These data support the safety of early BP reduction in intracerebral hemorrhage .


To verify clinical efficacy of abdominal acupuncture for cyclomastopathy .


One hundred and twenty-one cases of cyclomastopathy were randomly divided into an abdominal acupuncture group ( @ cases ) and a routine treatment group ( @ cases ) .


In the abdominal acupuncture , basic treatment ( including psychological counseling and Chinese patent medicine Rupixiao ) and abdominal acupuncture at Zhongwan ( CV @ ) , Xiawan ( CV @ ) , Qihai ( CV @ ) , Guanyuan ( CV @ ) and Huaroumen ( ST @ ) were applied at the same time .


In the routine treatment group , only basic treatment was applied .


Before and after the treatment , visual analogue scale ( VAS ) of main symptoms and WHO Quality of Life-@BREF score were observed , also clinical efficacy of both groups was compared .


The scores of VAS and WHO Quality of Life-@BREF in both groups had statistical significances before and after the treatment ( both P < @ ) , indicating two treatments could both effectively relieve pain and improve life quality .


The total effective rate was @ % ( @/@ ) in the abdominal acupuncture group , which was superior to @ % ( @/@ ) in the routine treatment group ( P < @ ) .


The abdominal acupuncture had best effect for moderate pain ( P < @ ) .


The abdominal acupuncture could improve clinical symptoms and life quality of patients with cyclomastopathy .


Recombinant human B-type natriuretic peptide ( rhBNP ) has been indicated for the treatment of acute decompensated heart failure ( ADHF ) .


However , the therapeutic efficacy of intravenous rhBNP is not always satisfactory in patients with extremely high blood BNP levels .


In this study , we evaluated the effects of rhBNP on patients with different BNP levels .


One hundred and five patients with ADHF whose left ventricular ejection fraction ( LVEF ) was < @ % , were assigned to a high BNP group ( BNP @ pg/mL ) or an extra-high BNP group ( BNP > @ pg/mL ) , depending on their admission plasma BNP levels .


Each group was then subdivided into rhBNP or dobutamine subgroups according to intravenous administration with either rhBNP or dobutamine for @-@h .


In the high BNP group , @ patients were randomized to subgroup rhBNP ( n = @ ) and subgroup dobutamine ( n = @ ) .


In the extra-high BNP group , @ patients were randomized to subgroup rhBNP ( n = @ ) and subgroup dobutamine ( n = @ ) .


The effects of rhBNP and dobutamine on patients in the high and extra-high BNP groups were compared .


In the high BNP group , rhBNP was more efficient than dobutamine at improving NYHA classification ( P < @ ) , decreasing plasma BNP levels ( P < @ ) , increasing LVEF ( P < @ ) , and reducing hospital length of stay ( P < @ ) .


However , rhBNP displayed no superior therapeutic efficacy to dobutamine in the extra-high BNP group .


Adverse cardiovascular events in patients treated with rhBNP were similar to adverse events in patients treated with dobutamine in both the high and extra-high BNP groups .


rhBNP was more efficient than dobutamine at improving heart function in patients with ADHF when plasma BNP was @ pg/mL .


However , rhBNP treatment showed no advantages over dobutamine when plasma BNP reached extremely high levels ( > @ pg/mL ) .


This double-blind , placebo-controlled , dose-finding phase IIb study evaluated the efficacy and safety of ponesimod , an oral selective S@P@ receptor modulator , for the treatment of patients with relapsing-remitting multiple sclerosis ( RRMS ) .


@ patients were randomised to receive once-daily oral ponesimod @ , @ or @ mg , or placebo for @ weeks .


The primary endpoint was the cumulative number of new T@ gadolinium-enhanced ( T@ Gd + ) lesions per patient recorded every @ weeks from weeks @ to @ after study drug initiation .


Secondary endpoints were the annualised confirmed relapse rate ( ARR ) and time to first confirmed relapse .


Safety and tolerability were also evaluated .


The mean cumulative number of new T@ Gd + lesions at weeks @-@ was significantly lower in the ponesimod @ mg ( @ ; rate ratio ( RR ) @ ; p = @ ) , @ mg ( @ ; RR @ ; p < @ ) and @ mg ( @ ; RR @ ; p < @ ) groups compared with placebo ( @ ) .


The mean ARR was lower with @mg ponesimod versus placebo , with a maximum reduction of @ % ( @ vs @ ; p = @ ) .


The time to first confirmed relapse was increased with ponesimod compared with placebo .


The proportion of patients with @ treatment-emergent adverse events ( AEs ) was similar across ponesimod groups and the placebo group .


Frequently reported AEs with higher incidence in the three ponesimod groups compared with placebo were anxiety , dizziness , dyspnoea , increased alanine aminotransferase , influenza , insomnia and peripheral oedema .


Once-daily treatment with ponesimod @ , @ or @ mg significantly reduced the number of new T@ Gd + lesions and showed a beneficial effect on clinical endpoints .


Ponesimod was generally well tolerated , and further investigation of ponesimod for the treatment of RRMS is under consideration .


Health professionals ' behaviour is a key component in compliance with evidence-based recommendations .


Opinion leaders are an oft-used method of influencing such behaviours in implementation studies , but reliably and cost effectively identifying them is not straightforward .


Survey and questionnaire based data collection methods have potential and carefully chosen items can - in theory - both aid identification of opinion leaders and help in the design of an implementation strategy itself .


This study compares two methods of identifying opinion leaders for behaviour-change interventions .


Healthcare professionals working in a single UK mental health NHS Foundation Trust were randomly allocated to one of two questionnaires .


The first , slightly longer questionnaire , asked for multiple nominations of opinion leaders , with specific information about the nature of the relationship with each nominee .


The second , shorter version , asked simply for a list of named `` champions '' but no more additional information .


We compared , using Chi Square statistics , both the questionnaire response rates and the number of health professionals likely to be influenced by the opinion leaders ( i.e. the `` coverage '' rates ) for both questionnaire conditions .


Both questionnaire versions had low response rates : only @ % of health professionals named colleagues in the longer questionnaire and @ % in the shorter version .


The opinion leaders identified by both methods had a low number of contacts ( range of coverage , @-@ each ) .


There were no significant differences in response rates or coverage between the two identification methods .


The low response and population coverage rates for both questionnaire versions suggest that alternative methods of identifying opinion leaders for implementation studies may be more effective .


Future research should seek to identify and evaluate alternative , non-questionnaire based , methods of identifying opinion leaders in order to maximise their potential in organisational behaviour change interventions .


About @ to @ % of children in West European countries have atopic dermatitis ( AD ) , often as part of the atopic syndrome .


The full atopic syndrome also consists of allergic asthma , allergic rhinitis and food allergy .


Treatment approaches for atopic dermatitis and asthma include intermittent anti-inflammatory therapy with corticosteroids , health education and self-management training .


However , symptoms persist in a subgroup of patients .


Several observational studies have shown significant improvement in clinical symptoms in children and adults with atopic dermatitis or asthma after treatment at high altitude , but evidence on the efficacy when compared to treatment at sea level is still lacking .


This study is a pragmatic randomized controlled trial for children with moderate to severe AD within the atopic syndrome .


Patients are eligible for enrolment in the study if they are : diagnosed with moderate to severe AD within the atopic syndrome , aged between @ and @years , fluent in the Dutch language , have internet access at home , able to use the digital patient system Digital Eczema Center Utrecht ( DECU ) , willing and able to stay in Davos for a six week treatment period .


All data are collected at the Wilhelmina Children 's Hospital and DECU .


Patients are randomized over two groups .


The first group receives multidisciplinary inpatient treatment during six weeks at the Dutch Asthma Center in Davos , Switzerland .


The second group receives multidisciplinary treatment during six weeks at the outpatient clinic of the Wilhelmina Children 's Hospital , Utrecht , the Netherlands .


The trial is not conducted as a blind trial .


The trial is designed with three components : psychosocial , clinical and translational .


Primary outcomes are coping with itch , quality of life and disease activity .


Secondary outcomes include asthma control , medication use , parental quality of life , social and emotional wellbeing of the child and translational parameters .


The results of this trial will provide evidence for the efficacy of high altitude treatment compared to treatment at sea level for children with moderate to severe AD .


Nasopharyngeal carcinoma ( NPC ) is one of the most common malignant tumors in southern China .


In this study , we compared the clinical efficacy and toxicity of cisplatin with nolatrexed ( LP ) or @-fluorouracil ( FP ) for NPC .


@ patients with metastatic NPC were randomized to the LP and FP regimens .


The LP regimen consisted of continuous intravenous infusions of @ mg/m ( @ ) nolatrexed on days @-@ and @ mg/m ( @ ) intravenous cisplatin on days @-@ .


The FP regimen consisted of continuous intravenous infusions of @ mg/m ( @ ) @-fluorouracil on days @-@ and @ mg/m ( @ ) intravenous cisplatin on days @-@ .


Cycles were repeated every @ weeks until disease progression or completion of a total of @ courses .


There were no significant differences in the response rates ( RR ) , disease control rates ( DCR ) , times to progression ( TTP ) , and median survival times ( MST ) between the regimens .


The toxicities of the two regimens were mostly grade I/II , but the stomatitis incidence in the patients on the LP regimen was significantly lower than that on the FP regimen .


The efficacy of the LP regimen was similar to that of the FP regimen .


The LP regimen had lower toxicity .


This study was designed to prospectively evaluate the role of nebulized hyaluronic acid ( HA ) given for @ days/mo over @ months as adjunct treatment to minimize symptoms and preventing exacerbation of chronic rhinosinusitis ( CRS ) .


Thirty-nine eligible patients were randomized to receive nebulized @-mg sodium hyaluronate nasal washes plus saline solution ( @ patients ) or @ mL of saline alone ( @ patients ) , according to an open-label , parallel-group design , with blind observer assessment .


A questionnaire about main CRS discomfort and nasal endoscopy for mucous discharge and/or mucosal edema of nasal cavities was used to assess primary outcomes of treatments .


Secondary outcome measures included side effects and satisfaction .


HA significantly improved quality of life in CRS patients according to the CRS questionnaire ( @ @ versus @ @ ; p < @ ) , contrary to saline group scores ( @ @ versus @ @ ; p = @ ) .


The HA group showed significantly reduced osteomeatal edema ( @ versus @ ; p < @ ) and secretions ( @ versus @ ; p < @ ) , whereas there was no statistically significant difference in the saline group .


The compliance to the treatment was similar in both groups and no side effects were recorded .


The results of this study suggested that intermittent treatment with topical @-mg sodium hyaluronate plays a role in minimizing symptoms and could prevent exacerbations of CRS .


Irritable bowel syndrome ( IBS ) is a common diagnosis in gastroenterology .


Its etiology is unknown and therapeutic options limited .


Trials suggest probiotics may be beneficial .


The aim of this study was to assess the symptomatic efficacy of Lactobacillus plantarum @ v ( L. plantarum @ v ) for the relief of abdominal pain in patients with IBS fulfilling Rome II criteria .


This study was conducted in a referral hospital .


Trial participants were randomized to receive either two capsules of L. plantarum @ v at a dosage of @ @ ( @ ) cfu per capsule or placebo daily for @ wk .


Severity of abdominal pain was assessed using a visual analog scale at each visit and a quality-of-life IBS ( QoL-IBS ) questionnaire was also completed .


There was no significant difference in abdominal pain relief between the study and placebo groups ( P = @ ) .


There was also no difference in QoL - IBS scores between the groups ( P = @ ) .


Both groups had a significant improvement in abdominal pain scores over the study period , from an average of @ to @ ( P < @ ) indicating a large placebo effect .


An @-wk treatment with L. plantarum @ v did not provide symptomatic relief , particularly of abdominal pain and bloating , in patients fulfilling the Rome II criteria .


Elderly polypharmacy patients may be more at risk of not adhering to medication .


If so , the underlying reasons may be more readily disclosed during private discussions with patients .


Hence pharmaceutical care discussions at home might improve treatment adherence .


The aim of this study was to investigate the impact of pharmaceutical care on medication adherence , hospitalisation and mortality in elderly patients prescribed polypharmacy .


Pharmaceutical care discussed at home .


A randomised controlled trial with two arms ; pharmaceutical care ( n = @ ) and controls ( n = @ ) was designed .


It involved patients aged @ + years living in Aarhus , Denmark who used five drugs or more without assistance .


Pharmacists visited the pharmaceuticalcare patients at home , once only , and followed them during the subsequent year with three telephone calls .


Non-adherence was measured by a pill-count .


Patients were categorised as non-adherent if their mean adherence rate for all drugs consumed was < @ % .


The impact of pharmaceutical care on non-adherence and hospitalisation was analysed by @ @ tables , and mortality by Cox regression .


Medication adherence , hospitalisation and mortality .


The final analyses included @ patients ( median age @ years ; females @ % ) .


Dropouts were more frequent for the pharmaceutical-care group than for controls .


Pharmacists encountered drug-related problems amongst @ % of pharmaceutical-care patients .


Pharmaceutical-care patients ( @ % ) and control patients ( @ % ) were similarly nonadherent ( Odds ratio @ ; @ % confidence interval @-@ @ ) , and similar with respect to hospitalisation frequency ( @ vs. @ % ; Odds ratio @ ; @ % confidence interval @-@ @ ) and mortality ( @ vs. @ % ; Hazard ratio @ ; @ % confidence interval @-@ @ ) .


Pharmaceutical care given to our elderly polypharmacy patients made no significant impact on medication adherence , hospitalisation or mortality , when compared to comparable control patients .


We aimed to determine the prevalence and risk factors for Strongyloides stercoralis infection in adult patients attending Siriraj Hospital , a tertiary hospital in Thailand .


A case-control study was carried out between July @ and April @ .


Case and control were identified from @ patients for whom results of faecal examination were available .


A case was a patient who had S. stercoralis larva detected from faecal examination .


Control was randomly selected from patients without S. stercoralis larvae detected in three consecutive faecal examinations .


The proportion of control to case was @ : @ .


Demographic and clinical data for the day of diagnosis and retrospectively up to @ days preceding the date of faecal examination were reviewed from their medical records .


Overall , @ ( @ % ) patients had S. stercoralis larvae positive .


There were @ males ( @ % ) , with the mean ( SD ) age of @ ( @ ) years .


A total of @ controls were selected .


Male gender ( odds ratio ( OR ) = @ , @ % confidence interval ( CI ) @-@ @ ) ) , human immunodeficiency virus ( HIV ) infection ( OR = @ , @ % CI @-@ @ ) , and eosinophilia ( OR = @ , @ % CI @-@ @ ) were found to be independent risk factors associated with S. stercoralis infection in this setting .


Corticosteroid or other immunosuppressive treatment , and other concomitant illnesses were not associated with increased risk of S. stercoralis infection .


In this setting , strongyloidiasis was seen more often in male patients with eosinophilia and with HIV infection .


Prevention of fatal complication caused by S. stercoralis by regular faecal examination , or serology for early detection and treatment of undiagnosed S. stercoralis infection , is warranted in these high-risk patients .


We hypothesized that valerian root might prevent cognitive dysfunction in coronary artery bypass graft ( CABG ) surgery patients through stimulating serotonin receptors and anti-inflammatory activity .


The aim of this study was to evaluate the effect of Valeriana officinalis root extract on prevention of early postoperative cognitive dysfunction after on-pump CABG surgery .


In a randomized , double-blind , placebo-controlled trial , @ patients , aged between @ and @years , scheduled for elective CABG surgery using cardiopulmonary bypass ( CPB ) , were recruited into the study .


Patients were randomly divided into two groups who received either one valerian capsule containing @mg of valerian root extract ( @,@ mg/daily ) or placebo capsule each @h for @weeks , respectively .


For all patients , cognitive brain function was evaluated before the surgery and at @-day and @-month follow-up by Mini Mental State Examination ( MMSE ) test .


Mean MMSE score decreased from @ in the preoperative period to @ at the @th day and then increased to @ at the @th day in the valerian group .


Conversely , its variation was reduced significantly after @days in the placebo group , @ at the baseline to @ at the @th day , and consequently slightly increased to @ at the @th day .


Valerian prophylaxis reduced odds of cognitive dysfunction compared to placebo group ( OR = @ , @ % CI @-@ @ ) .


We concluded that , based on this study , the cognitive state of patients in the valerian group was better than that in the placebo group after CABG ; therefore , it seems that the use of V. officinalis root extract may prevent early postoperative cognitive dysfunction after on-pump CABG surgery .


To assess lesion detection and diagnostic image quality of filtered back projection ( FBP ) reconstruction technique in ultra low-dose chest CT examinations .


In this IRB-approved ongoing prospective clinical study , @ CT-image-series at four different radiation-doses were performed for @ patients ( age , @-@ years ; F : M - @:@ ; BMI @-@ kg/m ( @ ) ) .


All patients provided written-informed-consent for the acquisitions of additional ultra low-dose ( ULD ) series on a @-slice MDCT ( iCT , Philips Healthcare ) .


In-addition to their clinical standard-dose chest CT ( SD , @ kV mean CTDIvol , @ @ mGy ) , ULD-CT was subsequently performed at three-dose-levels ( @ mGy -LSB- @ kV -RSB- ; @ mGy -LSB- @ kV -RSB- and @ mGy -LSB- @ kV -RSB- ) .


Images were reconstructed with FBP ( @ mm @ mm ) resulting into four-stacks : SD-FBP ( reference-standard ) , FBP@ @ , FBP@ @ , and FBP@ @ .


Four thoracic-radiologists from two-teaching-hospitals independently-evaluated data for lesion-detection and visibility-of-small-structures .


Friedman 's - non-parametric-test with post hoc Dunn 's - test was used for data-analysis .


Interobserver-agreement was substantial between radiologists ( k = @-@ @ ) .


With pooled analysis , @-pulmonary ( @-groundglass-opacities , @-solid-lung-nodules , @-consolidations , @-emphysema ) and @-mediastinal/soft tissue lesions ( @-mediastinal , @-hilar , @-axillary-lymph-nodes , and @-mediastinal-masses ) were evaluated .


Compared to the SD-FBP , @ % pulmonary-lesions were seen with FBP@ @ , up to @ % with FBP@ @ ( missed : @ ) , and up to @ % with FBP@ @ images ( missed :@ ) .


Compared to SD-FBP , all enlarged mediastinal-lymph-nodes were seen with FBP@ @ images .


All mediastinal-masses ( > @ cm , @/@ ) were seen equivalent to SD-FBP images at @ mGy .


Across all sizes of patients , FBP@ @ images had optimal visualization for lung findings .


They were optimal for mediastinal soft tissues for only non-obese patients .


Filtered-back-projection technique allows optimal lesion detection and acceptable image quality for chest-CT examinations at CDTIvol of @ mGy for lung and mediastinal findings in selected sizes of patients .


We decided to determine the effectiveness of oral bromocriptine in patients with active rheumatoid arthritis ( RA ) who are in methotrexate ( MTX ) therapy .


Patients receiving stable doses of MTX were randomized to one of two groups and received @ months of double-blind bromocriptine ( @ mg/day ) or matching placebo .


The moderate and major outcome measures were the proportion of patients with > @ and > @ improvement in RA based on the Disease Activity Score @ ( DAS@ ) at @ months .


Safety measures included adverse events and laboratory assessments .


On a background treatment of MTX , the percentage of patients with moderate and major DAS@ responses at @ months in the bromocriptine group ( @ % / @ % ) was not significantly different from placebo ( @ % / @ % ) .


Side effects were typically mild and included mild nausea and sleep disturbance ; we did not have any adverse events resulting in discontinuation of the study drug .


In patients with active RA receiving stable doses of MTX , bromocriptine showed non-significant improvement in efficiency outcomes compared to placebo .


Growth hormone ( GH ) treatment regimens do not account for the pubertal increase in endogenous GH secretion .


This study assessed whether increasing the GH dose and/or frequency of administration improves pubertal height gain and adult height ( AH ) in children with low GH secretion during stimulation tests , i.e. idiopathic isolated GH deficiency .


A multicenter , randomized , clinical trial ( No. @-@ ) followed @ children ( @ boys ) at study start from onset of puberty to AH who had received GH @ g/kg/day for @ year .


They were randomized to receive @ g/kg/day ( GH ( @ ) ) given as one ( GH ( @ ) ; n = @ ) or two daily injections ( GH ( @ ) ; n = @ ) , or to remain on a single @ g/kg/day dose ( GH ( @ ) ; n = @ ) .


Growth was assessed as heightSDSgain for prepubertal , pubertal and total periods , as well as AHSDS versus the population and the midparental height .


Pubertal heightSDSgain was greater for patients receiving a high dose ( GH ( @ ) , @ ) than a low dose ( GH ( @ ) , @ , p < @ ) .


AHSDS was greater on GH ( @ ) ( GH ( @ ) , -@ ; GH ( @ ) , -@ ) than GH ( @ ) ( -@ , p < @ ) , and heightSDSgain was greater on GH ( @ ) than GH ( @ ) ( @ and @ , respectively ; p < @ ) .


All groups reached their target heightSDS .


Pubertal heightSDSgain and AHSDS were dose dependent , with greater growth being observed for the GH ( @ ) than the GH ( @ ) randomization group ; however , there were no differences between the once - and twice-daily GH ( @ ) regimens .


@ S. Karger AG , Basel .


Interventions that improve HbA@c levels do not necessarily improve health-related quality of life ( QoL ) .


This issue may be particularly relevant in asymptomatic diabetes patients detected earlier in the course of the disease .


HbA@c , diabetes-specific QoL ( ADDQoL ) and health status were measured in @ screen-detected diabetes patients from the ADDITION-Cambridge trial at @ and @ years post diagnosis .


Multivariable logistic/linear regression was used to quantify the longitudinal association between change in HbA@c from @ to @ years and ADDQoL and health status at @ years , adjusting for age , sex , education and trial group ; alcohol consumption , smoking , physical activity , plasma vitamin C , HbA@c , ADDQoL or health status at @ year , and glucose-lowering medication at @ years .


From @ to @ years , median HbA@c interquartile range increased from @ % ( @-@ @ ) to @ % ( @-@ @ ) ; the median ADDQoL score and mean health status physical health summary score decreased from -@ ( -@ to -@ ) to -@ ( -@ to -@ ) ( suggesting an adverse impact of diabetes on QoL ) and by -@ ( @ ) points , respectively .


Increases in HbA@c were independently associated with reporting a negative impact of diabetes on QoL ( OR = @ , @ % CI : @ to @ ) but not with the health status summary scores .


Increases in HbA@c from @ to @ years post-diagnosis were independently associated with increased odds of reporting a negative impact of diabetes on QoL .


While our results suggest that efforts to reduce HbA@c do not adversely affect health-related QoL , large numbers of participants still report a negative impact of diabetes on their QoL @ years post-diagnosis .


The purpose of the study was to determine the efficacy of a @ % chlorhexidine tooth coating in reducing the incidence of cavitated carious lesions in adults .


The trial was a randomized , double-blind , multi-center , placebo controlled study with @ participants , receiving the application of either the active or the placebo coatings to the entire dentition .


Four applications were made in the first month and one at the @th month .


The final examination was performed at @ months .


Coronal caries showed a statistical reduction ( p = @ ) .


Examination of the results by site showed that the highest risk participants experienced the most significant preventive effect ( p = @ ) .


When two sites ( uninsured and public health ) are pooled the treatment p-value is @ , interaction term has a p-value of @ .


@ % Chlorhexidine was highly effective in high risk participants with more than two cavities at the initial examination .


This trial in conjunction with other published trials of this topical medication indicates that chlorhexidine exerts its action by preventing the transition of D@ lesions to cavitated lesions , not on sound to D@ lesions .


The monoclonal anti-CD@ antibody rituximab , combined with chemotherapeutic agents , has been shown to prolong overall survival in physically fit patients with previously untreated chronic lymphocytic leukemia ( CLL ) but not in those with coexisting conditions .


We investigated the benefit of the type @ , glycoengineered antibody obinutuzumab ( also known as GA@ ) as compared with that of rituximab , each combined with chlorambucil , in patients with previously untreated CLL and coexisting conditions .


We randomly assigned @ patients with previously untreated CLL and a score higher than @ on the Cumulative Illness Rating Scale ( CIRS ) ( range , @ to @ , with higher scores indicating worse health status ) or an estimated creatinine clearance of @ to @ ml per minute to receive chlorambucil , obinutuzumab plus chlorambucil , or rituximab plus chlorambucil .


The primary end point was investigator-assessed progression-free survival .


The patients had a median age of @ years , creatinine clearance of @ ml per minute , and CIRS score of @ at baseline .


Treatment with obinutuzumab-chlorambucil or rituximab-chlorambucil , as compared with chlorambucil monotherapy , increased response rates and prolonged progression-free survival ( median progression-free survival , @ months with obinutuzumab-chlorambucil vs. @ months with chlorambucil alone ; hazard ratio for progression or death , @ ; @ % confidence interval -LSB- CI -RSB- , @ to @ ; P < @ ; and @ months with rituximab-chlorambucil vs. @ months with chlorambucil alone ; hazard ratio , @ ; @ % CI , @ to @ ; P < @ ) .


Treatment with obinutuzumab-chlorambucil , as compared with chlorambucil alone , prolonged overall survival ( hazard ratio for death , @ ; @ % CI , @ to @ ; P = @ ) .


Treatment with obinutuzumab-chlorambucil , as compared with rituximab-chlorambucil , resulted in prolongation of progression-free survival ( hazard ratio , @ ; @ % CI , @ to @ ; P < @ ) and higher rates of complete response ( @ % vs. @ % ) and molecular response .


Infusion-related reactions and neutropenia were more common with obinutuzumab-chlorambucil than with rituximab-chlorambucil , but the risk of infection was not increased .


Combining an anti-CD@ antibody with chemotherapy improved outcomes in patients with CLL and coexisting conditions .


In this patient population , obinutuzumab was superior to rituximab when each was combined with chlorambucil .


( Funded by F. Hoffmann-La Roche ; ClinicalTrials.gov number , NCT@ . )


Enterovirus @ ( EV@ ) is one of the major causative agents of outbreaks of hand , foot , and mouth disease or herpangina worldwide .


This phase @ trial was designed to evaluate the efficacy , safety , and immunogenicity of an EV@ vaccine .


We conducted a randomized , double-blind , placebo-controlled , multicenter trial in which @,@ healthy infants and young children ( @ to @ months of age ) were randomly assigned in a @:@ ratio to receive two intramuscular doses of either EV@ vaccine or placebo , @ days apart .


The surveillance period was @ months .


The primary end point was the occurrence of EV@-associated hand , foot , and mouth disease or herpangina .


During the @-month surveillance period , EV@-associated disease was identified in @ % of vaccine recipients ( @ of @ children ) and @ % of placebo recipients ( @ of @ children ) in the intention-to-treat cohort .


The vaccine efficacy against EV@-associated hand , foot , and mouth disease or herpangina was @ % ( @ % confidence interval -LSB- CI -RSB- , @ to @ ; P < @ ) in this cohort .


Vaccine efficacies against EV@-associated hospitalization ( @ cases vs. @ cases ) and hand , foot , and mouth disease with neurologic complications ( @ cases vs. @ cases ) were both @ % ( @ % CI , @ to @ and @ to @ , respectively ) .


Serious adverse events occurred in @ of @ children in the vaccine group ( @ % ) and @ of @ children in the placebo group ( @ % ) .


In the immunogenicity subgroup ( @ children ) , an anti-EV@ immune response was elicited by the two-dose vaccine series in @ % of participants at day @ .


An anti-EV@ neutralizing antibody titer of @:@ was associated with protection against EV@-associated hand , foot , and mouth disease or herpangina .


The EV@ vaccine provided protection against EV@-associated hand , foot , and mouth disease or herpangina in infants and young children .


( Funded by Sinovac Biotech ; ClinicalTrials.gov number , NCT@ . )


Ischemic or volatile anesthetic preconditioning is defined as tissue protection from impending ischemic cell damage by repetitive short periods of tissue exposure to ischemia or volatile anesthetics .


Objective of this study was to elucidate , if ischemic preconditioning and pharmacological preconditioning with sevoflurane have effects on muscle tissue oxygen saturation in patients undergoing surgical revascularization of the lower limb .


In this prospective randomized pilot study ischemic and pharmacological ( sevoflurane ) preconditioning was performed in @ patients with lower limb arterial occlusive disease undergoing surgical revascularization .


Sevoflurane preconditioning was performed in one group ( N = @ ) by repetitive application of sevoflurane for six minutes interspersed by six minutes of washout .


Thereafter , ischemic preconditioning was performed in all patients ( N = @ ) by repetitive clamping of the femoral artery for six minutes interspersed by six minutes of reperfusion .


The effect of both procedures on leg muscle tissue oxygen saturation ( rSO@ ) was measured by near-infrared spectroscopy during both procedures and during surgery and reperfusion ( INVOS @C Oxymeter with Small Adult SomaSensor SAFB-SM , Somanetics , Troy , Michigan , USA ) .


Repetitive clamping and reperfusion of the femoral artery resulted in significant cyclic decrease and increase of muscle rSO@ ( p < @ ) .


Pharmacological preconditioning with sevoflurane resulted in a faster and higher increase of rSO@ during postoperative reperfusion ( Maximal @ % baseline@ versus @ % baseline@ , p = @ ) consistent with an additional effect of pharmacological preconditioning on leg perfusion .


Ischemic preconditioning of lower limb muscle tissue and pharmacological preconditioning with sevoflurane have an effect on tissue oxygenation in patients with lower limb occlusive arterial disease .


To compare stent strut coverage using optical coherence tomography ( OCT ) at three-month follow-up between a PLGA-polymer with electro-grafting base layer sirolimus-eluting stent ( SES ) ( BuMA ) and a PLA-polymer SES ( EXCEL ) .


This prospective , single-centre , non-inferiority randomised BuMA-OCT trial enrolled patients with de novo coronary artery lesions , treated with either the BuMA or the EXCEL stent .


The study primary endpoint was OCT-evaluated stent strut coverage at three months .


Secondary endpoints were neointimal thickness of stent struts , and incomplete stent apposition evaluated with OCT. .


A total of @ patients were randomly assigned to receive the BuMA ( n = @ ) or the EXCEL ( n = @ ) stent .


In OCT follow-up ( achieved in @ % of cases : BuMA , n = @ ; EXCEL , n = @ ) , the percentage of stent strut coverage was significantly higher in the BuMA vs. the EXCEL group ( strut level : @ % vs. @ % , p < @ ; p ( non-inferiority ) < @ ; p ( superiority ) < @ ) , while the proportion of malapposed struts ( strut level : @ % vs. @ % , p = @ ) and the mean neointimal thickness ( strut level : @ mm vs. @ mm , p = @ ) were similar .


Rates of myocardial infarction ( periprocedural non-Q-wave , @ % vs. @ % , p = @ ) and target lesion failure ( @ % vs. @ % , p = @ ) were similar between groups , with no cardiac death or stent thrombosis .


In the BuMA-OCT randomised trial , the novel BuMA PLGA-polymer with electro-grafting base layer SES was superior to the EXCEL PLA-polymer SES in the primary endpoint of stent strut coverage at three-month follow-up .


To determine the effect of thermal state and thermal comfort on cycling performance in the heat .


Seven well-trained male triathletes completed @ performance trials consisting of @ min cycling at a fixed rating of perceived exertion ( @ ) followed immediately by a @-km time trial in hot ( @C ) and humid ( @ % relative humidity ) conditions .


In a randomized order , cyclists either drank ambient-temperature ( @C ) fluid ad libitum during exercise ( CON ) , drank ice slurry ( -@ C ) ad libitum during exercise ( ICE ) , or precooled with iced towels and ice slurry ingestion ( @ g/kg ) before drinking ice slurry ad libitum during exercise ( PC+ICE ) .


Power output , rectal temperature , and ratings of thermal comfort were measured .


Overall mean power output was possibly higher in ICE ( +@ % @ % -LSB- @ % confidence limit -RSB- ; @ > smallest worthwhile change -LSB- SWC -RSB- ) and likely higher PC+ICE ( +@ % @ % ; @ > SWC ) than in CON ; however , no substantial differences were shown between PC+ICE and ICE ( unclear ) .


Time-trial performance was likely enhanced in ICE compared with CON ( +@ % @ % ; @ > SWC ) and PC+ICE ( +@ % @ % ; @ > SWC ) .


Differences in mean rectal temperature during exercise were unclear between trials .


Ratings of thermal comfort were likely and very likely lower during exercise in ICE and PC+ICE , respectively , than in CON .


While PC+ICE had a stronger effect on mean power output compared with CON than ICE did , the ICE strategy enhanced late-stage time-trial performance the most .


Findings suggest that thermal comfort may be as important as thermal state for maximizing performance in the heat .


Prior studies have reported @-L polyethylene glycol ( PEG ) plus ascorbic acid ( PEG + Asc ) is an effective alternative to standard @-L PEG for bowel preparation before colonoscopy , but they are limited because of some confounders .


Therefore , we compared the efficacy , patient compliance , satisfaction , and safety of @-L PEG + Asc versus @-L PEG for bowel cleansing in optimal preparation strategies .


In this prospective , randomized , single-blind trial , consenting outpatients were randomly assigned to one of two arms .


All colonoscopies were scheduled in the morning and cleansing solutions were administered as a split-dose regimen .


Bowel-cleansing efficacy in three different segments was measured on a five-point scale with four-point overall grading .


Patients ' opinions of the preparation regimens were obtained by questionnaire .


There was no significant difference between the @-L PEG + Asc ( @/@ ; @ % ) and @-L PEG ( @/@ ; @ % ) with respect to the overall success of bowel cleansing ( mean difference = -@ -LSB- -@ - -RSB- ) .


Patient compliance , acceptability , and satisfaction were better in the @-L PEG + Asc arm than the @-L PEG arm ( P < @ ) .


Additionally , the incidence of side effects was lower in the @-L PEG + Asc than the @-L PEG ( overall , @ % vs @ % , P < @ ) .


However , no significant difference was seen in patients ' rating of taste .


In an optimal preparation setting , @-L PEG + Asc has equal efficacy as a bowel cleanser prior to colonoscopy as @-L PEG , with the advantages of better patient compliance , satisfaction , and safety .


The use of bupropion , a smoking cessation aid , has been associated with improved health-related quality of life ( HRQOL ) in the general population of smokers ; but , its effect on HRQOL in post-myocardial infarction ( MI ) patients remains unknown .


To examine the effect of bupropion on HRQOL in post-MI patients who are attempting to quit smoking .


To accomplish this objective , we used data from a randomized , double-blind , placebo-controlled trial in @ hospitalized post-MI patients .


Treatment duration was @ weeks , and follow-up was @ months .


HRQOL was assessed via the EuroQol-@D ( EQ-@D ) questionnaire , which includes @ dimensions ( mobility , self-care , daily activities , pain/discomfort , and anxiety/depression ) .


Analyses were restricted to patients ( n = @ ) who completed the EQ-@D at baseline , @ months , and @ months .


Patients randomized to bupropion ( n = @ ) and those randomized to placebo ( n = @ ) experienced similar improvements in HRQOL during follow-up ( difference in change in EQ-@D index from baseline to @ months = @ , @ % confidence interval -LSB- CI -RSB- = -@ , @ ; from baseline to @ months = @ , @ % CI = -@ , @ ) .


No between-group differences were observed in any of the @ dimensions .


Similar improvements in HRQOL were observed between patients who remained abstinent and those who relapsed .


Lower baseline HRQOL , defined as having a HRQOL that was less than the median value , was associated with decreased smoking abstinence at @ months follow-up ( odds ratio OR = @ , @ % CI = @ , @ ) .


Bupropion does not improve HRQOL among patients attempting to quit smoking post-MI .


To evaluate angiographic and clinical outcomes associated with open and closed dissection tunnel endoscopic vein harvesting ( EVH ) devices .


A previous PREVENT-IV ( PRoject of Ex-vivo Vein graft ENgineering via Transfection IV ) analysis reported that EVH for coronary artery bypass graft surgery was associated with worse outcomes than with traditional vein harvesting ; however , outcomes by EVH device type were not available .


Using data from the PREVENT-IV trial , we compared @ patients from @ surgical sites who underwent EVH with open ( n = @ ) or closed ( n = @ ) harvest tunnel devices .


Outcomes included the incidence of vein graft failure at @ to @ months and a composite of death , myocardial infarction , and revascularization through @ years .


Among patients undergoing open and closed tunnel EVH , no difference in the per-patient incidence of vein graft failure ( @ % vs @ % ; adjusted odds ratio , @ ; @ % confidence interval , @-@ @ ; P = @ ) or per-graft incidence of vein graft failure ( @ % vs @ % ; adjusted odds ratio , @ ; @ % confidence interval , @-@ @ ; P = @ ) was observed .


At @ years , no difference was observed in the primary composite clinical outcome between patients who underwent open and closed system EVH ( @ % vs @ % ; adjusted hazard ratio , @ ; @ % confidence interval , @-@ @ ; P = @ ) .


No differences in angiographic or clinical outcomes were observed among patients who underwent open versus closed tunnel endoscopic harvesting for coronary bypass surgery .


These findings suggest that the risks associated with EVH that were reported in a previous PREVENT-IV analysis are not related to a specific EVH device .


Although dry socket ( DS ) is commonly investigated , many of its risk factors remain highly controversial .


In addition , few studies are available to show the preventive effect of chlorhexidine gel on DS .


Moreover , multivariable analyses of DS risk factors are scarce , and their interactions have not been assessed previously .


Therefore , the simultaneous effect of chlorhexidine gel and @ DS risk factors and their interactions were analyzed within a multivariable framework .


Using a split-mouth randomized clinical trial design , the investigators enrolled a cohort of patients requiring extraction of @ mandibular third molars .


The primary predictor variable was extraction socket treatment status , classified as experimental or standard .


Experimental treatment was the insertion of chlorhexidine gel ( @ % ) into the extraction socket .


Each patient had @ third molar randomly selected as the treatment site .


The contralateral third molar served as the control socket and was treated in the usual manner .


The primary outcome variable was DS status , present or absent , assessed on postoperative day @ .


Other study variables were categorized as demographic , smoking , and surgical difficulty according to the Pederson scale .


Appropriate bivariate and multiple logistic regression statistics were used to measure the association between risk for DS and chlorhexidine gel use , age , gender , smoking , and surgical difficulty and their interactions ( = @ ) .


The sample consisted of @ bilateral extraction sockets in @ patients ( @ men ; @ smokers ; mean age , @ @ yr ) .


Regression analysis showed that when other factors and their interactions were controlled for , chlorhexidine gel application lowered the risk of DS ( odds ratio -LSB- OR -RSB- = @ ; P = @ ) .


Increasing age ( OR = @ ; P = @ ) was associated with an increased risk for DS .


A similar association existed between increased difficulty level of extraction and DS risk ( OR = @ ; P = @ ) .


The effect of gender was marginally significant ( P = @ ) , whereas smoking did not have a significant influence ( P = @ ) .


Intra-alveolar application of chlorhexidine gel and practicing less traumatic surgeries are advocated , particularly in older patients .


Smoking seems unlikely to affect DS frequency .


The role of gender is inconclusive .


To observe the lower gastrointestinal mesenchymal tumors CT virtual endoscopy and pathology , and to explore its possible mechanism .


Select @ patients suspected colon gastroenterology treat in the hospital gastroenterology department , randomly divided into experimental group and control group , @ cases in experimental group were given CT virtual endoscopy and pathological check , the control group received conventional colonoscopy and pathological check , and all the results compared with the pathological results .


Compared with the pathological test results , consistent rate with the experimental group reached @ % , the same rate was @ % in control group .


The difference was not statistically significant ( P > @ ) .


CT virtual endoscopy can quickly image and draw detailed information , and can improve the sensitivity and specificity of cancer diagnosis greatly .


Clinically , CT virtual endoscopy have the same function as colonoscopy , can replace colonoscopy , can be important complement of electronic colonoscopy by those who can not tolerate electronic colonoscopy or have contraindications .


Its value is worth taking a step forward in-depth study .


Weight losses in lifestyle interventions are variable , yet prediction of long-term success is difficult .


The utility of using various weight loss thresholds in the first @ months of treatment for predicting @-year outcomes was examined .


Participants included @ adults with type @ diabetes ( BMI :@ ) randomized to the intensive lifestyle intervention ( ILI ) of the Look AHEAD trial .


ILI included weekly behavioral sessions designed to increase physical activity and reduce caloric intake .


@-month , @-month , and @-year weight changes were calculated .


Participants failing to achieve a @ % weight loss at Month @ were @ ( @ % CI :@ , @ ) times more likely to also not achieve a @ % weight loss at Year @ , compared to those losing @ % initially .


These odds were increased to @ ( @ % CI :@ , @ ) when using a @ % weight loss threshold at Month @ .


Only @ % and @ % of individuals failing to achieve the @ % and @ % thresholds at Months @ and @ , respectively , go on to achieve a @ % weight loss at Year @ .


Given the association between initial and @-year weight loss , the first few months of treatment may be an opportune time to identify those who are unsuccessful and utilize rescue efforts .


The rapid rise in the number of methamphetamine users , relative to cocaine users , has brought the number of each to nearly equal levels , making research on similarities and differences across these groups a needed area of exploration .


Craving is postulated to play a significant role in relapse for both user types , yet group differences on observed scale scores have been reported without first assessing the prerequisite measurement equivalence ( invariance ) of the items , which is essential for meaningful group comparisons .


Baseline data from stimulant users in residential treatment ( N = @ ; n = @ cocaine ; n = @ methamphetamine ) were used to assess the measurement invariance of the @-item Stimulant Craving Questionnaire ( STCQ ) , which was adapted from a cocaine-specific measure .


The unifactorial STCQ demonstrated measurement invariance across cocaine and methamphetamine users for factor loadings ( metric ) , common residual covariances between item pairs , and item intercepts ( scalar ) , as determined by fit indices ( RMSEA < @ ; CFI & TLI > @ ; SRMR < @ ) .


The latent mean , as well as @ ( out of @ ) item means and the overall composite scale score , was significantly greater for methamphetamine users compared to cocaine users .


Results indicate the STCQ is an invariant tool for the assessment of stimulant craving across the two most prevalent user types .


Methamphetamine users had significantly higher levels of observed and latent craving than cocaine users , demonstrating a potentially meaningful difference in craving between users of these two stimulants .


Future research will determine if treatments and statistical models need to account for craving variations across methamphetamine and cocaine users .


The COPD Assessment Test ( CAT ) has been proposed for assessing health status in COPD , but little is known about its longitudinal changes .


The objective of this study was to evaluate @-year CAT variability in patients with stable COPD and to relate its variations to changes in other disease markers .


We evaluated the following variables in smokers with and without COPD at baseline and after @ year : CAT score , age , sex , smoking status , pack-year history , BMI , modified Medical Research Council ( mMRC ) scale , @-min walk distance ( @MWD ) , lung function , BODE ( BMI , obstruction , dyspnea , exercise capacity ) index , hospital admissions , Hospital and Depression Scale , and the Charlson comorbidity index .


In patients with COPD , we explored the association of CAT scores and @-year changes in the studied parameters .


A total of @ smokers with COPD and @ without COPD were evaluated at baseline and @ smokers with COPD and @ without COPD @ year later .


At @ year , CAT scores for patients with COPD were similar ( @ points ) in @ % , higher in @ % , and lower in @ % .


Of note , mMRC scale scores were similar ( @ point ) in @ % of patients , worse in @ % , and better in @ % at @ year .


One-year CAT changes were best predicted by changes in mMRC scale scores ( - coefficient , @ ; P < @ ) .


Similar results were found for CAT and mMRC scale score in smokers without COPD .


One-year longitudinal data show variability in CAT scores among patients with stable COPD similar to mMRC scale score , which is the best predictor of @-year CAT changes .


Further longitudinal studies should confirm long-term CAT variability and its clinical applicability .


Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical urethrotomy , were the only treatment .


Clean Intermittent Self Catheterisation was introduced by Lapides has greatly decreased the recurrence of stricture .


Objectives were to determine the role of Clean Intermittent Self Catheterisation ( CISC ) in the prevention of recurrence of urethral strictures after Internal Optical Urethrotomy and to study the frequency of any postoperative complications and tolerability for the patients associated with this procedure .


A randomised controlled study conducted in the department of urology and renal transplantation , Institute of Kidney Diseases Hayatabad Medical Complex , Peshawar from June @ to June @ .


Total of @ patients with mean age @ years ( range @-@ ) were selected and randomly divided into Treatment Group ( @ patients ) and Control Group ( @ Patients ) .


Eight `` drop out '' occurred in the treatment group and four `` drop out '' occurred in the controlled group .


All the patients were treated with Internal Optical Urethrotomy using Sachse method followed by indwelling catheter for @ days .


The treatment group was then taught to perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter ( No. @ or @ ) twice a day for @ week , then once a day for another @ weeks and then once weekly continued for one year .


All the patients were followed up regularly at @ month intervals during the first @ months and then every @ months for the next @ months .


Total of @ patients completed the study , @ in the treatment group and @ in the control group .


Within the first year , @ patients ( @ % ) in the treatment group developed urethral stricture .


In the control group , @ patients ( @ % ) developed urethral stricture within the first year , showing a significant difference ( p < @ ) .


In the treatment group four patients developed simple UTIs while in the control group three patients developed UTIs , one with concomitant epididymitis .


No other complications were noted up to one year follow up .


Clean Intermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence after Internal Optical Urethrotomy and is associated with less morbidity and is cost effective .


CISC is an important modality for maintaining the normal urethral calibre .


Otitis media ( OM ) starts within weeks of birth in almost all Indigenous infants living in remote areas of the Northern Territory ( NT ) .


OM and associated hearing loss persist from infancy throughout childhood and often into adulthood .


Educational and social opportunities are greatly compromised .


Pneumococcus and non-typeable Haemophilus influenzae ( NTHi ) are major OM pathogens that densely colonise the nasopharynx and infect the middle ear from very early in life .


Our hypothesis is that compared to current single vaccine schedules , a combination of vaccines starting at @month of age , may provide earlier , broadened protection .


This randomised outcome assessor , blinded controlled trial will recruit @ infants between @ and @days of age and randomly allocate them ( @:@:@ ) to one of three pneumococcal conjugate vaccine ( PCV ) schedules : Synflorix at @ , @ , @months of age , Prevenar@ at @ , @ and @months of age , or an investigational schedule of Synflorix at @ , @ and @months plus Prevenar@ at @months of age .


The blinded primary outcomes at @months of age are immunogenicity of specific vaccine antigens ( geometric mean concentration ( GMC ) and proportion of participants with above threshold GMC of @ g/L ) .


Secondary outcomes at all timepoints are additional immunogenicity measures and proportion of participants with nasopharyngeal carriage of vaccine-type pneumococci and NTHi , and any OM , including any tympanic membrane perforation .


Parental interviews will provide data on common risk factors for OM .


Severe knee contractures that develop soon after muscle imbalance may not improve with stretching exercises and splinting .


An alternative treatment is serial casting , which has been used to promote increased range of motion .


The purpose of this study was to compare the effectiveness of using serial casting and passive stretching approaches to treat knee flexion contracture in children with spina bifida .


In a pre/post randomized controlled study , ten participants were included in the serial casting group , while eight participants were included in the passive stretching intervention group .


The degree of knee extension was measured at baseline , immediately after intervention , and at a one-year follow-up using a standard goniometer .


Both groups showed significant improvements in the degree of flexion contracture at the post-treatment evaluation and the follow-up evaluation .


The serial casting group showed significant improvements in knee flexion contracture at the post-treatment evaluation , t ( @ ) = @ , p < @ , and the one-year follow-up evaluation , t ( @ ) = @ , p < @ .


The passive stretching group also showed significant improvements in knee flexion contracture at the post-treatment evaluation , t ( @ ) = @ , p < @ , and the one-year follow-up evaluation , t ( @ ) = @ , p < @ .


However , statistically significant improvements in the serial casting group compared with passive stretching group in relation to the degree of flexion contracture were found at the immediate post-treatment evaluation , F ( @ , @ ) = @ , p = @ , and the one-year follow-up evaluation , F ( @ , @ ) = @ , p = @ .


The outcomes of this study provide the first evidence that serial casting may be a useful intervention in treating knee flexion contracture in children with spina bifida .


However , further investigations into serial casting , as well as investigations into the use of serial casting with other interventions , are warranted .


The authors tested whether clonidine blocks stress-induced seeking of heroin and cocaine .


The study was also intended to confirm translational findings from a rat model of drug relapse by using ecological momentary assessment of patients ' stress to test hypotheses about clonidine 's behavioral mechanism of action .


The authors conducted a randomized double-blind placebo-controlled clinical trial with @ opioid-dependent patients at an outpatient buprenorphine clinic .


The @ participants ( @ % ) who maintained abstinence during weeks @-@ were continued on buprenorphine and randomly assigned to receive clonidine ( N = @ ) or placebo ( N = @ ) for @ weeks .


Urine was tested thrice weekly .


Lapse was defined as any opioid-positive or missed urine test , and relapse as two or more consecutive lapses .


Time to lapse and relapse were examined with Cox regressions ; longest period of abstinence was examined with a t test , and ecological momentary assessment data were examined with generalized linear mixed models .


In an intent-to-treat analysis , clonidine produced the longest duration ( in consecutive days ) of abstinence from opioids during the intervention phase ( @ days -LSB- SD = @ -RSB- compared with @ days -LSB- SD = @ -RSB- ; Cohen 's d = @ ) .


There was no group difference in time to relapse , but the clonidine group took longer to lapse ( hazard ratio = @ , @ % CI = @-@ @ ) .


Ecological momentary assessment showed that daily-life stress was partly decoupled from opioid craving in the clonidine group , supporting the authors ' hypothesized mechanism for clonidine 's benefits .


Clonidine , a readily available medication , is useful in opioid dependence not just for reduction of withdrawal signs , but also as an adjunctive maintenance treatment that increases duration of abstinence .


Even in the absence of physical withdrawal , it decouples stress from craving in everyday life .


Evaluate long-term effects of group interventions on sleep and pain outcomes in a primary care population of older adults with osteoarthritis pain and sleep disturbance .


Double-blind , cluster-randomized controlled trial with @-mo follow-up .


Group Health and University of Washington , Seattle , WA , from @ to @ .


Three hundred sixty-seven adults age @ y and older , with osteoarthritis pain and insomnia symptoms .


Six weekly sessions of group cognitive behavioral therapy for insomnia and pain ( CBT-PI ) , pain alone ( CBT-P ) , and education-only control ( EOC ) delivered in patients ' primary care clinics .


There were no significant differences between treatment groups in sleep outcomes at @ mo. .


This is a change from published significant @-mo follow-up results for insomnia severity ( Insomnia Severity Index ) and sleep efficiency .


There were no significant treatment differences in pain at either follow-up .


Post hoc analyses of participants with greater insomnia and pain severity at baseline ( n = @ ) showed significant ( P = @ ) @-mo reductions in pain comparing CBT-PI versus CBT-P ( adjusted mean difference -LSB- AMD -RSB- = -@ -LSB- @ % confidence interval ( CI ) : -@ , -@ -RSB- ) .


Moderate , albeit nonsignificant , CBT-PI versus EOC treatment effects for insomnia severity ( AMD = -@ -LSB- @ % CI : -@ , @ -RSB- ) and sleep efficiency ( AMD = @ -LSB- @ % CI : -@ , @ -RSB- ) were also observed .


Possible trial design and methodological considerations that may have affected results are discussed .


Results suggest patients with higher levels of comorbid pain and insomnia may be most likely to experience sustained benefit from cognitive behavioral therapy interventions over time , and inclusion of insomnia treatment may yield more clinically meaningful improvements than cognitive behavioral therapy for pain alone .


To compare the efficacy of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in patients with levator ani avulsion .


This was a single-center , randomized interventional trial , of two standard surgical procedures for post-hysterectomy vaginal vault prolapse : Prolift Total vs unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair ( sacrospinous fixation , SSF ) , during the period from @ to @ .


Entry criteria included at least two-compartment prolapse , as well as complete unilateral or bilateral levator ani avulsion injury .


The primary outcome was anatomical failure based on clinical and ultrasound assessment .


Failure was defined clinically , according to the Pelvic Organ Prolapse Quantification system , as Ba , C or Bp at the hymen or below , and on translabial ultrasound as bladder descent to @ mm or more below the lower margin of the symphysis pubis on maximum Valsalva maneuver .


Secondary outcomes were evaluation of continence , sexual function and prolapse symptoms based on validated questionnaires .


During the study period , @ patients who were post-hysterectomy underwent surgery for prolapse in our unit ; @ of these were diagnosed with an avulsion injury and were offered participation in the study .


Seventy patients were randomized into two groups : @ in the Prolift group and @ in the SSF group .


On clinical examination at @-year follow-up , we observed one ( @ % ) case of anatomical failure in the Prolift group and @ ( @ % ) in the SSF group ( P < @ ) .


Using ultrasound criteria , there was one ( @ % ) failure in the Prolift group compared with @ ( @ % ) in the SSF group ( P < @ ) .


The postoperative POPDI ( Pelvic Organ Prolapse Distress Inventory ) score for subjective outcome was @ in the Prolift group vs @ in the SSF group ( P = @ ) .


In patients with prolapse after hysterectomy and levator ani avulsion injury , SSF has a higher anatomical failure rate than does the Prolift Total procedure at @-year follow-up .


The aim of this randomised controlled trial was to assess the clinical performance of single crowns in the posterior maxilla supported by either @-mm or @-mm implants combined with maxillary sinus floor elevation .


@ consecutive patients with one missing premolar or molar in the posterior maxilla and with an estimated bone height of @ to @ mm in that area were included .


Each patient was randomly allocated to one of the two treatment groups , namely to receive an @-mm implant ( Osseo Speed @ S , Dentsply Implants , Mlndal , Sweden ) in combination with maxillary sinus floor elevation surgery or to receive a @-mm implant ( Osseo Speed @ S ) without any grafting .


After a @-month osseointegration period , all implants were restored with custom-made titanium abutments and cemented zirconia-based porcelain crowns .


Outcome measures were : implant survival ; radiographic bone changes ; plaque accumulation ; bleeding tendency ; peri-implant inflammation ; presence of dental calculus ; biological and technical complications ; and patients ' satisfaction .


Clinical and radiographic examinations were performed at placement of the crown and @ months thereafter .


Patients ' satisfaction was scored before treatment and after @ months of functioning of the crown .


One patient of the @ mm implant group died during the follow-up .


No implant failed and no biological or technical complications occurred .


From loading to the @ months follow-up , no difference was found in mean marginal bone changes between the groups ( bone resorption in both groups @ @ mm ) .


Clinical items revealed very healthy peri-implant soft tissues in both groups .


Patients ' satisfaction scores were high in both groups .


@-mm implants and @-mm implants combined with sinus floor elevation surgery are equally successful to support a single crown in the resorbed posterior maxilla after @-year follow-up .


In accordance with the European Association of Urology guidelines , a second transurethral resection of the bladder ( TURB ) is recommended for high-grade or T@-category tumors .


This practice brings into question the benefit of photodynamic diagnosis ( PDD ) in reducing the residual disease after TURB in patients with positive results on urine cytology showing high-grade cancer cells .


A prospective , bicentric , randomized study comparing white light cystoscopy ( WLC ) + PDD with hexaminolevulinate arm with WLC alone ( control arm ) during the first TURB in patients with primary non-muscle-invasive bladder cancer and with positive results on urine cytology showing high-grade cancer cells .


Patients underwent a first TURB with WLC and PDD or WLC alone , and then a second TURB with WLC and PDD , after @ to @ weeks .


The number of tumors visualized in WLC and PDD and histology of the TURB specimen was recorded to perform a statistical analysis comparing both the @ arms .


A total of @ patients were enrolled ( hexaminolevulinate , n = @ ; control , n = @ ) .


The number of visualized tumors did not increase with PDD in the first or second TURB .


During the second TURB , the residual tumor rate was not reduced in patients who had PDD during the first TURB .


No significant difference was observed regarding the pattern of category and grade , the size , and the recurrence and progression risks during either the first or the second TURB .


In the setting of primary non-muscle-invasive bladder cancer with positive results on urine cytology , performing a second TURB allows to diagnose residual tumor in approximately half of the cases .


This rate was not significantly reduced by the use of the PDD during the first TURB .


Recent guidance for the management of acute otorrhea in children with tympanostomy tubes is based on limited evidence from trials comparing oral antibiotic agents with topical antibiotics .


In this open-label , pragmatic trial , we randomly assigned @ children , @ to @ years of age , who had acute tympanostomy-tube otorrhea to receive hydrocortisone-bacitracin-colistin eardrops ( @ children ) or oral amoxicillin-clavulanate suspension ( @ ) or to undergo initial observation ( @ ) .


The primary outcome was the presence of otorrhea , as assessed otoscopically , @ weeks after study-group assignment .


Secondary outcomes were the duration of the initial otorrhea episode , the total number of days of otorrhea and the number of otorrhea recurrences during @ months of follow-up , quality of life , complications , and treatment-related adverse events .


Antibiotic-glucocorticoid eardrops were superior to oral antibiotics and initial observation for all outcomes .


At @ weeks , @ % of children treated with antibiotic-glucocorticoid eardrops had otorrhea , as compared with @ % of those treated with oral antibiotics ( risk difference , -@ percentage points ; @ % confidence interval -LSB- CI -RSB- , -@ to -@ ) and @ % of those treated with initial observation ( risk difference , -@ percentage points ; @ % CI , -@ to -@ ) .


The median duration of the initial episode of otorrhea was @ days for children treated with antibiotic-glucocorticoid eardrops versus @ days for those treated with oral antibiotics ( P < @ ) and @ days for those who were assigned to initial observation ( P < @ ) .


Treatment-related adverse events were mild , and no complications of otitis media , including local cellulitis , perichondritis , mastoiditis , and intracranial complications , were reported at @ weeks .


Antibiotic-glucocorticoid eardrops were more effective than oral antibiotics and initial observation in children with tympanostomy tubes who had uncomplicated acute otorrhea .


( Funded by the Netherlands Organization for Health Research and Development ; Netherlands Trial Register number , NTR@ . )


We compare efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department ( ED ) nausea and vomiting .


A prospective , randomized , double-blind , placebo-controlled trial was conducted in @ metropolitan EDs in Melbourne , Australia .


Eligible patients with ED nausea and vomiting were randomized to receive @ mg intravenous ondansetron , @ mg intravenous metoclopramide , or saline solution placebo .


Primary outcome was mean change in visual analog scale ( VAS ) rating of nausea severity from enrollment to @ minutes after study drug administration .


Secondary outcomes included patient satisfaction , need for rescue antiemetic treatment , and adverse events .


Of @ recruited patients , @ ( @ % ) were available for analysis .


Of these patients , @ ( @ % ) received ondansetron ; @ ( @ % ) , metoclopramide ; and @ ( @ % ) , placebo .


Baseline characteristics between treatment groups and recruitment site were similar .


Mean decrease in VAS score was @ mm ( @ % confidence interval -LSB- CI -RSB- @ to @ mm ) for ondansetron , @ mm ( @ % CI @ to @ mm ) for metoclopramide , and @ mm ( @ % CI @ to @ mm ) for placebo .


Satisfaction with treatment was reported by @ % ( @ % CI @ % to @ % ) , @ % ( @ % CI @ % to @ % ) , and @ % ( @ % CI @ % to @ % ) for ondansetron , metoclopramide , and placebo , respectively ; rescue medication was required by @ % ( @ % CI @ % to @ % ) , @ % ( @ % CI @ % to @ % ) , and @ % ( @ % CI @ % to @ % ) , respectively .


Nine minor adverse events were reported .


Reductions in nausea severity for this adult ED nausea and vomiting population were similar for @ mg intravenous ondansetron , @ mg intravenous metoclopramide , and placebo .


There was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups , but differences from the placebo group did not reach significance .


The majority of patients in all groups were satisfied with treatment .


Telemedicine holds great potential to improve access to care and to reduce barriers to treatment for military populations with posttraumatic stress disorder ( PTSD ) .


This study sought to integrate the use of telemedicine mental health treatment services by a community healthcare provider to military populations residing in a rural location and to compare the equivalency of cognitive behavioral therapy ( CBT ) administered via telemedicine and traditional face-to-face therapy .


Study subjects were men or women @ years of age or older who had served in Operation Enduring Freedom ( OEF ) and/or Operation Iraqi Freedom ( OIF ) and were diagnosed with PTSD .


The @ study subjects were randomized and provided @ weekly therapy sessions of CBT .


Pre - and post-intervention assessments were conducted using the Clinician Administered PTSD Scale ( CAPS ) , Hamilton Anxiety Rating Scale ( HAM-A ) , Montgomery-Asberg Depression Rating Scale ( MADRS ) , Life Events Checklist , and SF-@v@ ( QualityMetric , Lincoln , RI ) Health Survey .


The CAPS , HAM-A , and MADRS each demonstrated lower scores , signifying improvement , and @ % of subjects experienced a clinically significant change in the CAPS .


Patient satisfaction results indicated greater satisfaction for telemedicine as opposed to traditional face-to-face treatment .


Findings reveal a trend expressing the equivalence of telemedicine and face-to-face therapy when treating OEF/OIF veterans with PTSD among rural populations by a community provider .


It further demonstrates the successful collaboration between a community healthcare provider and the military healthcare system .


To test the effects of a school-based prevention programme on students ' smoking-related behaviour , attitudes and knowledge @ months after implementation over @ school-years has ended .


Two-arm prospective cluster randomised controlled trial with a follow-up survey @ months after end of programme implementation , that is , @ months after baseline .


@ public secondary schools from four federal states in Germany ( Bremen , Hesse , North Rhine-Westphalia , Schleswig-Holstein ) .


A total of @ students from @ classes with a mean age of @ years ( SD = @ ) and @ % girls at baseline .


Analysis sample with follow-up up data merged to baseline data comprises @ datasets ( @ % ) .


` Eigenstndig werden @ +@ ' , a school-based prevention programme for grades @ and @ to enhance substance-specific and general life skills , consisting of @ units ( @ min ) and two workshops ( @-@ h ) being taught over a time period of @ school-years by trained teachers .


Lifetime and current smoking , incidence of smoking in baseline never smokers , smoking-related knowledge , attitudes , perceived norms of smoking and self-efficacy to refuse cigarette offers were assessed in students .


@ months after the end of programme implementation , students of intervention classes showed significantly lower rates for lifetime smoking ( adjusted OR = @ ; @ % CI @ to @ ; p = @ ) and incidence of smoking ( adjusted OR = @ ; @ % CI @ to @ ; p = @ ) , a higher increase of smoking-related knowledge ( adjusted = @ ; @ % CI @ to @ ; p < @ ) and a greater change in attitudes towards a more critical perception of risks and disadvantages of smoking ( adjusted = @ ; @ % CI @ to @ ; p = @ ) .


No group differences were found for current smoking , perceived norms of smoking and self-efficacy to refuse cigarette offers .


Participation in the school-based prevention programme ` Eigenstndig werden @ +@ ' may have small effects on smoking behaviour and attitudes and a moderate effect on smoking-related knowledge .


Intrathecal morphine for caesarean delivery provides excellent postoperative analgesia but it is commonly associated with nausea and vomiting .


This prospective , randomized , double blind study was carried out to compare the effectiveness of a combination of dexamethasone and ondansetron with dexamethasone alone for prevention of postoperative nausea and vomiting ( PONV ) following intrathecal morphine injection for caesarean section .


A total of @ parturients aged @-@ years for elective caesarean section were randomized into @ groups ( n = @ ) to receive either intravenous dexamethasone @ mg ( Group A ) or a combination of intravenous dexamethasone @ mg and ondansetron @ mg ( group B ) .


The study drug for each group consisted of @ % hyperbaric bupivacaine and @ mg morphine .


The primary outcome variables were postoperative nausea and vomiting ( PONV ) which were assessed for a period of @ hours .


The patient 's vital signs were monitored and documented .


The incidence of nausea and vomiting was significantly reduced in patients who received a combination of dexamethasone and ondansetron compared with dexamethasone alone ( @ % Vs @ % , respectively , P = @ ) .


This study showed that a combination of dexamethasone and ondansetron administered prophylactically significantly reduced the incidence of PONV in pregnant women on intrathecal morphine for caesarean section .


There is increasing evidence of Gleason score ( GS ) drift in prostatic core biopsies during the last two decades .


The ProtecT study is a randomized controlled study and provides an excellent cohort to study the effect of time , prostate-specific antigen ( PSA ) level , perineural invasion , tumour length and age on GS .


The ProtecT study recruited men in the United Kingdom between @ and @ .


The Gleason scores were grouped into four categories @ + @ , @ + @ , @ + @ and @ + @ for analysis .


Data from England between @ and @ were also available .


A total of @ biopsies containing cancer were analysed .


For each year of the ProtecT study , the odds of being diagnosed with a higher GS category increased by @ % .


Higher GS was also associated with perineural invasion , increasing tumour length , age and PSA level .


While biopsy GS from England was incomplete , it also showed a marked decrease in GS five and six tumours during the same period .


There was GS drift from @ + @ to @ + @ with time in the ProtecT study , but there appeared to be no significant change in percentage of GS @ + @ or higher .


This drift was less dramatic when compared to GS in the rest of England .


Sleep problems are common in children with attention-deficit/hyperactivity disorder ( ADHD ) , yet little is known about sleep medication use in this population .


The aim of this study was to describe sleep medication use , as well as associated child and family characteristics in school-aged children with ADHD .


Sleep medication use was ascertained using a prospective parent-completed seven-night sleep and medication log .


Exposure variables included socio-demographic characteristics , total sleep problem severity ( Children 's Sleep Habits Questionnaire ) , ADHD severity and subtype ( ADHD Rating Scale IV ) , ADHD medication use , internalising and externalising co-morbidities ( Anxiety Disorders Interview Schedule for Children/Parent version IV ) and parent mental health ( Depression Anxiety Stress Scale ) .


Two hundred and fifty-seven children with ADHD participated and of these @ ( @ % ) were taking sleep medication ( melatonin @ % and clonidine @ % ) .


Sleep medication use was associated with combined-type ADHD and ADHD medication use .


The presence of co-occurring internalising and externalising co-morbidities was also associated with sleep medication use in ad hoc analyses .


Sleep medication use is common in children with ADHD and is associated with combined-type ADHD and use of ADHD medication .


Further research is needed on the broad functional benefits and long-term safety of sleep medication in this population .


Despite policy interest , an ethical imperative , and evidence of the benefits of patient decision support tools , the adoption of shared decision making ( SDM ) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes ; resources and time pressures .


Patient decision support tools often require high levels of health and computer literacy .


Option Grids are one-page evidence-based summaries of the available condition-specific treatment options , listing patients ' frequently asked questions .


They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations .


This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee ( OA of the knee ) facilitates SDM , and explores the use of Option Grids by patients disadvantaged by language or poor health literacy .


This will be a stepped wedge exploratory trial involving @ patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham .


Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures .


After a period of brief training in using the Option Grid , the same six physiotherapists will consult with six further patients using an Option Grid in the consultation .


The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale .


Comparisons will be made between patients who have received the Option Grid and those who received usual care .


A Decision Quality Measure ( DQM ) will assess quality of decision making .


The health literacy of patients will be measured using the REALM-R instrument .


Consultations will be observed and audio-recorded .


Interviews will be conducted with the physiotherapists , patients and any interpreters present to explore their views of using the Option Grid .


Option Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice .


The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy .


The ingestion of carbohydrate ( CHO ) before and during exercise and at halftime is commonly recommended to soccer players for maintaining blood glucose concentrations throughout match play .


However , an exercise-induced rebound glycemic response has been observed in the early stages of the second half of simulated soccer-specific exercise when CHO-electrolyte beverages were consumed regularly .


Therefore , the metabolic effects of CHO beverage consumption throughout soccer match play remain unclear .


To investigate the blood glucose and blood lactate responses to CHOs ingested before and during soccer match play .


Crossover study .


Applied research study .


Ten male outfield academy soccer players ( age = @ @ years , height = @ @ m , mass = @ @ kg , estimated maximal oxygen consumption = @ @ mLkg ( -@ ) min ( -@ ) ) .


Players received a @ % CHO-electrolyte solution or an electrolyte ( placebo ) solution @ hours before kickoff , before each half ( within @ minutes ) , and every @ minutes throughout exercise .


Blood samples were obtained at rest , every @ minutes during the match ( first half : @-@ , @-@ , and @-@ minutes ; second half : @-@ , @-@ , and @-@ minutes ) and @ minutes into the halftime break .


Metabolic responses ( blood glucose and blood lactate concentrations ) and markers of exercise intensity ( heart rate ) were recorded .


Supplementation influenced the blood glucose response to exercise ( time treatment interaction effect : P @ ) , such that glucose concentrations were higher at @ to @ minutes in the CHO than in the placebo condition .


However , in the second half , blood glucose concentrations were similar between conditions because of transient reductions from peak values occurring in both trials at halftime .


Blood lactate concentrations were elevated above those at rest in the first @ minutes of exercise ( time-of-sample effect : P < @ ) and remained elevated throughout exercise .


Supplementation did not influence the pattern of response ( time treatment interaction effect : P = @ ) .


Ingestion of a @ % CHO-electrolyte beverage before and during soccer match play did not benefit blood glucose concentrations throughout the second half of exercise .


The aim of this study was to compare the effectiveness in the medium term between low and high doses of triamcinolone hexacetonide used in intra-articular injection in medium-sized joints of rheumatoid arthritis ( RA ) patients .


A randomized double-blind study was carried out in rheumatoid arthritis patients with wrist painful refractory synovitis .


Sixty wrists were included and randomized to receive low dose ( @ mg ) or high dose ( @ mg ) .


The outcomes assessed in T@ , T@ , T@ , T@ , and T@ weeks were visual analog scale for pain and for swelling , chronic disease activity index , goniometry , simplified Stanford Health Assessment Questionnaire , and side effects .


Baseline mean ( standard deviation ) values were pain visual analog scale of @ ( @ ) and @ ( @ ) , P = @ ; swelling visual analog scale of @ and @ , P = @ ; chronic disease activity index of @ and @ , P = @ ; and Health Assessment Questionnaire of @ and @ , P = @ , in the high - and low-dose groups , respectively .


Both groups improved pain and swelling assessed by the visual analog scale , P < @ , in the intragroup analysis .


Chronic disease activity index , goniometry , and Health Assessment Questionnaire also improved equally over time in both groups in the intragroup analysis ( P < @ , @ , and @ , respectively ) .


No serious side effects were detected .


High and low triamcinolone hexacetonide doses had good effectiveness in wrist-blinded intra-articular injection of rheumatoid arthritis patients , without statistical difference between them .


We assessed the impact of a noise-reduction program in a pediatric operating theatre .


Adverse effects from noise pollution in theatres have been demonstrated .


In @ operations spatially resolved , sound levels were measured before and after a noise-reduction program on the basis of education , rules , and technical devices ( Sound Ear ) .


Surgical complications were recorded .


The surgeon 's biometric ( saliva cortisol , electrodermal activity ) and behavioral stress responses ( questionnaires ) were measured and correlated with mission protocols and individual noise sensitivity .


Median noise levels in the control group versus the interventional group were reduced by -@ @ dB ( A ) ( @ vs @ dB ( A ) , P < @ ) with a grossly decreased number of peaks greater than @ dB ( A ) ( n = -@ / hour , P < @ ) .


The intervention significantly reduced non-operation-related noise .


The incidence of postoperative complications was significantly lower in patients of the intervention group ( n = @/@ vs @/@ control ; P < @ ) .


`` Responders , '' surgeons with an above-average noise sensitivity ( correlation r = -@ for the work subscale of the NoiseQ questionnaire , P < @ ) , experienced improved intrateam communication , a decrease in disturbing conversations and sudden noise peaks ( P < @ ) .


Biometrically , the intervention decreased both the surgeon 's pre - to postoperative rise in cortisol by approximately @ % and the surgeon 's electrodermal potentials of greater than @ S , indicating severe stress by @ % ( P > @ ) .


Spontaneous noise during pediatric operations attains the magnitude of a lawn mower and peaks resemble a passing truck .


The sound intensity could be reduced by @ % by specific measures .


This reduction was associated with a significantly lowered number of postoperative complications .


The surgeon 's benefits are idiosyncratic with `` responders '' experiencing marked improvements .


Asthma is a complex disease presenting with variable symptoms which are sometimes hard to control .


The purpose of the study was to describe the prevalence of asthma symptoms , use of asthma medications and allergic sensitization in subjects with asthma .


We also related those indices to the level of asthma control , lung function and in particular , cough .


An extensive questionnaire was sent to randomly selected adults from the West Sweden region .


Clinical examinations and interview were performed in a subset .


Of the participants , @ were defined as having an ongoing asthma - reported ever having asthma or physician diagnosed asthma and one of the following - use of asthma medications , recurrent wheeze or attacks of shortness of breath with or without wheeze in the last @months .


A respiratory disease-free control group of @ subjects was also described .


According to GINA guidelines , @ % of the asthmatics had partly controlled and @ % had uncontrolled asthma .


Asthmatic subjects reported significantly more symptoms in the last @months than the control group - wheezing ( @ vs @ % ) , shortness of breath ( @ vs @ % ) , wheezing with shortness of breath ( @ vs @ % ) .


Important complaints were morning cough ( @ vs @ % ) , cough with sputum production ( @ vs @ % ) and longstanding cough ( @ vs @ % ) , which bothered two thirds of the uncontrolled and one third of partly controlled subjects .


Asthma medications were used by @ % of the asthmatics , although around @ % of them who had insufficiently controlled disease used only short-acting beta-agonists .


Asthmatics also had lower lung function , reacted to lower doses of methacholine that the controls and @ % of them had a FEV@/FVC ratio below @ .


Allergic rhinitis was reported by @ % of the asthmatics and they were more frequently sensitized to several common allergens .


Approximately @ % of asthmatics from this population-based study had insufficiently controlled asthma and persistent complaints , despite a high use of asthma medications .


These self-reported symptoms were supported by clinical examination data .


Increased cough frequency is an indicator of a more severe and difficult to control disease and should be considered when asthma is characterized .


Current heart failure ( HF ) risk prediction models do not consider how individual patient assessments occur in incremental steps ; furthermore , each additional diagnostic evaluation may add cost , complexity , and potential morbidity .


Using a cohort of well-treated ambulatory HF patients with reduced ejection fraction who had complete clinical , laboratory , health-related quality of life , imaging , and exercise testing data , we estimated incremental prognostic information provided by @ assessment categories , performing an additional analysis on those with available N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) levels .


We compared the incremental value of each additional assessment ( quality of life screen , laboratory testing , echocardiography , and exercise testing ) to baseline clinical assessment for predicting clinical outcomes ( all-cause mortality , all-cause mortality/hospitalization , and cardiovascular death/HF hospitalizations ) , gauging incremental improvements in prognostic ability with more information using area under the curve and reclassification improvement ( net reclassification index ) , with and without NT-proBNP availability .


Of @ participants , @ patients had complete clinical data ; of these , @ had baseline NT-proBNP .


For prediction of all-cause mortality , models with incremental assessments sans NT-proBNP showed improvements in C-indices ( @ -LSB- clinical model alone -RSB- -@ -LSB- complete model -RSB- ) .


Compared with baseline clinical assessment alone , net reclassification index improved from @ ( w/laboratory data ) to @ ( complete model ) .


These improvements were significantly attenuated for models in the subset with measured NT-proBNP data ( c-indices : @ -LSB- w/laboratory data -RSB- -@ -LSB- full model -RSB- ) ; net reclassification index improvements were similarly marginal ( @ ) ; prediction of other clinical outcomes had similar findings .


In chronic HF patients with reduced ejection fraction , the marginal benefit of complex prognostic evaluations should be weighed against potential patient discomfort and cost escalation .


To evaluate the curative effect and safety of Bushen Qiangji Decoction ( BQD ) and Qingre Qiangji Decoction ( QQD ) in treating ankylosing spondylitis ( AS ) patients , and to verify the clinical utility of AS syndrome differentiation and treatment scheme -LSB- Shen-deficiency induced stasis obstruction syndrome ( SDISOS ) and dampness-heat obstruction syndrome ( DHOS ) being two basic syndrome types , Shen invigorating blood activating method ( SIBAM ) and heat clearing dampness resolving method ( HCDRM ) being two basic treatment methods -RSB- .


Totally @ AS patients of SDISOS and DHOS were randomly assigned to the treatment group and the control group using a multi-center randomized , positive drug parallel-controlled clinical trail .


Patients in treatment group were treated by BQD or QQD according to syndrome typing , while those in the control group took Sulfasalazine enteric-coated tablet ( SECT ) , @ weeks as one therapeutic course .


After treatment , the clinical efficacy was evaluated by using ASAS@ standard ( set by Asessment in Ankylosing Spondylitis working group ) , Chinese medical efficacy evaluation standards , and BASDAI , BASFI , BASMI , night-pain index , spinal pain index , PGA , C-reactive protein ( CRP ) , and erythrocyte sedimentation rate ( ESR ) .


After @ weeks of treatment by BQD or QQD , ASAS@ standard rate was @ % in the treatment group , and the total effective rate of Chinese medical syndrome was @ % .


They could significantly reduce patients ' integrals of Chinese medical syndrome , BASDAI , BASFI , BASMI , night-pain index , spinal pain index , and PGA ( all P < @ ) .


QQD and BQD got confirmable clinical effects in treating AS , providing strong evidence of evidence-based medicine for syndrome differentiation and treatment of AS .


The diagnosis of incurable cancer may evoke physiological arousal in patients .


Physiological arousal can negatively impact patients ' recall of information provided in the medical consultation .


We aim to investigate whether clinicians ' affective communication during a bad news consultation will decrease patients ' physiological arousal and will improve recall .


Healthy women ( N = @ ) , acting as analogue patients , were randomly assigned to watch one out of the two versions of a scripted video-vignette of a bad news consultation in which clinician 's communication differed : standard vs. affective communication .


Participants ' skin conductance levels were obtained during video-watching , and afterwards their recall was assessed .


While the diagnosis increased skin conductance levels in all analogue patients , skin conductance levels during the remainder of the consultation decreased more in the affective communication condition than in the standard condition .


Analogue patients ' recall was significantly higher in the affective condition .


Breaking bad news evokes physiological arousal .


Affective communication can decrease this evoked physiological arousal and might be partly responsible for analogue patients ' enhanced information recall .


Although our findings need to be translated to clinical patients , they suggest that clinicians need to deal with patients ' emotions before providing additional medical information .


To compare the efficacy of British Thoracic Society and American Thoracic Society guidelines for reintroduction of anti-tuberculous therapy after drug-induced liver injury , and to assess the ease of administration of each guideline on a scale of @-@ .


The randomised prospective interventional study was conducted at the Department of Medicine and Pulmonology , Dow University of Health Sciences , Karachi , from December @ to November @ .


Patients with anti-tuberculous therapy drug-induced liver injury were selected .


Hepatotoxic anti-tuberculous therapy was stopped and modified anti-tuberculous therapy was started .


Patients were followed weekly till clinical and biochemical parameters got stabilised .


After stabilisation , the patients were randomised to one of the two groups to receive re-introduction of anti-tuberculous therapy under the guidelines of British Thoracic Society ( Group I ) or those of American Thoracic Society ( Group II ) .


Means of the groups were analysed by Student 's t test and proportions were compared by chi-square test .


Multivariate analysis was done for age , body mass index and serum albumin for recurrence of drug-induced liver injury after the re-introduction .


P value < @ was taken as significant .


Of the total @ patients , @ ( @ % ) were in Group I , while @ ( @ % ) were in Group II .


The frequency of recurrence of drug-induced liver injury in Group I was @ ( @ % ) and in Group II it was @ ( @ % ) .


There was no statistically significant difference between the two groups ( p < @ ) .


Age was positively related with drug-induced liver injury , while body mass index and serum albumin were negatively associated .


There was no significant difference between the two major guidelines though the American Thoracic Society guideline was easier to follow .


Although the use of a dynamic hip screw ( DHS ) is considered to be the preferred treatment for intertrochanteric fractures , the external fixation device could produce clinical outcomes comparable to the outcomes obtained with conventional treatment .


Furthermore , because external fixation is minimally invasive , we expected a lower rate of morbidity .


Therefore , we compared the two treatments in a clinical trial of elderly patients with intertrochanteric fracture .


@ elderly high-risk patients with an average age of @ years were treated for intertrochanteric fracture , resulting from a low energy trauma .


Patients were randomly divided in two groups regarding to treatment .


In Group A the patients were treated with DHS , while in Group B were treated with external fixator .


The fixator was well accepted and no patient had significant difficulties while sitting or lying .


The average intraoperative time was @ min in Group A and @ min in Group B ( p < @ ) .


@ patients of Group A need blood transfusion postoperatively and none in Group B ( p < @ ) .


The mean duration of hospitalization in Group A and Group B was @ and @ days , respectively ( p < @ ) .


@ of patients Group B had pin-track infection grade @ that all were treated by oral antibiotics .


There were no differences in comorbidities , quality of reduction , screw cut out , bed sore and HHS between the two groups .


Treatment with external fixator is an effective treatment for intertrochanteric fractures in elderly highrisk patients .


The advantages include quick and simple application , minimal blood loss , less radiation exposure , adequate fixation , pain reduction , early discharge from hospital , low costs and favourable functional outcomes .


Constipation is often characterized by slow colonic transit , but the relationship between colonic transit time ( CTT ) and symptoms is unclear .


The aims of this study were to investigate the effect of prucalopride , a @-hydroxytryptamine receptor-@ agonist , on CTT and assess the relationship between CTT and symptoms .


This was an integrated analysis of three randomized , placebo-controlled , phase @ dose-finding trials of prucalopride in patients with chronic constipation ( ClinicalTrials.gov identifiers : NCT@ ; NCT@ ; and NCT@ ) .


Measurements of CTT were analyzed using radio-opaque markers at the start and end ( @ or @ weeks ) of treatment .


At these visits , patients assessed the presence and severity of their symptoms .


In total , @ patients had CTT measurements before and at the end of treatment and were included in the analysis .


Their mean age was @ years , @ % were women , and mean duration of constipation was @ years .


After a once daily treatment with prucalopride @ mg ( n = @ ) and @ mg ( n = @ ) , CTT was reduced by @ h ( @ % confidence interval ( CI ) : -@ , -@ ) and @ h ( @ % CI : -@ , -@ ) , respectively ; CTT increased by @ h ( @ % CI : -@ , @ ) with placebo ( n = @ ) .


At the end of the trial , symptoms including bloating/flatulence/distension and straining were rated as severe or very severe by a higher proportion of patients with slow or very slow CTT ( > @ h ) than by those with normal CTT .


There was a clear relationship between increased CTT and increased symptom severity in patients with chronic constipation .


Treatment with prucalopride accelerated CTT in these individuals .


Despite considerable use of make your own ( MYO ) cigarettes worldwide and increasing use in the United States , relatively little is known about how these cigarettes are smoked and the resultant toxicant exposure .


In a laboratory study , we compared two types of MYO cigarettes-roll your own ( RYO ) and personal machine made ( PMM ) - with factory-made ( FM ) cigarettes in three groups of smokers who exclusively used RYO ( n = @ ) , PMM ( n = @ ) , or FM ( n = @ ) .


Within each group , cigarettes were smoked in three conditions : ( i ) after confirmed overnight tobacco abstinence ; ( ii ) in an intense smoking paradigm ; and ( iii ) without restrictions .


All cigarettes were smoked ad lib through a smoking topography unit .


Plasma nicotine significantly increased after cigarettes in all conditions except PMM in the intense smoking paradigm .


Puff volume , puff duration , total puff volume , and puff velocity did not differ between cigarette types but the puffs per cigarette and time to smoke were significantly smaller for RYO compared with PMM and FM .


Regardless of the cigarette , participants consumed the first three puffs more vigorously than the last three puffs .


Despite the belief of many of their consumers , smoking MYO cigarettes is not a safe alternative to FM cigarettes .


Like FM , MYO cigarettes expose their users to harmful constituents of tobacco smoke .


Despite differences in size and design their puffing profiles are remarkably similar .


These data are relevant to health and regulatory considerations on the MYO cigarettes .


Declining cognitive function is relatively common and increasingly prevalent .


Studies have shown that different nutrients ( e.g. , Ginkgo biloba and vitamin E ) appear to be effective at improving memory and concentration , while less is known about their effect on immunity .


This study investigated the effect of Ginkgo Synergy ( ) plus Choline ( n = @ ) and OPC Synergy ( ) plus Catalyn ( ) ( n = @ ) versus placebo ( n = @ ) in a @-month , randomized , double-blind trial on cognitive and immune functioning among English-speaking , non-smoking , healthy older adults .