Ninety-four patients were randomly assigned to @ groups : ketorolac group ( ketorolac @ % in @ eye and ofloxacin @ % in the other eye ) and diclofenac group ( diclofenac @ % in @ eye and ofloxacin @ % in the other eye ) .


One drop of each ophthalmic drug was applied @ times to each eye @ minutes before PRK .


No other NSAID or steroid was prescribed until @ days after PRK .


The patients were asked to score the postoperative pain in each eye with a visual analog scale at @ , @ , @ , @ , @ , @ , and @ hours .


The natural peak of pain was located between @ and @ hours .


Initially , the degree of pain reduction was constant for both NSAIDs ; it dropped after @ hours and @ hours in the ketorolac group and the diclofenac group , respectively .


The postoperative time-serial pattern of the pain score changed in the diclofenac group but not in the ketorolac group compared with the pattern in the ofloxacin-treated eye .


The visual outcome was not affected by either NSAID , and significant complications were not noticed for a mean of @ months .


The duration and pattern of the action may vary according to types of NSAIDs .


Preemptive topical diclofenac @ % was a safe and effective method for post-PRK pain control .


Lower levels of vitamin D are associated with increased MS risk and with greater clinical and brain MRI activity in established relapsing MS.


The VIDAMS trial ( NCT@ ) is evaluating whether high-dose vitamin D supplementation reduces the risk of MS activity .


Eligibility criteria include diagnosis of RRMS , age @ to @ years , and Expanded Disability Status Scale @ .


Disease duration and activity requirements depend on whether @ or @ criteria are used for diagnosis .


Enrollment is restricted based on prior MS therapy exposure and recent vitamin D use .


After completing a one-month run-in of glatiramer acetate , @ patients will be randomized @:@ to oral vitamin D ( @ ) @ IU versus @ IU daily .


Clinical visits occur every @ weeks for @ weeks .


Sixteen sites throughout the United States are participating in the trial .


Complete enrollment is expected by late @ , with follow-up through @ .


No interim analyses are planned .


The primary outcome for the trial is the proportion of patients experiencing a relapse in each group .


Other clinical , patient-reported , and MRI outcomes will be evaluated .


The VIDAMS trial will provide critical information about the safety and efficacy of vitamin D therapy in RRMS , with implications for MS patients worldwide .


The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation ( TENS ) in the management of pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section .


A hundred healthy women who underwent cesarean section under general anesthesia were randomly assigned to the placebo group ( Group @ ) or the TENS group ( Group @ ) , while @ women who delivered by vaginal route without episiotomy were randomized into the placebo group ( Group @ ) or the TENS group ( Group @ ) .


The patients in Group @ had statistically lower visual analog scale ( VAS ) and verbal numerical scale ( VNS ) scores than the patients in Group @ ( p < @ for both ) .


The patients in Group @ had statistically lower VAS and VNS scores than the patients in Group @ ( p = @ and p = @ , respectively ) .


The analgesic requirement at the eighth hour of cesarean section was significantly lower in the patients who were treated with TENS ( p = @ ) .


The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo ( p = @ ) .


TENS is an effective , reliable , practical and easily available modality of treatment for postpartum pain .


Childhood overweight has noticeable psychological and social consequences for the child and leads to an increased risk of mortality and morbidity later in life .


With the high prevalence of overweight in children and adolescents , it is important to identify effective approaches for the prevention and treatment of overweight in children and young individuals .


The primary aim of the study is to assess the effect of an intensive day-camp intervention on body mass index ( BMI ) in overweight children .


The Odense Overweight Intervention Study is a semi-blinded randomized controlled trial .


Overweight children from the Municipality of Odense , Denmark , were invited to participate in the trial .


Based on power calculations @ participants were found to be sufficient to randomize in order to find an effect of minimum @ BMI points .


Gender-stratified concealed block randomization with a ratio of @:@ and random block sizes of two , four , and six ensured balance between study arms .


The intervention consisted of a six-week multi-component day camp including increased physical activity , healthy diet and health education followed by @weeks of family-based habitual intervention .


The standard care arm was offered two weekly hours of physical activity training for six weeks .


The outcomes were measured at baseline and at six-week and @-week follow-ups .


Furthermore , BMI will be assessed again at @-month follow-up .


Test personnel were kept blinded .


The intervention effect will be evaluated using mixed model analyses .


During @ and @ , @ children were enrolled in the study .


Fifty-nine children were randomized to the day-camp intervention arm and @ to the standard intervention arm .


This study will provide novel information about the long-term health effects of an intense day-camp intervention program on overweight children , due to the design and the follow-up period .


Moreover , it will add to the knowledge on designing and implementing feasible camp settings for preventing overweight in children .


To determine serum lipids in patients with age related macular degeneration from Pakistani population .


The study was a cross sectional , randomized and case-control .


Selected subjects ages were > or = @ years and were normotensive , non-diabetic with no family history of any such disease and no complication of posterior ocular chamber other than age related macular degeneration ( AMD ) .


Controls were age matched healthy individuals with no symptoms of AMD .


Diagnosis of AMD was done through conventional diagnostic techniques by professional ophthalmologists .


Serum samples were analyzed for total cholesterol , triglycerides , LDL and HDL using commercially available kits .


Data were compared with Student 's t-test .


Pearson correlation was calculated for relationship between different parameters .


P < @ was considered significant .


Compared to controls , AMD patients had significantly greater total cholesterol concentration ( p < @ ) , and power HDL/LDL ratio ( p < @ ) , while serum triglycerides , HDL and LDL were non-significantly different from control subjects .


Total cholesterol in AMD patients was significantly correlated with TG , LDL and HDL ( p < @ ) .


The study indicates that high cholesterol might be a predictor of AMD and can be a diagnostic parameter .


Postoperative morbidity is a major disadvantage after oral and maxillofacial ( OMF ) surgery , often caused by pain , trismus and swelling affecting patients ' quality of life .


The goal of this study was to examine the effect of kinesiologic taping ( KT ) on swelling , pain , trismus and patients ' satisfaction after OMF surgery .


Performing a pooled analysis of @ patients that were assigned for maxillofacial treatment ( midface fractures n = @ , mandibular fractures n = @ , wisdom tooth removal n = @ ) divided into treatment either with or without kinesiologic tape application .


Tape was applied directly after surgery and maintained for at least @ d postoperatively .


Facial swelling was quantified at six specific points in time using a five-line measurement .


Pain and degree of mouth opening was measured .


Patients ' objective feeling and satisfaction was queried .


Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for @ % during the first @ d after surgery .


Evaluating all patients swelling was significantly lower in the KT treatment group ( T@ : @ cm @ ; T@ : @ cm @ ; T@ : @ cm @ ) than in the no-KT group ( T@ : @ cm @ ; T@ : @ cm @ ; T@ : @ cm @ ) at T@ ( p < @ ) , T@ ( p < @ ) , and T@ ( p = @ ) .


VAS Pain values were scored significantly lower for the KT group ( T@ : @ @ ( p = @ ) ; T@ : @ @ ( p < @ ) ; T@ : @ @ ( p = @ ) ; T@ : @ @ ( p = @ ) compared to the no-KT group ( T@ : @ @ ; T@ : @ @ ; T@ : @ @ ; T@ : @ @ ) .


A statistically significant amelioration in mean mouth opening ability was observed in the KT group ( T@-BL : -@ cm @ ( p = @ ) ; T@-BL : @ cm @ ( p = @ ) ; T@-BL : @ @ ( p = @ ) ; T@-BL : @ @ ( p = @ ) ) compared to the no-KT group ( T@-BL : -@ cm @ ; T@-BL : -@ cm @ ; T@-BL : -@ @ ; T@-BL : -@ @ ) .


KT after OMF surgery is a promising , simple , less traumatic , economical approach free from systemic adverse reaction upgrading patients ' quality of life .


We examined the effectiveness of technical training ( TT ) and quiet eye training ( QE ) on the performance of one-handed square knot tying in surgical residents .


Twenty surgical residents were randomly assigned to the @ groups and completed pretest , training , retention , and transfer tests .


Participants wore a mobile eye tracker that simultaneously recorded their gaze and hand movements .


Dependent variables were knot tying performance ( % ) , QE duration ( % ) , number of fixations , total movement time ( s ) , and hand movement phase time ( s ) .


The QE training group had significantly higher performance scores , a longer QE duration , fewer fixations , faster total knot tying times , and faster movement phase times compared with the TT group .


The QE group maintained performance in the transfer test , whereas the TT group significantly decreased performance from retention to transfer .


QE training significantly improved learning , retention , and transfer of surgical knot tying compared with a traditional technical approach .


Both performance effectiveness ( performance outcome ) and movement efficiency ( hand movement times ) were improved using QE modeling , instruction , and feedback .


Postoperative nausea and vomiting ( PONV ) is one of the most common postsurgical complications .


Palonosetron , a @-hydroxytryptamine receptor antagonist , is effective for PONV prevention .


Herein , we compared palonosetron and aprepitant ( a neurokinin-@ receptor antagonist ) for PONV prevention in patients indicated for laparoscopic gynaecologic surgery .


Ninety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general anaesthesia were assigned to receive either a single intravenous injection of @-mg palonosetron or @-mg oral aprepitant in a double-blind randomised trial .


The primary efficacy end points included complete response ( visual analogue scale -LSB- VAS -RSB- nausea score < @ and no use of rescue therapy ) @-@ h after surgery .


Nausea severity ( @-@ ) and use of rescue therapy were monitored for @-@ h.


The secondary efficacy end points were the effect of aprepitant quantified using a @-point VAS for pain , consumption of intravenous patient-controlled analgesia , and use of rescue analgesics .


Aprepitant was non-inferior to palonosetron in terms of complete response @-@ hours after surgery ( @ % vs. @ % ) .


At @ and @ h after administration , the nausea severity with @-mg aprepitant was significantly lesser than that with @-mg palonosetron ( P < @ ) .


At @ and @ h after administration , fentanyl consumption with @-mg aprepitant was significantly lower than that with @-mg palonosetron .


Greater amounts of rescue analgesics were required in the aprepitant group .


Palonosetron and aprepitant were both effective for PONV prevention in the patients indicated for laparoscopic gynaecologic surgery .


The drugs can be used in combination for multimodal therapy because they bind to different receptors .


More research is needed to evaluate the effects of aprepitant on pain management in humans .


The role that environmental factors , such as neighborhood socioeconomics , food , and physical environment , play in the risk of obesity and chronic diseases is not well quantified .


Understanding how spatial distribution of disease risk factors overlap with that of environmental ( contextual ) characteristics may inform health interventions and policies aimed at reducing the environment risk factors .


We evaluated the extent to which spatial clustering of extreme body mass index ( BMI ) values among a large sample of adults with diabetes was explained by individual characteristics and contextual factors .


We quantified spatial clustering of BMI among @,@ adults with diabetes from the Diabetes Study of Northern California ( DISTANCE ) cohort using the Global and Local Moran 's I spatial statistic .


As a null model , we assessed the amount of clustering when BMI values were randomly assigned .


To evaluate predictors of spatial clustering , we estimated two linear models to estimate BMI residuals .


First we included individual factors ( demographic and socioeconomic characteristics ) .


Then we added contextual factors ( neighborhood deprivation , food environment ) that may be associated with BMI .


We assessed the amount of clustering that remained using BMI residuals .


Global Moran 's I indicated significant clustering of extreme BMI values ; however , after accounting for individual socioeconomic and demographic characteristics , there was no longer significant clustering .


Twelve percent of the sample clustered in extreme high or low BMI clusters , whereas , only @ % of the sample was clustered when BMI values were randomly assigned .


After accounting for individual characteristics , we found clustering of @ % while accounting for neighborhood characteristics resulted in @ % clustering of BMI .


After additional adjustment of neighborhood characteristics , clustering was reduced to @ % , effectively accounting for spatial clustering of BMI .


We found substantial clustering of extreme high and low BMI values in Northern California among adults with diabetes .


Individual characteristics explained somewhat more of clustering of the BMI values than did neighborhood characteristics .


These findings , although cross-sectional , may suggest that selection into neighborhoods as the primary explanation of why individuals with extreme BMI values live close to one another .


Further studies are needed to assess causes of extreme BMI clustering , and to identify any community level role to influence behavior change .


Monoclonal antibodies ( mAbs ) which potently neutralize a broad range of HIV isolates are potential microbicide candidates .


To date , topical application of mAbs in humans and their stability in vaginal secretions has not been studied .


To assess the pharmacokinetics and safety of the mAbs @F@ , @E@ and @G@ when applied vaginally in women .


A randomized , double-blind , placebo-controlled phase @ trial .


Twenty-eight healthy , sexually abstinent women administered @ g of gel daily for @ days containing either @ or @ mg/g of each mAb ( MABGEL ) or placebo .


Main clinical evaluations and sampling occurred at baseline , @ , @ , and @ hours post-@st dose and @ and @ hours post-@th dose .


After adjustment for dilution factors , median levels of @F@ , @E@ and @G@ in vaginal secretions at @ hour post high-dose MABGEL were @ , @ and @ mg/ml respectively .


Levels of @F@ and @E@ declined exponentially thereafter with similar estimated half-lives ( @ and @ hours ) .


In contrast , @G@ levels declined more rapidly in the first @ hours , with an estimated half-life of @ hours during this period .


There was no evidence of systemic absorption .


There were no significant differences in local or systemic adverse event rates or vaginal flora changes ( by qPCR ) between active and placebo gel arms .


Whilst at least @ adverse event was recorded in @ % of participants , @ % were mild and none were serious .


Vaginal application of @ mg of each mAb daily was safe over a @ day period .


Median mAb concentrations detected at @ hours post dose were potentially sufficient to block HIV transmission @ G@ exhibited more rapid elimination from the human vagina than @E@ and @F@ , likely due to poor stability of @G@ in acidic human vaginal secretions .


Further research is needed to develop mAb-based vaginal microbicides and delivery systems .


Agitation is common , persistent , and associated with adverse consequences for patients with Alzheimer disease .


Pharmacological treatment options , including antipsychotics are not satisfactory .


The primary objective was to evaluate the efficacy of citalopram for agitation in patients with Alzheimer disease .


Key secondary objectives examined effects of citalopram on function , caregiver distress , safety , cognitive safety , and tolerability .


The Citalopram for Agitation in Alzheimer Disease Study ( CitAD ) was a randomized , placebo-controlled , double-blind , parallel group trial that enrolled @ patients with probable Alzheimer disease and clinically significant agitation from @ academic centers in the United States and Canada from August @ to January @ .


Participants ( n = @ ) were randomized to receive a psychosocial intervention plus either citalopram ( n = @ ) or placebo ( n = @ ) for @ weeks .


Dosage began at @ mg per day with planned titration to @ mg per day over @ weeks based on response and tolerability .


Primary outcome measures were based on scores from the @-point Neurobehavioral Rating Scale agitation subscale ( NBRS-A ) and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change ( mADCS-CGIC ) .


Other outcomes were based on scores from the Cohen-Mansfield Agitation Inventory ( CMAI ) and the Neuropsychiatric Inventory ( NPI ) , ability to complete activities of daily living ( ADLs ) , caregiver distress , cognitive safety ( based on scores from the @-point Mini Mental State Examination -LSB- MMSE -RSB- ) , and adverse events .


Participants who received citalopram showed significant improvement compared with those who received placebo on both primary outcome measures .


The NBRS-A estimated treatment difference at week @ ( citalopram minus placebo ) was -@ ( @ % CI , -@ to -@ ) , P = @ .


Results from the mADCS-CGIC showed @ % of citalopram participants having moderate or marked improvement from baseline compared with @ % of placebo recipients , with estimated treatment effect ( odds ratio -LSB- OR -RSB- of being at or better than a given CGIC category ) of @ ( @ % CI , @-@ @ ) , P = @ .


Participants who received citalopram showed significant improvement on the CMAI , total NPI , and caregiver distress scores but not on the NPI agitation subscale , ADLs , or in less use of rescue lorazepam .


Worsening of cognition ( -@ points ; @ % CI , -@ to -@ ; P = @ ) and QT interval prolongation ( @ ms ; @ % CI , @-@ @ ; P = @ ) were seen in the citalopram group .


Among patients with probable Alzheimer disease and agitation who were receiving psychosocial intervention , the addition of citalopram compared with placebo significantly reduced agitation and caregiver distress ; however , cognitive and cardiac adverse effects of citalopram may limit its practical application at the dosage of @ mg per day .


Oxidative stress plays an essential role in the pathogenesis of type @ diabetes .


Anthocyanin , a natural antioxidant , has been reported to reduce oxidative stress and to attenuate insulin resistance and diabetes in animal models ; however , the translation of these observations to humans has not been fully tested .


This study was designed to investigate the effects of purified anthocyanins on dyslipidemia , oxidative status , and insulin sensitivity in patients with type @ diabetes .


A total of @ diabetic patients were given @ mg of anthocyanins twice daily or placebo ( n = @/group ) for @ wk in a randomized , placebo-controlled , double-blind trial .


Participants and investigators were masked to treatment allocation .


Anthocyanin supplementation significantly decreased serum LDL cholesterol ( by @ % ; P < @ ) , triglycerides ( by @ % ; P < @ ) , apolipoprotein ( apo ) B-@ ( by @ % ; P < @ ) , and apo C-III ( by @ % ; P < @ ) and increased HDL cholesterol ( by @ % ; P < @ ) compared with placebo after the @-wk intervention .


In addition , patients in the anthocyanin group showed higher total radical-trapping antioxidant parameter and ferric ion reducing antioxidant power values than did patients in the placebo group ( both P < @ ) .


Serum concentrations of @-iso-prostaglandin F@ , @-hydroxyoctadecadienoic acid , and carbonylated proteins in patients in the anthocyanin group were significantly less than in patients in the placebo group ( @ % , @ % ; P < @ and @ % ; P = @ , respectively ) .


Furthermore , supplementation with anthocyanin lowered fasting plasma glucose ( by @ % ; P < @ ) and homeostasis model assessment for insulin resistance index ( by @ % ; P < @ ) , and elevated serum adiponectin ( by @ % ; P < @ ) and - hydroxybutyrate ( by @ % ; P = @ ) concentrations compared with placebo supplementation .


These findings demonstrate that anthocyanin supplementation exerts beneficial metabolic effects in subjects with type @ diabetes by improving dyslipidemia , enhancing antioxidant capacity , and preventing insulin resistance .


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


Our aim was to evaluate the safety and efficacy of a low-intensity resistance training program combined with partial blow flow restriction ( BFR training ) in a cohort of patients with polymyositis ( PM ) and dermatomyositis ( DM ) .


In total , @ patients with PM and DM completed a @-week twice a week low-intensity ( that is , @ % one-repetition-maximum ( @RM ) ) resistance exercise training program combined with partial blood flow restriction ( BFR ) .


Assessments of muscle strength , physical function , quadriceps cross sectional ( CSA ) area , health-related quality of life , and clinical and laboratory parameters were assessed at baseline and after the intervention .


The BFR training program was effective in increasing the maximal dynamic strength in both the leg-press ( @ % , P < @ ) and knee-extension exercises ( @ % P < @ ) , as well as in the timed-stands ( @ % , P < @ ) and timed-up-and-go test ( -@ % , P = @ ) .


Quadriceps CSA was also significantly increased after the intervention ( @ % , P = @ ) .


Similarly , all of the components of the Short Form-@ Health Survey , the Health Assessment Questionnaire scores , and the patient - and physician reported Visual Analogue Scale were significantly improved after training ( P < @ ) .


Importantly , no clinical evidence or any other self-reported adverse event were found .


Laboratory parameters ( creatine kinase and aldolase ) were also unchanged ( P > @ ) after the intervention .


We demonstrated that a @-week supervised low-intensity resistance training program associated with partial blood flow restriction may be safe and effective in improving muscle strength and function as well as muscle mass and health-related quality of life in patients with PM and DM .


The aim of this hypothesis-generating pilot study was to assess prospectively the objective and subjective effects of treatment with quetiapine XR on sleep during early recovery from alcohol dependence ( AD ) .


Recovering subjects with AD and sleep disturbance complaints were treated with quetiapine XR ( n = @ ) or matching placebo pills ( n = @ ) for @ weeks .


Polysomnography was used to assess sleep objectively , and the Insomnia Severity Index and Pittsburgh Sleep Quality Index were used to measure subjective insomnia .


Other assessment measures included the @-minute psychomotor vigilance task ( for neurobehavioral functioning ) , the time-line follow-back measure ( for alcohol consumption ) , the Penn Alcohol Craving Scale ( for alcohol craving ) , the Patient Health Questionnaire-@ item scale ( for depressive symptoms ) , and the Beck Anxiety Inventory ( for anxiety symptoms ) .


Although there was no effect of quetiapine XR on sleep efficiency ( time spent asleep/total recording time ) , there was a pre-to-post reduction in wake after sleep onset time ( P = @ ) and nonsignificant trends for increases in sleep onset latency ( SOL ) and stage @ sleep time .


A time drug interaction was seen for the subjective insomnia , such that quetiapine XR-treated subjects reported greater initial improvement in their subjective insomnia , but the difference was not sustained .


There were no differences between treatment groups on other measures or medication compliance .


Quetiapine XR improves objective sleep continuity and transiently improves subjective insomnia early in recovery from AD .


Loss of phosphatase and tensin homologue ( PTEN ) function evaluated by loss of PTEN protein expression on immunohistochemistry ( IHC ) has been reported as both prognostic in metastatic colorectal cancer and predictive of response to anti-EGFR monoclonal antibodies although results remain uncertain .


Difficulties in the methodological assessment of PTEN are likely to be a major contributor to recent conflicting results .


We assessed loss of PTEN function in @ colorectal cancer specimens using Taqman copy number variation ( CNV ) and IHC .


Two blinded pathologists performed independent IHC assessment on each specimen and inter-observer variability of IHC assessment and concordance of IHC versus Taqman CNV was assessed .


Concordance between pathologists ( PTEN loss vs no loss ) on IHC assessment was @/@ ( @ % ) .


In specimens with concordant IHC assessment , concordance between IHC and Taqman copy number in PTEN loss assessment was @/@ ( @ % ) .


Assessment PTEN loss in colorectal cancer is limited by the inter-observer variability of IHC , and discordance of CNV with loss of protein expression .


An understanding of the genetic mechanisms of PTEN loss and implementation of improved and standardized methodologies of PTEN assessment are required to clarify the role of PTEN as a biomarker in colorectal cancer .


This study was designed to investigate whether garlic powder tablets in adjunct to conventional medical treatment could have an effect on carotid intima-media thickness ( CIMT ) and plasma lipoproteins and lipids in patients with coronary artery disease ( CAD ) .


A randomized , placebo-controlled , clinical trial was conducted on @ patients with CAD between the ages of @ and @ years .


The patients were randomly divided into two groups : garlic group ( n = @ ) , receiving garlic powder tablet ( @ g allicin/tab ) twice daily and the placebo group ( n = @ ) , receiving placebo for @ months .


The rate of atherosclerosis progression was measured by B-mode ultrasonography as the increase in CIMT .


After @ months of taking garlic tablets , CIMT values had minor variations ( @ @ mm reduction from baseline ) , while in the placebo group , an increase in CIMT values was observed ( @ @ mm increase from baseline ) .


After @ months of treatment , mean CIMT difference from baseline was significantly differ between the two groups ( p < @ ) .


Plasma lipids and lipoproteins ( total cholesterol , triglycerides , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , Apolipoprotein A@ and Apolipoprotein B ) did not differ between the two groups .


The results suggest that dry garlic powder tablet is superior to placebo in prevention of CIMT progression in patients with CAD and may be considered as an adjunct treatment for atherosclerosis .


Sedation or anaesthesia is recommended for all patients undergoing bronchoscopy unless absolute contraindications exist .


However , the widely used combination of propofol and opiates for moderate sedation ( MS ) in bronchoscopy results in a high incidence of hypoxaemia and a relatively high cough score during the procedure .


In this study , we evaluated the efficacy and safety of target-controlled infusion ( TCI ) of propofol and remifentanil , together with the use of high frequency jet ventilation ( HFJV ) , to achieve general anesthesia ( GA ) in diagnostic fibre-optic bronchoscopy .


A total of @ consecutive patients scheduled for flexible bronchoscopy were randomly assigned to receive either MS using TCI-delivered propofol and remifentanil ( n = @ ) , or GA using TCI-delivered propofol and remifentanil with HFJV ( n = @ ) .


The following were compared between the MS and GA groups : incidence of hypoxaemia , cough score , haemodynamic parameters , partial pressure of carbon dioxide in arterial blood , duration of bronchoscopy and patient satisfaction score .


The average and minimum oxygen saturation values in the MS group were lower than those in the GA group .


The MS group showed a higher incidence of hypoxaemia .


There was no significant difference in the partial pressure of carbon dioxide between the two groups .


Cough score and duration of the bronchoscopy were markedly lower in the GA group , and patient satisfaction score was higher in the GA group .


GA , achieved via TCI-delivered propofol and remifentanil with HFJV , provides better conditions for diagnostic bronchoscopy - it decreases the occurrence of hypoxaemia , shortens the duration of bronchoscopy and increases patient satisfaction .


Prescription drug abuse has reached epidemic proportions .


Nonmedical prescription opioid use carries increasingly high costs .


Despite the need to cultivate efforts that are both effective and fiscally responsible , the cost-effectiveness of universal evidence-based-preventive-interventions ( EBPIs ) is rarely evaluated .


This study explores the performance of these programs to reduce nonmedical prescription opioid use .


Sixth graders from twenty-eight rural public school districts in Iowa and Pennsylvania were blocked by size and geographic location and then randomly assigned to experimental or control conditions ( @-@ ) .


Within the intervention communities , prevention teams selected a universal family and school program from a menu of EBPIs .


All families were offered a family-based program in the @th grade and received one of three school-based programs in @th-grade .


The effectiveness and cost-effectiveness of each school program by itself and with an additional family-based program were assessed using propensity and marginal structural models .


This work demonstrates that universal school-based EBPIs can efficiently reduce nonmedical prescription opioid use .


Further , findings illustrate that family-based programs may be used to enhance the cost-effectiveness of school-based programs .


Universal EBPIs can effectively and efficiently reduce nonmedical prescription opioid use .


These programs should be further considered when developing comprehensive responses to this growing national crisis .


To examine the efficacy of telbivudine ( LdT ) + adefovir ( ADV ) vs continuation of lamivudine ( LAM ) + ADV in patients with LAM-resistant chronic hepatitis B ( CHB ) who show a suboptimal response to LAM + ADV.


This was a randomized , active-control , open-label , single-center , parallel trial .


All eligible patients were enrolled in this study in Severance Hospital , Yonsei University College of Medicine , Seoul , South Korea , between March @ and March @ .


Hepatitis Be antigen ( HBeAg ) - positive CHB patients whose serum hepatitis B virus ( HBV ) DNA remained detectable despite at least @ mo of LAM + ADV therapy were included .


Enrolled patients were randomized to either switching to LdT ( @ mg/d orally ) plus ADV ( @ mg/d orally ) ( LdT + ADV group ) or to continuation with LAM ( @ mg/d orally ) plus ADV ( @ mg/d orally ) ( LAM + ADV group ) , and were followed for @ wk .


One hundred and six patients completed the @-wk treatment period .


Serum HBV DNA , HBeAg status , liver biochemistry and safety were monitored at baseline and week @ , @ , @ and @ .


The duration of prior LAM + ADV treatment was @ ( LdT + ADV ) and @ mo ( LAM + ADV ) , respectively ( P = @ ) .


No difference was seen in baseline serum HBV DNA between the two groups -LSB- @ ( LdT + ADV ) vs @ ( LAM + ADV ) log@ IU/mL , P = @ -RSB- .


At week @ , although there was no significant difference in the mean reduction of serum HBV DNA from baseline between LdT + ADV group and LAM + ADV group ( -@ vs -@ log@ IU/mL , P = @ ) , more patients in the LdT + ADV group had undetectable HBV DNA levels compared to those in the LAM + ADV group ( @ % vs @ % , P = @ ) .


Three patients with LdT + ADV treatment and @ patients with LAM + ADV treatment achieved HBeAg loss .


The patients in both groups tolerated the treatment well without serious adverse events .


The proportion of patients with estimated glomerular filtration rate @ mL/min per @ m ( @ ) in the LdT + ADV group increased from @ % ( @/@ ) at baseline to @ % ( @/@ ) at week @ , while that in the LAM + ADV group decreased from @ % ( @/@ ) at baseline to @ % ( @/@ ) at week @ .


The switch to LdT + ADV in suboptimal responders to LAM + ADV showed a significantly higher rate of virologic response at week @ .


These results suggest that LdT + ADV could be a therapeutic option for patients who are unable to use enofovir disoproxil fumarate for any reason .


The objective of this study was to assess the influence of lingual bar and lingual plate major connectors on plaque retention and gingival health among patients who presented in University College Hospital ( UCH ) , Ibadan , Nigeria .


This comparative intervention study was carried out among fifteen patients aged @ to @ years with Kennedy class III lower edentulous arch .


Two metal dentures with different major connector designs ( lingual plate and lingual bar ) were fabricated for each patient .


After professional scaling and polishing , a baseline score of the oral hygiene was done using the plaque index of Sillness and Loe and the gingival health using the gingival index of Loe and Sillness .


Each patient was randomly assigned either a denture with the plate or bar design to use for three months and then recalled for reassessment of oral hygiene and gingival health .


Professional scaling and polishing was done post removal and a new baseline assessment of oral hygiene and gingival health recorded .


The dentures were now exchanged and the second major connector design inserted .


Each patient was recalled for reassessment of the oral hygiene and gingival health after three months .


The level of plaque accumulation and gingival inflammation with the use of lingual plate and bar dentures were determined and compared .


There was no statistically significant difference in the mean plaque index score for the lingual bar design at three months and the mean plaque index score at three months for the lingual plate ( p > @ ) .


However , a statistically significant lower mean gingival index score was noted three months post insertion for lingual bar designs when compared to plate designs .


Within the limitation of this study , better gingival health was noted with the bar designs when compared with the plate designs .


We evaluated the effect of an educational intervention administered to patients or/and physicians on the reduction in HbA ( @c ) and achieving diabetic control in a high-risk primarily Black inner-city population .


The study was designed as a four-arm randomized clinical trial where an educational program on diabetes was offered to physicians only , patients only , and both physicians and their patients , while the fourth arm did not receive any instruction .


We built regression models at @ months of follow-up to assess the likelihood of reaching glycemic goal as well as to measure the absolute reduction in HbA ( @c ) controlling for arm assignment , insulin use , race , age , sex , smoking , insulin use , and having achieved blood pressure control .


Between April @ and July @ , there were @ patients randomized into the study .


In multivariate analyses , the intervention group in which only patients received education showed a trend toward achieving a significant mean reduction in HbA ( @c ) with @ % ( P = @ ) higher odds of reaching glycemic control and @ ( P = @ ) greater absolute percentage point drop in HbA ( @c ) compared to the no education group .


Although our study reports positive results , it warrants a special emphasis on the behavior of the patient .


Study results bring attention to disease management programs such as peer support networks that empower the patients that shift some of the responsibility to them .


Hepatitis B virus ( HBV ) is a vaccine preventable infection yet vaccination rates are low among injection drug users ( IDUs ) despite the high risk of infection and longstanding recommendations to promote vaccination .


We sought to improve vaccination rates by reaching IDUs through syringe exchange programs ( SEPs ) in three U.S. cities .


IDUs were randomized in a trial comparing the standard HBV vaccination schedule ( @ , @ , and @ months ) to an accelerated schedule ( @ , @ , and @ months ) and participation data were analyzed to identify determinants of completion of the three-dose vaccine series .


Independent variables explored included sociodemographics , injection and syringe access behaviors , assessment of health beliefs , HBV-associated knowledge , and personal health status .


Covariates associated with completion of the three-dose vaccine series were accelerated vaccine schedule ( aOR @ , @ % CI @ , @ , p = < @ ) , older age ( aOR @ , @ % CI @ , @ , p = < @ ) , and poorer self-rated health score ( aOR @ , @ % CI @ , @ , p = @ ) .


Completion was less likely for those getting syringes from SEP customers than for SEP customers ( OR @ , @ % CI @ , @ , p = < @ ) .


SEPs should offer hepatitis vaccination in a manner that minimizes time between first and last visits by accelerating the dosing schedule .


Public health interventions should target younger , less healthy , and non-SEP customer participants .


Other health interventions at SEPs may benefit from similar approaches that reach out beyond regular SEP customers .


To examine the effect of low-volume sprint interval training ( SIT ) on the development ( part @ ) and subsequent maintenance ( part @ ) of aerobic fitness in soccer players .


In part @ , @ players from the same semiprofessional team participated in a @-wk SIT intervention ( SIT , n = @ , age @ @ y , weight @ @ kg ; control , n = @ , age @ @ y , weight @ @ kg ) .


The SIT group performed @ training sessions of @-@ maximal @-s sprints , in replacement of regular aerobic training .


The control group continued with their regular training .


After this @-wk intervention , the SIT group was allocated to either intervention ( n = @ , @ SIT session/wk as replacement of regular aerobic training ) or control ( n = @ , regular aerobic training with no SIT sessions ) for a @-wk period ( part @ ) .


Pre and post measures were the YoYo Intermittent Recovery Test Level @ ( YYIRL@ ) and maximal oxygen uptake ( VO@max ) .


In part @ , the @-week SIT intervention had a small beneficial effect on YYIRL@ ( @ % ; @ % confidence limits @ % ) , and VO@max ( @ % ; @ % ) compared with control .


In part @ , @ SIT session/wk for @ wk had a small beneficial effect on VO@max ( @ % ; @ % ) , with an unclear effect on YYIRL@ ( @ % ; @ % ) .


Two weeks of SIT elicits small improvements in soccer players ' high-intensity intermittent-running performance and VO@max , therefore representing a worthwhile replacement of regular aerobic training .


The effectiveness of SIT for maintaining SIT-induced improvements in high-intensity intermittent running requires further research .


The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery ( VA ) .


This pilot study was conducted as a blinded examiner cohort with @ randomized clinical tasks .


Ten healthy male participants aged @ to @ years ( mean , @ years ) volunteered to participate in the study .


None of the participants had a history of disabling neck , arm , or headache pain within the last @ months .


They did not have any current or history of neurologic symptoms .


In a neutral head position , physiologic measures of VA blood flow and velocity at the C@-@ spinal level were obtained using phase-contrast magnetic resonance imaging after @ different head positions and a chiropractic upper cervical spinal manipulation .


A total of @ flow-encoded phase-contrast images were collected over the cardiac cycle , in each of the @ conditions , and were used to provide a blood flow profile for one complete cardiac cycle .


Differences between flow ( in milliliters per second ) and velocity ( in centimeters per second ) variables were evaluated using repeated-measures analysis of variance .


The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities ( P = @ ) or flows ( P = @ ) throughout the conditions .


There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables .


There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations .


To investigate effects of perirenal space blocking ( PSB ) on gastrointestinal function in patients with severe acute pancreatitis ( SAP ) .


Forty patients with SAP were randomly allocated to receive PSB or no PSB ( NPSB ) .


All the SAP patients received specialized medical therapy ( SMT ) .


Patients in the PSB group received PSB + SMT when hospitalized and after diagnosis , whereas patients in the NPSB group only received SMT .


A modied gastrointestinal failure ( GIF ) scoring system was used to assess the gastrointestinal function in SAP patients after admission .


Pain severity ( visual analog scale , @ to @ ) was monitored every @ h for @ h.


Modified GIF score decreased in both groups during the @-d study period .


The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was performed .


During the @-h study period , pain intensity decreased in both groups .


The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points .


Patients in the PSB group had significantly lower incidences of hospital mortality , multiple organ dysfunction syndrome , systemic inflammatory response syndrome , and pancreatic infection , and stayed in the intensive care unit for a shorter duration .


However , no difference in terms of operation incidence was found between the two groups .


PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP .


Moreover , PSB administration could improve prognosis and decrease the mortality of SAP patients .


To examine the effect of a @-week Tai Chi ( TC ) intervention on physical function and quality of life .


Single-blind , randomized controlled trial .


General community .


Community-dwelling survivors of stroke ( N = @ ; @ % women ; mean age , @y ; time poststroke : @y ; ischemic stroke : @ % ; hemiparesis : @ % ) who were aged @ years and were @ months poststroke .


Yang style @-posture short-form TC ( n = @ ) , strength and range of movement exercises ( SS ) ( n = @ ) , or usual care ( UC ) ( n = @ ) for @ weeks .


The TC and SS groups attended a @-hour class @ times per week , whereas the UC group had weekly phone calls .


Physical function : Short Physical Performance Battery , fall rates , and @-minute step test ; quality of life : Medical Outcomes Study @-Item Short-Form Health Survey , Center for Epidemiologic Studies Depression Scale , and Pittsburgh Sleep Quality Index .


During the intervention , TC participants had two thirds fewer falls ( @ falls ) than the SS ( @ falls ) and UC ( @ falls ) groups ( ( @ ) = @ , P = @ ) .


There was a significant group by time interaction for the @-minute step test ( F@ ,@ = @ , P < @ ) .


Post hoc tests indicated that the TC ( t@ = @ , P = @ ) and SS ( t@ = @ , P < @ ) groups had significantly better aerobic endurance over time , though not in the UC group ( t@ = @ , P = @ ) .


Intervention adherence rates were @ % .


TC and SS led to improved aerobic endurance , and both are suitable community-based programs that may aid in stroke recovery and community reintegration .


Our data suggest that a @-week TC intervention was more effective in reducing fall rates than SS or UC interventions .


Future studies examining the effectiveness of TC as a fall prevention strategy for community-dwelling survivors of stroke are recommended .


In this prospective , randomized , observer-blinded study , we compared double-injection ( DI ) ultrasound-guided supraclavicular block to a novel targeted intracluster-injection ( TII ) technique , whereby local anesthetic is injected inside the main and satellite neural clusters ( confluences of trunks and divisions of the brachial plexus ) .


Ninety patients were randomly allocated to receive a DI ( n = @ ) or TII ( n = @ ) technique for ultrasound-guided supraclavicular block .


The local anesthetic drug ( lidocaine @ % with epinephrine @ g/mL ) and total volume ( @ mL ) were identical in all subjects .


In both groups , half the volume ( @ mL ) was injected inside the main neural cluster .


For the DI technique , the second half ( @ mL ) was deposited at the `` corner pocket '' ( intersection of the first rib and subclavian artery ) .


In contrast , for the TII technique , the remaining half was divided into equal aliquots and injected inside every single satellite cluster .


The main outcome variable was the total anesthesia-related time ( sum of performance and onset times ) .


Due to a quicker onset ( mean standard deviation ( SD ) : @ @ vs @ @ minutes ; P < @ ) , the total anesthesia-related time was shorter with the TII technique ( @ @ vs @ @ minutes ; P = @ ; @ % confidence interval for the difference of the means : @-@ @ minutes ) .


There were @ ( of @ ) and @ ( of @ ) surgical failures for the TII and DI group , respectively .


Thus , the @ methods achieved comparable rates of surgical anesthesia ( @ % -@ % ; @ % confidence interval for the difference of the success rates : -@ % to @ % ) .


No intergroup differences were observed in block-related pain scores and adverse events .


The DI group required fewer needle passes ( median interquartile range : @ @ vs @ @ ; P < @ ) as well as shorter needling ( @ @ vs @ @ minutes ; P < @ ) and performance ( @ @ vs @ @ minutes ; P = @ ) times .


Although DI and TII ultrasound-guided supraclavicular blocks seem to provide comparable success rates , we can not exclude the possibility that an intergroup difference of @ % might have gone undetected .


Due to its quick onset , the TII technique results in a shorter total anesthesia-related time .


Objectively measure the ability of facial reanimation surgery to normalize the appearance of facial paralysis using eye-tracking technology .


Prospective randomized controlled experiment .


An eye-tracker system was used to record the eye-movement patterns , called scanpaths , of @ nave observers gazing at pictures of paralyzed faces ( House-Brackmann IV-VI ) , smiling and in repose ; before and after facial reanimation surgery ; as well as normal , nonparalyzed faces .


Observers gazed at each face for @ seconds .


Fixation durations for all predefined facial areas of interest were analyzed using mixed-effects linear regression .


Observers spent the majority of time ( @ of @ seconds ) gazing in the central triangle region ( eyes , nose , and mouth ) of normal faces and paralyzed faces .


There were significant deviations in fixation within the central triangle of paralyzed faces as compared to normal faces .


Total fixation on the eyes remained conserved .


However , total nose fixation decreased and mouth fixation increased on paralyzed faces .


Facial reanimation surgery normalized many of the hemifacial gaze asymmetries caused by unilateral facial paralysis , and restored a normal distribution of gaze between the functional and paralyzed sides of the face and mouth .


There were objective differences in the way observers directed their attention to facial features when viewing normal and paralyzed faces .


After facial reanimation surgery , the attentional distraction caused by facial feature irregularities was reduced .


These findings are important additions to the emerging body of objective evidence indicating the effectiveness of reanimation surgery ; they also suggest opportunities to optimize reconstruction .


Psychological interventions show greater efficacy when evaluated with distressed patients .


We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem-solving therapy ( PST ) , characteristics associated with enrolment , and time investment and challenges of implementing screening .


Three medical settings implemented screening of patients , directly after cancer treatment ( T@ ) and @ months later ( T@ ) , using Hopkins Symptom Checklist-@ and one question about need for services .


Distressed patients indicating need for services were interviewed .


Eligible patients were offered the possibility to participate in the trial .


Consenting patients were randomized to PST or waitlist .


At T@ , @ of @ screened patients ( @ % ) scored above the cutoff and at T@ , @ of @ screened patients ( @ % ) .


At either or both T@ and T@ , @ patients reported distress , of whom @ indicated need for services .


Only @ ( @ % of @ ) patients consented to trial participation .


Twenty-seven patients needed to be screened to recruit a single patient , with @ h required for each patient recruited .


Barriers to screening were time constraints and negative attitudes of oncology staff towards screening .


Implementing screening proved inefficient for recruiting distressed cancer patients post-treatment to a randomized controlled trial on PST , with need for services being much less than anticipated .


Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients , which may lower generalizability .


An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated , funded staff assistance .


To compare the effects of combined oral contraceptives ( OCs ) containing cyproterone acetate and drospirenone in the treatment of polycystic ovary syndrome ( PCOS ) .


Fifty-two patients with PCOS were randomized in two groups : group A ( n = @ ) received @ mg ethinyl estradiol + @ mg cyproterone acetate and group B ( n = @ ) received @ mg ethinyl estradiol + @ mg drospirenone-containing OCs for @ months .


Baseline clinical features including body mass index , waist to hip ratio ( WHR ) , and modified Ferriman-Gallwey ( mFG ) score were noted .


Baseline biochemical parameters included androgen profile , carbohydrate metabolism , lipid profile , and oxidative stress .


The percentages of changes for all parameters were compared .


The groups were comparable regarding the baseline characteristics .


WHR decreased significantly from baseline ( -@ % -LSB- -@ to @ -RSB- ) in group B when compared to group A ( @ % -LSB- -@ to @ -RSB- ) ( P = @ ) .


The total mFG score decreased significantly from baseline ( -@ % -LSB- -@ to @ -RSB- ) in group A when compared to group B ( -@ % -LSB- -@ to @ -RSB- ) ( P = @ ) .


Changes in androgen hormone profile were comparable except DHEA-SO@ ( -@ % -LSB- -@ to @ -RSB- in group B vs. -@ % -LSB- -@ to @ -RSB- in group A ; P = @ ) .


The effects of the drugs were similar regarding carbohydrate metabolism , lipid profile , and oxidative stress parameters .


Cyproterone acetate containing OCs seem to be more effective to treat clinical hirsutism in patients with PCOS after @ months of treatment .


It is often difficult to enrol healthy volunteers into a randomized controlled trial ( RCT ) as there are barriers to participants ' proper understanding of a trial .


This study aimed to evaluate degrees of understanding of the informed consent ( IC ) process among healthy volunteers who participated in an RCT .


Additionally , factors associated with degree of understanding were investigated .


The J-START ( the Japan STrategic Anti-cancer Randomized controlled Trial ) is an RCT investigating the effectiveness of ultrasonography screening for breast cancer in women aged @ to @ years .


To evaluate participants ' understanding of the J-START , we administered questionnaires to @ Japanese women on the day of enrolment at five study sites across Japan .


The respondents were asked to complete the anonymous questionnaire within @ weeks .


We assessed objective understanding and perceived subjective understanding of IC using a Japanese version of the Quality of Informed Consent scale ( QuIC ) .


Then we analyzed the characteristics of women whose understanding was poor , and clarified the association between providing information and their understanding of the study protocol .


The average QuIC scores were @ and @ ( out of @ each ) for objective and subjective understanding , respectively .


These are generally acceptable scores for participants ' understanding of an RCT .


However , there were four domains with low scores , indicating poor understanding : ( @ ) experimental nature of the study , ( @ ) potential risks or discomfort , ( @ ) benefit to self , and ( @ ) compensation .


Healthy volunteers generally well understood the J-START .


Nevertheless , there were some domains in need of improvement .


In order to facilitate participants ' understanding , it is necessary to provide training to reduce differences in information-providing procedures between medical centres and to endeavour to provide consistent information and conditions .


To determine the feasibility of using a @-kVp protocol compared with a @-kVp protocol for cerebral CT angiography .


An additional target was to investigate a possible reduction in the volume of contrast medium ( CM ) using the @-kVp protocol .


Attenuation value and CNR for iodine were determined at various tube voltage settings using a phantom .


Sixty-nine volunteers were randomly assigned to one of three protocols : group A ( @-kVp and CM @ mL ) , group B ( @-kVp and CM @ mL ) , or group C ( @-kVp and CM @ mL ) .


The attenuation value , SNR , and CNR of cerebral arteries , subjective image quality , and radiation dose were compared among the groups .


The vascular attenuation , SNR , and CNR of group B were significantly higher than those of group A. Group C had a significantly higher vascular attenuation than group A. Groups B and C were significantly better than group A with respect to subjective image quality .


An effective dose of @-kVp was @ % lower than that of @-kVp .


Using @-kVp improved arterial enhancement , SNR , and CNR , and provided better subjective image quality , using a @ % lower effective dose .


Furthermore , the @-kVp protocol may both reduce volume of CM by @ % and improve arterial enhancement .


Cerebral CT angiography at @-kVp substantially improved vascular enhancement Subjective image quality was better at @-kVp , with lower radiation dose The volume of contrast media can be substantially reduced at @-kVp .


To better understand the implications of new-onset diabetes after transplant ( NODAT ) , we used our prospectively followed cohort of @ adult primary kidney transplant recipients to determine the prognostic impact of pretransplant diabetes and NODAT .


The study cohort consisted of all participants in four randomised immunosuppression trials performed at our centre since May @ .


For each cause-specific hazard analysed , Cox stepwise regression was used to determine a multivariable model of significant baseline predictors ; the multivariable influence of having pretransplant diabetes and NODAT ( t ) ( the latter defined as a zero-one , time-dependent covariate ) was subsequently tested .


Similar analyses of estimated glomerular filtration rate ( eGFR ) at @ and @ months post transplant were performed using stepwise linear regression .


Finally , a repeated measures analysis of mean HbA@c as a function of diabetes category ( pretransplant diabetes vs NODAT ) and randomised trial ( first to fourth ) was performed .


Median follow-up was @ months post transplant .


Patients with pretransplant diabetes comprised @ % ( @/@ ) , and @ % ( @/@ ) of the remaining patients developed NODAT .


Pretransplant diabetes had no prognostic influence on first biopsy-proven acute rejection and death-censored graft failure hazard rates , nor on eGFR , but was associated with significantly higher rates of death with a functioning graft ( DWFG ) ( p = @ ) , DWFG due to a cardiovascular event ( p = @ ) and infection that required hospitalisation ( p = @ ) .


NODAT ( t ) had no unfavourable impact on any of these hazard rates nor on eGFR , with actuarial freedom from DWFG remaining at over @ % among patients in pre - and post-NODAT states at @ months post transplant/NODAT .


Mean HbA@c for patients in the first to fourth randomised trials , averaged across diabetes category , decreased by trial ( @ % , @ % , @ % and @ % -LSB- @ , @ , @ and @ mmol/mol -RSB- , respectively ; p = @ ) .


Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant .


The aim of this study is to compare the effects of chest physiotherapy ( CPT ) and high-frequency chest wall oscillation ( HFCWO ) on lung function in lung transplant recipients .


Chest physiotherapy and HFCWO are routinely used after lung transplant to attenuate dyspnea , increase expiratory flow , and improve secretion clearance .


In a two-group experimental , crossover design with repeated-measures , @ lung transplant recipients ( @ single , @ bilateral ; @ % male ; mean age , @ years ) were randomized to receive CPT at @:@ AM and @:@ PM followed by HFCWO at @:@ PM and @:@ PM ( n = @ ) or vice versa ( n = @ ) on postoperative day @ .


Dyspnea ( modified Borg score ) , Spo@/FiO@ , and peak expiratory flow ( PEF ) were measured pre-treatment and post-treatment .


Data were analyzed using chi-square tests , t tests , and linear mixed effects models .


There was no statistically significant treatment effect for dyspnea or PEF in patients who received HFCWO versus CPT .


However , there was a significant treatment effect on the Spo@/FiO@ ratio ( p < @ ) .


Preliminary results suggest that lung function ( measured by Spo@/FiO@ ) improves with HFWCO after lung transplantation .


Although dyspnea and PEF did not differ significantly between treatment types , HFCWO may be an effective , feasible alternative to CPT .


Smoking-cessation counseling during pregnancy is important to prevent smoking-related harm in pregnant smokers and their children .


Therefore we evaluated the effects of an Inspectorate 's supervision programme on the provision of smoking-cessation counseling by midwifery practices in the Netherlands .


The supervision programme consisted of @ elements : A ) A deadline was announced by which all practices should comply with professional norms on such counseling ( @ ) ; B ) A set of randomly selected practices were assessed using a questionnaire and a personal feedback report ( @ ) ; C ) Another set of randomly selected practices were assessed through a site visit and a personal feedback report ( @ ) .


Programme A was evaluated in a before-after study , Programmes B and C were evaluated in a randomized controlled trial ( RCT ) with only a post-intervention measurement .


Primary outcome was provision of smoking-cessation counseling through a minimal-intervention strategy ( V-MIS ) .


Linear and logistic regression models were used to analyze data from @ primary-care midwifery practices .


A ) After announcement of the deadline , Dutch midwifery practices reported significantly more provision of smoking-cessation counseling .


For example , the use of V-MIS increased substantially from @ % to @ % ; B ) In practices that were assessed with a questionnaire , the provision of counseling improved partially compared to controls ; C ) The provision of counseling did not differ between practices that were visited and their controls .


While the training participation rate in counseling by midwifery practices did not differ between the intervention and control groups , the rate increased significantly in all practices after the start of the supervision programme .


The provision of smoking-cessation counseling improved spectacularly in Dutch midwifery practices .


Despite some limitations of our study , the Inspectorate 's supervision programme is likely to have contributed to the improvements in provision of counseling .


Predictors of asthma exacerbations , poor asthma control , or extreme - agonist overuse may be of clinical utility in the management of asthma .


To investigate characteristics that predict subsequent adverse outcomes in asthma .


An independent @-week , randomized controlled trial of @ adult patients with asthma who are at risk , which compared the efficacy of SMART ( single budesonide-formoterol inhaler as maintenance and reliever therapy ) with a fixed-dose regimen with salbutamol as reliever ( `` Standard '' ) .


Inhaled medication use was measured by electronic monitoring .


Baseline characteristics that were predictors of subsequent severe asthma exacerbations , poor asthma control ( Asthma Control Questionnaire -@ score @ ) , and `` extreme '' - agonist overuse ( > @ budesonide-formoterol actuations/d in SMART and > @ salbutamol actuations/d in Standard ) were assessed by multivariate analyses .


FEV % predicted ( rate ratio -LSB- RR -RSB- @ -LSB- @ % CI , @-@ @ -RSB- per @ % lower ) , more previous exacerbations ( RR @ -LSB- @ % CI , @-@ @ -RSB- ) , Standard therapy ( RR @ -LSB- @ % CI , @-@ @ -RSB- ) , and female sex ( RR @ -LSB- @ % CI , @-@ @ -RSB- ) were associated with future severe exacerbations .


Asthma Control Questionnaire -- @ ( regression coefficient @ -LSB- @ % CI , @-@ @ -RSB- per @ points higher ) and age ( regression coefficient @ -LSB- @ % CI , @-@ @ -RSB- per decade older ) were associated with future poorly controlled asthma .


Higher reliever use ( RR @ -LSB- @ % CI , @-@ @ -RSB- per categorical score in Asthma Control Questionnaire question no. @ ) , Mori ethnicity ( RR @ -LSB- @ % CI , @-@ @ -RSB- ) and FEV % predicted ( RR @ -LSB- @ % CI , @-@ @ -RSB- per @ % lower ) were associated with future extreme - agonist overuse .


Future severe asthma exacerbations , poor asthma control , and extreme - agonist overuse are predicted by different baseline clinical and demographic characteristics and management approaches in at-risk asthma .


Epidemiologically , there is a strong relationship between BMI and blood pressure ( BP ) levels .


We prospectively examined randomization to first-step chlorthalidone , a thiazide-type diuretic ; amlodipine , a calcium-channel blocker ; and lisinopril , an angiotensin-converting enzyme inhibitor , on BP control and cardiovascular outcomes in a hypertensive cohort stratified by baseline BMI -LSB- kg/m ( @ ) ; normal weight ( BMI < @ ) , overweight ( BMI = @-@ @ ) , and obese ( BMI > @ ) -RSB- .


In a randomized , double-blind , practice-based Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial , @,@ hypertensive participants , aged at least @ years , were followed for an average of @ years , for a primary outcome of fatal coronary heart disease or nonfatal myocardial infarction , and secondary outcomes of stroke , heart failure , combined cardiovascular disease , mortality , and renal failure .


Of participants , @ % were overweight and @ % were obese at randomization .


For each medication , BP control ( < @/@ mmHg ) was equivalent in each BMI stratum .


At the fifth year , @ , @ , and @ % of normal-weight , overweight , and obese participants , respectively , were controlled .


Those randomized to chlorthalidone had highest BP control ( @ , @ , and @ % , respectively ) and to lisinopril the lowest ( @ , @ , and @ % , respectively ) in each BMI stratum .


A significant interaction ( P = @ ) suggests a lower coronary heart disease risk in the obese for lisinopril versus chlorthalidone ( hazard ratio @ , @ % confidence interval @-@ @ ) and a significant interaction ( P = @ ) suggests a higher risk of end-stage renal disease for amlodipine versus chlorthalidone in obese participants ( hazard ratio @ , @ % confidence interval @-@ @ ) .


However , these results were not consistent among other outcomes .


BMI status does not modify the effects of antihypertensive medications on BP control or cardiovascular disease outcomes .


To evaluate the effect of a practice-based , culturally appropriate patient education intervention on blood pressure ( BP ) and treatment adherence among patients of African origin with uncontrolled hypertension .


Cluster randomised trial involving four Dutch primary care centres and @ patients ( intervention n = @ , control n = @ ) , who met the following inclusion criteria : self-identified Surinamese or Ghanaian ; @ years ; treated for hypertension ; SBP @ mmHg .


All patients received usual hypertension care .


The intervention-group was also offered three nurse-led , culturally appropriate hypertension education sessions .


BP was assessed with Omron @-IT and treatment adherence with lifestyle - and medication adherence scales .


@ patients ( @ % ) completed the study ( intervention n = @ , control n = @ ) .


Baseline characteristics were largely similar for both groups .


At six months , we observed a SBP reduction of @ mmHg - primary outcome - in @ % of the intervention group and @ % of the control group .


When adjusted for pre-specified covariates age , sex , hypertension duration , education , baseline measurement and clustering effect , the between-group difference was not significant ( OR ; @ ; @ % CI : @ to @ ; P = @ ) .


At six months , the mean SBP/DBD had dropped by @/@ @ ( SD @ / @ ) mmHg in the intervention group and by @ / @ ( SD @ / @ ) mmHg in the control group .


After adjustment , between-group differences in SBP and DBP reduction were -@ mmHg ( @ % CI : -@ to @ , P = @ ) and -@ mmHg ( -@ to -@ , P = @ ) in favour of the intervention group .


Mean scores for adherence to lifestyle recommendations increased in the intervention group , but decreased in the control group .


Mean medication adherence scores improved slightly in both groups .


After adjustment , the between-group difference for adherence to lifestyle recommendations was @ ( @ to @ ; P = @ ) .


For medication adherence it was -@ ( -@ to @ ; P = @ ) .


This intervention led to significant improvements in DBP and adherence to lifestyle recommendations , supporting the need for culturally appropriate hypertension care .


The primary aim of this study was to analyse two different methods of tonsil surgery , tonsillectomy ( TE ) and tonsillotomy ( TT ) , regarding post-operative dentofacial growth in children with tonsillar hypertrophy .


A secondary aim was to analyse these results in relation to cephalometric standards .


The study group consisted of @ subjects ( @ boys and @ girls ) , mean age @ years @ months .


They were randomized to a complete removal of the pharyngeal tonsil , TE , ( n = @ ) or a partial removal , TT , ( n = @ ) .


Pre-operative and @ years post-operative study material were obtained and analysed .


The results were compared with cephalometric standards .


Pre-operative , children with hypertrophic tonsils displayed an increased vertical relation ( P < @ ) compared with cephalometric standards .


Post-operative , no significant difference could be detected between the two surgical procedures regarding dentofacial growth .


Mandibular growth with an anterior inclination was significant ( P < @ / TE , P < @ / TT ) for both groups .


An increased upper and lower incisor inclination was noted ( P < @ / TE , TT ) .


The vertical relation decreased ( P < @ / TE , P < @ / TT ) as well as the mandibular angle ( P < @ / TE , P < @ / TT ) .


Reduction was also significant for the sagittal intermaxillar ( P < @ / TE , TT ) relation .


These post-operative results , together with a more prognatic mandible ( P < @ / TE , TT ) and chin ( P < @ / TE , P < @ / TT ) , might indicate a more horizontal direction of mandibular growth .


TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils .


This result should be considered when deciding upon surgical technique .


Whether sex-specific chest pain characteristics ( CPCs ) would allow physicians in the emergency department to differentiate women with acute myocardial infarction ( AMI ) from women with other causes of acute chest pain more accurately remains unknown .


OBJECTIVE To improve the management of suspected AMI in women by exploring sex-specific CPCs .


From April @ , @ , through August @ , @ , we enrolled @ consecutive patients ( @ women and @ men ) presenting with acute chest pain to @ emergency departments in a prospective multicenter study .


The final diagnosis of AMI was adjudicated by @ independent cardiologists .


Treatment of AMI in the emergency department .


Sex-specific diagnostic performance of @ predefined and uniformly recorded CPCs in the early diagnosis of AMI .


Acute myocardial infarction was the adjudicated final diagnosis in @ women ( @ % ) and @ men ( @ % ) .


Although most CPCs were reported with similar frequency in women and men , several CPCs were reported more frequently in women ( P < @ ) .


The accuracy of most CPCs in the diagnosis of AMI was low in women and men , with likelihood ratios close to @ .


Thirty-one of @ CPCs ( @ % ) showed similar likelihood ratios for the diagnosis of AMI in women and men , and only @ CPCs ( @ % ) seemed to have a sex-specific diagnostic performance with P < @ for interaction .


These CPCs were related to pain duration ( @-@ and > @ minutes ) and dynamics ( decreasing pain intensity ) .


However , because their likelihood ratios were close to @ , the @ CPCs did not seem clinically helpful .


Similar results were obtained when examining combinations of CPCs ( all interactions , P @ ) .


Differences in the sex-specific diagnostic performance of CPCs are small and do not seem to support the use of women-specific CPCs in the early diagnosis of AMI .


TRIAL REGISTRATION clinicaltrials.gov Identifier : NCT@ .


To improve mechanistic understanding , this pilot randomized controlled trial examined mediators of an exercise intervention effects on sleep in breast cancer survivors ( BCS ) .


Forty-six postmenopausal BCS ( Stage II , off primary treatment ) were randomized to a @-month exercise intervention or control group .


Intervention included @min/week of moderate intensity aerobic walking , twice weekly resistance training ( resistance bands ) , and six discussion groups ( to improve adherence ) .


Blinded assessments at baseline and post-intervention included sleep disturbance ( PSQI and PROMIS ) , objective sleep quality ( accelerometer ) , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , body composition , fatigue , and psychosocial factors .


Mediation was tested using Freedman-Schatzkin difference-in-coefficients tests .


When compared with control , the intervention group demonstrated a significant increase in PSQI sleep duration ( i.e. , fewer hours of sleep/night ) ( d = @ , p = @ ) .


Medium to large but non-significant standardized effect sizes were noted for PSQI daytime somnolence ( d = -@ , p = @ ) and accelerometer latency ( d = -@ , p = @ ) .


No statistically significant mediators were detected for PSQI sleep duration score or accelerometer latency .


Daytime somnolence was mediated by tumor necrosis factor-alpha ( mediated @ % of intervention effect , p < @ ) , interleukin ( IL ) -@ : IL-@ ( @ % , p < @ ) , IL-@ : IL-@ ( @ % , p < @ ) , and fatigue ( @ % , p < @ ) .


Mediating or enhancing relationships for several of the sleep outcomes were noted for accelerometer physical activity , PROMIS fatigue , exercise social support , and/or physical activity enjoyment .


Inflammation and psychosocial factors may mediate or enhance sleep response to our exercise intervention .


Further study is warranted to confirm our results and translate our findings into more effective interventions aimed at improving sleep quality in BCS .


Although the advantages of laparoscopic procedures has been well studied over the last two decade , laparoscopic appendectomy could not to be a standard therapy due to some disadvantages such as longer operative time and higher cost.The objective of our study is to re-evaluate the outcomes of laparoscopic versus open appendectomy with current data .


Between January @ and July @ , the data of the patients who had appendectomy were recorded prospectively .


Patients ' demographics , duration of procedure , length of hospital stay , need of analgesics , postoperative visual analogue scale scores and morbidity were assessed .


Of @ patients , @ ( @ % ) underwent open and @ ( @ % ) laparoscopic appendectomy .


The operating time was similar for both groups ( p = @ ) .


The visual analog scale scores of @st ( p = @ ) , @th ( p = @ ) and @th ( p = @ ) hours were higher in open the appendectomy group .


The total need of analgesics significantly was higher in open group ( p = @ ) .


There was no statistical difference in terms of total morbidity rate between open and laparoscopic appendectomy groups ( p = @ ) .


Two operative techniques are similar in terms of length of hospital stay , operative time , and postoperative complications .


Laparoscopic appendectomy reduces the need for analgesics and visual analog scale scores ; therefore , it should be considered as the gold standard for surgical treatment of acute appendicitis .


Antibiotic resistance has risen dramatically over the past years .


For individual patients , adequate initial antibiotic therapy is essential for clinical outcome .


Computer-assisted decision support systems ( CDSSs ) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines .


The aim of this study was to evaluate long-term effects after implementation of a CDSS .


This prospective ` before/after ' cohort study was conducted over four observation periods within @ years .


One preinterventional period ( pre ) was compared with three postinterventional periods : directly after intensive implementation efforts ( post@ ) , @ years ( post@ ) and @ years ( post@ ) after implementation .


Five anaesthesiological-managed intensive care units ( ICU ) ( one cardiosurgical , one neurosurgical , two interdisciplinary and one intermediate care ) at a university hospital .


Adult patients with an ICU stay of > @ h were included in the analysis .


@ patients were included in the analysis for a total of @,@ ICU days .


Implementation of a CDSS .


The primary end point was percentage of days with guideline adherence during ICU treatment .


Secondary end points were antibiotic-free days and all-cause mortality compared for patients with low versus high guideline adherence .


Adherence to guidelines increased from @ % prior to implementation to @ % in post@ , decreased in post@ to @ % and remained significantly higher compared with baseline in post@ , with @ % ( p = @ ) .


Additionally , antibiotic-free days increased over study periods .


At all time periods , mortality for patients with low guideline adherence was higher with @ % versus @ % ( p = @ ) and an adjusted OR of @ ( @ % CI @ to @ ) .


Implementation of computerised regional adapted guidelines for antibiotic therapy is paralleled with improved adherence .


Even without further measures , adherence stayed high for a longer period and was paralleled by reduced antibiotic exposure .


Improved guideline adherence was associated with reduced ICU mortality .


Previous investigations in pancreatic cancer suggest a prognostic role for - smooth muscle actin ( - SMA ) expression and stromal density in the peritumoural stroma .


The aim of this study was to further validate the impact of - SMA expression and stromal density in resectable pancreatic cancer patients treated with adjuvant gemcitabine compared with untreated patients .


CONKO-@ was a prospective randomised phase III study investigating the role of adjuvant gemcitabine as compared with observation .


Tissue samples of @ patients were available for immunohistochemistry on tissue microarrays to evaluate the impact of - SMA expression and stromal density impact on patient outcome .


High - SMA expression in tumour stroma was associated with worse patient outcome ( DFS : P = @ , OS : P = @ ) .


A dense stroma reaction was associated with improved disease-free survival ( DFS ) and overall survival ( OS ) in the overall study population ( DFS : P = @ , OS : P = @ ) .


This positive prognostic impact was restricted to patients with no adjuvant treatment ( DFS : P < @ , OS : P < @ ) .


In multivariable analysis , - SMA and stromal density expression were independently predictive factors for survival .


Our data confirm the negative prognostic impact of high - SMA expression in pancreatic cancer patients after curatively intended resection .


In contrast to former investigations , we found a positive prognostic impact for a dense stroma .


This significant influence was restricted to patients who received no adjuvant therapy .


The CRTH@ antagonist OC@ has previously been demonstrated to reduce airway inflammation and improve lung function in moderate persistent asthma .


A study was conducted to determine the effect of lower once daily doses of OC@ and to define the phenotype of subjects most responsive to treatment .


Adult subjects ( percentage of predicted forced expiratory volume in @s ( FEV@ ) @-@ % ) were randomized to OC@ at three dose levels ( @mg once daily , @mg once daily or @mg twice daily ) or placebo for @weeks ( n = @-@ per group , full analysis set ) .


The primary endpoint was the change from baseline in prebronchodilator FEV@ , and secondary endpoints included Asthma Control Questionnaire ( ACQ ) and Standardised Asthma Quality of Life Questionnaire -LSB- AQLQ ( S ) -RSB- , and incidence of exacerbations and respiratory tract infections .


OC@ caused a significant improvement in FEV@ compared with placebo at a dose of @mg once daily ( P = @ ) .


A similar increase was observed in the other dose groups , and the mean change in FEV@ in the pooled dose groups at endpoint was @ml greater than placebo ( P = @ ) .


In a post hoc analysis of atopic eosinophilic subjects with uncontrolled asthma , a mean increase in FEV@ of @ml was observed compared with placebo ( P = @ ) .


The mean increase in FEV@ was more marked in younger subjects in this group : for subjects aged @years , there was a mean increase of @ml compared with placebo ( P = @ ) .


Improvements in ACQ and AQLQ ( S ) were observed in both the full analysis set and the atopic eosinophilic subgroup .


There was a lower incidence of exacerbations and respiratory infections in subjects treated with OC@ .


There were no drug-related serious adverse events .


OC@ is a safe and effective oral anti-inflammatory agent , which achieved clinically meaningful improvements in lung function and asthma control in allergic asthmatics with an eosinophil-dominant form of the disease .


A dose of @mg given once daily was as effective as the higher doses studied .


Squamous cell carcinoma of the anus ( SCCA ) is highly sensitive to chemoradiation ( CRT ) which achieves good loco-regional control and preserves anal function .


However , some patients require permanent stoma formation either as a result of surgery on relapse , poor anal function or treatment-related symptoms .


Our aim was to determine patient , tumour and treatment-related colostomy rates following CRT and maintenance chemotherapy in the ACT II trial .


The ACT II trial recruited @ patients comparing @FU-based CRT using cisplatin ( CisP ) or mitomycin C ( MMC ) with or without additional maintenance chemotherapy .


We investigated the association between colostomy-free survival ( CFS ) and progression-free survival ( PFS ) with age , gender , T-stage , N-stage , treatment and baseline haemoglobin .


The median follow-up was @ years ( n = @ evaluable/@ ) ; tumour site canal ( @ % ) , margin ( @ % ) ; stage T@/T@ ( @ % ) , T@/T@ ( @ % ) ; N + ( @ % ) , N@ ( @ % ) .


Twenty out of @ ( @ % ) colostomies fashioned before CRT were reversed within @ months .


One hundred and twelve patients had a post-treatment colostomy due to persistent disease ( @ ) or morbidity ( @ ) .


Fifty-two per cent ( @/@ ) of all pre-treatment colostomies were never reversed .


The @-year CFS rates were @ % MMC/Maint , @ % CisP/Maint , @ % MMC/No-maint and @ % CisP/No-maint .


CRT with CisP did not improve CFS when compared with MMC ( hazard ratio : @ , @ % confidence interval : @-@ @ , P = @ ) .


The @-year CFS rates were higher for T@/T@ ( @ % ) than T@/T@ ( @ % ) tumours and higher for node-negative ( @ % ) than node-positive ( @ % ) patients .


Significant predictors of CFS were gender , T-stage and haemoglobin , while treatment factors had no impact on outcome .


Similar associations were found between PFS and tumour/treatment-related factors .


The majority ( @ % ) of pre-treatment colostomies were never reversed .


Neither CRT with @FU/CisP nor maintenance chemotherapy impacted on CFS .


The low risk of colostomy for late effects ( @ % ) is likely to be associated with the modest total radiotherapy dose .


The predictive factors for CFS were T-stage , gender and baseline haemoglobin .


Prior studies have suggested that low baseline quality-of-life ( QOL ) scores predict worse survival in patients undergoing lung cancer surgery .


However , these studies involved average-risk patients undergoing lobectomy .


We report QOL results from a multicenter trial , American College of Surgeons Oncology Group Z@ , which randomized high-risk operable patients to sublobar resection ( SR ) , or SR with brachytherapy , and included longitudinal QOL assessments .


Global QOL , using the @-item Short-Form Health Survey ( SF@ ) , and the dyspnea score from the University of California , San Diego Shortness of Breath Questionnaire ( SOBQ ) scale , was measured at baseline , @ , @ , and @ months .


SF@ physical component summary ( PCS ) and mental component summary ( MCS ) scores were standardized and adjusted for age and gender normals , with scores < @ indicating below-average health status .


SOBQ scores were transformed to a @-@ ( poor-excellent ) scale .


Aims were to : ( @ ) determine the impact of baseline scores on recurrence-free survival , overall survival , and @-day adverse events ( AEs ) ; and ( @ ) identify subgroups ( surgical approach , resection type .


tumor location , tumor size , respiratory function ) with a @-point decline or improvement in QOL after SR. .


Two hundred twelve eligible patients were included .


There were no significant differences in baseline QOL scores between arms .


Median baseline PCS , MCS , and SOBQ scores were @ , @ , and @ , respectively .


There were no differences in grade-@ + AEs , overall survival , or recurrence-free survival in patients with baseline scores median versus > median values , except for a significantly worse overall survival for patients with baseline SOBQ scores median value .


There were no significant differences between the study arms in percentage change of QOL scores from baseline to @ , @ , or @ months .


Further comparison combining the @ arms demonstrated a higher percentage of patients with a @-point decline in SOBQ scores with segmentectomy compared with wedge resection ( @ % vs @ % , P = @ ) at @ months , with thoracotomy versus video-assisted thoracic surgery ( VATS ) ( @ % vs @ % , P = @ ) at @ months , and T@b versus T@a tumors ( @ % vs @ % , P = @ ) at @ months .


A @-point improvement in PCS score was seen at @ months with VATS versus thoracotomy ( @ % vs @ % , P = @ ) .


In high-risk operable patients , poor baseline QOL scores were not predictive for worse overall or recurrence-free survival , or for higher risk for AEs following SR. .


VATS was associated with improvement in physical function at @ months , and improved dyspnea scores at @ months , lending support for the preferential use of VATS when SR is undertaken .


The purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy ( iCBT ) program in Manga format , the Japanese cartoon , for workers and to examine the effects of the iCBT program on improving subthreshold depression using a randomized controlled trial ( RCT ) design among workers employed in private companies in Japan .


All workers in a company ( n = @ ) and all workers in three departments ( n = @,@ ) at the headquarters of another large company were recruited by an invitation e-mail .


Participants who fulfilled the inclusion criteria were randomly allocated to intervention or control groups ( N = @ for each group ) .


A six-week , six-lesson iCBT program using Manga ( Japanese comic ) story was developed .


The program included several CBT skills : self-monitoring , cognitive restructuring , assertiveness , problem solving , and relaxation .


The intervention group studied the iCBT program at a frequency of one lesson per week .


Depression ( Beck Depression Inventory II ; BDI-II ) was assessed as a primary outcome at baseline , and three - and six-month follow-ups for both intervention and control groups were performed .


The iCBT program showed a significant intervention effect on BDI-II ( t = -@ , p < @ ) with small effect sizes ( Cohen 's d : -@ , @ % Confidence Interval : -@ to @ , at six-month follow-up ) .


The present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population .


It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program .


Nutritional support is crucial to the management of patients receiving invasive mechanical ventilation ( IMV ) and the most commonly prescribed treatment in intensive care units ( ICUs ) .


International guidelines consistently indicate that enteral nutrition ( EN ) should be preferred over parenteral nutrition ( PN ) whenever possible and started as early as possible .


However , no adequately designed study has evaluated whether a specific nutritional modality is associated with decreased mortality .


The primary goal of this trial is to assess the hypothesis that early first-line EN , as compared to early first-line PN , decreases day @ all-cause mortality in patients receiving IMV and vasoactive drugs for shock .


The NUTRIREA-@ study is a multicenter , open-label , parallel-group , randomized controlled trial comparing early PN versus early EN in critically ill patients requiring IMV for an expected duration of at least @hours , combined with vasoactive drugs , for shock .


Patients will be allocated at random to first-line PN for at least @hours or to first-line EN .


In both groups , nutritional support will be started within @hours after IMV initiation .


Calorie targets will be @ to @kcal/kg/day during the first week , then @ to @kcal/kg/day thereafter .


Patients receiving PN may be switched to EN after at least @hours in the event of shock resolution ( no vasoactive drugs for @ consecutive hours and arterial lactic acid level below @mmol/L ) .


On day @ , all patients receiving PN and having no contraindications to EN will be switched to EN .


In both groups , supplemental PN may be added to EN after day @ in patients with persistent intolerance to EN and inadequate calorie intake .


We plan to recruit @,@ patients at @ participating ICUs .


The NUTRIREA-@ study is the first large randomized controlled trial designed to assess the hypothesis that early EN improves survival compared to early PN in ICU patients .


Enrollment started on @ March @ and is expected to end in November @ .


Potassium-titanyl-phosphate ( KTP ) laser photocoagulation is commonly used for treatment of hereditary hemorrhagic telangiectasia-related epistaxis ( HHT-RE ) .


Electrosurgical plasma coagulation ( EPC ) , also known as coblation , has not been rigorously evaluated for HHT-RE .


Patients seeking treatment for HHT-RE between September @ and September @ were prospectively randomized ( @:@ ) to KTP or EPC in a single blind prospective cohort study .


Length of surgery and estimated blood loss ( EBL ) were recorded .


Epistaxis severity scores ( ESSs ) and @-cm visual analogue scale ( VAS ) scores for HHT-RE-related symptoms were administered at enrollment and at @ , @ , @ months following surgery .


Statistical analysis used Friedman 's and Pearson 's chi-square tests .


Eleven HHT patients were prospectively enrolled and followed .


Six patients underwent EPC treatment while @ underwent KTP .


Three patients in the KTP subgroup and @ patients in the EPC subgroup requested additional surgical treatment within @ months ( p > @ ) .


There were no significant differences in terms of EBL ( p = @ ) and length of surgery ( p = @ ) between treatment groups .


Mean ESSs were not significantly different between groups at any follow-up point ( KTP , p = @ ; EPC , p = @ ) .


Compared to KTP , mean ESSs were higher in the EPC subgroup at baseline and lower at all other time points .


Mean nasal obstruction VAS scores were significantly lower in the EPC subgroup at all follow-up points .


EPC is a viable alternative to KTP laser photocoagulation for epistaxis control in patients with HHT .


Subjectively , patients experience less nasal obstruction following EPC as compared to KTP treatment .


A multicentered , well-powered study is warranted to better determine treatment outcomes .


Xuezhikang ( XZK ) is an extract of fermented red yeast rice that has lipid-lowering properties .


To evaluate the effects of XZK on lipids in subjects with dyslipidemia but no coronary heart disease .


A total of @ adults with baseline non-high-density lipoprotein cholesterol ( non-HDL-C ) levels of approximately @mg/dL and low-density lipoprotein cholesterol ( LDL-C ) levels of approximately @mg/dL were randomized to either placebo or XZK @ or @mg daily and treated for @weeks .


A majority of the patients were white ( @ % ) or Asian ( @ % ) .


Daily XZK @mg and @mg for @ to @weeks resulted in statistically significant ( P < @ ) and clinically meaningful decreases in non-HDL-C ( @ % reduction ) and LDL-C ( @ % reduction ) compared with placebo .


XZK treatment at either dose enabled approximately @ % of subjects to reduce their LDL-C levels by@ % .


Doubling the XZK daily dose from @ to @mg at treatment week @ caused an additional @ % reduction in LDL-C .


Significant benefits were also observed across secondary efficacy variables , including total cholesterol ( TC ) , apolipoprotein B ( Apo B ) , triglycerides , HDL-C , the TC/HDL-C ratio , and the Apo B/Apo A-I ratio , at treatment week @ or @ .


XZK was safe and well tolerated .


Safety and tolerability profiles were similar across treatment groups .


Most adverse events were gastrointestinal .


No subject experienced myopathy or markedly elevated liver transaminases or creatine kinase .


Xuezhikang significantly reduced non-HDL-C and LDL-C , and was well tolerated .


Further , longer-term studies in more diverse patient populations are needed to corroborate these findings .


No prior study has compared the efficacy of bifrontal ( BF ) vs right unilateral ( RUL ) electroconvulsive therapy ( ECT ) by including the subgroup that is most likely to receive it : only elderly patients with major depression ( MD ) .


This single-site , randomized , assessor-blinded , controlled trial was conducted from @ to @ .


Seventy-three elderly patients with MD , unipolar and bipolar , were treated with a course of formula-based BF ECT or RUL ECT .


The @-item Hamilton Rating Scale for Depression ( HRSD@ ) was used to measure efficacy .


Safety was assessed with the Mini Mental State Examination ( MMSE ) .


Both electrode placements resulted in highly significant downward trends in symptom severity ( all p < @ ) , with a non-significant difference between methods ( p = @ ) .


At the end of the ECT course , response rates for the BF and RUL group were @ % and @ % , respectively .


Short-term remission , defined as an HRSD@ score@ , was achieved in @ ( @ % ) patients in the BF group and @ ( @ % ) patients in the RUL group .


Global cognitive function , as measured by the MMSE , did not deteriorate in the two treatment groups .


The small number of subjects may have led to reduced power to detect real differences .


The MMSE is not sufficient to ascertain the negative effect of ECT on cognition .


This study indicates that formula-based BF and RUL ECT are equally efficacious , and that remission rates of formula-based dosing are lower than those previously reported for titrated dosing , in a clinical sample of elderly patients with MD. .


Aging induces a shift in circulating hormones in women , accompanied by weight gain during the late reproductive , menopausal transition , and postmenopausal years .


Exercise has been shown to counter weight gain ; however , it might increase circulating androgens .


A @-month aerobic and resistance training exercise regimen was implemented to examine interrelationships between circulating sex hormones , body composition , aerobic capacity , insulin sensitivity , and insulin resistance .


Twenty-eight women , aged @ to @ years , completed the @-month intervention study .


They were randomly assigned to either a control ( CON ; n = @ ) group-and maintained their sedentary lifestyle-or an exercise intervention ( EXE ; n = @ ) group .


The exercise intervention consisted of combined aerobic and resistance workouts scheduled @ days/week for @ minutes/day .


Body weight , composition , VO@ peak , plasma insulin , glucose , lipid profile , estradiol , testosterone , progesterone , dehydroepiandrosterone , and dehydroepiandrosterone sulfate ( DHEAS ) were measured at baseline and on month @ .


Insulin sensitivity was estimated using the insulin sensitivity index and the quantitative insulin sensitivity check index , whereas insulin resistance was estimated using the homeostatic model for insulin resistance .


There was a trend toward increased DHEAS in both groups ( P < @ ) , but not as a function of the intervention .


Insulin sensitivity index increased in the EXE group compared with the CON group ( P < @ ) .


Multiple linear regression indicated that , at @ months , DHEAS was a negative contributor to insulin sensitivity in the EXE group , but not in the CON group .


In midlife women , an increase in circulating DHEAS , such as that previously reported during the menopausal transition , is associated with higher insulin resistance , but exercise can mitigate this risk by improving insulin sensitivity , thereby countering the effects of DHEAS .


To evaluate the effect of child obesity intervention comprehensive program on the improvement of overweight , obese control and knowledge-attitude-practice .


The study design was under cluster-randomized controlled trial , with @ children in the intervention and @ children in the control groups .


Repeated measurement data on child obesity was analyzed through Generalized Estimating Equation models .


The risk of becoming overweight or obesity in the intervention group was @ times more than children in the control group , showing a reduction of @ % the risk of being overweight or obese ( P = @ ) .


In addition , the possibility of increasing one unit of correct rate on obesity related knowledge , children in the intervention group children was @ times ( P = @ ) than in the control group .


On the mean obesity related correct attitude rate , it was @ times ( P = @ ) in the intervention group of the control group .


Regarding the possibility of increasing one unit om the mean obesity related behavior score , children in the intervention group was @ times ( P = @ ) than those in the control group ( P = @ ) .


The comprehensive child obesity intervention program could effectively reduce the risk of developing overweight or obesity and improving the obesity related knowledge , attitude and behavior in children .


This study aimed to determine whether the Physical Activity and Lymphedema ( PAL ) trial weight training program for breast cancer survivors at risk of or with breast cancer-related lymphedema provided skeletal benefits .


Of the @ participants in the randomized controlled PAL trial , @ ( weight training ; N = @ ; control , N = @ ) had complete measures of bone mineral density ( BMD ( in grams per square centimeter ) ) of the proximal femur and lumbar spine and were also categorized by T scores .


Women in the weight training group performed slowly progressive weight training @ days/week for @ months compared to women in the control group who maintained their usual physical activities .


There were no significant differences in the rate of BMD change at any skeletal site between weight training and control groups , regardless of menopausal status .


Distribution of bone health categories was not significantly different between groups at baseline , but became different at @ months ( p < @ ) among postmenopausal women due to an increase in the percentage of controls who became osteopenic ( @ to @ % ) compared to stable bone health in weight lifters .


The PAL weight training program that increased muscle strength without exacerbating or causing lymphedema among breast cancer survivors was not as efficacious at improving skeletal health .


The skeletal loads produced from the PAL program may be insufficient to notably shift BMD , but may have a subtle osteogenic effect .


The safety and efficacy of rigorous weight training programs for improving skeletal health in women at risk for or with breast cancer-related lymphedema remain to be determined .


Patients suffering from chronic kidney disease are at greater risk of developing infection than the normal population , and infections are the second cause of mortality after cardiovascular complications in this population .