These data provide evidence that MenACWY-CRM can be administered with typhoid Vi polysaccharide vaccine and live attenuated YF vaccine without compromising antibody responses stimulated by the individual vaccines .


MenACWY-CRM can , therefore , be incorporated into travelers ' vaccination programs without necessitating an additional clinic visit ( NCT@ ) .


Treatment with escalated BEACOPP achieved a superior time to treatment failure over ABVD in patients with disseminated Hodgkin lymphoma .


However , recent clinical trials have failed to confirm BEACOPP overall survival ( OS ) superiority over ABVD .


In addition , the gain in low-risk patients is still a matter of debate .


We randomly compared ABVD ( @ cycles ) with BEACOPP ( escalated @ cycles baseline @ cycles ) in low-risk patients with an International Prognostic Score ( IPS ) of @-@ .


The primary end point was event-free survival ( EFS ) .


This parallel group , open-label phase @ trial was registered under #RECF @ at French National Cancer Institute .


One hundred and fifty patients were randomized in this trial ( ABVD @ , BEACOPP @ ) : @ years was the median age , @ % were male and IPS was @-@ for @ % .


Complete remission rate was @ % for ABVD and @ % for BEACOPP .


Progression or relapses were more frequent in the ABVD patients than in the BEACOPP patients ( @ versus @ patients ) .


With a median follow-up period of @ years , seven patients died : six in the ABVD arm and one in the BEACOPP arm ( HL @ and @ , @nd cancer @ and @ , accident @ and @ ) .


The EFS at @ years was estimated at @ % for ABVD versus @ % , for BEACOPP -LSB- hazards ratio ( HR ) = @ , P = @ -RSB- .


The progression-free survival ( PFS ) at @ years was @ % versus @ % ( HR = @ , P = @ ) .


The OS at @ years was @ % versus @ % ( HR = @ , P = @ ) .


Fewer progressions/relapses were observed with BEACOPP , demonstrating the high efficacy of the more intensive regimen , even in low-risk patients .


However , additional considerations , balancing treatment-related toxicity and late morbidity due to salvage may help with decision-making with regard to treatment with ABVD or BEACOPP .


Lower levels of sex hormone-binding globulin ( SHBG ) have been associated with increased risk of diabetes among postmenopausal women ; however , it is unclear whether they are associated with glucose intolerance in younger women .


We examined whether SHBG concentrations , measured before pregnancy , are associated with risk of gestational diabetes mellitus ( GDM ) .


This was a nested case-control study among women who participated in the Kaiser Permanente Northern California Multiphasic Health Check-up examination ( @-@ ) and had a subsequent pregnancy ( @-@ ) .


Eligible women were free of recognized diabetes .


Case patients were @ women in whom GDM developed .


Two control subjects were selected for each case patient and were matched for year of blood draw , age at examination , age at pregnancy , and number of intervening pregnancies .


Compared with the highest quartile of SHBG concentrations , the odds of GDM increased with decreasing quartile ( odds ratio @ -LSB- @ % CI @-@ @ -RSB- ; @ -LSB- @-@ @ -RSB- ; @ -LSB- @-@ @ -RSB- ; P for trend < @ ) , after adjusting for family history of diabetes , prepregnancy BMI , race/ethnicity , alcohol use , prepregnancy weight changes , and homeostasis model assessment of insulin resistance .


Having SHBG levels below the median ( < @ nmol/L ) and a BMI @ kg/m ( @ ) was associated with fivefold increased odds of GDM compared with normal-weight women with SHBG levels at or above the median ( @ -LSB- @-@ @ -RSB- ) .


Low prepregnancy SHBG concentrations were associated with increased risk of GDM and might be useful in identifying women at risk for GDM for early prevention strategies .


To determine whether charge awareness affects patient decisions .


Pediatric uncomplicated appendicitis can be treated with open or laparoscopic techniques .


These @ operations are considered to have clinical equipoise .


In a prospective , randomized clinical trial , nonobese children admitted to a children 's hospital with uncomplicated appendicitis were randomized to view @ of @ videos discussing open and laparoscopic appendectomy .


Videos were identical except that only one presented the difference in surgical materials charges .


Patients and parents then choose which operation they desired .


Videos were available in English and Spanish .


A postoperative survey was conducted to examine factors that influenced choice .


The trial was registered at ClinicalTrials.gov ( NCT @ ) .


Of @ consecutive cases , @ met enrollment criteria .


In the group exposed to charge data ( n = @ ) , @ % chose open technique versus @ % not presented charge data ( P = @ ) .


Patients were @ times more likely to choose the less expensive option when charge estimate was given ( @ % confidence interval , @-@ @ ) .


The median total hospital charges were $ @ less for those who had open technique ( P < @ ) and $ @ less for the group exposed to charge information ( P = @ ) .


Survey found that @ % of families valued having input in this decision and @ % of patients exposed to charge listed it as their primary reason for their choice in technique .


Patients and parents tended to choose the less expensive but equally effective technique when given the opportunity .


A discussion of treatment options , which includes charge information , may represent an unrealized opportunity to affect change in health care spending .


Patients with bipolar disorder experience sleep disturbance , even in euthymic phases .


Changes in sleep pattern are frequent signs of a new episode of ( hypo ) mania or depression .


Cognitive behavioral therapy for insomnia ( CBT-I ) is an effective treatment for primary insomnia , but there are no published results on the effects of CBT-I in patients with bipolar disorder .


In this randomized controlled trial , we wish to compare CBT-I and treatment as usual with treatment as usual alone to determine its effect in improving quality of sleep , stabilizing minor mood variations and preventing new mood episodes in euthymic patients with bipolar disorder and comorbid insomnia .


Patients with euthymic bipolar I or II disorder and insomnia , as verified by the Structured Clinical Interview for DSM Disorders ( SCID-@ ) assessment , will be included .


The patients enter a three-week run-in phase in which they complete a sleep diary and a mood diary , are monitored for seven consecutive days with an actigraph and on two of these nights with polysomnography in addition before randomization to an eight-week treatment trial .


Treatment as usual consists of pharmacological and supportive psychosocial treatment .


In this trial , CBT-I will consist of sleep restriction , psychoeducation about sleep , stabilization of the circadian rhythm , and challenging and correcting sleep state misperception , in three to eight sessions .


This trial could document a new treatment for insomnia in bipolar disorder with possible effects on sleep and on stability of mood .


In addition , more precise information can be obtained about the character of sleep disturbance in bipolar disorder .


To prepare oral controlled-release cilostazol formulations and evaluate their pharmacokinetics and pharmacodynamics in dogs and humans compared with a commercial twice-daily immediate-release formulation ( Pletal ) , thereby showing the potential for the development of an improved once-daily cilostazol formulation .


Six different controlled-release preparations were formulated using a micronized cilostazol , solubilizer/absorption enhancer and erodible hydrogel .


In-vitro drug release profiles were tailored by varying hydrogel viscosity .


Pharmacokinetics and pharmacodynamic ( antithrombotic ) efficacy were evaluated in beagle dog model of arterial thrombosis .


Finally , their pharmacokinetics and pharmacodynamics were also evaluated in healthy human volunteers after single and multiple oral administrations .


Hydrogel viscosity-dependent sustained drug release profiles were observed with zero-order release kinetics during @-@ h.


In dogs and humans , compared with Pletal , prolonged drug absorption profiles were observed in the two controlled-release formulations studied .


In dogs , the controlled-release formulations showed greater antithrombotic efficacy than twice-daily Pletal .


In humans , the antithrombotic efficacy of the selected once-daily cilostazol formulation was equivalent to that of twice-daily Pletal after single and multiple administrations .


The prepared oral controlled-release cilostazol formulation may provide prolonged drug absorption and sufficient therapeutic efficacy , potentially serving as an oral once-daily cilostazol formulation to improve patient compliance .


Laryngeal tubes ( LT ) are often used as rescue airway devices .


Among prehospital medical personnel , the success rates are high and significantly faster compared to an endotracheal tube ( ETT ) .


Therefore , LTs are increasingly used in the prehospital setting .


The exchange of an LT for an ETT may often be desirable .


Two fiberoptic bronchoscope-facilitated techniques have been described to exchange an LT for an ETT : an intraluminal technique using an Aintree intubating catheter and an extraluminal technique using a nasal route alongside the LT. In this randomized cross-over mannequin study , we compared the intraluminal with the extraluminal exchange technique .


The primary outcome was time to achieve an effective airway through an ETT .


We hypothesized that the intraluminal technique would be significantly faster .


Thirty anesthesia providers were recruited to the study .


Each participant attempted both techniques in an intubation simulation model .


The tube exchange time was recorded from picking up the fiberoptic bronchoscope until confirmation of ventilation with the ETT .


Four participants in each group had a failed attempt at intubation .


Time to establish an endotracheal intubation was significantly shorter with the intraluminal technique vs the extraluminal technique ( @ vs @ seconds ; P = @ ) .


Based on the results of our study , we suggest that the intraluminal technique may be a suitable alternative for a fiberoptic-guided rapid exchange of an LT for an ETT to establish an effective airway in a challenging situation .


Driving is a vision-based activity of daily living that impacts safety .


Because visual disruption can compromise driving safety , contact lens wearers with astigmatism may pose a driving safety risk if they experience residual blur from spherical lenses that do not correct their astigmatism or if they experience blur from toric lenses that rotate excessively .


Given that toric lens stabilization systems are continually improving , this preliminary study tested the hypothesis that astigmats wearing toric contact lenses , compared with spherical lenses , would exhibit better overall driving performance and driving-specific visual abilities .


A within-subject , single-blind , crossover , randomized design was used to evaluate driving performance in @ young adults with astigmatism ( -@ to -@ diopters cylinder ) .


Each participant drove a highly immersive , virtual reality driving simulator ( @ degrees field of view ) with ( @ ) no correction , ( @ ) spherical contact lens correction ( ACUVUE MOIST ) , and ( @ ) toric contact lens correction ( ACUVUE MOIST for Astigmatism ) .


Tactical driving skills such as steering , speed management , and braking , as well as operational driving abilities such as visual acuity , contrast sensitivity , and foot and arm reaction time , were quantified .


There was a main effect for type of correction on driving performance ( p = @ ) .


Correction with toric lenses resulted in significantly safer tactical driving performance than no correction ( p < @ ) , whereas correction with spherical lenses did not differ in driving safety from no correction ( p = @ ) .


Operational tests differentiated corrected from uncorrected performance for both spherical ( p = @ ) and toric ( p = @ ) lenses , but they were not sensitive enough to differentiate toric from spherical lens conditions .


Given previous research showing that deficits in these tactical skills are predictive of future real-world collisions , these preliminary data suggest that correcting low to moderate astigmatism with toric lenses may be important to driving safety .


Their merits relative to spherical lens correction require further investigation .


Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications .


However , little is known about their practical day-to-day experiences with pain medication management .


The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self ( ) Plus Pain Control Program .


In this article , we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems .


We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients , family caregivers , and nurses about pain medication management during the @-week intervention .


The health systems context for pain medication management included multiple complex systems for clinical care , reimbursement , and regulation of analgesic prescriptions .


Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications .


Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians , overcoming barriers to access , and serving as a final safety checkpoint .


Significant effort was required of patients and family caregivers to insure safe and effective pain medication management .


Health systems issues related to access to needed analgesics , medication safety in outpatient settings , and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives .


The circadian clock coordinates numerous metabolic processes with light-dark and feeding regimens .


However , in humans it is unknown whether dietary patterns influence circadian rhythms .


We examined the effects of switching from a high-carbohydrate , low-fat diet to a low-carbohydrate , high fat ( LC/HFD ) isocaloric diet on the central and peripheral circadian clocks in humans .


Diurnal patterns of salivary cortisol and gene expression were analyzed in blood monocytes of @ nonobese healthy subjects before and @ and @ weeks after the dietary switch .


For this , we established a method of rhythm prediction by @-time point data .


The centrally driven cortisol rhythm showed a phase delay @ and @ weeks after the dietary switch to a LC/HFD as well as an amplitude increase .


The dietary switch altered diurnal oscillations of core clock genes ( PER@ , PER@ , PER@ , and TEF ) and inflammatory genes ( CD@ , CD@ , NFKBIA , and IL@B ) .


The LC/HFD also affected the expression of nonoscillating genes contributing to energy metabolism ( SIRT@ ) and fat metabolism ( ACOX@ and IDH@A ) .


Expression of clock genes but not of salivary cortisol in monocytes tightly correlated with levels of blood lipids and with expression of metabolic and inflammatory genes .


Our results suggest that the modulation of the dietary fat and carbohydrate content alters the function of the central and peripheral circadian clocks in humans .


Laparoscopic resection of colorectal cancer is widely used .


However , robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking .


A trial was designed to compare @-year rates of cancer recurrence in the pelvic or perineal area ( locoregional recurrence ) and survival after laparoscopic and open resection of rectal cancer .


In this international trial conducted in @ hospitals , we randomly assigned patients with a solitary adenocarcinoma of the rectum within @ cm of the anal verge , not invading adjacent tissues , and without distant metastases to undergo either laparoscopic or open surgery in a @:@ ratio .


The primary end point was locoregional recurrence @ years after the index surgery .


Secondary end points included disease-free and overall survival .


A total of @ patients were included ( @ in the laparoscopic-surgery group and @ in the open-surgery group ) .


At @ years , the locoregional recurrence rate was @ % in the two groups ( difference , @ percentage points ; @ % confidence interval -LSB- CI -RSB- , -@ to @ ) .


Disease-free survival rates were @ % in the laparoscopic-surgery group and @ % in the open-surgery group ( difference , @ percentage points ; @ % CI , -@ to @ ) .


Overall survival rates were @ % in the laparoscopic-surgery group and @ % in the open-surgery group ( difference , @ percentage points ; @ % CI , -@ to @ ) .


Laparoscopic surgery in patients with rectal cancer was associated with rates of locoregional recurrence and disease-free and overall survival similar to those for open surgery .


( Funded by Ethicon Endo-Surgery Europe and others ; COLOR II ClinicalTrials.gov number , NCT@ . )


Early palliative care provides better quality of life , increased prognostic awareness , and even improved survival for patients with advanced cancer but how the integrated care model achieves these outcomes has not been completely explained .


To better understand the clinical approach to early outpatient care from the clinicians ' perspective , we conducted focus groups with the palliative care clinicians who had participated in a randomized trial of early palliative care for metastatic lung cancer .


Clinicians described their role in providing early palliative care as having three distinct roles in the outpatient setting : ( @ ) managing symptoms to improve functional status and as a bridge to other issues ; ( @ ) engaging patients in emotional work to facilitate coping , accepting , and planning ; and ( @ ) interpreting the oncologist for the patient and the patient for the oncologist .


These data lay the foundation for developing training programs for clinicians in early integrated palliative care .


The National Institutes of Health.funded Trial to Assess Chelation Therapy ( TACT ) randomized @ stablecoronary disease patients aged @ years who were @ months post.myocardial infarction ( @ ) to @ infusions ofa multicomponent EDTA chelation solution or placebo .


Chelation reduced the primary composite end point of mortality , recurrent myocardial infarction , stroke , coronary revascularization , or hospitalization for angina ( hazard ratio , @ ; @ % confidence interval , @ ; P = @ ) .


In a randomly selected subset of @ patients , we prospectively collected a battery of quality-of-life ( QOL ) instruments at baseline and at @ , @ , and @ months after randomization .


The prespecified primary QOL measures were the Duke Activity Status Index ( Table I in the Data Supplement ) and the Medical Outcomes Study Short-Form @ Mental Health Inventory-@ .


All comparisons were by intention to treat .


Baseline clinical and QOL variables were well balanced in the @ patients randomized to chelation and in the @ patients randomized to placebo .


The Duke Activity Status Index improved in both groups during the first @ months of therapy , but we found no evidence for a treatment-related difference ( mean difference -LSB- chelation.placebo -RSB- during follow-up , @ -LSB- @ % confidence interval , @ to @ ; P = @ -RSB- ) .


There was no statistically significant evidence of a treatment-related difference in the Mental Health Inventory-@ during follow-up ( mean difference , @ ; @ % confidence interval , @ to @ ; P = @ ) .


None of the secondary QOL measures showed a consistent treatment-related difference .


In stable , predominantly asymptomatic coronary disease patients with a history of myocardial infarction , EDTA chelation therapy did not have a detectable effect on QOL during @ years of follow-up .


Gait impairment is common in people with Parkinson 's disease .


There is a lack of effective interventions to target this debilitating complication and therefore a need to identify new therapeutic options .


An underlying cholinergic deficit contributes to both the gait and cognitive dysfunction seen in Parkinson 's disease .


The combined impact of both impairments can be assessed in gait tasks performed with concomitant cognitive tasks .


The aim of this trial is to evaluate the impact of a cholinesterase inhibitor on cognitive function and gait performance in people with established Parkinson 's disease .


This is a single centre , double-blind , randomised placebo-controlled trial in @ people with Hoehn and Yahr stage @-@ idiopathic Parkinson 's disease who have fallen in the past year .


Participants will be randomised to two groups , receiving either rivastigmine capsules or identical placebo capsules for @months .


Assessment will be undertaken at baseline and at the end of medication prescription ( i.e. @months ) with participants remaining enrolled in the trial for a further @months to monitor for falls and adverse events .


The primary outcome is step time variability , assessed with and without the addition of concurrent cognitive tasks .


Secondary outcomes will include other gait parameters , sensorimotor and balance performances , cognitive indices , falls and fall related injury , fear of falling , Parkinson 's symptoms and data pertaining to possible harms .


This randomised controlled trial will examine the effect of cholinesterase inhibitor therapy on gait , balance and falls in Parkinson 's disease .


If effective , it would offer a new therapeutic option to ameliorating gait and cognitive deficits in a population at high risk of falls .


The impact of narrow band imaging in improving the adenoma detection rate in a screening scenario is still unclear .


To evaluate whether narrow band imaging compared with high definition white light colonoscopy can enhance the adenoma detection rate during screening colonoscopy .


Consecutive patients presenting for screening colonoscopy were included into this study and were randomly assigned to the narrow band imaging group ( Group @ ) or standard colonoscopy group ( Group @ ) .


Primary end point was the adenoma detection rate and secondary aim was the detection rate of advanced adenomas .


Overall , @ patients were allocated to Group @ and @ to Group @ .


Both the adenoma detection rate and the detection rate of advanced adenomas were not significantly different between the two groups ( respectively , @ % vs. @ % , RR = @ , @ % CI @-@ @ ; @ % vs. @ % , RR = @ , @ % CI @-@ @ ) .


No significant difference between the proportions of polypoid and flat adenomas was found .


Male gender , no prior history of screening , and endoscopist 's adenoma detection rate were independent predictive factors of higher advanced adenoma detection rate .


In a screening scenario , narrow band imaging did not improve the adenoma nor advanced adenoma detection rates compared to high definition white light colonoscopy .


To prospectively determine the efficacy of combination therapy with temsirolimus plus bevacizumab versus interferon alfa ( IFN ) plus bevacizumab in metastatic renal cell carcinoma ( mRCC ) .


In a randomized , open-label , multicenter , phase III study , patients with previously untreated predominantly clear-cell mRCC were randomly assigned , stratified by prior nephrectomy and Memorial Sloan-Kettering Cancer Center prognostic group , to receive the combination of either temsirolimus ( @ mg intravenously , weekly ) or IFN ( @ MIU subcutaneously thrice weekly ) with bevacizumab ( @ mg/kg intravenously , every @ weeks ) .


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


Median PFS in patients treated with temsirolimus/bevacizumab ( n = @ ) versus IFN/bevacizumab ( n = @ ) was @ and @ months , respectively ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; P = @ ) .


There were no significant differences in overall survival ( @ @ months ; HR , @ ; P = @ ) or objective response rate ( @ % @ % ) with temsirolimus/bevacizumab versus IFN/bevacizumab , respectively .


Patients receiving temsirolimus/bevacizumab reported significantly higher overall mean scores in the Functional Assessment of Cancer Therapy-Kidney Symptom Index ( FKSI ) -@ and FKSI-Disease Related Symptoms subscale compared with IFN/bevacizumab ( indicating improvement ) ; however , no differences in global health outcome measures were observed .


Treatment-emergent all-causality grade @ adverse events more common ( P < @ ) with temsirolimus/bevacizumab were mucosal inflammation , stomatitis , hypophosphatemia , hyperglycemia , and hypercholesterolemia , whereas neutropenia was more common with IFN/bevacizumab .


Incidence of pneumonitis with temsirolimus/bevacizumab was @ % , mostly grade @ or @ .


Temsirolimus/bevacizumab combination therapy was not superior to IFN/bevacizumab for first-line treatment in clear-cell mRCC .


Two arms with FOLFIRI , with or without cetuximab , were initially included in the randomized phase III intergroup clinical trial NCCTG ( North Central Cancer Treatment Group ) N@ .


When other contemporary trials demonstrated no benefit to using irinotecan as adjuvant therapy , the FOLFIRI-containing arms were discontinued .


We report the clinical outcomes for patients randomized to FOLFIRI with or without cetuximab .


After resection , patients were randomized to @ biweekly cycles of FOLFIRI , with or without cetuximab .


KRAS ( Kirsten rat sarcoma viral oncogene homolog ) mutation status was retrospectively determined in a central lab .


The primary end point was disease-free survival ( DFS ) .


Secondary end points included overall survival ( OS ) and toxicity .


One hundred and six patients received FOLFIRI and @ received FOLFIRI plus cetuximab .


Median follow-up was @ years ( range , @-@ @ years ) .


The addition of cetuximab showed a trend toward improved DFS ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @-@ @ ; P = @ ) and OS ( HR , @ ; @ % CI , @-@ @ ; P = @ ) in the overall group , regardless of KRAS status , and in patients with wild type KRAS .


Grade @ nonhematologic adverse effects were significantly increased in the cetuximab versus FOLFIRI-alone arm ( @ % vs. @ % ; P = @ ) .


Adjuvant FOLFIRI resulted in a @-year DFS less than that expected for FOLFOX .


In this small randomized subset of patients with resected stage III colon cancer , the addition of cetuximab to FOLFIRI was associated with a nonsignificant trend toward improved DFS and OS .


Nevertheless , considering the limitations of this analysis , FOLFOX without the addition of a biologic agent remains the standard of care for adjuvant therapy in resected stage III colon cancer .


Severe depression can be a life-threatening disorder , especially in elderly patients .


A fast-acting treatment is crucial for this group .


Electroconvulsive therapy ( ECT ) may work faster than medication .


To compare the speed of remission using ECT v. medication in elderly in-patients .


The speed of remission in in-patients with a DSM-IV diagnosis of major depression ( baseline MADRS score @ ) was compared between @ participants ( mean age @ years , s.d. = @ ) from an ECT randomised controlled trial ( RCT ) and @ participants ( mean age @ years , s.d. = @ ) from a medication RCT ( nortriptyline v. venlafaxine ) .


Mean time to remission was @ weeks ( s.d. = @ ) for the ECT group and @ weeks ( s.d. = @ ) for the medication group ; the adjusted hazard ratio for remission within @ weeks ( ECT v. medication ) was @ ( @ % CI @-@ @ ) .


Considering the substantially higher speed of remission , ECT deserves a more prominent position in the treatment of elderly patients with severe depression .


Parental language is associated with children 's later language development .


Parenting programmes , based on social learning theory , enhance a range of parenting behaviours , yet there is limited evidence for their effect on parental language .


To assess the benefits of a behavioural-based parenting programme , which features components of language and communication , to enhance parental language .


Parents of toddlers , aged @ to @ months , were recruited from eight Flying Start early intervention centres across Wales .


Participants were randomised @:@ either to a parenting programme ( n = @ ) or to a wait-list control group ( n = @ ) .


Researchers were blind to participant allocation throughout the trial .


Fifteen-minute video-recorded observations of parents and children interacting during free-play , both at a pre-intervention and at @-month follow-up , provided the data for the study .


Five observed measures of parental language were assessed ; quantity and variety , encouraging , critical , child-led and parent led interactions .


The Incredible Years Parent-Toddler Programme ( IYPTP ) is a @-week group-based behavioural intervention that teaches effective relationship and behavioural management skills including social , emotional and persistence coaching to enable parents to better support their children 's development .


Of @ dyads that completed pre-intervention assessments @ ( @ intervention and @ control ) met the criteria for the current study .


Intention to treat analysis indicated that child-led language interactions significantly benefited from the intervention -LSB- regression coefficient ( B ) = -@ , @ % confidence intervals ( CI ) = -@ to -@ , P = @ , effect size ( ES ) = @ -RSB- and a positive trend for encouraging language in favour of the intervention sample was evident .


Per-protocol sample analysis replicated these findings with encouraging language reaching statistical significance ( B = @ , @ % CI = @ to @ , P = @ , ES = @ ) .


No further benefits were evident .


The IYPTP has limited evidence as an effective programme for enhancing some aspects of parental language .


The Radiation Therapy Oncology Group ( RTOG ) conducted a randomized , placebo-controlled trial evaluating the efficacy of GM-CSF in reducing mucosal injury and symptom burden from curative radiotherapy for head and neck ( H&N ) cancer .


Eligible patients with H&N cancer receiving radiation encompassing @ % of the oral cavity or oropharynx received subcutaneous GM-CSF or placebo .


Quality of life ( QoL ) was assessed using the RTOG-modified University of Washington H&N Symptom Questionnaire at baseline @ , @ , @ , and @weeks from radiation initiation .


Of @ eligible patients , @ were evaluable for QoL ( @ GM-CSF , @ placebo ) .


Patient demographics , clinical characteristics , and baseline symptom scores were well balanced between the treatment arms .


At the end of the acute period ( @weeks ) , patients in both arms reported negative change in total symptom score indicating increase in symptom burden relative to baseline ( mean -@ GM-CSF , -@ placebo ) .


There was no difference in change in total symptom score ( p > @ ) or change in mucous , pain , eating , or activity domain scores ( p > @ ) between patients in the GM-CSF and placebo arms .


Analysis limited to patients treated per protocol or with an acceptable protocol deviation also found no difference in change in total symptom score ( p > @ ) or change in domain scores ( p > @ ) between treatment arms .


Provider assessment of acute mucositis during treatment did not correlate with patient-reported mucous domain and total symptom scores ( p > @ ) .


GM-CSF administered concurrently during head and neck radiation does not appear to significantly improve patient-reported QoL symptom burden .


This study sought to determine the impact that an electronic medical record ( EMR ) had on the provision of preventive health measures - including obtaining serologies for viral hepatitis and administering vaccinations to non-immune patients - to HIV patients at a hospital-based clinic .


Using a pre-post study design , we compared rates of preventive health delivery to HIV patients at an outpatient clinic during the use of a paper medical record ( PMR ) and after implementation of an EMR .


Retrospective chart reviews were conducted at two time points : @-@ months prior to and @ months following EMR implementation .


The records of @ active patients were randomly selected for review during both time periods .


There was no difference between the PMR and EMR samples with regard to the proportion of patients who had hepatitis A ( @ % in PMR group ; @ % in EMR ) and hepatitis C ( @ % in both groups ) serologies measured or the proportion of eligible patients who were given hepatitis vaccinations .


Slightly fewer patients had a serology for hepatitis B measured in the EMR sample .


As EMR implementation expands , it is important to evaluate the effects that EMRs have on patient outcomes , including preventive health provision .


Our study showed that after implementation of an EMR , the provision of most preventive care measures did not improve .


This finding is in agreement with many published studies .


Some studies have found positive effects from EMRs that may be attributable to specific aspects of EMRs .


Further study of the effect of specific EMR attributes on health care outcomes is needed .


Fast-setting impression materials may be prone to inaccuracies due to accidental divergence from the recommended mixing protocol .


This prospective randomized clinical trial aimed to assess three-dimensional ( @D ) deviations in the reproduction of subgingival tooth surfaces and to determine the effect of either following or purposely diverging from the recommended mixing procedure for a fast-setting addition-curing silicone ( AS ) and fast-setting polyether ( PE ) .


After three impressions each were taken from @ participants , sawcut gypsum casts were fabricated with a standardized procedure and then optically digitized .


Data were assessed with a computer-aided @D analysis .


For AS impressions , multivariate analysis of variance revealed a significant influence of the individual tooth and the degree to which the recommended mixing protocol was violated .


For PE impressions , the ambient air temperature and individual tooth showed significant effects , while divergence from the recommended mixing protocol was not of significance .


The fast-setting PE material was not affected by changes in the recommended mixing protocol .


For the two fast-setting materials examined , no divergences from the recommended mixing protocol of less than @ minutes led to failures in the reproduction of the subgingival tooth surfaces .


The acute phase of the nonthyroidal illness syndrome ( NTIS ) is characterized by low T@ and high rT@ levels , affecting up to @ % of critically ill patients .


Oxidative stress has been implicated as a causative factor of the disturbed peripheral thyroid hormone metabolism .


The objective of the study was to investigate whether N-acetylcysteine ( NAC ) , a potent intracellular antioxidant , can prevent NTIS in patients with acute myocardial infarction .


This was a randomized , multicenter clinical trial .


Consecutive patients admitted to the emergency and intensive care units of two tertiary hospitals in southern Brazil were recruited .


Patients and intervention included @ patients were randomized to receive NAC or placebo during @ hours .


Baseline characteristics and blood samples for thyroid hormones and oxidative parameters were collected .


Variation of serum T@ and rT@ levels was measured .


Baseline characteristics were similar between groups ( all P > @ ) .


T@ levels decreased in the placebo group at @ hours of follow-up ( P = @ ) but not in NAC-treated patients ( P = @ ) .


Baseline rT@ levels were elevated in both groups and decreased over the initial @ hours in the NAC-treated patients ( P = @ ) but not in the control group ( P = @ ) .


The free T@ and TSH levels were virtually identical between the groups throughout the study period ( P > @ ) .


Measurement of total antioxidant status and total carbonyl content demonstrated that oxidative balance was deranged in acute myocardial infarction patients , whereas NAC corrected these alterations ( P < @ ) .


NAC administration prevents the derangement in thyroid hormone concentrations commonly occurring in the acute phase of acute myocardial infarction , indicating that oxidative stress is involved in the NTIS pathophysiology .


The impetus of our study was to investigate the effects of a nutritional supplement Delphinol , an extract of maqui berries ( Aristotelia chilensis ) standardised to @ % delphinidins and @ % total anthocyanins , on postprandial blood glucose and insulin levels and identify the physiologic mechanism involved .


Postprandial blood glucose and insulin were investigated in double-blind , placebo-controlled , cross-over fashion in ten volunteers with moderate glucose intolerance .


Longer term effects on blood sugar levels were investigated in streptozotocin-diabetic rats over a four months period .


Effects of maqui berry delphinidins on sodium-glucose symport were examined in rodent jejenum of the small intestine .


Delphinol intake prior to rice consumption statistical significantly lowered post prandial blood glucose and insulin as compared to placebo .


We identified an inhibition of Na + - dependant glucose transport by delphinidin , the principal polyphenol to which Delphinol is standardised .


In a diabetic rat model the daily oral application of Delphinol over a period of four months significantly lowered fasting blood glucose levels and reached values indistinguishable from healthy non-diabetic rats .


Our results suggest a potential use of Delphinol for naturally controlling post-prandial blood glucose owed to inhibition of sodium glucose co-transporter in small intestine .


To determine changes in spinal reflex excitability of the soleus and fibularis longus muscles before and after fibular taping intervention .


Twenty-one individuals ( age = @ @ y , height = @ @ cm , mass = @ @ kg ) with chronic ankle instability ( CAI ) and at least @ ankle dorsiflexion asymmetry volunteered for this randomised crossover design study .


Each participant received a fibular taping with tension or fibular taping without tension during separate sessions .


Spinal reflex excitability of the soleus and fibularis longus was determined by obtaining maximum values for H-reflex ( Hoffmann reflex ) and maximum compound muscle action potential ( Mmax ) , which was expressed as a ratio ( H/M ratio ) .


Measures were obtained immediately before and after a fibular taping intervention .


The application of tape to the fibula , regardless of tension , did not produce a change in spinal reflex excitability for the soleus ( F@ ,@ = @ , P = @ ) or fibularis longus ( F@ ,@ = @ , P = @ ) .


Fibular taping with and without tension did not result in an immediate change in spinal reflex excitability of the soleus or fibularis longus in individuals with CAI .


Although fibular taping has been shown to reduce recurrent ankle sprains in individuals with CAI , the mechanism of effectiveness may not involve an immediate increase in spinal reflex excitability .


@ % saline is the most commonly used intravenous ( IV ) fluid in the world .


However , recent data raise the possibility that , compared with buffered crystalloid fluids such as Plasma-Lyte @ , the administration of @ % saline to intensive care unit patients might increase their risk of acute kidney injury ( AKI ) .


To describe the protocol for the @ % Saline v Plasma-Lyte @ for ICU Fluid Therapy ( SPLIT ) study .


This is a multicentre , cluster-randomised , double crossover feasibility study to be conducted in four New Zealand tertiary ICUs over a @-week period and will enroll about @ participants .


All ICU patients who need crystalloid IV fluid therapy ( except those with established renal failure needing dialysis and those admitted to the ICU for palliative care ) will be enrolled .


Participating ICUs will be randomly assigned to @ % saline or Plasma-Lyte @ as the routine crystalloid IV fluid , in a blinded fashion , in four alternating @-week blocks .


The primary outcome will be the proportion of patients who develop AKI in the ICU .


Secondary outcomes will include the difference between the most recent serum creatinine level measured before study enrollment and the peak serum creatinine level in the ICU ; use of renal replacement therapy ; and ICU and in hospital mortality .


All analyses will be conducted on an intention-to-treat basis .


The SPLIT study started on @ April @ and will provide preliminary data on the comparative effectiveness of using @ % saline v Plasma - Lyte @ as the routine IV fluid therapy in ICU patients .


Effect sizes of pharmacotherapy in alcoholism are modest .


They might improve if subjects could be divided into more homogeneous subgroups and would then be treated targeted to their neurobiological profile .


In such an effort , we tested neural cue reactivity as a potential predictor of treatment response to naltrexone .


Alcohol-associated cues cause brain activations in mesocorticolimbic networks due to the positive reinforcing properties of alcohol .


These activations were reported to be associated with relapse behavior .


Naltrexone , an antagonist at the mu-opioid receptor , improves drinking behavior in some but not all patients probably by blocking the positive reinforcement of alcohol .


Conversely , acamprosate is proposed to modulate negative reinforcement ( withdrawal and cue-induced withdrawal ) .


Identifying subjects with elevated cue reactivity and testing their response to medical treatment could thus improve our understanding of some of the mechanisms underlying pharmacotherapy response .


A picture-perception task featuring alcohol-related and neutral stimuli was presented to @ recently detoxified alcohol-dependent patients .


Patients came from @ center of a larger double-blind randomized multicenter clinical trial ( the `` PREDICT Study '' ) .


They were scanned prior to being randomized to either naltrexone or acamprosate .


We examined the interaction between medication and functional magnetic resonance imaging ( fMRI ) cue reactivity , as measured by the percentage of voxels activated , using the time to the first severe relapse as the outcome criterion .


Our a priori formulated hypothesis was that naltrexone but not acamprosate should be efficacious in subjects with high cue reactivity .


We observed an interaction effect between pretreatment brain activation induced by alcohol images and medication ( acamprosate/naltrexone ) on relapse behavior .


In line with our hypothesis , this interaction was driven by treatment response to naltrexone in patients with elevated pretreatment cue reactivity in the ventral striatum .


fMRI has the potential for predicting treatment response to naltrexone in a subgroup of alcohol-dependent patients .


However , this approach will be limited to researching the mechanisms and principles of treatment response .


This prospective randomised control study is to demonstrate whether or not there is a clinical benefit from inserting a Wallis implant on the functional recovery of patients who have undergone lumbar decompression surgery .


Sixty consecutive patients with an average age of @ years ( @-@ ) who were selected for primary lumbosacral decompression were randomly assigned into two groups with equal number of patients , decompression alone or decompression with Wallis implant .


The patients had an average follow-up of @ months .


Patients were assessed by visual analogue scale ( VAS ) ( Boonstra et al. , Int J Rehabil Res @:@ -@ , @ ; Price et al. , Pain @:@ -@ , @ ) pain score for back and leg pain , and the Oswestry Disability Index questionnaire ( ODI ) ( Smeets et al. , Arthritis Care Res ( Hoboken ) @ : S@-S@ , @ ) .


The results in both the groups did not reveal a significant difference in the clinical outcome assessment of back pain score or ODI .


With the Wilcoxon two-sample test , no difference in median values was achieved ( p value @ for ODI and p value @ for back pain ) .


The average ODI in the Wallis group dropped from @ to @ .


The average VAS for the Wallis group back pain dropped from @ to @ .


The Wallis implant is a safe medical device .


This study revealed a reduction in pain and functional disability in patients treated with decompression surgery for lumbar stenosis , with or without Wallis .


The Wallis group improved more , but it was not statistically significant .


The risk of complications is lower than other interspinous devices .


To determine whether treatment of attention-deficit/hyperactivity disorder ( ADHD ) with osmotic-release oral system ( OROS ) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment .


This is a secondary analysis of data from a randomized , double-blind , @-week trial conducted between December @ and January @ at @ clinical sites ; the original trial was sponsored by the National Drug Abuse Clinical Trials Network .


Adult cigarette smokers ( aged @-@ years ) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate ( @ mg/d ) ( n = @ ) or matching placebo ( n = @ ) .


All participants received nicotine patches ( @ mg/d ) and weekly individual smoking cessation counseling .


Logistic regression was used to model prolonged abstinence from smoking ( ascertained by self-report and breath carbon monoxide testing ) as a function of treatment , baseline ADHD Rating Scale-IV ( ADHD-RS ) score , change in ADHD-RS score during treatment , and their interactions .


Treatment interacted with both ADHD-RS score at baseline ( P = @ ) and change in ADHD-RS score during treatment ( P = @ ) .


Among patients with higher ADHD-RS scores ( > @ ) at baseline and the most improvement in ADHD during treatment ( ADHD-RS change score @ ) , @ % of those who took OROS methylphenidate achieved abstinence from smoking compared to @ % of those who took placebo ( P = @ ) .


In contrast , among patients with the lowest ADHD-RS baseline scores ( @ ) , @ % of those who took OROS methylphenidate achieved abstinence from smoking compared to @ % of those who took placebo ( P = @ ) .


OROS methylphenidate , in combination with nicotine patch , may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication .


OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD .


We evaluated a school-based child sexual abuse ( CSA ) prevention program , Safe Touches , in a low-socioeconomic status , racially diverse sample .


Participants were @ second - and third-grade students at @ public elementary schools in New York City .


The study period spanned fall @ through summer @ .


We cluster-randomized classrooms to the Safe Touches intervention or control groups and assessed outcomes with the Children 's Knowledge of Abuse Questionnaire .


Hierarchical models tested change in children 's knowledge of inappropriate and appropriate touch .


The intervention group showed significantly greater improvement than the control group on knowledge of inappropriate touch .


Children in second grade and children in schools with a greater proportion of students in general ( vs special ) education showed greater gains than other participants in knowledge of inappropriate touch .


We observed no significant change in knowledge of appropriate touch among control or intervention groups .


Young children benefited from a school-based , @-time CSA prevention program .


Future research should explore the efficacy of CSA prevention programs with children before the second grade to determine optimal age for participation .


We examined the differential impact of a well-established human immunodeficiency virus ( HIV ) / sexually transmitted infections ( STIs ) curriculum , Be Proud !


Be Responsible !


, when taught by school nurses and health education classroom teachers within a high school curricula .


Group-randomized intervention study of @ ninth and tenth grade students in @ schools .


Twenty-seven facilitators ( @ nurses , @ teachers ) provided programming ; nurse-led classrooms were randomly assigned .


Students taught by teachers were more likely to report their instructor to be prepared , comfortable with the material , and challenged them to think about their health than students taught by a school nurse .


Both groups reported significant improvements in HIV/STI/condom knowledge immediately following the intervention , compared to controls .


Yet , those taught by school nurses reported significant and sustained changes ( up to @ months after intervention ) in attitudes , beliefs , and efficacy , whereas those taught by health education teachers reported far fewer changes , with sustained improvement in condom knowledge only .


Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students ; however , teaching the technical ( eg , condom use ) and interpersonal ( eg , negotiation ) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have .


Inflammation-induced pain amplification and hypersensitivity play a role in the pathophysiology of numerous clinical conditions .


Experimental endotoxemia has recently been implemented as model to analyze immune-mediated processes in human pain .


In this study , we aimed to analyze dose - and time-dependent effects of lipopolysaccharide ( LPS ) on clinically-relevant pain models for musculoskeletal and neuropathic pain as well as the interaction among LPS-induced changes in inflammatory markers , pain sensitivity and negative affect .


In this randomized , double-blind , placebo-controlled study , healthy male subjects received an intravenous injection of either a moderate dose of LPS ( @ ng/kg Escherichiacoli ) , low-dose LPS ( @ ng/kg ) , or saline ( placebo control group ) .


Pressure pain thresholds ( PPT ) , mechanical pain sensitivity ( MPS ) , and cold pain sensitivity ( CP ) were assessed before and @ , @ , and @h post injection to assess time-dependent LPS effects on pain sensitivity .


Plasma cytokines ( TNF - , IL-@ , IL-@ , IL-@ ) and state anxiety were repeatedly measured before , and @ , @ , @ , @ , and @h after injection of LPS or placebo .


LPS administration induced a systemic immune activation , reflected by significant increases in cytokine levels , body temperature , and negative mood with pronounced effects to the higher LPS dose .


Significant decreases of PPTs were observed only @h after injection of the moderate dose of LPS ( @ ng/kg ) .


MPS and CP were not affected by LPS-induced immune activation .


Correlation analyses revealed that decreased PPTs were associated with peak IL-@ increases and negative mood .


Our results revealed widespread increases in musculoskeletal pain sensitivity in response to a moderate dose of LPS ( @ ng/kg ) , which correlate both with changes in IL-@ and negative mood .


These data extend and refine existing knowledge about immune mechanisms mediating hyperalgesia with implications for the pathophysiology of chronic pain and neuropsychiatric conditions .


To assess the optimal scan delays and contrast injection durations for contrast-enhanced whole-body computed tomography ( CT ) .


One hundred forty-two patients were randomized into three groups : protocol A-scan delay of @ s after starting contrast injection over @ s ; protocol B-@ and @ s ; and protocol C-@ and @ s , respectively .


Contrast enhancement and diagnostic acceptability were assessed .


Qualitative assessment was subtle among the three protocols .


Homogenous enhancement of deep veins was more assuredly achieved with protocol C.


With protocol C , qualitatively acceptable enhancement can be obtained in whole-body CT. .


Cardiorespiratory failure is the leading cause of death in Duchenne muscular dystrophy .


Based on preclinical and phase @ evidence , we assessed the efficacy and safety of idebenone in young patients with Duchenne muscular dystrophy who were not taking concomitant glucocorticoids .


In a multicentre phase @ trial in Belgium , Germany , the Netherlands , Switzerland , France , Sweden , Austria , Italy , Spain , and the USA , patients ( age @-@ years old ) with Duchenne muscular dystrophy were randomly assigned in a one-to-one ratio with a central interactive web response system with a permuted block design with four patients per block to receive idebenone ( @ mg three times a day ) or matching placebo orally for @ weeks .


Study personnel and patients were masked to treatment assignment .


The primary endpoint was change in peak expiratory flow ( PEF ) as percentage predicted ( PEF % p ) from baseline to week @ , measured with spirometry .


Analysis was by intention to treat ( ITT ) and a modified ITT ( mITT ) , which was prospectively defined to exclude patients with at least @ % difference in the yearly change in PEF % p , measured with hospital-based and weekly home-based spirometry .


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


@ patients in the idebenone group and @ in the placebo group comprised the ITT population , and @ and @ comprised the mITT population .


Idebenone significantly attenuated the fall in PEF % p from baseline to week @ in the mITT ( -@ % p -LSB- @ % CI -@ to @ -RSB- , p = @ , vs placebo -@ % p -LSB- -@ to -@ -RSB- , p = @ ; difference @ % p -LSB- @ to @ -RSB- , p = @ ) and ITT populations ( -@ % p -LSB- -@ to @ -RSB- , p = @ , vs -@ % p -LSB- -@ to -@ -RSB- , p < @ ; difference @ % p -LSB- @ to @ -RSB- , p = @ ) .


Idebenone also had a significant effect on PEF ( L/min ) , weekly home-based PEF , FVC , and FEV@ .


The effect of idebenone on respiratory function outcomes was similar between patients with previous corticosteroid use and steroid-naive patients .


Treatment with idebenone was safe and well tolerated with adverse event rates were similar in both groups .


Nasopharyngitis and headache were the most common adverse events ( idebenone , eight -LSB- @ % -RSB- and six -LSB- @ % -RSB- of @ patients ; placebo , nine -LSB- @ % -RSB- and seven -LSB- @ % -RSB- of @ patients ) .


Transient and mild diarrhoea was more common in the idebenone group than in the placebo group ( eight -LSB- @ % -RSB- vs four -LSB- @ % -RSB- patients ) .


Idebenone reduced the loss of respiratory function and represents a new treatment option for patients with Duchenne muscular dystrophy .


To determine the influence of different volumes of resistance exercise on circulating interleukin-@ ( IL-@ ) and to explore the relationships between IL-@ and glycaemia .


Eight participants with complication-free type @ diabetes , whose mean SEM age was @ ( @ ) years , mean SEM HbA ( @c ) concentration was @ @ mmol/mol ( @ @ % ) and mean SEM type @ diabetes duration was @ @ years , attended the research facility after an overnight fast on four separate occasions , having administered their basal insulin the night before ( glargine @ U , n = @ ) , but omitted morning rapid-acting insulin .


Participants completed either a one-set ( @-min ) , two-set ( @-min ) , or three-set ( @-min ) resistance exercise trial ( eight exercises @ repetitions ) at @ % one-repetition maximum followed by a @-min recovery , or a resting control trial .


Venous blood samples were taken before and after exercise .


Data were analysed using repeated-measures ANOVA ( P@ @ ) .


Whereas IL-@ levels remained similar to baseline levels after one set of resistance exercises ( @ min , P = @ ; @ min , P = @ ) , IL-@ levels were > baseline levels at @ min post-exercise after a two-set exercise trial ( @ @ pg/ml , P = @ ) and doubled at both @ min ( @ @ pg/ml , P = @ ) and @ min ( @ @ pg/ml , P = @ ) post-exercise after the three-set resistance exercise trial .


Post-exercise blood glucose area under the curve ( mmol/l/@ min ) was greater after both the one-set ( P = @ ) and two-set trials ( P = @ ) , than after the control trial , but similar between the three-set trial and the control trial ( P = @ ) .


The rise in IL-@ from baseline to peak concentration significantly correlated inversely with blood glucose area under the curve ( r = -@ , P = @ ) .


Circulating IL-@ is increased by resistance exercise in a volume-dependent manner , and resistance exercise-induced increases in IL-@ correlated with reductions in post-exercise hyperglycaemia in type @ diabetes , suggesting a role for IL-@ in improving post-resistance exercise glycaemic disturbances in type @ diabetes .


Ethnic minorities , especially African Americans and Latinos , bear a disproportionate burden of colorectal cancer ( CRC ) , as reflected in incidence , cancer stage , and mortality statistics .


In all ethnic groups , first-degree relatives ( FDRs ) of CRC cases are at an elevated disease risk .


However , underuse of CRC screening persists and is particularly evident among minority groups .


The current study tested a stepped intervention to increase CRC screening among an ethnically diverse sample of FDRs of CRC cases .


A statewide cancer registry was used to recruit CRC cases and through them their FDRs .


Relatives who were not current on CRC screening were randomized to intervention or usual-care control arms .


The stepped intervention consisted of ethnically targeted and individually tailored print materials followed by telephone counseling for those unscreened at @ months .


The study sample of @ individuals consisted of @ Latino , @ African American , @ Asian , and @ white FDRs .


Statistically significant effects were observed for the cumulative print plus telephone intervention at @ months ( @ % in the intervention vs @ % in the control group ) and the print intervention alone at @ months ( @ % in the intervention vs @ % in the control group ) .


The effect of the print intervention alone versus the cumulative interventions was not statistically significantly different .


Stratified analyses indicated that the intervention was effective among white , Latino , and Asian individuals , but not among African-Americans .


Overall , the intervention was effective in increasing screening rates .


Oversampling racial/ethnic minorities allowed for the examination of effects within subgroups , revealing no effect among African American individuals .


This finding illustrates the importance of including sufficient numbers of participants from diverse ethnic subgroups in intervention research to enable such stratified analyses .


To evaluate hip abductor strength-training for patients with unilateral transfemoral amputation .


Single-blind , cross-over ( AB/BA ) trial with randomization .


Seventeen patients with transfemoral amputation .


Subjects completed @-week programs of twice weekly hip abductor strength training or arm ergometry .


Subjects were randomly assigned to receive either the experimental or active control intervention first .


A physiotherapist blinded to group assignment conducted baseline and post-intervention assessments .


The Timed Up & Go ( TUG ) test was selected as the primary outcome measure ; secondary measures included the @ Minute Walk ( @MW ) , hip abductor strength , Activities Specific Balance Confidence Scale ( ABC ) and prosthetic use .


A two-way cross-over ANOVA was used for baseline and post-intervention treatment comparisons .


There were no baseline differences between treatments for TUG , @MW , ABC , Houghton scale , sitting or side-lying abductor strength ( p > @ for all ) , though supine strength was greater for the experimental treatment ( p < @ ) .


After @-weeks of hip abductor strength training , there were significant treatment effects for TUG , ABC ( p < @ for both ) , @MW ( p < @ ) , sitting and side-lying abductor strength ( p = @ for both ) , but not for supine strength , prosthetic use , nor thigh girth measures ( p > @ for all ) .


This study suggests that patients with unilateral transfemoral amputation can improve functional performance and balance confidence following intense hip abductor strength training .


Video-laryngoscopes have gained popularity in the recent years and have shown definite advantages over the conventional Macintosh direct laryngoscopes .


However , there is still insufficient evidence comparing the C-MAC with the Macintosh for patients during manual inline stabilization ( MILS ) .


This prospective , randomized , single blind study was carried out to compare tracheal intubation using the C-MAC video-laryngoscope and Macintosh laryngoscope in patients during MILS .


Ninety consented patients , without features of difficult airway , who required general anesthesia and tracheal intubation were recruited .


Intubation was performed with either the C-MAC video-laryngoscope or the Macintosh laryngoscope by one single investigator experienced with both devices .


Various parameters which included Cormack and Lehane score , time to intubate , intubation attempts , optimization maneuvers , complications and hemodynamic changes were recorded over the initial period of @ minutes .


C-MAC video-laryngoscope performed significantly better with lower Cormack and Lehane grades , shorter time to intubate of @ @ vs. @ @ seconds ( p = @ ) and needed less optimization maneuvers .


There were no significant differences seen in the intubation attempts , complications or hemodynamic status of the patients with either device .


The C-MAC video-laryngoscope was superior to the Macintosh laryngoscope for patients requiring intubation when manual inline neck stabilization was applied .


This study aimed to investigate the acute effect of intermittent walking exercise ( WE ) on blood pressure ( BP ) responses in patients with intermittent claudication ( IC ) .


Secondly , this study aimed to gain improved insight into the physiological mechanisms controlling BP regulation after intermittent WE in this patient group .


Twenty patients with IC participated in two experimental sessions in a random order , as follows : WE ( @ @-min bouts of WE interpolated with @-min rest intervals ) and control ( standing rest on a treadmill for @ min ) .


BP , cardiac output ( CO : CO@ rebreathing ) , and cardiovascular autonomic modulation ( spectral analysis of HR variability ) were assessed before and after both experimental sessions during supine rest , and stroke volume ( SV ) and systemic vascular resistance ( SVR ) were calculated .


Data were analyzed using two-way ANOVA .


WE decreased systolic , diastolic , and mean BP , with net effects of -@ @ , -@ @ , and -@ @ mm Hg versus control , respectively ( all P < @ ) .


WE also decreased SV ( -@ @ mL , P < @ ) and CO ( -@ @ Lmin ( -@ ) , P < @ ) versus preintervention and prevented the observed increase in SVR in the control condition ( +@ @ U , P < @ ) .


HR showed a decrease ( P < @ ) , consistent with evidence of increased vagal modulation , in the control condition .


BP measurements over the subsequent @ h were similar between experimental conditions .


In patients with IC , WE induced a postexercise hypotension response that had a significant magnitude versus control but was not maintained over the next @ h of daily activities .


The acute postexercise hypotension response was mediated by a decrease in CO and SV , which was not compensated by an augmentation of SVR , as observed in the control arm of the study .


To investigate the effects of recombinant human growth hormone on serum lipid in aged male patients with chronic heart failure ( CHF ) .


Eighty seven patients with chronic heart failure ( > or = @ years old ) were randomly divided into @ groups : the CHF control group ( n = @ ) who received regular therapy and the CHF experimental group ( n = @ ) who received regular therapy and recombinant human growth hormone .


The treatment would be continued for @ months .


Another group was normal control group ( n = @ ) .


The detection of serum growth hormone ( GH ) , insulin-like growth factor ( IGF-@ ) , total cholesterol ( TC ) , triglyceride ( TG ) , low-density lipoprotein cholesterol ( LDL-C ) , high density lipoprotein cholesterol ( HDL-C ) was carried out before and after treatment in the participants .


Before treatment , the levels of GH and IGF-@ were not significantly different among groups .


After treatment , the levels of GH ( @ + / - @ vs @ + / - @ ) and IGF-@ ( @ + / - @ vs @ + / - @ ) in CHF experimental group were higher than those before the treatment .


In CHF control group , the levels of GH ( @ + / - @ vs @ + / - @ ) and IGF-@ ( @ + / - @ vs @ + / - @ ) had no significant change after the treatment .


After treatment , the levels of GH ( @ + / - @ vs @ + / - @ ) and IGF-@ ( @ + / - @ vs @ + / - @ ) in CHF experimental group were higher compared with that of CHF control group .


Before treatment , the serum levels of LDL-C , HDL-C , TC and TG had no significant difference among groups .


After treatment , the levels of LDL-C ( @ + / - @ vs @ + / - @ ) and TC ( @ + / - @ vs @ + / - @ ) in CHF experimental group were lower than those before the treatment .


However , the levels of HDL-C ( @ + / - @ vs @ + / - @ ) and TG ( @ + / - @ vs @ + / - @ ) had no significant change after the treatment compared with before treatment .


In CHF control group , the serum lipid levels had no significant change after the treatment .


As the treatment of rhGH for aged male patients with chronic heart failure , GH influences lipid metabolism , which reduces the level of LDL-C , TC .


However GH has no effects on the serum HDL-C and TG level .


With the treatment of rhGH for long-term , lipid metabolism should be paid attention , and the treatment for blood lipid reduction should be adjusted in time .


The purpose of this prospective , double-blinded , parallel-arm , randomized trial was to examine the effects of epidural bupivacaine on the length of the second stage of labor in nulliparous women .


The authors assessed length of second-stage labor , degree of motor blockade , mode of delivery , and visual analog scores in @ nulliparous women with labor epidurals randomized to receive either : ( @ ) @ % bupivacaine and fentanyl @ g/ml or ( @ ) fentanyl @ g/ml alone via epidural using double blinding .


The median duration of the second stage was @ min ( @ , @ ) in the bupivacaine/fentanyl group versus @ min ( @ , @ ) in the fentanyl-only group ( P = @ ) with a median difference of @ ( @ % CI , -@ to @ ) .


Furthermore , there was no difference in degree of motor blockade , incidence of operative delivery , visual analog scores , or neonatal outcomes between the two groups .


No adverse events were reported .


Use of epidural bupivacaine/fentanyl or a fentanyl-only infusion during the second stage of labor did not affect the duration of the second stage of labor , degree of motor blockade , mode of delivery , pain relief , and maternal or neonatal outcomes .


However , in the fentanyl-only infusion group , there was a fivefold increase in opioid exposure to the fetus with unknown effects on neurobehavior , an outcome not assessed beyond the immediate postnatal period in this study .


Botulinum toxin type A ( BoNT-A ) is widely used to improve the lower facial contour .


To determine the difference in the changes in the lower facial contour achieved with @ and @ sessions of BoNT-A injections using @-dimensional ( @D ) laser scanning .


Twenty volunteers were randomly divided into @ groups .


Group I ( n = @ ) received a single injection , whereas Group II ( n = @ ) received @ sessions of injections , the second being administered @ months after the first .


Each injection comprised of @ U of BoNT-A and was administered to the masseter muscle bilaterally .


Evaluation of the effect of BoNT-A injection was performed using @D laser scan images obtained before the injection and @ months thereafter in Group I , and before the first injection and @ months thereafter in the Group II .


The mean changes in the volume and thickness in Group I were -@,@ mm and -@ mm , respectively ; the corresponding changes were -@,@ mm and -@ mm in Group II .


The reductions were significantly greater in Group II than in Group I.


The administration of a second BoNT-A injection is effective for better aesthetic results for the lower facial contour .


To observe the clinical effect of acupuncture combined with neck-skin electrical stimulation ( NSES ) on dysphagia in patients with cerebral infarction ( CI ) .


A total of @ CI patients with dysphagia were randomly divided into acupuncture group , NSES group and acupuncture + NSES group ( combined treatment group , n = @ in each group ) .


Acupuncture stimulation of Fengchi ( GB@ ) , Yifeng ( TE @ ) , etc. , and blood-letting of Jinjin ( EX-HN @ ) and Yuye ( EX-HN @ ) were administrated .


NSES was applied to the bilateral sites of the neck-median line .


The treatment was given once daily for two weeks .


The swallow function and swallow dysfunction degree of the dysphasia patients were evaluated by water swallow test and food-intake scale , respectively .


After one week 's and two weeks ' treatment , the water swallow score and swallow dysfunction score were significantly improved in the acupuncture , NSES and combined treatment groups ( P < @ ) , and the difference values between pre - and post-treatment of the water swallow score and swallow ability score in the combined treatment group were obviously higher than those of the acupuncture and NSES groups ( P < @ , P < @ ) .


No significant differences were found between the acupuncture and NSES groups in both the water swallow score and swallow ability score after one and two weeks ' treatment ( P > @ ) .


Of the three @ cases in the acupuncture , NSES and combined treatment groups , @ , @ and @ were basically cured , @ , @ and @ experienced marked improvement , @ , @ and @ were improved , and @ , @ and @ failed in the treatment , with the effective rates being @ % , @ % and @ % , respectively .


The therapeutic effect of the combined treatment group was apparently superior to that of the simple acupuncture and simple NSES groups ( P < @ ) .


Acupuncture and NSES intervention is effective in improving dysphasia in CI patients and the effect of combined treatment of acupuncture and NSES is obviously better than that of the simple acupuncture and simple NSES .


Combustion-generated fine particulate matter ( PM@ @ ) is associated with cardiovascular morbidity .


Both traffic-related air pollution and residential wood combustion may be important , but few studies have compared their impacts .


To assess and compare effects of traffic-related and woodsmoke PM@ @ on endothelial function and systemic inflammation ( C reactive protein , interleukin-@ and band cells ) among healthy adults in Vancouver , British Columbia , Canada , using high efficiency particulate air ( HEPA ) filtration to introduce indoor PM@ @ exposure gradients .


We recruited @ healthy adults from @ homes in traffic-impacted or woodsmoke-impacted areas to participate in this randomised , single-blind cross-over intervention study .


PM@ @ concentrations were measured during two consecutive @-day periods , one with filtration and the other with ` placebo filtration ' .


Endothelial function and biomarkers of systematic inflammation were measured at the end of each @-day period .


HEPA filtration was associated with a @ % decrease in indoor PM@ @ concentrations .


There was no relationship between PM@ @ exposure and endothelial function .


There was evidence of an association between indoor PM@ @ and C reactive protein among those in traffic-impacted locations ( @ % increase in C reactive protein per IQR increase in indoor PM@ @ , @ % CI @ % to @ % ) , but not among those in woodsmoke-impacted locations .


There were no associations with interleukin-@ or band cells .


Evidence of an association between C reactive protein and indoor PM@ @ among healthy adults in traffic-impacted areas is consistent with the hypothesis that traffic-related particles , even at relatively low concentrations , play an important role in the cardiovascular effects of the urban PM mixture .


Previous evidence has implicated corticostriatal abnormalities in the pathophysiology of psychosis .


Although the striatum is the primary target of all efficacious antipsychotics , the relationship between its functional connectivity and symptomatic reduction remains unknown .


To explore the longitudinal effect of treatment with second-generation antipsychotics on functional connectivity of the striatum during the resting state in patients experiencing a first episode of psychosis .


This prospective controlled study took place at a clinical research center and included @ patients with first-episode psychosis and @ healthy participants matched for age , sex , education , and handedness .


Medications were administered in a double-blind randomized manner .


Patients were scanned at baseline and after @ weeks of treatment with either risperidone or aripiprazole .


Their symptoms were evaluated with the Brief Psychiatric Rating Scale at baseline and follow-up .


Healthy participants were scanned twice within a @-week interval .


Functional connectivity of striatal regions was examined via functional magnetic resonance imaging using a seed-based approach .


Changes in functional connectivity of these seeds were compared with reductions in ratings of psychotic symptoms .


Patients had a median exposure of @ day to antipsychotic medication prior to being scanned ( mean -LSB- SD -RSB- = @ -LSB- @ -RSB- ) .


Eleven patients were treated with aripiprazole and @ patients were treated with risperidone .


As psychosis improved , we observed an increase in functional connectivity between striatal seed regions and the anterior cingulate , dorsolateral prefrontal cortex , and limbic regions such as the hippocampus and anterior insula ( P < @ , corrected for multiple comparisons ) .


Conversely , a negative relationship was observed between reduction in psychosis and functional connectivity of striatal regions with structures within the parietal lobe ( P < @ , corrected for multiple comparisons ) .


Our results indicated that corticostriatal functional dysconnectivity in psychosis is a state-dependent phenomenon .


Increased functional connectivity of the striatum with prefrontal and limbic regions may be a biomarker for improvement in symptoms associated with antipsychotic treatment .


Incisional hernia is a frequent complication of midline laparotomy and is associated with high morbidity , decreased quality of life , and high costs .


We aimed to compare the large bites suture technique with the small bites technique for fascial closure of midline laparotomy incisions .


We did this prospective , multicentre , double-blind , randomised controlled trial at surgical and gynaecological departments in ten hospitals in the Netherlands .


Patients aged @ years or older who were scheduled to undergo elective abdominal surgery with midline laparotomy were randomly assigned ( @:@ ) , via a computer-generated randomisation sequence , to receive small tissue bites of @ mm every @ mm or large bites of @ cm every @ cm .


Randomisation was stratified by centre and between surgeons and residents with a minimisation procedure to ensure balanced allocation .


Patients and study investigators were masked to group allocation .


The primary outcome was the occurrence of incisional hernia ; we postulated a reduced incidence in the small bites group .


We analysed patients by intention to treat .


This trial is registered at Clinicaltrials.gov , number NCT@ and with the Nederlands Trial Register , number NTR@ .


Between Oct @ , @ , and March @ , @ , we randomly assigned @ patients to the large bites group ( n = @ ) or the small bites group ( n = @ ) .


Follow-up ended on Aug @ , @ ; @ ( @ % ) patients completed follow-up and were included in the primary outcome analysis .


Patients in the small bites group had fascial closures sutured with more stitches than those in the large bites group ( mean number of stitches @ -LSB- SD @ -RSB- vs @ -LSB- @ -RSB- ; p < @ ) , a higher ratio of suture length to wound length ( @ -LSB- @ -RSB- vs @ -LSB- @ -RSB- ; p < @ ) and a longer closure time ( @ -LSB- @ -RSB- vs @ -LSB- @ -RSB- min ; p < @ ) .


At @ year follow-up , @ ( @ % ) of @ patients in the large bites group and @ ( @ % ) of @ patients in the small bites group had incisional hernia ( p = @ , covariate adjusted odds ratio @ , @ % CI @-@ ; p = @ ) .


Rates of adverse events did not differ significantly between groups .


Our findings show that the small bites suture technique is more effective than the traditional large bites technique for prevention of incisional hernia in midline incisions and is not associated with a higher rate of adverse events .


The small bites technique should become the standard closure technique for midline incisions .


A major limitation of primary percutaneous coronary intervention ( PPCI ) for the treatment of ST-elevation myocardial infarction ( STEMI ) is impaired microvascular perfusion due to embolization and obstruction of microcirculation with thrombus .


Manual thrombectomy has the potential to reduce distal embolization and improve microvascular perfusion .


Clinical trials have shown mixed results regarding thrombectomy .


The objective of this study is to evaluate the efficacy of routine upfront manual aspiration thrombectomy during PPCI compared with percutaneous coronary intervention alone in patients with STEMI .


This is a multicenter , prospective , open , international , randomized trial with blinded assessment of outcomes .


Patients with STEMI undergoing PPCI are randomized to upfront routine manual aspiration thrombectomy with the Export catheter ( Medtronic CardioVascular , Santa Rosa , CA ) or to percutaneous coronary intervention alone .


The primary outcome is the composite of cardiovascular death , recurrent myocardial infarction , cardiogenic shock , or new or worsening New York Heart Association class IV heart failure up to @ days .


The trial uses an event-driven design and will recruit @,@ patients .


The TOTAL trial will determine the effect of routine manual aspiration thrombectomy during PPCI on clinically important outcomes .


Improving adherence to ocular hypertension ( OH ) / glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage .


The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy .


A randomised controlled trial with a @-month recruitment and @-month follow-up period was conducted .


Patients with OH/glaucoma attending a glaucoma clinic and starting treatment with travoprost were approached .


Participants were randomised into two groups and adherence was measured over @ months , using an electronic monitoring device ( Travalert dosing aid , TDA ) .


The control group received standard clinical care , and the intervention group received a novel glaucoma education and motivational support package using behaviour change counselling .


Cost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence .


Two hundred and eight patients were recruited ( @ intervention , @ control ) .


No significant difference in mean adherence over the monitoring period was identified with @ % ( CI , @ , @ ) for the control group and @ % ( CI , @ , @ ) for the intervention group ( p = @ ) .


Similarly , there was no significant difference in percentage intraocular pressure reduction ; @ % ( CI , @ , @ ) for the control group and @ % ( CI , @ , @ ) for the intervention group ( p = @ ) .


Participants in the intervention group were more satisfied with information about glaucoma medication with a mean score of @ / @ ( CI , @ , @ ) compared with control group which was @ ( CI , @ , @ ) .


The mean intervention cost per patient was GB@ @ ( < US$ @ ) and not cost-effective .


Adherence with travoprost was high and not further increased by the intervention .


Nevertheless , the study demonstrated that provision of information , tailored to the individual , was inexpensive and able to achieve high patient satisfaction with respect to information about glaucoma medication .


Measurement of adherence remains problematic since awareness of study participation may cause a change in participant behaviour .


Progress towards MDG@ for child survival in South Africa requires effective prevention of mother-to-child transmission ( PMTCT ) of HIV including increasing exclusive breastfeeding , as well as a new focus on reducing neonatal deaths .


This necessitates increased focus on the pregnancy and early post-natal periods , developing and scaling up appropriate models of community-based care , especially to reach the peri-urban poor .


We used a randomised controlled trial with @ clusters ( @ in each arm ) to evaluate an integrated , scalable package providing two pregnancy visits and five post-natal home visits delivered by community health workers in Umlazi , Durban , South Africa .


Primary outcomes were exclusive and appropriate infant feeding at @ weeks post-natally and HIV-free infant survival .


At @ weeks of infant age , the intervention was effective in almost doubling the rate of exclusive breastfeeding ( risk ratio @ ; @ % CI : @-@ @ ) and increasing infant weight and length-for-age z-scores ( weight difference @ ; @ % CI : @-@ @ , length difference @ ; @ % CI : @-@ @ ) .


No difference was seen between study arms in HIV-free survival .


Women in the intervention arm were also more likely to take their infant to the clinic within the first week of life ( risk ratio @ ; @ % CI : @-@ @ ) .


The trial coincided with national scale up of ARVs for PMTCT , and this could have diluted the effect of the intervention on HIV-free survival .


We have demonstrated that implementation of a pro-poor integrated PMTCT and maternal , neonatal and child health home visiting model is feasible and effective .


This trial could inform national primary healthcare reengineering strategies in favour of home visits .


The dose effect on exclusive breastfeeding is notable as improving exclusive breastfeeding has been resistant to change in other studies targeting urban poor families .


The NCIC CTG/AGITG CO. @ trial demonstrated that cetuximab monotherapy improved overall and progression-free survival ( OS and PFS ) in patients previously treated for advanced colorectal cancer .


A strong relationship was observed between benefit from cetuximab and development of rash .


In this analysis , the association of rash and benefit from cetuximab is explored and presented by KRAS mutation status .


Rash was graded by NCI CTC @ criteria .


Landmark analysis was performed by excluding patients who died or dropped out within @ days and then grouping by worst grade of rash experienced by day @ .


Multivariate Cox models were conducted separately for patients with KRAS wild-type ( WT ) tumours and KRAS mutated ( MUT ) tumours .


CO. @ primary outcome was OS .


Development of grade @ + rash on cetuximab was associated with a trend towards increased OS ( HR @ with @ % CI @-@ @ and p = @ ) and PFS ( HR @ with @ % CI @-@ @ and p = @ ) as compared to grade @/@ rash in patients with WT tumours .


In patients with WT tumours on cetuximab both grade @/@ and grade @ + rash were associated with increased PFS ( HR @ @ % CI @-@ @ ; p = @ ; and HR @ @ % CI @-@ @ ; p < @ ) respectively , in comparison with best supportive care ( BSC ) .


Only development of grade @ + rash on cetuximab was associated with increased OS ( HR @ with @ % CI @-@ @ and p = @ ) in comparison with BSC .


No significant difference was found in OS or PFS among patients on cetuximab with MUT tumours with either rash grade as compared to BSC .


No consistent trend was observed for the association of severity of rash and quality of life ( QoL ) .


As all patients with WT tumours benefitted to some extent from cetuximab regardless of the grade of rash , grade of rash was not a useful predictive marker .


To compare quality-of-life ( QoL ) outcomes over @ years following initiation of treatment with a standard or newer antiepileptic drug ( AED ) in adults with new-onset epilepsy .


To examine the impact of seizure remission and failure of initial treatment on QoL outcomes measured over @ years .


We conducted a pragmatic , randomized , unblinded , multicenter , parallel-group clinical trial ( the Standard and New Antiepileptic Drugs -LSB- SANAD -RSB- trial ) comparing clinical and cost effectiveness of initiating treatment with carbamazepine versus lamotrigine , gabapentin , oxcarbazepine and topiramate , and valproate versus lamotrigine and topiramate .


QoL data were collected by mail at baseline , @ months , and at @ and @ years using validated measures .


These data were analyzed using longitudinal data models .


Continuous QoL measures , time to @-month remission and time to treatment withdrawal were explored using joint models .


Baseline questionnaires were returned by @,@ adults ; @,@ returned the @-month questionnaire , @,@ returned the @-year questionnaire , and @,@ returned the @-year questionnaire .


There were few statistically significant differences between drugs over @ years in QoL outcomes .


Significant association was identified between QoL scores over the @-year time frame and the risk of experiencing a @-month remission or treatment withdrawal over that period .


The choice of initial treatment had no significant effect on QoL by @-year follow-up .


However , overall QoL was reduced with continued seizures , adverse events , and failure of the initial treatment .


Ocular blood flow ( OBF ) disturbances could be involved both in the pathogenesis and in progression of glaucomatous damage .


The aim of the study was to compare the retrobulbar hemodynamic parameters in the ophthalmic artery ( OA ) , central retinal artery ( CRA ) and short posterior cilliary arteries ( SPCA ) after decreasing the elevated intraocular pressure ( IOP ) in primary open-angle glaucoma ( POAG ) patients by using color Doppler imaging ( CDI ) .


We examined @ patients ( @ male and @ female ) with diagnosed and treated POAG .


Thirty-nine patients had increased IOP ( > @ mm Hg ) .


Peak-systolic velocity ( PSV ) , end-diastolic velocity ( EDV ) , Pourcelot resistance index ( RI ) , and pulsatility index ( PI ) were assessed in the OA , CRA , and SPCA .


IOP was measured both with the Goldmann Applanation tonometer ( GAT ) and with the Dynamic Contour tonometer ( DCT ) , three times respectively .


Ocular pulse amplitude ( OPA ) was measured using DCT .


The retrobulbar parameters between the baseline and after IOP reduction showed no difference in measurements .


After Bonferroni correction ( p < or = @ , alpha/@ ) statistical significance was recorded only in the following retrobulbar hemodynamic parameters ; DCT ( @ + / - @ vs. @ + / - @ ) , GAT ( @ + / - @ vs. @ + / - @ ) and OPA measurements ( @ + / - @ vs. @ + / - @ ) , as compared to the baseline .


There was no correlation between the changes in IOP measured with either DCT or GAT and changes in the hemodynamic parameters ( p > @ for all ) .


Pearson correlation coefficient ( @ % CI ) showed very good correlation for IOP measurements between DCT and GAT : at baseline @ ( @ to @ ) and at the end @ ( @ to @ ) ; p < @ for both measurements , but without any difference between them ( p > @ ) .


There was a lack of correlation between the changes in IOP measured with either DCT or GAT and the changes in the hemodynamic parameters .


Guidelines for administering amino acids to critically ill children are largely based on uncontrolled observational studies and expert opinion , without support from rigorous outcome studies .


Also , data on circulating amino acid concentrations during critical illness are scarce .


We thoroughly studied the time profiles of circulating amino acid concentrations in critically ill children who received standard nutritional care according to international guidelines .


This is a subanalysis of pediatric critically ill patients included in a large ( n = @ ) randomized controlled study on intensive insulin therapy .


The study was conducted at a university hospital PICU .


We studied @ patients in PICU for at least @ days following cardiac surgery .


Patients were assigned to intensive insulin therapy targeting normal-for-age fasting blood glucose concentrations or insulin infusion only to prevent excessive hyperglycemia .


Plasma amino acid concentrations were measured at admission , day @ , and day @ in PICU .


At admission , the concentrations of most amino acids were comparable to those reported for healthy children .


Total amino acid concentrations remained stable during ICU stay , but individual amino acids showed different time profiles with eight of them showing an increase and five a decrease .


Nonsurviving children had higher total amino acid concentrations and individual amino acids compared with survivors at admission and/or during ICU stay .


Intensive insulin therapy lowered the concentrations of total amino acids and several individual amino acids .


Neonates showed somewhat different amino acid profiles with rather increased concentrations from baseline with time in ICU for total amino acids and several individual amino acids as compared with older infants and children .


Circulating amino acid concentrations in critically ill children after cardiac surgery differ according to survival status , blood glucose control with intensive insulin therapy , and age .


Bupropion was tested for efficacy to achieve methamphetamine ( MA ) abstinence in dependent , non-daily users .


A randomized , double-blind , placebo-controlled trial , with @-week treatment and @-week follow-up , was conducted with @ treatment-seeking participants having MA dependence per DSM-IV , who used MA on a less-than-daily basis .


@ were randomized to matched placebo and @ to bupropion , sustained-release @mg , twice daily .


Participants were seen three times weekly to obtain urine for MA and bupropion assays , study assessments , and thrice weekly , @-min , group psychotherapy .


There was no biomarker for placebo adherence .


The primary outcome was achievement of abstinence throughout the last two weeks of treatment ; ` success ' requiring at least two urine samples during each of Weeks @ and @ , and all samples MA-negative ( < @ng/mL ) .


Bupropion and placebo groups did not differ significantly in the percentage achieving abstinence for the last @ weeks of treatment ( chi-square , p = @ ) .


Subgroup analysis of participants with lower baseline MA use ( @ of last @ days before consent ) also revealed no difference in success between groups ( p = @ ) .


Medication adherence per protocol ( detectable bupropion , > @ng/mL , in @ % of urine samples from Study Weeks @-@ and @ % of urine samples from Weeks @ to @ ) was achieved by @ % of participants taking bupropion .


These data indicate that bupropion did not increase abstinence in dependent participants who were using MA less-than-daily .


Medication non-adherence was a limitation in this trial .


Psychosocial therapy remains the mainstay of treatment for MA dependence .


Further research on subgroups who may respond to bupropion may be warranted .


To observe the protective effect of Xuebijing injection pretreatment on hepatic ischemia reperfusion ( I/R ) injury and coagulopathy in liver cancer patients undergoing excision of hepatic cancer after occlusion of hepatic blood flow .


A prospective randomly controlled study was conducted .


Sixty patients with liver cancer classified as Child-Pugh class A undergoing hepatectomy in the Department of Hepatobiliary Surgery of Sun Yat-sen University Cancer Center from October @ to March @ were enrolled .


The patients were randomized into control group and Xuebijing group ( each patient received @ mL Xuebijing injection added to @ % saline as a preoperative treatment for @ days ) .


Complete blood count , coagulation function , hepatic function , serum pro-inflammatory cytokines and alpha-fetoprotein ( AFP ) levels were determined before and after operation .


Forty-five out of @ patients were enrolled eventually , with @ patients in control group and @ in Xuebijing group , and among them @ patients were positive for hepatitis B surface antigen ( HBsAg ) at admission .


Compared with those before operation , the postoperative levels of alanine transaminase ( ALT ) , aspartate transaminase ( AST ) and lactate dehydrogenase ( LDH ) in control and Xuebijing groups were significantly elevated , prothrombin time ( PT ) and activated partial prothrombin time ( AfYIT ) were significantly prolonged , and white blood cells ( WBC ) , proportion of neutrophils ( N ) and C-reactive protein ( CRP ) were significantly increased ( P < @ or P < @ ) .


Although the above indexes in Xuebijing group after operation were lower than those in control group in different degrees -LSB- ALT ( U/L ) : @ ( @-@ @ ) vs. @ ( @-@ @ ) , AST ( UIL ) : @ ( @-@ @ ) vs. @ ( @-@ @ ) , LDH ( lg , U/L ) : @ @ vs. @ @ , PT ( s ) : @ @ vs. @ @ , AfYIT ( s ) : @ @ vs. @ @ , WBC ( x @/L ) : @ @ @ vs. @ @ , N : @ @ vs. @ @ , CRP ( mg/L ) : @ ( @-@ @ ) vs. @ ( @-@ @ ) J , no statistical significance was found between the groups ( all P > @ ) .


The preoperative levels of tumor necrosis factor-a ( TNF - a ) and interleukin-@ OL-@ ) were both less than @ ng/L , and the postoperative levels of TNF-a showed no significant change , and IL-@ was increased to @ ( @-@ @ ) ng/L and @ ( @-@ @ ) ng/L in control and Xuebijing groups respectively ( P < @ ) .


The serum high mobility group box-@ ( HMGB@ ) protein levels after operation were higher than those of preoperative in both groups ( both P < @ ) , but the postoperative HMGB@ in Xuebijing group were significantly lower than those in control group ( j.Lg / L : @ @ vs. @ @ , P < @ ) .


Acute physiology and chronic health evaluation ll ( APACHE ll ) score in Xuebijing group was significantly lower than that in control group ( @ @ vs. @ @ , t = @ , P = @ ) , and the first passage of flatus and defecation after operation in Xuebijing group were significantly earlier than those in control group -LSB- exhaust time ( days ) : @ ( @-@ ) vs. @ ( @-@ ) , U = -@ , P = @ ; defecation time ( days ) : @ ( @-@ ) vs. @ ( @-@ ) , U = -@ , P = @ J. However , no difference was found between two groups in the postoperative and total hospital days .


Spearman rank correlation analysis showed there were positive correlations between hepatitis B virus ( HBV ) - DNA levels and preoperative ALT ( r = @ , P = @ ) and AST ( r = @ , P = @ ) in @ HBV-DNA positive patients , but there was no significant correlation between HBV - DNA levels or other preoperative liver function indicators .


Hepatic I/R injury and coagulopathy may occur in liver cancer patients undergoing resection of cancer with occlusion of hepatic blood flow .


Xuebijing injection may inhibit the release of serum pro-inflammatory cytokines , thereby alleviate hepatic I/R injury and promote the recovery of intestinal function .


But it does not offer protective effect on coagulopathy .


Muscle and fat are now recognized as metabolism-regulating endocrine organs .


However , muscle and adipocyte-derived novel cytokines such as irisin and omentin-@ remain understudied in relation to metabolic biomarkers that are associated with cardiovascular risk .


Thirty-nine subjects with mean ( SD ) BMI of @ @ kg/m ( @ ) and either diabetes or two other cardiovascular risk factors were enrolled in a @-month randomized trial of low-dose ethanol .


We examined cross-sectional data at baseline , @-month , and @-month visits to assess ( @ ) within-person stability of novel cytokines ( irisin , omentin-@ , visfatin , resistin , and soluble tumor necrosis factor receptor II ) and ( @ ) their associations with metabolic parameters , particularly lipoprotein subparticle profile .


Repeated measures of irisin and omentin-@ were highly correlated , with intra-class correlations of @ ( @ % CI : @ , @ ; P < @ ) and @ ( @ , @ ; P < @ ) , respectively .


Irisin was negatively correlated with omentin-@ ( @ % irisin decrease per a @-SD increment in omentin-@ ; @ % CI : @ % , @ % ; P = @ ) .


In models adjusted for age , sex , and race , irisin was negatively associated with HDL cholesterol ( @ % decrease per a @mg/dL increment ; @ % , @ % ; P = @ ) and large HDL particles ( @ % decrease per a @-SD or @-mol / L increment ; @ % , @ % ; P = @ ) .


Omentin-@ was positively associated with mean VLDL size ( @ % increase per a @-SD increment ; @ % , @ % ; P = @ ) .


Adjustment for alcohol intervention , BMI , and other cytokines did not materially affect these associations .


Irisin and omentin-@ are stable within-person , inversely associated with each other , and closely related to lipoprotein profile .


These molecules may be promising markers for cardiovascular risk .


Epistaxis is a common complication of nasal intubation .


Ease of insertion of the tracheal tube may be influenced by bevel orientation and tip bending .


We examined ease of insertion and epistaxis with two tubes with different orientations and with or without a stylet to modify tip bending .


Two hundred patients scheduled to undergo oral or maxillofacial surgery were randomized into four groups according to method of nasal intubation used after induction of anesthesia .


In one group , a Portex ( ) tracheal tube was inserted with bevel facing left ( Portex Group ) .


In the second group , a Parker Flex-Tip ( ) tube ( Parker Group ) was inserted with the bevel facing posteriorly , and in the last two groups , a stylet bent at @ anteriorly was used with the Portex tube ( Stylet-Portex Group ) or Parker tube ( Stylet-Parker Group ) .


When the tube advanced without resistance , insertion was defined as `` smooth '' , and when resistance was encountered , insertion was defined as `` impinged '' .


Severity of epistaxis was evaluated as none , mild , moderate , or severe .


Smooth insertion was observed in @ % of patients in the Portex Group ; @ % in the Parker Group ; @ % in the Stylet-Portex Group ; and @ % in the Stylet-Parker Group .


Epistaxis was found in @ % , @ % , @ % , and @ % of patients , respectively .