A subset of MRI patients underwent ventricular fibrillation induction testing post-MRI to characterize defibrillation function .


In @ centers , @ patients were enrolled ( @ % male , age @ @ years ) .


The safety endpoint was met with @ % freedom from the composite endpoint ( p < @ ) .


Both efficacy endpoints were met with minimal differences in the proportion of MRI and control patients who demonstrated a@ @ V increase in ventricular pacing capture threshold ( @ % MRI vs. @ % control , noninferiority p < @ ) or a@ % decrease in R-wave amplitude ( @ % MRI vs. @ % control , noninferiority p = @ ) .


A total of @ ventricular tachyarrhythmia/ventricular fibrillation episodes ( @ induced ; @ spontaneous ) occurred in @ subjects post-MRI , with no observed effect on sensing , detection , or treatment .


This is the first randomized clinical study of an ICD system designed for full-body MRI at @-T .


These data support that the system is safe and the MRI scan does not adversely affect electrical performance or efficacy .


( Confirmatory Clinical Trial of the Evera MRI System for Conditionally-Safe MRI Access ; NCT@ ) .


A strategy of early transfer for coronary angiography and intervention is superior to a standard approach of delayed coronary angiography after fibrinolysis for ST-elevation myocardial infarction ( STEMI ) .


STEMI patients with lesions in noninfarct-related arteries have a worse prognosis compared with patients with single vessel disease .


This study aimed to assess whether the benefits of an early invasive strategy differ in patients with single vessel and multivessel disease .


The Trial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction ( TRANSFER-AMI ) randomized STEMI patients receiving fibrinolysis to a strategy of early transfer and coronary angiography vs a standard approach .


In this post hoc analysis , we stratified @ patients into @ groups according to the presence or absence of multivessel disease .


We compared the @ groups in terms of baseline characteristics , in-hospital management , and patient outcomes , and tested for treatment heterogeneity .


Multivessel disease was present in @ ( @ % ) patients .


Patients with multivessel disease had a greater rate of the primary composite end point of in-hospital death , recurrence of infarction , recurrent ischemia , shock , or heart failure at @ days ( @ % vs @ % ; P < @ ) .


An early invasive strategy was efficacious in both groups for the primary outcome .


In multivariable analysis adjusting for Global Registry of Acute Coronary Events ( GRACE ) risk score , there was no significant treatment heterogeneity ( all P interaction > @ ) for the primary end point , or death/recurrence of infarction at @ months and @ year .


Multivessel disease is present in a significant proportion of STEMI patients treated with fibrinolysis and is associated with worse outcomes .


A strategy of early transfer and coronary intervention after fibrinolysis was beneficial regardless of the presence or absence of multivessel disease .


Heavy menstrual bleeding ( HMB ) diminishes individual quality-of-life and poses substantial societal burden .


In HMB endometrium , inactivation of cortisol ( by enzyme @ hydroxysteroid dehydrogenase type @ ( @HSD@ ) ) , may cause local endometrial glucocorticoid deficiency and hence increased angiogenesis and impaired vasoconstriction .


We propose that ` rescue ' of luteal phase endometrial glucocorticoid deficiency could reduce menstrual bleeding .


DexFEM is a double-blind response-adaptive parallel-group placebo-controlled trial in women with HMB ( @ to be randomised ) , with active treatment the potent oral synthetic glucocorticoid dexamethasone , which is relatively resistant to @HSD@ inactivation .


Participants will be aged over @years , with mean measured menstrual blood loss ( MBL ) for two screening cycles @mL .


The primary outcome is reduction in MBL from screening .


Secondary end points are questionnaire assessments of treatment effect and acceptability .


Treatment will be for @days in the mid-luteal phases of three treatment menstrual cycles .


Six doses of low-dose dexamethasone ( ranging from @ to @ mg twice daily ) will be compared with placebo , to ascertain optimal dose , and whether this has advantage over placebo .


Statistical efficiency is maximised by allowing randomisation probabilities to ` adapt ' at five points during enrolment phase , based on the response data available so far , to favour doses expected to provide greatest additional information on the dose-response .


Bayesian Normal Dynamic Linear Modelling , with baseline MBL included as covariate , will determine optimal dose ( re reduction in MBL ) .


Secondary end points will be analysed using generalised dynamic linear models .


For each dose for all end points , a @ % credible interval will be calculated for effect versus placebo .


Disrupting the physical structure of pulses by blending them or by using a digestive supplement ( - galactosidase ) to reduce intestinal discomfort could potentially negate the previously observed beneficial effects of whole pulses of lowering appetitive and glycemic responses because of more rapid digestion .


We hypothesized that blended lentils , - galactosidase , or both increase postprandial appetite and blood glucose responses vs. whole lentils .


Men and women -LSB- n = @ ; means SDs body mass index ( kg/m ( @ ) ) : @ @ ; aged @ @ y -RSB- consumed breakfast meals containing whole ( W ) , blended ( B ) , or no lentils -LSB- control ( C ) -RSB- , each with @ - galactosidase or placebo capsules in a randomized , crossover , double-blind placebo-controlled trial .


Between each test day there was a @ - to @-d washout period .


Mixed-model ANOVA showed effects of meal on postprandial appetite and glucose ( P = @-@ @ ) .


The B meal resulted in higher postprandial appetite ratings than did the W meal but not the C meal for hunger , desire to eat , and prospective consumption ( = @-@ @ points ; P = @-@ @ ) .


Postprandial glucose concentration was @ mg/dL lower for the B meal than for the C meal ( P < @ ) but did not differ from the W meal .


There were no main effects of - galactosidase , but there were meal - galactosidase interaction effects , with a greater postprandial desire to eat and lower postprandial fullness with the B meal than with the @ other meals in the placebo condition but not in the - galactosidase condition .


Blending lentils increased appetite ( @ % ) , but not glycemic response , compared with whole lentils , whereas - galactosidase did not .


Both B and W meals may be consumed ( with or without an - galactosidase supplement ) with little impact on appetite , without increasing glycemic response .


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


To determine whether patients prefer topical anesthesia or subconjunctival anesthesia for intravitreal injection .


Consecutive patients receiving bilateral simultaneous injections of anti-vascular endothelial growth factor agents were asked to participate in this within-patient , prospective , single-blinded , randomized , factorial study .


Fifty-seven patients completed the study .


Both eyes were treated with topical anesthesia .


One eye was also injected with subconjunctival lidocaine .


Anesthesia for the next treatment visit was based on patient preference at the conclusion of the study visit and at a @-hour and @-hour follow-up telephone call .


Patients were allowed to change their anesthesia preference during the next three visits .


The final endpoint for the study was anesthesia preference for ongoing intravitreal injections .


Fifty patients ( @ % ) preferred subconjunctival anesthesia and seven patients ( @ % ) preferred topical anesthesia for ongoing treatments .


( P = @ ) CONCLUSION : Given the choice , most patients prefer subconjunctival anesthesia to topical anesthesia for intravitreal injections .


To describe the experience and results from the roll-in phase of the Cardiovascular Outcomes with Renal Atherosclerotic Lesions ( CORAL ) study .


The CORAL roll-in database was used to describe the baseline characteristics of the patients in the roll-in cohort , all of whom underwent renal artery stent placement ; to evaluate CORAL site performance ; to compare estimates of lesion ( stenosis ) severity made by site interventionalists with the central CORAL angiographic core laboratory readings ; and to report outcomes after renal artery stent placement .


During the roll-in phase , @ patients ( mean age , @ y @ ; @ % male ) underwent renal artery stent procedures .


Angiographic core laboratory analysis of renal arteriograms was done , and participants were followed at @ month and @ months .


Major angiographic complications were identified in @ ( @ % ) subjects .


Kidney function remained unchanged at the short ( @-@ weeks ) follow-up interval .


Improvement in systolic blood pressure with use of distal embolic protection devices ( n = @ ) did not show any clinical benefit over nonuse of such devices ( n = @ ) in this small series .


At @ months , there were significantly more endpoints reported by site in subjects with bilateral renal artery stenosis ( P = @ ) and prior history of stroke ( P = @ ) .


In the roll-in phase of the CORAL study , a significant number of angiographic complications were identified .


No effect was seen on estimated glomerular filtration rate after renal artery stent placement , but systolic blood pressure decreased significantly .


There is a strong reciprocal association between two highly prevalent public health problems : intimate partner violence and heavy drinking , both of which remain major sources of morbidity and mortality .


Brief interventions in the Emergency Department setting have been found to be effective in reducing alcohol-related injury but neither classic intimate partner violence nor substance abuse interventions have adequately integrated assessment and treatment for these co-occurring conditions .


The overall goal of this study is to determine whether a motivational intervention delivered at the time of an Emergency Department visit will reduce heavy drinking and improve the safety of women experiencing intimate partner violence .


We are completing data collection for a randomized controlled trial enrolling @ female patients , age @-@ , presenting to one of two urban Emergency Departments , who self-disclose both problem drinking and intimate partner violence .


Eligible patients are randomized to a brief manual-guided motivational intervention , and a phone booster at @ days .


The intervention , which is delivered by masters-level therapists during the Emergency Department visit , is recorded and monitored for fidelity .


Primary outcomes are episodes of heavy drinking and incidents of intimate partner violence , assessed weekly by Interactive Voice Response System for @ weeks and at @ , @ and @ months by interviewers blinded to group assignment .


To identify the impact of assessment alone , we included a no-contact control group assessed only once at @ months .


Secondary outcomes include violence severity , changes in the Composite Abuse Scale and alcohol quantity/frequency , along with other health-related behaviors .


The analysis will also explore the impact of likely mediators and moderators of the intervention .


While screening and intervention for intimate partner violence is now recommended for women of child bearing age in health care settings , there is a need for rigorous evaluations of what works for whom .


Upon completion , we will have high-quality evidence regarding the effectiveness of a low-intensity , brief motivational intervention , delivered by social workers in the Emergency Department setting , for decreasing episodes of heavy drinking and intimate partner violence .


Ultimately , this is a model could be generalizable to other acute health care settings .


Phytotherapy has been used to treat patients with lower urinary tract symptoms ( LUTS ) .


We evaluated the efficacy and tolerability of combination therapy between Serenoa Repens ( SeR ) , Lycopene ( Ly ) , and Selenium ( Se ) + tamsulosin versus single therapies .


PROCOMB trial ( ISRCTN@ ) was a randomized double-blinded , double-dummy multicenter study of @ patients between @ and @ years old , PSA@ng/ml , IPSS @ , prostate volume @ cc , Qmax @ml/sec , postvoid residual urine ( PVR ) < @ml .


Participants were randomized group A ( SeR-Se-Ly ) , group B ( tamsulosin @ mg ) , group C ( SeR-Se-Ly + tamsulosin @ mg ) .


The primary endpoints of the study were the reduction of IPSS , PVR , and increase of Qmax in group C versus monotherapy groups .


The decrease for combination therapy was significantly greater versus group A ( P < @ ) and group B ( P < @ ) for IPSS and versus group A ( P < @ ) for PVR from baseline to @ months .


A greater decrease in IPSS was observed for Group C versus group A ( P < @ ) and increase in Qmax versus group B ( P < @ ) , from @ months to @ months .


At one year , the changes of IPSS and Qmax were greater for Group C versus monotherapies ( each comparison < @ ) .


The proportions of men with a decrease of at least three points ( each comparison P < @ ) and decrease of @ % for IPSS ( each comparison P < @ ) were greater for Group C.


SeR-Se-Ly + tamsulosin therapy is more effective than single therapies in improving IPSS and increasing Qmax in patients with LUTS .


Severe alcoholic hepatitis has high short-term mortality .


The aim of this study was to test the hypothesis that treatment of patients with alcoholic hepatitis with granulocyte colony-stimulating factor ( G-CSF ) might mobilize bone marrow-derived stem cells and promote hepatic regeneration and thus improve survival .


Forty-six patients with severe alcoholic hepatitis were prospectively randomized in an open study to standard medical therapy ( SMT ) plus G-CSF ( group A ; n = @ ) at a dose of @g/kg subcutaneously every @h for @ consecutive days or to SMT alone ( group B ; n = @ ) at a tertiary care center .


We assessed the mobilization of CD@ ( + ) cells on day @ , Child-Turcotte-Pugh ( CTP ) , model for end-stage liver disease ( MELD ) , and modified Maddrey 's discriminant function ( mDF ) scores , and survival until day @ .


There was a statistically significant increase in the number of CD@ ( + ) cells in peripheral blood in group A as compared with group B ( P = @ ) after @ days of G-GSF therapy .


There was a significant reduction in median change % in CTP , MELD , and mDF at @ , @ , and @ months in group A as compared with group B ( P < @ ) .


There was marked improvement in survival in group A as compared with group B ( @ % vs. @ % ; P = @ ) at @ days .


G-CSF is safe and effective in the mobilization of hematopoietic stem cells and improves liver function as well as survival in patients with severe alcoholic hepatitis .


Multiple studies have been conducted that demonstrate the superiority of patch angioplasty over primary closure for carotid endarterectomy ( CEA ) .


Patch angioplasty with polytetrafluorethylene patches ( ACUSEAL ) have shown results comparable to patch angioplasty with saphenous vein and polyester patches .


This is a prospective randomized study to compare the clinical outcomes of CEA using ACUSEAL versus bovine pericardium patching ( Vascu-Guard ) .


Two hundred patients were randomized ( @:@ ) to either ACUSEAL or Vascu-Guard patching .


Demographic data/clinical characteristics were collected .


Intraoperative hemostasis times and the frequency of reexploration for neck hematoma were recorded .


All patients received immediate and @-month postoperative duplex ultrasound studies , which were repeated at @-month intervals .


A Kaplan-Meier analysis was used to estimate the risk of restenosis and the stroke-free survival rates .


The demographics were similar in both groups , except for a higher incidence of current smokers in the ACUSEAL group and more patients with congestive heart failure in the Vascu-Guard group ( P = @ and @ , respectively ) .


The mean operative internal carotid artery diameter and the mean arteriotomy length were similar in both groups .


The mean hemostasis time was @ min for ACUSEAL patching vs. @ min for Vascu-Guard ( P = @ ) ; however , the mean operative times were similar for both groups ( ACUSEAL @ hr vs. Vascu-Guard @ hr , P = @ ) .


The incidence of reexploration for neck hematoma was higher in the Vascu-Guard group ; @ % vs. @ % ( P = @ ) .


The incidence of perioperative ipsilateral neurologic events was @ % for ACUSEAL patching vs. @ % for Vascu-Guard patching ( P = @ ) .


The mean follow-up period was @ months .


The respective freedom from @ % carotid restenosis at @ , @ , and @ years were @ % , @ % , and @ % for ACUSEAL patching vs. @ % , @ % , and @ % for Vascu-Guard patching ( P = @ ) .


The ipsilateral stroke-free rates at @ , @ , and @ years were @ % for ACUSEAL and @ % for Vascu-Guard patching .


Although CEA patching with ACUSEAL versus Vascu-Guard differed in hemostasis time , the frequency of reexploration for neck hematomas was more frequent in the pericardial patch group ; however , only @ patient had documented suture line bleeding and the surgical reexploration rate is not likely to be patch related .


There were not any significant differences in perioperative/late neurologic events and late restenosis in the @ groups .


Uptake of chlamydia screening by men in England has been substantially lower than by women .


Non-traditional settings such as sports clubs offer opportunities to widen access .


Involving people who are not medically trained to promote screening could optimise acceptability .


We developed two interventions to explore the acceptability and feasibility of urine-based sexually transmitted infection ( STI ) screening interventions targeting men in football clubs .


We tested these interventions in a pilot cluster randomised control trial .


Six clubs were randomly allocated , two to each of three trial arms : team captain-led and poster STI screening promotion ; sexual health adviser-led and poster STI screening promotion ; and poster-only STI screening promotion ( control/comparator ) .


Primary outcome was test uptake .


Across the three arms , @ men participated in the trial and @ accepted the offer of screening ( @ % , @ % CI @ % to @ % ) .


Acceptance rates were broadly comparable across the arms : captain-led : @/@ ( @ % ) ; health professional-led : @/@ ( @ % ) ; and control : @/@ ( @ % ) .


However , rates varied appreciably by club , precluding formal comparison of arms .


No infections were identified .


Process evaluation confirmed that interventions were delivered in a standardised way but the control arm was unintentionally ` enhanced ' by some team captains actively publicising screening events .


Compared with other UK-based community screening models , uptake was high but gaining access to clubs was not always easy .


Use of sexual health advisers and team captains to promote screening did not appear to confer additional benefit over a poster-promoted approach .


Although the interventions show potential , the broader implications of this strategy for UK male STI screening policy require further investigation .


Agitation is a major problem in acute schizophrenia .


Only a few studies have tested antipsychotic agents in severely agitated patients , mainly because of legal issues .


Furthermore , most studies were limited to the first @ hours .


We aimed to investigate the efficacy of oral haloperidol , risperidone , and olanzapine in reducing psychotic agitation in severely agitated patients with schizophrenia or schizophreniform or schizoaffective disorder over @ hours using a prospective , randomized , rater-blinded , controlled design within a naturalistic treatment regimen .


In total , @ severely agitated patients at acute care psychiatric units were enrolled .


Participants were randomly assigned to receive either daily haloperidol @ mg , olanzapine @ mg , or risperidone @ to @ mg over @ days .


Positive and Negative Syndrome Scale psychotic agitation subscale score was the primary outcome variable .


A mixed-model analysis was applied .


All drugs were effective for rapid tranquilization within @ hours .


Over @ days , the course differed between agents ( P < @ ) , but none was superior .


Dropouts occurred only in the risperidone and olanzapine groups .


Men responded better to treatment than did women during the initial @ hours ( P = @ ) as well as over the @-day course ( P < @ ) .


No difference between drug groups was observed regarding diazepam or biperiden use .


Oral haloperidol , risperidone , and olanzapine seem to be suitable for treating acute severe psychotic agitation in schizophrenia spectrum disorders .


Response to oral antipsychotics demonstrated a gender effect with poorer outcome in women throughout the study .


Early dysfunction of transplanted kidney is a serious complication that can lead to the premature loss of transplant .


Ischemic and reperfusion injury of donor kidney leads to the disturbance of the function of the graft , which is a form of post-transplantation acute kidney injury that causes the relevance of search of early markers for diagnosis .


Evaluation of the diagnostic value of determination in the urine neutrophilgelatinase-associated lipocalin ( u-NGAL ) in patients in the early period after kidney transplantation .


An open , randomized , retrospective comparative study of @ patients , who underwent kidney transplantation from a living human-related donor ( group @ , @ patients ) and from donor with brain death documentation ( group @ , @ patients ) was carried out .


In @ patients of the second group ( group @a ) rapid recovery of graft function was observed , and in @ patients ( group @b ) -- delayed graft recovery as a result of postischemic acute kidney injury .


During the first five post-transplantation days investigated biochemical analysis of blood and urine , as well as the marker u-NGAL .


Because of kidney transplantation was performed to the patients with end-stage chronic renal failure , high values of urea and creatinine in the blood samples during the first postoperative days were noted , that reflected the severity of the preoperative state of the patients .


In the patients , who underwent human-related kidney transplantation , a more favorable picture of the investigated laboratory parameters was seen .


Values of u-NGAL in this group in the early post-transplant period were normal , which attested to the absence of significant ischemic injury of transplanted kidney .


In @ patients with cadaver kidney transplantation average u-NGAL value during the first post-transplant day was @-times fold exceeded normal range ( @ ng/ml ) , while in @ patients of the group with human-related transplantation -- only @ times .


In the first day in group @a average u-NGAL value decreased to normal , while in group @b , where renal replacement therapy was carried out from the first day , remained extremely high ( more than @ ng/ml , p < @ to compare with other two groups ) during all @ days of investigation .


Conducting of hemodialysis sessions during the first week was required in @ patients of group @b , on the @nd week -- @ patients , on the @ and @ week in @ patients @ , and on the fifth week -- in @ patients .


Due to prolonged period of ischemia in kidney transplantation from a donor with established brain death the level of u-NGAL in these patients was significantly higher than in the kidneys transplantation from living human-related donor .


In patients after transplantation dynamics of u-NGAL allows to identify patients with delayed graft function recovery and the need for renal replacement therapy already in the early postoperative period .


Ultrasonic surgery can dissect structures and divide vessels by the effect produced by vibrations in the tissues .


It is believed to be less traumatic than the more commonly used monopolar electrosurgery ( ELC ) .


Laparoscopic techniques are being used increasingly in surgical conditions complicated by peritonitis .


This randomized study compares the acute inflammatory and systemic immune response after laparoscopic cholecystectomy in patients with acute calculous cholecystitis , complicated by peritonitis , performed using either ultrasonic energy or ELC .


Forty-three patients , scheduled for laparoscopic cholecystectomy , were randomly assigned to treatment using either an ultrasonic device ( UC ) ( n = @ patients ) or ELC ( n = @ patients ) .


Bacteremia , endotoxemia , white blood cells , the peripheral lymphocyte subpopulation , human leukocyte antigen-DR ( HLA-DR ) , neutrophil-elastase , interleukin-@ and -@ , and C-reactive protein ( CRP ) were investigated .


Significantly higher concentration of systemic endotoxin , neutrophil , neutrophil-elastase , interleukin-@ and -@ , and CRP were detected intraoperatively and/or postoperatively in the ELC group of patients in comparison with the UC group ( P < @ ) .


A statistically significant change in HLA-DR expression was recorded on postoperative Day @ as a reduction of this antigen expressed on the monocyte surface in patients from the ELC group ; no changes were noted in UC patients ( P < @ ) .


We recorded @ patients ( @ % ) who developed an intraabdominal abscess in the ELC group and @ ( @ % ) in the UC group ( P < @ ) .


Laparoscopic cholecystectomy after biliary peritonitis , conducted by ELC , increased the incidence of bacteremia and systemic inflammation compared with the UC group .


Early enhanced postoperative systemic inflammation may cause lower transient immunologic defense in the ELC group , leading to enhanced sepsis .


Elevated serum digoxin concentration can cause toxicity , including death .


Dronedarone increases digoxin concentration by P-glycoprotein interaction .


In Permanent Atrial Fibrillation Outcome Study Using Dronedarone On Top Of Standard Therapy Trial ( PALLAS ) , dronedarone was associated with both increased cardiovascular death and heart failure in patients with permanent atrial fibrillation .


The present analysis examines whether the dronedarone-digoxin interaction might explain these adverse outcomes .


Subgroup analysis was performed to compare outcomes of patients on digoxin at baseline or not .


In PALLAS , @ patients were randomized to dronedarone and @ to placebo , of whom @ ( @ % ) and @ ( @ % ) were receiving digoxin , respectively .


Median ( Q@ , Q@ ) digoxin serum concentration on day @ was @ ( @,@ ) ng/mL on dronedarone and @ ( @,@ ) ng/mL on placebo ( P < @ ) .


Among patients on digoxin , there were @ ( @ % / year ) cardiovascular deaths on dronedarone and @ ( @ % / year ) on placebo ( adjusted hazard ratio , @ ; @ % confidence interval , @-@ @ ; P = @ ) .


Among patients not on digoxin , there were @ cardiovascular deaths on dronedarone ( @ % / year ) and @ on placebo ( @ % / year ; adjusted hazard ratio , @ ; @ % confidence interval , @-@ @ ; P = @ ; interaction P value @ ) .


In patients on digoxin , there were @ arrhythmic deaths on dronedarone and none on placebo ; and in patients not on digoxin , there were @ arrhythmic deaths on dronedarone and @ on placebo ( P value for interaction @ ) .


There was no interaction between baseline digoxin use and the adverse effect of dronedarone on heart failure events .


In PALLAS , there was a strong effect of concurrent digoxin use on the adverse effect of dronedarone on cardiovascular death , but not on occurrence of heart failure .


Activation of the ileal brake , by infusing lipid directly into the distal part of the small intestine , alters gastrointestinal ( GI ) motility and inhibits food intake .


The ileal brake effect on eating behavior of the other macronutrients is currently unknown .


The objective of this study was to investigate the effects of ileal infusion of sucrose and casein on food intake , release of GI peptides , gastric emptying rate and small-bowel transit time with safflower oil as positive control .


This randomized , single-blind , crossover study was performed in @ healthy subjects ( @ male ; mean age @ years ; mean body mass index @ kgm ( -@ ) ) who were intubated with a naso-ileal catheter .


Thirty minutes after the intake of a standardized breakfast , participants received an ileal infusion , containing control ( ( C ) saline ) , safflower oil ( ( HL ) @ kcal ) , low-dose casein ( ( LP ) @ kcal ) or high-dose casein ( ( HP ) @ kcal ) , low-dose sucrose ( ( LC ) @ kcal ) and high-dose sucrose ( ( HC ) @ kcal ) , over a period of @min .


Food intake was determined during an ad libitum meal .


Visual analogue score questionnaires for hunger and satiety and blood samples were collected at regular intervals .


Ileal infusion of lipid , protein and carbohydrate resulted in a significant reduction in food intake compared with control ( HL : @ kcal , P < @ ; HP : @ kcal , P < @ ; HC : @ kcal , P < @ vs control : @ kcal , P < @ , respectively ) .


A reduction in energy intake was still apparent when the caloric amount of infused nutrients was added to the amount eaten during the ad libitum meal.Secretion of cholecystokinin and peptide YY but not of glucagon-like peptide-@ ( @-@ ) was increased during ileal perfusion of fat , carbohydrates and protein .


During ileal perfusion of all macronutrients , a delay in gastric emptying and intestinal transit was observed , but differences were not significant compared with control .


Apart from lipids , also sucrose and casein reduce food intake on ileal infusion , thereby activating the ileal brake .


In addition to food intake , also satiety and GI peptide secretion were affected .


To determine if the glucagon-like peptide-@ ( GLP-@ ) receptor agonist albiglutide , once weekly , impairs counter-regulatory responses during hypoglycaemia .


We conducted a randomized , double-blind , parallel , placebo-controlled study in subjects with type @ diabetes mellitus .


A single dose of albiglutide @mg ( n = @ ) or placebo ( n = @ ) was administered on day @ .


Glucose was clamped on day @ ( to coincide with the approximate albiglutide maximum plasma concentration ) at @ , @ , @ , @ and @ mmol/l ( @ , @ , @ , @ and @ mg/dl ) , with a post-clamp recovery period to @ mmol/l ( @mg/dl ) .


Hormone measurements were made at each plateau and adverse events ( AEs ) were recorded .


The counter-regulatory hormones glucagon , epinephrine , norepinephrine , growth hormone and cortisol were appropriately suppressed when plasma glucose levels were > @ mmol/l ( > @mg/dl ) , but increased in the albiglutide and placebo groups with glucose levels < @ mmol/l ( < @ mg/dl ) in response to hypoglycaemia .


The area under the curve geometric mean ratios ( albiglutide : placebo ) , calculated from the clamped plateau of @ mmol/l ( @mg/dl ) to the glucose recovery point , were not significantly different for any of the counter-regulatory hormones .


When plasma glucose levels were > @ mmol/l ( > @mg/dl ) , albiglutide increased pancreatic - cell secretion of C-peptide in a glucose-dependent manner to a greater extent than did placebo , and it was suppressed in each group when levels were < @ mmol/l ( < @mg/dl ) .


No significant difference between groups was observed in the recovery time to glucose level @ mmol/l ( @mg/dl ) .


There were no clinically relevant differences in AEs or other safety variables .


A single @-mg dose of albiglutide was well tolerated and did not impair the counter-regulatory response to hypoglycaemia .


These data provide mechanistic evidence supporting the low intrinsic hypoglycaemic potential of albiglutide .


A step stool is an ordinary device to improve the quality of chest compression ( CC ) during in-hospital cardiopulmonary resuscitation ( CPR ) .


We investigated the effect of an inclined step stool on the quality of CC during CPR on a hospital bed .


We conducted a randomized crossover study of simulation using a manikin .


Two different methods of CC were performed and compared : CC using a flat stool and CC using an inclined ( @ ) stool .


Each session of CC was performed for @ minutes using a metronome at a rate of @ beats per minute .


The primary outcome was the depth of CC .


The adequate CC rate , duty cycle , rate of incomplete recoil , and the angle between the arm of the participants and the bed were also measured .


The median value of the mean depth of CC was @ mm ( @-@ @ mm ) in the flat stool group and @ mm ( @-@ @ mm ) in the inclined stool group ( P = @ ) .


The adequate CC rate was significantly higher in the inclined stool group ( @ % -LSB- @ % -@ % -RSB- vs @ % -LSB- @ % -@ % -RSB- ; P = @ ) .


The duty cycle and the rate of incomplete recoil were comparable between the @ groups .


The angles between the arm of the participants and the bed were more vertical in the inclined stool group ( @ @ vs @ @ ; P = @ ) .


Using an inclined stool resulted in an improvement in the depth of CC and the adequate CC rate without increasing the rate of incomplete chest recoil .


Interlaminar epidural steroid injection is a well-established intervention for the treatment of radicular pain .


Pain is commonly reported during the injection into the epidural space ; this provocation is typically either concordant or discordant with the patient 's baseline pain .


It is not well known how this provocation pain relates to treatment outcomes .


To determine the relationship between concordant versus discordant provocation during interlaminar epidural steroid injection and its effects on pain reduction at follow-up .


Secondary analysis of a single center , prospective randomized double-blind study .


Interlaminar epidural steroid injections under fluoroscopic guidance were performed on @ patients with radicular lumbosacral pain .


After injection with @ mg methylprednisolone and @ mL of normal saline at a single level , patients were asked to report if pain was provoked , and whether the pain was concordant or discordant with their baseline pain .


The primary outcome measure was self-rated percentage of pain reduction from baseline at @-week follow-up .


Secondary outcomes included improvement in activity level and decreased analgesic consumption .


Provocation was observed in @ out of @ patients ( @ % ) .


This was further classified as concordant ( @/@ , @ % ) or discordant ( @/@ , @ % ) pain .


The concordant group achieved a significant decrease in self-reported pain as compared to the discordant group at @-week follow-up ( @ % , t = @ , P < @ ) .


There were also significantly more patients in the concordant group who reported @ % pain reduction as compared to the discordant group ( X = @ , df ( @ ) , P < @ ) .


There were no significant differences between concordant and discordant groups in regard to improvements in activity level ( X = @ ) and decreased analgesic use ( X = @ ) .


The secondary analysis did not examine long-term outcomes .


The concordant group demonstrated significantly higher pain reduction as compared to the discordant group .


There were no significant differences between the @ groups in terms of improved function or reduced analgesic requirements .


Concordant provocation during interlaminar epidural injection may be a predictor of outcome .


Previous small studies have indicated that commonly prescribed drugs may be associated with microscopic colitis ( MC ) .


With an increasing incidence of MC , it is important to explore the association between exposure to proton pump inhibitors ( PPIs ) , nonsteroidal anti-inflammatory drugs , statins , and selective serotonin reuptake inhibitors and MC in a larger setting .


Case-control study based on nationwide Danish registries .


The study included all patients with MC diagnosis during the period @ to @ .


One hundred sex - and age-matched controls per case were randomly selected among the Danish population .


Prescriptions were recorded in a Prescription Register in the year before the first recorded MC diagnosis .


Effect measure is the adjusted odds ratio ( OR ) of collagenous colitis ( CC ) and lymphocytic colitis ( LC ) according to prescriptions of PPIs , nonsteroidal anti-inflammatory drugs , statins , and selective serotonin reuptake inhibitors .


Within the control group , we identified a subgroup with MC-free colonic biopsies .


We identified @ patients with CC and @ with LC and found a positive association between redemption of prescriptions for PPIs and both CC ( OR = @ ; @ % confidence interval , @-@ @ ) and LC ( OR = @ ; @ % confidence interval , @-@ @ ) .


Among patients with MC-free colon biopsies in the control group , the association between PPIs and CC was strongly positive ( OR = @ ; @ % confidence interval , @-@ @ ) .


Adding this parameter to the model attenuated all of the associations , but they remained positive for PPIs versus CC and selective serotonin reuptake inhibitors versus LC .


We found positive associations between exposure to all @ medication classes and MC .


Variations in endoscopic frequency by drug category indicate a potential impact of bias .


Antiretroviral therapy reduces the risk of tuberculosis , but tuberculosis is more common in people with HIV than in people without HIV .


We aimed to assess the effect of isoniazid preventive therapy on the risk of tuberculosis in people infected with HIV-@ concurrently receiving antiretroviral therapy .


For this pragmatic randomised double-blind , placebo-controlled trial in Khayelitsha , South Africa , we randomly assigned ( @:@ ) patients to receive either isoniazid preventive therapy or a placebo for @ months ( could be completed during @ months ) .


Randomisation was done with random number generator software .


Participants , physicians , and pharmacy staff were masked to group assignment .


The primary endpoint was time to development of incident tuberculosis ( definite , probable , or possible ) .


We excluded tuberculosis at screening by sputum culture .


We did a modified intention-to-treat analysis and excluded all patients randomly assigned to groups who withdrew before receiving study drug or whose baseline sputum culture results suggested prevalent tuberculosis .


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


@ participants were randomly assigned to receive isoniazid preventive therapy ( n = @ ) or placebo ( n = @ ) between Jan @ , @ , and Sept @ , @ , and contributed @ person-years of follow-up to the analysis .


We recorded @ incident cases of tuberculosis ; @ were in the isoniazid preventive therapy group ( @ per @ person-years , @ % CI @-@ ) , and @ in the placebo group ( @ per @ person-years , @-@ ; hazard ratio -LSB- HR -RSB- @ , @ % CI @-@ ) .


Study drug was discontinued because of grade @ or @ raised alanine transaminase concentrations in @ of @ individuals in the isoniazid preventive therapy group and ten of the @ individuals in the placebo group ( risk ratio @ , @ % CI @-@ ) .


We noted no evidence that the effect of isoniazid preventive therapy was restricted to patients who were positive on tuberculin skin test or interferon gamma release assay ( adjusted HR for patients with negative tests @ -LSB- @-@ -RSB- and @ -LSB- @-@ -RSB- ; for positive tests @ -LSB- @-@ -RSB- and @ -LSB- @-@ -RSB- , respectively ) .


Without a more predictive test or a multivariate algorithm that predicts benefit , isoniazid preventive therapy should be recommended to all patients receiving antiretroviral therapy in moderate or high incidence areas irrespective of tuberculin skin test or interferon gamma release assay status .


Utilization of energy-dense lipid fuels is critical to the rapid development and growth of neonates .


To increase efficiency of milk fat utilization by newborn pigs , the effect of clofibrate on in vivo and in vitro long-chain fatty acid ( LCFA ) oxidation was evaluated .


Newborn male pigs were administered @ mL of vehicle ( @ % Tween @ ) with or without clofibrate ( @ mg/kg body weight ) once daily via i.g. gavage for @ d. Total LCFA oxidative capacity was measured in respiration chambers after gastric infusion ( n = @ per treatment ) with isoenergetic amounts of -LSB- @ - ( @ ) C -RSB- triglycerides ( TGs ) , either oleic acid ( @:@ n-@ ) TG -LSB- @ mmol/kg body weight ( BW ) ( @ ) -RSB- or erucic acid ( @:@ n-@ ) TG ( @ mmol/kg BW ( @ ) ) .


Total expired ( @ ) CO@ was collected and quantified at @-min intervals over @ h. Hepatic in vitro LCFA oxidation was determined simultaneously using -LSB- @ - ( @ ) C -RSB- oleic acid and erucic acid substrates .


The in vivo @-h accumulative -LSB- @ - ( @ ) C -RSB- TG oxidation ( percentage of energy intake/kg BW ( @ ) ) tended to increase with clofibrate supplementation ( P = @ ) , although there was no difference in the peak or mean utilization rate .


The maximal extent of oleic acid TG oxidation was @-fold that of erucic acid TG ( P < @ ) .


Hepatic in vitro LCFA oxidation increased @ % with clofibrate ( P < @ ) .


The increase in mitochondria was @-fold greater than in peroxisomes .


The relative abundance of mRNA increased @ - to @-fold for hepatic peroxisome proliferator-activated receptor and its target genes ( fatty acyl-coenzyme A oxidase and carnitine palmitoyltransferase ) in the pigs that were administered clofibrate ( P < @ ) .


Clofibrate may improve in vivo LCFA oxidative utilization in neonatal pigs .


This study sought to characterize major bleeding on the basis of the components of the major bleeding definition , to explore major bleeding by location , to define @-day mortality after a major bleeding event , and to identify factors associated with major bleeding .


Apixaban was shown to reduce the risk of major hemorrhage among patients with atrial fibrillation in the ARISTOTLE ( Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ) trial .


All patients who received at least @ dose of a study drug were included .


Major bleeding was defined according to the criteria of the International Society on Thrombosis and Haemostasis .


Factors associated with major hemorrhage were identified using a multivariable Cox model .


The on-treatment safety population included @,@ patients .


The rate of major hemorrhage among patients in the apixaban group was @ % per year compared with @ % per year in the warfarin group ( hazard ratio -LSB- HR -RSB- @ , @ % confidence interval -LSB- CI -RSB- : @ to @ ; p < @ ) .


Compared with warfarin , major extracranial hemorrhage associated with apixaban led to reduced hospitalization , medical or surgical intervention , transfusion , or change in antithrombotic therapy .


Major hemorrhage followed by mortality within @ days occurred half as often in apixaban-treated patients than in those receiving warfarin ( HR @ , @ % CI : @ to @ ; p < @ ) .


Older age , prior hemorrhage , prior stroke or transient ischemic attack , diabetes , lower creatinine clearance , decreased hematocrit , aspirin therapy , and nonsteroidal anti-inflammatory drugs were independently associated with an increased risk .


Apixaban , compared with warfarin , was associated with fewer intracranial hemorrhages , less adverse consequences following extracranial hemorrhage , and a @ % reduction in fatal consequences at @ days in cases of major hemorrhage .


Dislocation of the shoulder joint is one of the most common dislocations .


The reduction procedure is a painful procedure .


In this study , @ different treatment groups were compared for pain control during shoulder dislocation reduction .


It was aimed to evaluate the differences between the groups in reduction , success , length of hospital stay , complications , side effects , patient-physician satisfaction , and ease of application .


The study was planned to be prospective and randomized .


As procedural sedation analgesia ( SA ) , titration of ketamine @ to @ mg/kg was administered intravenously to group @ .


Suprascapular nerve block ( SNB ) was applied under ultrasound guidance ( USG ) to group @ .


Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test .


The @ test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test , and a value of P < @ was accepted as statistically significant .


The study comprised a total of @ patients ; @ in the group @ and @ in the group @ .


No statistically significant difference was determined between the groups in terms of age ( P = @ ) , sex ( P = @ ) , reduction success ( P = @ ) , and patient-physician satisfaction ( P = @ ) .


The time spent in the emergency department ( ED ) by patients in the SA group was signficantly longer compared with the SNB group .


No side effects were observed in the SNB group .


Suprascapular nerve block , which can be easily applied under USG in the ED , can be evaluated as a good alternative to SA in the reduction of shoulder dislocations .


Eicosapentaenoic acid ( EPA ) plus docosahexaenoic acid ( DHA ) supplementation has beneficial cardiovascular effects , but postprandial influences of these individual fatty acids are unclear .


The primary objective was to determine the vascular effects of EPA + DHA compared with DHA only during postprandial lipemia relative to control high-oleic acid meals ; the secondary objective was to characterize the effects of linoleic acid-enriched high-fat meals relative to the control meal .


We conducted a randomized , controlled , double-blind crossover trial of @ high-fat ( @-g ) meals containing @ ) high-oleic acid sunflower oil ( HOS ; control ) , @ ) HOS + fish oil ( FO ; @ g EPA and DHA ) , @ ) HOS + algal oil ( AO ; @ g DHA ) , and @ ) high-linoleic acid sunflower oil ( HLS ) in @ healthy men ( aged @-@ y ) with higher than optimal fasting triacylglycerol concentrations ( mean SD triacylglycerol , @ @ mmol/L ) .


Elevations in triacylglycerol concentration relative to baseline were slightly reduced after FO and HLS compared with the HOS control ( P < @ ) .


The characteristic decrease from baseline in plasma nonesterified fatty acids after a mixed meal was inhibited after AO ( @-@ h , P < @ ) .


HLS increased the augmentation index compared with the other test meals ( P < @ ) , although the digital volume pulse-reflection index was not significantly different .


Plasma @-isoprostane F@ analysis revealed opposing effects of FO ( increased ) and AO ( reduced ) compared with the control ( P < @ ) .


No differences in nitric oxide metabolites were observed .


These data show differential postprandial @-isoprostane F@ responses to high-fat meals containing EPA + DHA-rich fish oil compared with DHA-rich AO , but these differences were not associated with consistent effects on postprandial vascular function or lipemia .


More detailed analyses of polyunsaturated fatty acid-derived lipid mediators are required to determine possible divergent functional effects of single meals rich in either DHA or EPA .


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


Clonidine is used with local anaesthetics to improve analgesia .


However , the improvement conferred when clonidine is used together with ropivacaine is controversial .


Thus , the present study aimed to evaluate the improvement in analgesia when clonidine is used together with ropivacaine for supraclavicular brachial plexus block .


This was a prospective , randomised , double-blind controlled study .


A total of @ patients who were scheduled to undergo supraclavicular block were randomly assigned into three groups ( i.e. clonidine , lignocaine and control groups ) of @ .


Patients in all three groups received @ mL of @ % ropivacaine .


In addition to that , patients in the clonidine group received @ mL of clonidine ( @ g ) plus @ mL of saline , patients in the lignocaine group received @ mL of @ % lignocaine with adrenaline ( @:@,@ ) , and patients in the control group received @ mL of saline .


The characteristics of anaesthesia and analgesia for these three groups were assessed .


The addition of @ % lignocaine with adrenaline to ropivacaine led to earlier onset of the sensory block ( by @ mins ) , but no increase in the duration of analgesia when compared to analgesia using ropivacaine alone .


The addition of clonidine to ropivacaine led to earlier onset of sensory and motor blocks ( by @ mins and @ mins , respectively ) , as well as an increased duration of sensory and motor blocks ( by @ mins and @ mins , respectively ) when compared to analgesia using ropivacaine alone .


The total duration of analgesia was increased by @ mins with clonidine when compared to analgesia using ropivacaine alone .


There were no significant differences in sedation score and no side effects in all three groups .


When compared to the use of ropivacaine alone , the addition of @ g clonidine to ropivacaine for brachial plexus block achieved earlier analgesic onset and improved duration of analgesia , without unwanted side effects .


To explore the effect and the mechanism of Danhong Injection ( DI ) , Ligustrazine Injection ( LI ) , and adsorbable biomembranes in preventing the adhesion of tendons and tissues .


Totally @ patients all suffering from simple flexor digitorum tendon rupture on the hand zone two damaged by sharp weapons were randomly assigned to Group A ( Dikang adsorbable biomembrane ) , Group B ( Tianxinfu adsorbable biomembrane ) , Group C ( Tianxinfu adsorbable biomembrane + Ligustrazine group ) , and Group D ( Tianxinfu adsorbable biomembrane + DI group ) in accordance with random digit table , @ cases in each group .


Indicators such as total active movement ( TAM ) of the hand tendon , Minnesota manual dexterity test ( MMDT ) , and finger flex strength test ( FFST ) were observed .


The TAM and the favorable rate were higher in Group C and D than in Group A and B at post-operative @ and @ week ( P < @ , P < @ ) .


There was no statistical difference between Group C and D ( P > @ ) .


Each index of MMDT was lower in Group C and D than in Group A and B ( P < @ ) .


There was no statistical difference in FFST among all the @ groups ( P > @ ) .


Combined application of LI or DI with Tianxinfu adsorbable biomembranes could effectively prevent the adhesion of tendons .


DI showed equivalent effect as LI did .


Besides , the combined application was superior in preventing adhesion to using Xintianfu adsorbable biomembrane or Dikan adsorbable biomembrane alone .


Sham acupuncture turned out to be more effective than expected .


The effect of acupuncture can not be assessed by optical rhinometry ( ORM ) .


In most cases nasal congestion is caused by hypertrophy of the inferior turbinate as a result of allergic and chronic rhinitis .


Topical decongestants cause severe side effects .


As a consequence , there is an increasing demand for alternative treatment options such as traditional Chinese medicine ( TCM ) .


A total of @ patients with nasal congestion due to hypertrophic inferior turbinate were recruited .


The mucosal swelling status of the inferior turbinate was assessed by continuous ORM for @ min .


Patients were asked to score the severity of their nasal congestion on a visual analogue scale ( VAS ) before and @ and @ min after acupuncture .


Specific verum acupuncture points related to nasal congestion were tested against non-specific control sham acupuncture points .


Sham acupuncture improved VAS scores , whereas ORM measured an increase in nasal swelling .


The ORM revealed a quicker onset of the effect of verum acupuncture on the nasal blood flow .


Also , verum acupuncture reaches its maximum effect in a shorter time period , so that the net reaction time was much shorter .


However , ORM could not prove a decongestant effect of verum acupuncture on inferior turbinate .


To compare the efficacy of gait training using a single-leg version of the Hybrid Assistive Limb ( HAL ) on the paretic side with conventional gait training in individuals with subacute stroke .


Randomized open controlled pilot trial .


Hospitalized care .


Convenience sample of @ patients who met the criteria ; @ patients refused .


After randomization ( N = @ ) , @ patients withdrew and a total of @ poststroke participants ( HAL group : n = @ ; conventional group : n = @ ) completed the randomized controlled trial .


All participants received twelve @-minute sessions in @ weeks of either HAL ( wearing the single-leg version of the HAL on their paretic side ) or conventional ( performed by skilled and experienced physical therapists ) gait training .


Outcome measures were evaluated prior to training and after @ sessions .


Functional Ambulation Category ( FAC ) was the primary outcome measure , whereas secondary outcome measures included maximum walking speed , timed Up and Go test , @-minute walk distance , Short Physical Performance Battery , Fugl-Meyer Assessment of Lower Extremity , and isometric muscle strength ( hip flexion and extension , knee flexion and extension ) .


No participants withdrew because of adverse effects .


Participants who received gait training with the HAL showed significantly more improvement in the FAC than those who received conventional gait training ( @ % confidence interval , @ -@ ; P = @ ) .


Secondary measures did not differ between the @ groups .


The results obtained in this randomized controlled trial suggest that a gait training program with the HAL could improve independent walking more efficiently than conventional gait training .


To investigate the effectiveness of a program that utilizes community involvement to improve the self-management strategies among people living with hypertension .


Forty-four subjects , aged @ to @-year-old , with hypertension in Nakhon Pathom Province , Thailand , were randomly allocated to either an experimental group ( n = @ ) or a control group ( n = @ ) .


The experimental group attended a program to improve self-management methods based on social cognitive theory ( SCT ) .


The program lasted @ weeks , consisted of @@/@ hours meeting once a week , including group meetings and home visit monitoring .


Mann-Whitney U test and Friedman test were employed to analyze the program 's effectiveness .


After the program , the mean rank of the perceived self-efficacy for the self-management strategies was statistically different between the two groups ( p = @ ) .


In the experimental group , after the twelve week , the mean rank of perceived self-efficacy and outcome expectancy increased and diastolic blood pressure decreased after the eight week .


The program applied social cognitive theory ( SCT ) to promote self-management techniques , increased the health promoting behavior among hypertensive people .


The antiepileptic drug topiramate reduces levodopa-induced dyskinesia without exacerbating parkinsonism in animal models .


We report a randomized , double-blind , placebo-controlled crossover trial in patients with Parkinson 's disease and levodopa-induced dyskinesia .


Fifteen patients with Parkinson 's disease and stable levodopa-induced dyskinesia were enrolled into the study , of whom @ were randomized to topiramate or placebo .


The study medication was titrated to @mg/day over four weeks , and assessments were carried out after a further two weeks .


Dyskinesia severity assessed by a blinded rater from video recordings was the primary outcome measure .


Seven patients ( mean age @ years ) completed the study .


Patients taking topiramate vs. placebo showed a significant increase in dyskinesia severity compared to baseline ( Wilcoxon signed rank test , P = @ ) .


Five patients withdrew from the study whilst taking topiramate due to adverse effects .


Topiramate tended to worsen dyskinesia in patients with Parkinson 's disease , and was poorly tolerated .


Does functional electrical stimulation ( FES ) cycling increase urine output and decrease lower limb swelling and spasticity in people with recent spinal cord injury ?


Randomised cross-over trial .


Fourteen participants with a recent motor complete spinal cord injury were consecutively recruited from two spinal cord injury units in Sydney .


Participants were randomised to an experimental phase followed by a control phase or vice versa , with a @-week washout period in between .


The experimental phase involved FES cycling four times a week for two weeks and the control phase involved standard rehabilitation for two weeks .


Assessments by a blinded assessor occurred at the beginning and end of each phase .


Allocation was concealed and an intention-to-treat analysis was performed .


The primary outcome was urine output ( mL/hr ) and the secondary outcomes were lower limb circumference , and spasticity using the Ashworth Scale , and the Patient Reported Impact of Spasticity Measure ( PRISM ) .


In addition , participants were asked open-ended questions to explore their perceptions about treatment effectiveness .


All participants completed the study .


The mean between-group difference ( @ % CI ) for urine output was @mL/hr ( -@ to @ ) .


The mean between-group differences ( @ % CI ) for lower limb swelling , spasticity ( Ashworth ) , and PRISM were -@ cm ( -@ to @ ) , -@ points ( -@ to @ ) and -@ points ( -@ to @ ) , respectively .


All point estimates of treatment effects favoured FES cycling .


Participants reported many benefits from FES cycling .


There were no clear effects of FES cycling on urine output , swelling and spasticity even though all point estimates of treatment effects favoured FES cycling and participants perceived therapeutic effects .


Coronary artery bypass grafting ( CABG ) has been considered the standard of care for patients with three-vessel disease ( @VD ) , but long-term comparative results from randomized trials of CABG vs. percutaneous coronary intervention ( PCI ) using drug-eluting stents ( DES ) remain limited .


Patients with de novo @VD or left main disease were randomly assigned to PCI with the paclitaxel-eluting first-generation stent or CABG in the SYNTAX trial .


This pre-specified analysis presents the @-year outcomes of patients with @VD ( n = @ ) .


The rate of major adverse cardiac and cerebrovascular events ( MACCE ) was significantly higher in patients with PCI compared with CABG ( @ vs. @ % , respectively ; P < @ ) .


Percutaneous coronary intervention as opposed to CABG resulted in significantly higher rates of the composite of death/stroke/myocardial infarction ( MI ) ( @ vs. @ % , respectively ; P < @ ) , all-cause death ( @ vs. @ % , respectively ; P = @ ) , MI ( @ vs. @ % , respectively ; P = @ ) , and repeat revascularization ( @ vs. @ % , respectively ; P < @ ) ; however , stroke was similar between groups at @ years ( @ vs. @ % , respectively ; P = @ ) .


Results were dependent on lesion complexity ( P for interaction = @ ) ; in patients with a low ( @-@ ) SYNTAX score , PCI vs. CABG resulted in similar rates of MACCE ( @ % vs. @ % , respectively ; P = @ ) but significantly more repeat revascularization ( @ % vs. @ % , respectively ; P = @ ) , while in intermediate ( @-@ ) or high ( @ ) SYNTAX score terciles , CABG demonstrated clear superiority in terms of MACCE , death , MI , and repeat revascularization .


Differences in MACCE between PCI and CABG were larger in diabetics -LSB- hazard ratio ( HR ) = @ -RSB- than non-diabetics ( HR = @ ) , although the P for interaction failed to reach significance for MACCE ( P for interaction = @ ) or any of the other endpoints .


Five-year results of patients with @VD treated with CABG or PCI using the first-generation paclitaxel-eluting DES suggest that CABG should remain the standard of care as it resulted in significantly lower rates of death , MI , and repeat revascularization , while stroke rates were similar .


For patients with low SYNTAX scores , PCI is an acceptable revascularization strategy , although at a price of significantly higher rates of repeat revascularization .


This study aimed to compare the effects of topical and systemic lignocaine on the circulatory response to direct laryngoscopy performed under general anaesthesia .


Ninety-nine patients over @ years of age , with a physical status of I-II ( classified according to the American Society of Anesthesiologists ) , were randomly allocated to @ groups .


One group received @ml of @ per cent physiological saline intravenously , one group received @ mg/kg lignocaine intravenously , and another group received seven puffs of @ per cent lignocaine aerosol applied topically to the airway .


Mean arterial pressures , heart rates and peripheral oxygen saturations were recorded , and changes in mean arterial pressure and heart rate ratios were calculated .


Changes in the ratios of mean arterial pressure and heart rate were greater in the saline physiological group than the other groups at @ minute after intubation .


Changes in the ratios of mean arterial pressure ( at the same time point ) were greater in the topical lignocaine group than in the intravenous lignocaine group , but this finding was not statistically significant .


Lignocaine limited the haemodynamic responses to laryngoscopy and endotracheal intubation during general anaesthesia in rigid suspension laryngoscopy .


To investigate whether planning target volume ( PTV ) margins may be safely reduced in radiotherapy of localized prostate cancer incorporating daily online tube potential-cone beam CT ( CBCT ) image guidance and the anticipated benefit in predicted rectal toxicity .


The prostate-only clinical target volume ( CTV@ ) and rectum were delineated on @ pre-treatment CBCT each week in @ randomly selected patients .


By transposing these contours onto the original plan , dose-volume histograms ( DVHs ) for CTV@ and the rectum were each calculated and combined , for each patient , to produce a single mean DVH representative of the dose delivered over the treatment course .


Plans were reoptimized using reduced CTV@ to PTV@ margins and the consequent radiobiological impact modelled by the tumour control probability ( TCP ) and normal tissue complication probability ( NTCP ) of the rectum .


All CBCT images were deemed of sufficient quality to identify the CTV and rectum .


No loss of TCP was observed when plans using the standard @-mm CTV@ to PTV@ margin of the centre were reoptimized with a @ - or @-mm margin .


Margin reduction was associated with a significant decrease in rectal NTCP ( @-@mm ; p < @ and @-@mm ; p < @ ) .


Using daily online image guidance with CBCT , a reduction in CTV@ to PTV@ margins to @mm is achievable without compromising tumour control .


The consequent sparing of surrounding normal tissues is associated with reduced anticipated rectal toxicity .


Margin reduction is feasible and potentially beneficial .


Centres with image-guided radiotherapy capability should consider assessing whether margin reduction is possible within their institutes .


Risk of cancer progression is reduced for patients with human papillomavirus ( HPV ) - positive oropharynx cancer ( OPC ) relative to HPV-negative OPC , but it is unknown whether risk of death after progression is similarly reduced .


Patients with stage III-IV OPC enrolled onto Radiation Therapy Oncology Group trials @ or RTOG @ who had known tumor p@ status plus local , regional , and/or distant progression after receiving platinum-based chemoradiotherapy were eligible for a retrospective analysis of the association between tumor p@ status and overall survival ( OS ) after disease progression .


Rates were estimated by Kaplan-Meier method and compared by log-rank ; hazard ratios ( HRs ) were estimated by Cox models .


Tests and models were stratified by treatment protocol .


A total of @ patients with p@-positive ( n = @ ) or p@-negative ( n = @ ) OPC were included in the analysis .


Patterns of failure and median time to progression ( @ v @ months ; P = @ ) were similar for patients with p@-positive and p@-negative tumors .


After a median follow-up period of @ years after disease progression , patients with p@-positive OPC had significantly improved survival rates compared with p@-negative patients ( @-year OS , @ % v @ % ; median , @ v @ years ; P < @ ) .


p@-positive tumor status ( HR , @ ; @ % CI , @ to @ ) and receipt of salvage surgery ( HR , @ ; @ % CI ; @ to @ ) reduced risk of death after disease progression whereas distant versus locoregional progression ( HR , @ ; @ % CI , @ to @ ) increased risk , after adjustment for tumor stage and cigarette pack-years at enrollment .


Tumor HPV status is a strong and independent predictor of OS after disease progression and should be a stratification factor for clinical trials for patients with recurrent or metastatic OPC .


We analyzed the potential of abiraterone acetate ( henceforth abiraterone ) to reduce androgen levels below lower limits of quantification ( LLOQ ) and explored the association with changes in PSA decline in metastatic castration-resistant prostate cancer ( mCRPC ) patients .


COU-AA-@ is a @:@ randomized , double-blind , placebo-controlled study comparing abiraterone ( @mg q.d. ) plus low-dose prednisone ( @mg b.i.d. ) with placebo plus prednisone in mCRPC patients post docetaxel .


Serum testosterone , androstenedione and dehydroepiandrosterone sulfate from baseline to week @ were measured by novel ultrasensitive two-dimensional liquid chromatography coupled to tandem mass spectrometry assays in a subset of subjects in each arm ( abiraterone plus prednisone , n = @ ; prednisone , n = @ ) .


The association between PSA response ( < or = @ % baseline ) and undetectable androgens ( week @ androgen level below LLOQ ) was analyzed using logistic regression .


A significantly greater reduction in serum androgens was observed with abiraterone plus prednisone versus prednisone ( all P < or = @ ) , reaching undetectable levels for testosterone ( @ % versus @ % , respectively ) .


A positive association was observed between achieving undetectable serum androgens and PSA decline ( testosterone : odds ratio = @ ; @ % confidence interval : @-@ @ ) .


Reduction of androgens to undetectable levels did not occur in all patients achieving a PSA response , and a PSA response did not occur in all patients achieving undetectable androgen levels .


Abiraterone plus prednisone significantly reduced serum androgens , as measured by ultrasensitive assays and was generally associated with PSA response .


However , androgen decline did not uniformly predict PSA decline suggesting ligand-independent or other mechanisms for mCRPC progression .


Maintaining quality of life ( QOL ) and physical and mental health status are important outcomes throughout the aging process .


Although cross-sectional studies suggest a relationship between global QOL and physical activity , it is unclear whether such a relationship exists as a function of exercise training .


We examined the effects of two exercise intervention arms on health-related quality of life ( HRQOL ) and global QOL .


Low-active , older adults ( n = @ ) were randomly assigned to either a @-month aerobic walking group or a strengthening and flexibility group .


HRQOL and QOL were measured at baseline , @ , and @ months .


There was a significant group by time effect on QOL -LSB- F ( @,@ ) = @ , p = @ , ( @ ) = @ -RSB- .


There was also a significant overall group by time effect for HRQOL -LSB- F ( @,@ ) = @ , p = @ , ( @ ) = @ -RSB- , which was explained by the significant group by time interaction for mental health status ( p = @ , ( @ ) = @ ) favoring the walking condition .


Further analyses using latent class analysis revealed three classes of individuals with differential patterns of change in QOL and HRQOL across time .


These classes reflected no change , declines , and improvements in these constructs across time .


Walking appears to enhance the mental aspect of HRQOL and global QOL when compared to a non-aerobic intervention .


Additionally , the patterns of change in QOL and HRQOL were not linear over time .


Our findings are in contrast to previous reports that these outcomes change a little or not at all in randomized trials .


This study explores the usefulness of virtual simulation training for learning to place pedicle screws in the lumbar spine .


Twenty-six senior medical students anonymously participated and were randomized into two groups ( A = no simulation ; B = simulation ) .


Both groups were given @ minutes to place two pedicle screws in a sawbones model .


Students in Group A underwent traditional visual/verbal instruction whereas students in Group B underwent training on pedicle screw placement in the ImmersiveTouch simulator .


The students in both groups then placed two pedicle screws each in a lumbar sawbones models that underwent triplanar thin slice computerized tomography and subsequent analysis based on coronal entry point , axial and sagittal deviations , length error , and pedicle breach .


The average number of errors per screw was calculated for each group .


Semi-parametric regression analysis for clustered data was used with generalized estimating equations accommodating a negative binomial distribution to determine any statistical difference of significance .


A total of @ pedicle screws were analyzed .


The reduction in the average number of errors per screw after a single session of simulation training was @ % ( P = @ ) .


The average number of errors per screw in the simulation group was @ versus @ in the non-simulation group .


The simulation group outperformed the non-simulation group in all variables measured .


The three most benefited measured variables were length error ( @ % ) , coronal error ( @ % ) , and pedicle breach ( @ % ) .


Computer-based simulation appears to be a valuable teaching tool for non-experts in a highly technical procedural task such as pedicle screw placement that involves sequential learning , depth perception , and understanding triplanar anatomy .


We compared nab-paclitaxel or ixabepilone once per week to paclitaxel with bevacizumab as first-line therapy for patients with advanced breast cancer ( BC ) to evaluate progression-free survival ( PFS ) for nab-paclitaxel or ixabepilone versus paclitaxel .


Eligible patients were age @ years with chemotherapy-naive advanced BC .


Patients were randomly assigned to bevacizumab with paclitaxel @ mg/m ( @ ) ( arm A ) , nab-paclitaxel @ mg/m ( @ ) ( arm B ) , or ixabepilone @ mg/m ( @ ) ( arm C ) , once per week for @ of @ weeks .


Planned enrollment was @ patients , which would give @ % power to detect a hazard ratio of @ .


In all , @ patients were enrolled , and @ received treatment ( @ % received bevacizumab ) .


Arm C was closed for futility at the first interim analysis ( n = @ ) , and arm A ( n = @ ) and arm B ( n = @ ) were closed for futility at the second interim analysis .


Median PFS for paclitaxel was @ months , ixabepilone was inferior to paclitaxel ( PFS , @ months ; hazard ratio , @ ; @ % CI , @ to @ ; P < @ ) , and nab-paclitaxel was not superior to paclitaxel ( PFS , @ months ; hazard ratio , @ ; @ % CI , @ to @ ; P = @ ) .


Results were concordant with overall survival ; time to treatment failure was significantly shorter in both experimental arms v paclitaxel .


Hematologic and nonhematologic toxicity , including peripheral neuropathy , was increased with nab-paclitaxel , with more frequent and earlier dose reductions .


In patients with chemotherapy-naive advanced BC , ixabepilone once per week was inferior to paclitaxel , and nab-paclitaxel was not superior with a trend toward inferiority .


Toxicity was increased in the experimental arms , particularly for nab-paclitaxel .


Paclitaxel once per week remains the preferred palliative chemotherapy in this setting .


The aim of the present study was to assess the efficacy and safety of vildagliptin as add-on to sulfonylurea therapy in Chinese patients with type @ diabetes mellitus ( T@DM ) inadequately controlled on sulfonylurea monotherapy .


The @-week randomized double-blind placebo-controlled study compared vildagliptin @mg , q.d. , with placebo as add-on to glimepiride in T@DM patients who were inadequately controlled ( HbA@c @ % -@ % -LSB- @-@mmol / mol -RSB- ) on a stable dose of sulfonylurea for @ weeks before study entry .


In all , @ patients were randomized to receive either vildagliptin ( n = @ ) or placebo ( n = @ ) .


At baseline , overall mean age was @ years , body weight @ kg , duration of diabetes @ years and daily glimepiride dose @ mg .


After @ weeks , the adjusted mean change ( AM ) in HbA@c was -@ % ( -@ mmol/mol ; baseline @ % , @mmol/mol ) in the vildagliptin group and -@ % ( -@ mmol/mol ; baseline @ % , @mmol/mol ) in the placebo group , with a treatment difference of -@ % ( -@ mmol/mol ; P < @ ) .


The between-group difference in AM in fasting plasma glucose was -@ mmol/L ( P = @ ) .


There was a slight , but not significant , decrease in body weight in both groups .


No hypoglycemic events were reported in either group , including those patients reaching HbA@c < @ % .


Patients in the vildagliptin and placebo groups reported low and comparable incidences of adverse events ( @ % vs. @ % ) and serious adverse events ( @ % in each group ) .


Vildagliptin @mg , q.d. , added to sulfonylurea monotherapy is effective in Chinese patients with T@DM , without increasing the risk of hypoglycemia and weight gain .


A distinct suppressive effect of a whey protein ( including glycomacropeptide ) - enriched preload drink on subsequent food intake in comparison with a maltodextrin carbohydrate-enriched preload was demonstrated in an earlier companion study with the same female subjects ; however , the potential mediators underlying the effect are unclear .


The objective of this study was to investigate how the ingestion of a whey protein-enriched preload beverage affected postprandial plasma concentrations of several satiety-related gastrointestinal hormones and metabolites in comparison with a maltodextrin carbohydrate-enriched preload .


Eighteen normal-weight women were studied in a single-blind , randomized block design .


Blood samples were collected at various time intervals for @min after consumption of a test drink ( @ml , ~ @kJ ) enriched ( @g ) with either maltodextrin carbohydrate or whey protein containing naturally present glycomacropeptide .


Plasma-active ghrelin concentrations decreased after both maltodextrin carbohydrate - and whey protein-enriched test drinks ( P < @ ) .


The whey protein-enriched beverage led to increased plasma concentrations of cholecystokinin ( CCK ) at @ and @min ( P < @ ) , glucagon-like peptide-@ ( GLP-@ ) at @min ( P < @ ) , peptide tyrosine-tyrosine ( PYY ) at @ and @min ( P < @ ) and pancreatic polypeptide ( PP ) from @ to @min ( P < @ ) compared with maltodextrin carbohydrate .


Total amino acid , urea and ammonia plasma concentrations were also higher after whey protein compared with maltodextrin carbohydrate ingestion ( P < @ ) .


Increased plasma concentrations of some gastrointestinal hormones related to satiety , particularly PP , and of amino acids and their metabolites , may have acted either singly or together to mediate the observed satiety response to whey protein .


Sleep deprivation in hospitalized patients is common and can have serious detrimental effects on recovery from illness .


Lavender aromatherapy has improved sleep in a variety of clinical settings , but the effect has not been tested in the intermediate care unit .


To determine the effect of inhalation of @ % lavender oil on patients ' vital signs and perceived quality of sleep in an intermediate care unit .


A randomized controlled pilot study was conducted in @ patients .


Control patients received usual care .


The treatment group had @ mL of @ % pure lavender oil in a glass jar in place at the bedside from @ pm until @ am .


Vital signs were recorded at intervals throughout the night .


At @ am all patients completed the Richard Campbell Sleep Questionnaire to assess quality of sleep .


Blood pressure was significantly lower between midnight and @ am in the treatment group than in the control group ( P = @ ) According to the overall mean change score in blood pressure between the baseline and @ am measurements , the treatment group had a decrease in blood pressure and the control group had an increase ; however , the difference between the @ groups was not significant ( P = @ ) .


Mean overall sleep score was higher in the intervention group ( @ ) than in the control group ( @ ) , but the difference was not significant .


Lavender aromatherapy may be an effective way to improve sleep in an intermediate care unit .


Some observational studies have reported that transfusion of red-cell units that have been stored for more than @ to @ weeks is associated with serious , even fatal , adverse events .


Patients undergoing cardiac surgery may be especially vulnerable to the adverse effects of transfusion .


We conducted a randomized trial at multiple sites from @ to @ .


Participants @ years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for @ days or less ( shorter-term storage group ) or for @ days or more ( longer-term storage group ) for all intraoperative and postoperative transfusions .


The primary outcome was the change in Multiple Organ Dysfunction Score ( MODS ; range , @ to @ , with higher scores indicating more severe organ dysfunction ) from the preoperative score to the highest composite score through day @ or the time of death or discharge .


The median storage time of red-cell units provided to the @ participants who received red-cell transfusion was @ days in the shorter-term storage group and @ days in the longer-term storage group .


The mean change in MODS was an increase of @ and @ points , respectively ( @ % confidence interval for the difference , -@ to @ ; P = @ ) .


The @-day mortality was @ % in the shorter-term storage group and @ % in the longer-term storage group ( P = @ ) ; @-day mortality was @ % and @ % , respectively ( P = @ ) .


Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group .


The duration of red-cell storage was not associated with significant differences in the change in MODS .


We did not find that the transfusion of red cells stored for @ days or less was superior to the transfusion of red cells stored for @ days or more among patients @ years of age or older who were undergoing complex cardiac surgery .


( Funded by the National Heart , Lung , and Blood Institute ; RECESS ClinicalTrials.gov number , NCT@ . )


The two largest studies of mammalian target of rapamycin inhibitor treatment of autosomal dominant polycystic kidney disease ( ADPKD ) demonstrated no clear benefit on the primary endpoint of total kidney volume ( TKV ) or on eGFR .


The present study evaluated two levels of rapamycin on the @-month change in ( @ ) I-iothalamate GFR ( iGFR ) as the primary endpoint and TKV secondarily .


In a @-month open-label pilot study , @ adult patients with ADPKD were randomly assigned to low-dose ( LD ) rapamycin ( rapamycin trough blood level , @-@ ng/ml ) ( LD group , n = @ ) , standard-dose ( STD ) rapamycin trough level ( > @-@ ng/ml ) ( STD group , n = @ ) , or standard care ( SC group , n = @ ) .


They were evaluated with iGFR and noncontrast computed tomography .


Change in iGFR at @ months was significantly higher in the LD group ( @ ml/min per @ m ( @ ) ; n = @ ) than in the SC group ( -@ @ ml/min per @ m ( @ ) ; n = @ ) ( LD versus SC : P < @ ) .


Change in iGFR at @ months in the STD group ( @ @ ml/min per @ m ( @ ) ; n = @ ) was not significantly greater than that in the SC group ( P = @ ) , but it was in the combined treatment groups ( LD+STD versus SC : P < @ ) .


Neither eGFR calculated by the CKD-Epidemiology Collaboration equation nor TKV ( secondary endpoint ) changed significantly from baseline to @ months in any of the groups .


On the basis of results of the mixed model , during the study , patients in the LD group had significantly lower trough blood levels of rapamycin ( mean range SD , @ @ to @ @ ng/ml ) compared with those in the STD group ( @ @ to @ @ ng/ml ) ( P < @ ) .


Patients with ADPKD receiving LD rapamycin demonstrated a significant increase in iGFR compared with those receiving standard care , without a significant effect on TKV after @ months .


Conclusive evidence indicating an effective treatment for carpal tunnel syndrome ( CTS ) , a common entrapment neuropathy , is lacking .


Ultrasound therapy ( US therapy ) has long been used as one of the combination treatments for CTS .


In addition , paraffin bath therapy has been applied widely as a physical modality in treating patients with hand conditions .


The purpose of this randomized trial was to compare the efficacy of combining a wrist orthosis with either US therapy or paraffin bath therapy in treating CTS patients .


Patients with CTS were randomized into two groups .


All patients received a wrist orthosis .


Twice per week , one group underwent paraffin therapy , and the other group underwent ultrasound therapy .


Each patient received a questionnaire , physical examination and nerve conduction study of the upper extremities before and after treatment for eight weeks .


Sixty patients were recruited , and @ completed the study .


Statistical analysis revealed significant improvements in symptom severity scores in both groups .


After adjusting for age , gender and baseline data , the analysis of covariance revealed a significant difference in the functional status score between two groups .


The combination of ultrasound therapy with a wrist orthosis may be more effective than paraffin therapy with a wrist orthosis .


To study the role of exercise in asthma management in children and formulate exercise prescriptions for asthmatic children .


A total of @ asthmatic children aged @-@ years were randomized into control group ( n = @ , with medications only ) and exercise group ( n = @ , with medications and exercise prescription ) for a trial lasting for @ months .


An asthma diary was used for all children to record the morning and evening peak expiratory flow ( PEF ) , daytime and nighttime asthma symptom score , use of short-acting beta agonists , participation in physical activity , and exercise-induced asthma symptoms .


Of the @ children , @ dropped out before the trial completion .


From the @th week , PEF variation in exercise group was significantly lowered compared to that in the control group ( P < @ ) .


Upon the completion of the trial , the daytime and nighttime symptoms score and emergency medication score were all significantly lower in the exercise group than in the control group ( P < @ ) .


No severe adverse events occurred in the children during the trial .


Exercise for no less than @ min , @ days a week for @ months is safe and beneficial for asthma control in children .


Karydakis flap ( K-flap ) and excision with healing by secondary intention ( EHSI ) are currently accepted methods for surgical management of sacrococcygeal pilonidal disease .


This clinical trial study aimed to compare early and late outcomes of these two surgical techniques .


In this controlled , prospective , randomized clinical trial , patients diagnosed with sacrococcygeal pilonidal disease were randomly allocated to two groups .


Patients in the first group underwent Karydakis procedure , whereas EHSI was the surgical management in the second group .


The two techniques were compared based on their overall time of wound healing , return to work , rate of complications , and recurrence .


A total of @ patients including @ in the K-flap group and @ in the EHSI group were included in the study .


The median follow-up duration was @ mo. .


The mean time of wound healing ( @ versus @ d , P < @ ) , return to work ( @ versus @ , P < @ ) , rate of wound complications ( @ % versus @ % , P = @ ) , and recurrence ( @ % versus @ % , P = @ ) were all significantly lower in the K-flap group .


The mean operation time was significantly shorter in the EHSI group ( @ versus @ min , P < @ ) .


The K-flap group showed significantly higher pain on their first postoperative day and significantly less pain after @ wk ( P < @ ) .


Although both techniques are safe , the K-flap is associated with significantly lower rates of complications and recurrence and significantly shorter time of wound healing and return to work .


The adverse prognostic impact of metabolic syndrome ( METS ) in unselected populations and in patients with coronary heart disease has been previously shown .


The aim of the current analysis was to evaluate the impact of METS on prognosis in chronic heart failure ( HF ) .


International Diabetes Federation criteria were used for the diagnosis of METS .


Adjusted Cox regression models with all-cause and HF death as outcomes were fitted in @ patients enrolled in GISSI-HF trial with no missing values for the variables of interest .


Risk of all-cause and HF death was significantly reduced in patients with METS compared to patients without METS ( HR : @ , @ % CI : @ to @ , p = @ ; HR : @ , @ % CI : @ to @ , p = @ ; respectively ) .


As compared with patients with no METS and no type @ diabetes mellitus ( DM ) , the risk of all-cause and HF death was significantly lower in patients with METS and no DM ( HR : @ , @ % CI : @ to @ , p = @ ; HR : @ , @ % CI : @ to @ , p = @ ; respectively ) , whereas it was significantly increased in patients with DM and no METS ( HR : @ , @ % CI : @ to @ , p < @ ; HR : @ , @ % CI : @ to @ , p < @ ; respectively ) .


Patients with METS and DM showed no difference for risk of total and HF death compared with patients with no METS and no DM ( HR : @ , @ % CI : @ to @ , p = @ ; HR : @ ; @ % CI : @ to @ ; p = @ ; respectively ) .


METS is associated with reduced all-cause and HF mortality in patients with HF .


HF patients with DM without METS are at the highest risk of mortality , whereas METS attenuates mortality risk in HF patients with DM .


The aim of this randomized , crossover study was to determine if transoral fundoplication ( TF ) could further improve clinical outcomes in partial responders to high-dose ( HD ) proton-pump inhibitor ( PPI ) therapy and to evaluate durability of TF .


In seven United States centers , patients with hiatal hernia @ cm and abnormal esophageal acid exposure ( EAE ) were randomized to TF ( n = @ ) or HD PPIs ( n = @ ) group .


At @-month follow-up , PPI patients underwent crossover .


We assessed clinical outcomes @-month post TF in crossover patients ( COP ) , as compared to @-month of HD PPI therapy , and @-month outcomes in patients initially randomized to TF .


The primary outcome was symptom control evaluated by Reflux Disease Questionnaire and Reflux Symptom Index .


Secondary outcomes included healing of esophagitis , normalization of EAE and PPI use after TF .


We analyzed @ COP and @ TF patients .


McNemar 's test or Fisher exact test was used to compare proportions .


Of @ randomized patients , @ were lost to follow-up , leaving @ TF and @ COP for analyses .


In the COP , TF further improved control of regurgitation and of atypical symptoms achieved after six months of HD PPIs .


Of @ patients with GERD symptoms after six months of high-dose PPI therapy , @ % ( @/@ ) reported global elimination of troublesome regurgitation and atypical symptoms post TF off PPIs ; @ % ( @/@ ) reported no troublesome regurgitation .


Esophagitis further healed in @ % ( @/@ ) of patients .


Seventy-one percent of COP patients were off PPIs six months following TF .


Normalization of EAE decreased from @ % after HD PPIs ( on PPIs ) to @ % after TF ( off PPIs ) , p = @ .


In the original TF group , @-month post TF , @ % of patients achieved complete symptom control , @ % ceased PPI therapy , @ % healed esophagitis and @ % normalized EAE .


The results of this study indicate that in patients with incomplete symptom control on high-dose PPI therapy TF may provide further elimination of symptoms and esophagitis healing .


In the original TF group , the clinical outcomes of TF remained stable between @ - and @-month follow-up .


Sepsis bundles can decrease mortality in patients with severe sepsis or septic shock .


However , current methods of measuring pressure , such as central venous pressure , are inadequate .


This study investigated the effect of improved sepsis bundles informed by pulse-indicated continuous cardiac output .


We compared the outcome of treatment with sepsis bundles informed by either conventional pressure measurements or pulse-indicated continuous cardiac output .


Patients in @ groups received fluid resuscitation , standard antibiotics , and oxygen therapy .


A total of @ patients with septic shock were randomly divided into @ groups : the conventional sepsis bundle group ( n = @ ) or the improved sepsis bundle group ( ISBG , n = @ ) .


The ISBG significantly reduced the mean Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment scores .


Significantly fewer ISBG-treated patients received vasoactive drugs compared to conventional sepsis bundle group-treated patients .


In addition , patients in the ISBG exhibited a significantly increased arterial blood lactate clearance rate and required less total fluid resuscitation and a shorter duration of mechanical ventilation and stay in the intensive care unit .


Pulse-indicated continuous cardiac output-directed sepsis bundles can reduce the severity of septic shock , provide more accurate fluid resuscitation , and reduce the duration of mechanical ventilation and stay in the intensive care unit .


Pain is a common distressing adverse effect in the early postoperative period following caesarean section .


The aim of this study was to investigate the effect on postoperative pain , analgesic requirement and haemodynamic profile of placing a suprafacial bupivacaine-soaked absorbable gelatin sponge in the caesarean section wound .


A total of @ healthy patients scheduled to undergo general anaesthesia for elective caesarean section were randomised to a study group ( n = @ ) or a control group ( n = @ ) .


In the study group , a bupivacaine-soaked absorbable gelatin sponge was placed subcutaneously in the caesarean section wound .


Intramuscular diclofenac @ mg was given to all patients at @-h intervals during the first @h .


Postoperatively , visual analogue scale pain scores , requirement for pethidine and diclofenac and changes in blood pressure and heart rate were compared between groups .


Pain scores were lower in the study group compared to the control group at all assessments ( P < @ ) .


During the first eight hours after surgery , fewer patients in the study group required rescue pethidine compared with the control group ( @ vs. @ , P < @ ) .


In the study group , total opioid and diclofenac consumption was lower ( P < @ ) , and blood pressure and heart rate were lower ( P < @ ) compared to the control group .


Suprafascial wound placement of a bupivacaine-soaked absorbable gelatin sponge improved postoperative analgesia and decreased opioid consumption following caesarean section .


Transfusion of erythrocytes stored for prolonged periods is associated with increased mortality .


Erythrocytes undergo hemolysis during storage and after transfusion .


Plasma hemoglobin scavenges endogenous nitric oxide leading to systemic and pulmonary vasoconstriction .


We hypothesized that transfusion of autologous blood stored for @ days would increase the pulmonary artery pressure in volunteers with endothelial dysfunction ( impaired endothelial production of nitric oxide ) .


We also tested whether breathing nitric oxide before and during transfusion could prevent the increase of pulmonary artery pressure .


Fourteen obese adults with endothelial dysfunction were enrolled in a randomized crossover study of transfusing autologous , leukoreduced blood stored for either @ or @ days .


Volunteers were transfused with @-day blood , @-day blood , and @-day blood while breathing @ ppm nitric oxide .


The age of volunteers was @ @ years ( mean SEM ) , and their body mass index was @ @ kg/m ( @ ) .


Plasma hemoglobin concentrations increased after transfusion with @-day and @-day plus nitric oxide blood but not after transfusing @-day blood .


Mean pulmonary artery pressure , estimated by transthoracic echocardiography , increased after transfusing @-day blood ( @ @ to @ @ mm Hg ; P < @ ) but did not change after transfusing @-day blood ( @ @ to @ @ mm Hg ; P = @ ) .


Breathing nitric oxide decreased pulmonary artery pressure in volunteers transfused with @-day blood ( @ @ to @ @ mm Hg ; P < @ ) .


Transfusion of autologous leukoreduced blood stored for @ days was associated with increased plasma hemoglobin levels and increased pulmonary artery pressure .


Breathing nitric oxide prevents the increase of pulmonary artery pressure produced by transfusing stored blood .


Clinical trial registered with www.clinicaltrials.gov ( NCT @ ) .


To explore perceptions of spinal manipulative therapy and exercise among adults aged @ years and older with chronic neck pain .


Mixed methods study embedded within a randomized clinical trial .


Interviews were conducted with @ of @ randomized clinical trial participants .


They had a mean age of @ years and they had neck pain of moderate severity and of @ years mean duration .


Semi-structured interviews were conducted at the completion of the @ week intervention phase , during which participants received spinal manipulative therapy and exercise interventions .


Interviews explored determinants of satisfaction with care , whether or not therapy was worthwhile , and what was liked and disliked about treatment .


Interviews were recorded and transcribed ; content analysis was used to identify themes within responses .


Participants placed high value on their relationships with health care team members , supervision , individualized care , and the exercises and information provided as treatment .


Change in symptoms did not figure as prominently as social and process-related themes .


Percpetions of age , activities , and co-morbities influenced some seniors ' expectations of treatment results , and comorbidities impacted perceptions of their ability to participate in active care .


Relationship dynamics should be leveraged in clinical encounters to enhance patient satisfaction and perceived value of care .


Salivary gland tumors are mostly benign tumors .


Whether a more conservative surgical approach at greater risk of recurrence , or a more radical intervention with an increased risk of facial paralysis is warranted is still under discussion .


Our study addresses the opportunity for improving surgical outcome by employing platelet-rich plasma ( PRP ) gel at the surgical site .


Twenty consecutive patients undergoing superficial parotidectomy were randomized and assigned to two groups , one with and one without PRP gel .


Many parameters were evaluated after surgery and during follow-up , such as the duration of hospitalization , facial nerve deficit , onset of Frey 's syndrome , relapse , cosmetic results , presence of keloid or scar depressions , behavior of several facial muscles .


Our explorative analysis suggests a positive effect of PRP on surgical outcome in patients undergoing parotidectomy , whereas no negative effects were detected .


This work suggests that administration of PRP in patients undergoing parotidectomy is beneficial .


There is a growing recognition that cancer not only affects the lives of the patients , but also the lives of their partners .


Partners of cancer patients are highly involved in the illness trajectory by providing informal care and they often experience distress .


However , supporting interventions for this group are scarce and existing interventions bear several limitations .


On the basis of the need for theory - and evidence-based supportive interventions for partners of cancer patients , the web-based self-help intervention Hold on , for each other has been developed .


This intervention is based on Acceptance and Commitment Therapy .


The primary objective of the RCT is to investigate the ( cost - ) effectiveness of the intervention .


Additional goals are ( @ ) to examine if psychological flexibility , self-compassion , mastery , supportive behavior , posttraumatic growth and resilience are mediators of the intervention 's effects on the partners ' mental health ; ( @ ) to examine the moderating effects of the socio demographics ( age , gender , education , working situation , family situation ) and disease-related characteristics of the patients ( sort of cancer , stage of disease , duration and treatment of cancer ) ; and ( @ ) to investigate to what extend participants are satisfied with the intervention , which parts of the intervention are mostly used , and how adherent the users are .


A three-armed randomized controlled trial ( RCT ) will be conducted to compare two versions of the intervention Hold on , for each other with a waiting list control condition .


Both intervention conditions contain the same content and differ only with regard to the form of professional support ( personal support versus automatic support ) .


Adult partners of cancer patients with mild to moderate depressive and anxiety symptoms , will be recruited through a multi-component strategy .


Online measurements by self-assessment will be made on four measurement points ( prior to randomization ( baseline-measurement ) and @ , @ and @ months after baseline ) .


When proven effective , Hold on , for each other can be an invaluable contribution to the healthcare system and it could be offered to all partners of cancer patients who are in need for additional support .


Ensuring an open airway during cardiopulmonary resuscitation is fundamental .


The aim of this study was to determine the success rate of blind intubation during simulated cardiopulmonary resuscitation by untrained personnel .


Four devices were compared in a simulated resuscitation scenario : ILMA ( Intavent Direct Ltd , Buckinghamshire , United Kingdom ) , Cobra PLA ( Engineered Medical Systems Inc , Indianapolis , IN ) , Supraglottic Airway Laryngopharyngeal Tube ( SALT ) ( ECOLAB , St. Paul , MN ) , and Air-Q ( Mercury Medical , Clearwater , FL ) .


A group of @ paramedics intubated a manikin with continuous chest compressions .


The mean times to intubation were @ @ , @ @ , @ @ , and @ @ seconds ( SALT vs ILMA , Cobra PLA , and Air-Q ; P < @ ) .


The success ratios of blind intubation for the devices were @ % , @ % , @ % , and @ % ( SALT vs ILMA , Cobra PLA , and Air-Q ; P < @ ) .


The study showed that the most efficient device with the shortest blind intubation time was the SALT device .