypertensive patients .


Patients who are married , Hispanic , retired , or older or graduated college may be easier to reach and engage in telephone-delivered counseling .


Reaching patients with other sociodemographic characteristics may require more resources or alternate methods .


Noninvasive mechanical ventilation during the postoperative period ( PO ) following lung resection can restore residual functional capacity , improve oxygenation and spare the inspiratory muscles .


The objective of this study was to assess the efficacy of continuous positive airway pressure ( CPAP ) associated with physiotherapy , compared with physiotherapy alone after lung resection .


Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas .


Sessions were held in the immediate postoperative period ( POi ) and on the first and second postoperative days ( PO@ and PO@ ) , and the patients were reassessed on the discharge day .


CPAP was applied for two hours and the pressure adjustment was set between @ and @ cmH@O .


The oxygenation index ( OI ) , Borg scale , pain scale and presence of thoracic drains and air losses were evaluated .


There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy ( CP ) group , P = @ .


In the CP group the OI was significantly lower on PO@ ( P = @,@ ) , than CPAP group .


The air losses were significantly greater in the CPAP group in the POi and on PO@ ( P = @ , P = @ ) , but there was no significant difference between the groups on PO@ and PO@ .


There was a statistically significant difference between the groups regarding the Borg scale in the POi ( P < @ ) , but there were no statistically significant differences between the groups regarding the pain score .


CPAP after lung resection is safe and improves oxygenation , without increasing the air losses through the drains .


The aim of this study was to investigate the effect of acute L-carnitine supplementation at two different doses on nitric oxide ( NO ) production and oxidative stress after exhaustive exercise .


The subjects were @ healthy males aged @-@ years .


Subjects were randomly divided into two groups of @ each and received @ or @ g L-carnitine via a glass of fruit juice .


After @ h , the treadmill test was started at a speed of @ km/h , afterwards increasing the speed @ km/h every @ min with a @ min rest before every speed increase until exhaustion .


Venous blood samples were collected again within @ min following the exercise test .


One week later , the test was repeated on the same athletes with placebo fluids .


All subjects received a placebo via a glass of fruit juice .


@ h after the same exercise protocol mentioned above was performed and blood samples were drawn immediately .


These plasma samples were used for measurement of nitrate-nitrite ( NOx ) , which are known to be the stable end products of NO , TBARs as a lipid peroxidation indicator and an antioxidant glutathione ( GSH ) levels .


The results of this study have shown that L-carnitine applied at a @ g dose provides strong antioxidant action by increasing the GSH and NOx level and decreasing the TBARs level .


Treatment of patients with single-segment degenerative lumbar instability using unilateral pedicle screw fixation can achieve stability and fusion rates similar to those of bilateral pedicle screw fixation .


The aim of this study was to analyze the clinical outcome of using unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach to treat single-segment degenerative lumbar instability .


Thirty-nine consecutive patients with single-segment , low-grade , degenerative lumbar instability were randomly assigned to treatment with either unilateral ( n = @ ) or bilateral ( n = @ ) pedicle screw fixation .


In the unilateral group , patients underwent unilateral posterior lumbar interbody fusion ( PLIF ) and ipsilateral pedicle screw fixation through a tubular retractor via the Wiltse approach .


In the bilateral group , patients underwent modified bilateral PLIF with bilateral pedicle screw fixation via the posterior midline approach .


During follow-up , patients were evaluated using a visual analog scale ( VAS ) , the Japanese Orthopaedic Association ( JOA ) score , and the Oswestry Disability Index .


The unilateral group had a shorter operative duration ( p < @ ) and less blood loss ( p < @ ) .


All patients completed more than @ years of follow-up ( mean @ months ) .


In general , the time trends in improvement on the VAS and JOA differed slightly between the groups through @ years , but no significant difference in back pain VAS score or leg pain VAS score was found between these @ groups at the @-year follow-up .


Complete bone fusion was shown on CT in all patients at the @-year follow-up .


Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach appears to be as safe and effective as bilateral pedicle screw fixation for the treatment of single-segment degenerative lumbar instability .


To study the effects of both balneotherapy and mud-bath therapy treatments in patients affected by primary fibromyalgia ( FM ) using rheumatological , psychiatric , biochemical and proteomic approaches .


Forty-one FM patients ( @ females , @ males ) , who fulfilled the American College of Rheumatology criteria received a @-week thermal therapy programme consisting of therapy once daily for @ days/week .


Twenty-one patients received mud-bath treatment , while the other twenty balneotherapy .


Pain , symptoms , and quality of life were assessed .


Oxytocin , brain-derived neurotrophic factor ( BDNF ) , ATP and serotonin transporter levels during therapy were assayed .


Comparative whole saliva ( WS ) proteomic analysis was performed using a combination of two-dimensional electrophoresis ( @DE ) and mass spectrometry techniques .


We observed a reduction in pain , FIQ values and improvement of SF@ in both groups of patients treated with mud-bath or balneotherapy .


The improvement of the outcome measures occurred with different timing and duration in the two spa treatments .


A significant decrease in BDNF concentrations was observed either after balneotherapy or mud-bath therapy when assayed after twelve weeks , while no significant change in oxytocin levels , ATP levels and serotonin transporter were detected .


Significant differences were observed for phosphoglycerate mutase@ ( PGAM@ ) and zinc alpha-@-glycoprotein @ ( AZGP@ ) protein expression .


Our results showed that the thermal treatment might have a beneficial effect on the specific symptoms of the disease .


In particular , while balneotherapy gives results that in most patients occur after the end of the treatment but which are no longer noticeable after @ months , the mud-bath treatment gives longer lasting results .


Success rate of catheter applications is low in supraclavicular block .


Thus , bupivacaine and levobupivacaine become important with their long effect time in single injection practices .


In this study , we aimed to compare the effectiveness , side effects and complications of bupivacaine and levobupivacaine in supraclavicular block .


Sixty patients aged between @ and @ , with body weight between @ and @ kg , in the ASA I-II-III group who were scheduled for hand , forearm and arm surgery using supraclavicular block were randomized into two groups of @ .


The patients received @ ml @ % bupivacaine ( Group B ) or @ ml @ % levobupivacaine ( Group L ) .


Motor and sensory blocks were evaluated .


Motor and sensory block onset times , total block durations , postoperative pain , amount of postoperative analgesic used and patient satisfaction were recorded .


Demographic data , distribution of surgical area and hemodynamic data were similar between the two groups .


Surgery , motor and sensory block durations of Group B and L patients did not vary statistically significantly .


However , motor and sensory block onset times in Group B were significantly shorter than Group L ( p < @ ) .


The mean time for first postoperative analgesic demand were @ @ h in Group B and @ @ h in Group L ( p > @ ) .


@ ml @ % bupivacaine and levobupivacaine provide similar block characteristics for supraclavicular block .


Bupivacaine leads to faster motor and sensory block onset compared to levobupivacaine however similar duration of postoperative analgesia .


Patients with muscle-invasive urothelial carcinoma of the bladder have poor survival after cystectomy .


The EORTC @ trial aimed to compare immediate versus deferred cisplatin-based combination chemotherapy after radical cystectomy in patients with pT@-pT@ or N + M@ urothelial carcinoma of the bladder .


This intergroup , open-label , randomised , phase @ trial recruited patients from hospitals across Europe and Canada .


Eligible patients had histologically proven urothelial carcinoma of the bladder , pT@-pT@ disease or node positive ( pN@-@ ) M@ disease after radical cystectomy and bilateral lymphadenectomy , with no evidence of any microscopic residual disease .


Within @ days of cystectomy , patients were centrally randomly assigned ( @:@ ) by minimisation to either immediate adjuvant chemotherapy ( four cycles of gemcitabine plus cisplatin , high-dose methotrexate , vinblastine , doxorubicin , and cisplatin -LSB- high-dose MVAC -RSB- , or MVAC ) or six cycles of deferred chemotherapy at relapse , with stratification for institution , pT category , and lymph node status according to the number of nodes dissected .


Neither patients nor investigators were masked .


Overall survival was the primary endpoint ; all analyses were by intention to treat .


The trial was closed after recruitment of @ of the planned @ patients .


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


From April @ , @ , to Aug @ , @ , @ patients were randomly assigned ( @ to immediate treatment and @ to deferred treatment ) , and followed up until the data cutoff of Aug @ , @ .


After a median follow-up of @ years ( IQR @-@ @ ) , @ ( @ % ) of @ patients in the immediate treatment group had died compared with @ ( @ % ) of @ in the deferred treatment group .


No significant improvement in overall survival was noted with immediate treatment when compared with deferred treatment ( adjusted HR @ , @ % CI @-@ @ ; p = @ ) .


Immediate treatment significantly prolonged progression-free survival compared with deferred treatment ( HR @ , @ % CI @-@ @ , p < @ ) , with @-year progression-free survival of @ % ( @ % CI @-@ @ ) in the immediate treatment group and @ % ( @-@ @ ) in the deferred treatment group .


Grade @-@ myelosuppression was reported in @ ( @ % ) of @ patients who received treatment in the immediate chemotherapy group versus @ ( @ % ) of @ patients who received treatment in the deferred chemotherapy group , neutropenia occurred in @ ( @ % ) versus @ ( @ % ) patients , respectively , and thrombocytopenia in @ ( @ % ) versus @ ( @ % ) .


Two patients died due to toxicity , one in each group .


Our data did not show a significant improvement in overall survival with immediate versus deferred chemotherapy after radical cystectomy and bilateral lymphadenectomy for patients with muscle-invasive urothelial carcinoma .


However , the trial is limited in power , and it is possible that some subgroups of patients might still benefit from immediate chemotherapy .


An updated individual patient data meta-analysis and biomarker research are needed to further elucidate the potential for survival benefit in subgroups of patients .


Continuous-flow left ventricular assist device ( CF-LVAD ) implantation is associated with improved quality of life , but the effect on exercise capacity is less well documented .


It is uncertain whether a fixed CF-LVAD pump speed , which allows for sufficient circulatory support at rest , remains adequate during exercise .


The aim of this study was to evaluate the effects of fixed versus incremental pump speed on peak oxygen uptake ( peak VO@ ) during a maximal exercise test .


In CF-LVAD ( HeartMate II ) patients exercise testing measuring peak oxygen uptake ( VO@ ) was performed on an ergometer bike twice in one day : once with fixed pump speed ( testfix ) and once with incremental pump speed ( testinc ) .


The order of testfix and testinc in each patient was determined by randomization .


During testinc pump speed was increased from the baseline value by @rpm/@min .


Fourteen patients ( aged @years ) were included with a mean support duration of @days .


Baseline CF-LVAD speed was @rpm and during testinc speed was increased by a mean of @rpm .


Mean peak VO@ was significantly higher in testinc compared with testfix ( @ mL/kg/min vs. @ mL/kg/min ; P = @ ) , corresponding to a @ % increase .


All exercise tests ( n = @ ) were adequately performed with RER > @ .


Increasing pump speed during exercise augments peak VO@ in patients supported with CF-LVADs .


An automatic speed-change function in future generations of CF-LVADs might improve functional capacity .


The results of previous studies suggest that early goal-directed fluid therapy ( EGDT ) reduces delayed cerebral ischemia ( DCI ) after aneurysmal subarachnoid hemorrhage , but the effects of EGDT on clinical outcomes are still unclear .


This study aimed to determine whether EGDT improves outcomes compared with standard less-invasive hemodynamic therapy .


This study included @ patients treated within @ hours after subarachnoid hemorrhage , randomized to receive either ( @ ) EGDT guided by preload volume and cardiac output monitored by transpulmonary thermodilution ( treatment group ) or ( @ ) standard therapy guided by fluid balance or central venous pressure , assisted by uncalibrated less-invasive cardiac output monitoring during hyperdynamic therapy in patients with clinical or radiological indications of DCI ( control group ) .


DCI determined by clinical or radiological findings and functional outcome determined by the modified Rankin Scale score at @ months were compared between groups .


For all clinical grades combined , there were no significant differences in the rates of DCI ( @ % versus @ % ; P = @ ) or modified Rankin Scale score of @ to @ at @ months ( @ % versus @ % ; P = @ ) between the @ groups .


For patients with poor clinical grade , those who received EGDT had a significantly lower rate of DCI ( @ % versus @ % ; P = @ ) , modified Rankin Scale score of @ to @ at @ months ( @ % versus @ % ; P = @ ) , and shorter length of intensive care unit stay ( @ versus @ days ; P = @ ) than those who received standard therapy .


EGDT is beneficial for reducing DCI and improving postoperative functional outcome in patients with poor clinical grade .


Higher low-density lipoprotein cholesterol is associated with more rapid chronic kidney disease progression ; reduction in cholesterol with statins , in conjunction with statins ' pleiotropic effects , such as decreasing inflammation , may be renoprotective .


The Stroke Prevention by Aggressive Reduction in Cholesterol Levels ( SPARCL ) trial assessed the effect of statin treatment on the risk of nonfatal and fatal stroke in subjects with a noncardioembolic stroke or transient ischemic attack , no known coronary heart disease , and low-density lipoprotein cholesterol between @ and @ mmol/L ( @-@ mg/dL ) .


We explored the effect of randomization to atorvastatin @ mg/d or placebo on the change in estimated glomerular filtration rate ( eGFR ; using the @-component Modification of Diet in Renal Disease Study equation ) in SPARCL subjects ( n = @ ) with ( eGFR , < @ mL/min per @ m@ ; n = @ ) and without ( eGFR , @ mL/min per @ m@ ; n = @ ) chronic kidney disease overall and by glycemic status at baseline .


Mean baseline eGFR was similar between treatment groups ( @ versus @ mL/min per @ m@ atorvastatin versus placebo ; @ % versus @ % had chronic kidney disease , respectively ; P = @ ) .


After @ months , eGFR increased @ mL/min per @ m@ in those randomized to atorvastatin versus @ mL/min per @ m@ in those randomized to placebo ( P < @ ) independent of baseline renal function .


In the subgroup with diabetes mellitus at randomization , eGFR increased @ mL/min per @ m@ in the atorvastatin group and decreased @ mL/min per @ m@ in placebo group during a period of @ months ( P = @ ) .


This post hoc analysis suggests that atorvastatin treatment may improve renal function in patients with prior stroke or transient ischemic attack with and without chronic kidney disease , and that atorvastatin treatment may prevent eGFR decline in patients with stroke and diabetes mellitus .


Fluralaner , a novel isoxazoline , has both acaricidal and insecticidal activity through potent blockage of GABA - and L-glutamate-gated chloride channels .


This study investigated the in vitro and in vivo effects of fluralaner exposure on flea ( Ctenocephalides felis ) reproduction .


Blood spiked with sub-insecticidal fluralaner concentrations ( between @ and @ ng/mL ) was fed to fleas for @ days using a membrane system .


Cessation of reproduction in exposed fleas was assessed using flea survival , egg hatchability , and control of oviposition , pupae , and flea emergence .


Fluralaner efficacy for in vivo Ctenocephalides ( C. ) felis control on dogs was assessed using a simulated flea-infested home environment .


During a pre-treatment period , dogs were infested twice on days -@ and -@ with @ adult unfed fleas to establish a thriving population by day @ of the study .


On day @ , one group of dogs was treated with fluralaner ( Bravecto ; n = @ ) , while another group served as negative control ( n = @ ) .


Following treatment , dogs were infested three times with @ fleas on days @ , @ and @ to simulate new infestations .


Live flea counts were conducted weekly on all dogs for @ weeks starting @ day before treatment .


Fluralaner potently inhibited flea reproduction capacity in vitro .


Oviposition ceased completely at concentrations as low as @ ng/mL .


While no ovicidal effect was observed , fluralaner exerted a larvicidal effect at exceptionally low concentrations ( @ ng/mL ) .


In the simulated flea-infested home environment , flea-control efficacy on fluralaner-treated dogs was > @ % at every time point measured for @ weeks .


No adverse events were observed in fluralaner-treated dogs .


Fluralaner completely controls egg laying , larval development and flea reproduction even at sub-insecticidal concentrations .


Oral treatment of dogs with fluralaner is highly effective for eliminating fleas in a simulated flea-infested home environment .


It is difficult to improve negative symptoms and cognitive impairments in schizophrenia .


A previous pilot study has shown that minocycline , a semi-synthetic second-generation tetracycline , is effective in treating for negative and/or cognitive symptoms in schizophrenia .


The present study was designed to examine the efficacy and safety of minocycline for the treatment of negative symptoms and cognitive impairments in patients with schizophrenia .


Ninety-two patients with early stage schizophrenia treated with risperidone entered this @-week , double blind , randomized , placebo-controlled clinical trial .


Subjects were randomly assigned to receive minocycline ( @mg per day ) or the placebo .


The primary outcome was evaluated using the Scale for the Assessment of Negative Symptoms ( SANS ) .


Secondary outcomes included the response rate of SANS , the Positive and Negative Syndrome Scale ( PANSS ) , the Clinical Global Impression Scale ( CGI ) , and cognitive tests .


Subjects receiving minocycline had greater improvements on SANS total scores and PANSS negative subscale scores ( P < @ ) when compared with those receiving the placebo .


Rates of treatment response ( @ % ) in the minocycline group were significantly higher than those in the placebo group ( @ % ) after @weeks of treatment .


There was no significant difference between the seven cognitive domains ( P > @ ) , except for the attention domain ( P = @ ) .


The addition of minocycline to atypical antipsychotic drugs in early schizophrenia had significant efficacy on negative symptoms but had a slight effect on the attention domains of patients with schizophrenia .


It may be considered as a new adjunct treatment for negative symptoms of schizophrenia .


Clinical trials.gov identifier : NCT@ .


Advance care planning ( ACP ) provides patients with the ability to make their decisions known about how they would like to be treated if they lose capacity .


Medical practitioners have a key role to play in providing information on ACP to their patients .


This research explores their knowledge and attitudes to advance care planning and how this affects their practice .


The objective of this study is to assess the NSW medical practitioners ' knowledge and self-reported practice of ACP .


A postal survey of a random sample of @ general practitioners plus @ medical specialists from specialties most often involved in end-of-life decisions was conducted .


Respondents ' work location post codes were subsequently used to assign respondents to one of the eight NSW Area Health Services .


The main outcome measures were medical practitioners ' knowledge of and practice pertaining to ACP .


Thirty-four per cent of specialists ( n = @ ) and @ % of general practitioners ( n = @ ) responded ; the majority of respondents had heard of all ACP options .


However , respondents ' understanding of the uses and legal requirements of the relevant ACP options vary widely .


Respect for patient wishes expressed in advance directives is reassuringly high .


The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons .


Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues .


Low response rate , relating to only one legal jurisdiction , means results may not be generalisable .


The aim of this single - blind , multicenter , parallel , randomized controlled trial was to evaluate the effectiveness of the application of a high-fluoride toothpaste on root caries in adults .


Adult patients ( n = @ , = @ , = @ ; mean age SD : @ @ ) from three participating centers , diagnosed with root caries , were randomly allocated into two groups : Test ( n = @ , = @ , = @ ; lesions = @ ; mean age : @ @ ; intervention : high-fluoride toothpaste with @ ppm F ) , and Control ( n = @ , = @ , = @ ; lesions = @ ; mean age : @ @ ; intervention : regular-fluoride toothpaste with @ ppm F ) groups .


Clinical examinations and surface hardness scoring of the carious lesions were performed for each subject at specified time intervals ( T@ - at baseline before intervention , T@ - at @ months and T@ - at @ months after intervention ) .


Mean surface hardness scores ( HS ) were calculated for each patient .


Statistical analyses comprised of two-way analysis of variance and post hoc comparisons using the Bonferroni-Dunn correction .


At T@ , there was no statistical difference between the two groups with regard to gender ( P = @ , unpaired t-test ) , or age ( P = @ , chi-squared test ) , and for the overall HS ( Test group : HS = @ @ ;


HS = @ @ ; P = @ , unpaired t-test ) .


The anova revealed significantly better HS for the test group than for the control groups ( T@ : Test group : HS = @ @ ;


HS = @ @ ; T@ : Test group : HS = @ @ ;


HS = @ @ ; P < @ ) .


However , the interaction term time-point * group was not significant .


The application of a high-fluoride containing dentifrice ( @ ppm F ) in adults , twice daily , significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing ( @ ppm F ) toothpastes .


Study on quality of life of asymptomatic HIV infected persons with traditional Chinese medical , which can provide the clinical basis for improving the quality of life .


This study applied a randomized , double-blind , and placeb-parallel control designed method to select @ @ persons in the asymptomatic period of HIV infection as the subjects .


The subjects were randomly divided into the treatment group and the control group at the ratio of about @:@ .


According to the results of monthly differential diagnosis of TCM , the test group and the control group were given homologue Chinese drugs preparations and model Chinese drugs .


The total study period was @ months .


Using PRO scale and the world health organization AIDS determination of quality of life short scale form ( WHOQOL-HIV-BREF ) to investigate asymptomatic HIV infected persons , according to different times , we calculated the total score and each domain score of quality of life of the treatment group and control group , we did statistical analysis .


Form the PRO scale , we can see that the treatment group showed a trend of stability , compared with the control group with significant statistical difference ( P < @ ) after @ months ; from the WHOQOL-HIV scale analysis , we can see that compared with before treatment , the quality of life of the treatment group was increased , the difference was significant ( P < @ ) , but the quality of life of the control quality of life was decreased , the differences was significant ( P < @ ) .


Dialectical therapy of Chinese medicine can significantly improve the patient 's quality of life , which can provide the basis for the prevention and control policy formulation and implementation with asymptomatic HIV infected persons .


Molecular pathology tests are often carried for clinicopathological diagnosis and pathologists have established large collections of formalin-fixed , paraffin-embedded tissue ( FFPE ) banks .


However , extraction of DNA from FFPE is a laborious and challenging for researchers in clinical laboratories .


The aim of this study was to compare two widely used DNA extraction methods : using a QIAamp DNA FFPE kit from Qiagen and a Cobas Sample Preparation Kit from Roche , and evaluated the effect of the DNA quality on molecular diagnostics .


DNA from FFPE non-small cell lung carcinoma tissues including biopsy and surgical specimens was extracted with both QIAamp DNA FFPE and Cobas Sample Preparation Kits and EGFR mutations of non-small cell lung carcinomas were detected by real-time quantitative PCR using the extracted DNA .


Our results showed that DNA extracted by QIAamp and Cobas methods were both suitable to detect downstream EGFR mutation in surgical specimens .


Howover , Cobas method could yield more DNA from biopsy specimens , and gain much better EGFR mutation results .


Proximal attachment site complications continue to occur after endovascular repair of abdominal aortic aneurysms ( EVAR ) , specifically type Ia endoleak and endograft migration .


EndoAnchors ( Aptus Endosystems , Sunnyvale , Calif ) were designed to enhance endograft proximal fixation and sealing , and the current study was undertaken to evaluate the potential benefit of this treatment .


During the @-month period ending in December @ , @ subjects were enrolled at @ sites in the United States and Europe .


EndoAnchors were implanted in @ patients ( @ % ) at the time of an initial EVAR procedure ( primary arm ) and in @ patients with an existing endograft and proximal aortic neck complications ( revision arm ) .


Technical success was defined as deployment of the desired number of EndoAnchors , adequate penetration of the vessel wall , and absence of EndoAnchor fracture .


Procedural success was defined as technical success without a type Ia endoleak at completion angiography .


Values are expressed as mean standard deviation and interquartile range .


The @ male ( @ % ) and @ female ( @ % ) subjects had a mean age of @ @ years .


Aneurysms averaged @ @ ( @-@ ) mm in diameter at the time of EndoAnchor implantation ( core laboratory measurements ) .


The proximal aortic neck averaged @ @ ( @-@ ) mm in length ( @ % < @mm and @ % conical ) and @ @mm ( @-@mm ) in diameter ; infrarenal neck angulation was @ @ ( @-@ ) degrees .


The number of EndoAnchors deployed was @ @ ( @-@ ) .


Technical success was achieved in @ patients ( @ % ) and procedural success in @ patients ( @ % ) , @ of @ ( @ % ) and @ of @ ( @ % ) in the primary and revision arms , respectively .


There were @ residual type Ia endoleaks ( @ % ) at the end of the procedure .


During mean follow-up of @ @ months , @ patients ( @ % ) were free from secondary procedures .


Among the @ secondary procedures , eight were performed for residual type Ia endoleaks and the others were unrelated to EndoAnchors .


There were no open surgical conversions , there were no aneurysm-related deaths , and no aneurysm ruptured during follow-up .


Use of EndoAnchors to treat existing and acute type Ia endoleaks and endograft migration was successful in most cases .


Prophylactic use of EndoAnchors in patients with hostile aortic neck anatomy appears promising , but definitive conclusions must await longer term follow-up data .


Meals with a low glycemic index ( GI ) and rich in fiber could be beneficial with regard to postprandial metabolic profile and satiety .


The aim of this study was to investigate the effect of @ breakfasts with a different GI and amount of fiber on postprandial plasma glucose , insulin , and appetite in patients with type @ diabetes .


This randomized @-intervention crossover trial included @ patients -LSB- @ men ; ages @ @ y ; glycated hemoglobin : @ @ % ; BMI ( in kg/m ( @ ) ) : @ @ -RSB- .


Dietary interventions were as follows : breakfasts with a high GI ( @ @ % ) and high fiber ( @ @ g ) ( HGI-HF ) , a high GI ( @ @ % ) and low fiber ( @ @ g ) ( HGI-LF ) , a low GI ( @ @ % ) and high fiber ( @ @ g ) ( LGI-HF ) , and a low GI ( @ @ % ) and low fiber ( @ @ g ) ( LGI-LF ) .


Plasma glucose , insulin , and total ghrelin were evaluated postprandially ( @-@ min ) .


A visual analog scale was used to assess appetite .


Data were analyzed by generalized estimating equations and post hoc least significant difference ( LSD ) tests .


Data are reported as means SDs .


The area under the curve ( AUC ) -LSB- mean ( @ % CI ) ; P for LSD tests -RSB- for plasma glucose ( mmol/L min ) was higher after patients consumed the HGI-LF breakfast -LSB- @ ( @ , @ ) -RSB- than after the LGI-HF breakfast -LSB- @ ( @ , @ ) -RSB- ( P @ ) .


Insulin AUC ( IU/mL min ) after patients consumed the HGI-LF meal -LSB- @ ( @ , @ ) -RSB- was higher than after the HGI-HF meal -LSB- @ ( @ , @ ) -RSB- ( P @ ) .


The other observed difference was higher insulin AUC after the consumption of the LGI-LF breakfast -LSB- @ ( @ , @ ) -RSB- compared with the AUC after the LGI-HF breakfast -LSB- @ ( @ , @ ) -RSB- ( P @ ) .


Plasma ghrelin decreased in comparison with baseline only after patients consumed the LGI-HF and LGI-LF breakfasts ( P @ ) .


Subjective satiety did not differ between breakfasts .


Plasma glucose , insulin , and ghrelin responses were least favorable when patients with type @ diabetes consumed a breakfast with a high GI and low fiber , which suggests that reducing the GI or increasing the fiber content or both of breakfasts may be a useful strategy to improve the postprandial metabolic profile of these patients .


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


To investigate the feasibility and effect of early removal of the urethral catheter after transurethral plasma kinetic resection of the prostate ( PKRP ) in the treatment of benign prostatic hyperplasia ( BPH ) .


We equally randomized @ BPH patients treated by PKRP to an experimental group and a control group , urethral catheters removed at @ -@ days for the former and at @ -@ days for the latter .


We compared the relevant indexes and clinical effects between the two groups .


The baseline data were not significantly different between the two groups .


Compared with the controls , the experimental group showed a significantly shorter postoperative hospital stay ( -LSB- @ + / - @ -RSB- d vs -LSB- @ + / - @ -RSB- d , P < @ ) and lower infection rate ( @ % vs @ % , P < @ ) .


All the patients were followed up for @ -@ months postoperatively .


At @ months after surgery , both the experimental and the control groups showed remarkable improvement in the International Prostatic Symptoms Scores ( @ + / - @ vs @ + / - @ ) , maximum urine flow rate ( -LSB- @ + / - @ -RSB- ml/s vs -LSB- @ + / -@ -RSB- ml/s ) , and residual urine ( -LSB- @ + / - @ -RSB- ml vs -LSB- @ + / - @ -RSB- ml ) , but with no significant differences between the two ( P > @ ) , and no significant differences were observed in postoperative complications ( P > @ ) .


Early removal of the urethral catheter after PKRP , with its advantages of shorter postoperative hospital stay , lower infection rate , and no influence on the long-term effect , deserves to be recommended as a routine method in the treatment of BPH .


No previous studies have validated the use of portable monitoring ( PM ) for the diagnosis of obstructive sleep apnea ( OSA ) in morbidly obese individuals .


Our aim was to investigate the accuracy of PM for detecting respiratory events in morbidly obese patients that will be undergoing bariatric surgery .


This was a prospective study involving patients with body mass index ( BMI ) @ kg/m ( @ ) who were recruited from the Sleep Clinic of Universidade Federal de So Paulo .


Sleep-disordered breathing ( SDB ) was evaluated during full-night polysomnography ( PSG ) .


PM use was randomized and used on two consecutive nights : ( @ ) at home ( STDHome ) and ( @ ) at the sleep laboratory with PSG ( PSG_STDLab ) .


Although @ participants initially underwent the recordings , @ ( @ % ) were excluded because of technical problems .


The patients ' mean age was @ ( SD ) years , and @ % were female .


The mean BMI was @ kg/m ( @ ) .


All patients had high risk for OSA , as defined by the Stop-Bang questionnaire , and the mean apnea-hypopnea index ( AHI ) was @ / h.


The intraclass coefficient of the correlation between AHI_PSG and AHI_STDLab was r = @ ( p = @ ) ; the intraclass coefficient for AHI_PSG and AHI_STDHome was r = @ ( p = @ ) .


The Kappa index was @ ( p > @ ) for severe cases .


The sensitivity and the positive predictive value increased with the disease severity .


A Bland-Altman analysis showed good agreement between the investigated methods .


PM is an efficacious method for diagnosing OSA in obese patients who have a high clinical probability of the disease .


The method displays good sensitivity and specificity in severe cases ; nevertheless , the high rate of data loss must be taken into account .


There is evidence to support the use of lipid-based nutrient supplements ( LNSs ) to promote child growth and development in low-income countries , but there is also a concern regarding the safety of using iron-fortified products in malaria-endemic areas .


The objective of this study was to test the hypothesis that @ - to @-mo-old rural Malawian children receiving iron-containing ( @ mg/d ) LNSs would not have excess morbidity compared with infants receiving no supplementation .


A randomized controlled trial allocated @ children to receive daily supplementation with @ g/d LNS with milk protein base ( milk-LNS ) , @ g/d LNS with soy protein base ( soy-LNS ) , @ g/d corn-soy blend ( CSB ) , or no supplementation from @ to @ mo of age .


Morbidity was compared using a non-inferiority margin set at @ % excess morbidity in supplemented groups compared with the nonsupplemented group .


Baseline characteristics were similar across groups .


The proportion of days with febrile illness between @ and @ mo was @ % , and there were no differences between the groups : @ % ( @ % CI : @ , @ % ) , @ % ( @ % CI : @ , @ % ) , @ % ( @ % CI : @ , @ % ) , and @ % ( @ % CI : @-@ @ % ) in the milk-LNS , soy-LNS , CSB , and control groups , respectively .


The proportion of days with respiratory problems and diarrhea between @ and @ mo also did not differ between groups .


Compared with controls , the incident rate ratio ( @ % CI ) for clinical malaria was @ ( @ , @ ) , @ ( @ , @ ) , and @ ( @ , @ ) in milk-LNS , soy-LNS , and CSB , respectively , with @ % CIs confirming non-inferiority .


The incidence of febrile episodes , diarrhea , respiratory problems or admission to hospital , prevalence of malaria parasitemia throughout the follow-up , and mean change in hemoglobin concentration from baseline were also similar between the groups .


Daily supplementation with @ g of milk-based or soy protein-based LNS or @ g of CSB did not result in increases in malaria or respiratory morbidity in children in a malaria-endemic setting .


However , we could not conclude whether LNSs did or did not increase diarrheal morbidity .


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


To investigate the rate of operative success in excision of nonpalpable lymph nodes with metastatic disease achieved with radioguided occult lesion localization ( ROLL ) and intraoperative ultrasonography ( IOUS ) in patients with papillary thyroid cancer ( PTC ) .


Twenty consecutive PTC patients with nonpalpable lymph nodes with metastatic disease localized in previously operated fields were randomized to receive ROLL ( n = @ ) or IOUS ( n = @ ) .


Nodes were excised along with adjacent soft tissue to accomplish a compartment-oriented dissection .


The duration of operation , rate of postoperative complications , pre - and postoperative serum thyroglobulin ( Tg ) levels , and the findings of postoperative neck ultrasonography and postablation scan were recorded in all patients .


Measures of operative success included a postoperative Tg level < @ % of preoperative Tg level and no abnormal lesions on postoperative imaging .


Histopathologic examination confirmed the excision of all preoperatively identified metastatic nodes .


Additional nodes also were excised ( @ @ per specimen in the ROLL group and @ @ per specimen in the IOUS group ) , @ % of which were metastatic .


No postoperative complications occurred in either group .


The duration of operation was similar in the @ groups ( P = @ ) .


Postoperative imaging confirmed the clearance of suspicious nodes in all patients .


The rate of operative success in ROLL and IOUS group were @ % and @ % , respectively .


In patients with recurrent PTC , a high rate of operative success in excision of nonpalpable metastatic lymph nodes was achieved by both ROLL and IOUS .


We recommend compartment-oriented dissection ; this approach may maximize the removal of metastatic nodes not identified by preoperative imaging .


Extensive blood loss after total knee arthroplasty ( TKA ) may be a potential problem since it leads to anaemia , increased need for transfusion and prolonged hospitalization .


Aim of this study was to investigate the effects of postoperative knee flexion after TKA on blood loss and the need for transfusion .


One hundred consecutive patients undergoing primary TKA from @ to @ were randomizely divided into two groups .


In one group , the knee was extended for the first @ h after surgery , whereas in the other was flexed at @ for the same time .


Two doses of endovenous tranexamic acid were administered in all subjects .


Patients were homogeneous for all the possible confounding factors .


Calculated blood loss was @ @ ( ml ) in the flexion group and @,@ @ ( ml ) in the extension group ( p < @ ) .


Drop of haemoglobin levels at @ h in the study group and the control group was @ @ ( g/dl ) and @ @ ( g/dl ) , respectively ( p < @ ) .


Drop of haematocrit at @ h was @ @ ( % ) in the flexion group and @ @ ( % ) in the extension group ( p < @ ) .


Blood transfusion was necessary in @ patients in the control group and was not necessary in any patient of the study group .


Average knee flexion at day @ was @ @ in the flexion group and @ @ in the extension group .


Knee flexion at @ after TKA , associated with the intraoperative use of tranexamic , acid is an effective method to reduce blood loss and the need for blood transfusion .


The routine use of the present protocol is effective in reducing social costs and length of hospitalization of TKA procedures .


Around @,@ people each year attend hospitals in England due to self-harm , many of them more than once .


Over @,@ people die by suicide each year in the UK , a quarter of them having attended hospital in the previous year because of self-harm .


Self-harm is a major identifiable risk factor for suicide .


People receive variable care at hospital ; many are not assessed for their psychological needs and little psychological therapy is offered .


Despite its frequent occurrence , we have no clear research evidence about how to reduce the repetition of self-harm .


Some people who have self-harmed show less active ways of solving problems , and brief problem-solving therapies are considered the most promising psychological treatments .


This is a pragmatic , individually randomised , controlled , feasibility study comparing interpersonal problem-solving therapy plus treatment-as-usual with treatment-as-usual alone , for adults attending a general hospital following self-harm .


A total of @ participants will be randomised equally between the treatment arms , which will be balanced with respect to the type of most recent self-harm event , number of previous self-harm events , gender and age .


Feasibility objectives are as follows : a ) To establish and field test procedures for implementing the problem-solving intervention ; b ) To determine the feasibility and best method of participant recruitment and follow up ; c ) To assess therapeutic delivery ; d ) To assess the feasibility of obtaining the definitive trial 's primary and secondary outcomes ; e ) To assess the perceived burden and acceptability of obtaining the trial 's self-reported outcome data ; f ) To inform the sample size calculation for the definitive trial .


The results of this feasibility study will be used to determine the appropriateness of proceeding to a definitive trial and will allow us to design an achievable trial of interpersonal problem-solving therapy for adults who self-harm .


To compare the efficacy and safety between liposome-paclitaxel plus carboplatin ( LPC ) and paclitaxel plus carboplatin ( PC ) as first-line treatment for advanced non-small cell lung cancer ( NSCLC ) .


Totally @ chemotherapy-naive NSCLC patients were equally and randomly assigned into LPC group and PC group .


Liposome-paclitaxel was injected on D@ at a dosage of @ mg/m ( @ ) ; the same dose and administration with paclitaxel injection in the PC group for a maximum of @ cycles .


The efficacy and adverse reactions after @ cycles of chemotherapy were compared between these two groups .


The overall response rate ( CR+PR ) was @ % in the LPC group and @ % in the PC group after @ cycles of chemotherapy respectively ( P = @ ) .


In the LPC group and PC group , the incidences of myelodepression was @ % and @ % , respectively ( P = @ ) , gastrointestinal toxicity was @ % and @ % respectively ( P = @ ) , and allergic reactions was @ and @ % , respectively ( P = @ ) .


The median time to progression was @ months and @ months , respectively ( P = @ ) .


LPC group has the same efficacy with PC group and less adverse reactions than PC group .


The Trastuzumab for Gastric Cancer phase III trial demonstrated that combining trastuzumab with chemotherapy significantly improved overall survival compared with chemotherapy alone in HER@-positive advanced gastric or gastroesophageal junction cancer .


We report health-related quality of life ( HRQoL ) and quality-adjusted time without symptoms of disease or toxicity ( Q-TWiST ) results from this trial .


Patients were randomized to receive six cycles of chemotherapy given every @ weeks ( capecitabine or fluorouracil , plus cisplatin ) either alone or combined with administration of trastuzumab every @ weeks until disease progression .


At each clinical visit , HRQoL was assessed using two European Organization for Research and Treatment of Cancer quality of life questionnaires , QLQ-C@ and QLQ-STO@ .


Q-TWiST methodology was applied retrospectively using the clinical data and utility coefficients .


Trastuzumab plus chemotherapy prolonged time to @ % definitive deterioration in all QLQ-C@ and QLQ-STO@ scores , including QLQ-C@ global health status versus chemotherapy alone , from @ months to @ months .


In addition , trastuzumab plus chemotherapy extended Q-TWiST by @ months compared with chemotherapy alone .


Compared with chemotherapy alone , trastuzumab plus chemotherapy prolongs time to deterioration of HRQoL and increases quality-adjusted survival in patients with HER@-positive gastric or gastroesophageal junction cancer .


Verification of proper placement of an intravenous catheter may not always be simple .


We evaluated the auscultation technique for this purpose .


Twenty healthy volunteers were randomized for @G catheter inserted intravenously either in the right ( @ ) or left arm ( @ ) , and subcutaneously in the opposite arm .


A standard stethoscope was placed over an area approximately @ cm proximal to the tip of the catheter in the presumed direction of the vein to grade on a @-@ scale the murmur heard by rapidly injecting @ mL of NaCl @ % solution .


The auscultation was evaluated by a blinded staff anesthesiologist .


All @ intravenous injection were evaluated as flow murmurs , and were graded an average @ ( @ ) , whereas all @ subcutaneous injections were evaluated as either crackles or no sound , and were graded an average @ ( @ ) , without negative results .


Sensitivity was calculated as @ % .


Specificity and Kappa could not be calculated due to an empty false-positive group .


Being simple , handy and noninvasive , we recommend to use the auscultation technique for verification of the proper placement of an intravenous catheter when uncertain of its position .


Data obtained in our limited sample of healthy subjects need to be confirmed in the clinical setting .


Tai Chi is the Chinese traditional medicine exercise for mind-body health .


The objective of this study is to investigate the effect of Tai Chi Chuan ( TCC ) exercise on the proliferative and cytolytic/tumoricidal activities of peripheral blood mononuclear cells ( PBMCs ) in postsurgical non-small cell lung cancer ( NSCLC ) patients .


Patients ( n = @ ) were randomly divided into the control group ( n = @ ) and the TCC group ( n = @ ) .


TCC group participated in Tai Chi @-type exercise for @weeks , @-min every time , and three times a week .


Peripheral blood was collected and PBMCs isolated before and after the @-week TCC , PBMC proliferation and co-culture of PBMCs with the NSCLC cell line A@ were performed for proliferation and cell cytolysis assays .


Analysis of NKT cells , NK cells , and CD@ + and CD@c + dendritic cells were also performed .


( @ ) After @-week of TCC , cell proliferation increased significantly as compared with the control .


( @ ) PBMCs from the TCC group also demonstrated enhanced cytolytic/oncolytic activity against A@ cells .


( @ ) Significant differences were also found in NK cell percentage at t = @weeks , post-pre changes of NKT and DC@c between groups .


Regular Tai Chi exercise has the promise of enhancing PBMC proliferative and cytolytic activities in NSCLC patients .


Our results affirm the value of a future trial with a larger scale and longer duration for cancer survivors .


Perimenopausal women can experience rapid bone loss at skeletal sites with both cortical and cancellous bone , increasing the prevalence of osteoporosis following menopause .


We conducted a @-month randomized placebo-controlled trial evaluating the effects of alendronate @ mg with @ IU cholecalciferol administered once per week for @ months in comparison with placebo and cholecalciferol .


The primary end-point was the percentage change in the lumbar spine bone mineral density ( BMD ) from baseline to @ months .


Secondary end-points were the change in BMD at the femoral neck and changes in biochemical markers of bone turnover .


Forty-five women were recruited to participate in the study .


Five subjects withdrew from the study before randomization for unrelated reasons .


Forty subjects were randomly allocated to the alendronate and placebo groups .


The mean lumbar spine MD in women treated with alendronate increased by @ % ( mean paired difference , d = @ ; @ SE ) at @ months , compared with a reduction of @ % ( d = -@ ; @ SE ) in the control group ( P < @ ) .


In the femoral neck , the mean BMD in the alendronate group increased by @ % ( d = @ ; @ SE ) at @ months , compared with a reduction of @ % ( d = -@ ; @ SE ) in the control group ( P = @ ) .


There were no differences in BMD between the alendronate and placebo groups at the total hip sites after @ months .


At @ months , both bone-specific alkaline phosphatase and urinary N-telopeptide were significantly reduced , by @ % ( d = -@ ; @ SE ) and @ % ( d = -@ ; @ SE ) respectively , in the alendronate group ; in the control group , these levels increased ( P < @ ) .


Weekly treatment with alendronate @ mg and cholecalciferol @ IU increases BMD and decreases bone turnover in perimenopausal women .


To evaluate the effect of body position on the cardiorespiratory indicators of preterm newborns receiving nasal continuous positive airway pressure ( CPAP ) .


Analytical , observational , prospective , cross-sectional , randomised crossover study was carried out on sixteen newborns that received nasal CPAP .


The infants had a mean gestational age of @ @ weeks and birthweight of @ @ g. Cardiorespiratory indicators ( respiratory rate , heart rate and oxygen saturation ) were evaluated in each infant in the supine , prone and right and left lateral decubitus positions at intervals of @ min over a period of @ min .


The cardiorespiratory indicators were similar and within the normal range in the four decubitus positions .


There was no difference in respiratory or heart rate between body positions .


Although they showed desirable values , oxygen saturation was significantly lower in left lateral decubitus ( @ @ % ) when compared to the supine ( @ @ % ) and prone positions ( @ @ % ) ( p = @ ) and was also significantly lower in right lateral decubitus ( @ @ % ) when compared to the prone position ( p = @ ) .


We found no preferential decubitus position for preterm newborns receiving nasal CPAP , the supine position may be a choice , but the left and right lateral positions were less advantageous in terms of oxygen saturation .


General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others .


In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs ' role security and therapeutic commitment and , in addition , which professional related factors influenced the impact of the implementation programme .


In a cluster randomised controlled trial , @ GPs from @ Dutch general practices were randomised to either the intervention or control group .


The tailored , multi-faceted programme included combined physician , organisation , and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs .


The control group was mailed the national guideline and patients received feedback letters .


Questionnaires were completed before and @ months after start of the programme .


We performed linear multilevel regression analysis to evaluate effects of the implementation programme .


Participating GPs were predominantly male ( @ % ) and had received very low levels of alcohol related education before start of the study ( @ h ) .


The programme increased therapeutic commitment ( p = @ ; @ % - CI @ - @ ) but not role security ( p = @ ; @ % - CI -@ - @ ) .


How important GPs thought it was to improve their care for problematic alcohol consumption , and the GPs ' reported proportion of patients asked about alcohol consumption at baseline , contributed to the effect of the programme on therapeutic commitment .


A tailored , multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs ' therapeutic commitment towards patients with alcohol-related problems , but failed to improve GPs ' role security .


How important GPs thought it was to improve their care for problematic alcohol consumption , and the GPs ' reported proportion of patients asked about alcohol consumption at baseline , both increased the impact of the programme on therapeutic commitment .


It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme , to see whether the programme is effective on short term but faded out on the longer term .


Standardized training via simulation as an educational adjunct may lead to a more rapid and complete skill achievement .


The authors hypothesized that simulation training will also enhance performance in transesophageal echocardiography image acquisition among anesthesia residents .


A total of @ clinical anesthesia residents were randomized to one of two groups : a control group , which received traditional didactic training , and a simulator group , whose training used a transesophageal echocardiography-mannequin simulator .


Each participating resident was directed to obtain @ commonly used standard views on an anesthetized patient under attending supervision .


Each of the @ selected echocardiographic views were evaluated on a grading scale of @ to @ , according to predetermined criteria .


The effect of the intervention was assessed by using a linear mixed model implemented in SAS @ ( SAS Institute Inc. , Cary , NC ) .